case study about refugees

When re-using this resource, please attribute as follows: developed by Susanne Beilmann (The School of Public Policy and Global Affairs ) at the University of British Columbia.

Case Studies

Since late 2015, we have studied the refugee crisis in Europe and the Middle East. In this page, we present three case studies in three different cities in Germany. Refugees are everywhere in Germany, even in smaller towns and villages. The case study cities are at different scales and include Borken (15,000 people), Kassel, a mid-size city (200,000), and Essen, a larger city (600,000) which is part of the still larger Ruhr Area Megacity. In these cities we try to understand the life of refugees from their original escape city and country to their arrival in these new communities. Our research focuses on the social-spatial aspects of refugee experiences, and the impacts on urban morphology and building typology. We also try to understand how refugees manage their new life in partial safety of place, shelter, food and financial support, but also in uncertainty and insecurity until officially accepted as refugees. Beyond crisis, we are looking at how refugees can and will try to integrate into their host countries, cities, and neighborhoods and start a new life. Urban architecture projects for housing and work opportunities that help the process of integration are part of this study. Particularly, we investigate the reality on the ground of the positive Wilkommen Kultur (welcome culture) and the high expectations and implied promises that were set in 2015 by Angela Merkel and German society.

Case study by Professor Hajo Neis, Briana Meier, and Tomoki Furukawazono has been published on the “ Urban Planning ” (ISSN: 2183-7635). https://www.cogitatiopress.com/urbanplanning/article/view/1668

Neis, H., Meier, B., & Furukawazono, T. (2018). Welcome City: Refugees in Three German Cities. Urban Planning , 3(4), 101-115. doi: http://dx.doi.org/10.17645/up.v3i4.1668

Population: 582,614 (2015.12.31)

Refugee Population 2015: 4,391 (new) 2016: 4,125 (new) total: approx. 20,000

Refugees in Essen https://www.essen.de/leben/fluechtlinge_1/fluechtlinge_in_essen.de.jsp

Kassel County

Population: 235,813 (2015.12.31)

Refugee Population total: approx. 1,500

Refugees in Kassel County http://www.landkreiskassel.de/cms09/bildung/fluechtlingshilfeLKKS/Unterbringung/

Refugee Population total: approx. 200

Refugees in Borken http://www.borken-hessen.de/cms/B%C3%BCrgerinfo/Bekanntmachungen/Kommunales%20Aktuell/Fl%C3%BCchtlingsarbeit%20in%20Borken%20sucht%20und%20braucht%20weitere%20Helfer.cshtml

An official website of the United States government

The .gov means it’s official. Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

The site is secure. The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

• Publications
• Account settings

Preview improvements coming to the PMC website in October 2024. Learn More or Try it out now .

• Advanced Search
• Journal List
• Health Equity
• v.5(1); 2021

Cultural Competence in Refugee Service Settings: A Scoping Review

Ling san lau.

1 Program on Forced Migration and Health, Heilbrunn Department of Population and Family Health, Mailman School of Public Health, Columbia University, New York, New York, USA.

Graeme Rodgers

2 International Rescue Committee, New York, New York, USA.

Purpose: Refugees and asylum seekers have unique and complex needs related to their experiences of forced displacement and resettlement. Cultural competence is widely recognized as important for the provision of effective and equitable services for refugee populations. However, the delivery of culturally appropriate services—including health care and social services—is often complicated by unclear definitions and operationalization of cultural competence. Further, the unique needs and priorities of people from refugee backgrounds are under-addressed in the cultural competence literature. This scoping review seeks to synthesize the peer-reviewed literature examining cultural competence in refugee service settings.

Methods: A systematic search of four databases (EBSCO, Proquest, Scopus and Google Scholar) identified 26 relevant peer-reviewed studies for analysis.

Results: A range of approaches to cultural competence were identified at the level of individual providers and organizations.

Conclusion: We identified a need for greater refugee participation and perspectives in the practice of cultural competence, increased conceptual clarity and greater recognition of structural barriers. We call for further rigorous research that critically examines the concept of cultural competence and its meaning and relevance to refugee populations.

Introduction

Refugees and asylum seekers include persons who have fled their countries due to war or persecution. In common with other marginalized populations, they experience challenges accessing services that address their individual and cultural needs. Cultural competence is widely recognized as a critical component of effective and equitable service delivery 1 and has been proposed to reduce health disparities and improve access to services, including health care, social services, employment, and education. 2 Service providers are often the first point of contact for resettled refugees and play a critical role in helping them to adjust to life in a new country. 3 However, cultural competence approaches in refugee service settings continue to be limited by a lack of clear definitions and operational guidance, and insufficient attention to the unique challenges faced by people from refugee backgrounds. 1 , 4–6

There is considerable variation and inconsistency in the definition of cultural competence. 7 , 8 One frequently cited definition describes cultural competence as:

a set of congruent behaviors, attitudes, and policies that come together in a system, agency or among professionals and enables that system, agency or those professionals to work effectively in cross-cultural situations. 9 (p13)

Cultural competence has also been defined in health care settings as:

the ability of systems to provide care to patients with diverse values, beliefs and behaviors, including tailoring delivery to meet patients' social, cultural, and linguistic needs. 10 (p5)

Furthermore, Sue et al. 11 described three attributes of culturally competent service providers—cultural awareness, cultural knowledge, and cultural skills—which have been replicated in several cultural competence models. 8

The notion of cultural competence, as expressed in service settings, has been critiqued in the literature. 1 , 6 Hwang et al., for example, noted that “professionals who want and need to be culturally competent are left with the message that culture matters, but continue to struggle with how to be a more culturally competent practitioner in concrete terms.” 5 Compounding the lack of conceptual clarity and operational guidance, 1 , 6 cultural competence approaches have also been criticized for overemphasizing cultural traits and differences; conflating culture with ethnicity, nationality, or language; and reducing complex human behavior and experience to cultural stereotypes. 1 , 6 Furthermore, the term “competence” is increasingly being rejected, as it implies a technical endpoint or solution, rather than an enduring process and commitment. Alternative concepts have emerged, including cultural safety, which draws attention to power dynamics, institutional discrimination, and issues of colonialism and paternalism in health care. 12 A related construct, cultural humility, requires three commitments from practitioners: (1) self-reflection and critique; (2) action to redress power imbalances; and (3) partnerships with advocates. 13 Ethnographic approaches highlight what is most important to individuals, as culturally situated subjects, without essentializing culture or assuming it is the most critical factor in a given case. 6 , 14

Cultural competence has been studied most extensively in the health field, where interventions have been demonstrated to improve health care providers' knowledge, understanding, and skills when caring for patients from multicultural backgrounds. 15–19 However, the evidence for improved clinical outcomes and health disparities is weak. 8 , 19 A 2015 systematic review found a lack of evidence of impact of cultural competence on outcomes including health status, treatment adherence, equity, and quality of services. 8

While attention to cultural competence has expanded to consider the needs of increasingly diverse populations, 1 there is limited research that specifically examines the cultural competence of services for refugee and asylum seeker populations. We identified no published reviews that synthesize the literature on this subject and recognize refugees as a distinct population with unique needs that may differ from other immigrant populations. 20 Despite their diverse cultural backgrounds and nationalities, refugees and asylum seekers often share common experiences, including trauma, torture, the loss or separation of family members, the hardships of flight, as well as stigma, discrimination, social isolation, financial insecurity, and protracted asylum determination processes. 2 , 21–23 Studies suggest that refugees and asylum seekers may have a greater need than the general population for certain services, including mental health services, yet they access these services at lower rates. 24 , 25 Recognizing the unique backgrounds and needs of refugee populations, this scoping review synthesizes the literature on cultural competence in refugee service settings.

This study did not require institutional review board approval. A scoping review was conducted in May 2020, guided by Arksey and O'Malley's framework. 26 This methodology is appropriate for examining and clarifying broad research questions and synthesizing evidence across disciplines to inform practice. 26 , 27 An iterative search strategy was guided by the research question:

How does the peer-reviewed literature describe cultural competence in relation to services for refugee and asylum seeker populations?

Primary search terms, as summarized in Table 1 , were entered into four databases (EBSCO, ProQuest, Scopus, and Google Scholar), without date limits or restrictions based on geographic setting. The search strategy and review of titles and abstracts yielded 73 original records that were screened further for eligibility. Of these, 55 articles were selected for full-text review; 2 articles were excluded as only abstracts were available. A total of 26 articles met the inclusion criteria ( Table 2 ). Eligible literature included peer-reviewed articles published in English that examined cultural competence as it related to refugee or asylum seeker populations. Gray literature and records that did not explicitly include refugees or asylum seekers were excluded.

Primary Search Terms

Inclusion and Exclusion Criteria

All articles that met the inclusion criteria were uploaded and analyzed by the primary reviewer using Dedoose Qualitative Software (2018). Information on study characteristics was extracted and tabulated, and key qualitative themes were derived by thematic analysis. A second reviewer independently reviewed a subset of articles to validate emerging themes and study characteristics. Key themes were discussed and agreed upon by both reviewers.

Table 3 summarizes the characteristics of the 26 articles examined, including 13 qualitative studies, 7 discussion papers, 3 mixed methods studies, 2 reviews, and 1 quantitative study. Twenty-one studies considered refugees, 2 examined asylum seekers, and 3 included both groups. Among the 15 primary research studies, 8 considered service providers, 3 considered refugees or asylum seekers and 4 considered both populations. Only five studies addressed refugee perspectives directly. 21 , 22 , 28–30 Four of these also explored provider perspectives, typically in greater numbers than refugee participants; and only one author reported validating the research findings by consulting refugee participants. 22 The 23 articles that specified study setting were based in the United States ( n =14), Australia ( n =4), the Netherlands ( n =2), England ( n =1), Canada ( n =1), and Scotland ( n =1). An additional two reviews 31 , 32 drew from studies conducted across several high-income countries. Of the six articles that specified the country of origin of refugee participants or service recipients, 24 countries were represented, with Iraq ( n =4), Somalia ( n =4), Cambodia ( n =3), the Democratic Republic of the Congo ( n =3), Bhutan ( n =2), Bosnia ( n =2), Burundi ( n =2), Burma ( n =2), and Sudan ( n =2) mentioned most frequently.

Characteristics of Included Studies ( n =26)

The majority of studies (23) focused on health care settings, including health care in general ( n =6), mental health care ( n =5), primary care ( n =4), nursing ( n =3), social work ( n =2), maternal and child health ( n =1), internal medicine ( n =1), and infectious diseases ( n =1). Five studies referred to social service settings, including refugee resettlement services ( n =2), home safety services ( n =1), and other social services ( n =2).

