is in its flagellate mode of movement. it is most commonly spread through contaminated water and food in developing countries. symptoms are rather mild, and include abdominal pain, flatulence, and loose stool. studies have found that giardiasis is common amongst refugee populations, specifically those coming from afghanistan. however, the parasite is not particularly adept at sustaining infection within children. leishmaniasis leishmaniasis is another parasitic infection with a high burden of disease amongst refugee populations. it is a vector-borne parasite, commonly spread by the bite of an infected sand flies. there are two common types of manifestation: cutaneous (skin lesions) and visceral leishmaniasis (infection of internal organs). in 2012, there was an outbreak of leishmaniasis amongst syrians. leishmaniasis is of major concern in the eastern mediterranean, which is home to the majority of the globe's prevalence (≈57%). leishmaniasis is most common in this region, as well as in afghanistan, iraq, and the syrian arab republic. thus, refugees coming from these regions, which is the majority of all refugees, are highly susceptible to becoming infected by this parasite. additionally, refugees from other countries are put at a high risk of contraction, as they often share temporary settlements with refugees from syria, afghanistan, and iraq. as a preventative measure, refugees are administered, when available, albendazole and ivermectin prior to their asylum seeking journey to other countries like the united states. upon arrival, refugees are typically screened for these infections in order to prevent spread and fatality. mental health as mental illnesses are not necessarily tangible or easily quantifiable, it is easy to disregard the real ramifications that poor mental health can have on a person. these repercussions can materialize in any aspect of a person's life, whether that be physical, social, financial, etc. further, the manifestations of poor mental health are deeply rooted when trauma is experienced at a young age. thus, populations vulnerable to traumatic experiences are at a concerningly high risk of mental illnesses and poor mental health. prior to world war ii, immigrants were mainly driven from their countries by forces such as unemployment, famine and poverty, often combined with various forms of prejudice and oppression whilst war and ethnopolitical conflict were less common causes for emigration. they have known social oppression, including inadequate education, lack of job opportunities, inability to practice their faith or marry whom they wished, and inability to live where they want. beginning with world war ii, however, civilians were increasingly targeted as a strategy of warfare, and since then most newcomers (especially refugees) have been victims of war and/or political repression. many of them have also experienced or witnessed government-sponsored torture and/or terror. that said, refugees are often survivors who possess amazing resiliency, strength and resourcefulness. an assessment of mental health may be included in a refugee's domestic health screening. refugee mental health and integration into a new society are exquisitely interwoven. traumatic experiences that occurred in the home country or during the resulting flight from that country are common. these experiences, in addition to the stresses of resettling in the host country, increase the chances of a less successful adjustment to the society of the host country. mental health problems are one of the key barriers to the labor market integration of refugees in host societies. the influence of these traumatic and stressful events may be temporary and manageable with straightforward solutions or may be disabling and enduring. high rates of mental health concerns have been documented in various refugee populations. most studies reveal high rates of post-traumatic stress disorder (ptsd), anxiety, depression, and somatization among newly arrived refugees. variations reported in the prevalence of ptsd and depression may be ascribed to a number of factors, including prior life in their homeland, the experience of flight from that homeland, life in refugee camps, and stressors during and after resettlement in a third country. more specifically, socioeconomic status, educational background, and gender all affect levels of mental illness. in 2015, a study focused on the impacts of traumatic events on displaced persons from syria, lebanon, turkey, and jordan. it revealed that 54% of the population studied suffered from a severe emotional disorder. of the children who participated in the study, 44% revealed depressive symptoms, and 45% showed signs of ptsd. compared to other children around the globe, these statistics show a 10-fold increase in mental health disorders. similarly to topics surrounding menstrual health, mental health is considered to be another taboo topic amongst certain cultures. this prevents people from seeking psychiatric help. currently, there is only one functioning mental health hospital in syria that tends to psychiatric needs. in 2016, a syrian-american doctor named m.k. hamza coined a new term to more accurately describe the effects felt by nearly all refugees affected by the ongoing crisis—human devastation syndrome. there is a severe lack of, and a dire need for, mental health attention and care. these traumatic events typically worsen and amplify progressively in the years following. it is critical that mental health issues be addressed in the screening process. leaving behind all that is familiar and starting a new life in a new country with a different language and culture in addition to previous trauma and dislocation produces an immediate challenge that can have long-term effects. this is true whether an individual is coming from europe, sub-saharan africa, central america, or elsewhere in the world. many refugees will not share a western perspective or vocabulary, so questions will need to be explained through specific examples or re-framed in culturally congruent terms with the assistance of an interpreter or bicultural worker. one option is to administer an efficient and valid screener for emotional distress, such as the refugee health screener - 15, in the context of the overall health screening. methods of treatment for refugees with mental health issues must also be culturally congruent. western psychiatric methods may not applicable to individuals who do not conceive of the body and mind in the same way as people in the united states. for example, studies of tibetan refugees have shown how important the tibetan religion of buddhism is in helping the refugees cope with their situation. the religion provides them with an explanation for their situation and hope for a better