Sexual violence against migrants and asylum seekers. The experience of the MSF clinic on Lesvos Island, Greece

No evidence, no problem? A critical interpretive synthesis of the vulnerabilities to and experiences of sexual violence among young migrants in Europe

BACKGROUND

Growing evidence indicates that young migrants are particularly vulnerable to sexual violence, however most research has focused on instances of sexual violence occurring in conflict zones and during transit. Much less attention has been given to the vulnerabilities to and experiences of sexual violence among young migrants in Europe.

OBJECTIVES

To understand the scientific evidence regarding the experiences of and vulnerabilities to sexual violence among young migrants (aged 11-30 years) in Europe.

METHODS

A search of three databases resulted in 1279 peer reviewed articles published between 2002 and 2022. Of these, 11 were included in this review. A critical interpretive synthesis methodology was applied.

RESULTS

Few studies investigate sexual violence among young migrants in Europe. The existing studies focus on very specific sub-groups of migrants, and as such, experiences of persons outside these groups are largely absent from the academic discourse. How sexual violence is understood varies across studies, often conflated with other forms of violence, hampering comparisons. However, the results of this review indicate that young migrants in Europe, both male and female, experience sexual violence and there are multiple sources of vulnerabilities at all levels of the socioecological model.

CONCLUSION

The scarcity of research regarding sexual violence among young migrants in Europe could give rise to the perception that no evidence means no problem, resulting in a continued lack of attention to this issue. There is a critical need to address this gap to inform prevention interventions, to identify victims, and to facilitate access to care.

Correction: Sexual violence against migrants and asylum seekers. The experience of the MSF clinic on Lesvos Island, Greece

[This corrects the article DOI: 10.1371/journal.pone.0239187.].

Lifetime sexual violence experienced by women asylum seekers and refugees hosted in high-income countries: Literature review and meta-analysis

Screening and care for victims of sexual violence (SV) among asylum seekers and refugees (ASRs) living in High-income host countries were prioritized by the WHO in 2020. The lack of stabilized prevalence findings on lifetime SV among ASRs in High-income countries hinders the development of adequate health management. The objective of this study was to determine the lifetime prevalence of SV experienced by ASRs living in High-income countries. We conducted a systematic review and meta-analysis according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Studies were included in the meta-analysis if the sample consisted exclusively of asylum seekers or refugees over the age of 16 living in High-income countries and if they reported a lifetime prevalence of experienced SV. The results of the meta-analysis were expressed with 95 % confidence intervals (CIs) as estimates of lifetime SV prevalence using a random-effects model. The estimated lifetime prevalence of SV among women ASRs was 44 % (95 % CI, 0.24-0.67) and 27 % (95 % CI, 0.18-0.38) for both sexes. This meta-analysis revealed a high prevalence of SV among ASRs hosted in High-income countries and suggest the importance of developing specific screening and care programs in these host countries.

Sexual and nonsexual violence and mental health among male refugees from the Democratic Republic of Congo residing in Kampala, Uganda: a population-based survey

We conducted a population-based survey in 2013 in Kampala, Uganda, to examine violence and mental health outcomes among self-settled male refugees from the Eastern Democratic Republic of Congo (DRC). Male DRC refugees aged 18+ years were sampled through respondent-driven sampling. Key interview domains included demographics, experiences of sexual and nonsexual violence, social support, PTSD, depression and suicide ideation. Data analysis was weighted to generate population-level estimates. We sampled 718 men (mean age: 33 years), most of whom had lived in North or South Kivu. Nonsexual violence, such as beatings (79.4%) and torture (63.8%), was frequent. A quarter (26.2%) had been raped; 49.9% of rape victims had been raped on multiple occasions, and 75.7% of rape victims had been gang raped. We estimated 52.8% had post-traumatic stress disorder (PTSD); 44.4% reported suicidal ideation. Numerous traumas were significantly (p < 0.05) associated with PTSD such as rape (adjusted odds ratio [aOR] = 1.82), war-related injuries (aOR = 2.90) or having been exposed to >15 traumas (compared to ≤10; aOR = 6.89). Traumata are frequent experiences in this self-settled male refugee population and are often accompanied by adverse mental health outcomes. Screening for trauma and adverse mental health outcomes and providing targeted services are paramount to improve these refugees' lives.

