Refugees, trauma and PTSD [en]

Carla Dörr

According to the UN Refugee Agency, 70 million people were fleeing from war, persecution and conflict in 2018. This is the highest level that the UN Refugee Agency has seen in the last 70 years. Refugees mostly flee from unbearable situations in their home countries. Many of them are severely traumatized. In addition to the traumatic events many of them were confronted with in their countries of origin, they often encounter traumatic situations during flight such as accidents, torture, forced prostitution and others. Often it takes them years to find a secure place to settle down. Once they arrive in a host country, they are safe from war and persecution but a temporary asylum status, discrimination, separation from family members, life in refugee accommodations, unemployment and financial difficulties are just some of many further stressors refugees encounter.

The number and severity of traumatic experiences has a high burden on their mental health. Post-traumatic stress disorder is a severe mental disorder that often appears in survivors of traumatic experiences. In the German population, PTSD is rare: around 1.4 percent suffer from it during their lifetime, whereas around one third of refugees suffer from PTSD.

People suffering from PTSD continuously re-experience the traumatic event involuntarily in nightmares or flashbacks. They feel frightened by cues that remind them of the traumatic event, are easily startled and often suffer from sleep disturbances and anger outbursts. PTSD patients avoid situations that are related to the trauma, such as places, people and even thoughts and feelings. Often they have trouble to remember key features of the traumatic event. PTSD is typically accompanied by other mental disorders such as depression or anxiety.

Their past experiences prevent people with PTSD from adapting to the requirements of life in host countries. Learning a foreign language, searching for a job and even daily household activities can be very demanding or even impossible for them.

Beside these restraints, PTSD patients are often put at disadvantages in the asylum procedure: Avoidance symptoms prevent them from telling details of their experiences in court and incoherent memories of the traumatic events often let judges doubt the trustworthiness of their statements.

Many therapy centers in Germany offer free treatment for refugees, but the number of traumatized refugees is high and often exceeds their capacities. Therefore refugees often have to wait a long time to get help. Once they enter a therapy program, for many of them it is the first time to talk about their experiences. Avoiding symptoms make therapy very challenging. Some may worry that what is told during therapy could have a negative impact on their asylum process or could be transmitted to persecutors, but this fear is unfounded: the staff of therapy centers is bound to professional secrecy. Therapy is worth to do: Despite the severity of the disorder, PTSD can be treated and healed. Though traumatic experiences can’t be deleted, one can learn to deal with them.

Therefore, treatment of mental disorders is a key factor for successful integration of refugees.