Asylum seekers and refugees’ perspectives and experiences of what makes Glasgow welcoming

Longing for Stillness: The Forced Movement of Asylum Seekers

Purpose – The purpose of this paper is to highlight the key issues of concern for asylum seekers in the UK by focusing on their in depth talk about their experiences, a so far neglected element in the current debate about asylum seeking. Design/methodology/approach – The study involved thematic analysis of asylum seekers’ accounts of their lives in their country of origin, their journeys to the UK and experiences following arrival. Nine participants took part in semi-structured interviews. Findings – Analysis resulted in seven themes; the importance of safety, negative experiences of the Home Office, support, emotional effects, significance of family, hopes for the future and the positive experiences of living in the UK. Research limitations/implications – Asylum seekers largely left their countries of origin to escape conflict, persecution, violence, arranged marriages and rape. They reported safety as a key concern and for this reason they were scared to return home. Practical implications – The research found Asylum seekers have fled traumatic situations and then have a difficult time in the UK. A more compassionate and supportive approach is needed. Policy recommendations are made with the aim of improving service responses. Social implications – The research demonstrates that the public understanding of asylum seeking does not match asylum seekers’ experiences and increased knowledge may help to improve this (mis) understanding. Originality/value – There is currently a lack of literature and empirical investigation of this subject area, so this research makes a contribution to the field of understanding asylum seekers’ experiences. The paper's focus is original and important combining asylum seekers’ accounts of their experiences following arrival in the UK. This subject is strategically important due to the pressing need to develop holistic and culturally sensitive research, which bridges and informs academia, more sensitive service responses and civil society.

