Ukraine Update for Health Providers
How to access free health care in Queensland – how service providers can ensure community can receive free healthcare from Queensland Hospital and Health Services.
Watch video here from WHO –
Almost 6 million people have been forced to flee Ukraine following invasion by Russia, making this the fastest growing refugee crisis since World War II (UNHCR).
It is reported that approximately 4000 Visas have been granted for travel to Australia and families have already arrived in Australia, including arrivals into Queensland.
- Population – Ukraine has a population of around 44 million people.
- Ethnic groups – Ukrainian, Russian, other.
- Languages – the official language is Ukrainian, which is first language for two thirds of the population, the remaining third have Russian as first language.
- Religion – the main religion is Orthodox Christian, also with Catholic, Protestant, Muslim and Jewish populations.
The following will provide helpful information for clinicians regarding health considerations, Medicare access, COVID vaccination, and catch-up immunisations.
Visa Type, Medicare and Access to Qld Health Services and TIS National Interpreting:
Currently the VISA situation for people arriving from Ukraine is complex and has implications on Medicare access.
Those who arrived prior to July 31, 2022 were able to apply for a Temporary Humanitarian Visas (Visa 786). This Visa is a 3 year Visa made available for Ukrainian arrivals, which provides access to Medicare, work and study for up to 3 years and settlement service provision under Australia’s Humanitarian Settlement Program. In Qld, settlement assistance is provided by Multicultural Australia.
Ukrainians now entering Australia (since July 31st) can apply for either:
> Bridging E visa (subclass 050) : short term, full work rights, free TIS National, partial financial support if not working. No Medicare Access (this may change).
> Protection Visa (sublcass 866) : permanent for indefinite stay, full work rights, schooling, TIS National and Medicare access.
As above, Medicare access may be delayed or not granted therefore, the Qld Government have extended their Asylum Seeker Directive to include Ukrainian arrivals having full access to public health care in Qld Health Hospitals and QH facilities (including Sexual Health Services) without incurring fees. For some Ukrainians, access to General Practice and medications may rely on GPs providing Pro Bono consultations or funding sourced through other sources eg. family, friends, Ukrainian Community of Qld, Multicultural Australia. Local PHNs/ Refugee Health Services and RHNQ can provide GPs with further information and support in providing care.
Further information about the Qld Health Directive can be accessed at Public healthcare access Ukrainians in Qld without Medicare .
ALL Ukrainian arrivals have access to free interpreting services through TIS NATIONAL regardless of Medicare status – Read about it here.
Two dose vaccination coverage in Ukraine – approximately 35% so COVID catch up vaccination may be required.
Multiple vaccine types are in use in Ukraine: Moderna, AZ, Johnson and Johnson, Sputnik V and Sinopharm. All of these are TGA recognised vaccines and can be recorded in AIR (possible even prior to Medicare number using name, DOB – IHI number not required) and vaccine certificates arranged.
For catch up COVID vaccination when first dose/s were given overseas ATAGI has approved a mixed dose schedule of Therapeutic Goods Administration (TGA)-approved or TGA-recognised vaccines (ATAGI mixed dose schedule) The recommended interval between first and second doses of a mixed schedule is 4 to 12 weeks after the first dose, regardless of first dose brand. An interval longer than 12 weeks is acceptable if the second dose cannot be administered during this time window.
Health Assessment and considerations based on prevalence data for Ukraine:
A Comprehensive Refugee Health Assessment should be offered to every child, adolescent and adult from a refugee background who is new to your care, ideally within one month of arrival and with engagement of a qualified interpreter. However, with limitations in Medicare access it is prudent to focus on acute health care needs first and defer the full RHA to a later date once Medicare is available. (The MBS CHA item numbers are claimable once within the first 12 months of arrival).
Include: migration history; a full medical history, including current concerns, developmental history in children and adolescents and psychosocial history; physical examination; investigations and development of a management plan with a copy of the assessment given to the patient.
Important health considerations for people arriving from Ukraine:
- A Polio outbreak was identified in Ukraine in October 2021 (Rivne Province). Polio vaccination and catch-up immunisation is a priority for all ages arriving from Ukraine. Infants and children require 4 doses of polio vaccine, given at appropriate intervals to be considered as having completed a primary immunisation course.
