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PubMed1999

Trauma and mental health problems of Sudanese refugees in Uganda.

OBJECTIVES: To determine the extent of trauma and mental health problems. DESIGN: Screening surveys. SETTING: Sudanese refugee communities in Northern Ugandan camps. SUBJECTS: 100 adult refugees, 44 ex-soldiers, 60 patients at camp outpatient health facilities, 63 traditional healers' patients and 56 refugee children. MAIN OUTCOME MEASURE: Rate of trauma. RESULTS: The most common trauma events experienced by 100 adults were forced isolation from others (94%), forced separation from family members (91%) and lack of food or water (83%). Thirty-two percent of the adults suffered post traumatic stress disorder (PTSD). Among the 56 children, 12 (20%) suffered from a chronic PTSD. Forty-four ex-soldiers scored a median of 74.6 (Q1 = 62.3; Q3 = 79.1) on the depressive scale of the Hopskins Symptom checklist. Out of 60 outpatients at a dispensary, 12 (20%) had psychological disorder. Out of a total of 63 patients attending traditional and faith healers' facilities, 26% suffered from PTSD and 39% from depressive disorder. CONCLUSION: High rates of trauma and psychosocial problems were found among Sudanese refugees in Uganda.

Adolescent↗
PubMedDate not supplied

Barriers to access to health care for newly resettled sub-Saharan refugees in Australia.

OBJECTIVE: To determine barriers that affect access to health care for refugees from sub-Saharan Africa resettled in Sydney. DESIGN: Descriptive epidemiological study and survey. PARTICIPANTS AND SETTING: Parents of newly resettled refugee children seen at a tertiary hospital paediatric clinic between 10 June 2005 and 19 May 2006. MAIN OUTCOME MEASURES: Socioeconomic indicators, health seeking behaviour, social barriers, and beliefs about health. RESULTS: Parents of 34 of a possible 35 families (97%) agreed to participate. Barriers to accessing health care include language barriers, financial handicap, lack of health information, not knowing where to seek help, and poor understanding of how to access health services. Most refugee families established connections with community and religious groups soon after arrival in Australia. CONCLUSIONS: Our findings suggest that most refugee families are not totally isolated in Australia, but form early connections with cultural, social and religious groups of their own ethnic background. These groups provide an opportunity to deliver health education and health information that would improve their access to health services.

Africa South of the Sahara↗
PubMed1999

Mental health and social adjustment in young refugee children 3 1/2 years after their arrival in Sweden.

OBJECTIVE: To investigate the relative importance of various risk and protective factors for mental health and social adjustment in young refugee children. METHOD: Of 50 Iranian refugee preschool children who were first evaluated 12 months after arriving in Sweden, 39 were reevaluated in a follow-up study 2 1/2 years later. The effect of exposure to organized violence, age, gender, individual vulnerability, parental functioning, and peer relationships on the children's well-being and adjustment was investigated using multiple and logistic regression analyses. RESULTS: Exposure to war and political violence and individual vulnerability before traumatic stress exposure were important risk factors for long-lasting post-traumatic stress symptomatology in children. Mothers' emotional well-being predicted emotional well-being in children, whereas children's social adjustment and self-worth were mainly predicted by the quality of their peer relationships. CONCLUSIONS: The results underline the fact that refugee children's adaptation is the result of a complex process involving several interacting risk and protective factors. For many refugee children, current life circumstances in receiving host countries, such as peer relationships and exposure to bullying, are of equal or greater importance than previous exposure to organized violence.

Child↗
PubMed1999

Trauma and reconstruction in a large group of refugees.

The study is a continuation of a research which the expert team started in refugee and displaced persons' settlements in Croatia. By studying a group of refugees in its entirety we could not avoid noticing its extremely regressive position. Faced with the refugees' numerous existential problems we took the role of good, caring and tender mother (a good object) who will protect her children, give them security, meet their essential needs. Looking at the group dynamics, in the light of Melanie Klein's theory, we noticed the existence of schizo-paranoid and depressive position in the group, manifesting itself through the gap occuring as defense from its self-destructiveness, i.e. as the protection of introjected object which has be saved from destruction because the true "good object" was destroyed. Through the analysis of schizo-paranoid and depressive position of large group of refugees the aim of our work was to enable the group to gradually overcome the schizo-paranoid position and transfer into a more mature phase of development, thus creating a favorable atmosphere for maturation and self-protection.