<p dir="ltr">Asylum seekers and recently resettled refugees are at an increased risk of poor mental health. Besides pre-migration experiences, the early post-migration period in host countries presents numerous challenges that can negatively impact their mental health and well-being, including challenges such as poor housing, and socioeconomic difficulties. Additionally, Sweden has adopted more restrictive migration policies, which risk leading to a growing tension between mental health needs and the policy objectives of reducing migration. Gaining a deeper understanding of day-to-day challenges faced during the early post- migration period is crucial to effectively address and mitigate their potential adverse impact on the mental health of asylum seekers and refugees.</p><p dir="ltr">Study I, a cross-sectional population-based survey, utilized the generic EQ-5D- 5L scale to assess the health-related quality of life index value in a study population of 1,215 individuals from Syria who recently resettled in Sweden. The results showed that the most frequently reported problem on the EQ-5D-5L scale was depression/anxiety, and a low index value was associated with being a woman, older age, and low social support. Study II is a qualitative study based on semi-structured interviews with fourteen asylum seekers at two accommodation centers in Sweden, exploring their experiences of living in these centers. The results indicated that their experiences were heavily influenced by the uncertainty of the asylum process and the constraints imposed by limited resources and housing conditions, often described as living a frozen life. This frozen life was a source of constant worry, leading to concerns about potential long-term effects on their health. Despite these challenges, the asylum seekers highlighted care practices that arose spontaneously among the residents, reflecting a shared concern for each other's well-being. Study III, a qualitative study utilizing the same data collection process used in Study II, explored the experiences of asylum seekers during the COVID-19 pandemic. The findings revealed that the living conditions at the centers shaped how the pandemic was experienced. The asylum seekers reported feeling increasingly excluded from society, a sentiment reinforced by a pandemic response from authorities that was perceived as lacking understanding or care for their unique situation. Study IV is a register-based prospective longitudinal cohort study that includes all adult asylum seekers who received residence permits between 2010 and 2012. The study investigated the association between housing type during the asylum process (institutional or self-organized) and the prescriptions of antidepressants or anxiolytic medication, as well as specialized in- and outpatient visits with diagnoses of CMDs, over a five-year follow-up period after being granted refugee status. The results indicated that individuals who had lived in institutional housing were at greater risk of having more prescriptions for antidepressants or anxiolytic medication, as well as a higher likelihood of specialized in- and outpatient visits with diagnoses of CMDs, compared to those who had lived in self-organized housing.</p><p dir="ltr">The thesis emphasizes the importance of post-migration living conditions in shaping the mental health of asylum seekers and refugees in Sweden, with a particular focus on the asylum process and housing as key factors associated with distress. It also suggests that collective institutional accommodation tends to be more harmful to mental health than self-organized housing. Overall, the findings advocate for context-sensitive interventions addressing individual, community, and structural factors, with a focus on improving housing conditions, alleviating day-to-day challenges, and strengthening social support networks to prevent long-term mental health issues. Additionally, the thesis also calls for a transparent and fast-tracked asylum process.</p><h3>List of scientific papers</h3><p dir="ltr">I. Gottvall, M., Sjölund, S., <b>Arwidson, C.</b>, & Saboonchi, F. (2020). Health-related quality of life among Syrian refugees resettled in Sweden. Quality of Life Research. <a href="https://doi.org/10.1007/s11136-019-02323-5" rel="noreferrer" target="_blank">https://doi.org/10.1007/s11136-019-02323-5</a></p><p dir="ltr">II. <b>van Eggermont Arwidson, C.</b>, Holmgren, J., Gottberg, K., Tinghög, P., & Eriksson, H. (2022). Living a frozen life: a qualitative study on asylum seekers' experiences and care practices at accommodation centers in Sweden. Conflict and Health 2022, 16(1):1-47. <a href="https://doi.org/10.1186/s13031-022-00480-y" rel="noreferrer" target="_blank">https://doi.org/10.1186/s13031-022-00480-y</a></p><p dir="ltr">III. <b>van Eggermont Arwidson, C.</b>, Holmgren, J., Tinghög, P., Eriksson, H., & Gottberg, K. (2024). (Over)crowded house: exploring asylum seekers' experiences of the COVID-19 pandemic while living at accommodation centers in Sweden. BMC Public Health, 24(1): 622. <a href="https://doi.org/10.1186/s12889-024-18089-6" rel="noreferrer" target="_blank">https://doi.org/10.1186/s12889-024-18089-6</a></p><p dir="ltr">IV. <b>van Eggermont Arwidson, C.</b>, Holmgren, J., Gottberg, K., & Tinghög, P. Housing during the asylum process and its association with healthcare utilization for common mental disorders among refugees in Sweden: A nationwide cohort study. [Submitted]</p>

