A Perilous Journey: The Plight of Unaccompanied Minors
What are the mental health needs of children who become refugees on their own?
Posted Oct 31, 2017
"No one puts their children on a boat unless the water is safer than the land.” —Warsan Shire, Home
The decision to become a refugee is a choice between the lesser of two evils. There are the violence and destruction of war versus the perils of flight; the chaos and deprivation of armed conflict versus the loss of home and homeland; the continuous threat of bombs, bullets, and the brutality of armed combatants versus the uncertainty of life in the nowhere land of refugee camps, the terror of a journey in a flimsy boat that may never reach another shore, or a trek across countries and continents without food or shelter.
Far more often than we realize, children make the perilous journey of exile on their own, unaccompanied by any protective adult. Some children are sent on by parents unable to leave themselves, an agonizing decision for parents who can only hope their child will find safe haven in a far-off land. Other children start out together with their families, but through a host of circumstances, end up getting separated from them and must make their way alone or with others they encounter along the way.
"At an age at which most kids need supervision to complete their homework, these children cross continents alone"
—Lauren Collins, Europe's Child-Refugee Crisis
In 2015, 90,000 unaccompanied children sought asylum in Europe, fleeing wars in Afghanistan, Syria and elsewhere for the imagined safety a continent deeply divided in its attitudes towards them. Across the Atlantic, more than 68,000 children arrived on their own in the United States, seeking safety from horrific gang-related violence in Honduras, Guatemala, and El Salvador. Before they leave for el norte, many Central American kids have no idea just how hostile attitudes in the U.S. have grown towards asylum seekers. Even if they did know, it probably wouldn’t change their decision to flee. The certainly of deadly violence at home tends to outweigh the uncertainty of the hoped-for better world whose image is often embellished by the desperate hope of something, anything better than what they have already survived in their young lives.
The refugee journey is inevitably perilous even when children make it in the care of parents or other adults. When they go into exile on their own, however, their vulnerability increases dramatically. Common threats include:
- Physical and sexual abuse by adults or older children.
- Abduction and exploitation by human traffickers, drug smugglers, and prostitution rings. At least 10,000 unaccompanied minors have gone missing in Europe since 2014, according to the European criminal intelligence agency Europol. Many are feared to have been forced into sex work and other forms of child labor.
- Theft of their few possessions.
- Prolonged detention in asylum holding centers without the support of family members.
- Homelessness and a constant fear of deportation in whatever country they get to if they don’t seek asylum or their asylum application is denied.
- Social isolation.
- Hunger, malnutrition, and illness.
The Psychological Toll
In a pioneering series of studies of unaccompanied Cambodian refugee children in the United States, Kinzie and his colleagues (1986, 1989) documented high and persistent levels of trauma and depression, with roughly half the sample meeting diagnostic criteria for PTSD and depression across multiple assessment points. Importantly, those children who were able to reunite with family members fared significantly better than their peers who were placed in foster families. Kinzie et al.’s sample may have been unusually distressed due to the extremity of their exposure to violence and loss in Khmer Rouge ”labor” camps before they escaped from Cambodia; they’d endured beatings, starvation, forced labor, and lost an average of five family members. The researchers’ focus was also primarily on trauma experiences in Cambodia. We’ve since learned that a great deal of trauma exposure among unaccompanied minors occurs after they escape from the war zone, especially during the journey of exile, but also in whatever setting they end up in.
More recent studies have confirmed that unaccompanied minors are at higher risk than other refugee children of exposure to traumatic experiences, and to the development of high and enduring levels of psychological distress. (Derluyn et al., 2009; Derluyn & Broekkaert, 2007; Fazel et al., 2012; Hodes et al., 2008). Although rates of psychological trauma and depression have seldom reached the levels documented by Kinzie et al, they have generally been severe enough to warrant concern and intervention.
One of the more robust findings concerns the toxic impact on children's mental health of prolonged detention in holding centers for asylum seekers. Rates of depression and suicidal behavior tend to increase in these settings of prolonged confinement and uncertainty. Having escaped from grave danger in their homeland, and endured numerous travails on sea and/or land while making their escape, they now find themselves locked up, with limited access to information, legal recourse, or basic resources beyond minimal shelter and food.
It's important to balance these findings of elevated distress with the recognition that in most studies, the majority of unaccompanied refugee children do not develop clinical disorders or become significantly impaired by their distress. Resilience is surprisingly widespread among young people who've endured the chronic and often extreme stress commonly experienced by unaccompanied minors. That said, it's also important to bear in mind that being resilient does not mean children are altogether unscathed by what they have survived. Remarkable strength can certainly co-exist with emotional distress, and while clinical intervention may not be needed, other forms of assistance may be greatly valued.
