ORIGINAL RESEARCHHealth status of returnees to Kosovo: Do living conditions during asylum make a difference?
Introduction
Organized political violence in the 20th Century has primarily affected civilian populations,1 and it is estimated that nearly one-hundredth of the world's population has been displaced because of war or political unrest.2
Most studies on the health of people affected by war have focused on the impact of traumatic events before or during flight.3 Fewer have assessed the health of refugees living in host countries4, 5 or the health of populations in countries after the end of a conflict.6, 7, 8, 9 Few studies have explored the impact of living conditions during asylum, such as unemployment, lack of social support and policies of deterrence on health.4, 10, 11, 12, 13, 14, 15, 16, 17, 18 The possible long-term impact of conditions during asylum, after refugees have returned to their country of origin, is virtually unexplored.19, 20, 21
The present study was conducted to explore the associations between living conditions during asylum in Switzerland and the subjective health of returnees to Kosovo, differentiating between those with and those without post-traumatic stress disorder (PTSD).
Section snippets
Setting
The suppression of the autonomy of Kosovo in 1989 and the following repression resulted in the largest forced movement of people in Europe since World War II,22, 23 with over one million people displaced from their homes.
By the end of 1999, there were 60 000 asylum seekers from Kosovo in Switzerland, and, in March 1999, the Kosovar community had become the second largest immigrant group in Switzerland, numbering over 200 000 or one-tenth of the former population of Kosovo.24 Soon after the
Results
Interviewers located 94% (n=319) of selected households and interviewed 580 eligible subjects who had returned from exile in Switzerland. Table 1 describes the demographic and social characteristics of study participants, as well as self-reported chronic conditions or disabilities in people with or without PTSD.
Living conditions during asylum in Switzerland according to the presence or absence of PTSD are described in Table 2. Only 18 people in the study sample obtained regular employment and
General situation of returnees
Two years after the end of hostilities and many months after return from asylum, the sample of ethnic Albanian returnees from Switzerland were living in conditions of great poverty, reported a high rate of chronic conditions, showed a high prevalence of PTSD (for comparison, PTSD has a prevalence of 8% in the general US population9), and showed poor scores for subjective mental health. Furthermore, almost one-third reported a deterioration in their health in the year preceding the interview.
Limitations and strengths of the study
This study had the following limitations. As it was a cross-sectional survey, the observed relationships between variables were descriptive not causal. Information on non-responders was not collected, although 94% of the households participated. Some relevant data could not be collected reliably, such as the change in socio-economic status from the prewar situation. Although a broad range of factors related to conditions in Switzerland was assessed, many other factors were not assessed, such as
Conclusions
These results show that poor health, particularly mental health, among people affected by war and returning from asylum may be durable. Thus, the emerging healthcare system in war-devastated countries needs to address the burden of chronic illness beyond the phase of emergency.56
Clinical treatment of large numbers of asylum seekers with PTSD is presently hampered by the absence of evidence-based, short-term, low-cost treatment strategies.57, 58 This study suggests that people with PTSD and poor
Acknowledgements
This study was sponsored by the Geneva Foundation to Protect Health in War and the Humanitarian Fund of the Geneva University Hospitals.
References (59)
Emerging paradigms in the mental health care of refugees
Soc Sci Med
(2001)- et al.
Prevalence of subthreshold forms of psychiatric disorders in persons making suicide attempts in Hungary
Eur Psychiatry
(2000) Ethics of research in refugee populations
Lancet
(2001)- et al.
Long-term effect of psychological trauma on the mental health of Vietnamese refugees resettled in Australia: a population-based study
Lancet
(2002) War, a major health determinant
Soz Praventivmed
(2001)- et al.
Forced displacement in Yugoslavia: a meta-analysis of psychological consequences and their moderators
J Trauma Stress
(2001) - et al.
Trauma exposure, postmigration stressors, and symptoms of anxiety, depression and post-traumatic stress in Tamil asylum-seekers: comparison with refugees and immigrants
Acta Psychiatr Scand
(1998) - et al.
The dose–effect relationships between torture and psychiatric symptoms in Vietnamese ex-political detainees and a comparison group
J Nerv Ment Dis
(1998) - et al.
