The Overlooked return: Improving the Mental Wellbeing of Migrants in Rwanda.
What’s on the table?
I am sure many of you have come across the terms “MIGRATION” and “MENTAL HEALTH” before but, just to be on the same page, let us define it again here.
Mental health is a state of well-being in which every individual realizes his or her own potential, can cope with the normal stresses of life, can work productively and fruitfully, and is able to make a contribution to her or his community (4). Migration is a process of people adapting to a new environment, shifting physically to another geographical area, adjusting to the local cultural needs and becoming a part of the local system. Migration has two types, immigration and emigration but for now, let us focus on immigration, specifically refugees and asylum seekers.
A Refugee is a person who has fled war, violence, conflict or persecution and has crossed an international border to find safety in another country (7) whereas, An Asylum seeker is a person who has left his country of origin for any reason and applied for the shelter and protection in another country (6).
A Short story
Growing up in a country that experienced one of the worst atrocities of the 20th century, the 1994 genocide against the Tutsis in Rwanda, the tales of “life in exile” are part of my childhood stories. In my little curious mind, such stories were always gloomy and enlightening, scary and inspiring all at the same time, mainly because of how profound and heavy they were. At some point, I felt like I had a sense of what life in a refugee camp was like because I was now able to picture events like 12-15-year-olds working in plantation farms because their school year is not available in the area, a 14 year old carrying 50 kgs of Posho (a name for food provided by UNHCR) and many others.
It was not until 2010, I visited the Gihembe refugee camp, and nothing I saw was matching my imaginary pictures; I soon realized that there are was so much more to this life than I could ever hear in stories. But, there was one question that often came to mind whenever I heard a story of refugee life, and that was “How did/could that feel like?” and up to today, after more than 5 visits to refugee camps in Rwanda, I still ask myself that question and the answer is always one of the “you will never know until it happens to you” kinds.
A bit of context
Like the reasons for refugees and asylum seekers differ, so does their needs in their host countries but, safety and protection is their primary need. In most cases, when a country receives refugees, the basic things offered to them are shelter, food, water, electricity where possible and primary health care services in cases refugees need emergent care. Most countries offer shelter before anything else because they want to ensure the people received have an address, even if it is a temporary one. When it comes to primary health care services, countries provide them differently based on the health needs of their refugees and asylum seekers (4)
Primary health care services are what the government of Rwanda provides right after refugees get to their transit centre. This is mainly because most of the refugees and asylum seekers from more than 49 countries, with Congolese, Burundians and Libyans being the majority, are fleeing from wars and conflicts in their countries which leave some with injuries that need emergent care at their arrival. Once they have settled, the registration process follows to both refugees and asylum seekers so that they can be legally recognized in their host countries.
The country has also expanded the capacity of local schools in order to integrate refugees and asylum seekers into the country’s education system, which enable them to further their studies, learn the culture and get involved in society. One of the barriers to moving to another country is to learn a new language; however, the government has trained teachers in local schools that receive refugees, which allows the students to get the support their need on their transition (8).
For many new migrants, adjusting to life in a new country presents a range of challenges; for example, learning a new language, adjusting to different cultural and societal norms, coping with financial difficulties, and having fewer family and community connections.
The realities are…….
Such adjustments can disrupt the life patterns of refugees and asylum seekers, which affect their mental wellness. (6) Migration is identified as a cause for mental illnesses, mainly due to the challenges that migrants face before and after the migration process. Prior to Migration, migrants can suffer anxiety, sleeping disorder and stress due to the war or violence targeting them, and after Migration, while those illnesses might not grow severe, they might develop PTSD and depression as an effect of reflecting back on the traumatic experiences they had.
There is a lot of stigma around mental health in Africa, and Rwanda is not an exception. Conversations about mental issues are avoided by many because it is regarded as weakness, craziness or some demonic forces; all these affect the improvement of the mental well-being of people. Unlike other health issues, a migrant’s mental health is considered unimportant, although it has critical illnesses. 90% of native citizens with mental illnesses lack access to treatment in many African countries; how different could this be for migrants who are trying to settle themselves in a new country and integrating within the society? And if a person feels uncomfortable seeking help in their country of origin because of the stigma around mental health, how uncomfortable will that feel to a newcomer to a country while also learning its people and culture?
Rates of severe mental illness can double amongst refugee and asylum seeker populations. The WHO describes rates of mild to moderate mental disorders as increasing from 10% in the general population to 15-20% amongst refugees (1)
What could we do?
