Psychosocial Problems in Refugee Children Exposed to War

At any one time there are about two dozen armed conflicts throughout the world. It has been estimated that during 1993 alone violent upheavals generated about 16 million refugees worldwide. The United States has received a significant refugee population from war zones. The two largest groups of refugees entering the country since 1975 were from Southeast Asia (about 820 000) and Central America (between 800 000 and 1 900 000). Although exact statistics are unavailable, it appears that as many as half of the Central American immigrants were children. Various studies have documented common physical health problems in refugee children entering North America. Inactive tuberculosis and hepatitis are prevalent health risks for Southeast Asian youth; intestinal parasites and respiratory tract infections (eg, otitis media) are widespread in both Southeast Asian and Latin American refugee children. Histories of malnutrition and incomplete immunizations are common. Although physicians are well-equipped to treat the range of physical ailments of refugee children, some of the most serious symptoms are likely to be psychological. Recovery from physical deprivation appears to be more rapid and complete than recovery from emotional trauma and loss. The symptoms of posttraumatic stress disorder (PTSD), described below (Table 1), can be disabling and persistent and are often undetected by adult caretakers. Other psychological problems resulting from war-induced trauma and displacement, as well as immigration and chronic poverty, place refugee children at heightened risk. Pediatricians are typically the first and often the only contact these mothers and children have with any form of health care or social service.