Climate change as a veiled driver of migration in Bangladesh and Ghana

People living in deltaic areas in developing countries are especially prone to suffer the effects from natural disasters due to their geographical and economic structure. Climate change is contributing to an increase in the frequency and intensity of extreme events affecting the environmental conditions of deltas, threatening the socioeconomic development of people and, eventually, triggering migration as an adaptation strategy. Climate change will likely contribute to worsening environmental stress in deltas, and understanding the relations between climate change, environmental impacts, socioeconomic conditions, and migration is emerging as a key element for planning climate adaptation. In this study, we use data from migration surveys and econometric techniques to analyse the extent to which environmental impacts affect individual migration decision-making in two delta regions in Bangladesh and Ghana. The results show that, in both deltas, climatic shocks that negatively affect economic security are significant drivers of migration, although the surveyed households do not identify environmental pressures as the root cause of the displacement. Furthermore, environmental impacts affecting food security and crop and livestock production are also significant as events inducing people to migrate, but only in Ghana. We also find that suffering from environmental stress can intensify or reduce the effects of socioeconomic drivers. In this sense, adverse climatic shocks may not only have a direct impact on migration but may also condition migration decisions indirectly through the occupation, the education, or the marital status of the person. We conclude that although climate change and related environmental pressures are not perceived as key drivers of migration, they affect migration decisions through indirect channels (e.g., reducing economic security or reinforcing the effect of socioeconomic drivers).

"I Didn't Expect to Be So Caught Up in It": a Qualitative Study of Experiences of Medical Students' Volunteering for Ukrainian Refugees

OBJECTIVE

Russia's invasion of Ukraine in February 2022 triggered a huge wave of migration, with thousands of refugees arriving at Prague's Central Station. With no medical service available, medical students started to volunteer and were running an infirmary available around the clock. The research aimed to explore medical students' professional experiences, emotionally challenging situations, and coping strategies in this demanding setting.

METHODS

The authors used a qualitative analysis of semi-structured in-depth interviews with 19 participants recruited through purposive sampling. Interviews took place between April and May 2022. Data were recorded, transcribed, and processed by using thematic qualitative analysis.

RESULTS

The research identified five emotionally challenging situations: caring for traumatized refugees, refusal of treatment, disruption of everyday life, independent decision-making, and complexity of voluntary work. Students adopted both adaptive and maladaptive coping strategies for dealing with stress and trauma. Almost half the students reported signs of secondary traumatization and moral distress; however, no one asked for psychological help.

CONCLUSIONS

Medical school curricula should cover trauma-informed approaches, healthy coping strategies, and destigmatization of psychological problems.

Trans-border Mobility and Security in the Sahel: Exploring the Dynamics of Forced Migration and Population Displacements in Burkina Faso and Mali

Burkina Faso and Mali have been grappling with multiple security threats including jihadist challenge, military coup d'état, violent extremism, and poor governance. These complex security problems have escalated into national conflicts, state failure, internal displacements, and forced migration. This paper examined the changing patterns of the drivers and enablers of these security threats and how these forces feed into the protracted challenges of forced migration and population displacements. Using qualitative methods and documentary evidence, the paper found that poor governance, lack of state-building measures, and socio-economic exclusion of local populations contributed to the worsening crises of forced migration and population displacements in Burkina-Faso and Mali. The paper emphasised the human security perspectives hinged on good governance principles through effective leadership in Burkina-Faso and Mali particularly in the areas of industrialization, employment creation, reduction of poverty, and provision of adequate security for the people.

Social exclusion and critical transitions in later life: Trajectories, forms and mechanisms

Unequal ageing patterns are increasingly prevalent within the life courses of heterogeneous older populations. Critical transitions in later life may contribute to these patterns and to more multifaceted deep-rooted forms of social exclusion. Yet despite significant research in this area, knowledge gaps remain regarding the subjective experiences of these transitions, the trajectories and constituent events of these transitions, and the related mechanisms that may drive exclusion. With a focus on lived experience, this article aims to investigate the role of critical life transitions in older age in constructing multidimensional social exclusion. The onset of dementia, bereavement of a significant other, and forced migration are selected as three illustrative transitions in older age. Based on 39 in-depth life-course interviews and life-path analyses, the study sets out to illuminate common features of the transitional process that increases exclusion susceptibility, and the potential commonalities regarding transition-related exclusionary mechanisms. Transition trajectories related to each of the transitions are first described identifying shared exclusionary risk features. Transition-related mechanisms that can generate multidimensional social exclusion are then presented as arising from a transition's nature and character, its structural and management aspects, and its symbolic and normative positioning. Findings are discussed with reference to the international literature and future conceptualisation of social exclusion in later life.

Mental health coverage for forced migrants: Managing failure as everyday governance in the public and NGO sectors in England

