Additionally, it is crucial to take into account that the current global circumstances, such as the pandemic, worsened the imperilled mental health of refugee populations. For example, the Dadaab Response Association released a special working paper about the pandemic’s negative impact on youth well-being in the Dadaab refugee camps, which reveals the prevalence of self-harm and suicide amongst refugee youth. In light of the ongoing challenges refugees face and the impacts of the pandemic, it is urgent to strengthen mental health and psychosocial support systems for refugees and displaced persons.

In October 2022, UNHCR’s Executive Committee adopted , which draws special attention to the mental health and psychosocial needs of refugees and forcibly displaced persons. In the for the ExCom Conclusion, Sajjad Malik, Director for the UNHCR Division of Resilience and Solutions stated that “The best way to improve the mental health of refugees is to find lasting solutions to the crises they are fleeing.” While the global commitment to implementing sustainable psychosocial support systems is certainly a positive step, there are still various challenges and barriers to be considered.

We reached out to LERRN partners Pascal Zigashane and Michaela Hynie to hear their thoughts on the importance and implications of this Conclusion.

Michaela Hynie

Professor, York University

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Pascal Zigashane

Executive Director, Action Pour leĚýProgres

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Pascal Zigashane, Executive Director at Action Pour le Progrès, allocates services for children in pre-school with a focus on social and emotional issues, while also offering services to refugees from non-English speaking countries, such as English courses.

Dr. Michaela Hynie, the interim director of Center for Refugee Studies at York University, focuses on social inclusion using changes in mental and physical health outcomes as a measure of the success of our settlement programs as well as considering access to health care for people who have precarious migration status or who have experienced displacement or forced migration, as well as mental health consequences of social exclusion. The interviews below were conducted separately and have been edited for length and clarity.

Q: What do you think about the on mental health? Does it address the full scope of the issue?

Pascal Zigashane: I think the [Conclusion] addresses many of the mental health issues that refugees face. However, the refugees are currently struggling with even worsened situations with increased prices for essential goods and lack of food security.

You find that it is becoming an unbearable situation for refugees. They escape war and conflict, and their mental health becomes even more strained with food insecurity and life conditions in the camp.

Also, humanitarian organizations, including UNHCR, may add more stress to refugees’ lives and contribute to the victimization of refugees. Let me give you an example: I personally applied for a travel document, and I did it via UNHCR because I wanted to attend a conference in Uganda back in May. The documents were not processed in time for the conference because they were not a priority.

Michaela Hynie:ĚýA strength of the conclusion is that it does talk about the need to recognize that we create conditions that result in negative mental health consequences and acknowledges that the people who are working in these environments also can experience distress. Also, it is crucial to adapt these services culturally.

Q: What are the current barriers to access health services for asylum seekers and refugees in your community or areas of focus?

PZ: Refugees are still having issues with essential needs such as food assistance. The major problems are still related to offering the fundamental needs to refugees.

A person needs to see a hopeful future.

This affects especially refugee youth because they are not seen as a priority. They lose hope for their future because they do not get resettlement or chances to go to university and generate income. This leads refugee youth to criminalization.

Refugees spend years in the camp while they wait for a decision, that is why the rejection of refugee claims can also be very dangerous for the mental health of the claimant. That person cannot access the services in the camp anymore. Their movement is limited, their access is limited.

MH: We know that the majority of people who are refugees under UNHCR definitions are not living in UNHCR-controlled areas, that they are living in urban centres. How are they accessing care there? How people access any kind of care when they are outside of a refugee camp setting? Do clinics in these countries provide services and do they provide mental health services? And are those services culturally appropriate? These are all really important questions. In public health care systems, particularly in low-income countries which is where most people who are forced migrants are residing, mental health services receive a fraction of the funding of physical health services.

I think also talking about digital equity and people’s access to affordable Internet services when providing mental health services through technology is important to consider. Most people have access to a cell phone now, but not everybody can read. So, are those services that are being offered through technology accessible to people with low reading skills? Do those services require data plans that people might not be able to afford to access? It is also important to recognize who is included or excluded from technologically enhanced or mediated mental health services, because many of those services are not appropriate for people with very serious mental health issues, such as psychosis or post-traumatic stress disorder.

Q: What are the existing response mechanisms to the mental health needs of forcibly displaced and refugees in your community?

MH: This question depends on what your status is and it depends on what the insurance programs are in the country that you have migrated to. Those barriers sometimes include stigma and it can be not knowing how to access those services. So, when we speak to people who eventually ended up using mental health services, we have found that many of them would talk about how they didn’t know how to reach care or they didn’t know how to figure out if they need those services.

Mental health services need to work with community organizations, community leaders, and community networks, because the care needs to be community specific. A one-size-fits-all solution doesn’t actually work.

Other barriers could include language barriers, the times at which services are available, and accessibility to digital services.

Ěý

Q: What are some possible impacts of this Conclusion? How do you think it addresses social determinants, integration and inclusion into national health services?

