Cynthia Watters, William Mowlds and Kiran M. Sarma.
Objectives: In 2015, the Irish Government agreed to accept 4,000 refugees into Ireland via The Irish Refugee Protection Programme (IRPP). Refugees who enter Ireland via this pathway are offered temporary accommodation for 12 weeks in Emergency Reception and Orientation Centres (EROC) upon arrival to Ireland before being offered permanent resettlement within the community. The aim of this research was to explore programme refugees’ experiences of living in an EROC. Design: This research adopted an exploratory approach using a qualitative framework. Method: Semi-structured individual interviews were conducted with eight individuals (4 males, 4 females) with an average age of 33 years and an average of 7 months spent living in an EROC. Results: Thematic analysis underpinned by a critical realist epistemology was used to identify three main themes; ‘Powerlessness’, ‘Sense of Community’ and ‘A New Life’, each with a number of subthemes. Conclusion: Programme refugees living in an EROC experience significant psychosocial stress as a consequence of their lack of autonomy, feelings of uncertainty, and experiences of multiple losses. However, feelings of hope and optimism as well as a strong sense of community among residents can foster resiliency. Limitations and suggestions for future research are highlighted.
The United Nations High Commissioner for Refugees (UNHCR) defines a refugee as someone who has been forced to flee his or her country due to fears of persecution, war or violence1. Due to an on-going humanitarian crisis, there has been a significant increase in asylum seekers seeking refuge within the EU. Between 2015 and 2016, over one million people entered the EU from Turkey via small, overcrowded and unseaworthy boats2. The United Nations has described the situation as the worst humanitarian crisis that has ever occurred3, resulting in a growing number of refugee camps within the EU. In response to this crisis, the Irish Government established the Irish Refugee Protection Programme (IRPP) through which 4,000 programme refugees were to be offered resettlement in Ireland. Although Ireland has had formal resettlement programmes since 2000, the IRPP has resulted in an influx of programme refugees entering Ireland. By the end 2019, 3,151 programme refugees from refugee camps in Lebanon, Jordan and Greece had entered Ireland via this programme4.
The literature highlights how refugees are continually forced to adapt to multiple environments despite enduring extremely difficult circumstances5,6,7,8. Programme refugees come from camps which are often criticised for being overcrowded, with the limited resources available being largely overstretched8. Research suggests that those who have experienced living in a refugee camp outside of their home country have an increased risk of experiencing violence, psychological distress and mental health difficulties9,10,11. Ben Farhat et al.5 surveyed 1,293 refugees living in refugee camps in Greece and found that a high majority of refugees experienced acts of violence when leaving their country of origin and while living in a refugee camp. The most common acts of violence included ‘being bombed’, ‘being beaten’ and ‘receiving threats’. They also found that at least 75% of refugees screened positive for anxiety as measured using the Refugee Health Screener-155. The prevalence of PTSD in refugee camps has been found to be between 43%12 and 52%13. Those refugees who meet the criteria for PTSD were significantly more likely to have witnessed murders, kidnappings and other extremely violent events12,13. However, these studies used Western developed self-reported questionnaires to assess for Western developed constructs of mental health. The validity of doing so has been widely debated14,15. Other research has employed self-reported questionnaires and a psychiatric interview to assess for PTSD and found a lower prevalence of 34%16.
Emergency Reception and Orientation Centres (EROC) were generated to temporarily house newly arriving programme refugees via the IRPP for approximately 12 weeks until permanent resettlement became available in communities around the country17,18. However, the wider housing crisis in Ireland resulted in some refugees spending longer than a year living in an EROC19,20. Research carried out by UNHCR Ireland concluded that long periods of time spent in temporary accommodation can increase dependency and disempowerment among asylum seekers21. These findings are supported by the literature which describes how stressful the migration journey can be, placing refugees are at an increased risk of developing poor psychological well-being and mental health difficulties following resettlement22,23,24,25,26,27. Bogic, Njoku & Priebe28 reviewed 29 studies evaluating the long-term mental health outcomes among resettled refugees from war-torn countries and found varied prevalence rates; 4.4% – 86% for PTSD, 2.3% – 80% for depression and 20.3% – 88% for anxiety. Likewise, Tinghög et al.29 found that 30% – 40% of resettled Syrian programme refugees living in Sweden had poor mental health outcomes. Although these findings use different criteria, diagnostic manuals and methodological procedures, they all conclude that refugees are at risk of developing or exacerbating pre-existing mental health difficulties following resettlement. One Irish research study exploring the prevalence of trauma among 178 psychiatric outpatients found that refugees were significantly more likely to have experienced multiple traumas than those native to Ireland30. Traumas included lack of shelter, food, water, experiences of sexual and physical abuse, torture, imprisonment, forced separation from family and witnessing murders. The lifetime rate of PTSD symptoms among refugees was 32.8% compared to the Irish natives which was 6.1%30. In 2016, SPIRASI (Spiritan Asylum Services Initiative), the national centre for the rehabilitation of victims of torture in Ireland, reported a significant increased demand for their services31. This raises concerns regarding the current mental health services and questions if they are adequate to meet a refugee’s multifaceted needs32.
