A Community Organizational Approach to Improving the Social Determinants of Refugee Health During the COVID-19 Pandemic and Beyond

Resettled refugees experience adverse social determinants of health (SDH). Deemed a hard-to-reach population by public health scholarship and practice, resettled refugees often fall through the cracks of the U.S. healthcare system. The pandemic compounds the healthcare gaps and the overall challenges faced by resettled refugees. This study documents how refugee-led and managed community organizations, Refugee Community Organizations (RCOs), played a critical role in bridging the gaps and alleviating the burden on their communities at the height of the pandemic in 2020. The results of a daily survey of activities logged in by 16 RCO leaders for five months, and 39 interviews with leaders of three RCOs, inform our findings. Refugee populations seek RCO support for diverse SDH concerns, reinforcing the importance of tailored health approaches and the role that RCOs can play as community health workers. RCOs provided services that supported diverse aspects of SDH for their communities in addition to providing health education, systems navigation, hands-on assistance, and advocacy for their communities. They also educated healthcare systems to meet refugee needs while battling institutional racism and resource constraints. This study demonstrates the broader need for public agencies to establish protocols for refugee community involvement before public emergencies.