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PubMed2003

Operation Safe Haven: the needs of nurses caring for refugees.

Nurses played a significant role in providing care to Kosovar and East Timorese refugees at the East Hills Reception Centre in Sydney, Australia, during Operation Safe Haven in 1999-2000. To ascertain the needs of nurses in this setting, 13 nurses participated in two focus group interviews, and two in-depth interviews were conducted with nursing managers. Qualitative thematic analysis was conducted on the resulting transcripts. Nurses reported that, overall, they had the necessary clinical skills but needed specific refugee health profiles and training in culturally competent and trauma-sensitive care. The nurses experienced trauma-related, cultural, environmental and role-related stressors. They used a variety of informal psychosocial supports but reported the need for ongoing counselling and debriefing. While clinical skills were considered important, nurses identified other factors as having more impact on their ability to provide comprehensive care for traumatized refugees, particularly their role as client advocates.

Attitude of Health Personnel↗
PubMed2002

'It is a different war to fight here in Sweden'--the impact of involuntary migration on the health of refugee families in transition.

Involuntary migration and adaptation to a new cultural environment is known to be a stress factor. The aim of the study was to explore the impact of involuntary migration on the family health in order to identify specific health care issues related to refugee families in transition living in Sweden. Data was collected through interviews with 16 members of 10 different refugee families from Balkan countries, Kurdistan and Africa for which permission was obtained from the chairman of the local ethnic organizations in a municipality in the southern part of Sweden. In interpreting the material, analysis was made using a contextual approach with reference to phenomenography. The analysis resulted in four qualitatively different descriptive categories characterizing the health of the families: a distressed family living under prolonged tension; a contented family who leads a satisfactory life; a frustrated family who cannot lead a fully satisfactory life and a dejected family who feels deserted. Stressors seeking asylum, facing unemployment and changed roles, interacted negatively within the family. A friendly and understanding attitude from the host country was the main factor in promoting the health of the refugee families. Nursing interventions should therefore assist the families accordingly in order to promote the stability of the family system.

Adult↗
PubMed1997

Chloroquine resistance in Pakistan and the upsurge of falciparum malaria in Pakistani and Afghan refugee populations.

Surveys conducted in Pakistan during the last decade show that falciparum malaria has become resistant to chloroquine in Pakistani and Afghan refugee populations throughout the country. Although RI resistance is common everywhere (with a frequency of 30%-84%), RII is rarer (2%-36%), and RIII resistance has yet to be detected. The national policy is to prescribe chloroquine as first-line treatment of malaria. A repeated in-vivo survey in a sentinel village indicated that prescription of chloroquine can lead to a 15% increase in the frequency of resistance in a single year, and similar trends were observed in other districts. Coinciding with the spread of resistance is a 6-fold increase in the number of falciparum cases recorded nationally between 1982 and 1992 and a parallel, 5-fold increase in the number of cases recorded in the Afghan refugee population. Resistance contributes to this trend in various ways. Firstly, patients with resistant malaria make repeated visits to health centres. In the sentinel village, for example, where resistance was measured at 71%, recrudescent infections inflated by 66% the genuine incidence of new infections recorded at the health centre. Secondly, owing to ineffective treatment, resistant infections are often still patent during the post-transmission season. This may enlarge the 'overwintering' parasite reservoir, leading to a surge of new cases when transmission resumes. Other factors potentially contributing to the upsurge in falciparum include the decrease availability of insecticide for indoor spraying. Despite the problems posed by resistance for case management, the evidence from the vector-control programme among the refugees is that malaria control through well-targeted campaigns of insecticide spraying is still able to reduce the incidence of falciparum malaria to a level that existed before the advent of resistance.

Afghanistan↗
PubMedDate not supplied

Changing roles of Afghan refugee women in the United States.

