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Bantu refugee children from Somalia at a farewell party in Florida before being relocated to other places in the United States.
Nearly half of all refugees are children, and almost one in three children living outside their country of birth is a refugee. These numbers encompass children whose refugee status has been formally confirmed, as well as children in refugee-like situations.
In addition to facing the direct threat of violence resulting
from conflict, forcibly displaced children also face various health
risks, including: disease outbreaks and long-term psychological trauma, inadequate access to water and sanitation, nutritious food, and regular vaccination schedules. Refugee children, particularly those without documentation and those who travel alone, are also vulnerable to abuse and exploitation. Although many communities around the world have welcomed them, forcibly displaced children and their families often face discrimination, poverty, and social marginalization in their home, transit, and destination countries.
Language barriers and legal barriers in transit and destination
countries often bar refugee children and their families from accessing
education, healthcare, social protection, and other services. Many
countries of destination also lack intercultural supports and policies
for social integration. Such threats to safety and well-being are amplified for refugee children with disabilities. Additionally, North American schools often don’t have the resources needed to support refugee children.
Refugee children often have to handle discrimination, low socioeconomic
status, have no family, or come to a setting that clashes with their
cultural beliefs leading to behavioral issues teachers aren’t always
prepared for. Extracurricular resources provided to
refugee children include supplementary curriculum enrichment resources,
videos for the goal or increasing parent and school awareness,
informational leaflets and handbooks, as well as ICT based resources,
which serve to benefit refugee involvement in the school.
Legal protection
The Convention on the Rights of the Child,
the most widely ratified human rights treaty in history, includes four
articles that are particularly relevant to children involved in or
affected by forced displacement:
- the principle of non-discrimination (Article 2)
- best interests of the child (Article 3)
- right to life and survival and development (Article 6)
- the right to child participation (Article 12)
States Parties to the Convention are obliged to uphold the above articles, regardless of a child's migration status. As of November 2005, a total of 192 countries have become States Parties to the Convention. Somalia and the United States are the only two countries that have not ratified it.
The United Nations 1951 Convention on the Status of Refugees
is a comprehensive and rigid legal code regarding the rights of
refugees at an international level and it also defines under which
conditions a person should be considered as a refugee and thus be given
these rights.
The Convention provides protection to forcibly displaced persons who
have experienced persecution or torture in their home countries.
For countries that have ratified it, the Convention often serves as the
primary basis for refugee status determination, but some countries also
utilize other refugee definitions, thus, have granted refugee status
not based exclusively on persecution. For instance, the African Union
has agreed on a definition at the 1969 Refugee Convention,
that also accommodates people affected by external aggression,
occupation, foreign domination, and events seriously disturbing public
order.
South Africa has granted refugee status to Mozambicans and Zimbabweans
following the collapse of their home countries’ economies.
Other international legal tools for the protection refugee children include two of the Protocols supplementing the United Nations Convention against Transnational Organized Crime which reference child migration:
- the Protocol to Prevent, Suppress, and Punish Trafficking in Persons, especially Women and Children;
- the Protocol against the Smuggling of Migrants by Land, Sea, and Air.
Additionally the International Convention on the Protection of the Rights of All Migrant Workers and Members of Their Families
covers the rights of the children of migrant workers in both regular
and irregular situations during the entire migration process.
Stages of the refugee experience
Refugee
experiences can be categorized into three stages of migration: home
country experiences (pre-migration), transit experiences
(transmigration), and host country experiences (post-migration).
However, the large majority of refugees do not travel into new host
countries, but remain in the transmigration stage, living in refugee
camps or urban centres waiting to be able to return home.
Home country experiences (pre-migration)
The pre-migration stage refers to home country experiences leading up
to and including the decision to flee. Pre-migration experiences
include the challenges and threats children face that drive them to seek
refuge in another country.
Refugee children migrate, either with their families or unaccompanied,
due to fear of persecution on the premise of membership of a particular
social group, or due to the threat of forced marriage, forced labor, or conscription into armed forces.
Others may leave to escape famine or in order to ensure the safety and
security of themselves and their families from the destruction of war or
internal conflict.
A 2016 report by UNICEF found that, by the end of 2015, five years of open conflict in the Syrian Arab Republic
had forced 4.9 million Syrians out of the country, half of which were
children. The same report found that, by the end of 2015, more than ten
years of armed conflict in Afghanistan had forced 2.7 million Afghans
beyond the country's borders; half of the refugees from Afghanistan were
children. During times of war, in addition to being exposed to violence, many children are abducted and forced to become soldiers. According to an estimate, 12,000 refugee children have been recruited into armed groups within South Sudan. War itself often becomes a part of the child's identity, making reintegration difficult once he or she is removed from the unstable environment.
Examples of children's pre-migration experiences:
- Some Sudanese refugee children reported that they had either
experienced personally or witnessed potentially traumatic events prior
to departure from their home country, during attacks by the Sudanese
military in Darfur.
These events include instances of sexual violence, as well as of
individuals being beaten, shot, bound, stabbed, strangled, drowned, and
kidnapped.
- Some Burmese
refugee children in Australia were found to have undergone severe
pre-migration traumas, including the lack of food, water, and shelter,
forced separation from family members, murder of family or friends,
kidnappings, sexual abuse, and torture.
- In 2014 the President of Honduras testified in front of the United States Congress that more than three-quarters of unaccompanied child migrants from Honduras came from the country's most violent cities. In fact, 58 percent of 404 unaccompanied and separated children interviewed by the UN Refugee Agency, UNHCR,
about their journey to the United States indicated that they had been
forcibly displaced from their homes because they had either been harmed
or were under threat of harm.
In general, children may also cross borders for economic reasons,
such as to escape poverty and social deprivation, or some children may
do so to join other family members already settled in another State. But
it is the involuntary nature of refugees' departure that distinguishes
them from other migrant groups who have not undergone forced
displacement. Refugees,
and even more so their children, are neither psychologically nor
pragmatically prepared for the rapid movement and transition resulting
from events outside their control. Any direct or witnessed forms of violence and sexual abuse may characterize refugee children's pre-migration experiences.
