Evaluation of the Integrated Humanitarian Settlement Strategy (IHSS)

provide a range of short-term psychological and psychosocial interventions including counselling
for survivors of torture and trauma
provide training to a range of service providers including mainstream health services, general and
specialised medical practitioners, settlement service providers, IHSS funded services and other
relevant services to increase their awareness of refugee health needs and improve their ability to
provide effective and appropriate services to this group
provide advice, information products, consultancy and activities/initiatives to improve the
responsiveness of mainstream services to Humanitarian Service entrants’ health needs and
access to health services.
5.4.3 Issues raised in relation to EHAI
The evaluation found that clients of this service were very satisfied with the support they had received
from EHAI providers, particularly the providers’ cultural sensitivity and understanding of the
experience of survivors of torture and trauma. The wide range of intervention strategies used by
EHAI providers also reflected their sensitivity to the variety of cultural backgrounds and the potentially
alien concept of face-to-face counselling for some clients. In addition, clients appreciated that EHAI
providers adopted a holistic approach to the provision of their support by looking at and sometimes
providing support concerning other aspects of the client’s settlement experience. While this is not
really the role of the EHAI provider under the current model and it can often lead to duplication with
some of the contract responsibilities of other IHSS providers, clients’ attraction to this style of
settlement service reinforces the need for case coordination in the IHSS model.
Some issues emerged which relate in particular to the design of the EHAI service and its integration
with other IHSS services and mainstream health services.
Entrants’ immediate physical health needs
The current system under the Migration Regulations for carrying out medical examinations of
humanitarian entrants before they arrive in Australia does not ensure that any or all health problems
are identified and addressed. Although undertakings to undergo further specific medical checks upon
the entrants’ arrival in Australia are often placed in entrants’ files, there is no process for following up
to ensure that this happens. Privacy considerations have meant that there has not been an automatic
transfer of information to the appropriate IHSS provider.
Often humanitarian entrants have lived in camps for a considerable length of time and this frequently
affects their health. Some, but not necessarily all, of pre-existing health problems, may be identified
before leaving for Australia. Indeed, data from EHAI providers indicate that over 80% of EHAI clients
need to be referred to a GP soon after arrival. This is supported by the longitudinal survey of
immigrants to Australia reported in Life in a New Land (National Institute of Labour Studies,
commissioned for DIMIA, 2002) which found that humanitarian entrants were more likely than other
migrants to have a pre-existing long-term health condition and to have suffered from a medical
condition since arrival in Australia.
Several stakeholders claimed that it is important from the point of view of public health interest that
entrants are provided support as quickly as possible to follow up with treatment of any conditions they
may have acquired in the challenging conditions they lived in before arriving in Australia. Many
refugees have lived in areas where various diseases are endemic. Medical checks are carried out for
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Evaluation of the Integrated Humanitarian Settlement Strategy 27 May 2003