How We Can Help
There are several things to consider when offering support to unaccompanied minors:
- Unaccompanied minors are survivors. They have, by necessity, developed remarkable survival skills to make it across great distances under extraordinary, and sometimes life-threatening conditions. Any effort to help must start with a recognition of their strengths and how much they’ve accomplished by surviving all they’ve endured.
- Experiences of sexual abuse and other traumatic events during their journey of escape are common. These can be sources of shame, and may not be readily disclosed during health or psychosocial assessments. This is especially true among children from cultures where victims of sexual assault are made to feel they are to blame for their misfortune, and perhaps also that they have dishonored their families. By taking time to create a trusting relationship, and gently but directly asking about such experiences, it’s possible to diminish the shame and address the psychological and physical effects of such trauma.
- Because young refugees and asylum seekers have escaped from contexts of extreme violence and loss, it is natural to attribute their distress to whatever they endured in their homeland, as well as to traumatic experiences during their journey of exile. However, it’s also important to identify challenges they may be facing in their current living circumstances. Current stressors in their present environment such as isolation, bullying, or discrimination in an asylum holding center, an informal settlement such as the “Calais Jungle”, or even a foster home, may contribute significantly to feelings of fear, sadness, or isolation.
- Family reunification can be a powerful source of comfort and stabilization. When this isn’t possible, helping connect unaccompanied minors to peers from their country of origin can likewise be a source of comfort. It’s important to be mindful of any ethnic or religious conflicts that drove the conflict from which they escaped and to not assume that positive relations will naturally develop just because two young people of different ethnicities share the same homeland. Helping young people make contact with family members back home can also provide an important source of comfort and connection.
- Hope, structure, and social connection are powerful antidotes to despair. Helping young people access schooling, where they can form new social networks, regain a future orientation, and develop a predictable routine, can promote resilience and as well as psychological recovery. When schools are not available, community centers that offer non-formal education and recreational activities can serve a similar function.
- For unaccompanied children detained in asylum holding centers, psychosocial support is critical. An innovative intervention now being scaled up in the Netherlands is called TeamUp, a joint venture of War Child Holland, UNICEF, and Save The Children (disclosure: I work at War Child Holland, though am not involved with the TeamUp project). Trained volunteers spend time each week in asylum holding centers, leading fun, thematic activities with groups of children, offering them a safe and supportive reprieve from all they have endured and the monotony of everyday life in the centers.
- Finally, it's critical to hold governments accountable to abide by the laws they have adopted and the international treaties to which they have committed. The U.S. and the UK have both turned away from their commitments to refugees and asylum-seekers, including unaccompanied minors. The U.S. commonly detains young asylum seekers in contradiction of its own policy of using detention as a last resort, a "least restrictive setting" policy that too often gets ignored by immigration authorities. The UK has likewise abandoned its stated commitments to taking in unaccompanied refugee minors, bowing to anti-refugee sentiment that the government itself has actively stoked. Australia has likewise adopted a harsh practice of turning away refugees at sea, in some cases with disastrous consequences; it has also detained young asylum seekers in widely condemned, inhumane conditions in off-shore detention facilities. Throughout Europe, growing anti-refugee movements and closed borders mean rougher journeys and harsher receptions for young people fleeing violence and persecution. Numerous legal protections exist on paper, but they are meaningless without widespread and vocal demands that governments enforce them and honor their legal and moral commitments.
Two excellent articles about the experiences of unaccompanied minors are:
Durluyn, I., Mels, C., & Broekaert, E. (2009). Mental health problems in separated refugee adolescents. Journal of Adolescent Health, 44: 291-297.
Derluyn, I., & Broekaert, E. (2007). Different perspectives on emotional and behavioural problems in unaccompanied refugee minors. Ethnicity and Health, 12: 141-62
Fazel ,M., Reed, RV., Panter-Brick, C., & Stein, A. (2011). Mental health of displaced and refugee children resettled in high-income countries: Risk and protective factors. The Lancet 379: 266-282.
Kinzie, J.D., Sack, W., Angell, R., Manson, S., & Rath, B. (1986). The Psychiatric Effects of Massive Trauma on Cambodian Children: I. The Children. Child and Adolescent Psychiatry, 25: 370-376.
Kinzie, J.D., Sack, W., Angell, R., Clarke, G., & Rath, B. (1989)A Three-Year Follow-up of Cambodian Young People Traumatized as Children. Child and Adolescent Psychiatry, 28: 501-504.
Hodes, M., Jagdev, D., Chandra, N., & Cunniff, A. (2008). Risk and resilience for psychological distress amongst unaccompanied asylum seeking adolescents. Journal of Child Psychology and Psychiatry, 49: 723-732.