Fourth Quarter 2001 Newsletter (Last Updated On: ) The Impact of September 11 on Refugees Applying for Asylum Solvig Ekblad By Solvig Ekblad, co-chair of WFMH’s International Committee on Refugees and Other Migrants (ICROM) Eighty days after the terrorist attacks in the United States, I was walking at “Ground Zero” in New York. Christmas decorations were hanging in the streets at the edge of the site, but I was aware of the sticky smell of fire which not only induced stress but was also unhealthy to inhale. For all those directly and indirectly effected by the terror attacks, recovery from long-term psychological scars will take time. This was one of the main topics at the 17th Annual International Society for Traumatic Stress Studies Meeting in New Orleans in December, which mainly focused on trauma produced by terrorism and mass disaster. However, I have been thinking recently that the mental health impact of detention among asylum seekers must not be neglected, especially as our alertness against terrorism now encourages suspiciousness and hostility toward foreigners. That is the topic of my column, and I will draw on experiences as a visiting researcher in Australia earlier this year, at the department of my Committee co-chair, Professor Derrick Silove. In supporting the war against terrorism, we should not forget that one of the most certain outcomes is a large flow of refugees seeking asylum. We should all remember the lessons of history, and the purpose of the Refugee Convention, a landmark international instrument committing ratifying countries to providing humane protection to persons fleeing persecution worldwide . But “instead of providing special care for the most traumatised individuals fleeing persecution, Western countries may be subjecting them to the very conditions that are likely to hinder psychosocial recovery” (Silove, Steel, Mollica, 2001, p.1437). Contemporary refugee policies in Western countries have been thrown into stark relief by the effects of the terror attacks in the US. Detention of asylum seekers Increasingly, industrialized countries are building or extending facilities to detain asylum seekers. In 2000, the USA had about 5000 asylum seekers in detention at any one time (Silove, Steel, Mollica, 2001). Before September 11, Australia stood alone in mandating the detention of all individuals entering Australia without valid visas, irrespective of whether or not they were seeking asylum. According to a UNCHR report in 2000, Australia ranked 17th out of 21 industrialised countries in terms of the absolute number of asylum applications received during 1999. In a review of research studies in Australia and elsewhere, Steel and Silove (2001) suggested that detained asylum seekers may have suffered greater levels of past trauma than other refugees, and this may contribute to their mental health problems, with detention providing a retraumatising environment. After the 11 September terror attacks, there was bipartisan political support in Australia for an international war against terrorism. At the same time, those fleeing from terrorist States are treated as criminals when they reach Australia. Recent asylum seekers are mainly confined in detention centres in remote areas and in economically poor island countries to the north of Australia, a policy which has been criticized by UN and other international agencies. A visit to the Villawood Detention Centre Last August, together with Dr Zachary Steel, I visited the Villawood Detention Centre in Sydney to meet Aamer Sultan, a medical practitioner who fled persecution in Iraq after providing casualty medical care to Shiite Muslim rebels. He has been detained since May 1999. He is a bilingual Arab/English speaker and as a health professional he is a confidant of many detainees. Sultan, writing in a recent issue of Medical Journal Australia with a mental health professional (K. O’Sullivan) who had worked at Villawood, provided a unique picture of the daily difficulties of detained asylum seekers. A commentary in the same issue by Zachary Steel and Derrick Silove described how the policy of mandatory detention of asylum seekers is leading to serious psychological harm. During my hour of conversation with Aamer Sultan I was deeply impressed by his courage and the way he retained his world view in spite of losing his liberty for an indeterminate period of time. To me the physical environment at Villawood was intimidating, even during a short visit. The compound where we had the conversation was surrounded by multiple layers of high fencing topped and grounded by razor wire. All visitors had to pass through strict security checkpoints and I felt we (the visitors) were treated as cattle. Nevertheless my colleague was allowed to bring a manuscript to discuss with his co-author, Dr. Sultan. The detained people around us sat with visitors, but with boredom, aimlessness and apathy in their eyes. Birds were the only ones with freedom, flying in and out of the compound. I heard from Dr Sultan that most of the asylum seekers detained at Villawood came from developing countries ruled by oppressive regimes with poor human rights records. Many have been victims of state-organized violence, including torture and other forms of inhuman or degrading treatment and/or have family members who are suffering from such abuses. These people are at high risk of the different kinds of post-traumatic psychological reactions we know about from the literature. Children living in Villawood are at special risk of being influenced by a secondary effect mediated via their parents, whose ability to provide a normal caring and nurturing environment is more or less non-existent. These children are vulnerable to neglect and physical abuse. Recommendations The World Federation for Mental Health has had a longstanding commitment to advocating for the mental health and psychosocial well-being of refugees and other displaced persons, including those exposed to mass conflict and organized violence. Its International Committee on Refugees and Other Migrants consists of a multidisciplinary group of professionals dedicated to advancing that mission. Evidence-based research suggests that the most important intervention to reduce the high rates of mental distress amongst asylum seekers is the implementation of strategies to prevent unnecessary stress. At the present time, when eagerness to combat terrorism may result in a climate of discrimination, hostility and racism, we recommend the following: That access to the same social and health services that are available to permanent residents be provided for asylum seekers until the final determination of their refugee applications, in order to minimize the hardships they face. A policy to assess the psychological needs of asylum seekers is highly recommended. The literature shows that preventive psychosocial interventions for asylum seekers in a safe, supportive and predictable environment helps the recovery of those suffering from high levels of exposure to pre-migration trauma. A national forum for dialogue among politicians, policy makers, researchers, clinicians and NGOs would be valuable, to monitor carefully the impact of detention practices on asylum seekers, and to examine the effect of any policy changes on their mental health and well-being after they are released into the community. In the international arena, the United Nations meeting on children in New York in May could provide an opportunity to raise urgent issues about the impact of asylum detention centers on children’s mental health and well-being, under the provisions of the Convention on the Rights of the Child. Contact: Solvig Ekblad National Institute for Psychosocial Factors and Health Box 230, S-171 77 Stockholm, Sweden Fax: 46 8 33 06 52 Email: [email protected] References Silove, D., Steel, Z., Mollica, R. (2001). Detention of asylum seekers: assault on health, human rights, and social development. The Lancet 2001, volume 357, May 5, 1436-1437. Steel, Z., Silove, D.M. (2001). The mental health implications of detaining asylum seekers. Medical Journal Australia 3, volume175, 596-599. Sultan, A., O’Sullivan, K. (2001). Psychological disturbances in asylum seekers held in long term detention: a participant-observer account. Medical Journal Australia 3, volume175, 593-596. United Nations High Commissioner for Refugees (UNCHR)(2000). The state of the world’s refugees: fifty years of humanitarian protection. New York, NY: Oxford University Press. Fourth Quarter 2001 Newsletter