Young children's development after forced displacement: a systematic review

OBJECTIVES

To examine the impact of displacement experiences on 0- to 6-year-old children's social-emotional and cognitive development, as well as influencing factors on reported outcomes.

STUDY DESIGN

We systematically searched MEDline, Psyndex, Cochrane Library, Web of Science, Elsevier, TandF, Oxford Journal of Refugee Studies, Journal of Immigrant & Refugee Studies, and Canada's Journal on Refugees for existing literature regarding social-emotional and cognitive outcomes in children directly exposed to forced displacement due to political violence. Results were synthesized in the discussion and displayed using harvest plots.

RESULTS

Our search generated 9,791 articles of which 32 were selected for review and evaluation according to NICE criteria. Included studies provided results for 6,878 forcibly displaced children. Measured outcomes were diverse and included areas such as peer relations, prosocial behavior, family functioning, play, intelligence, learning performance, and language development. Repeated exposure to adverse experiences, separation from parents, parental distress, as well as duration and quality of resettlement in the host country were reported as influencing factors in the reviewed studies.

CONCLUSION

As protective factors like secure and stable living conditions help to promote children's development, we call for policies that enhance participation in the welcoming society for refugee families. Early integration with low-threshold access to health and educational facilities can help to mitigate the wide-ranging negative consequences of forced displacement on young children's development.

Immediate health and economic impact of the Tigray war on internally displaced persons and hosting households

Globally, war is the major cause of displacement from the usual place of the biological environment. The war of Tigray exposed thousands of people to internal displacement and migration. Evidence has shown that displaced people and migrants shoulder the health and economic burden to ensure survival. However, evidence of the impact of the war on health and the economy related to the displaced people and their hosting communities is not documented. Thus, this study aimed to investigate the health and economic impact of the war on displaced people and the hosting community. A community-based survey was conducted among randomly selected 3572 households of 48 woredas/districts from August 06 to 30/2021 in Tigray. Each district had 4 enumeration sites and there were 20 households (HHs) to be sampled per each enumeration site. Data were collected using a pretested structured questionnaire using face-to-face interviews of displaced and hosting household heads. The entered data is exported to SPSS version 26 statistical packages for data analysis. Summary statistics and geo-spatial analysis was computed. The war had a significant impact on the health and economy of the community of Internally Displaced People (cIDPs) and hosting households. There were 12,691 cIDPs and 3572 hosting HHs. About 12.3% had chronic illness12.3% of (cIDP) who had chronic diseases and follow-up medication was forced to stop their medication. 536 (15%) civilian family members of cIDPs were killed at their homes. During the war, 244 (6.83%) of civilian family members faced physical disability. Consequentially, 43.8% and 58.8% of respondents of cIDPs suffered from severe depression and post-traumatic stress disorder. The war had a significant amount of personal resources such as domestic animals, cereals, cars, machinery, and HH furniture was looted and vandalized by the perpetrator forces from the cIDPs and hosting HHs. The range of family size in the hosting households was 3 to 22. The war had a significant health and economic impact on both cIDPs and hosting HHs. cIDPs suffered from various illnesses and disabilities related to the war with no medical access and follow-up care leading them to stressful situations such as depression and PTSD. There was also a huge economic damage and distraction which threatens the survival of the survivors.

The need to increase antimicrobial resistance surveillance among forcibly displaced persons (FDPs)

Antimicrobial resistance (AMR) poses a significant threat to human health as 4.95 million deaths were associated with bacterial AMR in 2019 and is projected to reach 10 million by 2050. To mitigate AMR, surveillance is an essential tool for determining the burden of AMR and providing the necessary information for its control. However, the global AMR surveillance is inadequate and particularly limited among forcibly displaced persons (FDPs) despite having higher risks of harboring these pathogens. Predisposing factors among this group include poor living conditions, limited access to treatment and diagnostic tests, and inadequate trained health professionals in refugee camps. Strengthening AMR surveillance among FDPs would address the identified gaps and facilitate formulation and implementation of evidence-based policies on AMR control and prevention response. This article provides information on the growing population of FDPs, factors contributing to the AMR burden and AMR surveillance gaps in FDPs and highlighted recommendations for control.

