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MNAAP Newsletter

Reflections on Caring for Refugees in Lesbos, Greece

boys at fireBy Chuck Oberg, MD

As President Trump’s proposed U.S. refugee travel ban continues to work its way through the courts, I make a plea for benevolence and tolerance rather than that of fear.

I recently returned home from working in the refugee camps in Lesbos, Greece. I was volunteering with the Boat Refugee Foundation, a Netherlands based NGO.

I spent the majority of my time in the notorious Moria Refugee Camp. The camp is beyond description and is a surreal mix of an interment camp and shanty, squatter community encampment. Based in an old army compound, it is defined by the steel gates, high fencing and barb wire from the outside and an amorphous sea of tarps and tents on the inside. The weather had turned brutally cold. Over a foot of snow was followed by freezing rain. The cold and dampness penetrated to the bone. Food queues, inadequate unsanitary toilet facilities and ubiquitous garbage were the norm.

There are over 4,500 refugees. They had traveled from Syria, Iraq, Iran, Afghanistan and Pakistan from the Middle East. They came from across the African Continent with families from the Democratic Republic of the Congo (DRC), Ghana, Uganda, Somalia, Eretria and Sudan. In addition, I treated families from as far east as Bangladesh and west from Haiti and the Dominican Republic.

Almost all had experienced trauma. Some beaten, shot, tortured, and raped and all had experienced the stress of living in unlivable conditions. The complaints were a blur of physical, mental, and spiritual aliments.

Yet there was a palpable hope that one day things would be better with aspirations of a better future. Daily they expressed their gratitude that someone would listen as they shared the story of their journey, affirmed their worth, acknowledged their struggle and celebrated their humanity. You could see it in their eyes and their smiles that each was seeking a better life for themselves and their children.

I saw no terrorist. I just saw families, children, men and women–all vulnerable and suffering. So let us remember that our kindness will make us safer than any ban.

Poverty, Toxic Stress and Health Disparities

By Charles N. Oberg. MD, FAAP, Program Director of Maternal and Child Health at the University of Minnesota’s School of Public Health; pediatrician at Hennepin County Medical Center; District VI Vice Chair for the American Academy of Pediatrics

In 2013 the AAP added poverty and child health to its strategic plan as a key priority calling for further investigation as well as action. Its agenda reads in part, “When families can’t afford the basics in life, it negatively affects their health. Poverty can inhibit children’s ability to learn and contribute to social, emotional, and behavioral problems. Furthermore, poverty is a contributing factor to toxic stress, which has been shown to disrupt the developing brains of infants and children and influence behavioral, educational, economic and health outcomes for years.” As poverty affects children from minority communities at higher rates, the resulting disparity in toxic stress results in disparities of health.

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Persistent Disparities Causing Health of Minnesota Children to Slip

By Charles N. Oberg, MD, FAAP, Program Director of Maternal and Child Health at the University of Minnesota’s School of Public Health and pediatrician at Hennepin County Medical Center…

Minnesota prides itself on being one of the finest places to raise a family and has frequently been ranked as one of the healthiest states in the country. In 2004, the Annie E. Casey Foundation ranked Minnesota first overall in the well-being of its children using 16 measures of child well-being in the four major domains of economics, education, health, and family. But in its 2013 report, Minnesota had slipped to fourth overall and 15th in the health of children category. This decline in our state ranking is resulted in part to persistent disparities in health outcomes for minority children in Minnesota. Infant mortality and immunizations are two health outcomes that epitomize these disparities.

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Caring for Homeless Children

By Charles Oberg, MD, FAAP, program director of the Maternal and Child Health program at the University of Minnesota and practicing pediatrician at Hennepin County Medical Center

In the June issue of Pediatrics, the AAP Committee on Community Pediatrics released a policy statement titled “Providing Care for Children and Adolescents Facing Homelessness and Housing Insecurity.” The statement provides an important framework for thinking about the context of homelessness in our practices. It outlines both the antecedents of homelessness as well as the health, developmental, educational and social adverse outcomes of a child being raised in a transitory or less than permanent home environment. The statement concludes with a series of recommendations for the pediatrician to be cognizant of resources that might assist them in the care and management of these children.

What is the magnitude of this problem? The National Center on Family Homelessness recently released a report titled “America’s youngest outcasts 2010” and places the number of homeless children at 1.6 million children or close to 1 in 45 children. The center estimates that Minnesota had 15,898 homeless children. This is substantially less than the 337,105 in Texas, the state with the largest number of homeless children. However, for each of these children this housing instability can severely affect their life trajectory. A more recent study was conducted by the Amherst H. Wilder Foundation in 2012, which intermittently surveys the homeless population in Minnesota. It estimated there were 10,214 homeless adults, youth, and children statewide in 2012. This was a 6 percent increase over the 2009 survey. Surprisingly, the results show that nearly half (46 percent) of all homeless persons in the state of Minnesota were 21 years of age or younger. This included 3,546 children with their parents and 1,151 youth who were homeless on their own.

The table provides a listing of statewide resources designed to decrease the burden that homelessness places on a family. The list provides a description of services as well as contact information that might assist in the coordination of care for this vulnerable population.

The AAP and the Committee on Community Pediatrics should be applauded for their efforts to re-familiarize us with this most extreme form of risk for an infant, child or adolescent. The recent dialogue on Toxic Stress and Adverse Childhood Events emphasizes the importance of this risk. The contributing factor of homelessness such as parental unemployment, mortgage foreclosure, poverty, mental illness, substance abuse and/or domestic violence are magnified when a family slips into a homelessness, exponentially worsening the adverse health outcomes for children. As pediatricians, we should be familiar with these invaluable resources that might assist us in our coordination of care and to provide linkages to essential community services for these vulnerable families and their children.

Policy Statement on Care for Children Facing Homelessness and House Insecurity, Council on Community, Pediatrics, 2013; 131: 1206

The National Center on Family Homelessness, America’s Youngest Outcasts 2010: state report card on child homelessness. Available at:

Gerrard M, Shelton E, Pittman B, and Owen G: Initial findings: Characteristics and trends of people experiencing homelessness in Minnesota,
2012 Minnesota Homeless Study, Amherst H. Wilder Foundation, 2012

Caring for Homeless Children Resource Table