The Institute for Global Health and Development
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Item Refugee integration in national health systems of low- and middle-income countries (LMICs): evidence synthesis and future research agenda(Elsevier, 2025-09-12) Olabi, Amina; Palmer, Natasha; Bertone, Maria Paola; Loffreda, Giulia; Bou-Orm, Ibrahim; Sempé, Lucas; Vera Espinoza, Marcia; Dakessian, Arek; Kadetz, Paul; Ager, Alastair; Witter, SophieThis paper reviews evidence on healthcare responses for refugees, documenting the different approaches and their effectiveness and impact in particular in relation to supporting integrating refugees into national health systems. The review adopted a purposeful, iterative approach, utilizing electronic databases, grey literature, and reference lists from relevant studies. A total of 167 studies, primarily from low- and middle-income countries (LMICs), focusing on refugees and forcibly displaced persons with empirical data, were included. The review highlights a substantial literature on refugee health and healthcare access, with well-covered areas including delivery models, access barriers, gaps in coverage, and specific health services such as psychosocial care, non-communicable diseases, mental health, and maternal and child health. However, less attention is given to integration models, health system responses, and their impact on system resilience and social cohesion. Few studies examine the costs, feasibility, or sustainability of integration models, and little research focuses on health system perspectives or comparative analyses. Moreover, the host health system's status, capacity, and needs are often underexplored. Some countries are particularly well-represented in studies, e.g. Turkey, Jordan, Lebanon, Bangladesh, Democratic Republic of Congo (DRC), and Uganda. There is however a paucity of data that would provide the basis for more quantitative or analytical evaluation from a systems perspective. This gap highlights the need for further research on effective integration models, their operational aspects, and their long-term impact on local health systems' resilience and sustainability. To support this research agenda, we propose a conceptual framework to provide analytic guidance for future research on healthcare responses for refugees and health system integration.Item Editorial: Exploring the links between social connections, care and integration(Frontiers Media, 2024-10-08) Vera Espinoza, Marcia; Dakessian, Arek; Boeyink, ClaytonItem Exploring refugees' experience of accessing dental health services in host countries: a scoping review(Frontiers Media S.A., 2024-03-12) Asfari, Elaf; Rodriguez, Andrea; Dakessian, Arek; Yuan, SiyangIntroduction: Refugees often face worse oral health outcomes, such as periodontal diseases and dental caries in host countries due to barriers including language and cultural differences, institutional discrimination, and restricted use of dental health services. This scoping review aims to map and summarise the available studies on refugees’ experience of accessing dental health services in the host countries, to identify the main characteristics of the dental health services that refugees access and to explore the barriers and enablers to navigate the dental health service system in their host countries. Methods: The Joanna Briggs Institute (JBI) framework was adopted. PubMed, Scopus, Assia, CINAHL and Social Services Abstract were searched. A search strategy was developed using Medical Subject Headings (MeSH) terms and a combination of search operators and syntax used in MEDLINE were adopted for the remaining databases. Data were synthesised using thematic analysis. Results: Fourteen articles were included. Most studies used qualitative methods and Australia seemed to be the country with the highest number of publications surrounding this topic. The included studies showed that refugees frequently encountered substantial obstacles when attempting to access dental services in host countries. Numerous barriers such as language barriers, cultural differences, and lack of health insurance or financial support hindered refugees' ability to access these services. Additionally, many refugees possessed limited knowledge of the dental care system in their new country. As a result of untreated dental problems, refugees suffered from pain and other health complications. Discussion: This scoping review explored the challenges refugees have experienced in accessing dental health services in host countries, which included the key barriers such as affordability, accessibility, accommodation, availability, awareness, and acceptability. The scarcity of relevant research highlighted the need for a more comprehensive understanding of refugees’ experiences accessing dental health services in host countries. Limited data were identified regarding evidence focusing on the characteristics of dental services accessed by refugees in host countries.Item Pathways and Potentialities: the