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Political possibilities closed down as the war ended in 2005. With the negotiation of the Comprehensive Peace Agreement and the death of the SPLA’s leader John Garang – which sparked riots and racialised murder across Khartoum – many people’s connections and trust in inclusive intellectual and political projects were broken. This chapter briefly surveys the aftermath of the riots and peace process, which saw a massive movement of well over a million Khartoum residents to the south, where they reconstructed a very different set of neighbourhoods that in the late 2000s were often known as New Khartoums. The secession of South Sudan in 2011 was not a panacea or end goal of the long conflicts for many of these returned Khartoum residents. Reflecting discussions with returning residents over 2012 and 2013, the chapter examines the lost possibilities of the projects they undertook in Khartoum, and the closing space for political projects and democratic communities that they discussed and worked for during the war.
In a time of unprecedented displacement, hostility toward refugees is widespread. Two common strategies refugee advocates pursue to counter hostility and promote inclusion are perspective-getting exercises and providing information that corrects misperceptions. In this study, we evaluate whether these strategies are effective across four outcomes commonly used to measure outgroup inclusion: warmth toward refugees, policy preferences, behavior, and beliefs about a common misperception concerning refugees. Using three studies with nearly 15,000 Americans, we find that information and perspective-getting affect different outcomes. We show that combining both interventions produces an additive effect on all outcomes, that neither strategy enhances the other, but that bundling the strategies may prevent backfire effects. Our results underscore the promise and limits of both strategies for promoting inclusion.
There is a high prevalence of depression among refugee youth in low- and middle-income countries, yet depression trajectories are understudied. This study examined depression trajectories, and factors associated with trajectories, among urban refugee youth in Kampala, Uganda.
Methods
We conducted a longitudinal cohort study with refugee youth aged 16–24 in Kampala, Uganda. We assessed depression using the Patient Health Questionnaire-9 and conducted latent class growth analysis (LCGA) to identify depression trajectories. Sociodemographic and socioecological factors were examined as predictors of trajectory clusters using multivariable logistic regression.
Results
Data were collected from n = 164 participants (n = 89 cisgender women, n = 73 cisgender men, n = 2 transgender persons; mean age: 19.9, standard deviation: 2.5 at seven timepoints; n = 1,116 observations). Two distinct trajectory clusters were identified: “sustained low depression level” (n = 803, 71.9%) and “sustained high depression level” (n = 313, 28.1%). Sociodemographic (older age, gender [cisgender women vs. cisgender men], longer time in Uganda), and socioecological (structural: unemployment, food insecurity; interpersonal: parenthood, recent intimate partner violence) factors were significantly associated with the sustained high trajectory of depression.
Conclusions
The chronicity of depression highlights the critical need for early depression screening with urban refugee youth in Kampala. Addressing multilevel depression drivers prompts age and gender-tailored strategies and considering social determinants of health.
The COVID-19 pandemic brought to light the need to address the psychosocial and mental health needs of refugees and internally displaced persons in low- and middle-income countries. COVID-19 prevention measures slowed essential services and healthcare, creating unique challenges for refugees and IDPs, including economic insecurity and societal instability. All of these factors may contribute to the reported declines in their psychosocial well-being.
Methods
To effectively define the problems of low-and middle-income countries (LMICs) in addressing the needs of these populations, we conducted a systematic literature review of literature on the mental health and psychosocial well-being of refugees and displaced persons who have migrated between LMICs in the context of COVID-19.
Findings
Our findings indicate that mental health interventions, such as digital healthcare and community-focused solutions, have the potential to address the problems faced by refugees and IDPs. Nevertheless, these community-based support networks are overextended, continuously developing to meet the needs of these vulnerable populations while considering the limited digital literacy of the subject population, internet accessibility, and overall limits in reach. We found that the efficacy of interventions varied according to the distinctive needs and challenges of various refugee and IDP populations.
Implications
The findings indicate a need for an intersectional policy approach to address the complex network of factors influencing mental health outcomes, including gender, housing, employment status, and social inequalities. Global agencies, policymakers, and local governments must prioritize the development of comprehensive mental health support systems, assuring refugees and IDPs have sustainable and equitable access.
