The decision to leave their home country and start a dangerous flight to Europe bears many risks for refugees. This often leads to severe mental health problems that are reinforced by the living conditions which they are met with after their arrival in Europe. However, solutions can be found, writes Alexia Hack.
In March of 2020, a Medicines Sans Frontieres spokesperson shared with the press: ‘We are dealing with a crisis of mental health of dimensions we have never witnessed before. Children are self-harming, children are talking about suicide.’ The situation he was referring to is the one in the refugee camp Moria, on the Greek island of Lesvos. Reports about children refusing to eat and refusing to speak had reached the media in the last years, but as the peak of the so-called ‘refugee crisis in 2015 and 2016 has passed, the issue of the refugees’ living conditions has enjoyed less and less media attention.
A study published by the German Federal Agency for Civic Education showed that the most common traumatic experiences among adult refugees arriving in the country were having witnessed violence towards others (70%), having seen dead bodies (58%), having been victims of violence themselves (55%) and having had endured torture (43%). 26% of children and teenage refugees living in Germany reported having witnessed violence towards members of their families. These experiences have led to a prevalence of Post-Traumatic Stress Disorder (PTSD): 70% of the adult refugee population studied in this publication suffer from unwanted thoughts of their traumatic experiences, while approximately 50% of those same persons also have so-called ‘flashbacks’ of reliving certain moments in their every-day life.
Panic attacks, an additional common symptom of PTSD, were reportedly suffered en masse by a number of Yezidi women who had fled ISIS captivity during their flight to Germany because the construction of the airplane reminded them of the narrow spaces they had been held in. Among children, behavioral discrepancies seem widespread as a result of severe psychological trauma; for instance frequent displays of pathologically aggressive behavior.
However, these mental illnesses are not simply traced back to experiences within the countries of origin or during the journey to Europe. Alessandro Barberio, a psychiatrist working for Medicines Sans Frontieres in Moria, stated that in his opinion it was the conditions in the camp that were largely responsible for a severe decline in mental health. To illustrate the living conditions in Moria, Barberio explained that 72 people share one functioning sanitary facility, and 84 persons share one shower. Barberio further shared with the press that children are often tortured, beaten up by other individuals. In some cases specifically, strangulation or brandings with iron rods were reported.
According to Katja Becker, director of the clinic for Children- and Teenage- Psychiatry, Psychosomatics, and Psychotherapy of the University Clinic Giessen-Marburg, Germany, an increase in suicidality among children can be especially observed in cases where the child has been confronted by suicidal thoughts, suicide attempts, or suicide in its close family circle. This was confirmed by Barberio, who reported that he has encountered more than once the phenomenon of whole groups of children talking about suicide in Moria. What is missing, most importantly, he adds, is the optimism needed during the vulnerable childhood years: There is no message of a possible improvement in their and their families’ lives received. ‘I wish I had died at home’ is the sentence, he says, that most poignantly brings across the hopelessness and feeling of defeat these children experience. An article published in 2016 described the sense of captivity as pivotal for the mental health issues observed among refugees living in reception facilities in Epirus, Northern Greece.
Reaching out for help is very difficult, as was stated by the German Federal Association of Unaccompanied Underage Refugees. First examinations of arriving refugees focus solely on their physical wellbeing. Through the example of an unnamed young Afghan man’s experiences, it was shown that only after the young man’s settlement did the social worker assigned to his case recognize mental difficulties, such as nightmares and panic attacks. The problems continued while searching for a possible treatment place, since becoming a regular patient of a licensed, full-time therapist in the recipient country is practically impossible. This is due to a number of reasons: In a ‘Technical Guide’ on mental health care of refugees and migrants, which was published by the WHO in 2018, a list of obstacles is included, such as language barriers, lack of information about health care systems in host countries, limited entitlements to receive free health care, different explanatory models of mental distress, and different attitudes to psychological treatments, especially when compared to those of the majority population.
It should be noted, however, that individuals may be reluctant to ask for any kind of help in the first place, out of fear that they might be reported to authorities and receive unwanted negative attention. In order to tackle these issues, the WHO drafted a variety of policy-advice in its ‘Technical Guide’. First and foremost, they focus on the promotion of social integration: The guarantee of basic food security and nutrition, as well as stable accommodation and general subsistence, their data showed, is a crucial step in overcoming mental health issues and putting the person in a position where they wish to reach out for help. A focus on education is very central, too, since enrolment in school or any type of training can limit social isolation and support in finding and maintaining employment.
Furthermore, the WHO stressed the importance of social activity programs, community forums, peer-mentorship programs from integrated members of the same refugee groups, and other activity-oriented solutions. Individuals who lack the appropriate documentation, have failed to seek asylum, or have been rejected in their request for asylum, might profit from guidelines on how to address physical and mental health problems in their situation. Such approaches to supporting people threatened with deportation have been developed in the Netherlands and could pose as an example for other European countries, according to the WHO. The interventions that have been identified as most promising by the Dutch professionals are two methods called ‘narrative exposure therapy’, through which patients develop a coherent narrative of their life stories and traumata by integrating their fragmented memories, and trauma-focused cognitive behavioral therapy.
An area that needs further investigating and a greater corpus of data is the prevalence of psychotic disorders. This has been reported by the WHO as well as by studies conducted by a cooperation of the Medical Institution Karolinska (University of Stockholm) and the Psychiatric Department of University College London. Their results were published by the lead scholar Dr. Anna-Clara Hollander in the British Medical Journal in 2016. According to the article, refugees were 66% more likely to have schizophrenia or other psychotic disorders; the chances of having psychosis were 3.5 higher than among the general Swedish population. The importance of these results lies in the confirmation of a commonly known psychological fact, namely that the occurrence of highly traumatic life events is detrimental to the (non-) development of psychotic disorders. Addressing and dealing with these illnesses is of utmost importance, not least because studies have shown that conditions such as schizophrenia and other psychotic illnesses can decrease a patient’s life expectancy by 10 to 25 years.
STAR’s contact Levin S., who is involved in the French medical NGO ‘MedEqualiTeam’ (@medequaliteam) on the Greek island of Samos since September 2020, shared pictures of the Vathy-camp of Samos for this article. The pictures illustrate the difficult living conditions, a situation which worsened after an earthquake hit the island and two fires broke out in the camp in autumn of 2020. Levin confirmed with STAR that in his experience, panic attacks are a widely spread phenomenon among camp inhabitants and the most common medical issue following the fires. According to him, the camp residents were in great need of a person of trust to speak about their troubles with more than anything – making a member of ‘MedEqualiTeam’’s medical staff, a British general practitioner, their confidential contact within the NGO’s clinic.
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