To explain the consequences on their mental health, the authors of a study published in the UK journal, The Lancet, undertook a review of all the work on this subject, to see what lessons can be learned for the best way to support refugee and displaced children and their families.
One of the co-authors of the review, released on 10 August, Mina Fazal, told IRIN: "This is important because of the vast numbers affected, mostly in resource-poor countries, and we know that they are at high risk of mental-health problems because they are likely to have been exposed to violence, which is the strongest predictor of poor mental-health outcomes."
The Oxford-based researchers found one major information gap. The vast majority of existing work had been done with refugee children in high-income countries, and yet the typical refugee child probably lives in a camp, somewhere close to their country of origin, in a low or middle-income country with very limited resources to spend on mental-health issues.
This brings specific problems. In Sudan's Darfur region and in Chad, both boys and girls reported having been raped, usually while collecting firewood. At least 75 percent of children interviewed in internally displaced persons (IDP) camps in Darfur met the diagnostic criteria for post traumatic stress disorder and 38 percent had depression.
Local people, poor themselves, can be hostile and threatening towards newcomers competing for scarce resources. And just being close to home does not always diminish the culture shock. The report says, "Evidence suggests that adaptation to apparently similar settings is not necessarily easy, and refugees themselves draw attention to cultural dissimilarity in settings that western researchers judge to be similar on the basis of religion and language.”
One positive factor was the retention of community structures in the new setting. When non-Arabs were chased out of Mauritania in 1989, whole villages fled together across the river that marked the border. Entire schools, children and teachers moved together and reconstituted themselves on the Senegalese side. That kind of continuity and community support helps children to be more resilient to the shocks of exile.
The authors call for more research in poorer refugee-receiving countries, and for an integrated approach that, as well as providing basic food and shelter, will support the development of community structures and activities that promote mental health. And they suggest that richer countries should help pay for this, since it is their increasingly restrictive asylum policies that have left poorer countries to carry most of the burden.
For younger children, who are with their families, whichever country they end up in perhaps matters less. But refugee children carry their memories of past events and live with the continuing consequences. One aspect that emerged from the review was that exposure to violence, particularly continued exposure, carried the strongest risk of subsequent psychological disturbance. And worst of all is violence that disrupts the integrity of family or home. It may not be the violence of political conflict; high rates of domestic violence in the stressful environment of refugee camps cause great distress to children.
Children are very sensitive to the anxieties of their parents. Even traumatic family events that happened before a child was born can raise his or her risk of mental-health problems.
For refugee children in rich countries more resources are available, but there are specific problems. Another issue that emerged from the review of research was that post-migration detention, where children are held as part of the immigration process, seems to be particularly detrimental to their mental health.
Aoife O’Higgins, who works with young refugees on behalf of the Children’s Society, says this matches her experience. She told IRIN: “I think it is very shocking for young people who have travelled so far, and had very difficult journeys, and then they are detained on arrival.”
O’Higgins said she had direct evidence of the effect of detention on one of the women and girls she works with, a young Iraqi woman, who was sexually abused during her journey to the UK, and has severe mental-health problems, self-harming, scratching and cutting herself and pulling out her hair.
"Because her immigration status is unresolved, she has to go and sign on [at the department of immigration] every week,” O’Higgins said, “and every time she is terrified of being detained again. She was detained for two days last year by mistake, and her condition deteriorated significantly.”
Fazal hopes her work and that of her colleagues will help prevent this kind of extra stress. “What we highlight is that even if they have been exposed to these pre-disposing risk factors, you can try to moderate any future risk factors, because it is cumulative adversity which is the worst thing for these young people,” she told IRIN.
“So the important thing is not being forced to move too many times, not being placed in detention, not being separated from family – all these cause greater risk.”