Longer stays in refugee camps increase cases of acute mental illness

A new quantitative study suggests people seeking asylum are more likely to experience mental health deterioration as they spend more time living in refugee camps, backing up qualitative evidence from aid organisations.

The research, co-authored by Dr Francisco Urzua from the Business School (formerly Cass) alongside practitioners from Moria Medical Support (MMS) and academics from Universidad del Desarrollo, Chile and University of Amsterdam, the Netherlands measured incidences of acute mental health crises arising from extended stays in the Moria refugee camp on the western Greek Island of Lesbos.

Key findings from the study include:

  • Acute mental health crises were significantly linked with the length of time somebody stayed in the Moria refugee camp: the longer a refugee stayed in the camp, the more likely they were to suffer a mental health crisis.
  • A 10 per cent increase in the number of days spent in the camp led to a 3.3 per cent increase in the chances of a refugee suffering a mental health crisis – a significant factor given an average length of stay of 70.6 days.
  • Refugees of Iranian, Iraqi and Syrian ethnicity were most significantly affected by longer stays in the refugee camps, with male refugees more likely to experience incidences of acute mental health crises than women as time spent in the refugee camp increased.

The study used three months of anonymised data from MMS, a transitory clinic that offered night-time medical services to the island at the time, between January and April 2018. This included Psychological First Aid (PFA) and psychiatric crisis management, with patient data on age, gender, ethnicity and length of stay in the camp.

An acute mental health crisis is defined as a case of somebody either harming themselves through a non-accidental implemented wound, a suicide attempt requiring hospital care, or a state of unease constituted by anxiety, nervous agitation or undirected aggression.

Dr Urzua said that results supported prior claims about the quality of life in refugee camps, and that actions should be taken to safeguard inhabitants throughout the asylum process.

“The EU-Turkey deal of 2016 has seen camp populations multiply in size, but adequate mental health care provisions have not been expanded or improved in equal measure,” Dr Urzua said.

“Our study expands upon existing qualitative evidence that the prolonged system of asylum has detrimental effects on mental health, brought on by poor living conditions of refugee camps.

“This mental health deterioration not only affects the individuals themselves but also has significant repercussions for fellow refugees with increased physical violence and the destabilisation of an often close-knit social environment, which in turn affects the mental wellbeing of others. Furthermore, the implications of deteriorating mental health most likely continue even after release, which makes it harder for refugees to integrate into a new society.

“It is clear to see from our study and prior anecdotal evidence that mental health in these camps is a serious problem, and it is imperative that policymakers from across Europe take action and uphold the 1951 Geneva Refugee Convention to protect the rights and wellbeing those awaiting and granted asylum.”

Dr Willemine van de Wiel, doctor and coordinator at Moria Medical Support said more needed to be done to support conditions at the Moria camp and others in the northern hemisphere.

“During our time on the Island of Lesbos, my overwhelming feeling was frustration at the conditions in the camp – a sentiment shared by many seasoned NGO-workers.

“In our experience, refugees are better off in many camps in the global south in terms of safety, housing, access to food, sanitation and medical services.

“I hope this research adds to public awareness about the psychological impact of life in these camps and inspires the development of a more humane asylum process.”

Mental health consequences of long-term stays in refugee camps: preliminary evidence from Moria’ is published in BMC Public Health. The co-authors of the paper are:

Dr Willemine van de Wiel, Moria Medical Support

Carla Castillo-Laborde, Universidad del Desarrollo, Chile

Dr Francisco Urzua, The Business School (formerly Cass)

Michelle Fish, Moria Medical Support

Willem F. Scholte, University of Amsterdam, The Netherlands

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