MANY FEMALE REFUGEES and asylum seekers are dealing with serious mental health struggles as they adapt to life in Ireland, new research has found.
A report carried out by Akidwa, a national network of migrant women living in Ireland, also highlights the lack of support available to many women, particularly those who live in Direct Provision.
Women who have fled persecution, violence and, in some cases, war in their home country often have to deal with depression, anxiety and post-traumatic stress disorder (PTSD).
The report, Let’s Talk, will be launched at an event in Dublin city later this morning.
Forty women aged between 19 and 55 years were interviewed in various locations across the country for the research, as were relevant service providers.
The report notes that, once they leave their home country, “migrants can face uncertainty, hazardous journeys, and extended periods in refugee camps with poor resources and harsh condition”, adding: “These experiences can provoke or aggravate distress, fear, depression and other mental health problems.”
Many of the women interviewed spoke about being affected by PTSD, particularly those from Syria.
The study also identified the key barriers to accessing mental health services including stigma and shame, language barriers, lack of information and inadequate service provision.
‘Consumed with grief’
The report notes that all participants, to varying degrees, experienced “a rupture from their family, community and culture with a forceful relocation and reshaping of their lives”.
“They recounted experiences of many losses, not only the loss of a loved one, but also the loss of homeland, cultural group, employment, housing, and security. It is to be expected that being bereaved is only one of many losses that may affect mental health.
“In particular, for Syrian refugees there was a profound sense of grief about the loss of family members through death in the war, dislocation or leaving them behind. Some families had been separated during the journey, some had family members in other European countries, while others were still in their home countries,” the report states.
It added that many of the Syrian women they spoke to “reported concern for the safety of their children and are consumed with grief at their loss”.
“Yes, it is a grief, a sense of grief and sorrow at the same time because the children who are here, they keep crying most of the time because their siblings are living somewhere else,” one woman said.
Another added: “This feeling and the continuous thinking about our loved ones all the time, this is affecting our mental health because we can’t concentrate on other things here in Ireland, even if we want to learn the language, for example.”
Another Syrian woman spoke about how difficult it can be to adapt to life in another country after leaving your relatives and friends behind. “We left our loved ones behind. In Syria, for example, social life is very different from here and you would be surrounded by your extended families.
I think it’s very difficult because you have to change country, and you have no friends and you have no families, you don’t know the language, like you didn’t have nothing at all.
One woman said her parents are older and “thinking that you will never see again them” is “very hard”.
Another woman said she and others want to show Irish people that they want to work, “to show them that you can do something for yourself”. “We can do it, we can make, we can also work, we can do many things here,” she added.
Syrian women also spoke about the impact of the journey they made to Europe, sometimes arranged by traffickers, and the “suffering” they experienced in refugee camps in Greece.
Around 400,000 people are estimated to have died since the Syria war began almost nine years ago, while millions more are displaced.
As of last month, just over 3,100 people had arrived in Ireland as part of the Irish Refugee Protection Programme. A further 2,900 refugees, mainly Syrians, will be welcomed here over the next four years.
About 6,000 people live in Direct Provision centres across Ireland, while more than 1,500 other international protection applicants live in emergency accommodation.
‘Portraying us as spongers’
Participants in the research said they believed many people in their new communities did not understand or were not aware of their lived experiences as refugees and asylum seekers, and that the media had contributed to negative perceptions of them.
Speaking about certain media coverage, one woman stated: “Every day you have to explain yourself to people because even if you walk on the street, people ask why you are here, ‘Why did you leave your country?’ The media was saying a lot of things about us – portraying us as spongers, that we are here spreading diseases and all that.
“So those are the things that were really frustrating us, because we have noticed that people would not understand why we are here,” the woman said, adding that asylum seekers did not come to Ireland to “take over”, rather “to be part of the community and give back to the community when we’re given a chance to do so”.
One woman who has a master’s degree in media studies from Trinity College Dublin felt that despite her qualifications she was discriminated against when looking for a job.
“You are looking for a job and you can’t get it so you are stressed … you apply for jobs and sometimes you don’t even get an answer. So, you start maybe to question yourself, is it my name or maybe there’s something wrong with me?,” she said.
Another woman spoke of her concerns over whether or not she and her child would be accepted in their new community if she is sent somewhere “where I’m the only African woman”, asking: “How will my child feel amongst other Irish kids?”
Lack of integration opportunities
Women who live in Direct Provision centres spoke about their feelings of isolation and loneliness, and a lack of opportunities to integrate into their new communities.
“Living in Direct Provision with little contact with the local Irish community increased a sense of isolation and loneliness. This was particularly felt in relation to their children who had limited opportunities to interact with local children,” the report notes.
One mother said: “You feel like you are all alone, the children are not experiencing the full Ireland, to be out there and see the whole world.
