The difficulties and coping strategies of Sudanese Refugees pre, during and postmigration: A qualitative approach

A qualitative approach was adopted to interview 23 Sudanese refugees residing in Brisbane, Australia. Semi-structured interviews were conducted to examine the participants’ premigration, transit and postmigration experiences. Refugees reported traumatic and life threatening experiences during the premigration and transit phase. The difficulties during postmigration phase consisted of resettlement issues. Nevertheless, they reported using coping strategies across all phases. The coping strategies identified relied predominantly upon participant’s use of religious beliefs, and cognitive strategies such as reframing the situation, relying on their inner resources and focussing on future wishes and aspirations. Social support also emerged as a salient coping strategy. The findings are useful for mental health professionals as they highlight the plight of the refugees as well as the strategies used by them to manage their traumas and stresses. Sudanese Refugees in Australia 3 The past decade has seen an unprecedented increase in the global number of refugees and displaced persons. There are approximately 14 million refugees (UNHCR, 2004), while 23.6 million are internally displaced (USCR, 2004a). Most of these refugees have fled situations of war or famine (Adams et al., 2004) wherein they experienced significant trauma, including physical and psychological torture, sexual violence, shelling and other atrocities (Neuner et al., 2004). Given the high number of refugees globally, and the significant nature of the events suffered by this population, research examining the experiences of this group is warranted. Research investigating the experiences of refugees has largely employed a quantitative methodology to examine premigration trauma and its psychiatric sequelae (e.g., Momartin et al., 2004; Neuner et al., 2004). However, few studies have examined the ongoing experiences of refugees both prior and subsequent to fleeing their homeland. Research has indicated that the plight of the refugees is not limited to premigration phase, but extends to their transitional phase as well as after seeking asylum in a new country (Porter & Haslam, 2005; Silove, 2001). The present study addressed this empirical gap by examining the experience of refugees from Africa across three phases; premigration, transit and postmigration. It focussed on a sample of Sudanese refugees living in Brisbane, Australia and utilised a qualitative methodology. This methodology was adopted to study the narrative of the participants in order to identify salient aspects of their experience. Refugee Research The bulk of the psychological research examining the experiences of refugees has been based on a Western biomedical model of trauma which focuses on the psychological sequelae to trauma. Such research has yielded a number of consistent findings. First, in the case of Eritrean youth, exposure to war trauma and economical hardships were predictors of their psychological distress (Farwell, 2004). Similarly, exposure to mass violence is associated with a range of diverse detrimental psychological outcomes such as depression, anxiety, post traumatic stress disorder (PTSD) and substance use disorder (Silove, 2001). For example, Momartin et al. (2004) found a relationship between trauma and both PTSD and depression in a sample of 126 Bosnian refugees. They found that threat to life was a significant predictor of PTSD in Bosnian refugees while threat to life and traumatic loss were associated with comorbid PTSD and Sudanese Refugees in Australia 4 depression. Similarly, Steel et al. (2002) examined a sample of 1161 Vietnamese refugees and found that exposure to greater than three traumatic events was associated with increased prevalence of anxiety disorder, depressive disorder, substance use disorder and PTSD. A systematic review by Fazel (2005) indicated that refugees resettled in western countries could be about ten times more likely to develop PTSD than age-matched general populations of these countries. Second, there is a robust relationship between the number of traumatic events and severity of psychiatric symptoms experienced (Mollica et al., 1999). For example, Neuner et al. (2004) examined the relationship between trauma suffered and psychological outcomes in a sample of 3371 Sudanese nationals living in Southern Sudan and Uganda and found a near linear rise in PTSD symptoms with increasing psychological strain. Nearly a quarter (23%) of the participants who had experienced three or fewer traumatising experiences displayed symptoms of PTSD while 100% of the participants reporting 28 or more traumatic experiences exhibited the disorder. As such, the authors concluded that, while poor psychological outcomes are not an inevitable consequence of trauma, there may be no resilience to ward off such outcomes where there is cumulative exposure to traumatic events. Third, literature revealed that while