role of social connections in the integration of reunited refugee families(Queen Margaret University, 2020) Baillot, Helen; Kerlaff, Leyla; Dakessian, Arek; Strang, AlisonItem Art, refugeedom and the aesthetic encounter(Taylor and Francis Group, 2023-12-17) Dakessian, Arek; Riga, LilianaRefugeedom and its various politicisations, as a complex human experience of political alterity, poses unique challenges for the visual aesthetics of refugee subjecthoods and subjectivities. In contrast to media and humanitarian visualities, aesthetic engagement with what is contentiously referred to as ‘refugee art’ might have the potential to create more complex possibilities and open new subjective spaces by enabling a different epistemic access to the experiences of refugeedom's constituted subjects. We turn to Jacques Rancière's theoretical frame as we focus attention on the aesthetic encounter, or the affective and sensory experience of what an artwork does. Looking closely at six artworks focused on the recent Syrian ‘refugee crisis’, we ask: What might we perceive differently of forced displacement in the aesthetic encounter that we might not otherwise see in activist or politicised spaces, or in everyday visual representations of forced displacement? Whether by reinscribing real-world subject positions or transcending them, the aesthetic experience can open up a rift – even if momentary – in ordinary ways of seeing and perceiving refugeedom. In other words, the aesthetic experience expands our moral imagination by staging occasions for creating scenes of relationality with political alterity that do not exist or that have not been previously imagined.Item Equity in decline: illustrating fairness in a worse-off world. [Commentary](2023-10-30) Reidpath, Daniel; Khosla, Rajat; Gruskin, Sofia; Dakessian, Arek; Allotey, PascaleItem Equity in decline: fair distribution in a worse-off world.(2023-06-28) Reidpath, Daniel; Gruskin, Sofia; Khosla, Rajat; Dakessian, Arek; Allotey, PascaleItem Fragile, handle with care: Refining a key concept for global health and development(BMJ Publishing Group, 2023-06-28) Diaconu, Karin; Witter, Sophie; Dakessian, Arek; Loffreda, Giulia; Ager, AlastairSummary box In the development sphere, the term ‘fragile’ has generally been used as a pejorative label to represent ‘fragile and conflict-affected states’ with chronic governance challenges. Beginning with the formulation of the OECD’s multidimensional framing of fragility, a broader use of the term is emerging, which is of potential utility in the field of global health. Evidence from a series of studies addressing non-communicable disease and mental health provision—both of which require continuity of care and long-term investments into health service delivery and capacity—informs a ‘fragility for health’ framework consistent with this evolving understanding of fragility. This framework identifies two domains that warrant more intense, politically sensitive study: political economy and financing for health services delivery and community engagement in shaping systems for health. Consideration of these domains will critically inform health interventions in contexts of fragility.Item Chapter 12: Imagining defragmented university spaces(Critical Publishing, 2023-05-26) Dakessian, Arek; Ataekong, Anthony; Burrows, Olutayo; Haqani, Misbah; Rahman, Rezaur; Pearson, Georgina; Marcus, Geetha; Van de Peer, StefanieItem ‘Step by step’: the role of social connections in reunited refugee families’ navigation of statutory systems(Informa UK Limited, 2023-01-25) Baillot, Helen; Kerlaff, Leyla; Dakessian, Arek; Strang, AlisonFor asylum route refugees, the existence and persistence of structural barriers to navigating statutory systems are well-documented. Even when initial barriers are overcome, further transitions may disrupt refugees’ lives. One such is the arrival in the UK of family members from whom they had been separated during their flight from persecution. This paper draws upon data gathered using a Social Connections Mapping Tool methodology with reunited refugee families to make three contributions to the field of refugee studies. Firstly, families’ accounts of navigating statutory systems confirm the multi-directionality of integration. Refugees’ efforts to build and leverage social links proceed differentially across key statutory domains and cannot alone overcome systems barriers that require adaptation on the part of public services. Secondly, our findings contribute to scholarship that critiques the division of social relationships into categories of bonds, bridges and links, and the distinctions made between these based on ethnicity or nationality. Rather, refugees’ social relationships are more appropriately understood as a fluid continuum, with their nature and purpose subject to change. Finally, refugee families’ descriptions of settling in the UK highlight the influence of time on integration and the importance to refugees of re-building independence in a new country context.