Surviving in the present, thriving in the future?

Maria Gialama and Sinead McGilloway on meeting the psychosocial needs of refugee children/young people during Covid-19.
In summer 2018, two health psychologists – one a practising psychologist, PhD student and native Greek, and the other, a senior academic from Ireland – embarked on two separate but related journeys to the island of Lesvos in Greece, to gain some experience of, and insights into, working with child refugees. Their experience raises important questions about the psychosocial needs of this vulnerable group within the context of the Covid-19 pandemic.

A total of 70.8 million people globally have been forced to flee their homes, including almost 25.9 million refugees, over half of whom are aged under 18. Since 2015, Greece has been the main gateway to Europe for many of these people: the strategically located Lesvos island in the north Aegean sea has received hundreds or even thousands of refugees and migrants on a daily basis, mostly from Syria, Afghanistan and Iraq. 

Before we embarked on our separate journeys to Lesvos (in a ‘pre-Covid’ world), we knew very little about refugees and migrants; like most, our limited knowledge was based largely on media representations which tend to draw a firm line between ‘them and us’. Now, having worked (both in a professional/paid and voluntary capacity) with young ‘unaccompanied and separated children’ (UASC) and young people, as well as with NGO representatives, we have a greater understanding of the many challenges encountered by this population, including long stays in first reception facilities under violent, unsafe and unsanitary conditions, the often protracted family reunification process, and limited access to child protection services, education and psychosocial support.  

Currently however, these children/young people with multiple adversities (and their families where applicable) rarely feature in the public discourse, to the point that Covid-19 may be characterised as a pandemic which does not affect all equally. According to the latest UNICEF’s refugee/migrant report in Europe, in 2020, children still continue to make up one quarter of all refugees/migrants arriving in Europe. The spread of Covid-19 across Europe “has been deeply concerning for the tens of thousands of people, including children, staying in sub-standard and overcrowded reception and accommodation centres with limited access to water supply, sanitation and hygiene (WASH) facilities and basic services, especially on the Greek islands” (UNICEF, 2020a). Acknowledging the scale and the urgency of this challenge, the Greek government, the EU and several other EU Member States committed to accelerate the relocation of UASC from Greece (ECRE, 2020). 

Although children/young people seem less vulnerable to the new virus, they are amongst most of those indirectly affected. UNICEF (2020b) reports that “children on the move are already disproportionately affected by learning disruptions; school closures are also putting the health of 370 million children worldwide at risk by depriving them of school meals and other health and nutrition services, such as vaccination…” (p.1). In April 2020 – in an effort to address the health needs of this vulnerable population, which are arguably now more urgent than ever before – 121 European organisations signed an open letter to the Greek and European authorities, urging them to proceed immediately with the emergency relocation of unaccompanied children from the Reception and Identification Centres (RICs) on the Greek islands (European Council on Refugees and Exiles, 2020). NGOs also signed an open letter to the Greek and European governments to underscore the importance of protecting refugees/migrants in order to ensure that wider societies stay protected, and making a plea for the 1752 UASC to be relocated elsewhere (Relief Web, 2020). 

In the current pandemic, refugee children and young people – who have already endured traumatic events – may find themselves feeling more hopeless, helpless and unable at times to cope, whilst being at significantly increased risk of infection, serious illness or death, and especially if living with underlying health conditions. Anecdotal evidence suggests that some are currently struggling to communicate with their families back in their countries of origin, where Covid-19 has spread and their loved ones are at significant risk of infection due to their poor living conditions. Indeed, a recent Lancet article raised concerns about refugees’ typically cramped living conditions which can undermine their ability to follow public health measures/advice, including social distancing, basic hygiene and self-isolation (Kluge et al., 2020). This is the case in many migrant camps in northern France (Bird, 2020) as well as in Greece, including Europe’s largest reception camp, Moria, on Lesvos which accommodates almost 18,000 people (in a facility built for 3,000) (Hegarty, 2020) – amongst them, 1100 unaccompanied minors, the largest number of UASC in Europe (Watt, 2020). 

