War and persecution displace millions of refugees worldwide, mostly from developing countries, where health care is often crisis oriented. Physicians in host countries far from the nations in turmoil are increasingly encountering the complex needs of refugees in their practices. Primary care refugee medicine requires more than a general knowledge of preventive medicine or infectious disease burden of a particular refugee group. This review describes the challenges of caring for Somali women as an illustration of the complexities of delivering competent, culturally sensitive care to any refugee population. We begin by describing the refugee process from a historical and medical perspective. Next, we address special features of history taking and physical examination, such as acquiring an immigration history and describing female circumcision. Finally, we emphasize the importance of recognizing severe psychological trauma after human rights violations common in war. Understanding the unique circumstances facing Somali women will not only improve the integrity and appropriateness of their medical encounters but may provide widely applicable lessons for the primary care of other refugee groups. © 2002 Elsevier Science Inc. All rights reserved.

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Somalia cultural anthropology human female priority journal preventive medicine infection refugee psychotrauma anamnesis Physical Examination Article female circumcision human rights history immigration primary health care war