Asylum seeker

Objective: To review stressful experiences and stress reactions among child and adolescent refugees, as well as interventions and ethical considerations in research and clinical work, within the framework of the chronological experiences of child refugees; namely, the phases of preflight, flight, and resettlement. Highlighted are special refugee populations such as unaccompanied minors, asylum seekers, and former child soldiers. Pertinent medical findings are summarized. Method: The authors reviewed articles from 1990 to 2003 addressing the topics above. Literature was gathered from databases including PsycINFO, Medline, and SocioFile. Pertinent earlier papers and those from other disciplines cited in database-identified articles were also included. Results: Child and adolescent refugees suffer from significant conflict-related exposures. Reactions to stress may be mediated by coping strategies, belief systems, and social relations. Conclusions: More research is needed on interventions, specifically on efficacy and cultural relevance.

Context Worldwide, the number of refugees and asylum seekers is estimated to be about 11.5 million plus a much larger number of former refugees who have obtained a residence permit in a new country. Although asylum seekers have been coming to the Netherlands since the 1980s, very few epidemiological studies have focused on this group of inhabitants or on the refugees who have resettled in this country. Objectives The objectives of this study were to estimate the prevalence rates of physical and mental health problems and to identify the risk factors for these complaints. Design, Setting, and Participants A population-based study was conducted in the Netherlands from June 2003 to April 2004 among adult refugees and asylum seekers from Afghanistan, Iran and Somalia. Asylum seekers were living in 14 randomly selected reception centres, and random samples of refugees were obtained from the population registers of three municipalities (Arnhem, Leiden and Zaanstad). A total of 178 refugees and 232 asylum seekers participated (response rates of 59 and 89%, respectively). Main Outcome Measures General health and physical health were measured with the Short-Form 36 and a list of 19 chronic conditions, respectively; symptoms of post-traumatic stress disorder (PTSD), depression and anxiety, were measured with the Harvard Trauma Questionnaire and the Hopkins Symptoms Checklist-25. Results More asylum seekers (59.1%) than refugees (42.0%) considered their health to be poor (P=0.001). In both groups, approximately half of the respondents suffered from more than one chronic condition. More asylum seekers than refugees had symptoms of PTSD (28.1 and 10.6%, respectively; P=0.000) and depression/anxiety (68.1 and 39.4, respectively; P=0.000). Respondents from Afghanistan and, in particular, from Iran had a higher risk for PTSD and depression/anxiety. Female gender was associated with chronic conditions, PTSD and depression/anxiety, and higher age was associated with poor general health and chronic conditions. A greater number of traumatic events was associated with all health outcomes, and more post-migration stress and less social support were associated with PTSD and depression/anxiety symptoms. Conclusions Both physical and mental health problems are highly prevalent among refugees and asylum seekers in the Netherlands. Although higher prevalence rates for most health outcomes were found among asylum seekers, both the specific health services for asylum seekers and the general health services in the municipalities should be aware of these problems.

This paper uses 'othering' theory to explore how forced migrants are received in developed countries and considers the implications of this for public health. It identifies a variety of mechanisms by which refugees, asylum seekers and irregular migrants are positioned as 'the other' and are defined and treated as separate, distant and disconnected from the host communities in receiving countries. The paper examines how this process has the potential to affect health outcomes both for individuals and communities and concludes that public health must engage with and challenge this othering discourse. It argues that public health practitioners have a critical role to play in reframing thinking about health services and health policies for forced migrants, by promoting inclusion and by helping shape a narrative which integrates and values the experiences of this population. r

Compared to research on displaced persons whose refugee status has been endorsed prior to arriving in Western countries, there is little systematic information available about levels of past trauma, postmigration living difficulties and psychiatric symptoms amongst asylum-seekers who claim refugee status only after arrival. Asylum-seekers, authorized refugees and immigrants of Tamil background were recruited by personal contact and mail-out in Sydney, Australia. A total of 62 subjects, constituting approximately 60% of the estimated pool of Tamil asylum-seekers, agreed to participate in the study. They returned statistically significantly higher scores than immigrants (n=104) on measures of past trauma, symptoms of anxiety, depression and post-traumatic stress, and on all dimensions of postmigration difficulties. Asylum-seekers did not differ from refugees (n=30) on measures of past trauma or psychiatric symptoms, but they scored higher on selective components of postmigration stress relating to difficulties associated with their insecure residency status. Although limited by sampling and diagnostic constraints, the present study suggests that asylum-seekers may be a high-risk group in relation to ongoing stress in the postmigration period.