High-income countries (HICs) which are said to have "reached" universal health coverage (UHC) typically still have coverage gaps, due to both formal policies and informal barriers which result in "hypothetical access". In England, a user fee exemption has in principle made access to treatment for post-traumatic stress disorder (PTSD) and other mental health conditions thought to be caused by certain forms of violence universal, regardless of immigration status. This study explores the everyday governance of this mental health coverage for forced migrants in the English National Health Service (NHS) and NGO sector. Fieldwork was conducted in two waves, in 2015-2016 and 2019-2021, including six months of participant observation in an NGO and 21 semi-structured interviews with psy professionals across 16 NHS and NGO service providers. Further interviews were conducted with mental health commissioners and policymakers, as well as analysis of grey literature. Despite being formally covered for certain types of mental health care, in practice asylum seekers and undocumented migrants were often excluded by NHS providers. Undocumented migrants were also often excluded by NGO providers. Several rationalities linked discursive fields to practices developed by psy professionals and other street-level bureaucrats to govern coverage, in a process of "managing failure". These rationalities are presented under three paired themes which draw attention to tensions and resistance in the governance of coverage: medicalisation and biolegitimacy; austerity and ethico-politics; and differential racialisation and decolonisation. Rationalities were associated with strategies and tactics such as social triage, clinical advocacy, obfuscation, evidence-based advocacy and silencing critique. The concept of "health coverage assemblage" is introduced to explain the complex, unstable, contingent and fragmented nature of UHC policies and programmes. Misrecognition and underestimation of the everyday work of health professionals in promoting, resisting and reproducing diverse rationalities within the assemblage may lead to missed opportunities for reform.

Smartphone-delivered mental health care interventions for refugees: A systematic review of the literature

According to the United Nations, an estimated 26.6 million people worldwide were refugees in 2021. Experiences before, during, and after flight increase psychological distress and contribute to a high prevalence of mental disorders. The resulting high need for mental health care is generally not reflected in the actual mental health care provision for refugees. A possible strategy to close this gap might be to offer smartphone-delivered mental health care. This systematic review summarizes the current state of research on smartphone-delivered interventions for refugees, answering the following research questions: (1) Which smartphone-delivered interventions are available for refugees? (2) What do we know about their clinical (efficacy) and (3) nonclinical outcomes (e.g., feasibility, appropriateness, acceptance, and barriers)? (4) What are their dropout rates and dropout reasons? (5) To what extent do smartphone-delivered interventions consider data security? Relevant databases were systematically searched for published studies, gray literature, and unpublished information. In total, 456 data points were screened. Twelve interventions were included (nine interventions from 11 peer-reviewed articles and three interventions without published study reports), comprising nine interventions for adult refugees and three for adolescent and young refugees. Study participants were mostly satisfied with the interventions, indicating adequate acceptability. Only one randomized controlled trial (RCT; from two RCTs and two pilot RCTs) found a significant reduction in the primary clinical outcome compared to the control group. Dropout rates ranged from 2.9 to 80%. In the discussion, the heterogeneous findings are integrated into the current state of literature.

Mental health in refugee children

Almost half of the world's forcibly displaced population are children, most commonly originating from Syria, Iraq, and Afghanistan. Health disparities are well documented, especially for mental health, but not consistent across groups, time or context. Despite high exposure to trauma and stress, refugee children also show remarkable resilience. An ecological model of refugee health including both risk and resilience factors is therefore recommended. The model also includes the dynamic inter-relationship of past traumatic experiences, ongoing daily stressors and the disruptions of basic systems affecting both the individual and families as a whole, offering a framework to better understand the health disparities and appropriate interventions for refugee children.

Umma and the nation-state: dilemmas in refuge ethics

This article addresses the question of the Muslim umma (the universal community of Muslims) which arises within the context of the ongoing debates about the status of refugees and their rights around the world, especially in the Muslim world, where a significant majority of migrants and refugees originate and are hosted. We question the existence of the Muslim umma under contemporary circumstances and discuss the extent to which the modern nation-state has undermined the principles of Muslim unity and solidarity beyond national borders. We also examine how Islamic ethics and law (fiqh) identify the imperatives of providing comfort and protection for refugees (whether they are Muslim or non-Muslim) individuals, groups, and communities when required or requested. We see this in principle, but not always in practice. Are refugee policies applied by Muslim-majority countries today in accordance with the fundamental Islamic teachings and experiences of the original hijra? Or have such principles been made redundant by the political-geographic imperatives of ethnicized nation-states? To what extent can applied policies in Muslim-majority countries be developed and enhanced in the light of umma principles that might alleviate the longstanding refugee crises in this troubled area of the world? The article consists of three main sections. The first provides a theoretical and religious analysis of the idea of the umma as an inclusive entity that encompasses all Muslims, contrasted with the modern nation-state as an exclusive geographically defined political institution. The second looks at three Muslim-majority countries that played a significant hosting role in refugee crises over the past decade, namely Jordan, Bangladesh, and Turkey. We offer some insight in understanding to what extent their policies or behavior were based upon ummatic principles, or secularist notions of national interest and humanitarian aid? The last section summarizes the recent innovation providing for Muslim refugees through a UNHCR arrangement and adaptation with the Islamic charitable obligation of Zakat. It is suggested that the UNHCR Zakat Fund is an ummatic manifestation that has already proved honorable and viable. The conclusion calls for a better understanding of the umma as it is in the Islamic consciousness towards an effective reforming of refugee policies and practices, suggesting a further enhancement of ummatic institutional collaboration between the OIC and UNHCR for refugee integration.

Forced Migration and the Childbearing of Women and Men: A Disruption of the Tempo and Quantum of Fertility?

It is well known that migrant fertility is associated with age at migration, but little is known about this relationship for forced migrants. We study an example of displacement in which the entire population of Finnish Karelia was forced to move elsewhere in Finland in the 1940s. This displacement was unique because of its size and scale, because we have data on almost the whole population of both men and women who moved, and because of the similarity between origin and destination. These aspects enable us to investigate the disruptive impact of forced migration, net of other factors such as adaptation and selection. For all ages at migration from one to 20, female forced migrants had lower levels of completed fertility than similar women born in present-day Finland, which suggests a permanent impact of migration. However, women born in the same year as the initial forced migration showed no difference, which may indicate the presence of a counterbalancing fertility-increasing effect, as observed elsewhere for people born during a humanitarian crisis. There is less evidence of an impact for men, which suggests a gendered impact of forced migration-and its timing-on fertility. Results are similar after controlling for social and spatial mobility, indicating that there may be no major trade-off between reproduction and these forms of mobility.

