Abstract Objectives To assess the causes and risk factors of posttraumatic stress disorder (PTSD) in adult asylum seekers and refugees. To explore whether the causes and risk factors of PTSD, between male and female adult refugees/ asylum seekers is different. Study design Systematic review of current literature. Data Sources PubMed, Web of Science, Scopus and Google Scholar up until February 2019 Method A structured systematic search was conducted in the relevant databases. Papers were excluded, if they failed to meet the inclusion and exclusion criteria. Afterwards, a qualitative assessment was performed on the selected papers. Results 12 Studies were included for the final analysis. All papers were either case studies/report or cross sectional studies. The number of traumatic events experienced by refugees/asylum seekers, is the most frequently reported pre-migration causes for PTSD development. Whilst acculturative stress, is the most common post migration stressor. There were mixed reports, regarding the causes of PTSD between both genders of refugees/asylum seekers. Conclusion This reviews’ findings, have potential clinical application into helping clinicians, to risk stratify refugees/asylum seekers for PTSD development and thus aid in embarking on earlier intervention measures. However, more rigorous research similar to this one, is needed for it to be implemented into clinical practice.

Human trafficking is the third most lucrative form of trafficking in the world (just behind drugs and counterfeit goods). Multiple outbreaks of unrest between October 2016 and August 2017 in the Rakhine State of Myanmar triggered around 745,000 influxes of Rohingyas crossing into Bangladesh through the border boundaries at Teknaf and Ukhiya sub-districts of Cox’s Bazar. In this regard the media confirmed that over a thousand Rohingya people particularly women and girls were victims of human traffickers. This research aims to explore the underlying cause of human trafficking (HT) during emergency response and seeks how the knowledge and capacity of the refugee, local administration and law enforcement agencies in Bangladesh can be improved in promoting counter trafficking (CT) and safe migration processes. In order to achieve the objectives, this research starts with reviewing acts, rules, policies and action plans of the Government of Bangladesh on the HT, CT and safe migration processes. Then, a case study method has been applied to present ongoing the CT and safe migration programs of a NGO called Young Power in Social Action (YPSA) that received funding and technical support from the International Organization of Migration (IOM) for this purpose, the research in this paper will later evaluate the effectiveness of the program through conducting key informant interviews (KII) and focus group discussion (FGDs) with beneficiary and non-beneficiary participants from refugees, law-enforcing agencies (LEA) and non-governmental organizations’ (NGOs) in Teknaf, and Ukhyia sub-districts in Bangladesh. Thus, this research identified program level strengths and weaknesses in relation to the CT, and safe migration process and provide key directions how they can be improved.

Today's unstable labor market increasingly requires flexibility and adaptability to cope with the threat of unemployment. It can cause distress in people and have a more significant negative impact on fragile workers, such as migrants. This study aimed to test whether a Career Counseling intervention designed for Migrants (CCfM) can develop Career Adaptability and, therefore, both Work Self-efficacy (WSe) and Job Search Self-efficacy (JSSe) perceptions. It was conducted in Italy and involved a sample of 233 migrants, who were asked to respond to a questionnaire available in three languages (Italian, French, and English). Data analysis showed that an improvement was demonstrated in all the variables considered, namely career adaptability (including concern, control, confidence, and curiosity), WSe, and JSSe, even though the CCfM was not directly designed to increase the last one. In addition, the development of career adaptability explained the increase in migrants' WSe and JSSe, and the initial level of career adaptability was found to explain the increase in WSe due to the initial positive level of curiosity.

Hepatitis B and C are major health issues in developing countries such as Pakistan and Afghan-istan. The aim of this study was to determine the prevalence and effectiveness of a screening program for hepatitis B and C in a region with no existing programs, and to estimate their prev-alence in the general population in Khyber Pakhtunkhwa Province, Pakistan, as well as in Afghan refugees or migrants. A prospective cohort study was done in the general population of Peshawar and its adjacent districts, as well as migrants from neighboring provinces of Afghani-stan, who presented to our tertiary-care health facility. A Microsoft Excel registry was created for data collection, which were analyzed using IBM SPSS via descriptive analysis, normal distribution curve histograms, and chi-squared tests. A total of 9563 individuals were screened for hepatitis (5894 males and 3669 females), including Afghan migrants in Peshawar and surrounding districts. 876 individuals tested positive for hepatitis, with 538 positive for hepatitis B (383 males and 155 females) and 330 positive for hepatitis C (198 males and 134 females). Eight individuals had a hepatitis B and C co-infection. Among the study population, the prevalence rates were 2.2% for hepatitis B and 2.3% for hepatitis C, of which the Afghan migrants accounted for 2.7% and 0.5%, respectively. According to the gender-based distribution, hepatitis B was more prevalent in males, whereas there was no significant gender-based difference for hepatitis C. Our results highlight the need for a comprehensive approach to control hepatitis B and C in Pakistan and Afghanistan. Increased awareness, improved healthcare, and preventive measures such as screening and elimination programs to prevent severe liver diseases and eradicate hepatitis are necessary.

