Refugee Survivors Research Articles

South Sudanese Refugee Survivors of Sexual and Gender-Based Violence and Torture: Health and Justice Service Responses in Northern Uganda.

This British Academy/Leverhulme-funded research investigated the health and justice service responses to the needs of South Sudanese refugees living in refugee settlements in Northern Uganda who had been subjected to sexual and gender-based violence (SGBV) and torture. It involved the collection and thematic analysis of the narratives of 20 men and 41 women who were refugee survivors of SGBV and torture, including their experiences in South Sudan, their journeys to Uganda and experiences in refugee settlements, in particular their access to health and justice services. Thirty-seven key stakeholders including international, government, non-government organisations and civil society organisations were also interviewed regarding their experiences of providing health and justice services to refugees. All refugees had survived human rights abuses mainly carried out in South Sudan but some had also occurred on route to Uganda and within Uganda. Despite the significant impact of their experiences, the analysis indicated that there was limited service response in refugee settlements in Northern Uganda once the immediate humanitarian crisis ended. The thematic analysis indicated five main themes coming from the interviews. These included: the nature of refugee experiences of SGBV and torture, including domestic violence and child abduction and forced marriage; issues associated with service provision such as lack of adequate screening and under resourcing of health and justice services; a lack of gender sensitivity and specialist services, particularly for men; the sustained involvement of civil society organisations and local non-governmental organisations in providing counselling and offering emotional support and hope to survivors; and enhancing health and justice responses and services to improve refugee recovery, dignity and resilience. The authors recommend that integrated gendered and culturally sensitive service provision should be adopted, which brings together formal and informal health, justice services and survivor support programmes.

Trauma-informed Education Support Program for Refugee Survivors

Trauma-informed Education Support Program for Refugee Survivors

Refugees Who Have Experienced Extreme Cruelty: A Qualitative Study of Mental Health and Wellbeing after Being Granted Leave to Remain in the UK

This study explores how vulnerable refugees’ experiences in the first year after being granted leave to remain in the UK impact on mental health and wellbeing. Nine semi-structured interviews were conducted with refugee survivors of extreme cruelty. Data were analyzed using thematic analysis with a narrative influence. Reported challenges included requirements to organize housing, finances and welfare benefits rapidly. Most respondents reported low mood, worry, exacerbated PTSD symptoms, physical ailments and isolation, but valued stable housing, meaningful activities, emotional support and service provider sensitivity in managing this transition. Policy and service recommendations are made, to assist integration and improve wellbeing.

Methodological and Ethical Considerations in Research With Immigrant and Refugee Survivors of Intimate Partner Violence.

To promote safe and positive health outcomes by utilizing culturally relevant evidence-based interventions for immigrant and refugee women survivors of intimate partner violence, their active participation in research is critical. With 43.6 million immigrants and refugees living in the United States, there is a need for research studies to eliminate health disparities in these populations. However, barriers to recruiting and retaining these populations in research prevent the provision of quality and culturally informed services to meet their needs. The aim of this article is to discuss the recruitment and retention strategies employed and analyze the methodological and ethical challenges in the context of the weWomen Study. The use of a multifaceted approach informed by best practices maximized recruitment efforts and active participation that generated high numbers of immigrant and refugee women participants. The study also substantiated the need for more community-based participatory approaches to engage community members in the development of culturally appropriate approaches that instill a sense of ownership over the research process. Active research participation of immigrant and refugee survivors will help investigators understand their unique needs and facilitate the implementation of targeted evidence-based interventions.

Disappearing refugees inside the United States

I have been working as a psychotherapist and social worker with refugee survivors of torture since 1990. I am now involved at the Texas-Mexico border, drawn there by the torture of refugee families and their children who are disappeared under the U.S. Administration’s phrase, “family separation.” In the El Paso Sector, I collaborate with several clinical, legal, and investigative journalism organizations. We’ve read of the thousands of children and parents disappeared from one another at the border under that official phrase “family separation.”

Armenian Refugees in Aleppo: Humanitarian Efforts and Survival Strategies: 1915-1930

This article is an overview study of the international humanitarian response to the refugee crisis between 1915 and 1930 when Syria, and particularly the city of Aleppo, became home to tens of thousands of Armenian refugee survivors forcibly deported during the genocidal program implemented and carried out against the Ottoman Armenians by the Committee of Union and Progress (CUP) government in Constantinople. The objective of this article is threefold: the first is to determine the policies of the various governments of Syria between 1915 and 1930 towards the Armenian refugee population; the second is to examine the humanitarian efforts of international bodies, such as the League of Nations, the International Red Cross and the Near East Relief Society, to provide assistance to refugees; and the third is to identify the strategies refugees employed to ensure survival and to try to rebuild familial and communal ties.