Facilitating the prosocial development of Rohingya refugee children

Prosociality is essential for the success of human societies. Children's prosocial development is found to increase in contexts that foster collaboration or emotion perspective taking and is negatively affected by exposure to extreme psychosocial trauma and adversity. Based on these findings, we assessed the effect of collaboration and emotion perspective taking on three types of prosocial behavior-helping, sharing, and comforting-in Rohingya children living in a refugee settlement in India (N = 122; age range = 4-11 years). Half of the children were born in Myanmar (i.e., experienced forced migration from genocide), and half were born in the refugee settlement after their families left Myanmar. We also included a small sample of Rohingya Canadian children (N = 20; age range = 3-12 years) as a within-culture comparison of overall levels of prosocial responding, which were higher in this group relative to children in a refugee settlement. We assigned children in the refugee settlement to one of three conditions-Collaboration, Emotion Perspective Taking (intervention conditions), or Drawing (control condition)-and assessed the three types of prosocial responding following the intervention. Prosocial responding was highest after Collaboration for children born in the refugee settlement and was highest after Emotion Perspective Taking for children born in Myanmar. Overall, these findings point to the potential prosocial benefit in refugee contexts for intervention programs that are responsive to children's lived experience.

Impact of war and forced displacement on children's mental health-multilevel, needs-oriented, and trauma-informed approaches

The infliction of war and military aggression upon children must be considered a violation of their basic human rights and can have a persistent impact on their physical and mental health and well-being, with long-term consequences for their development. Given the recent events in Ukraine with millions on the flight, this scoping policy editorial aims to help guide mental health support for young victims of war through an overview of the direct and indirect burden of war on child mental health. We highlight multilevel, need-oriented, and trauma-informed approaches to regaining and sustaining outer and inner security after exposure to the trauma of war. The impact of war on children is tremendous and pervasive, with multiple implications, including immediate stress-responses, increased risk for specific mental disorders, distress from forced separation from parents, and fear for personal and family's safety. Thus, the experiences that children have to endure during and as consequence of war are in harsh contrast to their developmental needs and their right to grow up in a physically and emotionally safe and predictable environment. Mental health and psychosocial interventions for war-affected children should be multileveled, specifically targeted towards the child's needs, trauma-informed, and strength- and resilience-oriented. Immediate supportive interventions should focus on providing basic physical and emotional resources and care to children to help them regain both external safety and inner security. Screening and assessment of the child's mental health burden and resources are indicated to inform targeted interventions. A growing body of research demonstrates the efficacy and effectiveness of evidence-based interventions, from lower-threshold and short-term group-based interventions to individualized evidence-based psychotherapy. Obviously, supporting children also entails enabling and supporting parents in the care for their children, as well as providing post-migration infrastructures and social environments that foster mental health. Health systems in Europe should undertake a concerted effort to meet the increased mental health needs of refugee children directly exposed and traumatized by the recent war in Ukraine as well as to those indirectly affected by these events. The current crisis necessitates political action and collective engagement, together with guidelines by mental health professionals on how to reduce harm in children either directly or indirectly exposed to war and its consequences.

Resilience as a communal concept: Understanding adolescent resilience in the context of the Syrian refugee crisis in Bar Elias, Lebanon

Background

The conflict in Syria has led to the displacement of 1.5 million refugees into the neighboring country of Lebanon, with a majority that have yet to return to their homeland. Syrian adolescents in the town of Bar Elias in the Bekaa Valley, Lebanon have lived and grown in the face of resource-limited environments, restricted movement, and a longing for return. Resilience is manifested in the adaptation to such circumstances through close supportive relationships, social engagement, employment, and religion. There is a communal aspect to resilience that is important to the adolescent refugee experience and to the efforts supporting these communities.

Methods

Fifteen one-to-one interviews and two focus groups, with a total of eighteen Syrian adolescents, were analyzed using an inductive thematic analysis informed by grounded theory principles. Participants were recruited through partnering non-governmental organizations (NGOs) in the area, and ethical approval was granted through UCL and the American University in Beirut (AUB).

Results

Syrian adolescents highlighted supportive relationships, communal activities and spaces, memories of home, employment, and shared environments as integral elements to their personal adaptation. Methods of resilience involved social cohesion and establishing stability for one's family and close community. Adaptation to the present is intertwined with facing the consequences of displacement in this new context and maintaining aspirations for a bright future. Engaging with the environments they share and help create is an important facet of resilience and occurs through group gatherings , hobbies, and online communication. Additionally, inner strength can be derived from religious activities and empowers individual processing.

Conclusion

This study illuminates the elements and mechanisms embodied in these adolescents' communities and relationships that allow for adaptation to life in Bar Elias. These factors strengthen their approach to overcome social barriers and practice resilience. These communal aspects of the adolescents' lives also connect to their memories of home, current environment, and future aspirations.

