SRI LANKAN TAMIL DIASPORA: CONTEXTUALIZING PRE-MIGRATION AND POST- MIGRATION TRAUMATIC EVENTS AND PSYCHOLOGICAL DISTRESS

By

Miriam George

A thesis submitted in conformity with the requirements

for the degree of Doctor of Philosophy

Faculty of Social Work

University of Toronto

© Copyright by Miriam George (2009) ABSTRACT

Title: Sri Lankan Tamil Diaspora: Contextualizing Pre-Migration and Post- Migration Traumatic Events and Psychological Distress

Degree: Doctor of Philosophy

Year: 2009

Author: Miriam George

School: Faculty of Social Work, University Of Toronto

The objective of this study was to generate a deeper understanding of the influence of pre- and post-migration traumatic experiences on refugees’ psychological distress, including historical, political and social factors. This dissertation used a multi-method design to examine the impact of trauma on the psychological well-being of refugees. Further, the design included a quatitative component to provide a contextual framework for understanding refugee psychological distress that is not limited to an analysis of a disease model alone but by also making connections to important historical, social and political events. Post-Colonial, Refugee, Trauma and Feminist theories are used as analytic lenses to explain the social structures and events contributing to refugees’ pre- and post-migration traumatic events, and psychological distress.

This was an international study that spanned two continents. Sampling included 50 Sri

Lankan Tamil refugee participants who lived in Chennai, India and 50 Sri Lankan refugees in

Toronto, Canada. Inclusion criteria included a residency period of the last 12 months in either of the sampling sites, and participants 18 years of age or older. Participants from Toronto were recruited through social service agencies and associations, and participants from Chennai were recruited from refugee camps, and the Organization for Elam Refugee Rehabilitation. Tamil versions of the

Harvard Trauma Questionnaire, the Post-Migration Living Difficulties Questionnaire, and the

ii

Symptoms Check List – 90R were utilized to measure participants’ pre- and post-migration traumatic events and psychological distress. The Harvard Trauma Questionnaire contained qualitative open-ended questions to triangulate the quantitative data in identifying and exploring the impact of contextual influences.

Results showed that post-migration traumatic event scores positively predicted psychological distress, and refugee claimants living in Canada had the highest scores on pre-migration and post- migration scores. The qualitative analysis revealed themes related to civil war and resettlement as significant issues. Implications of these findings support the development and incorporation of a multi-level approach within social work practice which emphasizes contextual issues, focuses on individuals, and promotes social advocacy. The advocacy role of social workers suggests that better integration of micro and macro systems should be aimed for more consistently since internal and external factors interact to effect psychological functioning. Recommendations for future research point to conducting longitudinal studies to assess the cumulative effects of historical, social and political factors on refugees and identify resiliencies that mobilize their capacity to survive.

iii ACKNOWLEDGEMENTS

For the memory of the Tamils who fought for their rights during the Sri Lankan Genocide......

Completing a doctoral dissertation is a great accomplishment in anyone’s life. By completing this international scientific study, I am bringing to life the urgency of recognizing the unique voices of the Sri Lankan Tamil community that can enlighten and inspire readers to work towards social justice in Sri Lanka.

The more I thought about writing this acknowledgement section, the more I realized that the people I have known throughout my life journey in India and Canada have contributed in creating this work. The Indian village of Koratty, where I was born and brought up, gave me the space to cultivate and expand my creativity -starting from the Little Flower Girls School where I started my education, to the Koratty Muthi Church where my life moved forward. It’s all about Koratty, the place I was born and brought up, and the people in Koratty who encouraged my carefree spirit. Wherever I go, my memories of Koratty are my constant companion. I am stumbling now to find the right words to express my gratitude to my hometown. However, I believe that acknowledging my deepest connection to my village and its people, even after I left the village 20 years ago, proves my true feelings to my home town.

Canada brought a great deal of new experiences for me. My memories include individuals who inspired me to transform my previous experiences into hope and purpose. Two organizations: the University of Toronto and the Centre for Addiction and Mental Health (CAMH) played a huge role in who I am today. The University of Toronto is truly a home away from my real home. The comfort and support I received from the Faculty of Social Work is unforgettable.

No words are enough to express my gratitude for the intense mentorship and brilliant organization skills of Professor Ramona Allagia, my Doctoral supervisor, who guided me to complete my international research in four years. Her support and encouragement for me to complete this dissertation in a short period of time taught me so much about leadership and commitment to social work research.

Professor Charmaine Williams - my mentor, my doctoral committee member, a researcher, a social worker, a social activist and an educator - played a significant role in the last 11 years of my Canadian life. Her activism for the rights of people with severe mental illness and her commitment to diversity is a guiding light for any social worker. Her high energy and motivating presence is a blessing for students especially for those who are coming from vulnerable backgrounds.

Professor Tahany Gadalla came as a calming presence during my doctoral program. Her patience is her most admirable virtue which is a valuable asset for any educator. I would like to express many thanks to Professor Gadalla for providing me with stress- free statistical analysis lessons to complete my study. I extremely

iv appreciate Professor Uzo Anucha’s commitment to my research and her endless support to me as a social researcher from South Asia. The continuous support by many staff from the University of Toronto including Professor Adrienne Chambon, Professor Rupaleem Bhuyan, Professor Michael Saini, Sharon Bewell, Angela Umbrello and Kay Ramdass is also very much appreciated.

The Centre for Addiction and Mental Health provided the best research and practice environment for me. My heartfelt thanks to my CAMH colleagues, specifically to Akwatu Khenti; Debbie Thompson; Mahreen Hasan; Dr. Michael Bagby; as well as the Education and Health Promotion program; the Psycho-Geriatric program; the Mood and Anxiety Program and the Pro Act –Schizophrenia program, for accepting and encouraging my dream to be a researcher.

To my husband, James George: destiny brought us together from opposite sides of the world. You have been a rock for me in completing this doctoral program. Thank you for believing in my strengths as a social worker and a researcher.

To my daughter Amie, you were born in my heart. My activism and passion for women’s rights in the South Asian community are for you to have and live a life of your choice. My only wish for you is to continue my passion in the very best way you can.

To my son Varkey: when I look at you, I see the pain you went through with your health issues as a baby and admire the strength and resilience you demonstrated to get through and be the energetic, and charming boy you are today. Thank you for continuing to make me a special person in your life and I hope and wish that you will follow the footsteps of your namesake.

To my mother Elizabeth and my brothers Paul and Jojo: I know in my heart that I never followed the traditions you had expected. However, I acknowledge your confidence in my ability to carry my life as an independent working woman and thank you for your immense support during my many challenging and difficult times. A special acknowledgement for Amma, thank you for being a wonderful mother and grandmother to my children during my busy work/school schedule. I hope that your love and values will continue to flourish in their life.

The Kuttikat family paved the way for me to become a strong, independent and educated woman with my own opinions. My doctoral dissertation would not be completed without acknowledging one of the most powerful women in my life: my paternal grandmother and my namesake Mariamkutty Maliakkal. Her vision affirmed women’s value in society and continued to keep my spirit strong even after her death 33 years ago. I would also like to express my gratitude to my paternal aunts and uncles who encouraged me to have dreams and dream higher every day. The Erinjery family brought the blessing of laughter into my life. I fondly

v remember my maternal aunts and uncles who used laughter to live their lives to their fullest. Sincere appreciation to the Madapallimattam family for their care during many difficult times.

Recognizing the contributions of my friends in India and Canada during my personal journey is immeasurable. They were my defense during many rocky times and let me think through many of my creative ideas out loud. Many thanks to Anna Varghese, Preetha Paul, Raji Lakshmi, Shivaranjini, Anita Valliancourt, Steven Solomon, Charlene Cook, Magnus McCarthy, Stephen Willoughby, Cecilia Manicatide, and Betty Gillard, who helped me to be who I am. My deep appreciation to the Tamil Elam Society of Canada, the Canadian Mental Health Association, the Organization for Elam Refugee Rehabilitation, the Refugee authorities in Maviran, Gokulam, the Old refugee camps in Chennai, and to Dr. Mohandas and Dr. Shiva Nambi for making this endeavor successful.

Everyone has someone who deeply informs the way they move through life. For me, it was my father - he was and still is my strength and my initiator to social activism. He showed me the power of independent and confident women. His passion to community service and his ability to mix with people regardless of their differences was extremely admirable. He never gave up on me and never let anyone give up on me either. He was truly a man with constructive ideas for change. He often told me – You are like a cat, every time you fall, you fall with your four legs straight, which will make you fight back. He believed in me. To me, he was one of the most important and outstanding individuals in this world because of his care, love and inspiration. I am a daughter of a great father. My Doctorate was a shared dream and bond between us. I am dedicating this scientific study to my dear father - Kuttikat Paul Varghese - who loved and trusted me enough to let me go where I wanted to go.

