Tailoring the perioperative surgical home for children in refugee families.

According to recent United Nations High Commissioner for Refugees (UNHCR) estimates, ~90 million people are forcibly displaced due to conflict, persecution, violence, human rights violations, public disorder, natural disasters, or famine. Of those forcibly displaced, 27.1 million are refugees. By the 1951 Refugee Convention, a refugee is defined as a person, who, “owing to a well-founded fear of persecution for reasons of race, religion, nationality, membership of a particular social group or political opinion, is outside the country of his nationality and is unable or, owing to such fear, is unwilling to avail himself of the protection of that country.” More than half of all refugees are children. Refugees worldwide have steadily increased, almost tripling over the past decade. Most refugees today, roughly 80%, are hosted by lowand middle-income countries, while the United States receives the largest applications of refugees worldwide. Regardless of a host country’s health system capacity, refugees universally face barriers to access and delivery of quality health services. Children are considered among the most vulnerable throughout the migration process, with regard to health risks, physical and mental well-being, and adverse outcomes. Surgical conditions comprise a large and rising portion of the global burden of disease, but the majority of people around the world, including refugee children, cannot receive safe surgical and anesthesia care when needed. For forcibly displaced persons, there is an estimated surgical need of 3 million procedures annually. At least 60% of refugees live in urban settings, with resettlement in host communities. The area of focus for this work is based on an urban tertiary care center and partnering primary care clinic in the United States. First, we present the conceptual frameworks with regard to refugee policies and perioperative care. Next, we examine the health considerations of refugee children and a case scenario to illustrate this. Finally, we propose an integrated, patient-centered care model to equitably address the perioperative health care of refugee children. Frameworks