STUDENT NAME:
TIBANYENDERA DEOGRATIAS
REG No
MRM011CHP136
Course:
MASTERS
IN CHILD PSYCHOLOGY
Paper :
DISSERTATION
DISSERTATION TOPIC:
MENTAL HEALTH OF
CHILDREN IN REFUGEE CAMPS: A CASE OF NAMIBIA: OSIRE REFUGEE CAMP.
A DISSERTATION SUBMITTED TO THE INSTITUTE OF
HOLISTIC MENTAL HEALTH (INDIA) IN PARTIAL FULFILLMENT OF THE REQUIREMENTS FOR
THE AWARD OF THE DEGREE OF MASTER OF
CHILD PSYCHOLOGY
Guide:
Dr.
B. Imtiyaaz
JANUARY 2013
DECLARATION
I Tibanyendera Deogratias,
declare that, the material in this report has never been submitted to any
university or institution of higher learning for any academic qualifications.
This report is a result of my own independent research effort and
investigations. Where it is indebted to the work of others, the acknowledgment
has been made.
Signature… ………………………………….. Date: 31st JANUARY 203.
Tibanyendera
Deogratias
APPROVAL
This research report
has been submitted for examination with my approval as the candidate’s course guide.
Signature:……………………… Date:………………………
DEDICATION
I dedicate this dissertation to the refugee
children worldwide whose mental health status is at risk due to their refugee
status and situation in their home country or country of residence.
I further dedicate the report to world leaders
that promote peace and conflict resolution and individuals that contribute
resources to care and plight of refugees.
ACKNOWLEDGMENTS
I firstly thank GOD for having enabled me to
live up to this moment and reach such heights in my education. It has been a
breathtaking journey through out my school years. Without the support and
blessing of GOD I would have bound to drop out of this journey.
I acknowledge the tireless support of my course
Guide Dr B. Imtiyaaz who provided moral and academic support during the course
journey and the Institute of Holistic Mental Health that availed this course
that is important in addressing children psychological problems.
I acknowledge the support of the local leaders
and children in Osire refugee camp who were
involved in this study and research.
TABLE
OF CONTENTS
Page
LIST OF TABLES
Page
LIST OF FIGURES
Page
Acronyms
UN – United Nations
UNHCR – United nations High Commissioner for Refugees
WFU- United Nations World Food Program
OAU –
Organisation of African Union
ABSTRACT
Before being subjected to refugee life, the atrocities
and the conditions that force one to flee one’s own country are so traumatizing
that the effects may be lifelong. In the case of children, the impact may
affect their developmental and cognitive abilities that may culminate into
chronic mental health illness. The experiences of being forced to participate
in the killing or as child soldiers, tortures and violence, witnessing
killings, sexual exploitation, denial of basic needs and separation from
parent’s , all have an impact on a child’s mental health status.
The Purpose of
the study is to examine the Mental
Health of Children in Refugee Camps. Basing on the following objectives; to
find out the causes of mental health problems among children in refugee camps,
to find out the mental health problems among children in refugee camps, and to find out better solutions to
curb the dangers of mental health problems among children in refugee camps
The study
design was cross sectional and both qualitative and quantitative data were
employed to gain an in-depth understanding on the Mental Health of Children in Refugee Camps. Stratified sampling was used to determine the sample size. Data was both primary and
secondary, primary data was collected by questionnaires, observation checklist,
and interview guide and secondary data was got from reports, journals,
internet, and magazines. Frequency
tables and graphs were drawn using Statistical Packages for Social Scientist
(SPSS). In these frequency tables, and graphs analysis was done with a
corresponding percentage. Qualitative
data collected by the interview guide was analyzed by the use of content
analysis. Here findings were compared with responses got by the questionnaire
and analysis made thereon.
Findings revealed that Children in refugee children
are often affected by the sexual violence experiences encountered through the
refugee journey from the home country to the host country, loss of their loved
ones, forced into child soldiering,
displaced, poor nutrition, loss of parents, do not have identified or formal guardians, loss of their
cultures, and most of the Children in refugee camps use drugs. Besides that,
most children in the refugee camp are unable to grip objects that in the past
were easy to grasp securely, feel hopeless, suddenly lost interest in eating,
have difficulty falling asleep and staying asleep once they do, often talk,
react, and walk slower, are less active and playful than usual, and fidget a
lot. Nevertheless, Health professionals
need to strive for cultural competence when working with refugee
populations, and traditional healers, in conjunction
with western trained health care providers can bridge the gap between cultures
and make the transition from cultures smoother. For better results,
psychologists and in particular child psychologist need to be employed by
refugee agencies, so as to diagnose and offer psychotherapy to affected
children.
CHAPTER ONE
INTRODUCTION
1.0 Background of the Study
In January
1999, it was estimated that there were some 50 million refugees and displaced
persons worldwide. Of the 50 million refugees only 23 million are protected and
assisted by the Office of the United Nations High Commissioner for Refugees.
The current lack of international consensus over legal definitions deprives the
remainder 27 million people of the same support. The overwhelming majority of
refugees are from and in low-income countries; women and children represent
more than 50 per cent of the total refugee population. Heavier toll is imposed
on the most vulnerable: the children including the unaccompanied minors, the
orphans, the child soldiers, those detained, the children heads of household;
the women and girls survivors of torture and sexual violence and the widows;
the disabled, the mentally ill and retarded; also the elderly who are alone
(Reedy, 2010).
There is a
growing global awareness of the impact of war on the mental health of refugees.
International commitment to help is increasing. Certain areas of work need to
be further improved. Greater international cooperation and information exchange
will remedy the chaos of crisis situations. Given the impact of war on large
populations, care on individual basis is not realistic. Community-based
psychosocial rehabilitation has to be privileged and integrated in the primary
health care services to create sustainable responses. At the earliest possible,
people with chronic mental disorders and severe trauma should be detected and
treated. Non-mental health personnel, given appropriate technical support, have
been efficient in responding to the psychosocial distress of refugees. It is also
known that long term mental health responses to crisis can lead to the
reconstruction of relevant, effective and sustainable mental health services
(Prunier, 2009).
Most theories,
instruments and projects in refugee mental health care have been developed in
Western countries and are often implemented without the necessary adaptations.
The humanitarian impulse of many well-intended people is not always associated
with the needed evaluations. Therefore, approaches successful in one region do
not always correspond to the needs of other regions, their context and culture.
Highly specialised clinical models and techniques address the needs of very
few, while the many rarely receive adequate support. Moreover, such models are
not sustainable. They increase the dependency of populations concerned as well
as of services of host countries upon external support and hamper local
capacity building. Responses need to become holistic and multisectoral (Stein,
2009).
In the great
lakes region, where most refuges in Namibia hail from, conflicts involve
civilian populations. Massive human rights violations have been reported from
that region and in conflict zones ranging from forced rape, children soldiers,
and tribal cleansing impose serious risks on millions of people. The cognitive,
emotional and socio-economic burden imposed on individuals, the family and the community
is enormous. It is established that an average of more than 50 per cent of children
in Osire refugee camp present
mental health problems ranging from chronic mental disorders to trauma,
distress and great deal of suffering (Onyut, 2009).
Some 50% of
children in Osire refugee camp constitute
a group presenting chronic mental disorders (prior to the war) and of seriously
traumatised, who would require specialised mental health care had it been
available. Another 50% of the children in Osire refugee camp suffer from psychosocial dysfunctioning
affecting their own lives and their community. The remainder majority are faced
with distress and suffering. It is important to remember that refugees’
reactions are normal reactions to abnormal situations (Colombo, 2010).
The fact that the
entire refugee populations become mentally disturbed and are in need of
psychiatric care need to be avoided. Psychiatric morbidity and psychosocial
dysfunctioning depends on the nature and time span of the conflict, on the
level and the rapidity with which resilience will emerge, based on
socio-cultural factors, and other environmental parameters. The rapidity of
mental health support is critical (Hering, 2011).
1.1 Problem Statement
More than 50 per cent of children in Osire refugee camp present mental
health problems ranging from chronic mental disorders to trauma, distress and
great deal of suffering. These children have faced numerous stressors and are
at increased risk for developing mental health problems including traumatic
stress and a variety of emotional, behavioural, and educational difficulties.
The diverse contexts in which refugee children may come into contact with mental
health clinicians include school, child and adolescent mental health services,
child protection services, and hospitals.
The government of Namibia , UNHCR and partners have tried
to provide the necessary resources, restoring their dignity, giving them hope
and confidence in themselves and in the international community to work towards
a better future are the unavoidable preconditions for their well-being as well
as for reconciliation, development and peace but has not done much. Therefore,
there is need to examine the Mental
Health of Children in Refugee Camps and interventions aimed at reducing on the
psychological impact.
1.2 Purpose of the Study
The Purpose of
the study was to examine the Mental
Health of Children in Refugee Camps.
1.3 Objectives of the Study
1. To find out the causes of mental health problems among children in
refugee camps
2. To find out
the mental health problems among children in refugee camps
3. To find out better solutions to cub the dangers of mental health problems
among children in refugee camps
1.4 Research Questions
1. What are the causes of mental health problems among children
in refugee camps?
2. What are
the mental health problems among children in refugee camps?
3. What are the better solutions to cub the dangers of mental health
problems among children in refugee camps?
1.5 Scope of the Study
1.5.0 Refugees
and asylum seekers
Refugees and Asylum Seekers
An asylum seeker is someone who is seeking
international protection but whose claim has not yet been evaluated by the
country in which they have sought asylum (United Nations High Commissioner for
Refugees (UNHCR), (2009). The Article 1 of the United Nations 1951 Convention relating
to the Status of Refugees is the foundation of international refugee protection
(UNHCR, 2009) and has been ratified by Namibian Government. To be awarded
refugee status, asylum seekers must prove that they meet the definition of a
refugee specified in the convention; that is, “owing to a well-founded fear of being
persecuted for reasons of race, religion, nationality, membership of a
particular social group, or political opinion is outside the country of his
nationality, and is unable to or, owing to such fear, is unwilling to avail
himself of the protection of that country” (UNHCR 2009)
The 1969 organisation of African Unity (OAU)
convention on refugees further elaborates on who is a refugee in the African
context. A refugee” shall apply to a person who owing to a well founded fear of
being persecuted for reasons of race, religion, nationality, membership of a
particular social group or membership of a political opinion, is outside the
country if his nationality , and is unable to or, owing to such fear , is un
willing to avail him or herself to the protection of that country , or who, do
not have a nationality and being outside the country of his or her former
habitual residence as a result of such events , is unable or , owing to such
fear , is unwilling to return to it. And owing to external aggression, occupation,
and foreign domination, events seriously disturbing public order to either part
or whole of his or her country of origin or nationality, is compelled to leave
his or her place of habitual residence in order to seek refuge in another place
outside his country of origin or nationality.