'No public health without refugee and migrant health'

In a recently published agenda for action, UNICEF (2020a) highlighted an urgent need for global coordination to prevent the current public health crisis from becoming a “child-rights” crisis; they call for action to keep the most vulnerable children healthy and well-nourished, while also prioritising WASH facilities. Most importantly, disruptions to health care can undermine “recent gains in child health, nutrition and development, potentially leading to a significant rise in child mortality” (UNICEF, 2020). Thus, it will be beneficial for all of society to ensure that refugee and migrant children and adults can access safe spaces, health-care services, and appropriate information since there “can be no public health without refugee and migrant health” (Kluge et al.,2020). 

According to Kluge et al. (2020), governments must consider more inclusive approaches to refugee and migrant health in their Covid-19 response. These should enable access for this subgroup to public health services/supports without feeling “stigmatised and unjustly discriminated against for spreading disease” (Kluge et al.,2020). Undocumented migrants, in particular, may be overlooked. Therefore, it is essential to ensure that vulnerable children/young people included amongst are provided with sufficient age-appropriate information (in their native language) and effective support from health care professionals, including psychologists (Bradley et al., 2020).

School closures due to COVID-19 have reportedly disrupted the education of 1.57 billion students worldwide (UNICEF, 2020c). While many countries have acted quickly to set up distance learning programmes, there have been very few targeted interventions to ensure that these programmes are accessible for refugees, thereby widening further the already existing inequalities in education (UNHCR Staff, 2020). Conversely, in Greece, the digital language learning platform continued to expand to include UASC in ‘safe zones’ and shelters, thereby allowing them to continue learning, albeit in a more limited way, amidst the coronavirus outbreak. Likewise, in Italy, online activities, such as dance, music and video-making workshops offered to refugee and migrant young people, have been shown to be particularly effective in engaging participants, improving stress management and promoting skills building (UNICEF, 2020c). 

Notably, all of the children/young people whom we met/worked with, struggled with their mental health, and indeed, research points to consistently high levels of psychological morbidity among refugee children, especially PTSD, depression, and anxiety disorders (Fazel & Stein, 2002). Furthermore, UASC are at a greater risk of experiencing multiple traumatic events and PTSD symptoms than accompanied refugee children (ARC) (Hodes et al., 2008). However, mental health support, in terms of appropriate staffing, resources and effective interventions, is sadly lacking for refugee populations and as we learned, Greece is no exception. Living in such violent and abusive environments that perpetuate trauma and post-traumatic stress disorder (PTSD), not only acts as a barrier to “healing”, but also a recurrent trigger for poor mental health.

Perhaps unsurprisingly therefore, there is an urgent need for effective and culturally appropriate psychological support to help promote the mental health of these vulnerable children and young people and strengthen their coping strategies as they try to rebuild their new lives away from their home countries and often also, from their families. A recent systematic review and meta-analysis identified self-esteem, maintenance of cultural identity, safety and belonging as well as refugee settlement-specific policies, to be beneficial for children, but only if embedded within a positive, socially inclusive society (Marley & Mauki, 2019). 

Small steps

As we live through the current pandemic – and as we witness many acts of kindness and generosity across the world, might both the public and professional community be more motivated in a ‘post-Covid’ era to harness our enhanced sense of solidarity, empathy and altruism? In the case of psychologists, might our collective knowledge and expertise help reverse our years of neglect of these vulnerable children and young people? For example, on this International Refugee Day, it is worth noting that 16 UASC were among a group of 50 asylum-seekers and migrants who were flown from camps in Greece to the UK in mid-May to be reunited with their families; it’s a small step, but hopefully one of many more to come into the future (Hope, 2020).  