“We really don’t have access to the community for the children to get together with the other kids in the Irish community. So, that is a bit of a challenge for us. We still feel like we are in this on our own, secluded here.”
Another woman said: “You have people cooking for you, there’s security everywhere, there are cameras everywhere and then you have some people that were there before, who were saying if you’re not careful with your kids, they’re going to take your kids away, you know, so a different fear sets in.”
Another mother said she tries to stay as busy as possible, explaining: “I don’t like to be idle because when I was growing up my mum said ‘Anything you’re doing, your kids are watching you’. Any impact you’re making on yourself, that’s when your kids will see.”
She said her sons are dreaming about what they will be in the future, “they tell me, ‘Mummy, I’m going to be this, I’m going to be that’”.
“I want to be an example to them, a good example to them, so I don’t like to be idle,” she said.
Service providers
The researchers carried out five focus groups and four in-depth interviews with women in Waterford, Ballyhaunis in Co Mayo, Mallow in Co Cork, Cork city and Carlow from July to September 2019.
The majority of participants were asylum seekers (international protection applicants), seven were in Ireland under the Refugee Resettlement Programme and four had obtained Leave to Remain (residency) status.
Researchers also spoke to relevant service providers and healthcare professionals as part of the study.
“Overall, service providers perceived that the mental health concerns of refugees and asylum seekers are more complex than those of the general population,” the report notes.
Collectively, narratives highlighted that the most concerning mental health issues associated with the refugee and asylum-seeker population in Ireland include PTSD, trauma, depression, anxiety, isolation, separation from families, loss and grief.
One service provider said: “What seems to affect women the most would be complex PTSD.” They added that PTSD can affect the women “being able to study, being able to work, being able to manage their family life, being able to build relationships”.
The report notes that a number of service providers said the Direct Provision system itself is “as a major contributor to mental health difficulties in asylum seekers”.
“Some providers revealed how they witnessed, within Direct Provision, migrant women become progressively disempowered and depressed, as the system takes away their autonomy and engenders fear and anxiety,” the document adds.
One service provider stated: “Significant depression comes from numerous sources for asylum seekers related to the system, length of stay in DP and when it will end. Letters of refusal, deportation orders and refusal of family reunification – these all cause significant distress points. They don’t know the system. they rely on hearsay from others in Direct Provision.”
Another provider added: “Feeling fearful is present all the time and a lack of safety is there. So especially with clients who are in the asylum process when they’re completely in limbo and they don’t have that safety of knowing that they can stay, that’s exacerbated.”
The report notes that “the denial of the right of work for some asylum seekers” has also “caused distress and a sense of unfairness amongst residents in DP”.
Better integration needed
The report makes a number of recommendations in terms of how the situation could be improved for the women interviewed, as well as asylum seekers and refugees in general.
The report’s authors call for Direct Provision to be replaced “with a more humane and supportive system”. They also state that the asylum processing system “needs to be more transparent and faster”.
Akidwa and others have been campaigning for some time for vulnerability assessments for all applicants for international protection, including assessment of mental health, to be introduced.
A vulnerability assessment is a statutory obligation of opting into the EU (Recast) Reception Conditions Directive, which was transposed into Irish legislation in June 2018. However, it is yet to be introduced here.
The report also calls for a designated psychological and psychotherapy or counselling service to be made available at local level to provide support asylum seekers and refugees.
Akidwa also wants GPs and other primary care service workers to be “adequately trained and resourced to meet the complex needs of this vulnerable population”. The report adds that translation services “should be readily available in primary care and to all health providers that care for asylum seekers and refugees including psychology and psychotherapy/counselling services”.
When asked for comment, a spokesperson told TheJournal.ie the Department of Justice and Equality “welcomes all constructive suggestions to improve services to applicants for international protection” and “will consider the detail of the report, and its recommendations, as they pertain to the work of the Department of Justice”.
“It should be noted that the provision of health services is primarily a matter for the HSE, who work closely with the Department of Justice and Equality, and centre management, to provide a range of health services, including mental health services, to all residents,” they added.
A spokesperson previously told us the International Protection Accommodation Service (IPAS), which falls under the department’s remit and was previously known as the Reception and Integration Agency, liaises closely with colleagues in the HSE and other departments and agencies “to address the health needs of residents”.
“Any residents with complex medical conditions are assessed in Balseskin Reception Centre so that their needs can be addressed. Protection applicants have access to all emergency medical services immediately on arrival in the country,” the spokesperson said at the time.
They added that GPs or medical personnel in hospital can refer asylum seekers who have suffered torture or trauma for specialist medical services in Dublin or other centres.
It was announced in December that an expert group would examine new ways to “better meet needs of asylum seekers”.
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