1.5.1 Geographical scope
The study was conducted in Osire refugee camp. Osire refugee camp is located in
central Namibia, situated 200 km
north of the capital Windhoek on the main road
C30 from Gobabis to Otjiwarongo in Otjozozundjupa
region.
1.5.2 Subject Scope
The study
involved the
-
Causes of mental health problems among children in
refugee camps, looking at various levels or phases refugees go through and how
that journey contributes to the causes of mental health problems among refugee
children. This part hence examines the experiences they go through prior to
being forced out of their country, the asylum seeking journey to the second
country, and the experiences they go through when they are confined in a
refugee camp as they await a solution to their refugee claim, this is two way
in that, they either get resettled which also posses other problems or get
repatriated to their country of origin in case war and peace prevails.
-
Mental health problems among children in refugee camps. This section analyses the possible effects
of the torture, leaving own country, loss of the loved ones, the long journey
as they seek asylum and what they experience during the travelling especially
on the children and their caregivers.
The possible mental health problems discussed are either explained by
the refugees themselves, hence the mental health problems discussed are the
feelings though not confirmed through a proper psychological diagnosis.
-
Better solutions to curb the dangers of mental health
problems among children in refugee camps. These are the possible remedies aimed
at curbing the mental health problems experienced by refugee children; these
might be at family level, institutional or community level and or professional
level.
1.5.3 Time scope
The study
covered a time scope of five years from 2008 to 2012
1.6 Significance of the Study
a) The study
may help NGOs and other care givers in identifying the causes of Mental Health of Children in Refugee Camps
and find better solutions.
b) The study may act as a reference point for future researchers and
academics interested in the subject.
c) The study
is to help the researcher in understanding mental health of children in refugee camps in Namibia.
CHAPTER TWO
LITERATURE REVIEW
2.0 Introduction
This chapter
involves related literature on the causes of mental health problems among
children in refugee camps, the dangers of mental health problems among children
in refugee camps, and solutions
to curb the dangers of mental health problems among children in refugee camps.
2.1 Causes of mental health problems among children in refugee camps
Refugees often
experience traumatic events and adverse situations such as sexual violence,
genocide, torture, political persecution, the loss of loved ones, and forced
child soldiering, which frequently prompt them to escape from their country of
origin (Jong, 2000).
During migration, families and individuals are
usually forced to flee their homes , and they often move in any direction where
they often encounter dangers posed by
geography for example crossing deserts, mountains, rivers, encountering wild
animals, further conflict, and a lack of basic resources (Geltman et al.,
2005).
This phase may
also involve lengthy stays in refugee camps or urban centres in countries of
first asylum, where discrimination and lenghy bureaucratic procedures before
one attains status of refugee normally takes three months. They also face
inadequate access to food, water, security, and education are common place
(Grabska, 2006; Crowley, 2009). Those who flee by sea face the perils of
dehydration, starvation, extreme weather, and may witness the deaths of fellow
passengers (Hekmat, 2010). During all this movement, Children may sustain physical
injuries as a result of conflict or flight. Malnutrition in infancy and early
childhood can lead to permanent intellectual disability, and disrupted
education has significant implications for success in their future education
More to
that, children in great lakes region
have witnessed killing or slaying of their family members, witnessed rape of
their sisters and mothers at the hand of the militants . Many children also
experience persecution of family members, disappearances, deaths, and
deprivation (Berman, 2001). The deprivation is in form of basic needs and
rights- the right to a home, education, water, proper sanitation and right to
life.
In addition to
traumatic stress, refugee children experience acculturative stress as well as stresses
associated with migration and displacement. However, few of these children
receive services for a number of reasons such as stigma associated with seeking
mental health care and lack of understanding of the country’s mental health
system. Furthermore, because of complexities involved in addressing issues of trauma,
culture, and ongoing stress within a developmental context, and existing models
of the etiology are often insufficient to meet the needs of these children
(Rasmussen, 2010).
Crowley (2009) noted that the
impact of war on children has concerned psychiatric researchers for decades.
Pioneers in the field noted comparatively greater impact of war related separations
between children and parents, than of exposure to wartime atrocities. More
recently, researchers have focused on the number and types of atrocities.
Child soldiers represent a special
category of refugees because they both witness and participate in war violence.
By their own accounts, front line combat puts child soldiers at risk for rape, torture,
war injuries, substance abuse, depression, anxiety, and suicidal ideation (Crowley, 2009).
In addition to tangible losses such as home,
possessions, friends, and family members, child soldiers may lose trust in
authority figures who are unable to provide for their basic needs, or who
themselves are perpetrating atrocities. Child soldiers can lose their moral
perspective, as they come to believe that looting is not the same as stealing,
or that killing for political reasons may, in fact, be justified (Prunier, 2009).
Among child soldiers who were forced to
participate in Mozambique’s rebel military organization, length of time in the organization
was associated with difficulty refraining from learned, morally wrong
behaviors. Unanswered questions about child
soldiers include long-term outcomes, demobilization efforts, reintegration, and
appropriate psychosocial care (Crowley, 2007).
Onyut (2006) noted that some
have cautioned that interventions focused solely on trauma and victimization
overlook the complexities of child soldiers’ experiences. For example, some
youth combatants described a sense of belonging and a support system within
armed groups that served as surrogate family, particularly for children
separated from biological families due to war conditions. Challenges to
reintegration include histories of violence and perpetration, community ambivalence
and issues around acceptance, disrupted education, and psychiatric symptoms such
as
Many of the world’s young refugees do not
have identified guardians, and may have travelled for quite some time with
little or no adult supervision. If both parents have died, children are also
classified as orphans. Children identified as refugees may become separated
from caregivers by accident or by the necessity of unsafe circumstances at home.
Political violence or natural disasters can render entire villages suddenly
devoid of adults (Lamberg, 2008).
Children’s ability to self regulate depends
in large part upon the emotional state of their caretakers; those refugee youth
without caretakers may be at even greater risk for psychiatric symptoms following
traumatic stress (Bryce, 2003).
Resettlement means loss of homeland,
family, friends, and material possessions, and the challenges of a new language
and culture upon arrival. Refugees often have conflicting loyalties to new versus
old worlds. Loss of friends and family, including parents and other caregivers,
may initially be offset by hopes for a safer and perhaps more prosperous life
in the destination country (Bryce, 2003).
During resettlement, refugee children must navigate a
new society and culture, adjusting to school systems and peer groups in a
foreign language (Bates et al., 2005). Though it is a dream for most refugees
to be resettled in developed countries, very few put into consideration the
different cultural and education adjustments that await them. The adults may
not have a problems adjusting, but children often face a burden of changing environment,
language and norms. This itself may delay child growth, though at the same time
it should be remembered that children easily adopt to such changes.
Salama (2002) asserted that the
challenge of helping the child cope with loss is particularly difficult for
refugee families in resettlement because of the extreme nature of the move from
one culture to another, often in the context of war and other political conflict.
For refugee families it is much harder to comfort the child with familiar
objects and reassurances from loved ones left behind. Loss of family members
and neighbours is accompanied by few opportunities to stay in touch with them across
geographic and political boundaries.
It is also difficult for a family to re-establish
routines and a sense of “normalcy” in a new community that may also be
comforting to a child. Further, refugee parents have little time to devote to
such tasks in resettlement as they struggle to survive economically. Thus, if
and when children begin to show signs of distress they may be misunderstood or
overlooked (Spiegel, 2002).
From a mental health perspective,
“cultural bereavement” connotes refugees’ responses to losing touch with
attributes of their homelands. Elements of cultural bereavement include survivor
guilt, anger, and ambivalence (Spiegel, 2002).
A major issue
in treating the refugee population is the subject of torture. Many refugees come from parts of the world where torture
is still prevalent. This population suffers from significant problems besides
those that effect other refugees. Torture survivors suffer from high levels of
depression and anxiety with "existential" aspects that are not a part
of the traditional schemata; these may be reflective of a more subtle and
specific aspect of psychopathology or may be part of a more pervasive problem
of "complex PTSD." Psychotic
symptoms and suicide attempts are relatively frequent; these constitute severe problems which led to
psychiatric assessment and treatment. Domestic violence, aggression, alcohol problems, and psychological disorders
among the children of survivors are also frequent concomitants
of formal psychiatric disorders in torture victims. These symptoms have been
found to be consistent across cultural
and gender lines. Another significant aspect of the symptomatology of torture
victims is that the effects are more pronounced in those who become refugees than in those who stay in
their own country (Spiegel, 2002).
2.2 Mental health problems among children in refugee camps
Assuming that
the Post-traumatic stress disorder diagnosis is appropriate, findings relating
to its prevalence are described here. Regardless of the country of origin or
resettlement, research has shown an elevated prevalence of Post-traumatic
stress disorder among refugee children. Hering (2009) conducted a systematic
review identifying five surveys of 260 refugee children. They determined an
overall prevalence rate for Post-traumatic stress disorder of 11% (99% CI
7–17%), which is almost double the rate found in non-refugee adolescents (Colombo,
2010).
In addition to
having elevated prevalence, Post-traumatic stress disorder is also enduring.
Longitudinal studies in Sweden and America have documented persistently high
rates of Post-traumatic stress disorder up to 12 years following resettlement.
An American and an Australian study have documented dramatic declines in PTSD
diagnoses following resettlement; however, they both have significant
methodological limitations (Hering, 2009).
Several
studies show that refugee children can maintain academic and social adjustment
despite experiencing psychopathology. The discrepancy between symptoms and
function is evidence of the resilience of refugee children and that clinicians
should not ignore either refugee children’s resilience or their distress (Prunier,
2009).
