Health Of Asylum Seekers Research Articles

Advancing Knowledge Translations to Contribute to Resilience in Emergency Preparedness, Response and Recovery: The Role of Evidence Aid

Introduction:Policymakers, practitioners and the public all have a role in health emergency and disaster risk management (Health EDRM). They need to access, understand and use evidence from research to take actions to reduce health risks and harm. They need the best available evidence to maximize their ability to save lives and reduce suffering. Evidence Aid seeks to meet this need through collections of specially prepared plain-language summaries of systematic reviews, freely available online in multiple languages (www.EvidenceAid.org). The summaries and webpages can be linked to reference management software and embedded in other websites.Method:Evidence Aid has added a substantial number of summaries to its collections since 2020, for example, adding a collection for reviews of relevance to the COVID-19 pandemic and its associated measures. From 2021, Evidence Aid built on its partnership with the Pan American Health Organization (PAHO/WHO) to identify and summarize reviews relevant to building resilience into health systems. This included enhancements enriching the content of each summary with the authors’ implications for practice and research, equity considerations and funding sources.Results:In November 2022, the Resilient Health Systems collection contained more than 200 summaries relevant to ensuring that health systems are resilient to emergencies, disasters and related challenges. There were also 600 summaries relevant to the COVID-19 pandemic, 150 on the health of refugees and asylum seekers, more than 100 on physical and mental health impacts of disasters and 110 on preventing and treating acute malnutrition.Conclusion:Evidence Aid’s 1000+ summaries of systematic reviews relevant to Health EDRM provide a unique gateway into this evidence base for policymakers, practitioners and the public wishing to ensure that disaster preparedness, response, recovery and rehabilitation are effective and efficient. It should be a key component in helping people and organizations to care, cope and overcome in an increasingly challenging world.

Mental deterioration of refugees and asylum seekers with uncertain legal status in Australia: Perceptions and responses of legal representatives.

Many developed countries have introduced strict measures designed to deter people seeking asylum. Measures such as held detention, insecure visas, restrictions work and services all impact the mental health of asylum seekers. In 2014 Australia introduced a 'fast track assessment' (FTA) system of processing refugee claims for asylum seekers who arrived by boat, those found to be refugees were only eligible for temporary residence. Legal professionals play a pivotal role in protecting the rights of asylum seekers and gain unique insight into the impact of the legal system has on clients mental health. To investigate how legal professionals in Australia perceived the impact of the FTA process on their clients. Mixed methods comprising of two phases - (i) an online survey and (ii) follow-up focus groups and interviews with legal professionals involved in assisting asylum seekers in the FTA process. An inductive thematic analysis was used to analyse the data. Survey results were obtained from 38 legal professionals. Follow up in depth qualitative focus groups and interviews were conducted with 16 survey participants. The data demonstrate that legal professionals encounter clients in complex seemingly insurmountable mental health crises including deepening mental distress and deterioration, feelings of hopelessness, defeat and entrapment. Interviewees shared compelling examples of what they believed constituted a direct connection between asylum seekers experiencing uncertainty and deteriorating mental health over time with fluctuations in hopelessness, anger, withdrawal and suicidality. These negative impacts were often compounded by separation from family. The legal framework for determining whether an asylum seeker is a refugee can have a detrimental impact on the mental health of asylum seekers. The mental distress of asylum seekers and refugees is exacerbated by uncertainty linked to both delays in processing accompanied by sustained and ongoing uncertainty of legal status.

Life and mental health in limbo of the Ukraine war: How can helpers assist civilians, asylum seekers and refugees affected by the war?

