By Violet Ikong
People from conflict-torn regions of the world who flee their homes face numerous challenges as they rebuild their lives in new environments. Among the many issues they face, such as poverty, hunger, and homelessness, mental health is one of the most neglected, least talked about, and serious problems. The United Nations refugee agency (UNHCR) estimates that there are over 32.5 million refugees and 4.9 million asylum seekers in the world.
According to the American Psychiatric Association, one out of three asylum seekers or refugees suffers from depression, anxiety, and post-traumatic stress disorders. This is usually due to several reasons. First, most refugees live with memories of the war and conflict that they experienced in their respective countries. While escaping, they face numerous challenges, and even after they arrive at their new home, they suffer from poverty, hunger, and difficulties integrating into their new community. Depression and other mental health problems are common outcomes of these experiences and problems.
Globally, effective treatment coverage for those suffering from mental health conditions is extremely low, according to the World Health Organization (WHO). Many refugees struggle with undiagnosed mental health problems. Others who want mental health services lack access to them, and so are left with no choice but to try and manage their own depression. Others resort to suicide. A 2021 article in Oxford Textbook of Migrant Psychiatry revealed that suicidal behavior among refugees has a prevalence of 3.4% to 40%.
Integrating into a new community
When Raphael Akonkwa arrived in Uganda from the Democratic Republic of the Congo (DR Congo) in 2010, things were tough for him and his father. He could not get along easily with the new people he was living amongst in the Kyaka II refugee camp located in Western Uganda’s Kyegegwa District. Age 8 at the time, he couldn’t communicate with people there due to language and cultural differences, and he missed his family and friends back home. Above all, he missed DR Congo.
“I found myself in a new community where everything felt different, and the people spoke in languages I did not understand. Each time I heard them talking, I felt like they were talking about me and mocking me for being a refugee, so I began to judge myself and told myself that I was hopeless,” Akonkwa said.
He began to suffer from depression, which he battled until he was about 16 years old, and even though he tried to seek help, finding any was difficult. About 80% of refugee children around the world, ages 8 and under, suffer mental health problems including depression, anxiety, and behavioral problems.
Jerome Rwankuba, another refugee from DR Congo who also lives in a refugee camp in Uganda said, “I arrived here when I was 15, and it was hard adapting to everything that was going on. I felt like being alone and pushed myself away from everything – no friends, no connection, just me.”
Some refugees are temperamentally similar to Akonkwa, and continually seek help; others are more like Rwankuba, and refuse to tell anyone about their mental health issues. They prefer to deal with the issues alone.
“Depression doesn’t happen to a specific group of people; anyone can be affected. A lot of young people in refugee camps are victims of depression, but find it difficult to tell anyone,” Akonkwa said.
Why refugees are afraid to talk about their mental health
While Akonkwa was searching for help to improve his mental health, he realized it was, in effect, forbidden to talk about mental health and depression – and he understood there were many misconceptions, myths, and stigmas surrounding the topic.
One such very common misconception is that people with mental health issues are insane. Because of this, when refugees talk with others about the issues that affect their mental health, some people stigmatize them.
“The thought of being stigmatized makes them unable to tell anyone what they are going through. Staying silent is their way of defending themselves and ensuring that nobody judges them for having mental health issues,” said Rwankuba.
When he couldn’t get help from anyone, Akonkwa sought out ways to help himself. He started reading poems and listening to music, and according to him, these activities gave him relief and happiness.
The more he listened to music and read poems, the easier it was for him to express himself and talk about the issues that were affecting him without fear of stigma. So he decided he would start a group to help other young refugees like himself overcome depression and other mental health issues: “I wanted to build a platform where young refugees could socialize, learn, discuss mental health, and get help without fear of being stigmatized.”
Building a mental health safe space
In 2020, with the support of a few friends, Akonkwa founded Poetherapy, a youth-led mental health-focused group. Akonkwa and his friends started leading activities and projects to create awareness about mental health and encourage refugees to seek help for their mental health challenges.
The group runs its programs using three modules, or approaches. In the first module, the group organizes social events at which music, poetry, and comedy are used to entertain young people and create awareness about mental health. For the second module, Poethrapy visits schools and refugee learning centers to encourage mental health discussions and to teach students how and where to seek help.
The third module is where the actual intervention takes place. During this module, young refugees receive one-on-one counseling from experts. The counseling takes place both virtually and in person. So far, Poetherapy has connected over 100 refugees to online and in-person mental health experts. Since its founding, the group has also reached over 500 refugees in Uganda with talks and discussions on depression and mental health.
Rwankuba joined Poetherapy in 2020 and participated in the first and third modules of the group. Attending the music, comedy, and poetry events as well as connecting with other refugees who are members of the group helped him heal from the depression he had battled for about five years.
“It feels good hearing other refugees at Poetherapy share their stories and realizing that you’re not the only one with mental health issues,” he said. “I have learned from them that instead of worrying about the challenges we face as refugees, we should rather be thankful that we have a place to stay.”
The group carries out at least one activity every month under the first and second modules of the program, while the third module is always running. People can call and text at any time to get counseling services.
Even children need help
Of the various issues that Lyama Amadi witnessed during his first six years at the Kakuma refugee camp in Kenya, what worried him the most was how the environment could affect the mental health and development of children. Having experienced depression himself when he arrived at the camp, he thought of how much worse it could be for children.
“Most of the children were born here in the camp, while others came here as infants. They do not have access to education, and they miss out on fun things that children outside the camp do,” he said.
So Amadi started Tahirih Preschool in 2018 for children ages 2 to 6, to not only teach them to read and write, but also to engage them in fun activities that would help improve their mental health. Tahirih Preschool currently has over 250 kids in its art and gardening programs, which use fun activities to help the children stay happy. In the art program, the children learn to draw, paint, and design, while the gardening program teaches them to grow vegetables.
According to Amadi, “Teaching them art and gardening improves social and emotional learning and gives them hope, thereby reducing mental health issues.” The activities benefit not just the children, but also their parents. “The children teach gardening to their parents from the lessons they learn at school. Sometimes parents visit the school for meetings and they share ideas, build friendships, and are happy,” he said.
Hunger is a major problem for kids at the camp, so Amadi and his team give the children free lunch every day at school. The kids are excited by the free meals and, as a result, are always eager to go to school. Permaculture for Sustainable Communities, a nonprofit organization led by an Australian named Dave Harris, provides most of the financial support for Tahirih Preschool.
Despite the success of Poetherapy in improving the mental health of the children it serves, the program suffers from challenges. Finances are tight, and the organization does not yet have nonprofit status. Also, teachers and students at the school must walk long distances to get there because no school bus is available to transport them. The organization hopes to purchase a school bus in the future and build a better structure for the preschool, but this is not yet possible.
Akonkwa and Amadi
Poetherapy and Tahirih Preschool are both unique in that they were started by refugees living in a refugee camp, who had first-hand experience of what being displaced and depressed feels like. To reach either program founder, email: [email protected]
Violet Ikong is a freelance journalist based in Nigeria who reports on social issues in sub-Saharan Africa. Her stories have been published in Prime Progress and Nigeria Health Watch, in addition to Amjambo Africa.