- Mental Health Issues Affecting Refugees -

By Emma Reinisch

Refugees face exceedingly difficult circumstances and experience trauma in their home countries before and during the process of migration, in refugee camps, and during resettlement. These psychological stressors greatly increase the risk of suffering from numerous mental health issues. The traumatic events experienced vary widely but can include social upheaval, sexual violence, witnessing or experiencing murder and genocide, loss of loved ones, fear over lack of safety, and food or resource insecurity, among other events. In addition to experiencing trauma, the risk of mental health issues is also increased by the delayed asylum application process, detention, and a loss of culture and support.

Up to half of the world’s refugees are in “protracted” situations, meaning unstable and insecure situations like dense urban areas or refugee camps, which contributes to both the incidence of psychological stressors for these refugees, as well as the lack of access to proper care. Recent studies have shown that the post-migration environment that refugees are in can exasperate mental health problems. Conditions of adversity, prolonged detention, insecure residency, the refugee determination process, restricted access to services, and lack of employment or educational opportunities can compound the effects of past traumas.

The most common mental health diagnoses in refugee populations are post-traumatic health disorder, major depression, generalized anxiety, panic disorders, and adjustment disorders. Rates change based on the regions of the refugee populations, conditions of resettlement, and past historical trauma, but recent studies have shown up to 40% of settled adult refugees experience PTSD, and up to 15% experience major depression. Symptoms of PTSD can include disturbing thoughts and feelings that interfere with daily life up to years after the traumatic event occurred, and symptoms of major depressive disorder include persistent sadness, hopelessness, feelings of guilt or hopelessness, and thoughts of death or suicide.

While the identification and treatment of physical health problems, like infectious diseases, has been studied for years, mental health treatment is much farther behind. This, in conjunction with the scarcity of mental health services, complex cultural contexts, language barriers, scattered populations, and lack of access to medical care makes it very difficult for mental health problems to be identified or treated for refugees. Staff in refugee camps don’t always speak the languages of the refugees residing in the camps, some cultures do not believe in therapy or care for mental health problems the way many western countries do or attach stigmas to it, and there can be a lack of trust in staff or medical professionals due to the years of violence and discrimination refugees had previously faced. All these factors contribute to the lack of adequate mental health care for refugees and in refugee camps.

Refugee children and adolescents have even higher rates of mental health problems, with rates of PTSD ranging from 50-90%, and rates of major depression being estimated at up to 40%. Children and adolescents are often separated from their families, or may even witness the death of family and loved ones, and are put in vulnerable positions where their care and wellbeing is at the mercy of others. Even when with their families, their parents may be unable to adequately provide for their physical and emotional wellbeing. Children also experience trauma from witnessing violent events- in Mozambique, for example, 77% of the 500 children studied had witnessed murder or mass killings. The Lost Boys of Sudan are an example of the trauma of separation, being a group of boys orphaned or separated from their families after the Second Sudanese Civil War who walked thousands of miles to refugee camps in Ethiopia and Kenya. Valentino Achak Deng, one of the Lost Boys now resettled in the United States, explained that "in the group, there were many boys who became strange. One boy would not sleep, at night or during the day. He refused to sleep for many days, because he wanted always to see what was coming, to see any threats that might befall us."

In addition to experiencing those sorts of traumas, some refugee children are also coerced into being child soldiers and unwillingly or unknowingly participating in violence. An estimated 300,000 children under the age of 18 around the world have fought in armed conflicts, with more being enrolled in armed forces not currently involved in a conflict. Front-line combat puts children at risk of rape, torture, substance abuse, war violence, depression, anxiety, and suicide ideation. That experience is deeply traumatizing, and when those children make it to refugee camps they are put through disarmament, demobilization, and reintegration (DDR) programs. The efficacy of these programs, however, varies widely based on the administrative capacities of individual refugee camps and many former child soldiers are left without any type of support.

Social and familial support is one of the most important things for the emotional wellbeing of children. Families foster resilience in children and act as stress buffers, which is why it is important to strengthen parental support for vulnerable children either suffering from mental health problems or at risk of them. Separation of children from their parents, which has been done to thousands of children each year in the United States, increases stress to children post-migration. In the United States, children are often forced to navigate the legal system without parental support and are left with few resources and inadequate medical and psychological care which harms their emotional and psychological development.

It is crucial to care for the mental wellbeing of refugee children and adults and provide adequate mental healthcare. For example, children can benefit from being cared for by teachers who have received training in alleviating childhood PTSD and depression. As children commonly interact with teachers post-migration, training teachers to provide some mental healthcare can alleviate some barriers to access, and can reduce the stigma associated with receiving help. Training locals in the community, or other refugees who speak their dialect, can likewise reduce barriers to access by making the providers someone that can be trusted and who is knowledgeable in their culture and beliefs. Within refugee camps, engaging the individuals residing there through work and educational opportunities, religious activities, traditional cultural activities, and self-help groups can both help with at-risk individuals mental help, but can also serve as a strategy to identify those in need of mental health services.

Overall, refugee children and adults are both at high risk of mental health problems, especially PTSD and major depression due to the high incidence of traumatic events they experience. These groups overwhelmingly have poor access to medical and mental health care and suffer from other barriers to access, including cultural and language barriers. Mental health problems often go unidentified in refugee populations, despite the significant detrimental effect that mental health problems can have on the livelihoods of refugees before and during resettlement, on physical health, and on the development of children. It is essential that mental health becomes a focus and that efforts are made to provide adequate care.