Transit experiences (transmigration)
The
transmigration period is characterized by the physical relocation of
refugees. This process includes the journey between home countries and
host countries and often involves time spent in a refugee camp. Children may experience arrest, detention, sexual assault, and torture during their translocation to the host country.
Children, particularly those who travel on their own or become
separated from their families, are likely to face various forms of
violence and exploitation throughout the transmigration period.
The experience of traveling from one country to another is much more
difficult for women and children, because they are more vulnerable to
assaults and exploitation by people they encounter at the border and in
refugee camps.
Trafficking
Smuggling,
in which a smuggler illegally moves a migrant into another country, is a
pervasive issue for children travelling both with and without their
families. While fleeing their country of origin, many unaccompanied children end up travelling with traffickers who may attempt to exploit them as workers.
Including adults, sex trafficking is more prevalent in Europe and
Central Asia, whereas in East Asia, South Asia, and the Pacific labour
trafficking is more prevalent.
Many unaccompanied children fleeing from conflict zones in Moldova, Romania, Ukraine, Nigeria, Sierra Leone, China, Afghanistan or Sri Lanka are forced into sexual exploitation.
Especially vulnerable groups include girls belonging to single-parent
households, unaccompanied children, children from child-headed
households, orphans, girls who were street traders, and girls whose
mothers were street traders.
While refugee boys have been identified as the main victims of
exploitation in the labor market, refugee girls aged between 13 and 18
have been the main targets of sexual exploitation. In particular, the number of young Nigerian women and girls brought into Italy
for exploitation has been increasing: it was reported that 3,529
Nigerian women, among them underage girls, arrived by sea between
January and June 2016. Once they reached Italy, these girls worked under
conditions of slavery, for periods typically ranging from three to
seven years.
Detention
Children may be detained
in prisons, military facilities, immigration detention centers, welfare
centers, or educational facilities. While detained, migrant children
are deprived of a range of rights, such as the right to physical and
mental health, privacy, education, and leisure. And many countries do
not have a legal time limit for detention, leaving some children
incarcerated for indeterminate time periods. Some children are even detained together with adults and subjected to a harsher, adult-based treatment and regimen.
In North Africa, children travelling without legal status are frequently subjected to extended periods of immigration detention. Children held in administrative detention in Palestine
only receive a limited amount of education, and those held in
interrogation centers receive no education at all. In two of the prisons
visited by Defense for Children International Palestine, education was
found to be limited to two hours a week.
It has also been reported that child administrative detainees in
Palestine do not receive sufficient food to meet their daily nutritional
requirements.
Documented cases of child detention are available for more than
100 countries, ranging from the highest to the lowest income nations. Even so, a growing number of countries, including both Panama and Mexico, prohibit the detention of child migrants. And Yemen
has adopted a community-driven approach, using small-group alternative
care homes for child refugees and asylum-seekers, as a more
age-appropriate way of detention.
In the United States unaccompanied children are placed in single
purpose non-secure “children’s shelters” for immigration violations,
rather than in juvenile detention facilities. However, this change has
not ended the practice of administrative detention entirely.
Although there is commitment by the Council of Europe to work toward
ending the detention of children for migration control purposes,
asylum-seeking and migrant children and families often undergo detention
experiences that conflict with international commitments.
Refugee camps
Some refugee camps
operate at levels below acceptable standards of environmental health;
overcrowding and a lack of wastewater networks and sanitation systems
are common.
Hardships of a refugee camp may also contribute to symptoms
following a refugee child's discharge from a camp. A small number of Cuban
refugee children and adolescents, who were detained in a refugee camp,
were assessed months after their release, and it was found that 57
percent of the youth exhibited moderate to severe posttraumatic stress disorder (PTSD) symptoms. Unaccompanied girls at refugee camps may also face harassment or assault from camp guards and fellow male refugees.
In addition to having poor infrastructure and limited support services,
there are a few refugee camps that can present danger to refugee
children and families by housing members of armed forces. Also, at a few
refugee camps, militia forces may try to recruit and abduct children.
Host country experiences (post-migration)
The
third stage, host country experiences, is the integration of refugees
into the social, political, economic, and cultural framework of the host
country society. The post-migration period involves adaptation to a new
culture and re-defining one's identity and place in the new society. This stress can be exacerbated when the children arrive in the host country and are expected to adapt quickly to a new setting.
It is only a minority of refugees who travel into new host
countries and who are allowed to start a new life there. Most refugees
are living in refugee camps or urban centres waiting to be able to
return home. For those who are starting a new life in a new country
there are two options:
Seeking asylum
Asylum seekers are people who have formally applied for asylum in another country and who are still waiting for a decision on their status.
Once they have received a positive response from the host government,
they will legally be considered as refugees. Refugees, like citizens of
the host country, have the rights to education, health, and social
services, whereas asylum seekers do not.
For instance, the majority of refugees and migrants who arrived
in Europe in 2015 through mid-2016 were accommodated in overcrowded
transit centers and informal settlements, where privacy and access to
education and health services were often limited. In some accommodation centers in Germany and Sweden,
where asylum seekers stayed until their claims were processed, separate
living spaces for women, as well as sex-separated latrines and shower
facilities, were unavailable.
Unaccompanied children
face particular difficulties throughout the asylum process. They are
minors who are separated from their families once they reach the host
country, or minors who decide to travel from their home countries to a
foreign country without a parent or guardian. More children are traveling alone, with nearly 100,000 unaccompanied children in 2015 filing claims for asylum in 78 countries.
Bhabha (2004) argues that it is more challenging for unaccompanied
children than adults to gain asylum, as unaccompanied children are
usually unable to find appropriate legal representation and stand up for
themselves during the application process. In Australia,
for instance, unaccompanied children, who usually do not have any kind
of legal assistance, must prove beyond any reasonable doubt that they
are in need of the country's protection.
Many children do not have the necessary documents for legal entry into a
host country, often avoiding officials due to fear of being caught and
deported to their home countries.
