Interconnectedness Initiative: Second case conference report

During the previous year of the VCST’s Interconnectedness Initiative, “Case Conferencing” was identified by stakeholders as an essential tool to address sensitive cases among survivors of torture in the region, and to bring forward the experiences of the project’s stakeholders in addressing those cases. 

The project, funded by the Victoria Foundation, has undertaken a comprehensive approach to address the needs of survivors of torture in our community. You can read all about this project on our website. (Read the first case conference report here.)

For this project, the objectives of Case Conferences are:

1. To enhance the capacity of staff members to support survivors of torture. 
2. To foster the coordination and collaboration of professional services provided for the survivors of torture.
3. To share best practices and protocols among stakeholders. 

Second case conference report 

The second of three case conferences took place on March 7, 2024, with the participation of 14 people from nine organizations: VCST, VICCIR, ICA, and VIRCS in Victoria; CIS in Duncan; CVIMS in Nanaimo; and from the mainland, we had the participation of VAST, ISS of BC, and DIVERSEcity.

The second case conference was presented by Haley Smith, a Settlement Worker with the Intercultural Association of Greater Victoria (ICA). Haley addressed the case of a father from Africa who was orphaned by war at a young age, and how the torture and trauma he experienced affected him and his family, even years after they were resettled in the United States.

Due to the sensitive nature of this topic, participants who responded to our invitation were asked to accept a confidentiality pledge. Once participants accepted the pledge, a confidential link to the Zoom event was sent to them. No personal or private information about the person in this case was disclosed during the conference. The conference was not recorded.

The following background was shared with all participants before the event.

Civil wars and refugee camps in Africa

The African continent has been suffering from several civil wars for decades in most countries of the continent. 

The higher prevalence of war in Africa is not due to the ethnolinguistic fragmentation of its countries, but rather to high levels of poverty, failed political institutions, and economic dependence on natural resources.¹ These conditions, which are aggravated by climate change, are the result of colonization and exploitation from European countries, which started in the 1880s.

The UN defines refugee camps as “temporary facilities built to provide immediate protection and assistance to people who have been forced to flee their homes due to war, persecution or violence.” Four of the six largest refugee camps in the world are in Africa: Kenya, Uganda, Ethiopia, and Tanzania.²

Life in the refugee camp restricts the refugees’ rights and freedom, and limits their interactions with the host community. This isolation has adverse socio-economic effects on the refugees. 

Currently, there are approximately 10.8 million child refugees worldwide. Youth living in refugee camps face a wide range of challenges placing them at risk for trauma exposure and mental health disorders. Youth living in refugee camps are exposed to different stressors such as minimal access to shelters, food, water, and education, living in active war zones, and high levels of physical, psychological, and sexual violence.³

The largest camp in the world is the Dadaab refugee camp, established in 1991 because of refugees fleeing the civil war in Somalia, so they crossed the border into Kenya. Dadaab is a combination of three camps: Dagahaley, Ifo, and Hagadera. The first two are in the Lagdera (Dadaab) district, while Hagadera is located in the neighbouring Fafi district.⁴ 

The last statistics published by UNHCR reported 714,137 registered refugees and asylum seekers in Kenya, 47% of them (338,224) are in Dadaab.

Somalia represented most of the camp population by 96.7%. The rest of the refugees and asylum seekers in this camp are from other African countries such as South Sudan, DRC, Ethiopia, Burundi, Sudan, Eritrea, Rwanda, and others. 

More than half (51.1%) of the camp residents are females, compared to 48.9% of males. Children (5-11 years) represent 12.3%, while people 18-59 years make up 22.4% of the population in the camp.

Conditions in refugee camps are grave, as donor support has waned in recent years. The camp’s resources and infrastructure are overtaxed, and occupants have scant opportunities for gainful employment or education. Malnutrition is rampant among young occupants, and infectious diseases are spread widely.