Refugee women face many challenges, such as traumatic flight, loss of family members and property, and dramatic cultural differences in the country of resettlement. We examined the adjustment issues and role changes of Afghan women refugees in northern California. Afghans comprise the largest refugee population in the world, and continuing political turmoil prevents most Afghans in the United States from returning home. Data are presented from interviews with 32 Afghan women. These interviews were conducted as part of a larger ethnographic study that included participant observation and interviews with 90 Afghans and the American health and social service providers who worked with them. Although similar issues were expressed by most Afghan women, generation influenced the experience of such issues. The elderly suffer from social isolation and lack of respect; the middle generation shoulders the triple burden of housewife, employee, and mediator between children and spouse; and young and single women face culture conflict and the lack of appropriate mates.

Acculturation↗
PubMed2003

Screening for post-traumatic stress disorder among refugees in Stockholm.

UNLABELLED: A screening procedure (The Health Leaflet; HL) to assist social workers in finding subjects with possible post-traumatic stress disorder (PTSD) in recently resettled refugees is presented. It is compared with two established self-rating instruments, the Harvard Trauma Questionnaire (HTQ) and Impact of Event Scale-22 (IES-22), as well as structured clinical interview. AIM: To validate the screening interview and the rating scales in comparison to a clinical assessment for PTSD, and examine the feasibility of lay screening for PTSD. FINDINGS: The Health Screening Interview with a cut-off value of 10 points identified cases with fully developed PTSD with both sensitivity and specificity about 0.7. Only two items--difficulties concentrating and having been exposed to torture--contributed to the discriminatory performance of the HL interview. In the HTQ symptom subscale, emotional detachment and a feeling of going mad contributed to the discriminatory performance. In the IES-22, recurring strong affects about the events, as well as intrusive memories, were the items with the highest canonical correlation coefficients. In the HL, the single screening question about difficulties concentrating identified 31/32 individuals diagnosed with PTSD in this group, with a relative risk of 24. CONCLUSIONS: A mental health screening procedure during refugee reception performed by lay persons is clearly feasible and can assist in identifying subjects with trauma-related healthcare needs, thus leading to more realistic demands in refugee reception.

Adolescent↗
PubMed2004

Ethical aspects when treating traumatized refugee children and their families.

Basic ethical principles are worth analysing step by step when dealing with refugee children and their families. Three issues where potential ethical conflicts might arise for healthcare professionals in treating refugees with different cultural background are pointed out--traumatic life events, hierarchy and repatriation. An ethical analysis of the decision to admit a traumatized teenage refugee to a psychiatric ward is discussed with respect for the ethical principles autonomy, non-maleficence, beneficence and justice. There are both gains and losses, which are valued differently depending on the actors involved.

Acculturation↗
PubMed2004

Treatment of traumatized refugee children with Eye Movement Desensitization and Reprocessing in a psychodynamic context.

This study examines the effects of a psychodynamic approach of Eye Movement Desensitization and Reprocessing (EMDR) in treatment of traumatized refugee children. Among a child psychiatric outpatient refugee team, 13 children with post-traumatic stress disorder (PTSD), were treated by EMDR incorporated in a traditional psychodynamic therapeutic approach. The Posttraumatic Stress Symptom Scale for Children (PTSS-C) and the Global Assessment of Functioning (GAF) were administered before and after the treatment, to measure the effects. After treatment, a significant improvement was noticed in the functioning level and all PTSS-C scales, mostly in re-experiencing and least in the avoidance symptoms. The improvement in the functioning level was significantly correlated with the reduction of the PTSD-non-related and the depression, but not with that of the PTSD-related symptoms. Used in a psychodynamic context, EMDR is suggested to be effective treatment for traumatized refugee children. Our findings support the hypothesis of child-specific criteria for PTSD.

Adaptation, Psychological↗
PubMed2005

Ethics and interpreting in psychotherapy with refugee children and families.

Basic ethical principles like autonomy, non-maleficence, beneficence and justice should be taken into consideration step by step when treating refugee children and their families. These principles may be considered from the point of view of each of the actors involved--patient, therapist and interpreter. This paper is focused on the role of the interpreter and on different aspects to be considered by the therapist when working with interpreters in psychotherapeutic treatment of refugee children and families. Elements of case histories are used to illustrate situations faced in working with an interpreter. An ethical analysis of a case where a teenage refugee received therapeutic treatment using an interpreter is made.