Providing Mental Health and Psychosocial Support interventions (MHPSS) for forcibly displaced Ukrainians in Central and Eastern Europe poses numerous challenges due to various socio-cultural and infrastructural factors. This qualitative study explored implementation barriers reported by service providers of in-person and digital MHPSS for Ukrainian refugees displaced to Poland, Romania and Slovakia due to the war. In addition, the study aimed to generate recommendations to overcome these barriers. Semi-structured Free List and Key Informant interviews were conducted using the Design, Implementation, Monitoring and Evaluation protocol with 18 and 13 service providers, respectively. For in-person interventions, barriers included stigma, language, shortage of MHPSS providers, lack of financial aid and general lack of trust among refugees. For digital MHPSS, barriers included generational obstacles, lack of therapeutic relationships, trust issues, and lack of awareness. Recommendations included advancing public health strategies, organizational interventions, building technical literacy and support, enhancing the credibility of digital interventions and incorporating MHPSS into usual practice. By implementing the recommendations proposed in this study, policymakers, organizations and service providers can work towards enhancing the delivery of MHPSS and addressing the mental health needs of Ukrainian refugees in host countries, such as Poland, Romania and Slovakia.
This chapter examines how borderlands state building backfired against the background of aggressive collectivization movements in the two counries from 1958 to 1964. During agricultural collectivization, state building by the two communist states at the border became increasingly coercive. The border people nevertheless sought to take advantage of the porous international boundary to resist state incursion by voting with their feet, making the extension of state authority and its functions a highly contested process. The years from 1958 to the escalation of the Vietnam War in 1964 witnessed a widening gap between what the two centralizing governments sought to achieve at their shared border and the capabilities of the state organs stationed on the ground to pursue the diplomatic and state-building tasks assigned to them by the political centers. The famine caused by the Great Leap Forward drove an increasing number of unauthorized border crossings. The Vietnamese communists, who initiated their own cooperative movement in 1958, perceived the emerging chaos in China as detrimental to the consolidation of the DRV state. This severely tested the ability of the Chinese and Vietnamese local officials to enforce their recently established border control institutions, making this a prominent bilateral issue.
Evidence on the effectiveness and implementation of mental health and psychosocial support (MHPSS) interventions for men in humanitarian settings is limited. Moreover, engagement and retention of men in such interventions has been challenging. Adaptations may therefore be required to improve the appropriateness and acceptability of these interventions for men. This study conducted formative research and examined the feasibility of combining an MHPSS intervention, Self-Help Plus, with a brief intervention to reduce harmful alcohol use among refugee men in Uganda. We conducted a cluster randomized feasibility trial comparing the combined alcohol intervention and Self-Help Plus, Self-Help Plus alone and enhanced usual care. Participants were 168 South Sudanese refugee men in Rhino Settlement who reported moderate or high levels of psychological distress. Session attendance was adequate: all sessions had at least 69% of participants present. Participant outcome measures, including symptoms of psychological distress, functional impairment, self-defined problems, depressive symptoms, post-traumatic stress symptoms, overall substance use risk, substance specific risk (alcohol, cannabis, stimulants and sedatives) and well-being, were sensitive to change. A combined approach to addressing mental health and alcohol use appears feasible among men in refugee settings, but further research is needed to examine the effectiveness of combined interventions among men.
In 2022, the number of people forcibly displaced due to persecution, conflict, violence, human rights violations, and disturbing public order increased by 21 per cent from 2021 to an estimated 108.4 million. This means that more than 1 in 74 people worldwide were forcibly displaced. This is a significant increase of 19 million compared to the end of 2021, with UNHCR’s statistics on forced displacement indicating that from 2021–2022 saw the largest ever increase. Over half of this increase was due to record numbers of refugees, asylum-seekers, and other people in need of international protection who were forced to flee in 2022. An estimated 43.3 million (40 per cent) were children below 18 years of age. English proficiency of school-aged children and young people across all migration streams 2018–19 indicates that most children and young people in the humanitarian migration stream identified as having low proficiency in English, highlighting the need for strong on-arrival and long-term English language programs.
This article is a response to Christians in public and private life who favor policies, employ rhetoric, and view migrants in ways that contravene their faith traditions. Speaking primarily from the perspective of Christian migrant-serving, faith-based organizations in the United States, the author examines their challenges, sources of consolation, and understanding of migrants in light of their work and religious touchstones in an era of political polarization and unprecedented forced displacement. He outlines an inclusive path forward, rooted in a commitment to the common good, to solidarity with the displaced, and to a deeper understanding of the hopes, aspirations, and gifts of migrants.