Without documented status, unaccompanied children often face challenges
in acquiring education and healthcare in many countries. These factors
make them particularly vulnerable to hunger, homelessness, and sexual
and labor exploitation. Displaced youth, both male and female, are vulnerable to recruitment into armed groups. Unaccompanied children may also resort to dangerous jobs to meet their own survival needs. Some may also engage in criminal activity or drug and alcohol abuse.
Girls, to a larger extent than boys, are vulnerable to sexual
exploitation and abuse, both of which can have far-reaching effects on
their physical and mental health.
Refugee resettlement
Third country resettlement refers
to the transfer of refugees from the country they have fled to another
country that is more suitable to their needs and that has agreed to
grant them permanent settlement.
Currently the number of places available for resettlement is less than
the number needed for children for whom resettlement would be most
appropriate. Some nations have prioritized children at risk as a category for resettlement:
The United States established its Unaccompanied Refugee Minor
Program in 1980 to support unaccompanied children for resettlement. The Office of Refugee Resettlement (ORR) by the Department of Homeland Security
currently works with state and local service providers to provide
unaccompanied refugee children with resettlement and foster care
services. This service is guaranteed to unaccompanied refugee minors
until they reach the age of majority or until they are reunited with
their families.
Some European nations have established programs to support the resettlement and integration of refugee children.
The European countries admitting the most refugee children in 2016 via
resettlement were the United Kingdom (2,525 refugee children), Norway
(1,930), Sweden (915), and Germany (595). Together, these accounted for
66% of the child resettlement admissions to all of Europe. The United Kingdom
also established a new initiative in 2016 to support the resettlement
of vulnerable refugee children from the Middle East and North Africa,
regardless of family separation status.
It was reported in February 2017 that this program has been partially
suspended by the government; the program would no longer accept refugee
youth with "complex needs," such as those with disabilities, until
further notice.
Refugee children without caretakers have a greater risk of exhibiting
psychiatric symptoms of mental illnesses following traumatic stress. Unaccompanied refugee children display more behavioral problems and emotional distress than refugee children with caretakers.
Parental well-being plays a crucial role in enabling resettled refugees
to transition into a new society. If a child is separated from his/her
caretakers during the process of resettlement, the likelihood that
he/she will develop a mental illness increases.
Health
This section covers health throughout the different stages of the refugee experience.
Health status
Nutrition
Refugee children arriving in the United States often come from countries with a high prevalence of undernutrition.
Nearly half of a sample of refugee children who arrived to the American
state of Washington, the majority of which were from Iraq, Somalia, and
Burma, were found to have at least one form of malnutrition. In the
under five age range refugee children had significantly higher rates of wasting syndrome and stunted growth, as well as a lower prevalence of obesity, in comparison to low-income non-refugee children.
However, some time after they arrived in the United States and
Australia, many refugee children demonstrated an increasing rate of
overnutrition. An Australian study, assessing the nutritional status of
337 sub-Saharan African children aged between three and 12 years, found
that the prevalence rate for overweight amongst refugee children was
18.4%. The prevalence rate of overweight and obesity among refugee children in Rhode Island, increased from 17.3% at initial measurement at first arrival to 35.4% at measurement three years after.
But the nutritional profiles of refugee children also often vary
by their country of origin. A study involving Syrian refugee children in
Jordanian refugee camps found them to be on average more likely
overweight than acutely malnourished. The low prevalence of acute
malnutrition among them was attributed, at least partly, to UNICEF's
infant and child feeding interventions, as well as to the distribution
of food vouchers by the World Food Programme (WFP).
Among newly arrived refugees in Washington state, significantly
higher rates of obesity were observed among Iraqi children, whereas
higher rates of stunting were found among Burmese and Somali children.
The latter also had higher rates of wasting.
Such variation in the nutrition profiles of refugee children may be
explained by the variance in refugees' location and time in transition.
Communicable diseases
Communicable
diseases are a pervasive issue faced by refugee children in camps and
other temporary settlements. Governments and organizations are working
to address a number of them, such as measles, rubella, diarrhea, and
cholera. Refugee children often arrive in the United States from
countries with a high prevalence of infectious disease.
Measles has been a major cause of child deaths in refugee camps and among internally displaced people; measles also exacerbates malnutrition and vitamin A deficiency.
Some countries, such as Kenya, have developed preventive, detective,
and curative programs to specifically target measles within the refugee
children population. Kenya has reached over 20 million children with a
measles and rubella immunization campaign carried out at the national
level in May 2016. In 2017 the Kenya Ministry of Health even reported a
routine vaccination coverage of 95 percent in the Dadaab refugee camp.
As of April 2017, in response to the first confirmed cases of measles
in the camp, UNICEF and UNHCR have collaborated with the Kenya Ministry
of Health to swiftly implement an integrated measles vaccination program
in Dadaab. The campaign, which has been targeting children aged six to
14 years, also includes screening, treatment referrals for cases of
malnutrition, vitamin A supplementation, and deworming.
Diarrhea, acute watery diarrhea, and cholera
can also put children's lives at risk. Countries, such as Bangladesh,
have identified the introduction and development of proper sanitation
habits and facilities as potential solutions to these medical
conditions. A 2008 study comparing refugee camps in Bangladesh reported
that camps with sanitation facilities had cholera rates of 16%, whereas
camps without such facilities had cholera rates that were almost three
times higher.
In a single week in 2017, 5,011 cases of diarrhea in refugee camps in
Cox's Bazar in Bangladesh were reported. In response, UNICEF started a
year-long cholera vaccination campaign in October 2017, targeting all
children in the camps. At health centers in the refugee camps, UNICEF
has been screening for potential cholera cases and providing oral
rehydration salts. Community-based health workers are also going around
the camps to share information on the risks of acute watery diarrhea,
the cholera vaccination campaign, and the importance and necessity of
good hygiene practices.
Noncommunicable diseases
During
all points of the refugee experience, refugee children are often at
risk of developing several noncommunicable diseases and conditions, such
as lead poisoning, obesity, type 2 diabetes, and pediatric cancer.
