Displacement: Refugees, relocation and their mental health

According to the United Nations High Commissioner for Refugees (UNHCR), 68.5 million people worldwide have been forcibly displaced from their home countries.

Every day, 44,400 people are forced to flee their homes because of conflict and persecution (Source: UNHCR/19th June, 2018). There are approximately 25.4 million refugees in the world, 57% of who come from three countries: South Sudan (2.4 million), Afghanistan (2.6 million) and Syria (6.3 million).

Individuals and communities get displaced due to natural or man-made calamities, wars, genocide, administrative or political reasons, atrocities, crime, social and economic reasons. This makes them vulnerable and puts them at risk, often impacting their mental health. This impact is different for each individual, as it is based on their perceptions and reactions to events around them.

Can displacement affect mental health?
Displaced individuals and communities often respond with two types of complaints.

1. Threat perception: This occurs largely due to fear of certain situations which are interpreted as threatening even when they are not. Some of its symptoms are:

• Apprehension

• Dry mouth

• Increased irritability

• Autonomic arousal (increased heart rate and palpitations, respiratory issues, nausea, flushed skin)

• Tachycardia (rapid heart rate while at rest)

• Increased muscle tension
   

2. Depression arising from separation and loss. Some of the symptoms are: SYMPTOMS OF DEPRESSION ARE A LONGER LIST NO?

• Pessimism

• Sad moods

• Reduced physical activity

Most of these responses manifest through somatic complaints which are common among the displaced population, and need intervention.

Refugees may use unhealthy coping strategies when they cannot deal with the stimuli they face, or cannot adjust to their new environment. For instance, in the case of an acute stress disorder and acute stress reactions, they may consume an excessive amount of alcohol, self-medicate or display anger and aggressive behavior.

PTSD, adjustment disorders and other symptoms
When refugees are unable to cope at all they may show symptoms of post-traumatic stress disorder (PTSD) and adjustment disorders. A person experiencing PTSD tends to emotionally revisit the scene that has caused the trauma.

According to the WHO, 10% - 40% displaced adults and 50% to 90% displaced children experience PTSD, of which 5% - 15% displaced adults and 6% - 40% displaced children experience depressive symptoms.

Some of the symptoms experienced in PTSD and adjustment disorders are:

• Detachment

• Reduced awareness of self

• Depersonalization (sense of detachment from the self)

• Numbing of emotions

Some people may also experience dissociative symptoms – a stress reaction which is a dissociation from oneself, where the person experiences a sense of detachment. They observe and view themselves, their actions, emotions and feelings from a distance, almost like they're watching a movie. This reaction is a temporary state and they can easily come back to themselves.

Besides this, the trauma of displacement along with a delayed settlement process increases the risk factors of being diagnosed with mental health issues.  

Displacement and identity
Identity is a very social construct and people have a sense of identity with regard to their beliefs, practices, place of birth, caste, religion, gender, etc. Displacement can affect an individual or group's sense of identity.

• When an individual is displaced: they experience trauma and anger due to displacement. They further grapple with language (the biggest obstacle), and also with a sudden lack of sense of belonging, both of which impact one’s sense of identity.

• When a community is displaced: Although there is trauma and anger, there is also a sense of bonding which helps them carry and preserve their identity. For example, people who are displaced and share the same nationality can come together in a new country and continue to share traditions. In such cases, one’s identity is least affected.
   

Other challenges
Refugees who have lost their families experience trauma along with a constant struggle for existence - school dropout, child labor, trafficking and prostitution are common in such cases. Asylum seekers face a delayed settlement process and are treated like animals, being exploited along the path of the country they have relocated to.

Often, displacement can be internal too, i.e., being displaced within the borders of a country. For instance, the Kashmiri Pandits who were called refugees in India, and Sri Lankans who were internally displaced victims of the conflict in Sri Lanka.

Is there any help available?
The UNHRC has a national and international presence. In India, they work with refugees - the Rohingyas in Jammu, Bangladeshis in West Bengal, and Tibetans and Afghans in Delhi. Self-help groups and lawyers sponsored by NGOs also help refugees.

“A team effort has to be there, with a multidisciplinary community mental health team comprising doctors, nurses, occupational therapists, counselors, interpreters, and social workers. Help has to be given at a very large scale. Basic emotional and practical support from NGOs and the government, activating social networks, creating child-friendly spaces, providing therapy, family support networks, and advocacy for humanitarian practices,” says Ritu Chauhan, clinical psychologist and psychotherapist.
 

The importance of treatment

Mental health and physical health are intimately connected. In case a mental health issue is not treated, there are chance that it could turn into a physical health issue. For instance, anxiety that is left untreated could manifest into a physical health issue. The right treatment (emotional first aid, relaxation and breathing techniques, CBT - cognitive behavioral therapy, NET - narrative exposure therapy, trauma-focused interventions and clinical interventions are usually used) provided on time, can go a long way in ensuring better coping and recovery.

With inputs from Ritu Chauhan, clinical psychologist and psychotherapist.