In the Immigrant and Refugee Health Clinic at Boston Medical Center recently, we cared for a young woman from Eastern Africa who had been trafficked as a sex slave to Yemen before arriving in the US as a refugee. Now, she is grieving for her son, whom she fears will be trapped in Yemen.
Since President Trump’s immigration executive order was issued January 27, asylum seekers fleeing persecution are experiencing an unprecedented flare-up of PTSD symptoms ignited by the deep fear of uncertain futures, even with the travel ban now blocked by an appeals court. Some are afraid to come to the hospital for care and even staying away from schools. Their anxiety is exacerbated by reports of recent ICE immigration raids and political rhetoric that equates immigrants and refugees with criminals and terrorists.
Refugees, by definition, are already traumatized. Many suffer from physical injuries sustained during their arduous journey fleeing persecution. We know that about 30 percent of refugees suffer from post-traumatic stress and 30 percent from depression. Reports from Germany indicate that more than 50 percent of newly arrived refugees are experiencing serious mental health symptoms. Many are struggling with the loss of homeland, culture, and identity. They need our understanding and empathy.
As clinicians, we see the impact of the uncertainty and suffering that characterizes the experience of undocumented persons, asylum seekers, and refugees. We know the individual and societal effects of trauma are profound and reverberate through generations. We have collectively cared for thousands of refugees who have fled violence and torture in their homelands. Their injuries are compounded by marginalization in the US. The legal roller coaster of the past month has caused even more chaos, confusion, uncertainty, and fear.
The current outpouring of support in Boston is promising, but must be sustained once the dust settles over the legal wrangling. It is time for clinicians and community leaders alike to engage in thoughtful reflection and analysis on the refugee crisis and reclaim our ground as healers for those suffering. The current pandemonium cannot distract us from pursuing this goal.
Clinicians must insist that hospitals and clinics remain as safe spaces for immigrants and refugees to receive health care, without fear of having information turned over to immigration authorities or of being apprehended. Healing and rebuilding require a safe environment, which includes legal protection, stable housing, holistic health care based on trust and empathy, meaningful employment, and access to education. In the early stages of resettlement, newly arrived refugees may require intensive case management to help them acclimate to the new environment. Opportunities for cultural reciprocity, in the form of dialogue and artistic exchange with host communities, can also contribute to reducing stigma and building relationships.
We must remain focused on providing for the evolving needs of our immigrant and refugee patients in a challenging environment, and we must take individual responsibility to address our own anxiety in uncertain times. As healthcare professionals, we cannot be bystanders to human suffering in any form. Our moral imperative is to promote the well-being of all of our residents—no matter their place of birth or religion. That is who we are.
Sondra Crosby is an associate professor of public health and medicine and a physician with Boston Medical Center Immigrant and Refugee Health. Nisha Sajnani, an associate professor at Lesley University, co-authored this Viewpoint.