Skip to main content
View expanded cover

Violence and Mental Health pp 341–378Cite as

The New H5 Model of Refugee Trauma and Recovery

Abstract

Refugees and internally displaced persons remain high on the international priority agenda as a result of war, inter-ethnic conflict and other forms of violent conflict. 1.5 billion people live in countries affected by violent conflict with an estimated 40 % of post-conflict societies returning to conflict within 10 years. This chapter focuses on the health and mental health impact on the refugee experience. A new model of refugee care called the H 5 Model of Refugee Trauma and Recovery is presented. The centerpiece of this model is the appreciation of the traumatic life history of refugees and their communities including past, present and threatening future traumatic life events.

The five elements of the H 5 Model taken up in detail include: (1) Human Rights; (2) Humiliation; (3) Healing (self-care); (4) Health Promotion; (5) Habitat and Housing.

The cultural and scientific evidence behind this model is presented. This chapter lays out a roadmap for the implementation of a new approach to the recovery of refugee communities worldwide.

Keywords

  • Mental Health
  • Traumatic Experience
  • Refugee Camp
  • Refugee Community
  • Harvard Trauma Questionnaire

These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.

This is a preview of subscription content, access via your institution.

Chapter
USD   29.95
Price excludes VAT (USA)
  • DOI: 10.1007/978-94-017-8999-8_16
  • Chapter length: 38 pages
  • Instant PDF download
  • Readable on all devices
  • Own it forever
  • Exclusive offer for individuals only
  • Tax calculation will be finalised during checkout
eBook
USD   119.00
Price excludes VAT (USA)
  • ISBN: 978-94-017-8999-8
  • Instant PDF download
  • Readable on all devices
  • Own it forever
  • Exclusive offer for individuals only
  • Tax calculation will be finalised during checkout
Softcover Book
USD   159.00
Price excludes VAT (USA)
Hardcover Book
USD   169.99
Price excludes VAT (USA)
Learn about institutional subscriptions
Fig. 16.1
Fig. 16.2
Fig. 16.3
Fig. 16.4

References

  • Agyemang, C., Goosen, S., Anujuo, K., & Ogedegbe, G. (2011). Relationship between post-traumatic stress disorder and diabetes among 105 180 asylum seekers in the Netherlands. European Journal of Public Health, 22, 658–662.

    CrossRef  PubMed  Google Scholar 

  • Ahmad, A., Sofi, M. A., Sundelin-Wahlstein, V., et al. (2000). Posttraumatic stress disorder in children after the military operation “Anfal” in Iraqi Kurdistan. European Child and Adolescent Psychiatry, 9, 235–243.

    CrossRef  CAS  PubMed  Google Scholar 

  • Akinyemi, O. O., Owoaje, E. T., Ige, O. K., & Popoola, O. A. (2012). Comparative study of mental health and quality of life in long term refugees and host populations in Oru-Ijebu, Southwest Nigeria. BMC Research Notes, 5, 394. http://www.biomedcentral.com/176-0500/5/394.

    CrossRef  PubMed Central  PubMed  Google Scholar 

  • Al-Khatib, I., Arafat, R., & Musmar, M. (2005). Housing environment and women’s health in a Palestinian refugee camp. International Journal of Environmental Health Research, 15, 181–191.

    CrossRef  PubMed  Google Scholar 

  • Anda, R. (2006). The health and social impact of growing Up with adverse childhood experiences the human and economic costs of the status Quo.

    Google Scholar 

  • Anda, R. F., Brown, D. W., Felitti, V. J., Dube, S. R., & Giles, W. H. (2008a, June). Adverse childhood experiences and prescription drug use in a cohort study of adult HMO patients. BMC Public Health, 8.

    Google Scholar 

  • Anda, R. F., Brown, D. W., Dube, S. R., Bremner, J. D., Felitti, V. J., & Giles, W. H. (2008b, May). Adverse childhood experiences and chronic obstructive pulmonary disease in adults. American Journal of Preventive Medicine, 34, 396–403.

    Google Scholar 

  • Başoğlu, M., Livanou, M., & Crnobarić, C. (2007). Torture vs other cruel, inhuman, and degrading treatment: Is the distinction real or apparent? Archives of General Psychiatry, 64, 277–285.

