Revolutionizing Refugee Health Research at UCalgary

The University of Calgary (UCalgary) has emerged as a leader in refugee health research through the Migrant and Humanitarian Health Collective (MHHC), a multidisciplinary team dedicated to improving care for refugees and asylum seekers. This initiative, housed within the O'Brien Institute for Public Health, has culminated in the creation of Canada's most comprehensive refugee health dataset, spanning over a decade of data collection. Led by researchers like Dr. Gabriel Fabreau and Eric Norrie, the work addresses a critical gap: prior to this effort, refugee health data in Canada was fragmented and insufficient for meaningful analysis. By linking clinical encounters to provincial health systems, UCalgary scientists have illuminated patterns in health needs, care utilization, and long-term outcomes for one of Canada's most vulnerable populations.

Refugees and asylum claimants, defined by the United Nations High Commissioner for Refugees (UNHCR) as individuals fleeing persecution, conflict, or violence, arrive in Canada with complex health profiles shaped by trauma, displacement, and disrupted care. UCalgary's Refugee Health YYC platform complements this by fostering innovation in care models, education for providers, and community partnerships, particularly with the Calgary Refugee Health Clinic.

Constructing the MHHC Dataset: A Decade of Diligence

Developing the MHHC dataset began modestly with manual chart reviews in spreadsheets around 2011-2012, evolving into a sophisticated, automated system securely linked to Alberta Health Services data. Today, it encompasses health information from more than 14,000 unique patients representing over 110 countries, capturing over 100,000 clinical encounters. This makes it one of North America's largest refugee-specific databases, enabling longitudinal tracking of care patterns previously invisible in aggregate health statistics.

The dataset's strength lies in its granularity: it records demographics, diagnoses, treatments, referrals, and outcomes, allowing researchers to trace how factors like country of origin, age, and arrival timing influence health trajectories. For instance, a focused analysis from 2011-2020 on 10,661 refugees from 106 countries revealed a mean patient age of 24.49 years, with nearly 48% female, and monthly appointments surging from 455 to 2,208—a level increase of 1,656 and slope rise of 96 per month (p<0.01). Provider hours expanded 6.2-fold, from 176 to 1,097 monthly, underscoring the clinic's scalability.

Canada's Refugee Landscape: Scale and Support Systems

Canada, a signatory to the 1951 Refugee Convention, resettles tens of thousands annually through government-assisted, privately sponsored, and blended programs. In 2024, Immigration, Refugees and Citizenship Canada (IRCC) admitted 76,685 refugees and protected persons as permanent residents, up slightly from 74,979 in 2023, with Alberta receiving about 15,710. Projections for 2026 target 56,200 in humanitarian categories amid overall permanent resident goals of 380,000.

The Interim Federal Health Program (IFHP), administered by IRCC, provides temporary coverage for essential and urgent care not provincially insured, bridging gaps until provincial eligibility. However, 2012 cuts limited non-essential services, straining specialized clinics. Calgary, a key western resettlement hub, hosts the Calgary Refugee Health Clinic (also known as Mosaic Refugee Health Clinic), serving over 2,500 active patients and delivering 25,972 visits in the latest year reported.

• High prevalence of infectious diseases like tuberculosis, hepatitis, and intestinal parasites upon arrival.
• Mental health burdens: studies show 30-55% experience depression or anxiety, exacerbated by pre-migration trauma.
• Chronic conditions such as anemia, vitamin deficiencies, and non-communicable diseases from disrupted care.

Navigating System Shocks: A 10-Year Resilience Study

The landmark Lancet Regional Health – Americas publication details how the Calgary clinic adapted to four shocks: 2012 IFHP cuts restricting services; 2015 Syrian refugee surge; 2017 Yazidi genocide survivors' resettlement; and 2020 COVID-19 pandemic. Using interrupted time series analysis, researchers quantified shifts in appointments: family physician and multidisciplinary visits rose sharply, while specialist referrals dipped during COVID due to lockdowns.

Qualitative interviews with leaders highlighted resilience via partnerships—on-site hotel clinics, pharmacy collaborations, and community trust enabling rapid COVID responses. Yet, 'operational burdens' emerged: financial strains, material shortages, provider burnout, and vicarious trauma from high-trauma cases like Yazidi survivors.

Unveiling Health Needs and Care Gaps

Dataset analyses reveal common needs: among Afghan refugees (a subset), primary care dominated 66% of visits, multidisciplinary 27%, highlighting integrated models' value. Mental health looms large—Yazidi studies show comorbidities from genocide trauma—while preventive care lags due to cultural barriers and language issues. UCalgary's patient advisory committees, using Nominal Group Technique, prioritize community-led agendas like culturally responsive mental health services.

Stakeholders note structural challenges: policy flux, housing instability, and discrimination amplify burdens. For example, during surges, wait times lengthened despite clinic expansions, prompting calls for sustained funding.

Human Costs: Provider Well-Being and Systemic Strain

Resilience came at a price: 6.2-fold provider hour increases led to burnout and turnover risks. Dr. Annalee Coakley emphasized flexibility in delivery, but Norrie coined 'operational burden' for hidden costs like infrastructure limits. This mirrors broader Canadian challenges, where refugee care relies on underfunded specialized hubs amid provincial restructuring.

Policy and Practice Implications

The study urges anticipatory policies: stable IFHP funding, surge-capacity planning, and data infrastructure investments. UCalgary's Canadian Refugee Healthcare System Atlas maps 190+ organizations nationwide, aiding coordination. For higher education, it showcases public health research's impact, attracting talent to roles in migrant health.

Professionals interested in such work can explore opportunities at AcademicJobs.com/research-jobs or research assistant positions in Canada.

Future Horizons: Expanding Impact

MHHC plans dataset updates through 2025, forging ties with WHO Migration Health and Lancet Migration. Refugee Health YYC continues blogs on Afghan care trends and vaccination equity. As Canada targets humanitarian admissions amid global displacement, UCalgary's model offers scalable lessons.

Aspiring researchers can prepare with advice from how to write a winning academic CV on AcademicJobs.com.

Photo by Denise Jans on Unsplash

Engaging the Academic Community

UCalgary's efforts position it as a hub for migrant health scholarship, inspiring collaborations across Canadian universities. Faculty and students contribute via the APPROACH program, analyzing linked data for outcomes research.

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