REFUGEES’ MENTAL HEALTH - UNHCR - The UN Refugee …

1 refugees MENTAL HEALTH2017 RESEARCH REPORTPSYCHOSOCIALINNOVATIONNETWORK(PIN) ISENGAGEDINTHEDESIGN,IMPLEMENTATIONANDEV ALUATIONOFDIFFERENTPSYCHOSOCIALINTERVENT IONSTHATAIMTOPROTECTREFUGEES ,ASYLUMSEEKERS ANDMIGRANTS *MENTALHEALTHANDTOENHANCETHEIREMOTIONAL, PSYCHOLOGICAL, ,PINCONDUCTSRESEARCHONREFUGEES MENTALHEALTHINORDERTOKEEPTRACKOFTRENDS,A SSESSPSYCHOLOGICALNEEDS,ENSUREEVIDENCE-B ASEDPRACTICEANDPROVIDEACTIONABLERECOMMEN DATIONSFORDELIVERINGADJUSTEDPSYCHOSOCIAL SUPPORT.* ,Forbetterreadabilityandsimplicity,thete rmrefugeewillbeusedthroughoutthetext, , ,ANXIETY, ,SIGNIFICANTLEVELSOFANXIETYAREPRESENTIN3 7%,WHILESYMPTOMSINDICATIVEFORPOST-TRAUMA TICSTRESSDISORDERAREPRESENTIN26% , ,81%AREAFFECTEDBYPOVERTY,MORETHAN70% , ,56% ,80% (primarilyinBelgrade,SjenicaandTutin).

2 , AND DATA ,withtheassistanceofinterpretersandcultu ralmediators,andtheresponseswererecorded intheTraumaticExperienceQuestionnaire,wh ichrepresentsacheck-listcontaining62most frequentandmostrelevanttraumaticexperien cesrefugeesmightfaceintheircountriesofor igin(42events)orduringtheirflight(19even ts).Giventhefactthatreportingontraumatic experiencesrequiresadequateconditionsand carriesariskofre-traumatization,theinter viewswereconductedbypsychologistswhohave establishedatrustingrelationshipwithther efugees, mentalhealth(N=261)wasconductedinrelatio ntothemostfrequentproblemsrefugeesaredea lingwith,thatis,post-traumaticstressdiso rder(PTSD), ,theRefugeeHealthScreener(RHS-15)wasused ,whichwasavailabletoPIN spsychologistsinEnglish,Farsi,Arabic, ,inaccordancewiththeinstructions,wasadmi nisteredbypsychologists,withtheassistanc eofinterpreters,orwasindependentlyfilled inbytherefugeeswhentherequiredconditions weremet(adequatelevelofliteracy,understa ndingoflanguageandtheinstructionsforfili ngthequestionnaire,etc.)

3 Foridentifyingindividualsatrisk,thatis,p sychologicallyvulnerableindividuals,inac cordancewithrecommendations,thecut-offsc oreof12wasused,butinordertoincreasethein strument ssensitivity,anadditionalcut-offscoreof2 4wasaddedforidentifyinghighlyvulnerablei ndividuals(doublethescoresufficientforid entifyingindividualsinneedofapsychologic alsupport).Forthesymptomatologycorrespon dingtoPTSD,depression, ,thatis,thesumvalueofscoresonallitemswhi ch,withmostsensitivityandpreciseness, ,suchascopingcapacity(partoftheRHS-15que stionnaire),subjectiveexperienceofwell-b eing,satisfactionwithlife,happiness,opti mism, ,inordertogaininsightintothedominantdiff icultiesduringtheirstayinSerbia,duringin terviewsandwithassistanceofinterpreters, therefugeesfilledinthePost-MigrationLivi ngDifficultiesQuestionnaire(PMLDQ),which isusedfordeterminingthelevelofexposureto variousdifficulties,suchas.

4 Discrimination,languagebarrier,unemploym ent,poverty,worryingaboutfamilymembersfr omwhomtheindividualisseparated, ,thisquestionnairewasgivenonlytoindividu alsthathadbeenstayinginSerbiaformorethan 6months, ( ), ,whereinthemostparticipantswereminorsage d15to17( ),followedbyyoungadultsagedfrom18to30( ).Themajorityofrefugeesparticipatinginth isresearchoriginatedfromAfghanistan(N=42 9),Iran(N=36),Pakistan(N=33),Syria(N=26) ,Iraq(N=12),Cuba(N=6),whileothersorigina tedfromSudan,Algeria,NigeriaandSomalia(o nepersonpercountry).Themajorityofrefugee swereofIslamicreligiousdenomination(97%) ,andthesampleincludedmorethan20ethnicgro ups(Afghans,Hazaras,Pashtuns,Arabs,Kurds ,Urdu,Tajiks,Maliks,Luris,Cubans,etc.).T hemajorityofthemweresingle, ( ).Atthemomentofdatacollection,themajorit yofrefugeesandmigrantswereonflightbetwee n10to18months,andhadpassedontheirwaythro ughTurkey( ),Iran( ),Bulgaria( ),Pakistan( ),Greece( ),Macedonia( ),butalsoAlbania,Montenegro,Russia,Afgha nistan,Chad,Sudan,Iraq,KyrgyzstanandTaji kistan(lessthan1%).