Research among programme refugees is an area that has been overlooked. The limited research in this area has been highlighted in Irish research exploring the experiences of accompanied and unaccompanied children and adolescent refugees in Ireland20, resettled Somalian refugees in Wicklow33 and resettled Rohingya refugees in Carlow34. Programme refugees differ from convention refugees and asylum seekers in terms of their pathway into Ireland which in turn impacts on their experiences towards resettlement. Research among programme refugees in Ireland may have been overlooked because they spend less time living in state-funded temporary accommodation compared to asylum seekers and are thus sometimes excluded from research35. However, programme refugees are significantly vulnerable to poor mental health outcomes because their pool of resources are often depleted prior to arrival in Ireland increasing their risk of further resource loss within Ireland36, 37. Hobfoll’s Conservation of Resources (COR) theory36, 37 argues that resource loss is the central component underlining the stress process. This model implies that the loss of resources among refugees significantly contributes to the development of psychological stress. For example, refugees new to host countries have lost familiar surroundings, employment, social support and social status38, 39, 40, 41. The ability to demonstrate resilience is highly dependent on one’s ability to access available resources, thus an increase in resources can result in an increase in resilience. As resource loss is inevitable during the migration journey, research is needed to explore how individuals prevent further resource loss, acquire new resources or substitute resources in order to cope with adversity.
Watters15 argues that researchers should give individuals an opportunity to have their views heard in an attempt to avoid further institutional responses that may have historically been influenced by the homogenising and pathologizing of refugees. Thus, there is a pressing need to explore the experiences of programme refugees living in temporary accommodation as there is currently a significant influx of individuals entering Ireland via this pathway. An in-depth exploration of programme refugees’ multifaceted needs while living in temporary accommodation will greatly contribute to greater service provision and resettlement policy development. This knowledge is required for staff working with programme refugees in temporary accommodation as well as those working in resettlement services.
A qualitative research design was considered the most appropriate approach in order to elicit a rich insight into participants’ experiences of living in the EROC. All interviews were semi-structured, guided by an interview schedule which was developed by the main researcher based on the literature. The interview schedule was reviewed by an experienced clinical psychologist working in the area.
Eight individuals who were living in an EROC in Ireland with an average age of 33 years participated in this research. The average length of time spent in the EROC was 7 months. Seven of the eight participants entered Ireland via the IRPP from Lebanon and had spent an average of 6 years in a refugee camp before arriving in Ireland. One participant entered Ireland from a refugee camp in Greece via The Red Cross. Seven of the eight participants were married and travelled to Ireland with their spouses and children, one participant travelled on his/her own. Further details on participant characteristics are illustrated in Table 1.
Data collection occurred in March 2019. During this time there were 175 residents in the EROC (87 adults, 88 children). The lead researcher (CW) attended weekly mental health seminars delivered to residents by a clinical psychologist (WM). Following these seminars, the lead researcher (CW) informed the residents about this research project and offered them the opportunity to seek further information should they wish to participate. An information sheet in both Arabic and English was given to those requesting further information. The lead researcher (CW) was also available throughout the day for informal conversations in relation to the research to those residents that did not attend the seminars. HSE liaison keyworkers working in the EROC assisted in informing residents about the research and how they can partake. The lead researcher (CW) explained the purpose of the research again before obtaining written informed consent on the day of the interview. Interviews were conducted by the lead researcher (CW) in a clinic room in the health centre in the EROC. Interviews lasted approximately 70 – 90 minutes. All interviews were audio recorded using a digital WS-852 voice recorder in order to be transcribed. Participants were given the option of working with either a male or a female professional interpreter who were known to the residents. The interpreters used in this research were employed from an independent service who were trained to work with sensitive information and had previous experience working with this population group. In line with EU guidelines, the interpreter used was of a migrant background. Interpreters imitated the tone and pitch of the participants when translating their narratives which aided rapport building. Guidance on working with interpreters was sought from the British Psychological Society42 and the HSE Social Inclusion Unit43. Participants were informed about the on-site psychology service in the EROC and were offered an A4 handout (both in Arabic and English) on how they can access this service. A reflective journal was maintained throughout data collection and analysis.
