While seeking sanctuary in safe places – the health of refugees may often deteriorate. Extreme conditions, forced migration, large personal loss and other Human Rights violations, and the difficult asylum-seeking-process may worsen their mental health condition.

The group of asylum-seekers is not a homogeneous one, but in all vulnerable. Displaced from their homes, in flight from persecution, often suffering after mental and physical violence, they seek sanctuary in other countries that are free of war, violence and armed conflict. Yet on arrival in a safe haven, their health often deteriorates. Asylum-seekers have a higher risk of getting mental illness due to the fact that they often have been exposed to extreme conditions, forced migration and large personal loss and other Human Rights violations – and just due to the fact that they are refugees in a foreign country, may be with another culture, and unfamiliar codices. They often suffer of Post Traumatic Stress Disease PTSD, depression, anxiety. There are (depending on the study) between 10 and 20 % of all asylum-seekers suffering of such psychiatric symptoms.

Even though seeking asylum is a human right, people that need asylum are often met with stricter enforcement of who to grant asylum in order to try to restrict the flow of asylum-seekers. The process of screening asylum-seekers to decide who is eligible or not for asylum will often worsen their mental health situation.

The Universal Declaration of Human Rights – Art. 14
United Nations, dec. 1948

The first international document recognizing the right to seek and enjoy asylum from prosecution.

Convention relating to the Status of Refugees
UN, General Assembly resolution 429, entry into force april 1954

In this convention the UN frames the important topics how refugees are to be treated, referring to juridical status, employment, welfare and other subjects.

Refugees, Asylum Seekers & Migrants: A Crucial Difference
Habitat for humanity
What is the difference between a refugee, an asylum seeker and a migrant? Does it really matter to understand their definition? Yes, absolutely. It’s crucial today to understand what an asylum seeker or a refugee is because of all the misconceptions and misunderstandings around those terms.

Refugees and Internally Displaced Persons
Theirworld

Comprehensive information on this topic. The website also provides with the basic legal framework, agencies, as well as education and training materials by lots of quite useful links.

The Exclusion of Asylum Seekers in Europe
Liza Schuster, Centre of Migration, Policy and Society, Univ. of Oxford, 2004
The article discusses mechanisms of exclusion, practiced by a number of European states, and the associated costs.

Guidelines on the Treatment of Iraqi Asylum Seekers and Refugees in Europe
 ECRE 2007
This paper (30 p.) is in response to the treatment of Iraqi asylum seekers and refugees in Europe, it discusses the background of decisions in whether asylum is granted (or not), and criticises some principles in handling this problem.

The experience of migration can be complex and stressful, related to events before departure, during travel and transit, and after arrival. Subsequently, refugees, asylum seekers and migrants can suffer from mental disorders, although prevalence is highly variable across studies and population groups. The consequences on mental health are not always short-lived; some can last a lifetime and may even have an influence on the children of those affected. Yet in the midst of these negative experiences there may also be positive signs. Refugees should not be seen as helpless people who totally depend on the help they are given. It is also respectful to honor their capacity for resilience and to foster positive adaptation by helping to obtain and protect internal and external resources.

Mental health promotion and mental health care in refugees and migrants
WHO – Europe 2018
This technical guidance reviews the prevalence of some disorders such as post-traumatic stress disorder
and depressive and anxiety disorders. Based on best-available evidence regarding risk factors and
areas for intervention, eight key priority action areas are identified for consideration by policymakers
regarding the mental health of refugees and migrants.

Access to Health Care for Asylum Seekers in the European Union
European Journal of Public Health, 2005

The aim of this article (5 p.) is “to characterize and compare current standards of health care provision for asylum seekers in the 25 European Union (UN) countries, in order to identify the eeds and potential for improving access to health care for asylum seekers.”

The physical and mental health problems of refugee and migrant fathers: findings from an Australian population-based study of children and their families
Giallo et al 2017
Fathers of refugee background experience poorer mental health and poorer general health than Australian-born fathers. Fathers who have migrated from non-English-speaking countries also report greater psychological distress than Australian-born fathers. This underscores the need for primary healthcare services to tailor efforts to reduce disparities in health outcomes for refugee populations that may be vulnerable due to circumstances and sequelae of forced migration and to recognise the additional psychological stresses that may accompany fatherhood following migration from non-English-speaking countries. 

