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As I mentioned before reasons can be seperated into push and pull factors. P ushfactors are basically pushing someone out of their habitual country of residence or origin , while pull factors are tempting people to come to a certain area, like a good chance of e mployment, better salary or simply peace. Compared to their country of origin or residence, conditions in Europe often s em so much better,that refugees risk their physical and mental health, their safety and thei r lives. How bad must a situation be, to make people risk their lives and often that of their children 5 as well.
They are not leaving for pleasure or luxury. They are leaving for survival. They are often leaving everything they love behind, to find a future. But often this future is as dark as the holes they have to live in once they arrive in Europe. Refugees left to find a better live, risking everything and once they arrive in Eu rope they do not get treated with empathy or any human dignity at all. Many of them are suffering from malnutrition, open wounds, fever, diarrhae and other physical illnesses. Mental wounds are often deep. Families are destroyed, killed or seperated. Fri ends and siblings are lost or dead.
Everything is broken. Who is helping all this people in severe need of help and assistance ? Once refugees arrive in an european country they are supposed to stay in rec eption facilities. Reception facilities should offer adequate housing, food, education and healt h care, including mental health care. The basic needs of an human being should be met with dignity. Refugees are awaiting the decisions on their asylum claim in reception facilitie The European Union adopted an directive laying down minimum standards fo r the reception of asylum seekers in the member states in 2003 3.
This happend in an attempt to align the conditions in the member states of the European Union. 10 years later the situation of the treatment of refugees upon their arrival and later is as bad or worse then in 2003. The problem is that the conditions still vary alot fr om country to country. 6 Council Directive, 2003 5. Rights of refugees Once refugees manage to arrive onshore or in an country that belongs to the European Union, they have to lodge an asylum claim, as mentioned above. Their arrival i s in most cases already seen as an unauthorized arrival, what puts them at the risk of b eing arrested or detained.
Article 14 of the universal Declaration of Human Rights states that *veryone has the right to seek and to enjoy in other countries asylum from persecution” The Dublin Regulation enables an EIJ member state to return the asylum seek erto the EU state he first entered. With this regulation procedure the European Union put alot of pressure on the states with outer borders like Spain, France, Greece, Malta, Sl ovakia and Italy. This pressure is often leading to a harsh and brutal border policy and co ntrol. Nowadays it is quite difficult to get through with an asylum claim or to get a te mporary refugee status.
The UNHCR asked the EIJ not to send back refugees to nonELJ countries like G reece, because of their bad treatment of refugees. IJNHCR calls the refugee situation in Greece ?? a humanitarian vahlotis 2010) ??The refugee status determination system does not operate properly and as a result, persons needing international protection are not identified as such. This is a humanita rian crisis situation which should not exist in the European Marine/ There are seven different topics that can cause alot of grieves. Often these to pics appear combined.
Issues for difficulties can be : loss of family, a different culture, a di fferent 7 language, being far away from your homeland, loss of status, loss of contact with your ethical group and exposure to physical risks ( Haro/ Carta/ Bernal 2010 Today it is well known that refugees, IDPs and migrants are likely to suffer fro m depressions, anxiety, ASR or PTSD. 7. Classification of Mental Illnesses. ARS Acute Stress Reaction Acute Stress Reaction is a classified illness with the F43 diagnosis In the ICDI O system. It is escribed as an psycologicall answer to a traumatic event.
Sometimes it is als o called ??mental shock”, but not to be confused with the circulatory shock. ASR often o ccurs after unexpected life changing events, such as car accidents, sexual violence or the unexpected death of a family member. Often people describe flashbacks of the terrifying event or are avoiding trigge r memories. In general people feel moody, sad, anxious, experience insomnia or have physic al symptoms. ??The Symptoms usually appear within minutes of the impact of the stressfull s timulus or event, and disappear within two or three days (often within hours).
Partial or c omplete amnesia (F44. O) for the episode may be present. If the symptoms persist, a ch ange in diagnosis should be considered. ” (ICDI O) Three steps can be taken in fighting Acute Stress Reaction. In most cases thou gh, it will just decrease and then disappear on its own. One step could be a CBT, a Cognitive Behavioural Therapy. A CBT is a therapy in which patients learn to change their thinking st ructure through talking. Another option would be counseling, to learn differnt ways and meethods of dealing with stress. And the last option can be medication, such as Diazepam or Betablockers.
If s ymptoms 8 persist than other diagnosis should be considered to examine furtherand seei fan P T SD can be found. PTSD Post traumatic stress disorder Post traumatic stress disorder is another anxiety disorder, Cleary distinct from ASR. people that experienced war, natural disaster or other forms of life threating events are at tremendous risk of PTSD. ??Arises as a delayed protracted response to a stressfull event or situation (of either long or brief duration) of an exceptionally threatening or catastrophic nature, which s likely to cause pervasive disstress in almost everyone”( ICDIO).
