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ISSN: 2161-0711
Journal of Community Medicine & Health Education
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The Impact of the Migration on Psychosocial Well-Being: A Study of Kurdish Refugees in Resettlement Country

Fatahi Nabi1,2*

1Sahlgrenska Academy at Gothenburg University, Institute of clinical sciences Department of radiology Sahlgrenska University Hospital, Sweden

2Sahlgrenska Academy at Gothenburg University, Institute of Health and Care Sciences, Sweden

*Corresponding Author:
Dr. Fatahi Nabi
Senior Lecturer, RN
RTG Sahlgrenska Academy at Gothenburg University
Institute of Clinical Sciences Department of Radiology and Institute of Health a Care Sciences
Sahlgrenska University Hospital, 413 45 Gothenburg, Sweden
Tel: +46 313388570, +46 704383133
E-mail: [email protected]

Received date: January 17, 2014; Accepted date: February 10, 2014; Published date: February 12, 2014

Citation: Nabi F (2014) The Impact of the Migration on Psychosocial Well-Being: A Study of Kurdish Refugees in Resettlement Country. J Community Med Health Educ 4:273. doi:10.4172/2161-0711.1000273

Copyright: © 2014 Nabi F. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

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Abstract

The aim of the present study was twofold: 1) to investigate how pre-migration, migration and post-migration factors have an impact on the mental well-being of Kurdish refugees settled in Sweden, and 2) to examine the relation between pre-migration experiences and post-migration well-being.

Keywords

Kurdish refugees; Psychosocial well-being; Migration

Introduction

The history of migration is probably as long as human existence itself. Although the nature of migration has changed over time, factors that influence immigrant’s mental well-being largely remain the same. In the study of migration well-being problems can appear within the cultural, social and psychological areas [1]. Previous studies have indicated that each of the various steps of a forced migration process (pre-migration, migration and post-migration) has its own potential negative impact that may influence the well-being of refugees in their resettlement countries [2,3]. The nature of the migration problems can vary based on the reasons for the migration. If migration is a result of an ethical and political conflict, the risk that immigrants develop mental illness is higher than for immigrants who have left their homeland voluntarily [4].

A study has indicated that immigrants are probably more affected by mental disorder than the native inhabitants [5]. According to previous studies, not only post-migration stress, but also premigration, negative life-experiences are potential sources of anxiety and depression for immigrants in the resettlement countries [3,6]. As an example, Cambodian refugees who experienced war and violence under the Khmer regime developed major depression when resettled in the US [7]. A similar study in Sweden showed that refugees who had experienced war and trauma in their home country were more likely to be affected by mental illness [8]. A painful experience during the migration process is leaving behind one’s social capital in the country of origin. This is especially true if it has been an important part of the individual’s identity, which is usually the case in societies where the collective identity plays a stronger role than that of the individual one.

Discrepancies in culture values and norms, as well as difficulty in communication are generally factors that influence immigrants’ well- being in the post-migration stage. Due to negative life events in their country of origin, many refugees may present with more severe psychosocial or/and physical problems than the native population in the resettlement country [8,9]. This makes refugees more dependent and vulnerable in contacts with authorities, particularly in healthcare and social service systems [10]. In this context, a prerequisite for promoting refugees’ psychosocial well-being is to provide an adequate language link between the refugee and social services as well as healthcare professionals. Previous studyhas revealed how poor communication between these parties can adversely influence the refugee’s quality of life as well as psychosocial well-being [11]. In situations dealing with psychological and psychiatric disorders, such as depression, that are commonly found among the immigrant population, the role of good communication with healthcare professionals is crucial [9,12]. Both verbal and non-verbal communication is influenced by cultural diversity. In contact with immigrants, sensitivity for their beliefs and basic knowledge about their cultural background is essential for preventing misunderstandings in communication. Dealing with this matter in a sensitive and respectful way helps professionals to reduce misunderstandings [12].

Kurdish refugees

Kurds are the largest non-state nation in the world, with a population of above 30 million in terms of ethnic origin. Kurds live in the Middle East in an area partly inside Turkey, Iran, Iraq and Syria. The separation of the Kurds and division of the Kurdistan region occurred when the allied countries divided the defeated Ottoman territories among themselves, after World War I [13]. Since the division of Kurdistan the Kurdish resistance and fight for an independent Kurdistan has led to an enormous forced emigration from Kurdistan to other parts of the world [14].