Healthcare professionals as gatekeepers in research involving refugee survivors of sexual torture: An examination of the ethical issues.

This paper examines the ethical issues that arise when healthcare providers act as gatekeepers to research involving vulnerable populations. Traumatised refugees serve as an example of this subset of research participants. Highlighting the particular vulnerabilities of this group, we argue that specific ethical considerations are required that go beyond the conventional research approaches. While gatekeeping responds to some of those vulnerabilities, it risks wronging through unwarranted paternalism. Instead, we will propose that a relational ethics of justice and care serves as a more appropriate framework for responding to the challenges of research involving traumatised refugees. Specifically, such a framework allows us to reflect more deeply on the role of the gatekeeper. In conclusion, we recommend that clinicians and researchers collaborate with survivors' advisory groups in the development of specific research ethical guidelines.

Barriers and facilitators to physical and mental health help-seeking among Congolese male refugee survivors of conflict-related sexual violence living in Kampala

In Uganda, over 1.3 million refugees have fled armed conflicts from neighbouring countries, with about 251 730 refugees from the Democratic Republic of Congo (DRC) alone. In this article we report on a qualitative research study on the help-seeking behaviour of Congolese male refugee survivors of conflict-related sexual violence (CRSV) living in Kampala, Uganda. We recruited 10 Congolese male survivors of war-related rape and 6 Ugandan service providers (psychologists, social workers and physicians) who participated in individual interviews focused on barriers and facilitators to care seeking in Kampala, Uganda. We found that the major barriers to help-seeking were socio-cultural and political factors, health system and infrastructural barriers, poverty and livelihood barriers, physical effects of CRSV, fear of marital disharmony and breakup, and self-sufficiency The major facilitators were social support, symptom severity, professionalism among service providers, availability of free tailored services and information, education and communication. On the basis of our findings, we recommend that a multidisciplinary and multisectoral approach is important to address these barriers. In addition, we suggest that the Ugandan government should develop legislation and health policies to create protection for men who have experienced sexual violence.Keywords: armed conflict; conflict-related sexual violence; male refugee survivors; help-seeking; physical and mental health; barriers; and facilitators

Multilevel Risk and Protective Factors for Intimate Partner Violence Among African, Asian, and Latina Immigrant and Refugee Women: Perceptions of Effective Safety Planning Interventions.

Immigrant and refugee women are at high risk for intimate partner violence (IPV) and intimate partner homicide (IPH). Given the growing number of immigrants and refugees in the US and the concerns about IPV and IPH among immigrant and refugee groups, this paper aims to identify survivors and practitioners' perceptions of a) common and culturally specific risk and protective factors for IPV and IPH for immigrant and refugee women and b) areas of safety planning interventions for survivors who are at risk for severe or lethal violence by an intimate partner. Qualitative data for this multi-site study were collected from women and practitioners residing in seven geographically diverse US locations. Eighty-three in-depth interviews were conducted with adult immigrant and refugee survivors of IPV, who identified as Asian (n=30), Latina (n=30), and African (n=23). Additionally, nine focus groups and five key informant interviews were conducted with practitioners (n=62) who serve immigrant and refugee survivors of IPV. Results revealed multilevel risk and protective factors for IPV/IPH found at the societal-level (e.g., patriarchal cultural norms), relationship-level (e.g., partner abusive behaviors), and individual-level (e.g., acculturation in the US). These findings can inform the development of culturally responsive risk assessment and safety planning interventions across legal, social service, and healthcare settings.

Avoidance in posttraumatic stress among refugee survivors of violent conflict and atrocities: Testing trans-cultural risk processes and candidate intervention targets

BackgroundA fast-growing population of refugees and survivors of violent conflict and atrocities are at risk for trauma-related mental health problems. Experimental clinical research key to the development of interventions tailored to this population is limited. AimsIn an experimental psychopathology laboratory paradigm, we tested the expression and function of avoidance in posttraumatic stress (PTS) among a highly traumatized community sample of forcibly displaced refugees seeking asylum. MethodWe measured behavioral avoidance and emotional reactivity to repeated exposure to threatening stimuli (trauma-, war-, and geographically-relevant natural threat) in 110 Sudanese male asylum seekers (M(SD)age = 32.7(6.5)) recruited from the community in Israel. ResultsFirst, we found evidence of sensitization – traumatized refugees expressed increasing levels of behavioral avoidance and emotional reactivity in response to repeated exposure to threatening stimuli. Second, as predicted, refugees suffering from more severe PTS were more likely to exhibit greater behavioral avoidance and emotional reactivity reflexively or immediately upon exposure to threat stimuli. Finally, as predicted, behavioral avoidance mediated the effect of PTS severity on emotional reactivity to threat exposure. ConclusionsFindings are consistent with theorizing that avoidance may function as a trans-cultural malleable risk process sub-serving PTS and thereby a promising intervention target among highly traumatized refugees from E. Africa.

