PM3041: Understanding the Health Needs of Newly Arrived Afghan Children

Background: In August 2021, approximately 85,000 Afghan civilians were emergently evacuated from Afghanistan. Almost half of these evacuees were estimated to be children. Many of these children required medical care immediately upon arrival to US airports or over the following months while living on military bases awaiting resettlement. Due to the extraordinary circumstances of their evacuation and resettlement process, this population had unique clinical and care coordination needs compared to refugees arriving in the United States via the traditional resettlement process. Our goal is to describe the demographics, health status, medical problems, and healthcare utilization of pediatric Afghan evacuees who sought emergency or subspecialty medical care in our healthcare network, located near one of the military bases housing the largest amount of people, prior to resettlement.

Methods: This is a retrospective chart review of all pediatric Afghan evacuees who presented for care in our healthcare network between August 2021, when the evacuation began, and February 2022, when the last Afghan families were resettled. Patients were identified with the help of Arcus, a data platform that queried Epic for charts containing the word ‘Afghan’ with encounters within the study period, and by filtering for the insurance designation given to newly arriving Afghan children. Approximately 500 charts were reviewed for demographics, overall health status, reason for presentation, degree of healthcare resources utilized during each respective encounter, and challenges with planning disposition and follow-up care.

Results: Preliminary results demonstrate that newly arrived Afghan children received care for a wide variety of acute and chronic conditions. One cohort was referred directly to care from the airport upon arrival for immediate assessment and management of complaints including respiratory distress, fever, abdominal pain, and concern for potential infections with public health implications including measles, pertussis, and hepatitis A. Many children later required referral to Emergency Departments from the military base due to diagnoses such as diarrhea with dehydration, bronchiolitis, fractures and lacerations, dental infections, and exacerbations of chronic problems like arthritis. Others required subspecialty care for new or previously unrecognized, untreated, or undertreated conditions like type 1 diabetes, seizure disorders, congenital heart defects requiring surgical correction, and complex congenital syndromes requiring care coordination. Encounters for disease processes uncommonly seen in the United States included children presenting with malaria, hepatitis A, cutaneous leishmaniasis, and measles.

Conclusion: Due to their precipitous mass evacuation and nontraditional pathway to resettlement, newly arrived Afghan children are a unique cohort with diverse, and occasionally complex, medical needs. Results from this study will inform clinicians who care for Afghan evacuees after their resettlement and those who may have to care for similarly large volumes of children displaced by a humanitarian disasters in the future.