The following section summarizes key findings and themes that emerged from the literature, informing both individual and organizational levels of practice.

Individual-level themes

Self-awareness and respect for cultural diversity.

Self-awareness and respect for cultural diversity were identified in the literature as important components of cultural competence. 2 , 22 , 23 , 33–35 Refugee service providers may demonstrate self-awareness by critically evaluating their own culture, beliefs, biases, and values and how they influence interactions with refugee clients. 33 Self-awareness may also involve assessing one's own culture, race, ethnicity, gender, and class in relation to refugee clients 23 and recognizing power imbalances. 36 Self-awareness can help providers to avoid making assumptions, generalizations, stereotypes, or judgments about other cultures. 2 , 22 One study highlighted the importance of communicating honestly and openly with refugee clients and co-workers about cultural differences, 37 with another 29 arguing that “acceptance of a diverse range of health beliefs, rather than an emphasis on difference, is fundamental to the delivery of culturally competent community nursing care” for refugees. Recognizing one's limitations was another element of self-awareness described in the literature, including seeking guidance from senior colleagues or referring a client to more appropriate or specialized services. 4

Knowledge of refugee cultures, home countries, histories, and experiences

Cultural knowledge, including knowledge of refugees' cultural and religious beliefs and practices, ethnic identities, and languages and dialects, was highlighted in several studies, often by refugee participants. 4 , 4 , 20 , 23 , 33 , 38 , 39 Refugees in an upper Midwestern U.S. state emphasized that it was important for U.S. and local service providers to understand the cultural norms of their community, including gender norms and religious beliefs. 40 Somali and Bosnian refugees in Maine encouraged social service providers to learn about their cultural contexts, home countries, and refugee experiences, and to connect on a human level. 22

Experts and providers demonstrated appreciation of the unique experiences of refugees and asylum seekers, 39 including knowledge of refugee experiences and journeys, 4 , 20 , 23 social, historical, and political contexts in home countries, as well as conflicts and juridical systems. 4 , 23 , 33 For example, nurse practitioners working with asylum seekers in the Netherlands wove their knowledge of different stages of flight into health assessments of asylum seekers: considering that bone fractures may have resulted from torture or that the stress of asylum procedures and living conditions during resettlement may impact mental health. 4 One provider recognized that knowledge of ethnic conflict or tension was imperative to identify appropriate interpreters for refugee clients, beyond a simple language match. 4 Several studies highlighted challenges of learning about clients' cultures and backgrounds, including time pressures and highly diverse client caseloads, with some providers developing strategies to obtain targeted knowledge relevant to the services they delivered. 4 , 20 , 30 , 36 , 39 , 41 Other studies highlighted the complexity and diversity of refugee communities and the importance of testing and contextualizing understandings of cultural knowledge. 2 , 22 , 34

Respectfully engaging refugee clients

Service providers considered respectful engagement of refugee clients critical for advancing cultural competence. 4 , 20 , 30 , 33 , 40 , 41 Listening was identified as especially important, which also required attention to unequal power dynamics in refugee–provider relationships. 22 , 38 Providers were also mindful of refugees' past traumatic or negative experiences and emphasized the importance of building trust and rapport and creating a safe environment. 4 , 30 , 35 , 41 Approaches to facilitating trust included listening to refugee clients' concerns and priorities, ensuring continuity of service provision, exploring and managing clients' expectations of services, and clarifying the roles of providers. 20 Honest discussions about ethical obligations, including the rules and limits of confidentiality, and services and systems in resettlement countries were also suggested as important for cultural competence. 20 For example, nurse practitioners highlighted the value of explaining the health care system and its separation from the immigration system to asylum seeker patients, clarifying that they had no role in organizing entry to the Netherlands and would not share confidential health information with officials assessing immigration matters. 4

Sensitivity to difficult topics, including torture and trauma, was recognized as a crucial aspect of cultural competence with refugees. 4 , 39 For example, nurse practitioners reported prefacing certain questions with a statement, “I am going to ask some questions that may be painful” 4 and recognized that apparently routine questions regarding a person's marital status or children may be distressing for refugees who have lost or been separated from family members. Respectfully challenging unsafe or harmful practices, including gender-based violence and female genital cutting, was identified as an important but difficult skill for refugee service providers. 29 , 34 , 39

Services that recognize the “whole person,” including their spiritual and social needs, were highlighted as important elements of respectful engagement. 21 , 35 , 38 , 42 Refugee participants who received social services in an upper Midwestern city in the United States appealed for service providers to “be human” and to engage with empathy and respect. 22

How about if you are the one who left this beautiful country and went to another country with a new culture, new language, new everything, how would you feel? Emotionally already it's disaster inside. You are adjusting, you want to know the language, you are struggling to get yourself together. Before you do that, if you see some people mistreating you, it interrupts your mind. It's like, ‘whatever I try it's not working.’ 22(p190)

Organization-level themes

Organizational commitment to diversity and cultural competence.

Organizational commitment to cultural competence, particularly at leadership levels, was considered critical for enabling the cultural competence of mental health practitioners in Victoria, Australia. 33 Strategies at the organizational level include improving organizational policies and practices based on employee and client evaluations 33 and demonstrating commitment to staff diversity. The latter may be promoted by hiring bicultural and bilingual staff and ensuring that personnel policies, human resources practices, and staff compensation packages are fair and inclusive. 21–23 , 31 , 33 , 38 , 43 , 44 Flexibility in organizational policies and procedures, lower caseloads, and sufficient staffing can also enable providers to support refugee clients' needs in a more culturally sensitive way. 22 , 41 , 42

Cultural competence training was widely recognized as a method of promoting cultural competence among refugee service providers. 21 , 22 , 29 , 31 , 31 , 33 , 39 , 45 Several cultural competence training programs for medical students, medical residents, social workers, and nursing students working with refugees were described in the literature. 28 , 36 , 45 , 46 These were generally positively evaluated by provider participants; however, only one study sought the perspective of a single refugee participant. 28

Handtke et al. reported a number of organization-wide cultural competence initiatives, 31 including the “Sick-Kids Cultural Competence Initiative” at the Hospital for Sick Children in Canada, which trained more than 2100 hospital staff as cultural competence champions. One positive impact was the increased use of in-person and telephone interpreter services in the hospital.

Engaging and partnering with refugee communities

Partnerships between service organizations and refugee communities can facilitate cultural competence and provide mutual benefits to providers and refugee clients. 20 , 21 , 31 , 33 , 35 , 41 , 43 , 44

Ethnic communities may have the advantage of offering more culturally appropriate support to refugees, but lack knowledge of signs and symptoms of trauma; more formal systems may have greater access to information about mental health, while struggling to offer support that is culturally congruent or appropriate. 35(p30)

Kaczorowski et al. 20 reported that strong partnerships between mental health clinics, schools, and refugee-serving agencies improved the cultural competence of mental health services for refugees, increased trust in and engagement with clinical services, and reduced barriers to treatment. Other mental health providers reported similar positive effects from cultivating relationships with refugee communities. 33

Refugees can foster linkages between communities and service organizations by acting as cultural brokers. 21 , 31 , 34 , 38 In Australia, refugee mentors from Karen/Burmese, Assyrian/Chaldean, and South Sudanese backgrounds worked effectively with refugee families to access early childhood services. 21

Engaging family members and other community members (including community leaders and traditional healers) in service interventions, where appropriate and desired by refugee clients, may also improve cultural competence and acceptance of services. 21 For example, in Chicago, a family-centered mental health intervention for Bosnian refugees with post-traumatic stress disorder engaged family members and bicultural refugee facilitators from the Bosnian community. 23 Other studies have highlighted organizational flexibility and accommodation of the routines and rhythms of everyday life of the participating community. 40 Finally, some sources recommended attention to power dynamics and the need to ensure greater participation of refugees in defining and operationalizing cultural competence; and planning, designing, and evaluating policies, programs, and interventions. 21 , 37 , 43

Integrating clients' language and culture into services

Integrating clients' language and culture into services was a common approach used to strengthen organizational cultural competence. Professional interpreter services were the most frequently cited examples of this. 20–22 , 31 , 33 , 38–42 , 46 There was a consensus that professional interpreter services were preferable to relying on family members, friends, or other staff members, due to issues of privacy, quality, and ethics. However, several barriers to using professional interpreters were identified, including cost and time constraints and limited availability of interpreters, particularly for rare languages. 29 , 39 , 41 Several providers, including medical students, doctors, and social workers, highlighted the critical role of interpreters as cultural guides who improved the quality of interactions with refugee clients through triangulated discussion and constructive feedback. 20 , 40 , 46

Some studies recommended the provision of linguistically and culturally appropriate verbal, written, and visual material across the service continuum, including during scheduling, reception, appointments, referrals, and follow-up; providers believed that this improved engagement with and retention in services. 21 , 31 , 43 Incorporating culturally appropriate terms and concepts into services may also improve organizations' cultural competence. For instance, a culturally sensitive program for Southeast Asian refugees in Long Beach, California, used cultural brokers and integrated Southeast Asian concepts of pregnancy, birth, and health into clinical practice. 38 The use of culturally adapted or cross-cultural assessment tools, such as the Refugee Health Screener-15 (RHS-15) for emotional distress 47 and the Cultural Formulation Interview, 48 may also be helpful.

Addressing barriers to access

Assisting refugee clients to overcome barriers to access was described as important for advancing cultural competence. 20 , 30 Flexible models of service delivery were commonly described in the literature. 21 , 38 , 39 , 41 , 42 , 43 For example, a refugee health nurse modified her appointment times to fit the bus schedule used by many of her refugee patients 21 ; refugee health clinics in the United States and Australia offered flexible drop-in hours with interpreters available 41 , 21 ; and a North Texas clinic reported higher treatment completion rates among Muslim refugee patients after providing after-dusk home delivery of tuberculosis medications during Ramadan. 49 Integrating or colocating services that were commonly used by refugees, such as English lessons, employment assistance, food assistance, or primary care services 21 , 38 , 39 ; providing transportation assistance 38 , 41 , 44 ; offering home visits, school programs, and other community-based services 20 , 42 ; facilitating appointments and referrals 21 ; and using telemedicine and digital technologies 31 were also identified as facilitators. While many providers endeavored to be flexible and responsive to refugees' needs, they discussed the constraints of inflexible policies, procedures, and rules imposed by their organizations.

This scoping review of 26 peer-reviewed articles identified a range of approaches to cultural competence in refugee service settings, generally described at individual and organizational levels. At the individual level, self-awareness and respect for cultural diversity; knowledge of refugee cultures, journeys, and experiences; and respectfully engaging with refugee clients were emphasized. At the organizational level, a commitment to cultural competence and diversity; engaging and partnering with refugee communities; integrating clients' language and culture into services; and addressing barriers to access were highlighted. Humility, flexibility, and a commitment to ongoing learning and development were unifying themes across the literature.