Furthermore, the forthcoming Global Framework for Youth Mental Health, developed by the World Economic Forum (2020) in partnership with Orygen in Australia, has identified action on mental health as a global priority, and specifically youth mental health and early intervention as key areas for change. It is hoped that this framework will be used, as intended, to help guide and support the local implementation of youth mental health supports in all countries and contexts, including young ‘on the move’ refugees. Just like their Western counterparts, these vulnerable children and young people need to be cared for and nurtured in safe, protected environments and shielded where possible from violence, abuse and exploitation.

Moreover, the provision of appropriate and effective mental health support – underpinned by basic human values – should no longer be an 'optional extra'. Treat these vulnerable children and young people with respect. Allow them to cry without criticism. Empathise with them. Call them by their name and acknowledge them as unique individuals. Show them unconditional love. Make them feel valued and included, accepted and protected. Listen to their life stories. Show genuine interest. Give them time and a safe space to express their emotions without feeling judged. Above all else, help to make them feel like kids again.  

Maria Gialama is a practising psychologist and PhD candidate/ Graduate Teaching Assistant, in the Centre for Mental Health and Community Research, at the Department of Psychology and Social Sciences Institute, at Maynooth University, Ireland. (MBPSs 258184).

[email protected]

Prof. Sinead McGilloway (PhD, CPsychol., CSci, AFBPS) is Founder Director of the Centre for Mental Health and Community Research, at the Department of Psychology and Social Sciences Institute, Maynooth University, Ireland. (AFBPSs 95872).

[email protected]

See also 'Searching for happiness in camp Moria'.

References

Bird, N. (2020, April 29). Coronavirus: Newport volunteer in migrant camp lockdownBBC

Bradley, S., Barclay, H., & Farrington, R. (2020, March 20). Mitigating the impact of covid-19 on vulnerable migrantsThe BMJ Opinion. 

European Council on Refugees and Exiles (ECRE). (2020, March 25). Protect the most vulnerable to ensure protection for everyone.

Fazel, M., & Stein, A. (2002). The mental health of refugee children. Archives of Disease in Childhood87(5), 366-370.

Hegarty, S. (2020, April 5). Coronavirus: Second Greek migrant facility quarantinedBBC 

Hodes, M., Jagdev, D., Chandra, N., & Cunniff, A. (2008). Risk and resilience for psychological distress amongst unaccompanied asylum seeking adolescents. Journal of Child Psychology and Psychiatry49(7), 723-732.

Hope, R. (2020, May 12). Unaccompanied children among 50 migrants arriving in UK from camps in Greece. Sky News.

Kluge, H. H. P., Jakab, Z., Bartovic, J., D'Anna, V., & Severoni, S. (2020). Refugee and migrant health in the COVID-19 response. The Lancet395(10232), 1237-1239.

Marley, C., & Mauki, B. (2019). Resilience and protective factors among refugee children post-migration to high-income countries: a systematic review. European Journal of Public Health29(4), 706-713.

Medicines Sans Frontiers (MSF). (2018, September 17). Self-harm and attempted suicides increasing for child refugees in Lesvos

Random acts of kindness during the coronavirus outbreak. (2020, May 19). Mental Health Foundation.

Relief Web (2020, April 3). Immediately honour commitments to relocate unaccompanied children from the Greek islands

Shaw, M (2020, May 21). A time for small acts of kindness and major acts of mental health support. Cover Magazine.

UNHCR (2020). Figures at a glance

UNHCR Staff (2020. May 11). Refugee Children hard hit by coronavirus school closures.

UNICEF (2020a, May 10). Refugee and Migrant Response in Europe: Humanitarian Situation Report 35 (January- March 2020). Relief Web. 

UNICEF (2020b, May 15). Coronavirus (COVID-19) Global Response: Situation Report 5.11

UNICEF (2020c, April 3). Protecting the most vulnerable children from the impact of coronavirus: An agenda for action.

Watt, E. (2020, May 21). European countries must act urgently to help unaccompanied children in Greek refugee camps. Their World

World Economic Forum (2020). Global Framework for Youth Mental HealthOrygen.

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