The role of temporality in adolescent refugees' sense of well-being

Adolescent refugees confront a complex interplay of trauma arising from forced displacement, resettlement, and the challenges of transitioning from childhood to adulthood. Using photovoice methodology, this study engaged 14 Iraqi and Syrian adolescent refugees now residing in the United States with the aim to illuminate their well-being experiences. Our findings show that temporal continuities and discontinuities in adolescent refugees' lives contributed to their sense of well-being by helping satisfy their basic psychological needs for autonomy, competence, relatedness, and safety. Temporal continuities involved drawing upon past resources and formulating future career aspirations based on present experiences. Temporal discontinuities encompassed contrasting past and present and processing adversities endured. This study underscores that, beyond current circumstances, the interpretation of life experiences over extended timeframes influences the well-being of adolescent refugees.

'I am because you are': Community support as a bridge to mental wellbeing for resettled African refugee women living in Rhode Island

African refugee women resettled in the United States are exposed to multiple risk factors for poor mental health. Currently, no comprehensive framework exists on which to guide mental health interventions specific to this population. Through a community-based participatory research partnership, we interviewed N = 15 resettled African refugees living in Rhode Island. Here we (1) describe how meanings of mental health within the African refugee community vary from US understandings of PTSD, depression, and anxiety and (2) generate a framework revealing how mental health among participants results from interactions between social support, African sociocultural norms, and US norms and systems. Multiple barriers and facilitators of mental wellbeing lie at the intersections of these three primary concepts. We recommend that public health and medicine leverage the strength of existing community networks and organisations to address the heavy burden of poor mental health among resettled African refugee women.

Disaster mobilities, temporalities, and recovery: experiences of the tsunami in the Maldives

Large-scale disasters are frequently portrayed as temporally bounded, linear events after which survivors are encouraged to 'move on' as quickly as possible. In this paper, we explore how understandings of disaster mobilities and temporalities challenge such perspectives. Drawing on empirical research undertaken on Dhuvaafaru in the Maldives, a small island uninhabited until 2009 when it was populated by people displaced by the Indian Ocean tsunami of 2004, we examine what such understandings mean in the context of sudden population displacement followed by prolonged resettlement. The study reveals the diversity of disaster mobilities, how these reflect varied and complex temporalities of past, present, and future, and how processes of disaster recovery are temporally extended, uncertain, and often linger. In addition, the paper shows how attending to these dynamics contributes to understandings of how post-disaster settlement brings stability for some people while producing ongoing feelings of loss, longing, and unsettlement in others.

Breaching the family walls: Modelling the impact of prolonged visa insecurity on asylum-seeking children

OBJECTIVE

Children in asylum-seeking families are increasingly subject to deterrent host nation policies that undermine security in the post-migration context, however, little is known on the mental health consequences of such policy. This study examined the impact of prolonged visa insecurity on child mental health, by comparing two cohorts of refugee children entering Australia between 2010 and 2013, distinguished by visa security.

METHODS

The insecure visa sample comprised children from Tamil asylum-seeking families, while the secure visa sample was drawn from refugee families participating in the multi-ethnic 'Building a New Life in Australia' cohort study. Children in each sample were assessed for current mental health problems and trauma exposure. Mothers were assessed for trauma exposure, post-migration family stressors and post-traumatic stress disorder (PTSD). The effects of prolonged visa insecurity on child mental health via family-and child-level variables were modelled using multi-level path analysis.

RESULTS

Data comprised 361 children, aged 10-18, and 242 mothers across three levels of visa insecurity: permanent protection (n = 293), temporary protection (n = 40) and bridging visa (n = 28). Modelling showed that (1) visa insecurity was associated with poorer child mental health, (2) the association was mediated sequentially by post-migration family stressors and maternal PTSD and (3) the association was moderated by maternal PTSD.

CONCLUSION

Our findings suggest that when government policy persistently undermines post-migration security, the capacity of families to protect children from accrued stressors is lowered, leaving a significantly higher proportion of children developing along trajectories of risk rather than resilience.

Post-Resettlement Food Insecurity: Afghan Refugees and Challenges of the New Environment

BACKGROUND

Lack of access to adequate, safe, and nutritious food is a major concern for the Afghan population due to ongoing war and humanitarian crises. Recently resettled Afghan refugees in the US continue to face challenges securing adequate, nutritious food resources in new environments. This study examined Afghan refugees' food access and insecurity in the San Joaquin Valley, California.

METHODS

Semi-structured, in-depth interviews were conducted to collect the perspectives and experiences of key informants and newly arrived Afghan refugees.

RESULTS

This study highlights environmental and structural factors (availability and accessibility of grocery stores; availability of religious-appropriate items in the stores; the public benefit received by a family; and public transportation) and individual factors (religious and cultural practices; financial and language barriers) as major determinants of post-resettlement food insecurity.

CONCLUSION

Increasing the accessibility and affordability of culturally and religiously appropriate food items within the US food system, enhancing the collaboration of community volunteers and resettlement organizations in the direct assistance of new families, and providing continuous access to public benefits are possible steps to mitigate the risk of food insecurity among Afghan refugees. This study suggests a continuous examination of the degree of food insecurity in this population and its attendant health impacts.

"Step by Step We Were Okay Now": An Exploration of the Impact of Social Connectedness on the Well-Being of Congolese and Iraqi Refugee Women Resettled in the United States

Little is known about the gendered impacts of the displacement and resettlement process. Women are known to struggle more with feelings of belonging and the creation of social networks to access essential information, resources, and social and emotional support to enhance their overall health and well-being. The purpose of the present study was to qualitatively explore female refugee perceptions of belongingness and social connectedness post-resettlement into their U.S. host community. Conducted between January and June of 2016, through the partnership of multiple governmental, nonprofit, and community-based organizations, two female focus groups were conducted among Congolese (n = 6) and Iraqi (n = 6) U.S. resettled refugees. Descriptive surveys were distributed to participants, providing valuable insights into participant demographics and indicators that could impact the integration process (i.e., age, language, country of origin, ethnicity, education, length of time spent in the U.S., housing). Participants discussed the social connections (individuals, communities, organizations) that acted as facilitators or inhibitors of developing social capital. The importance of building strong transformational bonding (family members, other refugees) and bridging (host community) relationships, alongside transactional ties with linking agencies (resettlement social services), was critical for a positive resettlement experience. The strength of their network ties among these social connections contributed to their perceptions of belongingness and well-being post-resettlement into their host community.

