This guideline is intended to provide a summary of background and health issues for new arrival Afghan refugees. The guideline was developed at the time of the humanitarian uplift in August 2021, during Covid lockdowns in Victoria. 

Useful Afghan calendar converter and UNHCR situation report.

Background

In late August 2021, the Taliban returned to power in Afghanistan (summary). More than 120,000 people were evacuated over 10 days to 31 Aug 2021, by many different nations (media). Evacuees included foreign nationals and around 65,000 Afghans. Australia evacuated 4100 people ( PM press conference and media), with 3500 travelling on to Australia, including 2500 women and children. 

UNHCR reported more than 1.6M people left Afghanistan for neighbouring countries after August 2021. In Jun 2025, there were 4.3M registered Afghan refugees in neighbouring countries (Iran, Pakistan, Tajikistan, Uzbekistan, Turkmenistan). As of Dec 2025, UNHCR estimates there are 4.4M Afghans in Iran, and 2.0M in Pakistan, an estimated 2.0M of these cohorts do not have documentation.

• Both Pakistan (Oct 2023) and Iran (Sep 2024) announced plans to return/deport millions of Afghan refugees. More than 792K people returned to Afghanistan from Pakistan between Sep 2023 and Dec 2024 (UNHCR portal information). In 2025, more than 3.0M Afghans returned, including 1.5M deportations (see returns portal, Pakistan: DHA information,media summary; Iran: UN press release,Migration Policy Institute summary)
• These situations have implications for Afghan Australian families, and for their extended family visa applicants/holders residing in Pakistan and Iran without valid residency status - who are subject to exit permission requirements and costs, and risk deportation. The Australian government is working to expedite visa processing (see updates). Legal support is available through Refugee Legal.
  

Demography

• Population - Afghanistan has a population of around 44.6M people. After 40 years of conflict, Afghans make up one of the largest refugee populations globally, and the Uppsala Conflict Data Project reports more than 317,700 conflict related deaths since 1989. The country continues in a state of humanitarian emergency, with more than 90% of the population living in poverty, severe food shortages, and 38% acute food insecurity. Afghanistan is the lowest ranking country globally for the status of women (181/181).
• Ethnic groups - the main ethnic groups are Pashtun, Tajik, Uzbek and Hazara, other groups include Nuristani, Aimak, Turkmen and Baloch.
• Languages - official languages are Pashto and Dari, although there are more than 30 languages spoken and multilingualism is common.
• Religion - majority Sunni Islam (including Pashtun and Tajik populations), followed by Shi'a Islam (including Hazara populations).
• Naming conventions - Afghan names typically consist of a first/personal name alone, which may be a compounded name. Female names are usually a single name. Surnames/family names are not customary, but are more common in educated/wealthier groups. When used, surnames often represent tribal/ethnic affiliation or area of origin, and children will take the surname of their fathers. Women do not traditionally adopt their husbands surnames when they marry. 
  

Australian response

Australia allocated 3000 places from the existing humanitarian intake for the initial uplift; many agencies urged an additional intake of Afghan refugees - see Refugee Council of Australia. Australia (then Min. Alex Hawke) announced an Advisory Panel on Australia's Resettlement of Afghan Nationals in August 2021, and then $27.1M in funding for an Afghan Settlement Support package in October 2021. In January 2022, Min Hawke announced a further allocation of 15,000 places within the existing humanitarian (10,000 places) and family visa programs (5000 places) over the next 4 years, and on 29 Mar 2022, the federal budget allocated an additional humanitarian intake (above the existing humanitarian intake) of 16,500 Afghan refugees over 4 years (funding of $666M).

By end 2022, 31,500 places for Afghan nationals had been allocated over 4 years - 26,500 places under the humanitarian program (10,000+16,500) and at least 5000 places under the family migration stream.

