Asylum Seekers Alcohol and Drugs Abuse. A Public Health Dilemma?

Table of Contents

1 Introduction

2 Migration Trends 2015-2016

3 Asylum Seekers Health Status

4 Alcohol and Drugs abuse among Asylum seekers

5 Medical Care and Access to Healthcare

6 Substance Abuse Prevention

7 Conclusion

References

Abbreviation List

1 Introduction

Due to war and destruction, many Asylum seekers and refugees have had to leave their homes in recent years and have sought protection in European countries. In 2015 and 2016 more than one million people applied for asylum in Germany. This, in turn, has exposed an existing major challenge with the health care system. From a public health perspective, the significant concern has been about the healthcare needs of asylum seekers and refugees, the legal frame- work of immigration and the extent of health problems among this population. It is striking that there is little representative data available on the health situation of this population group. The studies to date have shown a few cases which are either regional but also difficult to compare. The existing findings suggest the need for care and action especially in the area of mental illness of asylum seek- ers and their families.

This paper will, therefore, try to investigate this complicated topic by trying to address some critical questions such as; is there a large-scale substance abuse among Asylum seekers? And if so, what could be the risk and protective fac- tors? What prevention interventions are available for this population, are there treatment opportunities for chronic users? Are there laws protecting this popula- tion in the context of prevention and treatment if yes, what policies are there for this population? And what implications does chronic substance abuse have on successful integration? To understand this complex dynamic, the paper will first highlight the current migration trends especially the period between 2015-2017. Secondly, this paper will explore the health status of asylum seekers, reviewing the risk and protective factors, especially mental health and its challenges. Thirdly, the paper will highlight substance abuse among Asylum seekers and the challenges on access to health care services especially mental health inter- ventions. Finally, the paper will investigate substance abuse prevention ap- proaches and highlighting some of the successful prevention interventions that have been piloted in different parts of Germany and finally conclusion and way forward.

2 Migration Trends 2015-2016

Before we investigate the Migration trends within this period,it is important to review the terms such as Migrants,Asylum seekers etc. According to 10M (2019), a migrant is a person who moves away from his, or her place of usual residence,whether within a country or across an intemational border,temporar­ ily or permanently,and for a variety of reasons.The term includes categories such as labor,economic and student migrants,refugees,unaccompanied mi­ nors and asylum seekers.

According to Abbas et al (2018,p1),between the period of 2015-2017 Ger­ many experienced a massive migratory crisis which saw unprecedented num­ bers of people on the move and tremendous diversity in terms of age,gender, and medical needs.This was due to severalfactors including war, economic, politicalpersecutions etc. which triggered the huge numbers of a refugee seek­ ing migrants within Germany.

About 1,2 million people, (BAMF, 2015) applied for Asylum in Germany.Most of the first-time asylum applicants came from Syria 35,9 % of all applicants. Alba­ nian citizens accounted for 12.2% of applicants and Kosovo for 7,6 %,while Af­ ghans and Iraqis each accounted for 7.1% and 6.7% respectively. The graph below shows the number of first-time asylum seekers in 2013-2016 in Germany in comparison to Europe (BAMF,2015).

Abbildung in dieser Leseprobe nicht enthalten

Figure 1:No.of first-time asylum seekers in 2013- 2016 in comparison to the totalnumber of applications inEurope

About 79% of the first-time asylum seekers were below 35 years old (Eurostat,2018) and overall, the age range 18-34 years accounted for slightly less than half (48%) of the overall number of applicants, while nearly one third (31%) were minors below 18 years.(see Figure 2). This (age distribution) was common in almost all the EU Member States,with the largest share of applicants being those aged 18-34.However, Germany reported a higher pro­ portion of asylum applicants less than 18 years old".This,therefore, explains the reason why most of the recent asylum seekers are relatively young.

Abbildung in dieser Leseprobe nicht enthalten

Figure 2: AQe offtrst-Ume asylum applicants In the EU

Young asylum seekers may experience challenges with the laws of the new country, learning a new language, building a social relationship, health prob­ lems including alcoholand drug abuse.

