Refugee and migrant health: the Australian general practice guide

Australia’s humanitarian intake brings people to general practice who have often experienced war, persecution, torture, prolonged displacement, and limited healthcare access. The refugee health assessment is one of the most rewarding — and most complex — encounters in general practice: it requires systematic infectious disease screening, mental health sensitivity, immunisation catch-up, and connection to a wide range of community services, often through a professional interpreter.

This article outlines the GP’s role in refugee and migrant health, the structured assessment framework, the most important conditions to screen for, and the services available to support patients after the initial encounter.

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A. Core clinical framework

Who is eligible for the refugee health assessment?

The MBS refugee health assessment items (701, 703, 705) are available to patients who arrived in Australia as:

• Refugees and humanitarian entrants under the Humanitarian Programme
• Holders of temporary protection visas (TPV) or safe haven enterprise visas (SHEV)
• Holders of certain bridging visas or protection visas pending determination

The assessment must be conducted within 12 months of arrival in Australia. Eligibility can be confirmed with the patient’s visa documentation or through the Department of Home Affairs. Many patients arriving through the humanitarian stream will also be eligible for the Medicare Safety Net and bulk-billed services through co-located refugee health clinics in major cities.

The RACGP Refugee Health guide provides the most comprehensive Australian resource for GPs undertaking these assessments.

The structured refugee health assessment

A systematic approach avoids gaps. The RACGP framework recommends the following components across one or more consultations:

1. Initial contact and relationship building

• Book a double or triple appointment with a professional interpreter pre-arranged.
• Never use family members — especially children — as interpreters for any healthcare consultation.
• Explain the purpose of the assessment before beginning; obtain consent.
• Use a trauma-informed approach: do not routinely take a detailed trauma history at first contact.

2. History

• Country of origin, date of arrival, journey and transit countries (affects infection exposure).
• Previous medical history, surgeries, chronic conditions.
• Medications and vaccination history (obtain documentation if available).
• Obstetric and gynaecological history in women.
• Dental history.
• Social circumstances: housing, family support, employment, school enrolment for children.
• Mental health history and current symptoms — gently, at the patient’s pace.

3. Physical examination

• Full physical examination including BP, weight, height, BMI, dentition (referral pathway).
• Skin examination for scabies, fungal infections, and signs of previous trauma.
• Lymphadenopathy (TB, HIV).
• Abdominal examination (splenomegaly in malaria or haematological conditions; hepatomegaly in chronic hepatitis B).

4. Investigations (see Section A: Infectious disease screening below)

5. Immunisations

• Review immunisation history; obtain official documentation if available.
• Australian childhood immunisation schedule catch-up for all children and adolescents.
• Adults: review and catch-up on hepatitis B vaccine (if seronegative), MMR, varicella (if no history), influenza, pneumococcal, and diphtheria-tetanus-pertussis (dTpa).
• BCG is NOT routinely given in Australia; its prior administration does not affect TB testing with IGRA.
• NCIRS provides specific catch-up schedules for humanitarian entrants.

6. Referrals and connections

• Dental referral (oral health is often severely neglected due to lack of access).
• Settlement services (Red Cross, AMES, local settlement providers).
• FASSTT network for torture and trauma counselling (see Section D).
• Allied health: dietitian, physiotherapist, social worker, as needed.
• Paediatrician for complex child health needs.
• Women’s health: contraception, cervical screening, LARC discussion where appropriate.

Infectious disease screening

The following tests form the core infectious disease panel for refugee health assessments, as recommended by eTG Complete and the RACGP:

Tuberculosis:

• IGRA (interferon-gamma release assay — QuantiFERON-TB Gold Plus or T-SPOT.TB) is preferred over the Mantoux tuberculin skin test in this population because BCG vaccination is common (false-positive Mantoux) and IGRA specificity is higher.
• A positive IGRA in an asymptomatic person with a normal chest X-ray = latent TB (LTBI).
• Latent TB affects approximately 40 per cent of humanitarian entrants from high-burden countries.
• Chest X-ray for all IGRA-positive patients and any with respiratory symptoms.
• Active TB is notifiable to the state health department.

Viral hepatitis:

• Hepatitis B surface antigen (HBsAg), core antibody (anti-HBc), and surface antibody (anti-HBs) — distinguish chronic infection from natural immunity from vaccine-induced immunity from no immunity (vaccinate if seronegative).
• Chronic hepatitis B prevalence 5–10% in newly arrived humanitarian entrants.
• Hepatitis C antibody (anti-HCV) with confirmatory HCV RNA if positive.

HIV:

• HIV combination antigen/antibody (4th generation assay) — screening for all patients.

Syphilis:

• Treponemal serology (TPPA) with RPR titres — high rates in some source countries.

Intestinal parasites:

• Strongyloides serology — Strongyloides stercoralis can persist for decades and reactivates with immunosuppression. Endemic in sub-Saharan Africa, Southeast Asia, and parts of the Pacific.
• Stool microscopy and culture (×3 samples on separate days) for ova, cysts, and parasites in those from endemic regions — hookworm, Giardia, Trichuris, Ascaris.
• Blood film for malaria in those with fever or recent arrival (<3 months) from endemic regions; PCR if clinical suspicion.