Epilepsy and psychogenic non-epileptic seizures in forcibly displaced people: A scoping review

With a growing number of forcibly displaced people (FDP) globally, the focus on their medical needs has necessarily increased. Studies about the prevalence and incidence of epilepsy and psychogenic non-epileptic seizures (PNES) in this population are, though, sparse. This Review highlights the importance of exploring and managing both conditions in these vulnerable people to promote global health. We performed an exhaustive review of 10 databases, as well as a manual search of relevant websites related to global health and refugee-related organizations. We analyzed data related to the prevalence and incidence of epilepsy and PNES; health visits; costs of medical care and challenges faced by healthcare workers in relation to FDP with these conditions. Fifty six papers met our inclusion criteria. Of these, 53 reported directly or indirectly on the prevalence of epilepsy and its costs in FDP. Two articles reported on the prevalence of PNES in forcibly displaced people. The reported prevalence of epilepsy in FDP varied from 0.2% to 39.13%, being highest in people with pre-existing neurological or psychiatric comorbidities. Only one study reported on the incidence of epilepsy in internally displaced children. Data from the United Nations Relief and Works Agency for Palestine Refugees in the Near East (UNRWA) have identified a tendency to higher incidence of epilepsy in children following wars. While within displaced women without a history of sexual violence the rate of PNES was 16.7%, in FDP women with such a history the rate of PNES was 43.7% (p=0.02). The healthcare costs for epilepsy can be high, with recurrent health visits related to seizures being the most common cause of health encounters in refugee camps. Increasing awareness and further studies of multicultural aspects to improve shared understanding of seizure phenomenon in vulnerable displaced populations would seem crucial.

Identifying the research gap of zoonotic disease in displacement: a systematic review

Background

Outbreaks of zoonotic diseases that transmit between animals and humans, against a backdrop of increasing levels of forced migration, present a major challenge to global public health. This review provides an overview of the currently available evidence of how displacement may affect zoonotic disease and pathogen transmission, with the aim to better understand how to protect health and resilience of displaced and host populations.

Methods

A systematic review was conducted aligned with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) reporting guidelines. Between December 2019 - February 2020, PubMed, Web of Science, PLoS, ProQuest, Science Direct and JSTOR were searched for literature. Studies were included based on a focus on zoonotic disease risks in displacement and/or humanitarian emergencies, and relevance in terms of livestock dependency of the displaced populations. Evidence was synthesised in form of a table and thematic analysis.

Results

Of all records, 78 papers were selected for inclusion. Among the included studies, the majority were based on secondary data, including literature reviews (n=43) and case studies (n=5), while the majority of papers covered wide geographical areas such as the Global South (n=17) and Africa (n=20). The review shows significant gaps in the literature, which is specifically lacking primary data on zoonotic diseases in displacement. Risk factors for the transmission of zoonoses in displacement are based on generic infectious disease risks, which include the loss of health services, increased population density, changes in environment, reduced quality of living conditions and socio-economic factors. Regardless of the presence of these disease drivers during forced migration however, there is little evidence of large-scale zoonotic disease outbreaks linked directly to livestock in displacement.

Conclusion

Due to the lack of primary research, the complex interlinkages of factors affecting zoonotic pathogen transmission in displacement remain unclear. While the presence of animals may increase the burden of zoonotic pathogens, maintaining access to livestock may improve livelihoods, nutrition and mental health, with the potential to reduce people’s vulnerability to disease. Further primary interdisciplinary and multi-sectoral research is urgently required to address the evidence gaps identified in this review to support policy and program development.

Supplementary Information

The online version contains supplementary material available at 10.1186/s41256-021-00205-3.

Lockdowns, lives and livelihoods: the impact of COVID-19 and public health responses to conflict affected populations - a remote qualitative study in Baidoa and Mogadishu, Somalia

BACKGROUND

Authorities in Somalia responded with drastic measures after the first confirmed COVID-19 case in mid-March 2020, closing borders, schools, limiting travel and prohibiting most group functions. However, the impact of the pandemic in Somalia thereafter remained unclear. This study employs a novel remote qualitative research method in a conflict-affected setting to look at how some of the most at-risk internally displaced and host populations were impacted by COVID-19, what determined their responses, and how this affected their health and socio-economic vulnerability.

METHODS

We conducted a remote qualitative study, using Katikati, a 1-to-1 conversation management and analysis platform using short message service (SMS) developed by Lark Systems with Africa's Voices Foundation (AVF), for semi-structured interviews over three months with participants in Mogadishu and Baidoa. We recruited a gender balanced cohort across age groups, and used an analytical framework on the social determinants of health for a narrative analysis on major themes discussed, triangulating data with existing peer-reviewed and grey literature.

RESULTS

The remote research approach demonstrated efficacy in sustaining trusted and meaningful conversations for gathering qualitative data from hard-to-reach conflict-affected communities. The major themes discussed by the 35 participants included health, livelihoods and education. Two participants contracted the disease, while others reported family or community members affected by COVID-19. Almost all participants faced a loss of income and/or education, primarily as a result of the strict public health measures. Some of those who were heavily affected economically but did not directly experienced disease, denied the pandemic. Religion played an important role in participants' beliefs in protection against and salvation from the disease. As lockdowns were lifted in August 2020, many believed the pandemic to be over.

CONCLUSIONS

While the official COVID-19 burden has remained relatively low in Somalia, the impact to people's daily lives, income and livelihoods due to public health responses, has been significant. Participants describe those 'secondary' outcomes as the main impact of the pandemic, serving as a stark reminder of the need to broaden the public health response beyond disease prevention to include social and economic interventions to decrease people's vulnerability to future shocks.

