Their resettlement, however, has not been without a new sort of trauma. According to a recent study by Paul L. Geltman, an assistant professor of pediatrics at Boston University School of Medicine, and colleagues, many of these young men have exhibited the behavioral and emotional distress associated with post-traumatic stress disorder (PTSD). The troubling findings are not without some promise, though, for they also indicate that future young refugees can thrive on all fronts if resettlement efforts take a comprehensive approach that includes greater family and community engagement augmented by innovative social service and health-care interventions.
The new study appears in the June issue of Archives of Pediatrics & Adolescent Medicine. It was funded by the Joel and Barbara Alpert Endowment for the Children of the City, Department of Pediatrics, Boston Medical Center.
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.
In undertaking the study, the researchers noted that 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. To determine whether such symptoms occurred among the "lost boys," the research team 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 youths who returned questionnaires, most had directly witnessed or were victims of war-related violence. Ninety-three percent reported that their villages had been attacked; many reported witnessing close friends or family members being tortured, injured or killed; 20 percent reported having been 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 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 team concludes. "The Sudanese minors seemed to function well in school and activities outside the home. 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."
According to the team, the findings 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.
Boston University School of Medicine, founded in 1848, is a leading academic and research institution, with an enrollment of nearly 1,000 students and more than 1,000 full-time faculty. Nationally renowned for its programs in heart disease, hypertension, stroke, pulmonary disease, arthritis, Alzheimer's disease, autism, alcoholism and drug addiction, among others, in the past year it ranked 13th among U.S. medical schools in total dollars of National Institutes of Health funding.
Note to Editors: The article is available online at www.archpediatrics.com (Arch. Pediatr. Adolesc. Med. 2005; 159:585–591).
Journal
Archives of Pediatrics and Adolescent Medicine