Stress & Grief

Impacts of Coronavirus on Refugee Mental Health

As the coronavirus continues to spread across the country, refugees are practicing social distancing guidelines recommended by public health experts and government entities to help slow the spread of the virus and prevent chaos in the healthcare system. Most public events are cancelled or postponed indefinitely, small businesses have shuttered, and refugee workers are struggling to maintain normalcy working from home; risking their health in essential positions or facing the uncertainties of unemployment. Concerns over the spread of the virus has also created panic shopping, hoarding, and for those most vulnerable, fear of starvation. Undoubtedly, we are living in a time when most of us face fear, uncertainty, and varying degrees of isolation. This is especially difficult for those who live alone or with mental illness and a history of trauma.

Isolation undoubtedly affects our mental health. Without adequate social interaction, we may be at risk of increasing negative thoughts and emotions. A research team at McGill University discovered that after just a few hours, isolation can lead to a distorted perception of time, high levels of anxiety, and even hallucinations. Insomnia, alcohol, tobacco, drug use and chronic health problems likely increase due to the fear of contracting or spreading the virus for ourselves and our loved ones. Additionally, fears about not being able to access the critical resources needed, which are very real, can also exacerbate mental health symptoms. For refugees that have survived conditions of war, violent conflict, poverty, torture, disease, the isolation of refugee camps, food shortages, restricted movement and separation of loved ones, the social conditions of living in the time of coronavirus can be especially difficult to endure.

The world is currently facing the worst refugee crisis since World War II. Political oppression and civil wars are forcing many people to leave their home countries in order to survive. Negative outcomes include post-traumatic stress disorder, depression, changing social status, victimization, exploitation, and lack of proper health care, including mental health treatment.

Similar experiences with COVID 

Many refugees have lived under dictatorships, authoritarian governments, lockdowns and martial law which tragically were often common experiences. Although the circumstances of coronavirus are quite different, the experiences of resource scarcity and movement restrictions trigger past memories of severe trauma which, in addition to the difficulties experienced moving to a completely new country, creates dramatic increases in fear and anxiety in the refugee community.

A community member shared with me that during the civil war in Mogadishu, Somalia in 1991, his family was forced to stay in their home for 15 days. Leaving the home was mortally dangerous and food was scarce. Family members would leave the home to search for food amongst flying bullets in the city center only to come home with empty hands. Most stores were empty or closed. They lived with limited food for two weeks. As one might imagine, shoppers panic-buying amid escalating coronavirus fears can be a reminder of the painful experiences of the civil war in Somalia.

For many refugees, mental health crises do not end in the refugee camp or when they leave their home country. Many refugees resettle with acute and chronic diseases, including the effects of trauma. Those who have settled in the United States for safety and security never imagined they would be again facing uncertainty, fear, anxiety, movement restriction, fear of losing loved ones, isolation, fear of economic insecurity and stability, or even the fear of not having proper burials for loved ones. A friend who lives in New York City who was separated from her family and witnessed mass starvation, graves, and burials during the war recently called me in distress. She again finds herself separated from her family during the epidemic and witnessing mass graves in NYC. She said she “feels like I am re-living the civil war in a new environment and country.”

Traditional ways of coping are challenging now 

Oftentimes people turn to community and tradition during difficult times to help cope and find meaning. Like many of us, refugees are often from cultures that manage difficulties by conducting communal rituals and ceremonies, both social and religious. Many come from societies in which problem solving occurs through community-based discussion and unity. As we know, these types of collectivist solutions and ways of coping are made impossible by social distancing, and many in the refugee community are not computer or English literate and experience existing cultural barriers to accessing care, leaving them especially vulnerable to the ill-effects of isolation and re-traumatization. Without a way to connect, many that are already vulnerable and more susceptible to mental illness are struggling alone with feelings of abandonment, fear of death, and despair.

Trouble accessing care

The uncertainty, frustration, and lack of a sense of safety caused by war traumas and living under the conditions of coronavirus are further exacerbated by misinformation about the coronavirus and lack of culturally competent mental health services. Hoaxes on social media like drinking bleach, using saunas, and eating garlic and ginger to cure the coronavirus spread dangerous information that can cause at best a false sense of security that can lead to more confusion and unsafe practices for those who don’t speak English. In addition, while social integrative services are more or less numerous, most do not understand or have access to mental health services, despite often needing them due to a lack of information, not knowing how to navigate the system and stigma that is often associated with mental illness. 

Those who are triggered by the effects of coronavirus and suffering from depression, anxiety, or struggling with suicidal thoughts have difficulty accessing treatment. Many organizations, doctors’ offices and social services agencies are closed, not accepting new clients, or are only offering telemedicine services, which, due to existing cultural, language, and technological barriers, leave many without care.

Community leaders taking actions to help 

In the midst of all the above struggles refugees are experiencing, there are refugee community leaders, elders, businessmen and women, and local nonprofit organizations that have come together to help the refugee community with initiatives to tackle the problems at hand. For example, community leaders are helping elderly isolated individuals connect with the rest of the community and be informed about the coronavirus and community updates by giving them iPods and helping with internet connection. Community Health Navigators in the community also are distributing coronavirus educational information in refugees’ native languages.

The organization of food delivery for needy and elderly people who cannot cook for themselves or are not able to go out to get food is active. Many health care professionals are creating a social media presence, speaking on the radio and tv stations to educate the refugee community about the coronavirus and its impact on mental health and sharing other related important information about the coronavirus. Community members are streaming videos about different lectures including spirituality, meditations, stress management and prayers. Many refugee individuals are from tribal societies where they have already created a platform to communicate.

Tribal groups usually use WhatsApp to share information and discuss tribal issues which helps reduce the difficulty in reaching the refugee community. Since refugee communities cannot do collective prayers, they are praying at home. Religious places like mosques and churches are doing video streams. While there are many concerns and struggles yet to face and move through, the refugee community is adapting, gathering their resources and mobilizing their community while standing in solidarity with their host community.

Kahin Adam works for Feeling Good MN as a Community Health Specialist. He is a public health practitioner, clinical social worker and a trauma focused psychotherapist. He is an influence in shaping trauma, mental health and public health education in the community.   

*This article was originally published on on May 3, 2020 and can be accessed here.