A seventeen-year-old with diabetes who does not have access to insulin. He is an asylum seeker and is being cared for at an emergency crisis reception site. The shared fridge for insulin is in a room that gets locked every night. The boy doesn’t know how much insulin to inject anyway: no one tells him how many carbohydrates are in his meals. In the short term, the boy is at risk of dangerously low or high blood sugar levels. And in the long run, extreme fluctuations in blood sugar damage blood vessels, eyes, and the heart.
The asylum crisis is destroying children’s health, according to the Foundation for the Experience Center for New Children and Adolescents in the Netherlands (Ekann). There is no good basic care in crisis emergency shelters, authorities have a poor overview of children who need care and doctors are losing patients to transfers.
The diabetic boy is one of seventeen refugee children from whom Icahn received a report this year. Norwegian Refugee Council Granted access to anonymous reports.
“This is the tip of the iceberg,” says Sarah Sahba, MD, pediatrician and deputy director of Ekann. “We were grounded this spring. Doctors don’t yet know where to find us all.” Doctors can ask Ekann for advice or report that something has gone wrong with the care of refugee children.
Seven of the 17 reports concerned children in emergency shelters – churches, cruise ships, commercial buildings and sports halls. Medical care is under pressure there, as the Health and Youth Inspectorate wrote in August: “Care is sometimes limited to emergency aid. This falls short of the normal medical care to which everyone is entitled.”
In regular asylum seekers centres, GP care is provided by the Health Asylum Seekers (GZA). From the GGD, the Youth Health Care (JGZ) carries out an initial medical examination of children and young people and assesses whether medical or psychological help is needed.
Care is fragmented in crisis emergency reception sites. The COA organizes care there with bodies such as the GZA, GPs from the area, or through the Arts en Specialist secondment agency.
Sometimes seconded doctors don’t have the authority or resources to provide quality care, says Sahba van Icahn. They have limited access to ICT systems and patient records. Sahba: If you can’t refer or diagnose, you can’t do anything as a doctor. Then you simply cannot help people who need care.”
Because the care doesn’t match, the kids get into a mess
Albertine Bow Founder Ekann
This leads to dangerous situations. Icahn received a report of a six-year-old girl with kidney failure who had already been moved three times between emergency shelters. Not checked. At the medical center, a doctor diagnosed the girl with high blood pressure. Kidney damage and high blood pressure can reinforce each other. The child should have been shown immediately by a specialist, but the doctor did not refer the girl. If high blood pressure and kidney failure are not treated for a long time, organs may be damaged.
Health care for young people is also faltering. It is difficult for the GGD to see all the children in the emergency shelter for discussion and examination, because the children often go home, says the spokesperson. And by no means all children are enrolled in a COA, so creating a file is tricky.
“It is clear to us that there is not enough knowledge about children’s health,” says Sahba. “It is not clear to anyone if there are children who need care on site. COA doesn’t know, GGD doesn’t know.”
Living conditions are often unsanitary, especially for children who need care. Icahn received a report of a three-year-old with a rare syndrome, who had been in emergency care for six months without any necessary special diet and daily activities. Deterioration of the child physically and mentally. Another child, a nine-year-old, was admitted to the intensive care unit in critical condition after a week and a half of illness, but was not subsequently discharged because the living conditions in the shelter were inadequate.
“Children who stay in a reception center receive the same care as other children in the Netherlands,” says a spokesman for the Ministry of Justice and Security, which is responsible for the care of asylum seekers. “The current challenges of receiving asylum also bring challenges in accessing health care, but in general, medical care for the children of asylum seekers is guaranteed.”
They disappear from view
Between 2015 and 2020, doctors can submit a report to the Dutch Pediatric Society (NVK) for an examination. During that period, 185 reports were received. When the search stalled, Sohba and Albertine Pao decided to start Ekann. The Foundation is funded by donations from private funds. The ministry announced that there are currently no plans to fund Ekann from the government.
In eight reports Ekann received, doctors reported losing patients after they were transferred. This also happens in centers for asylum seekers. Healthcare providers have struggled with this for years, says Karolye Eli, NVK’s chairman. “Children are seen at reception sites and treated, but they can be taken at any time and then disappear from view.”
Ekann helps doctors find transported babies and restart care. “It’s best not to move the child at all,” says Sahba. If the doctor wants to prevent this, he can also contact us. It is better to arrange well in advance than to clean up the rubble afterwards.”
“Many agencies are involved with this group of children, but because the care is not coordinated, the children fall into a mess,” says Albertine Pau. “Why do we have intake by the GZA, intake by the JGZ and screening for tuberculosis by the GGD? We want to combine these measures.”