The Psychological Consequences of Displacement and Refugee Trauma

Displacement due to conflict, persecution, or natural disasters represents one of the most profound humanitarian crises of our time. In 2024, there were 123.2 million forcibly displaced people globally, including 73.5 million internally displaced people, 36.8 million refugees, 8.4 million asylum-seekers, and 5.9 million others needing international protection. This staggering number reflects the scale of human suffering and the urgent need to understand the psychological toll of forced migration.

When individuals are forced to flee their homes abruptly, they leave behind not only their physical possessions but also their communities, cultural connections, and sense of security. This upheaval can lead to profound psychological impacts that affect refugees long after they reach what might be considered safety. Understanding these consequences is essential for providing appropriate mental health support and fostering resilience among displaced populations. The journey from displacement to resettlement is fraught with challenges at every stage, and the mental health implications can persist for years or even decades.

The Scope and Scale of Refugee Mental Health Challenges

The mental health crisis among displaced populations is both widespread and severe. Refugees and migrants exposed to adversity are more likely than host populations to experience mental health conditions such as depression, anxiety, post-traumatic stress disorder (PTSD), suicide and psychoses. The prevalence rates of these conditions far exceed those found in general populations, highlighting the extraordinary psychological burden carried by those who have been forcibly displaced.

Research has consistently demonstrated alarmingly high rates of mental health disorders among refugee populations. According to data from the World Mental Health Surveys, lifetime prevalence in the general population is 3.9% for PTSD and 12% for any depressive disorder, compared to our findings of 31% for PTSD and 31.5% for depression among refugees and asylum seekers. This nearly eight-fold increase in PTSD prevalence and more than two-fold increase in depression rates underscores the severe psychological impact of displacement.

The situation is particularly dire for certain populations. The prevalence of PTSD in our study was 83% (269/325, 95% CI 0.782–0.867) among refugee children and adolescents living in a Ugandan refugee settlement, revealing that young people in displacement settings face extraordinarily high rates of trauma-related disorders. Young refugees and asylum seekers comprise approximately 40% of the global refugee and asylum-seeking population, making their mental health needs a critical priority.

Common Psychological Effects of Displacement

Refugees frequently experience a range of emotional and mental health challenges that can manifest in various ways. These psychological effects are not merely temporary reactions to stress but can develop into chronic conditions that significantly impair functioning and quality of life.

Post-Traumatic Stress Disorder (PTSD)

PTSD stands as one of the most prevalent and debilitating mental health conditions among displaced populations. Exposure to potentially traumatic events such as conflict, abuse, violence and extended detention is associated with mental health conditions such as depression and PTSD. The symptoms of PTSD in refugees typically include flashbacks to traumatic events, intrusive memories, nightmares, hypervigilance, and heightened startle responses.

Refugees are typically exposed to multiple types of traumatic events in their countries of origin and during displacement. These events are often repeated, prolonged and interpersonal in nature, and have been demonstrated to have a deleterious effect on mental health. The interpersonal nature of many traumas experienced by refugees—such as torture, sexual violence, and witnessing the murder of family members—can be particularly damaging and may lead to more complex presentations of PTSD.

The prevalence of PTSD varies across different refugee populations and contexts. A comprehensive meta-analysis of rates of PTSD and depression in adult refugee and conflict-affected populations reported a point prevalence of 30.6% for PTSD (ranging from 0-99%) and 30.8% for depression (with individual study rates ranging from 3-86%). This wide range reflects differences in trauma exposure, displacement circumstances, and post-migration conditions.

Depression and Anxiety Disorders

Depression represents another major mental health challenge for displaced populations, often occurring alongside PTSD. Many refugees and migrants experience distress, such as feelings of anxiety, sadness, hopelessness, difficulty sleeping, fatigue, irritability, anger and physical pains. While for most people, these reactions improve over time, others will go on to develop mental health conditions.

The uncertainty inherent in displacement—not knowing if or when one can return home, uncertainty about asylum status, and concerns about separated family members—creates a persistent state of anxiety that can evolve into clinical anxiety disorders. The loss of control over one’s life circumstances, combined with the challenges of navigating unfamiliar systems in host countries, contributes to feelings of helplessness and hopelessness that characterize depression.

It is also notable that comorbid PTSD and depression is highly prevalent amongst refugees, and meeting criteria for both of these disorders simultaneously is associated with greater functional impairment than either disorder alone. This comorbidity complicates treatment and can lead to more severe and persistent symptoms.