5 , , ,ofonesfleeingwithafamilymember, , , , , , ( )orcousins( ),whileasmallernumberleftchildren( )oraspouse( ).Finally, (havenoearningsnorreceivemoneyfromanothe rperson), ,especiallythosethatcomefromwar-affected countries, scountryoforigin(pre-migrationtrauma),th osethathappenedonroutefromcountryoforigi n(migrationtrauma)andthosethathappenedin thedestinationcountry(post-migrationtrau ma).Regardlessofwhenthetraumaticeventtoo kplace,itcanhaveasignificantimpactonone EXPERIENCES IN THE COUNTRY OF ORIGIN Onaverage, ,only7%experiencedonetraumaticevent,whil e80% (84%) ,mining,bombing, , , was forced to leave the country of was forced to stay at home or hide due to external burning or destruction of inhabited or uninhabited witnessed beating or torture experienced murder or violent death of a family member or a friend s family member or a close friend participated in military was exposed to a minefield or has witnessed mining of building or experienced beating saw mutilated individuals ordecaying corpses was was exposed to frequent or continuous sniper fire was denied access tomedical removed the wounded or the dead s family member or a close friend is missing or was kidnapped and/or held was robbed, or its property was seized, burnt.

6 Or destroyed participated in combat ( open fire, explosions, shelling) witnessed mass execution of was present while someone searchestheir apartment for things or other individuals experienced extortion or witnessed desecration ordestruction of places of experienced claiming the body of a family member but being prevented from grieving or burying the deceased in a proper in captivity the, individual had experienced torture, Intentional and systematic infliction of physical or MENTAL was denied access to food or survived an attack with a cold experienced not having a place to was forced to give up the individual and thus endanger their safety or the safety of their family was subjected to forced was in witnessed arrest, kidnapping.

7 Torture or execution of religious leaders or other important members of the community was exiled from the country due to ethnic origin or religious participated in military suffered a severe bodily injury as a result of combat in captivity, individualwas keptin solitary confinement/was prevented from moving or sleeping or satisfying physiological needs, or was kept inunhygienic was kidnapped and/or held hostage was forced to join the s family member or a close friend was raped was forced into was forced to betray someone orphysically hurt someone witnessed rape or sexual abuse was forced to destroy someone s property or experienced sexual abuse was raped< 1%Individual was forced into prostitution < 1% , ,adultshadthehigherchanceofbeingforcedto jointhearmy,witnessbeatingsortorture, ,onaverage, , ,womenaremorefrequentlysubjectedtosexual andgender-basedviolence( ,forcedmarriages,sexualexploitation,etc. )

8 Finally,inthecountryoforigin,womenweremo repronetoexperiencinglackoffoodandwater, EXPERIENCES DURING , ,over80%ofrefugeeswereinacertainlife-thr eateningsituation, ,andthuswereforcedtospendanightorseveral daysinopen, flight, the individual did not have enough food or water flight, the individual did not have a was in a life-threatening situation during individual spent time in prison or captivity after leaving the country of origin flight, the individual experienced discrimination flight, the individual experienced psychological violence (insults, humiliation, threats, etc.) flight, the individual experienced unlawful or forcible seizure of personal property or money flight, the individual wasdenied relevant information by the police flight, the individual experienced physical violence smuggler did nothold up to his end of the deal( for additional money or did not bring the individual to the agreed place) flight, the individual experienced being lost, , did not know where they are or where to flight, the individual suffered a severe bodily injury captivity, the individual experienced inhumane conditions (no food, water, heating, bed, freedom of movement within the space, sufficient conditions for maintaining personal hygiene, medical assistance, etc.)

9 Individual was deported / captivity, the individual was denied legal rights (captivity without legal basis, without legal help and protection, the individual was not released within legal time frame, etc.) flight, the individual was separated from their family members or close flight, the individual experienced death of close smuggler asked for additional services from the individual ( carrying narcotics over border, recruitment of others, presenting children as their own) flight, the individual experienced sexual , ,andover90% (Vuk evi ,Dobri ,&Puri ,2014), ,thepercentageoftheindividualswhoexperie ncedspendingcertaintimeintheopenorwithou tsafehideoutincreasedfrom67%in2014to81% ,thepercentageofindividualsexperiencingd eportationorpush-backtothepreviouscountr yhasincreasedfrom38%to48%.

10 Thereisalsoanalarmingtrendofanincreasedn umberofseverebodilyinjuriesduringflight( ).Therefore,thepercentageofindividualswh osufferedaseverebodilyinjuryhasincreased from38%in2014toover50% , ,70%ofrefugeeshavespentsometimeduringthe irflightinprisonorcaptivity,andmorethana halfhave,duringcaptivity, ,childrenareespeciallyendangered,andthey experience,onaverage, ,moreoftensufferseriousbodilyinjuries, ,menweremorefrequentlyvictimsofphysicalv iolencethanwomen, ,theywereimprisonedwithoutlegalbasisand/ ,itappearsthatthemostvulnerablegroupareu nderageboys, , ,itisratherarulethananexceptionthataboym ightbedetainedorimprisonedduringthefligh t( ),aswellasexperiencingphysicalviolencemu ltipletimes( ). , a, , id, evo, evci, , , a, a, ,< , ,aswellasstressfullifeexperiences,posean egativeimpactonone ,andespeciallyrefuge,posesnumerouschalle ngesforone ,andtraumaticeventsinthecountriesoforigi n,followedbyfleeingthehomecountryandthed ifficultiesfacedduringtheflightononehand , mentalhealthinSerbiain2014hasshownthatth esymptomatologyofthemostfrequentpsycholo gicalhardshipsisveryprominent,withover2/ 3ofrefugeesshowingsignificantsymptomsofd epression,anxiety, ,theassessmentofmentalhealthisadjustedco mparedtorecommendedinstrumentsforworking withrefugeesfrom2014(seethesection:Resea rchMethodology).