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The border exists not only as a function of its physicality, but also of the way its discipline is internalized by migrants and asylum seekers. At the intersection of both, this chapter focuses on how asylum seekers are led to minimize the element of migrancy in their trajectories, making the reasons why they aspire to seek asylum in some countries than others invisible to international law. Contra this invisibility, it makes the case that asylum seekers, even as they flee persecution, are migrants too, drawn by certain countries rather than others on the basis of varying life projects and ongoing connections. The impossibility to normatively articulate such an ambition within the categories of international law must count as one of the considerable costs imposed by the border’s disciplining effect.
The transnational movement of peoples across the globe is one of the most bitterly contested political issues of our times, eliciting populist anger against migrants and refugees. This public outcry has muffled, however, a more dramatic process: the contemporaneous reconfiguration of territory, rights, and jurisdiction. This chapter highlights the formation of “shifting borders” that enable states to create lawless zones as well as rightless subjects. It then explores a combination of juridical and democratic possibilities for resistance and claims-making in a world of shifting borders and cosmopolitanism without illusions.
Dropout from healthcare interventions can negatively affect patients and healthcare providers through impaired trust in the healthcare system and ineffective use of resources. Research on this topic is still largely missing on refugees and asylum seekers. The current study aimed to characterize predictors for dropout in the Mental Health in Refugees and Asylum Seekers (MEHIRA) study, one of the largest multicentered controlled trials investigating the effectiveness and cost-effectiveness of a nationwide stepped and collaborative care model.
Methods
Predictors were multiply imputed and selected for descriptive modelling using backward elimination. The final variable set was entered into logistic regression.
Results
The overall dropout rate was 41,7%. Dropout was higher in participants in group therapy (p = 0.001; OR = 10.7), with larger satisfaction with social relationships (p = 0.017; OR = 1.87), with difficulties in maintaining personal relationships (p = 0.005; OR = 4.27), and with higher depressive symptoms (p = 0.029; OR = 1.05). Participants living in refugee accommodation (p = 0.040; OR = 0.45), with a change in social status (p = 0.008; OR = 0.67) and with conduct (p = 0.020; OR = 0.24) and emotional problems (p = 0.013; OR = 0.31) were significantly less likely to drop out of treatment.
Conclusion
Overall, the outcomes of this study suggest that predictors assessing social relationships, social status, and living conditions should be considered as topics of psychological treatment to increase adherence and as predictors for future research studies (including treatment type).
Chapter 6 looks at political responses to the MENA migration to Europe from 2011, the most harshly exclusionary case in my study. The migration mixed asylum seekers fleeing wars in Syria, Iraq, and Afghanistan, with labor migrants from other MENA states. The chapter tracks Europe’s progression from initially cautious receptiveness of asylum seekers to policies of exclusion of MENA migrants from the continent. It shows that the growing numbers, migrant “mix,” and terrorist attacks by (mostly non-migrant) Islamic extremists in Europe combined to undermine need-based deservingness, empower populist parties and feed xenophobic media. The chapter focuses on the EU’s turn to militarized securitization of its land and sea borders and ‘externalization of borders’ to Turkey and Libya, policies that ended the migration surge by indiscriminate physical exclusion of migrants and asylum seekers. Case studies show the varied effects of and responses to the migration in the five European cases and in Russia, which received much smaller numbers. Responses to the MENA migration brought international migration to the core of Europe’s politics, entrenched populist parties, and showed the failure of the Geneva Convention asylum system in the 21st century.
Immigration policies designed to deter people from seeking asylum are gaining traction in many Western nations, with the UK recently attempting to establish an offshore immigration processing centre in Rwanda. This letter outlines emerging evidence from Australia on the negative long-term psychological effects of offshore processing on people seeking asylum.
This epilogue reexamines select themes – return migration and transnational lives, estrangement from “home,” racism, and the inclusion of Turks in European society – applying the arguments put forth in the previous chapters to more recent developments. After the fall of the Berlin Wall in 1989 and German reunification in 1990, there was an explosion of racist violence that recalled the racism of the 1980s and reverberated throughout Germany and Turkey. The 1983 remigration law had its own echoes in a 1990 GDR law that incentivized the departure of unemployed foreign contract workers. In the new millennium, paying unwanted foreigners to leave became standard practice for dealing with asylum seekers – in Germany and a united Europe. Over time, Germans transposed the call “Turks out!” onto a new Muslim enemy: Syrian asylum seekers. For its part, Turkey’s turn to authoritarianism under Recep Tayyip Erdoğan has strained Turkey’s relations with Germany and the diaspora. These developments come with profound implications – regarding citizenship, political participation, and national identity – for the approximately 3 million Turks who live in Germany today, and for the hundreds of thousands who have returned.