Grief and Loss

The experience of displacement involves multiple layers of loss that can trigger profound grief reactions. Refugees mourn not only loved ones who may have been killed or from whom they have been separated, but also the loss of their homes, communities, cultural practices, social status, and way of life. This multifaceted grief can be particularly challenging because it is often disenfranchised—not fully recognized or validated by others.

Unlike grief following a single loss, the grief experienced by refugees is often ongoing and cumulative. They may continue to receive news of losses in their home countries, face ongoing separation from family members, and experience the gradual realization of all they have left behind. This chronic grief can manifest as persistent sadness, longing for what was lost, difficulty finding meaning or purpose, and challenges in forming new attachments.

Identity and Cultural Challenges

Displacement often results in a profound disruption of cultural identity, leading to feelings of alienation, confusion, and a sense of being caught between worlds. Refugees may struggle to maintain their cultural practices and values while simultaneously trying to adapt to the culture of their host country. This cultural dissonance can be particularly acute for children and adolescents who may acculturate more quickly than their parents, creating intergenerational tensions within families.

The loss of social roles and status that often accompanies displacement can also impact identity and self-esteem. Professionals may find themselves unable to practice their professions, parents may struggle to provide for their families, and community leaders may lose their positions of influence. These changes can lead to feelings of worthlessness and a diminished sense of self.

Refugees and asylum seekers often report experiencing direct exposure to multiple types of complex traumatic experiences, including sexual violence, torture, imprisonment, enforced isolation, physical assault, and the murder of friends or family members. In addition to pre-migration traumas experienced in the individuals’ countries of origin, traumatic events can also be experienced during forced migration journeys, for instance, at the hands of human smugglers or traffickers or in refugee camps.

These complex trauma experiences can lead to more severe and pervasive psychological difficulties than those captured by a PTSD diagnosis alone. Complex PTSD includes not only the core PTSD symptoms but also disturbances in self-organization, including problems with affect regulation, negative self-concept, and difficulties in relationships. Treatment needs for PTSD and DSO symptoms may differ; research indicates that solely trauma-focused treatment can overwhelm those who have suffered complex trauma, with a phased treatment approach required instead.

The Unique Psychological Impact on Children and Adolescents

Children and adolescents represent a particularly vulnerable population among the displaced, with unique developmental considerations that affect both their risk for mental health problems and their treatment needs. Prevalence estimates in young refugees and asylum seekers have demonstrated elevated rates of post-traumatic stress disorder (PTSD), depression, anxiety disorders and emotional and behavioural problems.

Young people face trauma exposure at critical developmental periods, which can disrupt normal developmental trajectories and have long-lasting effects. Considerably elevated rates of trauma-related symptoms have accordingly been documented in youth resettling as refugees, with up to 42%, 53%, and 33%, meeting diagnostic thresholds for posttraumatic stress disorder (PTSD), anxiety, and depression, respectively.

For child and adolescent refugees, factors related to the family of origin (i.e., loss of a parent or poor parental mental health) may have an especially pervasive impact on wellbeing. Children are particularly affected by family separation, witnessing violence against family members, and the psychological distress of their parents. PTSD in refugees is leading to adverse effects on their children’s mental health due to harsh parenting styles, creating an intergenerational transmission of trauma.

The impact of displacement on children extends beyond diagnosable mental health conditions to affect their overall development, educational attainment, and social functioning. Disrupted schooling, language barriers, and the stress of adapting to new educational systems can compound the psychological effects of trauma. Children may also take on adult responsibilities, such as serving as interpreters for their parents or contributing to family income, which can interfere with normal childhood development.

Factors Influencing Psychological Outcomes

The psychological impact of displacement is not uniform across all refugees. Several factors determine the severity and type of psychological effects experienced, and understanding these factors is crucial for identifying those at highest risk and tailoring interventions appropriately.

Pre-Migration Trauma Exposure

The nature, severity, and duration of traumatic experiences before and during flight significantly influence mental health outcomes. Previous exposure to violence, torture, sexual assault, or witnessing atrocities increases vulnerability to developing PTSD and other mental health conditions. The many risk factors that contribute towards the development of PTSD among refugees include cumulative exposure to war trauma.

Research has demonstrated a dose-response relationship between trauma exposure and mental health outcomes, with greater exposure to traumatic events associated with higher rates of psychological disorders. However, the strength of the effect varied considerably, and models using war exposure as the sole or primary predictor of mental health status typically left a great deal of variance in symptom levels unexplained, indicating that other factors also play crucial roles.