Dispositions that matter: Investigating criminalized women's resettlement through their (trans)carceral habitus

Whether prisoner resettlement is framed in terms of public health, safety, economic prudence, recidivism, social justice, or humanitarianism, it is difficult to overstate its importance. This article investigates women's experiences exiting prison in Canada to deepen understandings of post-carceral trajectories and their implications. It combines feminist work on transcarceration and Bourdieusian theory with qualitative research undertaken in Canada to propose the (trans)carceral habitus as a theoretical innovation. This research illuminates the continuity of criminalized women's marginalization before and beyond their imprisonment, the embodied nature of these experiences, and the adaptive dispositions that they have demonstrated and depended on throughout their lives. In doing so, this article extends criminological work on carceral habitus which has rarely considered the experiences of women. Implications for resettlement are discussed by tracing the impact of criminalized women's (trans)carceral habitus (i.e. distrust, skepticism, vigilance about their environments and relationships) on their willingness to access support and services offered by resettlement organizations.

Social Capital and Rural Health for Refugee Communities in Australia

Refugee resettlement significantly contributes to Australia's migration programs, with recent policy directives prioritising rural resettlement. As a result, the cultural diversity of populations of several Australian rural towns has substantially expanded. Newcomers may encounter challenges becoming part of closed social networks and accessing the resources they need for a healthy life in resettlement. However, there are also benefits that stem from positive integration for newcomers and for receiving populations. As part of a larger study, which aimed to explore facilitators and barriers to successful resettlement in a rural setting, the objective of this paper was to show how social ties were important for participants' health, both facilitating access to resources, including health services, and connecting people to health-promoting living conditions. In-depth individual interviews with 44 participants from refugee communities originally from Africa and South-East Asia, settled in a rural South Australian town, were conducted. Participants were invited to the study through snowball sampling via known connections between the researchers and key people within the communities. Interview transcripts were analysed using framework thematic analysis. The findings demonstrate how participants drew on connections within their cultural communities, reflecting collectivist cultural values. These social ties were key to enabling access to resources for health. These included emotional resources, such as a sense of belonging, as well as physical and practical resources, including food, housing, and/or accessing services. Several participants were also working towards a career in the health industry. Populations from refugee communities in rural towns are growing, not only with the continuation of new arrivals to these towns, but also as the settled populations expand their families and communities. Effective health service provision in these locations needs to serve these growing communities, and there is scope for services to tap into community networks to assist with this.

Practical advice for refugees aspiring to become registered nurses in Australia

AIMS

This paper describes practical advice for refugees aspiring to become Registered Nurses (RNs) in Australia.

DESIGN

Qualitative description using a naturalistic inquiry framework.

METHODS

Between February 2018 and September 2019, the lead author conducted semi-structured interviews with employed RNs that are former refugees that speak English. Interviews were 45-90 min in duration and digitally recorded. Participants provided voluntary informed consent and were sent questions beforehand. All transcription data were thematically analysed for key themes until no further themes were identified. This paper covers practical advice provided by the participants at the conclusion of their interviews.

RESULTS

Twelve participants provided practical advice. Six themes were identified: (1) Find your purpose and set goals; (2) Work hard and never give up; (3) Seek support; (4) Capitalize on opportunities; (5) Be optimistic; (6) Give back. The last theme, give back, was salient across all interviews and was an inherent motivator for some participants once their RN status was achieved.

CONCLUSION

Each participant set the goal of becoming a fully registered nurse and made it a life goal that provided meaning for them. Despite their experiences, the participants provided practical advice that could guide younger people aspiring to become successfully qualified RNs.

IMPACT

The findings in this study are unique as they are derived from people with experiences as refugees who, despite their adversity, became RNs. The practical advice provides a framework not only for younger people from refugee backgrounds seeking to achieve their professional goals, but others looking to succeed in other workforce sectors. The practical advice for success will be useful in informing nursing authorities, tertiary institutions and private and public health organizations to develop effective approaches to guide the next generation of would-be RNs set to contribute to nursing practice in Australia. There were no patient or public contributions as the focus was the personal and professional lives of nurses with refugee backgrounds.

Gender differences in Syrian refugees in Jordan: Psychological, self-esteem, family function, marital satisfaction, and life satisfaction

AIM

The current study examined gender differences in mental health, self-esteem, family function, marital satisfaction, and life satisfaction between men and women living in a refugee camp for Syrian refugees in Jordan.

METHOD

A snowball method used by local female and male students trained to collect data according to culturally competent methods. The following research instruments were deployed: Symptoms Checklist-SCL90, Self-esteem Scale, the McMaster Family Assessment Device, Marital Satisfaction Scale, and life Satisfaction Scale.

RESULTS

A sample of 290 adults (196 women and 94 men) living in a refugee camp in Jordan participated in the study. Findings revealed that marital satisfaction, self-esteem, and life satisfaction were significantly different between males and females, indicating less subjective well-being for women. Many of the mental health symptoms in this study were more common for women than men; particularly noteworthy were somatization, obsessive compulsive behavior, interpersonal sensitivity, depression, hostility, psychoticism, and higher scores on the Global Severity Index (GSI).

CONCLUSION

While some stressors are not gender-specific, there are unique factors that women face which place them at increased risk of mental health problems. Implications for practice include a greater understanding of the challenges and resilience mechanisms that are related to gender and culture.

Trauma and resettlement: lessons learned from a mental health screening and treatment programme for Syrian refugees in the UK

Resettlement schemes can offer refugees an opportunity to rebuild their lives and to heal from loss and trauma. Mental health services in host countries may have an important role to play in aiding refugees in this journey to recovery. However, facilitating the process of healing for refugees raises challenges for mental health services working within Western medicalised settings. Recovery and wellbeing for resettled refugees also depends upon an interaction of variables at a wider systemic level, that go beyond the direct remit of mental health services. Based on the experience of delivering a mental health screening and treatment programme for resettled Syrian refugees in the UK over a 5-year period, this paper reflects on these challenges and suggests that future resettlement schemes in the UK be designed in accordance with the principles of trauma-informed care. This means putting safety, trust, choice, collaboration, empowerment and respect for inclusion and diversity at the core of the services provided for resettled refugees.

The Importance of Local and Global Social Ties for the Mental Health and Well-Being of Recently Resettled Refugee-Background Women in Australia

Social connections are foundational to the human condition and are inherently disrupted when people are forcibly displaced from their home countries. At a time of record high global forced migration, there is value in better understanding how refugee-background individuals engage theirsocial supports or ties in resettlement contexts. A mixed methods research design aimed to understand the complexities of how 104 refugee-background women experienced their social networks in the first few months of resettlement in Australia. One of the research activities involved participants completing a survey with both quantitative and qualitative components. The quantitative analyses identified the impact of post-migration living difficulties that represented social stressors (worry about family, loneliness and boredom, feeling isolated, and racial discrimination) on the women's mental health outcomes in the months following resettlement. The qualitative data highlighted the complexities of social relationships serving as both stressors and sources of support, and the importance of recognizing extended families and supports around the globe. The findings point to the need for nuanced accounts of the social contexts surrounding refugee resettlement as important influences able to promote trauma-informed and gender sensitive practices to support mental health and well-being in new settings.