Mobile agency and relational webs in women's narratives of international study

Internationalisation and forced migration are rarely thought about as related phenomena in higher education (HE) literature. Internationalisation is associated with movement, choice and brand recognition, and used in international rankings methodologies as a proxy for quality. Forced migration is associated not only with movement, but also with lack of choice, containment, or 'stuckness'. Some scholars have called for a rethinking of 'the international' through attention to students as mobile agents, and international study as situated within broader mobile lives. Our study responded to these calls through exploring the educational biographies of 37 international and refugee-background women students based in two universities: 21 in New Zealand and 16 in Bangladesh. Ten of the women were from refugee or refugee-like backgrounds, while the remainder were international students. The women's accounts revealed the complex ways in which circumstances shaped their educational journeys similarly and differently. One woman represented mobility in relation to autonomy and choice; but most emphasised relational webs as shaping their access to and experiences of international study, and post-study aspirations. In this paper, we draw on selected narratives to illustrate the range of ways in which family and/or community members appeared in women's accounts of their education journeys: as a source of (1) sustenance and support; (2) inspiration and motivation; and (3) obligation, and sometimes regulation. We conclude by suggesting that attention to the affective and embodied entanglements that shape students' international study journeys might inform new ways of thinking about both 'the international' and higher education more broadly.

The case for refugee physicians: Forced migration of International Medical Graduates in the 21st century

In this paper we propose a new category of International Medical Graduates (IMGs) who are forced to leave their home countries: "refugee physicians." In US social science scholarship, IMGs are divided into US citizen IMG (USIMG) and non-US citizen IMG (non-USIMG). For purposes of US medical licensure qualifications and recordkeeping, US- and non-USIMGs are lumped together. These categorizations are too blunt to demonstrate important differences among non-USIMGs. The category of "refugee physicians" distinguishes non-USIMGs who are forced to flee their homelands from other IMGs. We define and develop this category based on qualitative in-depth interviews conducted in 2019 with 28 non-USIMGs who fled to the US within the past 15 years. Using narrative analysis, we constructed "flight biographies," storied chronological events and experiences, for each physician. The flight biographies highlight the medical and political contexts in which they were forced to flee and are situated in the US. Two representative cases demonstrate how and why lumping refugee physicians together with other IMGs obscures the constraints and challenges that set them apart from the other IMG categories. First, the term refugee physician focuses attention on how physicians are located among forcibly displaced people worldwide, including their distinct relationships to their home countries, transit countries in which some of them seek sanctuary, and the US, where some requested asylum and others have been resettled. Second, because refugee is an umbrella term that blends categories of law, policy, social science, and everyday usage it encompasses a wide variety of lived experiences along a continuum of compulsion to leave. Finally, refugee physician illuminates the group's distinct relationship to medical licensure and brings into focus structural barriers that impede their goal of gaining a US medical license.

The impact of COVID-19 on Venezuelan migrants' access to health: A qualitative study in Colombian and Peruvian cities

This research seeks to understand how COVID-19 has affected access to healthcare among migrants in Latin American cities. Using ethnographic research methods, we engaged with Venezuelans living in conditions of informality in four Colombian cities-Barranquilla, Cucuta, Riohacha, and Soacha-and three Peruvian cities-Lima, Trujillo, and Tumbes. We conducted 130 interviews of both Venezuelan migrants and state and non-governmental actors within the healthcare ecosystems of these cities. We found that forced migrants from Venezuela in both Colombia and Peru face common obstacles along their access trajectories to healthcare, which we summarize as legal, financial, and relating to discrimination and information asymmetry. By limiting effective access to care during the pandemic, these obstacles have also affected migrants' ability to cover the costs of basic needs, particularly food and housing. Our study also found a prevalent reliance on alternative forms of care, such as telemedicine, easy-to-access pharmacies, and extralegal care networks. We conclude that COVID-19 has exacerbated preexisting conditions of informality and health inequities affecting Venezuelan migrants in Colombia and Peru.

Navigating new lives: A scoping review and thematic synthesis of forced migrant women's perinatal experiences

BACKGROUND

For health systems and maternity services to respond effectively to forced displacement, an understanding of the lived experiences of women seeking protection during childbearing is required. This study aim was to systematically review existing literature on the perinatal experiences of forced migrant women.

METHODS

We conducted a scoping review including MEDLINE, CINAHL Plus, Web of Science and PsychINFO databases and manual search of references. Included studies were quality-assessed and analysed using inductive thematic synthesis.

FINDINGS

In total 39 studies were included, involving 624 forced migrant women in 12 countries. Three inductive themes were: (1) "The nature of being a forced migrant," describing multiple liminalities experienced by women; (2) support during the perinatal period, showing women's (re)negotiation of shifting kinship and support networks; and (3) interactions with maternity services, revealing variations in maternity care experiences.

CONCLUSION

Findings highlight the systemic power structures forced migrant women must (re)negotiate during the perinatal period and the supportive and empowering role maternity services can play through provision of woman-centred care. Further research is needed to understand the lived perinatal experiences of forced migrant in low-income and transit country contexts.

Safety Among Newly Resettled Refugees in the USA

Within a context of changing political and social perspectives toward refugee resettlement in the USA, this mixed methods study examines experiences of safety among recently resettled refugees. The study was conducted by resettlement agency personnel within two states, Utah and Arizona. We examine risk and protective factors associated with perceptions of safety among a sample of 243 participants, as well as experiences related to safety as described in focus groups with 50 participants. Of the environmental factors examined, attending events related to one’s culture, language, or religion and more frequent home visits were associated with higher levels of perceived safety, while experiencing discrimination was associated with lower levels of perceived safety. Some individual and social factors such as nation of origin were also associated with perceptions of safety. Focus groups identified key themes related to safety in the USA which included discrimination, concerns about family safety, and feeling safe in the USA. An increased emphasis on safety as a key resettlement outcome can strengthen resettlement policy and guide community responses.