Among all these challenges, many residents remain positive about their future.⁵

For example, Moulid Hujale was forced to flee Somalia with his family at the age of 10 to the Dadaab refugee camp across the border into Kenya.⁶ Moulid partnered with UNHCR and other organizations working in Dadaab to collaborate on an umbrella initiative that provided skills training and jobs to Dadaab youth. Moulid recently moved to Mogadishu to work on making education accessible to all.

Challenges

The community where the Client relocated in the USA has limited resources to help refugees resettle.

The Client coped with trauma by drinking – and developed an alcohol use disorder. He received a DUI (Driving Under the Influence), which immediately caused destabilization to his life. Because of the DUI, the Client could not receive permanent residence.

Language barriers were at the core of the Client’s challenges. He only speaks Kirundi, and was not able to learn English proficiently.

Employment instability was an important challenge. There were limited employment options available for the Client, because of his limited education and work experience.

Being unable to drive, public transit was the only option for the Client to be able to report to work. Unfortunately, there were limited or non-existent buses when work shifts started/ended.

The Client and his family faced 3 evictions and were at risk of losing their housing subsidy. This resulted in a destabilizing life for the children – changing neighbourhoods/schools multiple times over 3 years.

Living in a new culture changed the family dynamics. Children became interpreters for their parents, and they acquired a higher level of education than their parents.

As children straddle two cultures, the impact on the family relationships was also challenging. Culture at home was influenced by their parent’s lives in two different african countries, while at school and with their friends, children’s culture was American culture.

The Client inflicted physical punishment on his oldest daughter, and she reported it to the police. This added another challenge to the family settlement, as they had to deal with the Criminal Justice System. The Client ended up in jail, and the lack of interpretation made the interaction with the Court System, lawyers, jail staff and probation officer very ineffective. The court mandated the Client to seek addiction counselling and to attend parenting courses.

This incident brought increased societal pressure to the family, as the African community brought shame to the daughter for denouncing her father’s punishment to the police.

The family also faced several health issues, a reflection of the lack of health education and inadequate hygiene they had experienced in the past. A 4-year-old son needed emergency dental treatment due to poor oral health.

Support for children was not easy to find. They were able to approach “Big Brothers Big Sisters”, where they faced the challenges of not having interpretation available.

Lessons learned 

• Self-Awareness. The Client’s understanding of his personal history of torture and trauma was considered by him “normal”. He did not think his experiences in Africa were traumatic. This lack of self-awareness can hinder refugees’ ability to seek and receive the necessary mental health support. Trauma is not an isolated event with a defined endpoint; it can permeate every aspect of an individual’s life.
• Effective mental health services for survivors of torture must encompass the following:
  • Mental health professionals need to understand the cultural context of the survivors’ experiences and provide culturally sensitive care.
  • Service providers need to adopt trauma-informed approaches that recognize the pervasive impact of torture and trauma, and promote healing and resilience.
  • Ensure that mental health services are accessible to survivors, including interpretation services for those with language barriers.
  • Address not only the psychological aspects of torture and trauma but also the social, economic, and environmental impact on the dsurvivors’ well-being as part of a holistic approach. 
• Understanding the intergenerational nature of trauma is crucial in designing and implementing appropriate mental health services for refugees. Trauma can manifest in various ways and may impact the individual and future generations within the family. 
• Trauma does not exist in a vacuum. It does not have a defined endpoint and can make its way into every aspect of one’s life. 

“Trauma doesn’t occur in a vacuum. You don’t outgrow it with time. It grows with you, even if the growing goes all wrong. It’s like breaking an arm and never putting it in a cast. You’re bigger, but the bone is still broken. Maybe there’s a throb of pain once in a while. You can’t just stop using the arm. The more you use it the more it tears and contorts. You get clumsy. You break more limbs.” 