“Woman must not accept; she must challenge. She must not be awed by that which has been built up around her; she must reverence that woman in her which struggles for expression”. ~ Margaret Sanger ~

vi TABLE OF CONTENTS

CHAPTER 1: INTRODUCTION ...... 1

OVERVIEW OF THE DISSERTATION ...... 4 Structure of the Thesis...... 5 CHAPTER 2: CONTEXTUALIZING REFUGEES ...... 7 HISTORICAL, SOCIAL AND POLITICAL CONSTRUCTION OF REFUGEES...... 7 REFUGEE STATISTICS ...... 10 Asia...... 10 Africa ...... 11 Europe...... 11 The Americas...... 12 COLONIZATION AND THE CONSTRUCTION OF REFUGEES...... 13 TYPOLOGY OF DISPLACED POPULATION ...... 15 GLOBAL CONTEXT: UNITED NATIONS HIGH COMMISSIONER FOR REFUGEES ...... 16 SUMMARY...... 26 CHAPTER 3: REVIEW OF LITERATURE ON REFUGEES...... 28 THEORETICAL LITERATURE ...... 29 SYNTHESIS OF THEORETICAL PERSPECTIVES...... 40 EMPIRICAL LITERATURE...... 43 Migration Traumatic Events and Refugee Psychological Distress ...... 46 Typology of Refugee and Typology of Refugee Settlement ...... 53 Gender ...... 55 Host Country Status ...... 56 SYNTHESIS OF EMPIRICAL LITERATURE ANALYSIS...... 57 CHAPTER 4: BACKGROUND TO THE STUDY ...... 63 HISTORICAL, SOCIAL AND POLITICAL CONTEXT OF SRI LANKA...... 63 Colonization, Political Religions, Liberation Tigers of Tamil Elam and Global Politics...... 66 HISTORICAL, SOCIAL AND POLITICAL CONTEXT OF SRI LANKAN TAMIL REFUGEES IN INDIA & CANADA...... 639 MENTAL HEALTH NEEDS OF SRI LANKAN TAMIL REFUGEES ...... 73 SUMMARY...... 734 CHAPTER 5: RESEARCH METHODOLOGY ...... 75 RESEARCH QUESTIONS AND HYPOTHESES...... 75 RESEARCH DESIGN...... 78 SAMPLING...... 79 DATA COLLECTION/INSTRUMENTATION ...... 80 Demographics...... 81 Harvard Trauma Questionnaire - Tamil (HTQ-T)...... 81 Symptoms Check List - 90R (SCL-90R) ...... 82 PROCEDURES...... 83 Ethics Approval...... 83 Recruitment...... 83 Emergency Procedures...... 84 Participant Withdrawal...... 84 Confidentiality...... 84 Compensation...... 85 POSSIBLE RISKS AND BENEFITS ...... 85 Risks...... 85 Benefits...... 86 DATA MANAGEMENT...... 86 DATA ANALYSIS...... 86

vii CHAPTER 6: FINDINGS...... 89 DESCRIPTIVE ANALYSIS OF PARTICIPANTS ...... 89 Descriptive Analysis of Toronto, Canada Participants...... 90 Descriptive Analysis of Chennai, India Participants ...... 91 DESCRIPTIVE ANALYSIS OF SCALE SCORES ...... 93 SCALE RELIABILITY ANALYSIS...... 94 CORRELATION BETWEEN HTQ, PMLDC AND SCL-90R ...... 94 FINDINGS BASED ON RESEARCH QUESTIONS ...... 96 Research Question One ...... 96 Research Question Two...... 100 Research Question Three ...... 102 THEMES FROM QUALITATIVE ANALYSIS ...... 104 Civil War and Genocide ...... 104 Settlement/Kudiyettam...... 105 U.N. as Ineffective? ...... 106 CHAPTER 7: DISCUSSION AND CONCLUSION ...... 110 SUMMARY OF THE FINDINGS ...... 111 Refugee Status ...... 112 Pre-Migration Traumatic Events and Refugee Resiliency ...... 1124 Typology of Refugees & Typology of Refugee Settlement...... 1146 Gender Analysis ...... 117 Reformation of the U.N...... 1178 IMPLICATIONS FOR SOCIAL WORK PRACTICE AND POLICY...... 120 Working with Individuals ...... 121 Working for Social Advocacy ...... 123 STUDY IMPLICATIONS FOR FUTURE RESEARCH...... 125 LIMITATIONS OF THE STUDY...... 127 CONCLUSION ...... 128 CHAPTER 8: EPILOGUE ...... 130 TRANSFORMING CURIOSITY TO AN INTELLECTUAL EXPLORATION...... 130 East Meets West ...... 131 Here I Go… ...... 132 Indian Refugee Camps for Sri Lankan Tamil Refugees...... 133 Political Religions...... 134 Child Labour, Child Marriage and Child Soldiers...... 136 Arranged Forced Marriages and Honour Killings ...... 137 Civil War Ends (1981-2009); Political War Begins (2009 -?)!...... 138 REFERENCES ...... 142 APPENDIX A: QUESTIONNAIRES ...... 154 APPENDIX B: FLYER...... 189 APPENDIX C: INFORMATION SHEET FOR PARTICIPANTS ...... 192 APPENDIX D: TELEPHONE SCREEN INTERVIEW GUIDE...... 1984 APPENDIX E: CONSENT FORM FOR PARTICIPANTS...... 2006 APPENDIX F: REFERRAL LIST...... 2051 APPENDIX G: UNIVERSITY OF TORONTO ETHICS APPROVAL SHEET...... 2062 APPENDIX H: ADMINISTRATIVE SUPPORT LETTER-INDIA...... 2074

viii

INDEX OF FIGURES

FIGURE 1: COLONIZED WORLD DURING THE 1800’S ...... 14 FIGURE 2: ORIGINATING COUNTRIES OF REFUGEES SINCE THE END OF THE POST-COLONIAL PERIOD ...... 14 FIGURE 3: REFUGEE DETERMINATION PROCESS IN CANADA ...... 22 FIGURE 4: ROLE OF DEPENDENCY AND COLONIALISM IN CREATING TRAUMA AMONG FIRST NATIONS PEOPLE...... 30 FIGURE 5: TYPOLOGY OF REFUGEES ...... 34 FIGURE 6: CONCEPTUAL FRAMEWORK FOR UNDERSTANDING IMPACT OF PRE- AND POST- MIGRATION TRAUMATIC EVENTS ON PSYCHOLOGICAL DISTRESS OF SRI LANKAN TAMIL REFUGEES ...... 60 FIGURE 7: POLITICAL MAP OF SRI LANKA ...... 65 FIGURE 8: ORGANIZATIONAL STRUCTURE OF REFUGEE CAMPS IN TAMIL NADU ...... 72 FIGURE 9: PROFILE PLOT FOR HOST COUNTRY STATUS & TYPOLOGY OF REFUGEE SETTLEMENT INTERACTION ON PRE-MIGRATION TRAUMATIC EVENTS ...... 99 FIGURE 10: PROFILE PLOT FOR HOST COUNTRY STATUS & TYPOLOGY OF REFUGEE SETTLEMENT INTERACTION ON POST-MIGRATION TRAUMATIC EVENTS ...... 99 FIGURE 11: AN INTEGRATED FRAMEWORK FOR SOCIAL WORK PRACTICE...... 123

ix INDEX OF TABLES

TABLE 1: THEORETICAL ANALYSIS OF POST-COLONIAL THEORY/TRAUMA THEORY/REFUGEE THEORY/FEMINIST...... 38 TABLE 2: EMPIRICAL ANALYSIS OF REFUGEE PRE-MIGRATION/MIGRATION/POST-MIGRATION EXPERIENCES...... 56 TABLE 3: SUMMARY OF RESEARCH QUESTIONS AND QUANTITATIVE METHODOLOGY...... 84 TABLE 4: STUDY PARTICIPANT CHARACTERISTICS...... 88 TABLE 5: DESCRIPTIVE ANALYSIS OF HTQ, PMLDC, SCL-90R ...... 90 TABLE 6: RELIABILITY STATISTICS FOR HTQ, PMLDC & SCL 90-R ...... 91 TABLE 7: PEARSON CORRELATION TABLE FOR HTQ, PMLDC & SCL-90R SCORES...... 92 TABLE 8: MULTIVARIATE MODEL SHOWING DIFFERENCES IN PRE-AND POST-MIGRATION TRAUMA SCORES BETWEEN VARIABLES...... 94 TABLE 9: PEARSON CORRELATION MODEL EXAMINING PARTICIPANTS’ PRE- & POST- MIGRATION TRAUMATIC EVENTS PREDICTION OF PSYCHOLOGICAL DISTRESS ...... 98 TABLE 10: LINEAR REGRESSION MODEL EXAMINING PARTICIPANTS’ PRE- & POST-MIGRATION TRAUMATIC EVENTS PREDICTION OF PSYCHOLOGICAL DISTRESS...... 98 TABLE 11: BLOCK REGRESSION MODEL USED FOR INVESTIGATING PREDICTORS’ IMPACT ON PSYCHOLOGICAL DISTRESS ...... 100 TABLE 12: INTEGRATION OF FINDINGS FROM DATA ANALYSIS AND PRACTICE/POLICY IMPLICATIONS...... 108

x CHAPTER 1: INTRODUCTION

“A small body of determined spirits fired by an unquenchable faith in their mission can alter the course of history” (Mahatma Gandhi, 1869-1948)

This dissertation is my journey though many historical events that I have read, discussed, witnessed and experienced throughout the course of my life. It is not possible to articulate in a single sentence or two why I chose this topic for my dissertation. Part of my difficulty in deciding to conduct research with the Sri Lankan Tamil population was that I am from India, and many Indians believe that we have no role in the Sri Lankan civil war. Moreover, the Liberation Tigers of Tamil Elam

(LTTE) assassinated Indian Prime Minister Rajiv Gandhi. So I felt conflicted as an Indian doing my doctoral dissertation on Sri Lankan Tamil refugees. The Sri Lankan Tamil refugee situation is a personal and complicated issue. It is something that most people in India have strong views about.

Mass killings by the LTTE are a common occurrence both within and outside Sri Lanka. The peace treaty that was brokered by international mediators in 2002, ending almost 20 years of civil war, has recently led to the final war, resulting in a resurgent outflow of Sri Lankan Tamils fleeing the country.

As a history undergraduate and the daughter of a man with acute political insight, I have always believed that the Sri Lankan Tamil refugee issue requires analysis on a much deeper level to understand the causes and determine possible solutions.

The role of colonization in creating the situation in present day Sri Lanka cannot be overstated.

Many authors, including Stanley Tambiah and Kavita Philip have written about the significance of colonization on Sri Lanka (as well as South India), but there has little discussion on how it has affected the mental well being of the Sri Lankan Tamil community. Colonial history has left a huge thumbprint on current Sri Lankan governmental policies, which continue to impose colonial imperialism and use power and control to interfere with the rights and freedoms of the people.

1 So why, in such a contentious climate, would I decide to conduct a research study on Sri

Lankan Tamil refugees? I am still not able to explain the reason, but I feel it is my destiny to be involved in some small way in easing the plight of Sri Lankan Tamil refugees who have been so tragically affected by this complex conflict. There is no easy fix for this problem; it is interconnected with social, political, and historical factors. Many people will disagree with my view on Sri Lankan

Tamil history and the current situation. However, I feel that this is my opportunity to create a stepping stone for the global community – which includes governments, the United Nations, and non- governmental agencies – to bring lasting peace to Sri Lanka. Exploring the history of Sri Lanka will provide valuable insight into its connection with the mental wellbeing of the people. It is hoped that the research results will also encourage more academic scholars to put forward their thoughts for discussion and action on this issue.