The terror spread by the war disrupts lives and severs families, leaving individuals and communities devastated. People are left to fend for themselves on multiple levels, especially psychologically. It is well documented that war adversely affects non-combatant civilians, both physically and psychologically. However, how the war puts civilians' lives in a limbo is an under-researched area. This paper focuses on three aspects: (1) how the mental health and well-being of Ukrainian civilians, asylum seekers, and refugees are affected by the war caused limbo; (2) what factors affect this process of being stuck in the limbo of war; and (3) how psychologists and helpers in the war-ridden and host countries can provide meaningful support. Based on the authors' own practical work with Ukrainian civilians, refugees, and professional helpers during the war, this paper provides an overview of multi-level factors that impact human psyches in a war, and possible ways to help those who are living in the war limbo. In this research and experiential learning-based review, we offer some helpful strategies, action plans, and resources for the helpers including psychologists, counselors, volunteers, and relief workers. We emphasize that the effects of war are neither linear nor equal for all civilians and refugees. Some will recover and return to a routine life while others will experience panic attacks, trauma, depression, and even PTSD, which can also surface much later and can prolong over the years. Hence, we provide experience-based ways of dealing with short-term and prolonged trauma of living with war and post-traumatic stress disorder (PTSD). Mental health professionals and other helpers in Ukraine and in host countries can use these helping strategies and resources to provide effective support for Ukrainians and for war refugees in general.

Self-perceived mental health and factors associated with the mental health of Hong Kong's asylum-seekers and refugees – A mixed methods study

RationaleThe 21st century has seen vast flows of displaced people. In the year 2020 alone, an estimated 11.2 million were forcibly displaced as a result of persecution, conflict or generalized violence. The torment and fear of war, persecution and threat to life, whether in the home country, during the process of fleeing, or in the post-migration host country, can be extremely traumatic to these marginalized populations. Hong Kong is not a signatory to the 1951 UN Refugee Convention, but the territory has signed the 1967 UN(CAT) which requires the former colony to allow people who flee for their lives to have their cases processed in Hong Kong. Currently there are around 14,000 cases in Hong Kong, some of whom have been in Hong Kong for more than a decade, waiting for their claims to be processed, living on meagre government subsidies and with no right to work. ObjectivesThe paper examines the mental health of asylum-seekers and refugees in Hong Kong and the factors associating with their mental health. MethodA sequential mixed methods approach was conducted among asylum-seekers and refugees in Hong Kong between October 2019 and mid-2020. It comprised a pilot quantitative survey conducted with 47 participants, and follow-up qualitative interviews with 16 of the 47 participants. Survey results were analyzed using statistical measures while the qualitative in-depth interviews were thematically analyzed to identify emergent patterns and categories. ResultsResults from the quantitative data identify 52.2% of the asylum-seekers taking part as having symptomatic anxiety, 55.3% as having symptomatic depression and 54.3% as having overall problems. Qualitative results show that asylum-seekers and refugees cited lack of work and poverty as key factors affecting their mental health and well-being. Fear of being sent home was expressed by respondents who were married or having children for the fear of being separated from each other.

The effects of traumatic experiences during transit and pushback on the mental health of refugees, asylum seekers, and migrants

ABSTRACT Background: There are 26 million people recognised as refugees worldwide. Many of them spent a prolonged period of time in transit – time after they leave their country of origin and before they reach the receiving country. Transit brings numerous protection and mental health risks refugees are exposed to. Objective: The aim of this study was to assess the stressful and traumatic experiences refugees are exposed to during transit, with a special focus on the experience of pushback – the denial of access to the territory to foreign nationals and forcible return to countries of origin or neighbouring countries without an assessment of their rights to international protection, as well as the impact of these experiences on refugees’ mental health and well-being. Method: 201 refugees currently residing in Serbia completed the Stressful and Traumatic Experiences in Transit questionnaire – short version (SET-SF), questionnaire for assessing stressful and traumatic experiences during pushback (SET-SF PB), Refugee Health Screener (RHS-15), and Well-being index (WHO-5). Results: The results showed that refugees experience a large number of stressful and traumatic events (M = 10.27, SD = 4.85). In addition, half of the participants experience severe symptoms of depression (50.7%), while about a third of the participants experience severe symptoms of anxiety (37.8%) and post-traumatic stress disorder (PTSD) (32.3%). Refugees who experienced pushback showed overall higher levels of depression, anxiety, and PTSD. Traumatic experiences during transit and pushback were positively related to the severity of depression, anxiety, and PTSD. In addition, traumatic experiences during pushback showed an incremental contribution in predicting refugees’ mental health difficulties over and above traumatic experiences in transit. Conclusions: This study provides valuable insights into the multiple risks refugees are exposed to and emphasise the need for the provision of adequate protection and support.

