Asylum Seekers In Germany Research Articles

Translating restrictive law into practice: An ethnographic exploration of the systemic processing of legally restricted health care access for asylum seekers in Germany

BackgroundAccess to health services for asylum seekers is legally restricted in Germany. The law is subject to interpretation, therefore the chance of receiving care is not equally distributed among asylum seekers. What services are provided to whom is ultimately decided by health professionals and government employees. The respective prioritization processes and criteria are not transparent. We sought to understand how legal restrictions are translated into daily practices and how this affects the health system. We aimed to outline the complex process of cost coverage for health services for asylum seekers and provide insights into common decision-making criteria.MethodsWe conducted an ethnographic exploration of routines in two outpatient clinics in two federal states over the course of three months, doing participant and non-participant observation. Additionally, we interviewed 21 professionals of health care and government organizations, and documented 110 applications for cost coverage of medical services and their outcome. In addition to qualitative data analysis and documentation, we apply a system-theoretical perspective to our findings.ResultsTo perform legal restrictions a cross-sectoral prioritization process of medical services has been implemented, involving health care and government institutions. This changes professional practices, responsibilities and (power) relations. Involved actors find themselves at the intersection of several, oftentimes conflicting priorities, since “doing it right” might be seen differently from a legal, medical, economic, or political perspective. The system-theoretical analysis reveals that while actors have to bring different rationales into workable arrangements this part of the medical system transforms, giving rise to a sub-system that incorporates migration political rationales.ConclusionsHealth care restrictions for asylum seekers are implemented through an organizational linking of care provision and government administration, resulting in a bureaucratization of practice. Power structures at this intersection of health and migration policy, that are uncommon in other parts of the health system are thereby normalized. Outpatient clinics provide low-threshold access to health services, but paradoxically they may unintentionally stabilize health inequities, if prioritization criteria and power dynamics are not made transparent. Health professionals should openly reflect on conflicting rationales. Training, research and professional associations need to empower them to stay true to professional ethical principles and international conventions.

Cluster analysis of prolonged grief, posttraumatic stress, and depression symptoms in bereaved asylum seekers and refugees

ABSTRACT Background: Refugees and asylum seekers (ASRs) are frequently exposed to loss in addition to a variety of other stressors and often display high levels of various psychological symptoms. Objective: The study aimed to primarily determine clusters of prolonged grief disorder (PGD), posttraumatic stress disorder (PTSD), and depression symptoms in bereaved ASRs and secondly identify predictors of cluster membership. Sociodemographic – and flight-related variables were investigated in exploratory analyses. Method: ASRs in Germany (N = 92) with interpersonal loss exposure, i.e. at least one missing or deceased relative or friend, were assessed with interview-based questionnaires for PGD, PTSD, and depressive symptoms. We used k-means cluster analysis to distinguish symptom profiles and logistic regression analyses to identify predictors of cluster membership. Results: We found a three-cluster-solution. The PGD-cluster (30%) was characterised predominantly by PGD symptoms, while the PGD/PTSD-cluster (32%) had high PGD and PTSD and moderate depressive symptoms. The resilient cluster (38%) showed low symptoms overall. insecure residence status predicted membership in the PGD and PGD/PTSD clusters relative to the resilient cluster, whilst higher attachment anxiety predicted membership in the PGD/PTSD cluster relative to the other clusters. Explorative analysis revealed duration of stay as a significant predictor. Conclusion: Findings can extend the current knowledge about different symptom profiles among bereaved ASRs in Europe. Insights to attachment – and migration-related variables distinguishing between these profiles offer starting points for interventions.

The psychological impact of torture and state repression in Türkiye between 2015 and 2018: Reports from Turkish refugees seeking asylum in Germany.