Approximately 7-8% of all Kurds live outside their region of origin. Migration of Kurds to Sweden began in the middle of the1960s from the Kurdish part of Turkey, within the framework of labour recruitment. It is difficult to give an exact number of the Kurdish population in Sweden as figures are often based on their citizenship, and not on ethnic background. It is estimated that about 50,000-60,000 Kurds live in Sweden [15]. Among the Kurdish refugees there are many that were involved in guerrilla warfare against the central governments in their respective countries. The literature about refugee migration and war trauma suggests that war-wounded refugees constitute a high-risk group for mental-health problems and adjustment difficulties in the resettlement countries [16].

Methods

Data were collected through three focus-group discussions with Kurdish immigrants from the Kurdistan regions in Iraq and Iran, by using semi-structured interviews. This interview method starts with a main question, but also allows the participants (informants) to talk about related issues that had not been addressed in the main question. Additionally this technique is well suited for exploration of sensitive perceptions and opinions that sometimes may be more easily expressed in a group discussion than in an individual interview situation. Furthermore, a semi-structured interview allows greater freedom of response as well as permits reflecting on answers and developing of the discussion than in structured interviews [17,18].

The participants were informed about the aim and procedure of the study, including recording of the interviews, and all participants agreed on these terms. As the study group was almost homogeneous and had the same cultural background, focus-group interviews were considered appropriate for the collection of the data [19]. In total 17 individuals were interviewed. Participants were selected in cooperation with the local Kurdish Cultural Society and represented both men (n=9) and women (n=8) with a median age of 48 years (range 38- 59 years), with different occupational status. All participants were refugees and had lived in Sweden for a median of 22 years (range 3-24 years). The interviews, which took place at the Kurdish cultural association in Sweden during 2011, lasted for a total of four hours. The interview started with a main question “Could you please explain how you experienced the migration process and how it has affected your life in the resettlement country”? In the course of the interview, deepening of the content, clarifications and condensing were achieved through more targeted questions from the author, who acted as a moderator. The interviews focused on pre-migration, migration and post-migration factors and their effects on the immigrants´ well-being in the resettlement country. The interviews, performed in Kurdish (two groups) and the Swedish (one group) languages, were digitally recorded, transcribed verbatim and then translated from Kurdish and Swedish into English by the author.

A qualitative analysis method (content analysis) was used for the analysis and interpretation of the interviews [20]. The important issue in the analysis process is to be aware of the various modes; manifest or latent content. The text is first analysed focusing on the content and describing the visible elements (manifest content). Analysis of what the text is about involves an interpretation of the underlying meaning of the text (latent content). Both manifest and latent content deal with interpretation but the interpretations vary in depth and level of abstraction. Adhering to the method, the transcripts were read and reread carefully in order to identify the informants’ experiences of the migration process. The words, sentences or paragraphs containing aspects related to each other and addressing a specific topic were grouped together into meaning units. Then meaning units related to eachother were grouped together into a condensed meaning unit, with a description close to the original text. The condensed text was further abstracted and labelled with a code. Codes that addressed similar issues were grouped together, resulting in subcategories. Subcategories that focused on the same problem were broughttogether in order to create more extensive conceptions, which addressed an obvious issue as categories. Finally, a theme that covered the analysed text emerged from the categories [20].

Results

The content analysis resulted in three categories, 12 subcategories and a single theme (Table 1). The first category is deals with premigration factors; the second one tells us how migration factors influence immigrants’ well-being, and the last category covers postmigration factors and their association with pre-migration, respective migration, process.