“My heart is in his hands”: The lived spiritual experiences of Congolese refugee women survivors of sexual violence

ABSTRACTThe Democratic Republic of Congo (DRC) has experienced widespread violence, including sexual violence. Sexual violence toward women includes rape, genital mutilation, and sexual slavery. Many Congolese have sought to escape such conditions as refugees in the USA. In the present study, we examined lived spiritual experiences of nine Congolese refugee women survivors of sexual violence. Overall, this study provides new insights into participants’ experiences of spirituality in the aftermath of sexual trauma and in living as a refugees. Consensual qualitative research (CQR) methods were used to analyze participants’ responses to a semistructured interview protocol. Participants endorsed faith that God was in control, reliance on prayer, gratitude toward God, and difficulty practicing their faith in the USA relative to Africa. Results indicated that religion/spirituality is an integral part of the women’s lives and that it appears to facilitate coping. Clinical and community mental health implications are discussed.

After the Fall: The Tapestry of Disturbance and Recovery.

On July 3, 2015, Nalini Nadkarni, a world-renowned ecologist who had been studying the biologic processes of ecosystem disturbance and recovery, sustained a catastrophic 50-foot free-fall from the top of the rainforest canopy to the forest floor at her remote field research site. She lost consciousness in shock and sustained life-threatening injuries. Her accompanying students hiked out, radio-called 911, and the Harborview Medical Center (Seattle) Medivac team arrived 4 hours later to rescue her. Her prognosis was extremely grim; her family gathered in anticipation of her death as she underwent four operations during her 10 days in the ICU. As she emerged from coma, she spent weeks of hospital recovery and months of progressive mobility and physical therapy during medical leave from work. She experienced ICU psychosis and postintensive care syndrome, but slowly recovered nearly totally, to the point where she can solo hike up to 18 miles in a day, and has fully resumed her professional responsibilities as professor of biology, including climbing tall trees for her canopy research. She attributes her survival and remarkable recovery to both exquisite medical critical care and support she received, and also to incorporating lessons learned from her interdisciplinary study of how diverse natural systems commonly experience and recover from catastrophic disturbances (e.g., forest fires, traffic jams, orphaned children, and refugee survivors of war). Insights from her own encounter with critical illness and study of disturbance and recovery led her to reflect on the tapestry of disturbance and recovery that permeate all ecosystems, and with relevance to the evolving Society of Critical Care Medicine, postintensive care syndrome, and THRIVE initiatives.

The Drowned, the Saved, and the Forgotten: Genocide Survivors and Modern Humanitarianism

Dominant narratives of the Eastern Mediterranean's 20th century exclude the study of Western humanitarianism and refugee survivors of the 1915 genocide of the Ottoman Armenians. Reasons for this exclusion abound. At the forefront is the abject nature of the human beings who populate that history, something which often induces revulsion on the part of historians in the present: these were people who left little of the appealing and elegant traces left by a Beiruti journalist, a Damascene urban notable, or an elite Constantinopolitan feminist. They appear as an undifferentiated mass of survivors of intense violence, disease, and starvation who are bereft of any agency; slaves, and serially raped and pregnant teenagers in bureaucratic documents stored at the League of Nations archive or packs of feral emaciated street children roving the narrow alleyways of Aleppo's old city in the paternalistic memoirs of Western relief workers—usually American or Scandinavian female healthcare professionals. Their own voices are obscured, showing up in the occasional self-published autobiography written by an elderly genocide survivor for his grandchildren, or in handwritten accounts and letters in lost dialects inherited by descendants unable to read them.

Development and Piloting the MMMM Ecological Interactive Open Systems Model: A Prospective One-Year Treatment Outcome of Children of Tortured Refugees

Children of refugee torture survivors present a compelling case of cumulative and continuous chronic past and current traumas and complex post-cumulative trauma symptoms. Traditional models of interventions with victims of single past traumas may not be effective with such victims. The goal is to develop and initially test a new open multi-systemic, multi-component and multi-modal intervention model (MMMM) as applied in the context of Summer Day Treatment and After School (SDTAS) program, and to determine its potential effectiveness as well as the feasibility of a larger study with more rigorous experimental design. A total of 27 secondary torture survivor Iraqi refugee children (13 males and 14 females, age between 11-16), living in the US, who suffered from serious symptoms and were non-responsive to treatment as usual for at least the previous six months, completed the planned interventions and three times follow-up assessments of five domains: PTSD, complex PTSD, anxiety, depression, and global level of functioning (GAF). Repeated measure analysis of variance was used to analyze changes over the three time points. Results indicated significant decrease in symptoms, and increased GAF with high effect sized (Partial Eta Squared ranged between 0.85 - 0.93). The amount of change displayed by the treated individuals was large enough to be clinically meaningful. Current study provides evidence of potential effectiveness of this novel intervention and of the feasibility of more rigorous and larger future controlled clinical trials to help develop evidence-based treatments for the multiply traumatized children who suffer past and present ongoing adversities. We suggest that the model is cost effective, and can be conducted with children of torture survivors and refugees in different settings world-wide by professionals or by trained supervised para-professionals.