Trends and Impact Factors of Mental Health Service Utilization among Resettled Humanitarian Migrants in Australia: Findings from the BNLA Cohort Study

Resettled humanitarian migrants (HMs) have high levels of mental disorders, but factors associated with the utilization of mental health services (MHS) are poorly understood. We aimed to explore trends and impact factors of MHS utilization among HMs in the process of resettlement in Australia. A total of 2311 HMs from the 1st (2013), 3rd, and 5th (2018) waves of a national cohort study were included. MHS utilization in the past year was assessed by two indicators: having MHS contacts and the frequency of MHS contacts. Trends were identified by Cochran-Armitage tests, and generalized linear mixed models and ordered logistic models were fitted to explore impact factors of MHS utilization. The proportion of having MHS contacts significantly rose from 13.0% to 29.4% over the five years. MHS utilization was mainly driven by perceived needs, such as post-traumatic stress disorders and the degree of post-migration stress. Unemployment and strong belongingness to the local community were also associated with having MHS contacts. No significant gender difference was found in having MHS contacts but females tended to contact MHS more frequently. Resettled HMs have a persistent dilemma of high mental illness prevalence and MHS underutilization. Sustainable mental health education and long-term resettlement services targeted at social integration that consider gender difference are urgently needed in host countries.

Perspectives and feelings of refugee children from Syria and Iraq about places and relations as they resettle in Australia

Refugee children's experiences are situated in specific places where they interact with significant people. They are not usually asked about their perspectives although they are social agents with distinctive perspectives and feelings about relationships and events. We investigated the perspectives of refugee children on their experiences of places and relations as they resettled in Australia after their families fled from violence in Syria and Iraq and transitioned through Middle Eastern countries. One hundred-and-nine children chose to work with a computer program in either English or Arabic. They sorted feelings associated with home, school, and where they lived before and rated being nurtured at home. Hierarchical cluster analysis revealed five subgroups of children with distinctive patterns in their sorting of eight feelings for three places. Three subgroups had patterns of positive feelings about home and school. Two smaller subgroups had mixed, ambivalent feelings about either school or home. One subgroup was strongly positive, and two others were negative about before settlement. Subgroups identified on their sortings of feelings differed in their experiences of being nurtured, with positive feelings of places related to higher ratings of being nurtured at home. The study points to the importance of children's perspectives and feelings in how they interpret experiences with people and places and argues against assuming that refugee children are homogeneous in their experiences or perspectives.

Mental Health Screening Approaches for Resettling Refugees and Asylum Seekers: A Scoping Review

Refugees and asylum seekers often face delayed mental health diagnoses, treatment, and care. COVID-19 has exacerbated these issues. Delays in diagnosis and care can reduce the impact of resettlement services and may lead to poor long-term outcomes. This scoping review aims to characterize studies that report on mental health screening for resettling refugees and asylum seekers pre-departure and post-arrival to a resettlement state. We systematically searched six bibliographic databases for articles published between 1995 and 2020 and conducted a grey literature search. We included publications that evaluated early mental health screening approaches for refugees of all ages. Our search identified 25,862 citations and 70 met the full eligibility criteria. We included 45 publications that described mental health screening programs, 25 screening tool validation studies, and we characterized 85 mental health screening tools. Two grey literature reports described pre-departure mental health screening. Among the included publications, three reported on two programs for women, 11 reported on programs for children and adolescents, and four reported on approaches for survivors of torture. Programs most frequently screened for overall mental health, PTSD, and depression. Important considerations that emerged from the literature include cultural and psychological safety to prevent re-traumatization and digital tools to offer more private and accessible self-assessments.

Ecologies of Resilience for Australian High School Students from Refugee Backgrounds: Quantitative Study

Forced displacement of refugees, currently at record levels, leads to increased cultural diversity in many countries with benefits and challenges for individuals, communities, and societies. Refugees often face significant stressors both pre- and post-migration, and hence are at increased risk of poor mental health and wellbeing. Children and adolescents make up a significant proportion of refugees globally, and hence mental health supports for these young people are crucial. Current mental health research often uses pathologized approaches that focus on trauma, although there is growing literature highlighting the importance of a sense of belonging and the reduction in discrimination and social exclusion, emphasizing strengths and agency of individuals and communities. Resilience is often noted for its positive influence on mental health and wellbeing; however, research regarding how mechanisms of resilience function is still developing. This study investigated mental health and wellbeing of refugee-background Australian youth to better understand the role and function of resilience. Findings suggest that intersecting social ecologies, such as those within family, school, or community networks, contribute to development of identity and a sense of belonging for youth, which together form a resilient system that provides resources for wellbeing. Adaptations of school policy and practice can support positive mental health and wellbeing outcomes by contributing to and developing resilient environments, such as through building connections to family, improving positive recognition of cultural identity for individuals and across the whole school community, and actively working to minimize discrimination.

A Systematic Review of Public Housing, Poverty (De)Concentration, and Risk Behaviors: What About Youth?

Mobility housing programs aim to deconcentrate poverty in public housing areas. Previous synthesis research results describe the potential negative impact of mobility programs on the physical and mental health of youth. The current systematic review aims to expand our knowledge of the effects of living in a public housing development and leaving public housing and moving to a new neighborhood on youth risk behaviors, including both general crime/delinquency and substance use, sexual risk behavior, behavioral problems, and binge drinking. The systematic review process produced 7 primary research studies on public housing effects and 10 research studies on resettlement effects. Regarding public housing effects, five studies found a higher incidence of youth risk behaviors in public housing areas, while two studies concluded that not all children and adolescents living in public housing areas are adversely affected by the local environment. Of the 10 studies on the effects of relocation from public housing to other areas, 2 non-randomized controlled trial (RCT) studies found negative impacts, but 8 RCT studies found diversity in relocation effects on youth risk behaviors. These results highlight the need for tailored services for relocated youth taking into consideration their gender, age, family characteristics, and relocation sites. No studies on diversification housing projects satisfied the inclusion criteria in the current systematic review. With a thorough examination of the literature and a discussion of implications, a clear path for future inquiry and youth interventions is presented.

Refugee Resettlement: Case Studies of Two Syrian Women in Rhode Island

BACKGROUND

Key elements of social integration of refugees overlap with the social determinants of health. Limited research exists about Syrian refugees' resettlement in Rhode Island (RI).

METHODS

Case study life history method: Two Syrian women in RI were interviewed and observed longitudinally. Content analysis cycles led to emerging topics. Key informant interviews informed the question guide.

RESULTS

Several themes emerged: (1) Interpreters, community health workers (CHWs), and patient navigators help access healthcare; (2) Education about healthcare maintenance is important; (3) Anti-refugee bias has compromised safety and psychosocial wellness; (4) Although hard work is prioritized, high hopes for education and employment conflict with reality; and (5) Syrian women have unique experiences during resettlement.

CONCLUSIONS

RI leaders can address resettlement challenges through investment in CHW programs, peer-led health initiatives, English language education, interpreter services, psychosocial support, migrant rights education, social opportunities, and job training and matching.

