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Pre-departure screening for refugees (offshore Humanitarian Programme entrants to Australia)

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All permanent migrants to Australia, including migrants who enter through the offshore Humanitarian Programme, have a pre-migration Immigration Medical Examination (IME) within 3–12 months of departure. The IME includes:17,18

  • Full medical history and
  • Chest x-ray (CXR) in those aged 11 years and older (and in younger children if indicated).
  • Interferon gamma release assay (IGRA) or tuberculin skin test (TST) in children 2–10 years (if they: are applying for a Humanitarian or onshore protection visa, OR from a high tuberculosis (TB) prevalence country, OR declare previous household contact), with further investigation for TB if positive (starting in 2016).
  • Urinalysis in those 5 years and older (and in younger children if indicated).
  • Human immunodeficiency  virus (HIV) testing in those 15 years and older (and in younger children if indicated), all unaccompanied humanitarian minors, or where hepatitis C virus (HCV) infection is
  • Hepatitis B surface antigen (HBsAg) in pregnant women, unaccompanied minors; those aged 15 years and over and intending to study or work as a doctor, dentist, nurse or paramedic; and those aged 15 years and over applying for an onshore protection
  • Hepatitis C antibody tests in those aged 15 years and over and intending to study or work as a doctor, dentist, nurse or paramedic; or applying for an onshore protection
  • Syphilis testing in those aged 15 years and older and applying for either an onshore or offshore protection
  • Other tests as clinically

Humanitarian entrants are also offered voluntary pre-Departure Health Checks (DHC) within 72 hours of their intended departure for Australia. Not all humanitarian entrants undergo a DHC, as it depends on the visa subtype and port of embarkation. The DHC includes:19 20

  • A physical
  • Malaria rapid diagnostic testing (RDT) on blood, and treatment if positive, generally with three days of oral artemether/lumefantrine (based on location).
  • Empirical treatment for intestinal helminths with a single dose of albendazole in all those aged 12 months and older (unless pregnant).
  • CXR in those with a history of TB or latent TB infection (LTBI) or clinical suspicion of active
  • Measles, mumps, and rubella (MMR) vaccination in those aged 9 months to 54 years (unless pregnant).
  • Yellow fever (YF) vaccine where relevant (based on location).
  • Polio vaccination where relevant (based on location).

Extended screening will be implemented for the Syrian cohorts, with additional review of mental health and additional immunisations (MMR, polio vaccination and diphtheria-tetanus-pertussis vaccination – in the form of hexavalent or pentavalent vaccine in children <10 years – check available paperwork).

People seeking asylum who arrive by boat generally receive a health assessment on arrival in immigration detention. The detention health services provider completes this assessment. There is no published information on the format of detention health screening; however, assessment appears to have included: CXR in those 11 years and older, and screening bloods in those aged 15 years and older (screening for syphilis, hepatitis B (HBV), HCV and HIV; and screening with full blood examination (FBE), liver function test (LFT), blood sugar level (BSL) testing, urinalysis and pregnancy testing where clinically indicated). Prior to mid-2014, children had very limited detention health screening. After this time they had health assessments similar to adolescents and adults, with the addition of ferritin, vitamin D levels, strongyloides serology, and malaria testing and schistosoma serology where clinically indicated. Clinical experience suggests the management of health conditions detected on the detention health assessments varied depending on access to healthcare in detention, or may have been deferred while awaiting transfer to community-based arrangements.

Asylum seekers arriving by plane may not have had any health screening or healthcare in Australia and will not have had a pre-departure IME.

We recommend a full health assessment be offered to all newly arrived people from refugee-like backgrounds as soon as practical after arriving in Australia (ideally within one month) to ensure early and proactive intervention.

While these recommendations are based on expert opinion and clinical evidence, screening and management of certain conditions may vary depending on particular jurisdiction requirements.

Offering newly arrived individuals a full health assessment is a positive step towards optimising health, and addresses health inequity through the provision of ‘catch up’ immunisation, as well as diagnosis and treatment of unmanaged chronic conditions.

Last Updated November 2018

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The Australian Refugee Health Practice Guide was produced with funds from the Australian Government Department of Health.

Disclaimer

The information set out in the Australian Refugee Health Practice Guide (“the Guide”) is current at the date of first publication and is intended for use as a guide of a general nature only and may or may not be relevant to particular patients or circumstances. Nor is the Guide exhaustive of the subject matter. Persons implementing any recommendations contained in the Guide must exercise their own independent skill or judgement or seek appropriate professional advice relevant to their own particular circumstances when so doing. The statements or opinions that are expressed in the Guide reflect the views of the contributing authors and do not necessarily represent the views of the editors or Foundation House. Compliance with any recommendations cannot of itself guarantee discharge of the duty of care owed to patients and others coming into contact with the health professional and the premises from which the health professional operates.

Whilst the information is directed to health professionals possessing appropriate qualifications and skills in ascertaining and discharging their professional (including legal) duties, it is not to be regarded as clinical advice and, in particular, is no substitute for a full examination and consideration of medical history in reaching a diagnosis and treatment based on accepted clinical practices.

Accordingly, Foundation House and its employees and agents shall have no liability (including without limitation liability by reason of negligence) to any users of the information contained in the Guide for any loss or damage (consequential or otherwise), cost or expense incurred or arising by reason of any person using or relying on the information contained in the Guide and whether caused by reason of any error, negligent act, omission or misrepresentation in the information. Although every effort has been made to ensure that drug doses and other information are presented accurately in the Guide, the ultimate responsibility rests with the prescribing clinician. For detailed prescribing information or instructions on the use of any product described herein, please consult the prescribing information issued by the manufacturer.