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Migrations et traumatismes migratoires

La plupart des exilés vivent des événements traumatisants, un traumatisme migratoire parfois déclencheur d’un trouble de stress post-traumatique (TSPT). Fuyant déjà les violences dans nos pays d’origine, notre parcours migratoire, parfois étalé sur plusieurs années, est souvent jalonné de périls, allant de la captivité aux tortures, en passant par les violences sexuelles, voire à la mort de compagnons. 1 personne sans titre de séjour sur 6 souffrirait ainsi de stress post-traumatique en France.

Once we arrive in a country we consider "safe", such as France, the violence doesn't disappear; it takes on new forms. It takes a lot of energy for us and our children not to collapse, especially as access to care can be long and complicated.

Les professionnels et bénévoles qui nous accompagnent dans ce périple peuvent également être touchés par cette violence. Ils peuvent alors souffrir d’un TSPT vicariant, c’est-à-dire un trouble de stress post-traumatique provoqué par un événement non pas vécu directement mais à travers la souffrance d’un autre. Dans ce dossier, nous verrons qu’il existe des ressources pour repérer d’éventuelles blessures psychiques, chez soi et chez les autres, mais surtout pour les prendre en compte et vivre mieux les traumatismes migratoires.

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What is PTSD?

Post-traumatic stress disorder, sometimes referred to by its abbreviation PTSD, is a disorder that occurs following a traumatic event in which one is or feels confronted with death (an armed conflict, an attack, a car accident, etc.) or one's physical integrity is attacked (a physical and/or sexual assault, rape, etc.).

It's a reaction to intense stress, usually occurring within a month of the event, but can also manifest itself months or even years after the trauma. It affects more women than men, and also children. To find out more

Recognizing the symptoms of PTSD

There are four main types of symptoms that must persist for at least a month and cause discomfort:

- Avoidance: when we avoid going down a particular street, doing a particular activity, etc. In short, we avoid anything that might remind us of the traumatic event. In short, we avoid anything that might remind us of the traumatic event.

- Reliving: in spite of ourselves, we will "relive" the traumatic event and the emotions we felt at the time. These are particularly violent moments that can paralyze the person experiencing them. They can take the form of flashbacks, nightmares...

- Hypervigilance: you'll jump at the slightest noise, be on the alert all the time, turn around all the time in the street to see if anyone's following you, and so on.

- Negative emotions or ideas about oneself: one will feel anger, fear, guilt or shame in connection with the event. It can also be an inability to remember important elements of one's life from the traumatic event(s) (typically due to dissociative amnesia and not to other factors such as head trauma, alcohol or drug use).

Risk factors for PTSD

Not everyone develops PTSD after a traumatic event, but there are factors that increase the risk. These factors include:

- The severity of the event ;

- The person's proximity to the event;

- Lack of social support;

- Past trauma history;

- A history of other mental disorders.

It's important to understand that PTSD is not a weakness. PTSD is a psychological disorder that can occur in anyone who has been exposed to extraordinary and threatening events. In the next chapters, we'll look at how to identify, manage and overcome PTSD, whether after a natural disaster or any other traumatic experience.

Fiches TSPT dans d'autres langues / PTSD in other languages

- English sheet

- Albanian sheet

- Arabic sheet

- Georgian sheet

- Bengali sheet

- Fiche en pachto

- Swahili sheet

- Dari sheet

- Sheet in Chechen

Couverture migration trouble-stress-post-traumatisme tspt
sante mentale, migration exilées aide médicale soin urgence soutien

The health of exiles: a few benchmarks

Navigating the healthcare system in France can be complex, but people in a migrant situation, whether they have a residence permit or not, can benefit from access to healthcare.

After three months on French soil, you can apply forAide Médicale d'Etat (AME), which covers 100% of your healthcare costs - so you don't have to pay in advance. Permanences d'Accès aux Soins de Santé (PASS) are services specially designed to offer healthcare to people in precarious situations, including migrants. In these services, even if you don't qualify for the AME, or if you are in an irregular situation, you can benefit from free medical consultations and care.

Specific mental health services

Various mental health professionals can help exiles. In addition to emergency departments, some hospitals offer specialized psychiatric PASS services.

You can also turn to the Équipes Mobiles Psychiatrie Précarité (EMPP), which generally visit the places where the people concerned live, and the Centres Médico-Psychologiques (CMP), centers dedicated to mental health throughout France (to find the nearest one to you, type CMP + the number of the nearest large town into any search engine).