"Back Home You Just Go Talk to the Family": The Role of Family Among Women Who Seek Help for Intimate Partner Violence Pre- and Postresettlement to the United States

Gaps in knowledge remain regarding how and from whom women resettling to the United States as refugees seek help for intimate partner violence (IPV), and what happens when they do. This study examined ways in which women seek help for IPV across varied contexts and at different times both pre- and postresettlement. Researchers used a purposive sampling approach to recruit women who resettled to the United States as refugees (n = 35). An inductive approach to thematic analysis led to an examination of the role of family in seeking help for IPV and seeking help in the absence of family. The findings speak to the importance of applying a social support lens to theory, practice, and research concerned with women's help-seeking for IPV in the resettlement context.

Reflections on researching vulnerable populations: Lessons from a study with Bhutanese refugee women

This paper explores the critical roles of researchers in research involving vulnerable populations. Its purpose is to reflect on the complex nature of vulnerability of Bhutanese refugee women who had resettled in Australia involved in research looking at the barriers to accessing preventive cancer screening. First, we describe the vulnerabilities considered prior to the research study and the actions taken to protect participants while the study was conducted. Second, we discuss those vulnerabilities that we did not anticipate, but were subsequently revealed during the study and consequently included in the study findings. These vulnerabilities should be considered for future research involving similar populations. It is important for researchers to use appropriate research designs that enable the voice of vulnerable people to be heard and to use research strategies that ensure findings are robust and participants are protected and empowered. Potential implications include the development of research practices that take account of the sources of vulnerabilities and consideration of how different vulnerabilities can evolve and affect findings and research recommendations.

Health of war-affected Karen adults 5 years post-resettlement

BACKGROUND

An estimated 140 000 refugees from Burma have resettled to the USA since 2009, comprising 21% of total resettlement in the USA over the last decade. Our objective was to describe patterns of longitudinal health outcomes in a cohort of Karen refugees resettled in the USA for 5 years, and to translate these findings to a primary healthcare context.

METHODS

The study was a retrospective cohort study focused on the analysis of the first 5 years of electronic health records of a sample of 143 Karen refugees who were initially resettled between May 2011 and May 2013.

RESULTS

Through descriptive, inferential and survival statistics, we described patterns of retention in primary care, biometric trends, condition prevalence and survival probabilities. Highest prevalence health conditions documented at any point in the 5-year period included diagnoses or symptoms associated with pain (52%); gastrointestinal disturbance (41%); metabolic disorder (41%); infectious process (34%); mental health condition (31%) and central nervous system disorder (24%).

CONCLUSIONS

This study is the first retrospective longitudinal analysis of patterns of health in Karen refugees originating from Burma and resettled to the USA. Findings identified in the 5-year, the post-resettlement period provided important clinical insights into the health trajectories of war-affected populations. Burden of illness was high although results did not demonstrate the extent of trauma-associated physical health conditions reported in the literature. Indicators such as significant increases in body mass index (BMI), the overall prevalence of dyslipidaemia and others suggested that the cohort may be exhibiting an early trajectory towards the development of these conditions. Authors summarize potential protective factors experienced by the cohort that promoted aspects of health frequently challenged in forced migration.

Milestones in the journey: The story of refugees becoming registered nurses in Australia

AIMS

To explore the experiences of refugees who became registered nurses after arriving to Australia.

DESIGN

Qualitative description using a naturalistic inquiry framework.

METHODS

Between February 2018 and September 2019, the lead author conducted semi-structured interviews with employed registered nurses (RNs) that are former refugees and English-speaking. Interviews were 45-90 min' duration and digitally recorded. Participants provided voluntary informed consent and were sent questions beforehand. Data were collected and coded into themes. Rigor was achieved with multiple transcript readings by the research team to confirm common themes.

RESULTS

Twelve participants discussed their story. Three major themes were identified: (1) Milestone of being a refugee; (2) Milestone of resettling in Australia; (3) Milestone of becoming a RN.

CONCLUSION

Each participant's story started at a place of disadvantage. They progressed successfully through the three milestones; despite living with traumatic experiences, they learned new skills, developed English literacy, became a RN and juggled the demands of life. This paper highlights the poorly understood pockets of the current Australian RN workforce.

IMPACT STATEMENT

The nuanced stories of RNs with refugee backgrounds in this study move beyond trauma and struggle and demonstrate the important journey this particular group of health professionals undertake. Increasing the contextual knowledge of the complex lives of former refugees turned nursing professionals will raise public awareness of the diversity of life experiences of RNs working in Australia.

Assessment of U.S. Health Care Utilization Patterns Among Recently Resettled Refugees Using Data from the 2016 Annual Survey of Refugees

Purpose: Little is known regarding the health care utilization patterns of refugees resettled in the United States. We analyzed the Annual Survey of Refugees (ASR), a nationally representative survey of recently resettled refugees, to assess these patterns.

Methods: Anonymized 2016 ASR data were examined for refugees 16 years old who arrived from 2011 to 2014.

Results: Refugees most often used private physicians (34%), health clinics (19%), and emergency rooms (14%). Approximately 15% reported no regular source of care, and 34% had health insurance for 1 month of the prior year.

Conclusion: Results indicate differing health care use and coverage, revealing opportunities for educational interventions.

Immigration stress among refugees resettled in the United States

BACKGROUND

Immigration stress includes acculturation stress and the stress related to language barriers, discrimination, occupational challenges, and feelings of isolation from society and a sense of newness or loss.

AIMS

The purpose of this study was to examine immigration stress among refugees resettled in the United States.

METHODS

A self-administered or interviewer-administered survey was collected from individuals with a refugee background in Utah from summer through fall in 2017 (N = 190).

RESULTS

Older age was associated with higher levels of financial stress and homesickness. Poorer levels of self-rated health and fewer somatic symptoms were related to higher levels of homesickness and language barriers. Higher educational attainment was associated with higher levels of financial stress.

CONCLUSION

Refugees are a vulnerable population due to being displaced to a foreign country and having to quickly learn a new language and different culture. It is imperative to gain more knowledge on diverse refugee groups and ways in which they can maintain optimum quality of life through and after the resettlement process.

A Multidisciplinary Review of the Inka Imperial Resettlement Policy and Implications for Future Investigations

The rulers of the Inka empire conquered approximately 2 million km2 of the South American Andes in just under 100 years from 1438-1533 CE. Inside the empire, the elite conducted a systematic resettlement of the many Indigenous peoples in the Andes that had been rapidly colonised. The nature of this resettlement phenomenon is recorded within the Spanish colonial ethnohistorical record. Here we have broadly characterised the resettlement policy, despite the often incomplete and conflicting details in the descriptions. We then review research from multiple disciplines that investigate the empirical reality of the Inka resettlement policy, including stable isotope analysis, intentional cranial deformation morphology, ceramic artefact chemical analyses and genetics. Further, we discuss the benefits and limitations of each discipline for investigating the resettlement policy and emphasise their collective value in an interdisciplinary characterisation of the resettlement policy.

