Overview

The Center seeks to foster and conduct collaborative and transdisciplinary research with global partners through the lens of implementation science, leveraging theories and methods from diverse disciplines to influence migrant health programs and policy.

Sponsored research includes both domestic and international topics through strategic partnering in NYC, NYS and in major immigrant and refugee population centers in the US and abroad.

The Health Equity & Access to Care (HEAC) Project

The HEAC Project is an exciting collaboration with the NYC Department of Health and Mental Hygiene which seeks to better understand New Yorkers’ experiences accessing healthcare in hospitals in New York City (NYC). The goal is to share the results with the health department to inform NYC healthcare recommendations to better serve all New Yorkers.

The HEAC Project is an exciting collaboration with the NYC Department of Health and Mental Hygiene which seeks to better understand New Yorkers’ experiences accessing healthcare in hospitals in New York City (NYC).

The goal is to share the results with the health department to inform NYC healthcare recommendations to better serve all New Yorkers. They see this very much in line with their recent declaration of racism as a public health crisis.

We are conducting focus groups on New Yorkers’ experiences accessing health care; we’re particularly interested in racial, ethnic and health insurance status differences. Participants will receive $50 after the focus group to thank them for their time.

The FGs are 7 days a week – with morning, afternoon and evening slots – to be as convenient as possible for a wide range of New Yorkers.

Email HEAC@sph.cuny.edu

This study was approved by the City University of New York (CUNY) Institutional Review Board (protocol #2022-0401-PHHP)

Gender & Refugee Healthcare

Our newest project, a case study on the intersectionality of gender and refugee status and its effects on healthcare access in Lebanon, is in development in partnership with the Institute for Migration Studies at the Lebanese American University (LAU).

Preliminary Findings from convenings

Convenings with participants from UN Agencies, international humanitarian organizations, health facilities, and local non-government organizations (NGOs) and civil society organizations (CSOs) that work at the intersection of health, refugees and gender were conducted in May 2022. Prominent themes are listed below:

  • Lack of registration as potenial vulnerability
  • The economic crisis has a similar effect on refugee and host population
  • Need for multidisciplinary, intersectional, holistic and inclusive approach and services
  • Notable increase in gender-based violence in light of COVID-19
    Conservative region in Northern Lebanon and stigma does not allow for open access of services to gender minorities
  • Main barriers to accessing healthcare: Transportation, cost of fuel, internet connection, lack of privacy, possibility of harassment, retaliation and outing when seeking gender-inclusive services
  • Lack of healthcare providers trained in dealing with gender-minority cases and hence lack of gender-inclusive services

Over the past decade, more than 1.5 million Syrian refugees have fled to Lebanon. With a total population approaching 4 million people, Lebanon presently hosts the highest number of refugees per capita in the world. The Lebanese government’s response to the influx has been a series of patchwork legislation and ad hoc policies. In this climate, refugeehood, gender, and health remain at a sensitive and overlooked intersection particular regarding their access to health services. The country’s highly privatized healthcare system is expensive, inaccessible, and unattainable for many migrants and refugee groups. And while the UNHCR financially supports this marginalized group, it only covers life-saving services or parts of doctor’s feeds, leaving few options for those with serious or chronic health conditions such as cancer and kidney disease.

Beyond the economic and financial challenges, geographic disparity poses a major obstacle for the refugee community in Lebanon. Most recently, the country’s ongoing fuel crisis has exacerbated barriers to accessing healthcare. Additionally, women and LGBTQI+ refugees in Lebanon continue to endure extreme forms of violence, discrimination, stigmatization, and isolation in the “safe” places they seek. Their specific needs are often discounted from mainstream refugee services, and very little humanitarian programming is tailored specifically for them. More research is needed to understand the lived experience of refugees living at the intersectionality between immigration status and gender, and to inform gender and LGBTQI-inclusive policies and humanitarian programming.

How has gender identity impacted access to healthcare services in Tripoli and Akkar
since 2019 for the registered refugee community?

Other Research Questions Include:

  • How does this impact women, LGBTQI+, and children refugees’ access to healthcare specifically?
  • How does registration with UNHCR assist/impede healthcare access? How has the ongoing economic and financial crisis in Lebanon impacted the health sector, as well as the provision of health services to the refugee community in general?
  • What specific impediments to access to healthcare services are associated with this region specifically in Tripoli?

This case study will focus on the region of Tripoli in North Lebanon.  The city of Tripoli has been marred by decades of armed conflict and instability, resulting in a fragile economy that is struggling to support the local population, let alone the influx of refugees from neighboring Syria in the past decade. 

Syria and northern Lebanon have a long-shared history, with common cultural and religious characteristics. With the influx of Syrian refugees, the ongoing economic crisis and the COVID-19 pandemic, Tripoli’s capacity to meet host community and refugee health needs is severely strained, particularly when it comes to the most vulnerable refugees such as women and LGBTQI+ populations.