Background: This paper is a part of the work of the group that carried out the report "The state of the mental health in Europe" (European Commission, DG Health and Consumer Protection, 2004) and deals with the mental health issues related to the migration in Europe.

Immigration is an increasingly important political issue in Western democracies and a crucial question relates to the antecedents of public attitudes towards immigrants. It is generally acknowledged that information relayed through the mass media plays a role in the formation of anti-immigration attitudes. This study considers whether news coverage of immigrants and immigration issues relates to macro-level dynamics of anti-immigration attitudes. It further explores whether this relationship depends on variation in relevant real world contexts. The models simultaneously control for the effects of established contextual explanatory variables. Drawing on German monthly time-series data and on ARIMA timeseries modeling techniques, it is shown that both the frequency and the tone of coverage of immigrant actors in the news significantly influence dynamics in anti-immigration attitudes. The strength of the effect of the news, however, depends on contextual variation in immigration levels and the number of asylum seekers. Implications of these findings are discussed in the light of the increasing success of extreme right parties and growing opposition to further European integration.

Background: The aim of our article is to characterise and compare current standards of health care provision for asylum seekers in the 25 European Union (EU) countries in order to identify the needs and potential for improving access to health care for asylum seekers. Methods: The study is based on an e-mail survey performed between April and June 2004. The questionnaire was concerned with asylum seekers' access to medical screening upon arrival, and their general access to health care services on April 1, 2004. The questionnaire was sent to ministries and NGOs responsible for asylum seekers' health care in the 25 EU countries. A total of 60% of the ministries and 20% of the NGOs responded. We received answers from 24 out of the 25 countries. Results: Medical screening was provided to asylum seekers upon arrival in all EU countries but Greece. The content of screening programs, however, varied as well as whether they were voluntary or not. We found legal restrictions in access to health care in 10 countries. Asylum seekers were only entitled to emergency care in these countries. A number of practical barriers were also identified. Legal access to health care changed during the asylum procedure in some countries. Access to specialised treatment for traumatised asylum seekers existed in most countries. Conclusion: Health policies towards asylum seekers differ significantly between the EU countries and may result in the fact that the health needs of asylum seekers are not always adequately met.

■ Abstract With nearly one in ten residents of advanced industrialized states now an immigrant, international migration has become a fundamental driver of social, economic, and political change. We review alternative models of migratory behavior (which emphasize structural factors largely beyond states' control) as well as models of immigration policy making that seek to explain the gaps between stated policy and actual outcomes. Some scholars attempt to explain the limited efficacy of control policies by focusing on domestic interest groups, political institutions, and the interaction among them; others approach the issue from an international or "intermestic" perspective. Despite the modest effects of control measures on unauthorized flows of economic migrants and asylum seekers, governments continue to determine the proportion of migrants who enjoy legal status, the specific membership rights associated with different legal (and undocumented) migrant classes, and how policies are implemented. These choices have important implications for how the costs and benefits of migration are distributed among different groups of migrants, native-born workers, employers, consumers, and taxpayers.