Refugee perspectives, although limited, emphasized the importance of providers who demonstrated respect and empathy and understood the culture and lived experience of refugees.

Several approaches were consistent with the broader cultural competence literature, including using professional interpreters, leveraging bicultural and bilingual staff and cultural brokers, cultural competence training, integrated care models, family-centered or community-based service models, and the integration of culturally specific concepts and cross-cultural assessments into service provision. 5 , 31 Providers also described responding to the unique needs and experiences of refugees, paying particular attention to issues of trust and safety; histories of trauma, torture, or bereavement; political situations and ethnic conflicts in clients' home countries; and health risks and stressors at different stages of the refugee journey. Providers also emphasized the value of exploring and managing refugees' expectations of services, and explaining the roles of providers and national systems in resettlement countries.

It is notable that the literature focused largely on the United States and other high-income countries, and on health care and social service settings. A lack of conceptual clarity, methodological rigor, and comparative study designs meant that it was not possible to draw conclusions about which cultural competence approaches were most effective, or to generalize the findings to other refugee populations or service settings. Indeed, cultural competence is likely to be context-specific, given the heterogeneity of refugee populations and the services they use. As stated by Riggs:

there may not be one ‘model’ of best practice … but a suite of strategies that are flexible and adaptable and are reflective of the clients' cultures, languages, existing social groups and resources of local service providers—both mainstream and culturally- specific. 21(p14)

The cultural competence literature in refugee service settings reflected a lack of meaningful participation of the populations intended to benefit from cultural competence. Refugee voices were conspicuously underrepresented in the studies identified. The literature in this review was primarily informed by the perspectives of experts 50 and health care professionals, including doctors, nurses, psychologists, and social workers. The literature relied heavily on providers' self-reported understanding of their own cultural competence, and subjective perceptions of cultural competence outcomes, with little awareness of how these might be shaped by intersubjective interactions with refugee clients.

Interestingly, few articles included in this review disclosed or discussed the ethnic or cultural identity of providers, suggesting that their cultural values, norms, and practices were assumed, normalized, or perhaps considered less pertinent to the topic of cultural competence. Insufficient attention to the cultures of all parties in a client–provider relationship may hinder our understanding of cultural competence, or support narratives that present “other cultures” (typically nondominant cultures) as problematic. The notion of cultural competence is itself a culturally determined construct that is embedded in historically constituted power relations.

Anthropological approaches referred to by some authors may be broadly instructive for service providers working with refugees. Kleinman and Benson's Explanatory Models Approach and revised cultural formulation (an ethnographic approach describing six steps for culturally informed clinical practice) seek to understand “what really matters” and “what is at stake” for patients, their families, and their communities, and to use this information to guide clinical diagnoses, decision-making, and negotiations with patients. 6 These models require providers to “set their expert knowledge alongside, not over and above the patient's own explanation and viewpoint.” 6 Potocky-Tripodi suggested that social workers seeking to provide more culturally sensitive services to refugees should pose the question, “what would you like me to know so I can help you better?” 51 These approaches advance beyond viewing cultural competence as a set of technical skills to acquire or procedures to deliver, instead placing refugees at the center of the services they receive.

The literature was clear that an enabling organizational environment is key for opening up the institutional space required to achieve the goals of cultural competence. This can be facilitated by championing the values of cultural competence at leadership levels, advancing staff diversity, implementing more flexible policies, procedures and service delivery models, and partnering with refugee communities. While some refugee participants described structural barriers, including stigma, discrimination, racial profiling, and fears of interacting with authorities and government services, 40 recognition of these structural barriers was an important gap in the literature. Until structural inequalities impacting service quality and accessibility for refugees and other marginalized populations are recognized and addressed, the ideals of cultural competence will likely remain elusive.

Limitations

The nonexhaustive search strategy and reliance on peer-reviewed literature published in English is a limitation of this review. The included literature was largely U.S.-focused, and confined to health and social service settings, particularly mental health. Relevant publications, including the gray literature and literature published in other languages, disciplines, or service settings, may not have been located. In addition, as previously noted, the lack of refugee perspectives is a significant limitation of this review.

This scoping review identified a range of individual and organizational approaches to cultural competence in refugee service settings, including strategies responsive to the unique circumstances and needs of refugees. A lack of refugee perspectives and insufficient attention to structural barriers were notable gaps in this literature.

Future research on cultural competence in refugee service settings requires greater attention to what cultural competence means to people with refugee status, how they experience it, and how this is shaped by the social, political, and economic contexts in which they emerge. Otherwise, cultural competence approaches risk reproducing the same cultural hierarchies and structural inequities that they aim to address.

Acknowledgments

We wish to thank Margaret Gibbon, Rebecca Mulqueen, and Tabassum Siraj for their editorial review and constructive feedback.

The contents of this document are solely the responsibility of the authors and do not necessarily represent the official views of the U.S. Department of Health and Human Services, Administration for Children and Families.

Author Disclosure Statement

No competing financial interests exist.

Funding Information

This research was funded through Switchboard, a project implemented by the IRC. The IRC received $1,194,063 through competitive funding through the U.S. Department of Health and Human Services, Administration for Children and Families, Grant # 90RB0052. The project is financed with 100% of Federal funds and 0% by non-governmental sources.

Cite this article as: Lau LS, Rodgers G (2021) Cultural competence in refugee service settings: a scoping review, Health Equity 5:1, 124–134, DOI: 10.1089/heq.2020.0094.

Repatriation, Insecurity, and Peace

A Case Study of Rwandan Refugees

• © 2020
• Masako Yonekawa 0 ,
• Akiko Sugiki 1

Department of Economics and Informatics, Tsukuba Gakuin University, Tsukuba, Japan

You can also search for this editor in PubMed   Google Scholar

Faculty of Law, Keio University, Tokyo, Japan

• Examines how the United Nations’ refugee policies, such as forced repatriation and cessation of refugee status, have impacted refugees, particularly their psychology, which tends to be overlooked
• Describes the situation of the present Rwandan refugees in various African countries, including the eastern DR Congo, where the majority of them have lived for 20 years with no protection, as well as Zambia and Uganda
• Discusses both theory and practice, especially from the refugees’ point of view

1551 Accesses

1 Citations

41 Altmetric

This is a preview of subscription content, log in via an institution to check access.

Access this book

Subscribe and save.

• Get 10 units per month
• Download Article/Chapter or eBook
• 1 Unit = 1 Article or 1 Chapter
• Cancel anytime
• Available as EPUB and PDF
• Read on any device
• Instant download
• Own it forever
• Compact, lightweight edition
• Dispatched in 3 to 5 business days
• Free shipping worldwide - see info
• Durable hardcover edition

Tax calculation will be finalised at checkout

Other ways to access

Licence this eBook for your library

Institutional subscriptions

About this book

Similar content being viewed by others.

Refugee Rights: Essential for Positive Peace

The Trudeau Government, Refugee Policy, and Echoes of the Past

• Repatriation
• Rwandan Refugees
• Human Rights
• Cessation of Refugee Status

Table of contents (7 chapters)

Front matter, “voluntary” repatriation of rwandan refugees in uganda: an analysis of law and practice.

• Frank Ahimbisibwe

Renouncing Nationality to Avoid Repatriation: A Perspective from the Convention on the Reduction of Statelessness

• Hajime Akiyama, Osamu Arakaki

The Legacy of RPF Violence and Why Rwandan Refugees Refuse to Return

Aggravated trauma and insecurity among rwandan hutu refugees.

• Marcelline Nduwamungu

Refugee Repatriation and Peace Process: Motive and Nature of Repatriation of Rwandan Refugees (1990–2017)

Masako Yonekawa

Where is Rwanda’s Peace?

Correction to: repatriation, insecurity, and peace.

• Masako Yonekawa, Akiko Sugiki

Back Matter

Editors and affiliations.

Akiko Sugiki

About the editors

Bibliographic information.

Book Title : Repatriation, Insecurity, and Peace

Book Subtitle : A Case Study of Rwandan Refugees

Editors : Masako Yonekawa, Akiko Sugiki

DOI : https://doi.org/10.1007/978-981-15-2850-7

Publisher : Springer Singapore

eBook Packages : Political Science and International Studies , Political Science and International Studies (R0)

Copyright Information : Springer Nature Singapore Pte Ltd. 2020

Hardcover ISBN : 978-981-15-2849-1 Published: 28 July 2020

Softcover ISBN : 978-981-15-2852-1 Published: 29 July 2021

eBook ISBN : 978-981-15-2850-7 Published: 27 July 2020

Edition Number : 1

Number of Pages : XXXII, 115

Number of Illustrations : 5 b/w illustrations, 4 illustrations in colour

Topics : Peace Studies , Conflict Studies , African Politics , Human Rights

• Publish with us

Policies and ethics

• Find a journal
• Track your research

Henri’s story

Matur’s story

Michael’s story

Zimnako’s story

Refugee stories.

Andrew’s story

In this address, Andrew Havas reflects on his personal journey as a former refugee.

Yuol’s story

Roderick’s story.

Roderick sought asylum in Australia from Zimbabwe and now works as a firefighter.

Nazifa’s story

Aduc’s story

Santino’s story

Santino left the conflict in Sudan and, after living in limbo in Egypt, has come to Australia with his family.

Tony’s story

Nazem’s story.

Nazem tells his story of leaving Iraq by boat by himself. While he has become an Australian citizen, he cannot sleep while he is separated from his wife and children.

Anisa’s story

My-yen tran’s story.

Suite 4A6, 410 Elizabeth Street Surry Hills 2010 NSW Australia Phone: +61 (02) 9211 9333 Fax: +61 (02) 9211 9288

• Privacy policy
• Refugee Foundation
• Refugee Week
• Refugee Alternatives

We acknowledge the traditional owners of the land we work on - the Gadigal people of the Eora nation, and the Wurrundjeri people of the Kulin nation. We pay respects to elders past and present, and acknowledge sovereignty was never ceded. We also acknowledge the unique role Aboriginal & Torres Strait Islander people have in welcoming refugees and people seeking asylum to this land.

