Mental health for refugees, asylum seekers and displaced persons: A call for a humanitarian agenda

Every day, nearly 34,000 people are forcibly displaced as a result of war, conflict or persecution. Globally, more than 65 million people have been forced from their homes and about 21 million of these are refugees, over half of whom are under the age of 18. About 80% of these refugees, over 16 million, are under UNHCR (the UN Refugee Agency) mandate, and fully 5.2 million Palestinians are refugees registered by UNRWA (United Nations Relief and Works Agency for Palestine Refugees in the Near East). Approximately 10 million persons are stateless and denied access to basic rights such as education, healthcare, employment and freedom of movement. Currently, more than half of the world’s refugees are from three countries: Syria, Afghanistan, and Somalia (UNHCR, 2017). The major receiving countries are Turkey, Pakistan, Lebanon, Iran, Ethiopia, and Jordan. Despite all of the popular media attention to waves of refugees, only 17% of those displaced reach Europe; 56% remain in Africa and the Middle East. Behind every number in the UNHCR statistics there is an individual story of someone forced to uproot and move due to war, conflict, persecution, and hardship—and, for many, this situation has led to persistent displacement and uncertainty in “temporary” situations that now span generations. We know that being an asylum seeker, refugee, or forcibly displaced has a profound impact on mental health, with an increased risk of developing common psychiatric disorders, such as, depression, anxiety, post-traumatic stress disorder (PTSD), psychotic disorders as well as disabling symptoms of psychosocial stress (Hassan, et al., 2015; 2016). In addition, there is often poor access to mental health care and a lack of funding for mental health promotion strategies addressing the special needs of asylum seekers, refugees, and other displaced persons. The number of people seeking refugee status in Europe has soared over recent years with a peak in 2015 .   Waves of refugees continue to search desperately for sanctuary by crossing the Mediterranean, a perilous journey that already has cost thousands of lives. European countries have responded with joint efforts which increasingly aim to close their borders to refugees—with the notable exception of Germany, which as of late 2017 is still receiving large numbers of asylum seekers. With blocked borders to much of Europe, many refugees are stuck in countries like Greece and Italy. Recent reports from the   European Union Agency for Fundamental Rights (2017)   note that living conditions in the EU reception centers remain poor. In addition to unfair treatment at border zones in some places, practical and legal barriers to receiving health care, poorly resourced child protection services, and fragile relationships with local communities are aggravated by incidents of racism and discrimination. In parallel to the social strains in European countries marked by the rise of populist and protectionist policies and hostility towards refugees, there have been major efforts within several countries, communities, and the civil sector to promote a humanitarian response to people seeking protection from war and persecution. While 18 European countries currently fund and promote health education and staff training on cultural awareness ( Priebe et al., 2016 ), at present, there are no routine systems in place on a regional or national basis for documenting the mental health care services used by refugees, asylum seekers, and irregular migrants.