Refugee resettlement in Philadelphia, USA: Challenges and opportunities

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Irène Mathieu
Irène Mathieu is a pediatrician and writer based in Philadelphia. She holds a BA in International Relations and was a Fulbright scholar in the Dominican Republic. She has also completed global health projects in Peru, Guatemala, and with immigrant populations in Virginia and Tennessee. Her interests include child and family health, public policy, migration/urbanization, mental health, and chronic disease prevention. Irène’s poetry, prose, and photography have been published extensively. She is author of two poetry collections, the galaxy of origins (dancing girl press, 2014) and orogeny (Trembling Pillow Press, forthcoming).

Michelle Munyikwa is a MD/PhD (anthropology) candidate at the University of Pennsylvania. Her research centers on the experiences of refugees resettling in Philadelphia, PA. In this interview she discusses some of the unique challenges facing new residents of the city.

You’ve been researching how refugees are resettled in Philadelphia, PA. Could you describe the process as it typically works? What agencies are responsible for this process?
 My understanding of this process is evolving as I continue my dissertation research, but I’ll describe it here as I understand it. Refugees flee their homes and communities to either another region in their own country or to a country of asylum. Those who stay in the boundaries of their country of origin are referred to as internally displaced people (40.8 million in 2015), while those who cross national boundaries are classified as refugees (21.3 million). Only when efforts to either help refugees return home or settle permanently in their country of asylum does resettlement in a third country become an option, one that the UN High Commissioner for Refugees considers a last resort. As a result, resettlement is a relatively uncommon occurrence. Less than 1% of all refugees end up being resettled in another nation, meaning that in 2015, 107,100 refugees were resettled, 66,500 of whom found themselves in the United States of America. Of those, roughly 3000 ended up in Pennsylvania.

There are a number of organizations that oversee the resettlement process. Overall, the Department of State’s Bureau for Population, Refugees, and Migration oversees the refugee resettlement program. The State department develops application criteria, decides how many refugees will be admitted annually, and then presents them to the U.S. Citizenship and Immigration Services for consideration. The U.S. Department of State contracts resettlement agencies and other non-governmental organizations to assist refugees in all steps of the process, from preparing their applications for citizenship to facilitating resettlement in American cities. In Philadelphia the agencies that provide reception and placement services for refugees are the Hebrew Immigrant Aid Society (HIAS) and the Nationalities Service Center (NSC). These organizations ensure that refugees arriving in Philadelphia have somewhere to stay and are linked with healthcare providers for their initial assessments. They also link refugee families with social services, help them find employment, and provide other support as necessary. It’s important to note that even beyond these two agencies there are a variety of non-profit organizations as well as city-led initiatives that target immigrant populations as a whole and refugees in particular to help support them.

What are some of the biggest challenges refugees face once they’re resettled?

The challenges can vary greatly depending on country of origin, English language proficiency, and neighborhood placement. The resources available to various refugee groups are dependent especially on language access, with some refugee groups better resourced than others. In terms of healthcare, I would say that a big challenge is maintaining health insurance and accessing care. Refugees are entitled to 8 months of health insurance upon their arrival in the US, which resettlement agencies help them to access; after the 8 months lapse they must reapply for coverage, at which point many refugees fall off and end up uninsured or under-insured. This is a well-recognized problem, which many refugee clinics  have started to address in the form of patient education and assistance with applying for insurance. A large barrier that presents in various forms is related to language access and English proficiency. Patients often find it difficult to access healthcare, in part because while interpreters are often available during visits, they are often unable to call and schedule appointments. Many refugees also experience difficulty with employment, particularly with finding jobs that pay a living wage and offer some measure of stability.

What effects, if any, have racial tensions and Islamophobia (in the USA and globally) had on refugee communities?