Sung Yim’s quote from ‘What About the Rest of Your Life’

Best practices

Interpretation

• If you are not communicating in the person’s first language, always offer the use of an interpreter (if this is something that you have access to).
• Never assume that a person has strong enough English or feels able to express themselves properly in English.
• Be aware that if a Client’s friend/family member interprets, there may be challenges due to assumptions, power imbalances, trust, and status.
• Having a child interpret may result in negative shifts in family dynamics.
• A friend or family member may not be good at interpreting (it is a skill that requires training and supervision).
• A friend or family member may not have the Client’s best interests in mind. The Client may not be as comfortable sharing or may not provide needed information

Patience

Language, culture, education, and many other factors may all be barriers to helping a Client as quickly as we would like. Patience is needed.

Non-judgemental

Adverse Childhood Experiences can negatively impact a person. The Client did do bad things, but he is NOT a bad person.

How to end a meeting

Use the phrase “Is there anything else I can help you with today?”. This provides a chance for the Client to share something that may have been on their mind, but was not sure about sharing or may have not felt comfortable bringing up.

Next steps in this case

When knowing that she would be returning to Canada and leaving her job in the USA, Haley

worked with the Client to ensure that he continued to get the support he needed, by encouraging him to develop self-sufficiency, checking in with the support person regularly, and working on developing self-awareness. 

The Client was advised to develop self-awareness by keeping in mind the following three questions:

• Do I feel okay?
• Do I understand what is going on?
• Do I have any questions?

Support self-awareness and self-advocacy by encouraging reflection, empowering Clients to confidently request interpreters, and guiding them on who to contact for assistance and follow-up on tasks.

Some conclusions

The second case conference highlighted the important concepts of torture and its impacts on the survivors’ future, family, and community. This event proved that the resettlement of the survivors doesn’t end their suffering and heal their trauma, which can follow them wherever they go. On the other hand, building the capacity of personnel and employees who provide services for survivors of torture will help address the needs of survivors.

Challenges facing resettled survivors, such as language barrier, building a new life, finding a good job, and adapting to the new community, can be minimized by active coordination between different professionals.

In summary, the second case conference has offered valuable insights into the vital need to emphasize coordination, cooperation, and communication among professionals to improve support services for torture survivors and minimize the challenges they face in their journey. It underscored the need to develop strategies to reduce stigma related to trauma and torture, fostering a supportive environment for survivors seeking help. 

Another critical aspect is the need to support self-care for professionals and caregivers to enhance support quality and maintain resilience. Moreover, enhancing the capacity of personnel to address survivors’ complex needs and aid their integration into new communities is paramount. 

Acknowledgements 

Funding for this project is provided by the Victoria Foundation. This Case Conference was presented by Haley Smith, Settlement Worker with ICA. This report was written by Sarra Abd Alla, Ana Pavon and Álvaro Moreno.

1. Elbadawi, E. (2000) ‘Why are there so many civil wars in Africa? understanding and preventing violent conflict’, Journal of African Economics, 9(3), pp. 244–269. doi:10.1093/jae/9.3.244.
2. https://www.unrefugees.org/refugee-facts/camps/.
3. ³ Vossoughi, N., Jackson, Y., Gusler, S., & Stone, K. (2018). Mental Health Outcomes for Youth Living in Refugee Camps: A Review. Trauma, Violence & Abuse, 19(5), 528–542. https://www.jstor.org/stable/26638235 
4. Kenya-Refugee-population-statistics-package-31-january … Available at: https://www.unhcr.org/ke/wp content/uploads/sites/2/2023/02/Kenya-Refugee-Population-Statistics-Package-31-January-2023.pdf (Accessed: 05 March 2024).
5. Kenya-Refugee-population-statistics-package-31-january 2024 … Available at: https://www.unhcr.org/ke/wp-content/uploads/sites/2/2023/02/Kenya-Refugee-Population-Statistics Package-31-January-2023.pdf (Accessed: 05 March 2024).
6. https://www.unhcr.org/innovation/15-ted-talks-on-refugee-resilience/ (Accessed: 05 March 2024)