<p dir="ltr">Asylum seekers and recently resettled refugees are at an increased risk of poor mental health. Besides pre-migration experiences, the early post-migration period in host countries presents numerous challenges that can negatively impact their mental health and well-being, including challenges such as poor housing, and socioeconomic difficulties. Additionally, Sweden has adopted more restrictive migration policies, which risk leading to a growing tension between mental health needs and the policy objectives of reducing migration. Gaining a deeper understanding of day-to-day challenges faced during the early post- migration period is crucial to effectively address and mitigate their potential adverse impact on the mental health of asylum seekers and refugees.</p><p dir="ltr"><b>Study I</b>, a cross-sectional population-based survey, utilized the generic EQ-5D- 5L scale to assess the health-related quality of life index value in a study population of 1,215 individuals from Syria who recently resettled in Sweden. The results showed that the most frequently reported problem on the EQ-5D-5L scale was depression/anxiety, and a low index value was associated with being a woman, older age, and low social support. <b>Study II</b> is a qualitative study based on semi-structured interviews with fourteen asylum seekers at two accommodation centers in Sweden, exploring their experiences of living in these centers. The results indicated that their experiences were heavily influenced by the uncertainty of the asylum process and the constraints imposed by limited resources and housing conditions, often described as living a frozen life. This frozen life was a source of constant worry, leading to concerns about potential long-term effects on their health. Despite these challenges, the asylum seekers highlighted care practices that arose spontaneously among the residents, reflecting a shared concern for each other's well-being. <b>Study III</b>, a qualitative study utilizing the same data collection process used in Study II, explored the experiences of asylum seekers during the COVID-19 pandemic. The findings revealed that the living conditions at the centers shaped how the pandemic was experienced. The asylum seekers reported feeling increasingly excluded from society, a sentiment reinforced by a pandemic response from authorities that was perceived as lacking understanding or care for their unique situation. <b>Study IV</b> is a register-based prospective longitudinal cohort study that includes all adult asylum seekers who received residence permits between 2010 and 2012. The study investigated the association between housing type during the asylum process (institutional or self-organized) and the prescriptions of antidepressants or anxiolytic medication, as well as specialized in- and outpatient visits with diagnoses of CMDs, over a five-year follow-up period after being granted refugee status. The results indicated that individuals who had lived in institutional housing were at greater risk of having more prescriptions for antidepressants or anxiolytic medication, as well as a higher likelihood of specialized in- and outpatient visits with diagnoses of CMDs, compared to those who had lived in self-organized housing.</p><p dir="ltr">The thesis emphasizes the importance of post-migration living conditions in shaping the mental health of asylum seekers and refugees in Sweden, with a particular focus on the asylum process and housing as key factors associated with distress. It also suggests that collective institutional accommodation tends to be more harmful to mental health than self-organized housing. Overall, the findings advocate for context-sensitive interventions addressing individual, community, and structural factors, with a focus on improving housing conditions, alleviating day-to-day challenges, and strengthening social support networks to prevent long-term mental health issues. Additionally, the thesis also calls for a transparent and fast-tracked asylum process.</p><h3>List of scientific papers</h3><p dir="ltr">I. Gottvall, M., Sjölund, S., <b>Arwidson, C.</b>, & Saboonchi, F. (2020). Health-related quality of life among Syrian refugees resettled in Sweden. Quality of Life Research. <a href="https://doi.org/10.1007/s11136-019-02323-5" rel="noreferrer" target="_blank">https://doi.org/10.1007/s11136-019-02323-5</a></p><p dir="ltr">II. <b>van Eggermont Arwidson, C.</b>, Holmgren, J., Gottberg, K., Tinghög, P., & Eriksson, H. (2022). Living a frozen life: a qualitative study on asylum seekers' experiences and care practices at accommodation centers in Sweden. Conflict and Health 2022, 16(1):1-47. <a href="https://doi.org/10.1186/s13031-022-00480-y" rel="noreferrer" target="_blank">https://doi.org/10.1186/s13031-022-00480-y</a></p><p dir="ltr">III. <b>van Eggermont Arwidson, C.</b>, Holmgren, J., Tinghög, P., Eriksson, H., & Gottberg, K. (2024). (Over)crowded house: exploring asylum seekers' experiences of the COVID-19 pandemic while living at accommodation centers in Sweden. BMC Public Health, 24(1): 622. <a href="https://doi.org/10.1186/s12889-024-18089-6" rel="noreferrer" target="_blank">https://doi.org/10.1186/s12889-024-18089-6</a></p><p dir="ltr">IV. <b>van Eggermont Arwidson, C.</b>, Holmgren, J., Gottberg, K., & Tinghög, P. Housing during the asylum process and its association with healthcare utilization for common mental disorders among refugees in Sweden: A nationwide cohort study. [Submitted]</p>

