ABSTRACT
The COVID-19 pandemic may have affected morbidity patterns of residents in refugee centres, but empirical evidence is scarce. We utilised linked data from a health surveillance network in German refugee centres, employing a quasi-experimental design to examine the effects of the COVID-19 pandemic on newly diagnosed medical conditions. These diagnoses were coded in on-site healthcare facilities for refugee patients. Our analysis encompasses the timeframe from October 2018 to April 2023 and includes individual-level data for 109,175 refugees. This data resulted in 76,289 patient-months across 21 refugee centres, with a total occupancy of 144,012 person-months. We employed segmented regression analyses, adjusting for time trends, socio-demographic factors, centre occupancy, and centre-specific characteristics, to evaluate the COVID-19 pandemic's impact on incident diagnosis patterns among refugees. The COVID-19 pandemic significantly altered diagnosis patterns among refugees in German centres. Notably, incidents of injuries, mental disorders, psychotherapeutic drug prescriptions, and genitourinary diseases rose, while respiratory diseases decreased, later rebounding. An 88% increase in injury-related diagnoses suggests heightened violence experiences during flight or in centres. Mental disorder diagnoses and psychotherapeutic drug prescriptions rose by 73% and 95%, reflecting pandemic-related stressors in refugee centres, highlighting the pandemic's multifaceted impact on refugee health.
Subject(s)
COVID-19 , Mental Disorders , Chemical and Drug Induced Liver InjuryABSTRACT
Objectives Despite concerns about the impact of the severe acute respiratory syndrome corona virus (Sars-CoV-2) in refugee camps, data on attack rates and effectiveness of containment measures are lacking. We aimed to (1) quantify the attack rate of Sars-CoV-2 during outbreaks in reception and accommodation centres in Germany, (2) assess differences in the attack rate based on containment measures, and (3) provide an overview of testing strategies, communication, conflicts, and protection measures for refugees with special needs. Methods Systematic web-based review of outbreak media reports (until June 2020) on confirmed Sars-CoV-2 cases in reception centers for asylum seekers in Germany using the google search engine. Reports were screened for pre-defined inclusion criteria and complemented by snowball searches. Data on facility name, location, confirmed cases, containment measures, communication, protection strategies, and conflicts was extracted for each outbreak and reporting date. Evidence synthesis: meta-analysis and negative binomial regression. Findings We identified 337 media reports on 101 Sars-CoV-2 outbreaks in 99 reception and accommodation centers in Germany. The pooled Sars-CoV-2 attack rate was 13.1% (95% confidence interval, CI: 9.8- 16.7). Outbreak sites implementing mass quarantine (n=76) showed higher rates (15.7; 95% CI: 11.6 - 20.2) compared to sites using conventional strategies (6.6; 95%CI: 3.1 - 11.2), yielding a rate ratio of 0.44 (95%CI: 0.27-0.72) adjusted for testing strategies, type and size of accommodation. Conflicts occurred in at least 11.8% of all outbreaks. Few sites reported specific measures to protect refugees with special needs. Conclusion Mass quarantine is associated with higher attack rates, and appears to be a counter-productive containment measure in overcrowded camps. Although further research with individual-level data is required to rule out residual confounding, reception centers and refugee camps should follow the available guidelines on Covid-19 response and refrain from mass quarantine if physical distancing cannot be guaranteed.