ArticleLancet regional health. Americas2025
Refugee healthcare resilience and burdens: a 10-year mixed-methods analysis of system shocks in Canada.
Article in Lancet regional health. Americas, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 2 papers.
What it found
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Who cites it
2 citing papers in PubMed.
- Not Every Country Can Absorb a Shock: Unequal Capacity to Withstand World Health Organization Aid Cuts.Public health challenges · 2026Article
- Implementation and Evaluation of an Integrated Care Team for Refugee Health: A Case Study in Ontario, Canada.International journal of integrated careArticle
Corrections and comments
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Authors and funding
9 authors.
Funding
No grant is acknowledged in the PubMed record.
Abstract
Background: System shocks, including policy changes, refugee surges, and pandemics, strain healthcare systems. These shocks compound refugee health vulnerabilities, limiting care but may also trigger adaptive responses that build resilience. Understanding local responses is essential for resilient care models. Methods: This sequential explanatory mixed-methods retrospective study (2011-2020) examined how a refugee health centre in Alberta, Canada, responded to four shocks: Interim Federal Health Program (IFHP) Cuts (2012), Syrian Surge (2015), Yazidi Resettlement (2017), and COVID-19 (2020). We hypothesized that each shock would drive temporary utilization changes, reflected in level (immediate) and slope (monthly rate of change) shifts, with corresponding impacts on patients and providers. Interrupted time series analysis estimated level and slope differences in monthly appointments (total, family physician, specialist, multidisciplinary team). Interviews with health centre leaders were thematically analyzed using an adapted Health System Resilience framework and integrated with quantitative findings to assess resilience and operational burdens. Findings: Between 2011 and 2020, 10,661 refugees from 106 countries attended 107,642 appointments. The mean age was 24.49 years (SD 17.09; range 0-107), and 47.82% (5094) were female. Mean monthly appointments increased from 455 to 2,208, with an adjusted level difference of +1656.06 and slope increase of +95.68 (p < 0.0.01). Family physician and multidisciplinary team appointments rose substantially, while specialist care declined during COVID-19. Mean provider hours increased from 175.8 to 1097.3 (6.2-fold). Qualitative analysis indicated resilience capacities but also burnout, vicarious trauma, and financial strain. Integration revealed the centre developed resilience but experienced operational burden. Interpretation: Over a decade, the centre adapted to successive shocks, transforming into a beacon clinic. It demonstrated resilience through care expansion and innovation, at the cost of operational burden. Funding: O'Brien Institute for Public Health and the MSI Foundation of Alberta.
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