Neurologic Care of Forcibly Displaced Persons

Abstract

There is a growing number of forcibly displaced persons (FDPs) worldwide. With more than 100 million people forcibly displaced today, there is an urgent mandate to understand the neurologic care needs of this population and how neurologists and other health care workers can most effectively provide that care. In this Emerging Issues in Neurology article, we attempt to: (1) define the scope of the problem of providing neurologic care to FDPs, (2) highlight commonly encountered clinical challenges related to neurologic care of FDPs, and (3) provide useful clinical information for neurologists and other clinicians who deliver care to FDPs with neurologic needs. We address the terminology of forcible displacement and how terms may differ across a person’s migration journey.Common challenges encountered by FDPs with neurologic needs across settings include loss of support systems, loss of personal health information, language barriers and differing expression of symptoms, differing belief systems, epidemiological patterns of disease unfamiliar to the clinician, and patients’ fear and perceived risks of engaging with health systems. Practical approaches are shared for clinicians who encounter an FDP with a neurologic presentation. Finally, the article discusses many unmet neurologic needs of FDPs, which require significant investment. These include addressing lapses in neurologic care during displacement and understanding the effects of forcible displacement on people with chronic neurologic conditions. Future research and educational resources should focus on improving epidemiological intelligence for neurologic conditions across geographies, developing curricula for optimizing the neurological care of FDPs, and evaluating the most appropriate and effective uses of health technologies in humanitarian settings.

Neurological Care of Refugees and Other Forcibly Displaced Persons

“…Conflict, persecution, and precarious immigration status that can limit rights and protections magnify FDPs vulnerability risk, which includes vulnerability to neurological illness—an emerging, albeit understudied, issue in neurology. 3 This review highlights aspects of the existing literature on neurological disorders among FDPs, including presenting conceptual frameworks that emphasize different mechanisms involved in the disproportionate downward shift of health trajectories among FDPs. We aim to provide essential insights into the health risk etiologies, intervention targets, and future work considerations for addressing health disparities in FDPs.…”

Teleneurology and Artificial Intelligence in Clinical Practice

“…Contemporary AI models, and more specifically the large-language models that have recently appeared for commercial use, clearly exemplify this trend by demonstrating a growing capacity to summarize, analyze, and extract meaning from increasingly complex health care datasets. 33 With AI, neurologists should be able to provide more accurate and timely clinical assessments, hasten access to neurologic care, and allow for more nuanced insights into complex neurologic conditions, such as identifying acute stroke sooner than traditional recognition methods and pinpointing the onset of off states in patients with Parkinson disease. These tools will also be able to integrate complex data streams to "phenotype" disorder subtypes and characterize previously uncharacterized patient groups, such as medication-resistant subpopulations of patients with multiple sclerosis or headache disorders.…”

Lung Cancer Diagnoses and Outcomes During the Syrian War, 2011-2018

“…10 More than 12 million are in dire need of health care, as the war also forced about 70% of health workers to flee Syria and excluded half of the primary health facilities from service, 11 affecting the management of both communicable and uncommunicable diseases. [12][13][14][15][16][17][18][19] Furthermore, diagnostic and therapeutic approaches became progressively restricted, often proving prohibitively expensive for patients to access. 8,17 In the realm of cancer care, approximately 18 000 new cases were diagnosed in 2008, including 1818 cases of lung cancer.…”

“…In the case of the Syrian conflict, the 12-year war has evolved into one of the most severe global humanitarian crises, displacing large masses of people and leading the Syrian population, initially around 23 million in 2011 (reported pre-war), to fall below 19 million by 2016 . More than 12 million are in dire need of health care, as the war also forced about 70% of health workers to flee Syria and excluded half of the primary health facilities from service, affecting the management of both communicable and uncommunicable diseases . Furthermore, diagnostic and therapeutic approaches became progressively restricted, often proving prohibitively expensive for patients to access …”