Local elected officials' receptivity to refugee resettlement in the United States

Local leaders possess significant and growing authority over refugee resettlement, yet we know little about their attitudes toward refugees. In this article, we use a conjoint experiment to evaluate how the attributes of hypothetical refugee groups influence local policymaker receptivity toward refugee resettlement. We sample from a national panel of current local elected officials, who represent a broad range of urban and rural communities across the United States. We find that many local officials favor refugee resettlement, regardless of refugee attributes. However, officials are most receptive to refugees whom they perceive as a strong economic and social fit within their communities. Our study contributes to a growing literature on individual attitudes toward refugees by systematically examining the preferences of US local elected officials and offers unique insights into the views of this influential and policy-relevant group.

Impact of the Inflow Population From Outbreak Areas on the COVID-19 Epidemic in Yunnan Province and the Recommended Control Measures: A Preliminary Study

Background: COVID-19 developed into a global pandemic in 2020 and poses challenges regarding the prevention and control capabilities of countries. A large number of inbound travelers from other regions could lead to a renewed outbreak of COVID-19 in the local regions. Globally, as a result of the imbalance in the control of the epidemic, all countries are facing the risk of a renewed COVID-19 outbreak brought about by travelers from epidemic areas. Therefore, studies on a proper management of the inbound travelers are urgent.

Methods: We collected a total of 4,733,414 inbound travelers and 174 COVID-19 diagnosed patients in Yunnan province from 21 January 2020 to 20 February 2020. Data on place of origin, travel history, age, and gender, as well as whether they had suspected clinical manifestations for inbound travelers in Yunnan were collected. The impact of inbound travelers on the local epidemic was analyzed with a collinear statistical analysis and the effect of the control measures on the epidemic was evaluated with a sophisticated modeling approach.

Results: Of the 174 COVID-19 patients, 60.9% were not from Yunnan, and 76.4% had a history of travel in Hubei. The amount of new daily cases in Yunnan was significant correlated with the number of inbound travelers from Hubei and suspected cases among them. Using Susceptible–Exposed–Infectious–Recovered (SEIR) model analysis, we found that the prevention and control measures dropped the local R0 down to 1.07 in Yunnan province.

Conclusions: Our preliminary analysis showed that the proper management of inbound travelers from outbreak areas has a significantly positive effect on the prevention and control of the virus. In the process of resettlement, some effective measures taken by Yunnan province may provide an important reference for preventing the renewed COVID-19 outbreak in other regions.

Life on parole: The quality of experiences soon after release contributes to a conviction-free re-entry

BACKGROUND

People returning to the community after prison face many challenges, including finding suitable accommodation and employment, and accessing good social support. The prospects are particularly poor for high-risk offenders with up to a third of those released in New Zealand returning to prison within 100 days.

AIMS/HYPOTHESES

We developed the Parole Experiences Measure (PEM) to quantify the quality of men's life experiences during the first weeks of re-entry from prison. We aimed to answer the question, can the quality of life experiences differentiate men who survive in the community without reconviction from those who do not?

METHODS

Using a longitudinal design, we examined whether PEM scores for 178 men with extensive histories of crime and violence predicted three recidivism indices (breach of parole, reconviction and reimprisonment) over a 12-month follow-up period.

RESULTS

We found that PEM scores predicted all three indices of recidivism. Of the two PEM subscales, external circumstances (finances, support, accommodation) were more predictive of recidivism than subjective wellbeing (mental and physical health).

CONCLUSIONS/IMPLICATIONS

The results suggest that meeting basic practical needs in the early months of parole may be more important to avoiding reconviction than attending only to mental and physical health.

Integration and social determinants of health and wellbeing for people from refugee backgrounds resettled in a rural town in South Australia: a qualitative study

Background

There has been a recent focus on resettlement of migrants and refugee in rural settings in Australia and elsewhere. Rural resettlement is seen as an opportunity to revitalise rural communities, to fill the needs of employers in these areas, and to provide a welcoming community within which new arrivals can integrate and settle. However, challenges to rural resettlement have been identified including difficulties securing employment, discrimination and social isolation. These challenges can affect resettlement outcomes including health and wellbeing, though relatively little research has examined these links. In this paper we explored experiences of people from refugee background settling in a rural Australian town, examining interconnections between social determinants of health (SDH) and integration.

Methods

Face-to-face interviews were conducted with 44 participants from Southeast Asia and Africa in a rural setting in South Australia, covering experiences of resettlement and impacts on health and wellbeing. Participants were recruited through existing connections within the community and snowball sampling. Audio recorded data were transcribed verbatim and analysed using framework thematic analysis.

Results

The study findings revealed a mixture of settlement experiences for participants across a range of elements of SDH and integration. A sense of safety and some elements of social connectedness and support were key enablers for integration and health and wellbeing, with main challenges including limitations in employment opportunities, mismatched education provision, experiences of discrimination and constrained access to services.

Conclusions

Challenges experienced by refugees resettled in rural areas can affect integration, health and wellbeing and subsequent onward migration intentions. Attention to broader socioeconomic, cultural and environmental conditions, alongside tailored settlement support policies and practices for individual rural resettlement sites, is required to support integration and health and wellbeing.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12889-020-09724-z.

Attitudes Towards Family Planning among Bhutanese, Burmese, and Iraqi Refugee Women: A Qualitative Study

The number of foreign-born people living in the United States continues to increase yearly. Foreign-born women in the United States, a group that includes both refugees and immigrants, continue to have higher birth rates when compared to their US-born counterparts. This study examines the cultural and socioeconomic factors influencing family planning choices of resettled refugee women living in the United States. Thirty-two Bhutanese, Burmese, and Iraqi women living in Philadelphia participated in interviews and focus groups. A grounded theory approach was used for analysis. Three overarching themes were identified: knowledge acquisition and experiential learning with trans-border migration and resettlement, changes in gender roles and family relations, and provider relationships and provision of care. Findings from the study show that a stable environment results in increased opportunities and personal freedoms, a sense of empowerment, and the desire for family planning. Women want to discuss options, but healthcare providers must begin the conversation. As health care providers in Hawai'i, a state with about 18% of residents being foreign-born, what can be learned from the Philadelphia refugee experience and family planning?

Factors Shaping the Lived Experience of Resettlement for Former Refugees in Regional Australia

Refugees experience traumatic life events with impacts amplified in regional and rural areas due to barriers accessing services. This study examined the factors influencing the lived experience of resettlement for former refugees in regional Launceston, Australia, including environmental, social, and health-related factors. Qualitative interviews and focus groups were conducted with adult and youth community members from Burma, Bhutan, Sierra Leone, Afghanistan, Iran, and Sudan, and essential service providers (n = 31). Thematic analysis revealed four factors as primarily influencing resettlement: English language proficiency; employment, education and housing environments and opportunities; health status and service access; and broader social factors and experiences. Participants suggested strategies to overcome barriers associated with these factors and improve overall quality of life throughout resettlement. These included flexible English language program delivery and employment support, including industry-specific language courses; the provision of interpreters; community events fostering cultural sharing, inclusivity and promoting well-being; and routine inclusion of nondiscriminatory, culturally sensitive, trauma-informed practices throughout a former refugee’s environment, including within education, employment, housing and service settings.

