Resettlement and Medical Problems of Indochinese Refugees in the United States

GAO has identified several problems occurring in the placement of Indochinese refugees in the United States and feels that much needs to be done both to deal effectively with the social and medical problems of these refugees and to improve the medical examination and treatment of those expected to arrive in coming years. Placement decisions involving Indochinese refugees have depended heavily on the location of family members and friends already living in the United States. This has resulted in the concentrated placement of most refugees in a few areas. Further action is needed if the impact on these areas is to be contained, including limiting the reunification of refugees with distant relatives and friends and the identification of new resettlement areas. From 52 to 87 percent of the refugees studied by GAO received cash assistance, and 65 percent were still receiving public assistance 4 to 6 months after arriving in the United States. Some of the refugee sponsors were also receiving public assistance. Employment assistance has not been a high priority, and the GAO sample showed that most refugees had received little guidance in this area. Although three Federal offices have key roles in domestic refugee resettlement, none has clear responsibility and authority for the program. These roles should be addressed in the reauthorization of the Refugee Act with total responsibility for the program of initial resettlement being given to the Department of Health and Human Services. The United States has relaxed its usual medical admission requirements to expedite Indochinese refugee admissions. Under this procedure, refugees with certain health problems who would normally have been excluded were granted medical waivers to enter the United States. The refugees have a far greater incidence of serious and contagious diseases than the overall U.S. population, and several barriers hinder health departments' efforts to provide effective, inexpensive follow-on care. To alleviate this problem, the overseas medical examinations of refugees should be improved and the routine practice of granting medical waivers for excludable conditions should be discontinued. Unless the overseas medical examinations are improved, the notification to State health officials of refugee arrivals should not be stopped.