future. in some cases, indigenous methods of coping and psychological therapy can be integrated with western methods of therapy to provide a wide spectrum of mental help to refugees. a 2020 cochrane review focused on the mental health promotion, prevention and treatment of refugees, asylum seekers and internally displaced persons found gaps in the evidence for effectiveness of different interventions with a focus on post traumatic stress disorder and trauma related symptoms. additionally, refugee children face unique barriers to adequate psychological health support due to significant trauma during their vulnerable developmental years. women's health every woman from every country experiences her own menstrual process. however, some countries are more adept than others at providing proper resources and accessibility for women to easily maintain good hygiene. menstrual health requires constant and proper upkeep in order to avoid subsequent infections. menstruation requires attentive care and proper hygienic supplies. thus, it is no wonder that while in the high income countries, menstrual health is not a major public health concern, but in developing countries or in times of crises, menstruation can pose a distinct problem for women in vulnerable populations. proper menstrual care includes washing oneself with soap on a daily basis, and changing menstrual supplies (such as pads or tampons) multiple times per day. improper care can cause progressive infections, such as bacterial vaginosis (bv) or reproductive tract infection (rti). with limited access to clean, running water and hygienic supplies (soap, pads, tampons) within refugee camps, monthly periods create health problems for women and girls. as such, studies have been conducted in various refugee camps to assess the degree of burden that menstruation has on women. refugees staying in temporary settlements in myanmar reported poor latrine conditions, describing them as unsafe and dirty, with locks on the doors being a rare occurrence. additionally, many young girls reported dark, unlit paths at nighttime causing unwarranted assaults by intruders in the camps. thus, girls reportedly would not use the bathroom once it was dark outside, even if in need of a shower or a fresh pad. another obstacle that refugee women face in maintaining their menstrual health is limited to no access to an adequate amount of sanitary supplies. many refugees do not have the luxury of changing their pads every few hours per day, so a buildup of bacteria is common. other studies have revealed that when desperate, women will resort to using leaves or old pads to absorb the discharged blood, according to a report by sommer's team in the journal conflict and health. in addition to limited supplies and sanitary facilities, cultural attitudes towards menstruation create a difficult, taboo environment surrounding the topic. thus, women and girls may feel too uncomfortable to seek help or advice on tending to their personal needs. occupational health demand for labor is an important reason for migration. despite the difficulty in researching immigrant populations, there is evidence that occupational health is an area in which immigrants face disparities. many migrant or foreign-born workers fill low-wage, temporary or seasonal work in industries and jobs that may pose greater risks for worker health and safety such as agriculture, construction and services. in the united states, agriculture sector occupational risks such as asthma are more likely to affect immigrant workers. for refugee health in the united states, clinic structure and hours often overlap with working hours and require long waiting times that exceed what refugees can set aside, which can serve as a structural barrier to healthcare. overall, immigrants have higher rates of occupational morbidity and mortality than those who are native born, including higher rates of fatal and non-fatal injury. evidence from southern europe points to higher rates of occupational risks such as working many hours per day and extreme temperatures and greater exposure to poor employment conditions and job precariousness. health prevention and training programs related to occupational safety and health may not reach immigrants due to language, cultural and/or economic barriers. however, interventions tailored to their needs have been shown to be effective. developing partnerships with institutions in the immigrant communities is one way of improving access to information and resources to immigrant workers. improving work conditions can also improve other aspects of immigrant health however the work is often underutilized in efforts to promote migrant health. an emerging occupational health issue for immigrants relates to the health risks faced by people who are trafficked into situations of forced labor and debt bondage. interventions health literacy health literacy is a crucial component to preventative healthcare and improved public health. a cross-sectional study conducted amongst refugees in sweden, found that 60% of those assessed had inadequate functioning health literacy and 27% of them had inadequate comprehensive health literacy. the study concluded that health literacy should be taken into consideration when assessing refugee health and that more research is needed to assess the current dynamics and develop strategies to overcome the gaps in health literacy amongst refugees. through the provision of targeted, adequate health literacy tool kits, populations are more likely to adhere to treatment plans and prevention efforts—particularly in the realm of infectious disease. these health literacy tools must be relevant to the communities, administered in familiar language and vocabulary, and must truly take into account the competencies and limitations of the target audience. within health literacy initiatives, collaborative learning and social support could contribute to people's understanding and ability to judge, sift and use health information. consequently, adding these practices to the definition of critical health literacy could prove to be hugely beneficial to patient communities. civic orientation in some countries, e.g. eu and oecd countries, information about the host society is offered to refugee migrants in connection with applying for or obtaining a residence permit. civic orientation usually include information about the country's history, political system, laws, health, culture and everyday life. most countries combine the civic orientation with other introduction activities such as language courses. civics and language courses are commonly test based, meaning that a pass grade is required to obtain a residency or citizenship status. non-communicable diseases when addressing the needs of ncd patients within