Affect↗
PubMed2006

Predictors of mental health and quality of life in male tortured refugees.

Some of the most frequently reported mental health problems in traumatized refugees are depression, anxiety and post-traumatic stress disorder (PTSD). The aim of this paper is to describe a group of tortured refugees referred to the Rehabilitation and Research Centre for Torture Victims (RCT) and to study the importance of past trauma/torture and post-migratory factors for the present symptoms of PTSD, depression, anxiety and for health-related quality of life. The sample comprises 63 male tortured refugees admitted to a pre-treatment assessment at RCT. Data on personal background, trauma, present situation in Denmark, symptoms of depression, anxiety (Hopkins Symptom Checklist-25, HSCL-25, and Hamilton Depression Scale, HDS), PTSD (Harvard Trauma Questionnaire, HTQ), and on health-related quality of life (WHO Quality of life-Bref, WHOQOL-Bref) were collected through self-administered questionnaires and structured and semi-structured interviews. The scores in the questionnaires measuring emotional distress were high. Previous torture and trauma, lower education, fewer social contacts, no occupation and pain were identified as significant predictors of emotional distress. Few social contacts was a significant predictor of a lower health-related quality of life. Even after many years, past torture is significantly associated with emotional distress. Post-migratory factors are also significantly associated with emotional distress and health-related quality of life, and potentially modifiable factors, such as social relations and occupation, are of special interest.

Adult↗
PubMed2004

Ethiopian refugees in the UK: migration, adaptation and settlement experiences and their relevance to health.

OBJECTIVE: The study explores Ethiopian refugees' and asylum seekers' experiences of migration, adaptation and settlement in the UK and their health beliefs and practices. DESIGN: Data was collected using semi-structured depth interviews and a semi-structured questionnaire. The sample consisted of 106 Ethiopians resident in the UK. RESULTS: The majority of the participants fled Ethiopia due to political reasons. Whilst 65% of them had lived in the UK for over five years only 7% had full refugee status. Many of the participants faced difficulties with the immigration system, housing and social services and felt socially isolated. Many also had problems with gaining employment or employment appropriate to their qualifications, and 29% were unemployed. The majority of the participants believe that happiness is a prerequisite to healthiness and also an indication of healthiness. On the other hand the majority believed that sickness is caused by disease and mental illness is caused by both supernatural and psychosocial causes. Most of the participants sought the help of their GP in the first instance of illness although some had experienced difficulties accessing health services due to language problems and poor understanding of the primary healthcare system. The participants also believed that the stress of adaptation and settlement affected their mental health and led to depression. CONCLUSION: Migration, adaptation and settlement experiences impact on the health of refugees and are dependent on a number of barriers and enablers, both at a personal and societal level. These should be taken into account in the provision of health and social care services, in particular services should be provided in a culturally competent manner.

Acculturation↗
PubMed2005

Unaccompanied young adult refugees in Sweden, experiences of their life situation and well-being: a qualitative follow-up study.

OBJECTIVE: In the late 1980s unaccompanied children began arriving in Sweden. Many of them were teenage boys who had been called up or were at risk of being called up for military service in a war in their home country. Others had fled their homeland for political reasons. The purpose of the study was to describe how unaccompanied young adult refugees experienced their own life situation and well-being seven years after they had gained permanent residency. DESIGN: The original sample comprised 34 unaccompanied refugees who at 16-26 years of age were placed in a municipality in Sweden. Eleven of these participated in the present second follow-up study after a mean of 10 years in their new country. Qualitative interviews were conducted and analysed according to Giorgi's descriptive phenomenology. RESULTS: Most of the participants expressed contentedness with their lives and had begun to adjust to their new country. They had a social network of friends from the same ethnic group, and their Swedish contacts were mostly workmates. A few felt lonely and expressed despondency and depression. They were single and reported a small network and limited social support. One participant described symptoms of post-traumatic stress disorder (PTSD), even after 11 years in the new homeland. CONCLUSION: It appears that most of the participants in the present follow-up study had worked through the problems that typically face refugees and had begun adapting to their new country, while a few still felt lonely and did not feel part of the community. The results may be affected by non-response. Those who dropped out may live with more distress in everyday life and suffer depression more frequently.