In 2020, the Israeli Supreme Court held section 4 of the Law on Prevention of Infiltration and Ensuring the Departure of Infiltrators from Israel, also known as the Deposit Law, to be unconstitutional. Among other provisions, that law required 36 per cent of the wages of foreign workers to be paid into a dedicated account and returned when the person left the country. For years the Deposit Law had a negative impact on the lives of asylum seekers because of its racialised, gendered, ethnonational and religious impact. Its intersectional impact illustrates cultural, structural and systematic violence, which has been particularly punitive for asylum-seeking women, who are more exposed to sexual and gender-based violence (SGBV).
In this context, this interdisciplinary qualitative and empirical research article draws from empirical fieldwork conducted in Israel to understand the intersectional impact of the law. It therefore conducts a theoretical examination of the literature and connects that to the empirical study. Thus, the article empirically and theoretically investigates (i) the extent to which state-created categories foster unlawful multilayered and multilevel forms of vulnerability and discrimination; (ii) the intersectional impact of the Deposit Law and how it is related to SGBV; and (iii) how state-created intersecting vulnerabilities can be diagnosed. The overall goal of the article is to indicate the intertwined nature and interconnection between state-created categories and the inevitability of state-created vulnerabilities.
To access refugee protection in Australia and Canada, refugee applicants must speak. They must present their oral testimony in person, repeatedly and at length, unmediated by a legal representative or advocate, and in many cases without the benefit of documents, witnesses or other forms of evidence to verify their claims. This book is about the oral evidence that refugees are compelled to give, the stories they are required to narrate, and the genres of storytelling they are required to master during administrative oral hearings for the assessment of refugee status in Australia and Canada. This introductory chapter establishes the book’s central concerns, namely: what the presentation, interrogation and assessment of testimony during the oral hearing tell us about the refugee subject whom Refugee Convention-signatory states judge as authentic, credible and, ultimately, acceptable. It then carefully connects the demand for narrative within RSD with the intractable problems of credibility assessment. Finally, it interrogates the role of law, lawyers and interpreters in shaping the refugee testimony and analysis presented throughout the book.
This Element explains how cross-border mobility defines diplomatic relationships between Southeast Asian states and social and political dynamics within the region's key destination countries. It begins by providing an historically situated discussion of bordering processes within the region, examining evolving historical conceptions of power and sovereignty, and processes of bordering in colonial and post-colonial times. It then turns to the political, environmental, and economic drivers of contemporary cross-border mobility before examining governments' efforts to manage different kinds of border-crossers and the tensions that these efforts give rise to. Having discussed the politics of cross-border mobility in host communities, the Element returns to the question of why consideration of bordering practices and cross-border mobility is necessary in understanding contemporary Southeast Asia.
The German Democratic Republic (GDR) treated the Berlin Wall as an official state border, but the Federal Republic of Germany (FRG) did not recognize it as an official state border and thus did not impose entry controls. This asymmetric recognition opened up a gap in the regime of border policing and turned divided Berlin into one of the most significant sources of unauthorized migration into the FRG, creating tensions in Berlin, West Germany, and western Europe more broadly. Countries including France, Denmark, and the Netherlands all pressured the FRG to shut the open border in Berlin. This article examines how West German authorities sought to respond to their demands without recognizing the Berlin Wall as a state border. West German authorities pursued two broad strategies. The first involved internalizing the border through institutionalized racial profiling in West Berlin. The second entailed externalizing the border by asking the GDR to enforce FRG visa and passport requirements. Although both forms of border policing have often been associated with the end of the Cold War, this article shows that they were adopted earlier, and in response to Cold War imperatives.
This chapter foregrounds the subjective experience of asylum seekers like Hassan Ali Djan, who arrived in Munich from Afghanistan via Iran, Turkey, and Greece in 2005. It also presents accessibly the complex history of asylum legislation and practice across time. It points out the continuities amidst the changes: the number of refugees varies, the major countries of origin vary (at one point Bosnia, at another Syria), the escape routes vary (at one point the eastern, at another the middle Mediterranean route), the popularity of destinations changes (at one point Britain, at another Germany). What remains the same is that the causes that rarely allow for a neat separation of “political persecution” from economic, religious, ethnic, and other factors; refugees, who are rarely the oldest, the weakest, and the sick, but rather are young and dynamic; the reliance of refugees on word of mouth and local networks; the role of the traffickers and others who are inextricably part of the economy of refugee migration logistics; rescue, relief, gratitude; and countless traumas and tragedies.
