title: Neuropsychiatric disorders among Syrian and Iraqi refugees in Jordan: a retrospective cohort study 2012-2013.
abstract: BACKGROUND
  The burden of neuropsychiatric disorders in refugees is likely high, but little has been reported on the neuropsychiatric disorders that affect Syrian and Iraqi refugees in a country of first asylum. This analysis aimed to study the cost and burden of neuropsychiatric disorders among refugees from Syria and Iraq requiring exceptional, United Nations-funded care in a country of first asylum.
  
  
  METHODS
  The United Nations High Commissioner for Refugees works with multi-disciplinary, in-country exceptional care committees to review refugees' applications for emergency or exceptional medical care. Neuropsychiatric diagnoses among refugee applicants were identified through a retrospective review of applications to the Jordanian Exceptional Care Committee (2012-2013). Diagnoses were made using International Classification of Disease-10(th) edition codes rendered by treating physicians.
  
  
  RESULTS
  Neuropsychiatric applications accounted for 11% (264/2526) of all Exceptional Care Committee applications, representing 223 refugees (40% female; median age 35 years; 57% Syrian, 36% Iraqi, 7% other countries of origin). Two-thirds of neuropsychiatric cases were for emergency care. The total amount requested for neuropsychiatric disorders was 925,674 USD. Syrian refugees were significantly more likely to request neurotrauma care than Iraqis (18/128 vs. 3/80, p = 0.03). The most expensive care per person was for brain tumor (7,905 USD), multiple sclerosis (7,502 USD), and nervous system trauma (6,466 USD), although stroke was the most frequent diagnosis. Schizophrenia was the most costly and frequent diagnosis among the psychiatric disorders (2,269 USD per person, 27,226 USD total).
  
  
  CONCLUSIONS
  Neuropsychiatric disorders, including those traditionally considered outside the purview of refugee health, are an important burden to health among Iraqi and Syrian refugees. Possible interventions could include stroke risk factor reduction and targeted medication donations for multiple sclerosis, epilepsy, and schizophrenia.
authors.affiliation: Department of Neurology, Massachusetts General Hospital, 165 Cambridge Street, #627, 02114 Boston, MA USA ; School of Medicine, Queen's University, Kingston, ON Canada.
authors.forename: Erica D
authors.initials: ED
authors.lastname: McKenzie
authors.affiliation: United Nations High Commissioner for Refugees, Geneva, Switzerland.
authors.forename: Paul
authors.initials: P
authors.lastname: Spiegel
authors.affiliation: United Nations High Commissioner for Refugees, Damascus, Syrian Arab Republic.
authors.forename: Adam
authors.initials: A
authors.lastname: Khalifa
authors.affiliation: Department of Neurology, Massachusetts General Hospital, 165 Cambridge Street, #627, 02114 Boston, MA USA ; Harvard Medical School, Boston, MA USA.
authors.forename: Farrah J
authors.initials: FJ
authors.lastname: Mateen
keywords: Health services; Humanitarian emergencies; Iraq; Psychiatry; Refugees; Syria