Entry visas

• In the initial uplift, some new arrivals had Australian citizenship/permanent residency, others travelled under Australian refugee visas, and many arrived on Temporary Humanitarian Stay (449) visas - related to the speed of the uplift/evacuation.
  • The 449 visa did not carry Medicare initially, arrangements were made facilitating Medicare access for 449 visas by Sep 2021. 
    • The 449 is a temporary visa. Initial duration was 3m, with an assumption of renewal (to 12m) and transition to permanency. The 449 is not eligible for the MBS refugee health assessment item (707); or NDIS (it is a temporary visa). Temporary visas do not carry rights to family sponsorship. 
• Within the cohort, there were a small number of unaccompanied humanitarian minors (UHM) - see media. All UHM are eligible for the UHM Program.
  
• Current and future entrants will arrive on offshore refugee visas (with permanent residency).

Health screening

Unlike other humanitarian arrivals, very few Afghan refugees in the uplift had an offshore Immigration Medical Examination (IME). IME are recorded on the offshore Health Assessment Portal (HAP) system. It is plausible the same situation may occur for Afghan arrivals from Pakistan. Check HAP for all offshore refugee visas and humanitarian arrivals - the HSP provider can access the HAP number (but not the HAP system) - contact hspintake@ames.net.au. BUPA completed IME for new Afghan arrivals in late 2021 and early 2022 (details included for historical reference below). The IME was required for transition onto substantive visas, but is different to the recommended post-arrival refugee health assessment.

Recommended health assessment Afghan arrivals

All new arrivals should have an initial health assessment after arrival. In 2021, assessments were affected by the pandemic and delays in Medicare, it is worth confirming Afghan arrivals have completed a refugee health assessment, even if they arrived some time ago.

Screening tests children

• All: FBE/film, ferritin, active B12, folate, vit D/ALP, IGRA or TST, HBsAg, cAb, sAb, Strongyloides, malaria, faecal COP 
• Age/risk based: HCV, HIV (15y+/clinical/UHM), STI screening, syphilis (clinical/UHM), consider MMR and varicella serology adolescents, H pylori (symptoms)

Screening tests adults

• All: FBE/film, active B12, folate, IGRA, HBsAg, cAb, sAb, HIV, Strongyloides, malaria, consider MMR and varicella serology, faecal COP
• Age/risk based: ferritin (women, men with RF), vit D, rubella (women), HCV, STI screening, syphilis, H pylori (Sx)
  
• Catch-up primary care: 
  • CVD risk - 45-79 years, each 5 years, BP 18y+ opportunistically each 2 years; lipids - 45 years+, frequency varies with risk, 
  • Diabetes – general risk: >40y using AUSDRISK, each 3 years; high risk: BSL or HbA1C, each 3 years, more often (+extra tests) if abnormal results; 
  • Kidney disease - based on risk, Albumin:creatinine & eGFR, each 1-2 years (CKD handbook)
  • Bowel cancer - FOBT 45-74 years, each 2 years, extra screening high risk
  • Breast cancer - Mammogram women 50-74y, each 2 years; ≥40y if moderately increased risk
  • Cervical cancer - HPV test women 25-74y, each 5 years (clinician or self-collected)
    

Note screening for Schistosoma and HCV* is not routinely required for people from Afghanistan (*screen for HCV if risk factors identified). We suggest routine screening for malaria and for B12 deficiency in people from Afghanistan. 

Special note: B12 screening and preventive treatment in Afghan cohorts

We have seen widespread B12 deficiency (and also folate deficiency) in children and adolescents from Afghanistan (44.7%), despite reported regular meat/milk intake.

• Suggest FBE, ferritin, B12 and folate screening for all new arrivals from Afghanistan. 
• In infants, and anyone with poor nutrition, disability or neurological symptoms (all ages) - prioritise early screening, and also check serum homocysteine, and urine methylmalonic acid (Note - these tests may not be possible, and also may be billed outside the hospital setting).
• Where screening will be delayed, commence 3m oral B12 supplements (100 mcg oral daily, all ages), OR use 1000 mcg oral melts daily for 7 days, OR give 1000 mcg IMI if possible.
  • When screening is later completed: if B12 levels are replete - stop supplements and repeat levels in 3-6 months, if levels remain low, complete serum homocysteine & urine methylmalonic acid, and seek specialist advice. Consider investigation/treatment for Helicobacter pylori.
• Provide appropriate dietary advice.
• In breastfeeding infants with low B12 - seek specialist advice, and ensure their mothers also have screening for B12 and treatment if deficiency identified. 

