"I prefer dying fast than dying slowly", how institutional abuse worsens the mental health of stranded Syrian, Afghan and Congolese migrants on Lesbos island following the implementation of EU-Turkey deal

Coping Resources among Forced Migrants in South Africa: Exploring the Role of Character Strengths in Coping, Adjustment, and Flourishing

This phenomenological qualitative study explored how forced migrants in South Africa cope with violent, traumatic experiences and precarious resettlement conditions. Data came from a larger empirical project examining migration, psychological distress, and coping. In-depth interviews were conducted with 14 refugees and asylum seekers (Mage = 30.27, SDage = 9.27; male = 71.43%) who migrated from five African countries to Durban, South Africa. Despite overwhelming stressors, participants described pathways to transcend victimhood and hardship through engaging character strengths in ways that promote post-traumatic growth. Qualitative analysis revealed five overarching domains: spirituality and religiousness, love and kindness, hope and optimism, persistence and fortitude, and gratitude and thankfulness. Findings are framed within positive existential psychology and dual-factor understandings of mental health, which attend to both human suffering and flourishing. Limitations, future research directions, and clinical and community implications are discussed, with attention to the role of character strengths in adaptive coping and psychological well-being. The intergenerational transmission of strengths is explored as one potential means of buffering intergenerational trauma impacts and promoting family post-traumatic growth.

A mixed methods systematic review of mental health self-care strategies for Arabic-speaking refugees and migrants

BACKGROUND

Self-care strategies can improve mental health and wellbeing, however, the evidence on preferred strategies among Arabic-speaking refugees and migrants is unclear. This mixed methods systematic review aimed to identify and synthesise the global research on mental health self-care strategies used by these populations.

METHODS

English and Arabic language studies reporting on positive mental health self-care strategies to address symptoms of posttraumatic stress disorder, generalised anxiety and depression in the target populations were identified by systematically searching eight electronic databases and grey literature. Studies were deemed eligible if they were published from 2000 onwards and included Arabic-speaking migrants, refugees or asylum seekers aged 12 years and above. A narrative synthesis of study characteristics and relevant key findings was undertaken. The review protocol was registered on PROSPERO (registration number CRD42021265456).

RESULTS

Fifty-nine records reporting 57 studies were identified, the majority appearing after 2019. There were 37 intervention studies that incorporated a self-care component and 20 observational studies that reported on self-generated self-care practices. Across both study types, four broad groups of mental health self-care were identified-social, psychological, religious/spiritual, and other (e.g., expressive arts and exercise). Psychological strategies were the most reported self-care practice overall and featured in all intervention studies. Religious/spiritual and social strategies were more common in the observational studies. Intervention studies in diverse settings reported statistical improvements on a range of outcome measures. Observational studies reported a range of individual and community benefits. Linguistic, cultural and religious considerations, inherent in the observational studies, were variably addressed in the individual and group interventions.

CONCLUSION

Overall, study participants experienced self-care as helpful although some encountered challenges in practicing their preferred strategies. Further research on mental health self-care strategies among Arabic-speaking refugees and migrants is needed in Western resettlement countries to guide mental health service delivery and primary healthcare initiatives for new arrivals and in transit countries.

Afghan mental health and psychosocial well-being: thematic review of four decades of research and interventions

BACKGROUND

Four decades of war, political upheaval, economic deprivation and forced displacement have profoundly affected both in-country and refugee Afghan populations.

AIMS

We reviewed literature on mental health and psychosocial well-being, to assess the current evidence and describe mental healthcare systems, including government programmes and community-based interventions.

METHOD

In 2022, we conducted a systematic search in Google Scholar, PTSDpubs, PubMed and PsycINFO, and a hand search of grey literature (N = 214 papers). We identified the main factors driving the epidemiology of mental health problems, culturally salient understandings of psychological distress, coping strategies and help-seeking behaviours, and interventions for mental health and psychosocial support.

