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Despite recent worldwide migratory movements, there are only a few studies available that report robust epidemiological data on the mental health in recent refugee populations. In the present study, post-traumatic stress disorder (PTSD), depression and somatisation were assessed using an epidemiological approach in refugees who have recently arrived in Germany from different countries. The study was conducted in a reception facility for asylum-seekers in Leipzig, Germany. A total of 1316 adult individuals arrived at the facility during the survey period (May 2017-June 2018), 569 of whom took part in the study (N = 67 pilot study and N = 502 study sample; response rate 43.2%). The questionnaire (11 different languages) included sociodemographic and flight-related questions as well as standardised instruments for assessing PTSD (PCL-5), depression (PHQ-9) and somatisation (SSS-8). Unweighted and weighted prevalence rates of PTSD, depression and somatisation were presented stratified by sex and age groups. According to established cut-off scores, 49.7% of the respondents screened positive for at least one of the mental disorders investigated, with 31% suffering from somatisation, 21.7% from depression and 34.9% from PTSD; prevalence rates of major depression, other depressive syndromes and PTSD were calculated according to the DSM-5, which indicated rates of 10.3, 17.6 and 28.2%, respectively. The findings underline the dramatic mental health burden present among refugees and provide important information for health care planning. They also provide important information for health care systems and political authorities in receiving countries and strongly indicate the necessity of establishing early psychosocial support for refugees suffering from psychological distress.

Collectively, Ethiopians and Eritreans represent one of the largest African immigrant groups in the US, yet no research to date exists on families from these communities raising autistic children. The purpose of our study was to examine the experiences of Ethiopian and Eritrean families of autistic children including experiences (1) receiving the autism diagnosis and interacting with healthcare providers, (2) obtaining services and supports for children (including satisfaction with services and barriers to care), and (3) accessing services and supports for caregivers and families (including needs and barriers to care). Ethiopian and Eritrean parents ( N  = 51) raising autistic children in the US completed an online survey. Parents reported limited prior knowledge of autism within their communities and had varied experiences with healthcare providers through the diagnostic process. They endorsed barriers to accessing care for their child and family supports (such as provider shortages and cost of services), service needs, and dissatisfaction with school-based and behavioral supports. Many parents reported a negative impact on workforce participation in order to meet their child’s needs. Parents identified needs that would benefit their autistic children and families, such as accessible support groups to obtain relevant information. To our knowledge, this is the first systematic study exploring the experiences of Ethiopian and Eritrean families raising autistic children in the US. We discuss implications of our findings and recommendations for culturally responsive care.

Background Tailored and culturally appropriate latent tuberculosis (TB) infection screening and treatment programs, including interventions against TB stigma, are needed to reduce TB incidence in low TB incidence countries. However, we lack insights in stigma related to latent TB infection (LTBI) among target groups, such as asylum seekers and refugees. We therefore studied knowledge, attitudes, beliefs, and stigma associated with LTBI among Eritrean asylum seekers and refugees in the Netherlands. Methods We used convenience sampling to interview adult Eritrean asylum seekers and refugees: 26 semi-structured group interviews following TB and LTBI related health education and LTBI screening, and 31 semi-structured individual interviews with Eritreans during or after completion of LTBI treatment (November 2016–May 2018). We used a thematic analysis to identify, analyse and report patterns in the data. Results Despite TB/LTBI education, misconceptions embedded in cultural beliefs about TB transmission and prevention persisted. Fear of getting infected with TB was the cause of reported enacted (isolation and gossip) and anticipated (concealment of treatment and self-isolation) stigma by participants on LTBI treatment. Conclusion The inability to differentiate LTBI from TB disease and consequent fear of getting infected by persons with LTBI led to enacted and anticipated stigma comparable to stigma related to TB disease among Eritreans. Additional to continuous culturally sensitive education activities, TB prevention programs should implement evidence-based interventions reducing stigma at all phases in the LTBI screening and treatment cascade.

ObjectivesSexual health needs of young refugees and asylum-seeking men are seldom explored or addressed, adversely affecting their mental and physical well-being. By interviewing young male former unaccompanied minors, refugees and asylum seekers in Stockholm, Sweden, this study aimed to get a deeper understanding of what they needed to achieve a positive and respectful approach to sexuality, romantic and consensual relationships. Additionally, we explored how their sexual health needs were related to their mental health, as well as the factors influencing both.DesignAn exploratory qualitative study using semi-structured interviews was employed. Theoretical sampling was used for participant selection. Analysis of the data was performed using constructivist grounded theory.SettingThe study took place in Stockholm, Sweden.ParticipantsA total of 32 young male (aged 16-28) former unaccompanied minors, asylum seekers and refugees from Afghanistan, Eritrea and Syria were interviewed.ResultsOur analysis showed that our participants’ sexual and mental health needs followed a process of individual change. One core category described the different stages of the process: ‘On my way, but not there yet’. It contains four subcategories: ‘being on the move: the migration journey’; ‘newly arrived: contrasting old and new values and learning new concepts’; ‘navigating relationships, love and sex’; and ‘the respectful man’. We identified six key factors that influenced their sexual and mental health needs: attending school/receiving accurate sexual information, support to adapt, experiencing enjoyable relationships, restrictive parental values, exposure to stigma/discrimination and the negative image of young male refugees.ConclusionsThis study highlighted that the sexual health needs and related mental health aspects of young former unaccompanied minors, asylum seekers and refugees change over time and are influenced by contextual factors. Educational interventions aiming to improve the well-being of this population must address both sexual and mental health aspects, including issues related to gender norms, relationships, sex and consent.

