When refugees from Afghanistan arrive at Philadelphia International Airport, some of the first people they meet are the doctors and nurses staffing long lines of triage stations, prepared to care for people who’ve been in transit for days or weeks, and perhaps suffering trauma for even longer.

The all-hands-on-deck effort — staffed by health care workers from around the region — is a mark of how crucial health care is for the new arrivals. Many left quickly, with no time to bring vaccination or health care records or to get the medical checkups normally required before leaving for the United States. Some have suffered the physical and emotional trauma of struggling to get to airports blocked by weapons-wielding Taliban, and once there, waiting days to get a flight.

When they land in Philadelphia, new arrivals are tested for illnesses including COVID-19 — most are negative, and many accept the offer of vaccination, said Rohit Gulati, Einstein Health System’s chief medical officer, who’s been working shifts at the airport. Those who have tested positive are isolating. Marc Altshuler, the director of Jefferson University Hospital’s Center for Refugee Health, said doctors are being asked to vaccinate patients for measles at their first check-ups after the CDC identified a few isolated cases; those exposed were also quarantined.

Rather than subject them to the ordeal of an emergency room visit, health workers try to treat acute medical needs on the spot, anything from gastroenteritis after days of traveling to colds caught on long flights in frigid military planes.

“There’s not a lot that can be done in the airport terminal, but it’s nice if we can spare people from going to emergency rooms,” said Jessica Deffler, a Jefferson University Hospital physician and the medical director at the Hansjörg Wyss Wellness Center, a South Philadelphia primary care clinic whose clientele includes a large number of immigrants and refugees.

Even when a hospital visit is necessary, physicians are finding ways to avoid separating refugees from their families. When Bibi Samira Khalil arrived in Philadelphia in early August with her husband, Mohammad Sabour Khalil, and their three young children, she had to be taken to an emergency room to be tested for suspected tuberculosis. Instead of waiting at the airport, the entire family went with her. (Khalil tested negative.)

“Keeping families together was very important,” said Altshuler.

Many of the refugees coming through Philadelphia’s airport will settle elsewhere. Patients who do stay in the area and are working with local resettlement agencies are required to undergo an initial checkup, but Altshuler’s center works to build lasting relationships with patients beyond that appointment. “In addition to giving them [their first medical exam], we become their medical home,” he said. Some patients may need preventive care or treatment for chronic diseases that they were unable to get while waiting for placement. The center also offers mental health screening specific to the needs of people grappling with trauma from their home countries, and now must adjust to life in a new country.

Mohammad Sadiq Sadeed, who worked for years at the U.S. Embassy in Kabul, knows well the kind of trauma the new arrivals are facing. He arrived in Philadelphia in 2019 shortly after getting his special immigrant visa. Because his life was at risk from the Taliban, he fled quickly: He hadn’t even had time to register with the International Organization for Migration, which can help refugees and SIV holders access housing and health care.

The family had to find their own housing, and Sadeed’s five children couldn’t enroll in school for nearly a month because they had no vaccination records. Once settled into their home in Northeast Philadelphia, the family faced the kind of health care system problems that many Americans share: Sadeed remembers his shock at a $700 bill for a root canal and his frustration at getting a needed appointment with a specialist, even though he had private insurance.

Sadeed, an office manager at HIAS Pennsylvania, one of Philadelphia’s two major resettlement agencies, said he and his colleagues are discussing how to help new arrivals work through the stress of the evacuation, stress that is all too fresh for him. Earlier this summer, his family traveled to Afghanistan to see relatives, only to be trapped in Kabul as the city was overtaken with stunning speed.

Sadeed’s wife, Bibi Adela Sadeed, and their five children were forced to flee a month before their planned return to Philadelphia, as Taliban forces advanced into the city. Sadeed, who was already back in Philadelphia for work, spent frantic nights trying to get his family out of the country. Meanwhile, his wife and children tried in vain to get through Taliban checkpoints to the Kabul airport, choking on tear gas as Taliban fighters fired bullets into the air.

Eventually, with help from Sadeed’s brother, who posed as the head of the family to get them past the Taliban, they managed to get on a flight to Germany, and arrived back in the United States last week. “It was so difficult,” Sadeed said. He’s worried for family members who are still in the country, including his brother’s wife and children. “There are thousands like my family.”

Gulati and his colleagues see that kind of ambivalence constantly as they care for refugees.

“There’s both happiness and some remorse, and some sadness. Their family, their nuclear family is now here and protected. But their extended family could still be in Afghanistan,” Gulati said.

Maria Aini, an emergency medicine physician at Jefferson, is an Afghan immigrant who speaks fluent Dari, making her an especially welcome presence at the airport.

“There is a sense of relief when they hear me speak on their terms — they have been through so much to get here,” she wrote in an email. “There are things I catch that would otherwise have be lost in translation. We have laughed as well as teared — my accent is a particular focus for their giggles!”

Aini said her experience at the airport has been to see “medicine at its finest.”

“It’s also America at its finest — a modern-day Ellis Island,” she wrote.

“For me this was a calling, a chance to reconnect with my heritage,” she wrote. “Also, this gave me a way to actually do something instead of watching in sadness and despair. Sadly, for many of the Afghans working at the airport, this may be the closest to Afghanistan we get to be.”