How does environmental displacement fuel violent conflict? Worldwide environmental violence uproots more people every year than war, and the alarming acceleration of environmental displacement has generated significant speculation about its security consequences. This chapter undertakes a review of the literature linking environmental migration and violent conflict to: (1) map the complex causal pathways linking environmental migration to the onset and dynamics of political violence; (2) evaluate the “state of the evidence” or available empirical support underlying claims of an environment-migration-conflict link; and (3) identify gaps in existing literature. By systematizing existing research, this chapter seeks to clarify the state of knowledge on the environment-migration-conflict nexus, identify points of consensus and debate, and chart a path forward for future research. The review finds that while existing research suggests environmental displacement fuels civil war and communal conflict, there is a dearth of research addressing how environmental migrants may experience violence at the hands of the state. In addition, more comparative research is needed to gain deeper insights into the conditions under which environmental displacement impacts political violence.
This study evaluated the effectiveness of Baby Friendly Spaces (BFS), a psychosocial support program for Rohingya refugee mothers of malnourished young children in Bangladesh. Because BFS was already being implemented, we examined the benefit of enhancing implementation supports.
Methods
In matched pairs, 10 sites were randomized to provide BFS treatment as usual (BFS-TAU) or to receive enhanced implementation support (BFS-IE). 600 mothers were enrolled and reported on maternal distress, functional impairment, subjective well-being and coping at baseline and 8-week follow-up. Data were analyzed using multilevel linear regression models to account for clustering; sensitivity analyses adjusted for the small number of clusters.
Results
Significant within-group improvements in BFSIE were observed for distres (−.48, p = .014), functional impairment (−.30, p = .002) and subjective well-being (.92, p = .011); improvements in BFS-TAU were smaller and not statistically significant. Between-group comparisons favored BFS-IE for distress (β = −.30, p = .058) and well-being (β = .58, p = .038). Sensitivity adjustments produced p-values above .05 for all between-group comparisons.
Discussion
Feasible adjustments to implementation can improve program delivery to increase impact on maternal distress and well-being. Although results should be interpreted with caution, study design limitations are common in pragmatic, field-based research.
Multiple epidemiological studies have shown an increased prevalence of adverse mental health outcomes in refugee populations and have highlighted children and adolescents to be particularly at risk. This commentary considers a Cochrane Review examining the efficacy of community-based interventions at improving the mental health of refugee children and adolescents in high-income countries. The review concludes that community-based interventions are ineffective at improving mental health in such populations. Notably, the data are limited by significant risk of bias and a small sample size. This article aims to critically appraise this systematic review, extrapolate implications for current practice and identify avenues for further research.
Armed conflict and forced displacement can significantly strain nurturing family environments, which are essential for child well-being. Yet, limited evidence exists on the effectiveness of family-systemic interventions in these contexts. We conducted a two-arm, single-masked, feasibility Randomised Controlled Trial (fRCT) of a whole-family intervention with Syrian, Iraqi and Jordanian families in Jordan. We aimed to determine the feasibility of intervention and study procedures to inform a fully-powered RCT. Eligible families were randomised to receive the Nurturing Families intervention or enhanced usual care (1:1). Masked assessors measured outcomes at baseline and endline; primary outcome measures were caregiver psychological distress, family functioning, and parenting practices. Families and implementing staff participated in qualitative interviews at endline. Of the 62 families screened, 60 (98%) were eligible, 97% completed the baseline and 90% completed the endline. Qualitative feedback indicated specific improvements in adolescent well-being, caregiver distress and parenting, and family relationships. Data highlighted high participant engagement and adequate facilitator fidelity and competence. Outcome measures had good psychometric properties (most α > 0.80) and sensitivity to change, with significant changes seen on most measures in the intervention but not control group. Findings indicate the acceptability and feasibility of intervention and study procedures. Subsequent full-scale evaluation is needed to determine effectiveness.
Acculturative stress is a key social driver of health impacting the mental health of immigrants and refugees from Latin America, which contributes to inequities experienced by them. While there is a robust scientific literature describing and evaluating evidence-based treatments targeting a range of psychiatric disorders, these treatments often do not primarily target acculturative stress. Thus, the present study examined how psychotherapists ought to treat acculturative stress directly in their clinical practice. Ten therapists were interviewed using a qualitative descriptive approach. Rapid contemporary content analysis was used to describe Latino/Hispanic immigrants’ most common presenting problems, the context in which they provide care for these problems, and the psychotherapeutic approaches currently utilized or considered effective in mitigating acculturative stress. Findings revealed that common mental health conditions that therapists addressed among this population, including depression, anxiety and trauma-related somatization, including the unique context in which therapy was delivered. Additionally, specific strategies for addressing acculturative stress such as the importance of acknowledging this stressor, drawing out immigration journey narratives, and behavioural activation approaches were shared. The results from this study can be used to improve the effectiveness of mental health interventions addressing acculturative stress among immigrant and refugee populations.