Other:

• FBC and film — anaemia (iron deficiency, haemoglobinopathy, malaria), eosinophilia (parasitic infection).
• Vitamin D (25-hydroxyvitamin D) — deficiency affects ~80% of newly arrived refugees, particularly women who wear covering garments, those from sub-Saharan Africa with vitamin D-poor diets, and those from regions with limited sun exposure during displacement.
• Iron studies and ferritin — iron deficiency anaemia is common.
• Haemoglobin electrophoresis — sickle cell disease and thalassaemia in those from endemic regions (sub-Saharan Africa, Mediterranean, Southeast Asia, Middle East).
• Blood glucose (fasting or HbA1c) — diabetes screening.
• TSH — thyroid disease, particularly in those from areas with iodine deficiency.
• Lipid profile in adults ≥ 45 years or those with cardiovascular risk factors.
• Cervical screening (women ≥25 years who are overdue).

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B. Evidence review

The epidemiological evidence for infectious disease burden in humanitarian entrants to Australia is well established. Murray KE et al. (Aust J Gen Pract 2019) summarised the mental health burden: approximately 30 per cent of adult humanitarian entrants have PTSD, with rates higher in those from conflict-affected countries and those who experienced prolonged detention.

For latent TB treatment, eTG Complete and NICE NG33 both support treatment of LTBI in positive IGRA patients under 65 years without contraindications. The standard Australian options:

• Isoniazid 300 mg daily for 6–9 months — most evidence; requires pyridoxine co-prescription (25 mg daily) to prevent peripheral neuropathy; LFTs at baseline, 2 months.
• Isoniazid 300 mg + rifampicin 600 mg daily for 3–4 months — shorter course, better completion rates.
• 3HP (isoniazid + rifapentine weekly for 12 weeks) — excellent completion; often given as directly observed therapy (DOT) through state TB services.

Treatment is co-managed with state TB services in all states and territories.

For chronic hepatitis B, RACGP guidelines recommend: baseline LFTs, HBeAg/anti-HBe, HBV DNA, and liver ultrasound; six-monthly AFP and ultrasound for hepatocellular carcinoma surveillance; referral to hepatology or gastroenterology for those with high HBV DNA, abnormal LFTs, or family history of liver cancer; antiviral therapy (entecavir, tenofovir) for those meeting treatment criteria.

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C. Mental health — trauma-informed approach

The trauma-informed GP consultation

Many humanitarian entrants have experienced torture, sexual violence, witnessing deaths, imprisonment, and prolonged uncertainty. A trauma-informed approach means:

• Do not take a detailed trauma history in the first consultation. Trust is built over time. The assessment of current mental health symptoms and safety is appropriate early; probing into trauma details is not.
• Normalise mental health presentations. Many patients — especially those from cultures where mental illness carries significant stigma — will present somatically: headaches, body pain, insomnia, fatigue.
• Ask about current functioning and safety, not about past events: “Are you having trouble sleeping? Are there thoughts that disturb you? Are you safe where you are living?”
• Use validated screening tools with interpreter support: the Harvard Trauma Questionnaire (HTQ) and the Hopkins Symptom Checklist (HSCL-25) are available in many languages and validated in refugee populations.

PTSD management in general practice

PTSD management involves GP support, specialist counselling, and — where indicated — pharmacotherapy:

• Psychological treatment is first-line for PTSD: trauma-focused cognitive behavioural therapy (TF-CBT) or eye movement desensitisation and reprocessing (EMDR). Refer to the FASSTT network (see Section D).
• Pharmacotherapy for PTSD: sertraline and paroxetine have the strongest evidence; venlafaxine is also used. Start low, go slow in this population. Obtain informed consent including discussion of initial side effects.
• Sleep disturbance is a core PTSD feature; prazosin has evidence for nightmares; melatonin for sleep onset.
• Avoid benzodiazepines for PTSD — they are not effective for PTSD and carry significant dependence and disinhibition risk.

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D. Australian general practice operations

MBS items

The refugee health assessment items are among the most important GP items for this population:

• Item 701 — Health assessment for people who are refugees or humanitarian entrants, ≥45 minutes GP time. Higher rebate than item 23/36/44.
• Item 703 — ≥60 minutes.
• Item 705 — ≥90 minutes.
• These items can be claimed up to 12 months after arrival.
• Item 715 — ATSI Health Assessment for Aboriginal and Torres Strait Islander patients who are also humanitarian entrants (rare; check eligibility).
• Items 2715 / 2717 — Mental Health Treatment Plan for PTSD, depression, anxiety.
• Items 10950–10970 — Allied health referrals under a Chronic Disease Management (CDM) plan: dietitian, physiotherapist, psychologist, social worker.
• Item 36, 44, 23 — ongoing GP management after initial health assessment.