Seeking news and information through social networking sites: An experience of internally displaced people

This case study was designed to investigate the use of social networking sites (SNSs) for seeking news and information by internally displaced people (IDP). The study is guided by media dependency theory and related literature. Data were collected from 288 Iraqi internally displaced people (IDP) in four large camps through a survey questionnaire. The findings of the study reported how and why the respondents use SNSs for news and information and how much they trusted such platforms. Most of the respondents were found to depend on a variety of SNS media, old or new, to receive news and information, especially in times of crisis and conflicts. Such devices were very important for communicating with the families, news contributions, and news production.

Socio-economic and environmental factors affecting breastfeeding and complementary feeding practices among Batwa and Bakiga communities in south-western Uganda

Improving breastfeeding and complementary feeding practices is needed to support good health, enhance child growth, and reduce child mortality. Limited evidence is available on child feeding among Indigenous communities and in the context of environmental changes. We investigate past and present breastfeeding and complementary feeding practices within Indigenous Batwa and neighbouring Bakiga populations in south-western Uganda. Specifically, we describe the demographic and socio-economic characteristics of breastfeeding mothers and their children, and individual experiences of breastfeeding and complementary feeding practices. We investigate the factors that have an impact on breastfeeding and complementary feeding at community and societal levels, and we analysed how environments, including weather variability, affect breastfeeding and complementary feeding practices. We applied a mixed-method design to the study, and we used a community-based research approach. We conducted 94 individual interviews (n = 47 Batwa mothers/caregivers & n = 47 Bakiga mothers/caregivers) and 12 focus group discussions (n = 6 among Batwa & n = 6 among Bakiga communities) from July to October 2019. Ninety-nine per cent of mothers reported that their youngest child was currently breastfed. All mothers noted that the child experienced at least one episode of illness that had an impact on breastfeeding. From the focus groups, we identified four key factors affecting breastfeeding and nutrition practices: marginalisation and poverty; environmental change; lack of information; and poor support. Our findings contribute to the field of global public health and nutrition among Indigenous communities, with a focus on women and children. We present recommendations to improve child feeding practices among the Batwa and Bakiga in south-western Uganda. Specifically, we highlight the need to engage with local and national authorities to improve breastfeeding and complementary feeding practices, and work on food security, distribution of lands, and the food environment. Also, we recommend addressing the drivers and consequences of alcoholism, and strengthening family planning programs.

Mental health among displaced and non-displaced populations in Valledupar, Colombia: do inequalities continue?

During the long-lasting civil war in Colombia, thousands of people were displaced mainly from rural to urban areas, causing social disruption and prolonged poverty. This study aimed at analyzing the traumatic experience many years ago on the current psycho-emotional status of displaced families as well as the ongoing inequalities regarding displaced and non-displaced communities in one of the most affected areas by the armed conflict. An interview survey was conducted among 211 displaced families and 181 non-displaced families in 2 adjacent compounds in Valledupar, Colombia. The questionnaire used questions from the validated national survey and was revised and applied by staff members of the departmental secretary of health who conducted additional in-depth interviews. The study showed that the living conditions of the displaced community were precarious. The past traumatic events many years ago and the current difficult living conditions are associated with psychological problems being more frequent among the displaced people. The displaced people had experienced more violent acts and subsequently had a larger number of emotional symptoms (fright, headache, nervousness, depression, and sleeplessness). Other stress factors like economic problems, severe disease or death of family members and unemployment prevailed among displaced persons. The non-displaced lived in a more protected environment with less exposure to violence and stress, although belonging to a similarly low socio-economic stratum. It is recommended to take measures for a better protection of the displaced community, improve their access to the job market, offer different leisure activities and facilitate public transport.