Longitudinal Study of Psychiatric Symptoms, Disability, Mortality, and Emigration Among Bosnian Refugees
Journal of American Medical Association, Mollica et al 2001

The study outlines the association between psychiatric disorders, emigration status, mortality in Bosnian refugees.

Policies of Deterrence and the Mental Health of Asylum Seekers
JAMA, Silove et al 2000

The article outlines how increasingly restrictive measures within the asylum-seeking process can affect the mental health of the asylum-seekers, and creates risk of ongoing posttraumatic stress disorder and other psychiatric symptoms.

Mental illness in asylum seekers and refugees
Mann et. Fazil 2006
This paper reviews current literature regarding the mental health of asylum seekers and refugees. Factors increasing vulnerability of these groups to mental illness, and compounding social factors are discussed.

The Mental State of detained Asylum Seekers
Psychiatric Bulletin, Bracken and Gorst-Unsworth, 1991.
The article outlines the effects of detention of asylum-seekers in their country of refuge, in combination with underlying trauma. Some years old, focusing on UK, the article nevertheless discusses some basic problems.

The impact of detention on the health of asylum seekers: a protocol for a systematic review 
Filges et al. 2015
This Campbell systematic review assessed whether detaining asylum seekers has an impact on their mental health. The review also assessed whether detaining asylum seekers has a negative impact on their physical health and social functioning.

A paradigm shift: relationships in trauma-informed mental health services
Sweeney at. al 2018
Trauma-informed approaches emerged partly in response to research demonstrating that trauma is widespread across society, that it is highly correlated with mental health and that this is a costly public health issue. The fundamental shift in providing support using a trauma-informed approach is to move from thinking ‘What is wrong with you?’ to considering ‘What happened to you?

Common mental health problems in immigrants and refugees: general approach in primary care
Kirmayer et at. 2011
Systematic inquiry into patients’ migration trajectory and subsequent follow-up on culturally appropriate indicators of social, vocational and family functioning over time will allow clinicians to recognize problems in adaptation and undertake mental health promotion, disease prevention or treatment interventions in a timely way

Mental health among displaced people and refugees: Making the case for action at the World Bank Group
World Bank 2016
Mental, neurological and substance use disorders, often an “invisible” or “hidden” problem, contribute to a significant proportion of disease burden, and an increasing obstacle to development in countries around the world.

15 TED Talks on refugee resilience
UNHCR 
Inspiring TED and TEDx Talks that highlight the resilience of refugees from all around the world.

Resilience as a Protective Factor against the Development of Psychopathology among Refugees
Arnetz et. al 2013
Refugee research to date has predominantly focused on factors that make refugees more vulnerable for developing posttraumatic stress disorder (PTSD) and /or psychological distress. Few papers have studied potential protective factors such as resilience.

Resilience and Mental Health Risks among Syrian Refugees in Europe: A Cultural Perspective
Neftçi NB, Çetrez ÖA 2017
While working with refugee patients, it has been shown to be crucial to remain open to multiple explanatory models including biomedical, psychological, religious and traditional ones to enhance communication with the refugee patients [40]. This may refer to the fact that while clinicians provide psychological treatment, the patients may maintain their beliefs regarding what they believe/practice is also effective for their treatment.Falling Through the Cracks, Asylum Procedures and

Reception Conditions for Torture Victims in the European Union
IRCT 2016 

Torture victims are not receiving the specialised support they need to get better and to engage effectively with the asylum process. One reason for this is that most EU Member States, including the eight countries featured in this report, do not have a procedure for systematic identification of torture victims in the asylum procedure. This key issue has a range of negative consequences on the individual, such as deteriorating physical and mental health and flawed consideration of their asylum claim.

Mental health of refugees
UNHCR/WHO 1996
This is an old publication, but never the less still valid. Disasters and wars are happening constantly. One sure result is that some people have to leave their homes and countries and become refugees. While many refugees suffer physically from injury or hunger, far more suffer psychological harm.