Torture seeks to undermine not only the physical and emotional well-being of an individual, but to damage the coherence of entire communities. Thus, torture and state repression are used to weaken entire subpopulations. After the failed coup d'état in Türkiye in 2016 and during the subsequently following state of emergency that lasted until 2018, allegations of torture and other degrading treatment in Türkiye spread widely. Since then, the number of asylum-seekers in Germany has risen considerably. This paper analyses the reports of twenty Turkish citizens that fled to Germany to seek asylum in the aftermath of the events. In semi-structured interviews held in Turkish, we assessed the experiences of torture and state repression, psychological consequences, and the current well-being and living situation. All interviewees described illicit violence of state authorities and government supporters, especially while under arrest. Though the methods varied, there was a constant pattern of imbalance of power. The psychological impact of these methods were present after relocation to Germany and included signs of PTSD, anxiety disorders, and major depression. The reports of torture, state repression, and their psychological impact emphasise the importance for policy makers to address the prevention of human rights violations and support the needs of survivors.

Subjective health status and health literacy of African refugees and asylum seekers in Germany: a cross-sectional survey

PurposeMany refugees and asylum seekers in Germany experience a high disease burden and low health literacy. The current study aims to focus on assessing these issues among African refugees and asylum seekers in Bavaria, Germany. The authors evaluated their self-perceived health status and health literacy, and identified barriers and gaps in health care utilization, intending to improve health care services for this group.Design/methodology/approachThe authors conducted a cross-sectional, questionnaire-based study involving 69 refugees and asylum seekers from Ethiopia, Eritrea and Nigeria. The authors performed descriptive and exploratory statistical analyses.FindingsThe authors found a substantial disease burden in the early stages of resettlement in Germany, particularly mental health symptoms (53.6%) and musculoskeletal problems (47.8%). Challenges in health literacy were observed, such as difficulties in understanding health information and managing emergency situations. Access to interpreters was limited, and understanding treatment certificates was more challenging than using electronic health cards, with 18.2% of participants reporting denial of medical treatment.Practical implicationsThese findings highlight the need for early and tailored health support for refugees, with a particular focus on mental health. Efforts should be made to reduce language barriers and improve navigational skills within the health-care system, particularly in emergency situations. Addressing the restricted access to health care and bureaucratic obstacles is crucial for improved health outcomes among refugees.Originality/valueTo the best of the authors’ knowledge, this research is the first to specifically explore the self-reported health status and health literacy of African refugees and asylum seekers in Bavaria, Germany, providing valuable insights into the unique healthcare challenges of this often underrepresented and overlooked population.

Video-Assisted Psychotherapy For Refugees: A Pilot Study

Global conflicts and humanitarian crises led to an increase in forced migration to Germany in recent years. To improve the mental health care system for refugees and asylum seekers in Germany perspectively, we aim to examine the feasibility of implementing the culturally sensitive group psychotherapy Empowerment for refugees with affective disorders in a video-assisted setting. Empowerment is a culturally sensitive, interpreter-assisted intervention for the treatment of depressive and stress-related symptoms in refugees. Four male refugees from Afghanistan participated in a pilot study. The intervention included 16 modules delivered via video over a 12-week period. The internet connection was frequently unstable and led to organizational challenges. The therapy was feasible in terms of linguistic and interactional aspects. The stability of the internet connection represents the major criterion for a successful implementation of the therapy. Implications for future studies are discussed. Regarding the potential opportunities to improve the mental health care provision to refugees and asylum seekers in the future, the video-assisted therapy concept could be investigated in a randomized controlled trial.

"I don´t put people into boxes, but…" A free-listing exercise exploring social categorisation of asylum seekers by professionals in two German reception centres.

Newly arriving asylum seekers in Germany mostly live in large reception centres, depending on professionals in most aspects of their daily lives. The legal basis for the provision of goods and services allows for discretionary decisions. Given the potential impact of social categorisation on professionals' decisions, and ultimately access to health and social services, we explore the categories used by professionals. We ask of what nature these categorisations are, and weather they align with the public discourse on forced migration. Within an ethnographic study in outpatient clinics of two refugee accommodation centres in Germany, we conducted a modified free-listing with 40 professionals (physicians, nurses, security-personnel, social workers, translators) to explore their categorisation of asylum seekers. Data were qualitatively analysed, and categories were quantitatively mapped using Excel and the Macro "Flame" to show frequencies, ranks, and salience. The four most relevant social categorisations of asylum seekers referred to "demanding and expectant," "polite and friendly" behaviour, "economic refugees," and "integration efforts". In general, sociodemographic variables like gender, age, family status, including countries and regions of origin, were the most significant basis for categorisations (31%), those were often presented combined with other categories. Observations of behaviour and attitudes also influenced categorisations (24%). Professional considerations, e.g., on health, education, adaption or status ranked third (20%). Social categorisation was influenced by public discourses, with evaluations of flight motives, prospects of staying in Germany, and integration potential being thematised in 12% of the categorisations. Professionals therefore might be in danger of being instrumentalised for internal border work. Identifying social categories is important since they structure perception, along their lines deservingness is negotiated, so they potentially influence interaction and decision-making, can trigger empathy and support as well as rejection and discrimination. Larger studies should investigate this further. Free-listing provides a suitable tool for such investigations.