Like any living human, every refugee you know is fighting one or more battles in silence; there are things they chose to keep to themselves because they don’t want to be misunderstood or judged and, sometimes that is not a good option for it could cause them more harm than good. The same way neighbours show up and support each other in our culture, members of communities around camps can be of great support through simple gestures like advocacy. If the communities work together towards helping migrants transition into their new lives and get themselves back together, this would lower issues like low self-esteem, suicidal thoughts due to stigma and bullies, anxiety, inability to make a decision because of many uncertainties and others which will eventually improve the mental well-being of those migrants.
Every forest starts with a single tree! Maybe there is nothing much you can do but that little thing everyone can do, when brought together, they could make a huge difference.
Along with the support by communities, mental health services need to be included in the primary health care services that migrants access in camps instead of being referred to tertiary care services that could be expensive to them as (3) mentioned affordability of mental health services to be a barrier for getting the needed help. However, this will require the government to train aid workers and humanitarian actors based in camps to improve their ability to recognize mental health problem and intervene. The funds that the government of Rwanda donate to support migrants will have to increase, but so will the returns.
With cases of refugees who have been in the country for almost 21 years (2), improving migrant’s well-being will, in turn, help the country. From influencing migrant children’s academic performance to opening work opportunities to gaining financial stability, taking care of migrant’s mental well-being can have a significant impact on their lives which will then reflect in the impact, they will make in our country during their period of stay.
- Berquist, V. (2015). Refugees and Mental Health. Retrieved 28 March 2021, from https://ifmsa.org/2016/06/22/refugees-and-mental-health/
- Chiumento, A., Rutayisire, T., Sarabwe, E., Hasan, M., Kasujja, R., & Nabirinde, R. et al. (2020). Exploring the mental health and psychosocial problems of Congolese refugees living in refugee settings in Rwanda and Uganda: a rapid qualitative study. Retrieved 28 March 2021, from https://conflictandhealth.biomedcentral.com/articles/10.1186/s13031-020-00323-8
- Eaton, J. (2019). Mental health in Africa: The need for a new approach [Blog]. Retrieved from https://www.mhinnovation.net/blog/2019/dec/5/mental-health-africa-need-new-approach
- Economic Inclusion of Refugees in Rwanda. (2016). Retrieved 28 March 2021, from https://www.unhcr.org/rw/wp-content/uploads/sites/4/2017/02/Economic-Inclusion-of-Refugees-in-Rwanda-Final-Version.pdf
- Health of refugees and migrants. (2018). Retrieved 28 March 2021, from https://www.who.int/migrants/publications/AFRO-Practices.pdf?ua=1
- InfoMigrants. (2018). Most refugees suffering from severe mental health conditions have fled conflicts [Image]. Retrieved from https://www.infomigrants.net/en/post/8883/traumatized-refugees-need-urgent-help-doctors-say
- Virupaksha, G.H., Kumar, A., Nirmala, P. B. (2014). Migration and Mental health: An interface. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4121889/
- Refugees – UNHCR Rwanda. Retrieved 28 March 2021, from https://www.unhcr.org/rw/refugees
- Rwanda Country Refugee Response Plan 2019-2020 – Rwanda. (2019). Retrieved 28 March 2021, from https://reliefweb.int/report/rwanda/rwanda-country-refugee-response-plan-2019-2020
- V. McCann, T., Mugavin, J., Renzaho, A., & I. Lubman, D. (2016). Sub-Saharan African migrant youths’ helpseeking barriers and facilitators for mental health and substance use problems: a qualitative study. Retrieved 28 March 2021, from https://bmcpsychiatry.biomedcentral.com/track/pdf/10.1186/s12888-016-0984-5.pdf
Hello Gisele, this is a really insightful, and truly well-thought approach towards the needs of migrants, from basic necessities of shelter, food, and clothing. Additionally putting forth the key element of making it available for them to gain access of Mental Health solutions, to help with the stress, anxiety, and depression which as mentioned, they usually are battling- unfortunately silently. It is, therefore, crucial to making it comfortable for them to easily connect with their new communities.
Thank you Katlego
There’s a saying that you can not give what you don’t have. There’s a gap in provision of mental health services in the Rwandan healthcare system which makes it hard to scale the services to immigrants , refugees including. As you highlighted, stigma is the leading cause of not seeking mental health which weakens its integration in primary healthcare. Thus, the first step would be raising awareness and breaking that stigma.