• Refugees in the world
• Offshore processing
• Resettled refugees
• Settling in Australia
• Education & employment
• Reports & other publications
• Help refugee families reunite
• Raise YOUR voice to secure safety for 32,000 refugees
• Operation #NotForgotten
• Join the refugee self-Representation list
• Refugees & people seeking asylum
• Local government
• Interagency networks
• Face-to-Face: Schools & community program
• Refugee Education Special Interest Group
• Researchers
• Media centre
• Media releases
• Submissions
• Bright ideas
• Service directories
• Legal or migration advice
• Information and fact sheets
• Donating goods
• Films, books & more

• Open access
• Published: 11 May 2018

The Syrian conflict: a case study of the challenges and acute need for medical humanitarian operations for women and children internally displaced persons

• Rahma Aburas 1 ,
• Amina Najeeb 2 ,
• Laila Baageel 3 &
• Tim K. Mackey   ORCID: orcid.org/0000-0002-2191-7833 3 , 4 , 5  

BMC Medicine volume  16 , Article number:  65 ( 2018 ) Cite this article

27k Accesses

31 Citations

20 Altmetric

Metrics details

After 7 years of increasing conflict and violence, the Syrian civil war now constitutes the largest displacement crisis in the world, with more than 6 million people who have been internally displaced. Among this already-vulnerable population group, women and children face significant challenges associated with lack of adequate access to maternal and child health (MCH) services, threatening their lives along with their immediate and long-term health outcomes.

While several health and humanitarian aid organizations are working to improve the health and welfare of internally displaced Syrian women and children, there is an immediate need for local medical humanitarian interventions. Responding to this need, we describe the case study of the Brotherhood Medical Center (the “Center”), a local clinic that was initially established by private donors and later partnered with the Syrian Expatriate Medical Association to provide free MCH services to internally displaced Syrian women and children in the small Syrian border town of Atimah.

Conclusions

The Center provides a unique contribution to the Syrian health and humanitarian crisis by focusing on providing MCH services to a targeted vulnerable population locally and through an established clinic. Hence, the Center complements efforts by larger international, regional, and local organizations that also are attempting to alleviate the suffering of Syrians victimized by this ongoing civil war. However, the long-term success of organizations like the Center relies on many factors including strategic partnership building, adjusting to logistical difficulties, and seeking sustainable sources of funding. Importantly, the lessons learned by the Center should serve as important principles in the design of future medical humanitarian interventions working directly in conflict zones, and should emphasize the need for better international cooperation and coordination to support local initiatives that serve victims where and when they need it the most.

Peer Review reports

The Syrian civil war is the epitome of a health and humanitarian crisis, as highlighted by recent chemical attacks in a Damascus suburb, impacting millions of people across Syria and leading to a mass migration of refugees seeking to escape this protracted and devastating conflict. After 7 long years of war, more than 6 million people are internally displaced within Syria — the largest displacement crisis in the world — and more than 5 million registered Syrian refugees have been relocated to neighboring countries [ 1 , 2 ]. In total, this equates to an estimated six in ten Syrians who are now displaced from their homes [ 3 ].

Syrian internally displaced persons (IDPs) are individuals who continue to reside in a fractured Syrian state now comprising a patchwork of government- and opposition-held areas suffering from a breakdown in governance [ 4 ]. As the Syrian conflict continues, the number of IDPs and Syrian refugees continues to grow according to data from the United Nations High Commissioner for Refugees (UNHCR). This growth is continuing despite some borders surrounding Syria being closed and in part due to a rising birth rate in refugee camps [ 5 , 6 ]. This creates acute challenges for neighboring/receiving countries in terms of ensuring adequate capacity to offer essential services such as food, water, housing, security, and specifically healthcare [ 4 , 7 , 8 ].

Though Syrian refugees and IDPs face similar difficulties in relation to healthcare access in a time of conflict and displacement, their specific challenges and health needs are distinctly different, as IDPs lack the same rights guaranteed under international law as refugees, and refugees have variations in access depending on their circumstances. Specifically, there are gaps in access to medical care and medicines for both the internally displaced and refugees, whether it be in Syria, in transit countries (including services for refugees living in camps versus those living near urban cities), or in eventual resettlement countries. In particular, treatment of chronic diseases and accessing of hospital care can be difficult, exacerbated by Syrian families depleting their savings, increased levels of debt, and a rise in those living in poverty (e.g., more than 50% of registered Syrian refugees in Jordan are burdened with debt) [ 9 ].

Despite ongoing actions of international humanitarian organizations and non-governmental organizations (NGOs) to alleviate these conditions, healthcare access and coverage for displaced Syrians and refugees is getting worse as the conflict continues [ 4 , 10 ]. Although Syria operated a strong public health system and was experiencing improved population health outcomes pre-crisis, the ongoing conflict, violence, and political destabilization have led to its collapse [ 11 , 12 , 13 ]. Specifically, campaigns of violence against healthcare infrastructure and workers have led to the dismantling of the Syrian public health system, particularly in opposition-held areas, where access to even basic preventive services has been severely compromised [ 14 , 15 , 16 , 17 ].

Collectively, these dire conditions leave millions of already-vulnerable Syrians without access to essential healthcare services, a fundamental human right and one purportedly guaranteed to all Syrian citizens under its constitution [ 4 ]. Importantly, at the nexus of this health and humanitarian crisis are the most vulnerable: internally displaced Syrian women and children. Hence, this opinion piece first describes the unique challenges and needs faced by this vulnerable population and then describes the case study of the Brotherhood Medical Center (the “Center”), an organization established to provide free and accessible maternal and child health (MCH) services for Syrian IDPs, and how it represents lessons regarding the successes and ongoing challenges of a local medical humanitarian intervention.

Syria: a health crisis of the vulnerable

Critically, women and children represent the majority of all Syrian IDPs and refugees, which directly impacts their need for essential MCH services [ 18 ]. Refugee and internally displaced women and children face similar health challenges in conflict situations, as they are often more vulnerable than other patient populations, with pregnant women and children at particularly high risk for poor health outcomes that can have significant short-term, long-term, and inter-generational health consequences [ 10 ]. Shared challenges include a lack of access to healthcare and MCH services, inadequate vaccination coverage, risk of malnutrition and starvation, increased burden of mental health issues due to exposure to trauma, and other forms of exploitation and violence such as early marriage, abuse, discrimination, and gender-based violence [ 4 , 10 , 19 , 20 ]. Further, scarce medical resources are often focused on patients suffering from acute and severe injury and trauma, leading to de-prioritization of other critical services like MCH [ 4 ].

Risks for women

A 2016 United Nations Population Fund (UNFPA) report estimated that 360,000 Syrian IDPs are pregnant, yet many do not receive any antenatal or postnatal care [ 21 , 22 ]. According to estimates by the UNFPA in 2015, without adequate international funding, 70,000 pregnant Syrian women faced the risk of giving birth in unsafe conditions if access to maternal health services was not improved [ 23 ]. For example, many women cannot access a safe place with an expert attendant for delivery and also may lack access to emergency obstetric care, family planning services, and birth control [ 4 , 19 , 24 , 25 , 26 , 27 , 28 ]. By contrast, during pre-conflict periods, Syrian women enjoyed access to standard antenatal care, and 96% of deliveries (whether at home or in hospitals) were assisted by a skilled birth attendant [ 13 ]. This coverage equated to improving population health outcomes, including data from the Syrian Ministry of Health reporting significant gains in life expectancy at birth (from 56 to 73.1 years), reductions in infant mortality (decrease from 132 per 1000 to 17.9 per 1000 live births), reductions in under-five mortality (from 164 to 21.4 per 1000 live births), and declines in maternal mortality (from 482 to 52 per 100,000 live births) between 1970 and 2009, respectively [ 13 ].

Post-conflict, Syrian women now have higher rates of poor pregnancy outcomes, including increased fetal mortality, low birth weights, premature labor, antenatal complications, and an increase in puerperal infections, as compared to pre-conflict periods [ 10 , 13 , 25 , 26 ]. In general, standards for antenatal care are not being met [ 29 ]. Syrian IDPs therefore experience further childbirth complications such as hemorrhage and delivery/abortion complications and low utilization of family planning services [ 25 , 28 ]. Another example of potential maternal risk is an alarming increase in births by caesarean section near armed conflict zones, as women elect for scheduled caesareans to avoid rushing to the hospital during unpredictable and often dangerous circumstances [ 10 ]. There is similar evidence from Syrian refugees in Lebanon, where rates of caesarean sections were 35% (of 6366 deliveries assessed) compared to approximately 15% as previously recorded in Syria and Lebanon [ 30 ].

Risks for children

Similar to the risks experienced by Syrian women, children are as vulnerable or potentially at higher risk during conflict and health and humanitarian crises. According to the UNHCR, there are 2.8 million children displaced in Syria out of a total of 6.5 million persons, and just under half (48%) of Syrian registered refugees are under 18 years old [ 1 ]. The United Nations Children’s Fund (UNICEF) further estimates that 6 million children still living in Syria are in need of humanitarian assistance and 420,000 children in besieged areas lack access to vital humanitarian aid [ 31 ].

For most Syrian internally displaced and refugee children, the consequences of facing lack of access to essential healthcare combined with the risk of malnutrition (including cases of severe malnutrition and death among children in besieged areas) represent a life-threatening challenge (though some studies have positively found low levels of global acute malnutrition in Syrian children refugee populations) [ 24 , 32 , 33 , 34 ]. Additionally, UNICEF reports that pre-crisis 90% of Syrian children received routine vaccination, with this coverage now experiencing a dramatic decline to approximately 60% (though estimating vaccine coverage in Syrian IDP and refugee populations can be extremely difficult) [ 35 ]. A consequence of lack of adequate vaccine coverage is the rise of deadly preventable infectious diseases such as meningitis, measles, and even polio, which was eradicated in Syria in 1995, but has recently re-emerged [ 36 , 37 , 38 ]. Syrian refugee children are also showing symptoms of psychological trauma as a result of witnessing the war [ 4 , 39 ].

A local response: the Brotherhood Medical Center

In direct response to the acute needs faced by Syrian internally displaced women and children, we describe the establishment, services provided, and challenges faced by the Brotherhood Medical Center (recently renamed the Brotherhood Women and Children Specialist Center and hereinafter referred to as the “Center”), which opened its doors to patients in September 2014. The Center was the brainchild of a group of Syrian and Saudi physicians and donors who had the aim of building a medical facility to address the acute need for medical humanitarian assistance in the village of Atimah (Idlib Governorate, Syria), which is also home to a Syrian displacement camp.

Atimah (Idlib Governorate, Syria) is located on the Syrian side of the Syrian-Turkish border. Its population consisted of 250,000 people pre-conflict in an area of approximately 65 km 2 . Atimah and its adjacent areas are currently generally safe from the conflict, with both Atimah and the entire Idlib Governorate outside the control of the Syrian government and instead governed by the local government. However, continued displacement of Syrians seeking to flee the conflict has led to a continuous flow of Syrian families into the area, with the population of the town growing to approximately a million people.