My sense is that the current political climate has effects in two core ways on refugee communities, some of which have yet to fully be realized. The first is that refugees themselves have different experiences in their neighborhoods. Anecdotally, I have heard more stories from people describing their children being bullied, having people look at them strangely, or feeling unwelcome in their communities. I can’t say yet whether that is a significant change and what the core causes are, but it is something I’m hearing. On another note, I know that many people who work in refugee-serving institutions that are largely supported by grants are worried about the political backlash, particularly around Syrian refugees, and what it could for the financial support they will be able to have in the future to carry out their work. I think we are all concerned about what a Trump America might look like, and whether a refugee resettlement program could survive that kind of political shift.

What might “refuge” look like for refugees resettling in a country where so many U.S. Americans feel unsafe, especially Americans who look like many of those who come here seeking refuge

This is a core question of my research, and my ideas about this evolve daily. What I can say is that from conversations I have had with refugees and my own anecdotal experience as an immigrant, an integral part of coming to America is making contact with the reality of America’s racial past and present. Refugees often tell me about their experiences of suddenly becoming “Asian-American” or “black” and what that meant for their own self-image. Suddenly, people find that they are racially grouped with people with whom they previously would not have considered themselves allies. This can be a jarring or a powerful experience, depending on the person, but it is still a shift all the same. The Black Lives Matter movement has brought state violence out of the shadows and into the public imaginary, a moment that is significant when conceptualizing what refuge might mean. Many refugees are here directly because of their experiences with state-sanctioned violence, particularly at the hands of the police. I have witnessed those people grapple with their memories, particularly that sensation that things are “the same” here as they were at home. This experience can be profound especially for those who have PTSD and other effects from their experiences.

What are some of the core competencies necessary for health care providers caring for refugees and immigrants? How might medical education be expanded to reflect the needs of our growing refugee/immigrant populations?

I am a strong believer in the idea that two core competencies for health care providers are cultural humility and structural competency. What this means to me is that providers can never expect to know, without asking, what patients from different populations may need or want. This level of knowledge is simply impossible, particularly when you are dealing with refugees who, despite carrying the same label, come from a wide variety of contexts, linguistic and cultural backgrounds, and religious or spiritual preferences. Refugees tell me again and again that what they want is for providers to ask them what they need and what their preferences are.

Secondarily, structural competency, the ability to understand the politico-economic contexts of the city in which you’re practicing and the places your patients are coming from, is paramount. Similarly to non-refugee populations, it can be frustrating to have patients cancel appointments last minute, miss appointments, or not take their medications. But when we know that refugees often have difficult, manual labor jobs with odd hours and take multiple forms of public transit to see us, struggle to pick their children up from school, or have trouble reading the instructions we give them, we can see that more is at stake than individual responsibility.

Less philosophically and more practically, learning to work with interpreters both in person and over the phone is a skill that cannot be understated. Additionally, as is always the case for working in urban, underserved contexts, it’s important to know where people can receive low-cost dental care, eye care, and other similar services in your neighborhood. I’ve also learned that there are excellent patient education guides in a whole host of languages that you can find online. Philadelphia has some great ones, as do the Boston and New York health departments.

“Refugees” is a blanket label that belies the incredible diversity of new U.S. Americans. Could you give some examples of the unique strengths you’ve seen in these communities that mitigate the substantial challenges of resettlement?

What I would say to this is that refugees, like all of us, are human. They have experienced significant challenges which have brought them here and face some steep problems, but those circumstances do not fully define them. A core feature that helps mitigate the challenges of resettlement is the formation of strong communities that not only pool resources and share information but also provide a space to engage in cultural, religious, and spiritual practices that give texture to everyday life. I would also say that, given the vast array of backgrounds that refugees are coming from, the strengths they bring to the Philadelphia context are as varied as they are. Whether it is an individual talent for art, language acquisition, community organization, or navigating complex bureaucracies to get social services, refugees who come to the United States leverage all of their gifts in order to make livable lives for themselves. It’s this, in part, that allows them to be such a large part of what makes Philadelphia such an incredible place.


Michelle Munyikwa is an MD/PhD candidate in anthropology at the University of Pennsylvania and a graduate of the College of William and Mary. She hopes to combine her commitments to activist scholarship with her interests in race, migration, and citizenship; ethnographic writing and creative nonfiction; and social justice movements and their relationship to healthcare.

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