Health

• If you are registered with UNHCR as living in a refugee camp in Rwanda, then to access primary health care you must first approach the primary health care clinic in the camp to access primary health care services free of charge.
• Health care expenses occurred by refugees at primary healthcare centres outside the camps or at any private facilities will not be covered by UNHCR or health partners, except in exceptional circumstances as determined by UNHCR.
• If you are a refugee registered with UNHCR as living in an urban area in Rwanda or a student attending boarding school (from a camp) in an urban area, then UNHCR will support you to enrol in community-based health insurance (CBHI). CBHI enrolment happens on an annual basis before July 1^st and from that specific date, subscriber can start accessing healthcare services in the public health facilities.
• If you are an urban refugee not enrolled in CBHI, UNHCR will be able to assist you in enrolling during the year. Please contact your nearest community center, protection hotlines or email us at [email protected] providing your name, UNHCR Number in your Proof of Registration, and your valid Refugee ID number. If you do not have a valid refugee ID please inform UNHCR.

• If you are a refugee registered with UNHCR as living in a refugee camp in Rwanda, to have the cost of your health care treatment at secondary and tertiary levels covered by UNHCR, you first need a referral from the primary health clinic in the refugee camp. If you do not have a referral, then you risk the fact that UNHCR will not be able to pay for your health treatment.
• UNHCR, in collaboration with the health partners Save the Children/AHA, follows defined procedures for approving health referrals to secondary and tertiary health care.
• The decision to refer or counter-refer a patient must be approved by a medical doctor or a partner healthcare provider, considering the patient’s medical condition and the best interest of the patient. The decision should not be influenced by the patient, family, or non-medical personnel, and any attempts to influence it should be reported to UNHCR at [email protected].
• Please note that referrals are granted to the nearest public hospital. Private health facility use is only granted by UNHCR in exceptional circumstances.
• If you have not heard back about your request for referral to secondary and tertiary health care, please approach the head doctor or nurse at the health clinic in the camp to ask for an update.

To note, if you are able to cover the cost of your own health care, then you may approach any public health

All refugees, asylum seekers and forcibly displaced populations registered with UNHCR in Rwanda including camp-based refugees, urban refugees, refugees in the Emergency Transit Centres in Gashora and Nkamira, and students in boarding schools are eligible for referrals to secondary and tertiary health care through UNHCR support.

UNHCR will consider the following priority groups to consider for referrals:

• Children below 18 years of age
• The elderly above 60 years of age
• Reproductive health/pregnancy related conditions
• Mental health and trauma cases
• Individuals with emergency/life-threatening conditions as advised by a qualified health personnel.

UNHCR will not consider the following groups for referrals:

• Rwandan nationals
• Dependents of the persons living in camps but not registered with UNHCR as refugees or asylum seekers
• Persons whose asylum claim has been rejected and has exhausted domestic remedies.

Conditions Eligible for Referral Care Support

Considering available financial resources, UNHCR will prioritize health referrals for the following conditions:

• Obstetrical emergencies
• Urgent potentially life-threatening conditions
• Urgent conditions that might lead to severe permanent disability.

Due to funding constraints, UNHCR will not be able to refer individuals with the following conditions from camps to secondary or tertiary level of care:

• End-stage renal failure
• Degenerative diseases of known or unknown causes but of unknown or doubtful cure
• Terminal diseases including terminal cancers
• Irreversible disabilities (hearing loss, incurable blindness)
• Chronic physical disability
• Conditions requiring aesthetic or cosmetic plastic surgery
• People with mental health conditions stabilized with drugs that are available at the camp level
• Chronic headaches without signs or symptoms of increased intracranial pressure
• Laboratory investigation that is available at the health center
• Superficial benign small masses without mass effect
• Ritual circumcision
• Chronic fractures with deformity without significant functional disability
• Provision of prostheses / artificial limbs
• Dental care except for dental abscesses and tooth extractions
• Investigation or treatment for infertility problems
• Investigation or treatment for sexual impotence
• Rheumatologic/musculoskeletal pain without affecting viscera or other concerning systemic signs/symptoms
• Mental and developmental retardation
• Other conditions where treatment is expensive, sophisticated or beyond what is normally available to nationals. Examples are brain surgery, kidney, liver, heart surgery or transplant.

UNHCR will support health referrals to district hospitals as the first step of referral for refugee patients, managing emergency conditions such as medical, surgical, pediatric and obstetric pathologies.

The referral process to secondary level health care will follow the following procedure:

• Completion of Referral Form: The Medical Doctor or referring health professional at camp-based primary health clinic fills out the referral form, indicating the referral hospital and reason for referral.
• Patient Information: Patients and/or caregivers are informed about the reason and destination of referral. In cases where a caretaker is needed and not available, assistance can be requested from UNHCR, Save the Children or other health partners.
• Accompanying Staff: At least one accompanying staff member from the health partner is designated based on the patient’s condition. Emergency referrals will be closely monitored by a qualified health personnel and a caretaker.
• Ambulance Equipping: If an ambulance is needed for your referral you will be provided with one.

While at the hospital

• Refugees will be appointed a social worker at the district hospital for follow-up and to ensure coordination and efficiency.
• The social worker will also organize transport for your return home and ensure you have the necessary documents.

If you do not have a referral, then UNHCR will not be able to pay for your health treatment at secondary or tertiary levels (hospitals) and you will be liable for the medical cost occurred.

Tertiary level health care in Rwanda comprises of the following public facilities: Centre Hospitalier-Universitaire Kigali (CHUK), Ndera Neuropsychiatric Hospital and the Rwanda Military Hospital in Kigali and the Centre Hospitalier Universitaire de Butare (CHUB) in the Southern Province.

The referral process to tertiary level health care will follow the following procedure:

• Referral to tertiary level health care is only possible if requested by the District Hospital (secondary level).
• Direct referrals to tertiary health care from camp-based health facilities is only permitted in exceptional cases and lifesaving emergencies.

Following the referral decision:

• The referring district hospital will notify the social worker and health programme manager, providing a referral form with necessary information.
• The tertiary facility’s social worker arranges the patient’s appointment, ensures accommodation and food, and communicates in writing to the referring Doctor at the primary/secondary level.

Special Considerations for Urban Refugees:

• Urban refugees in are not eligible for accommodation and food when referred to tertiary level in their cities of residence.

Approval Process for Special Referrals:

• Referrals to King Faisal Hospital for investigations (labs, CT scans, MRI) are limited to necessary medical conditions, prioritizing life-saving interventions and conditions with a potential good prognosis. Approvals from UNHCR are necessary for treatment at King Faisal Hospital.

If you do not have a referral, then UNHCR will not be able to pay for your health treatment at secondary or tertiary levels (hospitals) and you will be liable for the medical cost incurred.