The signs of a
functional impairment typically include manifestations of some sort of decrease
in ability that is noticeable to others. For example, a functional impairment
that affects the hands may be the inability to make a fist or to grip objects
that in the past were easy to grasp securely. As it relates to emotional
issues, the development of depression, phobias, and anxiety disorders are all
conditions that may be classed as impairments, along with a diagnosis of dementia
or some other type of mental illness (Stein, 2009).
One of the
defining characteristics of functional impairment is that the reduction in
physical or mental capacity is sufficient to interfere with managing day-to-day
tasks. For example, if an individual experiences a severe nervous illness that
in turn leads to the development of agoraphobia, that individual’s ability to
work outside the home or participate in activities such as eating out or
attending a social event may be significantly diminished. When this occurs, the
functional impairment of the individual is considered somewhat high (Onyut,
2009).
Depression and
anxiety have received less attention than Post-traumatic stress disorder in the
literature. As with Post-traumatic stress disorder, rates of depression and
anxiety vary across studies. This is likely to be due, in part, to differences
in samples and differences in time in the country of resettlement (Petevi, 2006).
A study
conducted in 2010, noted that depression rates decreased more dramatically than
Post-traumatic stress disorder over time, but by 14 years post-settlement were
still relatively high. The prevalence of anxiety disorders over time is not
clear, but it appears to be of less concern than depression or Post-traumatic
stress disorder. In fact, in some studies, the prevalence of anxiety disorders
is no greater in refugee samples than host-nation samples (Reedy, 2010).
The warning
signs of depression in children fall basically into four different categories:
emotional signs, cognitive signs (those involving thinking), physical
complaints, and behavioural changes. Not every child who is depressed
experiences every symptom (Reedy, 2010).
Typical moods
or emotions experienced by children suffering from depression include: The
child may feel despondent and hopeless. They may cry easily. Some children will
hide their tears by becoming withdrawn. A child who has always enjoyed playing
sports, for example, may suddenly decide to not try out for the team. They may
complain of feeling "bored" or reject an offer to participate in an
activity, which they have always enjoyed in the past. The child may become
anxious, tense, and panicky. The source of their anxiety may well give you a
clue to what is causing their depression. The child may feel worried and
irritable. They may brood or lash out in anger as a result of the distress they
are feeling (Spiegel, 2002).
Depression is
not just an illness of the mind. It causes changes in physically as well. Many
people with depression find that their appetite either decreases or increases.
Children who usually have a healthy appetite may suddenly lose interest in
eating. Children may also respond in the opposite way, but eating too much to
self-medicate their feelings. Children with depression may have difficulty
falling asleep and staying asleep once they do. They may wake too early or
oversleep. They may have trouble staying awake during the day at school.
Children with depression often talk, react, and walk slower. They may be less
active and playful than usual. Depressed children may show signs of agitation
by fidgeting or not being able to sit still (Spiegel, 2002).
Wolfson (2007)
found anxiety to be highest among 20 Somali refugees when compared to refugees
from either the former Yugoslavia or Vietnam. Elevated anxiety was found to be
particularly present in Somali males. However, these differences failed
to reach statistical significance in this small sample.
Other commonly
reported problems displayed by child refugees include symptoms possibly
associated with sub threshold depression or PTSD (somatic complaints,
irritability, withdrawal, sadness, suicidal ideation, self harm, as well as
problems with peers, attention, sleeping, and eating (Wolfson, 2007). The
prevalence of grief reactions and psychosis may also be higher in child
refugees than the general population. Behavioural problems that have been
reported in studies with child refugees include conduct disorder, aggression,
hyperactivity, and enuresis regression (Spiegel, 2002).
Because of the
cumulative stressors that they have experienced, refugee children are also at a
high risk of developing emotional and behavioural problems. Children may arrive
at refugee camps alone, often having witnessed the death of a parent or loved one,
and having experienced or observed violence and torture. Refugee children are
particularly vulnerable to developing mental health problems when they are in
the process of moving to refugee camps since they are frequently separated from
their parents or guardians, or their parents may be too overwhelmed or
otherwise unable to attend to their emotional needs (Onyut, 2009).
An elevated
prevalence of learning difficulties and intellectual disability among child
refugees has also been reported. While some of these reflect genetic anomalies,
many aspects of the refugee experience increase the incidence of childhood
neurological damage: exposure to infection and illness (Onyut, 2009).
Malnourished
children have lifetime disabilities including impaired capacity for learning.
In young children, the effects of malnutrition impair mental and cognitive
developments, thus reducing their interaction both with their surrounding
environment and with their caregivers. Micronutrients are important for the
physical and the cognitive development of children. Iron deficiency can delay
psychomotor development and impair cognitive development in infancy and early
childhood. Folate deficiency in expectant mothers can cause birth defects in
infants, such as spina bifida; and vitamin D deficiency can lead to poor bone
formation, including rickets (Jong, 2000).
Intellectual
disability, once called mental retardation, is characterized by below-average
intelligence or mental ability and a lack of skills necessary for day-to-day living.
People with intellectual disabilities can and do learn new skills, but they
learn them more slowly. There are varying degrees of intellectual disability,
from mild to profound (Lamberg, 2008).
Crowley (2009)
noted that intellectual disabilities can have a variety of causes,
including hereditary disorders such as phenylketonuria, early alterations in
the embryo's development (Down's syndrome), and exposure to toxic substances (alcohol)
or infections while the child is in the mother's uterus. Problems in labour and
birth that put stress on the baby, or problems after birth like injuries to the
brain, can result in an intellectual disability and/or loss of specific
functions, such as memory or language abilities. In most cases the cause
of intellectual disabilities is not known, having no specific
identifiable source.
Children with
severe and profound degrees of intellectual disabilities constitute a
small percentage of intellectually disabled children. These
youngsters lack self-care skills. They communicate poorly and often have behavioural
problems including repetitive or self-stimulating behaviour. Home care is
frequently difficult or impossible for parents, and these children are often
placed in residential settings and receive special education. Nevertheless,
with new trends and philosophies, many experts feel that these children,
especially as teenagers or adults, are best served in smaller, more normal
environments such as group homes within the community (Crowley, 2007).
Many families face devastating separations
especially where some family members stay
behind to protect their property or some remain because of attachment to property,
some separations also come when some family members are resettled to another
country and some do not quality due to the measures involved. While some also suffer impaired parenting and
attachment relationships as a result of parents’ distress and subsequent
emotional unavailability (Frye & D’Avanzo,1994; Howard & Hodes, 2000).
In addition, several processes may lead to intergenerational conflict.
Parents’ attempts to preserve culture
and parental behaviour affected by
trauma may cause their children to view
them as punitive and controlling (Merali, 2004; Peltonen & Punamaki, 2010). Also, children’s faster
acculturation can lead to incompatible values and preferences (Merali, 2004) and can disrupt family
roles because children need to take on
responsibilities that are usually filled by their parents (Howard &
Hodes,2000).
2.3 Better solutions to cub the dangers of mental health problems among children in refugee camps
The range of psychological reactions and comorbid
diagnoses in refugee clients should be carefully considered when choosing interventions. As with other
client groups, treatment goals should be
negotiated with the client and should
target symptoms that are causing the
most distress and functional impairment (Nickerson, Bryant, Silove,
& Steel, 2011). Psychological interventions
can target disorders and risk modifiers such as social competence,
affect regulation, problem-solving and
coping skills, future orientation, positive relationships
With a supportive adult, parent’s mental health, and
family cohesion (Berman, 2001; Lustig et al., 2004; Ehntholt & Yule, 2006;
de Anstiss et al., 2009).
When doctors
or other health professionals work with refugee populations, it is necessary to
strive for cultural competence. Refugees most often come from
war-torn situations combined with prolonged time in refugee camps. Some of the
educated among them may speak some English and may have knowledge of Western
culture. However, some refugees from rural areas may speak only a local dialect
and have very little if any knowledge of the Western world. Health care
providers seeing refugees for their domestic screening are often the refugee's
first experience with Western style medical care. Physicians, nurses and other
health care providers would do well to learn about the cultural background of
their refugee patients and ensure that a professional bi-lingual/bi-cultural
medical interpreter is present for their encounters. Interpreters should not be
a relative or friend of the refugee (Bryce, 2003).
When seeing a
patient, it is important to understand that it is not just the patient's
culture that is at play, but one's own culture, as well as the culture of
medicine. All three of these cultures interact in ways we need to be sensitive
to and aware of, as they influence the outcome of the encounter. To understand
patients who are culturally different from ourselves, it is first necessary to
recognize our own cultural beliefs, values, and behaviors as well as how our
life experiences influence the way we think about health care, and how it
shapes the way we make clinical decisions (Petevi, 2006).
During assessment, it may become clear that a
child’s lack of fluency in English,
limited education, or cognitive impairments
will impact on the choice of therapeutic
intervention. For example, Kinzie et al. (2006) suggest that these
factors be taken into consideration before
applying cognitive techniques. Murray et al. (2008) suggest that
expressive therapies (e.g., Narrative Exposure
Therapy, music, or art therapies) may be more appropriate with clients
who are not literate in English.
Health
education has a special role: to explain what is new and different. Refugees in
their new environment might have access to services such as a free clinic for
the first time, or they might have available services which they have never
needed previously, such as an agency that can trace their missing relatives.
They might need to learn how to use these services. Also, refugees may no
longer have certain resources, such as familiar foods. In many cases, the basic
ration will consist of internationally-donated commodities, including
food-stuffs that are alien to the refugee population (Bryce, 2003).
A culturally relevant, developmental, theoretical
foundation is essential to understanding the experience of refugee youth in the
context of flight and resettlement. With respect to cultural issues, a large
body of literature has emerged on culturally and linguistically appropriate services
for ethnically diverse clientele (Salama, 2002).
Although much more research needs to be
done, coping strategies employed by children exposed to war, political
violence, and armed conflicts have been preliminarily investigated by a number
of researchers. For example, Berk (1998) observed the following features among
Bosnian war-exposed children: esprit de corps, ability to appeal to adults for caretaking,
ability to discern danger and avoid precarious situations, ability to manage
anxiety and calm oneself, devotion to a cause (for example, caring for wounded
victims of war), family stability, sense of humour, and making meaning of their
turbulent situation (Spiegel, 2002).