RESULTS

Mental health problems and psychological distress show higher risks for women, ethnic minorities, people with disabilities and youth. Issues of suicidality and drug use are emerging problems that are understudied. Afghans use specific vocabulary to convey psychological distress, drawing on culturally relevant concepts of body-mind relationships. Coping strategies are largely embedded in one's faith and family. Over the past two decades, concerted efforts were made to integrate mental health into the nation's healthcare system, train cadres of psychosocial counsellors, and develop community-based psychosocial initiatives with the help of non-governmental organisations. A small but growing body of research is emerging around psychological interventions adapted to Afghan contexts and culture.

CONCLUSIONS

We make four recommendations to promote health equity and sustainable systems of care. Interventions must build cultural relevance, invest in community-based psychosocial support and evidence-based psychological interventions, maintain core mental health services at logical points of access and foster integrated systems of care.

Considerations in designing trauma-focused interventions for displaced Afghan women

In light of the 2021 United States military withdrawal from Afghanistan, as well as the humanitarian crises of mass displacement and subsequent health system strain that have ensued, practitioners worldwide will need to develop a more nuanced understanding of the adverse life experiences that women from Afghanistan frequently endorse. As they bear a disproportionate impact of constraints within Afghan society, and as patriarchal systems affect most of their life domains, women from Afghanistan may present with high levels of baseline trauma upon resettlement, and health systems may seek to attenuate this distress; However, the nature of these traumatogenic events may shape women's receptivity to psychosocial interventions, particularly those which are at least partially rooted in Western modalities. In the absence of sufficient literature on evidence-based interventions for this population, a diversity of ethnographic and clinical literature is synthesized, including literature on interventions alleged to be compatible with Afghan norms. As it will be essential to support Afghan women's mental health following social reorganization on a massive scale, considerations arising from the interdisciplinary literature are offered so that they may inform the development of structured, trauma-focused interventions and so that the health systems with which they interface may be better prepared to serve them.

"Imagine, 7 Years Without a Future": A Qualitative Study of Rejected Asylum Seekers' Life Conditions in Norway

Asylum seekers are in an extraordinary situation as their future life depend on decisions made by authorities in a bewildering, bureaucratic system, with excessive waiting and unpredictable timeframes. Those that are not granted asylum, and not able to return to their country of origin, can neither spatially nor temporally visualize if, when or how a potential change is going to occur. This paper is part of a larger study based on narrative interviews with asylum seekers and refugees in asylum centers in Norway, exploring their experiences before, during, and after flight. As we found that the life circumstances for those being refused asylum, were highly different from other participants in the project, we chose to address this particular group in a separate paper. The participants in this part of the study consisted of 21 individuals (of a total of 78 participants) in the age range 18-44, of whom eight were female and 13 males. Trough qualitative interviews and participant observation the aim of this study was to explore and describe the life condition and mental health situation of rejected asylum seekers in Norway. We found that the gradual loss of rights, opportunities and finances are experienced as a form of violence that leads to extreme mental and social suffering. This policy clearly conflicts with Human Rights incorporated in the Norwegian constitution, and we argue that it legitimizes treating asylum seekers as a group of undesirable and underserving political bodies, with serious consequences for their mental health and wellbeing.

Human Responses and Adaptation in a Changing Climate: A Framework Integrating Biological, Psychological, and Behavioural Aspects

Climate change is one of the biggest challenges of our times. Its impact on human populations is not yet completely understood. Many studies have focused on single aspects with contradictory observations. However, climate change is a complex phenomenon that cannot be adequately addressed from a single discipline’s perspective. Hence, we propose a comprehensive conceptual framework on the relationships between climate change and human responses. This framework includes biological, psychological, and behavioural aspects and provides a multidisciplinary overview and critical information for focused interventions. The role of tipping points and regime shifts is explored, and a historical perspective is presented to describe the relationship between climate evolution and socio-cultural crisis. Vulnerability, resilience, and adaptation are analysed from an individual and a community point of view. Finally, emergent behaviours and mass effect phenomena are examined that account for mental maladjustment and conflicts.

