Refugee Health Guidelines
Guidelines for pre-departure and post-arrival medical screening and treatment of U.S.-bound refugees
Many health conditions may affect the health of refugees; therefore, CDC provides guidelines for health-care providers who may see refugees at any point during the resettlement process. These guidelines aim to:
- promote and improve the health of the refugee
- prevent disease
- familiarize refugees with the U.S. health-care system
The links below provide domestic and overseas guidelines for general refugee health screenings and care; 10 domestic guidelines and 2 overseas guidelines are available. All the guidelines are based on current medical knowledge and the advice of experts in refugee health. The guidelines are meant to assist health-care providers but are not mandates. New guidelines will be posted on this website as they become available.
CDC also works with physicians to provide specific instructions for the medical care of refugees before their resettlement in the United States and when they are changing their visa status. These specific directives (called Technical Instructions) focus on the medical screening of refugees and immigrants for certain diseases, such as tuberculosis, in accordance with U.S. immigration law. The Technical Instructions are only meant to be used by two types of health-care providers: panel physicians, who perform overseas screening, and civil surgeons in the United States, who do the exams for adjustment of visa status. The Technical Instructions should not be confused with the domestic or overseas guidelines provided below.
The Guidelines for the U.S. Domestic Medical Examination for Newly Arriving Refugees aid State programs and medical providers in the post-arrival medical screening for refugees. More »
Medical Screening of Asylees
Asylees are persons who meet the definition of a refugee but are already in the United States or are seeking admission at a US port of entry. From 2000 to 2010, the top ten countries of origin for people granted asylum in the United States were China, Colombia, Haiti, India, Ethiopia, Iraq, Armenia, Albania, Iran, and Somalia. Those who are living in the United States or are seeking admission at a US port of entry when they apply for asylum are recommended to have a domestic medical exam once they have been granted asylum status. When an asylee applies for adjustment of status, an I-693 medical examination (including vaccinations) by a civil surgeon is required. Once an asylee has been granted asylum status, their family members may follow to join them in the US, and therefore these family members would undergo the required medical examination overseas, prior to immigration.
Currently, there are very little data available about the health problems of asylees after they migrate to the United States. Many asylum seekers originate in, or transfer through, countries with public health issues similar to those facing refugees arriving through the US Refugee Admissions Program. Therefore we recommend that medical providers screening asylees apply the same screening and treatment recommendations in the CDC Refugee Domestic Guidelines when performing a medical evaluation of an asylee. For individuals who have been in the United States for more than one year, special attention should be paid to diseases with long latency and associated severe morbidity such as tuberculosis, hepatitis B, and Strongyloides infection.