How COVID is Complicating the Lives of Newly Arrived Refugees in Houston

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Before the pandemic, Huda Alhamdani, a case manager at Catholic Charities in the Archdiocese of Galveston-Houston, fought over Medicaid coverage and food stamps for newly arrived refugees within a week.

Now the process takes months, leaving her clients with limited healthcare options at a time when they need it most.

“If it’s an emergency, we just tell them to call 911, and we’ll pay the bills later,” she said.

Health insurance delays are among the ways COVID has complicated the stressful lives of newly arrived refugees in Houston. The virus has forced them to navigate a maze of increasingly tech-dependent providers with little knowledge of the country’s complex healthcare system, while dealing with their housing and transportation needs.

Houston welcomes hundreds of refugees each year fleeing violence or persecution in their home countries. Historical data from 1975 to 2018 shows that most refugees arrived in the city from Vietnam, Iraq and Cambodia. But the Taliban’s takeover of Afghanistan last year sparked an influx of more than 4,000 Afghans, according to earlier Chronicle reports.

“When they arrive, they’ve already been through a stressful situation, and it continues to be difficult because adjustments take time,” said Ali Al Sudani, programs manager for Interfaith Ministries for Greater Houston. “So if you add COVID on top of that, of course, it will make things a little more difficult and complicated for everyone.”

When it comes to health care, insurance delays are the most immediate concerns for refugee families, advocates say.

The problem is twofold, Alhamdani said. First, Social Security offices have remained closed throughout the pandemic, except for limited in-person visits. Case managers endure long waits on the phone to schedule appointments so their clients can receive their Social Security cards, a necessity for a Medicaid application.

Often, says Alhamdani, she cannot reach anyone. And when she does, appointments aren’t available until the following month.

For refugees who do eventually get their Social Security cards, case managers face another long wait during the application process for Medicaid and food stamps with the Texas Health and Human Services Commission, she said. declared. Medicaid provides health coverage for some low-income people and people with disabilities.

Texas Health and Human Services did not respond to an inquiry into the reasons for the delays. In an emailed statement, the U.S. Social Security Administration underscored its “commitment to operating our country’s immigration system more efficiently” by allowing refugees to apply for a Social Security card on the same form. than the one used to apply for a work permit. But the federal agency did not specify the long waiting times.

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Refugees have other options for health care. Many are eligible for temporary health insurance through the Refugee Medical Assistance Program, but that funding stops after eight months. Alhamdani says she tries to reserve these benefits for people who need immediate care.

Some uninsured refugees feel stranded if they test positive for COVID. Abdullah Laqaragoli, a 21-year-old Iraqi refugee living in Houston, said he lay on the floor of his home for four days in early 2021 as the virus left him tired and breathless.

“If I had health care, I would 100% have gone (to a doctor),” said Laqaragoli, who first moved to Turkey with his mother before coming to the United States in 2020. I would have called the ambulance and had them pull me, because I literally couldn’t move.

In addition to insurance delays, many refugees simply do not know where to go for treatment. Case managers should explain the difference between primary care and urgent care and define terms such as “out-of-pocket” and “in-network.” This can lead to expensive bills for visits to a hospital emergency room. If refugees need treatment, agencies often refer them to safety clinics for mild infections or to Ben Taub Hospital for serious illnesses. But many refugees are also following the lead of family members and neighbors who travel to Hillcroft Physicians PA, a 14-room clinic in southwest Houston that serves patients in 10 languages.

During COVID surges, the clinic sees a huge influx of refugees who work and live in the surrounding area, said Dr Forough Farizani, the medical director. The population, although widely vaccinated, is more vulnerable to the virus because many work in the service sector, she said.

At the height of the omicron surge, the clinic saw more than 70 people a day with various illnesses, stretching its staff by around six people.

“They depend a lot on us for education,” Farizani said. “They are not computer savvy or their English is not at the level where they can go online and find things. So they come here for everything.

Zamir Amiri visited the clinic in late December, four months after he and his pregnant wife fled Afghanistan and arrived in the United States. He sought treatment for his two-year-old son, who had cold symptoms.

He said the clinic is his preferred choice because it’s close and because some staff, including Farizani, can speak a mix of Dari and Farsi.

“We all want to come here,” he said through an interpreter.

The Hillcroft Clinic may be a convenient option, but it is not the only provider catering to the refugee population. Alhamdani said she often refers clients to Texas Children’s Hospital, which offers the Immigrant and Refugee Child Health Program, an initiative that connects uninsured or underinsured refugee patients with primary care providers and specialists across the region.

Program director Dr. Karla Fredricks noted that many refugees lack reliable sources of information in their language about treating a COVID infection. They often rely on social media or WhatsApp, she said.

“You were taught to fear it and avoid it, and now you’re new to this country and your child is sick,” she said. “That way we could do a better job of (informing them) what to do if you get sick.”

She also pointed out that the healthcare system has become increasingly dependent on technology with the rise of telemedicine. Communication between patient and providers is largely done online, and refugees sometimes lack the skills to navigate mobile apps or websites on their own.

They might not be able to access their COVID test results, for example, and therefore not know whether to quarantine or self-isolate.

“It’s just another aspect of the newcomer experience,” she said. “They say, ‘I knew who to talk to when we got home. I just went to the next village and asked my mother. But when you arrive in the United States, you usually don’t have that extended family support like you have back home.

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