The Migration Journey

Each stage of the migration journey presents unique stressors that can increase the risk of developing mental health conditions. Migration travel and transit: exposure to challenging and life-threatening conditions including violence, detention and lack of access to services to cover basic needs can compound pre-existing trauma and create new traumatic experiences.

The journey itself may involve dangerous border crossings, exploitation by smugglers, detention in harsh conditions, and ongoing uncertainty about reaching safety. These experiences during transit can be as traumatic as the events that prompted flight in the first place, and they occur at a time when individuals have few resources and support systems to help them cope.

Post-Migration Stressors

Increasingly, research has recognized that the conditions refugees face after reaching a host country play a critical role in determining mental health outcomes. The available data strongly suggest that (1) both war trauma and post-migration stressors exert a powerful influence on mental health, and (2) the post-migration environment plays a critical role in either fostering or impeding recovery from war-related trauma and grief.

Factors associated with PTSD included post-migration difficulties (OR = 4.11, 95% CI 2.52–8.43, p < .001) and exposure to war-related trauma (OR = 2.23, 95% CI 1.16–4.261, p = .016). This finding highlights that post-migration difficulties may actually have a stronger association with PTSD than war trauma itself.

In addition, refugees face numerous daily challenges in their home countries and during displacement, as well as in the post-migration environment, including those related to lack of resources, family separation, social isolation and discrimination, socioeconomic factors, and immigration and refugee policies. These stressors negatively impact mental health over and above the traumatic events experienced in the context of persecution.

Common post-migration stressors include unemployment or underemployment, poverty, inadequate housing, language barriers, discrimination and racism, social isolation, family separation, and uncertainty about legal status. Language barriers, lack of awareness and confidentiality concerns often prevent refugees and migrants from accessing mental health care, creating additional barriers to recovery.

Duration of Displacement

The length of time spent in displacement, particularly in refugee camps or temporary accommodation, can significantly impact mental health. There is evidence that these elevated rates of psychological disorders persist several years after displacement, both in countries of settlement and refugee camp contexts. For example, a review of mental disorders in adult refugees five years or longer after displacement reported prevalence rates of 4.4% to 86% for PTSD, and 2.3% to 80% for depression, with two-thirds and three-quarters of studies respectively reporting prevalence rates greater than 20%.

The increased prevalence of PTSD and depression appears to persist for many years after displacement, indicating that mental health problems do not simply resolve with time and that ongoing support is needed. Prolonged stays in refugee camps, where conditions are often overcrowded, resources are limited, and opportunities for meaningful activity are scarce, can exacerbate mental health problems and create new stressors.

Access to social support and community networks serves as a crucial protective factor that can buffer against psychological distress. Refugees who are able to maintain connections with family members, reunite with community members from their home countries, or develop supportive relationships in their host countries tend to have better mental health outcomes.

Conversely, social isolation—whether due to geographic dispersal, language barriers, discrimination, or the loss of social networks—increases vulnerability to mental health problems. The protective effect of social support operates through multiple mechanisms, including providing practical assistance, emotional support, a sense of belonging, and opportunities to maintain cultural practices and identity.

Resettlement Conditions and Host Country Policies

The policies and practices of host countries significantly influence refugee mental health. Settlement policy should consider the potentially negative effects of restrictive immigration policies on mental health. Policies that create prolonged uncertainty about legal status, separate families, restrict access to employment or education, or detain asylum seekers can have severe negative impacts on mental health.

Low- and middle-income countries host 71% of the world’s refugees and others needing international protection, and these countries often have limited resources to provide adequate support services. The availability of mental health services, language support, employment assistance, and other resettlement services varies widely across host countries and can significantly impact adaptation and recovery.

Individual Factors

Individual characteristics also influence vulnerability and resilience. Gender appears to play a role, with women, individuals with lower socio-economic status and intense exposure to assault being more vulnerable to PTSD. However, another notable finding was a difference in depression symptom trajectories among boys and girls – a difference that did not emerge regarding PTSD and anxiety. While there is cumulative data on sex-effects in anxiety, depression, and trauma-related disorders in adults, indicating a reliably larger prevalence and impact among females, less is known about sex differences during pre- and peri-pubertal age. While similar sex-effects in depression have been documented in adults, the lack of sex-effects herein regarding anxiety and PTSD may suggest lack of homogeneity in trauma type exposure among girls and boys.