Incidence of sexual violence among recently arrived asylum-seeking women in France: a retrospective cohort study

Background

The prevention of sexual violence (SV) occurring shortly after arrival in host countries towards female asylum seekers requires knowledge about its incidence. We aimed to determine the incidence of SV and its associated factors during the past year of living in France among asylum-seeking females who had arrived more than one year earlier but less than two years.

Methods

We conducted a retrospective cohort study using a life-event survey of asylum-seeking females who had been registered in southern France by the Office for Immigration for more than one year but less than two. The primary outcome was the occurrence of SV during the past year, weighted by the deviation in age and geographical origin of our sample from all females registered. The nature of SV was noted, and associated factors were explored by a logistic regression model.

Findings

Between October 1, 2021, and March 31, 2022, 273 females were included. Eighty-four females experienced SV during the past year of living in France (26.3% weighted [95% CI, 24-28.8]), 17 of whom were raped (4.8% weighted [95% CI, 3.7-6.1]). Being a victim of SV prior to arrival in France (202, 75.7%) was associated with the occurrence of SV after arrival (OR = 4.6 [95% CI, 1.8-11.3]). Lack of support for accommodation was associated with se.xual assault (OR = 2.6 [95% CI, 1.3-5.1]).

Interpretation

The months following arrival in a European host country among asylum-seeking females appear to be a period of high incidence of SV; even higher for those who previously experienced SV prior to arrival. Reception conditions without support for accommodation seem to increase exposure to sexual assault.

Funding

DGOS-GIRCI.

Emotions, perceived threat, prejudice, and attitudes towards helping Ukrainian, Syrian, and Somali asylum seekers

Europe receives thousands of asylum seekers. This study examined whether European participants distinguish between European, Middle Eastern, and African asylum seekers in relation to positive and negative emotions, perceived threat, prejudice, and attitudes towards helping. The study also examined how these variables interrelate to influence each other. 287 participants were recruited from the UK and Malta. The study found that higher positive emotions and attitudes towards helping, and lower negative emotions, classical prejudice, and conditional prejudice were reported in relation to Ukrainian than Syrian or Somali asylum seekers. A mediation analysis was conducted to examine the interrelationship of these variables. Emotions and perceived threat had an indirect effect on attitudes towards helping, via prejudice. The effect of perceived threat was stronger than that of emotions. The study suggests that to improve people's openness towards helping asylum seekers, it is necessary to reduce the perception that asylum seekers are threatening.

The Gory Details: Asylum, Sexual Assault, and Traumatic Memory

For asylum seekers to be granted asylum, they must convince immigration officials that they have been persecuted or that they fear they will be persecuted if returned to their home country. This article discusses the reluctance of asylum seekers to be forthcoming about sexual assault as a form of persecution and the ways in which traumatic memory can affect narratives of persecution for rape survivors. Many asylum seekers, particularly those who have been sexually assaulted, show symptoms consistent with trauma survivors. Consequently, their narratives of persecution are often shaped by partial and incomplete memory recall. The result is that how asylum seekers who have been sexually assaulted tell their stories of persecution is the antithesis of the expectations of credibility. This article is based on qualitative research in Los Angeles, California, and New York City, New York, in the United States. It includes interviews with asylum seekers, immigration attorneys, immigrant service providers, asylum officers, and immigration judges; observations of immigration court hearings; and content analysis of asylum applications. I use these sources to argue that the harm of rape and its long-lasting effects evidenced by symptoms of traumatic memory impacts how asylum seekers articulate stories of persecution. How these stories are told can have devastating effects for asylum seekers that may jeopardize their ability to gain asylum if immigration officials do not view them as credible applicants.

