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Refugee women who have left humanitarian aid camps and have moved permanently to countries of asylum and resettlement also face reproductive health challenges. A study published in 2004 by the Journal of Midwifery and Women's Health found that refugee women living in wealthy nations face troubles in accessing appropriate reproductive care due to stereotyping, language barriers, and lack of cultural respect and understanding.
In response to fleeing their home countries, refugee and asylum-seeking women develop posttraumatic stress disorder (PTSD). Many researchers subcategorize the construct of trauma as sexual assault, physical abuse, witnessing violence, partner violence, interpersonal trauma, childhood trauma, and complex trauma. Also, research studies define posttraumatic stress disorder (PTSD) as outlined by the American Psychiatric Association. Some symptoms of PTSD include intrusive and recurrent experiences such as nightmares or flashbacks, intense experience of feelings associated with the event, feelings of detachment, avoidance of stimuli associated with the traumatic event, increased arousal, negative alterations in mood, and exaggerated startle response. If symptoms are left untreated, many survivors may experience depression, anxiety, problems with concentration, sleep difficulties, irritable behavior, angry outbursts, and difficulty establishing healthy and meaningful relationships.
Fleeing a home country can cause prolonged psychological distress of marital and family relationships. In some cases, women's investment in family and community life has been detrimentally impacted, leaving them particularly vulnerable to the effects of the trauma because of the impact on women's gender roles in various countries. Women have at tendency to nurture others and maintain relationships. This dynamic ultimately contributes to attachment and attunement towards others. Attachment towards others is one of the social dynamics that is impacted when one experiences PTSD. These effects can be exceptionally detrimental for females who tend to thrive through creating and maintaining connections with others biologically. Unfortunately, refugee and asylum-seeking women face family displacement exacerbating symptoms of PTSD.
Mental health services would benefit refugees, and asylum seekers as PTSD symptoms could worsen if left untreated. A study conducted on refugee and asylum-seeking women examined the effect of a group-based mental health program designed to alleviate posttraumatic stress for Bhutanese refugee women who recently resettled in the United States. Participants were placed into several groups to determine the efficacy of the program. Women were divided into three groups; two groups provided a version of the intervention, and one group served as a control. Results from pre, post, and follow-up assessments show that participants in both intervention groups experienced significantly less anxiety, depression, anxiety, somatization, and PTSD symptoms at posttest. Interestingly, mental health improvement amongst these participants continued at the 3-month follow-up. Contrastingly, control participants who did not receive the same type of treatment showed their mental health symptoms became more severe over time. Importantly, these results suggest that a group-based mental health program designed to address posttraumatic stress can yield positive outcomes on the mental health of recently relocated refugees. Furthermore, these results provide substantial evidence that without intervention, recently relocated refugees could potentially experience declines in mental health over time while resettling in their host country. More research on program efficacy is necessary to provide much-needed support for refugee and asylum-seeking women.
Refugee women in transitory camps are also frequently subjected to forced labor, encompassing both forced prostitution and forced physical labor. In addition to violating the legal rights of refugees, forced labor experienced by women in refugee camps has been found to be detrimental to their physical, mental, and social well-being. Often, women subjected to these and other forced labors are sought out on the basis of their race and stereotyped low position in society.
According to a 2000 study, women are particularly vulnerable to rape and other forms of sexual assault in times of war and "disintegration of social structures" for a variety of reasons. These reasons include social unrest, the mingling of diverse cultures and values, prevalent power dynamics, and the vulnerability of women seeking refuge. Ways in which violence and sexual assault manifest themselves against refugee women include forced prostitution or coerced sex by international aid agency workers / volunteers, forced prostitution or coerced sex by fellow members of the refugee camp, forced prostitution or coerced sex by local community members, rape by any of the above demographics, exchange of sex for vital material goods or services, or an attempt to dishonor a woman, her husband, or her father. Sexual violence is considered a taboo subject in many cultures, and therefore gender-based violence often goes unreported as well. Even if women did seek to report violence, often there is nowhere within the refugee camp for them to turn.
Refugee and asylum-seeking women face not only physical violence but also emotional abuse. Emotional abuse is described as any intentional conduct that seriously impairs another person's psychological integrity through coercion or threats. Examples of emotional abuse include isolation from others, confinement, financial control, verbal aggression, dismissiveness, threats, intimidation, control, denying the victim's abuse, and using guilt or shame as a form of control. A study conducted on female trauma survivors focused on mental health amongst asylum seekers found that amongst all types of sexual and gender-based violence (SGBV), 62% of the sample experienced some form of emotional abuse.
Emotional abuse is often overlooked as there are no physical indicators. In a study focused on the association between emotional abuse and awareness, researchers found survivors often develop cognitive strategies to cope with their environments. To add, survivors of emotional abuse may develop denial and dissociation habits to keep distressing thoughts from awareness and ultimately protect themselves. As a result, survivors keep the reality of their situation from consciousness and may not interpret their circumstances as emotional abuse and do not hold the identity of being abused.