    CrossRef  PubMed  Google Scholar 

  • Corcoran, C. B., Green, B. L., Goodman, L., & Krinsley, K. (2000). Conceptual and methodological issues in trauma history assessment. In R. Y. Shalev & A. McFarlane (Eds.), International handbook of human response to trauma. New York: Kluwer Academic/Plenum Publishers.

    Google Scholar 

  • Cromer, K. R., & Sachs-Ericsson, N. (2006). The association between childhood abuse, PTSD, and the occurrence of adult health problems: Moderation via current life stress. Journal of Traumatic Stress, 19, 967–971.

    CrossRef  PubMed  Google Scholar 

  • De Jong, J. P., Scholte, W. F., Koeter, M. W. J., & Hart, A. A. M. (2002). The prevalence of mental health problems in Rwandan and Burundese refugee camps. Acta Psychiatrica Scandinavica, 102, 171–177.

    CrossRef  Google Scholar 

  • de Paardekooper, B., Jong, J. T., & Hermanns, J. M. (1999). The psychosocial impact of war and the refugee situation on South Sudanese children in refugee camps in northern Uganda: An explorative study. Journal of Child Psychology and Psychiatry and Allied Disciplines, 40, 529–534.

    CrossRef  CAS  Google Scholar 

  • Del Gaizo, A. L., Elhai, J. D., & Weaver, L. T. (2011). Posttraumatic stress disorder, poor physical health and substance use behaviour in a national trauma-exposed sample. Psychiatry Research, 188, 390–395.

    CrossRef  PubMed  Google Scholar 

  • Ekblad, S., & Silove, D. (1998, August 18). Proposals for the development of mental health and psychosocial services in refugee camps (A UNHCR and WFMH Report). Geneva: UNHCR.

    Google Scholar 

  • Felitti, V., Anda, R., Nordenberg, D., et al. (1998). Relationship of childhood abuse and household dysfunction to many of the leading causes of death in adults: The Adverse Childhood Experiences (ACE) study. American Journal of Preventive Medicine, 14, 245–258.

    CrossRef  CAS  PubMed  Google Scholar 

  • Fisher, J., Cabral de Mello, M., Izutsu, T., Vijayakumar, L., Belfer, M., & Omigbodun, O. (2011). Adolescent mental health in resource-constrained settings: A review of the evidence of the nature, prevalence, and determinants of common mental health problems and their management in primary health care. International Journal of Social Psychiatry, 57, v–vii: 9–116.

    CrossRef  Google Scholar 

  • Frankenberger, T., & Maxwell, S. (1992). Household food security: Concepts, indicators, and measurements. UNICEF. www.ifad.org/gender/tools/hfs/hfspub_1.pdf

  • Giacama, R., Abu-Rmeileh, N., Husseini, A., Saab, H., & Boyce, W. (2007). Humiliation: The invisible trauma of war for Palestinian youth. Journal of the Royal Institute of Public Health, 121, 563–571.

    Google Scholar 

  • Global Trends 2011. (2012). http://www.unhcr.org/4fd688789.htm. Geneva: UNHCR

  • Green, B. L., & Kimerling, R. (2004). Trauma, posttraumatic stress disorder, and health status. In P. P. Schnurr & B. L. Green (Eds.), Trauma and health physical health consequences of exposure to extreme stress. Washington, DC: American Psychological Association.

    Google Scholar 

  • Hourani, L. L., Armenian, H. K., Zurayk, H., & Afifi, L. (1986). A population-based survey of loss and psychological distress during war. Social Science and Medicine, 23, 269–275.

    CrossRef  CAS  PubMed  Google Scholar 

  • Hussain, F., Anderson, M., Lopes Cardozo, B., Becknell, K., Blanton, C., Araki, D., & Kottegoda, V. E. (2011). Prevalence of war-related mental health conditions and association with displacement status in postwar Jaffna District, Sri Lanka. Journal of the American Medical Association, 306, 522–531.

    Google Scholar 

  • IASC Reference Group. (2010). Mental health and psychosocial support in humanitarian emergencies: What should humanitarian health actors know. Geneva: IASC.