Is there a connection between history and social work? This question was once posed to me by an interview board when I applied for admission to the Master of Social Work program in India. They wanted to know why I was applying to the social work program after I have obtained an undergraduate degree in history. My response was that knowledge of the history of my community gave me the ability to connect with the people. This dissertation has reconfirmed my belief in the importance of social workers developing and maintaining a connection with community. Social work is interwoven and interconnected with the community and its history. Social workers have a unique role to play in the social welfare field. Unfortunately, the profession’s tradition of analyzing social problems from a clinical or policy perspective, instead of a clinical and policy perspective creates difficulty for social workers in dealing with the complex experiences of communities. However, it is not too late for the profession to develop the necessary skills to connect with individuals, including refugees, and their migration experiences. The history of refugees may have links to colonization. An analysis of this history will provide a basic understanding of refugee issues, including who they are and why their experiences need to be considered.

2 Who are the refugees? The 1951 United Nations Convention on the status of refugees defines a refugee is a person who is "owing to a well-founded fear of being persecuted for reasons of race, religion, nationality, membership of a particular social group, or political opinion, is outside the country of his nationality, and is unable to or, owing to such fear, is unwilling to avail himself of the protection of that country” (1951). In seeking protection from other countries, refugees remind us that we have responsibilities towards our fellow humans around the globe, and that the well-being of people anywhere must be the concern of people everywhere. Canada’s demographic profile has become more diverse due to a huge influx of refugees from countries all over the world. An increasing number of refugees are coming to Canada from war-torn countries and from countries where there has been exposure to disaster, incidents of extreme trauma and continued physical, sexual and psychological oppression. Canada, like other host countries, is struggling to live up to its obligations to refugees. Canada has a reputation for taking human rights seriously and for offering a generous welcome to refugees (CCR, 2002). But Canada also fails refugees in many ways (Crosby, 2006) through their migration policies and refugee board policies.

Every day basic rights of refugees are being violated in countless places around the world.

Refugees make easy scapegoats. They are foreigners in their country of asylum; they have no home to go back to. Refugees who are virtually powerless are often regarded as a threat by the powerful

(Hyndman, 2000). Refugee policies typically double as containment policies, because they define and hold people within particular definitional boundaries (Crosby, 2006). Refugees are often exposed to violence and lack of autonomy in their host country (White, 2004). It is also common for them to experience cultural and systemic barriers to care, poverty, language difficulties, underemployment, the burden of multiple roles within the family, social isolation, loss of pre-existing social support systems and discrimination (Health Canada, 2001). Emotional and mental health risks are more of a concern for refugees than tobacco, drug and alcohol addiction (Health Canada, 1999).

The effects of traumatic experiences on refugees are immeasurable, long lasting, and

3 shattering to both their inner and outer selves (Steel, Silove, et al., 2006). Refugees who have already survived trauma in their country of origin often experience particular difficulties, including feelings of not being safe, during the resettlement period. Dependent upon their employers for economic support, these refugees face threats of withdrawn work contracts, difficult access to legal help due to economic and language barriers, and communication and cultural roadblocks, leading to distrust and fear of the host country’s bureaucratic system (McDonald, 2001). The situation is often worsened by societal, religious and cultural attitudes toward their trauma during their settlement period in their new country.

These circumstances can increase the post-traumatic stress refugees may already be experiencing upon arrival (White, 2004). Analysis of the effectiveness of refugee policies shows that they leave much room for improvement, both in terms of knowledge of their existence and the successful delivery of services to refugee claimants (Crosby, 2006; Kelson, 1997). This dissertation analyzes the impact of refugee pre-migration and post-migration traumatic experiences, and attempts to fill in the gaps in the existing knowledge base by demonstrating how refugees’ experiences and their psychological distress are interconnected. The potential contribution of this dissertation include the integration of policy into social work practice, incorporation of historical, social and political factors into social work assessment and the impact of refugee board and host nations policies on refugees’ mental health.

STRUCTURE OF THE DISSERTATION

The primary objective of this dissertation is to broaden the scope of understanding regarding the impact of pre-migration, migration and post-migration traumatic experiences on refugees, specifically Sri Lankan Tamil refugees. Most of the research to date on refugees is focused on settlement, treatment intervention for refugee trauma, language barriers, and lack of community support and health care accessibility for refugees (Kilbride, Anisef & Khattar, 2001; Mollica, 1993;

Steel, Silove, et al., 2006; Spouse, 1999; Soroya & Stubbs, 1998). This researcher was unable to

4 identify any investigation specifically on the interconnection between historical, social, and political events in refugees’ country of origin, their pre-migration and post-migration experiences, and development of psychological distress. This dissertation critically analyzes specific existing bodies of knowledge derived from the refugee literature review and endeavours to fill in the gaps with respect to refugee mental health.

Organization of the Thesis

This dissertation consists of eight interrelated chapters.

ƒ Chapter 1 provides the introduction and an overview of the objectives of this dissertation.

ƒ Chapter 2 examines the historical, social and political factors related to refugees in global and local contexts, and discusses migration policies of the United Nations (UN) and United Nations High Commissioner for Refugees (UNHCR).

ƒ Chapter 3 reviews the theoretical and empirical literature that has been put forward to explain the struggles of refugees. This chapter also critically details each of the major theories and discusses major empirical terms used for analysis. At the end of this chapter, a conceptual model for understanding the impact of pre- and post-migration traumatic events on refugee psychological distress is presented. This model integrates social, political and medical models, building on Post- Colonial Theory, Refugee Theory, Trauma Theory, and Feminist Theory, and emphasizes refugee psychological distress as a consequence of multiple constraints embedded in personal experience. By building on the various theories this conceptual model identifies the different factors associated with being a refugee, which is crucial for the development of efficient service delivery for refugees.

ƒ Chapter 4 provides the background for the study by detailing the crisis in Sri Lanka which has led to displacement and refugee issues in that country.

ƒ Chapter 5 describes the research methodology, including study design, data collection and data analysis.

ƒ Chapter 6 presents the findings from data analysis. Also providing the major themes derived from the content analysis of the open ended questions.

5 ƒ Chapter 7 provides the study discussions on the implications in a global context as well as in a clinical practice and policy context that have the potential to increase the knowledge base on refugee issues within the profession.

ƒ Chapter 8 describes the researcher’s experiences, observations and reflections during the research including Doctoral program as a whole and this study in particular

6 CHAPTER 2: CONTEXTUALIZING REFUGEES

This dissertation attempts to put values to history. Historical analysis provides a link to connect the past to the present. It exposes the social, cultural and political inequalities in the present world, which are often continuations of the inequalities from the past (Chase-Dunn & Lerro, 2002). The refugee problem is global. Many countries around the world receive refugees who have lost their homes as well as their own identities. The word “refugee” is used in ordinary conversation to refer to someone fleeing various ills, including war, natural disaster and even the stresses of modern life (CCR,

2002). In the literature, refugees are often referred to as asylum seekers and/or displaced populations.

Although the refugee problem has existed for a long time, social work research has only focused on refugee settlement experiences. In the first section of this chapter, refugee problems are analyzed from historical, social and political perspectives in order to identify common patterns that create difficult and different migration experiences for refugees. In the second section, the researcher analyzes refugee statistics from a global perspective and provides a brief summary of refugees from each part of the world. In the third section, the researcher demonstrates the role of colonization in the creation of refugees, by comparing the colonized world as it existed in the 1800’s to the world as it is today. The last three sections of this chapter discuss typology of refugee, and the United Nations’ and

Canada’s policies on refugees.

HISTORICAL, SOCIAL AND POLITICAL CONSTRUCTION OF REFUGEES

Human history is the history of migration and the most advanced civilizations arose where human traffic was heaviest (Zolberg, 2000). Themes of containment and exclusion with respect to migration are not new. Aristide Zolberg (2000) considered the late 18th century to be the first chapter of modern migration. During this period nationalism became so prevalent in Europe that the phrase

“country of nationality” became meaningful and people crossing borders were required to provide identification (Zolberg, 2000). Industrial, democratic and demographic revolutions followed by the

7 colonization of the world by European powers inaugurated a distinctive era in human migration. The

Huguenots, who fled France to escape from religious persecution, though not a casualty of colonization, are generally considered the first group of modern refugees (Hyndman, 2000). A great deal of literature focuses on the fact that yesterday’s colonial policies and the boundaries that they imposed are to be held directly responsible for today’s refugees (Hyndman, 2006, 2000, 1997& 1996;

Collins, 1996; Crosby, 2006, 2000 &1995).

During the colonial period, little attempt was made to develop a sense of nationalism among the many ethnic and religious groups in the colonies as a strategy of colonial rule to prevent uprisings

(Philip, 2004). For example, in countries like India and Sri Lanka colonial governments used inter- ethnic or inter-religious rivalries to their advantage. At the end of the colonial era, these old rivalries often came to the surface during the fight for control of the emerging nations (Hyndman, 2006). In

India, inter-religious rivalries created during colonization resulted in the partition of the country into

India, Pakistan and Bangladesh after independence from the colonizers was achieved (Sivaraman,

2005). However, in Sri Lanka the inter-ethnic civil war continues to affect the country after many years of independence from Britain, and has already resulted in over 500,000 refugees and 324,700 internally displaced people (UNHCR, 2006).

Before the 20th century very little attention was paid to the precise definition of a refugee. The first international coordination of refugee affairs was undertaken by the League of Nations High

Commission of Refugees, during the third phase of modern migration after World War I (Zolberg,

2000). During this period, a refugee was defined as “a person from a specific group or country for which the League of Nations has approved mandate” (Macartney, 1999). Post-colonial theorists like

Hyndman (2000) criticize the League of Nations High Commissioner on Refugees for only supporting refugees from the Northern hemisphere. During this period, refugees from Africa and South Asia were left unattended because of colonization.

8 As states increasingly worried about their legal obligations to those who sought asylum, and wanted to pare down their respective welfare states, they essentially reinvented themselves by looking to multilateral organizations to take care of refugee problems (Hyndman, 2006). Various humanitarian agencies were formed to support refugees after the creation of the League of Nations. Meanwhile, the freedom of international movement for persons broadly defined as refugees was adversely impacted by the immigration policies of Western countries after World War I (Hyndman, 1997). The conflict and political instability during World War II led to massive amounts of forced migration. The right to asylum from persecution as an international human right was first recognized by the United Nations

(which replaced the League of Nations) after World War II (Marrus, 1985).