The UK has become a leading proponent of European restrictionalism and has focused its efforts on developing policy that excludes asylum seekers from mainstream society. Dispersal policy has focused upon sending asylum seekers to excluded urban areas where there is an excess of available housing. This paper discusses the potential impacts of this approach on the economic prosperity and social cohesion of UK dispersal areas and focuses specifically on new migrants who arrived under the NASS dispersal programme. It demonstrates that, whilst newly arrived asylum seekers and refugees (ASRs) have both skills and qualifications, they are currently experiencing high levels of unemployment and those who are employed are working in low-skilled jobs with earnings far below the average. The paper contends that the high levels of unemployment and underemployment currently experienced by ASRs may serve to exclude them from society in dispersal areas and in so doing exacerbate the general levels of social exclusion in those areas. It is argued that ASRs could offer new opportunities for deprived areas if initiatives were introduced to help them access work commensurate with their skills and qualifications.

Postnatal depression (PND) is recognised as a common maternal health problem, but little evidence examines PND among refugee, asylum seeker and immigrant women in developed country settings. This review aimed to identify the rates of PND and highlight common risk factors among this group of women. An iterative and dynamic literature search was conducted across ten databases to identify published articles on PND among immigrant, asylum-seeking and refugee women in developed country settings. Medical Subject Headings (MeSH) and 'free text' search terms, as well as thesaurus terms, acronyms and truncation were used where appropriate. Findings suggest that PND may affect up to 42% of migrant women, compared to around 10-15% of native-born women. Common risk factors for PND among migrant women include history of stressful life events, lack of social support and cultural factors. With a growing number of babies born to immigrant mothers, greater awareness of PND among this group is needed in order to respond to their particular maternal mental health needs. Maternity care providers should regard all recent immigrants as at high risk of PND and give closer observation and support as necessary.

Objective: To document the psychiatric status of a near complete sample of children and their families from one ethnic group held for an extended period of time in a remote immigration detention facility in Australia.Method: Structured psychiatric interviews were administered by three same-language speaking psychologists by phone to assess the lifetime and current psychiatric disorders among 10 families (14 adults and 20 children) held in immigration detention for more than two years.Results: All adults and children met diagnostic criteria for at least one current psychiatric disorder with 26 disorders identified among 14 adults, and 52 disorders among 20 children. Retrospective comparisons indicated that adults displayed a threefold and children a tenfold increase in psychiatric disorder subsequent to detention. Exposure to trauma within detention was commonplace. All adults and the majority of children were regularly distressed by sudden and upsetting memories about detention, intrusive images of events that had occurred, and feelings of sadness and hopelessness. The majority of parents felt they were no longer able to care for, support, or control their children.Conclusions: Detention appears to be injurious to the mental health of asylum seekers.Implications: The level of exposure to violence and the high level of mental illness identified among detained families provides a warning to policy makers about the potentially damaging effects of prolonged detention on asylum seekers. In their attempt to manage the international asylum crisis, it is important that Western countries do not inadvertently implement policies that cause further harm.

A social identity framework was employed to understand why people support the exclusionary treatment of refugee claimants ('asylum seekers') in Australia. Over and above individual difference effects of social dominance orientation and individuals' instrumental threat perceptions, insecure intergroup relations between citizens and asylum seekers were proposed to motivate exclusionary attitudes and behaviour. In addition, perceived procedural and distributive fairness were proposed to mediate the effects of social identity predictors on intergroup competitiveness, serving to legitimise citizens' exclusionary behaviours. Support for these propositions was obtained in a longitudinal study of Australians' social attitudes and behaviour. Small and inconsistent individual-level effects were noted. In contrast, after controlling for these variables, hostile Australian norms, perceived legitimacy of citizen status, and threatening socio-structural relations were strongly and consistently linked to intentions to support the harsh treatment of asylum seekers, and exclusionary attitudes and action at Time 2. Moreover, perceived procedural and distributive justice significantly mediated these relationships. The roles of fairness and intergroup socio-structural perceptions in social attitudes and actions are discussed.