Nr Age
(Years)
Occupation
in home country
Occupation in
Sweden
Escape  way Residency in
Sweden (No. of years)
Marital status
1 51 Company owner (carpenter) Taxi driver Turkey 22 Married children
2 43 Student Jobless Turkey 23 Married
3 50 mechanic Taxi driver Turkey 24 Married child
4 46 Student Engineer assistant  Iraq: UNHCR 22 Married children
5 56 State employee Taxi driver  Iraq:
UNHCR
23 Married
children
6 47 Student Cook Turkey 19 Married children
7 48 Student Mechanic Turkey 19 Married children
8 53 Student State employee Turkey 24 Divorced
9 49 Teacher unemployed Turkey 5 Marrid cheldren
10 38 Student Engeneer Turkey 14 Marrid children
11 45 Student Nurse Assistant  Iran 11 Marrid  cheldren
12 48 State employee unemployed Turkey 12 Marrid
13 59 Teacher Radiospeaker  Iraq: UNHCR 22 Marrid  cheldren
14 55 Teacher Worker  Iraq: UNHCR 22 Marrid  cheldren
15 39 State employee unemployed Turkey 3 Marrid  cheldren
16 54 Teacher Worker Turkey 23 Divorced
17 39 Teacher unemployed Turkey 9 Marrid

Table 1: Background data of the study group (n=17).

Life in the shadow of horror (pre-migration)

Discrimination: Participants expressed that they had been discriminated in their home countries because of their ethnic background. They mentioned that as minorities in Iran and Iraq they were unable to have control over their existence. They also stated that they used to speak, think and express themselves in the Kurdish language up to six years of age. Participants from the Kurdish region in Iran stated that when they began school they suddenly found that their language was forbidden and that they must switch their language from their mother tongue to Persian. One of the participants stated:

“As Kurds in Iran we have no right to education in our language and no role in the governing of our existence. When I was at primary school my teacher who was Persian-speaking, showed me a photo of a cone, and said “what is this? I couldn’t name it in Persian and answered in Kurdish; he beat me so hard that I broke my wrist”.

Another participant mentioned:

“Something that was both strange and horrible for me was my school start. When I began school in Iran, even though my teacher was a Kurd, we were never allowed to speak to each other in Kurdish”.

Feelings of insecurity: The majority of the study group experienced a number of difficulties during the pre-migration and migration periods that influenced their psychological well-being in the resettlement country. Feeling of insecurity because of the regime’s shift was the main factor that has forced them to leave their homeland. They pointed out that it was a terrible experience to be forced to leave all material and emotional belongings, without any choice; it was just a way to survive. One of the participants in the present study said:

“After the regime’s shift in Iran, and our struggle for our rights, the regime began to execute many politically-active persons in the other cities in the Kurdish region, and then I decided to flee because of horror”.

Another added:

“During the regime shift in Iran, I was 11 years old. The most terrible experiences were the executions of our friends and relatives, which I witnessed closely. I will never forget those horrible experiences”.

Subcategories Categories Theme
Discrimination    
Feeling of insecurity Pre-migration  
Unclear future    
Fear and anxiety Migration  
Powerlessness   Experiences of the migrationprocess
Loss of social capital    
Language barrier    
Cultural diversity    
Feeling of not belonging Post migration  
Social and professional regression    
Discrimination    
Climate    

Table 2: Categories, subcategories and theme that emerged in the interviews.

Forced and stressful travel (migration)

Uncertain future: Participants experienced the escape event and circumstances as stressful and terrible in most cases. They had to leave their home country without any exact plan or possibilities to predict how it would be. “The future was unclear to us; it was impractical to talk about it” said a participant in the study. Another participant expressed the following:

“If one just tried to find somewhere to survive, how could one think about the future?”

According to the study’s result the majorities of the participants had been in guerrilla bases for many years and then had fled illegally to Turkey. They experienced their life as a guerrilla soldier in the guerrilla bases and their time as an illegal refugee in Turkey as quite uncertain and stressful.

“When I fled to Turkey I didn’t know what was going to happen”.

Fear and anxiety: The majority of the participants in the present study escaped through Turkey. The Turkish government policy concerning cooperation with Iranian and Iraq’s-regimes against the Kurdish resistance movement has been addressed as the main reason for the fear and anxiety of participants in the present study.

“We had quite a fearful life-situation during our escape to and stay in Turkey; we had no security, we were afraid that the Turkish police would arrest us”.