In addition to the Center, there are multiple healthcare centers and field hospitals serving Atimah and surrounding areas that cover most medical specialties. These facilities are largely run by local and international health agencies including Medecins Sans Frontieres (MSF), Medical Relief for Syria, and Hand in Hand for Syria, among others. Despite the presence of these organizations, the health needs of IDPs exceeds the current availability of healthcare services, especially for MCH services, as the majority of the IDPs belong to this patient group. This acute need formed the basis for the project plan establishing the Center to serve the unique needs of Syrian internally displaced women and children.

Operation of the Center

The Center’s construction and furnishing took approximately 1 year after land was purchased for its facility, a fact underlining the urgency of building a permanent local physical infrastructure to meet healthcare needs during the midst of a conflict. Funds to support its construction originated from individual donors, Saudi business men, and a group of physicians. In this sense, the Center represents an externally funded humanitarian delivery model focused on serving a local population, with no official government, NGO, or international organization support for its initial establishment.

The facility’s primary focus is to serve Syrian women and children, but since its inception in 2014, the facility has grown to cater for an increasing number of IDPs and their diverse needs. When it opened, facility services were limited to offering only essential outpatient, gynecology, and obstetrics services, as well as operating a pediatric clinic. The staffing at the launch consisted of only three doctors, a midwife, a nurse, an administrative aid, and a housekeeper, but there now exist more than eight times this initial staff count. The staff operating the Center are all Syrians; some of them are from Atimah, but many also come from other places in Syria. The Center’s staff are qualified to a large extent, but still need further training and continuing medical education to most effectively provide services.

Though staffing and service provision has increased, the Center’s primary focus is on its unique contribution to internally displaced women and children. Expanded services includes a dental clinic 1 day per week, which is run by a dentist with the Health Affairs in Idlib Governorate, and has been delegated to cover the dental needs for the hospital patients . Importantly, the Center facility has no specific policy on patient eligibility, its desired patient catchment population/area, or patient admission, instead opting to accept all women and children patients, whether seeking routine or urgent medical care, and providing its services free of charge.

Instead of relying on patient-generated fees (which may be economically prohibitive given the high levels of debt experienced by IDPs) or government funding, the Center relies on its existing donor base for financing the salaries for its physicians and other staff as well as the facility operating costs. More than an estimated 300 patients per day have sought medical attention since its first day of operation, with the number of patients steadily increasing as the clinic has scaled up its services.

Initially the Center started with outpatient (OPD) cases only, and after its partnership with the Syrian Expatriate Medical Association (SEMA) (discussed below), inpatient care for both women and children began to be offered. Patients’ statistics for September 2017 reported 3993 OPD and emergency room visits and 315 inpatient admissions including 159 normal deliveries and 72 caesarean sections, 9 neonatal intensive care unit cases, and 75 admissions for other healthcare services. To better communicate the clinic’s efforts, the Center also operates a Facebook page highlighting its activities (in Arabic at https://www.facebook.com/مشفى-الإخاء-التخصصي-129966417490365/ ).

Challenges faced by the Center and its evolution

The first phase of the Center involved its launch and initial operation in 2014 supported by a small group of donors who self-funded the startup costs needed to operationalize the Center facility’s core clinical services. Less than 2 years later, the Center faced a growing demand for its services, a direct product of both its success in serving its targeted community and the protracted nature of the Syrian conflict. In other words, the Center facility has continuously needed to grow in the scope of its service delivery as increasing numbers of families, women, and children rely on the Center as their primary healthcare facility and access point.

Meeting this increasing need has been difficult given pragmatic operational challenges emblematic of conflict-driven zones, including difficulties in securing qualified and trained medical professionals for clinical services, financing problems involving securing funding due to the shutdown of banking and money transferring services to and from Syria, and macro political factors (such as the poor bilateral relationship between Syria and its neighboring countries) that adversely affect the clinic’s ability to procure medical and humanitarian support and supplies [ 40 ]. Specifically, the Center as a local healthcare facility originally had sufficient manpower and funding provided by its initial funders for its core operations and construction in its first year of operation. However, maintaining this support became difficult with the closure of the Syrian-Turkish border and obstacles in receiving remittances, necessitating the need for broader strategic partnership with a larger organization.

Collectively, these challenges required the management committee and leadership of the Center to shift its focus to securing long-term sustainability and scale-up of services by seeking out external forms of cooperation and support. Borne from this need was a strategic partnership with SEMA, designed to carry forward the next phase of the Center’s operation and development. SEMA, established in 2011, is a non-profit relief organization that works to provide and improve medical services in Syria without discrimination regarding gender, ethnic, or political affiliation — a mission that aligns with the institutional goals of the Center. Selection of SEMA as a partner was based on its activity in the region; SEMA plays an active role in healthcare provision in Idlib and surrounding areas. Some other organizations were also approached at the same time of this organization change, with SEMA being the most responsive.

Since the Center-SEMA partnership was consummated, the Center has received critical support in increasing its personnel capacity and access to medicines, supplies, and equipment, resulting in a gradual scale-up and improvement in its clinical services. This now includes expanded pediatric services and the dental clinic (as previously mentioned and important, as oral health is a concern for many Syrian parents and children). The Center also now offers caesarean deliveries [ 41 ]. However, the Center, similar to other medical humanitarian operations in the region, continues to face many financial and operational challenges, including shortage of medical supplies, lack of qualified medical personnel, and needs for staff development.

Challenges experienced by the Center and other humanitarian operations continue to be exacerbated by the ongoing threat of violence and instability emanating from the conflict that is often targeted at local organizations and international NGOs providing health aid. For example, MSF has previously been forced to suspend its operations in other parts of Syria, has evacuated its facilities after staff have been abducted and its facilities bombed, and it has also been subject to threats from terrorist groups like the Islamic State (IS) [ 42 ].

The case study of the Center, which evolved from a rudimentary medical tent originally located directly in the Atimah displacement camp to the establishment of a local medical facility now serving thousands of Syrian IDPs, is just one example of several approaches aimed at alleviating the suffering of Syrian women and children who have been disproportionately victimized by this devastating health and humanitarian crisis. Importantly, the Center represents the maturation of a privately funded local operation designed to meet an acute community need for MCH services, but one that has necessitated continuous change and evolution as the Syrian conflict continues and conditions worsen. Despite certain successes, a number of challenges remain that limit the potential of the Center and other health humanitarian operations to fully serve the needs of Syrian IDPs, all of which should serve as cautionary principles for future local medical interventions in conflict situations.

A primary challenge is the myriad of logistical difficulties faced by local medical humanitarian organizations operating in conflict zones. Specifically, the Center continues to experience barriers in securing a reliable and consistent supply of medical equipment and materials needed to ensure continued operation of its clinical services, such as its blood bank, laboratory services, operating rooms, and intensive care units. Another challenge is securing the necessary funding to make improvements to physical infrastructure and hire additional staff to increase clinical capacity. Hence, though local initiatives like the Center may have initial success getting off the ground, scale-up and ensuring sustainability of services to meet the increasing needs of patients who remain in a perilous conflict-driven environment with few alternative means of access remain extremely challenging.

Despite these challenges, it is clear that different types of medical humanitarian interventions deployed in the midst of health crises have their own unique roles and contributions. This includes a broad scope of activities now focused on improving health outcomes for Syrian women and children that are being delivered by international aid agencies located outside of the country, international or local NGOs, multilateral health and development agencies, and forms of bilateral humanitarian assistance. The Center contributes to this health and humanitarian ecosystem by providing an intervention focused on the needs of Syrian women and children IDPs where they need it most, close to home.

However, the success of the Center and other initiatives working to end the suffering of Syrians ultimately relies on macro organizational and political issues outside Atimah’s border. This includes better coordination and cooperation of aid and humanitarian stakeholders and increased pressure from the international community to finally put an end to a civil war that has no winners — only victims — many of whom are unfortunately women and children.

Abbreviations

the Brotherhood Women and Children Specialist Center

Internally displaced persons

Maternal and child health

Medecins Sans Frontieres

Non-governmental organizations

Outpatient department

Syrian Expatriate Medical Association

United Nations Population Fund

the United Nations High Commissioner for Refugees

The United Nations Children’s Fund

UNHCR. Syria Regional Refugee Response: Inter-agency Information Sharing Portal [Internet]. data.unhcr.org. 2017. http://data.unhcr.org/syrianrefugees/regional.php . Accessed 17 July 2017.

iDMC. Syria [Internet]. 2017. http://www.internal-displacement.org/countries/syria . Accessed 31 Aug 2017.

Connor P, Krogstad JM. About six-in-ten Syrians are now displaced from their homes [Internet]. pewresearch.org. 2016. http://www.pewresearch.org/fact-tank/2016/06/13/about-six-in-ten-syrians-are-now-displaced-from-their-homes/ . Accessed 31 Aug 2017.

Akbarzada S, Mackey TK. The Syrian public health and humanitarian crisis: a “displacement” in global governance? Glob Public Health. 2017;44:1–17.

Article   Google Scholar  

Albaster O. Birth rate soars in refugee camp as husbands discourage use of contraception [Internet]. 2016. independent.co.uk . http://www.independent.co.uk/news/world/middle-east/birth-rate-soars-in-jordan-refugee-camp-as-husbands-discourage-wives-from-using-contraception-a6928241.html . Accessed 21 Nov 2017.

Reliefweb. Closing Borders, Shifting Routes: Summary of Regional Migration Trends Middle East – May, 2016 [Internet]. reliefweb.int. 2016. https://reliefweb.int/report/world/closing-borders-shifting-routes-summary-regional-migration-trends-middle-east-may-2016 . Accessed 21 Nov 2017.

Schweiger G. The duty to bring children living in conflict zones to a safe haven. J Glob Ethics. 2016;12:380–97.

Article   PubMed   PubMed Central   Google Scholar  

Arcos González P, Cherri Z, Castro Delgado R. The Lebanese–Syrian crisis: impact of influx of Syrian refugees to an already weak state. RMHP. 2016;9:165–72.

UNHCR and partners warn in Syria report of growing poverty, refugee needs. Geneva: UNHCR; 2016.

Devakumar D, Birch M, Rubenstein LS, Osrin D, Sondorp E, Wells JCK. Child health in Syria: recognising the lasting effects of warfare on health. Confl Heal. 2015;9:34.

Ferris E, Kirişçi K, Shaikh S. Syrian crisis: massive displacement, dire needs and a shortage of solutions. Washington, DC: Brookings Institution; 2013.

Google Scholar  

Abu-Sada C, Serafini M. Humanitarian and medical challenges of assisting new refugees in Lebanon and Iraq. Forced Migr Rev. 2013:1:70–3.

