Refugees and asylum seekers

Delivery of effective mental health and psychosocial support programs requires knowledge of existing health systems and socio-cultural context. To respond rapidly to humanitarian emergencies, international organizations often seek to design programs according to international guidelines and mobilize external human resources to manage and deliver programs. Familiarizing international humanitarian practitioners with local culture and contextualizing programs is essential to minimize risk of harm, maximize benefit, and optimize efficient use of resources. Timely literature reviews on traditional health practices, cultural beliefs and attitudes toward mental health and illness, local health care systems and previous experiences with humanitarian interventions can provide international practitioners with crucial background information to improve their capacity to work efficiently and with maximum benefit. In this paper, we draw on experience implementing desk review guidance from the World Health Organization (WHO) and UNHCR, the United Nations Refugee Agency (2012) in four diverse humanitarian crises (earthquakes in Haiti and Nepal; forced displacement among Syrians and Congolese). We discuss critical parameters for the design and implementation of desk reviews, and discuss current challenges and future directions to improve mental health care and psychosocial support in humanitarian emergencies.

This study assessed the prevalence, continuation, and identification of maternal depressive symptomatology over the first 16 weeks postpartum among refugee, asylum-seeking, non-refugee immigrant, and Canadian-born women. A sample of 1125 women (143 refugees, 369 asylum-seekers, 303 non-refugee immigrant, and 310 Canadian-born) completed the Edinburgh Postnatal Depression Scale (EPDS) at 1 and 16 weeks postpartum. The sensitivity, specificity, and predictive power of the 1-week EPDS to identify women with elevated EPDS scores at 16 weeks were determined. The total number of women with EPDS scores >9 for each group at 1 and 16 weeks, respectively, was 26.6 and 18.2 % for refugees; 25.2 and 24.1 % for asylum-seekers; 22.4 and 14.2 % for non-refugee immigrants, and 14.8 and 7.4 % for Canadian-born. Using the cut-off score of 9/10, the 1-week EPDS accurately classified 77.6 % refugee, 73.4 % asylum-seeking, 76.6 % non-refugee immigrant, and 85.5 % Canadian-born women at 16 weeks with or without postpartum depressive symptomatology. The 1-week EPDS was significantly correlated to the 16-week EPDS (r = 0.46, p < 0.01). All groups were significantly more likely to exhibit depressive symptomatology at 16 weeks if they had EPDS scores >9 at 1 week postpartum: refugees (OR = 6.9, 95 % CI = 2.8–17.3), asylum-seekers (OR = 4.0, 95 % CI = 2.4–6.7), non-refugee immigrants (OR = 3.8, 95 % CI = 2.0–7.6), and Canadian-born women (OR = 8.0, 95 % CI = 3.3–19.8). Our findings suggest that refugee, asylum-seeking, non-refugee immigrant, and Canadian-born women at risk of postpartum depression may be identified early in the postpartum period such that secondary preventive interventions may be implemented.

AIMS:

This paper is based on a report commissioned by the United Nations High Commissioner for Refugees, which aims to provide information on cultural aspects of mental health and psychosocial wellbeing relevant to care and support for Syrians affected by the crisis. This paper aims to inform mental health and psychosocial support (MHPSS) staff of the mental health and psychosocial wellbeing issues facing Syrians who are internally displaced and Syrian refugees.

METHODS:

We conducted a systematic literature search designed to capture clinical, social science and general literature examining the mental health of the Syrian population. The main medical, psychological and social sciences databases (e.g. Medline, PubMed, PsycInfo) were searched (until July 2015) in Arabic, English and French language sources. This search was supplemented with web-based searches in Arabic, English and French media, and in assessment reports and evaluations, by nongovernmental organisations, intergovernmental organisations and agencies of the United Nations. This search strategy should not be taken as a comprehensive review of all issues related to MHPSS of Syrians as some unpublished reports and evaluations were not reviewed.

RESULTS:

Conflict affected Syrians may experience a wide range of mental health problems including (1) exacerbations of pre-existing mental disorders; (2) new problems caused by conflict related violence, displacement and multiple losses; as well as (3) issues related to adaptation to the post-emergency context, for example living conditions in the countries of refuge. Some populations are particularly vulnerable such as men and women survivors of sexual or gender based violence, children who have experienced violence and exploitation and Syrians who are lesbian, gay, bisexual, transgender or intersex. Several factors influence access to MHPSS services including language barriers, stigma associated with seeking mental health care and the power dynamics of the helping relationship. Trust and collaboration can be maximised by ensuring a culturally safe environment, respectful of diversity and based on mutual respect, in which the perspectives of clients and their families can be carefully explored.

CONCLUSIONS:

Sociocultural knowledge and cultural competency can improve the design and delivery of interventions to promote mental health and psychosocial wellbeing of Syrians affected by armed conflict and displacement, both within Syria and in countries hosting refugees from Syria.

OBJECTIVES: Study results on child maltreatment based on general population samples cannot be extrapolated with confidence to vulnerable immigrant or
refugee families because of the specific characteristics and needs of these families. The aims of this paper are 1) to conduct an evidence review of the
prevalence, risk factors and protective factors for child maltreatment in immigrant and refugee populations, and 2) to integrate the evidence in an analytical
ecosystemic framework that would guide future research.
METHODS: We used a 14-step process based on guidelines from Preferred Reporting Items for Systematic Reviews and Meta-Analyses and the Canadian
Collaboration for Immigrant and Refugee Health. We searched major databases from “the oldest date available to July 2014”. The eligibility criteria for paper
selection included qualitative or quantitative methodologies; papers written in English or French; papers that describe, assess or review prevalence, risk and
protection factors for child maltreatment; and a studied population of immigrants or refugees.
SYNTHESIS: Twenty-four articles met the criteria for eligibility. The results do not provide evidence that immigrant or refugee children are at higher risk of
child maltreatment. However, recently settled immigrants and refugees experience specific risk factors related to their immigration status and to the
challenges of settlement in a new country, which may result in high risk of maltreatment.
CONCLUSION: Future research must incorporate more immigrant and refugee samples as well as examine, within an ecosystemic framework, the interaction
between migratory and cultural factors with regard to the prevalence, consequences and treatment of child maltreatment for the targeted groups.