Typical features include episodes of repeated reliving of the trauma in intrusiv e memories, socalled ??flashbacks”, dreams or nightmares, occuring against the persisting background of a sense of numbness and emotional blunting, detachment from other peo unresponsiveness to surroundings, anhedonia, and avoidance of activities an d situations reminiscent of the trauma. WHO offered a new guidance sheet for primary health workers worldwide. It describes different methods of stress managment, such as Eye Movement Desensitizati on and Reprocessing, short EMDR, coping skills, CBT and social support methods for patients suffering from PTSD.
WHO, 2007) Imaginably there is a high pravalence in refugee youth, but not that many syst ematic treatment studies about them (Benedek, 2011). 8. Treatment of Refugees with Mental Health Problems According to British Guidelines on the treatment of traumarelated symptoms in refugees it is best to use a 3 phase model. Phase 1 is aiming to accommodate the refuge e with basic needs, such as housing, food and safety from persecution. Phase 2 should be the actual traumatherapy through counselling, CBT or others, while Phase 3 is aiming at the 9 integration of the refugee in the host country, through language, education, w
Ork possibilities and social embedding in the new culture. ( Health 2005 ) But often these Steps are not happening. There seems to be an denial Of men tal health issues in refugees, even though it is definitly wellknown that they went throug h traumatic events and catastrophes. Primary health workers that work in emergency sett ings do not learn about the mental health aspect when getting trained in health program mes. Even though psychological aspects often set the base for diseases, mental or physi Cal, health workers do not seem to pay enough attention onto that part of health.
If there is a special center or health worker for psychosocial support Of refuge es, it is important to spread the word about it to refugees that might have never hear d of an institution like this. Some of the refugees might be to traumatized to take adv antage of the service offered, in that case there must be assistance. Refugees have to use t he services offered, so that a longterm damage can be prevented. Sometimes it will just b e an ASR diagnosis, but untreated it can turn into a PTSD, what then may even be perm anent.
To mitigate the mental health problems that are occuring it is important to start ith the planning of mental health interventions and services in the emergency phase already. The way MSF is coping with refugees mental health issues is explained in the f ollowing section. In 1 994 MSF was still at the pilotstage of designing strategies of psychosocial a nd mental health interventions and programmes. They are claiming that the approach is a collection of expirience made in the field and is aiming at a community instead of the indiv idium.
For a quite large number of refugees the satisfaction of basic needs maybe sufficie nt, but others need additional support to profit of the relief help at all. Because some peopl e are just to emotionally numb or depressiv, that they cannot manage to stand in line for f ood distribution or cannot manage to do all that paperwork later on. They are falli ng into a spiral of grief, this grief will turn into apathy and in the end they will be unable to continue living. So it is very important to support additional help for those in need.
With providing some kind of psychosocial support it is possible to prevent 10 psychopathologies and further a then required medication. It is said, that 20% of people who went through a traumatic expirience need t herapeutical help. Refugees are at a way higher risk of beeing affected by disorders like de pressons, anxiety, suicidal thought, anger, aggression, drug and alcohol abuse, insomni a, paranoia and many more due to their in general often unstable living situations. The str ategies are not in specific aiming at psychatric cases, but at psychosocial cases.
It may be that also patients with urgent psychatric problems are reached with these strategies. It IS very difficult to diagnose refugees with PTSD, because it can have different appear ances depending on the cultural and ethical background Of the refugee. Still ,alot Of efugees are suffering from PTSD. The adaption of an intervention model is necessary. In a constant exchange with refugees and workers of refugee camps it is possible to adopt t o the traditional beliefs, customs and social settings of the refugee population.
Men interventions should be able to build a brigde in between social work and hea lth work, and within this it will also increase the outreach of the whole project. Another asp ect is the traditional way of coping with traumatic incidents. Are there mourning rituals ceremony or else? If so, these structures have to be included in mental health interventions. Interventions in these field are built on three pillars. The first one is simply to offer support for those people who are not able to cope with there traumatic incidents on t heir own.
The second pillar is the prevention of psychosocial problems being treated as me dical ones, what then leads to an overburden of the medical facilities. The third step is to to prevent that psychosocial illnesses turn into psychopathologies. In the acute emergen cy phase it is fundamental to support the social structures and mechanisms to help people to survive. When there are first signs of order and fuctioning in the society are showing, should be started with therapeutical help for people in need of it.
Different suggestion are there for the first phase. As mentioned before, in this time information about cultural grieving customs should be gathered and spread. All people involved in working with refugees should know about these facts. On the othe r hand, refugees should be informed about possible stress disorders that are likely to occur after traumatic events, so that they know they are not ??crazy people”. In addition ot her relief organisations working in the same area should be briefed about the significan ce of mental 1 1