Studies have
shown that much of the depression and anxiety of refugees can be alleviated if
they can keep family ties somewhat intact and can develop social networks with
others from their culture. Other studies, however, have shown that while family
can be a valuable source of emotional support, immigrant families can also be
too overwhelmed by their own immigration demands to provide support or can
generate additional stress for their members (Connolly, 2004).
Mental health
providers should elicit their refugee client's immigration history: length of
time in the country, circumstances of
flight and first asylum, and who and what was lost. This information is
critical for understanding client's adjustment and problems, such as
identifying post- traumatic stress disorder (PTSD). It is important to assess
for specific symptoms of PTSD and whether they are being confused with other symptoms, such as
grieving, losses of family, country,
and lifestyle, depression associated with downward social status and inability
to find work (Connolly, 2004).
Traditional psychiatric approaches such as individual insight or
supportive psychotherapy with psychoactive medications have had a limited
success; however support groups for such refugees composed of others from their background and
experience appear to be helpful (Hering, 2009).
The role of culture cannot be emphasized enough. Culture may not only be
the glue that holds a group together, it can also be their chief stressor in
trying to adapt to new surroundings without losing their own identity or sense
of self worth (Wolfson, 2007).
It is incumbent
on health care agencies that will be treating a refugee population to employ
members of the refugee community and
to look to them for guidance in their approach to the community. The use of traditional healers
from the refugee's home culture can assist the refugee in getting access to
health care in a culturally acceptable and meaningful way. Traditional healers,
in conjunction with western trained
health care providers can bridge the gap between cultures and make the
transition from cultures smoother (Wolfson, 2007).
In conjunction with the refugee community it is advisable to develop a
cultural competence check list. This
will assist in maintaining an approach to the community that is culturally sensitive while
allowing for the community's health care
needs to be met (Salama, 2002). It is also necessary to learn to work with and
through interpreters. This will require adequate training of interpreter staff.
Fluency in the languages of the host country
and refugee group is not enough. The interpreter must be knowledgeable of the
nuances of both languages and cultures. S/he must also be knowledgeable of the common medical terms and psychiatric terms
that will be used and how best to accurately translate them. The health care
worker must, on the other hand, not treat the interpreter as a mere
"mouthpiece", but as a respected colleague
who is to be consulted with (Salama,
2002).
A relatively
new concept is that of the cultural consultant in medicine and psychiatry. In a
sense the cultural consultant serves
as a bridge between the medical model and the refugee's world view. Ideally,
the cultural consultant should have
experience and training in health care and should be bicultural and bilingual.
Awareness of one's own identity, behaviour, and biases is also important. These
characteristics can be enhanced by training, for example, workshops in
clarification of values or cross-cultural communication
and working with and systematic observation of a good role model. Ultimately
the cultural consultant's chief task
is to answer the question: "Is this behaviour normal?" This question
lies at the heart of cross-cultural psychiatry, which must determine normality
in its cultural context (Bryce, 2003).
In reducing PTSD in children from refugee backgrounds,
the common thread between these various approaches is the incorporation of exposure techniques.
Gradual exposure to traumatic memories
is effective in alleviating intrusive thoughts and behavioural avoidance
among those with PTSD, but should only
be done once trust and safety have been established (Yule, 2002; Ehntholt &
Yule, 2006).
Due to problems or bureaucratic procedures with
accessing services like shelter materials, school may be an important
environment for intervention delivery. On arrival children should be grouped
according to their language or placed in special learning centres which may provide a unique opportunity for the delivery of psychosocial services at
a crucial time. However, individual interventions may be more appropriate for children who are more
vulnerable, highly symptomatic, have cognitive impairments, or demonstrate continuing problems following group
interventions (Yule, 2002; Barenbaum, Ruchkin, & Schwab-Stone, 2004; Kinzie
et al., 2006).
School-based programmes are more effective in reducing
prejudice if they adopt an explicit anti-racism curriculum (encouraging children to recognise and
confront racism in themselves and
others), as opposed to those that focus
on multicultural awareness by teaching children about the culture and lifestyle of minority groups
(Turner & Brown, 2008). Despite the increased use of anti-racist programmes, they are rarely evaluated. For example, four-session school-based
programme incorporating both anti-racist
and multicultural approaches had a short-term positive impact on British
students’ attitudes towards refugees (Turner & Brown, 2008).
Considering the strain that the refugee experience
places on families, equipping families
with education on addressing adjustment, resiliency and stressing the value of
family cohesiveness may curb the effects. Weine et al. (2008, 2003) have
evaluated multiple-family support and education groups with refugee families.
These groups are based on a family strength and resiliency approaches and
emphasise the role of family processes in facilitating adjustment (Weine et
al., 2008).
CHAPTER THREE
CHAPTER THREE
METHODOLOGY
3.0 Introduction
This section
presents the methods employed in data collection and analysis. It describes the
research design, study population, sampling method, sample size, data
collection tools, and data processing and analysis.
3.1 Research Design
The study
design was cross sectional and both qualitative and quantitative data were
employed to gain an in-depth understanding on the Mental Health of Children in Refugee Camps.
3.2 Area of the Study
The research was conducted in Osire refugee camp. Osire refugee camp
was established in 1992 and is located in central Namibia,
situated 200 km north of the capital Windhoek
on the main road C30 from Gobabis
to Otjiwarongo.
Between 1999 and 2003, Osire refugee camp
received 23,000 refugees but who have returned after application of the cessation
clause that saw almost all Angolan repatriate back to their country. The camp
however continued to receive refugees from the great lakes region (Democratic
Republic of Congo –DRC, Rwanda and Burundi) and other countries due to the
unfavourable political and humanitarian situations in their respective
countries. By 2011 the total refugee population in Osire stood at 6,936 of
which approximately 62% are from Angola, 29% from the democratic republic of
the Congo and 4 % from Burundi. Other nationalities include, Zimbabwe, Congo Brazzaville,
Ethiopia, and Somalia (UNHCR/WFP 2011 ).
3.3 Study Population
The population
comprised of refugee leaders and children in Osire refugee camp in central Namibia.
3.4 Sampling Method
Stratified sampling was used to determine the sample size. Respondents were grouped in Strata and Purposive sampling was used in each strata to get information from children in refugee camps and local leaders. In addition simple random sampling was used to limit on the biasness of purposive sampling.
3.5 Sources of Data
Data was both
primary and secondary, primary data was collected by questionnaires,
observation checklist, and interview guide and secondary data was got from
reports, journals, internet, and magazines.
3.6 Data Collection Methods
3.6.1 Questionnaire
Self-administered questionnaires were designed using closed ended
questions, and they were distributed to, local leaders who filled them within
15 days of research period.
3.6.2 Interviews
Interview guide was carried out in order to gain an
in-depth understanding on the Mental
Health of Children in Refugee Camps
located in central Namibia. These were conducted with children
in the camp. This interview guide helped to confirm responses collected by the
questionnaire. However key informant interview guide was conducted with the
parents of children in the camps to reduce on the biasness of the interview
guide.
3.6.3 Documentary Review
Documentary review started before and continued through
field data collection, analysis and report writing. Information on the Mental Health of Children in Refugee Camps was reviewed. Documentary review
was used to collect silent information that was not given out by respondents
3.6.4 Observation Checklist
The researcher used observation as
additional technique of data collection. Observation is an important technique
in that the researcher was able to gather silent but important data that was
otherwise not obtained through the other techniques. This also supplemented and
validated data from other techniques used.
The technique is very useful especially during interviews in which the
researcher was able to observe the facial expressions of the respondents and
other key issues that were not correctly stated by the respondents and yet the
evidence on the ground indicated otherwise.
3.7 Procedure for data collection
The researcher
began his study by getting an introductory letter and properly identified
himself to the respondents, he informed the respondents about the topic and the
objectives of the study, the type of questions to be asked and the possible
consequences that the research had on the respondents, especially the
importance of its findings to the community. He left the questionnaires with respondents and
answered them within five days of research period which were collected back for
analysis. All information and their identity were treated with utmost
confidentiality, information was only used for the purpose of the research and
it was not made available to other people for any reason or purpose.
3.8 Validity
Here a researcher
asked colleagues in the field to vouch for the items measuring what he intends
to measure. However, the researcher found
a group of people to test that have the exact opposite behaviors he is
interested in measuring the validity. A formula for Lawshe was used to measure
the validity of research, as indicated below:
CVR = (n - N/2)/ (N/2)
CVR= content validity ratio, n
= number of respondents indicating "essential", N= total number
of respondents. For essential validity content validity ratio was 0.86
3.9 Reliability
Inter-rater
reliability was employed. Here research assistants were used to do content
analysis for the researcher. To calculate this kind of reliability, the
researcher reported the percentage of agreement on the same subject between his
raters and that of the assistants.
However, half of the test, instrument, or survey, was used to analyze the half
as if it were the whole thing. Then comparisons of these results were taken
with the overall analysis.
Cronbach method was used to measure the validity of
research using alpha option in a
numerical coefficient of reliability. Computation of alpha was based on the
reliability of a test relative to other tests with same number of items, and
measuring the same construct of interest.
Alpha coefficient ranges in value from 0 to 1 was used to describe the
reliability of factors extracted from the study (that is, questions with two
possible answers) and/or multi-point formatted questionnaires or scales (that
is, rating scale: 1 = strongly agree, 5 = strongly disagree). The higher the
score, the more reliable the generated scale.
0.5 was used for acceptability of reliability coefficient, and the alpha
coefficient was 0.83
3.10 Data Processing, Analysis and Presentation
Quantitative
data collected by the questionnaire was first coded. In the coding process, a
coding sheet was constructed. A number was then assigned to each answer in the
questionnaire with a corresponding number on the coding sheet. Then the same
questionnaire was constructed on the computer using Statistical Packages for
Social Scientist (SPSS). Frequency tables and graphs were drawn using
Statistical Packages for Social Scientist (SPSS). In these frequency tables,
and graphs analysis was done with a corresponding percentage.
Qualitative data collected by the interview guide was analyzed by the use of content analysis. Here findings were compared with responses got by the questionnaire and analysis made thereon.
3.11 Limitations and Solutions
- Respondents were not willing to give confidential information, which was sufficient to the researcher. However, they convinced them that research is intended to help them improve on their problems.
·
There was too much pressure as a result of limited
time for the researcher. However, most
of the time was devoted on the research.
