Mental health of refugees in local communities hit by earthquakes and a pandemic

Description

During 2020 and 2021, devastating earthquakes affected the County of City of Zagreb, as well as Sisak-Moslavina County and parts of Zagreb and Karlovac Counties; where a large number of Croatian refugees in integration live. The experience of surviving a natural disaster covers the entire range of losses, which causes significant psychological stress to the general population, including refugees, and causes the heightened need for translators in the departments of institutions where psychological support activities are performed. Jesuit Refugee Service often assists refugees in visiting health services, noting that interpreters are not available by the system, which makes communication between doctors and patients difficult. NGO translators are available depending on project funding and cannot be a continuous support in quality refugee health care. Therefore, there is a need to provide long-term available translators to health services so that they can work well with refugee patients.

The aim of the proposed project is to advocate for the improvement of mental health services for refugees in integration in Croatia and the provision of adequate professional assistance with the help of interpreters in health care institutions in areas affected by earthquakes. Project activities include conducting research on the level of psychological distress of refugees and presenting the results of research to relevant stakeholders in the fields of advocacy for refugee rights, service delivery and assurance of health services in local communities. Target groups are: refugees in the quake-affected areas of the four counties, who will participate in our research; stakeholders in the refugee integration process (CSOs, relevant institutions); and relevant authorities to which we will present the research and suggest methods for ensuring better health care. The final beneficiaries of the project are Croatian refugees who seek access to mental health care.

Summary of project results

The project aimed to address several critical issues and challenges, primarily related to the mental health and psychological well-being of individuals affected by the COVID-19 pandemic, earthquakes, and the refugee crisis in Croatia:

1. Impact of the COVID-19 Pandemic:

   • The pandemic, declared by the World Health Organization (WHO) in March 2020, led to increased anxiety and mental health challenges in the general population. The need for psychiatric support surged as people faced new and compounded stressors, exacerbating pre-existing mental health issues.

2. Earthquake Aftermath:

   • In addition to the pandemic, Croatia faced a series of devastating earthquakes, with major tremors in March 2020 and again at the end of 2020 and beginning of 2021, which affected various parts of the country, including Zagreb and Sisačko-moslavačka, Karlovačka, and Zagrebačka counties.
   • The earthquakes caused severe material damage, physical injuries, and the loss of lives, resulting in significant psychological distress among the affected populations.
   • The experience of surviving such a disaster often involves a broad range of losses, both tangible and emotional, leading to increased vulnerability in the affected populations.

3. Vulnerability of Refugees:

   • A key challenge identified was that the counties most affected by the earthquakes also housed a significant number of refugees with international protection in Croatia. This refugee population was already vulnerable, not only due to their physical health risks but also due to psychological challenges caused by their migration experiences.
   • Refugees often face significant mental health challenges due to their traumatic migration experiences, which can further be compounded by natural disasters and the psychosocial stress of their new living conditions.
   • These issues were further amplified by the pandemic, creating even greater psychological vulnerabilities among the refugee population.

4. Lack of Professional Interpreters in Healthcare:

   • The project identified a major gap in healthcare access for refugees: the lack of professional interpreters in medical and psychiatric services. This posed a significant barrier to quality treatment for refugees, as language barriers often led to frustration among medical staff and hindered effective communication.
   • The absence of trained interpreters, particularly for psychiatric treatment and psychological support, meant that refugees were often unable to fully access mental health services, further exacerbating their psychological distress.

5. Barriers to Refugees’ Access to Mental Health Support:

   • Existing national laws and the Action Plan for Integration for refugees in Croatia (for the period 2017-2019) were not fully implemented or adapted to address these emerging challenges. Specifically, the project highlighted how many refugees in Croatia did not receive the necessary psychological support or treatment, particularly related to their mental health and well-being.
   • In alignment with existing literature, the project aimed to address these shortcomings by advocating for better psychosocial support for refugees, especially considering that many had not received adequate care for psychological issues linked to trauma or migration.

6. Timing of Psychological Assessments Post-Crisis:

   • The project emphasized that psychological assessments should be conducted at least four weeks after a traumatic event to identify distress signs effectively, as individuals often begin showing symptoms of emotional instability or distress after this period.
   • The continued aftershocks and uncertainty surrounding the duration of the earthquake crisis necessitated an adjusted timeline for mental health assessments to ensure that affected individuals received the appropriate support.

Overall, the project aimed to address the psychological impact of both natural disasters and the refugee crisis, with a particular focus on improving access to mental health support for vulnerable populations, especially refugees, who were facing compounded stressors due to migration, the pandemic, and the earthquake crisis. The initiative also sought to tackle the systemic issue of language barriers in healthcare settings and promote better integration of mental health services for these populations.

The project aimed to address the psychosocial needs of refugees in Croatia, particularly in the context of post-earthquake recovery and the ongoing COVID-19 pandemic. It focused on ensuring access to quality mental health services for refugees in areas affected by earthquakes, and specifically sought to address the language barrier in healthcare by advocating for the inclusion of interpreters in medical settings, especially for psychiatric treatment.

Key Activities and Outputs:

1. Advocacy and Awareness Raising:

   • The project engaged in active advocacy to improve mental health services for refugees, emphasizing the increased vulnerability of refugees in the context of the COVID-19 pandemic and natural disasters (earthquakes).
   • The project raised awareness among stakeholders in the integration process (government bodies, NGOs, local communities) about the urgent need for mental health services, particularly with the added challenge of language barriers.

2. Research on Psychological Distress:

   • The project conducted research on psychological distress experienced by refugees, focusing on those in four earthquake-affected counties.
   • The research utilized semi-structured interviews to gather data on various life aspects of refugees, such as health conditions, material situation, and employment, to gain insight into the stressors they faced in the post-migration phase.
   • The results were shared with key integration stakeholders and used as a basis for advocacy, to propose improvements in healthcare access for refugees.

