Part III: Healing the mind
In Part III of our season on refugees, we look at the mental-health toll of living as a refugee or an internally displaced person. Host Nelufar Hedayat speaks with an internally displaced Afghan woman about trying to care for herself and her children while living in a shipping container. She also examines different ways that refugees define and experience the trauma of conflict, and she shares stories from aid workers who help displaced persons process their experiences.
During this season of Course Correction, we’re challenging you to reflect on different aspects of the refugee experience and share your thoughts with us.
For today’s episode: Tell us about a time you coped with or lived through a situation of extreme stress. Have you been in a situation where you’ve had to worry about providing basic care for yourself or your family? What resources helped you through it? If you’re a refugee, what was the moment you felt that your life stabilized enough to start thinking about your long-term hopes and dreams rather than daily survival?
Note: We encourage you to listen to the audio if you are able, as it includes emotion not captured by the transcript. Please check the corresponding audio before using any quotes.
NELUFAR HEDAYAT, HOST:
In 2001, a Norwegian freight ship called the MV Tampa was sailing through the Indian Ocean when it came across a fishing boat in distress. The boat was filled with Afghan refugees — 433 of them to be precise — along with five crew members. The fishing boat had set out from Indonesia with the goal of seeking asylum in Australia.
RECORDING OF MAN SPEAKING:
For the time being, we are drifting off Christmas Island, 12 miles. We are running out of medical supplies. We do not have enough blankets.
NELUFAR: Watching with the rest of the nation was Dr. Suresh Sundram. Currently, he’s the chair and head of the department of psychiatry at the School of Clinical Sciences at Monash University in Melbourne. Dr. Sundram says once the MV Tampa started to make its way toward Australia, it was met with resistance.
The government of the day determined that it didn’t want these people —
NEWS CLIP OF AUSTRALIAN WOMAN SPEAKING:
What could have been an international humanitarian issue instead became an Australian security crisis.
SURESH: — and it sent out a naval force to stop the ship from entering Australian waters.
THEN-PRIME MINISTER OF AUSTRALIA, JOHN HOWARD:
The government was left with no alternative but to instruct the chief of the Australian Defense Force to arrange for defense personnel to board and secure the vessel.
NELUFAR: This incident would later be known as the Tampa affair.
SURESH: Now that was a very decisive moment in Australian political and social history, and the country split along two lines: those who believed that the ship should have been allowed to disembark its passengers, and those who believe that the government did the right thing.
PRIME MINISTER HOWARD: We will decide who comes to this country and the circumstances in which they come.
SURESH: And, at that time, I was on the side — and I think I still am on the side — that says that that ship should have been allowed to disembark its passengers.
From the Tampa, 150 asylum-seekers get sent to New Zealand, and the rest are sent to Nauru. Australia’s tough stance is criticized internationally.
RECORDING OF MAN SPEAKING:
It has made Australia a slightly different country and isolated us from both Indonesia and, also, I think, from international opinion.
NELUFAR: Dr. Sundram was well aware that those on the boat weren’t just in need of medical treatment for their physical well-being, but also would be in dire need of psychological treatment to start to address the trauma of displacement.
SURESH: I thought at that time that it would be good that rather than just talking and being cross about the issue, I’d do something. And so at that time, I started a mental health service for asylum-seekers. And from that, 17 years later, we are where we are.
NELUFAR: I’m Nelufar Hedayat, and you’re listening to Course Correction. And this is part three of our special season devoted entirely to examining the experiences of being a refugee. We’ve partnered this season with UNHCR, the United Nations refugee agency, whose mission is to protect people forced to flee their homes because of conflict and persecution. In our previous episode, we discussed the ramifications of bodily harm to refugees and displaced people, the outward wounds you can see and treat. But psychological trauma can be more damaging and longer lasting, sometimes taking years to heal. Dr. Sundram says these wounds often begin before a person has even left home.
SURESH: The first set of mental problems, if you like, relate to why it is that someone’s fled their home country. This might be individual persecution, experiences of being abused or imprisoned or tortured by authorities or by other agents in their country of origin. It may be persecution that they’ve experienced as a consequence of their religious or ethnic or cultural identity. It may be civil conflict. It may be war. It may be natural disaster, of course, all of which lead to them leaving their home. And, of course, leaving one’s home — potentially permanently — is a very, very difficult and traumatic experience, in addition to whatever it is that’s causing them to have to leave. So they carry that type of trauma, which may be, if you like, relatively acute, or it may be long-lasting.
NELUFAR: This makes sense. As we’ve stated before in this podcast, nobody wants to become a refugee. It’s a decision of last resort. Being forced to leave can often be the first psychological blow that falls on refugees, but it’s not the only one. Refugees often face what Dr. Sundram calls “compounding experiences,” like contending with a host country that’s reluctant to offer asylum.
