EVALUATION OF PUBLIC HEALTH PRACTICE IN THE REFUGEE ACCOMMODATION CENTRES FOR UKRAINIAN REFUGEES, MOLDOVA, 2023

Abstract

Objectives. The study assessed public health practices and mechanisms for the detection, reporting, and response to communicable diseases in Refugee Accommodation Centers (RACs) in the Republic of Moldova, with the aim of identifying gaps and opportunities to improve epidemiological surveillance.

Methods. A descriptive qualitative assessment was conducted in June 2023 in 14 RACs located in Chișinău municipality and six districts of the country. RACs were purposively selected based on the number of refugees accommodated, territorial location, frequency of reported communicable diseases, and living conditions. Fifteen staff members were interviewed, including managers, physicians, nurses, and social workers. Data were collected through semi-structured interviews and analyzed using a rapid qualitative analysis approach adapted from UNICEF’s Human-Centered Design for Health methodology.

Results. Important differences were identified in human resources and the organization of healthcare services. Daily presence of a healthcare worker was reported in 9 of the 14 RACs, while an initial health assessment upon refugees’ admission was conducted in half of the centers. In 13 RACs, persons presenting signs of illness were referred to family physicians, while emergency medical services were requested in 12 centers. Gaps were identified in knowledge of communicable disease reporting procedures and timelines, particularly among managers. Physicians highlighted cross-cultural communication barriers, while RAC staff reported the need for additional training and more direct communication with public health authorities.

Conclusions. The assessment identified vulnerabilities in the organization of healthcare services, initial health assessment, and communication and reporting mechanisms for communicable diseases in RACs. These vulnerabilities suggest the possibility of underdetection and underreporting of some cases, although they do not constitute a direct estimate of morbidity among refugees. Strengthening staff capacity, providing methodological support, and developing direct communication mechanisms between RACs and epidemiological surveillance structures are needed to improve the detection, reporting, and response to communicable diseases.