'Up to now I am suffering': justice, sexual violence and disability amongst refugees in Uganda

Sexual violence is a common feature of persecution, and of the displacement situations that follow it. Such violence can cause serious physical, psychological and social harm, sometimes amounting to disability. Despite formal obligations on host states and international bodies to ensure the rights of refugees with disabilities, many challenges exist to promoting access to justice for refugee survivors of sexual violence. Through the lens of international law, this article considers two conceptualisations of justice and how well it is achieved for refugee survivors of sexual violence living in Uganda. Drawing on recent fieldwork, it will argue that despite some positive developments, there remain significant barriers to true justice for this group.

Managing chronic pain in survivors of torture.

All generalist and specialist clinicians are likely to encounter torture survivors among refugees and asylum seekers. A minority of people survive torture and a smaller minority reach a developed country; those who do tend to be the more resilient and resourceful. They have many health, social and welfare problems; persistent pain in the musculoskeletal system is one of the most common. There is little specific evidence on pain in survivors of torture; the guidelines on interdisciplinary specialist management are applicable. Most of the literature on refugee survivors of torture has an exclusive focus on psychological disorders, with particularly poor understanding of pain problems. This article summarizes the current status of assessment and treatment of pain problems in the torture survivor.

Self-Reported Head Injury Among Refugee Survivors of Torture

To examine the prevalence of self-reported head injury among treatment-seeking refugee survivors of torture, a population at high risk for such injuries. A total of 488 survivors of torture accepted at a torture treatment clinic between January 1, 2008, and December 31, 2011. Harvard Trauma Questionnaire, incidence of head injury and resulting loss of consciousness (LOC), chief physical complaints, general health scale, indicators of torture severity (length of detention, sexual assault, and number of different persecution types). Of the 488 cases reviewed, 335 (69%) patients reported sustaining a blow to the head. Of the 335 with head injury, 185 (55%) reported LOC following the injury. Those who reported sustaining a head injury were significantly more likely to be men, to have a greater number of types of torture experiences, and report sleep disturbances and headaches as their primary medical complaints. The high rates of head injury and head injury followed by LOC among treatment-seeking survivors of torture indicates the need for torture treatment centers to assess for possible brain injury. Our findings suggest that patients with possible traumatic brain injury (TBI) may be at a higher risk of negative physical outcomes than those without possible TBI.

Resilience and Refugees: From Individualised Trauma to Post Traumatic Growth

Resilience and Refugees: From Individualised Trauma to Post Traumatic Growth

Working with refugee survivors of torture and trauma: An opportunity for vicarious post-traumatic growth

Clinical work with people who have survived trauma carries a risk of vicarious traumatisation for the service provider, as well as the potential for vicarious post-traumatic growth (VPTG). Despite a growing interest in this area, the effects of working with survivors of refugee-related trauma have remained relatively unexplored. In this study, we examined the lived experiences of people working on a daily basis with survivors of torture and trauma who had sought refuge in Australia. Seventeen clinical, administrative and managerial staff from a not-for-profit organisation participated in a semi-structured interview that was later analysed using interpretive phenomenological analysis. Analysis of the data demonstrated that the entire sample reported symptoms of vicarious trauma (e.g. strong emotional reactions, intrusive images and shattering of existing beliefs) as well as VPTG (e.g. forming new relationships, increased self-understanding and gaining a greater appreciation of life). Moreover, effortful meaning-making processes appeared to facilitate positive changes. Reduction in the risks associated with this work, the enhancement of clinician well-being, and improvement of therapeutic outcomes for clientele are responsibilities shared by the organisation and clinicians. Without negating the distress of trauma work, clinicians are encouraged to more deeply consider the unique positive outcomes that supporting survivors can provide.

‘Like two pieces of the sky’: Seeing North Korea through accounts of the famine (Respond to this article at http://www.therai.org.uk/at/debate)

North Korea is renowned for its inaccessibility, with anthropologists and others compelled to work beyond its borders. Presented in this article are select findings from ethnographic research carried out in 2006 among refugee survivors of the North Korean famine living in South Korea. The ethnographic material shows how refugees’ accounts of their plight are shaped by the political conditions of North Korea.