Active and latent tuberculosis in refugees and asylum seekers: a systematic review and meta-analysis

Background

In 2018, there were 70.8 million refugees, asylum seekers and persons displaced by wars and conflicts worldwide. Many of these individuals face a high risk for tuberculosis in their country of origin, which may be accentuated by adverse conditions endured during their journey. We summarised the prevalence of active and latent tuberculosis infection in refugees and asylum seekers through a systematic literature review and meta-analyses by country of origin and host continent.

Methods

Articles published in Medline, EMBASE, Web of Science and LILACS from January 2000 to August 2017 were searched for, without language restriction. Two independent authors performed the study selection, data extraction and quality assessment. Random effect models were used to estimate average measures of active and latent tuberculosis prevalence. Sub-group meta-analyses were performed according to country of origin and host continent.

Results

Sixty-seven out of 767 identified articles were included, of which 16 entered the meta-analyses. Average prevalence of active and latent tuberculosis was 1331 per 100 thousand inhabitants [95% confidence interval (CI) = 542–2384] and 37% (95% CI = 23–52%), respectively, both with high level of heterogeneity (variation in estimative attributable to heterogeneity [I²] = 98.2 and 99.8%). Prevalence varied more according to countries of origin than host continent. Ninety-one per cent of studies reported routine screening of recently arrived immigrants in the host country; two-thirds confirmed tuberculosis bacteriologically. Many studies failed to provide relevant information.

Conclusion

Tuberculosis is a major health problem among refugees and asylum seekers and should be given special attention in any host continent. To protect this vulnerable population, ensuring access to healthcare for early detection for prevention and treatment of the disease is essential.

Negotiating identity at the intersection of family legacy and present time life conditions: A qualitative exploration of central issues connected to identity and belonging in the lives of children of refugees

INTRODUCTION

Most studies on refugee populations are organized around trauma-related issues and focus on explanations of pathological factors. Few studies are anchored in general developmental psychology with the aim of exploring normal age-specific developmental tasks and how the special circumstances associated with forced migration can influence that development.

METHODS

Using an ecological and transactional understanding of developmental trajectories, this qualitative study explored issues connected to identity formation processes in an exile context based on interviews with 6 male and 10 female children of refugees (18-26 years) who have grown up in Norway.

RESULTS

The findings show that family experiences of war and conflict intersect with experiences of marginalization in exile. The interaction of these experiences influences the development of individual identity in cumulative and complex ways. Many of the participants expressed feelings of isolation, disconnectedness, and a lack of belonging. Nevertheless, though the participants described growing up facing major challenges, they also searched for ways to reframe their difficult personal and family histories into meaningful experiences.

CONCLUSIONS

In order to provide conditions and develop interventions that can support well-being and identity development, we need a better understanding of the different forces that influence the identity development of children of refugees. By foregrounding the participants' experiences, and perspectives, we gained insight into different ways in which participants negotiate identity issues in relation to often contradictory demands and messages from family and the wider social context.

A fairytale career in spite of political disenfranchisement: The jewish oral pathologist Bálint Orbán (1899-1960)

Viennese scientist Bálint Orbán (1899-1960) was an international pioneer in the area of oral pathology and one of the principle figures comprising the "Vienna School" of the 1920s. His works "Biology and Pathology of the Tooth and its Supporting Mechanism" (1938) and "Atlas of Clinical Pathology of the Oral Mucous Membrane" (1955), both published in the United States, set new standards across the globe. Even today, the American Academy of Periodontology (AAP) honors aspiring researchers with the Bálint Orbán Award in the context of its "Orbán Memorial Program". One aspect of Orbán's life that remains widely unknown is the fact that his career was thrown into existential threat following Hitler's rise to power in 1938. As a scientist of Jewish ancestry, the new government stripped him of his venia legendi and, as such, robbed him the basis for working as a university professor in Vienna. What became of Orbán's life and career in the years thereafter? What were the conditions that ultimately led him to the United States? How did he manage to set up his career in this new context - including in comparison to his other colleagues who also emigrated? Which factors were ultimately decisive for his further career? The present article seeks to address these very questions. The sources used for this study include documents from the Austrian State Archives as well as from the Vienna University Archive. Our archival work was followed by a critical re-analysis of the available secondary literature. This article illustrates that Bálint Orbán was part of a small group of Jewish scientists who did not suffer from a rupture or setback in their careers under National Socialism. In fact, despite professional disenfranchisement and forced migration, they succeeded in making smooth professional transitions and even advancing their careers. One decisive factor in this - apart from Orbán's consistently high-degree of dedication to his work and above-average research output - was his robust network academic contacts, which he previously laid the groundwork for during his first stay in the United States (1927-1929) and continued to resolutely foster afterwards. Thanks to these contacts, even before his permission to work as a professor in Vienna was revoked, Orbán managed to flee to Chicago and quickly attain a professorship. He spent the rest of his academic life in the United States and, much like his other émigré colleague from Vienna, Hans Popper (1903-1988), he developed what would become his posthumous prominence in this new country.