In the late twentieth century, a small number of wealthy nations joined forces to provide humanitarian intervention and consolidated their power by setting restrictions on poorer countries.

Zolberg calls this situation “the multilateral humanitarian intervention” (2000). The wide spread implementation of neo-liberal economic policies and globalization during the post-colonial era has resulted in the limited capacity of the governments of poor nations to implement policies to meet the basic needs of their citizens (Crosby, 2006). They are forced to accept funding aid from wealthy nations as an immediate source of capacity building support for their communities, but these funds have to be repaid after a few years. Many poorer nations, especially in Africa, are still struggling to repay their debt (Frelick, 1993). After spending most of their funds on building infrastructure and repaying interest, these governments have no money in the short term to help their citizens. As a result, many people have no food to feed their children, and their only option is to flee to other countries. The wealthy nations intervening in these poor countries’ internal issues appear to be doing so in the name of humanitarianism (Haraway, 1992), but many believe they have hidden agendas. News reports from

Asian countries argue that the current United States government is feigning concern for the people of

Iraq as to deploy to get control over their oil. I believe that the violence that often erupts as a result of poverty is no different than the violence caused by war; both are the products of power and control.

9 However, policy makers in wealthier nations never seem to view it in the same way. The researcher believes this situation is akin to “modern” colonization.

REFUGEE STATISTICS

As of January 1, 2007 there were 20,751,900 refugees in the world broken down as follows: 1)

Asia - 8,603,600; 2) Africa - 5,169,300; 3) Europe - 3,666,700; 4) Latin America and the Caribbean -

2,513,000; 5) North America - 716,800; and 6) Oceania - 82,500 (UNHCR, 2007). A closer examination of the refugee issue in these regions follows.

Asia

By the end of 2005, it was conservatively estimated that Asia was hosting over 8,000,000 refugees, spread across the region (UNHCR, 2006). It should be noted both how widespread is forced displacement, and how varied are the causes and number of circumstances that lead to this situation. In the Northwest, the people of Afghanistan continue to flee the lingering oppression of the Taliban regime and new threats from Afghan war lords, while millions wait in adjoining Pakistan and Iran for lasting peace with neighbouring rivals (UNHCR, 2007). Other conflicts in the Middle East region include the ongoing Palestine/Israel dispute, the Kuwait Invasion in the 1990’s, the Iraq War, and displacement in Lebanon (UNHCR, 2007). In tiny Hong Kong in the Northeast, roughly 18,000

Vietnamese asylum-seekers wait in detention, likely to be forced back home (Human Rights Watch,

2007). Their “grand dreams of a life in the West have now ended and their youth is wasted amid the boredom and brutality of long years in the camps” (Gibney, 2004).

In the small island nation of Sri Lanka in the Southwest, at least a million of its 16 million people have been forcibly displaced within the country or are living as refugees in India as the violent civil war continues, and civilians of all communities – Tamil, Sinhalese and Muslim – are targeted for deception and terror (Dignam, 1996). Author Kavita Philip points out that the impact of colonization on Asia, which has created inter-ethnic and inter-religious rivalries across the continent (2004).

10 Continuous human rights violations lie at the heart of most of these refugee problems, even after the end of colonization, and a lasting solution clearly requires efforts on the part of the international community, both governmental and non-governmental, to put pressure on Asian governments and other parties to ensure respect for human rights.

Africa

According to the most recent data available, there are over five million refugees in Africa. Most of these refugees fled home countries that were overtaken by violence or ravaged by famine. The existence of so many refugees seems to point to system failure in modern African society (Gupta &

Ferguson, 1992). At the same time, the fact that so many African refugees seem to adapt to their situation and survive the experience of being in exile also indicates some unseen ability that is incongruent with the common perception of what a refugee is (Goldring, 1996). In an attempt to explain the very large number of refugees in Africa, some researchers have pointed to one fundamental cause: colonialism and its lasting effects (Hyndman, 2000). Literature suggests that the colonial boundaries that were superimposed on Africa by European colonial powers were artificial and therefore separated ethnic and linguistic areas that were formerly closely linked into two or more colonies that often had different colonial masters (Collins, 1996). At the end of the colonial era, old rivalries between different ethnic/religious groups often came to the surface during the fight for control

(Crosby, 2006). When the colonizers left, many of these countries were left unprepared for independence, and in many cases the groups that gained power singled out ethnic, religious or linguistic groups, and pursued discriminatory policies against them, leading to large-scale refugee migration.

Europe

Over 3 million refugees are in Europe. The majority of these refugees come from the Balkans,

Azerbaijan, Georgia, Turkey, Poland and the Russian Federation (Human Rights Watch, 2007).

11 Movement of Eastern European asylum seekers (from pro-communist countries loyal to the former

Soviet Union) into Western Europe (pro-capitalist and loyal to the United States) had been common throughout the post-World War II era. These migrants were generally permitted to stay until the host countries’ economies grew worse (Shami, 1996). Western European nations realized the economic motivations of most of these refugees, who were from different races and religions (Canclini, 1995).

Most European host nations originally recognized a variety of statuses that allowed these individuals to remain on humanitarian grounds, but governments are increasingly questioning the use of these intermediate statuses for large numbers of people (Shami, 1996). With a renewed sense of urgency after the terrorist attacks on the United States in 2001, Western European governments are looking towards coordinated policies that may permit more effective handling of asylum applications. At the same time, throughout Central and Eastern Europe the UNHCR is providing training and capacity- building to strengthen national structures (UNHCR, 2006).

The Americas

Since 1980, more than one million El Salvadorans, Nicaraguans, Cubans, Columbians and

Guatemalans have left their countries due to political oppression and related anarchy and poverty.

These countries were once colonized by Portugal and Spain (UNHCR, 2006), and most of them were left with very little organizational structure when their colonizers departed. Some 118,000 of these refugees are in UNHCR-supported refugee camps in Costa Rica, Honduras and Mexico (UNHCR,

2006). Large numbers of the others are living illegally in these countries and also in the United States.

Most of the refugees from Central and South America are viewed and assisted by the UNHCR as political refugees. However, while the U.S. government recognizes that there is war going on and that human rights abuses are occurring, it still takes the position that the vast majority of the refugees from these regions are economic migrants (Crosby, 1995). The United States also argues that these refugees fail to avail themselves of the opportunity to acquire safe haven in any one of the countries they pass

12 through en route to the U.S. (Rousseau, Crépeau, Foxen & Houle, 2002). Mexico has become a home to many, and it also serves as a transit country for Central and South American refugees seeking to reach the U.S. (Marrus, 1985). Although most of the latter have sought protection in the United States,

Canada has admitted thousands of these refugees (Rousseau, Crépeau, Foxen & Houle, 2002). There is also a new wave of political refugees coming to Canada in the last five years from the United States

(Toronto Star, 2007). Most of these refugees seek asylum in Canada due to their political opposition to

U.S president George W. Bush’s military actions in Iraq and Afghanistan.

COLONIZATION AND THE CONSTRUCTION OF REFUGEES

Throughout this analysis on different regions of the world, there has been one constant in the refugee issue – colonization. Colonization has been responsible for creating great struggles for democracy. Colonizers brought with them their own social, political and economical values and practices that transformed the colonies into a place they could understand. Colonial imperialism replaced or degraded the native system to the point where it became harder and harder for the natives to survive in their own land. Some of the effects were enormous. By employing different ways of managing the land, the colonists were taking the first steps toward creating the landscape we know today. The following maps illustrate the link between colonization and refugee movement. The current migration and refugee issues are the legacy of colonialism. Figure 1 shows the colonized world during the 1800’s, and Figure 2 shows refugees in the current world by their originating countries, most of which were colonized as shown in Figure 1 and were left with anarchy and despair after gaining independence from their colonizers, ultimately leading to mass refugee migration.

13 Figure 1: Colonized World during the 1800’s

Figure 1 (Ishvara, 2008)

Figure 2: Originating Countries of Refugees since the End of the Post-Colonial Period

Figure 2 (Thomson Reuters Foundation, 2009)

14 There is a striking absence of scholarly work that examines the connection between refugee problems and colonization across the world over the past century (Lesch & Lustick, 2005).

Colonization left countries with chaos, oppression and no organizational structure to intervene in the inter-racial, inter-ethnic and/or inter-religious conflicts left behind, which were originally created by colonizers as a means of control (Escobar, 1999; Hyndman, 1999). Colonization also left behind ecological imperialism, which replaced the native ecosystem and made it hard for the indigenous population to survive in their land (Mann, 2007). Colonizers were unable to adapt to this foreign land, so they transformed it into a place which they could understand. This political and ecological colonization continues under globalization and transnationalism, causing further oppression and anarchy in these nations. Economic inequality combined with demographic pressures and environmental crises has generated ethnic conflict, terrorist threat and forced migration (Richmond,

2002). When we attempt to unravel colonialism, it reveals the ways in which the colonial past is connected to the present liberal world (Malki, 1995). There can be no global theory that provides insight on the effects of varied forms of colonialism and post-colonialism (Williams-Braun, 1997) on refugees’ lives. Such insight is produced only by refugee experiences, which need to be explored in scholarly works.

TYPOLOGY OF DISPLACED POPULATION

The UNHCR provides protection and assistance to displaced persons, which include: 1)

Environmental Refugees – people displaced because of environmental disasters such as drought; 2)

Internally Displaced People (IDP) – civilians who have been forced to flee their homes, but who have not reached a neighboring country and therefore, unlike refugees, are not protected by international law and may find it hard to receive any form of assistance; and 3) Asylum Seekers – people who seek refuge in a foreign country because of war and violence in their home country, or out of fear of persecution on account of race, religion, nationality, political opinion, or membership in a particular

15 social group (Alberozi, 2006). Very few refugees today would meet the formal Eurocentric post-

World War II requirements. The conventional definition is becoming increasingly irrelevant to the majority of recent refugees, who face violence on a broader scale and for different reasons than those of post-war Europe (Feller, 2006; Hyndman, 2000). Most civil wars today involve violence between cultural or ethnic groups. In the conventional definition, civil and political rights take precedence over social, cultural and economic rights.

