Mental health in the lives of refugee children

Written by Alejandra Mateo.

The estimated number of refugees has doubled in the past 25 years: according to UNHCR, this total number reached 103 million people by the end of 2022. Among them, UNICEF estimates that 43.3 million children were displaced from their homes at the end of last year, a 3% of them being unaccompanied by caregiver adults. Both adults and children that come to Europe as asylum seekers usually carry with them a difficult and very complex background due to the huge amount of violence they have witnessed – or even suffered – in their origin countries and during the migratory routes. Some of these violent practices that have been part of refugees’ daily lives include constant persecution, sexual abuse, intrafamilial conflicts, poverty and war. Research on new developments in the mental health of refugee children and adolescents, conducted by the Imperial College of London, show that these adversities associated with displacement come together with elevated risks of psychiatric disorder.

Therefore, we must bear in mind that, even though most of the children have experienced violence and have left their hometowns due to fear, the violent context varies from one country to another. The violent context of an Afghan person may have nothing to do with the background of another person from Kurdistan or Syria: while Syrian refugees are fleeing war and destruction, Afghans usually leave their country because of the huge lack of human rights and opportunities as well as poverty since the Taliban returned to power in 2021. The impact of these violent events that children have been experiencing for years as part of their natural environment usually results in serious psychological issues and mental health troubles. For instance, as reported by Cecile Dangman in her research about mental health in refugee children, studies reveal how Syrian children have lived traumatic events just like bombing and shooting that are closely linked to high levels of PTSD (Post Traumatic Stress Disorder).

However, this violence doesn’t normally end once they enter Europe: the mistreatment that they often receive in registration centres – detention, living illegally and only receiving temporary protection -, camps and even in schools contribute to increase mental health problems such as anxiety and depression. Another factor is related to the discrimination they suffer because of their ethnicity or religion and the poor living conditions (related to the lack of social services, mobility or even a comfortable space to be) in the camps. Recent reviews show that there have been frequent attacks on asylum seekers and their residences in Germany. Disputes, disbelief and lack of safety are incessant among underage muslim refugees across the EU as a cause of islamophobia: thus, this racial discrimination has a detrimental effect on mental health.

Multiple research prove that traumatised parents have to struggle with such huge psychological pain that they are not able to take care of their children properly, which increases the risk of parental negligence or even family mistreatment

The most common mental health pathologies among refugee children and teenagers are PTSD, insecure attachment and emotional instability, depression and anxiety disorders. Firstly, it is important to remark the fact that parent’s mental health is strongly linked with their children’s: Multiple research prove that traumatised parents have to struggle with such huge psychological pain that they are not able to take care of their children properly, which increases the risk of parental negligence or even family mistreatment. Postraumatic stress normally shows up when a child is directly or indirectly in front of an event that might provoke his own death or the death of someone close to him. The normal symptoms of this stress are reminiscence phenomena, evitative reactions, compulsive behaviour and tendency to hypervigilance. Further, the most frequent symptoms of depressions are a loss of vitality, loss of interest, apathy, passivity, lack of hope and mistrust in self and others.

Other psychopathologies include suicidality, psychosis and neurodevelopmental disorders that require disorder specific treatments. The way these issues are usually expressed can vary depending on the living reality of each child. OCC’s teachers and volunteers need to be aware of individual behaviours and student’s reactions in order not to cause them more harm. The mental health problems previously mentioned may manifest in children by developing new fears, clinginess, low frustration tolerance, aggressiveness and eating and attachment disorders. In order to be helpful to students who normally suffer from some of these common mental health issues OCC provides its volunteers with useful information about safeguarding in its online handbook. This tool, as well as the multiple trainings that volunteers receive during their time of work, is useful in order to not expose children to harm and abuse.

What about unaccompanied minors’?

Unaccompanied refugee minors constitute an important group of migrants coming to Europe and they are recognised as needing special protection by UNHCR. According to data collected by the EUAA portal express in 2019, about 17.700 applications for international protection were lodged by unaccompanied minors. The majority of them were male (86 %) between the ages of 14 and 18 (91 %).
The Centre de la Santé mentale Enfants-Parents (Liège, Belgium), believe that unaccompanied minors are more likely to live traumatic experiences and generally face more adversities during their migratory compared to children who travel with their parents. They have to travel long distances on their own and when they arrive at their resettlement country, they have to prove they had “good” reasons to leave their country of origin. Many of them experience hunger, robbery and lack of shelter and legal assistance. That’s why they usually present a higher number of psychiatric problems over children and teenagers who come with their family. The most common symptomatology among unaccompanied minors is anxio-depressive state and / or PTSD.

The role of the governments in this issue

All children have the – internationally recognised- right to access appropriate support and services without bearing in mind their country of origin or reasons that pushed them to start their journey. As previously mentioned, living conditions have a huge impact on children’s mental health and can worsen the pathologies they already had before and during the routes. Therefore, improvement of the living conditions in camps, schools and institutions is crucial in order to increase refugee’s resilience and benefit their mental health. Multiple aspects such as the school environment, cultural acceptance, safety, absence of religious or ethnic discrimination and good quality of the accommodations are usually understood as resilience factors.

It is crucial to implement preventive mental health policies and cease practices that are known to be detrimental to health and abuse human rights.

Matthew Hodes, psychiatrist

Children’s psychological function often improves with positive attitudes towards their receiving country. Adaptation to a new country and its culture plays a very important role in this issue: Learning how to adapt to a very different place involves a process of acquiring knowledge of the language, social relationships and many cultural factors that might vary from their country of origin. However, as said by psychiatrist Matthew Hodes, it is crucial to implement preventive mental health policies and cease practices that are known to be detrimental to health and abuse human rights. Likewise, the Centre de la Santé mentale Enfants-Parents state that it is essential to show an institutional response based on active listening. This way, children can develop a metabolisation process of the experiences lived during the journey, which therefore lets them strengthen their self-esteem and develop a feeling of identity, as well as growing adaptation strategies.

What’s more than clear is that due to their extra vulnerability, refugee children should be a priority for public health care systems in the host country. For that reason integration is key to achieve this. Countries should ease access – without any kind of border or discrimination- to health care services but also establish prevention plans inside and outside of the schools. As already stated, educational centres who help children in their adaptation process usually are the biggest resilience factor to increase their sense of identity and inclusion in a new society.