This study will apply a mixed-methods approach that is participatory, inclusive, and target-group sensitive. The data collection will be conducted in hybrid mode (i.e. remote and in-person).

The data collection phase will encompass convenings and key informant interviews with UN Agencies, international humanitarian Organizations, health facilities and local non-government organizations (NGOs) and civil society organizations (CSOs) that work at the intersection of health, refugees and gender.

Subsequently, Focus Group Discussions will be held with Syrian refugees in Tripoli.

Migrant Health CBOs in NY

In January 2021, CIRGH launched a cross-sectional survey of migrant-serving organizations in NYC to collect important information on their early experiences with COVID-19, focusing on the five areas of funding, staff capacity, technological capacity of communities served, resources in communities served, and difficulty working remotely.

Key Study Findings

Organizational capacity is somewhat correlated with number of groups served and types of services offered:

  • Smaller organizations tend to offer health and social services, i.e., more day-to-day “survival” assistance
  • Larger organizations report greater involvement in areas related to education and employment
  • All organizations offer legal assistance

Fear and ineligibility due to legal status are the service barriers cited most frequently

Topics and resources frequently identified for support include: support for advocacy and communications around migrant policy (86%), provision of best practices and policies through a resource hub (55%), access to interns (55%), connections to researchers (50%), and convening spaces (50%)

In NYC there are hundreds of migrant-serving organizations (MSO) with deep, long-standing connections to immigrant communities. Throughout COVID-19, they have provided critical lifelines to community members. Many MSOs are struggling to survive, lacking the human and financial resources to meet the increasing demand for services and support, including food, housing, cash assistance, employment, legal assistance, health care and mental health services, among others. Moreover, immigrants have been avoiding federal and local COVID-19 relief aid because of legal concerns.

What are the early experiences of migrant-serving organizations with the COVID-19 panemic?

Other research questions include:

What are the main effects of COVID-19 on the communities served?

Are there barriers/factors that exacerbate hardships during the pandemic?

What would be the most valuable tools or useful services MSOs could benefit from?

In January 2021, CIRGH launched a cross-sectional survey of migrant-serving organizations (MSOs) in NYC to collect important information on their early experience with COVID-19 while being cognizant to minimize demands on their limited time and resources. Additionally, as an academic research institution whose mission is to advance public health within a social justice framework, we were interested in determining if MSOs would be interested in collaboratively developing a migrant health resource hub and in what ways it might be useful. We developed a brief survey focusing on three domains:

  1. General organizational information (i.e., staff, budget, target populations)
  2. Special challenges (service or policy-related) posed by COVID-19
  3. Interest in learning more about and collaborating with the Center

The survey was distributed to 122 MSO contacts. Of the 41 organizations that responded to the survey, 38 with complete data were included in analysis (RR=31%). Survey data was examined to identify the areas in which organizations were most affected by the pandemic and problems associated with limited access to services. A proxy measure for organizational capacity was created.

We developed a brief (13-item) survey focusing on three domains: (1) general organizational information (e.g., staff, budget, target populations); (2) special challenges (service or policyrelated) posed by COVID-19; and (3) potential interest in collaborating with an academic research center on a migrant health resource hub. The survey was emailed via Qualtrics (12/2020-1/2021) to 122 MSOs in NYC collecting data about the organizations; challenges posed by COVID-19; and, interest in potential intersectoral collaboration. Descriptive analysis focused on the pandemic’s impact on service provision, type of MSO and organizational capacity.

City Intersection

Supporting Migrant-Serving Organizations (MSOs) to Improve Health Service Access: Perspectives & Strategies

Dima Masoud and Ansley Hobbs will represent CIRGH at this year’s North American Refugee Health Conference during the poster session on June 22. Make sure to stop by our poster to learn about the results of the recent focus group study that informed the development of the Migrant Service Provider Resource Center. See you in Calgary!

Pre-Print Paper

Supporting Organizations to Improve Migrants’ Access to Health Services in New York City

CIRGH surveyed community-based, migrant-serving organizations (MSOs) in New York City (NYC) regarding their experiences early during the COVID-19 pandemic and perspectives on academic collaborations. Thirty-eight MSOs identified COVID-19-related challenges, including limited staff capacity, organizational funding, and technological and resource limitations of communities served. Organizational capacity correlated with types of services offered. MSOs indicated interest in collaboration on migrant policy advocacy and communications, access to interns, and resources regarding best practices and policies.

Results

Service Provision

The survey found that community-based organizations in NYC fill a critical service gap for immigrants and refugees, with a majority of MSOs surveyed serving multiple populations and offering multiple types of services, including legal assistance, social services, education, health, and employment assistance. Most organizations served undocumented individuals (97.4%), lawful permanent residents (84.2%), and naturalized citizens (78.9%), with fewer services related to student visa holders (34.2%), employment-based visa holders (39.5%), and unaccompanied child migrants (39.5%).

