Mixed evidence for stress effects on cortisol-testosterone coupling in Syrian refugee and Jordanian non-refugee adolescents.

ABSTRACT Background: Torture, banned under international treaties such as the UN Convention Against Torture, remains a widespread violation with profound health consequences. The Istanbul Protocol (IP) sets global standards for the medical documentation of torture highlighting the important role of healthcare providers. A limitation of existing research on torture's health impacts is that studies are largely cross-sectional and reliant on self-reported clinical data. Norway's detailed healthcare registry data offers a robust opportunity to conduct longitudinal, population-based studies, advancing our understanding of torture's long-term effects on refugees and its public health implications. Objectives: This study has two main aims: (1) to examine the frequency of torture-related diagnostic codes and the factors associated with their use in primary and specialized care among adult Syrian refugees resettled in Norway, and (2) to link self-report data on torture exposure in adult refugees from Syria with data on HCSU over a 6-year follow-up to explore group differences in utilization patterns. Methods: Study participants include the RBMI cohort (N = 14,350), comprised of all adult refugees from Syria resettled in Norway in 2015–2017; and the REFUGE cohort – a subsample of the RBMI cohort – comprised of those in the RBMI cohort who participated in a nationwide survey study in 2018. Aim 1 will be addressed using data (2015–2024) from the Norwegian Registry for Primary Health Care (KPR) and the Norwegian Patient Registry (NPR), which contain information on all contacts with primary- and specialized healthcare services throughout Norway (e.g. date of contact, diagnostic code given). To address aim 2, we will link 2018 survey data on torture exposure to the abovementioned registry data on HCSU. In addition to descriptive statistics, multivariable, two-part hurdle regression models will be used to analyse data since we expect zero inflation and overdispersion of the outcomes (HCSU). Stage of study: This manuscript reports Stage 1 of a Registered Report; analyses will be conducted after in-principle acceptance.

ABSTRACT This study investigated predictors of gifted identification among Syrian refugee students in Jordan, focusing on academic achievement, gender, and school context. A dataset comprising 13,598 students assessed using the Arabic version of the HOPE Teacher Rating Scale was analyzed. Logistic regression and random forest analyses examined the influence of GPA, gender, school stage (elementary, middle, secondary), and school location (in-camp and out-of-camp) on identification patterns. GPA emerged as a strong predictor, with higher GPA substantially increasing the likelihood of gifted identification. School location demonstrated a modest effect, as students in camp settings were less likely to be identified, reflecting structural inequities in educational provision. Middle school students were less likely to be identified compared to secondary students, while gender differences were not significant. Predictive modeling results should be interpreted with caution, as gifted identification was derived directly from the HOPE total score; models incorporating HOPE items closely mirrored the HOPE-based classification, whereas models using only demographic variables had limited discriminatory power. These findings underscore the importance of culturally validated, behaviorally anchored teacher rating tools in promoting equitable gifted identification in refugee education contexts and highlight the need for policies that reduce reliance on academic metrics alone.

ABSTRACT The Syrian crisis in 2011 transformed Syria into the world's primary refugee-producing country, dispersing millions across various countries. Humanitarian NGOs tasked with delivering assistance to Syrian refugees faced a critical dilemma; while their mission revolves around assisting refugees and alleviating their suffering, they must also incessantly pursue financial support to sustain vital aid programs. Consequently, several humanitarian organizations have found themselves compromising certain humanitarian principles, whether partially or entirely, as they exploited the Syrian refugee crisis to raise funds from donors. By employing a qualitative methodological approach and the deontological theory of obligation, this paper explores how well humanitarian organizations comply with humanitarian ethics – focusing on the principle of dignity – by analyzing the excessive use of logos and refugee advertisement during the Syrian refugee crisis. The findings suggest that while humanitarian organizations prioritize and remain focused on their duty to provide aid, they often overlook the moral implications of their activities, particularly the dignity of the refugees they serve. Given the growing global displacement crisis, this paper provides critical insights for policymakers and humanitarian actors, urging a more ethical and effective approach to governing refugee crises and migration in various contexts.

Healthcare workforce distribution during multiple crises: a 12-year analysis of physician allocation, retention and equity patterns in Turkey.