A house is not a home: a network model perspective on the dynamics between subjective quality of living conditions, social support, and mental health of refugees and asylum seekers

Background:Providing adequate living conditions for forcibly displaced people represents a significant challenge for host countries such as Germany. This study explores refugee mental health’s reciprocal, dynamic relationship with post-migration living conditions and social support.Methods:The study sample included 325 Arabic- or Farsi-speaking asylum seekers and refugees residing in Germany since 2014 and seeking mental health treatment. Associations between reported symptoms of post-traumatic stress and depression and the subjective quality of living conditions and perceived social support were analyzed using a two-level approach including multiple linear regression and network analyses.Results:Post-migration quality of living conditions and perceived social support were significantly associated with negative mental health outcomes on both levels. In the network, both post-migration factors were negatively connected with overlapping symptoms of psychiatric disorders, representing potential target symptoms for psychological treatment.Conclusion:Post-migration quality of living conditions and social support are important factors for refugee mental health and should be targeted by various actors fostering mental well-being and integration.

Making an economic argument for investment in global mental health: The case of conflict-affected refugees and displaced people.

Mental health expenditure accounts for just 2.1% of total domestic governmental health expenditure per capita. There is an economic, as well as moral, imperative to invest more in mental health given the long-term adverse impacts of mental disorders. This paper focuses on how economic evidence can be used to support the case for action on global mental health, focusing on refugees and people displaced due to conflict. Refugees present almost unique challenges as some policy makers may be reluctant to divert scarce resources away from the domestic population to these population groups. A rapid systematic scoping review was also undertaken to identify economic evaluations of mental health-related interventions for refugees and displaced people and to look at how this evidence base can be strengthened. Only 11 economic evaluations focused on the mental health of refugees, asylum seekers and other displaced people were identified. All but two of these intervention studies potentially could be cost-effective, but only five studies reported cost per quality-adjusted life year gained, a metric allowing the economic case for investment in refugee mental health to be compared with any other health-focused intervention. There is a need for more consistent collection of data on quality of life and the longer-term impacts of intervention. The perspective adopted in economic evaluations may also need broadening to include intersectoral benefits beyond health, as well as identifying complementary benefits to host communities. More use can be also made of modelling, drawing on existing evidence on the effectiveness and resource requirements of interventions delivered in comparable settings to expand the current evidence base. The budgetary impact of any proposed strategy should be considered; modelling could also be used to look at how implementation might be adapted to contain costs and take account of local contextual factors.

Mental health of asylum seekers and refugees: The role of trauma and postmigration living difficulties and the moderating effect of intergroup contact

Refugees undergo traumatic events during the premigration and transit phases and also experience severe difficulties after resettlement in a new country, and they are therefore at high risk of developing mental health problems. The present studies examined if intergroup contact with members of the receiving society moderates these negative impacts on refugees’ mental health. Two studies with refugees in Switzerland (N = 262) revealed both buffering and exacerbating effects of intergroup contact. Having more Swiss friends was associated with a less negative relationship between postmigration living difficulties and mental health. Surprisingly, having more Swiss friends was also associated with a more negative relationship between traumatization and mental health. These results suggest that intergroup contact may help refugees adjust to the living conditions in the receiving society, but may pose a risk regarding trauma-related disorders.