‘Invisible existence’: Perspectives of forced migrants’ living within Zimbabwe

Involuntary human mobility within and outside national borders continue to raise connotations of these migrants being dispossessed of more than their physical shelter. In 2005, the Zimbabwean government demolished hundreds of buildings, which it had condemned as illegal through a program code named Operation Murambatsvina. Likewise, for the people dislodged by this program, the article contends that internal displacement did not only lead to loss of shelter but also denied them their inherent dignity and rendered them ‘invisible’. In turn, this heightened their susceptibility to deprivations that are synonymous with forced migration. Therefore, this article aims to explore the forced migrants’ perspectives of the effects of displacement on their lives vis-à-vis the above contentions. It mainly seeks to address the displaced people’s perceptions and socially constructed meanings of internal displacement. This qualitative article is based on empirical data gathered from Hopley and Caledonia settlements in Zimbabwe. The essay uses purposive sampling and snowballing to capture the people living in displacement. The article’s findings indicate that displacement births adaptive preferences which are used to counter the negative effects experienced due to the conditions in their settlements. Despite the conspicuousness of Hopley and Caledonia residents’ type of shelter, the article also establishes that internal displacement has ironically increased their invisibility both within and outside Zimbabwe. The article determines that their ‘invisibility’ is manifested through waning interest by institutions mandated to safeguard their assistance and protection, which exposes them to heightened vulnerabilities.

Effects of an African Circle Dance Programme on Internally Displaced Persons with Depressive Symptoms: A Quasi-Experimental Study

Background: Internally Displaced Persons (IDPs) are people who have been forced to flee their homes due to disasters. Depressive symptoms, at over 31–67%, are prevalent in IDPs in Africa. Despite the evidence for the benefits of the promotion of dance interventions on psychological health, supporting information is needed to outline the benefits of an African Circle Dance (ACD) intervention for IDPs in Africa. Methods: A quasi-experimental design (pre-/post-test) was employed. Two IDP camps were randomized into the intervention group (psychoeducation and ACD intervention) and the control group (psychoeducation). Adults aged ≥18 years, living in an IDP camp, able to perform brisk walking, and who scored ≥10 on a depressive symptoms subscale were recruited. The intervention group received an 8-week ACD dance intervention and two 1-h psychoeducation sessions on stress management; the controls only received the psychoeducation sessions. Outcomes were depressive symptoms, stress, and anxiety. Data were collected at baseline (T0), immediately after the intervention at week 8 (T1), and at week 12 (T2) at the post-intervention and follow-up session. A generalized estimating equation was used to test the effects of the ACD intervention, with a 0.05 significance level. Results: 198 IDPs completed the study (n_control = 98; n_intervention = 100). The intervention group reported significantly greater improvements in depressive symptoms (v = 0.33, p < 0.001) and stress (v = 0.15, 0.008) than did the control group. Conclusions: ACD could be a valuable complementary intervention in health promotion but more research is needed.

A Cross-Sectional Analysis of the Prevalence and Determinants of Mental Distress Among Ethiopian Returnees

BACKGROUND

Returning internally displaced persons (IDPs) to their homes can be a difficult and traumatic experience, particularly after a long period of displacement. Furthermore, traumatic experiences encountered during displacement during the flight process may be replayed in the minds of IDP returnees when they return to their original locations, raising the risk of re-traumatization. This could have a detrimental impact on the mental health of returning IDPs. Despite this, the mental health of returnee IDPs in Ethiopia has received less consideration. As a result, the aim of this study was to determine the prevalence and determinants of mental distress among Ethiopian returnees.

METHOD AND PARTICIPANTS

A community-based cross-sectional study with 623 participants was conducted from January 1 to 30, 2021, using a systematic sampling technique. The Kessler psychological distress scale was used to assess mental distress (K-10). Bivariable and multivariable binary logistic regression is used to investigate the relationship between variables. Statistical significance was described as a P-value of less than 0.05 with a 95% confidence interval.

