Evidence-based care for Iraqi, Kurdish, and Syrian asylum seekers and refugees of the Syrian civil war: A systematic review.

Abstract

The start of the Syrian Civil War in 2011 displaced many from their homes. In the years since, Western countries have received an influx of Syrian asylum seekers and refugees. The United Nations High Commissioner for Refugees (UNHCR) defines an asylum seeker as someone who claims to be a refugee without those claims being verified (UNHCR, 1951). Thus, as these displaced people wait to qualify for international protection they are classed as asylum seekers. Consequently, a refugee is defined by the UNHCR as someone whoowing to a well-founded fear of being persecuted for reasons of race, religion, nationality, membership of a particular social group or political opinion, is outside the country of his nationality, and is unable to, or owing to such fear, is unwilling to avail himself of the protection of that country. (UNHCR, 1951, p. 3, para. 1)A recent poll by the UNHCR (2015) estimated there were 15.1 million refugees and 2.3 million asylum seekers worldwide by mid-2015, the highest rates recorded in 20 years, with Syrian refugees being the largest source by mid-2015 (4.2 million, apCisse proximately 24.1%). As part of the newly elected Canadian government's plan to resettle 25,000 refugees from Syria to Canada, it is crucial that such individuals are looked after for their humanitarian needs, including mental health.To determine whether an asylum seeker qualifies as a refugee they must demonstrate a well-found fear of persecution in their home country, and the legitimacy of this claim is determined by the host country. The refugee status determination is conducted by the state or the UNHCR-if the state is unable or unwilling. Once refugee status is awarded, refugees that are deemed low risk by the UNHCR or the state are contacted to determine whethere they are interested in being resettled to Canada. Canadian visa officers process refugees overseas in Beirut or Amman, interviewing interested refugees and conducting a full medical examination. As well, interested refugees undergo a security screening against immigration, law enforcement, and security databases using biometrics. Following that, refugee identification is verified before departure to the host country and once again upon arrival (Ministry of Justice Canada, 2001). As can be expected on the basis of the requirement of fear of persecution by one's home country in determining refugee status, elevated rates of posttraumatic stress disorder (PTSD) in refugees have been documented (Teodorescu et al., 2012). Moreover, interestingly, previous studies found that asylum seekers experienced more traumatic life events when compared to refugees and that PTSD symptom severity is predicted by a lack of refugee status (vs. asylum seeking status) and the number of traumatic life events experienced (Knipscheer et al., 2015; Nickerson et al., 2011; Stenmark et al., 2013). Although there are multiple factors that predict PTSD symptom severity, it is worthwhile to note that refugee status is potentially one that could be controlled for with faster processing of refugee applications without sacrificing the rigor of detailed security checks (Knipscheer et al., 2015). For example, Nickerson et al. (2011) found that refugees with temporary protection visa who were granted permanent residency demonstrated a decrease in PTSD symptoms and depression, along with an increase in quality of life, suggesting ease of transition into residency status can directly impact psychological symptoms and functioning. The most common fears identified in refugees indeed include being sent back to their country of origin, whereas on the other hand also include being unable to return home in case of emergencies. In other words, the cause of PTSD in asylum seekers and refugees may have begun with the conflict in their native country; however, stress experienced as a result of the process of becoming a refugee and seeking asylum in a foreign country has been shown to evoke further psychological disturbance. …