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Services for Affected Populations

Refugee camps, while affording some protection from the upheaval caused by conflict, offer little else. The camps often do not have adequate sanitation, food, or medical care. While groups such as the United Nations and the International Rescue Committee attempt to meet people’s needs, there are always more people than money or ability to help them, causing supplies to be inadequate. The close quarters and aforementioned lack of access to adequate health care, food, or water cause disease to be rampant. Diseases such as malaria, diarrhea, and typhoid become common in refugee camps, raising mortality rates, especially in children (Meleigy, 2010; Zwi et al., 2006). Support for the deleterious mental health consequences is extremely limited, if available at all.

The limited supplies may also not reach the people who need them due to denial of humanitarian access by combatants. In some areas, combatants will refuse to allow resources such as food or medicine to reach civilians affected by the conflict, exacerbating the situation. For example, in a region of Somalia, a blockage of humanitarian access by rebels affected 3.5 million people who were also dealing with famine. In Syria, hospitals were attacked by government forces; medical workers were threatened for suspicion of having provided medical care to the opposition (United Nations Security Council, 2012a).

In some cases, refugees are unable to return to their home country and are assisted with resettlement in a new country. The United

States accepted the highest number of refugees for resettlement in 2011: 51,500 (UNHCR, 2012). However, the new laws created as a result of the attack in the United States on September 11, 2001, have reduced the number of refugees eligible to resettle in the United States. The Patriot Act and the Real ID Act both ban entry to the United States to anyone who belongs to, or has provided material support to, armed rebel groups. This requirement does not vary if the rebel groups fought alongside US troops or opposed governments to which the United States government was opposed, or if the group is not considered to be a terrorist organization. This has created great difficulty for Iraqis and Afghanis who have worked for the US government while US troops were in the country. Once the troops leave the country, those who assisted them are typically targets for the opposition. However, they are frequently prohibited from being granted refugee status within the United States for having fought against the previous government. As of late 2012, visas for only 50 of the 6,000 Afghan interpreters had been approved (Sieff, 2013).

While all immigrants to a new country face challenges in adapting to a new culture, refugees and asylum seekers face special barriers (Suarez-Orozco, 2001). They have not chosen to leave their home country but were forced to migrate. All that was familiar and comfortable has been lost. There is often an economic impact, as professionals in their home country are often not granted equivalent status in their new country and may be forced to work multiple low-wage jobs for economic survival, resulting in financial stress as well as emotional stress from the loss of status. For example, Italy grants asylum to a fairly high number of applicants (40%-50%); however, there is a lengthy waiting list to receive support in resettlement. This leaves refugees to figure out the school systems, health care, and how to find employment on their own or with volunteers (Povoledo, 2012).

Asylum-granting countries within the Global North often have very different cultures than those from which the refugee is fleeing. These cultural differences, including differences in the treatment of women and expectations of children, can create strife within the family as some family members become more acculturated than others. Refugees who look different from the majority in the host country may experience discrimination (Suarez-Orozco, 2001).

Because they have been granted the status of refugee, it can typically be assumed that they have suffered trauma. The trauma may have been inflicted upon them or upon those dear to them and often results in long-term psychological impacts. Basic trust in humankind has often been lost, and survivors will be mistrustful, especially of those in positions of authority. This group may also have suffered torture, and this should be assessed. Engstrom and Okamura (2004) note that the experience of torture often goes undocumented, and the unaddressed trauma can cause problems for the individual and family.

Women can experience unique impacts. If resettled in a Western nation, they are often expected to become economically independent, including being able to get around by themselves. Due to their experiences in their home country, they may not have had the opportunity to get an education, learn to drive, or develop employment skills, which can inhibit their ability to become self-sufficient in their new country. They may not feel comfortable going out by themselves or understand the day care system (Deacon & Sullivan, 2009).

Youth who migrate with their families may have a difficult time adjusting. Although they have the support of their families, there may be tensions with their parents as they try to adapt to the new culture. These children may wish to fit in with their peers, yet their parents may desire that they maintain their native culture and values. Furthermore, there will often be financial difficulties in the new country because working parents are typically not able to obtain employment at their previous level from their home country. Parents can also be coping with their own trauma and adjustment issues and may not be available as a support for their children. Xenophobia in the new country may also be a barrier to successful adjustment. Children’s education can also be affected if they do not speak the language of the new country or if schooling is at a different grade level than it would be in their home country. Refugee children may also be bullied by other children (“No school today,” 2012).

Children who arrive as unaccompanied minors have additional issues, including the impact of trauma-related mental health issues. Living in a state of fear can create permanent trauma for children if it is not addressed. The separation from parents can exacerbate this trauma. Children who arrive unaccompanied are more likely to have higher levels of trauma and stress than those who arrive with family (Barrie & Mendes, 2011). Children can overcome this trauma, but it requires culturally sensitive care, including supportive caregivers and a secure community (Machel, 2001). They may also be dealing with uncertainty about their legal status within the country. In the United Kingdom, about half of this population is permitted to remain only until their 18th birthday (Barrie & Mendes, 2011).

Even if these children are granted refugee status, the difficulties for these children are not yet over because they then face the stress of acclimating to a new country, a new culture, and often a new language. In some cases, symptoms of PTSD do not start developing until 8-10 months after resettlement as they become comfortable in their new surroundings and begin to process the trauma to which they have been subjected (Schmidt, 2005). In addition, they frequently have the stress of concern for those who have remained behind and are still in danger (Cambridge & Williams, 2004). They must also cope with concerns around basic needs. It was found that in Scotland that unaccompanied children were sometimes placed in homeless shelters. In other cases, they were housed for extended periods of time in hotels, which left them isolated and unable to cook for themselves. This is an important need for children who miss the food of their native culture or have dietary needs, such as Muslim children who require halal meat (Hopkins & Hill, 2010).

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