난민 위기 이후 독일의 난민과 망명 신청자의 노동시장 통합정책에 대한 고찰

난민 위기 이후 독일의 난민과 망명 신청자의 노동시장 통합정책에 대한 고찰

Social categorisation of asylum seekers: Free-listing by professionals in German reception centres

Abstract Background Newly arriving asylum seekers in Germany mostly live in large reception centres. Goods and services are provided by professionals. Their social categorisations may impact discretionary decisions and determine the scope of access to health and social services. We sought to explore what social categories were mostly applied to asylum seekers in that context. Methods We conducted a modified, verbal free-listing with health care, security, translation, social work and administrative staff in two German reception centres, asking what kind of asylum seekers were there. After qualitative content analysis, categories were quantitatively mapped using the Excel Macro “Flame” showing frequencies, ranks and salience of those social categories. Results 40 professionals listed on average 16 items (min = 4, max = 31). In total 624 items were analysed. Categorisations were of individual, interactional, professional, and societal nature. Professionally relevant categories like needs were not mentioned with the highest frequencies. The leading social categorisations of asylum seekers referred to asylum seekers attitudes professionals derived from their behaviour mostly in combination with socio-demographic variables, such as countries and regions of origin and sex. The most relevant social categories were “demanding and expectant” and “polite and friendly” behaviour, also the effort to adapt to the German environment was often evaluated. The category “economic refugees” ranked forth. Conclusions Social categorisation is permeable to public and political discourses related to motives for flight, or integration efforts and chances, impacting on negotiations of deservingness. Since categorisation structures perception, it potentially influences interaction and decision-making, it can trigger empathy and support as well as rejection and discrimination. Free-listing provides a suitable tool, to explore real world categorisation without leaning on pre-given social categories. Key messages • Public health studies on bias, racism and discrimination could benefit from free-listing as useful methodological tool to explore real world social categorisation without using pre-given categories. • Health sciences should foster awareness on political and societal discourses about migrant and minority populations seeping into professional cognition, which can trigger support or discrimination.

Effects of restrictive asylum-seeker healthcare policies: systematic review of evidence from Germany

Abstract Background Asylum-seekers’ entitlements to healthcare vary within and across European countries, over time, and between different nationalities. Within Germany, healthcare policies for asylum-seekers range from restrictions of both scope and access to healthcare to full health entitlements, depending on a person's legal status, duration of stay, country of origin, and place of residence. We seized these variations to study the effects of restrictive vs. inclusive healthcare policies on health status, health system outcomes (incl. health equity), healthcare provision, healthcare utilization, and efficiency. Methods We conducted a systematic review in five databases (PubMed, Web of Science, SCOPUS, LIVIVO, Google Scholar) to identify and analyse empirical studies on the effects of healthcare policies for asylum-seekers in Germany. Out of 1159 initial hits, 66 records were assessed for quality and included in the narrative synthesis. Results The synthesised evidence shows that more inclusive policies facilitate needs-based health care utilization, incl. broader utilization of ambulatory services and lower use of emergency services. They reduce complexity, fragmentation and bureaucracy for healthcare users and providers by simplifying authorisation and reimbursement. Evidence suggests that inclusive policies contribute to better subjective and mental health among asylum-seekers. We found no evidence for access restrictions being associated with cost savings or other health system benefits. Conclusions Restrictive healthcare policies are often justified with the need to protect fiscal resources and health systems. Yet, evidence from Germany shows that more inclusive healthcare policies for asylum-seekers hold benefits in terms of health system outcomes, while not entailing higher costs. Inclusive policies are thus not only normatively preferable to restrictive policy options; they also yield better performance from a health systems perspective. Key messages • Germany is a pertinent test-case for analyzing the effects of restrictive vs. inclusive healthcare policies for asylum-seekers. • Inclusive healthcare policies hold benefits in terms of health outcomes and health system performance, while restrictions fail to show advantages in fiscal or other domains of performance.