·
Financial constraints since research requires money
for printing and transport. However, the costs were minimized as lowest as
possible.
·
Language barriers especially among some Congolese
families that only spoke local dialects . However,interviewers tried their best
to make them understand the question as well as get the most accurate answer.
· Some respondents failed to interpret some of the questions in the questionnaire. However, interview assistants helped respondents to interpret for them some questions
· It was time consuming because every question had to be interpreted in several languages so as to get the respondent understand and to get the most accurate responses.
CHAPTER FOUR
PRESENTATION, INTERPRETATION AND DISCUSSION OF FINDINGS
4.0 Introduction
This chapter
involves presentation, interpretation and discussion of findings in relation to
the study objectives and results are evidenced below
4.1 Personal data of Respondents
Findings on the personal data of respondents were
captured and results are evidenced in below
Source: Primary
Data
From the figure
above, 67.5% of the respondents were male and 32.5% were female. This implies
that there was less or no gender bias in the study.
Source: Primary
Data
From the table
above, 10% of the respondents were below 25years of age, 17.5% were between 25
to 35years, 52.5% were between 36 to 45years, and 20% were above 45years. This
implies that respondents were mature enough to understand the questions as well
as provide the most accurate responses depending on their experiences recalled.
Source: Primary
Data
From the table
above, 2.5% of the respondents had spent below 5years in the refugee camp, 10%
between 5 to 10years, 25% between 11 to 16years, and 62.5% above 16years. This
shows that respondents had experience with the study.
4.2 The causes of mental health problems among children in refugee camps
Findings on the causes of mental health problems among children in refugee
camps were captured and results are evidenced below
Source: Primary
Data
From the table
above, 47.5% of the respondents strongly agreed that most refugee children have ever experienced
sexual violence, 40% agreed, 2.5% were not sure, 5% disagreed, and 5% strongly
disagreed. This implies that Children in refugee camps often experience sexual
violence. This relates with the findings of Jong (2000) who noted that Refugees during the refugee journey often
experience traumatic events and adverse situations such as sexual violence.
Therefore children most girls who experience sexual violence develop a trauma
and start fearing men psychologically and some end up not getting married.
One girl
interviewed said that “while there were
fleeing, they were caught by militants who subjected the family to sexual
violence in front of their brothers and other family members. A sister who was resisting was pieced with a
machete in her abdomen and she was left to die.”
One girl
interviewed said that “ they resort to
sex for favours since they live in poverty. Girls have sex just to get money to
buy a small perfume or deodorant or petroleum jelly. Some girls are enticed to accept
gifts in return for sexual to even older men”. This shows that girls are susceptible to
contracting sexually transmitted infections since their bargaining power is
compromised with.
One boy from
the camp interviewed said that “sometimes
girls entice them to sleep with them when they see that they have some money.
They attract them so as to have sex and be able to provide their necessities.
And that most girls do not mind getting pregnant”
Source: Primary
Data
From the table above, 20% of the respondents
strongly agreed that Children in refugee camps often experience genocide,
10% agreed, 52.5% disagreed, and 17.5% strongly disagreed. This implies that
Children in refugee camps do not often experience genocide. This disagrees with
the findings of Jong (2000) who noted that Refugees often experience traumatic
events and adverse situations such as genocide. Normally refugees in camps are
protected from outside attacks and this ensures maximum security from external
forces but normally the problem is within themselves in the camps where those
who are mentally damaged violent the rest in the camps. Rasmussen (2010)
further noted that because of complexities involved in addressing issues of
trauma, culture, and ongoing stress within a developmental context, and
existing models of the etiology are often insufficient to meet the needs of
these children, genocide from DRC where the Nyamulenge and other tribes in south kivu are always in
constant conflict and in ethnic cleansing.
Source: Primary
Data
From the table
above, 52.5% of the respondents strongly agreed that Children in
refugee camps often loss their loved ones, 40% agreed, 2.5% were not sure, 2.5%
disagreed, and 2.5% strongly disagreed. This implies that Children in refugee
camps often lose their loved ones. This agrees with the findings of Crowley
(2009) who noted that the impact of war on children
has concerned psychiatric researchers for decades. Pioneers in the field noted
comparatively greater impact of war related separations between children and
parents, than of exposure to wartime atrocities.
One girl from
the refugee camp when interviewed said that “I lost all my parents during the war and am here with people who do not
care about me” . she wished she could
return and look for the other relatives who she claims she does not know if
they are alive of not. But information from the other people who came later and
were knew the parents, she was told that no one in that village survived or
remained there. Which implies that, her relatives may have escaped to another
country or were victims of the merciless rebel militants.
One boy
interviewed said that “I lost my brother
who was abducted and I cannot know whether he died or he is still alive”
One boy
interviewed said that “I lost my mother
who I loved most she was taken by some unidentified men and they left me in the
bush alone, until when a soldier found me and took me to the camp.”
One girl said
that “her parents were brutally murdered
one early morning when the rebels broke their house and shot the parents and
the elder brother , she was left alone in the pool of blood and was rescued by
other fleeing neighbours who took her along the journey to Namibia”
Source: Primary
Data
From the table above, 65% of the respondents
strongly agreed that Children in refugee camps are often forced into child
soldiering, 22.5% agreed, 2.5% were not sure, 7.5% disagreed, and 2.5% strongly
disagreed. This implies that Children in refugee camps are often forced into
child soldiering. This relates with the findings of Crowley (2009) who noted that child soldiers represent a special category
of refugees because they both witness and participate in war violence. By their
own accounts, front line combat puts child soldiers at risk for rape, torture,
war injuries, substance abuse, depression, anxiety, and suicidal ideation
One boy
interviewed said that “when a boy grows
up and is very strong, they disappear unknowingly you just wake up and you don’t see them. That is why we feared to walk at night apart from the boys who are
still young”
One girl
interviewed said that “in DRC, When boys make crimes they are kept in a
certain place then after taken to the army to be soldiers”
A girl intimated that “her two elder brothers were
taken from home and forced to join the rebels by force. By the time they were
abducted, they were around 15 and 16 years of age and she does not know whether
they are still alive or were killed by government forces”
Source: Primary
Data
From the table above, 55% of the respondents
strongly agreed that Children in refugee camps are often displaced, 27.5%
agreed, 5% were not sure, 10% disagreed, and 2.5% strongly disagreed. This
implies that Children in refugee camps are often displaced. This is in line
with the findings of Rasmussen (2010) who noted that refugee children
experience acculturative stress as well as stresses associated with migration
and displacement. However, few of these children receive services for a number
of reasons such as stigma associated with seeking mental health care.
One girl
interviewed said that “I came to the camp
when I was too young so I do not know where I came from, which means I cannot
go back when given a chance”
One boy in the
refugee camp when interviewed said that “ I
know my home is not safe there are lots of killings so I rather stay here than
going to a place where they can easily kill me”
One boy
interviewed said that “here in the camp
there are no gun shots and I can get free food and play with my friends so I
fear to be killed by a gun when I go back home”
One boy said
that “ he was at home alone when the
parents had gone to the market to sell food and all of a sudden bullets started
flying from every direction. He decided to ran away with other people and he
has never her about her parents”
Source: Primary
Data
From the table above, 40% of the respondents strongly
agreed that Children in refugee camps often get poor nutrition,
47.5% agreed, 2.5% were not sure, 5% disagreed, and 5% strongly disagreed. This
indicates that Children in refugee camps often get poor nutrition. This agrees
with the findings of Prunier (2009) who
noted that In addition to tangible losses such as
home, possessions, friends, and family members, child soldiers may lose trust
in authority figures who are unable to provide for their basic needs, or who
themselves are perpetrating atrocities. Therefore people who feed poorly
develop some diseases like ulcers, which over disturb them and are affected
psychologically.
According to
the nutrition survey carried out in Osire refugee camp in 2011 by UNHCR and
World Food Program, it was discovered that 4.5% of children aged 6-59 months
had acute malnutrition(UNHCR/WFP. 2011). This is a serious health hazard in
that it will affect their physical growth as well as psychological maturity.
The UNHCR/WFP
report further asserts that 8.5% of the 590 people were severely food insecure.
These people were found to have poor and
borderline food consumption, with poor food access. The moderately food insecure
were 88.4% representing 6,131 people. These are people with average poor food
access, and can only survive with food provided by World Food Program with no other supplements.
One girl
interviewed said that “I eat maize meal,
soya, beans, and am now fade of I want to
change to rice and meat”
One mother
said that “her child has stomach ulcers hence she cannot eat the hard meals
provided by WFP like maize meal and soya, the family is forced to sell off some
food items so that they can buy rice for her. This however affects other people
food sustainability to the next food distribution”.
One boy
interviewed said that “we eat food so
late in the evening and we even do not get satisfied, sometimes we could miss
food or porridge and starve”
On girl
interviewed said that “we eat once in a
day and eat the same food without changing and there is nothing to do”
Source: Primary
Data
From the table above, 57.5% of the respondents
strongly agreed that most of the Children in refugee camps lost their
parents, 30% agreed, 5% were not sure, 5% disagreed, and 2.5% strongly
disagreed. This implies that most of the Children in refugee camps lost their
parents. This relates with the findings of Bryce (2003)
who noted that Loss of friends and family, including parents and other caregivers,
may initially be offset by hopes for a safer and perhaps more prosperous life
in the destination country.
One girl
interviewed said that “I live with my
mother I the camp but I lost my father”
One boy
interviewed said that “I don’t know where
my parents are, I just see myself here and I do not know where to find them”
One boy
interviewed said that “ one girl interviewed said that “I live with all my parents because I was born here in the camp, and
our home is also here”
One girl said that “her father who was a village chief was
targeted by rebels and killed in front of the family as they had dinner while
still in Congo”
Source: Primary
Data
From the table above, 50% of the respondents
strongly agreed that most of the Children in refugee camps do not have identified guardians, 32.5% agreed, 2.5% were not sure,
7.5% disagreed, and 7.5% strongly disagreed. This shows that most of the
Children in refugee camps do not have identified
guardians. This is in line with the findings of Lamberg (2008) who noted that many of the world’s young refugees do not
have identified guardians, and may have travelled for quite some time with
little or no adult supervision. If both parents have died, children are also
classified as orphans. Children identified as refugees may become separated
from caregivers by accident or by the necessity of unsafe circumstances at home.