SURESH: Transit countries might have a very persecuted approach to refugees or asylum-seekers, believing that they don’t want them, believing that they want to get rid of them as quickly as possible, making their life as difficult and as destabilized as possible so that they don’t stay. And of course, that can be compounded in places like refugee camps, where there might well be very significant violence. And in places like, you know, in transits from, say, North Africa to Europe or from Indonesia to Australia, we have very perilous boat journeys, where people might lose their lives. Now, during all of these experiences, both the pre-migration as well as the migration journey, people might be again subjected to a whole host of injuries and violence and abuse. People might be robbed, people might be beaten, people might be sexually assaulted or raped, people might be imprisoned. So all of these sorts of experiences contribute to the cumulative trauma that refugees and asylum seekers might then take into their host country, either if they’re refugees to be accepted by their host country, or if they are asylum-seekers, whilst they’re still applying to be recognized as refugees.
NELUFAR: For internally displaced people, trauma often comes in the form of having to make do with less. The daily stress of finding the bare essentials — food, water, shelter — they can all be overwhelming, especially if there are children to look after. For today’s featured voice, I spoke with a woman we’re calling Medina. We’re giving her that name to protect her identity. She’s from Takhar province. It’s a mountainous region in northeastern Afghanistan. Medina told me how her displacement meant surviving without basic necessities.
[MEDINA SPEAKS IN DARI]
We don’t have a place to live, and when the Taliban came, we were forced to live inside a container on the street. We don’t have water, power, carpet and dishes. Some neighbors have helped by giving us old blankets and carpets to help us live here.
[SOUND OF PERSON COUGHING]
NELUFAR: It sounds like there’s somebody coughing in the background — a child. Are they OK?
[FEMALE TRANSLATOR SPEAKS]
[MEDINA SPEAKS IN DARI]
MEDINA, THROUGH FEMALE TRANSLATOR: Yes, it is my child. It’s cold and snowing. Now we are making a fire by using plastics to provide heat for our child. We gather across the stove, but the smoke makes them cough and feel sick. Only Allah knows our situation. Allah sees our condition, and he has been helping. I pray to God that people don’t forget about us in this container.
NELUFAR: Apart from the Taliban, Medina also lives in fear of the weather. Climate change has increased the frequency of mudslides and flooding in the area. She told me that 50 homes were lost to flooding in her village. She now fears the container she lives in will be destroyed by sliding rocks overhead. With so much to contend with, I asked her what she thought would bring her happiness.
[FEMALE TRANSLATOR SPEAKS]
[MEDINA SPEAKS IN DARI]
MEDINA, THROUGH FEMALE TRANSLATOR: What do I say about what happiness means? We don’t have anything, except Allah and this container. And whatever comes, I will try to be happy. Whatever house you want to give me, I’ll gladly take it.
NELUFAR: The conditions that Medina lives in are heartbreaking, but it can also be crushing to a person’s mental state.
SURESH: So we see very high rates of major depressive disorder. We see very high rates of post-traumatic stress disorder. And then we see a whole host of other conditions, which are also in some way directly or indirectly related to, to stress.
NELUFAR: Again, this is psychiatrist Suresh Sundram from Monash University in Melbourne. He says emotional trauma can lead to a whole range of issues.
SURESH: So we might see psychotic symptoms, stress-related psychotic symptoms in vulnerable individuals. We might see substance-use disorders as a way of coping with the stress. We may see family violence being played out because of the stresses that family units are under.
In addition to that, we also have the sorts of problems that children experience. And children are also experienced and subjected to the same sorts of stresses that their parents have had, and they’re, in addition, compounded by the lack of the normative social influences that children use; for example, schooling and peer group relationships, which become very important in normal development. But if they’re disrupted for refugees and asylum-seekers, they can’t have that beneficial effect. And so we see a whole host of anxiety- and stress-related disorders in kids, things such as school refusal, anxiety disorders, oppositional behaviors, nightmares, bed-wetting, those sorts of manifestations, as well as depressive syndromes in older children — can be in younger children, but more commonly in older children — as well as more prevalence of — high prevalence of things such as substance use and post-traumatic stress disorder as well.
NELUFAR: And for girls who have experienced gender-based violence — well, it can leave them as shells of their former selves. So says Leena Al-Mujahed:
You cannot imagine how is the children’s situation.
NELUFAR: Leena is a Yemeni refugee now living in Malaysia where she started an organization to help advocate for women and girls, and it’s through her work that she often encounters victims of gender-based violence.
LEENA: We go to check up on the kids in the schools. Their situation is too bad. They cannot focus. They are not feeling with other kids and playing with them. They are in a different world. And of course, this is because what they had seen in their homes. And one point is when any woman goes through any problems, she cannot talk to anyone, because if she will talk, they will do something to her. So she keeps silence most of the time until she destroyed her mental health.