All adolescents and adults who have not received primary vaccination are recommended to receive 3 doses polio vaccine for primary vaccination. Arriving adults who have had full primary vaccination but who have not had a booster within the last 10 years are recommended to receive a booster dose given potential recent Polio exposure. (https://immunisationhandbook.health.gov.au/vaccine-preventable-diseases/poliomyelitis)
- Tuberculosis– 10-fold higher incidence of TB compared to Australia (73/100,000 vs 7.3/100,000) with higher prevalence of Multi Drug Resistant MDRTB (13.3% of cases) and Extensive Drug Resistant TB XDRTB (3.7% of cases) – TB screening is a priority. TB screening can be arranged through your local TB Service, including for patients without Medicare. If a local TB service is not easily available, IGRA may be arranged through a local pathology provider but this will not be covered by Medicare unless patient is a direct contact of a confirmed case of TB. (Some patients may choose to pay for IGRA). Whilst live vaccines can interfere with Mantoux testing, this is not the case for IGRA. When making a referral please record the date of any live vaccines given (eg Varicella, MMR). Anyone with possible TB symptoms will need urgent discussion with and referral to a TB service. Classic clinical symptoms of active pulmonary TB include chronic cough and haemoptysis. However, active TB may present with non-specific symptoms, including fever, malaise and weight loss or failure to thrive/poor growth in children, night sweats and lymphadenopathy. For further information: Tuberculosis Referral Information – RHNQ
- Hepatitis C– moderate to high prevalence – 3.6% HCV-Ab positive, and 7% HCV RNA positive (Australia 1.7%, 1.5%) – include HCV screening for children and adults
- Hepatitis B– lower prevalence compared to Australia – 1.3% HBsAg positive (Australia modelled – 2.14%) – part of normal refugee pathology screening
- HIV– higher prevalence compared to Australia in adults (predominantly in people with history of injecting drug use)- 1.0% in age 15-49 years, very low in children (comparison – Australia – 0.1% in adults 15-49 years). Excellent access to treatment and high rates of viral suppression noted. HIV screening in age 15 years and older is part of normal refugee screening
Recommended Screening tests (in line with ASID Guidelines: Comprehensive Post Arrival Refugee Health Assessment):
All: FBE/film, ferritin, UE LFT,IGRA or TST (Mantoux), HBsAg, cAb, sAb, HCV
Age/risk based: HIV (15y+/risk/unaccompanied minor), STI screening, syphilis (risk/unaccompanied minor), varicella 14y+ if no Hx of infection, consider faecal OCP and H Pylori (if symptoms)
All: FBE/film, UELFT,IGRA or TST (Mantoux), HBsAg, cAb, sAb, HCV, HIV
Age/risk based: ferritin, B12, folate, rubella (women) , varicella (if no Hx), STI screening, syphilis, H pylori (Sx), Bhcg, TFTs if goitre.
Catch-up primary care: HPV screen (women 25-74y), Alb:creat/eGFR (30y+ if high risk), BSL/HbA1C (40y+), lipids (45y+), FOBT (50y+), Mammogram (women 50-74y)
Many of the arrivals have experienced significant trauma and remain distressed regarding loved ones remaining in Ukraine and other countries. To access further mental health support including The Qld Program of Assistance to survivors of torture and trauma refer to: RHNQ Mental Health Support Services
For guidance on Interpreter engagement for medical assessments please refer to: RHNQ Interpreter resources.
ALL Ukrainian arrivals have full free access to interpreting services provided by TIS National (regardless of Medicare status).
Catch up Immunisation:
- Missing compared to Australian schedule: rotavirus (usually not relevant for catch-up because of age restrictions), pneumococcal, meningococcal ACWY, varicella, zoster, and HPV.
- Where written records are not available, full catch-up vaccination is recommended – see Catch Up Immunisation guidelines.
- Clinical Leads in Refugee Health are available for telephone advice / discussion by phoning: 3864 7580
- Contact the Ukrainian Community of Queensland E: firstname.lastname@example.org
- The information sheet for service providers provides guidance on how service providers can confirm the status of asylum seekers living in the community, so they can receive free healthcare from Queensland Hospital and Health Services.
- More information for GPs