Mental Health Interventions in Refugee Camps
Can mental health interventions (MHIs) in refugee camps and among the internally displaced and asylum seekers be an effective tool in the well-being and future security of the millions of people fleeing conditions of violence and conflict?
This is the subject of critical analysis being undertaken by Veronica (Roni) Fynn who is currently pursuing her Master's in Public Health at the University of Nottingham, UK. Initially, Roni intended to conduct a field survey among the women and children at the Buduburam Refugee Camp in Ghana, in conjunction with RESPECT Ghana volunteers.
Unable to follow through with her initial plan, Roni decided to analyze the literature available on psychological interventions for West African refugees.
It is strongly assumed that the impact of trauma caused by prolonged exposure to mass violence is non-disabling and it can be adequately addressed through transitory interventions.
However, displacement can impact mental health in three major ways. First, the trauma associated with the displacement process itself, involving serious and more often than not continuing violation of rights. Second is the feeling of loss of belonging due to dislocation and uncertainty of the future. And, finally, a feeling of discrimination and insecurity felt in refugee camps and other places of refuge.
Some studies have already shown that mental health interventions in refugee camps are desirable. When refugees are in a better frame of mind, more certain about their future and security, the ability to integrate into mainstream increases. Effective MHIs also aid in successful repatriation as well as resettlement attempts.
MHIs can ease acceptance of the challenge to return home, where refugees have undergone severe trauma, or even third-country resettlement where integration into a new culture and socio-economic milieu has to begin from scratch.
On the other hand, forcing return or resettlement without proper intervention might result in causing more psychological damage than improvement. Ineffective intervention can lead to a gap between children and guardians/adults as the ability of children to adapt to a new culture or language is higher than those noted in adults.
This can create an acculturation gap — conflicts between parents and children relating to autonomy, cultural identity, and adherence to traditional norms and rituals.
Because women and children are the principal sufferers of conflict and violence-based displacement, it is essential to direct MHIs in refugee camps towards them. Men either die fighting or are deliberately killed. Women and children are often, as a tactic, left maimed, dismembered, or grievously hurt. Experiencing such situations makes them susceptible to double victimization: first as a vulnerable group in society, and then as refugees.
Roni believes that opportunities provided to women and children for development, growth and attainment of education would aid in raising better men as well as improving the status of women in society. Also, directing MHIs toward women is more fruitful in terms of reach as women spend maximum time with their children and are the most effective source of passing on information.
Although some progress has been made to integrate MHIs in all rehabilitation process, as directed by the World Health Organization (WHO), there is still need for more work to be done.
One of the major difficulties impeding successful implementation of MHI programs is their unavailability in the native language of the displaced families. Roni suggests that people with past experiences or who come from the same background as the affected groups could be more involved in the interactions since they may have a better chance of bringing about change in the group.
A key point to note, however, is that although refugees are alike and most face similar, if not identical, traumatic experiences, MHIs should be flexible and modified to fit the needs of the local communities, taking into account the myriad cultural diversities.
Roni suggests that a participatory approach has to be adopted if MHIs are to be successful. International organizations, especially the United Nations High Commission for Refugees (UNHCR), and other agencies have to work together with the displaced populations as well as with on-field workers to understand the practical difficulties and problems facing the displaced and address them accordingly. It is also necessary to involve displaced persons who have overcome such experiences. They should form part of the process.