The UNHCR, once limited to supporting refugees, now works worldwide to assist all displaced people (UNHCR, 2006). Until a request for refuge has been accepted, a displaced person is referred to as an asylum seeker (Feller, 2006; Chan, 2006). Only after recognition of the asylum seeker's protection needs is he or she officially referred to as a refugee claimant/refugee and entitled to refugee status, which carries certain rights and obligations according to the legislation of the receiving country

(Crepeau, Foxen, Houle & Rousseau, 2000). Asylum seekers can sometimes get temporary protective status that allows them short-term legal entry and residence in the host country while their petitions for permanent asylum are being considered (Crepeau, Foxen, Houle & Rousseau, 2000). The statuses of asylum seeker, refugee claimant, refugee, and displaced person can be confusing, but should become familiar to those involved in service delivery. Fong and Mokuau (1994) note that many of the terms related to refugees exemplify the complexity of the systems ascribing status and conditions of treatment. Also these statuses reflect the variety of migration experiences and affect the ways refugees settle in the Western world.

GLOBAL CONTEXT: UNITED NATIONS HIGH COMMISSIONER FOR REFUGEES

The United Nations High Commissioner for Refugees (UNHCR) was established on December

14, 1950 with a mandate to lead and coordinate international action to protect and assist refugees at the request of a government or the United Nations (UNHCR, 2006). Its primary purpose is to ensure that anyone can exercise the right to seek asylum and find safe refuge in another country, with the option to

16 return home voluntarily, integrate locally or resettle in a third country (UNHCR, 2006). The 1951

Convention on the Status of Refugees is the key legal document defining who is considered a refugee, their rights and the legal obligations of states (UNHCR, 1995). Despite its objective to protect refugees, the UNHCR is explicitly and implicitly Eurocentric in their policies, and was primarily designed to help refugees from Europe (Hyndman, 2006). The 1967 Protocol removed geographical and temporal restrictions from the 1951 Convention. The1967 Protocol provides the definition of a refugee as “a person who, owing to a well-founded fear of being persecuted for reasons of race, religion, nationality, membership of a particular social group or political opinion, is outside the country of his nationality and is unable or, owing to such fear, unwilling to avail himself of the protection of that country; or who, not having a nationality and being outside the country of his former habitual residence as a result of such events, is unable or, owing to such fear, unwilling to return to it”

(Hyndman, 1997).

In emphasizing civil and political rights, the Convention had the effect of minimizing the importance of socio-economic human rights (Crosby, 2000). Post-colonial theorists argue that the

Convention gave priority to political over individual persecution (Philip, 2004; Hyndman, 2000;

Burstow, 2001). It does not consider the internally displaced population, who are unable to leave the national boundaries due to the inadequate migration policies or the lack of support received from the

UNHCR (Crosby, 1995). The Convention gives priority to refugees whose flight was motivated by pro-Western political values (Hathaway, 1992). Responding to the outcry of people against the

Convention, the UNHCR amended it in 1975 (Gibney, 2004). This amendment created two legally binding human rights instruments designed to protect civil and political rights on the one hand, and economic, social, and cultural rights on the other. It ensured respect for citizens regardless of such characteristics as language, religion, sex, or political opinion, as well as the right to liberty of movement and freedom (Hyndman, 2006). Still, the political focus in the promise of asylum was exclusively Eurocentric (Hathaway, 1999).

17 While the mandate of the UNHCR had broader overtones, it can not be claimed that the UN

General Assembly intended to create an independent administrative agency whose sole concern would be refugees and displaced persons in general (Gordenker, 1987). The UNHCR continually faces economic and political pressures to rethink its terms of reference and operational mandate. The United

States government, as a large provider of funds to the United Nations, has enormous influence over the

UNHCR (Malki, 1992). The United Nations has become “the West’s mercy mission to the flotsam of failed states left behind by the ebb tide of empire” (Ignatieff, 1993, pp.42).

Wealthy western countries have demonstrated generosity in funding UNHCR efforts, and have become hosts to vast numbers of refugees (Crosby, 1995). However, the practical determination of whether a person is a refugee or not is most often left to host countries’ immigration departments. UN standards do not need to be adopted by the host countries. So while there is consensus recognition that refugees have the right to seek asylum, countries do not agree that they have an obligation to grant refugees asylum. This has led to abuse in countries with very restrictive official immigration policies

(Stein, 1998). For example, in many cases a potential host country will neither recognize the refugee status of asylum seekers nor see them as legitimate migrants, and will consider them to be illegally present in that country. Governments are using migration policies as a form of population control, similar to what countries like Britain and France did in colonizing Third World countries (Hyndman,

2006). In short, migration policies have become human rights and social justice issues.

By 1980, refugees were present on every continent in large numbers. The difficulties asylum seekers encountered in seeking refuge in industrialized countries is well-documented. Migration policies reflect who we are as nations and citizens, because they set the boundaries between “us” and

“them” (Crosby, 2006 & 2000). Crosby (2006) claims that migration policies often focus on the fight against irregular migration and the strengthening of border controls – it deters displaced persons from entering territory in which they could lodge an asylum claim. The lack of opportunities to legally access the asylum process can force asylum seekers to undertake often expensive and hazardous

18 attempts at illegal entry. The popularity of, and sympathy for, displaced peoples on the part of western governments lie precisely in their location “over there” (Hathaway, 1998). As they approach “our” borders, they become “immigrants, illegal immigrants, bogus refugees or foreigners”, who face less than enthusiastic reception (Hyndman, 2006).

Recently, there has been a new trend in ensuring the survival of refugee countries by the United

Nations. Prime examples are the situations in Afghanistan and Iraq, where those governments are being encouraged to maintain responsibility for their citizens. It has resulted from Western countries realizing that resettling refugees from these countries would overburden their welfare systems

(Cockburn, 1998). It is important to remember that the UNHCR and other humanitarian agencies are supported by these wealthy nations, and so cutting down the potential expenditures related to taking in these refugees is a request that cannot be ignored.

Meanwhile, humanitarian intervention as an ideology to justify military force using the language of human rights to legitimize a range of dubious practices is still very prevalent (Chimni,

2002). This is another reason why the UNHCR has moved from encouraging humanitarian efforts to managing crises of displacement on the ground in Afghanistan and Iran (Hyndman, 2000). This tactic provides an advantage for wealthy nations, particularly the U.S., in controlling the indigenous people and the resources of these poorer nations, who have little organizational structure remaining after the events of the recent past. The dimensions of the problem encompass legal protection and rights, emergency responses, continuing care and maintenance, and the promotion and implementation of durable solutions (Gallagher, 1989).

DOMESTIC CONTEXT: CANADIAN IMMIGRATION AND REFUGEE POLICY

Canadian migration policies have in the past been drawn along racial lines, as illustrated by the imposition of a head tax on Chinese immigrants and the deportation of East Indians from Vancouver

(Crosby, 2006). Meanwhile, the nation was being built on the extermination, exclusion and

19 containment of indigenous people, who to this day suffer the consequences of this foundational injustice, confined to reservations and confronted with multi-faceted and structural forms of discrimination in all aspects of life (Soufert, 2007). Although research results clearly illustrate the economic benefit from migration, the privileged in the western countries perceive the flow of refugees to be a threat to their economy and their high standards of living (Crosby, 2006). These boundaries of belonging have become an iron wall separating the privileged from the marginalized. They have also led to the pigeonholing of different types of refugees: internally displaced, asylum seekers, trafficked persons, etc. Despite these categorizations, all refugees face many of the same issues and obstacles

(Hyndman, 1995).

Canada’s record with respect to implementing refugee policies has been mixed. For much of the 20th century, Canadian refugee policies were viewed by many as racist, due to their bias against refugees from non-European countries (Hathaway, 1997). In 1978, the Refugee and Immigration Act was created to recognize refugee needs, and introduced the Immigration and Refugee Board. Important amendments to the Act were made in 1989, and also in 2002, using frameworks from the Canadian

Charter of Rights and Freedoms of 1985 and the Geneva Convention of 1951 (Citizenship and

Immigration Canada, 2003).

Citizenship and Immigration Canada (CIC) has overall responsibility for immigration and refugee issues (Crepeau, Foxen, Houle & Rousseau, 2000). According to CIC, a refugee is a person who has had to flee his or her country because of a well-founded fear of persecution and has been given protection by the Government of Canada. The Immigration and Refugee Board (IRB) is an independent tribunal under CIC that makes decisions on immigration and refugee matters. The IRB decides who needs refugee protection, hears appeals on certain immigration decisions, and conducts admissibility hearings and detention reviews (CIC, 2006). IRB has two divisions: the Refugee

Protection Division, and the Refugee Appeal Division (CIC, 2000). While each division is responsible

20 for making decisions on different immigration or refugee matters, they both follow an administrative tribunal process similar to that followed in a court of law, though not as formal.

The IRB tribunal process is based on Canadian law, Canada's international obligations and

Canada's humanitarian traditions (CIC, 2006). In the tribunal process, a refugee has the right to be heard and to present evidence and arguments to an impartial decision-maker (Crepeau, Foxen, Houle &

Rousseau, 2000). Proceedings are in either English or French, but refugees appearing before the IRB may use an interpreter provided by the Board who speaks their language (Jalbert, 1998). However, interpreters may have difficulties in adequately translating due to inter-cultural barriers such as dialects and behaviours. Also, they are not able to translate the non-verbal communications of the refugee, because they have not lived through the refugee’s experiences.

