The world now has a total of 70.8 million displaced people (United Nations Refugee Agency, 2021). For the millions of refugees fleeing from violence worldwide, obtaining access to health care is difficult. Even more difficult, and often overlooked, is mental health. According to the World Health Organization an estimated 272 million people migrated to settle elsewhere. Out of those 272 million people, thousands of them are refugees escaping from violence caused by their families, their community, or in many cases, violence created by their own government.
Violence manifests in many forms. The World Health Organization has deemed violence a global public health crisis. Over sixty-seven percent of refugees are described to be from conflict prone zones (United Nations Refugee Agency, 2018). Violence is often visible, in acts of terrorism or mass civil unrest, or invisible in cases of psychological harm. Most violence against women and girls is social or private, does not typically involve death, and is often, invisible. The World Health Organization’s definition of violence includes the term psychological harm to describe the structure of violence. Violence is: “the intentional use of physical force or power, threatened or actual, against oneself, another person, or against a group or community, that either results in or has a high likelihood of resulting in injury, death, psychological harm, maldevelopment or deprivation (World Health Organization, n.d). State violence is an instrument of political groups or arms of the state government that aim to silence dissidence, disenfranchised groups, and political opposition.
Social conflict is a driver for migration. Refugees are a primary result of the interchanging exchanges of power balancing in society where inequalities arise due to coercions and conflict of interests. Conflict is often ideological and is often based on a viewpoint on how the community the refugee is from, or the world, should be arranged. This can cause a lot of emotional and mental repercussions to the victims of conflict caused violence. There is a need for victims to understand and accept that these forms of violence from a specific viewpoint, which has disrupted their very lives, are no longer in their direct state.
Collective violence is violence committed in conflict to advance a particular agenda. These agendas can be economic, political, social, and produce conflicts that force migrations. Forms of collective violence committed by groups of people can develop into state sponsored violence, resulting in persecution or civil unrest. Refugees are the primary targets of such violence, and their effects last decades after individuals can leave the conflictual community they once inhabited. In most cases, violence is founded on physical and ethnic characteristics that the victim cannot change.
Multiple Factors and Identities
Discrimination and persecution based on gender, sex, or sexual orientation many times consists of torture. For LGBTQ+ refugees the higher rates of forced migration and the trauma caused by physical or psychological torture in private or public hands, in countries where the existence of LGBTQ+ is criminalized, results in a fear that was once daily. A fear that any day, they would be killed (Kostenius and Pelters, 2021).
In countries where refugees forcibly fled due to cultural conditions, such as proposed honor killings by family members, which proportionally affects girls more so than men, result in a trauma that shapes the future development of women and girls. These effects can become a familiar affair after relocation where the unwavering uncertainty of stability and poverty can increase the risk of depression and other forms of mental illnesses. Another factor, political persecution, persecution based on political opinion, often results in imprisonment in the refugee’s home country. The effects can manifest itself in the mental health of those who have escaped. A medical study conducted on former persecuted individuals from past communist countries in Southeastern Europe, “suggest that political detention may have long-term psychological consequences that outlast the changes in the political system”(Bichescu and Salpetsi et al, 2005). The consequences of imprisonment ranged from psychotic disorders to behavioral issues resulting from the traumatic experience of repression from human freedoms.
Refugees are facing a mental health crisis. Asylum seekers are at higher risk for long-term health effects when compared to the general population. Professor of Psychiatric and Social Epidemiology at University College London James Kirkbride, who conducted a large-scale study on the 1.3 million migrant people who arrived in Sweden in 2014, found that refugees, compared to other migrants who were not refugees, had a sixty-six percent higher rate of psychotic disorders (Kirkbride and Ullrich, 2014). Children were at a higher risk of developing these mental illnesses. In an analysis for the American Psychiatric Association, Dr. Susan Song and Dr. Sara Teichholtz, authored that in “about one out of three asylum seekers and refugees experience high rates of depression, anxiety, and post-traumatic stress disorder” (2017). For younger adults, the stressors caused by displacement, and the poverty and insecure housing that occurs when drastically relocating, have a disproportionate effect on their mental health.
Obstacles to Mental Health Care
In their new homes or places of settlement refugees are often provided with physical healthcare. Doctors from community volunteers or international organizations, such as the United Nations Refugee Agency, provide cures for physical illness and support for maternal care. Mental health is typically the last consideration in their care, especially in times of emergencies. Yet most migrants and refugees suffer from mental health illnesses such as post-traumatic stress disorder, depression, and other forms of mental health maladies. Let alone, these mental health illnesses can disrupt the refugee’s quality of life or develop into other forms of interpersonal conflict, or social violence, that the refugee themself was fleeing from.
As a global health issue, mental health is often spoken openly in community structures that offer a haven. Violence can be culturally defined. Social communities’ views on violence differ and what can be one act of violence in one society is not another act of violence in another. Refugees are migrants that are removing themselves from a type of violence that they view as urgent but might not view other types of violence as acts of violence. This includes intermarriage violence or acts of psychological harm. Another obstacle to mental health services for refugees is disclosure. Fear of losing opportunities, such as job prospects for disclosure, is frequent when refugees identify their mental care. In certain communities, sensitivities of masculinity cloud inter-personal judgements. This is a cause of resistance in seeking mental health care. The WHO’s definition assists with the global unification of identifying violence in its many forms. Nonetheless, barriers remain in identifying the harm caused by the refugee not identifying the violent psychological act itself from fears of loss prospects.
Access to mental healthcare should be a human right and made more accessible for the millions of refugees fleeing from violence every year. While strides have been made in identifying and providing mental healthcare to refugees in settlement camps, more assistance when resettled is needed. Refugees are victims of violence in its many forms. Identifying the barriers to mental health access is a first step in alleviating the mental anguish caused by the lasting trauma of societal induced violence. When addressing mental health, refugees enter the workforce at higher and quicker rates, and there is an increase in their overall life span. Ensuring the ability for refugees to settle safely, in all aspects of their health and wellbeing, provides refugees with the stability needed to live a new life.
It got me when you said that about one in three asylum seekers and refugees have been having depression, anxiety, and PTSD. I hope that there would be psychiatric counseling services available for them from the country they will be living in for now. It will be a huge help for them because they have been through so much and one of them is losing their home.
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Priscilla is an MPhil student in Latin American Studies, Politics and Economics. She researched and wrote this article as part of the Oxford University Micro Internship programme.