Types of Services Offered

Types of services offered (%, n)

30 CBOs offer 2+ types of services
CBOs provide an average of 3 services

Impact of COVID-19 on Organizational Operations

We also assessed the impact of COVID-19 on migrant-serving MSOs, including those with a specific focus on health, regarding limitations in the five areas of funding, staff capacity, technological capacity of communities served, resources in communities served, and difficulty working remotely, as well as other issues reported by respondents. Limited funding was reported by about half of the sample. Health-focused organizations were more likely to report limited staff capacity than non-health organizations (63% vs. 27%), as well as limited resources in communities served (69% vs. 50%) and difficulty working remotely (37% vs. 27%). Limited technological capacity of communities served was reported more by non-health focused organizations (64%) than by health-focused organizations (56%). Other less frequent issues related to COVID-19 were court closures, remote learning, and limited operating space.

Factors facilitating or hindering the access of organization’s clients to programs and services

We included an open-ended question on the factors hindering migrant access to programs and services and subjected the responses to word-cloud analysis, which identified the words ineligible, fear, undocumented, and unemployed as the most prominent. Further thematic analysis resulted in three substantive categories: 1) ineligible for CARE Act; 2) fear of seeking services due to migrant status, COVID-19, public charge risk, etc.; and 3) lack of information/knowledge on how to acquire aid and other services. Analysis by organizational type revealed that non-health focused MSOs more often reported ineligibility for the CARE Act as the primary problem affecting their clients compared to health-focused MSOs (36% vs. 19%). Fear of seeking services was reported by 31% of health-focused MSOs, while just 14% of non-health focused MSOs raised the issue. Lack of information/knowledge regarding services was evenly distributed.

Scaling the Effort

The NYC-focused MSO study is being scaled into a statewide intervention in 2022. The decision to broaden the scope of the intervention to the state level is rooted in the understanding that NYC is often just an entry point for migrants, with well over one million immigrants and refugees settled throughout New York State. Some cities like Buffalo have seen population growth—and an increase in federal funding—for the first time in 70 years, in large part due to the arrival of immigrant and refugee communities. Additionally, many of the policies affecting the health of migrants in New York City are designed and implemented at the state-level. Therefore, we want to foster collaboration with and between MSOs and policymakers to ensure new constituents across the state are both considered and included in policy dialogue.

In response to our findings, we are developing the Migrant Health Resource Hub (MHRH). The MHRH addresses the absence of and need for a comprehensive source of NYC/S migrant health data, research and policy information, and serves as a convener to promote statewide multi-sectoral engagement between organizations, policymakers, and researchers. The components described below will advance the activities of the MHRH and build directly on findings from our recent research with MSOs in the context of the COVID-19 pandemic.

Migrant Health Dashboard & Repository

The hub will house a migrant health dashboard to visualize and communicate the results of the longitudinal survey, as well as the following stakeholder-identified resources: filterable map and directory of organizations and services (500+ organizations identified), programming toolkits, policy directory and briefs, interpretation and translation services, expert witness testimony services, internship matching, migrant-focused grant postings, training and certificate programs (e.g., Migrant Health Worker training, mental health and psychosocial support trainings via the Mental Health and Psychosocial Support Knowledge Hub, Assistive Technologies with International Society of Wheelchair Professionals, etc.), and pertinent open-source publications.

Stakeholder Convening & Advocacy Support

MSOs and other stakeholders across NYC/S lack a centralized convener and resource for fostering data/information exchange to better serve migrant communities and provide a space for policy dialogue and evidence-informed advocacy planning. The MHRH will sponsor quarterly convenings with stakeholders to advance health policy dialogue between organizations and encourage consistent stakeholder engagement and input.

CIRGH also seeks to promote intentional dialogue between organizations and city- and state-level policymakers. CIRGH and CUNY SPH have existing relationships with policymakers at the NYC Department of Health and Mental Hygiene and the New York State Department of Health, putting us in a unique position to support intersectoral town hall meetings to discuss governmental policy and programming. We currently host digital convening spaces for MSOs and other relevant stakeholders, but there is interest in attending in-person meetings to discuss policy advocacy priorities in 2022.

Stakeholder Convening & Advocacy Support

There is currently no comprehensive, longitudinal data source measuring migrant health in NYC/S. Using MSO/stakeholder input from the convenings, we are co-developing a survey to regularly assess the health of migrants across the state. Rooted in data equity, the longitudinal survey is being developed with the input of organizational and community stakeholders to determine what data are collected, how the data will be used, and how migrant experiences are captured.

The database will allow for monitoring migrant health over time and across New York’s ten geographic regions: Capital District, Central New York, Finger Lakes, Mid-Hudson, Long Island, Mohawk Valley, New York City, North Country, Southern Tier, and Western New York.