3. Collaboration with Health Authorities:

   • The project facilitated collaborations with the healthcare system, specifically focusing on the need for interpreters in medical settings, especially for refugees requiring psychiatric care. This was critical, as many refugees faced difficulties in accessing services due to language barriers.
   • Through this collaboration, refugees received professional psychological support and treatment in areas where they previously lacked access.

4. Workshops and Coordination Meetings:

   • Workshops and coordination meetings were held with stakeholders from the refugee integration sector, including NGOs, government institutions, and healthcare professionals. These meetings focused on discussing the research findings and formulating solutions for improving mental health support for refugees.
   • Decision-makers and relevant institutions were presented with research results, and recommendations for improving the quality of healthcare and ensuring the availability of interpreters for Arabic and Persian languages (the most prevalent languages in the refugee population in Croatia).

5. Communication and Public Engagement:

   • Throughout the project, JRS (Jesuit Refugee Service) communicated the project''s progress, challenges, and results to the public and relevant stakeholders via social media, the organization’s website, and email communications. This facilitated increased visibility of the project and kept key stakeholders informed.
   • Public engagement was also achieved through the dissemination of research findings, which helped maintain a focus on the issue among decision-makers.

6. Impact on Policy and Service Delivery:

   • The project contributed to the policy dialogue on refugee integration and healthcare, leading to increased recognition of the need for interpreters and mental health services for refugees, particularly in areas affected by natural disasters.
   • Through advocacy and research, the project successfully highlighted gaps in the system and pushed for measurable improvements in healthcare access for refugees, especially in the areas of mental health care.

Overall Outcome:

The project succeeded in:

• Raising awareness about the mental health needs of refugees in Croatia, especially in earthquake-affected areas.
• Advocating for improved healthcare services, including language support for refugees in medical settings.
• Collecting valuable data on the psychological distress of refugees and using it to advocate for systemic changes.
• Fostering collaboration between NGOs, government entities, and healthcare providers to improve services for refugees.

The ultimate goal was to ensure that refugees in Croatia receive the necessary mental health support in a manner that is linguistically accessible, especially in the wake of the compounded crises they faced.

The project successfully reached and benefited multiple target groups, achieving significant outcomes that directly impacted both individuals and broader systemic efforts for refugee integration in Croatia.

1. Refugees (Primary Beneficiaries)

• Target Group: 30 adult refugees with some form of international protection, residing in Sisak-Moslavina, Karlovac, Zagreb, and Zagreb City counties, participated in the research.
• Outcomes:
  • The refugees were actively involved in the project, providing sociodemographic data and information on their living conditions and barriers to successful integration in Croatia.
  • The psychological distress levels of refugees were assessed, offering insight into their mental health challenges post-migration.
  • The participation itself provided psychosocial support as many refugees expressed that simply being asked about their mental health felt like a form of therapy, reducing their isolation and increasing their sense of being seen and valued.
  • The research was conducted in a comfortable and supportive environment, where refugees felt empowered and respected during the interviews. This approach also contributed to the decentralization of services, reaching refugees outside of Zagreb.

2. NGOs and Civil Society Organizations (CSOs)

• Target Group: Non-governmental organizations (NGOs) and civil society organizations (CSOs) involved in refugee integration.
• Outcomes:
  • The project fostered networking and collaboration between CSOs, leading to the development of joint recommendations for further advocacy activities.
  • CSOs, which are often resource-constrained and face challenges in communication and cooperation, benefitted from improved coordination and stronger advocacy strategies for refugee rights, especially in mental health services.

3. Government Institutions and Decision-makers

• Target Group: Representatives from government ministries, relevant offices, healthcare institutions, and the Ombudsperson’s office.
• Outcomes:
  • The project presented the research findings to government bodies and healthcare providers, emphasizing the urgent need for language support (interpreters) in mental health services and the psychological distress among refugees.
  • Although not all institutions showed full understanding or interest in the topic, advocacy efforts helped raise awareness among key stakeholders and initiated discussions on potential policy changes.
  • The empirical data presented during meetings provided a strong foundation for evidence-based decision-making, which could lead to more effective integration policies and better mental health services for refugees in the future.

4. The Public

• Target Group: The general public, which includes Croatian citizens and other stakeholders.
• Outcomes:
  • The project utilized public communication (via radio shows, the organization''s website, and social media) to sensitize the public about the challenges faced by the most vulnerable members of society, particularly refugees experiencing mental health distress.
  • Efforts were made to avoid victimizing the refugees further in the eyes of the public, ensuring that communication was thoughtful and respectful.
  • The project also highlighted the struggles of refugees residing outside major metropolitan areas like Zagreb, helping to decentralize refugee support and raise awareness of regional disparities in access to services.

5. Civil Society Organizations (CSOs) in Croatia

• Target Group: Other CSOs that could benefit from the empirical data on refugee mental health.
• Outcomes:
  • The project facilitated the first empirical discussion on refugee mental health in Croatia, with civil society organizations engaging in data-driven dialogue at targeted meetings.
  • CSOs were able to use the research findings as a tool for advocacy and policy recommendations, ensuring the visibility of refugee mental health issues in broader societal conversations.

Impact Summary:

The project had a direct positive impact on refugees by providing them with psychosocial support and empowering them through participation in research. For the wider integration sector, it fostered improved collaboration and advocacy among civil society organizations and increased awareness within government institutions about the need for mental health services for refugees. The project also contributed to a more informed public dialogue about refugee integration and mental health, leading to a better understanding of the vulnerabilities faced by refugees in Croatia, especially in the aftermath of natural disasters and the ongoing pandemic.