The Use of Art Therapy in Alleviating Mental Health Symptoms in Refugees: A Literature Review

There are over thirty million refugees globally with severe experiences of trauma.Art therapy intervention allows for nonverbal expression and could alleviate mental health symptomatology among refugees.The present review’s aim was to integrate and summarize the previous research which examined the effects of visual arts on alleviating psychological conditions of refugees.However,due to the paucity of studies which solely used visual arts,we included studies that used visual arts alongside other modalities as part of an expressive arts therapy intervention.The present review synthesizes studies that examined the effect of art therapy on mental health issues of refugees from January 2000 to March 2021.Seven studies(child and adolescent sample,N=5 and adult sample,N=2)with a total of 298 refugee participants(n=298)met our inclusion criteria.The participants were from the Middle East and North Africa(MENA),Southeast Asia,and Europe.We found three commonly reported mental health disorders,namely Post Traumatic Stress Disorder(PTSD),anxiety,and Major Depression Disorder.The research highlights how art therapy interventions could be a great starting point to alleviate symptomatology among refu-gees.Four additional benefits of art therapy which were commonly reported across the seven studies emerged from this review:working with traumatic experience/loss,rebuilding social connection and trust,nonverbal com-munication and self-expression of loss and trauma,and retelling stories.Art therapy interventions could be used as a starting point in the healing process of traumatized refugees to encourage verbal articulation of their feelings and reduce mental health symptoms.Despite these promisingfindings,due to a dearth of robust methodologies,further research is required to assess the long-term effectiveness of art therapy.

Food and Nutritional Security in the Refugee Women’s Life Narratives

Objective: To understand, based on the life narratives of refugee women, food and nutritional security. Method: Qualitative, descriptive, exploratory study, Narratives of life method, by Daniel Bertaux. Conducted with 11 participants, refugee women residing in the state of Rio de Janeiro, Brazil. Results: The meanings and feelings evidenced in the life narratives of refugee women expressed the insecurities and weaknesses with food in the resettlement. Final Considerations: Given the meanings and feelings regarding food in the refuge, it is expected that the present study will contribute to the elaboration of new action plans and intersectoral public policies of agile action to meet the demands of the refugee population, in the attempt to mitigate starvation, poverty, social differences and the compromised health status of the refugee population.

Intensive care outcomes of refugee patients in Turkey between 2013 and 2019: A retrospective descriptive study

Objectives:To assess the outcomes of the intensive care of Syrian refugees under temporary protection (SRUTP). Methods: The sample of the study was composed of 110 SRUTP patients who were treated at a tertiary intensive care unit (ICU) between 2013 and 2019 in Istanbul, Turkey. Baseline information and clinical data of the patients were collected by scanning the hospital's electronic database and clinical decision support system. Results:The mean length of ICU stay was 97.6 (36.3-187.8) h. Among the patients, 71 (64.5%) had comorbid diseases, and ICU mortality was 40%. The median cost of health care for each patient was 2144 (1060-4471) USD, and the total health care cost of all patients was 534012USD. Conclusions: Use of vasoactive drug, hemodialysis application, and low Glasgow Coma Scale scores are independent risk factors of the mortality. More researches are needed to clearly reveal the health and cost consequences of war.

The Pattern of Refugee Management for Ensuring Their Rights： The Indian Approach

In its short history India has hosted some of the largest refugee movements in history including the massive flows between India and Pakistan in 1947. At that time, Partition and India giving asylum to approximately 10 million refugees from the former East Pakistan （now Bangladesh） in the early 1970. Presently India has in its refugee protection Tibetans from Tibet, Tamils from Sri Lanka and Chakma from Bangladesh who have been granted protection and care and are directly assisted by the Government of India. Also refugees such as Burmese, Afghans and others are under Indian care. India is not a state party to the 1951 UN Convention relating to the status of refugees or the 1967 protocol, nor is there any domestic law or legal procedure governing the protection of refugees. There is no binding regional agreement concerning refugees in South Asia. India continues to maintain the same for various reasons but primarily internal security. In spite of the fact that there is no any legal regime to govern the refugee protection, India has acceded to or signed all the major international human rights instruments such as International Covenant on Civil and Political Rights, 1966, International Covenant on Economic, Social Cultural Rights, 1966, Convention on the Rights of Child 1989. Indian laws that are enacted from time to time necessarily incorporate many of the international provisions so that the refugees are taken care of adequately. Further, the Indian Constitution makes no distinction between Indian nationals and others including refugees in ensuring basic human rights and freedom. Articles 14 and 21 of Indian Constitution, for example, are equally applicable to all. Of late the interventions of Indian Judiciary and Human Rights Institutions such as National and State Human Rights Commissions are praiseworthy and of paramount importance in safeguarding refugees against arbitrary actions. The role of civil societies and the media is noteworthy in this context. India adopts the principle of non-refoulement in matters pertaining to refugee protection. The Sri Lankan Tamils＇ case is a glaring example to substantiate the above principle. This article dwells on the pattern of refugee management in India and the issues involved in it.