The aim of the analysis was to inductively identify, interpret and report patterns of shared meaning across participant’s narratives using Thematic Analysis underpinned by a critical realist epistemology (Guest, MacQueen & Namey, 2012). This analysis initially involved the researcher becoming more familiar with the data in order to generate initial codes based on the shared meaning within the data. Themes were then developed from clustering the codes in order to accurately reflect the complexity of the data. Following reflection and advice from clinicians and researchers in the field, themes were revised and further defined.
The School of Psychology Research Ethics Committee National University of Ireland Galway and the Galway Clinical Research Ethics Committee granted ethical approval for this research. This study also adhered to the EU guidance note regarding safeguarding and best practice with regards to conducting research with a vulnerable population45.
Three themes were developed from the analysis; Powerlessness, Sense of Community and A New Life, each with a number of subthemes (see Fig. 1). The themes are discussed in detail with quotes from interviews provided. The number in brackets after each quote indicates the interviewee, ellipses (…) indicates words omitted from the quote and words within brackets demonstrates explanations made by the author to aid accessibility.
Theme 1: Powerlessness
Sub-theme: Uncertainty. Feelings of uncertainty were predominantly expressed throughout the narratives. Uncertainty and confusion with regards to status, expectations of Ireland, housing and the reasons why participants are living in the EROC longer than the proposed three months was a source of significant stress.
“The first 3 months we were all excited and happy, going to classes and then when we are passed three months, we got anxious – ‘when are we going to move?’ You get anxious, you are not in a house, you are not in a private house yourself…it is difficult to live more than 3 months here…The food, the children, the stress 24 hours” (8)
Broken promises and unmet expectations fostered a sense of mistrust in services, ultimately establishing a disconnection from Irish society. Participants expressed uncertainty whether resettlement in Ireland was a good decision for their family.
“They promised me only stay 12 weeks in the hotel, that’s it and then we will have a house. Then after they denied. They denied us…I am here 6 months so what is the problem?” (1)
“I just heard ‘oh Europe is this, Europe is that’. But then I came here and all I have seen is nothing what I expected…I haven’t gotten used to the life here yet, so I don’t know if this is right or if that is right because I haven’t really mixed in yet” (4)
Living with overwhelming feelings of uncertainty and despair is anxiety provoking. However, participants disclosed that they perceived it as futile to engage with psychology while they remained in the same situation that underlies the source of their distress.
“I don’t need a doctor, I need a house…I remember I say to you if you give me a nice house and a college and school and I will be fairly good and I won’t need a doctor” (5)
Sub-theme: Life in Waiting. After years of living in refugee camps, life in an EROC presented different challenges. Participants expressed a lack of opportunities to engage with meaningful activities and spent their time waiting to begin a new life in Ireland. A comparison between a previous ‘busy life’ and their current reality of living with little stimulation was evident. Participants disclosed spending their mornings in English classes and their afternoons eating and sleeping. The EROC was described as an “open jail” (7), with the surrounding gates resembling “a prison” (1).
“It’s just a complete change for people that come. For example, we were in our country, we were working, we had this constant routine and then we come here and then we have nothing…It’s just complete boredom” (3)
Although life in the EROC was considered a better quality of life than living in a refugee camp, a lack of engagement in activities left some participants ruminating on their difficult migration trajectory to date.
“It (memories) affects me, it affects us as a family. It’s like something contagious. I eat, I sleep, I drink, I sleep, I eat, and then I drink” (2)
“You just sit there, and you think about this stuff that happened, for any human being of course they just sit there and get all of these memories” (3)
Sub-theme: Lack of Autonomy. Participants frequently expressed their awareness over their lack of control and autonomy over where they lived, who they lived with or even daily decisions such as what they ate.
“I get a sore stomach so I can’t eat rice or I can’t eat bulgur but I go into the canteen sometimes and that is exactly what they have cooked. If I can’t eat, I just stay without food” (3)
“They force you to live this way. They force you to live with these people, I’m not choosing…after all I’m here and what I’ve been through I’m now here and living with those people…I want to live how I want to live” (1)
A lack of independence caused distress to one mother who felt unable to soothe her children. The lack of facilities to cook appeared to threaten her perceived role as a mother.
