1. BY Millicent Oloo

3. Introduction Refugees have special mental health and psychological concerns. This is attributed to their country of origin prior to migration, flight and settling in the country of asylum. Kenya hosts a large percentage of refugees mostly from Ethiopia, Burundi, Somali, Sudan, Uganda, Congo and Eritrea. They are hosted in Dadaab camp, Kakuma camp and in urban centres such as Nairobi and Mombasa. Mental illness that are common among refugees are PTSD, anxiety disorders,depression and psychosomatic illnesses. They are linked to the three main stages they undergo in their lives as refugees. These are; life in county of origin, process of flight and life in country of asylum.

4. Country of origin and PTSD A refugee is a person who owing to a well founded fear of being persecuted for reasons of race, religion, sex, nationality, membership of a particular social group or political opinion, is outside the country of his nationality and is unable or, owing to such fear, is unwilling to avail himself of the protection of that country. During interviews, refugees share traumatic incidences they faced in their country of origin. These include torture in detentions, deaths of loved ones, rape, sodomy, loss of property and division of families.

5. Cont’ These traumatic events, if not well dealt with, may cause Post Traumatic Stress Disorder. Since this trauma continues and with the absence of help most refugees are unable to deal with it. This is the reason for the high rates of PTSD. According to East African journal issue 87, a research done by Moi University, school of Medicine (psychiatry)on post election violence, it shows a direct correlation between forced migration and PTSD.

6. Flight and anxiety disorders The process of flight for a refugee involves a lot uncertainties for individuals. Before flight, refugees do not have an option but to escape. They are unsure of their fate and live consistently on the fear and worry of the same happening. This may lead to development of anxiety disorders which manifests in panic attacks, phobias and maladaptive social behaviours. Most are unable to access the necessary help since most of the relatives will keep them in their homes since they are considered insane.

7. Country of asylum and depression Kenya has been able to give asylum to most refugees from the different regions experiencing political instabilities and wars. There are issues that refugees face while in the countries of asylum that are associated with depression. Refugees face xenophobia in the COA. In Kenya xenophobia has been high for the Somali refugees. This is because of the association with terror attacks in Kenya. Refugees face issues of language barrier. This especially for the French and Amharic speaking countries. They are unable to communicate their needs or establish where they can get help. Social issues such as unemployment, family breakdown and lack of support system. All the above factors lead to hopelessness and contributes a lot to depression among this population

8. Psychological support  In reaching the refugees, it is important to consider the special population. These include victims of torture, the old, disabled, pregnant women and children. This is because they are more vulnerable.  One should also consider issues of family division due to war and histories of individuals to use as a guide in identifying and giving the required help.  Psychological help without social assistance may not achieve much. One cannot counsel a hungry person. There is need for social support through basic needs such as food and water. Access to medical assistance is vital since some conditions may manifest as psychosomatic illnesses.

9. Chart showing services provided by RCK for the months of May and June

10. Psychological approaches The main psychological approaches and techniques include CBT Cognitive behaviour therapy is an approach that has proved to be highly effective when dealing with PTSD. It focuses on challenging irrational beliefs and behaviours resulting from traumatic events. Unlike other therapeutic methods it takes less time. This is because there is limited resource when it comes to psychosocial officers. According to research CBT has shown incredible results in dealing with trauma and PTSD. Psychological first aid This is especially useful for new arrivals. Immediately after trauma one needs to be given a chance to process and for memory consolidation.

11. Cont’ Group therapy This is to offer individuals facing similar challenges, an opportunity to meet and share with facilitation from a counselor. The participants get the unique opportunity to receive multiple perspectives concerning their issues, support, encouragement and feedback from the other members in a confidential environment. Art and play therapy This is offered in a child friendly environment. It is to get the children to express and cope with resultant trauma and psychological issues. This is also the best therapy when there is a communication barrier.

12. Cont’ Couple therapy Rape has been used a lot as a weapon of war. Most women and girls get pregnant as a result and get STIs. When families reunite in the country of asylum, there is mistrust. This is manifested in domestic violence among them. Couple therapy after individual therapy is a technique that equips them in handling the conflicts. Applying basic counselling in other services offered to refugees Since there are a few counsellors and given the need of this population, there is need to equip other service providers with basic counselling skills. These include legal offices and community based counsellors. They will be able to offer psychological first aid as well as identify cases that require professional counselling.

13. Conclusion  Mental and psychosocial support for refugees should be holistic given their diverse needs.  People offering services to this population should receive frequent counselling due to the exposure to secondary trauma.