The Mental Health of Male Sexual Minority Asylum Seekers and Refugees in Nairobi, Kenya: A Aualitative Assessment

Very little information exists about the experiences of asylum seekers and refugees who are men who have sex with men (MSM). Therefore, this study explores the psychological distress of MSM asylum seekers and refugees in the Nairobi metropolitan area. We collected data using in-depth interviews transcribed verbatim, coded using NVivo 12 Plus, and analyzed using the six-step thematic analysis framework. Four major themes emerged from the study: psychological distress, traumatic stress symptoms, mental health care access, and coping strategies. Although we did not use any diagnoses, the results indicate that MSM asylum seekers and refugees share mental health problems with other refugees. However, MSM have specific needs that derive from their persecution based on their sexual minority status. The results confirm extant findings, as seen in the discussion, and encourage more research. Further research will inform collaborative, culturally sensitive, and targeted interventions that decrease adverse mental health outcomes for MSM asylum seekers and refugees in the Nairobi metropolitan area.

Health status of recently arrived asylum seekers in their host country: results of a cross-sectional observational study

BackgroundThe World Health Organization (WHO) considers that the heterogeneity of concepts and definitions of migrants is an obstacle to obtaining evidence to inform public health policies. There is no recent data on the health status of only asylum seekers who have recently arrived in their Western host country. The purpose of this study was to determine the health status of asylum seekers and search for explanatory factors for this health status.MethodsThis cross-sectional observational study screened the mental and somatic health of adult asylum seekers who had arrived in France within the past 21 days and went to the Marseille single center between March 1 and August 31, 2021. In order to study the explanatory factors of the asylum seekers' health status, a multivariate analysis was performed using a logistic regression model to predict the health status. Factors taken into account were those significantly associated with outcome (level < 0.05) in univariate analysis.ResultsIn total, 419 asylum seekers were included and 96% CI95%[93;97.3] had at least one health disorder. Concerning mental health, 89% CI95% [85.1;91.4] had a mental disorder and in terms of somatic health exclusively, 66% CI95% [61.4;70.6] had at least one somatic disorder. Women were more likely to have a somatic disease OR = 1.80 [1.07; 3.05]. We found a statistically significant association between the presence of at least one disorder and sleeping in a public space OR = 3.4 [1.02;11.28] p = 0.046. This association is also found for mental disorders OR = 2.36 [1.16;4.84], p = 0.018.ConclusionsDue to the high prevalence of health disorders our study found, asylum seekers are a population with many care needs when they arrive in their host country. The main factors linked to a poor health status seem to be related to a person’s sex, geographical origin and sleeping in a public space.

Finding agency in limbo: A qualitative investigation into the impact of occupational engagement on the mental health and wellbeing of asylum seekers in the UK.

The process of seeking asylum is complex and often leads to extended periods of uncertainty and liminality for people awaiting decisions on their status. Occupational engagement-defined as meaningful activities and roles that bring purpose and agency to one's life-may be a key driver for mental health recovery for marginalized populations, including asylum seekers with traumatic experiences pre- and post-migration. This study aimed to clarify how occupational engagement impacts on mental health and wellbeing and how asylum seekers maintain engagement in occupation in the context of socio-political constraints of the asylum process. We explored the occupational experiences of 12 clients of one human-rights charity, utilizing community-based participatory research methods. Participants completed group mapping sessions where they depicted routine journeys taken to perform occupations in London, which included discussion around the significance of their journeys. Four participants also completed additional "walking maps"-semi-structured interviews which occurred along a selected "occupational journey" they identified as meaningful to their wellbeing. All data were analyzed using thematic network analysis. Findings revealed that engagement in routine occupations within safe, social spaces positively affects the mental wellbeing of asylum seekers by promoting competence, agency, and feelings of belonging. The liminal space of the asylum process meant that participants' occupational engagement was limited to 'leisure' activities but was still critical to establishing forms of agency associated with their wellbeing. Implications for programs and interventions responding to the needs of asylum seekers are discussed.

"Tough on borders": how Australia's immigration detention system fails refugee and asylum seeker health.

"Tough on borders": how Australia's immigration detention system fails refugee and asylum seeker health.

Post-Migration Life Adversity and Mental Health of Refugees and Asylum Seekers: The Mediating Role of Resilience between Perceived Discrimination, Socio-Economic Strains, Structural Strains, and Mental Health.