Other individual factors that may influence outcomes include age at displacement, previous mental health history, coping strategies, religious or spiritual beliefs, education level, and personal resilience factors. Understanding these individual differences is important for developing personalized approaches to support and treatment.

Barriers to Mental Health Care Access

Despite the high prevalence of mental health problems among refugees, access to appropriate care remains severely limited. Many refugees and migrants struggle to access mental health services and face disruptions in continuity of care. Multiple barriers operate at individual, community, and systemic levels to prevent refugees from receiving the mental health support they need.

Structural and Systemic Barriers

Structural barriers include lack of available mental health services, particularly culturally appropriate services, in areas where refugees are resettled. Even when services exist, refugees may face long waiting lists, lack of transportation, or inability to take time off work for appointments. Insurance coverage for mental health services may be limited or nonexistent, creating financial barriers to care.

Despite the high prevalence of mental health difficulties in young refugees and asylum seekers, evidence suggests that they underutilise mental health services. This underutilization reflects not a lack of need but rather the multiple barriers that prevent access to care.

Language and Communication Barriers

Language barriers represent one of the most significant obstacles to mental health care for refugees. The nuanced communication required in mental health treatment is particularly challenging when conducted through interpreters. Refugees may struggle to express complex emotional experiences in a language they are still learning, and mental health providers may lack access to qualified interpreters, particularly for less common languages.

Even when interpreters are available, issues of confidentiality may arise, particularly in small refugee communities where interpreters may be known to clients. The use of family members, especially children, as interpreters is problematic but sometimes occurs due to lack of alternatives, creating inappropriate role reversals and potential breaches of confidentiality.

Cultural Barriers and Stigma

Cultural differences in understanding and expressing mental health problems can create barriers to care. Mental health concepts and diagnostic categories developed in Western contexts may not align with how refugees from other cultural backgrounds understand and experience psychological distress. Some cultures may emphasize somatic symptoms over psychological ones, or may not have concepts equivalent to Western diagnostic categories.

Stigma surrounding mental health problems exists in many cultures and can prevent refugees from seeking help. Concerns about being labeled as “crazy,” fears that mental health problems will affect asylum claims or family reunification processes, and worries about confidentiality can all deter help-seeking. In some communities, seeking help outside the family or community for personal problems may be seen as shameful or inappropriate.

Lack of Culturally Competent Care

Even when refugees do access mental health services, they may encounter providers who lack understanding of refugee experiences, cultural backgrounds, or the impact of displacement on mental health. Standard mental health treatments may need to be adapted to be culturally appropriate and relevant to refugee experiences. Providers may lack training in working with interpreters, understanding cultural expressions of distress, or addressing the complex interplay of trauma and ongoing stressors that refugees face.

Competing Priorities

Refugees often face multiple urgent practical needs—securing housing, finding employment, learning a new language, navigating complex bureaucratic systems—that may take precedence over addressing mental health concerns. When basic survival needs are unmet, mental health care may seem like a luxury rather than a necessity. Additionally, the symptoms of mental health problems themselves, such as fatigue, difficulty concentrating, or avoidance, can make it harder to seek and engage with treatment.

The Ecological Model of Refugee Mental Health

An ecological model offers a framework for understanding the diversity of factors affecting the psychological wellbeing of refugees, and for responding in ways that correspond to the various sources of their distress. This model recognizes that refugee mental health is influenced by multiple interacting systems, from individual factors to family dynamics, community contexts, and broader societal and policy environments.

The ecological perspective moves beyond a narrow focus on individual pathology or trauma exposure to consider the full context of refugees’ lives. The ecological model of refugee distress showed significantly greater predictive power than the more narrowly focused war exposure model that had guided earlier research. Although the direct effect of war exposure on mental health, and PTSD in particular, generally remained significant after post-migration stressors were added to models, the strength of that effect was consistently diminished.

This broader perspective has important implications for intervention. Rather than focusing solely on treating individual trauma symptoms, an ecological approach suggests the need to address the multiple levels of influence on mental health, including improving living conditions, reducing discrimination, facilitating family reunification, and creating supportive communities.

Comprehensive Strategies for Support and Recovery

Addressing the psychological consequences of displacement requires a comprehensive, multi-level approach that goes beyond traditional mental health treatment to address the full range of factors affecting refugee wellbeing. These results highlight the importance of early and ongoing mental health care, extending beyond the period of initial resettlement, to promote the health of refugees and asylum seekers.