j Abstract Background Refugees in western countries often face long juridical procedures before their requests for a resident permit is granted. The, still scanty, literature shows high prevalence rates of psychopathology among asylum seekers, but there has been little interest for other impaired dimensions of health. The present study is part of a community-based mental health survey among Iraqi asylum seekers in the Netherlands, conducted between November 2000 and September 2001, on the risks of a long asylum procedure. Objectives The objectives of this study were to explore quality of life (QoL), disability and physical health and their relationships with psychopathology and pre-and post-migration variables. Method Two groups of pre-stratified (length of asylum procedure), randomly selected Iraqi asylum seekers (N = 143 and N = 151), were interviewed with fully structured, culturally validated questionnaires. Quality of life was examined with QoLWHO-Bref, functional disability with the Brief Disability Questionnaire and physical health with a newly developed questionnaire. Psychiatric (DSM IV) disorders were measured with the WHO Composite International Diagnostic Interview 2.1. Multivariate logistic regression analyses were used to estimate the relationships between the outcome measures and socio-demographics, adverse life events in Iraq, post-migration living problems (PMLP) and psychopathology. Results Respondents with a long asylum procedure reported significantly lower QoL, higher functional disability and more physical complaints. Multivariate regression shows that length of stay is the strongest predictor for a low overall QoL. In addition, lower QoL was predicted by psychopathology, higher age, adverse life events in the Netherlands and the PMLP-clusters: family issues, socio-economic living conditions and socio-religious aspects. Disability was predicted by psychopathology, higher age and the PMLP clusters: family issues and socio-religious aspects. Physical complaints were predicted by length of asylum procedure, psychopathology, female sex, adverse life events in Iraq and PMLP-family issues. Conclusion A long asylum procedure has a negative impact on the overall health situation and the QoL of asylum seekers. The situation is not only harming the affected, but also interferes with the integration process in the Netherlands or elsewhere. The findings are important for health professionals, governments and human right specialists.

... This shifting between categories is here referred to as status mobility. ... due to financial difficulties, or to the traffickers to whom people are in debt; in other cases they are because of the policies of transit and destination states which place hurdles across paths to final destinations. ...

Background: Missed appointments are known to interfere with appropriate care and to misspend medical and administrative resources. The aim of this study was to test the effectiveness of a sequential intervention reminding patients of their upcoming appointment and to identify the profile of patients missing their appointments.

Biometrics is often described as `the next big thingin information technology'. Rather than IT renderingthe body irrelevant to identity – a mistaken idea tobegin with – the coupling of biometrics with ITunequivocally puts the body center stage. The questions to be raised about biometrics is howbodies will become related to identity, and what thenormative and political ramifications of this couplingwill be. Unlike the body rendered knowable in thebiomedical sciences, biometrics generates a readable body: it transforms the body's surfaces andcharacteristics into digital codes and ciphers to be`read' by a machine. ``Your iris is read, in the sameway that your voice can be printed, and yourfingerprint can be read'', by computers that, in turn,have become ``touch-sensitive'', and endowed with seeingand hearing capacities. Thus transformed into readable``text'', the meaning and significance of the biometricbody will be contingent upon ``context'', and therelations established with other ``texts''. Thesemetaphors open up ways to investigate the differentmeanings that will become attached to the biometricbody and the ways in which it will be tied toidentity. This paper reports on an analysis of plans andpractices surrounding the `Eurodac' project, aEuropean Union initiative to use biometrics (specif.fingerprinting) in controlling illegal immigration andborder crossings by asylum seekers.

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Although women, young people and refugees are vulnerable to sexual and genderbased violence (SGBV) worldwide, little evidence exists concerning SGBV against refugees in Europe. Using community-based participatory research, 223 in-depth interviews were conducted with refugees, asylum seekers and undocumented migrants in Belgium and the Netherlands. Responses were analysed using framework analysis. The majority of the respondents were either personally victimised or knew of aclose peer being victimised since their arrival in the European Union. At otal of 332 experiences of SGBV were reported, mostly afflicted on them by (ex-)partners or asylum professionals. More than half of the reported violent experiences comprised sexual violence, including rape and sexual exploitation. Results suggest that refugees, asylum seekers and undocumented migrants in Belgium and the Netherlands are extremely vulnerable to violence and, specifically, to sexual violence. Future SGBV preventive measures should consist of rights-based, desirable and participatory interventions, focusing on several socio-ecological levels concurrently.