Catch-up immunisation

Catch-up immunisation is required for all new arrivals, including full catch-up for anyone without a written vaccination record.

• The Afghan immunisation schedule includes: BCG, rotavirus, DTwP-Hib-HBV, Td, IPV/OPV, measles, conjugate pneumococcal (i.e. no mumps, rubella, meningococcal ACWY, varicella/zoster, HPV or influenza).
• Note - RCH/MVEC protocols for catch-up vaccination after chemotherapy use infanrix-hexa and MMR-V up to age 18y, this reduces needles required, and we use this in practice. AIR will accept these vaccines for adolescents, **AIR data entry - use other, and enter by antigen, and then accept queries. 
• Many families have excellent quality overseas vaccination records, which can be entered on AIR - you will need an Afghan calendar converter (!).
  

Other considerations

• Consider vaccine preventable diseases such as hepatitis A and measles where people have arrived from crowded displacement settings.
  
• Emergency department presentations - multiple new arrival Afghan children required ED care. In this situation, note:
  • Individuals may not yet have Medicare, ensure local billing processes record them as refugees/asylum seekers rather than international arrivals.
  • Individuals may not yet have any phone or address details or may be in the process of moving accommodation.
  • Liaise early with the HSP provider (Victoria = AMES, and at RCH, contact Immigrant health if needed).
• Disability and equipment needs -  multiple individuals within the cohort had disability/equipment needs, equipment access was/is difficult.
• Medications - individuals who have had an offshore IME should arrive with 1 month supply of medications.
• Mental health - individuals may have been separated from immediate family, and there has been wide ranging impact on other Afghan-background populations in Australia. Distress may be amplified by separation and the current situations in Afghanistan, Pakistan and Iran. Refer for mental health support or trauma counselling if required e.g. Foundation House.

Historical reference

Covid, hotel quarantine, and covid vaccination at the time of the uplift

Due to the Covid pandemic, new arrivals from the uplift were subject to hotel quarantine (HQ) after arrival in WA, SA, Vic, NSW, Qld and NT. HQ arrangements (and healthcare available in HQ) varied across the jurisdictions. In Melbourne, the process of commencing case work support, Centrelink/Medicare access, and finding accomodation was complicated because of HQ and lockdowns, and most arrivals spent some time in short term accomodation close to the CBD. Many interstate Afghan arrivals subsequently moved to Victoria, often to City of Greater Dandenong.

BUPA IME assessment (2021-22)

• BUPA completed IME for new Afghan arrivals in 2021-22. BUPA declined to accept local pathology results, resulting in duplication of testing. The BUPA contact email is BupaMedicalOfficerOnshore@bupamvs.com.au. 
• BUPA test protocols for Afghans were: (as of 30/9/21 and confirmed 24/11/21) by age:
  • <2 years - medical exam (no blood tests)
  • 2-10 years - medical exam, IGRA or TST
  • 11-15 years - medical exam (no blood tests), CXR
  • 15 years and older - medical exam, HIV, HBsAg, HCV, HIV, syphilis screening, CXR
  • UHM - HIV, HBsAg (all ages), + age based as above. UHM status was missed in a number of cases resulting in repeat assessment.
• Key points
  • Positive TB screening or blood-borne virus tests were disclosed to the client (who was called back for an appointment) and referred to local TB services/health service.
  • Clients got a 'duty of care' letter with limited clinical information and the HSP was notified. There was inadequate information in the 'duty of care letter' for the HSP provider to communicate concerns to the client's GP. 
  • There was no medical referral process or handover for any other findings on the IME (raised with DHA).  There were multiple clinical risk situations (where individuals were not referred for care).
    
  • Clients did not get a copy of their test results unless they requested them (BUPA request form (in English) & emailing the local pathology provider (Victoria = Dorevitch - RequestforMedicalRecords@Dorevitch.com.au).
  • Screening results were uploaded onto the HAP system - although there were delays, and HAP numbers were difficult to identify. 

_{Immigrant health clinic resources. Author Georgie Paxton, Jen Schaefer, Sep 2021, last update Feb 2026  - Contact: georgia.paxton@rch.org.au}