RESULTS

The total number of people interviewed was 623, with a 100% response rate. With a 95% confidence interval of 47 to 51.9, the prevalence of psychological distress was 49.4%. Unemployment (AOR=2.1, 95% CI 1.38 to 3.40), inadequate social support (AOR=1.92, 95% CI 1.53 to 2.56), having little knowledge of post-returnee life (AOR=2.17, 95% CI 1.23 to 3.37), and the number of traumatic events (AOR=1.92, 95% CI 1.53 to 2.56) were all found to be significant in the multivariate logistic regression.

CONCLUSION

Returnee IDPs have a high prevalence of psychological distress, according to this report. It is suggested that knowledge of how to adapt to a new life after returning to the original land be given, as well as consistent psychosocial help.

Traditional leadership and the Tokwe-Mukosi induced displacements: Finding the missing link

There is increasing empirical evidence that the relocation of the victims of the Tokwe-Mukosi floods in Zimbabwe was marred by a combination of challenges. These challenges are argued in this article to have resulted from the adoption of Eurocentric models by government and non-governmental organisation technocrats and experts while relegating traditional leadership and the lived experiences of the displaced to the shadows. The writer provides a summary and critique of the Elizabeth Colson-Thayer Scudder four-stage model and Michael Cernea's Impoverishment Risks and Reconstruction Model. This article argues that traditional leadership is the missing link in disaster-induced displacement and its integration can overcome most of the challenges faced by the displaced in Zimbabwe. Traditional leadership in Zimbabwe can be traced to precolonial states and it has survived the colonial and postcolonial epochs. The study was guided by the Afrocentric theoretical framework. The case for the integration of traditional leadership was buttressed by numerous arguments. Among these arguments include proximity of traditional leadership to the displaced, the Zunde raMambo concept and ubuntu, among others.

Burden of malaria is higher among children in an internal displacement camp compared to a neighbouring village in the Democratic Republic of the Congo

BACKGROUND

In the Democratic Republic of the Congo (DRC), violent conflict has caused the displacement of millions of people into camps where they are exposed to poor living conditions and high rates of infectious diseases. Malaria, in particular, is a major cause of mortality in children under five; however, the burden of disease in displacement camps has not previously been described.

METHODS

Two cross-sectional surveys were performed. First, prevalence of Plasmodium falciparum antigenemia was measured in a random sample of 200 children living in a displacement camp and 200 children from a nearby village (control group). Second, the proportion of febrile illness attributable to malaria was measured in a study of 100 children from the displacement camp and 100 children from the control village presenting to the same health clinic with fever. All participants were tested for P. falciparum with a rapid diagnostic test and additional demographic data, clinical characteristics, and malaria risk factors were determined using a parental questionnaire.

RESULTS

In the community survey, children living in the displacement camp had a higher prevalence of P. falciparum infection (17 %) than controls (7.5 %) (OR 2.6; 95 % CI 1.3-4.1; P = 0.0095). In the clinic-based survey, the proportion of febrile illness attributable to malaria was higher among children from the displacement camp (78 %) than controls (39 %) (OR 5.5; 95 % CI 3.0-10.3; P < 0.001). Household bed net ownership and use was significantly lower in the displacement camp than control village in both surveys. Statistically significant differences in household wealth, maternal education, and exposure to community violence were also found.

CONCLUSIONS

Population displacement due to violent conflict appears to be a risk factor for malaria, a major cause of child mortality. Children living in displacement camps are a relatively understudied population, but have a high burden of malaria, despite control programmes focused on bed net distribution.

Changes in mental disorder prevalence among conflict-affected populations: a prospective study in Sri Lanka (COMRAID-R)

BACKGROUND

Longitudinal data are lacking on mental health trajectories following conflict resolution and return migration. COMRAID-R is a follow-up study of Muslims displaced by conflict from Northern Sri Lanka 20 years ago who are now beginning to return.