In private practice, i.e. outside hospital structures, psychologists and psychiatrists specialize in the treatment of psychotrauma. To understand the difference between "psychiatrist" and "psychologist" and find out more about treatments > Seeking help

Consultations are available at the Centres Régionaux du Psychotraumatisme(CRP), but it can take a long time to get an appointment.

Am I risking anything by asking for help?

It's common, when you've experienced a violent event, to react to it and feel bad. When you break your leg, it's normal to feel pain and try to alleviate it. The same applies to psychological trauma!

Asking for help when you think you're suffering from post-traumatic stress disorder is not a sign of weakness. Nor does it mean you're "crazy". There are therapies available to help you get better and live more serenely, even when you've been through horrible things.

If you ask a doctor, nurse or psychologist for help:
- You won't be judged;
- Your family will not be affected;
- You will not be forcibly hospitalized;
- You will not be forced to take medication;
- No one else will know about it, if you want to keep it between you and your caregiver.

In all cases, mental health professionals must respect confidentiality. What you tell them will have no impact on your asylum application or your administrative situation in general, unless you request it.

To find out more about mental health and support for exiles in France, take a look at this comprehensive practical guide produced by Orspere-Samdarra.

How does exile affect us?

The experience of exile is often marked by traumas that go beyond the direct violence suffered, for example, in one's country of origin. Losses, family separations and radical changes in our environment can cause deep psychological wounds, or accentuate existing ones.

Violence against women in migration

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).

Ces violences de genre exacerbent les risques de troubles de stress post-traumatique (TSPT) chez les femmes exilées. Les conséquences psychologiques de telles expérience, liées à des traumatismes migratoires, sont profondes et la stigmatisation sociale associée à ces violences peut entraver l’accès à un soutien adéquat.

Reception conditions

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.

Other words of trauma

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.

Who to ask for help?

In addition to the healthcare services available to exiles (see above), we also offer a range of other services. France's healthcare system for foreigners and Specific mental health services), there are a number of structures that can help you through this difficult period.

Existing structures

> Associations such as Médecins du Monde, La Cimade and France Terre d'Asile can refer you to mental health services adapted to exiles and offer specific support;

> Specialized centers such as the Centre Primo Levi (Paris) or Osiris (Marseille) offer psychological support to exiles. You can contact these organizations for information on the services available;

> In anemergency, you can call 15 at any time. And if you or your loved one is developing suicidal thoughts, call 3114, the national suicide prevention number.

Using an interpreter

If you don't speak French well, or if you'd like to help a loved one who doesn't, you may find it useful to use an interpreter. In this case, when you make an appointment with a healthcare professional, inform the staff that you need an interpreter. Ideally, the facility will use a professional interpreter who speaks your mother tongue.

This interpreter is also required to respect the confidentiality of any exchanges you may have with the healthcare professional. He or she is there to ensure that communication between you and the healthcare professional is clear and confidential, and that you understand the healthcare professional's questions and answers correctly.

If you have any concerns during the consultation, don't hesitate to express them. Adjustments can be made to ensure your comfort. Our aim is to provide you with care tailored to your needs, despite language differences. Don't be afraid to share your concerns and ask questions if you feel uncomfortable during consultations and translation sessions.

10 techniques to help yourself

In addition to seeking professional help, there are techniques you can use to help yourself cope with PTSD. These are not intended to "cure" the trauma, nor to replace treatment or therapy, but to provide a few tips for everyday life.

Here are some examples > 10 techniques to help yourself after a trauma

How can I help a child?

Exile can have a profound effect on children's mental health, manifesting itself in post-traumatic stress disorder (PTSD). Being a child, even a very young one, does not make you immune to trauma, nor does it prevent you from developing post-traumatic stress disorder. The same goes for teenagers.

Signs of PTSD in children and adolescents

Children in exile may show specific signs of PTSD, aggravated by the precarious living conditions. Symptoms may include intense fears, nightmares, difficulty distinguishing past from present, stress reactions linked to the uncertainty of their situation...

Most of the time, children and adolescents in exile situations will be more affected by what is known as complex post-traumatic stress disorder, because they will have experienced prolonged and/or repeated violence, whether in their country of origin, on the way to exile or once they have arrived in France.