UNHCR Handbook for the Protection of Women and Girls
UNHCR, 2006

Solid handbook (164 p.) discussing the specific problems occurring for women and girls, especially as refugees. Recommendations how awareness can be increased in the helpers, and the target group can be helped better. No special focus on mental health. –

Women’s Refugee Commission
This Commission advocates for laws, policies, and programs to improve the lives and protect the rights of refugee and internally displaced women, including those seeking asylum.

Female Asylum-Seekers and Refugees in France 
UNHCR Freedman 2009
The aim of this study is to provide a comprehensive review of the situation of female asylum-seekers and refugees in France, in order to furnish a base of information which might guide future UNHCR policies and actions in this area, and which may serve to make recommendations to French government and institutions.

Gender-Based Violence against Women: Both Cause for Migration and Risk along the Journey 
Migration Policy institute 2017
Each year, countless women and children flee violence at home and take an uncertain journey in the hope of finding safety in a new country. While many escape conflict zones or generalized human-rights abuses, some also run from more intimate forms of violence—namely, sexual and domestic violence perpetrated by men. Setting off on the journey is no guarantee of safety; many are vulnerable to gender-based abuse in transit and even at destination.

Women migrants fearing rape take contraceptives before journey – rights groups 
Thomson Reuters Foundation, 2017
Women migrants fleeing wars, political instability and poverty are taking contraceptives in the expectation of being raped but are so desperate they still embark on the journey, a human rights group said on Wednesday.

Women in detention: a guide to gender-sensitive monitoring 
Association for the Prevention of Torture (APT), 2017
In this paper, “Women in detention” is addressed to monitoring bodies responsible for the external scrutiny of places of deprivation of liberty. It outlines the risks faced by women deprived of their liberty of being subjected to torture and ill-treatment and measures that can be taken to reduce such risks.

Sexual violence against refugee women on the move to and within Europe 
WHO European Region, 2017
The objective of this overview is to present the issue of sexual violence (SV) against refugee women and girls and to discuss countermeasures that have been suggested or initiated by the Member States of the WHO European Region and national nongovernmental organizations (NGOs) between January 2015 and May 2016. A literature review was undertaken using Google scholar, the WHO publication database and a cross-search of journal databases.

I didn´t Have Anywhere to Run: Migrant Women Are Facing a Rape Epidemic 
Anna-Cat Brigida, 2016
An estimated 60 to 80 percent of female migrants from Central America are sexually assaulted on their journey—and perpetrators often act with total impunity. As thousands of Central American women weigh the risks of migrating to the US each year, they must take into account an extra peril: An estimated 80 percent of female migrants from Central America are victims of sexual abuse at the hands of criminal groups, human smugglers, or corrupt officials during the journey.

New report: women refugees at risk in Europe 
Novel´s Women Initiative, 2015
The report finds that women are vulnerable a bottleneck points along the route, and even more vulnerable when they reach reception centres that do not have secure and separate sleeping areas for women. Women also experience sexual violence at alarming rates and there is currently 100% impunity for gender-based crimes committed against refugee women. High numbers of refugee women are pregnant with no access to pre- or post-natal care.

INITIAL ASSESSMENT REPORT: Protection Risks for Women and Girls in the European Refugee and Migrant Crisis 
UNCHR, 2015
For the first time since World War II, Europe is experiencing a massive movement of refugees and migrants, women, girls, men and boys of all ages, fleeing armed conflicts, mass killings, persecution and pervasive sexual and gender-based violence (SGBV). Many seek refuge in Europe from the ongoing armed conflicts that have torn apart their societies, and are entitled to protection under the 1951 Refugee Convention, its subsequent Protocol, and other international instruments.

80% of Central American women and girls are raped crossing to the US 
IMPACT, September 2014
According to a stunning Fusion investigation, 80 percent of women and girls crossing into the U.S. by way of Mexico are raped during their journey. That’s up from a previous estimate of 60 percent, according to an Amnesty International report. Through May, the number of unaccompanied girls younger than 18 caught at the US-Mexico border increased by 77 percent.