Currently, migrants and other mobile individuals, such as migrant workers and asylum seekers, are an expanding global population of growing social, demographic and political importance. Disparities often exist between a migrant population's place of origin and its destination, particularly with relation to health determinants. The effects of those disparities can be observed at both individual and population levels. Migration across health and disease disparities influences the epidemiology of certain diseases globally and in nations receiving migrants. While specific disease-based outcomes may vary between migrant group and location, general epidemiological principles may be applied to any situation where numbers of individuals move between differences in disease prevalence. Traditionally, migration health activities have been designed for national application and lack an integrated international perspective. Present and future health challenges related to migration may be more...

The present study examines the effect of torture in generating post-traumatic stress disorder (PTSD) symptoms by comparing its impact with that of other traumas suffered by a war-affected sample of Tamils living in Australia. Traumatic predictors of PTSD were examined among a subsample of 107 Tamils (refugees, asylum seekers, and voluntary immigrants) who had endorsed at least one trauma category on the Harvard Trauma Questionnaire. Principal components analysis (PCA) yielded five trauma factors that were applied to predicting PTSD scores. Tamils exposed to torture returned statistically higher PTSD scores than other war trauma survivors after controlling for overall levels of trauma exposure. The torture factor identified by the PCA was found to be the main predictor of PTSD in a multiple regression analysis. Although limited by sampling constraints and retrospective measurement, the present study provides support for the identification of torture as a particularly traumatic event, even when the impact of other war-related trauma is taken into account.

This paper examines the relationship between the nation-state and migration through the activities of the International Organization for Migration (IOM). The IOM operates at the intersection of nation-states, international human rights regimes, and neo-liberal governance. We find that the IOM enforces the exclusions of asylum seekers and maintains the central role of nation-states in ordering global flows of migration. In addition, we argue that the IOM acts on behalf of nation-states by using the language of international human rights, as though working in the interests of migrants and refugees. In providing a geographic appraisal of the IOM alongside its image and presentation with an analysis of its activities on voluntary returns, we address the new spaces of ‘networked’ governance that control and order migratory flows in the interests of nation-states.

Refugee and asylum-seeking women in Canada may have significant harmful childbearing health outcomes and unmet health and social care needs. The most vulnerable of these women are: those who have left their countries by force (e.g., war, rape or abuse histories), are separated from their families, have limited knowledge of the host country languages, and are visible minorities. Asylum-seekers face additional stresses related to their unknown future status and are marginalized with regards to access to provincial health care systems. The prevalence and severity of health issues in this population is not known nor is the extent of response from social service and health care systems (including variation in provincial service delivery). Understanding the magnitude of health and social concerns of newcomers requires data from a representative sample of childbearing refugee and asylum-seeking women resettling in Canada to permit comparisons to be made with non-refugee immigrant and Canad...

Right-wing authoritarianism, social dominance orientation, Australian and human identity salience, and perceived Australian and human norms were related to the attitudes, feelings and behaviors toward asylum seekers of 242 Australian students and activists. Those high in right-wing authoritarianism and social dominance orientation were less welcoming, as were participants who identified strongly as Australians and perceived hostile national norms. Independently, participants who identified strongly as humans were significantly more welcoming to asylum seekers, and an interaction was found such that those who identified strongly as Australians were more welcoming when they also identified strongly as humans. Implications for theories of identity and prejudice are examined, and interventions to reduce conflict by utilizing the human level of identification are discussed.

Background: Changing immigration trends pose new challenges for the UK's open access health service and there is considerable speculation that migrants from resource-poor countries place a disproportionate burden on services. Data are needed to inform provision of services to migrant groups and to ensure their access to appropriate health care. We compared sociodemographic characteristics and impact of migrant groups and UK-born patients presenting to a hospital A&E/Walk-In Centre and prior use of community-based General Practitioner (GP) services.