Many refugee children come to their host countries with elevated
blood lead levels; others encounter lead hazards once they have
resettled. A study published in January 2013 found that the blood lead
levels of refugee children who had just arrived to the state of New
Hampshire were more than twice as likely to be above 10 µg/dL as the
blood lead levels of children born in the United States. Evidence from the Centers for Disease Control and Prevention
(CDC) in the United States also found that nearly 30% of 242 refugee
children in New Hampshire developed elevated blood lead levels within
three to six months of their arrival to the United States, even though
their levels were not found to be elevated at initial screening.
A more recent study reported that refugee children in Massachusetts
were 12 times more likely to have blood lead levels over 20 µg/dL a year
after an initial screening than non-refugee children of the same age
and living in the same communities.
A study analyzing the medical records of former refugees residing
in Rochester, New York between 1980 and 2012 demonstrated that former
child refugees may be at increased risk of obesity, type 2 diabetes, and hypertension following resettlement.
Many Afghan children lack access to urban diagnosis centers in
Pakistan; those who do have access have been found to have various types
of cancer.
It is also estimated that, within Turkey's Syrian refugee population,
60 to 100 children are diagnosed with cancer each year. Overall, the
incidence rate of pediatric cancers among Turkey's Syrian refugee
population was similar to that of Turkish children. The study
additionally noted, however, that most refugee children affected by
cancer were diagnosed when the tumor was already at an advanced stage.
This could indicate that refugee children and their families often face
obstacles such as poor prognoses, language barriers, financial problems,
and social problems in adapting to a new setting.
Mental health and illness
Traditionally,
the mental health of children experiencing conflict is understood in
terms of either post-traumatic stress disorder (PTSD) or toxic stress.
Prolonged and constant exposure to stress and uncertainty,
characteristic of a war environment may result in toxic stress that
children express with a change in behavior that may include anxiety,
self-harm, aggressiveness or suicide.
A 2017 study conducted in Syria by Save the Children determined that
84% of all adults and most children considered ongoing bombing and
shelling to be the main psychological stressor, while 89% said that
children were more fearful as the war progressed, and 80% said that
children had become more aggressive. These stressors are leading causes
of the symptoms described above, which lead to diagnosis of PTSD and
toxic stress, among other mental conditions. These issues may then be
further exacerbated by a forced migration to a foreign country, and the
beginning of the process of refugee status determination.
A review of refugee children in high-income countries showed PTSD
prevalence ranging from 19 – 54%, with an average prevalence of 36%.
Refugee children are extremely vulnerable during migration and
resettlement, and may experience long-term pathological effects, due to
"disrupted development time." Psychoanalysts of refugee health have
proposed that refugee children experience mourning for their culture and
countries, despite the fact that the war-torn state of their homes is
unsafe. This sudden loss of familiarity places children at a greater
risk for mental dysfunction. In addition, studies have shown that
refugee children show a higher vulnerability to stress when separated
from their families.
Studies from treatment facilities and small community samples have
confirmed that refugee youth are at higher risk for psychopathologic
disorders, including post-traumatic stress disorder, depression, conduct
disorder, and problems resulting from substance abuse. Refugee children living in high-income countries have a prevalence of depression of 3 – 30%, with an average prevalence of 18%.
However, other large-scale community surveys have found that the rate
of psychiatric disorder among immigrant youth is not higher than that of
native-born children.
Nonetheless, experiments have shown that these adverse outcomes can be
prevented through adequate protective factors, such as social support
and intimacy.
Additionally, effective adaptation strategies, such as absorption in
work and creation of pseudofamilies, have led to successful coping in
refugees. Many refugee populations, particularly Southeast Asian,
undergo a secondary migration to larger communities of kinfolk from
their countries of origin, which serve as social support networks for
refugees. Research has shown that family reunification, formation of new
social groups, community groups, and social services and professional
support have contributed to successful resettlement of refugees.
Refugees can be stigmatized if they encounter mental health
deficiencies prior to and during their resettlement into a new society. Differences between parental and host country values can create a rift between the refugee child and his/her new society. Less exposure to stigmatization lowers the risk of refugee children developing PTSD.
Access to healthcare
Cognitive
and structural barriers make it difficult to determine the medical
service utilization rates and patterns of refugee children. A better
understanding of these barriers will help improve mental healthcare
access for refugee children and their families.
Cognitive and emotional barriers
Many
refugees develop a mistrust of authority figures due to repressive
governments in their country of origin. Fear of authority and a lack of
awareness regarding mental health issues prevent refugee children and
their families from seeking medical help.
Certain cultures use informal support systems and self-care strategies
to cope with their mental illnesses, rather than rely upon biomedicine. Language and cultural differences also complicate a refugee's understanding of mental illness and available healthcare.
Other factors that delay refugees from seeking medical help are:
- Fear of discrimination and stigmatization
- Denial of mental illness as defined in the Western context
- Fear of the unknown consequences following diagnosis such as deportation, separation from family, and losing children
- Mistrust of Western biomedicine
Language barriers
A
broad spectrum of translation services are available to all refugees,
but only a small number of those services are government-sponsored.
Community health organizations provide a majority of translation
services, but there are a shortage of funds and available programs.
Since children and adolescents have a greater capacity to adopt their
host country's language and cultural practices, they are often used as linguistic intermediaries between service providers and their parents. This may result in increased tension in family dynamics where culturally sensitive
roles are reversed. Traditional family dynamics in refugee families
disturbed by cultural adaptation tend to destabilize important cultural norms,
which can create a rift between parent and child. These difficulties
cause an increase of depression, anxiety and other mental health
concerns in culturally-adapted adolescent refugees.
Relying on other family members or community members has equally
problematic results where relatives and community members
unintentionally exclude or include details relevant to comprehensive
care. Healthcare practitioners are also hesitant to rely on members of the community because it is breaches confidentiality.
A third party present also reduces the willingness of refugees to trust
their healthcare practitioners and disclose information.
Patients may receive a different translator for each of their follow-up
appointments with their mental healthcare providers, which means that
refugees need to recount their story via multiple interpreters, further
compromising confidentiality.
