Asylum applicant (17) with diabetes cannot reach his insulin in the evening

A seventeen-year-old boy with diabetes cannot reach his insulin. He is an asylum seeker and is being looked after at a crisis reception centre. The communal fridge with insulin is in a room that is locked every night. The boy does not know how much insulin to inject anyway: no one tells him how many carbohydrates are in his meals. In the short term, the boy risks dangerously low or high blood sugar levels. And in the long term, a wildly fluctuating sugar level is harmful to blood vessels, eyes and heart.

The asylum crisis is harming children’s health, according to the Ekann foundation Expertise Center for Children and Adolescents New in the Netherlands (Ekann). There is no good basic care in crisis response homes, authorities have a poor overview of children who need care, and doctors lose patients due to relocations.

The boy with diabetes is one of seventeen refugee children that Ekann received a report about this year. NRC had access to the anonymized reports.

“This is the tip of the iceberg,” says Sara Sahba, pediatrician and deputy director of Ekann. “We were founded in the spring. The doctors don’t know where to find us all yet.” Doctors can seek advice from Ekann or report that something has gone wrong in the care of refugee children.

Seven of the seventeen reports concern children in emergency shelters – churches, cruise ships, business premises and sports halls. Medical care is under pressure there, the Health and Youth Authority wrote in August: “Care is sometimes limited to emergency care. It is less than the normal medical care that everyone is entitled to.”

Fragmented care

At regular asylum seeker centers, GPs are looked after by Healthcare Asylum Seekers (GZA). From GGD, Ungdommens Sundhedspleje (JGZ) carries out an initial medical examination of children and young people and assesses whether there is a need for medical or psychological help.

Care is fragmented at crisis response reception sites. COA organizes care there with parties such as GZA, general practitioners from the region or through the secondment agency Arts en Specialist.

Expatriate doctors sometimes do not have the authority or resources to provide good care, says Sahba van Ekann. They have limited access to IT systems and patient records. Sahba: “If you can’t refer or do diagnostics, then you can’t do anything as a doctor. Then you simply cannot help people who need care.”

Because the care does not match, children end up in a mess

Albertine Baauw founder Ekann

This leads to dangerous situations. Ekann received a report of a six-year-old girl with kidney failure who had already been transferred three times between emergency shelters. She was not screened. At a doctor’s office, a doctor diagnosed the girl with high blood pressure. Kidney damage and high blood pressure can reinforce each other. The child should have been seen by a specialist doctor immediately, but the doctor did not refer the girl. If high blood pressure and kidney failure are not treated for a long time, organs can be damaged.

Youth healthcare is also faltering. It is difficult for GGD to see all the children at the shelter for discussion and examination because children often move home, says a spokesman. And by no means are all children registered with COA, so it is difficult to build a file.

“It is clear to us that there is not enough insight into children’s health,” says Sahba. “It is not clear to anyone whether there are children in need of care on site. COA does not know, GGD does not know.”

Living conditions are often unhealthy, especially for children who need care. Ekann received a report of a three-year-old child with a rare syndrome who had been in the emergency department for six months without any necessary special diet and daily activities. The child deteriorated physically and mentally. Another nine-year-old child was admitted to the intensive care unit in critical condition after a week and a half of illness, but could not be discharged from the hospital afterwards because the living conditions at the shelter were unsuitable.

“Children staying in a reception center receive the same care as other children in the Netherlands,” says a spokesman for the Ministry of Justice and Security, which is responsible for the care of asylum seekers. “The current challenges for asylum reception also bring challenges for access to health services, but in general, medical care for the children of asylum seekers is guaranteed.”

They disappear from sight

Between 2015 and 2020, doctors could register with the Dutch Pediatric Association (NVK) for examination. During that period, 185 reviews were received. When the research stopped, Sahba and Albertine Baauw decided to create Ekann. The foundation is financed by donations from private foundations. The ministry has announced that there are currently no plans to finance Ekann from the government.

In eight reports received by Ekann, doctors reported losing patients after a transfer. This also happens in asylum seeker centres. Healthcare providers have struggled with this for years, says Károly Illy, chairman of NVK. “Children are seen in reception centers and treated, but they can be moved at any time and then disappear from sight.”

Ekann helps doctors find transferred children and restart care. “Even better is not transferring the baby at all,” says Sahba. “If a doctor wants to prevent this, they can also contact us. It is better to arrange well in advance than to clean up afterwards.”

“Many agencies are involved in this group of children, but because the care is not coordinated, children end up in a mess,” says Albertine Baauw. “Why do we have an intake by GZA, an intake by JGZ and a tuberculosis check by GGD? We want to combine these actions.”

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