Migration and migration trauma

Women suffer additional gender-based violence throughout their exile journey. Numbers are hard to pin down, but it is estimated that almost all of them suffer sexual violence during their migratory journey. In 2019, a survey carried out by the Commission des Femmes Réfugiées pointed the finger at the passage to Libya, where many migrant women were subjected to sexual assaults up to and including rape, resulting in unwanted pregnancies and sometimes suicides.

Testimonies mention :
- Sexual violence ;
- Rape ;
- Forced marriages ;
- Sexual exploitation;
- Torture, etc.

Beyond the taboo that surrounds issues of sexual violence, the phenomenon of dissociation includes reactions of sideration andamnesia that often prevent female victims from testifying about their experiences, let alone in a short time. According to a Swedish study published in 2017, 70% of victims of sexual violence are affected by sideration. This inability has an impact on their asylum applications, during which they are asked to give a detailed account of the violence they have experienced and to be credible, which dissociation makes impossible (see "Reception conditions" below).

The phenomenon of dissociation explains why many women are unable to react, to say no, to defend themselves, during a sexual assault. To find out more about this common psychological mechanism, take a look at the video " Rape: why the brain prevents some victims from reacting " by Le Monde newspaper (warning, contains testimonials).

Gender-based violence exacerbates the risk of post-traumatic stress disorder (PTSD) in exiled women. The psychological consequences of such experiences, linked to migratory trauma, are profound, and the social stigma associated with such violence can hinder access to adequate support.

In addition to the violence committed in asylum seekers' countries of origin, and the violence experienced throughout the migration process, reception conditions in France can also have an impact on the mental health of exiles.

Among the elements that affect exiled people and can act as a brake on recovery are:
- A feeling of uncertainty about the future;
- Low financial resources;
- Lack of health coverage
- Language barriers;
- The maze of administrative procedures;
- Everyday difficulties with food, housing and work;
- Isolation;
- Fear of being locked up in a Centre de Rétention Administrative (CRA) and deported, etc.

These vulnerability factors are frequent and cumulative. According to a Santé Publique France study published in 2017, a quarter of exiled people accumulated at least five vulnerability criteria.

The asylum procedure also triggers a great deal of stress. If you have been through traumatic experiences in your home country, such as physical violence, political persecution, war etc., the asylum procedure can rekindle these traumas, as we often have to recount these traumatic experiences in detail to support our claim.

Moreover, asylum procedures can be long and uncertain. This prolonged wait can generate chronic stress, all the more so as it adds to the fear of being confronted again with dangerous and violent situations if the asylum application is refused.

Asylum procedures, by challenging applicants' traumatic past, can reactivate memories of traumatic events, leading to symptoms such as flashbacks, nightmares, anxiety and avoidance of trauma-related stimuli.

You may not describe the distress you feel following traumatic situations in the same way, as post-traumatic stress disorder, or "PTSD". In some non-Western cultures, manifestations of psychological distress may be interpreted and described differently. Sometimes, too, you may attribute the origin of your pain to other factors. Here are a few examples of concepts that may refer to trauma, and that you can mention in a transcultural consultation

> In Latin America, a " nervios attack "is often characterized by intense emotional reactions, such as crying, screaming or temporary loss of consciousness, in response to emotional stress. Some episodes of dissociation and extreme anxiety observed in a nervios attack may be comparable to reactions seen in some PTSD sufferers.

> In the culture of the Maghreb, the concept of " Jinn "represents spiritual entities, and certain ailments are sometimes attributed to their influence. Although the concept of Jinn is not directly comparable with PTSD, psychological manifestations may be interpreted differently according to cultural beliefs.

> " Khal'a " is a term used in certain North African cultures to describe a state of intense fear or shock, often resulting from a traumatic experience. It is sometimes associated with physical and emotional manifestations, such as tremors, nightmares and sleep disturbances. Khal'a can be interpreted as a reaction to trauma, and its symptoms may overlap with those of PTSD. Both disorders involve a prolonged response to stress.

> " Susto " is a term of Spanish origin meaning "fright" or "shock". It is used in South America to describe a situation in which a person may experience psychological distress after experiencing a traumatic event. Symptoms of susto, such as nightmares, are similar to those of PTSD. Both disorders can result from traumatic events and share aspects of psychological distress.

These few examples of cultural concepts highlight the diversity of responses to trauma around the world, and how different societies conceptualize and understand these experiences.

In all cases, don't be afraid to explain the origin of your suffering to the caregiver in front of you, even if it's unknown or unfamiliar. There are also specialized transcultural psychiatry clinics (see "Who can I ask for help?") to take these differences into account and offer appropriate support.