Stronger together: Community resilience and Somali Bantu refugees

OBJECTIVES

Refugee populations are at risk of adverse mental health outcomes. It is important to identify refugee strengths at the community level that can be leveraged to overcome barriers to well-being. In pursuit of this goal, this study focuses on identifying what promotes community resilience among Somali Bantu refugees in the United States.

METHOD

Researchers used snowball-sampling strategies in a large New England city to recruit 81 Somali Bantu youth and adults to participate in 14 focus groups conducted between 2011 and 2013. Researchers used principles of thematic content analysis to analyze data specific to the construct of community resilience.

RESULTS

Authors identified 2 main components of Somali Bantu community resilience: independence and cultural preservation. There were 2 themes related to promoting community resilience among Somali Bantu: commitment to community, and religion and spirituality.

CONCLUSIONS

We discuss the importance of identifying culturally informed components of community resilience that can be used to develop services for refugee populations. (PsycINFO Database Record (c) 2020 APA, all rights reserved).

A house is not a home: Modeling the effects of social support and connection within resettled refugee populations

AIM

The U.S. resettlement program currently resettles refugees in communities of similar or the same ethnic background known as like-ethnic communities. This practice provides resettled refugees with a familiar community who may be able to provide support through the difficult resettlement process. However, by associating with a like-ethnic community, resettled refugees may limit interaction with the host community, which may have subsequent adverse effects on well-being.

METHODS

This study examined whether satisfaction with community support is moderated by a premigration factor (trauma history) or a postmigration factor (English fluency) in predicting depressive symptoms in a resettled refugee community (N = 179). Four moderation models were analyzed and compared.

RESULTS

The model in which English fluency moderated the relationship between satisfaction with community support and depressive symptoms had the best overall model fit. In addition, trauma history was found to also be a meaningful but secondary moderator within this relationship. English fluency and trauma history within this study did not significantly interact.

CONCLUSION

These results highlight the importance of early English language lessons and community support during resettlement. Further, they emphasize the need to integrate refugees with individuals from similar backgrounds, as well as with host communities throughout resettlement.

Intersectoral and integrated approaches in achieving the right to health for refugees on resettlement: a scoping review

BACKGROUND

Better understanding, documentation and evaluation of different refugee health interventions and their means of health system integration and intersectoral collaboration are needed.

OBJECTIVES

Explore the barriers and facilitators to the integration of health services for refugees; the processes involved and the different stakeholders engaged in levaraging intersectoral approaches to protect refugees' right to health on resettlement.

DESIGN

Scoping review.

METHODS

A search of articles from 2000 onward was done in MEDLINE, Web of Science, Global Health and PsycINFO, Embase. Two frameworks were applied in our analysis, the 'framework for analysing integration of targeted health interventions in systems' and 'Health in All Policies' framework for country action. A comprehensive description of the methods is included in our published protocol.

RESULTS

6117 papers were identified, only 18 studies met the inclusion criteria. Facilitators in implementation included: training for providers, colocation of services, transportation services to enhance access, clear role definitions and appropriate budget allocation and financing. Barriers included: lack of a participatory approach, insufficient resources for providers, absence of financing, unclear roles and insufficient coordination of interprofessional teams; low availability and use of data, and turf wars across governance stakeholders. Successful strategies to address refugee health included: networks of service delivery combining existing public and private services; system navigators; host community engagement to reduce stigma; translation services; legislative support and alternative models of care for women and children.

CONCLUSION

Limited evidence was found overall. Further research on intersectoral approaches is needed. Key policy insights gained from barriers and facilitators reported in available studies include: improving coordination between existing programmes; supporting colocation of services; establishing formal system navigator roles that connect relevant programmes; establishing formal translation services to improve access and establishing training and resources for providers.

Addressing Marginality and Exclusion: The Resettlement Experiences of War-Affected Young People in Quebec, Canada

Accessing meaningful forms of support can be an onerous experience for young people resettling from war-affected contexts. In addition to facing linguistic and financial barriers in this process, these young people negotiate care systems that are often structurally and culturally insensitive to their unique needs, values, beliefs, and intersectional experiences of oppression. Drawing on interviews with 22 young people from war-affected areas living in Quebec, Canada, this paper critically examines how dominant cultural norms and social relations in Quebec's health, social and educational services network shape their experiences in seeking care, healing and belonging. Alternative care systems and approaches, as proposed by the participants, are then explored. The findings emphasize the need for spaces and care services where war-affected young people's identities and lived realities are validated and represented.

Civilian resettlement patterns in civil war

This article proposes a descriptive typology of civilian resettlement patterns in civil wars. The patterns vary in two dimensions: whether or not displaced civilians cluster together or resettle independently, and if they remain within their home country or not. The combination of the factors leads to four resettlement patterns: expulsion, segregation, integration, and dispersion. Expulsion and segregation occur when the displaced cluster, either within the home state (segregation) or beyond it (expulsion). Integration and dispersion occur when the displaced do not cluster but seek to blend in with other communities, either abroad (dispersion) or within core cities and towns in the state (integration). After introducing the typology and illustrating it with examples, the article engages in theory-building to explain variation in resettlement patterns. It argues that resettlement forms are based on the type of displacement that civilians experience, and the perpetrator of the violence. The displacement type influences individuals' best strategy for achieving relative safety. Within and across wars, groups that experience political cleansing are likely to cluster together for safety. The best destination options for the displaced to resettle depend on the perpetrator, which lead to clustering either within a state if the actor is non-state, or outside the state if the actor is the state or an ally. The argument is illustrated with examples. Finally, the article considers the implications of resettlement patterns for violence, conflict, and state-building.

Barriers or enablers? Chiefs, elite capture, disasters, and resettlement in rural Malawi

Chiefs are at the centre of household and community development efforts in most low-income countries around the world. Yet, researchers and scholars have paid limited attention to the institution of chieftaincy and to understanding its role in the management of climate change adaptation and disaster risk reduction. This paper draws on a micro ethnographic evaluation conducted in two predominantly rural districts of Malawi in southeast Africa to assess two different manifestations of elite control. In the first case, a resettlement programme was implemented where chiefs were co-opted and took the lead. In the second case, a food insecurity response programme was designed to exclude chiefs. The study finds that neither co-opting nor countering chiefs prevents elite capture. Rather, the majority of chiefs oscillate between malevolent and benevolent capture. The findings require that states focus on the cultural and political dimensions of rural life when designing climate change adaptation and disaster risk reduction programmes.