Culturally competent care
Culturally competent
care exists when healthcare providers have received specialized
training that helps them to identify the actual and potential cultural
factors informing their interactions with refugee patients.
Culturally competent care tends to prioritize the social and cultural
determinants contributing to health, but the traditional Western
biomedical model of care often fails to acknowledge these determinants.
To provide culturally competent care to refugees, mental
healthcare providers should demonstrate some understanding of the
patient's background, and a sensitive commitment to relevant cultural
manners (for example: privacy, gender dynamics, religious customs, and
lack of language skills).
The willingness of refugees to access mental healthcare services rests
on the degree of cultural sensitivity within the structure of their
service provider.
The protective influence exercised by adult refugees on their
child and adolescent dependents makes it unlikely that young
adult-accompanied refugees will access mental healthcare services. Only
10-30 percent of youth in the general population, with a need for mental
healthcare services, are currently accessing care. Adolescent ethnic minorities are less likely to access mental healthcare services than youth in the dominant cultural group.
Parents, caretakers and teachers are more likely to report an
adolescent's need for help, and seek help resources, than the
adolescent.
Unaccompanied refugee minors are less likely to access mental
healthcare services than their accompanied counterparts. Internalizing
complaints (such as depression and anxiety) are prevalent forms of
psychological distress among refugee children and adolescents.
Other obstacles
Additional structural deterrents for refugees:
- Complicated insurance policies based on refugee status (e.g.
Government Assistant Refugees vs. Non-), resulting in hidden costs for
refugee patients
According to the United States Office of Refugee Resettlement, an
insurance called refugee Medical Assistance is available in the short
term (up to 8 months), while other such as Medicaid and CHIP are
available for several years.
- Lack of transportation
- A lack of public awareness and access to information about available resources
- An unfamiliarity with the host country's healthcare system,
amplified by a shortage of government or community intervention in
settlement services
Structural deterrents for healthcare professionals:
- Heightened instances of mental health complications in refugee populations
- A lack of documented medical history, which makes comprehensive care difficult
- Time constraints: medical appointments are restricted to a small
window of opportunity, making it difficult to connect and provide mental
healthcare for refugees
- Complicated insurance plans, resulting in a delay in compensation for the healthcare provider
Health education
The
World Association of Girl Guides and Girl Scouts (WAGGGS) and Family
Health International (FHI) have designed and piloted a peer-centered
education program for adolescent refugee girls in Uganda, Zambia, and
Egypt. The goal of the program was to reach young women who were
interested in being informed about reproductive health issues. The
program was split into three age-specific groups: girls aged seven to 10
learned about bodily changes and anatomy; girls aged 11 to 14 learned
about sexually transmitted diseases; girls aged 15 and older focused on
tips to ensure a healthy pregnancy and to properly care for a baby.
According to qualitative surveys, increased self-esteem and greater use
of health services among the program's participants were the largest
benefits of the program.
Education
This section covers education throughout the different stages of the
refugee experience. The report, "Left Behind: Refugee Education in
Crisis," compares UNHCR sources and statistics on refugee education with data on school enrollment around the world provided by UNESCO,
the United Nations Educational, Scientific, and Cultural Organization.
The report notes that, globally, 91 percent of children attend primary
school. For all refugees, that figure is at 61 percent. Specifically in
low-income countries, less than 50 percent of refugees are able to
attend primary school. As refugee children get older, school enrollment
rates drop: only 23 percent of refugee adolescents are enrolled in
secondary school, versus the global figure of 84 percent. In low-income
countries, nine percent of refugees are able to go to secondary school.
Across the world, enrollment in tertiary education stands at 36 percent.
For refugees, the percentage remains at one percent.
Adapting to a new school environment is a major undertaking for refugee children who arrive in a new country or refugee camp. Education is crucial for the sufficient psychosocial adjustment and cognitive growth of refugee children.
Due to these circumstances, it is important that educators consider the
needs, obstacles, and successful educational pathways for children
refugees.
Graham, Minhas, and Paxton (2016) note in their study
that parents' misunderstandings about educational styles, teachers' low
expectations and stereotyping tendencies, bullying and racial
discrimination, pre-migration and post-migration trauma, and forced
detention can all be risk factors for learning problems in refugee
children. They also note that high academic and life ambition, parents'
involvement in education, a supportive home and school environment,
teachers' understanding of linguistic and cultural heritage, and healthy
peer relationships can all contribute to a refugee child's success in
school.
While the initial purpose of refugee education was to prepare students
to return to their home countries, now the focus of American refugee
education is on integration.
Access to education
Structure of the education system
Schools
in North America lack the necessary resources for supporting refugee
children, particularly in negotiating their academic experience and in
addressing the diverse learning needs of refugee children.
Complex schooling policies that vary by classroom, building and
district, and procedures that require written communication or parent
involvement intimidate the parents of refugee children.
Educators in North America typically guess the grade in which refugee
children should be placed because there is not a standard test or formal
interview process required of refugee children.
Sahrawi refugee children learning Arabic and Spanish, math, reading and writing, and science subjects.
The ability to enroll in school and continue one's studies in developing countries is limited and uneven across regions and settings of displacement, particularly for young girls and at the secondary levels.
The availability of sufficient classrooms and teachers is low and many
discriminatory policies and practices prohibit refugee children from
attending school. Educational policies promoting age-caps can also be harmful to refugee children.
Many refugee children face legal restrictions to schooling, even
in countries of first asylum. This is the case especially for countries
that have not signed the 1951 Refugee Convention or its 1967 Protocol.
The 1951 Convention and 1967 Protocol both emphasize the right to
education for refugees, articulating the definition of refugeehood in
international contexts. Nevertheless, refugee students have one of the
lowest rates of access to education. The UNHCR reported in 2014 that
about 50 percent of refugee children had access to education compared to
children globally at 93 percent. In countries where they lack official refugee status, refugee children are unable to enroll in national schools.
In Kuala Lumpur, Malaysia, unregistered refugee children described
being hesitant to go to school, due to risk of encountering legal
authorities at school or while on the way to and from school.