PBS prescribing

• Isoniazid, rifampicin, pyrazinamide, ethambutol — General Schedule for TB treatment; co-managed with state TB services.
• Vitamin D (calecalciferol/colecalciferol) — available OTC; high-dose loading may be prescribed for documented severe deficiency.
• Sertraline, paroxetine, venlafaxine — PBS-listed for depression and PTSD.
• Entecavir, tenofovir — PBS Authority Required for chronic hepatitis B meeting treatment criteria.
• Ivermectin — PBS-listed for confirmed Strongyloides (General Schedule after Restricted item removal); consult current PBS schedule.
• Mebendazole, albendazole — for intestinal helminths; check current PBS listing.
• Iron preparations — ferrous sulfate or ferrous fumarate on General Schedule.
• Vitamin B12 — General Schedule.

Interpreter services

TIS National (131 450) provides free telephone interpreter access to GPs on Medicare. The service is free for the GP to call for any patient consultation, including home visits and after-hours calls. In-person interpreters can be booked in advance for planned consultations (longer booking window). Video interpreting is also available in some metropolitan areas.

Never use a family member, friend, or child as an interpreter for healthcare consultations. This is ethically problematic and clinically unsafe. Children used as interpreters for parents can be significantly harmed by exposure to adult medical and psychological content.

The FASSTT network

The Foundation for Australian Survivors of Torture and Trauma (FASSTT) network provides specialist torture and trauma counselling services to humanitarian entrants in each state and territory. GPs can refer directly. The services are free to eligible humanitarian entrants:

State/Territory	Service	Phone
Victoria	Foundation House	(03) 9388 0022
New South Wales	STARTTS	(02) 9794 1900
Queensland	QPASTT	(07) 3316 2999
Western Australia	TVPS (Trauma/Violence Prevention Service, Relationships Australia)	(08) 9489 6400
South Australia	STTARS	(08) 8346 5433
Australian Capital Territory	Companion House	(02) 6251 4550
Tasmania	Phoenix Centre	(03) 6231 5765

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E. Special populations

Children and young people

Refugee children may have missed early childhood vaccination and developmental surveillance. Child development assessment, hearing and vision screening, dental review, and school enrolment support are all components of the paediatric refugee health assessment. Children should be enrolled in the Australian National Immunisation Program catch-up schedule. School social workers and settlement services can support transition to schooling.

Women and girls

Female humanitarian entrants have particular health needs including: female genital mutilation/cutting (FGM/C) — assessment requires a culturally safe approach, sensitivity, and knowledge of the mandatory reporting obligations that vary by state; obstetric history and access to contraception and cervical screening; and higher rates of domestic violence and sexual assault in the context of displacement and resettlement stress. Warm referral to specialist women’s health services or a GP with experience in FGM/C is appropriate.

Older adults

Older refugees may have undiagnosed hypertension, diabetes, cardiovascular disease, and musculoskeletal problems accrued over years of displacement. Cognitive assessment may be complicated by limited literacy and language barriers — validated culturally adapted tools are needed. Social isolation is a significant risk factor for mental health deterioration in older refugee adults.

People in immigration detention

Asylum seekers in immigration detention have poor health access and high rates of mental health deterioration, self-harm, and suicide. GPs working in detention settings face specific ethical obligations under AHPRA guidance and human rights frameworks; the RACGP has published position statements on this.

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When to escalate

Seek urgent review or emergency care for:

• Active TB symptoms (cough ≥3 weeks, haemoptysis, night sweats, weight loss, fever) with a positive IGRA — urgent chest X-ray and state TB service notification.
• HIV with constitutional symptoms or CD4 <200 cells/µL — urgent infectious disease or sexual health referral.
• Suspected chronic hepatitis B with hepatocellular carcinoma features (weight loss, RUQ pain, hepatomegaly) — urgent hepatology referral and AFP + ultrasound.
• Severe PTSD with active suicidal ideation or self-harm — mental health emergency; involve the FASSTT network, GP mental health resources, and if urgent safety risk, 000 or emergency psychiatric services.
• Child safeguarding concerns — mandatory reporting obligations apply regardless of cultural context; follow state-specific mandatory reporting procedures.
• Malaria with fever in a recently arrived patient — blood film or PCR urgently; malaria is treatable but deteriorates rapidly if missed.

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What this article is and is not

This article provides general education about refugee and migrant health in Australian general practice, based on RACGP guidelines and current evidence. It is not a substitute for clinical assessment or for culturally safe, patient-centred care delivered with a professional interpreter.

The health needs of humanitarian entrants are complex and individual. This article describes common patterns but every patient’s history, background, and circumstances are unique. If you are a patient reading this with questions about your own health, please speak with your GP.

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Sources cited

• RACGP — Refugee health — a guide to general practice care
• eTG complete — Tuberculosis: latent TB infection
• Australian Government — Settlement services and humanitarian programme
• Foundation House (Victorian Foundation for Survivors of Torture)
• STARTTS — NSW Service for the Treatment and Rehabilitation of Torture and Trauma Survivors
• TIS National — Translating and Interpreting Service
• NCIRS — Immunisation handbook for refugee and humanitarian entrants
• NICE — Tuberculosis: NICE guideline NG33
• WHO — Refugee and migrant health
• Murray KE et al. — Mental health of refugee patients in Australian general practice (Aust J Gen Pract 2019)
• HealthDirect Australia — Refugee health