The 21st century has, so far, been a time of unprecedented migration and displacement of populations. The majority of this movement is due to economic migration, but a notable number of people have been forcibly displaced due to conflict, persecution, or disaster events. According to the UNHCR, 79.5 million people have been displaced in 2019 alone - the highest number since 2000 [1]. The people in this group generally fall into one of four categories: internally displaced persons, stateless persons, refugees, and asylum seekers.
The US has been home to 3 million refugees since 1975 and has accepted an average of 24,000 asylum seekers annually since 1990 (with some fluctuation due to policy restrictions during the Trump administration) [2, 3]. Both refugees and asylum seekers are persons unable or unwilling to return to their nation of origin due to persecution or fear of persecution. However, while refugees to the United States have legal protection and have been accepted into this country prior to their arrival, asylum seekers are a distinct group in that they have arrived in a country of refuge (such as the United States or at its border) but do not yet have legal recognition.
According to the UN World Migration Report, there are over 700,000 asylum seekers in the U.S. with over 250,000 claims made in 2018 alone [4]. This makes the U.S. the largest recipient of asylum applications in the world. Unlike refugees who come to the US already receiving the support of resettlement agencies, asylum seekers do not have assistance, health insurance, or access to public or private resources. As a result, this group is particularly vulnerable in terms of health access, risks, and outcomes.
Despite this clear high-risk status, relatively little has been published about the particular health problems of asylum seekers in the United States. A few of the existing studies have begun to shed light on this issue, one study noting that more than half of the participants of US asylees had chronic health issues and another study noting 100% prevalence of mental health issues in one population (Bosnian torture survivors) and more than 50% prevalence in another (Colombian torture survivors) [5, 6]. Despite these findings, another study found that 57% of the studied asylum seekers did not have any contact with the healthcare system, despite almost all having physical and psychological conditions [7]. A study looking specifically at asylum seekers who were pregnant found several previously undetected health problems placing them at risk of potentially poor pregnancy outcomes [8].
In contrast, the US medical literature is quite robust when it comes to the health status and outcomes of refugees. For example, one study assessed the health of refugee children arriving at major ports of entry in the United States and was able to create health profiles based on country of origin [9]. Data established in this manner allows for the stratification of health needs and recommended medical care for these populations. The impact of such research also extends beyond their medical health and assists with readjustment and integration into their new environments.
There are many health issues that arise as a result of the movement of people across borders. The latest coronavirus pandemic is just one example, but the World Migration Report points out the limited nature of evidence-based medicine and research into the health of migrating populations and their host nations. Most of the literature is about populations arriving in developed, rather than developing countries and the most commonly studied migrant category is “refugees and asylum seekers” (as one group) [10].
The literature on asylum seekers in Europe and elsewhere appears to be quite robust, (though differing definitions of “asylum seekers” make this somewhat difficult to study). Gerritsen, et. al performed a population-based study of refugees and asylum seekers in the Netherlands and found that the health problems of asylum seekers were more numerous than those of refugees [11]. A WHO report about the health problems of refugees and asylum seekers in Europe found that the asylum process itself can significantly impact health: prolonged proceedings, extended periods in detention, and threat of deportation all have negative effects on an already vulnerable population
In contrast to the body of knowledge about refugees in both the U.S. and around the world, as well as asylum seekers in other countries, there appear to be few articles related to the specific health concerns of asylum seekers in the U.S. We sought to perform a bibliometric review of the literature about the health of asylum seekers in the US as a means to identifying gaps in our understanding of the health status, disease prevalence, and other issues affecting the health of asylum seekers, and make recommendations for future studies.