Due to the informal camp in Namibia, the children cannot go through the formal
government fostering procedures. They are placed in families that are willing
to cater for them without considering their backgrounds and their attitude and
treatment of children. Most of the
children may call the present caretakers Mama or papa but in reality they are
uncles.
One
girl interviewed said that “I do not have
any relative guiding me, but I have friends and pastors who guide me”
One
boy interviewed said that “I have my
uncle guiding me because is the one who brought me here”.
One
girl from the refugee camp interviewed said that “she stays with the family that was their neighbour in Congo though they
have no blood relations. But she says they were family friends hence they treat
her as their own daughter.”
Source: Primary
Data
From the table
above, 55% of the respondents strongly agreed that Most of the
Children in refugee camps lost their cultures, 32.5% agreed, 5% were not sure,
2.5% disagreed, and 5% strongly disagreed. This implies that most of the
Children in refugee camps lost their cultures. This relates with the findings
of Salama (2002) who asserted that the challenge of
helping the child cope with loss is particularly difficult for refugee families
in resettlement because of the extreme nature of the move from one culture to
another, often in the context of war and other political conflict.
For example in Namibia there are over 12
nationalities and they are all asked to adhere to the culture and norm of their
host country Namibia also while respecting the UN codes of conduct as refugees
under the care on UNHCR. Like marriage practices where in Congo they allowed to
marry when they girls are 16 years, but the law in Namibia says the girl has to
be 18 and above years. The food culture and other practices are not known by
the children since they were born eating the food provided by World Food Program. Hence their cultural practices are
prohibited as long as they are in a foreign country and as long as they under
the UN care.
Source: Primary
Data
From the table above, 60% of the respondents
strongly agreed that most of the Children in refugee camps use drugs, 27.5%
agreed, 2.5% were not sure, 5% disagreed, and 5% strongly disagreed. This
implies that Most of the Children in refugee camps use drugs. This relates with
the findings of Spiegel (2002) who noted that Psychotic symptoms and suicide
attempts are relatively frequent; these constitute
severe problems which led to psychiatric assessment and treatment. Domestic
violence, aggression, alcohol
problems, and psychological disorders among the children of survivors are also frequent
concomitants
of formal psychiatric disorders in torture victims.
One boy
interviewed said that “I see so many boys
smoking caflorinha (a plant when chewed makes one tipsy and intoxicated), and
marijuana because they are idle, and
like drinking alcohol even during day time”
One parent
responded that “most people and
especially the adolescents use drugs to forget the conditions they stay in.
Some have been here for over 10 years and have lost hope of a better life hence
they resort to drugs taking, some cannot attend higher education hence they are
idle and redundant”
4.3 Mental health problems among children in refugee camps
Findings on the
mental health problems among children in refugee camps were captured and
results are evidenced below
Table 12: Most children
in the refugee camp are unable to grip objects that in the past were easy to
grasp securely
Source: Primary
Data
From the table above, 47.5% of the respondents
strongly agreed that most children in the refugee camp are unable to grip
objects that in the past were easy to grasp securely, 40% agreed, 2.5% were not
sure, 5% disagreed, and 5% strongly disagreed. This shows that most children in
the refugee camp are unable to grip objects that in the past were easy to grasp
securely. This is in line with the findings of Stein (2009)
who noted that the signs of a functional impairment typically include
manifestations of some sort of decrease in ability that is noticeable to
others. For example, a functional impairment that affects the hands may be the
inability to make a fist or to grip objects that in the past were easy to grasp
securely.
A respondents
interviewed said that “when children in
camp are given glasses, are broken within few days because they are careless
and have many thoughts. That is why we prefer plastic utensils in the camp”
One respondent
said that “most children are absent
minded that why they cannot grasp to objects , their minds are still
traumatised by the events they witnessed while in Congo”
Source: Primary
Data
From the table above, 60% of the respondents
strongly agreed that most children in the refugee camp feel hopeless, 27.5%
agreed, 5% were not sure, 2.5% disagreed, and 5% strongly disagreed. This
implies that most children in the refugee camp feel hopeless. This agrees with
the findings of Spiegel (2002) who noted that typical moods or emotions
experienced by children suffering from depression include: The child may feel
despondent and hopeless. They may cry easily. Some children will hide their
tears by becoming withdrawn. A child who has always enjoyed playing sports, for
example, may suddenly decide to not try out for the team this year. They may complain
of feeling "bored" or reject an offer to participate in an activity,
which they've always enjoyed in the past.
One boy
interviewed said that “every day there are people fighting amongst each
in the camp because they feel hopeless and get annoyed very fast”
One girls
responded that “she feels her future is
determined by what she sees around the camp and nothing better. She was
dreaming of a better family but she is aging and she will only settle for a man
that has nothing but a small room no business and no money , but that is our
destination”
Source: Primary
Data
From the table above, 40% of the respondents
strongly agreed that most children in the refugee camp suddenly lost
interest in eating, 47.5% agreed, 2.5% were not sure, 5% disagreed, and 5%
strongly disagreed. This implies that most children in the refugee camp
suddenly lost interest in eating. This is in line with the findings of Onyut
(2009) who noted that if an individual experiences a severe nervous illness
that in turn leads to the development of agoraphobia, that individual’s ability
to work outside the home or participate in activities such as eating out or
attending a social event may be significantly diminished.
One boy
interviewed said that “I see most new
children brought in the camp starving, they do not have appetite to eat
food because they are not used to the
food in the camp and others are scared of the situation in the camp”
One parents
said that: “they came in the camp 8 years
ago and they receive the same kinds of food no change, the children sometimes
refuse to eat because they eat maize meal for breakfast, lunch and supper the
whole year. They now eat to survive but not because they like the food”
Table 15: Most children
in the refugee camp have difficulty falling asleep and staying asleep once they
do
Source: Primary
Data
From the table above, 40% of the respondents
strongly agreed that most children in the refugee camp have difficulty
falling asleep and staying asleep once they do, 40% agreed, 5% were not sure,
7.5% disagreed, and 7.5% strongly disagreed. This implies that most children in
the refugee camp have difficulty falling asleep and staying asleep once they do.
This is in line with the findings of Spiegel (2002) who noted that children
with depression may have difficulty falling asleep and staying asleep once they
do. They may wake too early or oversleep. They may have trouble staying awake
during the day at school. Most children
in Namibia have witnessed traumatising events like slaying of their parents or
seeing dead bodies along the road or other forms of torture that they may take
long to heal their memories
One parent
said that her child “who is now 9 years
fears to sleep when there is no light and when he wakes up and there is no
light he starts to shout for help. The son keeps within the family house
circles because of fear of being attacked. He used to fear going to school
because he thought the militants may abduct them while there since it happened
to him while in Congo.”
Source: Primary
Data
From the table above, 60% of the respondents
strongly agreed that most children in the refugee camp often talk, react,
and walk slower, 27.5% agreed, 2.5% were not sure, 5% disagreed, and 5%
strongly disagreed. This implies that most children in the refugee camp often
talk, react, and walk slower. This is in line with the findings of Spiegel
(2002) who noted that Children with depression often talk, react, and walk
slower. They may be less active and playful than usual. Depressed children may
show signs of agitation by fidgeting or not being able to sit still.
One boy said
that “there are a lot of conflicts and
fights at school, simple misunderstanding results in a fight especially between
the boys. They normally accuse each other of witchcraft and backbiting”
One boy also
said that “football matches rarely end
without a fight, especially when one team is losing or when there is a bad tackle.”
Source: Primary Data
From the table above, 47.5% of the respondents
strongly agreed that most children in the refugee camp are less active and
playful than usual, 32.5% of the respondents agreed, 2.5% were not sure, 10%
disagreed, and 7.5% strongly disagreed. This implies that most children in the
refugee camp are less active and playful than usual. This relates with the
findings of Prunier (2009) who noted that refugee children
can maintain academic and social adjustment despite experiencing
psychopathology. The discrepancy between symptoms and function is evidence of
the resilience of refugee children and that clinicians should not ignore either
refugee children’s resilience or their distress.
One girls said
that “she does not like to join the girl’s
netball team because they talk a lot and they have a lot of conflicts there”
One boy said
that “he does not like to join the sports
activities because what will be the end result, we play but we do not get a
competition and there are no rewards at the end of the day so he decided to
just stay and do his personal things”
Source: Primary
Data
From the table above, 50% of the respondents
strongly agreed that most children in the refugee camp fidget a lot, 27.5%
agreed, 12.5% were not sure, 5% disagreed, and 5% strongly disagreed. This
implies that most children in the refugee camp fidget a lot. This agrees with the findings of Onyut (2009)
who noted that Refugee children are particularly vulnerable to developing
mental health problems when they are in the process of moving to refugee camps
since they are frequently separated from their parents or guardians, or their
parents may be too overwhelmed or otherwise unable to attend to their emotional
needs.
4.4 Better solutions to cub the dangers of mental health problems among children in refugee camps
Findings
on Better solutions to cub the dangers of mental health problems among children
in refugee camps were captured and results are evidenced below
Table 19: Health
professionals need to strive for cultural
competence when working
with refugee populations
Source: Primary
Data
From the table above, 57.5% of the respondents strongly agreed that Health
professionals need to strive for cultural competence when working with refugee
populations, 30% agreed, 2.5% were not sure, 5% disagreed, and 5% strongly
disagreed. This indicates that Health professionals need to strive for cultural competence when working with refugee
populations. This is in line with the findings of Bryce (2003) who noted that
Refugees most often come from war-torn situations combined with prolonged time
in refugee camps. Some of the educated among them may speak some English and
may have knowledge of Western culture. However, some refugees from rural areas
may speak only a local dialect
and have very little if any knowledge of the Western world.
On respondents
interviewed said that “There are still
children who are not capacitated yet to have self esteem to talk about issues
which concern them, to ensure the community and the world provide both moral
and material support and help to solve their problems which they are facing. I
would love to see agencies/organizations which deal with children protection
ensures that seminars and campaigns are conducted in order that children are
capacitated to be able to express their problems and to be heard”.
