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Emergency care provided to refugee children in Europe: RefuNET: a cross-sectional survey study
  1. Ruud Gerard Nijman1,2,
  2. Johanna Krone3,
  3. Santiago Mintegi4,
  4. Christoph Bidlingmaier5,
  5. Ian K Maconochie2,
  6. Mark D Lyttle6,7,
  7. Ulrich von Both3,8
  1. 1 Department of Infectious Diseases, Section of Paediatric Infectious Diseases, Imperial College London, London, UK
  2. 2 Paediatric Emergency Department, Imperial College Hospital NHS Healthcare Trust, London, UK
  3. 3 Division of Paediatric Infectious Diseases, Dr. von Hauner Children's Hospital, University Hospital, Ludwig Maximilian University, Munich, Germany
  4. 4 Emergency Department, Hospital Universitario Cruces, Barakaldo, País Vasco, Spain
  5. 5 Department of Paediatric Accident and Emergency, Dr. von Hauner Children's Hospital, University Hospital, Ludwig Maximilian University, Munich, Germany
  6. 6 Emergency Department, Bristol Royal Hospital for Children, Bristol, UK
  7. 7 Faculty of Health and Applied Science, University of the West of England, Bristol, UK
  8. 8 German Centre for Infection Research (DZIF), partner site, Munich, Germany
  1. Correspondence to Dr Ruud Gerard Nijman, Department of infectious Diseases, Section of Paediatric Infectious Diseases, Imperial College London, London W2 1PG, UK; r.nijman{at}


Background Refugee children and young people have complex healthcare needs. However, issues related to acute healthcare provision for refugee children across Europe remain unexplored. This study aimed to describe the urgent and emergency healthcare needs of refugee children in Europe, and to identify obstacles to providing this care.

Methods An online cross-sectional survey was distributed to European healthcare professionals via research networks between 1 February and 1 October 2017 addressing health issues of children and young people aged <18 years fulfilling international criteria of refugee status, presenting to emergency departments. Survey domains explored (1) respondent’s institution, (2) local healthcare system, (3) available guidance and educational tools, (4) perceived obstacles and improvements required, (5) countries of origin of refugee children being seen and (6) presenting signs and symptoms of refugee children.

Results One hundred and forty-eight respondents from 23 European countries completed the survey, and most worked in academic institutions (n=118, 80%). Guidance on immunisations was available for 30% of respondents, and on safeguarding issues (31%), screening for infection (32%) or mental health (14%). Thirteen per cent reported regular teaching sessions related to refugee child health. Language barriers (60%), unknown medical history (54%), post-traumatic stress disorder (52%) and mental health issues (50%) were perceived obstacles to providing care; severity of presenting illness, rare or drug-resistant pathogens and funding were not.

Conclusions Many hospitals are not adequately prepared for providing urgent and emergency care to refugee children and young people. Although clinicians are generally well equipped to deal with most types and severity of presenting illnesses, we identified specific obstacles such as language barriers, mental health issues, safeguarding issues and lack of information on previous medical history. There was a clear need for more guidelines and targeted education on refugee child health.

  • paediatrics
  • emergency department
  • global health
  • mental health
  • infectious diseases

This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non-commercial. See:

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  • Handling editor Simon Carley

  • Twitter @rgnijman, @mdlyttle

  • Contributors RGN and UvB were responsible for the conception of the study, for obtaining funding, and writing of study protocol. JK was responsible for data collection and data analysis. SM, MDL, IKM and CB were responsible for scientific input, study design and the support and distribution across networks. RGN wrote the first draft of the manuscript, and was responsible for data quality control and data analysis. All authors have contributed significantly to the drafting and revising of the manuscript. All authors have approved the manuscript as submitted, and they are willing to take responsibility for the reported research. Main authors and guarantors of this paper are RGN and UvB.

  • Funding This project was awarded a small grant award by the European Society of Paediatric Infectious Diseases (ESPID). RGN was awarded an academic clinical fellowship (ACF-2015-21-016) and an academic clinical lectureship (CL-2018-21-007) in paediatrics funded by the National Institute of Health Research (NIHR), UK. UvB was awarded a clinical leave fellowship funded by the German Centre for Infection Research (DZIF), Germany.

  • Disclaimer The funders had no role in study design, data analysis, or decision to publish this manuscript. RGN and UvB had full access to all data.

  • Map disclaimer The depiction of boundaries on the map(s) in this article does not imply the expression of any opinion whatsoever on the part of BMJ (or any member of its group) concerning the legal status of any country, territory, jurisdiction or area or of its authorities. The map(s) are provided without any warranty of any kind, either express or implied.

  • Competing interests None declared.

  • Patient and public involvement Patients and/or the public were involved in the design, or conduct, or reporting, or dissemination plans of this research. Refer to the Methods section for further details.

  • Patient consent for publication Not required.

  • Ethics approval This survey sought responses from healthcare professionals via collaborative networks and societies and did not contain any patient identifiable data; ethics approval was therefore unnecessary as confirmed by the Health Regulation Authority research decision tool.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data availability statement Data are available on reasonable request. All data relevant to the study are included in the article or uploaded as online supplementary information. Requests for data sharing will be considered by the authors of this study: relevant and anonymised data can be made available on reasonable request to the corresponding author.

  • Press release Yes.

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