NELUFAR: So what can be done to help girls who are victims of violence and others in desperate need of psychiatric care? Well, it starts with destigmatizing mental health in general. Dr. Sundram says this is a problem that goes well beyond displaced people.
SURESH: We have cultures and communities and ethnic groups who have almost no conception of mental illness as an entity in and of itself.
You know, in Cameroon, we don’t really, like — low mood or depression. It’s not like — it’s not actually a thing.
NELUFAR: Cyrille Tchatchet is a refugee from Cameroon who’s found a home in the UK. He told me that in his home country, the concept of mental health is almost nonexistent.
[Laughs.] We don’t, we don’t really think about things like that in Cameroon.
NELUFAR: Right! Do you mean that it’s not a thing because it doesn’t exist?
CYRILLE: It does exist, but society doesn’t really acknowledge it. So we don’t really think — see it as, you know, as, as a thing. I don’t really know how — [Laughs.]
NELUFAR: No, I get you, I get you. Do you mean, like, it’s invisible? So you can be depressed, but there’s no language, there’s no space.
NELUFAR: There’s no — like, I said to my auntie who’s in Afghanistan, I said, “Listen, it must be really hard for you, because the Taliban are back and everything.” And she says, “Oh, the only person that asks me this is you, because we don’t talk like this to each other, you know?”
CYRILLE: Yeah, it’s really a shame, because it does — when you look at the society today, you can tell. Depression does exist. You can tell. You can see some people being depressed. When you talk to people, you can tell your mood is very low. But I think just because of the way society sees it, so you just have to man up or, you know, you have to just carry on. There’s nothing you can do about it until someone actually commits suicide. Even then, they still don’t, they still don’t acknowledge that the person was low or depressed.
NELUFAR: We’ll hear more from Cyrille and his amazing story later in the series, but for now, we should note that helping others deal with trauma has become Cyrille’s calling. Since moving to the UK, he’s become a nurse specializing in mental health.
But of course not all refugees see trauma the same way. Some refugees may be reluctant to even characterize their experience as traumatic. And this was the case with the writer Rodaan Al Galidi. After fleeing Saddam Hussein’s Iraq to the relative safety of the Netherlands, he spent years struggling to get by, but he still doesn’t like to use the word “trauma.”
RODAAN AL GALIDI:
Trauma — this kind of feeling the Europeans use — we don’t have the trauma, because we have the terrible life every second, and we speak all the time about things — happy or not, when we are not deep enough to have kind of this trauma as the European people understand it, you know? I met thousands of refugees in Europe, because I spent years in the refugees’ camp. And later, when the people discussed with them, then they began to think, “Oh, maybe I have trauma, maybe.” Not “the war is the problem in my head,” but the trauma of the war. Maybe not losing my whole family was the problem, but the trauma of losing. The human is not so simple to put in the word “trauma,” you know?
NELUFAR: Although I disagree with Al Galidi’s views — that trauma is some kind of European construct not applicable to refugees — I can relate to another point he’s making: that feeling of not wanting to be seen as being needy.
The “good refugee.” It feels like that’s mostly what the host nations and the wider world wants. When the media mentions a refugee, often they’re astonishing people that have managed to overcome astounding odds to be the best of the best in whatever they’ve chosen. There is no room to be anything less than perfect — or perfectly redeemed. That pressure refugees feel is real. I feel it. Like we’re wearing a badge that says “refugee” for the rest of our lives, and we have to make sure that we’re good immigrants. I’ve often felt that in order to be accepted as a citizen of the UK, I don’t have to be normal. I have to be more. This is something I’ve heard again and again when speaking to other refugees: the feeling that we want to prove ourselves, demonstrate to our adapted countries that we are worthy of their assistance, and most of all, not to be seen as a burden.
Again, this is Cyrille Tchatchet:
CYRILLE: The term “refugee,” I would say it’s just a label. I wish people could know that refugee — that being a refugee doesn’t mean you have to feel sad for me or, you know, you have to feed me or something. I know some people do have, you know, go through difficult periods, and it’s not because they’re refugees, because even people who are citizens do go through difficult times. I wish people could just, you know, know that a refugee is just a citizen. It’s just someone who, you know, who wants to live a normal life and try as everyone else.
NELUFAR: Being treated like everyone else is recognizing that looking after your mental health is something everyone deals with. This is critical, says Leena Al-Mujahed, the founder of the Yemeni Refugee Women Association.
LEENA: For those who knows that there is a refugee woman around, don’t think that because she is a refugee, she is not a human. No. Each woman, refugee or not refugee, she has the rights to all the human rights for survival in this life.
NELUFAR: It starts with providing a safe place for victims of trauma to have space to actually deal with their emotional stress, says Dr. Sundram. And this is where host countries can really make a big difference.