Mental Health Services and Clinical Interventions

Providing accessible, culturally appropriate mental health services is a critical component of supporting refugee mental health. Services should be tailored to refugees’ cultural backgrounds, languages, and specific experiences. Addressing these typically requires targeted, multi-disciplinary action, including culturally sensitive and integrated mental health care, social support, legal assistance and community engagement.

Evidence-based treatments for PTSD and depression can be effective with refugee populations when appropriately adapted. Evidence suggests that trauma-focused cognitive behavioural therapy or eye movement desensitisation and reprocessing should be considered in individuals with PTSD. However, these treatments may need to be modified to account for ongoing stressors, cultural factors, and the complexity of refugee experiences.

For individuals with complex trauma, research indicates that solely trauma-focused treatment can overwhelm those who have suffered complex trauma, with a phased treatment approach required instead. Phased approaches typically begin with stabilization and safety, move to processing traumatic memories, and conclude with integration and reconnection.

Trauma-Informed Care

All service providers who work with refugees—not just mental health professionals—should be trained in trauma-informed approaches. Trauma-informed care recognizes the widespread impact of trauma and understands potential paths for recovery. It involves recognizing the signs and symptoms of trauma in clients, families, staff, and others involved with the system, and responding by fully integrating knowledge about trauma into policies, procedures, and practices.

Clinicians and support workers should take into account contextual factors (i.e., cultural background, daily stressors, living, family and school environments) when working with refugees and asylum-seekers. This contextual understanding helps providers avoid re-traumatization and deliver services in ways that promote safety, trustworthiness, choice, collaboration, and empowerment.

Addressing Post-Migration Stressors

Given the significant impact of post-migration stressors on mental health, interventions must address the practical challenges refugees face in their daily lives. Several intervention researchers in high-income countries have suggested that the failure to address displacement-related stressors such as poverty, unemployment, social isolation and housing difficulties may limit the effectiveness of psychotherapy and psychopharmacology with refugee clients. Growing recognition of the adverse psychological impact of post-migration stressors has led to a multi-service approach in many clinical settings, in which services such as individual and group therapy and psychiatric medication are complemented with case management aimed at helping refugee clients address the social and material conditions of their daily lives.

Practical support might include assistance with housing, employment, education, language learning, legal issues, and navigating healthcare and social service systems. Through the assisted acquisition of housing, jobs, education, translation/language assistance services, and other resources—including financial support—resettlement agencies and case workers can build rapport and trust with families, laying the foundation for a long-lasting relationship upon which other programming can be added—host country language learning, cultural literacy, and mental health care.

Building support networks and promoting social integration are crucial for refugee mental health. Community-based interventions can help reduce isolation, provide opportunities for cultural expression and maintenance, and create supportive environments for healing. In addition to providing assistance with housing, health, education and employment issues, such services might also include connecting refugees with each other and with sympathetic non-refugees to foster community support.

Community engagement approaches might include creating spaces for refugees to gather, supporting cultural and religious organizations, facilitating mentorship programs that connect newly arrived refugees with those who have been resettled longer, and promoting interaction between refugees and host community members. These approaches recognize that healing occurs not just through individual therapy but through reconnection with community and culture.

Family-Based Interventions

Given the importance of family factors in refugee mental health, particularly for children and adolescents, family-based interventions can be valuable. These might include family therapy, parenting support programs, and interventions to address parental mental health problems that may be affecting children. Supporting family reunification when members have been separated is also critical for mental health.

Family interventions should be culturally adapted to respect different family structures and cultural values around family roles and relationships. They should address the unique stressors refugee families face, such as role reversals when children acculturate more quickly than parents, intergenerational trauma, and the impact of parents’ trauma on parenting capacity.

Resilience and Empowerment Programs

While addressing mental health problems is important, approaches that build on refugees’ strengths and promote resilience are equally valuable. Resilience programs might include skills development, education and vocational training, leadership development, and activities that support cultural preservation and expression.

Empowerment approaches recognize refugees not as passive victims but as active agents in their own recovery and adaptation. They create opportunities for refugees to use their skills and knowledge, contribute to their communities, and have voice and choice in decisions that affect them. Such approaches can help restore a sense of agency and purpose that may have been lost through displacement.

