The Mental Health Needs of Refugees and Asylum Seekers

Most refugee people are forced to flee their countries because of wars, human rights violations, persecution, organised violence or torture (German, 2004). This is reflected in the statistical data which show that shifts in the areas of conflict and human rights violations across the globe correspond to changes in the nationalities or ethnic groups seeking asylum in the UK (Home Office, Asylum Statistics 2003 & 2004). In terms of asylum applications relative to the population of a country, the UK ranks tenth in western Europe (UNHCR, 2005). Many people do not have the resources or desire to flee to the west but cross for safety into a neighbouring country or, as internally displaced people, locate to a different area of their own country or region of origin. Asia hosts over a third of the world’s refugees, while a quarter are in Africa and nearly a quarter in Europe, with North America absorbing less than six per cent (UNHCR, 2005). Refugees often suffer tremendous losses, giving up everything familiar and facing severe difficulties en route as well as when they arrive in the host country (Blackwell, 2005). They often prove to be very resourceful and resilient and it is these strengths which may enable them to flee to a different country and face the associated challenges. Refugees are not a recent phenomenon, although the current terminology and descriptive language were developed after the Second World War. There have been mass movements of people from persecution since the time of the Roman Empire (Wilkinson, 2003). Despite being seen by some as a ‘burden on society’, refugees contribute significantly to the economic wellbeing, the knowledge base and cultural life of their host countries. Many are highly qualified professionals who, prior to coming to the UK, had a good standard of living but, as refugees residing in the UK, often find themselves living in poverty with poor physical and mental health (Burnett, 2002). In April 2005, there were 1,010 refugee doctors on the British Medical Association/Refugee Council database (BMA, 2005). The Council for Assisting Refugee Academics claims that it can cost as little as £1,000 to prepare a refugee doctor to practise in the UK compared with £250,000 to train a doctor from the beginning (CARA, 2005). If human rights were better respected around the world, fewer people would feel the need to flee across national borders, although economic disparity between countries remains an issue. As with any large group of people there may be a small number who abuse the system. Unfortunately the media have focused on these few and generalised this to apply to all refugees, with the unfortunate consequence that the voices of the majority have not been heard and their considerable losses and hardships have frequently gone unrecognised. If, in their country of origin, the government or the human rights situation changes, many refugees choose to return, as they did when Pinochet was replaced in Chile and after the memorandum of understanding was signed in Sri Lanka.