    Google Scholar 

  • Janowski, K. (2012). PTSD and Physical Health. 2007 http://www.ptsd.va.gov/professional/pages/ptsd-physical-health.asp

  • Kamau, M., Silove, D., Steel, Z., Catanzaro, R., Bateman, C., & Ekblad, S. (2004). Psychiatric disorders in an African refugee camp. Intervention, 2, 84–89.

    Google Scholar 

  • Kim, G., Torbay, R., & Lawry, L. (2007). Basic health, women’s health and mental health among internally displaced persons in Nyala Province, South Darfur, Sudan. American Journal of Public Health, 97, 353–361.

    CrossRef  PubMed Central  PubMed  Google Scholar 

  • Kinzie, J. D., Riley, C., McFarland, B., et al. (2008). High prevalence of diabetes and hypertension among refugee psychiatric patients. The Journal of Nervous and Mental Disease, 196, 108–112.

    CrossRef  PubMed  Google Scholar 

  • Lopes Cardozo, B., Talley, L., Burton, A., & Crawford, C. (2004). Karenni refugees living in Thai-Burmese border camps: Traumatic experiences, mental health outcomes, and social functioning. Social Science & Medicine, 58, 2637–2644.

    CrossRef  Google Scholar 

  • Mollica, R. F. (2000). Invisible wounds special report: Waging a new kind of war. Scientific American, 282, 54–57.

    CrossRef  CAS  PubMed  Google Scholar 

  • Mollica, R. F. (2006). Healing invisible wounds: Paths to hope and discovery in a violent world. Orlando: F. Harcourt Press.

    Google Scholar 

  • Mollica, R. F., & Jalbert, R. R. (1989, February). Community of confinement: The mental health crisis in site two (Displaced persons camps on the Thai-Kampuchean border). Committee on refugees and migrants. The World Federation for Mental Health, Washington, DC.

    Google Scholar 

  • Mollica, R. F., Lavelle, J., Tor, S., & Elias, C. (1989b). Turning point in Khmer mental health: Immediate steps to resolve the mental health crisis in the Khmer border camps. Alexandria: The World Federation for Mental Health.

    Google Scholar 

  • Mollica, R. F., Donelena, K., Tor, S., et al. (1993). The effect of trauma and confinement on functional healing and mental health status of Cambodians living in Thailand-Cambodian border camps. JAMA, 270, 581–586.

    CrossRef  CAS  PubMed  Google Scholar 

  • Mollica, R. F., McKinnes, K., Poole, C., et al. (1998). Does effect relationships of trauma to symptoms of depression and post-traumatic stress disorder among Cambodian survivors of mass violence. British Journal of Psychiatry, 173, 482–488.

    CrossRef  CAS  PubMed  Google Scholar 

  • Mollica, R. F., Mcinnes, K., Sarajlic, N., Lavelle, J., Sarajlic, I., & Massagli, M. (1999). Disability associated with psychiatric comorbidity and health status in Bosnian refugees living in Croatia. Journal of the American Medical Association, 282, 433–9.

    CrossRef  CAS  PubMed  Google Scholar 

  • Mollica, R. F., Cui, X., McKinnes, K., & Massagli, M. (2002). Science-based policy for psychosocial interventions in refugee camps. A Cambodian example. The Journal of Nervous and Mental Disease, 190, 158–166.

    CrossRef  PubMed  Google Scholar 

  • Mollica, R. F., Lopes Cordozo, B., Osafsky, H. J., Raphael, B., Ager, A., & Salama, P. (2004). Mental health in complex emergencies. The Lancet, 364, 2058–67.

    CrossRef  CAS  Google Scholar 

  • Mollica, R. F., Lyoo, I. K., Chernoff, M. C., Bui, H. X., Yoon, S. J., et al. (2009). Brain structural abnormalities and mental health sequelae in South Vietnamese ex-political detainees who survived traumatic head injury and torture. Archives of General Psychiatry, 66, 1221–32.

