Opinion: we need to allocate more resources to deal with the mental health needs of the 50 million refugee and migrant children worldwide

By Maria Gialama and Sinéad McGilloway, Maynooth University

"We're now refugees. People don't like us. No one is loyal, everyone lies. I was a kid before. I am older now. I know more." (Rawan, aged 12, who had to flee from Aleppo in Syria)

According to the 2017 statistics from UNICEF, 50 million children around the world have been forced to flee their homes, more than half of whom do so due to conflict and violenceA recent United Nations High Commissioner for Refugees (UNHCR) report indicates that children under 18 account for 52 percent of the refugee/migrant population worldwide, 7.4 million of whom are of school-going age.  

Up to 92 percent of these children have travelled to Europe alone, separated from their parents and other family members. Typically, they have fled their homes in countries such as Syria, Afghanistan, Iraq, Somalia and Sudan to escape war, armed conflict, persecution, population displacement, human rights violations, violence, abuse and extreme poverty.

Childhood has long been considered to be the most important period of human development. During this time, children develop not only physically, but also psychologically, emotionally and socially in order to (hopefully) achieve their full potential. However, we know from a substantial body of literature, that there are many factors that interrupt a child’s developmental trajectory including, in particular, adverse childhood experiences (or ACEs), which include abuse, neglect, trauma and family dysfunction. These have attracted considerable research attention in recent years, not least because of their negative impact on both physical and mental health in the short and longer term.

"Childhood has long been considered to be the most important period of human development"

Hundreds of thousands of refugee and migrant children have experienced often multiple ACEs, including trauma, extreme violence and abuse (physical, psychological and sexual), prior to their departure from their home countries. This often continues during their long and arduous journeys to, and upon arrival in, host countries, such as Greece, Italy, Spain and Bulgaria. The vast majority have been exposed to armed conflict which has left many psychologically scarred with high levels of Post-Traumatic Stress Disorder, depression and anxiety; if left untreated, these can lead to the development of more severe and persistent psychopathology into adolescence and adulthood. 

These kinds of problems tend to be especially prevalent amongst children who are unaccompanied by an adult carer and separated from their parents/families. In 2017, the proportion of children arriving alone to Europe increased by 31 percent. Unaccompanied minors (UAMs) or Unaccompanied or Separated Children (UASC), as they are called, are considered to be the most vulnerable group of all.

The reality on the ground – and one that we have witnessed first-hand in Lesvos in Greece - is the marked lack, or total absence, of mental health support

These children live with the additional uncertainty and often unbearable stress of not knowing where their parents or other family members might be and whether they are alive or dead. This uncertainty, coupled with a desire for self-protection in the absence of their parents/ adult caregivers, can increase feelings of loneliness, depression and desperation.  As a result, many children withdraw from daily life - alienated, apathetic and missing out on the effect of social interaction, not to mention the lack of a nurturing, safe and secure environment. Other children express their emotions by "acting out" and may become verbally and/or physically aggressive toward others (e.g. other children/ staff) whilst sometimes engaging in (or experiencing thoughts of) self-harm or even attempting suicide.  

Recently, The Guardian reported that 3,000 minors are living in Moria camp (the Reception and Identification Centre) on the island of Lesvos in Greece. Reassuringly, a recent report from the International Rescue Committee makes a number of useful recommendations to improve the mental health of all refugees/migrants in the Moria campbut it remains to be seen if these will be implemented. 

The Moria camp on the island of Lesvos in Greece

The refugee crisis is arguably the greatest humanitarian crisis of our time. It means many children find themselves living in inhumane conditions in temporary accommodation with only limited or no access to basic facilities, health services and education, thereby negatively influencing their emotional and psychosocial well-being and development.

The reality on the ground – and one that we have witnessed first-hand in Lesvos in Greece - is the marked lack, or total absence, of mental health support. This may be borne out of a need to prioritise the most basic physical, housing and, where possible, education needs of these children. But at the same time, there can be no justification for neglecting, intentionally or otherwise, their often invisible and very pressing mental health needs.

Having said that, the myriad ACEs to which these children are exposed, present significant challenges for NGOs and frontline humanitarian aid workers in terms of how best to identify and tackle their mental health and well-being needs, often within limited resources, and in the context of little staff training or support.  A recent rapid systematic review suggests that a small number of interventions have been used to successfully meet the mental health needs of child refugee and asylum seekers in Europe. However, research in this field is still very much in its infancy and much more high quality research is urgently needed.

These children live with the additional uncertainty and stress of not knowing where their parents or other family members might be and whether they are alive or dead

Given the heterogeneous nature of this population, mental health difficulties need to be addressed in culturally appropriate, multi-level and non-stigmatising ways. This needs to take historical and pre-existing factors into account, as well as the here-and-now difficulties that often occur as a result of displacement and the re-traumatisation of adapting to different cultural contexts. The lack of staff training and support and the high rates of staff turnover further serve to exacerbate the problem, leading to low levels of care continuity and a potentially catastrophic mental health systems failure.

On World Children’s Day, we should spare a thought for one of the most disadvantaged and vulnerable groups of children in the world. The transition from ill-being to well-being requires collective efforts and let’s not forget that governments have a legal obligation under the United Nations Convention on the Rights of the Child to protect and safeguard all of our children. Social scientists in collaboration with community partners and practitioners are ideally placed to help develop, implement and test appropriate, timely and effective mental health solutions and interventions for refugee and migrant children. But financial support/resources, a collective will, meaningful engagement and creative thinking/approaches are required to make that happen. Carpe diem!

Maria Gialama is a practising psychologist and PhD student/researcher in the Centre for Mental Health and Community Research at the Department of Psychology and Social Sciences Institute at Maynooth UniversityProfessor Sinead McGilloway is a founding director of the Centre for Mental Health and Community Research at the Department of Psychology and Social Sciences Institute at Maynooth University

The views expressed here are those of the author and do not represent or reflect the views of RTÉ