Structure of classes
Student-teacher ratios are very high in most refugee schools, and in some countries, these ratios are nearly twice the UNCHR guideline of 40:1.
Although global policies and standards for refugee settings endorse
child-centered teaching methods that promote student participation,
teacher-centered instruction often predominates in refugee classrooms.
Teachers lecture for the majority of the time, offering few
opportunities for students to ask questions or engage in creative
thinking. In eight refugee-serving schools in Kenya, for example, lecturing was the primary mode of instruction.
In order to address the lack of attention to refugee education in
national school systems, the UNHCR developed formal relationships with
twenty national ministries of education in 2016 to oversee the political
commitment to refugee education at the nation-state level.
The UNCHR introduced an adaptive global strategy for refugee education
with the aim of "integration of refugee learners within national system
where possible and appropriate and as guided by ongoing consultation
with refugees".
Residence
Refugee children who live in large urban
centers in North America have a higher rate of success at school,
particularly because their families have greater access to additional
social services that can help address their specific needs.
Families who are unable to move to urban centers are at a disadvantage.
Children with unpredictable migration trajectories suffer most from a
lack of schooling because of a lack of uniform schooling in each of
their destinations before settling.
Language barriers and ethnicity
Acculturation stress occurs in North America when families expect refugee youth to remain loyal to ethnic values while mastering the host culture
in school and social activities. In response to this demand, children
may over-identify with their host culture, their culture of origin, or
become marginalized from both. Insufficient communication due to language
and cultural barriers may evoke a sense of alienation or "being the
other" in a new society. The clash between cultural values of the family
and popular culture in mainstream Western society leads to the
alienation of refugee children from their home culture.
Many Western schools do not address diversity among ethnic groups
from the same nation or provide resources for specific needs of
different cultures (such as including halal food in the school menu). Without successfully negotiating cultural differences in the classroom, refugee children experience social exclusion in their new host culture.
The presence of racial and ethnic discrimination can have an adverse
effect on the well-being of certain groups of children and lead to a
reduction in their overall school performance. For instance, cultural differences place Vietnamese refugee youth at a higher risk of pursuing disruptive behaviour. Contemporary Vietnamese American
adolescents are prone to greater uncertainties, self-doubts and
emotional difficulties than other American adolescents. Vietnamese
children are less likely to say they have much to be proud of, that they
like themselves as they are, that they have many good qualities, and
that they feel socially accepted.
Classes for refugees, more often than not, are taught in the host-country language.
Refugees in the same classroom may also speak several different
languages, requiring multiple interpretations; this can slow the pace of
overall instruction.
Refugees from the Democratic Republic of Congo living in Uganda, for
example, had to transition from French to English. Some of these
children were placed in lower-level classes due to their lack of English
proficiency. Many older children therefore had to repeat lower-level
classes, even if they had already mastered the content. Using the language of one ethnic group as the instructional language may threaten the identity of a minority group.
The content of the curriculum can also act as a form of discrimination
against refugee children involved in the education systems of first
asylum countries.
Curricula often seem foreign and difficult to understand to refugees
who are attending national schools alongside host-country nationals. For
instance, in Kakuma refugee camp in Kenya, children described having a
hard time understanding concepts that lacked relevance to their lived
experiences, especially concepts related to Kenyan history and
geography.
Similarly, in Uganda, refugee children from the Democratic Republic of
Congo studying together with Ugandan children in government schools did
not have opportunities in the curriculum to learn the history of their
home country.
The teaching of one-sided narratives, such as during history lessons,
can also threaten the identity of students belonging to minority groups.
Vietnamese refugee mother and children at a kindergarten in upper
Afula, 1979.
Other obstacles
Although
high-quality education helps refugee children feel safe in the present
and enable them to be productive in the future, some do not find success
in school. Other obstacles may include:
- Disrupted schooling - refugee children may experience disruptive
schooling in their country of origin, or they may receive no form of
education at all. It is extremely difficult for a student with no
previous education to enter a school full of educated children.
- Trauma - can impede the ability to learn and cause fear of people in positions of authority (such as teachers and principals)
- School drop outs - due to self-perceptions of academic ability,
antisocial behaviour, rejection from peers and/or a lack of educational
preparation prior to entering the host-country school. School drop outs
may also be caused by unsafe school conditions, poverty, etc.
- Parents - when parental involvement and support are lacking, a
child's academic success decreases substantially. Refugee parents are
often unable to help their children with homework due to language
barriers. Parents often do not understand the concept of parent-teacher
meetings and/or never expect to be a part of their child's education due
to pre-existing cultural beliefs.
- Assimilation - a refugee child's attempt to quickly assimilate
into the culture of their school can cause alienation from their
parents and country of origin and create barriers and tension between
the parent and child.
- Social and individual rejection - hostile discrimination can cause
additional trauma when refugee children and treated cruelly by their
peers
- Identity confusion
- Behavioral issues - caused by the adjustment issues and survival behaviours learned in refugee camps
Role of teachers
North American schools are agents of acculturation, helping refugee children integrate into Western society.
Successful educators help children process trauma they may have
experienced in their country of origin while supporting their academic
adjustment.
Refugee children benefit from established and encouraged communication
between student and teacher, and also between different students in the
classroom. Familiarity with sign language and basic ESL strategies improves communication between teachers and refugee children. Also, non-refugee peers need access to literature that helps educate them on their refugee classmates experiences.
Course materials should be appropriate for the specific learning needs
of refugee children and provide for a wide range of skills in order to
give refugee children strong academic support.
Educators should spend time with refugee families discussing
previous experiences of the child in order to place the refugee child in
the correct grade level and to provide any necessary accommodations
School policies, expectations, and parent's rights should be translated
into the parent's native language since many parents do not speak
English proficiently. Educators need to understand the multiple demands
placed on parents (such as work and family care) and be prepared to
offer flexibility in meeting times with these families.
A booklet published in 2000 written by Dr. Sheila and Dr. Dick
detailed the ways teachers can approach refugee children in school as
well as the common problems refugee children present with at school.
According to the booklet, refugees can come from traumatizing
situations and thus may struggle with school attendance, literacy, and
their cultural identity.