What the eye does not see: a critical interpretive synthesis of European Union policies addressing sexual violence in vulnerable migrants 
Ines Keygnaert & Aurore Guieu, 2015
In Europe, refugees, asylum seekers and undocumented migrants are more vulnerable to sexual victimisation than European citizens. They face more challenges when seeking care. This literature review examines how legal and policy frameworks at national, European and international levels condition the prevention of and response to sexual violence affecting these vulnerable migrant communities living in the European Union.

Hidden violence is silent rape: sexual and gender-based violence in refugees, asylum seekers and undocumented migrants in Belgium and the Netherlands 
Ines Keygnaert, 2012
Although women, young people and refugees are vulnerable to sexual and gender-based 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.

Sexual Violence and Migration The hidden reality of Sub-Saharan women trapped in Morocco en route to Europe 
MSF 2013
The exact proportions of sexual violence are impossible to measure, yet MSF’s medical data reveals that it is a problem of alarming proportions. Information provided by our patients reveals the high risk of sexual violence throughout the migration process, with survivors experiencing rape and other forms of sexual violence by numerous different perpetrators in their countries of origin, in route and in Morocco itself.

Mental health among children seeking asylum in Denmark – the effect of length of stay and number of relocations: a cross-sectional study
BMC Public Health, Signe Nielsen et al 2008

This study concludes with that protracted stays at asylum centres and relocations within the asylum system appears to have an adverse effect on the mental health of refugee children. –

The Forgotten Children. National Inquiry into Children in Immigration Detention 2014
Australian Human Rights Commission 2014
This Report gives a voice to these children. It provides compelling first-hand evidence of the impact that prolonged immigration detention is having on their mental and physical health. The evidence given by the children and their families is fully supported by psychiatrists, pediatricians and academic research

Traumatic experience and sleep disturbance in refugee children from the Middle East
E. Montgomery, A. Foldsprang. Journal of Public Health, 2001 

Discussion of the connection between sleep disturbance, experience and family situation for refugee children. – Europ.

Seeking asylum in Denmark: refugee children’s mental health and exposure to violence
E. Montgomery, A. Foldsprang. Journal of Public Health, 2005
Study on the effects of asylum-seeking process and mental health of refugee children.

Lone asylum seeking children
Imperial College London, M. Hodes et al, 2008.

The article discusses the situation of unaccompanied refugee children in the UK (nevertheless lots of general reflections), and how this affects/worsens their state mental health, and comes with some recommendations how to help better.

Humanitarian Situation Refugee camp Al Hol, North East Syria

The war in Syria is one of the deadliest conflicts of the 21st century and a severe humanitarian crisis. According to the United Nations High Commissioner for Refugees (UNHCR), the registered number of Syrian refugees is as alarmingly high as 5,636,155 persons. People inside Syria are facing extremely difficult conditions because of the conflict, and thousands live in overcrowded refugee camps. One of these camps is Al Hol in North East Syria, hosting mostly women and children from the last ISIS controlled areas. As per 31 July 2019, 68,823 people lived in the camp according to a United Nations Office for the Coordination of Humanitarian Affairs (UNOCHA) Syria Situation Report. 94 percent of the camp’s population are women and children. The conditions in the camp are dire, reports Human Rights Watch. Below you can find available UNOCHA reports about the humanitarian situation and the developments in Al Hol refugee camp up until August 2019. We have also included a report from Human Rights Watch from July 2019 and a report from the World Health Organization (WHO) from July/August 2019.

For more information about other humanitarian crises you can access ReliefWeb that is the leading humanitarian information source on global crises and disasters. It is a specialized digital service of the UNOCHA. ReliefWeb provides reliable and timely information, enabling humanitarian workers to make informed decisions and to plan effective response. They collect and deliver key information, including the latest reports, maps and infographics from trusted sources. 

The information presented here is an example of what kind of information is available on ReliefWeb on current humanitarian crises. In the future we plan to include up to date information on other humanitarian crises.

For information on mental health related issues for refugees and asylum seekers, please go the Mental health related issues section above (on this same thematic page). 