Adaptation, Psychological↗
PubMed1999

Somatisation among Asian refugees and immigrants as a culturally-shaped illness behaviour.

Epidemiological studies indicate a high prevalence of major depression and anxiety disorder (including post-traumatic stress disorder) among Asian refugees and immigrants living in North America. Yet there exists an alarming underutilization of mental health services and underdiagnosis of psychiatric illness in this rapidly growing minority group. In order to investigate a culturally-derived basis for these observations, a critical review was conducted on descriptive epidemiologic, sociologic, and anthropologic studies of psychiatric illness among Asians and Asian refugees and immigrants reported in the general psychiatric and trans-cultural psychiatric literature of the past forty years. Studies examining the mode of illness presentation among Asian refugees seeking medical care suggest a marked tendency to articulate somatic rather than affective complaints when serious underlying psychiatric conditions exist. In this context, somatisation among Asian refugees and immigrants may reflect culturally-shaped beliefs regarding notions of disease aetiology and treatment as well as what is deemed culturally-appropriate help-seeking behaviour during illness. Misdiagnosis and underdiagnosis of psychiatric illness in this and other minority populations can be minimised by establishing pluralistic norms and multidimensional criteria which take into account the ethnically diverse manifestations of illness behaviour encountered increasingly in Western primary care and psychiatry clinics.

Asia↗
PubMed2000

Effect of parasite screening on refugee health.

Intestinal parasitic infections among refugees have been perceived as a public health problem for decades. A control program strategy to reduce morbidity and eventually transmission of intestinal parasites was initiated in 1993 by Mercy International (MI) for a group of Somalia refugee and has been implemented successfully. The management of the program operating within a comprehensive health care project and the control activities has been performed through the existing health facilities. This project was based on the "Comprehensive Health Care Approach" concept and applied to a collection of 10,000 Somali refugees. A project, which could be further, developed and modified for other similar situations. The strategy adopted was based on periodic chemotherapy of schoolchildren, intense health education in close collaboration with the local community leaders. An overall reduction in prevalence of intestinal parasitic infections of 53% was one of the targets achieved through this effort after three years of activities. 92% and 62% reduced the intensity of Ascaris lumbricoides and Trichuris trichiura infection, respectively. This approach in concert with the political commitment and limited operational costs is a warranty for the future sustainability of the control activities. Future control strategies are tailored to the results of evaluation surveys and are targeted to the identified high-risk areas. This project can be seen as a model in other refugee situation with the use of limited local resources.

Adult↗
PubMed2000

Acceptability of health status questionnaire screening and vaccination among Kosovar refugees.

During 1999, following the war in Kosovo, thousands of Kosovar refugees were received by different countries. The public health reception protocols for these refugees varied widely between and within reception countries. We surveyed a group of Kosovar refugees received in Bolton to assess the acceptability of vaccination and health status questionnaire screening. We also examined the refugees' opinions about the confidentiality of their medical history and their willingness to take part in research. Fifteen out of 29 people responded. Most respondents were happy with the interventions.

Adult↗
PubMed2000

Scholastic achievement of adolescent refugees from Cambodia and Central America.

This study investigated the relationship of emotional disturbance and pre- and postmigration environment to the scholastic achievement of adolescent refugees of very different cultural backgrounds. One hundred fifty-two Central American and Cambodian students in six Canadian high schools, as well as their parents, were interviewed to assess the students' emotional problems (using the Youth Self-Report and Child Behavior Checklist) and to determine the pre- and postmigration family environment. The findings indicated that the relationship between the emotional problems and scholastic achievement of teenaged refugees was tenuous. It was concluded that a connection between young refugees' symptomatology and their functional capacity should not be assumed. Nonetheless, certain pre- and postmigration variables, particularly trauma experienced in the homeland, seem to be associated with the academic achievement of some refugees.

Achievement↗
PubMedDate not supplied

Tuberculous lymphadenitis in Afghan refugees.

