Children refugees' mental health: The unseen scars of trauma

It can be easy to take for granted certain things in life and forget the privilege of living in a stable, peaceful, tolerant and safe place where all our basic needs are met and human rights guaranteed.

But this is not the case for the more than 108 million displaced people worldwide by the end of 2022, according to numbers provided by the United Nations High Commissioner for Refugees. They have been forced to leave their homes due to persecution, conflict, violence, human rights violations or other traumatic experiences.

Displaced people include those internally displaced, refugees and asylum seekers, among others. Out of those 108 million forcibly displaced, around 35 million are refugees, which means they have crossed an international border seeking safety in another country.  

More mental health problems

"When you flee, you lose everything that made up your world and kept you rooted and connected," Lynn Jones, a child and adolescent psychiatrist and relief worker, wrote in a 2018 article. There, Jones shared 10 lessons from her more than 25 years of experience with children in war and disaster zones.

It is not only the war, violence, threats to their lives or freedoms that they fled from. Fleeing itself, and all that it entails, can be devastating for refugees' mental well-being and can lead to severe anxiety, high levels of stress, post-traumatic stress disorder (PTSD), depression, and suicide.

"It's pretty consistent that they [refugees] have higher rates of mental health problems than the general population, at least four or five times higher," Panos Vostanis, a child psychiatrist and professor of child mental health in the UK, told DW. He focuses on vulnerable children who have experienced traumatic events.

Refugee children are particularly vulnerable

Refugee children are particularly vulnerable. "Because they lack cognitive functioning to understand what's going on. And it's so easy for children to think that this is much more dangerous than it really is," Jon-Hakon Schultz, senior researcher at the Norwegian Centre for Violence and Traumatic Stress Studies, told DW.

Children also often lack the experience and skills to deal with these situations, added Schultz.

Many factors can contribute to children refugees' mental health issues besides the horror of the war, violence or prosecution that forced them to flee. They can go through more traumatic experiences during the journey itself, they can be separated from their families or have abusive parents, and their mental health is subject to that of their parents, which can be severely affected as well.

Traumatic events on children can cause psychological, behavioral and emotional problems. PTSD, depression, anxiety, strong reaction to noise, intense fears and nightmares, excessive crying, taking more risks, disobeying teachers and parents, to name a few.  

The journey can be traumatic

Fleeing and finding a new home can be brutal. And there are many stages in between, each with its own impact and consequences.

Syrian refugees face death by crossing the Mediterranean Sea on overcrowded boats, hoping to reach Greece or Italy. Venezuelans crossing the Darien Gap from Colombia into Panama face many dangers and abuse on their way to the United States. 

The journey itself can cause trauma and affect the whole family, not just the children.

Family plays a key role

Having loving parents can be as important as leaving the horrors of war, violence or prosecution, according to Jones. "It is now well established that one of the key protective factors against the long-term negative effects of toxic stress is the availability of a responsive, loving parent," said Jones. Family reunification should be a priority, she added.

Sadly, not all parents are loving and can also cause further trauma or mental abuse to children.

During the Bosnian War, many children were evacuated from their parents. Some later experienced PTSD a few years after the war, explained Jones. In part because they were separated from their parents.

But it gets more complicated. Even when the parents are with their children, their own mental health problems can further damage the children’s mental wellbeing, if not addressed properly and promptly.

The mental health impact of war and displacement can contribute to family violence, says Jones.

"Violence inside the family may be as damaging to long-term mental health as violence outside," she adds.

Present context often outweighs traumatic experiences

Once they arrive in a refugee camp or get asylum in a host country, the harshness continues. 

In refugee camps, like the one in Calais in 2015, on the northern French coast, referred to as "the jungle" by those living there, the conditions can be deplorable, as reported by Human Rights Watch.

The Jungle was taken down in 2016.

"The asylum seeking process can go on for six, eight years, until they're adults," said Vostanis.

Refugees and asylum seekers not only face past traumas and the harshness of fleeing itself, but also often terrible conditions. A lack of water and hygiene, discrimination, abuse, stigmatization, and many other forms of anti-refugee reactions in the host nations. Each with its own toll on the refugees' mental health, both family and children.

"So it's the complexity, the multitude of problems. That is the main challenge here, which even professionals and researchers don't quite know how to tackle well," added Vostanis.

Such conditions can sometimes outweigh the original past trauma in children. "A growing amount of research shows that the persistence and accumulation of adverse experiences such as child maltreatment, neglect and poverty in a child's life have profound effects on both physical and mental health throughout the life course," explains Jones.

Hunting the children's sleep

One of the many symptoms that refugee children often experience is recurring traumatic nightmares. 

Not the kind you might experience once or twice in the past months, but rather those where "you thought you were about to die when you experienced this, or be seriously wounded," explained Schultz.

Children with this kind of nightmares can wake up during the night and relive the traumatic experience and what they felt when it happened. "That means that the brain releases stress hormones into your body and you are in full alarm," he said.

Nightmares like these have a huge impact on the children’s sleep quality, which affects not only their normal functioning, including school performance, but also their underlying psychological problems.

"But the good news is, of course, that when you first identify the nightmare and provide treatment for it, it can actually work very effectively … almost 70% get rid of the nightmares [completely]," said Schultz.

One way Schultz together with the Norwegian Refugee Council help with nightmares is with group sessions where kids can share with each other. "And they [are] so relieved when they hear that other children also have [nightmares]. They're not alone, and they're not going crazy," he added.

Edited by Cathrin Schaer and Andreas Illmer