BackgroundForced migrants fleeing conflict and violence face a high risk of mental health problems due to experiences before displacement, perilous journeys, and conditions in the new host societies. Asylum seekers seem to be in particularly vulnerable situations, indicated by higher prevalence rates of mental health problems compared to resettled refugees. Asylum seekers’ mental health is highly influenced by the conditions they face in host countries while awaiting a decision on their case. In Sweden, 40% of asylum seekers reside in state-provided accommodation centers during the asylum process. Collective accommodation centers for asylum seekers have been said to impose restrictive social conditions and to be associated with poorer mental health outcomes than other housing forms (e.g., self-organized housing). However, there seems to be a scarcity of qualitative studies exploring the experiences of asylum seekers in different contexts. The aim of this study was therefore to explore the experiences of asylum seekers and how they manage their mental wellbeing while living at accommodation centers in Sweden.MethodsFourteen semi-structured interviews with asylum seekers were conducted at two accommodation centers in Sweden. Participants were recruited using purposeful sampling and represented a diverse group of asylum seekers regarding age, background, and gender. The data was analyzed using content analysis.ResultsThree overarching categories were identified; 1) Frozen life, 2) Constant worrying and “overthinking”, and 3) Distractions and peer support. Participants experienced a state of being that could be characterized as a frozen life, which was associated with intense feelings of psychological distress, mostly described as manifesting itself in consuming patterns of ruminative thoughts, for instance overthinking and constant worrying. However, despite high levels of distress, participants demonstrated agency in managing negative mental health outcomes through self-care practices, peer support, and the development of care practices in caring for others in need.ConclusionThis study offers new insights into the everyday challenges that asylum seekers at accommodation centers face. Furthermore, it offers valuable observations of how asylum seekers at accommodation centers cope through self-care practices, peer support, and care practices in caring for peers in need. In order to enable sustainable and empowering support, mental health and psychosocial support services must identify and address both challenges and strengths, be grounded in the lived reality of asylum seekers, and build on existing resources. Moreover, further policy work needs to be done to enable faster asylum processes.