ObjectivesThe study aimed to explore the experiences and perceptions of healthcare providers (HCPs) regarding the sexual and reproductive health (SRH) challenges of Eritrean refugee women in Ethiopia.DesignA qualitative exploratory design with the key informant approach.Setting and participantsThe study was conducted in the Afar regional state, North East, Ethiopia. The study participants were HCP responsible for providing SRH care for refugee women.ResultsEritrean refugee women have worse health outcomes than the host population. The SRH needs were found to be hindered at multiple layers of socioecological model (SEM). High turnover and shortage of HCP, restrictive laws, language issues, cultural inconsistencies and gender inequalities were among the main barriers reported. Complex multistructural factors are needed to improve SRH needs of Eritrean refugee women.ConclusionsA complex set of issues spanning individual needs, social norms, community resources, healthcare limitations and structural mismatches create significant barriers to fulfilling the SRH needs of Eritrean refugee women in Ethiopia. Factors like limited awareness, cultural taboos, lack of safe spaces, inadequate healthcare facilities and restrictive policies all contribute to the severe limitations on SRH services available in refugee settings. The overlap in findings underscores the importance of developing multilevel interventions that are culturally sensitive to the needs of refugee women across all SEM levels. A bilateral collaboration between Refugees and Returnees Service (RRS) structures and the Asayta district healthcare system is critically important.

ObjectiveThis study aimed at testing the significance of mediating and moderating roles of sense of coherence, adaptive coping styles and social support in the relationship between exposure to trauma and psychological symptoms in a refugee population in sub-Saharan Africa.MethodsA cross-sectional survey design was employed to collect data. The study was carried out in Mai Aini refugee camp in Ethiopia. A total of 562 adult Eritrean refugees aged 18–74 years were selected randomly to screen for depression and post-traumatic stress disorder (PTSD) symptoms and to examine associated factors. Data were collected using the premigration and postmigration living difficulties checklist, Center for Epidemiologic Studies Depression (CES-D) scale, Primary Care PTSD Screener, coping style scale, Sense of Coherence scale and Oslo Social Support scale. Path modelling was used to test the mediation and moderation effects of prespecified factors.ResultsPremigration living difficulties were associated directly with symptoms of PTSD (β=0.09, p<0.05), and associated indirectly with PTSD symptoms in paths through duration of stay in the camp, sense of coherence, postmigration living difficulties, task-oriented coping style and depressive symptoms (β=0.26, p<0.01). Premigration and postmigration living difficulties were associated directly with depressive symptoms with standardised estimate of β=0.35(p<0.001) and β=0.23(p<0.05), respectively. Postmigration living difficulties were associated indirectly with PTSD through paths of sense of coherence, task-oriented coping style and depressive symptoms (β=0.13; p<0.01). Social support moderated the effect of postmigration living difficulties on depressive symptoms (p<0.05). Emotion-oriented coping style moderated the effect of premigration threat for abuse on PTSD (β=−0.18, p<0.001) and depressive (β=−0.12, p<0.01) symptoms, as well as moderating threat to life on PTSD symptoms (β=−0.13, p<0.001).ConclusionsSense of coherence and task-oriented coping style showed a partial mediating effect on the association between exposure to trauma and symptoms of PTSD. An emotion-oriented coping style and social support moderated the effect of premigration and postmigration living difficulties, respectively. Fostering social support, task-oriented and emotion-oriented coping styles may be beneficial for these refugees.

Objectives: This study aims to compare obstetric outcomes between Eritrean and Swiss women in Switzerland, focusing on instrumental or surgical interventions and analgesia use.Methods: The study included data from 45,412 Swiss and 1,132 Eritrean women who gave birth in Swiss hospitals (2019–2022). Mixed-effects logistic regression was used to assess the effect of nationality on mode of delivery and analgesia use and multinomial mixed-effects logistic regression to assess the effect of nationality on mode of delivery in women intended for spontaneous vaginal delivery.Results: Compared with Swiss, Eritrean women had a lower rate of primary C-section (Adj. OR 0.73, 95% CI [0.60, 0.89]) but a higher risk of initially planned vaginal deliveries ending in emergency C-section (RRR 1.31, 95% CI [1.05, 1.63]). Eritrean women were less likely to receive epidural analgesia (Adj. OR 0.53, 95% CI [0.45, 0.62]) and more likely to not receive any analgesia (Adj. OR 1.73, 95% CI [1.52, 1.96]).Conclusion: This study reveals disparities in obstetric care, notably in higher emergency C-section rates and lower analgesia use among Eritrean women. For promoting equitable healthcare practices deeper understanding of obstetrics decision-making is needed.