ABSTRACT Canada resettled over 74,000 Syrian refugees between 2015–2019. Thousands of refugee-learners were consequently introduced into the provincial education systems. This paper explores a particular subset of this population by focusing on the experiences of Syrian refugee young adults, aged between 16–24 in Montreal, who were aged out of the traditional education system, having to access adult education as their only option to complete highschool. These students struggled to navigate the foreignness of the Quebec education system, with years of missed schooling and financial worries. Ironically, while equity is offered, exclusion is created. The purpose of this paper is to illustrate that while educational opportunities offer a semblance of equity, the lived experiences of these Syrian youth reveal exclusion, unintentionally marginalized by educational policymakers. Semi-structured, one-hour interviews with 29 Syrian refugee-learners and 12 educators provide rich data, analyzed thematically. Critical race theory frames this research exposing systemic issues that hinder inclusion.

The issue of educational access in prolonged displacement contexts has sparked considerable discussion, with numerous studies underscoring the importance of educational opportunities for refugees. This research, grounded in structuration theory, investigates the obstacles and enabling factors that affect Syrian refugees’ access to education in Jordan. Recognizing the dynamic interplay between individual agency and institutional structures, this paper argues that a comprehensive socio-political framework is essential for addressing educational inequities in prolonged displacement settings. Employing a qualitative methodology that engages parents and caregivers of school-aged children and adolescents, educators, school administrators, and practitioners involved in both formal and informal educational settings, this paper seeks to illuminate the challenges faced by Syrian refugees in securing educational opportunities within the Jordanian landscape. It does this by identifying the primary barriers to educational access; analyzing the perspectives of parents and caregivers experiencing prolonged displacement; and exploring potential strategies to assist refugees in obtaining quality education. The results reveal that several policy and social strategies aimed at ensuring high-quality educational experiences for Syrian children and youth can be taken, and that a holistic approach to education can improve access to learning and enhance educational opportunities for refugees.

This article examines forced migrants’ decision-making over time on movement from first country of asylum. Building on 150 in-depth interviews with Syrian refugees (A note on terminology: the term refugee is used colloquially by our participants, other scholars, the legal profession, and international actors to denote most Syrian migrants, yet it often means different things to its users. While many of our participants may be refugees, it is beyond our competence to judge and is not a term that describes their legal standing in Turkey or Lebanon. As such, we often use the term forced migrants as all our participants (and all refugees) can be described as forced migrants, whether they are refugees or not.) in Turkey and Lebanon (85 in Turkey and 65 in Lebanon) conducted in 2022–2023, we develop a tri-partite conceptual framework that integrates spatio-temporalities, migration infrastructure, and forms of capital. Methodologically, the study uses purposive, stratified sampling and semi-structured interviews, with coding for social, cultural, economic, and symbolic capital and mapping against local legislative, social, and temporal conditions. Our findings show that decision-making is iterative and situational, rather than a simple cost–benefit calculation or a linear trajectory. Spatio-temporal positions determine which infrastructures are visible and how urgent onward movement feels; migration infrastructures—formal and informal, digital and clandestine—translate possibilities into concrete routes and risks; and migrants’ varying capitals shape who can access regularized, document-based pathways versus hazardous, informal channels. Higher starting or converted capital often correlates with a preference for legal, document-dependent strategies and greater willingness to wait and convert capital; lower capital correlates with urgency, recourse to smugglers, and shorter latency between failed attempts and retrying. Digital platforms mediate both safe and exploitative practices, while administrative opacity and high transaction costs distort access to formal routes. The paper offers a dynamic, meso-informed account of secondary movement that foregrounds infrastructure as a relational system that shapes incentives and risk. Policy implications, therefore, call for interventions that reconfigure migration infrastructure, expand affordable, regular pathways, increase institutional transparency, and reduce markets for exploitative intermediaries to lessen harm and broaden durable onward-movement options.

ABSTRACT While the drivers of public attitudes towards immigration have been extensively studied in Western contexts, less is known how these attitudes form in developing countries that host the majority of the world’s refugees. This paper addresses this gap by conducting a conjoint experiment in Türkiye, which hosts the largest Syrian refugee population globally, to test a broad range of theories related to economic, cultural, and humanitarian concerns. The rating outcome findings indicate a strong reluctance to host Syrian refugees, with 61% of respondents favouring return to Syria. Results from the AMCEs analysis further reveal that cultural concerns driven by fears about long-term integration of Syrian refugees, along with sociotropic economic concerns related to their potential economic burden or expected economic contributions play an important role in shaping preferences. Contrary to expectations, shared religious identity is not influential, even among more religious respondents. These findings challenge existing assumptions that cultural closeness plays an important role in forming attitudes towards immigration. The study contributes to the growing body of literature on attitudes towards refugees by demonstrating the limits of Western-derived theories and emphasising the importance of context-specific factors in shaping public opinion.