BACKGROUND: Tuberculosis is a disease of poor countries. The war-stricken Afghan refugees, owing to abject poverty, illiteracy, lack of social awareness and poor hygienic conditions, are highly susceptible to tuberculosis. This study was conducted to assess the frequency of peripheral lymph node tuberculosis in Afghan refugees. METHODS: One thousand lymph node biopsies from Afghan refugees were examined histopathologically. The diagnosis was undertaken on morphological grounds. Lymph nodes containing caseating epithelioid cell granulomas were identified as tuberculous. Age and sex of the patient and site of biopsy were also recorded. RESULTS: Sixty nine percent of the nodes revealed tuberculosis. Male:Female ratio was 1:1.2. Of all the cases 72% cases were 10-30 years of age. The most common site involved was neck that was involved in 79% of cases. CONCLUSIONS: Tuberculous lymphadenitis has an alarmingly high prevalence in Afghan refugees of NWFP.

Adolescent↗
PubMed1986

International factors in the formation of refugee movements.

The authors construct a theoretical framework for analyzing factors influencing international refugee movements. "On the basis of detailed case studies by the authors of the principal refugee flows generated in Asia, Africa, and Latin America from approximately 1960 to the present, it was found that international factors often intrude both directly and indirectly on the major types of social conflict that trigger refugee flows, and tend to exacerbate their effects. Refugees are also produced by conflicts that are manifestly international, but which are themselves often related to internal social conflict among the antagonists."

Behavior↗
PubMed1986

Fertility and adaptation: Indochinese refugees in the United States.

"Levels of fertility among Indochinese refugees in the United States are explored in the context of a highly compressed demographic transition implicit in the move from high-fertility Southeast Asian societies to a low-fertility resettlement region. A theoretical model is developed to explain the effect on refugee fertility of social background characteristics, migration history and patterns of adaptation to a different economic and cultural environment controlling for marital history and length of residence in the U.S." The chief source for the data and analyses is the Indochinese Health and Adaptation Research Project (IHARP), San Diego State University. "Multiple regression techniques are used to test the model which was found to account for nearly half of the variation in refugee fertility levels in the United States. Fertility is much higher for all Indochinese ethnic groups than it is for American women; the number of children in refugee families is in turn a major determinant of welfare dependency. Adjustments for rates of natural increase indicate a total 1985 Indochinese population of over one million, making it one of the largest Asian-origin populations in the United States."

Acculturation↗
PubMed1989

International law and human rights: trends concerning international migrants and refugees.

Not with standing human rights linkages, migrants and refugees are often on the periphery of effective international protection. State sovereignty and self-regarding notions of community are used to deny or dilute substantive and procedural guarantees. Recently, even non- discrimination as a fundamental principle has been questioned, as has the system of refugee protection. This article located both migrants and refugees squarely within the human rights context, contrasting both inalienable rights with the demands of sovereignty, and juxtaposing the 2 in a context of existing and developing international standards. Migration and refugee flows will go on, and the developed world, in particular, must address the consequences - legal, humanitarian, socioeconomic, and cultural. Racism and institutional denials of basic rights daily challenge the common interest. This article shows how the law must evolve, responding coherently to contemporary problems, if the structure of rights and freedoms is to be maintained.

Demography↗
PubMed1989

Repatriation: its role in resolving Africa's refugee dilemma.

The literature on Africa's refugees has grown dramatically over the past decade. 2 issues, however, remain relatively unresearched and poorly understood - the plight of urban refugees and the problems associated with repatriation. This article examines the dimensions of the latter. After placing repatriation into the context of contemporary durable solutions applied to the African refugee dilemma, the article examines some of the problems, concerns and frustrations associated with African repatriation exercises in terms of cultural, economic, and political obstacles encountered in the process of repatriation and the concomitant rehabilitation of refugees in their areas of origin. The article is illustrated with examples drawn from the Southern Sudanese repatriation of the early 1970s.

Africa↗
PubMed1989

The Organization of American States and legal protection to political refugees in Central America.

Since 1978, massive influxes of asylum seekers have placed great strain upon recipient states in Central America. At the global level, protection and assistance to refugees is entrusted to the United National High Commissioner for Refugees (UNHCR). At the regional level, one would expect involvement by the Organization of American States with Central America refugees; either to supplement UNHCR activities or to enforce independent inter-American standards. This article reviews inter-American standards and agencies of concern for asylum seekers and refugees. Special attention is given to the inter-American human rights regime as the mechanism best suited to supplement or complement UNHCR activities in Central America.