Refugees and asylum seekers present with high levels of post-traumatic stress disorder (PTSD), whilst little research has been conducted to assess the effectiveness or acceptability of psychological interventions for this group. Imagery rescripting is effective in reducing distressing intrusive memories within a range of conditions. The current study evaluates this approach for the treatment of PTSD in refugees and asylum seekers within a UK NHS service.
Aims:
To evaluate the clinical outcomes of using imagery rescripting for the treatment of PTSD in UK-based refugees and asylum seekers.
Method:
Ten adult service-users from an NHS specialist service with a primary diagnosis of PTSD were recruited as part of routine service delivery. A multiple baseline design was used with participants randomly allocated to a baseline varying from 5 to 9 weeks. A baseline wait-period was followed by up to five sessions of psychoeducation and treatment preparation, in turn followed by up to 10 sessions of imagery rescripting. The Post-traumatic Symptom Scale (PSS) and Physical Health Questionnaire-9 (PHQ-9) were collected every week during baseline, at end of treatment and weekly for 5 weeks after treatment, and again at 12-week follow-up. Data were analysed with mixed regression.
Results:
Results indicate a significant improvement both in PTSD symptoms and mood, and that this was attributable to the imagery rescripting phase of the intervention, and not the passage of time or non-specific therapy factors.
Conclusions:
Evidence indicates imagery rescripting to be a safe and effective treatment choice for PTSD in refugees and asylum seekers.
This chapter examines the ways in which people with mental health conditions who also belong to other excluded groups may be particularly disadvantaged, in general and by mental health services. People with mental health conditions are at risk of social exclusion, but many from certain social identity groups are particularly at risk: for example, women, people from black and minority ethnic groups, and those from sexual minorities. In addition, certain groups of people are defined by their exclusion from society, such as refugees and asylum seekers, prisoners, and the homeless. The occurrence of mental health conditions in these groups is much higher than in the general population and they will often face barriers to accessing essential material resources and adequate healthcare. The presence of mental health conditions and group characteristics intersect to exacerbate the degree of exclusion experienced by the people in these groups. Some combinations may result in particularly profound states of deprivation and destitution. These severe and multiple forms of exclusion have been named ‘deep social exclusion’ or ‘people with multiple and complex needs’, two examples of which are seen in ‘multiple exclusion homelessness’ and people with multiple diagnoses.
Among asylum seekers in a high-risk unstable post-displacement context, we aimed to investigate the prevalence of and risk for suicidal ideation (study 1), and then to test whether and how Mindfulness-Based Trauma Recovery for Refugees (MBTR-R) may prevent or treat suicidal ideation (study 2).
Methods
Study 1 was conducted among a community sample of N = 355 (31.8% female) East African asylum seekers in a high-risk urban post-displacement setting in the Middle East (Israel). Study 2 was a secondary analysis of a randomised waitlist-control trial of MBTR-R among 158 asylum-seekers (46.2% female) from the same community and post-displacement setting.
Results
Prevalence of suicidal ideation was elevated (31%). Post-migration living difficulties, as well as posttraumatic stress, depression, anxiety and their multi-morbidity were strongly associated with suicidal ideation severity. Likewise, depression and multi-morbidity prospectively predicted the onset of suicidal ideation. Relative to its incidence among waitlist-control (23.1%), MBTR-R prevented the onset of suicidal ideation at post-intervention assessment (15.6%) and 5-week follow-up (9.8%). Preventive effects of MBTR-R on suicidal ideation were mediated by reduced posttraumatic stress, depression, anxiety and their multi-morbidity. MBTR-R did not therapeutically reduce current suicidal ideation present at the beginning of the intervention.
Conclusions
Findings warn of a public health crisis of suicidality among forcibly displaced people in high-risk post-displacement settings. Although preliminary, novel randomised waitlist-control evidence for preventive effects of MBTR-R for suicidal ideation is promising. Together, findings indicate the need for scientific, applied and policy attention to mental health post-displacement in order to prevent suicide among forcibly displaced people.
This commentary conveys appreciation for a recent review of the rates of complex post-traumatic stress disorder (CPTSD) among refugees, describes the relevance of CPTSD to the refugee experience and discusses implications for assessment and treatment, the effective development of which requires collaboration among researchers, clinicians and individuals with lived experience.
