By the end of 2015, over 65 million people had been forcibly displaced worldwide. Of this number, at least 32% are refugees who were forced to flee danger in their home countries. This mass movement of people represents more than a migration of bodies; each refugee must carry the overwhelming experiences of war, oppression, and migration while aiming for resettlement in foreign countries that are often unwelcoming.
Before leaving their homes, refugees may endure the physical and emotional trauma of being subjected to violence. To escape conflict, many attempt the dangerous journey away from home–often facilitated by criminals who promise safe passage, only to exploit refugees along the way–and encounter interminable delays at holding camps or detention centers. Upon reaching a place that will provide shelter, refugees must adapt quickly, sacrificing their culture and language in order to integrate with the host country’s population.
Since each step of the generalized migration experience challenges the physical, mental, and emotional well-being of refugees, it is not surprising that post-traumatic stress disorder, depression, and generalized anxiety prevail among these individuals. Securing food, water, and shelter is paramount to refugees’ physical safety, but addressing the mental health issues that spring from such an upheaval is equally important in resettling those who have fled their homes.
Image source: Jeff J Mitchell
There are currently 21.3 million people encompassed in the global refugee crisis: 4.9 million individuals from Syria, 2.7 million from Afghanistan, 1.1 million from Somalia, as well as hundreds of thousands from South Sudan, Sudan, the Democratic Republic of Congo, the Central African Republic, Myanmar, Eritrea, and Colombia. The sheer magnitude of those fleeing persecution is appalling, and the diversity of global refugees requires that mental health screening incorporates these differences in language and cultural perceptions of health. In the host countries willing to assist refugees in their transition, a standardized screening instrument must consider the nuances of various languages. Including these linguistic differences is crucial in ensuring that the description of symptoms and the meaning of a diagnosis do not get lost in translation. Furthermore, the instrument must be sensitive to the emotional distress of various ethnic groups; it will be most efficient if it can be applied to the broad range of refugees.
Overcoming cultural barriers is key to detecting mental health issues, and it may be the most challenging factor in establishing relationships between those suffering from trauma and those attempting to give therapy. For refugees whose experiences have been shaped by betrayal–by militants, people in their communities, or the foreign countries that intercept them–fostering trust may be the most critical step of healing. To mitigate the plight of resettlement, host countries must work toward assimilating refugees into the public health infrastructure. Rather than perpetuate the trauma that refugees have faced, those delivering aid must emphasize each individual’s mental well-being.
