The Refugee Experience
The refugee experience is typically divided into three stages: premigration, migration, and postmigration. Prior to escaping from their home country, refugees are in the premigration stage. This phase is often accompanied by chaos, violence, sexual abuse, war, anxiety, and torture. When the migration phase begins the refugees may be uncertain about the present and the future. On the trek to an asylum country refugees are most concerned about food, water, and shelter. They also experience underlying anxiety about the future and their reception and treatment upon arrival (Crowley, 2009). Any person seeking refugee status is interviewed by the office of the United Nations High Commissioner for Refugees (UNHCR). If qualified as a refugee, UNHCR seeks to find a durable solution for the refugee’s situation. There are three such solutions including: voluntary repatriation to the home country, integration into the country of asylum, and resettlement into a third country. The best solution for any refugee is to allow them to safely return to their home country. If a refugee’s home country is no longer safe, then the second best choice is to assimilate him/her into the country of asylum. If neither option is appropriate, resettlement into a third country is the chosen alternative (Cultural Orientation Resource Center, 2009). Countries including Australia, Canada, Denmark, Finland, the Netherlands, New Zealand, Norway, Sweden, Switzerland, and the United States have ongoing resettlement programs. Other countries accept refugees on an individual basis. However, only about 1% of all refugees are actually offered resettlement. The other 99% of refugees return home or reside permanently in a country of asylum (U.S., 2009).
To be accepted into the United States Refugee Resettlement Program, a refugee must be referred by the U.S. embassy in the country of asylum or UNHCR. After receiving a referral, a representative from the Immigration and Naturalization Service travels to interview the refugees in their country of asylum. There are three characteristics that make a person eligible to be resettled in the U.S.: a history of persecution, membership of an ethnic or religious group that is considered by the United States to be of “special humanitarian concern,” or relation to a resettled refugee as a spouse, parent, or unmarried child in the U.S. (U.S., 2009). Once approved, the refugee will be matched with one of ten U.S. resettlement organizations. In 2008, only one third of all the refugees and asylum-seekers who sought settlement in the United States were approved.
Prior to coming to America, refugees must complete several procedures that can take anywhere from two months to two years to complete. First, the resettlement agency must assure the Department of State that it has the resources to accept the refugee. Then, each refugee must be medically screened for any public health concerns. The overseas medical screening looks for certain conditions that would give reason to deny a person entry into the United States. These conditions include tuberculosis, Hansen’s disease, human immunodeficiency virus (HIV) infection, AIDS, certain sexually transmitted diseases, drug abuse or addiction, and a current or past mental or physical disorder associated with harmful behavior. However, there is a waiver process to allow some individuals with these conditions into the U.S. based on their personal circumstances. All other conditions are not considered to be detrimental to public health and do not prevent entry into the U.S. The refugee is then subjected to a specific security clearance depending on his/her country of origin. Lastly, all refugees must receive American cultural orientation concerning what to expect in America during the resettlement phase (U.S., 2009). This cultural orientation, lasting between 3 hours and a few days, consists of pre-departure processing, travel arrangements, rights and responsibilities of refugees, housing, employment, transportation, education, health care, money management, cultural adjustment, and other topics (United, 2008).
Travel to the United States is coordinated by the International Organization for Migration. Refugees who cannot pay their way are required to repay the U.S. government once they are established (U.S., 2009). Upon arrival, the Reception and Placement Program coordinates the resettlement process by ensuring appropriate agencies have been assigned to the refugee (United, 2008). An agency arranges for housing and basic supplies and refers refugees to employment and social services (Cultural, 2009). Upon arrival at the airport, each passenger is assessed for signs of illness. Those with previously acknowledged conditions are reminded to report to a local health department for evaluation. The airport personnel also send notice to the state health department to ensure follow up. Within the first 90 days, new medical exams are conducted for all refugees, regardless of previous conditions. There are four levels of examination provided. Level I evaluates solely for tuberculosis. Level II consists of a complete physical exam and an assessment of immunizations. Level III involves listening for a normal heart rate or abnormal lung sounds as well as other testing as appropriate. Level IV entails case management, if the patient’s condition warrants it. Refugees with health problems are then referred to a local physician or a health department clinic nearby. Children have measurements taken to evaluate their growth, are assessed for their developmental milestones, and screened for genetic conditions including sickle cell anemia and thalassemia. Adults may receive education about HIV, cancer, and cardiovascular disease (Virginia, 2004).
During the first thirty days in the United States all refugees are registered for a social security number, children are enrolled into school, and English language training is provided. Within the first six months, refugees are required to find a job. After one year, refugees can apply for Permanent Resident Alien status and after five years, they are eligible to apply for U.S. citizenship (U.S., 2009).
The postmigration phase presents an entirely new set of concerns for refugees. Upon arrival to their new country, refugees may feel excitement and relief. As reality sets in they may be filled with confusion, bewilderment, fear and/or anxiety. While they may have escaped previous problems, new challenges quickly appear. The refugees must now begin the process of acculturation. “Acculturation comprehends those phenomena which result when groups of individuals sharing different cultures come into continuous first-hand contact, with subsequent changes in the original culture patterns of either or both groups” (Abreu & Kim, 2001, p. 395-396). As discussed in Abreu & Kim, 2001, Berry et al. presented four acculturation attitudes for the adherence to host and indigenous cultures: integration, assimilation, separation, and marginalization. Integration is when an individual continually interacts with the host culture while still remaining proficient in their indigenous culture. Assimilation is when a person rejects their indigenous culture in favor of the host culture. Separation occurs where the value is placed solely with the native culture and persons of the host culture are avoided. Marginalization includes individuals who maintain interest in neither culture (Abreu & Kim, 2001).
Some of the struggles refugees may encounter during the acculturation process include: learning a new language, finding a job, adjusting to new legal structures, and supporting themselves financially. Social hierarchies may collapse as children tend to learn English more quickly than adults and become interpreters for their elders. Religious values may change as western dress and/or dietary habits do not coincide with previous beliefs (Mercer, 2004). The attitudes listed above are examples of how refugees may relate to their host and indigenous cultures, but the acculturation status of each individual must be specifically assessed.
Before coming to the United States, many Somali families lived in refugee camps with little food or water and inadequate medical supplies. They may have faced sexual abuse and the death of loved ones. In the U.S., these families are continuing to cope with past experiences and may have trouble adjusting to their new environment. During the immigration process, many families lose their family systems and experience a loss of support. They may feel isolated in the United States and struggle to achieve a new family balance. Children often become responsible for paying bills, reading mail, and communicating with the outside world due to their English language proficiency, thus having power over the parents in certain situations. Not only do parents face difficulties learning the language, but they experience problems holding jobs or finding jobs that pay above minimum wage, acquiring housing for their large families, and simply keeping food on the table (Alarcón et al., 2007).