Dental age estimation methods based on the radiologically detected third molar developmental stages are implemented in forensic age assessments to discriminate between juveniles and adults considering the judgment of young unaccompanied asylum seekers. Accurate and unbiased age estimates combined with appropriate quantified uncertainties are the required properties for accurate forensic reporting. In this study, a subset of 910 individuals uniformly distributed in age between 16 and 22 years was selected from an existing dataset collected by Gunst et al. containing 2,513 panoramic radiographs with known third molar developmental stages of Belgian Caucasian men and women. This subset was randomly split in a training set to develop a classical regression analysis and a Bayesian model for the multivariate distribution of the third molar developmental stages conditional on age and in a test set to assess the performance of both models. The aim of this study was to verify if the Bayesian approach differentiates the age of maturity more precisely and removes the bias, which disadvantages the systematically overestimated young individuals. The Bayesian model offers the discrimination of subjects being older than 18 years more appropriate and produces more meaningful prediction intervals but does not strongly outperform the classical approaches.

To assess feasibility and yield of diagnostic procedures after active case finding for tuberculosis with radiologic screening at the three main entry points for asylum seekers to Switzerland. Method: Prospective multicenter study on the value of symptoms, spontaneous and induced sputum, and bronchoscopy for the confirmation of tuberculosis in radiologically selected cases. Results: Among 101 asylum seekers examined, spontaneous sputum was collected "on the spot" in 83 and yielded 7 (54%) of 13 smearpositive and 13 (39%) of 33 culture-positive cases. Morning sputum, collected in 84, yielded 8 (62%) and 16 (49%), and the two spontaneous sputa combined 9 (69%) and 20 (61%), respectively. Two additional induced sputa, collected in 91 persons, yielded no additional smear-positive, but yielded seven culture-positive cases (yield, 82%). Bronchoscopy, performed in 87 of 92 sputum smearnegative cases, yielded four additional smear-positive and six culture-positive cases. Culture confirmation was independently and significantly predicted by obtaining a specimen using bronchoscopy (adjusted odds ratio, 11.0; 95% confidence interval, 1.9-62) and a prior decision to treat (adjusted odds ratio, 3.0; confidence interval, 1.1-8.1). Conclusion: Radiographic anomalies compatible with tuberculosis found during screening are a poor guide to initiation of treatment. Respiratory and systemic symptoms correlated weakly with culture confirmation of tuberculosis. All radiologically selected cases must be examined with on-the-spot and early-morning sputum, regardless of symptoms. If both specimens are smear negative, the yield is increased by bronchoscopy and, to a lesser extent, by two samples of induced sputum. The examination of any single specimen has a low yield of 36 to 63% and is insufficient to exclude active tuberculosis.

The number of refugees worldwide is now 12 million, up from 3 million in the early 1970s. And the number seeking asylum in the developed world increased tenfold, from about 50,000 per annum to half a million over the same period. Governments and international agencies have grappled with the twin problems of providing adequate humanitarian assistance in the Third World and avoiding floods of unwanted asylum seekers arriving on the doorsteps of the First World. This is an issue that is long on rhetoric, as newspaper reports testify, but surprisingly short on economic analysis. This paper draws on the recent literature, and ongoing research, to address a series of questions that are relevant to the debate. First, we examine the causes of refugee displacements and asylum flows, focusing on the effects of conflict, political upheaval and economic incentives to migrate. Second, we examine the evolution of policies towards asylum seekers and the effects of those policies, particularly in Europe. Finally, we ask whether greater international coordination could produce better outcomes for refugee-receiving countries and for the refugees themselves.