A qualitative exploration of post-migration stressors and psychosocial well-being in two asylum reception centres in Belgium

Purpose

Prolonged exposure to daily stressors can have long-term detrimental implications for overall mental health. For asylum seekers in European Union transit or destination countries, navigating life in reception centres can represent a significant burden. The purpose of this study was to explore post-migration stressors during residency in reception centres, and to formulate recommendations for adequate service provision in Belgium.

Design/methodology/approach

Research was conducted in two reception centres in Belgium. A total of 41 in-depth interviews were carried out with asylum seeker residents (n = 29) and staff (n = 12). Purposive recruitment was used for asylum seekers (for variation in length of centre residency and family status) and staff (variation in job profiles). Interviews were conducted in English, French or with a translator in Arabic or Dari. Interviews were audio-recorded, transcribed verbatim and manually coded using thematic analysis.

Findings

Asylum seekers face significant constraints with regard to their living conditions, including total absence of privacy, overcrowding and unhygienic conditions. These act as continuous and prolonged exposure to daily stressors. Several barriers to accessing activities or integration opportunities prevent meaningful occupation, contribute towards eroded autonomy and isolation of asylum seeker residents. Inadequate capacity and resources for the provision of psychosocial support in reception centres leads to a sense of abandonment and worthlessness.

Originality/value

Analysis indicates that structural and practical challenges to adequately support asylum seekers are rooted in policy failures necessary for appropriate resourcing and prioritization of preventative measures. Such deliberate decisions contribute towards state deterrence strategies, eroding both individual well-being and manufacturing a crisis in the systems of support for asylum seekers.

Mental health consequences of long-term stays in refugee camps: preliminary evidence from Moria

Background

Ever since the implementation of the EU-Turkey deal, most refugees that enter Greece via sea are confined to the island on which they arrive until their asylum claims are adjudicated, where they generally reside in camps. Some of these camps have detention-like characteristics and dire living conditions, such as Moria camp on the island of Lesbos, Greece. Aid-organizations have stated that the situation in camp Moria deteriorates the mental health of its inhabitants and there is qualitative evidence to support this. This study explores the quantitative relationship between the incidence of acute mental health crises and the length of stay in the camp.

Methods

A cross-sectional study was conducted using routinely collected data on 856 consultations of 634 different patients during 90 nights at an emergency clinic in Moria camp. Logistic regression analysis was used to explore whether the length of stay in the camp was predictive of the occurrence of an acute mental health crisis.

Results

Of the 634 patients, the majority were men (59·3%), the average age was 23·2 years [0–71], and 24·3% was < 18 years. 25·5% (n = 218) of consultations were related to mental health problems; 17·0% (n = 37) of these met the study’s case definition of an acute mental health crisis. Such crises were positively associated with the length of stay in the camp (p = 0·011); the odds ratio of a mental health crisis increases with 1·03 for every 10% increase in days of residence in the camp. This is notable when considering the average length of stay in the camp is 71 days.

Conclusion

This study offers quantitative support for the notion that the adverse conditions in Moria camp deteriorate the mental health of its inhabitants as suggested in qualitative research. Although this study does not provide evidence of causality, it is likely that the poor and unsafe living conditions, challenging refugee determination procedures, and a lack of mental health services in the camp are significant contributing factors. We urgently call for Europe’s policymakers to honour the ‘51 Geneva refugee convention and terminate the neglectful situation on the Greek archipelago.

Towards a Model for Integrating Informal and Formal Learning for Children in Refugee Camps: The Example of the Lesbos School for Peace

The aim of this paper is to describe a unique, bottom-up model for building a school based on humanistic intercultural values in a post-disaster/refugee area. We think that this model will be of use in similar contexts. This single-case study can teach us about the needs of refugee children, as well as provide strategies to reach these needs with limited resources in additional similar contexts. Additionally, this paper will outline a qualitative arts-based methodology to understand and to evaluate refugee children’s lived experience of in-detention camp schools. Our field site is an afternoon school for refugee children operated and maintained by volunteers and refugee teachers. The methodology is a participatory case study using arts-based research, interviews, and observation of a school built for refugee camp children in Lesbos. Participants in this study included the whole school, from children to teachers, to volunteers and managers. The research design was used to inform the school itself, and to outline the key components found to be meaningful in making the school a positive experience. These components could be emulated by similar educational projects and used to evaluate them on an ongoing basis.