This article provides an understanding of the lived experiences of Syrian refugees and forcibly displaced Ukrainians living in Sault Ste. Marie, a small city in northern Ontario, using personal narratives. The comparative analysis reveals diverse but overlapping integration challenges, with the aim to expand academic and policy knowledge about refugee integration in small cities in northern Ontario. Findings highlight that both groups faced similar challenges including limited employment, discrimination, language barriers, and inadequate health care. Despite these obstacles, participants valued affordable housing, access to nature, and a welcoming community. Limited job opportunities remained a major barrier to retention.

ABSTRACT Education is an important factor that both forces and guides refugees’ decision-making about their migrations. In this article, we explore the complex interplay between education, migration, and conflict. To do so, we bring together multiple research projects to analyze 121 interviews that we conducted with 88 participants: 15 Syrian refugee students and 73 Syrian and Lebanese teachers of refugees. We examine how Syrian refugee students and teachers experience and explain migration decisions and the connection between those decisions and their views of and experiences with education and with conflict. We analyze how teachers and students understand and experience the structures and content of schooling and show how these structures and content interact with conflict and migration dynamics. We find that these educational experiences both shape and are shaped by their experiences with conflict, their visions for the future, and their migration decision-making.

Young adult Syrians who arrived in Canada with ‘disrupted education’ in recent years are in a vulnerable position as they are transitioned into an education sector designed for independent and self-directed adults. This study examines how Syrian refugee young adults’ agency and freedoms are supported in the adult education (AE) sector in Quebec. Specifically, how do they navigate the AE system to achieve their educational goals? How do they perceive the progress of their learning in the AE system? Data were collected from 10 Syrian students (18-24 years) through in-depth interviews and focus group discussions. Findings revealed that despite their strong self-motivation and drive to achieve their educational goals, these students are vulnerable due to several factors, among them, the different methods of teaching in Syria and unfamiliarity with independent teaching methods in AE in Quebec that make it difficult to navigate this new system, all whilst having to learn new languages.

BackgroundThe Syrian civil war has caused large-scale displacement, with many Syrian refugee women migrating to Türkiye. Lactation is a critical period requiring adequate nutrition for maternal and infant health. However, data on the nutritional status of lactating Syrian refugee women are limited.AimThis study aimed to assess the nutritional status of lactating Syrian refugee women who migrated to Türkiye due to the Syrian civil war.MethodsA cross-sectional study was conducted between October 5, 2017, and January 29, 2018, with 102 lactating Syrian refugee women with infants aged 0-6 months attending the Istanbul Al Farah Child and Family Support Center. Participants were selected using convenience sampling. Inclusion criteria were being a Syrian refugee woman in the lactation period, having an infant aged 0-6 months, and volunteering to participate in the study. Women with chronic illnesses or metabolic disorders were excluded. Data were collected through face-to-face interviews with the assistance of a translator, using a structured Turkish questionnaire covering demographic information, anthropometric measurements, and 3-day dietary records. Dietary intake was analyzed with the BEBIS9 program and compared to the Türkiye Nutrition Guide recommendations. Although the dietary data were collected in 2017-2018, the analysis was conducted using the most up-to-date national guidelines to reflect current public health priorities.ResultsParticipants (n = 102) had an average age of 27.9 ± 5.7 years, BMI of 27.3 ± 4.6 kg/m², and monthly income of 1267 TL. Their daily energy intake was 1593.7 ± 556.5 kcal/day. A large proportion of participants had inadequate intake of micronutrients, with the highest insufficiency observed for pyridoxine (88.2%), followed by vitamin A (81.4%), vitamin C (76.5%), thiamine (71.5%), riboflavin (63.7%), folic acid (81.4%), vitamin B12 (72.6%), iron (62.8%), and zinc (68.6%). Women with higher BMI in early lactation consumed more fat (p < 0.05). Significant associations were found between micronutrient intake and sociodemographic factors (p < 0.05). However, due to the small sample size and use of convenience sampling, the generalizability of the findings is limited. Future studies with larger and more representative samples are needed to confirm these results.ConclusionSyrian refugee women in the lactation period showed inadequate intake of energy and essential micronutrients, likely due to poor socioeconomic and living conditions. Interventions such as culturally sensitive nutrition education, postpartum micronutrient supplementation, and improved access to migrant-friendly healthcare services are needed. Additionally, targeted policies and sustainable public health nutrition programs-such as food voucher schemes, fortified food distribution, and maternal support groups-should be developed in collaboration with health institutions and NGOs to improve maternal and infant health outcomes in this vulnerable population.