Warning signs:

- Difficulty regulating emotions
- Fragile attachment
- Regressions and abrupt emotional changes
- Aggressivenesś towards self and others
- Behavioral, attention and learning difficulties
- Sleep and eating disorders
- Somatic manifestations (stomach aches, headaches, eczema, etc.)
- Feeling of never fitting in
- Guilt, self-hatred, lack of self-confidence
- Risky behavior
- Difficulty setting limits

Find out more about complex post-traumatic stress disorder in children and adolescents.

Who can I turn to for help for my child/teenager?

In addition to the structures listed at the beginning of this file, assistance may be offered:

- In medical-psychopedagogical centers (CMPP) all over France; to find them, type "CMPP" into any search engine. These centers offer specific services for children and adolescents;

- In the maisons des adolescents (MDA), specially designed to support and help teenagers and young adults;

- Mother and child protection services (PMI), for pregnant women and young children.

Catastrophes naturelles : comment aider un enfant migration conséquence, exil

In addition to the help you can get from associations, here are a few tips to help your child cope with the trauma of exile, and to help them live better day by day, depending on their age.

How to help your child (0 to 5 years)

- Create routines: Stable routines offer a sense of security, essential for reducing anxiety. Regular reassurance, such as cuddling before bedtime, creates soothing moments that help mitigate the effects of trauma.

- Play with your child: Use play as a way for your child to release his or her emotions. Toys can be simple therapeutic tools for expressing difficult feelings.

- Encourage physical contact: Physical contact, such as cuddling, releases soothing hormones. This helps reduce stress and strengthen the emotional bond, providing crucial emotional support.

How to help your child (ages 6 to 12)

- Focus on creative hobbies: Encourage your child to express himself through art (drawing, painting, writing, dancing...). Artistic expression offers a way of giving shape to emotions that are difficult to express verbally. This helps children to better understand and cope with painful experiences.

- Don't deny your culture: Maintain a connection with the culture of origin, through relatives who share the same culture, the transmission of a mother tongue, the celebration of festivals and the maintenance of traditions, etc. This can be an essential anchor for the child's identity in a new context. This can be an essential anchor for the child's identity in a new context. It helps the child to feel more rooted, strengthening his or her resilience in the face of change.

- Offer soothing activities: Sporting or artistic activities release endorphins that act as natural antidepressants. They help release accumulated stress and promote emotional well-being.

How to help your child (ages 13 to 18)

- Don't be afraid to talk about it: It's not always easy, but expressing their experiences openly can help teens understand and process their emotions. Open dialogue creates a safe space for sharing thoughts and concerns.

- Turn it to the future: Having future goals gives meaning to the experience: sports competition, studies... This can help teens focus on building a positive future rather than staying focused on the painful past.

- Make sure he has support: Facilitate participation in peer support groups. Teens can find comfort and advice from those who share similar experiences.

Unaccompanied minors (MNA)

In 2022, some 15,000 children and teenagers were considered unaccompanied foreign minors and entrusted to the Aide Sociale à l'Enfance (ASE). These young people are all the more fragile and affected by psychotrauma, as the traumas they experience are compounded by the difficulties associated with loneliness and the difficulty of obtaining recognition of their rights.

For more information on unaccompanied minors, visit InfoMIE, a resource center for unaccompanied foreign minors.

Psychological disorders presented

Between 40% and 50% of these young people are thought to have mental health problems requiring treatment on arrival in France. The most common disorders are :

- Depression, sometimes leading to suicide;
- Anxiety disorders;
- Prolonged grief disorders (especially when these young people have lost their parents).
- Post-traumatic stress disorder (PTSD)

! Children and teenage boys are regularly victims of sexual violence during their migratory journey!

Why do we call it "mijeur"?

The fact of being a "mijeur", i.e. a minor not recognized as such, can add a further source of stress to the already difficult situation of the individuals concerned. By not being recognized as a child in the eyes of the law because they lack the ability to prove it (with a birth certificate, for example), these young people find themselves in a grey zone where they do not benefit from child protection or the rights accorded to adults.

This situation often leaves them vulnerable and destitute, facing challenges such as access to basic services, including education, health and social protection. Lack of recognition of their status as minors can also lead to further obstacles in their migration path, exposing them to increased risk of exploitation, violence and marginalization.

Being a "mijeur" can add to the stress and uncertainty already present in the lives of unaccompanied minors, compromising their well-being and their ability to integrate into their new environment.

How can social workers and volunteers help?