<p dir="ltr">Asylum seekers and recently resettled refugees are at an increased risk of poor mental health. Besides pre-migration experiences, the early post-migration period in host countries presents numerous challenges that can negatively impact their mental health and well-being, including challenges such as poor housing, and socioeconomic difficulties. Additionally, Sweden has adopted more restrictive migration policies, which risk leading to a growing tension between mental health needs and the policy objectives of reducing migration. Gaining a deeper understanding of day-to-day challenges faced during the early post- migration period is crucial to effectively address and mitigate their potential adverse impact on the mental health of asylum seekers and refugees.</p><p dir="ltr"><b>Study I</b>, a cross-sectional population-based survey, utilized the generic EQ-5D- 5L scale to assess the health-related quality of life index value in a study population of 1,215 individuals from Syria who recently resettled in Sweden. The results showed that the most frequently reported problem on the EQ-5D-5L scale was depression/anxiety, and a low index value was associated with being a woman, older age, and low social support. <b>Study II</b> is a qualitative study based on semi-structured interviews with fourteen asylum seekers at two accommodation centers in Sweden, exploring their experiences of living in these centers. The results indicated that their experiences were heavily influenced by the uncertainty of the asylum process and the constraints imposed by limited resources and housing conditions, often described as living a frozen life. This frozen life was a source of constant worry, leading to concerns about potential long-term effects on their health. Despite these challenges, the asylum seekers highlighted care practices that arose spontaneously among the residents, reflecting a shared concern for each other's well-being. <b>Study III</b>, a qualitative study utilizing the same data collection process used in Study II, explored the experiences of asylum seekers during the COVID-19 pandemic. The findings revealed that the living conditions at the centers shaped how the pandemic was experienced. The asylum seekers reported feeling increasingly excluded from society, a sentiment reinforced by a pandemic response from authorities that was perceived as lacking understanding or care for their unique situation. <b>Study IV</b> is a register-based prospective longitudinal cohort study that includes all adult asylum seekers who received residence permits between 2010 and 2012. The study investigated the association between housing type during the asylum process (institutional or self-organized) and the prescriptions of antidepressants or anxiolytic medication, as well as specialized in- and outpatient visits with diagnoses of CMDs, over a five-year follow-up period after being granted refugee status. The results indicated that individuals who had lived in institutional housing were at greater risk of having more prescriptions for antidepressants or anxiolytic medication, as well as a higher likelihood of specialized in- and outpatient visits with diagnoses of CMDs, compared to those who had lived in self-organized housing.</p><p dir="ltr">The thesis emphasizes the importance of post-migration living conditions in shaping the mental health of asylum seekers and refugees in Sweden, with a particular focus on the asylum process and housing as key factors associated with distress. It also suggests that collective institutional accommodation tends to be more harmful to mental health than self-organized housing. Overall, the findings advocate for context-sensitive interventions addressing individual, community, and structural factors, with a focus on improving housing conditions, alleviating day-to-day challenges, and strengthening social support networks to prevent long-term mental health issues. Additionally, the thesis also calls for a transparent and fast-tracked asylum process.</p><h3>List of scientific papers</h3><p dir="ltr">I. Gottvall, M., Sjölund, S., <b>Arwidson, C.</b>, & Saboonchi, F. (2020). Health-related quality of life among Syrian refugees resettled in Sweden. Quality of Life Research. <a href="https://doi.org/10.1007/s11136-019-02323-5" rel="noreferrer" target="_blank">https://doi.org/10.1007/s11136-019-02323-5</a></p><p dir="ltr">II. <b>van Eggermont Arwidson, C.</b>, Holmgren, J., Gottberg, K., Tinghög, P., & Eriksson, H. (2022). Living a frozen life: a qualitative study on asylum seekers' experiences and care practices at accommodation centers in Sweden. Conflict and Health 2022, 16(1):1-47. <a href="https://doi.org/10.1186/s13031-022-00480-y" rel="noreferrer" target="_blank">https://doi.org/10.1186/s13031-022-00480-y</a></p><p dir="ltr">III. <b>van Eggermont Arwidson, C.</b>, Holmgren, J., Tinghög, P., Eriksson, H., & Gottberg, K. (2024). (Over)crowded house: exploring asylum seekers' experiences of the COVID-19 pandemic while living at accommodation centers in Sweden. BMC Public Health, 24(1): 622. <a href="https://doi.org/10.1186/s12889-024-18089-6" rel="noreferrer" target="_blank">https://doi.org/10.1186/s12889-024-18089-6</a></p><p dir="ltr">IV. <b>van Eggermont Arwidson, C.</b>, Holmgren, J., Gottberg, K., & Tinghög, P. Housing during the asylum process and its association with healthcare utilization for common mental disorders among refugees in Sweden: A nationwide cohort study. [Submitted]</p>

This paper shows how asylum seeker accommodation produces a politics of discomfort among both asylum seekers as well as local residents. The paper compares two collective asylum centres located in the city of Augsburg, Germany, one of which is a nationally renowned refugee integration project, the ‘Grandhotel Cosmopolis’, the other, a state-run asylum centre. Data was obtained through participant observation and semi-structured interviews between September 2016 and November 2017. Drawing on carceral geographies, the paper identifies three mechanisms through which the material and institutional standards of asylum accommodation generate discomfort among and between asylum seekers and local residents, which are self-mortification, depersonalization and role-breakdown. Through the sharing of rooms and facilities, asylum accommodation contributes to asylum seekers' self-mortification, referring to changes in the conceptions and beliefs of oneself. The comparison of the two cases highlights how large asylum centres depersonalize asylum seekers by creating images of a homogenized ‘mass’ and contribute to role-breakdown, meaning a reduction of individuals' identities performed with regard to work, home or family life. National discourses of asylum seekers as dangerous merged with the space of asylum accommodation, thereby preventing social interaction ‘as neighbours’ between asylum seekers and local residents. Overall, the paper exposes how a politics of discomfort utilizes affect as a governmental device, thereby turning asylum accommodation into a carceral space by creating social distance and ‘moral closure’.

