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Practical Needs and Considerations for Refugees and Other Forcibly Displaced Persons With Neurological Disorders: Recommendations Using a Modified Delphi Approach Publisher



Rezaei S1 ; Mateen F1, 14 ; Sakadi F2 ; Hiew FL3 ; Rodriguezleyva I4, 5 ; Kruja J6, 7 ; Wasay M8 ; Seidi OAA9, 10 ; Abdelaziz S11 ; Nafissi S12, 13
Authors
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Authors Affiliations
  1. 1. Neurology, Massachusetts General Hospital, Boston, 02114, MA, United States
  2. 2. General Hospital of National Reference, N'Djamena, Chad
  3. 3. Neurology, Kuala Lumpur Hospital, Kuala Lumpur, Malaysia
  4. 4. Universidad Autonoma de San Luis Potosi, San Luis Potosi, Mexico
  5. 5. Neurology, Hospital Central Dr. Ignacio Morones Prieto, San Luis Potosi, Mexico
  6. 6. Neurology, University of Medicine, Tirana, Tirana, Albania
  7. 7. Neurology, University Hospital Center Mother Teresa, Tirana, Albania
  8. 8. Neurology, Aga Khan University Hospital, Karachi, Pakistan
  9. 9. University of Khartoum, Khartoum, Sudan
  10. 10. Neurology, Soba University Hospital, Khartoum, Sudan
  11. 11. Medecins Sans Frontieres, Amman, Jordan
  12. 12. Neurology, Tehran University of Medical Sciences, Tehran, Iran
  13. 13. Neurology, Shariati Hospital, Tehran, Iran
  14. 14. Harvard Medical School, Boston, 02115, MA, United States

Source: Gates Open Research Published:2021


Abstract

Background: There are >70 million forcibly displaced people worldwide, including refugees, internally displaced persons, and asylum seekers. While the health needs of forcibly displaced people have been characterized in the literature, more still needs to be done globally to translate this knowledge into effective policies and actions, particularly in neurology. Methods: In 2020, a global network of published experts on neurological disease and refugees was convened. Nine physician experts from nine countries (2 low, 1 lower-middle income, 5 upper-middle, 1 high income) with experience treating displaced people originating from 18 countries participated in three survey and two discussion rounds in accordance with the Delphi method. Results: A consensus list of priority interventions for treating neurological conditions in displaced people was created, agnostic to cost considerations, with the ten highest ranking tests or treatments ranked as: computerized tomography scans, magnetic resonance imaging scans, levetiracetam, acetylsalicylic acid, carbamazepine, paracetamol, sodium valproate, basic blood tests, steroids and anti-tuberculous medication. The most important contextual considerations (100% consensus) were all economic and political, including the economic status of the displaced person's country of origin, the host country, and the stage in the asylum seeking process. The annual cost to purchase the ten priority neurological interventions for the entire displaced population was estimated to be 220 million USD for medications and 4.2 billion USD for imaging and tests. Conclusions: A need for neuroimaging and anti-seizure medications for forcibly displaced people was emphasized. These recommendations could guide future research and investment in neurological care for forcibly displaced people. © 2021 Rezaei S et al.