Powerlessness: Based on the participants’ statements, the most dreadful experience was fear of deportation to Iran by the Turkish police. As an illegal refugee in Turkey they felt quite powerless and at the beginning there were no international organisations at hand to support them, as one participant expressed it. Many of the refugees that were members of the Kurdish resistance parties in Iran who had been deported to Iran by the Turkish police were executed, mentioned another participant in this study.

“When we were in Turkey, we had no control over our lives or our future. There was a risk that the Turkish police would send us back to Iran”.

Multi-facetted difficulties in the new society (post-migration)

Loss of previous social capital: Despite the similarity of the participants’ experiences in pre-migration and migration, they presented different points of view regarding post-migration experiences. Interestingly, differences in post-migration experiences seemed to depend mostly on job status in the resettlement country. Participants with a qualified work status reflecting their level of education were more satisfied and optimistic than those who were unemployed or had a job for which they were overqualified. However, loss of social capital based on relationships and emotions was also evident. All participants shared common experiences regarding their emotional feeling about their home country. One of the participants stated:

“After more than twenty years as a resident in Sweden, I am still living in the shadow of my life experiences in my home country, and my dreams are often traced back to my birthplace”.

A participant who left his homeland 35 years ago and visited his homeland after the regime shift in Iraq stated as follows:

“I have no friends in Sweden and none remain in Kurdistan, they are nowhere”.

Language barrier: Based on the participants’ experiences, it is problematic to move to a foreign country as an adult, with a different language and culture, particularly if one has no higher education in the home country. I came here with a lot of problems; to stand up to a supplementary problem is difficult, said one of the participants. To learn the Swedish language has been considered as the first problem that they have faced in the resettlement country. Two of the participants expressed difficulties in learning the Swedish language as shown in the following citations:

“I came to Sweden as an adult, and the Swedish language is difficult to learn, particularly as an adult”.

“In order to learn the language and to become integrated into society, a better introduction for immigrants and better language education is needed, particularly for immigrants who are illiterate”.

Cultural diversity: According to the participants’ experiences, even though at the beginning both language and cultural barriers are problematic for immigrants, language barriers may be reduced or sometimes fade away in time. Unfortunately, cultural diversity remains with us constantly, said one of the participants in the study group. Another participant stated that culture appears before language. He said, “the first time I met the Swedish police I could not speak or understand the Swedish language, but I understood and appreciated such a nice political culture in contrast to the police in my homeland. Now I speak the Swedish language well, but many of the cultural aspects in Sweden still are unknown to me. Every day we are in contact with the native people and their culture”. Generally, “cultural diversity was obvious on the first day”, expressed another participant. The following citations are some of the participants’ expressions regarding cultural diversity.

“Absolutely, the cultural difference is an undeniable fact. I think there are a lot of differences in culture, but differences in the political culture are more obvious”.

“I think we grew up in a cultural and political tradition, which is absolutely different from Swedish modern society. It may take one hundred years to come up to such a level of freedom as in Sweden, so we have passed through one hundred years in a five hour’s flight”.

“Our strong social and cultural relationship to each other could be considered as a factor that hampers our contacts with the new society”.

Feeling of not belonging: According to the result of the present study in contrast to the relative similarity of the participants’ experiences in pre-migration and migration stages, some variations appeared in the post-migration stage. The result of the study has showed that the feeling of not belonging was different, based on the grade of integration into the new society. The results of the study showed this issue was strongly associated with the grade of the immigrants’ participation in the new activity. The result showed that employment and job status have significant impact on the feeling of not belonging. Employed participants were more positive to the question of integration and have better mental well-being.The following citations reveal this issue:

Quotations from unemployed participants:

“Emotionally I have no place in this world so that I feel it is mine. I have been pushed out of my homeland and I am a guest in Sweden”.

“I feel that I am living in a vacuum rather than among the people. Although I have a nice house and an expensive car, many times it feels that they are not mine”.

Quotations from employed participants:

“I have got a job with a high position, it is easy for me to adapt to the new society. I am very satisfied with the circumstances of my life, I enjoy my life and it feels that I am at home in my country”.

“I work as a teacher and have really good communication with people. It does not matter if they are black or white, Swedish or immigrant, it works well for me”.