Introduction Violence against women (VAW) is a manifestation of power relations. One in three women experience physical or sexual violence at least once globally. This concern poses a substantial barrier to accomplishing target 5.2 of the Sustainable Development Goals (SDGs) to eliminate all forms of VAW. This escalates in humanitarian crises settings. Despite the importance there is a dearth of evidence about VAW in refugee settings in Ethiopia. Methods A community-based cross-sectional study was conducted between March and August 2023 in Asayta, Ethiopia. The study population consisted of 867 women, including Eritrean refugees residing in Asayta camp and women from the surrounding Afar pastoralist host community. A multistage compact segmentation technique was employed to collect data. Logistic regression and latent class analysis (LCA) were used for advanced analysis. Results Overall, 231 (33%), or 1 out of 3 women ‘ever’ experienced physical or sexual violence. Married women (AOR = 19.80; 95% CI: 2.18, 166), age group 24–49 years (AOR = 4.0; 95% CI: 1.28 ,12.54), better women’s education (AOR = 2.89; 95% CI: 1.40, 5.96), contraceptive use (AOR = 2.17; 95% CI: 1.07–4.42), history of childhood abuse (AOR = 43; 95% CI: 19.24, 96.39) and husband’s substance use (khat) (AOR = 3.49 (2.09–5.87) were associated with an increased risk for VAW. On the other hand, better income (AOR = 0.35; 95% CI: 0.19, 0.67), being pregnant (AOR = 0.26; 95% CI: 0.14, 0.48) and access to referral services (AOR = 0.26; 95% CI: 0.11, 0.60) showed protective effect from VAW. The likelihood of VAW is found to be almost 15 times higher (AOR: 15.64, 95% CI: 1.52, 161) among women constituted in class seven (multiple violence group) of the LCA model. Conclusion VAW was found to be a prevalent problem among Eritrean refugee women in Asayta refugee camp, Ethiopia. Despite wide variations in the magnitude of the problem, risk exposures seem similar across studies. Women’s age, marital status, income level, history of childhood abuse, husband`s substance use and access to sexual and reproductive health (SRH) services, including contraceptive use—were strongly associated with VAW. Multi-level violence prevention programs are needed. These should focus on challenging harmful gender norms, preventing childhood abuse, empowering women economically and socially, and tailored community awareness about the link between substance use and VAW.

Background With more than 20,000 asylum seekers arriving every year, healthcare for this population has become an important issue. Pregnant asylum seekers seem to be at risk of poor pregnancy outcomes. This study aimed to assess the difference in pregnancy outcomes between asylum seekers and the local Dutch population and to identify potential substandard factors of care. Methods Using a retrospective study design we compared pregnancy outcomes of asylum-seeking and Dutch women who gave birth in a northern region of the Netherlands between January 2012 and December 2016. The following data were compared: perinatal mortality, maternal mortality, gestational age at delivery, preterm delivery, birth weight, small for gestational age children, APGAR score, intrauterine foetal death, mode of delivery and the need for pain medication. Cases of perinatal mortality in asylum seekers were reviewed for potential substandard factors. Results A total of 344 Asylum-seeking women and 2323 Dutch women were included. Asylum seekers had a higher rate of perinatal mortality (3.2% vs. 0.6%, p  = 0.000) including a higher rate of intrauterine foetal death (2.3% vs. 0.2%, p = 0.000), higher gestational age at birth (39 + 4 vs. 38 + 6 weeks, p  = 0.000), labour was less often induced (36.9 vs. 43.8, p  = 0.016), postnatal hospitalization was longer (2.24 vs. 1.72 days p  = 0.006) and they received more opioid analgesics (27.3% vs. 22%, p  = 0.029). Babies born from asylum-seeking women had lower birth weights (3265 vs. 3385 g, p  = 0.000) and were more often small for gestational age (13.9% vs. 8.4%, p  = 0.002). Multivariate analysis showed that the increased risk of perinatal mortality in asylum-seeking women was independent of parity, birth weight and gestational age at birth. Review of the perinatal mortality cases in asylum seekers revealed possible substandard factors, such as late initiation of antenatal care, missed appointments because of transportation problems, not recognising alarm symptoms, not knowing who to contact and transfer to other locations during pregnancy. Conclusion Pregnant asylum seekers have an increased risk of adverse pregnancy outcomes. More research is needed to identify which specific risk factors are involved in poor perinatal outcomes in asylum seekers and to identify strategies to improve perinatal care for this group of vulnerable women.

Bringing care to thousands of refugees in northern France comes with many challenges, as Richard Hurley reports. The charity Doctors of the World is well versed in helping the most vulnerable people in both developing and developed countries, which is why we’ve chosen it for The BMJ’s winter appeal this year. Please give generously