General Refugee Health Guidance


On average, more than 70,000 refugees relocate to the United States annually.1 They come from diverse regions of the world and bring with them health risks and diseases common to all refugee populations as well as some that may be unique to specific populations. The purpose of this document is to describe general and optional testing components that do not fall into the specific disease categories of the domestic screening guidance. This guidance is based upon principles of best practices, with references to primary published reports when available.

The guidance in this document includes testing for abnormalities or clinical conditions that are not specific disorders but are suggestive of underlying disorders. The tests in this document may indicate either acute or chronic disorders and generally indicate the need for further testing and evaluation to identify the condition causing the abnormality. Testing for chronic health conditions is important, since these conditions are common in newly arriving refugees, both children and adults. 2 Since refugee populations are diverse and are predisposed to diseases that may differ from those found in the U.S. population, the differential diagnosis and initial evaluation of abnormalities are discussed to assist the clinician.

General and Optional Tests

Many disorders may be detected by using general, nonspecific testing modalities. Preventive screening, counseling, and testing, which are routinely used in the general U.S. population, may identify people with or at risk for chronic disorders. In addition, the process of migration and adaptation to a new lifestyle in the United States generally predisposes refugees to disorders, such as hyperlipidemia and cardiovascular diseases, not commonly encountered in refugee populations on arrival.

This document discusses guidelines (Table 1) for conditions commonly detected on arrival, including hematologic disorders, renal disease, and metabolic disorders of adults and children. In addition, medical screening routinely recommended in the United States for such conditions as cardiovascular diseases and cancers should be performed. This may be done at the new-arrival medical evaluation, or arrangements should be made for timely follow-up with primary care for testing.

Table 1. General and Optional Testing for Newly Arrived Refugees

General and Optional Testing for Newly Arrived Refugees
Recommended for All Refugees
  • Complete blood count with a white blood cell differential and platelets
  • Urinalysis (if old enough to provide a clean-catch urine specimen)
  • Infant metabolic screening in newborn infants, according to state guidelines
Recommended for Specific Populations
  • Serum lipid profilea
  • Cancer screeningb
  • Uric acid (for Hmong refugees)
  • Serum chemistries and glucose
  • a See Discussion and Table 4 for population-specific information.
  • b See Discussion and Table 5 for population-specific information.