Kherallah M, Sahloul Z, Jamil G, Alahfez T, Eddin K. Health care in Syria before and during the crisis. Avicenna J Med. 2012;2:51–3. Available from: https://doi.org/10.4103/2231-0770.102275

Heisler M, Baker E, McKay D. Attacks on health care in Syria — normalizing violations of medical neutrality? N Engl J Med. 2015;373:2489–91.

Cook J. Syrian medical facilities were attacked more than 250 times this year [Internet]. huffingtonpost.com . 2016. http://www.huffingtonpost.com/entry/syria-hospital-attacks_us_56c330f0e4b0c3c550528d2e . Accessed 31 Aug 2017.

Ozaras R, Leblebicioglu H, Sunbul M, Tabak F, Balkan II, Yemisen M, et al. The Syrian conflict and infectious diseases. Expert Rev Anti-Infect Ther. 2016;14:547–55.

Article   CAS   PubMed   Google Scholar  

Fouad FM, Sparrow A, Tarakji A, Alameddine M, El-Jardali F, Coutts AP, et al. Health workers and the weaponisation of health care in Syria: a preliminary inquiry for The Lancet-American University of Beirut Commission on Syria. Lancet. 2017:390:2516–26;

Women in the World. Women and children now make up the majority of refugees [Internet]. nytimes.com. 2016. http://nytlive.nytimes.com/womenintheworld/2016/05/16/women-and-children-now-make-up-the-majority-of-refugees/ . Accessed 31 Aug 2017.

Yasmine R, Moughalian C. Systemic violence against Syrian refugee women and the myth of effective intrapersonal interventions. Reprod Health Matters. 2016;24:27–35.

Article   PubMed   Google Scholar  

Elsafti AM, van Berlaer G, Safadi Al M, Debacker M, Buyl R, Redwan A, et al. Children in the Syrian civil war: the familial, educational, and public health impact of ongoing violence. Disaster Med Public Health Prep. 2016;10:874–82.

Save the Children. A devastating toll: the impact of three years of war on the health of Syria's children [Internet]. 2014. http://www.savethechildren.org/atf/cf/%7B9def2ebe-10ae-432c-9bd0-df91d2eba74a%7D/SAVE_THE_CHILDREN_A_DEVASTATING_TOLL.PDF . Accessed 12 Jan 2016.

UNFPA. Women and girls in the Syria crisis: UNFA response [Internet]. unfpa.org. 2015. https://www.unfpa.org/sites/default/files/resource-pdf/UNFPA-FACTSANDFIGURES-5%5B4%5D.pdf . Accessed 31 Aug 2017.

UNFPA. Shortage in funding threatens care for pregnant Syrian refugees [Internet]. unfpa.org. 2015. http://www.unfpa.org/news/shortage-funding-threatens-care-pregnant-syrian-refugees . Accessed 31 Aug 2017.

Bilukha OO, Jayasekaran D, Burton A, Faender G, King’ori J, Amiri M, et al. Nutritional status of women and child refugees from Syria-Jordan, April-May 2014. MMWR Morb Mortal Wkly Rep. 2014;63:638–9.

PubMed   PubMed Central   Google Scholar  

Reese Masterson A, Usta J, Gupta J, Ettinger AS. Assessment of reproductive health and violence against women among displaced Syrians in Lebanon. BMC Womens Health. 2014;14:25.

Samari G. Syrian refugee women’s health in Lebanon, Turkey, and Jordan and recommendations for improved practice. World Med Health Policy. 2017;9:255–74.

Hakeem O, Jabri S. Adverse birth outcomes in women exposed to Syrian chemical attack. Lancet Glob Health. 2015;3:e196. https://doi.org/10.1016/s2214-109x(15)70077-x

West L, Isotta-Day H, Ba-Break M, Morgan R. Factors in use of family planning services by Syrian women in a refugee camp in Jordan. J Fam Plann Reprod Health Care. 2016. doi:10.1136/jfprhc-2014-101026.

Benage M, Greenough P, Vinck P, Omeira N, Pham P. An assessment of antenatal care among Syrian refugees in Lebanon. Confl Heal. 2015;9:8.

Huster KMJ, Patterson N, Schilperoord M, Spiegel P. Cesarean sections among Syrian refugees in Lebanon from December 2012/January 2013 to June 2013: probable causes and recommendations. Yale J Biol Med. 2014;87:269–88.

UNICEF. Humanitarian Action for Children - Syrian Arab Republic [Internet]. unicef.org. 2017. https://www.unicef.org/appeals/syria.html . Accessed 31 Aug 2017.

Hossain SMM, Leidman E, King’ori J, Harun Al A, Bilukha OO. Nutritional situation among Syrian refugees hosted in Iraq, Jordan, and Lebanon: cross sectional surveys. Confl Heal. 2016;10:26.

Mebrahtu S. The struggle to reach Syrian children with quality nutrition [Internet]. 2015. https://www.unicef.org/infobycountry/syria_83147.html . Accessed 31 Aug 2017.

Nolan D. Children of Syria by the numbers [Internet]. 2016. http://www.pbs.org/wgbh/frontline/article/children-of-syria-by-the-numbers/ . Accessed 31 Aug 2017.

Roberton T, Weiss W, The Jordan Health Access Study Team, The Lebanon Health Access Study Team, Doocy S. Challenges in estimating vaccine coverage in refugee and displaced populations: results from household surveys in Jordan and Lebanon. Vaccine. 2017;5:22.

Al-Moujahed A, Alahdab F, Abolaban H, Beletsky L. Polio in Syria: problem still not solved. Avicenna J Med. 2017;7:64–6.

Mbaeyi C, Ryan MJ, Smith P, Mahamud A, Farag N, Haithami S, et al. Response to a large polio outbreak in a setting of conflict — Middle East, 2013-2015. MMWR Morb Mortal Wkly Rep. 2017;66:227–31.

Sharara SL, Kanj SS. War and infectious diseases: challenges of the Syrian civil war. PLoS Pathog. 2014;10:e1004438.

Hassan G, Ventevogel P, Jefee-Bahloul H, Barkil-Oteo A, Kirmayer LJ. Mental health and psychosocial wellbeing of Syrians affected by armed conflict. Epidemiol Psychiatr Sci. 2016;25:129–41.

Sen K, Al-Faisal W, AlSaleh Y. Syria: effects of conflict and sanctions on public health. J Public Health (Oxf). 2013;35:195–9. https://doi.org/10.1093/pubmed/fds090 .

Pani SC, Al-Sibai SA, Rao AS, Kazimoglu SN, Mosadomi HA. Parental perception of oral health-related quality of life of Syrian refugee children. J Int Soc Prev Community Dent. 2017;7:191–6.

Liu J. Syria: Unacceptable humanitarian failure [Internet]. 2015. http://www.msf.org/en/article/syria-unacceptable-humanitarian-failure . Accessed 31 Aug 2017.

Download references

Author information

Authors and affiliations.

Joint Masters Program in Health Policy and Law, University of California - California Western School of Law, San Diego, CA, USA

Rahma Aburas

Brotherhood Medical Center for Women and Children, Atimah, Syria

Amina Najeeb

Department of Anesthesiology, University of California, San Diego School of Medicine, San Diego, CA, USA

Laila Baageel & Tim K. Mackey

Department of Medicine, Division of Global Public Health, University of California, San Diego School of Medicine, San Diego, CA, USA

Tim K. Mackey

Global Health Policy Institute, San Diego, CA, USA

You can also search for this author in PubMed   Google Scholar

Contributions

We note that with respect to author contributions, all authors jointly collected the data, designed the study, conducted the data analyses, and wrote the manuscript. All authors contributed to the formulation, drafting, completion, and approval of the final manuscript.

Corresponding author

Correspondence to Tim K. Mackey .

Ethics declarations

Ethics approval and consent to participate.

This community case study did not involve the direct participation of human subjects and did not include any personally identifiable health information. Hence, the study did not require ethics approval.

Competing interests

Amina Najeeb and Laila Baageel, two co-authors of this paper, were part of the foundation of the Center, remain active in its operation, and have a personal interest in the success of the operation of the clinic. The remaining authors declare that they have no competing interests.

Publisher’s Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Open Access This article is distributed under the terms of the Creative Commons Attribution 4.0 International License ( http://creativecommons.org/licenses/by/4.0/ ), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver ( http://creativecommons.org/publicdomain/zero/1.0/ ) applies to the data made available in this article, unless otherwise stated.

Reprints and permissions

About this article

Cite this article.

Aburas, R., Najeeb, A., Baageel, L. et al. The Syrian conflict: a case study of the challenges and acute need for medical humanitarian operations for women and children internally displaced persons. BMC Med 16 , 65 (2018). https://doi.org/10.1186/s12916-018-1041-7

Download citation

Received : 05 September 2017

Accepted : 20 March 2018

Published : 11 May 2018

DOI : https://doi.org/10.1186/s12916-018-1041-7

Share this article

Anyone you share the following link with will be able to read this content:

Sorry, a shareable link is not currently available for this article.

Provided by the Springer Nature SharedIt content-sharing initiative

• Maternal child health
• Syrian crisis
• Humanitarian health aid
• Internally displaced people

BMC Medicine

ISSN: 1741-7015

• Submission enquiries: [email protected]
• General enquiries: [email protected]

UNHCR Compilation of Case Law on Refugee Protection in International Law

• Author : Status Determination and Protection Information Section (SDPIS)
• Document source : UN High Commissioner for Refugees (UNHCR)
• Date: March 2008
• Document view Document
• Information

In this section

Document details.

Disclaimer: © UNHCR

Refugees in Australia are miles behind in health and wellbeing outcomes. Here’s why

Senior Lecturer in Public Health, University of Technology Sydney

Professor of Biostatistics, University of Technology Sydney

Professor of Public Health, Faculty of Health, University of Technology Sydney

Disclosure statement

Abela Mahimbo receives funding from NHMRC.

Andrew Hayen receives funding from the NHMRC, MRFF and UNICEF.

Angela Dawson receives funding from NHMRC and the Department of Health and Aged Care

University of Technology Sydney provides funding as a founding partner of The Conversation AU.

View all partners

Health outcomes for refugees and people with humanitarian visas are far worse than the general Australian population. They are more likely to self-report long-term conditions, including diabetes (80% higher), kidney disease (80%), stroke (40%) and dementia (30%).

Among hospitalisations for refugees and humanitarian migrants, one in 14 are for potentially preventable conditions. New data shows that when it comes to COVID, they are five times more likely than permanent migrants to be hospitalised.

And those who’ve been held for long periods in immigration detention shoulder significant health-care costs – an estimated 50% higher than other asylum seekers .

Why is the health of refugees and humanitarian entrants so much worse than the rest of the country? And what can we do about it?