PZ: The Conclusion will help humanitarian organizations to assign more budget to mental health support and psychosocial services. It will also create more jobs in this area. However, it is important to make sure everyone can access these services, not just a select few.

MH: Organizations and governments should reflect on how their policies are impacting mental health and well-being in partnership with the communities that they’re working with, because policies that are well intended can sometimes have very negative consequences. This is because the governing bodies haven’t consulted with communities about what they need. Again, there isn’t going to be one-size-fits-all within a community. We want standardized solutions because it’s easier and it’s cheaper. However, the first step in implementing mental health services needs to be partnering with the community around identifying the appropriate solution. It is also important to think very carefully about who is speaking for the community. Who is not being heard from? Often, the most vulnerable people are excluded from the conversation.

Q: What do you hope international collaboration would entail in terms of mental health and psychosocial support services to refugees?

PZ: It is good to mobilize resources internationally for mental health support. But there should be accountability for how these resources will be allocated.

MH: I feel like international always needs to be a network of local for these kinds of initiatives.

There can be international initiatives that provide support, tools, and recommendations around processes, but it always has to be taken up at a local level.

Q: What role do you see refugee-led organizations can play in advancing the Conclusion?

PZ: COVID actually made refugee-led organizations more visible. At Action Pour le Progrès, we are already taking initiatives to help children in pre-school who are affected by the distressing processes.

RLOs know what refugees go through and they are connected to their communities, which makes it easier to connect and reach the refugee leaders. Their doors are open to their community.

Q: Would you like to share any concluding remarks?

PZ: The refugee conditions are getting worse. Food and security remain the primary concerns for refugees. Mental health services are definitely needed, but counselling is not enough.

MH: Providing access to appropriate affordable and timely mental health and psychosocial support services is absolutely important.

We’re so focused on individual-level solutions rather than thinking about the upstream causes of distress. So, never lose sight of reflecting on prevention not just at an individual level, but prevention at a structural, social, and policy level.

This publication was prepared by LERRN Project Writer Irem Karabag.

Event details and recordings available here.

Detalles del evento y interpretaciĂłn en espaĂąol se pueden encontrar aquĂ­.

DĂŠtails de l’ĂŠvĂŠnement et interprĂŠtation en français sont disponibles ici.

On 21 January 2021, the (LERRN) hosted two webinar panels for the North American component of the United Nations High Commissioner for Refugees’ (UNHCR) virtual conference: commemorating the 70^th anniversary of the UNHCR. The first panel, “Realizing Protection and Solutions Within North America” brought together co-moderators Jennifer Hyndman and Michaela Hynie and presenters Alejandra MacĂ­as Delgadillo, Delphine Nakache, and Eskinder Negash to discuss challenges relating to refugee protection in North America and the future role of UNHCR in the region.

North America may not be the first region that comes to mind when thinking about refugees and the UNHCR, but as the panel made clear, it is not for lack of concerns. A key theme of the presentations was what co-moderator Jennifer Hyndman referred to as the region’s “thickening borders” – or the set of new state policies and practices that work to limit asylum seekers’ access to legal protection. Delphine Nakache, Associate Professor at the University of Ottawa, provided examples of these processes at work in Canada. She argued that while Canada has become a world leader in refugee resettlement, “there is a growing gap in Canada between the treatment of refugees selected overseas versus those claimants who arrive at the Canadian border.”

A key issue is the Safe Third Country Agreement (STCA), which dictates that refugee claimants entering Canada or the US at an official land port of entry must request protection in the first country in which they arrive. In the past 5 years, the number of claimants at the border has increased, resulting in greater numbers of individuals being sent back to the US. But as Nakache pointed out, the US cannot always be considered ‘safe’. Many unsuccessful claimants in the US face deportation to countries where there is a high risk of persecution, and there is currently no way for the Canadian government to ensure their protection and safety. In addition, many claimants who are returned to the US are put into detention. On these grounds, the Federal Court of Canada ruled in July 2020 that the STCA violated the Canadian Charter of Rights and Freedoms and should therefore be suspended. The Trudeau government, however, filed an appeal, keeping the STCA in force for the time being. Nakache underlined how the pandemic has magnified these safety risks. In December 2020, the Canadian government resumed deportations of unsuccessful refugee claimants, despite their own policies which have closed the borders to non-essential travel.

The scale of Canada’s ‘spontaneous’ arrivals, however, is minor compared to that of Mexico’s. Recent economic, environmental, and political crises in Central America have put Mexico at the centre of one of the world’s major migration corridors. Alejandra MacĂ­as Delgadillo, Executive Director of Asylum Access Mexico, described how the Mexican government’s response has been driven by security concerns. The military presence at the southern border has been dramatically increased, and large numbers of arrivals are detained and deported, including families and unaccompanied minors.Ěý In fact, between 2017 and 2019 the Mexican government has deported 87% of claimants who have been detained at the border. Delgadillo highlighted how reversing these policies will not be easy. There is currently a lack of political will in the country, but a desperate need to improve the legislative environment to ensure greater protection for asylum seekers and refugees, particularly the most vulnerable. Additionally, the Mexican Commission for Refugee Assistance (COMAR) – Mexico’s refugee agency – faces significant staffing and resource limitations. As a result, there is a backlog of 80,000 asylum cases.