It Happened in the Desert, in Libya and in Italy: Physical and Sexual Violence Experienced by Female Nigerian Victims of Trafficking in Italy

Nigerian girls and women constitute a large percentage of African victims of human trafficking in Italy. Extensive research has been conducted on the causes, push-and-pull factors, and the perpetrators in the phenomenon of trafficking Nigerian women and girls into Italy. However, limited data exist on the women and girls' narratives of their experiences during their migratory journey from Nigeria to Europe. Using data collected through a mixed method, longitudinal design, 31 female Nigerian victims of trafficking in Italy were interviewed for this study. This study gives voice to the experiences of sexual violence that these women and girls encounter during transit, leading to many of them arriving in Italy severely traumatized. It also discusses the health impact of these experiences and the different survival strategies that they are forced to employ. The study shows how sexual and physical violence is employed by smugglers, traffickers, and people in authority alike. It shows that the violence experienced along the way does not end after arrival in the destination country (in this case, Italy), but is, in some cases, exacerbated and similar to previous experiences of violence.

Left behind on the path to 90-90-90: understanding and responding to HIV among displaced people

INTRODUCTION

In 2021, the number of people affected by displacement worldwide reached the highest on record, with an estimated 30.5 million refugees and 4.6 million asylum seekers seeking safety across international borders and further 53.2 million people displaced within their countries of origin. Most forcibly displaced persons come from or relocate to lower- and middle-income countries (LMICs) and many of those countries have large HIV epidemics. In this commentary, we describe some of the challenges at the intersection of HIV and displacement vulnerabilities that cannot be easily addressed in resource-limited environments.

DISCUSSION

HIV transmission and prevention and treatment efforts in the context of displacement are affected by myriad behavioural, social and structural factors across different stages of the displacement journey. For example, structural barriers faced by people experiencing displacement in relation to HIV prevention and care include funding constraints and legal framework deficiencies. Such barriers prevent all forced migrants, and particularly those whose sexual identities or practices are stigmatized against, access to prevention and care equal to local residents. Xenophobia, racism and other social factors, as well as individual risky behaviours facilitated by experiences of forced migration, also affect the progress towards 90-90-90 targets in displaced populations. Current evidence suggests increased HIV vulnerability in the period before displacement due to the effect of displacement drivers on medical supplies and infrastructure. During and after displacement, substantial barriers to HIV testing exist, though following resettlement in stable displacement context, HIV incidence and viral suppression are reported to be similar to those of local populations.

CONCLUSIONS

Experiences of often-marginalized displaced populations are diverse and depend on the context of displacement, countries of origin and resettlement, and the nature of the crises that forced these populations to move. To address current gaps in responses to HIV in displacement contexts, research in LMIC, particularly in less stable resettlement settings, needs to be scaled up. Furthermore, displaced populations need to be specifically addressed in national AIDS strategies and HIV surveillance systems. Finally, innovative technologies, such as point-of-care viral load and CD4 testing, need to be developed and introduced in settings facing displacement.

Victimization of Applicants for International Protection Residing in Belgium: Sexual Violence and Help-Seeking Behavior

BACKGROUND

Sexual violence (SV) literature on applicants for international protection (AIPs) shows that they are at high risk of victimization. The study objectives are to provide an exploratory overview of the occurrence of SV in AIPs in Belgium and their help-seeking behavior (HSB). This overview is crucial to develop prevention strategies and care paths focusing on providing adequate care to AIP SV victims in Belgium.

METHODS

Quantitative data from structured interviews with AIPs (n = 62) triangulated with qualitative data from in-depth interviews with AIP SV victims (n = 11) served to explore the nature and impact of SV in AIPs in Belgium and their HSB.

RESULTS

A total of 83.9% of respondents have experienced SV. A total of 61.3% were victimized within the past year. Victimization seems more gender-balanced than in the general population. AIPs link SV to their legal status and their associated vulnerable situation. HSB upon SV was very limited in this sample. Help-seeking barriers interfering with the decision-making process to consult (in)formal resources were identified.

CONCLUSIONS

AIPs in Belgium are at high risk of SV. Despite the impact of SV on AIPs' lives, HSB upon SV is rare. The provision of age-appropriate sexual education and development of policies that will reduce help-seeking barriers is needed.

