Refugee children who are not accompanied by parents or family members when resettled in other countries seem to be at particularly high risk for symptoms of emotional distress related to their experiences with violence, according to background information in the article. In 2000, the U.S. began the resettlement of unaccompanied minors from a Kenyan refugee camp, a group called the "Lost Boys of Sudan" by the news media. As very young children in the Sudan in the 1980s, they had been forced to flee their burning villages as their parents and families were often killed. Seeking shelter in Ethiopia, an estimated 25,000 children trekked hundreds of miles across the savannah and desert, stalked by hyenas and lions. Expelled by force from Ethiopia in 1991, they fled to Kenya, fording rivers in which many drowned or were killed by crocodiles.
Paul L. Geltman, M.D., of Boston University School of Medicine, and colleagues assessed the functional and behavioral health of the unaccompanied Sudanese refugee minors approximately one year after resettlement in the United States. A sample of the refugees in foster care were interviewed using questionnaires, adapted from standardized questionnaires using feedback from foster parents, resettlement program staff and the children themselves, to assess trauma, coping and quality of life.
Of the 304 individuals who returned questionnaires, most had directly witnessed or were victims of war-related violence. Ninety-three percent of the youths reported that their villages had been attacked; many reported witnessing close friends or family members being tortured, injured or killed; 20 percent reported being tortured themselves. Although many of the children said they were at least a little comfortable with U.S. society and culture in general, many also expressed a desire for more detailed and ongoing orientation in social and cultural issues both before and after coming to the U.S.
The youths scored well on measures related to functioning at school and with peers. They tended to score less well on measures of general and mental health, family activities and family cohesion. A number of factors were associated with increased risk of post-traumatic stress disorder (PTSD) in the youths, including separation from immediate family, direct personal injury and head trauma. Experiences in the U.S. that increased risk of post-traumatic stress disorder included living in a group home or being in foster care alone with an American family, feeling lonely or isolated and less participation in group activities. Feeling safe at home and at school reduced the risk of post-traumatic stress disorder. "This suggests that relative levels of family and community engagement after arriving in the United States may mediate the ultimate impact of early trauma on later psychosocial functioning," the authors write.
"The Sudanese minors seemed to function well in school and activities outside the home," the authors conclude. "However, problems emerge in their home lives and emotional states, as evidenced by low scores on the CHQ [Child Health Questionnaire] family and mental health subscales. This finding suggests that the criteria used to assess the 'success' of resettlement programs should include broader measures of household or family life and emotional well-being. In this manner, the findings of this study outline not only the promise and challenges of resettling refugee children but also the important opportunities for innovative social service and health care interventions. As such, a comprehensive approach could help ensure that future cohorts of unaccompanied refugee minors in the United States will reach their full psychological and physical potential to live full and vibrant lives."
(Arch Pediatr Adolesc Med. 2005; 159:585-591. Available post-embargo at www.archpediatrics.com.)
Editor's Note: This study was funded by the Joel and Barbara Alpert Endowment for the Children of the City, Department of Pediatrics, Boston Medical Center, Boston.
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Journal
Archives of Pediatrics and Adolescent Medicine