Because of the unique circumstances surrounding refugee and asylee patients, special attention must be paid to human rights issues when they are evaluated in a health care setting. Refugees and asylees suffer other human rights violations despite international law. There are early opportunities for health care workers to determine if their patients have been exposed to human rights violations and to assess the effect these may have had on their health. Prior to departing for the United States, refugees will have received a health assessment to detect conditions that may preclude their entrance, such as active tuberculosis, human immunodeficiency virus infection, or leprosy.
Refugees receive a similar assessment after they arrive in the United States.
Although asylees, unlike refugees, do not receive mandatory health assessments, their attorneys may request, as part of an asylum claim, a medico-psychological evaluation to document sequelae of torture or related refugee trauma. Two surveys of US medical and public health schools found that only a small percentage of them teach about human rights violations and their relation with health. There are several ways of confronting human rights violation issues in the primary care clinic. Ideally, obtaining a history about a refugee or an asylee starts before the actual visit takes place. Providers should obtain some basic information about the patient beforehand, including his or her country of origin, the country's politicosocioeconomic conditions and prevalent health problems, and the population's cultural values.