SURESH: This is a real opportunity for intervention by host countries that recognize this trauma burden that refugees and asylum-seekers carry, where if they’re provided with support, they’re provided with basic, if you like, essentials of living, such as accommodation, bilateral support, access to employment, access to education, access to food and clean water, sanitation and most importantly, access to health care, people can, over a period of time, readjust and normalize their life.
NELUFAR: Dr. Sundram says getting this part right is essential for refugees and stateless people, as he’s found that mainstream treatments like medication or therapy are often ineffective until underlying pressures are addressed first.
SURESH: Some of the mainstream psychological therapies, which are effective for most people with, say, PTSD or major depression, will have little to no effect in this group. And that’s because there are a whole set of other psychosocial factors which impact upon an individual’s ability to engage in the treatment process and to be able to undertake the types of treatment that are required.
NELUFAR: Getting through a traumatic life experience can take years, even decades. And even if you manage to live without the daily mental burden, it still never quite leaves you. It just doesn’t define who you are. But for those who are able to make it through, there’s this amazing thing that refugees can have. A superpower, if you will. It’s a fortitude to succeed in almost any situation you can put them in. It is, in a word, resilience. We’ll close today with a story from Erol Yayboke, who researches human mobility issues at the Center for Strategic and International Studies in Washington.
I was talking to an employer in, in Texas a few years ago, and he was telling me, “I love hiring refugees, because they are some of the most dependable, hard-working people that I have ever met.” And he said, “I’m guessing it’s because they literally had to go through hell to get here. So they’re really happy to show up in my factory or my office every day.”
And I think that that’s not certainly the case for every displaced person, but I do think that that resilience is an inherent quality that I think they wish they didn’t have to have, but so many of them are, are forced to have it.
NELUFAR: Imagine if we could measure resilience in the same way that we do IQ. Every refugee would be able to have a sheet of paper that proves that they have a skill that many countries, businesses and communities need. I’d venture that we would win every resilience test someone could give us. In my more thoughtful moments, I allow my mind, in a safe way, to remember the hardship I faced and the trauma that I incurred as a child fleeing war. The horror of the sounds of bombs, the screams of people, the days I didn’t eat much — or at all — and the look on my mother’s face to just hang in there, to be strong, to be resilient. Since then, I’ve grown a thick skin. But like many of my refugee community, the thick skin helps stop bad things getting to me — it doesn’t solve or heal the hurt and the pain that has already got inside. The trauma that some of us have to deal with.
Having inner strength is one thing. Having the tools to succeed — that’s another. And this is why education is so essential to getting refugees and other forcibly displaced persons back on track. Next week on the show, we’ll hear from the UNHCR on what it does to overcome the challenges of getting proper schooling for refugees. We’ll also hear from the agency’s Goodwill Ambassador and acclaimed actor Cate Blanchett on her firsthand experience witnessing the transformational power of education not just for the individuals, but whole societies.
It is such an important global solution in keeping children in education for as long as possible. You know, refugee children, because, you know, then there is a future for their country because they are connected to it, and they are the ones who are going to know how to restructure and rebuild. And we have a responsibility, a global responsibility, to help them do just that.
NELUFAR: That’s all ahead in part four of our series on refugees.
And now for our listener challenge. As a reminder, this is something we’ve been doing all season, where we ask you to put yourself in the shoes of a refugee and share your stories with us at @DohaDebates via Twitter, Instagram and Facebook. You can also tweet me directly. I’m @Nelufar. We’ve heard today about the many stresses that can bring on trauma and how for refugees, it’s often compounded by the stress that comes from a lack of stability about money, education or the essentials of food, shelter and physical safety. For today’s listener challenge, we want to hear if you’ve ever been in a situation where you’ve had the stress of worrying about providing the basic essentials for yourself or your family. What resources did you rely on to cope? And how were you able to get through it? If you’re a refugee, what was the moment you felt your life was stabilized enough that you could start thinking about long-term hopes and dreams and no longer worry about surviving day to day? Please do share your thoughts with us at @DohaDebates.
That is our show for today. Course Correction is hosted by me, Nelufar Hedayat. This season, we’re partnering with UNHCR, the UN refugee agency. Production assistance comes from Foreign Policy with producers Manveena Suri, Anisa Pezeshki and Claudia Teti. The managing director of FP Studios is Rob Sachs. My thanks to Medina from Afghanistan for taking the time to speak to me, UNHCR for arranging that interview, and to Abdul Basser for providing an English transcription. Our show is brought to you by Doha Debates, which is a production of Qatar Foundation. Our executive producers are Japhet Weeks, Amjad Atallah and Jigar Mehta. Join us for the next episode of Course Correction wherever you get your podcasts.