The issue of irregular migration is experiencing heightened attention in political, social and legal arenas. While deterrence and crime-control discourse and practices dominate current approaches to irregular migration, this article seeks to focus on the problematic neglect of the treatment of irregular migrants in destination countries, in relation to their ability to access fundamental rights and basic public services. This article will put forth an argument for the establishment of firewalls – a separation between immigration enforcement activities and public service provision. This article will canvass existing trends and practices that have both contributed to the erosion of firewall protections, and have built and maintained meaningful firewalls between immigration and public service provision.

Children and parents seeking asylum are regularly detained in Canada, however little is known about the experiences of detained families. International literature suggests that the detention of children is associated with significant morbidity. Our study aims to understand the experiences of detained children and families who have sought asylum in Canada by using a qualitative methodology that includes semistructured interviews and ethnographic participant observation. Detention appears to be a frightening experience of deprivation that leaves children feeling criminalized and helpless. Family separation further shatters children’s sense of well-being. Children’s emotional and behavioral responses to separation and to detention suggest that the experience is acutely stressful and, in some cases, traumatic–even when detention is brief. Distress and impairment may persist months after release. Given the burden of psychological suffering and the harmful consequences of separating families, children should not be detained for immigration reasons and parents should not be detained without children.

Research articles about unaccompanied refugee minors (UM) have rarely addressed ethical issues. This is remarkable, given UM’s specific, marginalized and vulnerable position within society, and the growing interest and developments in research ethics in refugee research. This article poses the question whether studies involving UM raise specific ethical issues compared to research on other refugee groups. We formulate personal reflections on ethical issues in a particular research project—a longitudinal study of UM in Belgium—and connect them to the existing body of literature on research ethics in qualitative and refugee research. We conclude that research ethics in studies with UM need to be multilayered because of researchers’ obligation to take ethical responsibility at both the micro and socio-political levels

En juin 2005 la Coalition « Solidarités sans frontières » a organisé la « Marche sur Ottawa – Personne n’est illégal ». Cette marche de plus de 200 kilomètres a duré huit jours et elle visait à rendre visible la situation et la lutte de toutes les personnes migrantes et sans statut au Canada. Une centaine de personnes y ont participé, dont bon nombre de réfugiés et de « sans papiers ». Ces personnes quotidiennement touchées par les injustices et l’exclusion liées à leur situation ont, pour ainsi dire, « pris la route » parce qu’elles refusaient de demeurer invisibles, parce qu’elles voulaient que soient entendues leurs revendications.

Refugees and refugee claimants are faced with the task of rebuilding their lives in an unfamiliar environment, while having to deal with past trauma and multiple ongoing stressors. As part of the clinical intervention with this population, it is important to understand and act on the social determinants of health, which may maintain or exacerbate mental health problems and impede integration. In this chapter, we summarize the legal rights of refugees and refugee claimants, with a strong focus on the criteria that a refugee claimant must meet in order to be accepted as a refugee according to international and Canadian law. We then examine some of the main stressors that refugees and refugee claimants may face during the premigratory, transit and postmigration phase, and discuss in greater depth the impact of immigration detention in the host country and of family separation and reunification. This is followed by a discussion of the clinical assessment and treatment of refugees who have experienced trauma and forced migration. Finally, we provide guidance on writing reports assessing refugee claimants’ mental health in the context of refugee status determination proceedings. To conclude, we briefly examine the relevance for clinicians to engage in advocacy on behalf of this population.

Extensive media exposure to natural disasters such as tsunamis may cause adverse effects including psychological distress and even posttraumatic symptoms in young children, particularly those who have suffered previous losses and trauma. This paper analyzes spontaneous representations of the 2004 tsunami through sandplay by a group of immigrant and refugee preschoolers, beginning 2 weeks after the tragedy. The children used a variety of coping strategies, making both nonverbal and verbal references to the tsunami. It was represented using a variety of figurines, including religious ones. We considered the children in light of four categories based on family homeland and psychological affinity to the tsunami experience. Our results suggest that sandplay provides an appropriate space to express and work through emotions stemming from the interaction of past and present experiences of adversity.

The universality of the health system in Canada is often emphasised to contrast the differences between the Canadian and American systems of access to care. However, changes in migration patterns and tightening of administrative procedures around undocumented persons are beginning to challenge this Canadian image. Currently, there is a lack of data to support the existence and the consequences of this shift. This pilot project documents health care professionals’ and community organisation workers’ perceptions of the problems faced by recent migrants in accessing health care, and the health consequences of such barriers. Results confirm the existence of numerous health care access problems for both completely undocumented migrants and legal migrants who fall into the cracks of the provincial and federal health systems. The data suggests that these barriers may have important unrecognised morbidity and mortality consequences, and that they are a source of severe stress and psychological distress. To protect recent immigrant families, there is a need not only to revise the articulation between the provincial and federal health mandates but also to address the strong societal perception linking universality of health care to the notion of citizenship. Further research is warranted on this emerging social problem, but the institutional sensitivity of these issues may constitute an obstacle to a more comprehensive understanding.