The Analysis of the Refugee Determination System of China in the New International Situation

The refugee determination system directly affects whether or not an asylum seeker can obtain a country’s legal protection. The rational construction of China’s refugee determination system is not only the need to comply with China’s obligations under the International Refugee Convention, but also the requirement for the protection of the legitimate rights of refugees in China. Under the current framework of international law and domestic law, we should gradually improve China’s legal system of refugee status determination, and we should determine refugee screening agencies and define their division of labor and powers rationally, according to the actual situation of China. In the meantime, we should attach importance to undertaking China’s international obligations and strengthening international cooperation in refugee relief.

Prevalence of hepatitis B and C markers among refugees in Athens

AIM: To assess the prevalence of hepatitis B and C serological markers in a population of refugees living in Athens.METHODS: One hundred and thirty refugees (81 males and 49 females, mean age ±SD: 31.7±8 years) were included in the study. The hepatitis B virus surface antigen (HBsAg),the hepatitis B virus core antibody (anti-HBc) and the hepatitis C virus antibody (anti-HCV) were detected using a third-generation immunoassay.RESULTS: Twenty individuals (15.4%) were HBsAg positive and 69 (53.1%) were anti-HBc positive. The prevalence of HBsAg and anti-HBc was higher among refugees from Albania and Asia (statistical significant difference, P＜0.008 and P＜0.001 respectively). The prevalence of these markers was found irrelevant to age or sex. Anti-HCV was detected in the serum of 3 individuals (2.3 %). No differences among age, sex or ethnicity regarding anti-HCV prevalence were found.CONCLUSION: It can be concluded that refugees living in Athens are an immigrant population characterized by a high incidence of HBV infection. The prevalence of HBV markers is higher among refugees from Albania and Asia. It is therefore believed that the adherence to general precautions and the initiation of HBV vaccination programs will be necessary in the future, especially in these communities.Although the prevalence of HCV infection seems to be relatively low, extended epidemiological surveys are needed to provide valid results.

Microbiological screenings for infection control in unaccompanied minor refugees： the German Armed Forces Medical Service＇s experience

Background:The German Military Medical Service contributed to the medical screening of unaccompanied minor refugees(UMRs)coming to Germany in 2014 and 2015.In this study,a broad range of diagnostic procedures was applied to identify microorganisms with clinical or public health significance.Previously,those tests had only been used to screen soldiers returning from tropical deployments.This instance is the first time the approach has been studied in a humanitarian context.Methods:The offered screenings included blood cell counts,hepatitis B serology and microscopy of the stool to look for protozoa and worm eggs as well as PCR from stool samples targeting pathogenic bacteria,protozoa and helminths.If individuals refused certain assessments,their decision to do so was accepted.A total of 219 apparently healthy male UMRs coming from Afghanistan,Egypt,Somalia,Eritrea,Syria,Ghana,Guinea,Iran,Algeria,Iraq,Benin,Gambia,Libya,Morocco,Pakistan,and Palestine were assessed.All UMRs who were examined at the study department were included in the assessment.Results:We detected decreasing frequencies of pathogens that included diarrhoea-associated bacteria[Campylobacter(C.)jejuni,enteropathogenic Escherichia(E.)coli(EPEC),enterotoxic E.coli(ETEC),enteroaggregative E.coli(EAEC),enteroinvasive E.coli(EIEC)/Shigella spp.),Giardia(G.)duodenalis,helminths(comprising Schistosoma spp.,Hymenolepis(H.)nana,Strongyloides(S.)stercoralis]as well as hepatitis B virus.Pathogenic microorganisms dominated the samples by far.While G.duodenalis was detected in 11.4%of the assessed UMRs,the incidence of newly identified cases in the German population was 4.5 cases per 100,000 inhabitants.Conclusion:We conclude that the applied in-house PCR screening systems,which have proven to be useful for screening military returnees from tropical deployments,can also be used for health assessment of immigrants from the respective sites.Apparently healthy UMRs may be enterically colonized with a broad variety of pathogenic and apathogenic microorganisms.Increased colonization rates,as shown for G.duodenalis,can pose a hygiene problem in centralized homes for asylum seekers.