Caught between Vulnerability and Competence – UNHCR’s Visual Framing of Refugees, Economic Threat Perceptions and Attitudes toward Asylum Seekers in Germany

Humanitarian actors often present refugees as vulnerable to mobilize support. Their visual framing, in particular, moves refugees’ helplessness to the center. Critical scholars, however, argue that this representation can have exclusionary effects. In this article, we outline a research agenda to examine this claim empirically and provide initial results testing it. Based on a survey experiment, we show that vulnerability representations have significant effects on the perception of refugees as more dependent than refugees in capacity representations. These perceptions are linked to the view that refugees are economically burdensome, which, in turn, is linked to negative attitudes towards asylum seekers.

Populism Predicts Sympathy for Attacks Against Asylum Seekers Through National Pride and Moral Justification of Political Violence

Right-wing populism which had been considered fringe just a few years ago became gradually more mainstream. Given the epidemic impact of divisive populist rhetoric on hostile behavior and its strong association with anti-immigration, it is important to ask whether people endorsing populism also justify attacks against asylum seekers. Using the German General Social Survey data ( N = 3,268), we tested a model in which the endorsement of populist beliefs predicted sympathy for attacks against asylum seekers in Germany, through national pride and moral justification of political violence. Results showed that people who evinced higher endorsement of populist beliefs showed also higher sympathy for attacks against asylum seekers. Furthermore, national pride and moral justification of political violence mediated the relationship between populist beliefs and sympathy for attacks against asylum seekers. The role of right-wing populism in the justification of violence toward outgroups is discussed within a contemporary social-psychological framework.

Language mediation in psychotherapeutic healthcare for refugees in Germany – shunting responsibility between levels and actors

PurposeRefugees’ access to psychotherapeutic care is insufficient in Germany. One factor particularly contributing to hindering their access to adequate therapeutic care is a lack of provision of language mediation. This paper aims to explore the institutional system in which the financing of language mediation in the context of the medical treatment of asylum seekers in Germany is located. It examines why the language barrier problem resulting from a lack of financing is not being solved, even though it has been well known for years as a structural problem of day-patient health care to refugees and migrants in Germany.Design/methodology/approachThe financing of language mediation is analysed against the background of theories of the so-called “shunting yard”, in which public responsibilities for the assumption of costs are shifted from one level and actor to the other, thus preventing sustainable solutions being achieved. A mix of qualitative methods including the evaluation of official documents, reports and secondary literature, and of 23 expert interviews was used.FindingsThe financing of language mediation is a perfect example of the “shunting yard” phenomenon, with responsibilities being shifted between federal government, health insurance bodies and the municipalities in Germany. This paper argues that the specific financing structure in the German federal system can be viewed as a reason for the non-solution of the language barrier that hinders refugees’ access to health care.Originality/valueThe problem of the financing of language mediation in the context of health care has been rarely treated from a social sciences perspective. This paper contributes to addressing this gap.

Conceptualising difference: a qualitative study of physicians’ views on healthcare encounters with asylum seekers

ObjectivesIn many high-income countries, structural, legal, social and political barriers to adequate healthcare interfere with the ability of health professionals to respond to the healthcare needs of a fluctuating and...

