The mental health impacts of displacement

Over 120 million people are currently displaced around the world due to war, armed conflict and other related threats. Despite the number of displaced people growing year on year, mental health services for displaced communities remain woefully inadequate. This is due to barriers to seeking care, lack of services available, not being a funding priority, as well as the stigma behind it.

Mental health and displacement 

The trauma and experiences faced by displaced populations in their home countries in tandem with the process of being forcibly displaced and learning how to navigate new environments leads to high levels of stress and can have long-term mental health consequences. In addition, the lack of income and access to health care further impacts the mental health of many refugees and asylum seekers. This includes post-traumatic stress disorder (PTSD), depression and anxiety. If these are not addressed, they can lead to even more severe consequences, such as psychosis, domestic violence, substance abuse and increased suicidal ideation.

Systemic reviews show the prevalence of these mental health disorders varies widely with rates ranging from 20% to 80% for various mental health conditions:

• 40% anxiety
• 44% depression
• 36% PTSD

Symptoms

Individuals who are exposed to life-threatening events, torture and violence due to war, genocide and natural disasters, including climate change, experience anxiety, hyper-vigilance, avoidance, nightmares, flashbacks, distressing thoughts, or self-destructive behaviour which are just some symptoms of PTSD. Additionally, those who have experienced severe deprivation, with a lack of food, water, shelter, medical needs, and education tend to experience hopelessness, defeat, irritability, and trouble adjusting to a new place, all of which are associated with depression.

Effects on children

In 2023, children comprised 40% of the world’s refugees. Children are massively impacted due to war. They may have lost parents or siblings or witnessed torture in their home countries. Some might have been forced into armed combat and upon settling, be treated as perpetrators rather than survivors and are thus linked to higher rates of anxiety, PTSD, or depression. The mental health of parents can also negatively impact their emotional well-being. However, children might present symptoms differently from adults. Children could show physical symptoms, which could be unexplainable complaints of pain in their stomach, weakness, heart racing, and difficulty breathing. Due to chronic stress, these children are at a greater risk of behavioural problems which can have an impact on their development and cognition.

A review by the European Journal of Psychotraumatology entitled ‘Crossing Borders: a systematic review identifying potential mechanisms of intergenerational trauma transmission in asylum-seeking and refugee families’ investigated intergenerational trauma transmission in forcibly displaced families where parents have experienced direct war-related trauma exposure, but children have no history of direct trauma exposure. The findings showed that refugee children, with no first-hand exposure to trauma, can be affected by potential mechanisms of insecure attachment, maladaptive parenting styles, diminished parental emotional availability, decreased family functioning, accumulation of family stressors, dysfunctional intra-family communication styles and severity of parental symptomatology.

Addressing the mental health needs of displaced communities

It is critical to address these concerns and identify solutions at an individual, familial and community level and break down barriers they may face in order to create a safe environment. Good mental well-being is a right for everyone, especially those who have faced indescribable conditions.

How can we help?

According to WHO, there are 5 key items to improve the mental health care of displaced communities:

1. Community support – Evidence shows that being part of a community with a shared background and attending school are associated with lower rates of mental disorders.
2. Provide basic needs and security – For example, an insecure legal status can contribute to poor mental health.
3. Stigma – experiences of racism and discrimination are consistently associated with adverse mental health outcomes.
4. Address diversity and trauma – For example, extended detention is associated with increased rates of depression and PTSD.
5. Access to services – Refugees and migrants often do not prioritise their mental health because they are not aware of the services available free of charge or do not accept health care due to language barriers and concerns around confidentiality.

It is imperative to offer a welcoming environment defined by an asylum system that does not further traumatise those with lived experience of displacement and instead works effectively, humanely and efficiently. Training should be provided to teachers and schools so children with experience of displacement can continue their education safely in an environment that can provide support.

Rehumanising the narrative around displacement

Many people with lived experience of displacement experience racism and discrimination, which can also lead to poor well-being. It is important to educate communities where refugees and asylum seekers are resettled about the reasons people were forced to flee their homes to actively address stereotypes and myths. Mental health support should be provided to people who have lived experience regularly, as well as education regarding mental health, as some may not be familiar with the services available and may still carry a stigma behind mental health problems.

Currently, only 3% of refugees are referred to mental health care, as compared to 30-40% seen for physical conditions. Doctors must be attentive to their needs and consider their mental well-being as well as physical needs. Health professionals should be educated and trained in the effects of migration from war-torn countries as well as how to manage accordingly.

Despite the challenges they have faced, people who have been forced to be refugees are incredibly resilient and deserve to be given every right and opportunity and to be treated with dignity and respect.

Finding support

If you need help for a mental health crisis or emergency, you should get immediate expert advice and assessment.

إذا كنت بحاجة إلى مساعدة بشأن أزمة أو حالة طوارئ تتعلق بالصحة العقلية، فيجب عليك الحصول على مشورة وتقييم الخبراء على الفور.

UK:

Get help from 111 online or call 111 and select the mental health option.

المملكة المتحدة: احصل على المساعدة من 111 عبر الإنترنت أو اتصل بالرقم 111 وحدد خيار الصحة العقلية

USA:

Call or text 988 or chat 988lifeline.org. You can also reach Crisis Text Line by texting MHA to 741741.

الولايات المتحدة الأمريكية: اتصل أو أرسل رسالة نصية إلى 988 أو قم بالدردشة على 988lifeline.org. يمكنك أيضًا الوصول إلى Crisis Text Line عن طريق إرسال رسالة نصية إلى MHA على الرقم 741741.

Jordan:

Suicide and crisis line, call 911

UNHCR hotline: 0795546383 / 0796139584 – Sexual and Gender-Based Violence & Children at Risk help hotline for refugees.

الأردن

خط الانتحار والأزمات، اتصل بالرقم 911

الخط الساخن للمفوضية: 0795546383 / 0796139584

العنف الجنسي والعنف القائم على النوع الاجتماعي والأطفال المعرضين للخطر يساعدون الخط الساخن للاجئين

Lebanon:

The Lifeline 1564: 1564; Al Dar Women and Girls Safe Shelter Line: +961 76 06 06 02

لبنان:

شريان الحياة 1564: 1564؛ خط الدار للمأوى الآمن للنساء والفتيات: +961 76 06 06 02

Germany:

Die TelefonSeelsorge: Tel: 116 123

International Helpline Berlin Tel: 030-44 01 06 07

ألمانيا:

Die TelefonSeelsorge: هاتف: 116123

خط المساعدة الدولي برلين هاتف: 030-44 01 06 07

Dr. Wardah Rana is a dedicated member of Our World Too, an organisation focused on re-humanising the narrative surrounding refugees and displaced communities globally. She most recently served as an emergency medicine doctor during the COVID-19 pandemic and as a general physician in the UK, where she provided care to Afghan refugees who had recently arrived in the country. Currently based in the US, she plans to pursue residency there. Her diverse experience also includes working in Saudi Arabia, Pakistan, and Bahrain.