“My son as a child, he might like some food and we can’t find it in the canteen…It is upsetting because I can’t do anything, I can’t cook for my son so that is upsetting for me as a mother. He’s always asking me to cook, he wants my cooking because I am his mother” (5)
Theme 2: Sense of Community
Sub-theme: Shared Meaning. The act of forced migration inherently disrupts lives in which individuals lose their social supports and communities. However, there was a strong sense of shared meaning within the narratives that may have intensified bonding among residents defending against isolation. Participants reported spending their evenings visiting each other’s rooms and offering support, with longer term residents offering new residents’ guidance and advice.
“We are social, we like to be social. So for example, we are here, refugees. We sit together, we talk together so we don’t make judgements like he is rich or he is poor. If someone has a problem, we like to solve it, we like to help each other. If someone’s family member has died, we sit around that person and try to help them the best we can” (1)
“We all think of each other as just one big family now…we came here we knew nobody and now we think of each other as very close friends and we will stay friends forever” (4)
“what we do is we go visiting the rooms so let say for example 10 ladies will go to 1 room so we do visit each other’s rooms. Sometimes until 12 midnight talking… Sometime I feel they’re like my daughters” (6)
Sub-theme: Coping. Individuals offered narratives that were consumed with hardships of life in refugee camps and beginning a new life without family members and social networks. Participants acknowledged their difficult experiences and questioned their own ability to cope.
“What I’m talking about is really hard, and I’m wondering ‘how am I still standing?’ Because bad things have happened to me before, I ask myself ‘how am I still standing?’” (1)
A collectivist culture appears to have been established within the EROC, in which relationships with others plays a central role in coping with difficult experiences.
“Well in Syrian culture, if someone doesn’t leave their house or their room, then their neighbour checks on them after 4 days. I want to check on my neighbour, I want to make sure” (6)
Some residents indicated the importance of becoming a role model for the group, challenging the stigma and group norms towards mental health and demonstrating support seeking behaviours.
“No I want to come to see (Psychologist) because I want to prove opposite to them (other residents). When I go to see (Psychologist), the other men will see me going in for the chat. So I want to prove something, that I can go in and chat to (Psychologist)…I want to talk with (Psychologist), not for myself but on behalf of others” (1)
Theme 3: A New Life
Sub-theme: Children’s Future. Hopes for a new and better life were evident throughout the narratives. Participants sought safety and refuge by coming to Ireland for themselves and their families. Participants noted the hope and optimism they experienced when they first arrived to the EROC, some describing the experience “like a dream” (7) (8). However, the longer participants spent in the EROC, their optimism diminished “for the worse, it’s changing for the worse” (4). All participants pinpointed their children’s future as the main reason for coming to Ireland. The majority of children did not attend schools in refugee camps and instead were required to work in order to survive.
“Believe me, I am only here for my other children and their future. I give up my 3 children in Syria for my children here. I felt that if I stayed in Lebanon, then I am destroying their future. Especially my youngest one. So I am here for their future” (6)
Sub-theme: Women’s Rights. Participants described how their human rights were violated on a daily basis while living in refugee camps. It was difficult for them to practice their religion, shop in local markets, seek employment and education.
“I can practice it (religion) more here than in Lebanon. Here I am free to do whatever I want, I can fast, I can go to the mosque, nobody says anything to me. In Lebanon, they just wait for the slightest thing to tell you that you are wrong and they just take you in and beat you up” (4)
“In your country, no discrimination, no racism, freedom…You can live a good and safe life here” (8)
However, women in particular voiced their optimism for a new life in Ireland with enforced rights for women. The women in this research narrated their decisions to marry early in life, obtaining a primary level education only. All women expressed a desire to acquire further education and determination to learn the English language that will aid future employment. The process of forced migration may have fostered an inner strength and empowered them to improve future outcomes for themselves, their children and their family’s ‘new’ life.
“I want my daughters to get for example, university studies degrees. There are more rights for the woman here than the Middle East” (8)
“I’m going to work hard for myself even if I need to repeat the leaving cert and I want to work here in Ireland…I want to study, I want education, I want to change my life” (5)
Sub-theme: Loss. In the development of a new life there is the insurmountable feeling of loss over a life left behind. Participants expressed grief over the loss of family members, their previous lifestyle as well as the childhood their children could have had.
“My son in Lebanon, they took his name out from the list (EU relocation list)” (6)
“I have lost everything. My mum, my dad, my brothers, my family, everything. The country, the passport, everything” (4)
The theme of loss also presented itself in terms of friendships lost as a result of families leaving the EROC into permanent housing.
“We come altogether from Lebanon and we make friends and then just suddenly the friends moving, and they get the houses and we really, it is very upsetting for us, we feel so sad” (5)
Living in the EROC with growing feelings of uncertainty and ambivalence, participants conveyed a sense of missing out on life, losing or wasting time while living in the hotel. Participants were anxious to start their new lives outside of temporary accommodation, resettled permanently in Ireland.