Stepped Care Approaches

Not all refugees need the same level of mental health intervention. Stepped care models provide different levels of support based on need, starting with universal preventive interventions and moving to more intensive treatments for those who need them. Stepped care is efficient, cost effective, and avoids pathologizing refugees’ experiences.

A stepped care approach might include universal psychoeducation about common stress reactions and coping strategies, community-based support groups for those experiencing mild to moderate distress, and specialized mental health treatment for those with more severe or complex problems. This approach ensures that resources are used efficiently while avoiding the assumption that all refugees need clinical treatment.

Policy-Level Interventions

Settlement policy and mental health and psychosocial support (MHPSS) programming should facilitate positive mental health outcomes amongst refugees via the provision of resources, enhancing the capacity of the individual for resilience, and strengthening family and community supports. Settlement policy should consider the potentially negative effects of restrictive immigration policies on mental health.

Policy interventions that can support refugee mental health include expediting asylum processes to reduce uncertainty, facilitating family reunification, providing adequate financial support during resettlement, ensuring access to language training and education, protecting against discrimination, and ensuring access to healthcare including mental health services. Policies that allow refugees to work and contribute economically can support both practical needs and psychological wellbeing by restoring purpose and self-sufficiency.

Special Considerations for Children and Adolescents

Supporting the mental health of refugee children and adolescents requires developmentally appropriate approaches that consider the unique needs of young people. When working with forcibly displaced children and adolescents, it is necessary to conceptualize interventions from a systemic perspective.

School-based interventions can be particularly valuable for refugee youth, as schools provide a natural setting for reaching children and can offer both mental health support and opportunities for social connection and skill development. Educational support is crucial, as disrupted schooling is common among refugee children and educational success is associated with better long-term outcomes.

Interventions for children must also address family factors, as parental mental health and family functioning significantly impact child wellbeing. Supporting parents’ mental health and parenting capacity can have positive ripple effects on children. Creating safe, stable environments where children can develop normally despite past trauma is essential.

The Role of Culture in Mental Health and Healing

Culture profoundly influences how people understand, express, and cope with psychological distress, as well as what forms of help they find acceptable and effective. Mental health services for refugees must be culturally adapted to be effective and acceptable.

Cultural adaptation goes beyond translation to include modifying treatment content, processes, and delivery to align with cultural values, beliefs, and practices. This might involve incorporating cultural healing practices, using culturally relevant examples and metaphors, adapting the therapeutic relationship to cultural norms, and involving family or community members in ways that are culturally appropriate.

At the same time, it’s important to avoid stereotyping and to recognize the diversity within cultural groups. Refugees from the same country or cultural background may have very different experiences, beliefs, and needs. Cultural humility—an ongoing process of self-reflection and learning—is more valuable than assuming cultural expertise.

Building Capacity and Training Providers

Addressing the mental health needs of refugees requires building capacity among service providers. This includes training mental health professionals in refugee mental health, trauma-informed care, and cultural competence, as well as training other service providers who work with refugees to recognize mental health problems and make appropriate referrals.

High-quality research should be undertaken in collaboration with refugee communities to increase understanding and treatment of psychological disorders amongst refugees and asylum-seekers. Involving refugees themselves in research, program development, and service delivery ensures that interventions are relevant, acceptable, and effective.

Training should also include working effectively with interpreters, understanding the impact of displacement on mental health, recognizing cultural expressions of distress, and addressing the complex interplay of trauma and ongoing stressors. Providers need skills in both evidence-based treatments and in addressing practical needs and social determinants of health.

The Importance of Early Intervention and Prevention

While treatment for established mental health problems is important, early intervention and prevention approaches can reduce the development of chronic mental health conditions. Early psychosocial support, psychoeducation about normal stress reactions, and assistance with practical needs during the early phases of displacement can help prevent the development of more severe problems.

Universal preventive interventions that promote wellbeing and resilience for all refugees, regardless of symptom levels, can be valuable. These might include orientation programs that help refugees understand and navigate their new environment, social support programs, and activities that promote cultural expression and community connection.

Screening for mental health problems can help identify those who need more intensive support before problems become severe. However, screening must be done carefully, with appropriate follow-up available, and in ways that are culturally appropriate and don’t create additional stigma or distress.

