A seventeen year old boy with diabetes can’t reach his insulin. He is an asylum seeker and is assisted in a shelter for crisis emergencies. The common refrigerator with his insulin is in a room that is locked every night. However, the boy doesn’t know how much insulin he should inject: no one tells him how many carbohydrates are in his meals. In the short term, the boy runs the risk of dangerously low or high blood sugar levels. And in the long run, extremely fluctuating sugar levels are bad for your blood vessels, eyes and heart.
The asylum crisis is harming children’s health, according to the foundation of the Competence Center for Children and Adolescents in the Netherlands (Ekann). There is no good basic care in emergency shelters, authorities have a poor view of children in need of treatment, and doctors lose patients to relocations.
The boy with diabetes is one of 17 refugee children Ekann has received a report on this year. NRC extension had access to anonymous reports.
“This is the tip of the iceberg,” says Sara Sahba, a pediatrician and deputy director of Ekann. “We were founded this spring. Doctors still don’t know where to find us all.” Doctors can ask Ekann for advice or report that something has gone wrong in the care of refugee children.
Seven of the seventeen reports concern children in emergency shelters: churches, cruise ships, commercial premises and sports arenas. Medical care there is under pressure, the Health and Youth Inspectorate wrote in August: “Care is sometimes limited to emergency aid. This is less than the normal medical care to which everyone is entitled.
Fragmented care
In regular asylum seeker centres, general medical care is provided by Healthcare Asylum Seekers (GZA). From the GGD, Youth Health Care (JGZ) conducts an initial medical examination of children and young people and assesses whether medical or psychological help is required.
Assistance is fragmented in crisis emergency reception places. The COA organizes care there with entities such as the GZA, the general practitioners of the region or through the secondment agency Arts en Specialist.
Seconded doctors sometimes lack the authority or resources to provide good care, says Sahba van Ekann. They have limited access to ICT systems and patient records. Sahba: “If you can’t refer or diagnose, then you can’t do anything as a doctor. So you simply can’t help people who need treatment.
Because the cures don’t match, the kids get into trouble
Albertine Bauw founder Ekann
This leads to dangerous situations. Ekann received a report of a six-year-old girl with kidney failure who had already been moved between emergency shelters three times. She was not screened. At a medical post, a doctor diagnosed the girl with high blood pressure. Kidney damage and high blood pressure can reinforce each other. The child should have been seen by a specialist immediately, but the doctor did not refer the girl. If high blood pressure and kidney failure are left untreated for a long time, organs can be damaged.
Youth health care is also faltering. It’s difficult for the GGD to see all the children in the emergency shelter for discussion and scrutiny because children often move homes, a spokesperson said. And not all children are registered with the COA, so creating a file is difficult.
“It is clear to us that there is not enough information about children’s health,” Sahba says. “It is not clear to anyone if there are any children in need of assistance on site. The COA doesn’t know it, the GGD doesn’t know it.
Living conditions are often unhealthy, especially for children in need of care. Ekann received a report of a three-year-old boy with a rare syndrome who had been admitted to the emergency room for six months with no special diet needed and daily activities. The child has deteriorated physically and mentally. Another nine-year-old boy was admitted to intensive care in critical condition after a week and a half of illness, but was subsequently unable to be discharged because the living conditions in the shelter were not suitable.
“Children staying in a reception center receive the same care as other children in the Netherlands,” says a spokesman for the Ministry of Justice and Security, responsible for assistance to asylum seekers. “The current challenges in receiving asylum also bring challenges in accessing healthcare, but in general, medical assistance for the children of asylum seekers is guaranteed”.
They disappear from view
Between 2015 and 2020, doctors could present themselves to the Dutch Pediatric Association (NVK) for an examination. During this period, 185 reports were received. When the search stalled, Sahba and Albertine Baauw decided to found 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 to a transfer. This also happens in centers for asylum seekers. Healthcare professionals have struggled with this problem for years, says Károly Illy, president of the NVK. “Children are seen in places of care and cared for, but they can be moved at any time and then disappear from view”.
Ekann helps doctors find the relocated children and restart treatment. “Even better is not to transfer the child at all,” Sahba says. “If a doctor wants to prevent it, he can also contact us. It is better to organize well in advance than to clean up the rubble later.
“Many agencies are involved with this group of children, but because the assistance is not coordinated, the children get into trouble,” says Albertine Baauw. “Why do we have a GZA intake, a JGZ intake and a GGD tuberculosis check? We want to combine these actions”.
