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Asylum seekers and bridging the gap in mental health

*Selam sits nervously in my office, lost in thought. In tears, she recalls her brushes with violence and terror since leaving Ethiopia in 2009. She has been diagnosed with a major depressive disorder, manifested by the continual abuse.

She is one of many people being helped by Lawyers for Human Rights’ pilot project, funded by the United Nations High Commissioner for Refugees (UNHCR), aimed at providing holistic support to traumatised refugees and asylum seekers in South Africa.

Selam was forced to flee her country because of political persecution. Her political activism led to her being arrested and detained for five months. While in prison she was repeatedly beaten and tortured. When she arrived in South Africa she tried to start a new life but a few years later, after opening her own shop, she was assaulted and raped while on her way home from work.

Selam has struggled since to get her life back on track. The sexual violence perpetrated against her has only added to her feelings of loss and loneliness since fleeing Ethiopia.

This wasn’t the end to the abuse, however. Selam was again targeted by a township gang during xenophobic attacks. She still bears the scars.

The build-up of unaddressed rage and fear has ravished the once spirited and affectionate woman. She eventually abandoned her shop, moving from one town to the next before ending up living on Gauteng’s streets, haunted.

The complete lack of any proper medical care and counselling has led to a depressive disorder. Selam became convinced that a spell had been cast over her and that she was surrounded by a satanic presence.

Lawyers for Human Rights (LHR) was approached for help and Selam was admitted to the Weskoppies — a psychiatric facility in Pretoria. Here she received medication and counselling but she will need years of treatment. Being an asylum seeker, though, she has no access to the long-term help that she needs.

So once again, Selam is homeless.

In August, LHR launched the project to provide legal services to refugees and asylum seekers with psychological disorders while liaising with government and other stakeholders to ensure a rights-based approach to identify, prevent and reduce the effects of psychological challenges among the migrant population.

Situations of rape, torture, harsh detention conditions, destruction of personal assets, killing of family members, separation from communities and families, discrimination and violations of basic human rights affect most asylum seekers and refugees. They are forced to flee their countries, often without any prior planning, which causes further stress through cultural differences, an uncertain future, xenophobic violence and racism.

The consequences of an inadequately treated psychological disorder are profound. They face more difficulties in obtaining and renewing their documentation, often neglect to renew their permits, suffer unlawful arrest and detention, are isolated, become victims of further violence and abuse and have more trouble finding jobs and accessing education and other services.

They are made easy prey for various kinds of psychological and sexual exploitation.

LHR, along with the UNHCR and Centre for the Study of Violence and Reconciliation is attempting a first in South Africa. A holistic approach to the problem by creating a structure where all the organisations involved can communicate and work together for more effective results.

A tight system of referrals has been running for a few months, offering refugees and asylum seekers legal assistance, temporary accommodation and counselling. The exchange of information has become invaluable and already the project has helped many in need.

The challenges, however, are many. A lack of consolidated information about the extent of the problem, a scarcity of resources and misconceptions surrounding mental health continue to weigh down the process. The consequences of rape, for example, are often exacerbated by ostracisation from communities.

Most of all, the length of the refugee claim assessment process is devastating for someone whose emotional and mental stability is already compromised by previous trauma.

For those like Selam, a lack of support continues to prevent them from seeking help, exacerbating the problem and widening the chasm around stigma.

* Not her real name

Federica Micoli heads the mental health project at Lawyers for Human Rights.