METHODS

Of 450 participants in displacement interviewed in 2011, 338 (75.1%) were re-interviewed a year later, and a supplementary random sample (n = 228) was drawn from return migrants with a comparable displacement history. Common mental disorder (CMD; Patient Health Questionnaire) and post-traumatic stress disorder (CIDI-subscale) were measured.

RESULTS

A CMD prevalence of 18.8% (95%CI 15.2-22.5) at baseline had reduced to 8.6% (5.6-11.7) at follow-up in those remaining in displacement, and was 10.3% (6.5-14.1) in return migrants. PTSD prevalences were 2.4%, 0.3% and 1.6% respectively.

CONCLUSIONS

We observed a substantial decrease in CMD prevalence in this population over a short period, which may reflect the prospect of return migration and associated optimism following conflict resolution.

An intervention to improve mental health care for conflict-affected forced migrants in low-resource primary care settings: a WHO MhGAP-based pilot study in Sri Lanka (COM-GAP study)

Background

Inadequacy in mental health care in low and middle income countries has been an important contributor to the rising global burden of disease. The treatment gap is salient in resource-poor settings, especially when providing care for conflict-affected forced migrant populations. Primary care is often the only available service option for the majority of forced migrants, and integration of mental health into primary care is a difficult task. The proposed pilot study aims to explore the feasibility of integrating mental health care into primary care by providing training to primary care practitioners serving displaced populations, in order to improve identification, treatment, and referral of patients with common mental disorders via the World Health Organization Mental Health Gap Action Programme (mhGAP).

Methods/Design

This pilot randomized controlled trial will recruit 86 primary care practitioners (PCP) serving in the Puttalam and Mannar districts of Sri Lanka (with displaced and returning conflict-affected populations). The intervention arm will receive a structured training program based on the mhGAP intervention guide. Primary outcomes will be rates of correct identification, adequate management based on set criteria, and correct referrals of common mental disorders. A qualitative study exploring the attitudes, views, and perspectives of PCP on integrating mental health and primary care will be nested within the pilot study. An economic evaluation will be carried out by gathering service utilization information.

Discussion

In post-conflict Sri Lanka, an important need exists to provide adequate mental health care to conflict-affected internally displaced persons who are returning to their areas of origin after prolonged displacement. The proposed study will act as a local demonstration project, exploring the feasibility of formulating a larger-scale intervention study in the future, and is envisaged to provide information on engaging PCP, and data on training and evaluation including economic costs, patient recruitment, and acceptance and follow-up rates. The study should provide important information on the WHO mhGAP intervention guide to add to the growing evidence base of its implementation.

Trial registration

SLCTR/2013/025.

Prolonged internal displacement and common mental disorders in Sri Lanka: the COMRAID study

Background

Evidence is lacking on the mental health issues of internally displaced persons, particularly where displacement is prolonged. The COMRAID study was carried out in year 2011 as a comprehensive evaluation of Muslims in North-Western Sri Lanka who had been displaced since 1990 due to conflict, to investigate the prevalence and correlates of common mental disorders.

Methods

A cross-sectional survey was carried out among a randomly selected sample of internally displaced people who had migrated within last 20 years or were born in displacement. The total sample consisted of 450 adults aged 18–65 years selected from 141 settlements. Common mental disorders (CMDs) and post-traumatic stress disorder (PTSD) prevalences were measured using the Patient Health Questionnaire and CIDI sub-scale respectively.

Results

The prevalence of any CMD was 18.8%, and prevalence for subtypes was as follows: somatoform disorder 14.0%, anxiety disorder 1.3%, major depression 5.1%, other depressive syndromes 7.3%. PTSD prevalence was 2.4%. The following factors were significantly associated with CMDs: unemployment (odds ratio 2.8, 95% confidence interval 1.6–4.9), widowed or divorced status (4.9, 2.3–10.1) and food insecurity (1.7, 1.0–2.9).

Conclusions

This is the first study investigating the mental health impact of prolonged forced displacement in post-conflict Sri Lanka. Findings add new insight in to mental health issues faced by internally displaced persons in Sri Lanka and globally, highlighting the need to explore broader mental health issues of vulnerable populations affected by forced displacement.