Ammunition Waste Pollution and Preliminary Assessment of Risks to Child Health from Toxic Metals at the Greek Refugee Camp Mavrovouni

The Mavrovouni refugee camp near the former Moria camp on the island of Lesvos, Greece, housed approximately 3000 asylum-seekers including children as of October 2021. The camp was built on the site of a military shooting range. This study aimed to characterize the soil contaminants and assess the risk of toxic environmental exposures for children living in Mavrovouni. Methods: Samples of surface soil (0−2 cm depth; particle size < 2 mm) from eight locations inside the camp were compared with two reference samples. Soil samples were microwave digested using a mixture of nitric and hydrofluoric acids and analyzed for lead (Pb), antimony (Sb), bismuth (Bi), and other metals using inductively coupled plasma mass spectrometry. These values were compared with action limits established by the Norwegian Environment Agency for kindergartens, playgrounds, and schools. Findings: Five of eight soil samples from inside the camp exceeded Pb levels of 100 mg/kg, which is currently the maximum acceptable value of Pb in soil for playgrounds in Norway. Two sites had extreme soil Pb levels of approximately 8000 mg/kg and 6000 mg/kg. The concen-tration of Sb and Bi in the surface soil of the firing range area strongly indicated environmental contamination, most likely from previous military activity and ammunition residue that has re-mained on the surface soil. Concentrations of arsenic (As), cadmium (Cd), copper (Cu), and zinc (Zn) in surface soil were lower than action limits. Discussion: Extremely high levels of Pb, together with high levels of Sb and Bi, were identified in soil where children live and play in the Mavrovouni refugee camp. This is the first independent study of environmental contamination at this camp and adds to the limited evidence base documenting Pb exposures prior to migrant and refugee reset-tlement. On top of the multiple existing public health crises and traumas that these asylum-seeking families face, exposure to toxic ammunition residues may have profound impacts on children’s development and health for years to come.

Trauma, Post-Traumatic Stress Disorder, and Mental Health Care of Asylum Seekers

Asylum seekers in Israel from East Africa frequently experienced traumatic events along their journey, particularly in the Sinai Peninsula, where they were subjected to trafficking and torture. Exposure to trauma has implications for rights that are contingent on refugee status. This retrospective chart review aimed to characterize the types of traumas experienced by 219 asylum seekers (149 men) from Eritrea and Sudan who sought treatment at a specialized mental health clinic in Israel, and to compare the mental health of trauma victims (n = 168) with that of non-trauma victims (n = 53). About 76.7% of the asylum seekers had experienced at least one traumatic event, of whom 56.5% were diagnosed with post-traumatic stress disorder (PTSD). Most reported traumas were experienced en route in the Sinai, rather than in the country of origin or Israel. Few clinical differences were observed between trauma victims and non-trauma victims, or between trauma victims with and without a PTSD diagnosis. Our findings emphasize the importance of accessibility to mental and other health services for asylum seekers. Governmental policies and international conventions on the definition of human trafficking may need to be revised, as well as asylum seekers’ rights and access to health services related to visa status.

Migrants’ Sexual Violence in the Mediterranean Region: A Regional Analysis

Migration in the Mediterranean region has increased greatly during the last years. Reports and studies reveal that violence and injuries among refugees and migrants is a common occurrence in the WHO Europe Region. Available literature indicates that sexual violence incidents take place: (a) during the migratory journey to the host country, (b) while in detention centers, (c) once migrants have reached their destination, and (d) during the period in which a woman is subject of trafficking. This manuscript explores how sexual violence against refugee/immigrant women is presented in the international literature; a narrative review of the literature was conducted on the phenomenon of migration in the Mediterranean area, and specifically on sexual violence of migrant women. In order to face the challenges faced by migrant women victims of sexual violence, the following policies are suggested by international literature: (a) offer emergency medical and health care to sexual violence survivors, which is usually relatively limited, (b) offer mental health care and psychological support for sexual violence when planning services to provide clinical care, and (c) work towards the aim of transforming norms and values in order to promote gender equality and support non-violent behaviours.