Social structures are intangible forms of human organisation in which people's everyday lives occur. They are therefore integral to understanding human experiences. Australia's policy context is a social structure that excludes asylum seekers from conditions that would fulfil their human rights. This research, using constructivist grounded theory methods, aims to understand the mechanisms through which Australia's policies contribute to the everyday life experiences of people seeking asylum in Australia. Participant observations took place in one detention centre and across two organisational settings in the community. Asylum seekers and those who work with them participated in informal key-informant interviews, formal semi-structured interviews, and surveys. Particular policy documents were reviewed, selected on their applicability to asylum seekers and their relevance to asylum seeker statuses. The ‘Structural-Personal Interaction Process’ was identified through analysis of the data. It illustrates interactions between structures (status and policy), and human beings (personal characteristics) to create human experiences. This process uses the participants’ language, which differs from human rights language. It explains how asylum seekers are assigned a status that determines relevant policies, which in turn, shape the situations that they encounter. These situations interact with individual personal characteristics to contribute to human experiences. Policies and situations that harm and protect asylum seekers are identified. Human experiences that result from the Structural-Personal Interaction are distributed along a continuum that spans from suffering (mental distress and having ‘nothing to do’) through to wellbeing (feeling hopeful, feeling safe, and 'having something to do'), referred to in this thesis as the suffering-wellbeing continuum. Drawing on this empirical analysis and existing theories, conceptualisations of suffering, wellbeing, harming, and protecting are explored. Mechanisms through which policies affect asylum seekers' everyday human experiences are considered in terms of emotional responses and engagement in meaningful activities. Each person's human experiences are unique, created out of an interaction between social structures and personal characteristics. Yet, a pattern of predominantly harming policies contribute to harming situations which are linked to a tendency for most asylum seekers' human experiences to lie in the suffering zone on the continuum, especially for people assigned the status 'person in detention'. This pattern illustrates the structural violence inflicted upon asylum seekers. Engagement in meaningful activities is a concept that flows from policy to human experience. The concept of engagement in meaningful activities embodies the human rights to engage in work, housing and privacy, education, welfare, freedom of movement, self-expression, an adequate standard of living, physical and mental health, dignity and freedom from cruel treatment, and participation in cultural life. Nonetheless, this research found that asylum seekers tend to have 'nothing to do'. The tendency for Australia's asylum seeker policies to be harming, contributing to harming situations, with asylum seekers' experiences lying predominantly in the suffering zone of the suffering-wellbeing continuum, provides a concrete example of how structural violence occurs. The Structural-Personal Interaction Process offers new insights into mechanisms through which status and policy structures contribute to situations that interact with asylum seekers personal attributes to shape their human experiences.

Purpose – This paper studies the experiences of asylum seekers in Australia. The purpose of this paper is to explore the relationship between mental wellbeing, living conditions, and Australia’s detention policies in light of human rights. Design/methodology/approach – Using grounded theory, data were collected via observations, semi-structured interviews, key-informant interviews, and document analysis. Participants included seven asylum seekers and three professionals working with them. Findings – In light of a human rights framework, this paper reports on the mental distress suffered by asylum seekers in detention, the environments of constraint in which they live, and aspects of detention centre policy that contribute to these environments. The findings highlight a discrepancy between asylum seekers’ experiences under immigration detention policy and Australia’s human rights obligations. Research limitations/implications – This research indicates human rights violations for asylum seekers in detention in Australia. This research project involved a small number of participants and recommends systemic review of the policy and practices that affect asylum seekers’ mental health including larger numbers of participants. Consideration is made of alternatives to detention as well as improving detention centre conditions. The World Health Organization’s Quality Rights Tool Kit might provide the basis for a framework to review Australia’s immigration detention system with particular focus on the poor mental wellbeing of asylum seekers in detention. Originality/value – This study links international human rights law and Australian immigration detention policies and practices with daily life experiences of suffering mental distress within environments of constraint and isolation. It identifies asylum seekers as a vulnerable population with respect to human rights and mental wellbeing. Of particular value is the inclusion of asylum seekers themselves in interviews.

