Refugee experiences and the traumatic impacts ***Trigger warning - could be triggering so please use caution****

Many refugees, especially children, have experienced traumatic experiences related to war or persecution that may affect their mental and physical health long after the events have occurred. These traumatic events may occur while the refugees are in their country of origin, during displacement from their country of origin, or during their resettlement process.

While in their country of origin, refugee children may have experienced traumatic events or hardships including:

Violence (as witnesses, victims, and/or perpetrators)
War
Lack of food, water, and shelter
Physical injuries, infections, and diseases
Torture
Forced labor
Sexual assault
Lack of medical care
Loss of loved ones
Disruption in or lack of access to schooling

Before being forced to flee, refugees may experience imprisonment, torture, loss of property, malnutrition, physical assault, extreme fear, rape and loss of livelihood. The flight process can last days or years. During flight, refugees are frequently separated from family members, robbed, forced to inflict pain or kill, witness torture or killing, and/or lose close family members or friends and endure extremely harsh environmental conditions. Perhaps the most significant effect from all of the experiences refugees endure is having been betrayed, either by their own people, by enemy forces, or by the politics of their world in general. Having misanthropic actions of others become a major factor controlling the lives of refugees has significant implications for health and for their ability to develop trusting interpersonal relationships, which are critical to resettlement and healing.

During displacement, refugee children often face many of the same types of traumatic events or hardships that they faced in their country of origin, as well as new experiences such as:

Living in refugee camps
Separation from family
Loss of community
Uncertainty about the future
Harassment by local authorities
Traveling long distances by foot
Detention

When refugees resettle in another country, it is most often in a place that is not of the refugees choosing, the refugee must adapt to a new place and language under uncertain circumstances and with uncertain futures. Re-establishing a home and identity, while trying to juggle the tasks of daily living, is yet another significant challenge that the refugee must undertake.

The short term impact on trauma on refugee's including children include the following:

Refugee children and adolescents are often exposed to trauma in their country of origin and/or in refugee camps, during displacement, and during resettlement and acculturation in a new country. Once resettled, refugee youth are vulnerable to stressors such as a new language, new cultural expectations, economic stressors including accessing resources, and social isolation stressors such as discrimination and lack of social support within their communities. Further, many of these children and adolescents have limited or no formal schooling. They may also experience family stress, given the history of intergenerational trauma and ongoing stressors within refugee families. Differences in acculturation between children and their parents may also contribute to conflict and breakdowns in communication within families. All of these factors may contribute to a refugee childs risk for suicide or suicidal ideation.

Refugee children and adolescents who experience suicidal ideation may not receive the help they need, as many refugee families do not seek traditional mental health services and lack access to other sources of support.

What are the stressors associated with being a refugee?

Traumatic Stress occurs when a child experiences an intense event that threatens or causes harm to his or her emotional and physical well-being. Refugees can experience traumatic stress related to:

War and persecution
Displacement from their home
Flight and migration
Poverty
Family/community violence

Resettlement Stress; stressors that refugee children and families experience as they try to make a new life for themselves.

Examples include:

Financial stressors
Difficulties finding adequate housing
Difficulties finding employment
Loss of community support
Lack of access to resources
Transportation difficulties

Acculturation Stress; stressors that refugee children and families experience as they try to navigate between their new culture and their culture of origin. Examples include:

Conflicts between children and parents over new and old cultural values
Conflicts with peers related to cultural misunderstandings
The necessity to translate for family members who are not fluent in English
Problems trying to fit in at school
Struggle to form an integrated identity including elements of their new culture and their culture of origin

Isolation Stress; stressors that refugee children and families experience as minorities in a new country. Examples include:

Feelings of loneliness and loss of social support network
Discrimination
Experiences of harassment from peers, adults, or law enforcement
Experiences with others who do not trust the refugee child and family
Feelings of not fitting in with others
Loss of social status

Treatments for trauma related symptoms need to be acceptable to different cultural groups and be developed in partners hips with refugee communites and based on an understanding of different models of mental health and recovery.

Factors important in refugee well-being and recovery include:

Rebuilding a sense of safety and security
Development of attachments and social groups
Support in developing plans and goals for the future
Maintaining a sense of cultural identity
Developing a safe way of communicating traumatic experiences

Distinct challenges

There are several challenges that often affect the assessment and treatment of refugees. Individuals may express psychological distress in different ways. And, the stressors that are considered traumatic may be different for different people. For example, being forbidden to live according to one's religion might be highly stressful for some peoples, but not for others . Some refugees are particularly suspicious of people in positions of authority as a result of the conditions under which they fled their home country. In addition, language barriers may exist. Further, even when language is not a barrier because an interpreter is available or because the provider and refugee speak a common language, the exchange is still likely to be influenced by complex religious and ethnic interconnections. As a result, talking about trauma through interpreters does not necessarily make for culturally relevant care.

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