Working with refugees and asylum seekers during the time of covid-19
Many thanks for the opportunity to talk about how refugees and asylum seekers’ mental health is impacted by covid-19. I am the founder and director of Trauma Foundation SW a charity that works in Bath and Bristol in the UK. We provide counselling and psychotherapy to refugees and asylum seekers. I will use the term refugees for all of our clients in this talk unless I specifically mean asylum seekers as asylum seekers are refugees in the non-technical sense. I’ll start by saying something about the mental health of refugees in general and then go on to say how Covid-19 has impacted on them.
As I’m sure you know, the mental health of refugees is very compromised at the best of times because of the multiple and complex trauma they have experienced. They have, what we might call in England, a triple wammy of trauma. There is the extreme traumatisation they received in the countries they come from. Many have been tortured, at risk of being killed, seeing loved ones killed or injured, been imprisoned etc. Those who become refugees somehow manage to get away, the lucky ones might get an air flight but most have horrific, gruelling and frightening journeys on foot and/or in lorries or boats, constantly in fear of being caught, at the mercy of traffickers, hungry and thirsty. Then when they arrive in this country they have to go through the asylum process which typically involves an initial hearing in which their claim is most often dismissed and then various appeals. The lucky ones gain leave to remain – often limited in length – and the unlucky ones run out of options and either return to a very uncertain future or live from hand to mouth without recourse to public funds.
At TFSW our work is often gruelling and, on the face of it unrewarding, in that our refugee clients are unlikely to go into a bright future, or often even a tolerable one. We have to be prepared to stay with them through feelings of complete despair and hopelessness as well as symptoms of post-traumatic stress disorder such as sleeplessness, nightmares and panic attacks. When working with us, often their mental health will improve for a while. The depth of their despair and sense of loss is being heard and we show that we are trying hard to understand what life is like for them. But it is only too likely that they will receive very bad news, not just from having a claim refused, but other bad news such as the death of a family member they haven’t seen for a long time. This brings home their loss, not only of this person but their family, community and culture. Although I have said how difficult our work is, it is also rewarding and moving, in that we have contact and often a deep connection with people who have faced such difficulty bravely, often heroically.
So what is the impact of covid-19 on those already suffering in this way?
Firstly it is strangely connecting.
There is something ironically connecting about a pandemic. It is like a dark version of looking at the moon – all the world looks at the same moon. We are all experiencing the same pandemic. Of course our refugee clients worry about friends and family back home that maybe don’t have the same access to health care as in the UK but there is also a sense of ‘being in the same boat’.
Then there is the isolation.
The mental health implications of isolation are in some ways similar to those of the general population. Often refugees are already isolated and, for some, covid-19 hasn’t made a lot of difference. Some refugees I know of feel that others have joined them in their isolation. They feel less strange to be on their own, knowing that others are too.
On the other hand, in Bristol and elsewhere there are many agencies that provide services to refugees. This importantly includes Drop In centres which provide a life line of contact with other refugees and with professionals that can give help and advice as well as food and activities. The contact in these places are often the nearest things refugees have to a family. Being cut off from this contact is maybe the worst effect of the virus. This is particularly so for single people, often young men. There is a group of young Afghani men in Bristol, for example, that we know are particularly at risk, and we and other agencies in Bristol are looking for ways of supporting them. One of the them recently committed suicide and we fear others will follow suit.
However, families are also suffering. While children were not at school, they had to live in very small rooms and flats for 24 hours a day, trying to keep the children happy in such restriction. Several of us have clients for whom it was almost impossible to have a phone conversation because of interruptions and noise from the children. Privacy is impossible.
Many refugees do not understand and are mistrustful of English law and law enforcement. During lockdown and as it eased, they were afraid of going out, for fear of being arrested. Being given the information that it was fine to do so, did not persuade many to leave their accommodation. The fear goes deeper than rational explanation. This has had implications for their physical as well as mental health. Now winter is coming, one of my clients who would go no further than her garden is facing cold weather so that sitting outside is no longer a pleasant option.
Then there is fear for the future
Refugees and particularly asylum seekers always fear for the future. It is always uncertain for them as they don’t know if they can settle down to a life in the UK or if they will be sent home. The pandemic has made the future look uncertain for everyone but it has added another layer of uncertainty for asylum seekers. This is particularly the case because the government is being very slow at processing asylum claims at the moment but have not stopped altogether. They are slow at the best of times but are now even slower so the uncertainty in the lives of asylum seekers can go on for years.
There are also particular responses to covid that are specific to individuals.
Each of our individual clients may have specific responses to the pandemic that others may not share. For instance there are some who are triggered into a panic attack by seeing people wearing masks. These kinds of responses are not amenable to reason – the fear goes deeper than that. If someone has come at you with a machete, for instance, while wearing a mask, simply knowing that the masks they see everywhere are a coronavirus precaution does not make it less terrifying.
For people who are already frightened, this frightening pandemic increases the fear. It is a dangerous enemy and out of sight – an enemy that is implacable, potentially deadly and might spring on you at any time. It piles on a level of fear to one that is already there and the usual supports are not as present as they were.
I say ‘not as present’ because all the agencies that support refugees have still been functioning, though mostly at arms-length. There has been little face to face contact and the drop in centres have been closed. In the easing of lockdown, some face to face work has resumed but meetings with groups have to be at social distance, not the buzzing, friendly mixing that happened before. Now we seem to be going towards a second lockdown and one that will happen in cold weather. It is hard for refugees, and workers that help them, not to despair.
So what of my own agency, Trauma Foundation South West? We have continued to see all our clients in some kind of remote way, though most can only manage the phone. Some use WhatsAp and a few use zoom. Many of our clients need an interpreter to work with us and arranging for one to be present as well in this situation is often challenging.
Sometimes clients don’t answer the phone. They are too sunk in despair to do so or have finally fallen asleep having been awake most of the night. We persist in trying to get through and leave messages of concern. We have also found innovative ways of seeing clients in person, such as in the park. This was more possible in the warm weather. Some of our therapists have started seeing individuals in person in our room in St Pauls, Bristol, where the clients are prepared to come in. Those who come by public transport are often wary of catching the virus that way. Some of our therapists are over 65 and feel they should not be seeing people in person themselves.
This is a time of stress and distress for many in the population but those who are the most vulnerable suffer the most, as usual. Refugees are certainly amongst those whose mental health are the most compromised and trying to address this is very hard.