premigration stressors impact significantly on psychological distress, post migration adaptational difficulties and loss of social and cultural support add appreciably to post traumatic stress symptoms. Porter and Haslam (2005) in their meta-analysis identified enduring contextual variables, such as accommodation and financial stress as factors related to poor mental health outcomes. According to these researchers refugees living in institutions, older in age, more educated, females and those who had a higher socioeconomical status prior to displacement were at higher risk. Keeping in view the complexity of a refugee experience, recent research indicates that the intrapsychic PTSD framework may be too narrow for conceptualizing war trauma as it is psychosocial in nature and contexualized in the community’s socio economic and political aspects of the conflict and its consequences (Fawrwell, 2004). Thus, more complex, holistic and ecological models are currently being proposed that emphasize factors such as the experienced stress, available social support as well as the societal, political and cultural perspective, essential for the mental health Sudanese Refugees in Australia 5 and well being of the refugees (Hjern & Jeppsson, 2005; Porter & Haslam, 2005; Zarowsky, 2004). Limitations of Refugee Research While refugee research has demonstrated a robust relationship between trauma and deleterious psychological outcomes, research based on a traditional biomedical trauma model is controversial for three reasons. First, this approach adopts a narrow focus by examining only premigration phase or the post migration experience. As such, it neglects the impact of transit stressors as well as the temporal nature of the refugee experience (Miller et al., 2002). This approach is problematic as the refugee experience evolves over the period of threat in the home country, the time of flight and asylum and final resettlement or repatriation (Silove, 2001). Stressors may occur throughout any stage and their nature, meaning and impact is likely to vary depending on the strengths of the individual and difficulties incurred prior to the stressors (Miller et al., 2002). As such, further research examining the refugee experience across the pre migration, transit and postmigration periods is required. A second limitation of the biomedical model is that, despite finding a correlation between trauma and psychiatric symptoms, it is unable to explain relatively low rates of psychiatric symptomatology in post-war societies (Silove, 2001). For example, Mollica et al. (1993) found that only 15% of Cambodian residents living in a refugee camp suffered from PTSD even though the majority had experienced several forms of trauma. Even lower rates (3%) of PTSD were reported in a sample of traumatised Vietnamese refugees living in Australia (Steel et al., 2002). These figures suggest that the majority of refugees adapt to the stressors and trauma they have encountered. These findings are consistent with existential and humanistic models (Silove, 2001), which highlight the significance of an individual’s or community’s ability to cope and adapt to challenges of exposure to mass violence and forced migration. Recently studies have started to examine the coping mechanism of refugees. Further, factors that buffer the impact of stress and promote positive adaptation in refugees have been explored (Goodman, 2004; Silove, 2001). There is evidence that social support acts as a protective factor against the impact of violence and persecution. Refugees rely on support from their families and communities (McMichael and Manderson, 2004). Goodman (2004) analysed Sudanese Refugees in Australia 6 accounts of refugee youth from Sudan and found that used collectivity and communal self as a way of coping. Moreover, limited studies conducted so far on refugees have highlighted various cognitive and belief systems which help them cope with their difficulties (Brune et al., 2002, Gorman et al., 2003). Beliefs in the form of a strong allegiance to religion have acted as a primary source of resourcefulness (Halcon et al., 2004). The use of religion as a coping strategy appears to be commonly held amongst refugees from Africa. For example, in a sample of Somalian and Ethiopian refugees, Halcon et al. (2004) found that between 50% and 75% of individuals believed in God and prayer and used these as a strategy to relieve their sadness. The attitude to “endure” the sufferings for a reward in the form of a “better future” seemed to be linked to religious beliefs (Colic-Peisker and Tilbury, 2003). Further, such beliefs are likely to be an effective coping strategy in assisting individuals to adapt to their life difficulties. Specifically, Brune et al. (2002) found that refugees who reported holding a firm belief system tended to report higher educational achievement, better mastery of language and fewer symptoms of PTSD. Cognitive processes, in the form of interpretations and perceptions of oneself and the situation, have enab