DRC Refugees: Most Common Presentations
Since January 2013, an estimated 400,000+ DRC nationals have become refugees. This does not include the 3.1 million nationals who are classified as IDPs, or internally displaced persons, as a result of in-fighting between rebels in the country and the government since the 1990s. Many refugees from the DRC settle in camps in the neighboring countries, with about 113,000 DRC nationals having found temporary refuge in Uganda, 68,000 in Rwanda, 59,000 in Tanzania, and 38,000 in Burundi. Thousands of DRC refugees from these camps arrive in the United States annually. In 2019, the US took in a total of 30,000 refugees from around the globe: 12,958 of those refugees were from the DRC (over 43% of the total admitted). The country with the next highest number of nationals allowed into the US that were classified as refugees was Burma, with 4,932 people admitted. This is nearly a third of the number of DRC refugees.
The risk of contracting certain diseases differs widely between nations. Those from the DRC are considered to be at very high risk of having been exposed to major infectious diseases including diarrhea, hepatitis A, typhoid, malaria, dengue fever, African sleeping sickness, schistosomiasis, rabies, and, in 2019, Ebola. The CDC adds that tuberculosis, syphilis, chlamydia, gonorrhea, anemias, etc. are also conditions that refugees from the DRC are at elevated risk for having. The DRC is also ranked 18th in the world for people living with HIV/AIDS (450,000) and 17th for deaths due to HIV/AIDS (13,000). However, the cases of asthma (7,692 per 100,000), hypertension (~50,000 per 100,000), and diabetes (10,500 per 100,000) are far higher in the US than in the DRC (see below).
For context, the CDC reports that about 2,000 cases of malaria are diagnosed in the US annually - where the population is about 327.2 million. That comes out to 0.00061% of people infected. Likewise, an estimated 0-6.1% of people in the US are infected with strongyloides and 0.0094% with syphilis.
There are only about 0.09 physicians per 1,000 people with 28.7% of the population having access to an improved sanitation facility. The cost to stay in a hospital bed for one day at a primary health care facility in 2005 was only $5.48. Below is a table demonstrating the prevalence of certain conditions in arriving refugee children from several countries, the DRC included. According to the CDC, “parasitic infections, malaria, mental health, and sexual- and gender-based violence” are the priority health conditions to screen for when caring for refugees from the DRC.
Current and Past Healthcare Considerations
Previous programs have been put in place to try and address some of the most common and most dangerous diseases pervading from the circumstances of refugees. In the case of camps housing displaced persons from the DRC, some of the most common illnesses include malaria (as transmitted by mosquitoes) and cholera (travelling by water). In fact, studies have found that:
~20% of people own and use bed nets in Internally Displaced Person camps in the DRC
Most families owning bed nets use them to protect children, if they have any
The incidence of malaria in children under 5 is far higher than adults, nearly 58%
While people are very familiar with malaria and its dangers, the main issue is that many refugees face challenges obtaining such precautionary “equipment.” Not only can cost be an issue, but so too can set-up of bed nets be very inconvenient.
The DRC has the fourth highest number of cases of cholera in IDP and refugee camps. The internationally recognized “Sphere Standards” have been updated with such issues in mind. They include extremely specific guidelines for maintaining sanitation in camps and providing clean water to IDPs and refugees. These have dramatically lowered the incidence of cholera in camps.
One of the other primary concerns in refugee camps pertaining to health is the stigmatization of various diseases and/or treatment plans. This can include:
Mental health, an issue not openly discussed, and, with a lack of resources, clinicians, and interpreters, not one typically addressed or noticed as it should be. Moreover, there exists a lack of training for people travelling to help in IDP/refugee camps, where people are at higher risk of having endured traumas such as human trafficking or torture.
HIV. Studies interviewing patients, patient families, and healthcare workers in the DRC has demonstrated a specific aversion to discussing HIV and the associated treatments. In many cases, infected individuals will not seek to be tested until they are in the advanced stages of the disease - conclusions from the study noted that, should a patient be diagnosed, their family may mourn for them as if they were dead. Given how important family is as a support system for patients seeking treatment, this makes the process infinitely more difficult.