Higher risk of physical and mental health issues

Health is a fundamental human right . But refugees and humanitarian entrants in Australia face multiple challenges that limit their ability to fully enjoy this right.

Compared with the rest of the population, people in Australia who hold humanitarian visas are at a higher risk of physical and mental health issues . Factors contributing to this are complex, interrelated and interconnected.

People fleeing persecution are more likely to have experienced significant human rights violations, torture and trauma, which impacts their mental health and wellbeing.

While in exile, they are also likely to have experienced precarious living conditions with limited access to water, sanitation and hygiene, as well as food insecurity and limited access to basic health care.

These can lead to significant health issues. The most common include:

• mental illnesses
• nutritional deficiencies
• infectious diseases
• under-immunisation
• poor oral and eye health
• poorly managed chronic diseases
• delayed growth and development in children.

These conditions may require immediate care or long-term management – or both.

One study measured the burden of mental health diseases – such as post-traumatic stress disorder (PTSD) – on refugees and humanitarian migrants in Australia over five years. It found more than 34% had either PTSD or elevated psychological distress.

Persistent mental illness was associated with loneliness, discrimination, insecure housing, financial hardship and chronic health conditions.

3 gaps for refugees

People from refugee backgrounds have unique health and cultural beliefs, practices, and needs that are often not well understood by health-care providers. These unique needs can affect the quality of care they receive.

1. Language barriers

Most refugees and humanitarian entrants have limited English proficiency and some have limited written literacy in their own languages.

This can make navigating health-care settings a challenge. Difficulties understanding diagnoses, treatment options, and the need for follow-up can especially complicate chronic health issues such as diabetes and high blood pressure, which need ongoing monitoring and treatment.

While the government funds translating and interpreting services, research shows they are often underused and inefficient . Accessing interpreting for smaller or emerging groups can also be more challenging, as services tend to cater to established language groups.

Language barriers can also limit job opportunities and lead to financial pressure, with a ripple effect in overall health and wellbeing.

2. Health literacy

Health literacy is the ability to access, understand and use health information to make more informed decisions about our health. It is linked to improved self-reported health status, lower health-care costs, increased health knowledge, and reduced hospitalisation.

Some refugees and humanitarian entrants have limited health literacy, associated with poor health outcomes .

A study we undertook during the early stages of the pandemic with Arabic, Karen, Dari and Dinka-speaking refugees showed participants with lower health literacy were less willing to receive COVID vaccines. Their scepticism about the vaccine and the virus was further affirmed by conspiracy theories and misinformation online.

3. Continuity of care

Patients from refugee backgrounds can fall through the cracks when services are not well coordinated or can’t be followed up.

For example, Australia’s National Immunisation Program schedule for children is very comprehensive compared with other countries. But many childhood vaccinations require multiple doses over time . When the need for follow-up appointments is not communicated properly – or recall systems aren’t culturally appropriate – they may be missed.

Looking to the future

Improving health and wellbeing for refugees and humanitarian entrants is complex. We need strong foreign policy that promotes stability and basic services overseas, as well as humanitarian aid for crises.

In Australia, non-medical factors also influence health outcomes . They include housing, secure employment, working conditions, social inclusion, safety from discrimination and general literacy, as well as health literacy.

We need to recognise and draw on the protective factors that are strongly linked to the health and wellbeing of people from refugee backgrounds. These include things such as social connectedness, resilience, a sense of belonging and identity, and adapting to a new culture.

We need further research into what helps and hinders refugee health and wellbeing. It must involve people of refugee backgrounds, community organisations and academic institutions.

Our health-care services need to be responsive, sensitive and inclusive. This is imperative in meeting the unique cultural and social needs of people of refugee backgrounds.

• Chronic diseases
• Post-traumatic stress disorder (PTSD)
• Refugee health
• Vaccination rates
• hospitalisation
• COVID hospitalisations
• Language barriers

Microsoft and Citrix Technical Consultant

Casual Facilitator: GERRIC Student Programs - Arts, Design and Architecture

Senior Lecturer, Digital Advertising

Manager, Centre Policy and Translation

Newsletter and Deputy Social Media Producer

Follow U of T News

PhD researcher draws on refugee experience to study plight of asylum-seekers in Canada

Jona Zyfi, a doctoral candidate at the Centre for Criminology & Sociolegal Studies, is using a human rights lens to explore the links between technology and migration (supplied image)

Published: August 14, 2024

By Cynthia Macdonald

Jona Zyfi ’s life has so far been an “adventurous story” full of fear, hope, resilience and relief.

At age seven, Zyfi was smuggled into Australia under a false name as a child refugee claimant. At 16, after a forced return to her native Albania, she emigrated to Canada carrying only a suitcase and teddy bear.

Now a PhD candidate at the University of Toronto’s Centre for Criminology & Sociolegal Studies, Zyfi is examining how public policy shapes the plight of asylum seekers and migrants in Canada. Her work is shedding valuable light on some of the little-known – and sometimes shocking – injustices faced by refugee claimants in a country widely thought to be among the most welcoming and multicultural in the world.

“The work that I do is very much informed by my lived experiences,” she says. “It’s where I find the strength to do it.”

Why is Zyfi examining the refugee experience through the lens of criminology and not political science?

“Lots of people have asked me that,” she says. “Even I had moments when I’d wonder, ‘Am I in the right department?’ But the deeper I go into my research, the more confirmation I get that I am doing the right thing.”

This is due to the phenomenon of “crimmigration,”  a term that’s used to describe how refugee claimants are often subjected to processes normally associated with the criminal justice system.

“Immigration is an administrative field, while the criminal justice system is a lot more heavy-handed,” Zyfi explains. “And yet, we’re using criminal justice mechanisms to deal with what should be an administrative process. That doesn’t make sense.”

In some ways, she says, Canada’s approach to refugees is a good news story.

In the last decade, for example, the country has welcomed more than 40,000 Syrian refugees, and has been in the vanguard of acceptance for those fleeing persecution on the basis of gender identity and sexual orientation.

But there is darker side, too. Many Canadians are unaware that children can be held in detention with or without their parents and that adult asylum seekers who can’t be accommodated in holding centres have been detained in provincial jails alongside those serving criminal sentences.

Canada is also one of the few countries in the Global North where there is no legal limit on detention, meaning that claimants can spend years in jails or holding centres before their cases are heard.

“They rarely get access to legal aid and many of them can’t speak the language,” Zyfi says. “So they don’t even understand what’s happening. They’re unaware of their rights and terrified of being deported.”

Zyfi says she is particularly interested in the role technology plays in immigration and asylum processes and application assessment procedures. In an effort to reduce dependence on migrant detention, some asylum seekers are now granted temporary freedom but monitored in ways that are highly controversial.

These methods include the use of electronic ankle monitors as well as voice reporting via cellphone – both of which can fail if batteries or cell reception run out. Facial recognition software is also gaining in popularity.

But even a small technical mistake, Zyfi argues, can place a claimant’s life in danger. “There’s this idea that technology is going to solve all our problems,” says Zyfi. “It’s going to make faster decisions, better decisions. The decisions are faster, but that doesn’t always mean that they are better.”

Zyfi’s concern about the rights of asylum seekers is born from her own experiences.

Born shortly after the fall of communism in Albania, her early life was spent amid the anarchy and civil insurrection that followed the collapse of the country’s economy. “We had to hide under the tables, because bullets could fly through at any minute,” she recalls. “One flew through our balcony window. The arms depots were open; anybody could get bullets, a grocery bag full of grenades, whatever they could find. It was a free-for-all.”

Using a false name, Zyfi made her way to Australia with her mother and sister via a human smuggling network. But the family was expelled from Australia in 2005 when Albania was deemed to be a safe country of origin. “I remember my mother packing up our entire life in a shipping container,” she says.

Four years later, Zyfi came to Canada and two years ago, after a lengthy series of applications and various immigration statuses, she was finally granted citizenship.

Now, she is firmly committed to making life better for other migrants and refugees, including by giving them a bigger say in decisions that affect them. In policymaking, “our stories are not being incorporated in a meaningful way,” she says. “To me, that is the saddest part.”

The groundswell of private support for Syrian refugees – Zyfi herself was an enthusiastic sponsor – shows that caring for survivors of global crisis is a Canadian value. But she says that civil society alone cannot provide the support needed, and the government can do more – not only for immigrants deemed to be economically desirable, but for those whose lives are in jeopardy.

“Historically, immigration has been key to the Canadian economy. It has also been a fundamental tenet of nation-building and multiculturalism,” Zyfi says. “But we are doing the bare minimum. We have the capacity to do so much more.”

Share this page

Subscribe to The Bulletin Brief

More u of t news.

UCL Grand Challenges

• Impacts and Outputs
• Partnerships
• Funded Projects

Syrian Refugees as Leaders: An Innovative Model for Cross-Cultural Exchange and Education

This collaboration between UCL and the University of Lincoln will pilot an innovative cross-cultural exchange educational model

22 February 2021

Grant:   Grand Challenges Doctoral Students' Small Grants Year awarded:  2021-22 Amount awarded:  £2,500

Project Team

• ​​​​​ Natalie Garland, Institute for Global Prosperity
• Charlotte Cartledge, Psychology (University of Lincoln)

This project trained Syrian refugee youth enrolled in Multi-Aid Program's (MAPs) Higher Education Platform to design and lead seminar workshops for UK secondary school students. MAPs, a refugee-led community-based humanitarian organization in Lebanon, was a partner in this participatory project that takes a co-design approach. The key action-oriented objectives related to community engagement beyond the academy included:

• changing attitudes on global challenges and harmful stereotypes around refugee capabilities through cross-cultural communication and dialogue
• strengthening refugee leadership and critical thinking capacity
• enhancing engagement on global challenges and collective solutions for all students

The activities were designed to contribute new knowledge around innovative forms of connected learning practices and the influence this can have on both students and the leaders from marginalised backgrounds. 

The project was designed to impact the lives of students in both Lebanon and the UK. The outcomes included: 

• Introducing students at schools in Lincolnshire to global challenges and perspectives, new ideas, concepts and cultures 
• Enhancing leadership and critical thinking skills for refugee leaders 
• An innovative cross-cultural exchange educational curriculum is piloted to inform future scaleable models for Connected and Social-Networking Based Learning.

The group co-created a short documentary Through the Lens of Dignity.  Through the Lens of Dignity (22 mins) is an educational documentary exploring the experiences of three Syrian women living as refugees in Bekaa, Lebanon. We follow Reem, Eman and Bayan as they fight for their dignity in displacement. The film takes a community-based and participatory approach to capture unheard narratives crafted on the terms of refugees themselves.