Clinical Audit on the Provision of Diabetes Care in the Primary Care Setting by United Nations Relief and Works Agency for Palestine Refugees in the Near East (UNRWA)

OBJECTIVE: United Nations Relief and Works Agency for Palestine Refugees in the Near East (UNRWA) provides primary health care services including care for diabetes and hypertension, with limited resources under difficult circumstances in Gaza, West Bank, Jordan, Lebanon and Syria. A total of 114,911 people with diabetes were registered with UNRWA health centres in 2011. The aim of this cross-sectional observational study was to assess the quality of diabetes care in the UNRWA primary health care centres. METHOD: The study population consisted of 1600 people with diabetes attending the 32 largest UNRWA health centres and treated there for at least one year. Between April and Sept. 2012 data from medical records, including results of clinical examinations and laboratory tests performed during the last one year, current management including self-care education and evidence of diabetes complications were collected and recorded in a previously validated data collection form (DCF). Patients were interviewed and clinically examined on the day of the audit and blood collected for HbA1c testing which was done at a central lab using High-performance liquid chromatography (HPLC) method (HLC&reg-723G8 Tosoh Corporation, Japan). Data was transferred from paper records into a computer and analysed with Epi-info 2000. RESULTS: Type 1 diabetes was present in 4.3% and type 2 diabetes in 95.7%. Co-morbid hypertension was present in 68.5%;90.3% were either obese (64.0%) or overweight (26.3%). Clinical management of diabetes was largely in line with UNRWA’s technical instructions (TI) for diabetes. Records for 2 hour postprandial glucose (2 h PPG), serum cholesterol, serum creatinine, and urine protein analysis were available in 94.7%, 96.4%, 91.4% and 87.5%, cases, respectively. Records of annual fundoscopic eye examination were available in 47.3% cases but foot examinations were less well documented. Most patients (95.6%) were on anti-diabetic drugs—68.2% oral anti diabetic drugs (OAD) only, 14.4% combination of OAD and insulin, and 12.9% insulin only. While 44.8% patients had 2 h PPG ≤ 180 mg/dl, only 28.2% had HbA1c ≤ 7%;55.5% and 28.2% had BP ≤ 140/90 and ≤130/80 mm of Hg respectively. Serum cholesterol ≥ 200 mg/dl, serum creatinine ≥ 1.2 mg/dl and macro albuminuria were noted in 39.8%, 6.4% and 10.3% cases respectively. Peripheral neuropathy (52.6%), foot infections (17%), diabetic retinopathy (11%) and myocardial infarction (9.6%) were the most common long term complications. One or more episodes of hypoglycaemia were reported by 25% cases in total and in 48% of those using insulin. 17.7% and 22.6% cases received no or ≥4 self-care education sessions respectively. CONCLUSION: The study confirmed that UNRWA doctors and nurses follow TI for diabetes and hypertension fairly well. Financial constraints and the consequent effects on UNRWA TI and policies related to diabetes care were important constraints. Key challenges identified were: reliance on 2 h PPG to measure control;non-availability of routine HbA1c testing, self-monitoring of blood glucose (SMBG) and statins within the UNRWA system;and high levels of obesity in the community. Addressing these will further strengthen UNRWA health system’s efforts of providing services for diabetes and hypertension at the primary care level. Given that most developing countries either have no or only rudimentary services for diabetes and hypertension at the primary care level, UNRWA’s efforts can serve as an inspiration to others.