To claim refugee protection, a refugee must first notify an immigration officer. Refugees can do this at any port of entry to Canada. The officer will interview the refugee claimant, and unless the officer determines that their claim is not eligible, he or she will send it to the Refugee Protection

Division (RPD) of the IRB (Bibeau, Chan-Yip, Lock, Rousseau, Sterlin & Fleury, 1992). The IRB considers many factors, including the country the claim is made against and the nature of the claim, to arrive at a decision (Crepeau, Foxen, Houle & Rousseau, 2000). The IRB determines whether people who appear before them are convention refugees or persons in need of protection. Convention refugees are people who have left their home country and have a well-founded fear of persecution based on race, religion, nationality, political opinion, or membership in a particular social group, as per the definition of “refugee” in the UNHCR’s Convention on the Status of Refugees (CIC, 2006). A refugee protection officer may assist the applicant to ensure that all relevant evidence is presented, and a representative of the UNHCR may observe the hearing (Crepeau, Foxen, Houle & Rousseau, 2000). If the IRB determines that a person is entitled to protection in Canada, he/she may apply to CIC to become a permanent resident. If the IRB determines that someone is not a convention refugee or a person in need of protection, he or she may ask the Federal Court of Canada for judicial review of the

21 IRB's decision (CIC, 2006). If permission is granted and the judicial review is allowed, the claim is returned to the RPD for re-hearing. The following chart illustrates the refugee determination process:

Figure 3: Refugee Determination Process in Canada

(Citizenship and Immigration Canada, 2006) Figure 3

The refugee determination process is a very thorough and arduous one. Still, many believe that sometimes refugees are not provided due process or that some jury members are incompetent and insensitive to the plight of the refugee claimant (Crepeau, Patricia Foxen, France Houle and Cecile

Rousseau, 2000). It is an expectation and assumption of the IRB that jury members will make decisions on refugees based on their “common sense”. The so-called use of common sense can be questionable when taking into consideration the social, cultural and psychological dimensions of each refugee’s experiences (Bibeau, Chan-Yip, Lock, Rousseau, Sterlin & Fleury, 1992). A report by

Francois Crepeau, Patricia Foxen, France Houle and Cecile Rousseau (2000) analyzed legal, cultural and psychological factors involved in the decision-making process for several IRB cases. Results from this study showed that lack of knowledge in international refugee law, Canadian refugee law and the

22 laws of the refugee country negatively impacted IRB decisions. On a psychological level, ambivalence toward traumatization and uncontrolled emotional reactions by refugees, lack of knowledge about trauma, and lack of empathy from jury members played a huge role in the decision-making process

(Crepeau, Foxen, Houle & Rousseau, 2000). On a cultural level, lack of understanding of the refugees’ cultural and social context adversely affected decision making (Crepeau, Foxen, Houle & Rousseau,

2000). There is a tendency to view refugees as a monolithic group. However, they are very different based on their nationality, race, ethnicity, culture, language, and most importantly on their experiences as a refugee (Stein, 1998).

Migration is often described as a flood, which is considered a threat to privileged countries.

Citizens of these wealthy nations fear that huge refugee populations will wreak havoc on their welfare systems (Crosby, 2006). This politics of indifference reached its height when refugees started to be considered security threats (Hyndman, 2000). In the wake of the attacks on the United States on

September 11, 2001, anti-terrorism legislation has been introduced in all Western nations. The

Canadian International Civil Liberties Monitoring Group outlined the nature of this legislation as

“regulation which has contributed to an increase in racial profiling, in contravention of the fundamental rights of freedom of expression, association and movement as well as of the basic democratic rights to protest and to simply assert one’s rights” (2004). This indifference is also experienced by refugees who have rare conditions of disease (Hyndman, 2000). The Canadian refugee review board states in their policy that refugee claimants who have certain diseases will be deported

(Crepeau, Foxen, Houle & Rousseau, 2000). Only if they are accepted as refugees will they be able to receive any medical help from Canada. For those who are rejected, the only option available to them is to leave the country and face physical and mental pain, and most likely death.

The international community has created many categories to contain people. Categorization is a means of control, designed to confine people within rigid boundaries. The categorization of migration is inherently racialized, classed and gendered (Dauvergne, 2006). The category of ‘refugee’ is giving an

23 image of an anonymous mass, and tends to depersonalize refugees (Lumsden, 1999). The way we label and categorize people who move creates invisibility to their lived experience. In Sri Lanka, for instance, hundreds of people leave their homes every day because of the civil war. Families are torn apart. Some will become part of the internally displaced population; some may be able to escape the country. Of the latter, some may be able to come to Canada and may be accepted as refugees. Others who are determined not to fall in the category of “refugee” may merge into Canadian society silently, but it is a dangerous existence – they are often targets of violence, exploitation, and sexual abuse. As noted by Crosby (2000), “Same family and same history of abuse in their home country, but different categories and different futures for them in their host countries.”

The big area of focus within the international arena is the abuse of women’s bodies, through trafficking and sexual slavery (Dauvergne, 2006). The actual lived experience of women on the move is far removed from this scenario. Alice Miller’s feminist analysis proves that the focus must be on the economic exploitation and social marginalization that lead people to situations where they are trafficked (1995). She believes paying too much attention to human trafficking is primarily a male construct, by which they block intervention in the realities of urban and rural poverty and illegal labour sectors where most refugees search for their livelihoods (1995). This is an example of what happens when socio-economic reasons are minimized. Miller also claims that international protection mechanisms that have been drawn up to address the situation of trafficking serve more the interests of states in controlling their borders than the protection of women in situations of vulnerability. This crime control approach is one that “sees the state as the victim of trafficking, borders penetrated and contagion let in” (Macklin, 2004). Female refugee movement has become restricted because of the assumption of sexual harm. This has left female refugees to remain in war-torn countries as victims of extreme violence including death (Kapoor, 2003). Policies that create the categorization are containment policies, because they define and hold people within particular definitional boundaries

(Crosby, 2000). At the same, there is little recognition of the significant number of refugees that are an

24 integral part of our economy, who in return receive few protections and none of the benefits afforded to citizens.

Another important trend within the containment policies in the West is the increasing erosion of the right to asylum for those fleeing war and persecution. This is creating challenges for the entire category of “refugees”. In the twentieth century, international human rights law protected refugees.

Recently, Western nations have started developing their own refugee policies, which set limits on refugee movement to these nations. Crosby calls this the “not in my backyard syndrome” (Aiken &

Brouwer, 2004). These containment policies include strategies of diversion, deflection, deterrence and increasingly, prevention of movement altogether (Crosby, 2006). In December, 2002, Canada and the

United States signed the Safe Third Country Agreement as part of the implementation of the Smart

Border Agreement adopted by the two countries after September 11, 2001 (Crosby, 2000). The Safe

Third Country Agreement asserts that refugees should claim protection in the first safe country they reach. Under the agreement, Canada can turn away refugees if they passed through the United States first. Implementation of this policy has created dramatic drops in Canadian refugee claims (Canadian

Council for Refugees, 2005). The U.S. is not a safe haven for refugees and Canada is failing those who need our protection (Summers, 1995).

Refugee warehousing is another new trend in refugee settlement, in which refugees are kept in refugee camps or segregated settlements for years. The premise here is that when the disaster situation is over in their country of origin, they can go back (Flynn, 2005). So, refugees can be contained, or

“warehoused” for years without any support system. In India, thousands of Tamil refugees are in such warehouse camps, allowed to leave only for jobs created by the camp authorities, and required to return by a curfew time. Thousands of Tamil refugees have died due to the poor camp conditions, but most of these cases have been covered up by government authorities (Sivaraman, 2005). People who are forced to leave their homes in search of safer and better lives to escape from poverty are not protected by the Geneva Convention, and they are most likely to face human rights abuse. Refugees

25 who leave their home with an expectation based on the Geneva Convention that they will receive equality of treatment are left to face abuse, rape, unemployment, violence, warehousing, and in some cases death.

Migration policies are supposed to promote relationships with other countries instead of controlling or containing people. We need to recognize that in this era of transnationalism, people move all over the world as a normal part of their lives (Bacon, 2005). In challenging migration containment policies that create misery and desperation, we must not ignore the rights of some while protecting the rights of others (Huntington, 2004). Our commitment to protecting the rights of refugees who are fleeing from persecution and who have been recognized as “refugees” by wealthier nations must not be at the expense of those at the mercy of ruthless containment policies (Crosby, 2006). The only way to overcome the politics of indifference and categorization is to set boundaries of belonging to unite every citizen in the universe. Canadians take a dark view on human rights abuses in other parts of the world, but it is also a violation of human rights to treat certain refugees as “different”

(Hyndman, 2000). It has destructive consequences and contributes absolutely nothing to the well-being of any nation as a whole.

SUMMARY

This chapter provided an overview of the historical, social and political construction of refugees. It also detailed how colonization created refugee issues and has influenced policies by the

UNHCR and Canadian Immigration and Refugee Board. Such agencies employ processes using inclusion and exclusion criteria that have constructed the imagined community of modern nation states, typically Western countries, and that have led to the definition of who is permitted to belong to, and participate within, the national space (Hyndman, 2000 & 1995). These processes have always been racialized. Examples include anti-Jewish immigration campaigns in the 1880’s, nativist movements in the U.S. and in Canada in the 1920’s, and the “White Australia Policy” in the 1980’s.

26 We need to rethink the concept of “nationhood” with unique identity and culture, and consider whether it is just a myth. Have we deluded ourselves into thinking we are preserving our unique and ancient identity? Canada is a good example of the myth of nationhood. Canada already had a large indigenous population before the British people arrived and forced everyone to practice their language and customs; the indigenous peoples have had to suffer social injustice and social inequality ever since.

And yet, how does Canada’s Eurocentric society today react to recent migrants to Canada? Are these migrants free to practice their culture like the British when they arrived in Canada? And what is the unique and ancient identity of Canada – is it that of the original indigenous population or of the British who created the national structure so as to deny all future migrants to claim this country just like they did? The myth of a nation is a sum of different structures imposed by certain systems.

Migration policies and settlement services for refugees are as much about “Us” and “Them” as anything else (Crosby, 2006). These policies have been developed based on capitalist goals to control bodies and their movement as they serve or threaten economic interests. Control of their movement has led refugees to not access social welfare services including those that address their health care needs.

These psychosocial experiences of refugees are contradictory to the welfare nation’s ideology of welcoming diversity while protecting hierarchical notions of national identity. Ideally, we should introduce a policy of “open borders” in this era of globalization. If we are expecting free movement of goods, it is vital to have free movement of people, including refugees. An open-door policy would also facilitate social equality and social justice (Crosby, 2006), and promote mental/physical health.

It is important to realize that not everyone is inclined to move. Movement happens only as a result of some life-influencing situation. When does one stop being a refugee? While there is no simple answer, the legal and political definitions drawn are frequently far too limited and unrealistic. The majority of refugees are not here by choice and would probably return home if they could. By understanding the refugee experience as a unique social problem, society can be encouraged to provide specific attention to refugee struggles.

27 CHAPTER 3: REVIEW OF LITERATURE ON REFUGEES

The seeds for this study topic were planted during my childhood in the Southern Indian state of

Kerala during the late 1980’s and early 1990’s. During this period, many incidents, including the assassination of Indian Prime Minister Rajiv Gandhi, caused heated discussions among family, friends and neighbours on the Sri Lankan inter-ethnic civil war between the Sinhalese and Tamils, and, the intervention of the Indian government which ultimately led to the killing of Gandhi. As a teenager with a keen interest in politics, I read a great deal about the assassination and condemned the murderers.