    CrossRef  PubMed  Google Scholar 

  • Mollica, R. F., et al. (2011). Global mental health trauma and recovery: A companion guide for field and clinical care of traumatized people worldwide. Cambridge: HPRT.

    Google Scholar 

  • Mollica, R. F., Brooks, R., Tor, S., Lopes-Cardozo, B., & Silove, D. (2014). The enduring mental health impact of mass violence: A community comparison study of Cambodian civilians living in Cambodia and Thailand. International Journal of Social Psychiatry, 60, 6-20.

    Google Scholar 

  • Murthy, R. S., & Lakshminarayan, R. (2006). Mental health consequences of war: A brief review of research findings. World Psychiatry, 5, 1.

    Google Scholar 

  • Onyut, L. P., Neuner, F., Ertl, V., Schauer, E., Odenwald, M., & Elbert, T. (2009). Trauma, poverty, and mental health among Somali and Rwandese refugees living in an African refugee settlement-an epidemiological study. Conflict and Health, 3, 6. doi:10.1186/1752-1505-3-6.

    CrossRef  PubMed Central  PubMed  Google Scholar 

  • Petevi, M., & Kerko, H. (2011). Global mental health trauma and recovery: A companion guide for field and clinical care of traumatized people worldwide: Human rights health instruments. Cambridge: HPRT.

    Google Scholar 

  • Porter, M., & Haslam, N. (2005). Predisplacement and postdisplacement factors associated with mental health of refugees and internally displaced persons. Journal of the American Medical Association, 294, 602–12.

    CrossRef  CAS  PubMed  Google Scholar 

  • Priebe, S., Bogic, M., Ajdukovic, D., Franciskovic, T., Galeazzi, G. M., Kucukalic, A., Lecic-Tosevski, D., Morina, N., Popovski, M., Wang, D., & Schutzwohl, M. (2010). Mental disorders following war in the Balkans: A study in 5 countries. Archives of General Psychiatry, 67, 518–28.

    CrossRef  PubMed  Google Scholar 

  • Punamaki, R. L. (1990). Relationships between political violence and psychological responses among Palestinian women. Journal of Peace Research, 27, 75–85.

    CrossRef  Google Scholar 

  • Rahe, H. R., Looney, J. G., Ward, H. W., Tung, T. M., & Liu, W. (1978). Psychiatric consultation in a Vietnamese refugee camp. The American Journal of Psychiatry, 135, 185–190.

    CrossRef  CAS  PubMed  Google Scholar 

  • Roberts, B., Patel, P., & McKee, M. (2012). Noncommunicable disease and post-conflict countries. Bulletin World Health Organization, 90, 2–2A.

    CrossRef  Google Scholar 

  • Salama, P., Spiegel, P., Talley, L., & Waldman, R. (2004). Lessons learned from complex emergencies over past decade. Lancet, 364, 1801–1813.

    CrossRef  PubMed  Google Scholar 

  • Sameroff, A. J., & Rosenblum, K. L. (2006). In Sci ANYA (Ed.), Psychosocial constraints on the development of resilience (Annals of the New York Academy of Sciences, Vol. 1094, pp. 116–124). New York: New York Academy of Sciences.

    Google Scholar 

  • Sareen, J., Cox, B. J., Stein, M. B., Afifi, T. O., Fleet, C., & Asmundson, G. J. G. (2007). Physical and mental comorbidity, disability, and suicidal behavior associate with posttraumatic stress disorder in a large community sample. Psychosomatic Medicine, 69, 242–248.

    CrossRef  PubMed  Google Scholar 

  • Silove, S., & Rees, S. (2011). Global mental health trauma and recovery: A companion guide for field and clinical care of traumatized people worldwide: Planning community mental health services. Cambridge: HPRT.

    Google Scholar 

  • Sledjeski, E. M., Speisman, B., & Dierker, L. C. (2008). Does number of lifetime traumas explain the relationships between PTSD and chronic medical conditions? Answers from the National Comorbidity Survey-Replication (NCS-R). Journal of Behavioral Medicine, 31, 341–349.

    CrossRef  PubMed Central  PubMed  Google Scholar 

  • Sphere Project. (2011). Sphere handbooks: Standard on mental health.

