Abstract
Introduction: This chapter explores the mental health and resilience of young women refugees in an urban context in Africa. We studied this topic within our research regarding “young African refugees in urban context: psychosocial, identity and resilience: Comparative research between Africa (Abidjan, Ivory-Coast, and Dakar-Senegal) and Europe (Geneva, Switzerland)” (We conducted the research, “Young African refugees in urban context”: psychosocial, identity and resilience: Comparative research between Africa (Abidjan, Ivory-Coast, and Dakar-Senegal) and Europe (Geneva, Switzerland) from 2011 to 2013. The research was supported by a grant from The Council for the Development of Social Science Research in Africa (Codesria—Dakar) and The Rectors’ Conference of the Swiss Universities of Applied Sciences for the financial support (Switzerland). Principal investigators are Théogène-octave Gakuba in Geneva, Mohamadaou Sall in Dakar, and Gilbert Fokou in Abidjan. Kouakou Christiane was research assistant in Abidjan. This research is not yet published).
Main Body: A review of literature, study methodology, and results is presented. The African sample consisted of 123 young people aged 18–30 years. To gather and analyse the data, we employed qualitative methods (semi-structured interviews with young refugees as well as with the healthcare professionals and social workers) and quantitative methods (physical and mental health questionnaires). The results indicate that a number of the young refugee women have mental health problems. These problems are related to their pre-migration experiences in their country of origin and the post-migration conditions they experience in the host country. More specifically, these problems are linked to poverty, problems of cultural adaptation, family separation, and sexual abuse. Some women have constant anxiety and psychological problems characterised by fatigue, sleep disturbances, headaches, and stomach pains.
Discussion: Most refugee women in Dakar and Abidjan are in a vulnerable situation, creating a negative impact on their mental health. They also have problems accessing health care.
Implications: We include recommendations for promoting integration of woman refugees in Dakar and Abidjan. Those programmes are of crucial importance within the integration process.
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Notes
- 1.
Cf. Mental health: a state of well-being, http://www.who.int/features/factfiles/mental_health/en/ , accessed on 09/5/2014.
- 2.
“Global valuation is defined as the prevailing societal-esteem of a particular cultural group; it entails how that group is judged by the post-migration society as well as levels of exposure to it (for example through mass media)” (Khanlou et al., 2008, p.497).
- 3.
Due to the smallness of the sample, although, we had in the crosstabs, some cells with counts of less than 5, we have used the chi square.
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The experience of the ASAPSU in the management of medical care of young refugees with mental health problems in Abidjan (Ivory Coast)
The Non-Governmental Organisation the Association de Soutien à l’Auto-Promotion sanitaire Urbaine (ASAPSU) was created May 19th, 1989 in the Ivory Coast. The ASAPSU is the organisation responsible for the medical management of urban refugees in Abidjan and the Ivory Coast. Within this mission, the ASAPSU organises healthcare for refugees; however, the association does not have sufficient infrastructure to adequately support the health of refugees. In this context, the ASAPSU has signed agreements with public and private health facilities. Thus, urban refugees in Abidjan in cases of sickness have an infrastructure to rely on for the following benefits:-
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Four community health centres
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A referral hospital: Hôpital Militaire d’Abidjan (HMA)
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Three University Hospitals (CHU) in Abidjan. These are the CHU of Cocody, Yopougon, and Treicheville
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An agreement with pharmacies to purchase drugs in Abidjan
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Medical support and pharmaceutical expenses covered for refugees between 80 % and 100 %, depending on the circumstances and vulnerabilities
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A medical team of three doctors and social services made up of three social workers from the ASAPSU in place to serve urban refugees who are or who become sick
However, it has been identified within this study how there is a lack of psychiatric and other mental health specialists within the teams implementing activities alongside the ASAPSU medical assistance which is in place to care and support urban refugees in Abidjan. In addition, there is no current activity regarding the development of programmes to promote positive mental health for refugees including urban refugees in Abidjan, within the UNHCR framework, and its implementing partners. The question may arise as to how the ASAPSU handles cases of mental health in general and in particular the poor mental health status of young female refugees.
As indicated above, the NGO in question lacks health specialists and an appropriate structure to support refugees with mental health problems. When there are cases of mental health issues, medical services delivered by the ASAPSU are able to transfer patients to specialised governmental institutions in Abidjan, the psychiatric hospital of Bingerville. Psychiatric services and care for the mentally ill are the responsibility of the National Institute Public Health (Institut National de Santé Publique—INSP) in Adjamé.
The procedures for the medical care of people with mental health issues are the same for all cases that occur and there is no difference in the case of young refugee women. However, on the level of standard operating procedures, the UNHCR requires a financial contribution from refugees of approximately 20 % for consultations and medical services; the remaining 80 % of the overall cost is covered by the UNHCR. This measure, however, does not apply to those with mental health problems. The fees for people with mental health problems are covered in their entirety, 100 % of any medical expenses. Social support (transport, food …) is also administered to the individuals with health issues by the ASAPSU.
Acknowledgements
We the researchers would like to express our gratitude to all the people and institutions that contributed to the realisation of this research.
Our thanks go out to:
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The Council for the Development of Social Science Research in Africa (Codesria), and The Rectors’ Conference of the Swiss Universities of Applied Sciences for the financial support
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The University of Applied Sciences of Western Switzerland (HES-SO), Haute Ecole de travail Social de Genève (High School of Social Work Geneva)
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The University Cheikh Anta Diop of Dakar and the Swiss Centre for Scientific Research in the Ivory Coast
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The young African Refugees in Abidjan and Dakar that have contributed with their life stories and actively participated in the research
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The professionals of many institutions who have agreed to participate in this research
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Gakuba, TO., Sall, M., Fokou, G., Kouakou, C., Amalaman, M., Kone, S. (2015). Mental Health and Resilience of Young African Women Refugees in Urban Context (Abidjan—Ivory Coast and Dakar—Senegal). In: Khanlou, N., Pilkington, F. (eds) Women's Mental Health. Advances in Mental Health and Addiction. Springer, Cham. https://doi.org/10.1007/978-3-319-17326-9_13
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