“I have been living here 7 months and the children, I feel have lost 7 months… When I leave the hotel, that will be the first day I am in Ireland” (8)
“I just have to be patient and wait until I move out to a house to start my life” (4)
This research explored the lived experiences of individuals living in an EROC in Ireland using a qualitative framework. Eight residents were interviewed and their narratives were analysed using Thematic Analysis44 underpinned by a critical realist epistemology. Codes were inducted from the data to develop three themes; Powerlessness, Sense of Community and A New Life. Programme refugees are a population that have been overlooked within research33, 20, 34, 41. The increase of programme refugees from refugee camps in Lebanon, Jordan and Greece into Ireland means that it is imperative their experiences of living in temporary accommodation is explored. These experiences may impact on their ability to integrate and adapt to Irish society while in the next stage of their migration journey; resettlement into permanent accommodation.
The key findings from this research highlight how programme refugees are a significantly vulnerable population with limited control over their environment which has a significant impact on their psychological well-being. Participants narrated how they have experienced a lot of loss contributing to significant psychological stress, offering support to Hobfoll’s COR theory36, 37. Participants describe how they have limited engagement in meaningful activities within the EROC resulting in feelings of boredom and with ongoing uncertainty about when they might leave temporary accommodation. There was a strong sense of powerlessness in participant narratives and many expressed feeling like they were living ‘a life in limbo’, a feeling widely documented in the literature6. Although their physiological needs are being met within temporary accommodation, their higher up psychological needs are being overlooked46. Living in an EROC is a stressful experience in which many residents living together may not share similar perspectives about the ongoing war in Syria. This further highlights participant’s feelings of powerlessness and lack of control over their circumstances.
Participants described the importance of a sense of community within the EROC which was evidenced by how they highlighted their shared meaning within the EROC. A sense of community was used as a means to cope with difficult experiences endured during the migration journey as well as within temporary accommodation in Ireland. Community resilience and social support have been shown to play an integral role within the literature, mediating the relationship between forced migration experiences and psychological distress47.
Conducting research with multiple interpreters can interfere with the integrity of qualitative research. In addition, there may be a double interpretation occurring when using a translator in research; between participant and translator, and between translator and researcher. In order to reduce the risk of bias, all interpreters used were trained in research, highly experienced working with this population group and were known to participants. This fostered a safe environment in which participants could speak about their experiences freely. The use of a reflexive journal during data collection and analysis was used to reflect on the research process in order to further reduce the researcher’s bias. The main strength of this research is that it adds to the limited literature available on the lived experiences of programme refugees living in temporary accommodation within an Irish context.
The influx of refugees in Ireland poses new challenges to the delivery of mental health and primary care services. There is a need for greater flexibility among health services in order to alleviate refugee suffering. It is paramount clinicians strive to understand an individual’s unique migration trajectory and how they make sense of it. This involves systematically exploring the common themes found from this research and how they can affect one’s ability to successfully adapt and resettle into a new host country. Wider community involvement could encourage integration into Irish society as well as offering meaningful activities to further foster the resident’s inherent resilience. The development of peer support groups within the EROC could further build upon the strong sense of community as well as alleviating a sense of uncertainty and mistrust among residents. Adopting a holistic approach and naturally building the collectivist perspective found in the narratives towards offering support may be an effective means to offering support to programme refugees living in temporary accommodation.
It would be worthwhile for future research to consider the next stage of the migration trajectory and explore the lived experiences of programme refugees who have resettled into permanent accommodation following life in the EROC. Although Ní Raghallaigh et al.20 offers a detailed account of the experiences of child programme refugees entering Ireland via the IRPP, more research is needed in this area. This final phase of migration may pose different challenges to programme refugees as well as to services offering support. The majority of participants in this research travelled with family members, only one male travelled alone who had spent a significantly longer amount of time living in the EROC as a result. The experiences of single and unmarried programme refugees may differ to that of those travelling with families. Future research should consider focusing on this smaller cohort of individuals.
The researchers would like to thank all participants who offered their valuable contributions and insights, HSE liaison staff and interpreters for their support with this research.
Cynthia Watters, Psychologist in Clinical Training, School of Psychology, National University of Ireland, Galway. Email firstname.lastname@example.org
Dr. William Mowlds, Senior Clinical Psychologist, Community Healthcare West.
Dr. Kiran M. Sarma, Senior Lecturer in Clinical Psychology, School of Psychology, National University of Ireland, Galway
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