Syria crisis, WHO’s response in Al-Hol camp, Al-Hasakeh Governorate
World Health Organization, August 2019
The Security situation is still considered as unstable inside the camp due to the stress caused by the deplorable and unbearable living conditions, the inhabitants of the camp have been experiencing. However, during reporting period, 126 people left the camp to Manbij district in Aleppo governorate. 18 static medical points, eight mobile teams, three delivery clinics, two leishmaniasis teams, two vaccination teams, two family well-being centers and three field hospitals are providing health services to the camp’s inhabitants in different sectors of the camp. The Foreigners Annex is still suffering from the lack for full provision of health services, as only one static health point is operating outside the Annex.

Syria: Dire Conditions for ISIS Suspects’ Families
Human Rights Watch, July 2019
The Kurdish-led Autonomous Administration for northeast Syria is holding more than 11,000 foreign women and children related to Islamic State (also known as ISIS) suspects in appalling and sometimes deadly conditions in a locked desert camp in northeast Syria, Human Rights Watch said today. At least 7,000 of the children are under 12.

Syria: Humanitarian Response in Al Hol camp
UN OCHA, March 4, 2019
Al Hol camp population stands at 56,002 individuals of which more than 90 per cent are women and children. Between February 22 and March 1, approximately 15,000 people reached Al Hol camp from Baghouz in south- eastern Deir-Er-Zour. At the time of writing, on March 4, hundreds of people are expected to arrive in the camp at daybreak on March 5. New arrivals have been provided with NFI kits and winterization items and are now hosted in family-size and communal tents in phase 5, 7 and the annex of the camp.

Syria: Humanitarian Response in Al Hol camp
UNOCHA, March 7, 2019
A stream of new IDP arrivals from Baghouz in south-eastern Deir-Er-Zour to Al Hol camp has continued, with over 5,200 arriving between 5-7 March. Thousands more are expected in coming days. Al Hol camp has significantly surpassed its capacity, with the current population exceeding 62,000 individuals. More than 90 per cent of the new arrivals are women and children. Children represent the vast majority, 23 per cent are under the age of 12 and 12 per cent are under the age of 5.

Syria: Humanitarian Response in Al Hol camp
UNOCHA, March 11, 2019
With the resumption of the offensive on the last ISIL-held enclave of Baghouz village, Deir-ez-Zour governorate on 10 March, the number of new arrivals to Al-Hol camp has significantly reduced, with only 30 families arriving in the past twenty-four hours. Overall, some 4,000 people have been brought to Al-Hol camp since 7 March. In total, the camp population is now 66,247 people (19,216 families), the vast majority of them women and children, including 23 per cent under the age of 5 and 8 per cent pregnant and nursing mothers. While the most recent influxes have placed additional stress on already over-stretched resources and space inside the camp, no families are currently staying out in the open, with the 13,750 newest-arrivals all being accommodated in either communal areas or big sized tents.

Syria: Humanitarian Response in Al Hol camp. Flash update #8
UNOCHA, March, 2019
1,500 IDPs from Baghouz arrived in Al Hol in the morning of 14 March bringing the total camp population to 67,794 people. More are expected to arrive in the coming days. The vast majority of new arrivals are women and children, most of whom show clear signs of distress, fatigue, malnutrition and require some form of medical care or attention.

Syria: Humanitarian Response in Al Hol camp. Flash update #9
UNOCHA, March, 2019
As of 20 March, 70,480 people reside in Al Hol camp, the majority of whom are women and children. A further 2,000 people, many of them in markedly poor health, arrived late on 20 March, 12 of whom died either en route or shortly after arriving in the camp. Several hundred people also arrived on 21 March.

Syria: Humanitarian Response in Al Hol camp. Situation Report no. 1
UNOCHA, March 2019
As of 31 March, the population of Al Hol camp is 73,041 (21,245 households). Some 65% are children under the age of 18, and 27% are women. New arrivals since 4 December 2018 are 63,323. The number of new arrivals has significantly reduced in the reporting period, with only 500 new arrivals in the past week. Current capacity for hosting additional arrivals in communal areas and big size tents is at 2,000. If future influx is greater than that, initial shelter cannot be guaranteed. Approximately 100 people are sheltered in the reception center, close to a medical center, due to their medical condition.

