Refugees and mental health: How displacement can devastate well-being

Do you maintain a go bag where you keep critical documents, petty cash, a flashlight, water, a can opener, family heirlooms…? Is that theoretical survival kit starting to feel a little heavy right now? Can you imagine lugging it for miles if the roads are impassable by car? 

Maybe you have a baby. That baby would need its own bugout supplies: bottles, diapers, onesies. Maybe you have a beloved cat or dog. A fish tank. Maybe you have an elderly neighbor. Maybe you have a medical or mental health condition that requires daily medication. If you had to leave now, how many days of pills would you have on hand? Is there room in your bag for a change of socks and underwear? How much of your life can your body haul, and for how far? 

Because if you’re facing war, conflict, persecution, natural disaster, or some other calamity that forces you from your home overnight, you may only be left with the weight on your back and your childrens’ hands in yours. And at first you’re running on adrenaline, trying to preserve your life and the lives of the people you care about. But then you cross the border or get on the bus or pause to catch your breath and it hits you that you may never get to return home. You were made not only to abandon your worldly possessions but also your sense of safety and security. Your community is scattered. Your house or apartment is burned to the ground. Your peace has vanished. And nothing remains but uncertainty.

This is the fragile position that millions of people around the world find themselves in today, and their numbers are growing. We’re all potentially one disaster away from being refugees, asylum seekers, or internally displaced people ourselves. What would you do? How would you feel? Where would you turn not only for food and shelter, but for emotional support? Refugees face enormous mental health challenges as they’re abruptly expelled from the reality they know. In order to help them, we can start by trying to recognize the extent of their suffering, so we can give them the best we have to offer in terms of care and resources.

What Research Says About the Mental Health of Refugees

It’s hard enough to maintain one’s mental health in the modern world without emergency evacuations. Before having to leave their home, some people might have physical disabilities that present challenges to daily life. Some might have chronic health problems or mental disorders. Some might be dependent, elderly, anxious, depressed, already living with trauma from previous experiences. For a moment, displacement might seem to eclipse all the other preexisting conditions in their lives. Everyone is in survival mode, in a state of fight or flight. But those other issues don’t actually disappear. So now these populations are even more vulnerable post-migration. 

The invisible injuries that refugees might have include the trauma of family separation, as when many Ukrainian fathers return to the front lines of war after getting their children to safety. Refugees also may need to live with long-term uncertainty about their future. They may feel an emotionally destabilizing lack of control over their situation. Children may lose their sense of structure and safety overnight. According to epidemiological data, roughly 1 in 3 refugees suffers from major depression, anxiety, and/or post-traumatic stress disorder (PTSD).

And then there are the resettlement stressors, all the risk factors in the refugee’s environment post-migration: Lack of employment, housing, legal aid, hygiene sources, and educational opportunities in the host country. Obviously all of this extreme adversity and material desperation affects mental health. Envision Maslow’s hierarchy of needs: It’s impossible to achieve your psychological and self-fulfillment needs if you lack the basic necessities at the bottom of the pyramid. Refugees might also encounter language barriers, social exclusion or rejection, discrimination, poverty, and predatory people who seek to take advantage of those who have lost everything. All of these post-migration stressors can create a vicious cycle of intergenerational trauma, negative effects on child development, worsening mental illness, substance abuse, suicide, and more, in refugee populations. 

Addressing Mental Health Problems After Traumatic Events

What works best to improve refugee mental health? It seems that the answer is psychosocial support. Amanda Nguyen of the University of Virginia has studied mental health interventions for refugees all over the world. Her research has shown the positive psychological impact of activities aimed at strengthening social connectedness and coping skills within displaced populations. 

For example, Nguyen champions a program that situates Baby-Friendly Spaces in Rohingya refugee camps in Cox’s Bazar, Bangladesh. These spaces not only provide nutritional aid that benefits children, but also mental health support that benefits mothers. The winning idea is to use a light touch to integrate mental health interventions into other care programs that deliver nutrition, education, medical care, and the like. So a woman might seek help for breastfeeding and also walk away with stress management skills.

Humanitarian aid can’t tackle only mental distress, as if war and conflict are psychotherapy problems, not social problems. Refugees need long-term solutions to their terrible, uncertain circumstances. But global assistance can’t ignore mental health either. Experts recommend integrating mental health treatment into an overall humanitarian response early on, to help refugees feel empowered, resilient, and in control again from the very beginning. Where mental health specialists are few and far between, as they tend to be in many low-income countries, clinicians can train a community workforce to respond to mental health issues. 

Through diverse means of psychosocial support, refugees can begin to rebuild their communities and their sense of agency through interconnected pathways, slowly making their way toward a new normal that was once unfathomable.