Cheryl Robertson

Somali and Oromo Refugees: Correlates of Torture and Trauma History

OBJECTIVES This cross-sectional, community-based, epidemiological study characterized Somali and Ethiopian (Oromo) refugees in Minnesota to determine torture prevalence and associated problems. METHODS A comprehensive questionnaire was developed, then administered by trained ethnic interviewers to a nonprobability sample of 1134. Measures assessed torture techniques; traumatic events; and social, physical, and psychological problems, including posttraumatic stress symptoms. RESULTS Torture prevalence ranged from 25% to 69% by ethnicity and gender, higher than usually reported. Unexpectedly, women were tortured as often as men. Torture survivors had more health problems, including posttraumatic stress. CONCLUSIONS This study highlights the need to recognize torture in African refugees, especially women, identify indicators of posttraumatic stress in torture survivors, and provide additional resources to care for tortured refugees.

Sampling in difficult to access refugee and immigrant communities

We evaluated sampling strategies and trust-building activities in a large multiphase epidemiologic study of torture prevalence in populations that were difficult to locate and enroll. Refugee groups under study were Somalis from Somalia and Oromos from Ethiopia who were living in Minneapolis and St. Paul, Minnesota, in 1999–2002. Without a complete sampling frame from which to randomly recruit participants, we employed purposive sampling methods. Through comparative and statistical analyses, we found no apparent differences between our sample and the underlying population and discovered no effects of recruiting methods on study outcomes, suggesting that the sample could be analyzed with confidence. Ethnographic trust and rapport-building activities among investigators, field staff, and immigrant communities made it possible to obtain the sample and gather sensitive data. Maintaining a culture of trust was crucial in recovering from damaging environmental events that threatened data collection.

Community and family approaches to combating the radicalization and recruitment of Somali-American youth and young adults: A psychosocial perspective

Between late 2007 and autumn 2008, an estimated 18 or more Somali-American adolescent boys and young men living in the Minneapolis area secretly left their homes and flew to Somalia to join militant extremist training camps run by the Al Shabaab extremist organization. Political instability in Somalia, the 2006 Ethiopian invasion, social difficulties in US refugee communities, family instability, and local networks, all adeptly exploited by extremist recruiters, have together created contextual risks for violent radicalization amongst those Somalis resettled as refugees in the US as children and adolescents. While existing terrorism prevention efforts may interact with the community and family processes that influence radicalization and recruitment, the lack of adequate conceptualization of these processes poses a major challenge. In particular, it impedes progress in the development of prevention strategies. In this paper we examine the situation of Somalis in Minnesota from a psychosocial perspective. Specifically, we propose strategies derived from public health interventions for managing the risks of radicalization and recruitment by focusing on ways to enhance community and family protective resources for those at risk.

Evaluating Health Realization for Coping Among Refugee Women

Many East African refugee women have experienced torture and trauma while fleeing from their home countries. Many also experience high rates of isolation, depression, and symptoms of posttraumatic stress disorder after resettlement. Effective methods are needed for improving the mental well-being of this population. This pilot study (N = 19) tested the feasibility, accessibility, and acceptability of a strengths-based, community-delivered intervention with Somali and Ethiopian women refugees. Feasibility was established through recruitment, retention, participation, and participant response. Accessibility was established through providing meals, transportation, and child-care assistance. Acceptability was established through evaluating translated materials, cultural congruence, and perceived relevance. Results support testing in a full-scale controlled study.

A Theoretical Framework for Using Health Realization to Reduce Stress and Improve Coping in Refugee Communities

Refugees have faced extraordinarily stressful situations in their past, and many continue to experience stress daily as they cope with the refugee adjustment experience. A strengths-based, community-focused intervention known as Health Realization (HR) is a promising strategy for nurses to promote positive psychological outcomes in these populations. Although similar in some ways to cognitive therapy, the HR intervention emphasizes the role of thought versus the content of thought. It does not promote actively changing intrusive or negative thoughts but rather promotes an understanding that allows a degree of detachment from thoughts—a shift in consciousness that can provide relief and facilitate healing. An adapted stress and coping model provides a theoretical framework to test the effectiveness of using HR with refugees, which in turn provides a solid foundation for research that can support or refute the existing substantial anecdotal evidence for the use of this intervention in holistic nursing practice.

