Debunking Common Myths about Refugees
Examining the facts about refugees' mental health and behavior.
Posted Feb 15, 2019
Nowadays our perception of refugees is distorted by fear-driven politics and media coverage of refugees and migrants. We often hear that they are potential terrorists or traumatized beyond recovery, or spreading other ills. These stories manufacture falsehoods to suit those who want to exclude outsiders, deny history, and negate the humanity of whole populations.
Instead of giving into fear and lies, we should acquaint ourselves with the facts about refugees and let the evidence inform building sensible policies and programs. This includes understanding their exposure to adversity and its impact on their mental health and behavior.
Most refugees live in low- and middle-income countries (LMICs). 3.5 million Syrian refugees live in Turkey, now the world’s largest refugee host country, with 8% there living in refugee camps. In comparison, in 2018, the U.S. resettled only 22,491 refugees overall, which is half the 45,000 cap. Last year the U.S. resettled only 62 Syrian refugees.
By now a great many surveys of different refugees populations demonstrated the presence of common mental disorders in these group: post-traumatic stress disorder, depression, and anxiety. These studies show a prevalence of between 25 and 50%. Although Post Traumatic Stress Disorder is a major focus, depression, and anxiety are often just as high.
This prevalence is not surprising, given that refugees typically experience high rates of conflict-related violence and family loss and separation, followed by the stressors of displacement, such as lack of resources, discrimination, loss of social networks, low wage work, and uncertainty about their future.
These mental health problems among refugees are for the most part treatable. However, many refugees face difficulties accessing mental health resources, especially in LMICs. Although there are several evidence-based interventions which have been shown to be effective with refugees, they may not be available and stigma regarding mental health problems is often high.
The challenge in LMICs and low resource settings in high-income countries is to utilize task-sharing approaches, which rely upon mental health support being provided by lay health workers, primary care nurses or doctors, or community advocates. Another challenge is to develop mental health support which fits with their daily lives, including the strong family orientation of many refugees. Unfortunately, presently the vast majority of refugees globally still have little to no access to evidence-based mental health services. In the U.S., many states have successfully developed mental health services for refugees as part of the resettlement system—the system which has been sacked by the current administration.
Regarding terrorism, no attacks in the U.S. have been carried out by refugees. The majority of terrorist attacks in both the U.S. and Europe were committed by the countries' own citizens.
One specific concern about refugees is whether refugee youth, or the children of refugees, are in some ways uniquely vulnerable to terrorist recruitment or online radicalization, perhaps because of their exposure to adversity. For example, approximately two dozen Somali-Americans who came to the U.S. as refugees left the U.S. to become foreign fighters for the Al Shabaab terrorist organization or ISIS. A study conducted led by Dr. Heidi Ellis among resettled Somali refugees showed that greater exposure to trauma was associated with greater openness to illegal and violent activism, especially among those with weaker social bonds. Another study led by myself among Somali-Americans in Minneapolis-St. Paul identified protective resources that communities and families can mobilize to protect against the risks of recruitment and radicalization.
Further research is needed to better understand whether the conditions of refugee resettlement are creating an environment which is uniquely vulnerable to violent extremism. Experience on the ground suggests that over-reliance on punitive law enforcement approaches can increase the sense of discrimination and weaken civic engagement, which could unintentionally drive some persons closer to violent extremism. Other approaches are needed which are less driven by law enforcement, more preventive in nature, led by civil society, and not focused just on one community.
Another specific fear often voiced by political leaders and the media is that foreign terrorist fighters may be attempting to return to Europe or the U.S. by slipping in amongst refugee or migrant flows. In Europe, several ISIS-affiliated terrorists came in as migrants. Investigations have found no credible evidence of any systematic effort for terrorists to slip in amongst refugees or migrants.
With the collapse of the Islamic State, we must remain vigilant regarding returning ISIS fighters. This calls for efforts to strengthen border security to detect returned foreign terrorist fighters. But this can be achieved without shutting down refugee flows—not to mention putting asylum-seeking migrant families in cages.
At the same time, we should put any concerns about refugees in proper perspective. The greatest terrorist threat facing the U.S. today is white supremacy from U.S. citizens, which many claim has been seriously under-addressed for years.
Refugees who fled war and terrorism want to build peaceful lives and contribute to their new countries. Existing evidence reflects that refugees are not potential terrorists and that their mental health needs are addressable. Now imagine what refugee policies based on these two truths would look like.