But I also was very curious about the social, political and historical backgrounds of the assassins which led them to commit such a disturbing act of violence. Fortunately, Indian journalists of the time were able to uncover a great deal of information to produce a number of interesting articles. I remember reading one article on the primary assassin of Rajiv Gandhi – a woman named “Thenmozhi

Rajaratnam”, alias “Dhanu” – who had been raped in front of her family by Indian soldiers during their military intervention in Sri Lanka, which eventually led her to join with Liberation Tigers of Tamil

Elam. She volunteered for the suicide mission and died carrying out the assassination. After her death, her family was forced to flee Sri Lanka and ended up in different parts of the world as refugees.

Although Dhanu’s tragedy did not justify for me the violent revenge perpetrated by her and her comrades, it did make me come to see the importance of analyzing the social, political and historical factors associated with these actions.

Years later, as a social worker in Canada, I met with many Sri Lankan Tamil refugees with severe mental health issues, who were receiving treatment for psychiatric symptoms. These refugees were forced to hide their past because no one showed any interest in knowing their migration experiences amidst the anarchy and oppression in their country of origin. This compelled me to look deeper into the lives of these Sri Lankan Tamil refugees. In order to capture the complex nature of their experiences,

I decided to inform this study by using a triangulation of theoretical perspectives: Post-Colonial

28 Theory, Refugee Theory, Trauma Theory and Feminist Theory, and by the empirical literature from other researchers in this area of interest which focuses on refugee pre-migration and post- migration traumatic events, psychological distress, typology of refugees, typology of refugee settlement, gender and host country status.

THEORETICAL LITERATURE

Theoretical frameworks help to analyze and explain social structures and social actions (Payne,

2005). The theories discussed in this section were used by the writer to help her to explore her thoughts on various complex abstract on the refugee system and critique the ideologies behind the creation of this oppressive social system. Examining and linking various theories within the refugee context provided diverse perspectives on refugee issues. For this dissertation, theoretical literature on

Post-Colonial Theory, Refugee Theory, Trauma Theory and Feminist Theory was reviewed.

Post-colonialism has been described as a movement to decolonize the mind (Hyndman, 2000).

Post-Colonial Theory critiques traditional European philosophy and thought, and tries to put value to history (Philip, 2004). Post-Colonial Theory provides a link to connect the past to the present. It exposes the social, cultural and political inequalities in the present world. Post-Colonial Theory helps to understand why the powerful seek to control and contain the movement of people through various policies (Crosby, 2006). Post-colonial theorists look at the role of colonization in the development of social problems in today’s society (Hyndman, 2000; Philip, 2004; Gagne, 1998; Kneebone, 2005;

Jones, 2004; Richmond, 2002; Sivaraman, 2005; Nieves, 2001; Dauvergne, 2005). Marie-Anik Gagne

(1998) proposed a theoretical framework to explain colonial domination and dependency in generating trauma in First Nations citizens. She put forward an integrated psychological-sociological approach to understanding trauma, instead of following Diagnostic and Statistical Manual criteria, which considers single individuals with a disorder related to trauma. Her theoretical framework (see Figure 4 below) provides a post-colonial perspective on trauma, which makes the link between colonialism, long-term

29 control of persons/bodies, and the associated psychological and social consequences (Gagne, 1998).

Figure 4: Role of Dependency and Colonialism in Creating Trauma among First Nations People

Figure 4 (Gagne, 1998) This framework may be revisited within the context of the refugee experience. Colonial policies promoted socio-political dependency for the colonized (similar to the First Nations community), leading to anarchy in these nations. A prime example is Sri Lanka, which was a British colony until 1948. Characteristic of the British government, its strategy was to divide and rule; in Sri

Lanka it established policies that generated tension between the Tamils and Sinhalese. Just as it was responsible for the rift between the religious factions of the Muslim majority in Pakistan and Hindu majority in India after 1948, the British similarly created a devisiveness between the Tamils and the

Sinhalese communties in Sri Lanka. The fight of the Sri Lankan Tamils was not for a separate nation, but rather for a partnership in the Sri Lankan government primarily through non- violent means under the leadership of SJV Chelvanayakam (Jeyaraj, 2007). However, all attempts to achieve their goal by dialogue and non-violent action failed and Sri Lanka was gradually left with no political or social structure, leading to civil war and consequently a large number of refugees. The failure of the British

30 government to recognize the unique contributions of both the Tamil and Sinhalese communities to a common national government culuminated in devastating results, in addition to the vast psychological impact of colonization on the colonized population, both durfing and after their rule: “colonist were to leave they would regress into barbarism, degradation and bestiality” (Fanon, 2004). Having gained independence, the colonized developed a structure of government based on the value system of the colonizer with oppression, a common medium of political strategy. The relationship between the powerful colonizer and the powerless colonized was one of oppression (Memmi, 1969) which subsequently extended in similar manner between the powerful Sinhalese and the powerless Tamils.

Consistent with the colonization theories of Memmi (1965) and Fannon (1965), lengthy periods of colonization promoted the superiority of the British in Sri Lanka which the Sinhalese assumed, thereby relegating the Tamils to a status of inferiority.

Post-colonial theorists argue that colonization influenced implementation of neo-liberal economic policies and globalization during the post-colonial era, resulting in a limited capacity of governments of poor nations to implement economic policies to meet the basic needs of their citizens

(Hyndman, 2000; Stein, 1998). As a result, many people have no food to feed their children, and their only option is flee to another country. At the same time, wealthy nations started intervening in the internal issues of these poor countries under the guise of humanitarian effort (Hyndman, 1999 &

1996). The violence that often erupts as a result of poverty is no different than the violence caused by war. However, policy makers in wealthier nations never seem to view it in the same way. Often, refugees from war zone countries get preference over “economic” refugees, who leave their home countries due to extreme poverty (Zolberg, 2000).

Post-colonial theorists examine the struggles of refugees by detailing the difficulties of displaced persons seeking asylum in industrialized countries. They argue that the practical determination of whether or not a person is admitted as a refugee is most often left to the host country’s immigration department’s refugee criteria. This can lead to abuse in a country with a very

31 restrictive official migration policy (Stein, 1998). For example, when a country will neither recognize the refugee status of asylum seekers nor view them as legitimate migrants, they are often dealt with harshly as illegal aliens. Governments of wealthy nations today use migration policies as a form of population control, which is similar to how countries like Britain and France colonized Third World countries (Hyndman, 2000). As their migration policy often focuses on the fight against irregular immigration and the strengthening of border controls, displaced persons are deterred from entering territory in which they could lodge an asylum claim (Haraway, 1989). The lack of opportunities to legally obtain asylum can force refugees to undertake hazardous attempts at illegal entry. Post-colonial theorists (Hyndman, 2000; Philip, 2004; Harding, 2000) stress the importance of considering these contextual issues before developing service delivery strategies for refugee populations.

Standpoint Feminist Sandra Harding puts forward an interesting thought on “political unconsciousness” in Western science and philosophy. She questions the transparency of so-called “real science” to the real world (2000). Scientists are obligated to exclude political, social or cultural influences from the representations of the world they produce, and to leave the world unchanged by their research projects (Harding, 2000; 1998). Science should not produce politically charged conceptual frameworks or narrative structures. However, the philosophies of modern Western science were formulated through five centuries of social upheaval in diverse European, and later American, societies. Harding discusses the influence of Western science, which is grounded in class exploitation, racism, and colonial domination (Sander, 1986). Among the implications of these Western influences is that refugee lives are being controlled through their country of origin’s colonial background, with colonial-influenced migration policies focused on restricting refugee movement and the application of

Western medicine in intervening with refugees.

As large-scale migration took place all over the world during the twentieth century, the need for categorization of refugees was put forth by certain theorists. Despite the criticism from various researchers against the politics of categorization (Crosby, 2006, Hyndman, 2000), these theories are

32 still widely used as a means of understanding refugee migration. According to Hyndman’s field research, the United Nations created refugee categories, including gender categorization to create space for women in the decision-making process. However, Hyndman reveals in her book, Managing

Differences: Gender and Culture in Humanitarian Emergencies (2000) that many UN officials informed her during her field visit that this categorization is only on paper. Women are not getting enough opportunity to express their concerns during the decision-making process.

E.F. Kunz's kinetic model of Refugee Theory (1973) provides many insights on refugees’ attitudes towards displacement. In his later theoretical expansion (1981), he explored further the periods before and after flight (Colin, 1996). Kunz views the flight and settlement patterns of most refugees as conforming to two kinetic types – anticipatory refugee movement and acute refugee movement (Colin, 1996). Anticipatory refugees sense the danger early, before a crisis makes orderly departure impossible. They may be accompanied by their entire family, take resources with them, and have made preparations for a new life. The anticipatory refugee will leave as soon as he/she finds a country willing to take him/her. Acute refugee movements result from an overwhelming push. In an acute movement, refugees leave their homeland on a moment's notice. They have not prepared for the journey and they are simply trying to get out of the disaster zone (Kunz, 1981). Because the acute refugee makes the decision within a short time span, little thought has been given to the consequences of flight. Not until the place of asylum is reached, often in a state of shock, in a condition Kunz calls

"midway to nowhere” (1973), will the acute refugee ponder the three classic choices that face him/her: to return home, to remain in the place of first asylum, or to accept a distant resettlement opportunity in a strange land.

In 1974, Anne Paludan proposed another expansion to the refugee theoretical framework: new versus traditional refugees. The key differences between new and traditional refugees are that new refugees are culturally, racially and ethnically vastly different from their hosts, they come from less- developed countries at a greatly different stage of development than the host country, and they are

33 likely to lack kin and/or potential support groups in their country of resettlement. Traditional refugees, on the contrary, are culturally and ethnically similar to the people in their host country, come from societies whose levels of development are similar, and are likely to be welcomed and assisted by family and friends who know their language and can cushion their adjustment. Paludan asserts that differences between new and traditional refugees can influence certain patterns of settlement behaviour

(1981).