The problems are said to present themselves as anger, withdrawal,
issues with authority, concentration, rules, and other inappropriate
behavior. The booklet suggests that teachers address those issues by helping children manage their behavior and emotions.
According to Dr. Sheila and Dr. Dick, teachers can do so by knowing
what the children need, being supportive, and turning them to
specialists if need be.
According to a study by Dr. Strekalova, teachers in the United
States often have little experience with the trauma that refugees often
face. The study focuses on how teachers can educate themselves on their students’ situations.
The study encourages teachers to be aware of common behavioral problems
that refugee children may exhibit in the classroom like anger,
withdrawal, rule testing, problems with authority, inability to
concentrate, inappropriate behavior, lower academic achievement.
The study also notes how refugee children often exhibit this behavior
because they are put into a different cultural context, face discrimination,
live with families in low socioeconomic circumstances, have no family,
and/or have conflicts with their traditional cultural beliefs.
According to the study, teachers who understand these barriers refugee
children face and thus the inappropriate behavior they may exhibit can
help their students have a more positive school experience.
Academic adjustment of refugee children
Syrian refugee children attend a lesson in a UNICEF temporary classroom in northern Lebanon, July 2014
Teachers can make the transition to a new school easier for refugee children by providing interpreters.
Schools meet the psychosocial needs of children affected by war or
displacement through programs that provide children with avenues for
emotional expression, personal support, and opportunities to enhance
their understanding of their past experience.
Refugee children benefit from a case-by-case approach to learning,
because every child has had a different experience during their
resettlement. Communities where the refugee populations are bigger
should work with the schools to initiate after school, summer school, or
weekend clubs that give the children more opportunities to adjust to
their new educational setting.
Bicultural
integration is the most effective mode of acculturation for refugee
adolescents in North America. The staff of the school must understand
students in a community context and respect cultural differences.
Parental support, refugee peer support, and welcoming refugee youth
centers are successful in keeping refugee children in school for longer
periods of time.
Education about the refugee experience in North America also helps
teachers relate better with refugee children and understand the traumas
and issues a refugee child may have experienced.
Refugee children thrive in classroom environments where all
students are valued. A sense of belonging, as well as ability to
flourish and become part of the new host society, are factors predicting
the well-being of refugee children in academics. Increased school involvement and social interaction with other students help refugee children combat depression and/or other underlying mental health concerns that emerge during the post-migration period.
A 2016 study conducted by Dr.Thomas found that education helps refugee children feel socially included within their new culture.
For example, Dr. Thomas noted that education often provided a sense of
stability as well as support in developing language, cultural, and
technical skills.
Peace education
Implemented
by UNICEF from 2012 to 2016 and funded by the Government of the
Netherlands, Peacebuilding, Education, and Advocacy (PBEA) was a program
that tested innovative education solutions to achieve peacebuilding results. The PBEA program in Kenya's Dadaab refugee camp aimed to strengthen resilience and social cohesion in the camp, as well as between refugees and the host community.
The initiative was composed of two parts: the Peace Education Programme
(PEP), an in-school program taught in Dadaab's primary schools, and the
Sports for Development and Peace (SDP) program for refugee adolescents
and youth. There was anecdotal evidence of increased levels of social
cohesion from participation in PEP and potential resilience from
participation in SDP.
Peace education for refugee children may also have limitations and its share of opponents. Although peace education from past programs involving non-refugee populations reported to have had positive effects,
studies have found that the attitudes of parents and teachers can also
have a strong influence on students' internalization of peace values. Teachers from Cyprus also resisted a peace education program initiated by the government.
Another study found that, while teachers supported the prospect of
reconciliation, ideological and practical concerns made them uncertain
about the effective implementation of a peace education program.
Pedagogical Approaches
Refugees
fall into a unique situation where the nation-state may not adequately
address their educational needs, and the international relief system is
tasked with the role of a "pseudo-state" in developing a curriculum and
pedagogical approach.
Critical pedagogical approaches to refugee education address the
phenomenon of alienation that migrant students face in schools outside
of their home countries, where the positioning of English language
teachers and their students create power dynamics emphasizing the
inadequacies of foreign-language speakers, intensified by the use of
compensatory programs to cater to 'at-risk' students.
In order to adequately address state-less migrant populations,
curricula has to be relevant to the experiences of transnational youth.
Pedagogical researchers and policy makers can benefit from lessons
learned through participatory action research in refugee camps, where
student cited decreased self-esteem associated with a lack of education.
Haitian refugee children playing in the playground after school
An interventional study conducted by Dr. Kendall in California
documented that the main resources provided to refugee children and
their families fall under these categories: supplementary classroom
material, curriculum enrichment resources, videos for the goal or
increasing parent and school awareness, informational leaflets and
handbooks, as well as ICT based resources. The study also found that extracurricular activities provided by Los Angeles schools enhanced refugee student involvement in school life by reducing isolation.
Out of school activities provided by the school included after school
study programs that included clubs for homework, revision sessions, exam
preparation, and coursework completion.
According to the study, the extracurricular language, academic, and
social development support provided by the school yielded improvements
in the refugee children who attended. The study demonstrated that school staff could also support refugees by raising awareness of refugee culture.
For example, some schools in Los Angeles arranged celebrations,
assemblies, and cultivated a school environment that actively involved
the different cultures, languages and backgrounds of the refugees.
The study concluded that the actions of the school had an overall
positive effect on the attitudes and empathy of refugee children.
Additionally, an anthropological paper found that participation in
after school programs lead to increased self concept, high school
achievements, educational aspirations and interpersonal competence. As
vulnerable populations, marginalized by language, ethnicity, religion
and class, refugees can find support in community based organizations as
stated by that paper.
According to a study by Dr. Roxas, refugees often don't have
access to school programs that can meet their unique academic,
developmental, and social needs; thus, their integration into public
schools becomes difficult due to language, trauma, and lack of
counseling and extra academic services.
One extracurricular program that the study detailed involved bringing
in local community members to interact with the refugee children for the
purpose of exposing them to the real world.
