Beyond Hijrah (هِجْرَة ): perspectives on resettlement, health and quality of life for Afghan and Kurdish refugees in Christchurch and Perth

Worldwide, conflict situations and the resultant number of refugees continue to increase, with over 43 million recorded at the end of 2009. Nearly half of those currently under the protection of the United Nations High Commissioner for Refugees (UNHCR) originally came from Iraq or Afghanistan. Although less than 1% will eventually be resettled in new host nations, their long term health and settlement prospects are a matter of continuing relevance. Since 2000, Australia alone has accepted over 58,000 Afghan refugees, with more than 5000 resettled in New Zealand. Although refugees accepted under humanitarian programs receive state support frequently denied to asylum seekers, they are still vulnerable to acculturative stress. Public attitudes and government policies to immigration in receiving countries inevitably play an important role in resettlement outcomes.The overall aim of this research project was to examine the resettlement experiences of refugees settled in Australia and New Zealand, taking into consideration the different policy and social setting in each location. A mixed methods approach was adopted for this exploratory study, utilising both qualitative and quantitative methods to investigate the social and political environment surrounding refugee issues in the public sphere, as well as assessing the health and wellbeing of former refugee participants.A comparative study of newspaper reporting of refugee issues was conducted to monitor trends in reporting over time, to assess public attitudes in each location, and provide background context to the main study findings. This media study provided insights into the politics of the refugee debate and policy environment in New Zealand and Australia, revealing significant differences in the way refugee issues are portrayed by the media in each location. Compared to New Zealand, newspaper articles in Australia were more politicised, and less likely to portray refugees in a positive manner. Since 2001, political attitudes to asylum seekers hardened, as revealed in Australian coverage, reflecting increasing negativity towards refugees overall. In particular, reporting suggests public attitudes towards refugees and those who are visibly different may be shifting over time.This was followed up by a survey of former refugees from Afghanistan and the Kurdish regions of Iraq and Iran, who were living in Perth, Western Australia and Christchurch, New Zealand at the time of data collection in 2008. A mixed methods approach was used to evaluate the perceived effectiveness of resettlement programs in addressing the psychosocial and health care needs of these groups. For the purposes of the study, it was necessary to define what was meant by ‘successful resettlement’. Based on the availability of suitable quantitative instruments this was primarily conceptualised by measuring subjective well being and psychological distress. An additional instrument was also included to assess general self efficacy, as this can influence motivation and attitudes to change. Translated and culturally validated Instruments were provided in Farsi (Persian), Arabic and English for self completion during interview.Participants were recruited by a snowball sampling technique, using multiple initial contacts with short chains of contacts within each of the refugee groups to improve representativeness and reduce selection bias. Comparison with census data and community profile maps provided reassurance that this had been achieved. Ascending methods help to overcome some of the sampling challenges encountered with difficult to access and vulnerable populations such as these, accepting that achieving an indicative sample provides valuable information even if not truly representative.Quantitative data collected using individual, questionnaire-based interviews was obtained from 193 participants settled up to 20 years. This assessed key outcome variables using the Kessler-10 Psychological Distress Scale (K10), the Personal Well Being Index (for subjective well being) and the General Perceived Self Efficacy scale. In combination with demographic data, this allowed comparisons across domains based on ethnic group, gender, temporal variables and country of settlement. Qualitative material from open ended questions, presenting the personal perspectives of 124 participants, offered valuable insights into their overall resettlement experiences, quality of life, sources of stress and coping responses.Psychological distress was revealed to be a chronic problem, with 60% of those settled more than 8 years still above the K10 threshold. Despite this, many people were reluctant to seek professional help despite considerable morbidity. Introspection and depression were the main sources of concern for participants at all stages of resettlement, closely followed by separation from family and friends, feeling overwhelmed by the challenges facing them and relationship issues. Unemployment was significantly associated with poor mental health, especially as it often resulted in people sitting at home ‘thinking too much’. In addition, the impact of political events and the situation of significant others in their home countries, as reinforced by media reporting of conflicts in Iraq and Afghanistan, was also influential. Women in particular, struggled due to a lack of family support, changing roles and expectations, and social isolation. The perception that public attitudes towards Muslims changed as a result of political events elsewhere, resulted in some people believing that they would never really fit in. This may be linked with the cultural and religious concerns expressed by some participants and reflect wider societal attitudes to refugees in general, or Muslims in particular, especially in Australia. Reality often fell short of expectation as refugees experienced difficulties forming relationships within the host society and were concerned around discrimination and employment challenges.The study findings contribute to the current literature on refugee resettlement in a number of ways. Firstly, both the media and refugee components of the study provide unique comparative data between Australia and New Zealand in this area, and the ability to disaggregate the refugee survey findings by ethnic origin is also distinctive. The inclusion of participants settled up to twenty years, which highlighted continuing concerns around unemployment and possible discrimination, has also contributed to the discussion on long-term settlement outcomes. Taken together, the findings of the study suggest possible links between public attitudes to refugees as portrayed by media reports, and wider societal attitudes towards certain groups which impact on the mental health and well being of former refugees. Although the research confirmed the prevalence of chronic psychological distress for some participants, identified risk factors related to ongoing settlement concerns and revealed a number of chronic long term stressors, a number of positive aspects of their lives were also described.The research has highlighted the need to understand differences between refugee groups, especially those with a wide cultural distance from the host community, recommending tailored programs to most effectively target areas of greatest need for each group and ensuring that access to support is still available long term if needed. One key finding has been to highlight the importance of suitable employment or other form of daily activity for former refugees, to provide them with a sense of meaningful achievement and respectable social position. As obtaining suitable employment is a primary means of accomplishing this, it is recommended that more support be given to encourage employers to take on former refugee workers, to acknowledge their experience and transferable skills and to build on the resilience and initiative many people have developed during their time as refugees. Doing this will assist with refugees more rapidly and successfully integrating into their new societies and moving towards a post-resettlement sense of identity and belonging