This study made a claim that perceived discrimination, socio-economic strain, and structural strain on displaced people have an adverse impact on their mental health. Our claim also acknowledges that these people potentially have a unique set of strengths and abilities that they rely on to overcome their immediate and future problems. The aim of this study is thus to examine the relationship between post-migration life adversity and mental health problems, and assess the potential mediating role of resilience among asylum seekers and refugees (219 asylum seekers and 42 recognized refugees) living in South Korea. Structural equation modelling was used to examine hypothesized pathways between post-migration life adversity, mental health and resilience. Fit indices showed adequate to excellent fit of the examined models with mental health as the outcome. Mental health was positively regressed on PMLA and negatively regressed on R. In addition, R partially mediated the association between PMLA and MH. In addition to providing the academic contributions of this study to the ongoing study of resilience and its social welfare implications, the result of the study indicated the necessity of improving the present and future socio-environmental factors that foster resilience among refugees and asylum seekers.

The patient journey of newly arrived asylum seekers and responsiveness of care: A qualitative study in Germany.

BackgroundResearch on health and healthcare for asylum seekers and refugees (ASR) has focused strongly on accessibility and legal entitlements, with quality of care receiving little attention. This study aimed to assess responsiveness, as non-medical quality of care, in the narratives of ASR patients recently arrived in Germany.Methods31 ASR with existing medical conditions were recruited in six refugee reception centres and three psychosocial centres. Semi-structured, qualitative interviews were conducted which reconstructed their patient journey after arrival in Germany. Interviews were recorded, transcribed verbatim and evaluated using thematic analysis.ResultsThe experiences of participants throughout the patient journey provided a rich and varied description of the responsiveness of health services. Some dimensions of responsiveness, including respectful treatment, clear communication and trust, resurfaced throughout the narratives. These factors were prominent reasons for positive evaluations of the health system, and negative experiences were reported in their absence. Other dimensions, including cleanliness of facilities, autonomy of decision-making and choice of provider were raised seldomly. Positive experiences in Germany were often set in contrast to negative experiences in the participants’ countries of origin or during transit. Furthermore, many participants evaluated their experience with healthcare services in terms of the perceived technical quality of medical care rather than with reference to responsiveness.ConclusionThis qualitative study among ASR analysed patient experiences to better understand responsiveness of care for this population. While our results show high overall satisfaction with health services in Germany, using the lens of responsiveness allowed us to identify particular policy areas where care can be strengthened further. These include in particular the expansion of high-quality interpreting services, provision of professional training to increase the competency of healthcare staff in caring for a diverse patient population, as well as an alignment between healthcare and asylum processes to promote continuity of care.

Educators as Health and Education Mediators for African Asylum Seekers in Israel.

Israel is not isolated from the global migration process. It is required to provide a medical, educational, and socio-cultural response to the integration of tens of thousands of African asylum seekers. This qualitative-phenomenological study collected data from 15 educators as a primary source and learned about their actions to mediate health and educational issues for African asylum seekers. The findings reveal four categories: (1) a healthy lifestyle; (2) emotional-behavioral; (3) learning disabilities and special needs; (4) diseases, vaccines, and medical treatments. It seems that educators are forced to take on roles traditionally entrusted to the state, and they have become agents of socialization who mediate between parents and the Israeli health and education system through personal relationships and individual conversations. This study reveals a dual reality: on the one hand, African asylum seekers experience alienation, exclusion, and violence; on the other hand, they gain a positive point of view when parents see the educators as loyal partners and sources of knowledge who can be consulted to receive help in routine times and during the coronavirus pandemic, a time in which they lost their livelihood, health insurance, and ability to understand the new rules of the lockdowns.

Threats and Interventions on Wellbeing in Asylum Seekers in the Netherlands: A Scoping Review.