Adult↗
PubMedDate not supplied

Survival with pain: an eight-year follow-up of war-wounded refugees.

The aim of this study was to investigate the nature of chronic pain in male war-wounded refugees and to examine the relationship between chronic pain and psychiatric symptoms. A culturally heterogeneous group of 44 war-wounded refugees were investigated during hospitalization, shortly after arrival, and followed up after two years. This study is an additional follow-up after eight years. The data collection methods used were structured interviews and physical examination. The measures of outcome were: Visual Analogue Scale (VAS) grading of pain; clinical categorization of pain into nociceptive or neurogenic; Hopkins Symptom Check List (HSCL-25); Post Traumatic Symptom Scale (PTSS-10). Chronic pain was found in 32 (73%) out of 44 subjects. The pain was purely nociceptive and neurogenic in 53% and 25%, respectively. The frequency of psychiatric symptoms was significantly related to the mean intensity of pain. War-wounded refugees display psychiatric symptoms and chronic pain in a complex pattern. Further research is needed as a basis for pain rehabilitation programmes suitable for this group.

Adult↗
PubMed1997

Bosnian refugees in the Scandinavian countries: a comparative perspective on immigration control in the 1990s.

"In all the Nordic countries, a change of direction in refugee policy has taken place in recent years, primarily for similar reasons to those in the rest of Western Europe. These changes have been sparked off by the situation in the former Yugoslavia, but should also be seen as reflecting something more.... The prospect of a continuing influx of refugee groups, and a corresponding strain on national budgets, creates a backdrop for new thinking in all countries. An interesting aspect of this issue in the Nordic region is that, despite being a fairly homogeneous area, these countries have chosen radically different points of departure for their approach to refugees from Bosnia-Herzegovina. The article identifies these different national strategies and analyses the subsequent tendency towards convergence of policies that has taken place along the way."

Bosnia and Herzegovina↗
PubMed2006

Trauma, post-migration living difficulties, and social support as predictors of psychological adjustment in resettled Sudanese refugees.

OBJECTIVE: This paper explores the impact of pre-migration trauma, post-migration living difficulties and social support on the current mental health of 63 resettled Sudanese refugees. METHOD: A semistructured interview including questionnaires assessing sociodemographic information, pre-migration trauma, anxiety, depression and posttraumatic stress, post-migration living difficulties and perceived social support were administered assisted by a bilingual community worker. RESULTS: Resettled refugees from Sudan evidenced a history of trauma. Less than 5% met criteria for posttraumatic stress but 25% reported clinically high levels of psychological distress. The results indicate that social support--particularly perceived social support from the migrant's ethnic community--play a significant role in predicting mental health outcomes. Pre-migration trauma, family status and gender were also associated with mental health outcomes. CONCLUSIONS: Refugees in Australia may constitute a particularly vulnerable group in terms of mental health outcomes. Culturally specific sequelae in terms of social isolation and acculturation may be particularly problematic for these migrants.

Adaptation, Psychological↗
PubMed2003

An outbreak of measles in Tanzanian refugee camps.

From March 2000 to May 2001, four camps in Kibondo District, Tanzania, hosting refugees from Burundi reported 1062 cases of measles, a highly infectious and potentially lethal disease. Of 1062 case-patients, 225 (21%) were <9 months old, 286 (27%) were 9 months to 5 years, 324 (31%) were 6-15 years, and 227 (21%) were >/=16 years old. No deaths were reported. Although, in accordance with Sphere Project guidelines for humanitarian emergencies, camp policy was to vaccinate all new arrivals aged 6 months to 15 years against measles, 152 (72%) of 210 newly arrived refugees in this age group were unvaccinated; 143 (94%) of the 152 had lived in the camp >/=1 month before rash onset. This investigation supports Sphere Project recommendations for wide age group vaccination and suggests that in some circumstances vaccination of refugees >15 years old may be beneficial.