Multi-family therapy for veteran and refugee families: a Delphi study

Background: Research indicates that Posttraumatic stress disorder(PTSD) has an extensive impact on family relationships. Nevertheless, there is a dearth of empirically supported interventions addressing family functioning and PTSD. In the Netherlands, it is considered good clinical practice to offer multi-family therapy(MFT) to veteran and refugee families. MFT for traumatized families aims to address the dysfunctional family patterns that have evolved to address the consequences with trauma.Methods: The aim of this study is to generate a common framework for the practical impact and active ingredients of MFT in families confronted with trauma. The Delphi method was used to study the expert opinion of 11 therapists in Dutch expert trauma institutes.Results: The results indicate that MFT is a promising treatment for families dealing with the consequences of trauma. According to experts, positive outcomes include an increased understanding between family members,particularly visible in the de-escalation of conflicts within the family, and improved parenting. One explanation for the effectiveness of MFT with these target groups is its defining feature of therapy with several families.Conclusions: The findings support the importance of considering family relationships and the family context in interventions for traumatized individuals.

Blinding trachoma among refugees:complicating social disaster

Objective:To determine the prevalence of blinding trachoma among refugees in South Western Ethiopia.Methods:A cross-sectional outreach clinic based descriptive study was conducted on 1054 refugees in Southwest Ethiopia.A basic eyelid and cornea examination for signs of trachoma was done by using 2.5× binocular magnifying loupe.The findings were classified by using the World Health Digitization simplified trachoma grading system and data were analyzed by using SPSS version 16.0.Results:A total of 1054 refugee patients were examined for trachoma.179(16.98%) of them had clinical signs of trachoma.About 6(3.35%) patients had active trachoma with trachomatous trichiasis(TT),47(26.26%) patients had TT only and the rest 126(70.39%)patients had TT with trachomatous corneal opacity.All of the trachoma patients had blinding trachoma(TT with or without trachomatous corneal opacity),and about 60.89% of them had visual impairment.Blinding trachoma was significantly more common among females.patients in age group of 16-59 years,married patients,illiterates and Fugnido camp settlers(P<0.05).Conclusions:There is a very high burden of blinding trachoma among refugees.Urgent surgical intervention is needed to prevent blindness and low vision in the study subjects,and targeted regular outreach-based eye care service should be commenced.

The Rise of the Far Right in Europe and the Refugee Crisis

The rise of the far right in Europe has captured the attention of the international community in recent years. Its specific features are: an unprecedentedly strong influence, an obvious trend towards the moderate line, horizontal collaboration to expand its reach, and a very adept use of social media networks. The refugee crisis has given the far right an historical opportunity. The rise has also had a profound effect on European politics; it has deepened the political divide inside EU member states, and shaken up the traditional political values and the foundation of the union.The rise of the far right will likely not change Europe's political landscape, but problems of EU governance over its handling of the refugee crisis cannot be ignored.

Culture- and evidence-based health promotion group education perceived by new-coming adult Arabic-speaking male and female refugees to Sweden—Pre and two post assessments

Objective: According to a theoretical approach, events that elicit stress after arrival in the reception country, i.e., post-migration stress, have a negative impact on health-related quality of life among newly-arrived refugees. With the aim of paying attention to such symptoms, a revised culturally-tailored clinical health promotion model developed at Harvard Program in Refugee Trauma was used for invited groups of new-coming adult refugees in a town south of the Swedish capital. Methods: A coordinator administered the five-weekly sessions, 2 hours/week, with a professional interpreter. It covered major topics from Western and Arabic worldviews: 1) introduction;2) health care: organisation and access to;3) exercises;4) stress management and coping, 5) medical doctor-patient communication. Each topic was led by a nurse, a physiotherapist, a psychologist and a physician with experience of encounters with this target group in health care. Data cover results from 70 participants attending six groups;39 participants with pre-course findings and, post-course and six-month follow-ups. There were no significant differences in background factors between the participants and the drop-outs. Results: Participants’ perceptions of their health, measured by EQ-5D, changed positively over time, above all immediately after the course, with no significant differences between the two follow-ups. In the follow-ups, female participants perceived their health as significantly worse than males. Qualitative data at the six-month follow-up assessed the course as useful but expressed a wish to continue a similar course with a focus on post- migration stress. Conclusion: The results sup- port earlier findings. A course, administered to a small group in a dialogue setting, has value for the participants’ empowerment and perception of health. It is recommended that reception be more adapted to coping of post-migration stress of new-coming refugees. Practical Implications: The results have implications for education in clinical health promotion, intercultural communication and inter-professional collaboration in refugee reception.