YouTube Widget Placeholder www.youtube.com/watch?v=agxPWumsnIk

Outputs and Impact

• The co-creation of a short documentary (22 mins), titled Through the Lens of Dignity.
• A pilot workshop facilitated at Lincoln University (including film screening + discussion and pre and post questionnaire with participants)
• Ongoing data analysis and paper write up 

Grand Challenge of Justice and Equality

Related links.

• More Doctoral Small Grants projects
• Grand Challenges Special Initiatives
• Grand Challenges funding opportunities

share this!

August 14, 2024

This article has been reviewed according to Science X's editorial process and policies . Editors have highlighted the following attributes while ensuring the content's credibility:

fact-checked

trusted source

Study explores immigrant challenges and hopes

by Neph Rivera, University of Texas at Arlington

Some refer to the United States as a land of opportunity for those looking to better their lives. A research team headed by a University of Texas at Arlington social worker recently asked a group of immigrants if they agreed.

Led by Saltanat Childress, assistant professor in the School of Social Work, the researchers interviewed 24 Arab-speaking Middle Eastern North African refugees in the United States about their experiences immigrating to the country.

"Our research was driven by the expressed needs and concerns of the community and service providers. There was a strong anecdotal and community-based recognition of the challenges faced by immigrants, particularly around family conflicts and adaptation processes," Dr. Childress said.

The team's findings were published in Families in Society: The Journal of Contemporary Social Services .

During the conversations, two main topics became clear: the challenges these immigrants face daily and the opportunities and hopes they have for a better future here in the U.S.

Their main challenges include the language barrier they face upon entering the country, intimate partner violence and the addressing of stress or mental health problems , with some respondents downplaying the latter as a critical issue.

"Key issues on the instrumental side include language barriers, legal status , affordable housing , employment, transportation, and access to health care and childcare," Childress said. "On the ideological side, cultural adaptation challenges, particularly around gender roles and family dynamics and stigma of mental health issues, add another layer of difficulty to the refugee experience."

Childress says the community, including local organizations, can help support these immigrants early in their journeys in their new homeland.

"One key recommendation is to provide more robust language support for early adaptation stages, and it's possible that all the new automated translation tools can help in this regard," she said. "Additionally, improving access to affordable housing and employment opportunities is crucial."

When it comes to opportunities and hopes, the research team found that common responses included the quality of U.S. governance, support from fellow immigrants and the quality of education for their children.

"The U.S. is seen by many immigrants and refugees as a desirable destination due to its economic opportunities , political and religious freedoms, and the presence of pre-existing communities that provide support," Childress said. "These factors make the U.S. an attractive option for those seeking a better life for themselves and their children."

In the end, Childress says, it will take a team effort to help immigrants succeed in the face of the difficult issues that brought them to the U.S. in search of a fresh start.

"The key message is that refugee populations are full of wonderful, hard-working families that are silently struggling with significant challenges, and it is crucial for the profession, services, and mainstream population to be more aware, informed, and resourced to help them cope with these challenges effectively," Childress concluded.

Provided by University of Texas at Arlington

Explore further

Feedback to editors

Small molecule organic eutectics show potential for replacing plastics

5 hours ago

Animals with higher body temperatures are more likely to evolve into herbivores, study finds

6 hours ago

Study explains why laws are written in an incomprehensible style

7 hours ago

Understanding of early life ecosystems sheds light on evolution of life on Earth

Sea anemone study identifies potentially regenerative stem cells linked to conserved genes

8 hours ago

Ultrathin quantum light sources: Scientists show excitonic interactions boost efficiency of entangled photon generation

Study finds gun violence in rural America rises as deer hunting season begins

Mapping Martian meteorites: Tracing origins on the red planet

9 hours ago

Scientists investigate triggers of explosive volcanic eruptions in lab simulation study

10 hours ago

Scientists uncover exciton behavior in van der Waals magnets

Relevant physicsforums posts, interesting anecdotes in the history of physics, cover songs versus the original track, which ones are better, why are abba so popular.

Aug 17, 2024

Today's Fusion Music: T Square, Cassiopeia, Rei & Kanade Sato

Favorite songs (cont.).

Aug 16, 2024

Talent Worthy of Wider Recognition

More from Art, Music, History, and Linguistics

Related Stories

Migrants wanting to call Australia home still face significant challenges

Apr 19, 2023

Expert insight: As Canada welcomes historic numbers of immigrants, how can communities be more welcoming?

Jul 5, 2023

Homestays can help refugee women adapt to life in a new country

Jun 30, 2024

Refugees in Australia are miles behind in health and well-being outcomes. Here's why

Aug 13, 2024

Study: Engaging in civic leadership empowers refugees, immigrants

Mar 30, 2023

Refugees face poverty, food insecurity

Jun 15, 2020

Recommended for you

Spread the love (online): Study reveals in-party positivity drives online engagement more than out-party hostility

How some states help residents avoid costly debt during hard times

Singing from memory unlocks a surprisingly common musical superpower

Aug 15, 2024

Renewable energy policies provide benefits across state lines, study shows

Let us know if there is a problem with our content.

Use this form if you have come across a typo, inaccuracy or would like to send an edit request for the content on this page. For general inquiries, please use our contact form . For general feedback, use the public comments section below (please adhere to guidelines ).

Please select the most appropriate category to facilitate processing of your request

Thank you for taking time to provide your feedback to the editors.

Your feedback is important to us. However, we do not guarantee individual replies due to the high volume of messages.

E-mail the story

Your email address is used only to let the recipient know who sent the email. Neither your address nor the recipient's address will be used for any other purpose. The information you enter will appear in your e-mail message and is not retained by Phys.org in any form.

Newsletter sign up

Get weekly and/or daily updates delivered to your inbox. You can unsubscribe at any time and we'll never share your details to third parties.

More information Privacy policy

Donate and enjoy an ad-free experience

We keep our content available to everyone. Consider supporting Science X's mission by getting a premium account.

E-mail newsletter

• Skip to main content
• Keyboard shortcuts for audio player

Weekend Edition Sunday

• Latest Show

Sunday Puzzle

• Corrections

Listen to the lead story from this episode.

Politics chat: The Harris-Walz campaign is gearing up for the DNC

by  David Folkenflik ,  Asma Khalid

In this file photo, Vice President Harris speaks at an event in Manassas, Va., on Jan. 23, 2024, to campaign for abortion rights. Harris will commemorate her historic nomination in Chicago this week as Democrats hold their convention against the backdrop of a state that has become a hub for abortion access. Susan Walsh/AP hide caption

As Democrats meet in Chicago, Illinois' role in abortion access is in the spotlight

by  Sarah McCammon

Ukraine's incursion into Russia may have changed the course of the war

by  David Folkenflik

How Biden's debate performance snowballed into Harris becoming the new candidate

The harris-walz campaign is confusing grammar nerds everywhere.

Sunday Puzzle NPR hide caption

Sunday Puzzle: Rhyming destinations

by  Will Shortz

SUNDAY PUZZLE 08182024

Appalachian authors are coming together to counter the narrative in jd vance's book, author interviews, comic novel 'how to leave the house' follows a young man on a day-long hero's quest, harris and trump zero in on the economy in campaign speeches.

Left to right: Lucero Lopez, Jasmine Perez Moreno, Josue Rodriguez, Raneem Le Roux, and Jossue Ureno pose for a portrait at The Leroy and Lucile Melcher Center for Public Broadcasting on Thursday, Aug. 1, 2024, in Houston. Joseph Bui for NPR hide caption

How growing up in the U.S. immigration system shapes how these young Americans vote

by  Elena Moore ,  Hiba Ahmad

People stand in front of a sign featuring Democratic presidential candidate Vice President Kamala Harris and Democratic vice presidential candidate Minnesota Gov. Tim Walz at the United Center before the start of the Democratic National Convention Friday in Chicago. Joe Raedle/Getty Images hide caption

2024 Election

The dnc starts today. here’s what you need to know.

by  Jeongyoon Han

The largest branch in American Judaism now ordains rabbis in interfaith marriages

by  Deena Prichep

Where the law stands 30 years after a woman sued McDonald's for spilling hot coffee

The promise keepers, a 1997 evangelical men's group, is back with a new agenda.

by  Elizabeth Caldwell

Movie Interviews

A documentary investigates deaths of indigenous children at canadian boarding schools.

Searching for a song you heard between stories? We've retired music buttons on these pages. Learn more here.

• Skip to main content
• Skip to search
• Skip to footer

Products and Services

Cisco Catalyst 8200 Series Edge Platforms

Flexible connectivity for the lean branch.

Accelerate your cloud journey with edge platforms designed for multilayer security and cloud-native agility.

Your SASE journey, streamlined

Build an optimized multicloud SD-WAN branch with multilayer security and optimized routing.

Connect wherever you are

Flexibly connect to the SD-WAN fabric, allowing for simple, plug-and-play deployments.

Get a leading edge

Transform your lean branch with the power of customized, hardware-enabled services.

See more, solve more

Centrally manage your environment with Cisco Catalyst SD-WAN Manager. Get actionable insights across the internet, cloud, and applications with built-in Cisco Catalyst SD-WAN Analytics and Cisco ThousandEyes solutions.

Do cloud your way

Deliver cloud resources securely and flexibly across customer branch locations with Cisco Umbrella technology.

Catalyst 8200 Series models

C8200-1N-4T

1 rack unit, 4 x 1G WAN

Catalyst SD-WAN modular router for small and midsize branches that need higher throughput

• 8 CPU cores
• Up to 32 GB of DRAM
• 1G SD-WAN throughput
• SD-WAN Manager, Cisco Catalyst Center management, programmable APIs

C8200L-1N-4T

Catalyst SD-WAN modular router for small branches with SASE-compliant, cloud-based security requirements

• 4 CPU cores
• 500-Mbps SD-WAN throughput

Powered by Cisco DNA Software

Get licensing and support for Cisco Catalyst 8200 and Cisco SD-WAN through flexible subscriptions.

Meet your next edge platform

Catalyst 8200 Series Edge Platforms provide secure, flexible, and scalable connectivity to cloud applications.

Upgrade your branch routers and save

Get up to 28% off when you upgrade your branch routers to Cisco Catalyst 8000 Edge Platforms.

Get the guidance that you need

Business Critical Services

Move your business forward

Build modern IT environments and enhance agility with advisory services for resilient, adaptive, and transformative IT.

Cisco Capital

Flexible payment options

Make the most of your budget. Get your Cisco solutions with no upfront costs, and spread payments over time.

See real-world SD-WAN results

IDC researched the value and benefits for organizations that use Catalyst SD-WAN. See the results, including a projected 402% ROI over 5 years.