Determinants of refugee naturalization in the United States

The United States operates the world's largest refugee resettlement program. However, there is almost no systematic evidence on whether refugees successfully integrate into American society over the long run. We address this gap by drawing on linked administrative data to directly measure a long-term integration outcome: naturalization rates. Assessing the full population of refugees resettled between 2000 and 2010, we find that refugees naturalize at high rates: 66% achieved citizenship by 2015. This rate is substantially higher than among other immigrants who became eligible for citizenship during the same period. We also find significant heterogeneity in naturalization rates. Consistent with the literature on immigration more generally, sociodemographic characteristics condition the likelihood of naturalization. Women, refugees with longer residency, and those with higher education levels are more likely to obtain citizenship. National origins also matter. While refugees from Iran, Iraq, and Somalia naturalize at higher rates, those from Burma, Ukraine, Vietnam, and Liberia naturalize at lower rates. We also find naturalization success is significantly shaped by the initial resettlement location. Placing refugees in areas that are urban, have lower rates of unemployment, and have a larger share of conationals increases the likelihood of acquiring citizenship. These findings suggest pathways to promote refugee integration by targeting interventions and by optimizing the geographic placement of refugees.

Arriving old: A qualitative study of elder refugee women's self-perceptions of the first year of resettlement

This qualitative study examines eight elder women's experiences of resettling with their family and the protective factors that enhanced their resiliency. The implications for social work include the need to assess elder refugees' strengths, resilience, pre-resettlement functioning instead of services that might encourage integration into the dominant culture and community, and that the refugee experience is a lifelong experience that shapes and informs various stages of life.

The psychosocial needs of refugee children and youth and best practices for filling these needs: A systematic review

Conflict across the globe has displaced over 16.1 million refugees, with approximately half under the age of 18. Despite the number of young refugees, there is a dearth of research reporting on the needs of refugee children and youth. The purpose of this systematic review is to begin to fill this gap by summarizing what we know about the needs of refugee children and youth (5-18 years old). Eighteen manuscripts met the study inclusion criteria. In these studies, the identified needs of refugee children and youth were primarily in the domains of social support, security, culture, and education. Several strategies were identified as facilitating their integration, such as mentorship programs. The current review can help inform future integration programs designed for refugee children and youth. Supporting the integration of refugee children and youth, and their families, promotes positive outcomes and is beneficial for both refugees and members of host communities.

Changes in the self-rated well-being of people who move from congregated settings to personalized arrangements and group home placements

A natural experiment contrasted the self-rated well-being of people with intellectual disabilities ( n = 75) and those with enduring mental health problems ( n = 44) after they moved to new accommodation and support options, while others remained in congregated settings or living in the family home. Most support staff also provided well-being ratings. In personalized arrangements, personal well-being was significantly higher than in congregated settings; particularly for people with intellectual disability who had higher support needs compared to people with mental health problems. Moving to a group home also brought some improvement in the well-being ratings of people with intellectual disability but only for those with higher support needs. Such moves seemed to lead to a decline in well-being for those with mental health problems. There were marked discrepancies between ratings given by the person with those of staff. The well-being measure shows promise for use in further comparative and longitudinal studies.

Evaluation of a complex intervention (Engager) for prisoners with common mental health problems, near to and after release: study protocol for a randomised controlled trial

INTRODUCTION

The 'Engager' programme is a 'through-the-gate' intervention designed to support prisoners with common mental health problems as they transition from prison back into the community. The trial will evaluate the clinical and cost-effectiveness of the Engager intervention.

METHODS AND ANALYSIS

The study is a parallel two-group randomised controlled trial with 1:1 individual allocation to either: (a) the Engager intervention plus standard care (intervention group) or (b) standard care alone (control group) across two investigation centres (South West and North West of England). Two hundred and eighty prisoners meeting eligibility criteria will take part. Engager is a person-centred complex intervention delivered by practitioners and aimed at addressing offenders' mental health and social care needs. It comprises one-to-one support for participants prior to release from prison and for up to 20 weeks postrelease. The primary outcome is change in psychological distress measured by the Clinical Outcomes in Routine Evaluation-Outcome Measure at 6 months postrelease. Secondary outcomes include: assessment of subjective met/unmet need, drug and alcohol use, health-related quality of life and well-being-related quality of life measured at 3, 6 and 12 months postrelease; change in objective social domains, drug and alcohol dependence, service utilisation and perceived helpfulness of services and change in psychological constructs related to desistence at 6 and 12 months postrelease; and recidivism at 12 months postrelease. A process evaluation will assess fidelity of intervention delivery, test hypothesised mechanisms of action and look for unintended consequences. An economic evaluation will estimate the cost-effectiveness.

ETHICS AND DISSEMINATION

This study has been approved by the Wales Research Ethics Committee 3 (ref: 15/WA/0314) and the National Offender Management Service (ref: 2015-283). Findings will be disseminated to commissioners, clinicians and service users via papers and presentations.

TRIAL REGISTRATION NUMBER

ISRCTN11707331; Pre-results.

"My World is Upside Down": Transnational Iraqi Youth and Parent Perspectives on Resettlement in the United States

The U.S. war with Iraq led to the displacement of millions of Iraqis, many of whom have resettled in the United States as refugees. We explore the challenges Iraqi families face after resettlement, with a particular focus on the agency of refugees and challenges/opportunities of familial social reproduction in a transnational context. We conducted 181 qualitative interviews with 38 Iraqis (11 youth, 27 adults) and 5 service providers. Our findings highlight the importance of exploring refugee agency and illuminate how the interplay between structure and agency in transnational contexts is a useful framework for understanding transformations around social roles.

Adversity and resilience amongst resettling Western Australian paediatric refugees

AIM

Cumulative adverse childhood experiences have long-term consequences and may manifest within and influence health, educational and psychosocial domains. The Princess Margaret Hospital Refugee Health Service (RHS) undertakes multidisciplinary screening of refugee children <16 years, allowing standardised identification of negative childhood experiences. Addition of the extended Strengths and Difficulties Questionnaire (SDQ) in 2014 aimed to augment psychological assessment of this cohort.

METHODS

An audit of prospectively collected standardised RHS proformas, health records and initial and 6-month follow-up SDQs for new patients aged 2-16 years between August 2014 and January 2016 was undertaken. Wider refugee adverse childhood experiences (R-ACE) were also captured.

RESULTS

Initial SDQ data were obtained from 204 patients (mean age 9.2 ± SD 4.4 years) with 143 follow-up SDQs available. One third (37.3%) had at least one psychological symptom identified based on initial screening proforma. Multiple R-ACE were disclosed with 126 of 201 (62.7%) experiencing ≥3. African ethnicity, age >10 years, separation anxiety on initial proforma and no formal parental education were associated with higher R-ACE. Initial SDQ results varied with age/ethnicity; however, peer problem scores were consistently elevated. Total difficulty SDQ scores did not capture psychopathology at expected frequencies. Improvement in follow-up SDQ results were appreciated for children aged 4-10 years. Most patients (80.2%) disclosed improvement in health status following RHS involvement.