Professionals who regularly interact with people in exile, whether as social workers, healthcare professionals, educators, volunteers in associations, or in reception and emergency accommodation centers, are on the front line in screening for post-traumatic stress disorder.

In your day-to-day interactions with these people, you often witness the concrete difficulties they face: lack of financial resources, precarious housing conditions, language barriers, limited access to healthcare services, as well as migration-related traumas such as experiences of violence and bereavement.

Spotting the signs of PTSD

Your role in screening for PTSD is crucial, especially as in many cultures, seeking help from a mental health professional is not taken for granted, and many are unaware that such help even exists.

Here are the signs to look out for:

- Flashbacks;

- Recurring nightmares;

- Hypervigilance;

- Excessive startle reactions;

- Intense emotional distress

- Difficulty concentrating;

- Sleep disorders;

- Avoidance behaviors;

- Sudden changes in behavior or mood.

By recognizing these signals, you can play a crucial role in directing people to appropriate resources and supporting them in accessing mental health services.

Advice and guidance

It's not always easy to know what to do when someone in distress shows signs of PTSD. In addition to referring the sufferer to a health professional, we can provide support on a day-to-day basis:

> When counseling and orienting people in exile, provide them with clear information about post-traumatic stress disorder (PTSD) in a language and form they can understand. This can include providing information sheets translated into different languages, so they can better understand what is happening to them. See "PTSD in English and other languages" at the top of the page.

To find out more about using an interpreter, see our fact sheet " Using interpreters to welcome and care for exiles " and the replay of our webinar on interpreting in the care of traumatized exiles.

Two useful applications in the absence of an interpreter:
- TraducMed, a website and application for healthcare professionals, and a version for social workers and association staff;
- MediPicto, an application for patients and healthcare professionals.

> Reassure people in exile that consulting a psychologist or mental health professional does not mean they are "crazy". Stress that they won't be forced to tell their whole story again, and that there are ways to feel better.

> Take cultural differences into account when dealing with PTSD. Try to understand how they perceive their symptoms, to whom or what they attribute their suffering, and how they would deal with the situation in their country of origin.

> Creating a reassuring, stable environment is essential to helping people in exile feel secure. Make sure you maintain a lasting bond with the people you counsel and guide. Social support plays a crucial role in the healing process of PTSD, so maintaining an ongoing, empathetic relationship can be an essential protective factor for their mental well-being.

To find out more about how to support people in exile suffering from post-traumatic disorders, take a look at this comprehensive guide produced by Ospere-Samdarra: " Supporting the mental health of migrants, a resource guide for social workers".

Protecting yourself

Your involvement with people in exile can have a significant impact on your own mental well-being. Repeated exposure to traumatic situations or stories increases the risk of developing vicarious post-traumatic stress disorder.

Vicarious PTSD?
Vicarious post-traumatic stress disorder (vicarious PTSD) is a form of traumatic stress that affects individuals who are repeatedly exposed to the traumatic stories or experiences of others, often as part of their work or professional commitment. Unlike classic PTSD, where the individual is directly exposed to a traumatic event, vicarious PTSD develops in those who hear or witness the traumas experienced by others.

This phenomenon is common among professionals working in fields such as mental health, social services, emergency relief and journalism, where they are regularly confronted with others' stories of suffering and trauma. The signs and symptoms of vicarious PTSD are similar to those of classic PTSD and can include flashbacks, nightmares, irritability, anxiety, avoidance of situations reminiscent of the trauma, sleep disturbances and emotional distress.

It's essential to recognize the signs of vicarious PTSD and take steps to prevent its development by implementing self-care strategies, seeking professional support and taking regular breaks to recharge emotionally.

Certain signs may alert you to the state of your mental health and the possibility that you are developing vicarious PTSD. For example:

- If you find it hard to let go of your work when you get home ;

- If you feel constantly preoccupied by a person you are accompanying ;

- If you feel disproportionately angry or irritable;

- If you feel overwhelmed by your emotions and can't keep a distance.

Other signals may include disturbances in your sleep, increased or excessive alertness, or changes in your eating habits or social behavior. If you notice these persistent signs, don't hesitate to talk to a healthcare professional, such as your GP. They can help you find strategies to manage your stress and anxiety, and direct you to additional resources if necessary. Getting help at an early stage can help prevent symptoms from worsening.

If you need psychological support, Parcours d'Exil's national " Résonances " program (support for professionals) is there to help.

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