Asylum seekers are required to narrate past experiences to the UK Home Office, doctors, lawyers and psychologists as part of their claims for international protection. The Home Office often cites perceived inconsistencies in asylum interviews as grounds for refusal of their claims. A number of processes affect asylum seekers' abilities to narrate past experiences fully to the professionals interviewing them. The dilemmas around disclosure that asylum seekers face have received little attention to date. This work aims to explore the perspectives of UK-based medico-legal report-writing doctors, lawyers and psychologists whose work involves eliciting narratives from asylum seekers on the processes that affect asylum seekers' abilities to disclose sensitive personal information in interview settings. Eighteen professionals participated in semi-structured interviews in individual or focus group settings to discuss, from their perspectives of extensive collective professional experience, the narrative dilemmas experienced by asylum seekers with whom they have worked. Professionals identified a number of processes that made disclosure of personal information difficult for asylum seekers. These included asylum seekers' lack of trust towards the professionals conducting the interview, unclear ideas around pertinence of information for interviewers, feelings of fear, shame and guilt related to suspicions around collusions between UK and their country-of-origin's authorities, sexual trauma and, occasionally, their own involvement or collusion in crimes against others. Recommendations are made on how to improve the interview environment to encourage disclosure. These have important implications for future research and policy initiatives.

The influx of undocumented migrants and asylum seekers into Lithuania, particularly during the COVID-19 pandemic, presents unique public health challenges. This study employs the Social Determinants of Health framework to explore the healthcare and social needs of this vulnerable population. In May 2022, we carried out a qualitative study through semi-structured interviews with asylum seekers across four centers in Lithuania. Employing both purposive and snowball sampling techniques, we selected participants for our investigation. The study comprised 21 interviews-19 conducted in Arabic and 2 in English-with durations ranging between 20 and 40 min each. We audio-recorded all interviews, transcribed them verbatim, and subsequently performed a thematic analysis using Atlas.ti software. This process of design and analysis strictly followed the principles of thematic analysis as outlined by Braun and Clarke, guaranteeing methodological precision and rigor. 21 interviews revealed critical insights into the healthcare access challenges, mental health issues, and social integration barriers faced by the participants. Key themes included 'Healthcare Needs and the Impact of the COVID-19 Pandemic 'and 'Social needs and Aspirations Amidst Pandemic-Induced Uncertainty '. The findings highlight the multifaceted healthcare and social needs of asylum seekers, juxtaposed against significant barriers they face. Access to medical services is hindered by long waiting times and financial constraints, especially for specialized care such as dental services. Communication issues during medical appointments due to language barriers and the lack of gender-specific healthcare, such as access to gynecological services, further exacerbate the challenges. Additionally, the COVID-19 pandemic introduces hurdles such as limited testing, isolation measures, language-specific information barriers, and insufficient social distancing practices. Mental health has emerged as a critical concern, with asylum seekers reporting significant stress and emotional exhaustion due to uncertainty and restrictive living conditions. Social needs extend to delayed asylum application processes, inconsistent language education opportunities, inadequate clothing, and nutrition that lacks cultural sensitivity, and living conditions characterized by overcrowding and insufficient facilities. The restricted freedom of movement within asylum seeking centres severely impacts their psychological well-being, underscoring a deep longing for autonomy and a better life despite the myriad of challenges faced. The study illustrates the complex interplay between migration, health, and social factors in the context of a global pandemic. It highlights the need for culturally sensitive healthcare services, mental health support, and structured language education programs. Offering educational avenues alongside language courses for children and adults is essential for fostering social inclusion and securing economic prosperity. Addressing the challenge of language barriers is of utmost importance, as these barriers significantly impede undocumented migrants' and asylum seekers employment opportunities and their access to crucial services. The findings emphasized immigration as a health determinant and underscored the importance of inclusive health policies and advocacy for undocumented migrants and asylum seekers' rights and needs. There is an urgent need for comprehensive policies and practices that are grounded in the principles of equity, compassion, and human rights. Additionally, advocating for practice adaptations that are culturally sensitive, linguistically inclusive, and responsive to the unique challenges faced by undocumented migrants and asylum seekers. As global migration continues to rise, these findings are crucial for informing public health strategies and social services that cater to the diverse needs of this vulnerable population.