Adolescent↗
PubMed2005

Seeking asylum in Denmark: refugee children's mental health and exposure to violence.

AIMS: The aim of this study was to compare profiles of present mental health and previous exposure to violence among refugee children from the Middle East, whose asylum seeking families either did or did not obtain permission to stay in Denmark. METHODS: Shortly after arrival in Denmark, the parents of 311 Middle-Eastern children answered a structured interview on their children's exposure to organized violence and their mental health. The families were followed-up as concerns receipt of a residence permit. RESULTS: At arrival in Denmark, the children's patterns of previous exposure to violence and present mental health was generally similar irrespective of the family getting a residence permit, as was the case for 90 families (60.4%) with 190 children (61.1%). In both groups an overwhelming majority, eight to nine out of 10 children, had been exposed to conditions of war and had stayed in a refugee camp, and seven out of 10 had witnessed violence. Half of the children had a tortured parent. Considerably more children of families who did not get a residence permit had lost a parent (30.6% versus 13.7%; P<0.001). In both groups about two-thirds suffered from anxiety and about 30% from sleep problems, and children whose families did not later on get a residence permit more often appeared sad or miserable (43.8% versus 27.9%; P<0.005). CONCLUSIONS: The asylum-granting decision process seems to have divided the children into two groups with only superficial disparity as concerns their previous exposure to violence and their present mental health. There seems to be good reason to systematically integrate evidence on the children of refugee families in the treatment of applications for permission to stay.

Adolescent↗
PubMed1983

Clinical illnesses and causes of death in a Burmese refugee camp in Bangladesh.

In 1978 almost 200 000 Burmese refugees entered Bangladesh. Thirteen camps were set up for refugees. Data for the camp at Leda is presented here. There were four medical clinics; including a diarrhoea clinic operated by the International Centre for Diarrhoeal Disease Research, Bangladesh. The four clinics recorded a total of 174 201 visits by the refugees, of which 28% were for watery diarrhoea, 32% for dysentery and 40% for other illnesses. Of 2321 diarrhoea stools cultured, 29.2% yielded pathogens of which 22% were Shigellae alone. Coliform count of water was extremely high. The death rate (89/1000/year) was higher than the birth rate (28/1000/year). Most of the deaths were among infants (640), children (357) and old people (131). Main causes of death were clinical diarrhoea (11.8%), fever (23%) and poor nutrition (52%). Prompt arrangements for food, identifying the vulnerable groups, and proper sanitation perhaps could have reduced the number of deaths considerably.

Adolescent↗
PubMed1987

Infant mortality and childhood nutritional status among Afghan refugees in Pakistan.

In 1984 and again in 1985, systematic surveys were undertaken to evaluate infant mortality and childhood nutritional status among the Afghan refugee population in Pakistan. The entire Afghan refugee population under the administration of the United Nations High Commissioner for Refugees was sampled. Infant mortality rates were estimated to be 156 per 1000 for 1984 and 119 per 1000 for 1985. A decline was also suggested in neonatal mortality rates from 61 per 1000 for 1984 to 46 per 1000 for 1985. For neither infant nor neonatal mortality was the difference statistically significant. Improvements were seen in the percentage of children who died before their fifth birthday (22.5% in 1984 and 18.8% in 1985), in the percentage of children who were malnourished (3.5% in 1984 and 2.3% in 1985), and an increase in the percentage of children above the WHO/NCHS/CDC weight-for-height reference median (26% in 1984 and 35% in 1985). Diarrhoea was the most frequently reported cause of death for both years and was a particularly important cause of death among one-year-old children. In 1985, measles was related to 24% of the deaths and neonatal tetanus to 9% of the deaths, an increase from 8% for measles and 6% for tetanus in 1984.

Afghanistan↗