Nightmares, Intrusive Memories, Depression: Israeli Researchers Look at the Dark Side of Asylum-seeking

Tens of millions of asylum seekers survived extreme traumatic events with severe implications for their mental health. This public mental health crisis is not a priority of the scientific community who has yet to develop knowledge and capacity to respond effectively.

Amit Bernstein, Ph.D. and Kim Yuval, M.A.
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Migrants from Africa waiting on line in Tel Aviv to register as asylum seekers.Credit: Ilan Assayag
Amit Bernstein, Ph.D. and Kim Yuval, M.A.

A. was saved from death when members of the Janjaweed militia, identified with the Sudanese government, attacked his village in Darfur, burned the huts and robbed and killed the inhabitants. A number of A.’s relatives were killed, but he was able to escape. After surviving additional Janjaweed attacks across Darfur, A. fled across Chad, Lybia, and the Egyptian Sinai peninsula. He ultimately reached Israel seeking asylum. Daily nightmares bring back the pillaging of this village.

E. reached Israel after fleeing Eritrea for his life. E. fled after repeated attacks by forces of the dictatorial government headed by Isaias Afwerki. E. first fled to Sudan, where he was abducted by smugglers together with other Eritreans and held for ransom. “We, the men in the group, tried to protect the young women from the smugglers who wanted to rape them. They took us, put our legs and hands in chains and raped us as a punishment.” The memories haunt him.

According to the United Nations High Commissioner for Refugees, about 60 million people worldwide have been uprooted by civil war, ethnic cleansing, genocide and starvation. These forcibly displaced persons are subject to violence, torture and sexual assault – experiences that continue to haunt them. Tragically, the stress does not end with physical survival and migration. Too often, life post-migration where survivors seek asylum – such as here in Israel – is extremely stressful.

The media floods us with reports on the geopolitical implications of mass migration of the forcibly displaced fleeing to safety from war-torn nations. Some governments and NGOs are making great efforts to house, feed and take care of the basic physical needs of the forcibly displaced. Yet, their suffering – the scars on the consciousness and memory of these many millions – remain unnoticed and untended. Only a tiny fraction of refugees worldwide receive any kind of mental health treatment, and fewer still receive interventions demonstrated scientifically to be effective. Thus, in terms of mental health, millions of the most vulnerable human beings on earth have been abandoned, left to remember the unthinkable, to suffer, and to heal on their own.

The  world has faced multiple global public health crises in recent decades, such as HIV/AIDS and Ebola. Each became the focus of a global scientific mission. In kind, billions of dollars were invested in research to study and work to solve these public health crises. Huge gains were made world-wide despite the enormity and complexity of these problems. Accordingly, you might expect a similar global research agenda in response to the public mental health crisis faced by the tens of millions of asylum seekers world-wide. Yet, despite its social, economic, ethical and human costs, the mental health crisis among asylum seekers has not yet become a priority of the scientific community. Accordingly, the, clinical science of refugee mental health is decades behind its urgent global need. Access to effective mental health interventions can change the fate of millions and save lives, and thus should be a basic right of every human being.

Over the past three years, our laboratory at the University of Haifa has been  conducting research to identify psychological mechanisms underlying suffering and resilience among African asylum-seekers in Israel, in order to develop specialized therapies to target these key mechanisms. To carry out this research we partnered with leading figures from the African refugee community in Israel and non-governmental organizations who work with forcibly displaced populations. Because our laboratory is housed in the University of Haifa, far from the heart of the community of asylum-seekers in Israel, we established a “satellite laboratory” in the Central Bus Station in Tel Aviv to carry out this research.

One of our studies, presented recently in Israel and abroad, focused on asylum-seekers from Sudan. We asked, first, what is the nature and scope of the traumatic events experienced by asylum seekers from Sudan residing in Israel and what are the mental health implications of these experiences? Second, are risk and resilience factors studied in recent years in the West relevant to such socio-culturally distinct populations?

Our initial findings document a disturbing mental health crisis. The study included 116 men from the general Sudanese asylum-seeking population living in Israel, averaging 32 years of age, who have been living in Israel for an average of 3.5 years . We found that more than 80 percent of the men had been subjected to torture or had witnessed torture, and about 50 percent had been raped or had witnessed rape. The rate of psychological distress in these asylum seekers was extremely high – between 55 and 80 percent suffer from symptoms of post-traumatic stress disorder, including nightmares and intrusive memories, hyper-arousal, fear and dissociation, and about 40 percent suffer from depression. In comparison, 3.5% of the general population in the United States suffer from PTSD, and 7% from depression. In Israel, approximately 7-10% of the population suffers from PTSD and 6% from depression.

We believe that in order to develop the knowledge and capacity to effectively help alleviate the suffering born of torture and genocide, we must learn both from those survivors experiencing the most distress and whose functioning is most impaired, as well as from those who are miraculously resilient. Accordingly, we focused our initial research on the identification and analysis of risk and resilience factors that may be candidate targets of novel therapeutic interventions for this population.

For example, we found that asylum seekers who avoided cues that remind them of traumatic events in their past (for example by avoiding looking at images related to their traumatic memories) demonstrate significantly greater post-traumatic stress than those better able to be in contact with these trauma cues and the memories and distress they elicit. Similarly, we found that asylum seekers better able to mindfully attend to their experience in the present moment reported less psychological distress and better functioning. We also found that asylum seekers who demonstrated dysregulated attention in response to threat and trauma cues (difficulty disengaging attention from these cues or actively avoiding them) demonstrated significantly greater post-traumatic stress than those whose attention to these emotionally distressing stimuli was better controlled. These and related risk and resilience factors identified in our research may serve as candidate intervention targets to advance the mental health of asylum seekers.

We are now working to develop a larger-scale research initiative entitled, “From Surviving to Striving”, with two primary goals: first, to develop and disseminate effective new intervention methods to improve the mental health of survivors of genocide, human trafficking and torture among African asylum-seekers in Israel; and second, to gain novel insights into the nature of human resilience despite unimaginable trauma and suffering, knowledge of great value to society at large.

Amit Bernstein is a professor of psychology at the University of Haifa and is Kim Yuval’s Ph.D. dissertation adviser; Yuval is the coordinator of psychotherapy at the open clinic run by Physicians for Human Rights.