War And Mental Health: Forced Displacement And Mental Health

SAFMH News Room


Key Terms

  • Refugee: someone who has been forced to flee his or her country because of persecution, war or violence. A refugee has a well-founded fear of persecution for reasons of race, religion, nationality, political opinion or membership in a particular social group.
  • Asylum Seeker: when people flee their own country and seek sanctuary in another country, they apply for asylum – the right to be recognised as a refugee and receive legal protection and assistance.
  • Migrant: while there is no formal legal definition of an international migrant, most experts agree that an international migrant is someone who changes his or her country of usual residence, irrespective of the reason for migration or legal status.
  • Host Country: the country of which a person of refugee status has resettled.

As someone who has migrated to another country, I am all too familiar with the sadness and anxieties of leaving the home you know and the loneliness that greets you in the place you will now call ‘home’. It was an experience unlike any other and yet, I was not forced to leave my home or my country, and I was certainly not facing the violence and hostilities of war.  I therefore chose to focus on the issue of forced displacement, war and mental health for this, the 3rd part of our 4-part series on “War and mental health”.

In June 2022 it was announced that there are more than 100 million people now forcibly displaced around the world, mostly through armed conflict and war. The ongoing war in Ukraine is what tipped the scales and now we have more people than ever before who have been forced to flee their homes.

Whilst the Russia-Ukraine war is at the forefront right now, the Council on Foreign Relations Global Conflict Tracker reports that there are currently 27 ongoing conflicts worldwide. The tracker also categorises these conflicts into three groups: unchanging, worsening and improving. Worryingly, none of the conflicts are described as “improving”.

Forced displacement is one of the world’s most challenging and pressing issues. Increasingly, nations have responded with an emphasis on the securitisation of migration and tightening of immigration policies over the rights and well-being of those who have been forced to flee their homes. This ABC News report sharing Mohammad Harb’s story is an example of the complex traumas those forcibly displaced face on their journey to find refuge.

“The global refugee crisis is a mental health catastrophe.” – Ellie Khan

In Part One of our War and Mental Health series, we reported that there were significantly more persons living with mental health disorders in areas affected by conflict than had previously been thought, with one in five persons being affected by some type of mental health disorder. Community studies done with recently resettled refugees confirms this estimate, listing depression, PTSD and other anxiety disorders as more common amongst refugee populations than that of non-war affected populations. The increased risk to mental health problems is linked to both experiences before fleeing (i.e. exposure to war trauma) and afterwards (i.e. stress of being in a new country, dealing with refugee processing, the treat of deportation).

The below video explains the many complexities that come with immigrant and refugee mental health very well.

Prevalence of mental illness amongst persons forcibly displaced

Despite the gaps in research and difficulties in gathering data, there have been a number of studies showing the prevalence of mental illness amongst refugee populations when compared to the host county. For example, refugees who have lived in a host country for more than five years tend to show higher rates of depressive and anxiety disorders than the host population. Some studies also indicate that the risk for forced migrants having a serious mental illness is higher in those fleeing from war than the general population of the host country. This is true even for those who have been resettled for several years, which suggests a significant and lasting impact of the war experience.

Whilst people might assume that refugees and asylum seekers would mostly be diagnosed with post-traumatic syndrome (PTSD), the WHO Regional Office for Europe reports that mood disorders such as depression are in fact more prevalent. Refugees and other forcibly displaced people may also be disproportionately affected by suicide risk.

The recently released WHO report on refugees and migrant health, describes the causes of developing mental illness after leaving one’s country as discrimination, missing family, and a lack of community support. Prevalence rates of mental illness are also dependent on how long refugees have spent in their host country, with the most recent estimates from the WHO finding that the burden of mental illness is up to 22.1% in “conflict affected populations”.

Their lives have been abruptly taken from them, they have lost control of their world and their security has been abruptly wrenched from them. Often they feel guilt and shame, as if they could have done something to prevent it, when they could not. The consequences for an entire population may take many years to resolve, if in some cases that is even possible. – Cheryl Johnson (Counsellor)

Children Are Most At Risk

In a study by Burgin et. al, the authors argue that younger migrants and adolescents who have experienced war and violence are more affected by poor mental health, which can mean long-term consequences for their development.  An article published in the European Journal of Public Health found that refugee children are facing severe psychological health issues. These include depression, sleep disorders, anxiety and PTSD.  

The threat of protracted conflict sees many parents making the difficult decision of sending their children on the perilous journey to find a better life, many of them alone. Studies have found that the impact of war on adolescents and children is “tremendous and pervasive” and can mean that children are at an increased risk for developing specific mental illnesses. Indeed, mental health professionals in host countries are struggling to deal with the issues related to refugee and asylum-seeking children, especially because of the number of child refugees coming through their borders.

Those children that do have a mental illness often have limited access to psychiatric healthcare services. A study in Denmark found that “only 3.5% of refugee children access psychiatric facilities compared to 7.7% of their Danish-born peers.” The barriers experienced by refugee children in accessing services are many including fears of discrimination, no awareness of services, and language barriers.

The below poem by 12-year old Abdullah reminds us that the effects of war go far beyond the physical destruction that we see. There are millions of Abdullah’s navigating the world today and it is imperative that we prioritise understanding the long-term mental health of refugee children to guide policies and promote long-term wellbeing.

What Can Be Done

A major issue that is furthering displacement has been the inability to find an answer for lasting peace around the world. The fact that wars have been allowed to ravage nations, devastating civilian populations for centuries, is the ugly reality facing the international protection regime right now.

Whilst there are three traditional durable solutions when it comes to forced displacement – voluntary return, local integration and third country resettlement – a majority of displaced persons are living in enduring displacement with no answers as to when they can return to their normal lives. This is why instead of focusing all resources on ending wars, we should instead focus on meaningful investment into safeguarding the mental health of a generation of people who have been robbed of their right to attain good mental wellbeing.

The WHO’s Global Action Plan (2019-2023) is a resource for Member States to use when trying to understand how they should meet the health needs of refugees and migrants. It also outlines the number of barriers that refugees and asylum seekers experience in accessing health-care services.

According to the experts, a comprehensive, multi-disciplinary and inclusive approach is what is needed to tackle the mental health needs of refugees and asylum seekers. These include:

  • Making mental health care available and easily accessible through general health care, taking into account language and cultural considerations.
  • International protocols ensuring continuity of care for refugees and asylum seekers as they move through different countries.
  • Migration laws that include detention, or the separation of families should be avoided. Host countries should ensure there are meaningful social integration policies that will allow forced migrants to feel part of the community.

Essam Daod is one of the only child psychiatrists working on the shorelines  in Greece and the Mediterranean. He is also a co-founder of Humanity Crew, one of the only organisations offering psychosocial support to people fleeing by sea. Whilst the work Essam and the Humanity Crew is doing is commendable, one can’t help but wonder why there aren’t more Essam’s in the world? Why are people who are fleeing the clutches of danger not being offered the emergency services, including mental health care, that they need? Why are they being treated like prisoners by the countries in which they arrive? These are the questions we must ask of our officials and of ourselves.

Often the debate around refugees and asylum seekers is framed as a security or economic issue; however, it is a human rights issue and we all need to do better to ensure the mental wellbeing of persons forcibly displaced is adequately supported and that they feel that their needs and fears are being heard. After all, in the words of Benjamin Zephaniah, “we can all be refugees”.

By Michel’le Donnelly – Project Leader: Advocacy & Awareness, SA Federation for Mental Health

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