Americas↗
PubMed1992

Health issues of Afghan refugees in California.

Since the 1979 Soviet invasion of Afghanistan, more than 6 million Afghan refugees have become the world's largest refugee population. Although refugees in Pakistan and Iran are now beginning to repatriate, continuing political turmoil in Afghanistan and children's acculturation and educational opportunities will keep many Afghans in the United States permanently. Although there are no accurate statistics, local resettlement agencies and Afghan community leaders estimate that there are 10,000 to 35,000 Afghans in northern California. They suffer from a variety of problems common to refugees: language, economic and occupational problems, and substantial challenges in psychological, family, social, and cultural adjustment to the United States. Although many Afghans are doing well, many others have depression, psychosomatic symptoms, and posttraumatic stress disorder.

Adaptation, Psychological↗
PubMed1992

Use of traditional health practices by Southeast Asian refugees in a primary care clinic.

To determine the prevalence of use of traditional health practices among different ethnic groups of Southeast Asian refugees after their arrival in the United States, we conducted a convenience sample of 80 Cambodian, Lao, Mien, and ethnic Chinese patients (20 each) attending the University of Washington Refugee Clinic for a new or follow-up visit. Interpreters administered a questionnaire that dealt with demographics, medical complaints, traditional health practices, health beliefs, and attitudes toward Western practitioners. In all, 46 (58%) patients had used one or more traditional health practices, but the prevalence varied by ethnic group. Coining and massage were used by all groups except the Mien, whereas moxibustion and healing ceremonies were performed almost exclusively by the Mien. Traditional health practices were used for a variety of symptoms and, in 78% of reported uses, patients reported alleviation of symptoms. The use of traditional health practices is common among Southeast Asian refugees. Clinicians who care for this population should be aware of these practices because they may supersede treatments prescribed by physicians or leave cutaneous stigmata that may be confused with disease or physical abuse. Good patient care may necessitate the use or tolerance of both Western and traditional modalities in many Southeast Asian refugees.

Adolescent↗
PubMed2005

Rapid malaria screening and targeted treatment of United States-bound Montagnard refugees from Cambodia in 2002.

In 2002, a group of Montagnard refugees living in Cambodia was accepted for resettlement in the United States. Pre-departure malaria screening and targeted treatment was conducted to prevent morbidity, and minimize the potential for local malaria transmission post-arrival. We screened 902 of 906 refugees using rapid diagnostic tests (RDTs), microscopy, and polymerase chain reaction (PCR) analysis. Twelve (1.3%) RDT results were positive and 28 (3.1%) were indeterminate. Microscopy confirmed Plasmodium species in two of the positive RDT and one of the indeterminate results. Among a random 10% sample of negative RDT results (n = 86), none were positive by microscopy. The PCR confirmed the two microscopically (and RDT) positive specimens. The PCR result was negative for all other specimens tested. Eighteen (2.0%) refugees were treated with antimalarials. The RDTs were useful in this setting, facilitating timely, sensitive diagnosis and targeted treatment. Evaluations to determine the most appropriate interventions in other refugee settings should include cost-effectiveness analyses of alternative strategies.

Antimalarials↗
PubMed1990

[Refugees' encounter with the Danish psychiatric system].

Recently, Western clinicians have met an increasing number of victims of organized violence who, as political refugees, have sought asylum here. On basis of literature-studies and research carried out by the authors, the article gives an overview of present knowledge about the composition of the refugee population in Denmark, and the need of psychiatric/psychological assistance. The most common presenting symptoms of traumatized refugees are related to traumatic stress-conditions, sometimes accompanied by acute outbursts of affect, psycho-somatic complaints, substance abuse or psychotic break-down. The relevance of the concept of Post-Traumatic Stress Disorder (PTSD) for the field of refugee treatment is briefly described, and possible offers of therapy, including Post-Traumatic Therapy (PTT), are discussed. Some immediate questions facing psychiatry are raised, the need of a co-ordination of treatment offers is pointed out, and directions for further development of clinical practice and research are proposed.

Denmark↗