(Un)safety of LGBT+ asylum seekers in asylum accommodations in Germany

Abstract LGBT+ asylum seekers face multiple challenges in their countries of origin as well as in their host countries. Violence and structural discrimination against this community are common and affect their whole asylum process. Violence and structural discrimination based on sexual orientation and gender identity stress the needs of LGBT+ asylum seekers in particular in regards to reception accommodations. In this study we investigated factors that contribute to the (un)safety of reception accommodations for LGBT+ asylum seekers in Germany. Qualitative semi-structured interviews were conducted with 11 participants from two groups, namely, professionals, and former and current LGBT+ asylum seekers. Thematic analysis was used to analyze the data and revealed multiple factors influencing the safety of LGBT+ asylum seekers in accommodations. These were clustered according to the used frameworks in the categories individual level, physical and social environment, and policies. The factors for (un) safety included amongst others interpersonal violence based on sexual orientation and gender identity, gender-neutral sanitary areas or lockable rooms, community support, and policies that govern where asylum seekers are accommodated, and which protection measures are set up in accommodations. Applying an intersectional lens, transgender asylum seekers were described as more vulnerable than other LGBT+ individuals. The analysis concluded that binding policies are necessary to guarantee safer accommodations for LGBT+ asylum seekers in Germany. Besides, the social cisheteronormative structures that manifest in discrimination of LGBT+ asylum seekers must be structurally deconstructed by, among others, training staff on LGBT+ needs and increase inclusivity among the asylum seeker community and in the host country. Key messages

From Research into Practice: Converting Epidemiological Data into Relevant Information for Planning of Regional Health Services for Refugees in Germany.

Health data of refugees and asylum seekers (ASR) is not routinely collected in Germany. Based on health data of ASR collected in 2018 in regional accommodation centres, we developed a dashboard to estimate regional burden of disease in Baden-Wuerttemberg, Germany. We aimed to find out how scientific data can support actors involved in healthcare planning for ASR in Germany and, within this scope, to explore how healthcare planning is conducted in this context. We conducted 12 qualitative semi-structured interviews including a usability test for a health data dashboard with regional decision-makers. Results showed that healthcare planning processes for ASR in Germany involve a complex set of actors in both long- and short-term decision-making. Data gained from representative surveys can support long-term decision-making and thus support the resilience of the health system, but it must balance the need for simple data presentation with transparent communication of potentially complex methods.

Association between housing and health of refugees and asylum seekers in Germany: explorative cluster and mixed model analysis

BackgroundAccommodation for asylum seekers and refugees (ASR) in Germany differs in many ways depending on a range of political, structural, social, and environmental factors. These contextual differences present a challenge for assessing health impacts of refugee accommodation. We aimed to devise a broad typology of refugee accommodation that allows to assess associations between housing and health of ASR.MethodsWe performed a cluster analysis of population-based, cross-sectional secondary data in Germany to identify clusters of refugee accommodation. We then assessed health disparities across clusters by performing bivariate analysis and linear mixed model regression analysis.ResultsWe identified four clusters, three of them reflected different types of private accommodation and one pointed to collective accommodation. The collective accommodation cluster clearly differed from the private accommodation clusters in terms of space, area, level of restrictions, social connections and respondent satisfaction. Across private accommodation clusters we also found differences in space, area, and level of restrictions. In regression analysis, belonging to one of the private accommodation cluster was significantly associated with better mental health compared to belonging to the collective accommodation cluster. Physical health was significantly lower in one private accommodation cluster characterized by poor access to public transport and a higher level of restrictions compared to a private accommodation cluster showing better connections and a lower level of restrictions.ConclusionWe demonstrate that unfavourable conditions cluster in collective accommodation with negative outcomes for mental health but not for physical health. We also found health disparities across types of private accommodation. We conclude that housing plays a role in the production of health inequalities in ASR but needs to be assessed in a differentiated, multidimensional way.

Making asylum work? Civic stratification and labor‐related regularization among rejected asylum seekers in Germany

AbstractRejected asylum seekers often do not return to their countries of origin and face precarious living conditions in destination countries. Taking Germany as a strategic case, we investigate whether labor‐related regularization, or “laborization,” may serve as a solution for such migrants. We analyze the factors determining access to such regularization and how labor‐related regularization relates to migrants' needs and aspirations. Based on extensive desk research and interviews with stakeholders, including (rejected) asylum seekers in Stuttgart, we find that laborization provides resourceful and “deserving” individuals with valuable opportunities to realize their aspirations, but it is insufficient to fully address non‐deportability.