3 Asylum Seekers Health Status

Fehr A et al. (2017) states that, so far, there is no representative data available on the health situation and care of asylum seekers and refugees in Germany. In Accordance to § 62 AsylG¹ and § 36 Infection Protection Act (IfSG), one of the important sources of data could be the initial admission examinations, which asy- lum seekers must undergo before or immediately after admission to a shared accommodation, but this has been a huge challenge due to several factors such as, huge number of applicants, lack of enough trained staff on initial admission examinations, lack of enough funds etc. (Robert Koch Institute, 2017) also rec- ommended a minimum standard for the standardized initial admission examina- tion per the Asylum seekers Act. The main goal of this investigation is to detect as early as possible acutely transmitted diseases such as infectious Pulmonary tuberculosis. Apart from other infectious diseases such as TB and hepatitis A infections, mental illness is one of the biggest problems affecting asylum seekers. Some refugees and asylum seekers from conflict and War zones have before their flight to their host countries experienced war, political persecution, torture, robberies, and sexual assault. This also includes traumatizing experiences in the countries of origin, long the escape way. This means asylum seekers and refu- gees must cross several transits countries and are often on the move for months or even years. In addition to the threat to their own lives, some experience the loss of relatives or witnesses the deaths of other refugees.

Unaccompanied minors are particularly vulnerable to robbery and sexual assault. Traumatic experiences can increase the risk of trauma disorder. These include post-traumatic stress disorder, depression, anxiety disorders, chronic pain, and somatoform disorders. "According to estimates, 30-50 percent of refugees in Ger- many suffer from trauma disorders (Hartwig/Mennen/Schrapper, 2018, p461). However, until their legal status is clarified, access to psychotherapeutic care for refugees is limited by law and this is also coupled with a severe lack of resources in the Gemeinschaftsunterkunften. In some cases, there is also a fundamental distrust of psychological services on the part of the refugees (DGPPN 2016). According to (AOK Studies, 2018), more than three-quarters of all refugees from the countries of origin Syria, Iraq and Afghanistan have experienced different forms of violence and are often traumatized several times as a result. The result of a survey by the Scientific Institute of the AOK (WIdO) shows that this has a serious impact on their health: Compared to fugitives without the experience of violence, this group reports more than twice as many physical and psychological complaints. "Asylum seekers must be adequately supported in coming to terms with their traumatic experiences. Specialist trauma treatment facilities and thera- pists could help here," says Helmut Schröder, Deputy Managing Director of the Wissenschaftliches Institut der AOK (WIdO) and co-author of the study.

The study (AOK,2018) also shows that most refugees from Syria, Iraq, and Af- ghanistan who have reported traumatic events of war experiences at (60.4 per- cent) or attacks by the military or armed at (40.2 percent). In every third case (34.8 percent), relatives or close relatives were kidnapped, disappeared or killed by force (15.4 percent). Only less than a quarter (22.5 percent) of respondents had not experienced any of these traumatic experiences. Multiple trauma, on the other hand, is common: 16.3 percent of all respondents report only one trauma, 15.1 percent report two traumas and 12.5 percent report three traumas. 30.7 per- cent report more than three traumatic experiences.

“Compared to asylum seekers who never had these experiences, the ones with traumatic experiences reported more than twice as many physical and psycho- logical complaints. Psychological complaints such as despondency, sadness, de- pression (42.7 percent) and nervousness, restlessness (42.9 percent) occurred. Klaus Zok:” (AOK Study, 2018). "The experiences of war and violence made by most refugees in their country of origin or while fleeing have a direct influence on health, especially on the psyche.

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¹ (1) Ausländer, die in einer Aufnahmeeinrichtung oder Gemeinschaftsunterkunft zu wohnen haben, sind verpflichtet, eine ärztliche Untersuchung auf übertragbare Krankheiten einschließlich einer Röntgenauf- nahme der Atmungsorgane zu dulden. Die oberste Landesgesundheitsbehörde oder die von ihr bestimmte Stelle bestimmt den Umfang der Untersuchung und den Arzt, der die Untersuchung durchführt. (2) Das Ergebnis der Untersuchung ist der für die Unterbringung zuständigen Behörde mitzuteilen. Wird bei der Untersuchung der Verdacht oder das Vorliegen einer meldepflichtigen Krankheit nach § 6 des Infektionsschutzgesetzes oder eine Infektion mit einem Krankheitserreger nach § 7 des Infektionsschutz- gesetzes festgestellt, ist das Ergebnis der Untersuchung auch dem Bundesamt mitzuteilen.