Obstetric Care among Refugees: The Complex Interplay of Barriers to Care, Culture, Health Resources and the Healthcare Infrastructure of Host Countries

There is a worldwide increase in the rate of caesarean sections. With recent migration patterns and the influx of refugees into high-income countries, migrants and refugees are also subjected to the increase in caesarean section rates. This article explores known information about the obstetrical experiences of refugee and displaced women. Pregnancy care varies depending on the location of the displaced women. Obstetrical care in refugee centers in Greece is examined as an example of the overall challenges facing European countries as they juggle the influx of refugees. Challenges to obstetrical care include physician shortage and the ongoing economic crisis in Greece. Refugees are some of the world’s most vulnerable populations and overall their obstetrical outcomes are worse than women of the host communities. Providers in refugee centers must be supported and educated in best obstetrical practices including labor management and a judicious use of caesarean deliveries. Increased outreach and training of maternal health worker can improve reproductive healthcare for refugees in non-camp environments.

The Power of Theater Expression and Communication:A Psychological Theraputical Intervention in a Refugee Camp:An IPA Study Into the Narratives of Women Refugees’Experience With Drama Therapy

Forced displacement poses a major global crisis that must be tackled at all levels:political,socio-economic,and psychological.This paper describes the psychological impact of forced displacement on women and explains the significance of drama therapy intervention(DTI)in treating and empowering trauma impacted refugee women.Frequently used to treat immigrant and refugee adolescents and children in many host communities,DTI is seldom applied to women refugees who suffer from psychological disorders compounded by fleeing their home country and by difficulties faced in host communities.This makes our study the first on women refugees leaving a zone of war and residing in dire conditions in refugee camps.To best analyze the impact of DTI,this study(1)utilizes a qualitative approach to explain the effects of drama therapy intervention on Syrian and Palestinian-Syrian refugee women in Lebanon;(2)It applies a modified five-phase DTI program to fit the experiment setting and conducts post-DTI interviews;(3)It uses interpretative phenomenological analysis(IPA)method to identify emergent themes and to analyze the effectiveness of DTI;(4)Finally,the study concludes that drama therapy can both help refugee women deal with war-related/post-migration emotional trauma and can implement positive changes and help its participants form social bonds among each other.

Photographs of Refugees in Polish Daily Newspapers—Critical Discourse Analysis

This paper describes the way in which the European migrant crisis is depicted in the Polish daily press.This topic seems to be important because of the current political situation in Poland,which presents right-wing and anti-immigrant views,and because of the ongoing conflict concerning this matter between the Polish government and European institutions.The analysis includes articles about refugees published in the selected months of 2015 and 2017 in three daily newspapers presenting opposing political sympathies.The paper employs critical discourse analysis and its discourse-historical approach describing strategies of presenting refugees in press photography.The analysis encompasses types of photographs,their functions,the relationship with their captions,and most importantly,topoi which constitute the focal point when addressing the relationship of power,knowledge,and discourse which is significant for critical discourse analysis(CDA).

Visual Manifestations of the European Discourse on Solidarity of Refugees and Migrants

The paper aims to examine different visual manifestations of the European discourse on solidarity during the immigration crisis (2015-2017). International Organizations such as UN (United Nations), IOM (International Organization for Migration), and EASO (European Asylum Support Office) following a set of European policies reflect solidarity in practice among the European Union (EU) states. Policy makers, apart from implementing and drafting different sets of policies in moments of emergency due to the immense migrant flow, have also accompanied these practices with visual representations in the form of posters and photos. These visual representations feature the organizations themselves and the discourse on solidarity towards the migrants. Hence, examining this material we can have a clear picture of the identity of the organizations but also, and most importantly, how they visualize their understanding of solidarity discourse. The paper is unfolded in the following way. Firstly, the theoretical framework of solidarity and the European Union’s perspective of solidarity are discussed in detail. Then, the focus is moved towards a theoretical discussion of emotion, the role of affect, and the role these Organizations play in the creation of European policies on migration. Thirdly, the analysis of the material, photos, posters, and a leaflet will be discussed in conjunction to the aforementioned theoretical framework of solidarity and affect.