Key learning aims
(1) To explore how acculturative stress represents a key driver of mental health for immigrants and refugees from Latin America.
(2) To consider ways that cognitive behavioural therapy (CBT) elements can be applied to treating acculturative stress and mental health problems among immigrants and refugees from Latin America.
(3) To expand upon strategies that can be helpful in rapport-building and establishing trust with patients who are struggling with acculturative stress.
In addition to the loss of life, Russian aggression against Ukraine, which began in February 2022, also brings interpersonal losses resulting from the need to emigrate. Parallel to the fighting men, women bear most of the burden of caring for the family. Using in-depth interviews supplemented by questions about adverse childhood experiences and administration of The Centrality of Events Scale and the PTSD Checklist – PCL-5 with 43 Ukrainian women (18–60 years old), we analyzed adaptation to the situation of emigration and the association of their war and earlier experiences with the level of traumatization. Women were interviewed shortly after emigration to the Czech Republic (3–42 week afterward). High levels of adverse childhood experiences and post-traumatic stress symptoms were found. The war was perceived as a currently negative central event associated with traumatic stress symptoms, and 79% of the sample expressed the opinion that the war had changed them. The results of this study suggest an intertwining of previous life experiences with the current need and ability to adapt.
Various robust communication effects have been identified, but evidence is overwhelmingly based on artificial survey treatments with limited real-world insight. I conducted a natural experiment on the impact of the European–Turkey statement closing the Balkan route during the 2015/16 European refugee crisis in Germany. This design tests the lasting effect of the statement's framing on public sentiment. I identify treatment and control groups based on timing to demonstrate its effect on perceptions of the crisis, asylum attitudes, and policy preferences. Effects are largest immediately following the announcement but decline rapidly. This shows political communication can significantly change opinion within a limited time frame. This study enhances our understanding of real-world communication effects and offers a broadly applicable methodology.
Our aim was to examine mental health needs and access to mental healthcare services among Syrian refugees in the city of Leipzig, Germany. We conducted a cross-sectional survey with Syrian refugee adults in Leipzig, Germany in 2021/2022. Outcomes included PTSD (PCL-5), depression (PHQ-9), anxiety (GAD-7) and somatic symptom (SSS-8). Descriptive, regression and effect modification analyses assessed associations between selected predictor variables and mental health service access. The sampling strategy means findings are applicable only to Syrian refugees in Leipzig. Of the 513 respondents, 18.3% had moderate/severe anxiety symptoms, 28.7% had moderate/severe depression symptoms, and 25.3% had PTSD symptoms. A total of 52.8% reported past year mental health problems, and 48.9% of those participants sought care for these problems. The most common reasons for not accessing mental healthcare services were wanting to handle the problem themselves and uncertainty about where to access services. Adjusted Poisson regression models (n = 259) found significant associations between current mental health symptoms and mental healthcare service access (RR: 1.47, 95% CI: 1.02–2.15, p = 0.041) but significance levels were not reached between somatization and trust in physicians with mental healthcare service access. Syrian refugees in Leipzig likely experience high unmet mental health needs. Community-based interventions for refugee mental health and de-stigmatization activities are needed to address these unmet needs in Leipzig.
Cultural food security is crucial for cultural health and, for people from refugee backgrounds, supports the settlement journey. Cultural communities are vital in facilitating access to cultural foods; however, it is not understood how refugee-background communities sustain cultural food security in the Australian context. This study aimed to explore key roles in refugee-background communities to understand why they were important and how they facilitate cultural food security.
Design:
Interviews were conducted by community researchers, and data analysis was undertaken using best-practice framework for collaborative data analysis.
Setting:
Greater Brisbane, Australia.
Participants:
Six interviews were conducted between August and December 2022 with people from a refugee-background community, lived in Greater Brisbane and who fulfilled a key food role in the community that facilitated access to cultural foods.
Results:
Fostering improved cultural food security supported settlement by creating connections across geographical locations and cultures and generated a sense of belonging that supported the settlement journey. Communities utilised communication methods that prioritised the knowledge, wisdom and experience of community members. It also provided community members with influence over their foodways. Community leaders had an ethos that reflected collectivist values, where community needs were important for their own health and well-being.
Conclusions:
Communities are inherently structured and communicate in a way that allows collective agency over foodways. This agency promotes cultural food security and is suggestive of increased food sovereignty. Researchers and public health workers should work with communities and recognise community strengths. Food security interventions should target cultural food security and autonomy.