Substance Use and Refugee Populations

Research shows that substance use among refugees is growing in the U.S. Because of trauma histories, refugees may be especially vulnerable to developing substance use disorders and they may turn to drugs and alcohol at various stages of their experience. Refugees may use substances to cope with trauma symptoms related to war, displacement, and violence. In refugee camps, people may turn to drugs and alcohol to numb feelings of isolation and uncertainty. Once resettled in new countries, they may use substances to cope with separation from family, the stress of finding employment, as well as adapting to a new culture.

In addition, PTSD, if left untreated, may often complicate other adverse mental health outcomes, presenting as comorbid depression, anxiety, and substance abuse disorders. Addressing substance use requires integrated treatment that addresses both substance use and underlying trauma and mental health problems, as well as the ongoing stressors that may contribute to substance use as a coping mechanism.

Long-Term Perspectives and Ongoing Support

The mental health impact of displacement is not a short-term problem that resolves once refugees reach safety or complete initial resettlement. Mental health support needs to be available on an ongoing basis, extending well beyond the initial resettlement period. Some refugees may not develop mental health problems until years after displacement, while others may experience chronic or recurring symptoms that require long-term support.

Long-term support should be flexible and responsive to changing needs over time. As refugees move through different phases of adaptation and as their circumstances change, their support needs will also change. Ongoing access to mental health services, community support, and assistance with emerging challenges is important for sustained recovery and wellbeing.

The attitudes and actions of host communities significantly impact refugee mental health. Welcoming, inclusive communities that provide opportunities for social connection and integration support better mental health outcomes, while discrimination, hostility, and social exclusion exacerbate mental health problems.

Promoting positive attitudes toward refugees in host communities, creating opportunities for interaction and mutual understanding, and addressing discrimination and racism are important for refugee mental health. Community education about refugee experiences and the impact of displacement can build empathy and support. Creating inclusive spaces and opportunities for refugees to contribute to their communities can facilitate integration and mutual benefit.

Global Responsibility and Humanitarian Response

Working with partners such as the International Organization for Migration (IOM) and The UN Refugee Agency (UNHCR), WHO supports mental health in diverse countries and territories hosting large numbers of refugees and migrants, including Chad, Colombia, Ethiopia, Jordan, Lebanon, Sudan, Türkiye and Uganda. International cooperation and support are essential for addressing the global refugee mental health crisis.

Humanitarian responses to displacement should include mental health and psychosocial support as core components from the outset. WHO’s 2023 Global Evidence Review on Health and Migration (GEHM) focused on the mental health needs of refugees and migrants, identifying major risks and protective factors and making key research and policy recommendations. With partners, WHO has also published a range of practical tools and guidelines to meet the mental health needs of people affected by emergencies, including refugees and migrants. These are used by most large international humanitarian organizations active in mental health.

Supporting countries that host large numbers of refugees, particularly low- and middle-income countries that host the majority of the world’s refugees, is a global responsibility. This includes providing financial resources, technical assistance, and capacity building to strengthen mental health systems and services.

Moving Forward: Hope and Recovery

While the psychological consequences of displacement are severe and widespread, recovery is possible. Refugees and migrants contribute positively to society and there are many evidence-based strategies to support them in reaching their full potential. With appropriate support, individuals and families can heal from trauma, adapt to new environments, and rebuild meaningful lives.

Refugees and displaced persons embody remarkable resilience. Despite being forced from their homes—whether across borders as refugees or within their own countries as internally displaced persons (IDPs)—they continue to adapt, rebuild, and persevere. With compassionate care, community support, and effective treatment, recovery is possible. Refugees and IDPs can cultivate stability, restore hope, and continue to thrive.

Understanding and addressing the psychological impact of displacement requires a comprehensive approach that recognizes the complexity of refugee experiences, addresses both trauma and ongoing stressors, provides culturally appropriate support, and creates conditions that foster healing and integration. It requires action at multiple levels—from individual clinical care to community support to policy change—and sustained commitment over time.

The global community has a responsibility to support the mental health and wellbeing of displaced populations. This includes not only providing mental health services but also addressing the root causes of displacement, creating safe and supportive conditions for those who have been displaced, and building inclusive societies that welcome and support refugees in rebuilding their lives. By doing so, we honor the resilience and strength of refugees while providing the support needed for recovery and thriving.

For more information on supporting refugee mental health, visit the World Health Organization’s refugee and migrant health resources and the UNHCR mental health resources. Additional guidance on trauma-informed care can be found through the Substance Abuse and Mental Health Services Administration. Organizations like the International Rescue Committee and Refugee Council USA provide valuable resources and support for refugees and those working with displaced populations.

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