One of the greatest challenges that humanity faces today is the ever-increasing number of forcibly displaced people in the world—over 89 million in 2021, which is more than double the figure for 2012. The reasons why people flee their homes are mainly political, and include armed conflicts, human rights violations, the use of violence against citizens, and other traumatic situations.
Events such as conflicts, persecution, dangerous journeys, and long waiting periods negatively impact forcibly displaced people’s mental health. Forced migrants experience upsetting episodes that expose them to the development of psychological disorders related to trauma, stress, and cultural exclusion. In particular, people forced to flee unsafe situations suffer from several specific mental health issues, namely post-traumatic stress disorder (PTSD), depression, and anxiety.
For all these reasons, the mental health issues of internally displaced people (IDPs), refugees, and asylum seekers must be addressed, along with the economic and political factors contributing to high levels of global forced displacement.
The forcibly displaced person’s mental health under threat
Forcibly displaced people are exposed to traumatic factors even before they decide to flee their homes. Pre-migration stressors such as civil wars, persecution, torture, and other forms of violence put forced migrants’ mental health at risk, potentially exposing them to serious psychological disturbances. Consequently, migration stressors come into play concerning the forced displacement itself. Estrangement from family members combined with long journeys in inhumane conditions aggravate forcibly displaced people’s existing emotional distress. In addition, illegal migration and long waiting periods in refugee camps lead people who have been forced to flee to endure further suffering from harmful physical and mental health conditions, as they come into contact with crime and lawless environments. Finally, there are post-migration stressors, which concern forced migrants’ new lives once they have managed to arrive in another country. Many of them end up living in cheap, overcrowded buildings located in neighbourhoods with high crime and violence rates. Furthermore, discrimination and prejudice by native populations are obstacles that endanger the forced migrant’s mental health.
All of these traumatic situations cause forced migrants to be particularly sensitive to the development of serious mental illnesses. Adults suffer mainly from PTSD, depression, and anxiety—the severity of which depends on the proximity, duration, and intensity of stress factors. People forced to flee may also develop certain psychological issues due to the stress accumulated during the acculturation process. Some individuals may even begin to behave violently within their family unit or engage in compulsive behaviours like excessive gambling.
Children and young adult forced migrants are prone to develop psychological disorders akin to those of adults. However, these mental health problems may have a profound impact on their development, and may be aggravated by poor peer relationships and parental mental ill-health. Those most likely to develop mental health disorders are older adult forced migrants. The main underlying reasons are their traditionalism and cultural intransigence, language difficulties, limited social support, and poorer physical health.
Since less than 20 percent of refugees fleeing developing countries manage to settle in Western countries, it is important to emphasise the conditions in which people find themselves while living in refugee camps. These camps are extremely frightening and inhospitable, as residents are crowded together and private space is hard to find. People can barely adapt, and begin to develop mental health problems stemming from continuous stress and anxiety, as they are forced to accept the compromise of living in such camps rather than in conflict-ridden areas. Various national and non-governmental health agencies should therefore act to improve not only the physical health of people living in refugee camps, but equally their mental well-being.
Difficulties in promoting forcibly displaced people’s mental health
The World Health Organisation (WHO) has implemented several initiatives that emphasise the need to address mental health issues, and especially refugees’ psychological disorders given their barriers to accessing adequate services. In doing so, the WHO has reinforced the relevance of mental health within the framework of global health policy. However, countries hardly ever implement and donate money to such initiatives, preventing the achievement of WHO’s objectives in global mental health.
The United Nations 2030 Agenda for Sustainable Development (SDGs) incorporates the mental health dimension in the third goal of promoting healthy lives (Target 4). Moreover, the Global Compact for Safe, Orderly and Regularly Migration and the Global Compact on Refugees have been enacted by the UN as cooperative frameworks, with the aim of encouraging access to basic services for all migrants and mental health services for refugees. As for the UNHCR, it has launched several projects to improve the mental health conditions of people forced to flee, or those who are still living in countries affected by refugee crises.
However, global mental health initiatives lack support and funding. Some of the underlying reasons are non-specific mental health language and poor coherence between different policy instruments. In fact, the mental health of refugees is neglected and overshadowed by the other challenges of forced migration. Global health policy must therefore start giving priority to the mental health needs of forced migrants.
Analysing forced migrants’ access to mental health services in their countries of origin and destination provides insight into the barriers they face when seeking treatment for psychological disorders. For instance, the current Syrian crisis, which has now lasted for over 10 years, has led to the forced displacement of nearly 13.5 million Syrians, half of whom are IDPs and the other half of whom are refugees. Because of this civil war, many Syrians have developed psychological disturbances which are aggravated by the country’s inability to provide mental health services, due to targeted attacks on hospitals and other health care centres. Furthermore, the latest mental health policies are only being partially implemented because of the conflict.
With regard to destination countries, Turkey has registered the highest number of Syrian refugees, a number exceeding 3.5 million. At the policy level, refugees can access Turkey’s universal health care system, even though delays, language issues, and unfamiliarity with the health system are practical barriers. In a survey, Syrian refugees stressed the presence of distinct hurdles to mental health services, such expensive treatment bills, feelings of isolation, and a cultural belief that diseases disappear by themselves.
Another significant destination country is Germany, where more than 600,000 Syrian refugees are registered. German law stipulates that new refugees only have access to basic health services for the first 15 months. After this period, refugees have the right to be part of the German universal health care system, although challenges associated with language, acculturation, and unemployment often hinder access to mental health treatments.
As a result, new solutions promoting greater consideration of forced migrants’ mental health conditions must be implemented. Destination countries’ mental health services must address the specific cultures of refugees in order to understand their symptom expressions, as well as solve problems related to accessibility and acceptability, including issues of language, stigma, and treatment procedures. Furthermore, because refugees should be guided in understanding societal norms and customs that are new to them and given the option to assimilate, teams of mental health professionals familiar with refugees’ language and culture should be assembled.
In general, mental health systems should be enhanced in transit and destination countries. It is therefore essential to address poor socio-economic conditions, incorporate psychological treatments in mental health services, and increase funding from international donors. At the policy level, equal access should be ensured in destination countries, and stronger international pressure should be applied when it comes to attacks against health care infrastructures in countries of origin. Global health policy instruments should focus on refugees’ mental health needs.
As for refugee camps, it is crucial that refugees be able to control and improve their lives and environment, since being active in everyday life improves one’s mental health. In addition, the organisation of culturally appropriate leisure activities and the decision to keep families together will strengthen forced migrants’ mental health.