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Memories Torment War Refugees

by Catherine Gianaro


Twenty years after fleeing Guatemala's civil war, refugees still live in Mexican refugee camps. Their children drew pictures of the war's helicopter raids for a UGA study of the refugees' mental health. (Child's drawing courtesy of Miriam Sabin)

We heard a terrible noise. Large, dark things with moving arms were flying from the sky and killing everyone. We were screaming and running out of our homes. The helicopters started shooting. I took my children [and] ran to the river. I couldn’t swim. The current was strong. My baby slipped out of my arms. I lost her in the river. Every time I hear a noise in the sky today, my heart pounds. I feel that I am going to die. Sometimes I spend days in my house, too afraid to go outside. I can’t sleep. I don’t want to eat. I cry all the time.

— Excerpts from a Guatemalan refugee’s story told to UGA researchers

A generation after escaping Guatemala’s civil war, Maya refugees are still haunted by war’s heart-wrenching events and psychological aftershocks.

“The negative effects of trauma and living in refugee camps appear to be pervasive 20 years later,” Miriam Sabin said. “People cope as well as they can.”

The University of Georgia social work professor has led a study to assess levels of mental illness among Maya refugees and their need for mental health services.

The research team found that many Guatemalan refugees continue to experience psychiatric problems and that high rates of mental illness seriously affect their ability to integrate into new surroundings, Sabin said. The findings were published in the Journal of the American Medical Association last August.

Nearly 54 percent of the refugees in the study had elevated scores for anxiety symptoms, another 39 percent showed elevated symptoms of depression and nearly 12 percent exhibited clinical levels of post-traumatic stress disorder (PTSD).

The findings are “significant not only for people who work with refugees in Central America,” Sabin said, “but also for clinicians, physicians, social workers, educators and others, who need to have an idea what some of these risks to [refugees’] mental health are.”

Anxiety symptoms were associated with experiencing high numbers of traumatic events such as being wounded and witnessing a massacre.

People with PTSD were associated with having been close to death; witnessing a kidnapping and living with nine to 15 persons in the same home at the time of the survey. Lacking food during the flight to Mexico was found to be protective against PTSD.

Depression was associated with being a woman, being a widow, being married, experiencing between 13 and 19 traumatic events, and witnessing a kidnapping.

“A poor mental health status is making it more difficult for them to become productive members of the Mexican society,” said Larry Nackerud, interim dean of the UGA School of Social Work.

With the United Nations High Commissioner for Refugees (UNHCR) phasing out programs for these refugees, the study calls attention to a need for mental health assistance for these and the millions of other refugees worldwide.

“We think of refugees as living in developed nations, such as the U.S., but many of them are in the developing world,” Sabin said.

By 1984, 46,000 displaced Guatemalans were under UNHCR jurisdiction because of a civil war that erupted in 1961 and lasted until a 1996 peace accord. Many Guatemalans may have settled, undocumented, in the United States and Canada, but many fled to UNHCR camps in Mexico.

In November 2000, Sabin led a research team to Chiapas to interview Mayas who escaped to southern Mexico and were still living in refugee camps there. The team conducted survey questionnaires — in Spanish and in two Maya languages — of 179 people in five camps.

The team measured symptoms of anxiety and depression using the widely accepted Hopkins Symptoms Checklist. They determined PTSD using criteria from the Harvard Trauma Questionnaire, a survey used in refugee mental health studies worldwide that “allows for an epidemiologic analysis of risk factors associated with traumatic events and PTSD diagnosis,” Sabin said.

The researchers also recommended developing cost-effective, sustainable mental health programs, such as refugee-led groups and educational campaigns. Refugees, for example, could be taught how to run group discussions dealing with refugee life and other common issues.

Sabin, who regards good mental health as a basic human right, returned to Mexico in March 2001, to present the findings to the Mexican government’s Commission for the Assistance of Refugees and to the UNHCR.

Because refugees who return to some areas of Guatemala may face starvation, human rights issues and other severe economic and political challenges, the UNHCR funded Sabin to continue the study with refugees who have returned to their homeland.

So in May 2001, a research team, under Sabin’s supervision, traveled to Guatemala and repeated their surveys with repatriated refugees. Again, Sabin found high rates of mental illness, but even higher rates of depression than in Mexican refugees.

Sabin attributes higher depression levels to economic factors and the country’s instability. She said she hopes the weight of both studies will attract more attention to the plight of refugees. In the meantime, she has begun a pilot study, funded by a University of Georgia Research Foundation new faculty grant, of U.S. immigrants from Mexico and Central America. She is looking at their treatment-seeking behaviors at an Athens, Ga., health clinic.

“Poor mental health impacts [refugees’] ability to integrate in society,” she said, “whether they remain in the host country or return for repatriation.”


Research Communications, Office of the VP for Research, UGA
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