|Refugee Emergencies. A Community-Based Approach (UNHCR, 1996, 142 p.)|
|Part Two. Refugees at Risk|
REFUGEES AT RISK
"It is not the same when you are independent and responsible for your life and when you are dependent on someone else. You can never be satisfied with handouts. I am not the same, I am not happy to be dependent on someone when I know how wonderful it was to be independent."
"I am always depressed. I don't have any relatives or friends in the camp. I feel very lonely and I cry all the time. I am afraid I will lose my mind."
In an emergency, while the basic needs of food, water, shelter and health care of refugees are easily recognised, measured and understood, the deeper human needs (for security, a sense of belonging, coming to terms with loss, for mourning, and to feel in control of one's life) are often ignored or brushed aside as of no importance. It should not need to be emphasized that refugees do not live by bread alone, that provision for their psychological and emotional needs is of equal importance in assisting them to not only to survive, but to attain self-sufficiency. No emergency worker would wish, that in the process of providing material assistance, he increased their sense of helplessness, and deprived refugees of their self-respect and dignity as human beings. Unfortunately, emergency workers are often guilty of not being sensitive enough to these needs, of inflicting even greater hurt, and, in a way, adding insult to injury.
Responding to Mental Health Problems: In planning an effective mental health component of an emergency programme, all the refugees' experiences must be taken into consideration: what happened to them before, during and after their exodus. A knowledge and understanding of how the population dealt with trauma, loss, grief and mental illness prior to exile is also important.
Survivors of physical abuse or violence require co-ordinated medical care, counselling, protection, material and legal assistance.
Not all victims of violence will benefit from counselling however. When family or friends can help, emotional support or counselling by an outsider is often not wanted or needed. Informal contacts can be used to let victims know mat support is available if needed.
In most cases, people who have suffered extreme grief or trauma will, in a matter of days or weeks, be able to carry out daily tasks and will have begun to come to terms with their experiences. Many are able to do this on their own or with help from family or friends. Some who have difficulty making progress in this psychological healing may benefit from therapy with a professionally trained psychologist or social worker. If possible, it is best for professional therapeutic assistance to be provided by someone of the same cultural background as the person needing help.
When assisting a victim, it is important not to overlook the needs of his/her family in coming to terms with what has happened. As a result of feeling helpless to prevent the situation, these people may turn their anger on themselves, the victim, or others.
Preventive Measures: Measures to prevent mental health problems should also be considered. In general this will include action to pursue durable solutions and to re-establish, to the extent possible, normal family and community life.
As much as possible, refugees should have the opportunity to control their own lives. Freedom of movement and the right to employment or other forms of self-support are basic. In camps, refugee participation in planning and decision making, and the implementation, management and evaluation of all assistance measures should be as extensive as possible.
Ensuring access to information concerning their present situation, responsibilities, and rights to basic health, nutrition and other services has important secondary mental health benefits. The refugees' efforts to reestablish community social structures and institutions, normal cultural and religious life should also be supported. In camps, enabling refugees to build structures that provide places for them to gather informally, to hold meetings or to organize activities can also facilitate the re-establishment of a healthy community life.
What is perceived as normal human behaviour, including "normal reactions to stress", depends on perceptions which are determined by our physical appearance, health, personality, age, culture, religion, education, socio-economic status, and circumstances. Each individual has a different threshold of tolerance to stress.
Was violence or physical injury involved during flight?
Was he/she involved personally in the violence (e.g. torture, imprisonment, rape) in the place of origin?
Was he/she a witness to violence and were members of the family involved?
Could important rituals for burying the dead be carried out prior to flight, during flight and presently?
Is information on the situation in the country of origin and asylum status being shared? The hardest thing to live with is not knowing.
Is he/she consulted at all possible times on current/future plans?
Do the conditions under which the person is living allow for self-respect? Are there culturally appropriate measures to determine space and privacy?
Is self-reliance being facilitated? Are goals for self-reliance realistic?
Are cultural factors being respected, i.e. food habits, traditional child-rearing methods?
Has a mental health programme been incorporated into the basic health services provided to refugees at various levels?