Impact of Forced Migration on Communication and Social Adaptation

Forced migration has spread and grown across continents in recent decades. This has had an impact at various levels such as societal communication, health and education priorities, as well as political agendas and economic stability. As a result of the combined forces of migration, globalisation, advances in communication technology and education, there is an exceptional research interest in individuals seeking refugee status or asylum. The literature is sporadic on forced migrants' communication and social adaptation. The perception of residents and professionals who encounter the challenges faced by these individuals on a regular basis needs to be evaluated, as well as the perception of the migrants themselves. This paper presents the current state of affairs and reviews the relevant literature with the intention of providing a more coordinated overview of forced migrants' and relevant stakeholders' views. A case scenario is presented that discusses the communication challenges faced by forced migrants. Strategic recommendations are also discussed.

Suicide and Suicide-related Behavior among Bhutanese Refugees Resettled in the United States

Suicidal behavior and death by suicide are significant and pressing problems in the Bhutanese refugee community. Currently, Bhutanese refugees are dying by suicide at a rate nearly two times that of the general U.S. population. Proper identification of risk factors for suicide saves lives; however, if risk is underestimated due to culturally inflexible risk assessments, preventable deaths may continue to occur. In this review, we examine specific cultural factors related to psychopathology and suicide among Bhutanese refugees. To contextualize the current suicide crisis among Bhutanese refugees, we propose an integration of the interpersonal psychological theory of suicide (Joiner, 2005) and the cultural model of suicide (Chu, Goldblum, Floyd, & Bongar, 2010). We provide recommendations for preventing suicide from a systems framework and discuss practical lessons from a preliminary study designed to test a culturally-responsive model of suicide in Bhutanese refugees.

The Impact of Forced Migration on Mortality: Evidence From German Pension Insurance Records

We examine the long-run effects of forced migration for individuals who were displaced from Eastern Europe to Germany in the aftermath of World War II. Evidence suggests that displaced individuals were worse off economically, facing a considerably lower income and a higher unemployment risk than comparable nondisplaced Germans, even 20 years after being expelled. We extend this literature by investigating mortality outcomes. Using social security records that document the exact date of death and a proxy for pre-retirement lifetime earnings, we estimate a significantly and considerably higher mortality risk among forced migrants compared with nondisplaced West Germans. The adverse displacement effect persists throughout the earnings distribution except for the top quintile. Although forced migrants were generally worse off regarding mortality outcomes, those with successful labor market histories seem to have overcome the long-lasting negative consequences of flight and expulsion.

Recognising forced migrants in transnational social work

Purpose

Nation states’ neoliberal policies do not regard asylum seekers and undocumented migrants as deserving of a good life. Social work in welfare states is highly connected to the policies of nation states. There is a need to address theories in social work that have a transnational focus at the local level. Axel Honneth’s recognition theory enables an approach to forced migration from the direction of personal relations and personhood itself. The core idea is that if people cannot gain recognition, this causes harm to their self-realisation. The purpose of this paper is discuss how the recognition theory overcomes a national focus in social work.

Design/methodology/approach

This paper is theoretical. The relations of recognition are discussed in the context of transnational social work in welfare states with forced migrants.

Findings

The theory of recognition in social work practice with people who do not have a residence permit is best articulated by an understanding of rights concerning all the attributes of the person, i.e. as a needy being, autonomous and particular in a community.

Originality/value

Forced migrants’ backgrounds provide a specific backdrop for misrecognition, which may harm self-relations. The relations of recognition contribute to social work by providing the sensitivity required to evaluate the complexity of views and attitudes that affect the way we encounter service users. The relations of recognition (care, respect and esteem) give normative criteria for communication in order to take another person as a person, which, in turn, contributes to healthy self-relations of forced migrants.

The health needs and access barriers among refugees and asylum-seekers in Malaysia: a qualitative study

BACKGROUND

In Malaysia, refugees and asylum-seekers are a vulnerable group that often face circumstances in which their health and wellbeing can be compromised. This qualitative study sought to examine the key health concerns and barriers to healthcare access among refugees and asylum-seekers in Malaysia through the lens of healthcare professionals, program staff and experts on refugee and migrant health.

METHODS

We conducted 20 semi-structured in-depth interviews with experts, healthcare professionals, program managers or executives from UN agencies, public healthcare facilities, civil society organizations, and academic institutions in Malaysia. Interviews were transcribed and analyzed both deductively and inductively using thematic analysis.

RESULTS

Participant narratives highlight that the health needs of refugees and asylum-seekers in Malaysia are complex. As reported, access to healthcare is underpinned by numerous social, cultural and economic determinants compounded by a legal environment that lacks inclusivity of refugees and asylum-seekers. Apart from the health risks associated with the migration process, limited access to comprehensive healthcare post-arrival remain a problem for refugees and asylum-seekers in Malaysia. Key barriers to healthcare access are linked to poor health literacy and the lack of awareness on one's right to healthcare; language and cultural differences; protection issues resulting from a lack of legal status; and an inability to afford healthcare due to inadequate livelihoods. Overall, poor access to healthcare is perceived to have detrimental consequences on the health status of refugees, asylum-seekers and its host population, and may incur greater costs to the health system in the long run.

CONCLUSION

Comprehensive efforts in practice and research that tackle the social, cultural and economic determinants of health, and more inclusive health policies are crucial in strengthening healthcare access among refugees and asylum-seekers in Malaysia. Practical recommendations include improving the health literacy of refugees and asylum-seekers for better navigation of the health system; bridging language and cultural gaps through translation support and inter-cultural orientation; implementing policies grounded in the right to healthcare for all regardless of legal status and in the interest of public health; and establishing a larger evidence base to drive policy development and implementation for refugee health within the Malaysian context.

