Living in the Shadows: Refugee children show resilience despite horrors at home

The reaction to the Living in the Shadows project has been tremendous. And more than one informed reader has recommended we take a look at the Resilience of Refugee Children After War report put together by the American Psychological Association. I read it this week and recommend it to everyone who cares about these issues. The football season is over. Baseball doesn’t start until the end of March. Find a comfy chair and enjoy a comprehensive assessment of decades of research into the psychological effects of the refugee experience. Here are three key points to look for.

War is just the beginning. We often read and write about what people experience during a traumatic event like a war or natural disaster. The researchers found that the pathway out of the disaster zone can be just as mentally taxing. Where possible, I’ve added hyperlinks to the research papers that are cited by the APA.

In addition to direct exposure to violence and dangerous conditions from warfare, the experience of displacement and flight from their country of origin presents additional risks and threats to the safety of these children. Refugee children often experience secondary traumatic events associated with displacement, including loss of community and family, limited resources to meet basic needs (e.g., food, water, housing), health risks, lengthy and dangerous journeys to safety, and interim or long-term shelter without adequate resources (for summary, see Lustig, Kia-Keating et al., 2004). Children who experience forced migration are often separated from their family during their journey or may have already lost family members to armed conflict (Lustig, Kia-Keating et al., 2004). Their journey can be circuitous and haphazard and may involve travel across borders to one or more countries before resettlement. Living conditions along the way are substandard at best and dangerous at worst (United Nations, 2007). For example, millions of children and families are placed in refugee and internally displaced persons camps where they often struggle with basic survival and safety needs. In addition to limitations of access to food, water, shelter, and medical treatment, these camps can present their own set of hazards and safety risks including crime, rape, and ongoing violence (Machel, 1996; Wessells, 1997).

Gender leads the way on determining recovery path. The report shows what you might have anticipated, that girls are more likely to experience sexual violence during a war and that boys are more likely to be shot, killed or recruited as child soldiers. Once they are resettled, their genders also help determine their psychological experiences in their new home. The researchers write:

Resettled girls may experience more family pressures related to changes in family roles, acculturation, and sexual norms (Warikoo, 2005). For example, in many cultures girls play central roles in caregiving and household duties (Suárez-Orozco & Suárez-Orozco, 2001; Warikoo, 2005). These roles and norms may create tension when a family is resettled in the United States, where expectations can exist for girls to attend school regularly, pursue higher education, and work outside the household (Vasquez, Han, & De las Fuentes, 2006). Tension may also develop for immigrant girls navigating American adolescent activities such as dating, which may conflict with their family or cultural expectations (Suárez-Orozco & Suárez-Orozco, 2001). In response, families may monitor the activities of their female children more closely. However, restrictions imposed by families, as well as the cultural affiliation demonstrated by girls’ close connection to their families, may in fact serve a protective role for refugee and immigrant girls (Suárez-Orozco & Suárez-Orozco, 2001). By enacting the roles and duties within their homes and families, girls may exert and maintain a strong sense of cultural identity (Warikoo, 2005). For example, parental monitoring and girls’ adherence with parental expectations may explain immigrant girls’ higher educational achievement as compared to immigrant boys in the United states (Portes & Rumbaut, 2001).

Trauma is difficult to measure. Anyone who has spent a little time with the literature on trauma will have seen reference to the “dose effect,” which usually means that if a person is exposed to more war, more violence, more trauma from a natural disaster that the person will suffer from more severe mental and behavioral problems. The researchers from the APA found that this theory doesn’t fully capture the experiences of children recovering from war.

This dose-effect relationship between war trauma and psychopathology—i.e., the finding that more frequent and severe trauma exposure leads to worse psychological outcomes—only partially describes the experience of war-affected children, many of whom demonstrate high levels of resilience and do not develop enduring patterns of distress (Bonanno & Mancini, 2008). Further, the dose effect cannot fully explain the complexity associated with the type or impact of specific traumas on individuals at different phases of their lives. For example, the experience of even one incident of sexual trauma in the context of war may constitute a profoundly traumatic and life-altering event for girls in terms of the impact on their worldview, relationship to their communities, and functioning.

There are many specific recommendations in the report for clinicians, for researchers and for people working closely with refugee communities. So what should reporters do with all of this? I think it starts with the first interview. We so often try to take people back to the scene of the crime, so to speak, which makes sense. But in the case of people who have experienced traumatic events, our interviews may add to the trauma. This doesn’t mean that we don’t ask questions, but it does mean that we should understand more about the war experience and the recovery-from-war experience to help us learn how to ask questions and when to back off.

During one of the interviews for our series, a refugee explained to a reporter that even her asking questions about what he went through was likely to cause painful nightmares. Also, our focus should shift from what happened in the past to what is happening now. I think we have done a great job on this front in the Living in the Shadows series. We are trying to document the immigrant experience as it intersects with health in many different ways. For us, the story really starts after the person was resettled in the United States, crossed the border, or lost a parent to deportation.

Have your own thoughts on how to cover these issues? Share them via Twitter @immighealth.

Image by DFID via Flickr