Using civil sphere theory, this chapter investigates the role of Australian doctors in civil repair in relation to asylum seekers. Doctors take professional and personal risks in speaking out over terrible conditions in detention centers and critiquing repressive asylum seeker policies. Analysis of media reporting, websites, and doctors’ testimony at public hearings, reveals that visceral experiences with asylum seekers, and institutional supports like medical associations and broader social networks, motivate and support doctors in their acts of civil repair. Promoting solidarity with asylum seekers through symbolic and material actions, doctors instantiate a cosmopolitan ideal in relation to all who seek refuge in Australia, no matter how they arrive. Even if, in the present, the narratives of care and responsibility promoted by “righteous doctors” within broader networks of solidarity with asylum seekers fail to shift government policy, they provide resources to overcome civil indifference toward the suffering of others.

To determine whether community-based asylum seekers experience difficulty in gaining access to primary health care services, and to determine the impact of any difficulties described. Qualitative study using semi-structured interviews between September and November 2010. Participants were community-based asylum seekers who attended the Asylum Seekers Centre of New South Wales, and health care practitioners and staff from the Asylum Seekers Centre and the NSW Refugee Health Service. We interviewed 12 asylum seekers, three nurses, one general practitioner and one manager. Asylum seekers' responses revealed that their access to primary health care was limited by a range of barriers including Medicare ineligibility, health care costs and the effects of social, financial and psychological stress. Limited access contributed to physical suffering and stress in affected asylum seekers. Participants providing care noted some improvement in access after recent government policy changes. However, they noted inadequate access to general practitioners, and dental, mental health and maternity care, and had difficulty negotiating pro-bono services. Both groups commented on the low availability of interpreters. Access to primary health care in Australia for community-based asylum seekers remains limited, and this has a negative effect on their physical and mental health. Further action is needed to improve the affordability of health care and to increase the provision of support services to community-based asylum seekers; extending Medicare eligibility would be one way of achieving this.

The mental health of asylum seekers has attracted significant interest and examination. Quantitative studies have consistently indicated that asylum seekers experience mental distress at a higher rate than both host populations and their refugee counterparts. Qualitative insight into asylum seekers' embodied experience of mental distress is limited. This qualitative narrative study aimed to explore African asylum seekers' everyday embodied experiences of mental distress. Sixteen semi-structured one-to-one interviews were conducted with African asylum seekers who had experienced mental distress and were receiving mental health care services in Ireland. Narrative data were analysed using a holistic analysis framework of narrative form and content. Participants described their everyday endurance of relentless rumination, shame, self-loathing, anger, and mistrust, and of becoming demoralised and hopeless. Study findings indicate that asylum seekers' mental distress interweaves the physical, psychological, emotional, and social realms, thus impacting on the whole of their being. Consequences for asylum seekers include feeling anaesthetised, having a severely diminished capacity to connect and interact with their external surroundings and other people, and, for some, efforts to end their life.Examinations of, and responses to, asylum seekers' mental distress must delve beyond the confines of diagnostic categorisations and codifications of symptomology. To achieve heightened understanding and efficacious interventions, we must empathetically listen and engage with asylum seekers' narratives of distress and the socio-cultural and socio-political context they inhabit.

IntroductionBy end of 2018, the European Union countries hosted approximately 2.5 million refugees and Lebanon alone hosted more than 1 million. The majority of refugees worldwide came from Syria. The...