CONCLUSIONS

Refugee children have complex backgrounds with exposure to multiple traumatic events. Comprehensive standardised health and psychological screening is recommended to target intervention. Further validation of culturally age-appropriate mental health screening tools in this diverse population is required.

Intersectoral approaches and integrated services in achieving the right to health for refugees upon resettlement: a scoping review protocol

INTRODUCTION

Global insecurity and climate change are exacerbating the need for improved management of refugee resettlement services. International standards hold states responsible for the protection of the right of non-citizens to an adequate standard of physical and mental health while recognising the importance of social determinants of health. However, programmes to protect refugees' right to health often lack coordination and monitoring. This paper describes the protocol for a scoping review to explore barriers and facilitators to the integration of health services for refugees; the content, process and actors involved in protecting refugee health; and the extent to which intersectoral approaches are leveraged to protect refugees' right to health on resettlement, especially for vulnerable groups such as women and children.

METHODS AND ANALYSIS

Peer-reviewed (through four databases including MEDLINE, Web of Science, Global Health and PsycINFO) and grey literature were searched to identify programmes and interventions designed to promote refugee health in receiving countries. Two reviewers will screen articles and abstract data. Two frameworks for integration and intersectoral action will be applied to understand how and why certain approaches work while others do not and to identify the actors involved in achieving success at different levels of integration as defined by these frameworks.

ETHICS AND DISSEMINATION

Findings from the scoping review will be shared in relevant conferences and meetings. A brief will be created with lessons learnt from successful programmes to inform decision making in design of refugee programmes and services. Ethical approval is not required as human subjects are not involved.

TRIAL REGISTRATION NUMBER

Registered on Open Science Framework at https://osf.io/gt9ck/.

"In our community, a friend is a psychologist": An ethnographic study of informal care in two Bhutanese refugee communities

The recent rise in suicide among Bhutanese refugees has been linked to the erosion of social networks and community supports in the ongoing resettlement process. This paper presents ethnographic findings on the role of informal care practiced by relatives, friends, and neighbors in the prevention and alleviation of mental distress in two Bhutanese refugee communities: the refugee camps of eastern Nepal and the resettled community of Burlington, Vermont, US. Data gathered through interviews ( n = 40, camp community; n = 22, resettled community), focus groups (four, camp community), and participant observation (both sites) suggest that family members, friends, and neighbors were intimately involved in the recognition and management of individual distress, often responding proactively to perceived vulnerability rather than reactively to help-seeking. They engaged practices of care that attended to the root causes of distress, including pragmatic, social, and spiritual interventions, alongside those which targeted feelings in the "heart-mind" and behavior. In line with other studies, we found that the possibilities for care in this domain had been substantially constrained by resettlement. Initiatives that create opportunities for strengthening or extending social networks or provide direct support in meeting perceived needs may represent fruitful starting points for suicide prevention and mental health promotion in this population. We close by offering some reflections on how to better understand and account for informal care systems in the growing area of research concerned with identifying and addressing disparities in mental health resources across diverse contexts.

Health of adolescent refugees resettling in high-income countries

Adolescent refugees are a vulnerable population with complex healthcare needs that are distinct from younger and older age groups. Physical health problems are common in this cohort with communicable diseases being the focus of attention followed by an emphasis on nutritional deficiencies and other chronic disorders. Adolescent refugees have also often experienced multiple traumatic stressors and are at a heightened risk of developing mental health problems. Navigating these problems at the time of pubertal development adds further challenges and can exacerbate or lead to the emergence of health risk behaviours. Educational difficulties and acculturation issues further compound these issues. Adolescents who have had experiences in detention or are unaccompanied by parents are particularly at risk. Despite a constantly growing number of adolescent refugees resettling in high-income countries, knowledge regarding their specific healthcare needs is limited. Research data are largely extrapolated from studies conducted within paediatric and adult cohorts. Holistic management of the medical and psychological issues faced by this group is challenging and requires an awareness of the socioeconomic factors that can have an impact on effective healthcare delivery. Legal and ethical issues can further complicate their management and addressing these in a culturally appropriate manner is essential. Early identification and management of the healthcare issues faced by adolescent refugees resettling in high-income countries are key to improving long-term health outcomes and future healthcare burden. This review article aims to increase knowledge and awareness of these issues among paediatricians and other health professionals.

Medical Aid, Repression, and International Relations: The East German Hospital at Metema

Between 1984 and 1988, the German Democratic Republic (GDR) built a hospital in a remote part of Ethiopia, close to the Sudanese border. The project evolved in a complex combination of contexts, including the general foreign policy goals of the GDR, its specific alliance with Ethiopia, the famine of 1984-85, civil war in Ethiopia, and a controversial resettlement program by the government of Mengistu Haile Mariam. Though almost unknown today, it was a high-profile project at the time, which received the personal support both by Erich Honecker in the GDR and Mengistu Haile Mariam in Ethiopia. However, their interest was directed more at the political goals the project was expected to serve than at the hospital itself. Both the preparation and the implementation of the project were extremely difficult and almost failed due to problems of transportation, of red tape, and of security. The operation of the hospital was also not ideal, involving frustrated personnel and less than complete acceptance by the local population. Ironically, for all its practical difficulties, the hospital has outlived both governments and their political goals, surviving as a medical institution.

Climate change-related migration and infectious disease

Anthropogenic climate change will have significant impacts on both human migration and population health, including infectious disease. It will amplify and alter migration pathways, and will contribute to the changing ecology and transmission dynamics of infectious disease. However there has been limited consideration of the intersections between migration and health in the context of a changing climate. This article argues that climate-change related migration - in conjunction with other drivers of migration - will contribute to changing profiles of infectious disease. It considers infectious disease risks for different climate-related migration pathways, including: forced displacement, slow-onset migration particularly to urban-poor areas, planned resettlement, and labor migration associated with climate change adaptation initiatives. Migration can reduce vulnerability to climate change, but it is critical to better understand and respond to health impacts - including infectious diseases - for migrant populations and host communities.

Post-tsunami relocation of fisher settlements in South Asia: evidence from the Coromandel Coast, India

The tsunami that struck the coasts of India on 26 December 2004 resulted in the large-scale destruction of fisher habitations. The post-tsunami rehabilitation effort in Tamil Nadu was directed towards relocating fisher settlements in the interior. This paper discusses the outcomes of a study on the social effects of relocation in a sample of nine communities along the Coromandel Coast. It concludes that, although the participation of fishing communities in house design and in allocation procedures has been limited, many fisher households are satisfied with the quality of the facilities. The distance of the new settlements to the shore, however, is regarded as an impediment to engaging in the fishing profession, and many fishers are actually moving back to their old locations. This raises questions as to the direction of coastal zone policy in India, as well as to the weight accorded to safety (and other coastal development interests) vis-à-vis the livelihood needs of fishers.