This is part of a paper in the AMerican Journal of Psychiatry. It is not research per se: it a useful list of needs that a group of Muslim and refugee friendly doctors have found they need within a very liberal part of the USA to accommodate refugees. I have put some estimated costs in. I am estimating the real charge out rate for lawyers at $400 an hour, GPs and specialist medical at $300 an hour, and nurses at $100 an hour.
As of November 2016, about 35 Syrian families had arrived safely in Portland. Unless new immigration policies prevent it, it is estimated that up to 500 families will make Portland their permanent home. This project is intended to ensure the smooth settlement and integration of these newcomers into the Muslim, Arab, and larger communities of the Portland area. Along with resettlement agencies, we are trying to verify that each refugee has the following needs met (1):
Legal needs: It is important for refugees to know their exact legal status and their rights and responsibilities and to comply with any legal requirements and restrictions of their status.
Immigration lawyer assessment 10 billable hours at half rate: 2000
Physical needs: It is vital for refugees to be followed by primary care physicians, dentists, pediatricians, and other medical personnel on a regular basis.
General Practitioner two visits: one assessment hour and follow for inoculations $450
Psychological needs: Given the prevalence of post traumatic stress disorder and other consequences of war, refugees need to be connected to affordable, accessible, and culturally sensitive mental health providers (psychiatrists, therapists, social workers, and case workers).
Base rate of PTSD estimated at 10% and needing 20 h CBT: average thus $200 per refugee
Financial needs: The success of settlement and integration efforts cannot be ensured unless the basic needs of the Syrian refugees are met, including a stable income.
Half population (ie 80% of adult population) on benefit @200 a week ie $5200 a refugee
Housing: Refugees need to have stable, safe housing guaranteed for an extended period of time until they master the English language, build their credit, and secure stable employment and can navigate permanent housing options.
accommodation supplement of $100 per week per family: assuming that there are four people per family $1300
Education: Regardless of their age, gender, and educational background, refugees need to have access to decent education to refine their skills and reach their full potential.
Impossible to calculate: no one has an absolute right to education
Vocational needs: Many refugees are currently capable of and interested in pursuing work and becoming empowered. It is important to ensure that there are no limitations that could preclude their chances of gaining employment.
In NZ experience with highly unemployable families, this is in the tens to hundreds of thousands of dollars per family(we do it because such families cost more in criminal behaviour). Not computable
Spiritual needs: Many Syrian refugees are welcome to be active members of the Muslim (or their chosen faith) community in Portland. Their connection with their religion and spirituality needs to be facilitated.
Cost of monitoring the mosques, again, not computale
Leisure: Syrian refugees need to exercise regularly and have hobbies that they enjoy, as that will help speed their physical and emotional recovery and well-being.
In integration expected, minimal cost. If require separate sessions 200 -1200 per year
Other logistics: Refugees need identification cards (driver’s license, Social Security card, work permit, travel document, Green Card, citizenship, etc.), translation and interpretation services, transportation, and connections with family and their culture of origin.In Covered in immigration lawyers fees
On January 27, an initial Executive Order was issued temporarily barring refugees and immigrants from seven countries entry into the United States. The Editors of the Journal felt it important for U.S. psychiatrists and U.S. psychiatry to remain in touch with colleagues from the affected countries.
On the back of an envelope, using NZ prices, and making some assumptions, the direct cost os around %630 for health, 2000 for legal fees and $6200 in welfare payments. Per refugee. Educational, recreational and other direct cost are harder to estimate. These expenses are significant to a moderately well off country such as NZ. I am uncertain if the Insurance markets in Oregon can sustain them.
But the signalling of virtue has clear costs. Be prepared to pay them, or look after refugees closer to home, where it is cheaper and reintegration into the home country is much easier.