Mental health, social functioning, and attitudes of Kosovar Albanians following the war in Kosovo
JAMA
(2000) - et al.
Predictors of hostility in a group of relocated refugees
Cult Divers Ment Health
(1997)
Mental health and nutritional status among the adult Serbian minority in Kosovo
JAMA
Lifetime events and posttraumatic stress disorder in 4 postconflict settings
JAMA
Policies of deterrence and the mental health of asylum seekers
JAMA
The relationship between post-traumatic symptoms and life in exile in a clinical group of refugees from the former Yugoslavia
Acta Psychiatr Scand
Compounding of premigration trauma and postmigration stress in asylum seekers
J Psychol
Anxiety, depression and PTSD in asylum-seekers: assocations with pre-migration trauma and post-migration stressors
Br J Psychiatry
Pathways from war trauma to posttraumatic stress symptoms among Tamil asylum seekers, refugees, and immigrants
J Trauma Stress
A 3-year follow-up study of psychosocial functioning and general symptoms in settled refugees
Acta Psychiatr Scand
Health needs of asylum seekers and refugees
BMJ
Mental health and health-related quality of life among adult Latino primary care patients living in the United States with previous exposure to political violence
JAMA
Profiling the trauma related symptoms of Bosnian refugees who have not sought mental health services
J Nerv Ment Dis
Migration and health. A study of Latin American refugees, their exile in Sweden and repatriation
Scand J Prim Health Care
The influence of exile and repatriation on mental and physical health. A population-based study
Soc Psychiatry Psychiatr Epidemiol
Psychological sequelae of torture and organised violence suffered by refugees from Iraq. Trauma-related factors compared with social factors in exile
Br J Psychiatry
International Organization for Migration: experience on the need for medical evacuation of refugees during the Kosovo crisis in 1999
Croat Med J
Unpublished reports and personal communcations
Cited by (22)
A qualitative study into the reintegration of vulnerable migrant children and families after return to Kosovo: Findings from a follow-up
2021, Children and Youth Services ReviewCitation Excerpt :Difficulties related to health, feelings of belonging, education, language, friendships and acceptance by peers were also identified in previous studies about children’s return experiences (Bonhage-Talsma et al., 2020; Hasanović et al., 2005; Kienzler et al., 2019; Lie, 2004; Vathi & Duci, 2016). As corroborated by other studies about adult returnees (Toscani et al., 2007; Von Lersner, Elbert, & Neuner, 2008), poverty-related difficulties are a significant determinant of how returnees fare. Returnees often sell all their property and belongings to pay for their migration and their social networks may be weakened due to their stay abroad (Ruben, Van Houte, & Davids, 2009).
A mixed methods systematic review of studies examining the relationship between housing and health for people from refugee and asylum seeking backgrounds
2018, Social Science and MedicineCitation Excerpt :Studies that focused on migrants only were excluded, as were studies that referred to “migrants” or “immigrants” but did not provide sufficient information to ascertain whether any participants had refugee or asylum-seeking backgrounds. Studies which included refugees or asylum seekers amongst other populations (such as children of refugees or other migrants) but did not disaggregate the data (e.g., (Sabin et al., 2003; Toscani et al., 2007)) were also excluded, as were those looking only at internally displaced populations. All study designs were included, encompassing both qualitative, quantitative and mixed-methods designs.
Post-traumatic stress disorder in internally displaced people of Colombia: An ecological study
2017, Travel Medicine and Infectious DiseaseCitation Excerpt :Several world-wide populations, chronically and directly exposed to armed conflicts have been studied in recent years. Inhabitants of Kosovo, Southeastern Europe, long time later after being exposed to war and displaced as refugees to Switzerland, showed different degrees of mental illness, with high incidence of chronic PTSD [8]. Effects of murder and forced population displacement in northern Uganda have evidenced trauma and somatization in this community, with a rising of anger, leading to changes in social and cultural norms, such as increased “adultery”, “defilement”, and “thieving” [5,7].
How Stress, Trauma, and Emotion May Shape Post-Conflict Environments–with Implications for International Peacekeeping
2024, International PeacekeepingReturn migration and psychosocial wellbeing
2022, Handbook of Return MigrationThe impact of housing on refugees: an evidence synthesis
2022, Housing Studies