Table 20: Traditional
healers, in conjunction with western
trained health care providers can bridge the gap between cultures and make the
transition from cultures smoother
Source: Primary
Data
From the table above, 45% of the respondents strongly
agreed that Traditional healers, in conjunction
with western trained health care providers can bridge the gap between cultures
and make the transition from cultures smoother, 32.5% agreed, 12.5% were not
sure, 5% disagreed, and 5% strongly disagreed. This implies that traditional
healers, in conjunction with western
trained health care providers can bridge the gap between cultures and make the
transition from cultures smoother. This is in line with the findings of Petevi
(2006) who said that there is need to understand patients who are culturally
different from ourselves, it is first necessary to recognize our own cultural
beliefs, values, and behaviors as well as how our life experiences influence
the way we think about health care, and how it shapes the way we make clinical
decisions.
One respondent
interviewed said that “There are still
children living in extreme hardships such as lack of food, clothing, and
beddings. Children lack food because their parents/caretakers sell the food
provided by WFP on their own satisfaction and not for the benefit of the entire
family. In this situation, I call upon organizations which are providing
humanitarian services to refugees to take this issue of food as a serious
problem to the health development of a child and to the entire life of the
child”.
Source: Primary
Data
From the table above, 57.5% of the respondents
strongly agreed that there is need to develop a cultural competence check list, 30% agreed, 7.5%
disagreed, and 5% strongly disagreed. This implies that there is need to
develop a cultural competence check
list. This disagrees with the findings of
Wolfson (2007) who noted that Culture may not only be the glue that
holds a group together, it can also be their chief stressor in trying to adapt
to new surroundings without losing their own identity or sense of self worth.
One respondent
said that “we are always blamed when we
get into conflict with other peoples cultures, but we are from different
backgrounds and how are we supposed to know that this culture behaves like this
, we should be sensitised on how different cultures behave so that there is
less cultural conflicts”
Source: Primary
Data
From the table above, 57.5% of the respondents
strongly agreed that more spiritual education need to be emphasized in
camps, 32.5% agreed, 5% disagreed, and 5% strongly disagreed. This implies that more spiritual education
needs to be emphasized in camps. This is in line with the findings of Connolly
(2004) who noted that family can be a valuable source of emotional support,
immigrant families can also be too overwhelmed by their own immigration demands
to provide support or can generate additional stress for their members.
One respondent interviewed said that “In
refugee camp there are still children who are denied their right to
education. This situation impels children to randomly roam in camp, as a result
most of them end up with resorting to involve into substance abuse, theft and
the like. I would love to see children’s right to education is honoured and
that children are going to school in both, refugee camps and in communities
outside the camps and in the world in general. Follow ups are made through our
children and youth club and the radio programme (children for children) and the
child voice out initiative to find out as to why some children are not
schooling”.
Source: Primary
Data
From the table above, 57.5% of the respondents
strongly agreed that Different game Sports need to be introduced in camps
to reduce on idleness and crimes, 30% agreed, 2.5% were not sure, 5% disagreed,
and 5% strongly disagreed. This implies that Different game Sports need to be
introduced in camps to reduce on idleness and crimes. This is in line with the
findings of Bryce (2003) who noted that the cultural consultant should have experience and
training in health care and should be bicultural and bilingual. Awareness of
one's own identity, behaviour, and biases is also important. These
characteristics can be enhanced by training, for example, workshops in
clarification of values or cross-cultural communication
and working with and systematic observation of a good role model. This can be
done through sports.
One boy said
that “ we only have football, volleyball
and athletics , but not all of us like them, and we are many to the one
playground so other sports like, table tennis, badminton, tennis need to also
be introduced to cover a wider area of the refugee population and that is when
many people will also participate.”
One girl said that “idleness is killing them and it is the reason why many girls get
pregnant before they are adults. Girls only have netball game and they are many,
other activities need to be started to make girls active “
Table 24: Children in
refugee camps need to be trained in vocational work so that they can easily be
employed
Source: Primary
Data
From the table above, 47.5% of the respondents
strongly agreed that Children in refugee camps need to be trained in
vocational work so that they can easily be employed, 32.5% agreed, 5% were not
sure, 7.5% disagreed, and 7.5% strongly disagreed. This implies that Children
in refugee camps need to be trained in vocational work so that they can easily
be employed. Salama (2002) who noted
that it is necessary to learn to work with and through interpreters which would
require adequate training of interpreter staff, fluency in the languages of the
host country and refugee group is not
enough. The interpreter must be knowledgeable of the nuances of both languages
and cultures.
One respondent
interviewed said that “I am still
maintaining that there are still some children who are involved in various
worst forms of labour such as to look after goats, shop keeping, working in
video show rooms as video keepers in exchange with money. Here I suggest that
agencies and the community in general to ensure they save children from such
worst forms of child. On my part, in collaboration with other agencies which
deals with advocacy of children’s protection, I will ensure that the community
is aware of their responsibilities towards children’s rights and their entire
life”.
One boy who
completed grade 12 but did not have marks to be sponsored said “I got marks not enough to take me to
university and get sponsored but I could as well do other technical courses
like carpentry, shoe making, construction and building , such courses should be
introduced here in the settlement or get sponsorship for such courses. Now what
will I be in future when I go back to my country and am old enough not to go
for further education?”
Table 25: Children in
refugee camps need to be sensitized on the dangers of HIV/AIDS and how to
prevent it
Source: Primary
Data
From the table above, 47.5% of the respondents
strongly agreed that Children in refugee camps need to be sensitized on the
dangers of HIV/AIDS and how to prevent it, 32.5% agreed, 5% were not sure, 7.5%
disagreed, and 7.5% strongly disagreed. This indicates that Children in refugee
camps need to be sensitized on the dangers of HIV/AIDS and how to prevent it.
This is in line with the findings Wolfson (2007) who noted that the use of
traditional healers from the refugee's home culture can assist the refugee in
getting access to health care in a culturally acceptable and meaningful way.
Traditional healers, in conjunction
with western trained health care providers can bridge the gap between cultures
and make the transition from cultures smoother. Therefore cultures can be used
to sensitize refugees on HIV/AIDS and
other sexually transmitted diseases using the culture norms and other
strategies.
One respondent
interviewed said that “In the refugee
camp there are still children who are easily infected of HIV/AIDS because of
ignorance and lack of knowledge on how to use condoms. When they are infected
they live in denial and are affected mentally because they think about death
and some find it difficult to cope with the disease due to the medicine and
food needed by the person suffering from
AIDS. The parents also do not sensitise their children on sexually transmitted
infection and how to avoid them , so most of the burden rests on the parents
and caregivers. However, most of these
deaths are caused by ignorance of parents on how to protect their children from
this disease and extremely poverty in most of families in which children live.
Children advocacy organizations in collaboration with radio programmes should
strengthen efforts in provision of trainings on how to prevent children from malaria
and other dangerous diseases”.
One community
health worker said that “people in the
camp do not take seriously the messages on HIV/AIDS and prevention of diseases.
Most people are still tied to their culture and neglect modern teachings.
Children especially engage in promiscuous relationships and do not bother to
use condoms since some thinks AIDS is for the adults, but they forget that the
adults also have sex with the children and some may be infected”
CHAPTER FIVE
SUMMARY CONCLUSION AND RECOMMENDATIONS
5.0 Introduction
This chapter involves summary of the findings based on
the objectives, conclusion based on the problem statement, and recommendations
based on the conclusion
5.1 Summary of the Findings
5.1.1The causes of mental health problems among children in refugee camps
Findings revealed that most Children in refugee camps
have experienced sexual violence, Children in refugee camps do not often
experience genocide, Children in refugee camps are often loss their loved ones,
and Children in refugee camps are often forced into child soldiering. Besides that Children in
refugee camps are often displaced, Children in refugee camps are often get poor
nutrition, most of the Children in refugee camps lost their parents, most of
the Children in refugee camps do not have identified
guardians, most of the Children in refugee camps lost their cultures,
and most of the Children in refugee camps use drugs.
5.1.2 Mental health problems among children in refugee camps
Findings
revealed that most children in the refugee camp are; unable to grip objects
that in the past were easy to grasp securely, feel hopeless, are suddenly lost
interest in eating, have difficulty falling asleep and staying asleep once they
do, often talk, react, and walk slower, are less active and playful than usual,
and fidget a lot in addition to experiencing stress related disorders.
5.1.3 Better solutions to cub the dangers of mental health problems among children in refugee camps
Findings revealed that Health professionals need to
strive for cultural competence when working with refugee
populations, Traditional healers, in conjunction
with western trained health care providers can bridge the gap between cultures
and make the transition from cultures smoother, there is need to develop a
cultural competence check list, more
spiritual education needs to be emphasized in camps, Different game Sports need
to be introduced in camps to reduce on idleness and crimes, Children in refugee
camps need to be trained in vocational work so that they can easily be
employed, and Children in refugee camps need to be sensitized on the dangers of
HIV/AIDS and how to prevent it.
5.2 Conclusion
Children in refugee camps have been exposed or
experienced sexual violence during wars
or during the camp situation, so they are traumatized, have lost their loved
ones, have been forced into child soldiering,
been displaced, get poor nutrition, lost their parents, do not have identified guardians, lost their cultures, and most
of the Children in refugee camps use drugs. Besides that most children in the
refugee camp are unable to grip objects that in the past were easy to grasp
securely, feel hopeless, suddenly lost interest in eating, have difficulty
falling asleep and staying asleep once they do, often talk, react, and walk
slower, are less active and playful than usual, and fidget a lot. Nevertheless, Health professionals need to
strive for cultural competence when working with refugee
populations, and traditional healers, in conjunction
with western trained health care providers can bridge the gap between cultures
and make the transition from cultures smoother.
5.3 Recommendations
UNHCR's
activities need to provide life-saving assistance, deliver essential services
to meet refugees' basic needs like enough food, decent shelter, provide
education to the children as mandated by the millennium development goals of Universal
Primary education , and ensure that international protection standards are
maintained. The standards stress prevention of child violence of whatever form
by the service providers as well as by the fellow refugees and respect of child rights as stipulated in the 1992
convention on the rights of the child.
There is need
to introduce and provided children with psychosocial services, or putting up a
psychological centre where children can go and interact and at the same time
access psychotherapy services. This may also call for UNHCR and refugee agencies
to designate a person who is able to attend to children psychological problems.
