Bosnian refugees in New Zealand : their stories and life experiences, health status and needs, and the implications for refugee health services and policy : a thesis submitted in partial fulfilment of the degree of Masters in Business Studies (Health Management), Massey University

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New Zealand has been accepting refugees for resettlement since the 1940s and currently accepts a quota of up to 750 refugees per year. Although international literature demonstrates that refugees have substantial health needs, little research has been conducted in New Zealand. This study used a semi-structured interview guide containing a list of predetermined themes that were explored through open-ended questions. Twelve refugees from Bosnia, seven male (former concentration camp detainees) and five female refugees were interviewed in the setting of their choosing between April and October 1996. Findings indicate that though severely traumatised by their experiences, the respondents were not assessed for mental health during the comprehensive medical screening process at the Mangere Refugee Reception Centre. As with other aspects of the resettlement process, no follow-up of this group of refugees took place to assess how they were coping and adapting to the new surroundings since the completion of their orientation programme at the Centre. This, in part, may explain their lack of awareness of the service provided by the Refugees as Survivors Centre established some two years after their resettlement in the community. Though unsure of the long-term effect that their experience may have on their health, immediate and most common symptoms reported were headaches, irritability, persistent thoughts of the past, difficulty with sleeping, and nightmares. Believing that they would not be understood by those who had not been through the experience themselves, former concentration camp detainees have come to rely on each other for mutual support rather than other members of their family or any outsider who had not been through the camps. The majority of those interviewed said they had limited contact with the wider community which resulted in a sense of social isolation. Contact with other Bosnians has been retained, although contact with non-Bosnian immigrants from the former Yugoslavia, including those who arrived in New Zealand well before recent conflicts, has been avoided. Despite their ordeal, most of those interviewed seemed to enjoy good physical health. The reported use of General Practitioners and other health services was low. The major reported health need was dental, but dental care was largely not met because of the cost. Language and transport were not identified as major barriers to health care. This may have been mitigated by the availability of interpreters known to the respondents who initially also took them to the health care providers. No other barriers to health care were reported. Mental health services were not seen as a need by those interviewed, in spite of the symptoms reported. The findings of this study highlight the potential difficulties when an established ethnic group, from the country of origin, is selected as a sponsor, especially considering the cultural religious and political complexities of the former Yugoslavia. Greater consultation with the refugees themselves, speedier family reunification, orientation programmes that more closely reflected the character and background of the refugee group, and greater financial assistance, would have facilitated the resettlement process and minimised possible downstream personal, social and financial costs and in the long term, potential health problems. The major conclusion of this study is that refugee health and refugee health policy cannot be isolated from the total refugee experience (the pre-flight period, asylum and resettlement in a distant foreign country). This experience is characterised throughout by loss (of loved ones, homes and homeland), trauma and a lack of choice. An effective refugee resettlement and health policy must take these factors into account.
New Zealand, Bosnia and Hercegovina, Refugees, Health and hygiene, Yugoslav War, 1991-1995, Adjustment disorders, Bosnians, Mental health, Post-traumatic stress disorder - Treatment