Contrastingly, some survivors experience many psychological effects, which further describe the complexities of emotional abuse. The asylum process caused many women to encounter humiliation, confinement, and emotional distress. Consequences of emotional-psychological distress were detected in two-thirds of participants. Respondents described being 'depressed,' 'a psychological wreck,' 'dispirited,' or 'very insecure.' Additionally, survivors became isolative and no longer trusted others. Others dealt with anxiety, shame, guilt, frustration, anger, and hatred. One respondent reported, "Hitting is better than talking. What he said hurt me more than getting slapped. Sometimes being hit is easier to cope with than psychological torture". This sad quote sheds light on how painful the reality is of those who suffer from physical and emotional abuse.
Some risk factors associated with refugees and asylum seekers are identified as behavioral and interpersonal factors. Behavioral risk factors include drug and alcohol use, verbal and non-verbal attitudes, being alone on the streets at night, lack of self-defense skills, and not knowing how to speak the language of the host country. These types of behavioral risk factors caused women to have "no-self confidence," "feeling mentally-ill," and "not having a lot of brains." A quarter of the respondents believed being a woman was also a risk factor, leading them to vulnerable experiences. To add, respondents described intrapersonal risk factors as "having bad examples as friends and parents" and "not having anyone to turn to". Without a doubt, a combination of these risk factors causes many women to feel worthless and hopeless.
Furthermore, outcomes of emotional abuse may affect individuals regarding their social networks and deprive them of opportunities for future personal, social, and economic development. Often, when asylum-seeking and refugee women reach out for help, they risk being separated from their children, being dishonored as a woman, or having dishonor brought to their families. The act of reaching out for help could potentially cause more risk to their livelihood. This dynamic makes it incredibly difficult for survivors of (SGBV) to seek support. More research is needed to address the complexities of help-seeking for refugees and asylum seekers.
An estimate given by the UNCHR regarding the 2015 European refugee ‘crisis’ stated that approximately twenty-percent of the refugees entering the EU were women. Women made vulnerable due to their refugee status have reported border personnel tasked with overseeing their health and safety as perpetrators of sexual and gender-based violence (SGBV). In response, institutions tasked with addressing SGBV such as the Common European Asylum System (CEAS), have formally integrated gender sensitivity training to meet international and EU standards. These include the 1951 Refugee Convention, Convention on the Elimination of All Discrimination Against Women, and the United Nations Security Council Resolution 1325.
However, research on the issue conducted in 2016 by Jane Freedman amongst key actors such as refugees, Frontex (European Border and Coastguard officials), the UNCHR and human rights organizations have highlighted that the integration of gender specific anti-violence training has yielded poor results. Consequently, refugees entering the EU had voiced concerns of inaccessibility to basic shelter and services in camps with high population densities as a fundamental barrier to ensuring safety from SGBV. Refugee women also face increased exposure to violence on their journeys. This occurs most often at the hands of those facilitating their voyage, which Freedman refers to as ‘smugglers’. The legal nature of these incidents of violence renders reporting difficult and inaccessible. Moreover, the frequent changing of asylum routes due to border restrictions in the EU compounds refugee women's exposure to violence by increasing the duration of their route.
In 1989, the first efforts towards gender specific aid for refugees was published in UNHCR manuals. The first initiatives of gender mainstreaming in refugee aid were developed in response to the refugee crises of Guatemala, Bosnia-Herzegovina, and Rwandan genocide. Since that time, the concept of gender mainstreaming has gained traction in a variety of refugee aid initiatives, yet experts believe that there are gaps between the policies they outline and the experience of refugee women.
Studies by Doreen Indra found that while there are many institutions providing humanitarian aid to refugee women, it may not reach its full potential due to a lack of refugee input in the programming and policies meant to provide them assistance. When refugee women are excluded from the development process of humanitarian assistance, it was found that policies are often made rooted in traditional gender assumptions, thereby reinforcing traditional and sometimes harmful gender roles in refugee camps.
A review by Linda Cipriano revealed that another barrier in executing effective aid for refugee women is that women are disproportionately denied status as a refugee, which in turn acts as a barrier to receiving the assistance they need. Since its inception, the universal definition for a refugee as described by the United Nations is a person with a “well-founded fear of persecution due to race, religion, nationality, or political opinion.” Under this definition, persecution on the basis of gender and sexual violence are not protected. Many countries abide by this strict language and deny women access to services of declared refugees on these grounds.
The International Rescue Committee serves as an advocate for women to foreign governments to pass laws concerning the health and well-being of refugee women. They also educate men and boys to change the culture of violence towards women. International Rescue Committee. The IRC at a Glance. Retrieved 14 November 2010.
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