There is one country in North America, however, that may soon see dramatic changes in a positive direction. “The United States is back in business” claimed Eskinder Negash, President and CEO of the US Committee for Refugees and Immigrants. Negash highlighted how President Biden has signalled his intention to overhaul the country’s immigration system and repair the moral reputation of the US on the global stage. During his campaign, President Biden announced his administration would admit 125,000 refugees per year, a number that would once again make the US the world leader in refugee resettlement. On the day of his inauguration, he rescinded the controversial ‘Muslim ban’. Larger changes are evident in President Biden’s proposed immigration bill, which would offer pathways to citizenship for the country’s 11 million undocumented immigrants, extend legal protections for families and unaccompanied minors, and provide additional resources to relevant federal departments, including $4 billion for an inter-agency plan to address the underlying causes of migration in Central America. While Negash recognized it will take time to repair the damage done by the previous administration, he was optimistic that these changes will soon have a positive global impact.

Panelists also offered insights into what role the UNHCR might play in North America in the coming years. In terms of country specific activities, this role will depend on context. As emphasized by Nakache, we do not have a good idea of what happens to refugee claimants sent back to the US from Canada, and Canada’s practices at the border are not without fault. Here, the UNHCR could play a key role in terms of monitoring and advocacy. The same goes for the US, where the detention of families and unaccompanied minors has been in practice for several years. In Mexico, there may be room for a more hands-on approach. While advocacy is still critical, Mexico’s refugee agency COMAR requires more financial and human resources to cope with the growing number of asylum applications and refugees continue to face considerable barriers to integration.

But North America also has common concerns. The biggest issue facing the region is displacement from Central America. Individuals travelling this route face considerably health and security risks, and the scale of movement places strain on the immigration system of Mexico and to a lesser extent the US. Delgadillo stressed that a regional approach, guided by human rights principles, is critical. Considering a potential windfall of resources in the US for activities in Central America, the UNHCR could play a key role in bringing players together to develop, implement, and monitor a regional approach that increases the health and safety of migrants. Here, the UNHCR can also play a key role sharing information, lessons, and best practices between policy-makers and advocates of the region. As stated by Negash, the UNHCR has done incredible work in North America and worldwide over the past 70 years, but they may require new tools, ideas, and strategies to address the challenges of the future.

This report was prepared by Tyler Foley, PhD Student, ĐÓ°ÉÔ­´´ University, with assistance from ĚýRachel McNally, LERRN Knowledge Mobilization and Translation Officer.

These panels and the LERRN-IDRC Webinar Series on Forced Displacement are coordinated by Jennifer Kandjii, LERRN Research Officer. For further information or ideas please contact us here.

To read the report on Panel 2, “North America within the global refugee regime,” click here.

Dr. Nimo Bokore is leading a project devoted to providing cultural-based trauma responses to refugees.

The complex needs of survivors wars have left service providers in the West struggling to use the “one size fits all” Western-style intervention model that doesn’t provide the specific, cultural-based trauma responses service users need to help them resettle in their new country. As a result, the , an Ottawa-based community organization which serves refugees from diverse non-western countries, asked Dr. Bokore to lead a collaborative study to create a cultural-based trauma-informed intervention.

From there, the project “Rethinking Resettlement And Integration: Creating Cultural-Based Trauma-Informed Intervention” was born. The project is based on Participatory Research (CBPR) that responds to SCFS needs and will work on the development of a culturally-based trauma intervention model (CBTI). The goal of this project is to extend the benefits of CBTI beyond SCFS to other community organizations, thus contributing to the programming of other resettlement services and data for future research.

Dr. Bokore says “The team of researchers in this study recognizes the need to provide a lasting integration necessary to develop and implement services/policies that promote healing.”

This project strives to create a practice model that will benefit communities in Canada and beyond. Dr. Bokore hopes that each resettled refugee will have access to need-based services that are informed by a cultural-based and trauma-informed intervention.

The project team is comprised of:

● Dr. Patricia McGuire, Professor at ĐÓ°ÉÔ­´´ University’s School of Social Work, (co-applicant- academic).

● Dr. James Milner, Director of Local Engagement Refugee Research Network (LERRN), Associate Professor of Political Science at ĐÓ°ÉÔ­´´ University (co-applicant- academic).

● , Professor Emerita, York University School of Social Work and Centre for Refugee Studies (co-applicant- academic).

● , Faculty of Psychology and the Centre for Refugee Studies at York University (co-applicant- academic).

● , Associate Professor at the University of Calgary (co-applicant- academic).

● and (Collaborators) at SCFS and expertise in post resettlement programs.

Congratulations once again, Dr. Bokore! We look forward to seeing the great impact and benefits of this work.