SARS-CoV-2 attack rate in reception and accommodation centres for asylum seekers during the first wave: Systematic review of outbreak media reports in Germany

ObjectivesDespite concerns about the impact of the severe acute respiratory syndrome corona virus (SARS-CoV-2) in refugee camps, data on attack rates and effectiveness of containment measures are lacking. We aimed to (1) quantify the attack rate of SARS-CoV-2 during outbreaks in reception and accommodation centres in Germany during the first pandemic wave, (2) assess differences in the attack rate based on containment measures, and (3) provide an overview of testing strategies, communication, conflicts, and protection measures for refugees with special needs. MethodsSystematic web-based review of outbreak media reports (until June 2020) on confirmed SARS-CoV-2 cases in reception centres for asylum seekers in Germany using the google search engine. Reports were screened for pre-defined inclusion criteria and complemented by snowball searches. Data on facility name, location, confirmed cases, containment measures, communication, protection strategies, and conflicts was extracted for each outbreak and reporting date. Evidence synthesis: meta-analysis and negative binomial regression. FindingsWe identified 337 media reports on 101 SARS-CoV-2 outbreaks in 99 reception and accommodation centres in Germany. The pooled SARS-CoV-2 attack rate was 13.1% (95% confidence interval, CI: 9.8–16.7). Outbreak sites implementing mass quarantine (n = 76) showed higher rates (15.7; 95% CI: 11.6–20.2) compared to sites using conventional strategies (6.6; 95% CI: 3.1–11.2), yielding a rate ratio of 0.44 (95% CI: 0.27–0.72) adjusted for testing strategies, type and size of accommodation. Conflicts occurred in at least 11.8% of all outbreaks. Few sites reported specific measures to protect refugees with special needs. ConclusionMass quarantine is associated with higher attack rates, and appears to be a counter-productive containment measure in overcrowded camps, but further research with individual-level data is required to rule out residual confounding. Despite available vaccines, reception centres and refugee camps should follow the available guidelines on COVID-19 response and refrain from mass quarantine if physical distancing cannot be guaranteed.

Providing health care in politically charged contexts: a qualitative study about experiences during a public collective hunger strike of asylum seekers in Germany

ABSTRACT Purpose Role expectations of physicians providing health care for hunger strikers have been discussed in the context of prisons and detention centres. Ethical guidance for physicians in these situations is codified in the Declaration of Malta. In the last years, new forms of collective, public hunger strikes of asylum seekers have occurred. We have aimed at reconstructing the experiences of health-care personnel involved in one of such cases. Methods Semi-structured interviews with nine participants (physicians and paramedics) that had been involved in a public collective hunger strike of asylum seekers in Germany were conducted. Results We identified three health-care provider groups: voluntary physicians, emergency service providers and medical consultants for the authorities. Role conflicts arising from multiple loyalty situations with obligations towards different stakeholders (e.g., strikers, employers, authorities) were perceived as the greatest challenge especially for voluntary doctor and emergency service provider participants. Such conflicts culminated in feeling instrumentalized for political goals. Conclusion The results illustrate that professional challenges in the health care during a public collective hunger strike differ in various aspects from those described in the literature on custodial settings. We recommend expanding and adapting the medico-ethical guidance.

Getting under the Skin: The Impact of Terrorist Attacks on Native and Immigrant Sentiment

Abstract There is growing academic interest in examining how terrorist attacks shape the majority’s attitudes towards minority groups. Yet, little is known of how these minority groups react to the backlash such events provoke. This paper leverages the exogenous occurrence of a series of terrorist attacks during the fieldwork period of two surveys to estimate how such events affect the sentiment of both citizens and asylum seekers in Germany. Results of the natural experiment reveal that the 2016 terror attacks in Nice, Würzburg, and Ansbach substantially increased anti-refugee sentiment among German respondents. In line with this increase in hostility, refugees experienced more discrimination, felt less welcome in Germany, and suffered clinically relevant declines in mental health in the aftermath of the attacks. These results provide a more holistic understanding of how terrorism corrodes intergroup relations and how it affects those that are blamed for the events and thus suffer the brunt of the backlash following their occurrence.