Health Outcomes of Afghan Migrants in the DMV
Graduate student Makenna Lindsay discusses original research findings on Afghan Migrants, published first on the Immigration Lab's blog at American University.
This article was written by Makenna Lindsay, MA SORP ‘24, reproduced with permission here. See the previous co-authored article in this series by the Immigration Lab at American University titled The Educational Attainment of Recently Arrived Afghans in the DMV. Full disclosure: I am currently a Research Fellow at the Immigration Lab.
In the Immigration Lab’s project on recently arrived immigrants to the United States and the Washington Metropolitan Area, we find that Afghans have unique medical and healthcare needs.
Operation Allies Welcome (OAW), a program designed by the federal government to support Afghans resettling in the United States, offers medical coverage. Afghan arrivals who have been accorded humanitarian parole are eligible for health coverage through Medicaid or Refugee Medical Assistance (RMA), a short-term coverage option for refugees who are ineligible for Medicaid.
Among the 22 Afghans in our research study, more than half of participants (68%) had medical insurance through Medicaid while another 23% had medical insurance through other providers. These findings speak to the effectiveness of Operation Allies Welcome in providing health care services to Afghan arrivals.
On access to Medicaid, Noor, a 34-year-old male, shared: “The good thing is that they’re providing Medicaid, or medical assistance to those families that are coming from Afghanistan with a specific legal status, like for special immigrant visa holders there is that medical assistance, and through that you can access medical services.”
While Afghan migrants' access to Medicaid indicates the benefits of OAW, many participants communicated some issues with the efficiency of Medicaid. Rahman, 44-years-old, shared his experience with a delay in Medicaid care that ultimately negatively impacted his family:
“The problem was when we came here for the first three months we had no Medicaid, I think…the problem was with the agency. They had lots of clients, so we had to wait for more than three months to receive Medicaid. A couple of times my kids were sick and not feeling well. It was not a good experience. But it was not because of [immigration] status. It was because of the process, it took a longer time, it took about three months, which is not common, I think. But anyhow, we had to wait, and our kids suffered because of that.”
Some participants emphasized that while they had access to Medicaid, their coverage did not support all of their medical expenses. It is possible that people are not being adequately informed about what their insurance will cover in the United States upon arrival, especially because health insurance is less common in Afghanistan:
“The hospital sent me a bill up to $1200. I showed my Medicaid—why should I pay from my pocket, you know? There are these kinds of problems we have…they say Medicaid is not covering this [so] I can’t afford it at this time,” Hamza, male, 34-years-old.
Other participants who did not relay their insurance provider or who have an unknown insurance provider also described difficulty paying for medical services that were not covered. Farjaad, age 25, described unanticipated expenses when visiting an ophthalmologist whose services were not covered by health insurance. Upon finding out that his appointment would not be covered by insurance, he canceled it and opted for eye drops. Farjaad’s experience reflects the issue of unaffordable health care in the United States despite having access to government insurance.
There is an underwhelming number of responses in the data that speak to the health problems of Afghan migrants and refugees that they are aware of or are receiving treatment for. Most participants reported that they either do not have any health problems or they are unaware of any health problems they have. There was one affirmative response for having each of the following health problems: 1) High Cholesterol, depression, anxiety, 2) Asthma, anemia, 3) TB, 4) Diabetes, PTSD, ulcer, 5) Anxiety, PTSD, Thyroid, and 6) High blood pressure, high cholesterol, hypertension.
However, some participants indicated that they had health problems in Afghanistan. Participants mentioned having conditions such as diabetes, hemorrhoids, heart problems, and kidney stones, to name a few.
The findings were also limited in identifying disability. Most interviewees reported that they either do not have a disability or are unaware of any disability they have. Only one participant reported having an undiagnosed disability but did not specify which. Nonetheless, qualitative data from the research reveals that though disabilities may not be diagnosed, participants are aware that they have one. For example, one interviewee noted they have lower back pain and fibromyalgia, which they believe are indications of an undiagnosed disability. Another participant mentioned having undiagnosed depression and post-traumatic stress disorder (PTSD) from their time in the army.
Only 23% of respondents answered the question, “When was the last time you went to the dentist?”, three individuals in the affirmative responding in 2022 and two in 2023. The survey asks two reproductive health care questions, both of which were only answered by three [male] participants. In the first reproductive health question participants responded that they have never received reproductive health care, and two out of three responded that they have not been adequately informed about reproductive health care services in the United States. The final respondent affirmed that they have been informed about reproductive health care. However, the data indicates that there is a general lack of awareness surrounding reproductive health care and how to access it in the United States.
It is important to note that income level does not appear to have a significant impact on qualifying for Medicaid. Most participants who are insured by Medicaid disclosed their income level, ranging from a yearly salary of $80,000-100,000 to less than $30,000. In comparison to their lives in Afghanistan, where health insurance is not as common, the data demonstrates that Afghan arrivals are able to securely access federally funded medical coverage in the United States.
Overall, health is certainly considered to be a priority for Afghans settling in the United States, though total medical coverage seems to be a rare occasion. Many Afghans do use Medicaid but convey their dissatisfaction for the process of receiving care upon arrival. This data points to discrepancies in the efficacy of the Operation Allies Welcome program.
Some consistent qualitative patterns in the responses to the health care questions are 1) participants being unaware of the extent to which Medicaid/other insurance providers cover their medical expenses, 2) lack of reproductive health care knowledge, and 3) preliminary health problems in Afghanistan that are rarely being assessed in the U.S.
About the Study
This report is part of a larger research project titled Recent-Arrivals to the DMV from Conflict Affected Areas. The project relies on a mixed-methods research project conducted by faculty and students from the Immigration Lab and the Center for Latin American and Latino Studies (CLALS) at American University. Researchers solicited information about migrants’ identities and experiences using a survey form that collected quantitative data and asked open-ended follow-up questions to collect narrative-rich qualitative data. This project was supported by the Mellon Foundation through the College of Arts and Sciences and the Faculty-Student Scholarly Collaboration Grant from the Office of the Deputy Provost and Dean of Faculty at American University. The larger team includes Ernesto Castañeda, Bashir Mobasher, Tazreena Sajjad, Mubbashir Rizvi, Lauren Carruth, Daniel Jenks, Makenna Lindsay, Diana Flores Garay, Sofia Guerra, Joseph Fournier, Montse Hernandez, and over 30 students working at the Immigration Lab. We aim to interview more Afghans and compare them to other immigrant and asylum-seeking groups.
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