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.
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