Such a person should be trained and is able to attend and understand children
problems and at the same time offer a solution either an individual or through
institutional collective efforts to the
problems faced by the children.
Parents with
children out of school should be encouraged and sensitised on the positives of
children attending school. Most parents refuse to send their children to school
since they say it is a temporary stay but they end up staying for many years in
refugee camps . during this recess the children outgrow their respective
classes that by the time they are supposed t return to their home country they
find it hard to rejoin the same level due to age. Hence parents need to know
the importance school plays on the psychological healing and wellbeing on
children as they access education.
Priority need
to be given to ensuring that all people
of concern in camps and urban settings are protected in accordance with
national legislation and policies, as well as international conventions
relating to the protection of refugees. The protection of vulnerable groups
such as women, children, unaccompanied and separated children, the elderly
persons with special needs will feature prominently on the protection agenda.
Measures aimed
at removing any forms of violence should be applied in all refugee camps. These
include sexual gender based violence committees and a designated person who is in
charge, child protection officer and committees that include service
recipients. It should be noted that most of the violence is from services hence
water points and food points should be well monitored to ensure that all forms
of exploitation are not compromised
with.
Camps that
were built in the past also urgently
need to be improved so to provide educational facilities and registration.
Education should also cater for adult and literacy education as well as
registering children who are of school age to ensure all are given the
opportunity if possible free of charge since refugee are generally not able to
pay for such services.
UNHCR and
refugee agencies need to introduce a supplementary feeding program for the
children that are traumatised and facing nutrition problems . poor feeding
habits impacts negatively on child growth as well as psychological wellbeing ,
hence ensuring a stable feeding for children may help curb some problems. This
may be an expensive venture, but it is a life saving activity and it should be
budgeted for. The food provided may attain the recommended dietary body intake
but when consumed on a daily basis without change may become monotonous to
children and they may lose appetite which may culminate into further health and
psychological problems.
UNHCR needs to
work through partners with expertise in livelihoods and self-reliance to offer
training and entrepreneurial opportunities and income-support schemes such as
backyard gardening where refugees in camps are able to grow crops to supplement
their static food rations provided by United Nations agencies. UNHCR and
partners need to undertake activities with partners for refugees in urban
settings aimed at a greater level of self reliance. Self – reliance helps to
restore the skills and abilities embedded within refugee individuals who may be
incapacitated because of their situation and keeps individuals active as well
as improving their economic wellbeing.
For many,
resettlement will remain the only durable solution and, as such, an important
element of UNHCR's comprehensive protection and durable-solutions strategy in
Namibia. Hence to avoid refugees overstaying in camps, resettlement
to a third country should be facilitated so as to reduce on the negative
impacts of overstaying in refugee camps. During the resettlement process,
children and families with psychological / mental health problems should be
given priority, because, the longer they stay in the camp the more the mental
health problems escalate, and many resettlement countries for example United
States of America, Australia, The Scandinavia countries and Canada have set up
psychological centres where they can easily get mental health assistance and
therapy.
Key priorities
such as; access to adequate housing,
health, water, sanitation, education and livelihood opportunities for
camp-based, urban and host communities around the refugee camp need to be
considered . This guarantees continuation of normal life though they may be in
a refugee camp. Limited access to such services further affects their mental
health wellbeing.
As
part of refugee registration, clinical assessment of a refugee or as a family
should also be encouraged and emphasised in all camps. Particular emphasis should be placed on
the history prior to the refugee journey. The purpose and aim of capturing such
information should be well explained to the refugees and they should be further
encouraged to express what they recall throughout their refugee or asylum
seeking journey. Such information should be treated with utmost confidentiality
because it may stigmatize some refugees and further affect their society well
being. Proper explanation of the essence of such information should be well
explained, though interviews should know that it is not easy to capture or
extract information to a suffering person because in some cases refugees come
from cultures in which mental health problems and disability are highly stigmatized.
The effects of exposure to trauma on the brain and memory processes and
different cultural traditions of storytelling can also make it difficult for
refugees to tell their story in a chronological and detailed way. Hence
techniques in extracting all the necessary information should be employed.
Camp
authorities should avoid all forms of discrimination and stigmatization based
on race, religion and origin because these forms of discrimination further exacerbate
the existent mental health problems. A child that is prohibited to play with
another because of tribal differences will find it a problem to socially
cohabitate with people of different tribes in future. Hence discrimination and
stigmatization are dangerous vices that should be addressed seriously
especially in distribution and provision of services like shelter materials,
food items, water distribution points and participation in leadership
positions.
Refugee
children should be assisted to form clubs like debate clubs, drama clubs and
youth groups where they come together and share experiences of learn about
society, sports, drama and career guidance. This in itself restores hope to
such children and enables them to think about their future. These groups also
address the dangers of dangerous living like smoking, drug use and other
unwarranted behavior from children.
5.4 Areas for Further Research
Further research need to focus on the causes of mental health of children in refugee camps. This
will help in making sure that the causes are eliminated and hence healthier
refugee children.
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APPENDIX 1: QUESTIONNAIRE FOR REFUGEE LEADERS
Dear respondent,
You have been selected to take part in a study
on “Mental Health of Children in
refugee camps: a case of Osire
Refugee Camp Namibia”.
Your response will be treated with utmost confidentiality and the information
obtained will be purely for research purposes
Section
A: Demographic characteristics of respondents
1. Gender of respondents
Male Female
2. Age range
Below 25years 25 -35
years 36 – 45 years above 45years
3. Period spent in the refugee
camp
Below 5years 5
-10years 11 – 16 years above 16years
Section B: The causes of mental health
problems among children in refugee camps
4. Children in refugee camps have experienced sexual violence
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Strongly agree
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Agree
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Not sure
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Disagree
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Strongly Disagree
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5. Children in refugee camps are often experience genocide
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Strongly agree
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Agree
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Not sure
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Disagree
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Strongly Disagree
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|
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6. Children in refugee camps are often loss their loved ones
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Strongly agree
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Agree
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Not sure
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Disagree
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Strongly Disagree
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7. Children in refugee camps are often forced into child soldiering
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Strongly agree
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Agree
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Not sure
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Disagree
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Strongly Disagree
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8. Children in refugee camps are often displaced
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Strongly agree
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Agree
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Not sure
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Disagree
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Strongly Disagree
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9. Children in refugee camps are often get poor nutrition
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Strongly agree
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Agree
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Not sure
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Disagree
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Strongly Disagree
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|
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10. Most of the Children in refugee camps lost their parents
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Strongly agree
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Agree
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Not sure
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Disagree
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Strongly Disagree
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|
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11. Most of the Children in refugee camps do not have identified guardians
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Strongly agree
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Agree
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Not sure
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Disagree
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Strongly Disagree
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|
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12. Most of the Children in refugee camps lost their cultures
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Strongly agree
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Agree
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Not sure
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Disagree
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Strongly Disagree
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|
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13. Most of the Children in refugee camps use drugs
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Strongly agree
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Agree
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Not sure
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Disagree
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Strongly Disagree
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|
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Section C: The dangers of mental
health problems among children in refugee camps
14. Most children in
the refugee camp are unable to grip objects that in the past were easy to grasp
securely.
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Strongly agree
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Agree
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Not sure
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Disagree
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Strongly Disagree
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|
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15. Most children in the refugee camp feel
hopeless.
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Strongly agree
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Agree
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Not sure
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Disagree
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Strongly Disagree
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|
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16. Most children in the refugee camp suddenly
lost interest in eating.
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Strongly agree
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Agree
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Not sure
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Disagree
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Strongly Disagree
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|
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|
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17. Most children in
the refugee camp have difficulty falling asleep and staying asleep once they do
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Strongly agree
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Agree
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Not sure
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Disagree
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Strongly Disagree
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|
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|
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18. Most children in the refugee camp often talk,
react, and walk slower
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Strongly agree
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Agree
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Not sure
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Disagree
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Strongly Disagree
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|
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19. Most children in
the refugee camp are less active and playful than usual
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Strongly agree
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Agree
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Not sure
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Disagree
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Strongly Disagree
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|
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|
|
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20. Most children in the refugee camp fidget a
lot
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Strongly agree
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Agree
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Not sure
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Disagree
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Strongly Disagree
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|
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Section D: Better solutions to cub the
dangers of mental health problems among children in refugee camps
21. Health professionals need to strive for cultural competence
when working with refugee populations.
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Strongly agree
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Agree
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Not sure
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Disagree
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Strongly Disagree
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|
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22. Traditional healers, in conjunction with western trained health care
providers can bridge the gap between cultures and make the transition from
cultures smoother
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Strongly agree
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Agree
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Not sure
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Disagree
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Strongly Disagree
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|
|
|
|
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23. There is need to develop a cultural competence check list
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Strongly agree
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Agree
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Not sure
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Disagree
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Strongly Disagree
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|
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24. More spiritual education need to be
emphasized in camps
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Strongly agree
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Agree
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Not sure
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Disagree
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Strongly Disagree
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|
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25. Different game Sports need to be introduced
in camps to reduce on idleness and crimes
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Strongly agree
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Agree
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Not sure
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Disagree
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Strongly Disagree
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|
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26. Children in refugee camps need to be
trained in vocational work so that they can easily be employed
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Strongly agree
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Agree
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Not sure
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Disagree
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Strongly Disagree
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|
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27. Children in refugee camps need to be
sensitized on the dangers of HIV/AIDS and how to prevent it.
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Strongly agree
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Agree
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Not sure
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Disagree
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Strongly Disagree
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|
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APPENDIX 2: INTERVIEW GUIDE FOR CHILDREN IN OSIRE REFUGEE CAMP
1. Have you ever been forced or enticed into
sex in the camp or before you came?
2. Have you ever lost people you loved most? Who are they?
3. Do you of children forced into child soldiering?
4. Can you go back to your home when given
chance?
5. What is the quality of food served in the camp?
6. Do you have your parents?
7. Do you have any relative guiding you?
8. Do you know of children in the camp who use drugs
9. Do you know of some children who are violent in the camp?
10. Mention some of the cases of
unwanted / teenage pregnancies in the camp
APPENDIX 3: INTERVIEW GUIDE FOR KEY INFORMANTS
1. What is your name?
2. What are the mental health problems among children in refugee camps?
3. What can be done to curb the dangers of mental health problems among
children in refugee camps?
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