“Anak ini kalau makan, ya apapun yang diminta…”: Eksplorasi Nilai Anak dan Pola Pengasuhan Anak pada Suku Jawa di Desa Besowo, Kediri, Jawa Timur

Background: Several studies have found that the nutritional status of children was much influenced by childcare patterns. While other studies reveal that parenting patterns were influenced by children's values. The higher the value of the child in the eyes of parents, the better the pattern of care provided is expected, including the habit of dietary given to the child. The study was aimed to explore the value of children (psychology, social, and economy) in Besowo.Methods: Qualitative research was carried out through an ethnographic approach. The researcher lived in Besowo for six months (June-November 2019). Informants were determined purposively on 23 women and 6 men. The main focus of the research was on the values of children and parenting patterns, including a child's diet.Results: The value of children psychologically, children were everything. This value makes parents try to be able to fulfill all the wishes of children. When the child did not want to eat, then whatever the child wants will be fulfilled, including eating snacks that were categorized as unhealthy. Value of children socially, children were considered as successors in the family, including those who were obliged to continue and maintain the good name of the family. Parents want children to follow in the footsteps of parents. Unconsciously the parents in question were male parents. The value of the child economically, the child was an investment or an asset. Children were where parents depend on old age. The pattern of parenting showed that even though the value of the child was considered very high, the pattern of care, especially the pattern of food intake in children, tend to be ignored.Conclusion: Javanese children in the village of Besowo have psychological, social and economic values. Although assessing children was everything, parenting patterns, including intake patterns, showed the opposite treatment.ABSTRAK Latar Belakang: Beberapa penelitian menemukan bahwa status gizi anak banyak dipengaruhi pola pengasuhan anak. Sementara penelitian lain mengungkap bahwa pola pengasuhan dipengaruhi oleh nilai anak. Semakin tinggi nilai anak di mata orang tua, maka diharapkan semakin baik pola pengasuhan yang diberikan, termasuk pola makan yang diberikan pada anak. Penelitian ditujukan untuk mengeksplorasi nilai anak (psikologi, sosial,  dan ekonomi) di Desa Besowo.Metode: Penelitian kualitatif dilakukan melalui pendekatan etnografi. Peneliti lived in di Desa Besowo selama enam bulan (Juni-November 2019). Informan ditentukan secara purposif pada 23 perempuan dan 6 laki-laki. Fokus utama penelitian pada nilai anak dan pola pengasuhan, termasuk pola makan.Hasil: Nilai anak secara psikologi, anak adalah segalanya. Nilai ini membuat orang tua berusaha untuk dapat memenuhi semua keinginan anak. Pada saat anak tidak mau makan, maka apapun maunya anak akan dipenuhi, termasuk makan jajanan yang masuk kategori tidak sehat. Nilai anak secara sosial, anak dianggap sebagai penerus dalam keluarga, termasuk yang berkewajiban untuk meneruskan dan menjaga nama baik keluarga. Orang tua menginginkan anak mengikuti jejak orang tua. Secara tidak sadar orang tua yang dimaksud adalah orang tua laki-laki. Nilai anak secara ekonomi, anak adalah investasi atau aset. Anak adalah tempat orang tua bergantung di hari tua. Pola pengasuhan anak menunjukkan bahwa meski menganggap nilai anak sangat tinggi, tetapi pola pangasuhan, terutama pola asupan makanan pada anak, cenderung diabaikan.Kesimpulan: Anak pada suku Jawa di Desa Besowo memiliki nilai psikologi, sosial dan ekonomi. Meski menilai anak adalah segalanya, tetapi pola pengasuhan, termasuk pola asupan, menunjukkan perlakuan yang bertolak belakang.

