Work Package 1

Background

This work package identifies which elements of existing models for integrating displaced people into healthcare systems were applied in our protracted displacement contexts. This was done through systematic reviews of the literature on: (a) healthcare systems that seek to integrate displaced people and (b) the evolution of legal and regulatory frameworks for IDPs (in Eastern DRC and Somalia) and refugees (in Kenya and South Africa) so as to understand why they have hitherto been organised differently.

We evaluated the implications of recent international commitments such as Kenya’s implementation of a Comprehensive Response Framework, the Kampala Convention for IDPs in Africa, and other binding and non-binding agreements and guidelines brokered by regional bodies (African Union, WHO Afro) and sub- regional bodies (East African Community, SADC).

Semi-structured interviews were undertaken with key informants including policymakers identified via our network of partners – especially the Migration Health and Development Research Initiative and the Panzi Foundation and Mukwege Chairs networks associated with Nobel Peace prize winner Dr Dennis Mukwege.

Initial Findings

Mental health in relation to refugees and migrants in South Africa is understood primarily as trauma and sexual violence. This means that mental health that is layered (i.e., trauma experienced at all stages of migration); complex and, shaped by specific socio-cultural experiences is ignored.
Mental health challenges are determined by structural violence: Lack of documents, exclusion, poverty, poor access to housing, employment and support systems; discrimination, stigma and xenophobia; Violence within healthcare.
Mental health challenges for refugees and migrants are felt through the body: “The body knows the score”: Can be due to a lack or inability of language to express pain; Link between body and mind and somatic experiences; Visible/invisible pain.
Health care workers do not understand the needs of refugees and migrants: the system is over-whelmed and refugees and migrants with some of greatest mental health challenges are seen as a threat and burden to the system while also misunderstood. This is compounded by: A shortage of psychiatrists and psychologists and community-responses; Lack of understanding and compassion; Poor mental health literacy; HCW themselves struggling with mental health.
Services work but there is limited to no access to mental health care for refugees and migrants in South Africa: The mental healthcare system in South Africa is under-resourced, over-burdened and unable to respond to the needs of all and especially migrants.
Responses: “Plugging the gaps” and responding to immediate needs to reduce mental stress: In recognition of specific needs and challenges faced by refugees and migrants’ civil society create “parallel systems” to by-pass state services and reduce risks of stigma and discrimination; Recognition that responding to immediate needs ie no food, no rent money, access to schools etc. is the central response needed to reduce stress created by structural violence – this is the starting point.

Outputs

Online article: Behind the Masks: Mental Health, Marginalisation and COVID-19

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Op-Ed: Drones, dinghies and an army helicopter – why the state’s new toys won’t help South Africa’s response to Covid-19

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Blog post: “Your home is the place you can’t return to, and the place where you are doesn’t appear to want you”

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Article: “Let’s manage the stressor today” exploring the mental health response to forced migrants in Johannesburg, South Africa

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