Women refugees: mental health issues and trauma

The number of people being uprooted and displaced from their homes and countries has been steadily increasing. We see people moving from war-torn Syria to Europe; Afghanistan to Europe, India and the US; Myanmar to Bangladesh and India; and from Bhutan to Nepal. This widespread phenomenon of displacement is traumatizing in nature. It involves a difficult journey for individuals and communities as well as new challenges for the host countries. In this context, women  are more vulnerable and most affected. As per the United Nations High Commissioner for Refugees (UNHCR), "Women and girls make up around 50% of any refugee — internally displaced or stateless —population and those who are unaccompanied, pregnant, heads of household, disabled or elderly are especially vulnerable."

Other than displacement due to war and human conflict, natural disasters are another major cause. Displacement due to natural disaster primarily occurs within the country. The 2017 Global Report on Internal Displacement says that, “There were 24.2 million new displacements because of disasters in 2016. Like previous years, South and East Asia were the most affected regions. China, India and the Philippines have the highest number of affected persons but small island states suffer disproportionately once their population size is factored.”

The impact of displacement on women

I have seen that women refugees and those displaced by natural disaster have often had to live in life-threatening situations. They may have lost property, members of their family and been witness to death and destruction in their community. In instances of human conflict and war, women are often victims of sexual violence or have seen it happen to members of their family and community.

The journey from where they once lived to the camp locations is a harrowing one – it exposes them, their children and families to various dangers.Travel might be undertaken with infants or when pregnant, while having to see their children go hungry. It might involve crossing rivers, seas, walking for days and seeking cover for protection.

Sometimes they might lose family members during the journey. All of these experiences in isolation are incredibly painful and traumatic in nature, women refugees face several of these in their ordeal.

When women are victims of war or human conflict it is likely that the community they belonged to was persecuted, discriminated against in its place of origin and denied self-determination or identity. They probably lived in circumstances prior to the displacement that were extremely stressful on a daily basis, with poor access to basic services, nutrition and a constant threat to life. In such an environment women often take on multiple roles — such as that of caregiver, managing domestic work, working outside home to earn an income — without any support. Humanitarian conflict often results in the families having lost their male members, causing the entire burden of care to fall on the women.

In addition to this, how the host country perceives refugees or displaced persons is an important contribution to latter’s mental health. Where a strain of resources is felt due to the arrival of refugees, there might be conflict and discrimination that causes harm to their safety and wellbeing.

Mental health issues

The mental health challenges faced by women refugees change over time depending on a few factors – their lived experience, current living conditions, future possibility of relocation or return to their homeland, emotional coping mechanisms and available social support systems.  

Acute symptoms in women refugees after they have arrived at a camp can manifest in various forms, such as:  

• Sleeplessness

• Acute anxiety

• Loss of appetite

• Low mood

• Flashbacks

• Nightmares

• Lack of affect (absence of emotional expression in varying degrees to situations)

• Mutism

These symptoms can eventually, over the course of a few months, develop into Post Traumatic Stress Disorder (PTSD) and depression. Not every person experiencing trauma will develop PTSD or depression but there is a high likelihood of it happening.

The first step taken by mental health professionals is Psychological First Aid. It comprises of having  empathetic interactions with persons who have experienced displacement and connecting them to basic services to make sure that their primary needs are met. These needs are: feeling safe, having access to shelter, food and health services. This first response focuses on having a humane interaction with the refugee, with the aim of ensuring that their diverse needs are met by service providers.

Struggles and vulnerabilities

In situations where I have worked with women refugees and women displaced by natural disaster, the main  feeling has been one of hopelessness. They have often lost all property and in case of war or human conflict might have also lost male family members. Often, governments and organisations working with refugees take a long time to figure out next steps. The period of uncertainty ensuing from this can last anywhere between a few months or even years; and refugee communities have to live with that.  In my work I have seen that the relief of survival co-exists with the feeling of immense loss and grief. They’re often asking themselves about who will take responsibility for them and their children in the future.

When refugees or displaced persons arrive in large numbers to a location, the shelters are initially often temporary, crowded and lack privacy without locks or doors. Women’s vulnerability to sexual violence in such spaces is particularly high, both from their own and the host community. They might also have no choice but to take up jobs that involve learning new skills to cope in a new environment, or ones where they have no prior experience.  

Given the circumstances, a woman refugee is constantly looking for ways to meet her basic needs while learning to adapt. Managing and coping with these many number of stressors drains her inner resources, leaving her in a constant state of fighting for survival. When the conditions for survival are met this gives the person energy, when your own resources are depleted the state of survival diminishes causing depression to set in. This happens frequently because of the enormity of the challenges and how long they have to be endured. This change can take place over different periods of time and manifest in different ways for each individual.

The strain on mental health for women refugees is relentless and caused due to several reasons. The path to recovery and rehabilitation is long and difficult because it requires for both internal and external changes to be made in their life over a n extended period of time.

Prathama Raghavan is a mental health and disability professional based in Kathmandu, Nepal. The information in this article is based on her experience of working in Nepal, Myanmar and Bangladesh with Refugee and Internally Displaced Communities.

Correction: A previous version of this article talked about the movement of refugees from Nepal to India and Bhutan. This has been corrected to state that they moved from Bhutan to Nepal.