From Immigrant Connect:

The barrier to entry into the United States frequently comes in the form of one’s own immune system for refugees seeking resettlement in the United States. U.S. law stipulates that resettlement exists as a humanitarian policy for individuals who have faced or fear persecution due to race, religion, nationality, political opinion or membership in a particular political group. Not all refugees fitting these criteria will be eligible for resettlement, however.

Health becomes an important factor in determining the acceptance of a refugee’s application, and a paradox arises as U.S. officials struggle to accommodate the most vulnerable refugees who could be more susceptible to adverse health conditions, and protect the American public.

“Do they come with a clean bill of health?” Judith Weinstein, the director of Heartland Health Outreach, a subsidiary of Heartland Alliance, says of the refugee population she works with in Chicago. “No, of course not. Just by definition a refugee has experienced some kind of traumatic experience…So, that is a very complicated question.”

For the millions refugees worldwide living in refugee camps or affiliated urban areas, resettlement to a third country is rare; the United Nations High Commission on Refugees (UNHCR) reports that less than one percent of refugees are ever resettled. The United States receives one half of those who make up that one percent, more than any other nation in the world.  Despite this relatively high number of acceptances, however, the process for refugees to be granted admission to the U.S. is not easy.

In the majority of cases, the UNHCR must refer a refugee to the United States Refugee Admissions Program (USRAP) in order for that person to be considered. A referral from the UNHCR does not guarantee resettlement, however. Refugees must also pass background checks, have an interview with a United States Citizenship and Immigration Services officer, and, finally, have a health screening.

The Centers for Disease Control and Prevention (CDC) regulate this screening process through a network of 400 physicians abroad and 3,000 physicians in the United States who carry out specific guidelines for medical assessment of refugees to determine eligibility for living in the U.S.  Before departing for the U.S., refugees are tested for communicable diseases such as tuberculosis, leprosy, and yellow fever, among others, and must also have completed or started a full set of vaccinations.

Mansha Mirza, a postdoctoral fellow at the Northwestern University Feinberg School of Medicine specializing in refugee health, describes the maze-like system that refugees must navigate once recommended.

Refugees, she explains, “already will have undergone some health screenings while they were overseas in refugee camps even before they come [to the United States]. And if found to have some infectious diseases, say, tuberculosis or something, they have to go through a period of treatment over there until they get to a point where it’s no longer infectious, and only then are they allowed [into the country].”

Testing positive for tuberculosis, or another infectious disease deemed “inadmissible” by the CDC, can mean a delay of six months or longer as the refugee is treated in an overseas clinic that often is not optimally equipped or staffed, says Mirza.

Despite this seemingly rigorous admissions process, though, the health condition of many of the refugees who resettle in the United States is far from perfect.