Ableism and Structural Inequities: A Refugee Child With Developmental Disabilities

Amir, a 5-year-old racialized refugee from Syria with suspected autism spectrum disorder, was admitted with respiratory distress and fever. His case highlights the systemic barriers faced by families with children with the experience of disability navigating the health care system compounded by the family's refugee status and the challenges of hospital care. Despite supportive measures, Amir's prolonged hospitalization was marked by communication difficulties, cultural misunderstandings, and a lack of developmental accommodation. Behavioral challenges related to Amir's developmental disability were both not anticipated and misinterpreted, leading to stigmatizing labels and inadequate interventions. These challenges were further exacerbated by structural issues, such as the family's lack of health insurance and the lack of comprehensive refugee health records. This case underscores the importance of addressing intersectional inequities in pediatric care. Refugee families often face unique barriers, including trauma from displacement, fear of persecution from their home country, socioeconomic instability, and limited access to health care resources. For children with developmental disabilities, ableism within health care systems further contributes to suboptimal care and adverse outcomes. We discuss actionable strategies to improve equity in health care delivery, including the use of consistent interpreter services to support communication and the integration of a framework such as the World Health Organization International Classification of Functioning, Disability and Health to ensure care that is both culturally responsive and inclusive in addressing the full diversity intersectional barriers that can be experienced by families. By examining Amir's experience, we highlight the need for systemic changes to create accessible health care environments that meet the needs of diverse populations.