These working papers provide a means for UNHCR staff, consultants, interns and associates to publish the preliminary results of their research on refugee-related issues. The papers do not represent the official views of UNHCR. They are also available online under 'publications' at <www.unhcr.org>

Little is known about the food insecurity situation among families resettled into the United States as part of the refugee resettlement program. This paper reports on a pilot study examining food insecurity among recently arrived refugee families (n = 33). Objectives were to evaluate the usefulness and feasibility of methods to assess the prevalence of food insecurity and child hunger, and to examine associations between child hunger and measures of socioeconomic status and measures of acculturation. Results indicated that 85% of households were food insecure, and 42% experienced child hunger. Hunger was more likely to be indicated in households using foods stamps, with lower income, and lower education. Hunger was also more likely to be indicated in households where the primary shopper experienced difficulty shopping and with language. Results are in broad agreement with those reported in other studies and highlight economic and information barriers to achieving food security. These data suggest that further study of food insecurity is warranted among recently resettled refugee communities resettled in the United States.

Much of the literature on asylum seekers and refugees tends to be atheoretical. This article uses ideas from Giddens' structuration theory as a conceptual framework to analyse the voices of a group of asylum seekers and refugees. The empirical database consists of semistructured interviews with 18 asylum seekers and refugees living in the UK from a wide range of countries, including Ethiopia, Kenya, Poland, Somalia, and the Yemen. The study shows that the experiences of asylum seekers and refugees are impacted by both structural and individual agency factors. The former, it is argued, consist of public and political reaction towards the increase in the number of asylum applications, while the latter include asylum seeker and refugee experiences of specific places and people which can create social networks. Structural factors had the greatest impact upon the integration of the participants into the host society. The nature of the experiences of asylum seekers and refugees can influence the way they feel about their position in the host society. For example, negative experiences of the UK can reduce their sense of security in the society whereas positive experiences can increase their feelings of comfort. Structuration theory conceptualises how asylum seekers and refugees utilise coping strategies to raise their comfort level in the host country.

Parents and children in immigration detention are often vulnerable to mental health problems before they reach Australia. Experiences in prolonged detention add to their burden of trauma, which has an impact not only on the individual adults and children, but on the family process itself. Immigration detention profoundly undermines the parental role, renders the parent impotent and leaves the child without protection or comfort in already unpredictable surroundings where basic needs for safe play and education are unmet. This potentially exposes the child to physical and emotional neglect in a degrading and hostile environment and puts children at high risk of the developmental psychopathology that follows exposure to violence and ongoing parental despair. Psychiatrists have a role in advocating for appropriate treatment of these traumatized and vulnerable parents and children.

Policies of deterrence, including the use of detention and temporary visas, have been widely implemented to dissuade asylum seekers from seeking protection in Western countries. The present study examined the impact of visa status change on the mental health of 97 Mandaean refugees resettled in Australia. At the time of the first survey (2004), 68 (70%) participants held temporary protection visas (TPVs) and 29 (30%) held permanent residency (PR) status, whereas by the second survey (2007), 97 (100%) participants held PR status. We tested a meditational model to determine whether the relationship between change in visa status and change in psychological symptoms was mediated by change in living difficulties associated with the visa categories. The conversion of visa status from TPV to PR status was associated with significant improvements in PTSD and depression symptoms, and increases in mental health-related quality of life (MHR-QOL). The relationship between change in visa status and reduced PTSD and depression symptoms was mediated by reductions in living difficulties. In contrast, the relationship between change in visa status and increased MHR-QOL was not mediated by changes in living difficulties. These results suggest that restriction of rights and access to services related to visa status negatively affect the mental health of refugees. Implications for government policies regarding refugees are discussed.

Refugees often suffer from complex trauma including persecution in their home countries, flight, and disadvantaged conditions of life in the host country. The body is directly involved in these traumatic experiences. Dance/movement therapy allows for the treatment of complex psychological trauma (torture, rape, war experiences) and contributes to the healing process directly on a body level. The complex traumata in the life of refugees require creative therapeutic interventions on different levels. This article introduces work with traumatised refugees at the treatment center REFUGIO in Munich, Germany. The center offers a multifaceted therapeutic program and offers among other approaches an interface of dance and verbal psychotherapy. Individual and group cases illustrate how the connection of both therapeutic modalities can be employed in a facilitative and clinically meaningful way.