In this context one of the participants stated that he had not got the opportunity to have higher education in his homeland and addressed two factors as hampering him with regard to getting higher education and a good jab in the resettlement country. The first one was his age; the second one was the Swedish language, which is difficult to learn. He expressed the importance of higher education and a good and healthy life as follows:

“If one has a higher education, there is an opportunity to get a good job and a better life, everywhere”.

Social and professional regression during time in new society: According to the result, many of the participants have had a high social position and wide social contact, particularly as an active member in the political parties. But in the resettlement country they have minimal social contact, especially those who are unemployed. This issue has led to a feeling of futility for many of them. The following citation reveals this feeling.

“I have had a high position in a Kurdish political party. I was responsible for advising thousands of people. When I spoke as a member of a political party, hundreds and thousands of people listened to me. But now I am a lonesome man in a limited sphere in Sweden; it is a miserable feeling”.

Because of the terrible pre-migration and migration experiences many have not succeeded in going on to higher education in Sweden stated a participant. In this context many of us are working with jobs that do not require long and complementary education, for example as a taxi driver. This issue has resulted in professional regression, which has created anxiety for many immigrants according to the result. The following citation illustrates the above:

“Anyway, in my home country I had a job that was better than being a taxi driver”.

Discrimination: As the result of the present study has indicated, somein the study group experienced discrimination as an absolutely dreadful feeling. As an ethnically- discriminated group in their home country, they have had very bad experiences of this issue. In this context, when they meet any discriminating attitude in the resettlement country, unconsciously they connect this to their previous experiences of discrimination in their homeland. This feeling was expressed by participants as follows:

“Dramatic experiences from our previous society, and unfavourable attitudes from the new one, are our essential problems”.

“One study has indicated, if a person that is named Anders sends a job application to the employment Service, he has an 85% higher chance of getting a job than a person whose name is Mohammad”.

Climate: Some of the participants stated that environmental factors, such as coldness and darkness have significant impact on their mental well-being. One of the participants expressed this issue as follows:

“In our country we have about four months of sunshine, but here we see only rain or darkness, it’s very terrible”.

Discussion

As the purpose of this study was to examine the experiences of Kurds who had to leave their homeland and seek asylum abroad, a qualitative approach was considered necessary to gain more knowledge about the migration process, and to generate a hypothesis for future research. In this context, I found a content analysis method to be a suitable method to analyse and interpret the collected data. In this way the method is capable of handling the categorisation and classification of text, in order to analyse its content and its underlying meaning [20].

The process of migration is a series of events that influence each other.Pre-migration experiences of war,persecution, political violenceand other negative life events have a significant impact on the immigrant’s psychosocial well-being in the post-migration phase.

The rise of anxiety and psychological problems among immigrants in the resettlement countries, in comparison with native inhabitants, has been addressed in previous studies [19-22]. Factors that may influence immigrant’s psychological well-being in resettlement countries might accord our findings be traced back to the pre-migration and migration processes. Many of the participants in this study expressed their anxiety regarding violence and discrimination in the pre-migration and migration periods, in line with a previous study in Sweden [23]. A study in Denmark has indicated a significant relationship between violence in pre-migration and decreasing psychological well-being in post-migration [24].

The majority of the participants in the present study have been forced to leave their homelands. In this context they had neither the opportunity to choose their escape route, nor to plan their resettlement country. These factors might contribute to dissatisfaction, a sense of lack of control, and the feeling of not belonging in the resettlement country, which many times has resulted in alienation for the immigrant. In the present study a significant factor influencing the well-being of the migrants in the new society was “loss of social capital”. This refers to losses of social capital achieved in the home-country pre-migration. This loss of capital is not “caused” by the new society, and it appears immediately on arrival in the new society. Many of the participants also experienced “social and professional regression”, which refers to changes causedby or occurring during the stay in the new society, depending on e.g. imbalance between competence and availability of jobs, new demands and requirements not being reached etc.A similar study in the United States of America about a group of immigrants forced to flee from Bosnia has indicated almost the same problem concerning the feeling of not belonging [25]. This approach has led to a strong social relation between immigrant groups that has been considered as a factor increasing a feeling of alienation and hampering adaptation to the new society [25]. Additional social support is needed in order to prevent psychological strain and improve mental health among involuntary immigrants. This issue has been confirmed by a Spanish study [26].