According to the study, the program offers a means for refugee children
to receive support from community members while also learning about the
different types of communities.
A 2008 study by Dr. Kanu describes the school environment as a microsystem important to the acculturation of refugee children.
The study states that the inclusivity of schools can be improved by
increasing the cultural basis of recreational support, more diverse
cafeteria food, and prayer rooms for Muslim students.
In addition, teachers are encouraged to undergo training to increase
knowledge on refugees and thus adapt their curricula for this group's
benefit.
Dr. Pastoor's 2016 research article also detailed the benefits of
activities beyond school that may benefit refugee learning and social
inclusion.
For example, community wide collaboration between the school and
surrounding organizations can help refugee students achieve their full
potential. Dr. Wellman's and Dr. Bey's research in art education found that visual
arts may help refugee students find their own role in and out of school
through collaborations between museums, schools, and art exhibitions.
Dr. Brunick's paper also found that art served as a valuable
extracurricular tool for refugees to reconcile with psychological
trauma.
According to Dr. O’Shea's 2000 article, inside the school but outside
of the curriculum, school based mental health services have been shown
to reduce SDQ scores and dramatic positive implications to those exposed
to SES and traumatic adversities.
The study conducted by Dr. Thomas recommended training for school
social workers to help refugee children manage stress and trauma. Dr. Daniel's 2018 article found that refugee children can themselves use translanguaging
and social media to themselves complete their school work which
teachers and educators can build upon to help teens with this
multifaceted work.
A 2017 research paper also found that refugee children express their
individuality and culture through drawings, think-aloud techniques, and
Acculturation, Habits, and Interests Multicultural Scale for Adolescent
instrument in order them to cope with their transitions and express
their culture.
A research paper focused on policies put in place for refugees in
the school system indicated that refugees in Jordan often face
institutional discrimination where they don’t have the same access to
extracurricular activities.
According to the paper, funding for refugee education often comes from
an emergency fund leading to a lack in long term-planning, which can
lead to refugees being educated in separate schools and informal
community based schools. Iran has a policy including refugees into their
education system allowing refugees to join in the same extracurricular
programs.
As for extracurricular participation, a 2016 publication noted that
refugee children often have similar amounts of participation in most
extracurricular school activities; however, they are less likely to
participate in after school sports activities, attend day care, and
participate in a parent-child conference.
A 2011 review noted that schools alone do not provide enough support
for refugees and their cultural and linguistic needs. Thus the paper
suggests that secondary school programs like the Refugee Action Support
(RAS) program can benefit refugee literacy by creating a partnership of
schools and non-government organizations.
Programs
Dr.
Georgis's 2014 book offers another example of extracurricular support
for refugee children called involved Transition support programs.
The study suggests that this program offers classroom support for
English Language learners, after school activities involving
recreational activities and homework help, as well as parental support
that includes English as well as computer classes. In school services
include interpretation, translation, personal communication through
phone by the school to the homes, cultural mediation and advocacy.
The study concluded that cultural brokers who support refugee parents
foster a sense of belonging and support for refugee children as well.
A review on the refugee action support program created by a
partnership among the Australian Literacy and Numeracy foundation the
University of Western Sydney and the NSW department of education and
training found that RAS supported the educational goals of the schools
in Australia. For example, tutors provided assistance in completing assignments. RAS tutors also allowed for specialized support that teachers often did not have the time to provide.
Another supplemental school program is ACE.
A research paper analyzing ACE by Heidi Lynn Biron found that ACE
provides support for refugees who struggle with exclusion and school as a
result of their English skills and trauma.
A 2000 study by Dr. Zhou and Dr. Bankston found that while Vietnamese
refugees may do well in school academically, they may have psychological
strains that are often overlooked due to their academic performance. The study recommended peer support groups, so the children can share their stress with each other.
One 2007 research paper by Dr. Beirens detailed the Children's Fund
Service, a program involved in creating social bridges to reduce refugee
children social exclusion specifically by giving practical and
emotional support.
Disabilities
Children
with disabilities frequently suffer physical and sexual abuse,
exploitation, and neglect. They are often not only excluded from
education, but also not provided the necessary supports for realizing
and reaching their full potential.
In refugee camps and temporary shelters, the needs of children
with disabilities are often overlooked. In particular, a study surveying
Bhutanese refugee camps in Nepal, Burmese refugee camps in Thailand,
Somali refugee camps in Yemen, the Dadaab refugee camp
for Somali refugees in Kenya, and camps for internally displaced
persons in Sudan and Sri Lanka, found that many mainstream services
failed to adequately cater to the specific needs of children with
disabilities. The study reported that mothers in Nepal and Yemen have
been unable to receive formulated food for children with cerebral palsy
and cleft palates. The same study also found that, although children
with disabilities were attending school in all surveyed countries, and
refugee camps in Nepal and Thailand have successful programs that
integrate children with disabilities into schools, all other surveyed
countries have failed to encourage children with disabilities to attend
school. Similarly, Syrian parents consulted during a four-week field assessment conducted in northern and eastern Lebanon
in March 2013 reported that, since arriving in Lebanon, their children
with disabilities had not been attending school or engaging in other
educational activities.
In Jordan, too, Syrian refugee children with disabilities identified
lack of specialist educational care and physical inaccessibility as the
main barriers to their education.
Likewise, limited attention is being given to refugee children
with disabilities in the United Kingdom. It was reported in February
2017 that its government has decided to partially suspend the Vulnerable
Children's Resettlement Scheme, originally set to resettle 3,000
children with their families from countries in the Middle East and North
Africa. As a result of this suspension, no youth with complex needs,
including those with disabilities and learning difficulties, would be
accepted into the program until further notice.
Countries may often overlook refugee children with disabilities
with regards to humanitarian aid, because data on refugee children with
disabilities are limited. Roberts and Harris (1990) note that there is
insufficient statistical and empirical information on disabled refugees
in the United Kingdom.
While it was reported in 2013 that 26 percent of all Syrian refugees in
Jordan had impaired physical, intellectual, or sensory abilities, such
data specifically for children do not exist.
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