Throughout history, wars and conflicts have led to large-scale forced migration movements, causing various economic, social, and political problems in the countries receiving migrants. The Middle East is one of the regions where such forced migrations have frequently occurred. The Arab Spring, which began in Tunisia in 2010 and rapidly spread across the region, triggered a civil war in Syria in 2011. As a result of this conflict, millions of Syrians were forced to leave their country and sought refuge primarily in neighboring states, with Türkiye hosting the largest number of Syrian refugees under its “open-door policy.” However, this policy soon led to serious economic, social, and political challenges and provoked diverse reactions within the public sphere. This study examines how the Syrian refugee crisis has been securitized in Türkiye through economic, social, and political dynamics within the framework of the Copenhagen School. Focusing on the period 2011–2024, it argues that the increasing economic burden, social tensions, and political transformations have contributed to the construction of refugees as security threats. The study reveals that Türkiye’s initial humanitarian approach gradually evolved into a security-oriented perspective as the crisis became protracted.

ABSTRACT For Syrian refugee children resettled in Türkiye, Arabic exists in three overlapping repertoires: colloquial Arabic for home, Qurʾānic fuṣḥā for sacred practice, and Turkish for schooling and mobility. This study integrates investment theory, translanguaging, and heritage literacy to examine how sacred, colloquial, and host-language literacies are braided through private tutoring. Fifteen semi-structured interviews with four child–parent–tutor triads in Gaziantep were coded using a 22-item analytic framework combining these perspectives. Using R-based co-occurrence mapping and network analysis, 535 coded excerpts were analysed to trace how participants negotiate Arabic’s dual role as both sacred heritage and practical resource. Findings reveal asymmetric yet complementary investments across stakeholders. Parents prioritise faith and home-based translanguaging as moral continuity; children foreground schooling motives and perceived difficulty; tutors actively bridge Qurʾānic and academic literacies. Network centrality analysis identifies two key bridges, home translanguaging and perceived challenge, linking pragmatic schooling goals with faith-oriented identity talk. Qurʾānic literacy clusters strongly with heritage identity but rarely with economic investment, indicating its function as spiritual rather than market capital. Children’s identity trajectories diverge: those confident in Arabic and Turkish articulate hybrid identities, while others frame Arabic competence as a deferred obligation. Overall, the study advances sociolinguistic understanding of Islam and heritage.

Forced migration, as exemplified by the ongoing Syrian refugee crisis, has been consistently associated with elevated rates of psychiatric conditions, including post-traumatic stress disorder (PTSD), depression, anxiety, and increased suicide risk. However, the psychological mechanisms linking trauma-related symptoms to suicide risk in refugee populations remain insufficiently understood. The present study examines the mediating role of anxiety sensitivity in the relationship between PTSD symptoms and suicide risk among Syrian refugees residing in Turkey. Data were collected from 627 Syrian refugees aged 18-65 years living in Bursa province. Participants completed validated self-report measures assessing PTSD symptoms (Impact of Event Scale-Revised; IES-R), depression (Beck Depression Inventory; BDI), anxiety sensitivity (Anxiety Sensitivity Index-3; ASI-3), and suicide risk (Suicide Probability Scale; SPS). Elevated PTSD symptom levels were observed in 81.2% of the sample. Logistic regression and mediation analyses were conducted to examine associations between PTSD symptom clusters, anxiety sensitivity dimensions, and suicide risk. Results indicated that intrusion and hyperarousal symptoms were positively associated with suicide risk, whereas avoidance symptoms and physical concern (ASI-3 subscale) were negatively associated. Mediation analysis revealed that cognitive concern-defined as fear of losing mental control-partially mediated the association between PTSD symptoms and suicidal ideation (SPS suicidal ideation subscale). Taken together, these findings suggest that maladaptive interpretations of cognitive distress may represent a clinically relevant target for reducing suicide risk in trauma-exposed refugee populations. In contrast, avoidance and heightened awareness of bodily sensations may function as temporary protective strategies in the context of overwhelming stress. Overall, the findings underscore the importance of trauma-informed interventions that prioritize suicide stabilization in forcibly displaced individuals prior to the initiation of PTSD-focused treatment.