According to the result of the present study profound differences in language, culture and ethnicity may hamper the immigrants’ establishment in the new society. This issue has significant impact on participants in this study, because to talk about and foster a Kurdish identity was forbidden in the home country. In order to protect their identity and as a “defence mechanism”, the Kurdish immigrants have a strong social relationship with each other in the resettlement country [27]. This issue has been reflected frequently in the study’s result by study-groups. Furthermore, to overcome language difficulties in the resettlement country, learning of the non-native language as soon as possible is needed. A previous study [28] has indicated that mastering the mother tongue (L1) facilitates learning of the second language (L2). It should be noted that the majority of the participants in this study were Kurds from the Iranian part of Kurdistan, where the use of the Kurdish language within the entire educational system is forbidden. Consequently, Kurds do not learn to master their own language, which makes it difficult to learn the other language, because mastery of one’s mother tongue has significant impact on learning a new language.

Besides these factors, increasing unemployment among immigrants, because of low education and sometimes as a result of discrimination, has led to alienation and a deterioration of immigrants’ mental well- being. The result showed that immigrants that succeeded in securing a job that was equal or above their level of competence in their homelands, became integrated into the new society and reported satisfaction with their life situation and high self-esteem. Our findings confirm previous studies showing that having a job has a significant impact on the question of integration and establishment in the resettlement country, which is important for the immigrants’ mental health and well-being.

The effect of discrimination on immigrants’ mental health has been addressed in previous studies [21,29]. Immigrants’ experiences of discrimination in the pre-migration stage make them more vulnerable for the same processes in the post-migration phase. Our findings showed that the immigrants’ dramatic experiences from their previous society, and hostile attitudes from the new one, are potential sources of diminished mental well-being. Work is considered as an important tool to enter society’s activities and in preventing alienation, but the present study suggests significant occurrence of discrimination with regard to employment and work opportunities.

Potential sources of bias

The investigator in the present study belongs to the same ethnic group, which may be considered a risk factor for impartiality in the planning, execution and analysis of the research, because of preunderstanding [30]. The investigator’s background and his preunderstanding might have been advantageous since he was aware of the potential problem areas that Kurdish refugees might be exposed to. In order to minimize such biases the interviews had a semi-structured design starting with a neutral question: ‘‘could you please explain how you experienced migration processes. In addition, the interviews were performed in the participants’ native tongue. The interviews were perceived to be held by “one of their own”, and the content was probably less censored than if the interview had been held by someone with a non-Kurdish background. Although some bias due to the investigator’s background and pre-understanding cannot be ruled out, the degree of openness, depth and confidence obtained in the interview situations probably out-performed potential biases that could not be ruled out. Awareness of one’s own historicity and pre-understanding, and understanding the impact of the “life-world paradigm”[31], is probably the most effective measure to minimize bias in the research process.

Study’s limitation and weakness

Although a large amount of data was obtained, the number of participants was small. Despite the limited number of participants we believe that the information obtained was rich. All informants were very active during the interviews and provided various examples of factors influencing their well-being. In addition, the participants represented different ages, gender and occupations from two parts of divided Kurdistan. The weak point in this study is lack of variation in the participants’ experiences of the migration process, though they had had different backgrounds and ways of escape.

Conclusion

The present study suggests that not only post-migration factors, but also pre-migration and migration factors, have an important role regarding the refugees’ mental well-being in the resettlement country. Refugees seem to be more sensitive to factors associated with premigration negative experiences, such as discrimination. The alteration of the immigrants’ social and professional status has a significant impact on their psychological well-being. Social and professional regression has contributed to decreased self-esteem. Refugees that sought work and were employed at their professional level learned better ways of communication with the new society, and a high status of mental wellbeing.

Acknowledgements

This study was financially supported by the Department of Radiology at the Sahlgrenska University Hospital in Gothenburg. Many thanks to practical and technical support from Ata Ghaderi at Uppsala University, Mikael Hellström the head of the department of clinical sciences and Anne Olmarker the head of the department of Radiology at Sahlgrenska University Hospital.

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