Life on the margins: the experiences of sexual violence and exploitation among Eritrean asylum-seeking women in Israel

BACKGROUND

Eritrean migrants in Israel, the majority of whom are seeking asylum, have limited access to institutional support. While the temporary group protection granted to Eritreans by Israel ensures that they are not deported, it does not confer permanent legal status, nor does it allow access to the formal work sector. This study qualitatively explores how political and economic marginalization increases the risk of sexual and other forms of violence as well as the exploitation of Eritrean women asylum seekers living in Israel.

METHODS

Twenty-five interviews with key informants, twelve individual interviews (six with men and six with women), and eight focus group discussions (four with men and four with women) were conducted among Eritreans of reproductive age in Tel Aviv, Israel. Qualitative data analysis was conducted using open, focused, and axial coding.

RESULTS

Participants reported that Israel's restrictive immigration policies laid the foundation for the political and economic marginalization of asylum seekers. This manifested in limited access to institutional support during and after arrival, and hindered access to formal employment and its associated protections. The Israeli government's decision to grant provisional status with a stipulation banning Eritreans from the formal work sector was perceived to create direct and indirect conditions for a heightened sense of structural vulnerability, particularly for women. Participants reported that this structural vulnerability increased the risk of sexual and domestic violence in addition to the risk for the exploitation of women asylum seekers.

CONCLUSIONS

Israel's immigration policies may contribute to women asylum seekers' vulnerability to sexual violence upon arrival in their host country. These policies shape the social realities of women asylum seekers, potentially increasing their risk of violence and exploitation during their time in Israel. This study provides an example of the effects of political and economic marginalization on violence against women, a concept that may apply to other settings globally.

From forced migration to forced arrival: the campization of refugee accommodation in European cities

In the aftermath of large refugee arrivals in 2015, EU regulations and national asylum laws were tightened, especially those regarding reception and accommodation. The current contribution introduces the concept of "campization" to explain the impact of law and policy changes on the socio-spatial configuration and functions of refugee accommodation in European capital regions. Based on qualitative research concerning case studies for Athens, Berlin, and Copenhagen, I argue that refugee accommodation has increasingly been transformed into large, camp-like structures with lowered living standards and a closed character. This is shown by the structural, functional, and socio-spatial characteristics of the accommodation in the three case studies, as well as the political and administrative objectives that determine the campization of accommodation. The contribution lastly highlights changing notions and forms of containment, exclusion, and temporality as part of campization, and links this process to current trends in asylum and urban development.

Structure and agency in development-induced forced migration: the case of Brazil's Belo Monte Dam

This paper examines how structure and agency interact to shape forced migration outcomes. Specifically, I ask how structural factors such as compensation policies as well as social, financial, and human capital may either foster or constrain migration aspirations and capabilities. I use longitudinal, semi-structured interview data to study forced migration among farmers displaced by the Belo Monte Dam in the Brazilian Amazon. Results from baseline interviews indicate that nearly all community members aspired to purchase rural land in the region and maintain livelihoods as cacao farmers or cattle ranchers. Constraints limiting the ability to attain aspirations included strict requirements on land titles for properties, delays in receiving compensation, rising land prices, and the lack of power to negotiate for better compensation. Despite these constraints, most migrants succeeded in attaining aspirations, as they were able to mobilize resources such as social networks, financial capital, skills, and knowledge. These findings highlight the importance of considering the relationship between structure and agency within forced migration research. I conclude by discussing how the findings may inform resettlement policies for future cases of development- or environment-induced forced migration.

Forced migration: health and human rights issues among refugee populations

Undocumented migration is a global phenomenon that is manifest in diverse contexts. In this article, we examine the situations that precipitate the movement of large numbers of people across several African countries, producing a unique type of undocumented migrant--the refugee. These refugee movements impact already fragile African health care systems and often involve human rights violations that are of particular concern, such as gender-based violence and child soldiers. We use examples from several countries in sub-Saharan Africa, including the Democratic Republic of the Congo, Rwanda, Liberia, Sierra Leone, and Mozambique. Drawing on key documents from the United Nations High Commissioner for Refugees, current research, and our personal international experiences, we provide an overview of forced migration and discuss implications and opportunities for nurses to impact research, practice, and policy related to refugee health.

A systematic review of resilience and mental health outcomes of conflict-driven adult forced migrants

BACKGROUND

The rising global burden of forced migration due to armed conflict is increasingly recognised as an important issue in global health. Forced migrants are at a greater risk of developing mental disorders. However, resilience, defined as the ability of a person to successfully adapt to or recover from stressful and traumatic experiences, has been highlighted as a key potential protective factor. This study aimed to review systematically the global literature on the impact of resilience on the mental health of adult conflict-driven forced migrants.

METHODOLOGY

Both quantitative and qualitative studies that reported resilience and mental health outcomes among forcibly displaced persons (aged 18+) by way of exploring associations, links, pathways and causative mechanisms were included. Fourteen bibliographic databases and seven humanitarian study databases/websites were searched and a four stage screening process was followed.

RESULTS

Twenty three studies were included in the final review. Ten qualitative studies identified highlighted family and community cohesion, family and community support, individual personal qualities, collective identity, supportive primary relationships and religion. Thirteen quantitative studies were identified, but only two attempted to link resilience with mental disorders, and three used a specific resilience measure. Over-reliance on cross-sectional designs was noted. Resilience was generally shown to be associated with better mental health in displaced populations, but the evidence on this and underlying mechanisms was limited.

DISCUSSION

The review highlights the need for more epidemiological and qualitative evidence on resilience in forcibly displaced persons as a potential avenue for intervention development, particularly in resource-poor settings.