Modeling Psychological Functioning in Refugees

BACKGROUND: Refugee trauma survivors often experience posttraumatic stress disorder, other anxiety disorders, depression, and somatization. As a result, many suffer a disproportionate vulnerability to a variety of interpersonal, health, and social problems. OBJECTIVE: The study purpose was to develop a preliminary predictive model identifying high-risk refugee trauma survivors based on levels of trauma and psychological functioning. METHOD: A subset of 449 Somali and Oromo refugee trauma survivors was randomly selected from a larger study for secondary data analysis. Data from the PTSD Checklist–Civilian version, the Revised Hopkins Symptom Checklist, and the Sheehan Disability Inventory contributed to a psychological functioning score. A researcher-developed survey contributed to a composite trauma score. RESULTS: Predictors associated with functioning level differed by gender. Of interest, caring for children and increasing coping strategies were related to lower functioning in women. The regression relationship between trauma and functioning was linear in men but quadratic in women. CONCLUSION: Understanding the mechanisms linking trauma and function is implicated in the assessment of risk among trauma survivors. Predictive models inform the effective psychosocial interventions targeting those at greatest risk.

A systematic review of Karen refugee health

Purpose – The purpose of this paper is to provide a comprehensive perspective of the documented physical and mental health issues Karen refugees from Burma face as a result of war and refugee trauma, and migration. The review will address the question: What is the impact of trauma and migration on the physical and mental health of Karen refugees? Design/methodology/approach – A total of 18 articles were systematically selected for inclusion in the final review. The focal content for included articles includes qualitative and quantitative research representative of the health and migration experiences of Karen refugees. Findings – The findings of this review demonstrate significance for health providers from a public health standpoint as programs and services are targeted to meet the specific health needs of the Karen community. It also highlights the contribution of the Karen forced migration experience to the complexity of individual and community health needs, particularly as a result of the protracted ...

Conflict and forced displacement: human migration, human rights, and the science of health.

We do not know where the adage “the wars of the 20th century were fought over oil, but the wars of the 21st century will be fought over water” comes from. However, its relevance to today’s circumstance of conflict and scarcity of natural resources and the profound influence of these factors on human migration are undeniable. Moreover, although for a brief moment, the impact of these global circumstances did not appear to directly impact the universal human experience (at least not from the perspective of the global north), we now knowdifferently. Let us consider this awareness a call to action for nurse scientists to expand our discipline’s perspective on the science of health, in recognition of the ways the influence of policy, the state of environment, and the application of the human rights framework impress on the changing world. In particular, let us consider the ways these external issues contribute to health inequity; disparities; and the mental, physical, and psychosocial health consequences of forced migration. The forced migration of families and communities is a complex phenomenon, driven by armed conflict, climate change, the allocation of scare, nonrenewable natural resources, and shifting patterns in the politics of globalization. On June 14, 2014, World Refugee Day, the United Nations High Commission for Refugees reported that the number of refugees, asylum seekers, and internally displaced people worldwide has, for the first time in the post-World War II era, exceeded 50 million people. As of 2014, in Syria, over 6.5 million people are internally displaced by the civil war (meaning they have fled their homes to seek protection but have not fled their country as refugees). In Columbia, 5.7 million people are internally displaced because of the decadeslong conflict involving the international drug trade, political corruption, and armed resistance movements. In the Democratic Republic of Congo, nearly 3 million have been driven from their communities to escape the conflict caused by “Africa’s world war” only to be faced with profound levels of disease and malnutrition. In Sudan, 2.4 million remain homeless because of the flight from human rights atrocities that have taken place since the start of their civil war. In Iraq, in addition to the regional instability caused by the Syrian conflict, tens of thousands have urgently fled cities to escape gender-based and religious persecution. In Somalia, 1.1 million people remain displaced because of violence, drought, and

Physical Correlates of Torture Exposure in Karen Refugees

ABSTRACT We explored associations between torture history and physical health symptoms of 111 Karen refugees newly arrived to the United States. We conducted a retrospective cross-sectional analysis of electronic health data collected at the initial refugee health-screening exam. Unique to this analysis was the exploration of relationships between torture exposure, war trauma, and presenting physical and psychological health issues. We identified no unique effects of torture on physical health above and beyond trauma exposure. Overall, in our sample we found a high prevalence of underlying infectious conditions, pain, and hypercholesterolemia, regardless of torture exposure. We discuss effects of war trauma and torture experiences on physical exam findings and implications for future research.

Outcomes of Climate Change in a Marginalized Population: An Ethnography on the Turkana Pastoralists in Kenya

To its inhabitants, Turkana was once a land of abundance. This vital terrain was generous to its occupants 40 years ago; unfortunately, this setting has changed significantly. The climate has changed, and as a result, life has changed as well. Food insecurity, water scarcity, altered disease patterns, extreme weather events, displacement of communities, migration, population growth, and human conflict are among the previously reported effects of climate change on human health that we have witnessed and community members have shared.1,2 Some of these issues have surfaced in most of the northern part of Kenya and are currently being experienced by the Turkana community.3-5 Evidence supports the notion that underresourced communities, like pastoralists with limited livelihood alternatives, experience climate change disproportionately.2 This editorial reflects on our six-week period of data collection in Turkana County, Kenya. (Am J Public Health. Published online ahead of print October 26, 2017: e1-e2. doi:10.2105/AJPH.2017.304063).