Dimitris Anagnostopoulos, Johannes Hebebrand, Stephan Eliez, Maeve B Doyle, Henrikje Klasen, Sofie Crommen, Fusun Cetin Cuhadaroglu, Milica Pejovic-Milovancevic, Oscar Herreros, Ruud Minderaa, Andreas Karwautz, Carl Goran Svedin, Jean Philippe Raynaud
Flight and migration are not new phenomena, and many countries in Europe and the Middle East have been experiencing the recent refugee/migration wave. The number of refugees coming to Europe has currently reached staggering proportions in some countries, and it is, to some degree, unpredictable as to what extent, and in which countries, this influx will increase or decrease. The brunt of the refugee influx has been borne by those countries in eastern, southern, middle, and northern Europe that the refugees travel through and finally settle in. A successful – medium- and long-term – integration is fraught with uncertainty due to the possibility of refugees returning (or having to return) to their home countries and the potential development of tensions between subgroups of both the refugees and the local and/or national populations.
In the EU-28 (total population: 508 million inhabitants), first-time asylum applicants in 2015 were 1,255,688, 29% of whom were minors (19 % < age 14; 10 % between 14 and 17 years). Indeed, the numbers of asylum applicants do not capture the scope of the problem, since a large proportion of those fleeing or migrating from conflict zones opt for a residence permit or refuse to apply for either option.
The high prevalence of physical disorders and nutritional deficiencies among young refugees warrant attention, and provision of somatic health care represents a major concern particularly during the flight and upon arrival at the country of settlement.
Child and adolescent refugees are exposed to many risks pre-flight, during their flight, and upon arrival, which make them also vulnerable for the development of psychiatric disorders, such as post-traumatic stress disorder (PTSD), anxiety disorders, mood disorders or externalizing disorders.
The pre-flightexperiences of young refugees depend on their country of origin; exposures to poverty, war, or war-like conditions are common. Also, the acquired education, social status, familial, religious, and sociocultural values also shape coping and help-seeking behaviour.
The flight in itself can be traumatic or compound trauma via, for instance, separation experiences, sexual abuse, and trafficking including forced labour and sexual exploitation. In this context, it should be pointed out that many unaccompanied underage refugees attempt to travel in groups, which include adults known to them; in many cases, the parents of unaccompanied children and adolescents are aware of their travels. To allow for better protection of such young refugees, it would seem helpful not to totally separate underage refugees from such groups.
The arrival in the hosting country entails risks due to unsafe or otherwise problematic living conditions, non-access to schooling, years of insecurity with uncertain legal and residential status, multiple moves, parental illness and unemployment, social exclusion, and in the medium- and long-term maladaptation with respect to the cultural norms of the hosting country. Hostility toward foreigners and refugees, in particular, represents a threat that requires both surveillance of refugee camps and political education within the hosting country. Within this context, the initial provision of a safe environment to traumatized young refugees should not be taken for granted. Moreover, even once migrants have settled and formed families, their children, the second-generation migrants, have an increased risk for mental health problems.
European attitude toward young refugees and their families will greatly determine the burden of trauma, not only on their adult future but also on our community. An empathic and mentalizing attitude, secure sheltering, addressing health and educational needs will create a sense of stability and confidence. This is the very first step to favour, for these future adults and their families, either a productive integration in the European heritage of strength and diversity, or the potential to rebuild and stabilize their native countries for those who will return.
ESCAP Call for Action
European attitude toward young refugees and their families will greatly determine the burden of trauma and attachment disorders, not only on their adult future but also on our community. An empathic and mentalizing attitude, secure sheltering, addressing health and educational needs will create a sense of stability and confidence. This is the very first step to favour, for these future adults and their families, either a productive integration in the European heritage of strength and diversity, or the potential to rebuild and stabilize their native countries for those who will return.
ESCAP for mental health of child and adolescent refugees,
posted June 27th 2016
Original ECAP journal editorial, July 2016 (pdf, 4 pages).