Ethical challenges in mental health research among internally displaced people: ethical theory and research implementation

Millions of people undergo displacement in the world. Internally displaced people (IDP) are especially vulnerable as they are not protected by special legislation in contrast to other migrants. Research conducted among IDPs must be correspondingly sensitive in dealing with ethical issues that may arise. Muslim IDPs in Puttalam district in the North-Western province of Sri Lanka were initially displaced from Northern Sri Lanka due to the conflict in 1991. In the backdrop of a study exploring the prevalence of common mental disorders among the IDPs, researchers encountered various ethical challenges. These included inter-related issues of autonomy, non-maleficence, beneficence, confidentiality and informed consent, and how these were tailored in a culture-specific way to a population that has increased vulnerability. This paper analyses how these ethical issues were perceived, detected and managed by the researchers, and the role of ethics review committees in mental health research concerning IDPs. The relevance of guidelines and methodologies in the context of an atypical study population and the benefit versus risk potential of research for IDPs are also discussed. The limitations that were encountered while dealing with ethical challenges during the study are discussed. The concept of post-research ethical conduct audit is suggested to be considered as a potential step to minimize the exploitation of vulnerable populations such as IDPs in mental health research.

Forced migration and mental health: prolonged internal displacement, return migration and resilience

Forced internal displacement has been rising steadily, mainly due to conflict. Many internally displaced people (IDP) experience prolonged displacement. Global research evidence suggests that many of these IDP are at high risk for developing mental disorders, adding weight to the global burden of disease. However, individual and community resilience may act as protective factors. Return migration may be an option for some IDP populations, especially when conflicts end, although return migration may itself be associated with worse mental health. Limited evidence is available on effects of resettlement or return migration following prolonged forced internal displacement on mental health. Also, the role of resilience factors remains to be clarified following situations of prolonged displacement. The public health impact of internal displacement is not clearly understood. Epidemiological and interventional research in IDP mental health needs to look beyond medicalised models and encompass broader social and cultural aspects. The resilience factor should be integrated and explored more in mental health research among IDP and a clearly focused multidisciplinary approach is advocated.

The psychological impact of forced displacement and related risk factors on Eastern Congolese adolescents affected by war

BACKGROUND

While the current knowledge base on the mental health effects of displacement is mainly limited to refugees residing in industrialised countries, this paper examines the impact of war-induced displacement and related risk factors on the mental health of Eastern Congolese adolescents, and compares currently internally displaced adolescents to returnees and non-displaced peers.

METHODS

Data were collected from a community sample of 819 adolescents aged 13 to 21 years, attending one of 10 selected schools across the Ituri district in the Democratic Republic of Congo. Respondents completed culturally adapted self-report measures of posttraumatic stress symptoms (using the Impact of Event Scale - Revised) and internalising and externalising behaviour problems (by means of the Hopkins Symptoms Checklist - 37 for Adolescents). Associated factors studied were age, sex, parental death, exposure to war-related violence and daily stressors.

RESULTS

Internally displaced persons (IDPs) reported highest mean scores for the IES-R and the HSCL-37A internalising scale, followed by returnees, while non-displaced adolescents scored significantly lower. However, ANCOVA tests showed that posttraumatic stress and internalising symptoms were mainly associated with traumatic exposure and daily stressors and not with displacement status. Externalising problem scores were associated with traumatic exposure, daily stressors and displacement. Remarkably, death of father was associated with fewer externalising problems. Sex was differently associated with internalising and externalising problems through traumatic and daily stressors.

CONCLUSIONS

As IDPs are highly exposed to violence and daily stressors, they report most psychological distress, when compared to returnees and non-displaced peers. The distinct mental health outcomes for returned youngsters illustrate how enhancing current socio-economic living conditions of war-affected adolescents could stimulate resilient outcomes, despite former trauma or displacement.