We deploy a novel and radical approach to vulnerability theory to investigate Scotland's response to asylum seekers’ vulnerability during the COVID-19 pandemic and test Scotland's self-affirmation as a hospitable country. Our ethical vulnerability analysis enhances Fineman's vulnerability analysis by denationalising the vulnerable subject and locating her within our ‘uneven globalised world’. We further enrich this fuller version of vulnerability analysis with insights from Levinas's and Derrida's radical vulnerability theory and ethics of hospitality. We demonstrate how our ethical vulnerability analysis enables us to subvert the hostile premise of migration laws and policies, and thus fundamentally redefine relationships between guests and hosts so that the host is compelled to respond to the Other's vulnerability. We argue that this hospitable impulse yields a generous and absolute commitment to progressive social welfare provision for asylum seekers, which brings Scotland closer to fulfilling its aspirations to be a hospitable host by welcoming the Other.
Chapter 11 takes us to the edges of the Pacific archipelago for a closer look at the camps for Japanese Surrendered Personnel and the War Crimes Trials Compounds in the Australian-administered island territories of New Guinea. The chapter traces their changing accommodation in underground tunnels, timber barracks and Quonset huts. The War Criminals Prison at Manus Island precedes the later location there of the infamous offshore detention center, one of many such facilities later created for incarcerating unauthorized asylum seeker arrivals to Australia. The chapter makes the case for a genealogical approach to physical sites of incarceration as important for understanding the continuous historical entanglements of sovereignty and spatial forms of violence.
Cognitive behavior therapy is the treatment of choice for a wide range of mental health difficulties in the United Kingdom, Europe, North America, Australia, and New Zealand, but research evidence suggests that access to this therapy and clinical outcomes for patients is worse for patients from Black and minority ethnic (BAME) backgrounds compared with patients from white majority communities in most of these countries. This chapter looks at the changes that services and therapists can make to adapt the way that they work to ensure that access and outcomes for minority communities improve. Some of these changes are modest, such as ensuring that therapists acknowledge ethnic and cultural differences; however, some might need more extensive adaptation such as developing family system maps that take into account the beliefs, practices, and migration histories of different family members or understanding how spiritual beliefs can be incorporated into treatment plans. This chapter provides a practical and accessible framework for adaptation and suggests further reading to support the development of therapist skills in trans-cultural assessment and treatment of mental health problems when working with patients from BAME communities.
Rohingya refugees, a group of religious and ethnic minorities, primarily reside in the South Asian nations. With decades of displacement, forced migration, limited freedom of movement, violence and oppression, they have been termed by the United Nations (UN) as the ‘most persecuted minority group’ in world history. Literature shows an increased prevalence of psychiatric disorders such as depression, anxiety, post-traumatic stress, insomnia, etc., in this population. However, beyond ‘medicalisation’, the psychosocial challenges of the Rohingyas need to be understood through the lens of ‘social suffering’, which results from a complex interplay of multiple social, political, environmental and geographical factors. Lack of essential living amenities, poverty, unemployment, overcrowding, compromised social identity, and persistent traumatic stressors lead to inequality, restricted healthcare access, human rights deprivation and social injustice in this group. Even though the United Nations High Commission for Refugees (UNHCR) has taken a renewed interest in Rohingya re-establishment with well-researched standards of care, there are several pragmatic challenges in their implementation and inclusion in policies. This paper reviews these multi-dimensional psychosocial challenges of the Rohingyas by synthesising various intersecting conceptual models including minority stress, health-stigma-discrimination framework, refugee ecological model and capability approach. Furthermore, it highlights multidisciplinary interventions to mitigate these adversities, improve their living situation and eventually foster healing via means which are culturally relevant and contextually appropriate. These interventions need to involve various stakeholders from a human rights and dignity based lens, including the voices of the Rohingyas and supported by more research in this area.
Asylum-seekers experience high levels of traumatic events pre-, post- and during migration. Poly-traumatisation is associated with complex post-traumatic stress disorder (CPTSD), which has not yet been extensively explored in this population. CPTSD is a prevalent and highly disabling disorder in the present population requiring culturally sensitive diagnostic and treatment approaches. In this service evaluation, we evidence the high prevalence of CPTSD in an asylum-seeking sample and its association with greater distress compared with PTSD. We outline the treatment needs of asylum seekers with CPTSD.