    Google Scholar 

  • Spiegal, P. B., Checchi, F., Colombo, S., & Paik, E. (2010). Health-care needs of people affected by conflict: Future trends and changing frameworks. Lancet, 375, 341–345.

    CrossRef  Google Scholar 

  • Spitzer, C., Barnow, S., Volzke, H., John, U., Freyberger, H. J., & Grabe, H. J. (2009). Trauma, posttraumatic stress disorder, and physical illness: Findings from the general population. Psychosomatic Medicine, 71, 1012–1017.

    CrossRef  PubMed  Google Scholar 

  • Steel, Z., Chey, T., Silove, D., Marnane, C., Bryant, R. A., & van Ommeren, M. (2009). Association of torture and other potentially traumatic events with mental health outcomes among populations exposed to mass conflict and displacement: A systematic review and meta-analysis. Journal of the American Medical Association, 302, 537–549.

    CrossRef  CAS  PubMed  Google Scholar 

  • Summerfield, D. (1999). A critique of seven assumptions behind psychological trauma programmes in war-affected areas. Social Science & Medicine, 48, 1449–1462.

    CrossRef  CAS  Google Scholar 

  • Tang, S., & Fox, S. (2001). Traumatic experiences and the mental health of Senegalese refugees. Journal of Nervous and Mental Disease, 189, 507–512.

    CrossRef  CAS  PubMed  Google Scholar 

  • Van Ommeren, M., Sharma, B., Sharma, G. K., Komproe, I., Cardena, E., & de Jong, J. V. M. (2002). The relationship between somatic and PTSD symptoms among Bhutanese refugee torture survivors: Examination of comorbidity with anxiety and depression. Journal of Traumatic Stress, 15, 415–421.

    CrossRef  PubMed  Google Scholar 

  • World Bank. (2012). Issues brief: Fragile and Conflict Affected Situation (CAS)

    Google Scholar 

  • World Health Organization, & UNHCR. (2012). Assessing mental health and psychosocial needs and resources: Toolkit for humanitarian settings. Geneva: World Health Organization.

    Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Harvard Program in Refugee Trauma (HRPT), Massachusetts General Hospital and Harvard Medical School, Cambridge, USA

    Richard F. Mollica

  2. Australian Aboriginal and Torres, Islander Healing Foundation, Canberra, Australia

    Robert T. Brooks

  3. School of Psychology, University of New South Wales, Sydney, Australia

    Robert T. Brooks

  4. Trauma and Recovery Certificate Program, Harvard Program in Refugee (HRPT) Trauma, Cambridge, USA

    Robert T. Brooks

  5. Department of Learning, Informatics, Management and Ethics (LIME), Cultural Medicine Unit, Karolinska Institutet, Stockholm, Sweden

    Solvig Ekblad

  6. Massachusetts School of Professional Psychology, Newton, MA, USA

    Solvig Ekblad

  7. Harvard Program in Refugee Trauma (HRTP), Cambridge, MA, USA

    Solvig Ekblad

  8. World Bank, Washington, D.C., USA

    Laura McDonald

Authors
  1. Richard F. Mollica
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Robert T. Brooks
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Solvig Ekblad
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Laura McDonald
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Richard F. Mollica .

Editor information

Editors and Affiliations

  1. University of Emden, Emden, Germany

    Jutta Lindert

  2. University of Haifa, Haifa, Israel

    Itzhak Levav

Rights and permissions

Reprints and Permissions

Copyright information

© 2015 Springer Science+Business Media Dordrecht

About this chapter

Cite this chapter

Mollica, R.F., Brooks, R.T., Ekblad, S., McDonald, L. (2015). The New H5 Model of Refugee Trauma and Recovery. In: Lindert, J., Levav, I. (eds) Violence and Mental Health. Springer, Dordrecht. https://doi.org/10.1007/978-94-017-8999-8_16

Download citation

  • DOI: https://doi.org/10.1007/978-94-017-8999-8_16

  • Published:

  • Publisher Name: Springer, Dordrecht

  • Print ISBN: 978-94-017-8998-1

  • Online ISBN: 978-94-017-8999-8

  • eBook Packages: MedicineMedicine (R0)