BackgroundMost asylum seekers experience stress, not only due to the reason for fleeing and their travel but also due to their compulsory stay in the asylum seeker center in the Netherlands and the asylum procedure. This often leads to self-medication and addiction which causes lower self-esteem and lower quality of life. Adverse life events, forced migration, and prolonged asylum procedures, in addition to the complexity of the acculturation process, can all contribute to higher levels of psychopathology.ObjectiveWhat are the threats to wellbeing in terms of mental health, psychosocial, and addiction problems, and what are the effective interventions for wellbeing for asylum seekers in asylum seeker centers in the Netherlands, reported in the literature?MethodFollowing the descriptive nature of the research question and the need for identifying knowledge gaps, an overview of existing knowledge was created by executing a scoping review on influencing factors on the mental health of asylum seekers. The Neuman system model was used as a guiding framework to understand the complexity of the issues this population experience and to identify the stressors and the factors which cause the imbalance and also the disease.ResultsThe literature review resulted in 26 articles that met the criteria for inclusion. The threats included the influence of staying in the environment of an asylum seekers center, drug abuse among asylum seekers, health-care professionals and employees who do not detect or underestimate the underlying suffering of asylum seekers, and frequent relocations of asylum seekers. The two assessment instruments used were the Rapid-Assessment-Response method (RAR method) and the Health Information Assessment Tool Asylum Seeker tool (HIATUS tool). Finally, the five interventions were identified: therapy for asylum seekers diagnosed with post-traumatic stress disorder (PSTD), art therapy, education focused on prevention as intervention, cultural interview, and mindspring.ConclusionThe knowledge on identifying and reducing threats, assessment, and treatment interventions for asylum seekers living in an asylum seekers center found in the literature provided perspectives on improving their wellbeing. The great diversity of cultural aspects and continuous changes in the number and origin of refugees in the Dutch asylum seekers centers disrupted the continuity of care.

The impact of immigration detention on the health of asylum seekers during the COVID-19 pandemic

COVID-19 disproportionately affects racial and ethnic minority groups as well as people in jails and immigration detention centers in the United States. Between April and August of 2020, the mean monthly COVID-19 case ratio for ICE detainees was 13.4 times that of the general U.S. population. This study aims to understand the experiences of detained asylum seekers during the pandemic and to provide insight into COVID-19's impact on this population's health. This qualitative study employed first-person, in-depth narratives obtained from 12 asylum seekers, all of whom were detained in immigration detention centers or prisons during the initial surge of the COVID-19 pandemic and were subsequently released. Detained asylum seekers reported inadequate medical care, obstacles to receiving care, an inability to social distance, poor hygiene, restricted movement, and a lack of infection control-- all which increased their risk of contracting and spreading COVID-19 and exacerbated health inequalities brought to the forefront by the pandemic. Advocating for improved disease prevention and screening, prompt access to health care and treatment, cohorting of infectious cases, and community alternatives to detention to decrease the detained immigrant population sizes are crucial to halt communicability of the virus and its subsequent morbidity and mortality in this vulnerable population.

Advancing a programme theory for community-level oral health promotion programmes for humanitarian migrants: a realist review protocol

IntroductionHumanitarian migrants often suffer from poor health, including oral health. Reasons for their oral health conditions include difficult migration trajectories, poor nutrition and limited financial resources. Oral health promotion is...

Barriers and challenges around the mental health of refugees and asylum seekers in Chile.

Asylum and refuge in Chile h¬ave received limited attention in policymaking and academia, and there is scarce evidence on their mental health needs and outcomes. Studies on mental healthcare access for international migrants suggest systemic barriers linked to costs and coverage, administrative issues, and adequacy of services. Today, we see that asylum and refuge is an emerging topic in Chile, which opens up the challenges around the mental health of refugees and asylum seekers. This topic is gaining visibility due to increased asylum claims over the past ten years, making it an urgent topic at a policy level. An exploratory qualitative study was conducted in 2018 on the health and social needs of asylum seekers and refugees from Latin America in Chile. This study indicated a general lack of knowledge on the mental health needs of refugees and asylum seekers and Chile and a lack of training in mental health professionals to address specific needs. Consequently, the health needs of these people remain largely unaddressed in terms of the number of available services and the relevance and pertinence of the services delivered. As Chile is positioning itself as a receiving country of refugees and asylum seekers in Latin America and the Caribbean, there is an opportunity to "do better" and adequately address the mental health of these marginalized populations.

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.