“Diberi air gula… awalnya nangis menjadi diam, karena kenyang, gak lemas, daya tahan tubuhnya meningkat”; Studi Pola Asupan pada Bayi

Background: Babies were vulnerable to health and nutrition problems. WHO states that 60% of deaths of children under five were caused by malnutrition. Of these, two-thirds of them were caused by improper feeding of babies. Objective: to describe patterns of food intake in infants in Kepung Village, Kediri District.Methods: The study was designed qualitatively with an ethnographic approach. Data collection was performed using in-depth interviews and participatory observation. The study was conducted in Kepung Village, Kediri, East Java. The process of collecting data was done by researchers by staying with the target for 6 months. Results: The pattern of intake in infants aged 0-6 months in Kepung Village was not only given breast milk but was given food in the form of formula milk, sugar water and ‘kepok’ banana. When the mother or caregiver feels that the baby was still hungry, it will be given food intake other than the milk. The practice of feeding was inseparable from the influence of hereditary belief, where sugar water was believed to make the baby not fussy because the baby becomes full and healthy. Conclusion: The pattern of intake in infants in Kepung Village was very varied. Not only breast milk, babies have also been given mashed up adult food. People in Kepung Village also have a habit of giving their babies sugar water. ABSTRAKLatar Belakang: Bayi adalah masa yang rentan terhadap masalah kesehatan dan gizi. WHO menyatakan bahwa 60% kematian anak balita disebabkan oleh keadaan kurang gizi. Dari jumlah tersebut, dua per tiga diantaranya disebabkan oleh pemberian makan yang kurang tepat.Tujuan: Penelitian ditujukan untuk menggambarkan pola asupan pada bayi di Desa Kepung, Kabupaten Kediri.Metode: Studi didesain secara kualitatif dengan pendekatan etnografi. Pengumpulan data dilakukan dengan menggunakan metode wawancara mendalam dan observasi partisipatif. Studi dilakukan di Desa Kepung, Kecamatan Kepung, Kabupaten Kediri, Jawa Timur. Proses pengumpulan data dilakukan oleh peneliti dengan tinggal bersama target. Peneliti lived in di lokasi penelitian selama 6 bulan.Hasil: Pola asupan pada bayi usia 0-6 bulan di Desa Kepung tidak hanya diberikan ASI saja, tapi diberikan makanan berupa susu formula, air gula dan pisang kepok. Praktik pemberian makanan tersebut tidak terlepas dari pengaruh kepercayaan yang turun-temurun, yang mana air gula diyakini dapat membuat bayi tidak rewel karena bayi menjadi kenyang dan menyehatkan.Kesimpulan: Pola asupan pada bayi di Desa Kepung sangat bervariasi. Tidak hanya ASI, bayi juga sudah diberi makanan orang dewasa yang dilembutkan. Masyarakat di Desa Kepung juga memiliki kebiasaan memberikan bayinya air gula.

"With every passing day I feel like a candle, melting little by little." experiences of long-term displacement amongst Syrian refugees in Shatila, Lebanon

Background

Long term displacement and exposure to challenging living conditions can influence family dynamics; gender roles; violence at home and in the community and mental well-being. This qualitative study explores these issues as perceived by Syrian refugees who have been living in Shatila, a Palestinian camp in South Beirut, Lebanon, for at least 2 years.

Methods

Twenty eight in-depth interviews with men and women were conducted between February and June 2018. Women were recipients of mental health services, and men were recruited from the local community. Interviews were conducted in Arabic, translated, transcribed, coded and analysed using thematic content analysis.

Results

Our results show patterns of harsh living conditions similar to those described earlier in the course of the Syrian refugee crisis. Lack of infrastructure, overcrowding, cramped rooms and violence were all reported. Participants also described a lack of social support, discrimination and harassment within the host community, as well as limited social support networks within their own Syrian refugee community. Family dynamics were affected by the increased responsibilities on men, women and children; with additional economic and employment demands on men, women assuming the roles of ‘mother and father’ and children having to work and contribute to the household. Participants discussed several types of violence, including parental violence against children and violence in the community. Violence against women was also reported. Reported mental health issues included depression, anxiety, sadness, frustration, hopelessness, self-neglect and a loss of sense of self and self-worth. Some participants expressed a wish to die.

