Elżbieta M. Goździak reflects on the trauma and resiliency of children displaced by war
Displaced Ukrainians in Poland
Russia’s invasion of Ukraine on February 24, 2022 has led to a displacement of more than 14 million people, with over 6.5 million fleeing Ukraine. Poland has received the largest number of Ukrainian refugees at approximately 3.5 million, and other neighboring countries--Romania, Russia, Hungary, Moldova, Slovakia, and Belarus--have received about 4.3 million combined. The United Nations Children's Fund (UNICEF) estimates that two million Ukrainian children have fled the country and another 2.5 million are displaced internally.
Focus on trauma
Arrival of refugees, adults or children, fleeing wars and armed conflict almost always results in fervent discussions of the traumatic experiences of forced migrants. The discussions often medicalize these experiences; calls for urgent mental health interventions follow. The arrival of Ukrainian children in Poland aslo sparked debates about the need to address their trauma. UNICEF alleged that just a few weeks in a combat zone can permanently and irrevocably alter the trajectory of a child's life. Speaking at the conference in Warsaw, James F. Leckman, a professor of psychiatry at theYale Child Study Center (YCSC), said: “The mental health needs of Ukrainian refugee children, youth, and families must be urgently addressed to help them deal with the multiple acute and potential long-term traumatic consequences of being victims of this war.”
We have heard similar statemenets from teachers working with Ukrainian children. They are eager to refer their young charges to school psychologists or pedagogical and psychological counseling programs. Several school directors we spoke with during our recent field research in Wrocław were dismayed that parents are resisting such referrals. Only one brave principal acgnowledged that children, including Polish pupils, are often overdiagnozed and prescribed medication for behavioral issues that should be resolved by a teacher working with the student, not by a mental health professional.
What about resilency?
Research on forced migrants, children and adults, has tended to emphasize the psychological sequelae of uprootedness. Some researchers indicate that refugees and asylum seekers have high and persistent rates of PTSD and depression, approximately 30 percent. They emphasize the need for ongoing, long-term mental health care beyond the initial period of resettlement. However, we need to keep in mind that much of this research is skewed towards those refugees who have sought psychological services; very few researchers study those forced migrants who are doing well.
Also, if 30 percent experience PTSD, what about the remaining 70 percent? Why aren't we studying those who are doing well in order to learn about their strategies and assist them in staying well?
Several researchers in the Netherlands shifted the focus from refugees’ mental health problems to understanding what allows forced migrants to cope psychologically. Their interests align with recent scholarship that has argued that refugee research needs to focus on resilience to complement research using a psychopathological approach. The Dutch scholars concluded that resilience can be enhanced on a cultural level.
Migrant children fleeing wars may very well be, owing to the many limitations associated with both young age and displacement, particularly vulnerable to a variety of risk factors. However, focusing exclusively on children’s vulnerablities my harm their self-esteem and undermine their efforts to overcome challenges. At the same time, an excessive emphasis on resilience and coping could obscure individual vulnerabilities or even result in blaming those individuals who appear more vulnerable for their failure to cope. As my colleague, Marisa Ensor, and I wrote in our book on Children and Migration. At the Crossroads of Resiliency and Vulnerability, it is important to acknowledge that children’s agency and their ability to overcome the challenges of forced migration, is framed by their evolving capacities and reflects their own individual and socially-generated vulnerabilities and resilience.
Call to action
Having spent many years researching the effects of forced migration on refugees, asylum seekers, and trafficked children, I think that there is a need to distinguish between common self-limiting psychological responses to violence and persisting and disabling reactions.
As the Canadian medical anthropologist, Allan Young, wrote in The Harmony of Illusions. Inventing Post-Traumatic Stress Disorder, PTSD is a normal response to an abnormal situation. Many other scholars cautioned against considering wars, ethnic cleansing, civil strife, and natural disasters as mental health emergencies and PTSD as a ‘hidden epidemic.’ Arthur Kleiman, another medical anthropologist and psychiatrist, and Derek Summerfield, also a psychitrist, wrote extensively about the dangers of medicalizing human suffering.
There is also a need to support empirical research, especially participatory action research, on the well-being of children (and adults) escaping armed conflict. Such research should focus both on those children who need assistance, including psychological help, and on those who are doing well. This research ought to be readliy ranslatable into new program designs and policy approaches.
As we try to do justice to the Ukrainian children studying in Polish schools, let's rememebr that their
ability to do well in school and in life depends as much on their own resiliency and coping strategies as on our and our children's attitudes towards them, the respect we show them and their families, and the appreciation of their presence in Poland we exhibit in daily interactions. These 'soft' interventions will go a long way towards decreasing their traumatic experiences. They will also ensure that the children continue to be well.