Although many individuals applying for political asylum allege maltreatment and sometimes torture in their countries of origin, the utility of medical evaluations in asylum adjudication has not been documented. This study compares the asylum grant rate among US asylum seekers who received medical evaluations from Physicians for Human Rights (PHR), with rates among asylum seekers who did not receive PHR evaluations. Retrospective analysis was carried out on all asylum cases referred to PHR between 2000 and 2004 for medical evaluations for which adjudication outcome was available. Basic demographic information was obtained: age, sex, country of origin, English language ability, US region where adjudication occurred, whether legal representation was pro bono, type of evaluation, provision of oral court testimony, and whether asylum seekers were in detention. Cases were analyzed descriptively and with chi square tests. Between 2000 and 2004, 1663 asylum seekers received medical evaluations from PHR; the adjudication status (either granted or denied) was determined in 746 cases at the time of the study. Of these cases, 89% were granted asylum, compared to the national average of 37.5% among US asylum seekers who did not receive PHR evaluations. Medical evaluations may be critical in the adjudications of asylum cases when maltreatment is alleged.

Background: Several suicide and suicidal behaviour risk factors are highly prevalent in asylum seekers, but there is little insight into the suicide death rate and the suicidal behaviour incidence in this population. The main objective of this study is to assess the burden of suicide and hospital-treated non-fatal suicidal behaviour in asylum seekers in the Netherlands and to identify factors that could guide prevention.

This article examines the policy responses of Western countries in the realm of asylum. We begin by explaining the reasons why the asylum issue has made its way up the political agendas of liberal democratic countries in recent years. While applications for asylum have risen in the last two decades, we also highlight the way rights-based constraints and financial costs have contributed to controversy around the issue. We then examine in detail the major policy responses of states to asylum, grouping them into four main categories: measures aiming to prevent access to state territory, measures to deter arrivals, measures to limit stay, and measures to manage arrival. Moving then to explore the efficacy of these measures, we consider the utility of policy making from the viewpoints of states, asylum seekers and refugees, and international society. The article concludes with the presentation of four new directions in which policies could move in order better to square the professed interests of Western states with the needs of refugees for protection.

Although the numbers of asylum seekers in Europe is decreasing, the asylum policy of most European Union member states (EU MS) continues to be driven by a fear of a potential increase. As a result, EU MS refuse to address the growing numbers of people caught between Eurodac and Dublin II. These includes the many thousands who transit Greece and Spain, where in theory they should claim asylum, but where in reality they have little chance of being able to make a claim, and almost no chance of having it examined properly, much less being actually granted asylum. This article argues that the concern of EU MS is actually to reduce the number of those able to apply for asylum to an absolute minimum, rather than ensuring access to this status to anyone who might need it. Focusing on the ‘waiting’ of young Afghan men in Paris, this article seeks to show the daily suffering inflicted in pursuit of this policy goal.

An estimated 190 million people are now living outside their countries of birth or citizenship, and the rate of this migration is expected to remain high. The resulting growing cultural and ethnic diversity in societies adds specific challenges to the requirement of delivering public services such as health care to consumers. Globally, about half of the migrant population are women. Migrants’ outcomes of pregnancy are known to be poor, showing significant disparities when compared with those of native populations. Although these disparities have been noted, knowledge is limited regarding the availability and accessibility of healthcare services, as well as the acceptability of maternity care for women with experiences of free and forced migration. Healthcare research in general, and maternity care research specifically, have often neglected this population. This paper examines the existing international guidelines intended to address inequities in health outcomes, policies which have been introduced at national levels, and the widely used concepts of ‘patient-centred’ and ‘woman-centred’ health services. The ideals implicit in those guidelines and concepts are contrasted with the available evidence of many overseas nationals’ experiences with healthcare provisions in general, and maternity care in particular. This is followed by reflections on deficiencies in current studies and on those methodological problems which make research on maternity care for migrant women particularly challenging. The conclusion considers the appropriateness and relevance of guidelines currently promoting equity in maternity care and suggests a future agenda for priority research.