Conclusions

This study describes experiences of changing gender roles, family dynamics, violence and mental health after long-term displacement in in Shatila camp, South Beirut as perceived by Syrian refugees. A lack of safety and security coupled with economic hardship rendered refugees even more susceptible to exploitation and harassment. Parental violence was the most commonly reported type of domestic violence.

In island containment: a qualitative exploration of social support systems among asylum seekers in a mental health care programme on Lesvos Island, Greece

Background

Social support is a core determinant of health and plays a key role in the healing process of people with mental health problems and those who have been exposed to torture or other traumatic events. At the same time, social support is particularly challenging to build in such populations, as self-isolation and social withdrawal are common consequences of traumatic incidents. Defining social support is also challenging as there is no globally adequate definition. Our aim was to explore how social support was understood by Médecins Sans Frontières (MSF) beneficiaries, and how they perceived their needs on Lesvos Island, Greece to be met.

Methods

This was a qualitative study, based on exploratory free-listing interviews that explored how MSF beneficiaries on Lesvos understood and defined social support, followed by a series of in-depth interviews through which participants explained how they perceived their needs to be met. The study was conducted over a period of two weeks in August 2018, with 32 migrants and asylum seekers (22 male, 10 female) enrolled in the mental health services of MSF on Lesvos Island. The majority of interviewees were single men of African origin who had resided in Moria camp between 2 months and 2.5 years. Countries of origin include Syria, Afghanistan, Cameroon, Democratic Republic of Congo (DRC), Iraq, Iran, Nigeria, Senegal and other West African countries.

Results

Participants defined social support as the practical, informational and emotional support that people receive from organisations, friends and family members. Results revealed a lack of community links, isolation, tensions and conflict, insufficient amenities and limited orientation to services that lead to and amplify isolation, discrimination and tension. Most of the participants received little or no support both formally from organisations and informally from other migrants and asylum seekers in the camp.

Conclusions

Functional support networks are urgently required to overcome the consequences of restrictive policies which force people into containment and remove their support systems. Actors who are involved in providing social support, including MSF, are strongly encouraged to engage in activities that work towards building and strengthening peer support networks and creating a sense of community.

A Descriptive Study of the Schooling and Higher Education Reforms in Response to the Refugees’ Influx into Greece

Since 2015, a large number of migrants (refugees and asylum seekers) from the Middle East, Asia, and Africa have arrived in Greece and continued their onward journey to western European countries where they settled. As various European Union (EU) countries have later blocked the flow of migrants from Greece to their final destination, thousands of them have been trapped in Greece, confined in overcrowded, temporary camps (known as “hot spots”) and awaiting the processing of their asylum application. The current article examines the response of the Greek educational institutes (primary, secondary and tertiary levels) to the recent migrant influx, with ultimate goals to integrate, educate, and assist them. The number of refugees and asylum seekers living in Greece is estimated to be 58,000 (2018 data) with 22,500 children among them. Their schooling inclusion follows the plan 111, “Refugee Education Host Structures (REHSs)”, as initiated by the Greek Ministry of Education in 2017. Students’ leakage range is still high (10–40% at elementary school and 45–56% at high School). The disruption in their life results in the lack of regular attendance. Greek universities responded to the challenge of the refugee influx, especially the University of the Aegean (UAeg), which is located on the eastern Mediterranean migration route. The UAeg’s response plan focuses on four areas: (a) to provide education to refugees; (b) to conduct research on the refugee phenomenon and migration processes; (c) to increase local citizens’ awareness and improve social inclusion toward the migrants; and (d) to develop technologies to improve daily life in the refugee camps. These actions are significant toward the social inclusion and cohesion of refugees and the further improvement of their daily life.