The Impact of Za’atari Refugee Camp on the Water Quality in Amman-Zarqa Basin

Za’atari camp is the largest refugee camp in Jordan. It was first established in 2012 to host Syrian refugees. Currently the camp hosts more than 81,000 refugees, with no proper sanitary system which might pose a major threat to surface resources in the area. An investigation was done at Za’atari refugees’ camp to find the impact of refugees settling on surface and groundwater quality. Surface water quality of surface runoff generated from thirty rain fall events were collected during the winter season of 2013/2014 from the major Wadi that passes through the camp and small ponds within the camp after the rainfall event. The collected samples were analyzed for acidity (pH), the electrical connectivity (EC), total dissolved solids (TDS), nutrients (NO3<sup style='margin-left:-7px;'>- and PO4<sup style='margin-left:-7px;'>3-) and selected heavy metals (Mn, Cd, Zn, Pb and Ni) in addition to biological oxygen demand (BOD5), chemical oxygen demand (COD) and intestinal worms (Total Coliform, E. cali). The results showed that there are significant variations in the EC as well as with TDS between the sites due to fluctuating amounts of water used for different activities within the camp as it was highest in the center of the camp where most of the refugees settle decreasing away from the center. The pH values were within the specifications of the World Health Organization and the Jordanian Standards. For nutrients, nitrate concentration was low with high phosphate ions which are most probably from detergents origin.

Assessing the Factors Influencing Migration Decision of Climate Refugees in Coastal Areas of Bangladesh

The major impacts of climate change play a substantial role in triggering human migration, especially in the coastal areas. The individual or combined effects of climate change are likely to trigger mass human movement both within and across international borders. People rarely move for a single reason;the motivation to migrate is complex of many factors. The main goal of this article is to identify the factors related to the decision to migrate taken by refugees in the coastal area. To assess this objective we employ exploratory factor analysis and structural equation modeling (SEM) and find that different factors influence refugees’ migration decision differently. From the findings, it is seen that loss of shelter, extreme events, decreasing soil fertility and food shortage, variability in temperature patterns and exhaustion of natural resources are the most important environmental factors that affect the decision to migrate of climate refugees. Low income, increasing price, decreasing purchasing power are the most important economic factors that influence migration decision. No social factors have significant effect on migration decision while safety as a political factor has a moderate influence on refugees’ decision to migrate. Finally, this article provides some recommendations for recognition of and protection for migrants forced to move to safer places due to certain direct impacts of climate change, notwithstanding the existence of multi-causality.

The Thin Line Between Sanity and Insanity： The Case of Internment of the Asia Minor Refugees in Dromokaition Lunatic Asylum

Drawing on the completely unsearched case-books of the Dromokaition Lunatic Hospital of Athens, this paper gives the reader a chance to understand the origins of the mental disorder of the Asia Minor refugees who were interned there aiter the end of the Greek-Turkish war in 1922, and to bring to light for the first time in Greek history their spatial relations with physical as well as mental dimensions. On the one hand, the present research will attempt to investigate the trauma of war as well as the experiences of the refugees in Asia Minor that led to their personality disorder. On the other hand, it will illuminate their experiences of being refugees in the social, cultural and economic space of the Greek state that also led to their internment and the labeling of these refugees as mentally unstable. To explore the limits between sanity and insanity, these experiences will be presented in parallel with those of the refugees who were not interned in Dromokaition but were successfully settled in Greek society.

The Politics of Repatriation: Rwandan Refugees in Uganda, 2003-2017

Uganda hosts refugees from neighboring countries including Rwanda.According to United Nations High Commissioner for Refugees(UNHCR),by the end of 2018,Uganda was the 3rd and 1st top refugee hosting country in the world and Africa respectively.It hosted over 1.2 million refugees.In 2003,a tripartite agreement was signed to repatriate 25,000 Rwandan refugees.Only 850 of them accepted to return and many of them came back almost immediately to Uganda claiming insecurity and human rights violations in Rwanda.The Rwandan repatriation was not devoid of politics.It was influenced by political interests of various actors:the international community,regional geo-politics,Uganda,and Rwanda.This article analyzes the politics of repatriation of Rwandan refugees by focusing on politics at international and regional levels as well as in Uganda and Rwanda.