Background/Objectives: Traumatic experiences may lead to both negative and positive outcomes. Positive psychological changes following trauma are commonly referred to as posttraumatic growth (PTG). The present study aims to examine factors associated with posttraumatic growth among Syrian refugees who have been living in Turkey for an extended period. Methods: This cross-sectional study included a sample of 240 Syrian refugees. Participants completed the Posttraumatic Stress Disorder Checklist (PCL-5), the Posttraumatic Growth Inventory (PTGI), and the Mindful Attention Awareness Scale (MAAS). Path analysis was conducted to examine the effects of PTSD symptoms and mindfulness levels on posttraumatic growth. In addition, Multivariate Adaptive Regression Spline (MARS) analysis was used to identify threshold values for the contributions of these variables to posttraumatic growth. Results: The mean age of the participants was 36.9 ± 10.4 years, and 47% were female. The direct effect of PTSD symptoms on posttraumatic growth was negative and statistically significant (β = -0.291, p < 0.001). PTSD symptoms also had an indirect effect on posttraumatic growth through mindfulness (β = -0.254), resulting in a total effect of -0.545. According to the MARS model, when MAAS scores exceeded 78, mindfulness demonstrated a positive effect on posttraumatic growth. Conclusions: The findings indicate that PTSD symptoms among refugees are associated with posttraumatic growth through both direct and indirect pathways. Furthermore, mindfulness emerges as a key factor in understanding the development of posttraumatic growth in this population.

Objective: This study aimed to examine the relationship between the internalized stigma of mental disorders and mental health literacy in Syrian refugees receiving psychosocial services. Method: This cross-sectional, correlational study was conducted with a total of 101 Syrian refugees living in Istanbul, Turkey. Data were collected between October 2023 and May 2024 by self-reporting, using the Arabic language Information Form, the Internalized Stigma of Mental Illness Scale (ISMI), and the Mental Health Literacy Scale (MHLS). Results: While no significant correlation was found between the ISMI and MHLS, gender and status of having children were statistically significant predictors of the ISMI (R2=0.16), with the internalized stigma scores of women and those who had not children being statistically higher. Status of having received psychoeducation related to mental disorders was a statistically significant predictor of the MHLS (R2= 0.05). Conclusion: Psychoeducation could enhance mental health literacy and reduce internalized stigmatization. Future in-depth studies on internalized stigma among Syrian immigrant women are recommended.

ABSTRACT This study examines the complex ways in which international students in Turkey navigate and constructs their racial identities within a socio-political landscape that simultaneously aligns with and distances itself from Western conceptions of whiteness. Through a multi-scale racial analysis of international students with racially and nationally diverse backgrounds, the research highlights the complex and often ambiguous racial identities that emerge among students, particularly those from Muslim-majority countries. The three main findings: (1) the minimization of a racial awareness that nonetheless exposed racial perception with the conceptualization of ‘Brunette’ and white beauty ideals, (2) the construction of the ‘Syrian refugee’ vis-à-vis other Arab groups and (3) how anti-Blackness was negotiated through a Muslim identity – all point to the role of travelling racial processes, Turkey’s racial history and contemporary reality and multi-scale relational racial understandings. International student’s racial experiences in Turkey highlight the overlapping entanglements to racialization in non-Western contexts that are also always embedded in wider global forces, regional understandings and intersectional markers.

This article explores vulnerability in the resettlement experiences and imaginaries of Syrian refugee youth (aged 18–35) in Türkiye, a group often excluded from conventional vulnerability frameworks. Based on in-depth interviews, it conceptualizes vulnerability as multi-faceted, spanning innate, structural, and situational dimensions. Findings show how shifting migration policies, politicization, and institutional barriers compound insecurities, shaping how youth imagine and pursue resettlement in a protracted refugee context. The study contributes to debates on vulnerability, youth migration, and the evolving possibilities of resettlement, and underlines the need for international policies and agreements that adopt context-sensitive approaches addressing structural and situational factors.