Syria: Humanitarian Response in Al Hol camp. Situation report no. 2
UNOCHA, April 2019
The total current population of Al Hol is now 73,393 people, having doubled between February and March. In the last week, around 71 families (approx. 174 individuals) have arrived to Al Hol, mainly from neighbouring camps such as Al Roj and Ein Issa. Around 70 per cent of the camp population is under the age of 18 and 65 percent under the age of 12.

Syria: Humanitarian Response in Al Hol camp. Situation Report No. 3
UNOCHA, May 2019
As of 1 May, the total population of Al Hol camp is 73,477 with dozens of families recently arrived from other camps in north-east Syria for family reunification as well as persons discharged from hospitals. A total of 64,087 individuals have arrived since 4 December, putting the camp infrastructure under significant strain.

Syria: Humanitarian Response in Al Hol camp. Situation Report No. 4
UNOCHA, May 2019
As of 29 May, the population of Al Hol is 73,782 people or 21,331 households. A total of 64,756 individuals have arrived since 4 December, putting the camp infrastructure under significant strain. The vast majority of the camp population are women and children (91%), with around 65% under the age of 12. The Al Hol camp population consists of Iraqis (43%), Syrians (42%) and Third Country Nationals (15%).

Syrian Arab Republic, North East Syria: Al Hol camp
UNOCHA, June 2019
As of 19 June, the population of Al Hol is 73,043 people or 21,039 households, representing a slight reduction in figures previously reported following the departure of 740 Syrian IDPs to Tabqa in Ar-Raqqa on 3 June, and an increase in the number of third country nationals repatriated by their countries of origin, including children.

Syria: Humanitarian Response in Al Hol camp. Situation Report No. 5
UNOCHA, June 2019
The camp population is at 70,097 individuals or 19,824 households, as of 26 June; more than 90% are children and women. The decrease in numbers from 73,782 four weeks ago, is the result of updated distribution figures, a slight increase in repatriation of 3rd country nationals and the return of hundreds of internally displaced Syrians to Raqqa governorate.

Syrian Arab Republic, North East Syria: Al Hol camp
UNOCHA, August 2019
As of 31 July, the population of Al Hol has reduced to 68,823 people (or 19,244 households), following the deregistration of some 2,000 individuals who failed to present for three consecutive rounds of assistance, and the departure of 196 Syrian IDPs to Sur in Deir-ez-Zour on 11 July and 126 Syrian IDPs to Menbij in Aleppo on 23 July. Overall the camp population remains roughly the same, comprising Iraqis (45 per cent), Syrians (41 per cent) and Third Country Nationals (14 per cent). Of the overall total, some 94 per cent are women and children, of which 67 per cent are under the age of 18. 

UNHCR
The UN Refugee Agency, is a global organization dedicated to saving lives, protecting rights and building a better future for refugees, forcibly displaced communities and stateless people.

European Council on Refugees and Exiles
ECRE represents a pan-European network of 69 refugee-assisting non-governmental organizations, promoting a humane and generous European asylum policy.

Migrant & Refugee Communities Forum
An english organization, founded to provide help for asylum seekers and refugees in London. Some useful information in general.

The Norwegian Refugee Council
An independent humanitarian organisation helping people forced to flee. We work in crises in 31 countries, where we help save lives and rebuild futures.

The Jesuit Refugee Service Europe
Jesuit Refugee Service (JRS) is an international Catholic organisation with a mission to accompany, serve and advocate for the rights of refugees and others who are forcibly displaced.

The International Rescue Committee IRC
Responds to the world’s worst humanitarian crises and helps people whose lives and livelihoods are shattered by conflict and disaster to survive, recover, and gain control of their future.

Medical Foundation for the care of victims of torture

Refugee Council Online
The Refugee Council is one of the leading charities in the UK working directly with refugees, and supporting them to rebuild their lives. We also speak up for refugees using our direct work as an evidence base, and ensure refugees have a stronger and more influential voice in decisions that will affect them.

British Red Cross Refugee Services
Website of the British Red Cross service for refugees

Refugee- Action
An refugee organization based in the UK, but with some general topics as well.

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