Mental health and social resilience play a significant role in refugees’ adaptation during the resettlement process in the host country. Maintaining good mental wellbeing helps the refugees to respond to stressful experiences with healthy life choices. This study aimed to explore the mental wellbeing and social resilience of Eritrean refugees living in Germany and to identify social conditions and enablers to foster adaptation. This study employs a qualitative approach with a semi-structured, in-depth interview data collection method. Informants were identified among mostly young adult refugees living in Heidelberg, Germany, with a migration history of 3-6 years. In total, 15 informants were recruited through snowball sampling. Data were sorted and analyzed using the five pillars of the Adaptation and Development after Persecution and Trauma (ADAPT) model. The findings suggest that Eritrean refugees experience psychological distress after resettlement in Germany, however with time, their mental health has improved. The study revealed conditions that were experienced as hindrances, as well as ones that were considered to be resources of positive mental wellbeing and social resilience for resettled refugees. Challenges described were the language barrier, discrimination, unemployment, insecure residence status, loss of family and friends, conflict within the diaspora community, and isolation. The main sources of mental wellbeing and social resilience include the feeling of being welcomed by local communities, access to social services, adopting new relationships, and educational opportunities. These experiences encouraged refugees to have a favorable view of their lives and futures as well as also found to facilitate better integration and adaptation. Understanding refugee mental wellbeing and social resilience require a multidimensional perspective. Eritrean refugees living in Germany have experienced and still are experiencing resettlement challenges, as for example loss of family and friends, negative perception of the German system, loss of past achievements, or unemployment. But they have developed adaptive and resilience mechanisms, too, such as seeing an opportunity for a better life, adopting new roles, and accepting Germany as a “second home”. In addressing those by the refugees as hindrances reported issues, these could be turned into sources of mental well-being and resilience.

1) Background: Sexual violence (SV) is a major public health issue with negative socio-economic and physical, mental, sexual and reproductive health consequences. Migrants, applicants for international protection and refugees (MAR) are identified as a vulnerable group for SV. Since many European countries have been confronted with high migratory pressure, developing prevention strategies and care paths focusing on those MAR affected by SV is needed. To this end, this study reviews evidence on the prevalence of SV among MAR groups in Belgium. 2) Methods: A critical interpretive synthesis was applied to 25 peer-reviewed articles and 22 grey literature documents based on the socio-ecological model. 3) Results: The evidence shows that prevalence rates of SV are high among MAR in Belgium, but comparable prevalence data are lacking. Several challenges for conducting prevalence studies SV in this population are identified and discussed. 4) Conclusions: Sexual violence in MAR in Europe is probably more frequent than in the general population, however representative studies confirming this hypothesis are lacking. Future research should start with a clear definition of the concerned population and acts of SV to generate comparable data. Participatory qualitative research approaches should be applied to fully grasp the complexity of interplaying determinants of SV in MAR.

1) Background: Northwest Syria (NWS), is a conflict-affected and unstable area. Due to its limited health infrastructure, accessing advanced COVID-19 testing services is challenging. COVID-19 antigen rapid diagnostic tests (Ag-RDTs) have the potential to overcome this barrier. Therefore, a pilot project was implemented to introduce Ag-RDTs in this setting aiming to a) describe the feasibility, uptake, and results of Ag-RDTs; and b) identify facilitators and barriers to Ag-RDTs testing. 2) Methods: A cross-sectional study design involving secondary analysis of data collected during the project’s monitoring was developed. A local NGO implemented 25,000 Ag-RDTs cross boarder through trained community health workers. 3) Results: A total of 27,888 persons were found eligible and enrolled, of which 24,956 (89.5%) consented to test and 121 (0.5%) were found positive. Highest positivity was observed among those with severe COVID-19 symptoms (12.7%), those with respiratory illnesses (2.5%), persons enrolled at Afrin Hospitals (2.5%), and healthcare workers (1.9%). A non-random sample of 236 people underwent confirmatory rt-PCR test. Accordingly, observed sensitivity, specificity, positive and negative predictive values, were 80.0%, 96.1%, 91.4% and 90.3%, respectively. Key encountered challenges included obtaining informed consent and conducting confirmatory rt-PCR testing. 4) Conclusion: This project demonstrated great feasibility utilizing Ag-RDTs as a screening/diagnostic tool for COVID-19 infections with nearly 90% uptake. Considering the high specificity and negative predictive values and the higher positivity rates among severe COVID-19 symptomatic, embedding Ag-RDTs into COVID-19 testing strategies for ruling out and in COVID-19 infections would hold a great advantage.

The ongoing conflict in Syria and Iraq has caused many residents of these countries to flee. This study explored how these refugees cope with traumatic experiences from pre-migration to post-migration phases and how they develop resilience experiences at the individual, familial, and community levels. Data were collected through individual interviews and analyzed using Interpretative Phenomenological Analysis. A discussion of the findings revealed (1) a cumulative effect of prolonged adversity from pre-migration to resettlement phases; (2) the impacts of post-migration context as it facilitates refugees’ adjustment or leads to re-traumatization through increased marginalization; and (3) finally, an overview of refugees’ ongoing survival. Clinical implications are presented along with policy implications and future directions for research.

The objective is to describe infant feeding practices and the nutritional status of infants under six months among Syrian refugees in Greater Beirut, Lebanon. A cross-sectional study was conducted among Syrian refugee mothers with children under five years (July-October 2018), mothers with infants under six months were included in the analysis (n=114). Additionally, eleven focus groups discussions were conducted to explore supportive factors and barriers associated with early breastfeeding practices. The prevalence of pre-lacteal feeding was high (62.5%), whereas early initiation of breastfeeding (EIBF) was low (31%), and exclusive breastfeeding (EBF) very low (24.6%). About one-fifth of the infants were suffering from anemia (20.5%) and 9.6% were wasted. Supporting factors of adequate infant feeding practices comprised knowledge on maternal nutrition and EBF, in addition to receiving support from healthcare professionals and family members. Identified barriers included preterm delivery, pre-lacteal feeding, an at-risk waist circumference and moderate to severe depression among mothers, bottle feeding, early introduction of food, maternal health reasons, breastmilk substitutes’ distribution, and misinformation offered by mothers-in-law. To address sub-optimal feeding practices documented among Syrian refugees in our study, existing infant and young child feeding policies and programs need to be strengthened and revised to tackle the identified gaps.