Germany has seen a massive influx of migrants since opening its borders to refugees from war-torn countries in Africa and the Middle East. This year alone it is estimated more than 300,000 people have entered the country.
We are physicians working at the refugee camps in Dresden, the capital of Saxony, which has accommodated 41,000 refugees this year alone. A volunteer staff of around 200 local physicians and student aides provides medical care for the refugees. They have been seeing roughly 60 to 90 patients a day in recent months.
While many of the complaints are ordinary infectious diseases such as the common cold, abdominal complaints and transit-related skin and bone injuries, a number of refugees show symptoms of post-traumatic stress disorder (PTSD).
The decision was made to offer psychiatric care as well. However, the experience and situation of many of the refugees precludes successful treatment of PTSD. This is due to the nature of the disorder and what it requires to ease.
What causes PTSD?
The causes for PTSD are manifold. At the core of the disorder lies the feeling of constant fear. This creates tremendous pressure on an individual’s body (stressor) leading to hormonal imbalances (steroids). Steroidal hormones can attack the entire body system, which reacts by becoming ill.
While journeying to the country where they hope to find safety, refugees often remain in constant fear of losing their lives due to war hostilities, exposure, drowning, hunger and thirst.
Reaching alleged safety, there’s still the constant fear of being ostracised from the community they attempt to join, or being deported back home.
How do we treat PTSD?
The first step in dealing with patients who have suffered repeated trauma is to provide them with a safe environment. Individuals under severe stress usually have trouble sleeping at night and concentrating during the day, which causes them to become aggressive and agitated.
Medical treatment with tranquillisers is usually initiated so the patient can face their fears in a cognitive way. Only when patients have regained the feeling of being safe can psycho-therapeutic measures begin.
This includes psychodynamic psychotherapy (which focuses on revealing the unconscious content of the psyche), eye movement desensitisation and reprocessing (where the disturbing memories are focused on in order to desensitise the patient against them) and cognitive-behavioural therapy (a form of psychotherapy that aims to change unhelpful thinking behaviours).
Treatment may also call for drug therapy such as antidepressants or neuroleptics (tranquillisers) for some time since a traumatised patient who feels helpless and unable to cope may eventually be engulfed by a feeling of permanent sadness.
Why they’re not getting effective treatment
One group of refugees in particular need of protection and care are the nearly 6% of unaccompanied underage refugees. So far, psycho-therapeutic treatment for members of this particularly vulnerable group is non-existent.
If the refugees with PTSD are not treated in a timely manner, this could result in an acute progression of the disorder with symptoms endangering the individuals themselves, or others, and may even lead to suicide. Given suicidal thoughts have been reported, it would appear treatment may not be occurring fast enough.
There have been challenges regarding the psychiatric care of refugees right from the beginning. Particular problems include the lack of interpreters and language-specific psychometric measuring instruments, as well as unsuitable premises for collecting psychiatric clinical data.
The general living conditions of the refugees are not acceptable by any medical standards: inappropriate nutrition, lack of temperature regulation in the accommodation (heating/cooling) and lack of proper hygiene. Hostile attitudes towards refugees from local inhabitants gathering in front of the camps constitute an additional burden for the refugees.
In addition to all of this, psychiatric care is undertaken on a purely voluntary basis, meaning there are no mandated standards for treatment.
It has already been shown that as a consequence of severe dramatisation, feelings of insecurity and destabilisation are passed on to several successive generations. This possibly elicits changes in the genes, making successive generations more susceptible to mental illness and disorders.
To ensure this is avoided, four things need to be done.
First, safe countries must offer protection to people fleeing from unsafe countries.
Second, the health sectors of countries accepting refugees must lend profound support to the sensitisation and training of physicians and other medical staff to diagnose and treat PTSD.
Third, language barriers need to be overcome, whether this is by traditional translation or by using technology such as translation apps.
Finally, those in countries accepting refugees who are hostile towards them need to be more accepting. To not be so is to significantly undermine morale and give refugees a reason to feel stressed, anxious, unsafe and unwanted.