In the 1981 expansion of his Refugee Theory, Kunz introduced the concepts of majority- identified, event-related and self-alienated refugees. Majority-identified refugees are those who oppose social and political events in their home country (Colin, 1996). Examples are refugees from

Afghanistan and Pakistan, who because of the social and political unrest in these countries were forced to leave. Event-related refugees are those who must leave because of active discrimination against the particular group to which they belong. An example would be Sri Lankan Tamil refugees who faced oppression from the majority Sinhalese. Self-alienated refugees are those who have to leave their home country due to a variety of individual reasons, including physical and sexual assault.

Kunz’s later work focused more on these three categories of refugees and the connection with their repatriation. He commented that the majority-identified refugees had a strong attachment to their home nations and typically wanted to repatriate, and if they did return it would result in less of a burden on the host country’s welfare system (1973 & 1981). Host countries often treat refugees based on the categories they belong to. The United Nations High Commissioner for Refugees (UNHCR) gives higher priority to refugees leaving countries due to socio-political reasons (i.e., majority- identified refugees), who typically have pro attitudes toward Western countries (Stein, 1998). Often self-alienated refugees and event related refugees do not receive enough attention from host countries.

The following typology of refugees, as identified by Refugee Theory provides a better understanding of refugee settlement patterns:

Figure 5: Typology of Refugees

34

Figure 5

Richard Mollica’s Trauma Theory proposes that trauma survivors have an innate capacity to heal themselves along with medical or formal psychological intervention (1999). There is a "healing force hidden in all of us, even if depleted by violence, that is always striving for survival” (Mollica,

2006). Mollica criticizes doctors for overuse of medicine in treating trauma and mental health practitioners for overemphasizing the brutal facts of the trauma story in their attempts at "debriefing”

(1999). According to Mollica, victims of violence must play an active role in their healing. Not only telling but also interpreting one's trauma stories is crucial for healing (Mollica, Sarajlic & Chernoff,

2001). Understanding the cultural meaning of the trauma, taking a new perspective on it and realizing the motivations of the perpetrators are necessary to reframe the trauma for the survivor. "Storytelling coaches" (e.g., doctors, social workers, therapists) should guide survivors in telling their stories without overwhelming listeners with horrifying details (Mollica, 2006). The realization that by telling their story they will pass on knowledge on how to deal with loss and tragedy also contributes to healing. Mollica’s Trauma Theory focuses on self-healing through engaging in altruistic acts, working to provide for oneself rather than accepting long-term handouts, spirituality, humour, physical exercise, relaxation techniques and good nutrition (Mollica, 2006). Ultimately, traumatized people heal themselves along with traditional medical intervention – and what's more, their experience can teach the rest of us how to deal with the tragedies of everyday life (Mollica, 2006). Mollica contends that

35 through the application of his theoretical approach, trauma victims can transcend the most horrific events imaginable and go on to lead rich and meaningful lives.

Trauma theorist Jerome Kroll and Laurence Kirmayor provided some noteworthy thoughts on

Trauma Theory. Kroll critiqued the notion of trauma as a timeless, fundamentally biological response to adversity that occurs independently of culture as a naïve and essentialist idea (Haslam, 2000).

Kirmayor emphasized the thoughts of brings social meanings to trauma and psychological distress

Although Kroll and Kirmayor agreed that trauma and fright were hardwired into human biology, he questioned whether the particular psychological reactions to trauma are influenced by cultural norms of how individuals are expected to respond to threat, injury and loss, or by the severity, duration and proximity of an individual’s exposure to the traumatic event (2000; Dohrenwend, Shrout & Egri,

1980). Kroll argued against the definition of trauma as a necessary cause of post-traumatic stress disorder (PTSD). He supported a public health model which incorporated experiential and environmental factors in the diagnosis and treatment of PTSD (Koren, Armon & Klein, 1999).

However, Kroll’s inclusion of a public health model in PTSD diagnosis does not necessarily address refugee trauma. He detailed scientific studies whose results showed that refugees were more likely to have depression than PTSD (Eisenman, Gelberg, Liu & Shapiro, 2003; Sabin, Cardozo, Nackerud,

Kaiser & Varese, 2003). But this researcher believes it is necessary to include factors and symptoms associated with refugee trauma in this model. Kirmayor proposed a cultural axis to DSM, which brings the therapists in power to decide to use the axis for diagnosis or not. Nevertheless, Kroll and

Kiramayor (2000) propose scientifically sound treatment strategies which incorporate cultural components as well as traditional medical intervention.

Feminist Theory, particularly Burstow’s radical feminist understanding of trauma (2003) critiques post-traumatic stress disorder conceptualisation. Burstow criticizes psychiatry for overmedicating individuals with trauma (2001). Burstow believes that the diagnosis of trauma which is based on the Diagnostic and Statistical Manual was developed to help Vietnam War veterans with

36 long-term psychological damage to receive therapeutic services. This inclusion helped traumatized soldiers to receive benefits, particularly those provided under insurance policies. Burstow (2005),

Brown (1995) and Lewis (1999) critique the medical model of Trauma Theory by asserting that psychiatrists view PTSD based on DSM criteria as a neutral tool that is useful in assessing and helping people who are troubled, when in reality it is a tool through which hegemonic world view is imposed upon people. Burstow (1998) argues that people who have trauma know the reality of our current world. By labelling these individuals, the medical model forces them to accept the societal norm that

“the world is a safe place”, even while women continue to live in an abusive patriarchal society (2005).

Feminist theorists argue that Trauma Theory only considers experiences of the dominant class

– white, young, able-bodied, educated men – and does not consider the daily struggles of traumatized women in society (Burstow, 2003). Burstow advocates analysis of the role of social institutions in the creation of trauma. Radical feminist theorists see trauma as a reaction to the wound, and not necessarily a disorder. Feminist Theory brings the impact of social location into trauma discourse

(Burstow, 1998). Feminist theorists have also argued the importance of witnessing the trauma, and critiqued the psychiatric institutionalization of trauma (Burstow, 1992; Smith, 1990). Feminist theorists have influenced the reframing of trauma conceptualization in DSM, as well as the reframing of symptoms as “coping skills” (Burstow, 1992). Radical feminist theorists believe that the two major assumptions psychiatry makes when looking at trauma are flawed: 1) That the world is essentially benign and safe, and so general trust is appropriate; and 2) That people who have been traumatized have a less realistic picture of the world than others (Burstow, 2005 & 2003).

Judith Lewis Herman (1992) argues that for the trauma survivor the world is not a safe place, so mistrust is appropriate (1992). She claims that highly traumatized persons actually see the world more accurately than the less traumatized. However, the traditional values of current society hide the existence of possible oppressive conduct and the political structure fails to assist the victims. Trauma victims recognize the present reality of the world as a safe place and the past reality of a world in

37 which oppression exists; both co-exist in their mind, thus, trauma individuals face the experience of living a double reality (Herman, 1992). Herman emphasizes the importance of paying a lot of attention to the meaning of specific symptoms in individual cases, and an approach that ranges from the biological to the social. She points out that trauma survivors and therapists are never able to recover in isolation, but rather also need to engage the community. Both are dealing with very profound questions of human cruelty and the abuse of power and authority. Herman puts forward the significance of community belonging in trauma intervention, especially for individuals who experienced continuous traumatic events in their life.

Radical feminists also critique other feminist theorists who work with trauma and have accepted the views of institutional psychiatry (Burstow, 1998). Burstow criticizes them for using the language and operating under the definitions established by psychiatry, and she challenges the psychiatric profession to make its definitions more socially aware and responsible (1992). Burstow states that in this regard, other feminist theorists are seriously minimizing the problems with psychiatry, and are obstructing radical praxis (2003).

Hyndman (2006) utilizes post-colonial feminist discourse to explain how gender plays a significant role in determining whether a refugee’s application to seek asylum is successful or not, which may ultimately result in further trauma. Hyndman cites Refugee Board hearings as prime examples of the lack of sensitivity in our social structures when they intervene with female refugees

(Hyndman, 1996). For instance, female refugees are required to provide a medical certificate to prove they have been raped, and this requirement is applicable to all female refugees regardless of culture, social class, family status or age (Crepeau, Foxen, Houle & Rousseau, 2000). Women refugees have the same level of traumatic experiences as men during their pre-migration/migration/settlement period, plus they also have experiences unique to women.

Post-colonial feminist theorists argue that UNHCR policies and projects aimed at protecting women are problematic. The UNHCR’s frequent use of the category of “women” as a primary

38 organizing concept minimizes the issues of discrimination, violence and social inequality facing women across ethnic, clan and other axes of identification (Crosby, 2006 &1996). On the other hand, this categorization of women does not fit in with the UNHCR’s objective of ensuring refugee women are equal partners in decision making processes and have equitable access to services and resources

(Marchand & Parpart, 1995). Hyndman argues that the UNHCR’s approach to women refugees cannot be viewed as coherent, unitary, or internally consistent, reminds that the main purpose of the UNHCR policies to promote women is to encourage and create change within the social structures so that operations on the ground are also positively affected (UNHCR, 2001). NGO work for the UNHCR demonstrates that its culture just refuses to deal with feminism on these terms (Hyndman, 2000). The

UNHCR recognizes that women refugees are often more susceptible in camp situations because family protection and traditional authority structures break down and economic support is less available

(UNHCR, 2006). Crosby argues that the actual lived experience of refugee women is removed from the paradigm of categorization (2006).

Alice Miller (2004) states that we need to avoid the perpetual retelling of the story of sexually abused victims who need only rescue rather than that of demands of women who need rights and social justice as citizens. She also emphasizes the importance of focus on the conditions of economic exploitation and social marginalization that lead people to situations where they are trafficked. In a popular discourse, the harms of trafficking become entirely sexual or racialized, but almost always in a way that reinforces gender stereotypes and protects against reflection on northern economic accountabilities (Miller, 2004). Post-colonial feminists argue that instead of addressing border control, states should pay more attention to protecting women in situations of vulnerability (Crosby, 2006).

Possible sexual harm has become the justification for restraining women’s movement. Women’s own motivations to move, and the diverse experiences of migration, are lost. Female refugees have become bodies, victims to be saved and contained (Macklin, 2004; Sanghera & Kapur, 2004).

39 SYNTHESIS OF THEORETICAL PERSPECTIVES

This review of the theoretical literature on refugees has helped the writer to organize the various views on the refugee population. Exploring each of these theories has helped the author to understand the complex issues facing refugees and how these theories can be useful for service providers during interventions. Although there are many advantages to using these theories, the writer has also identified some shortcomings, to be discussed shortly. Table 1 provides a summary of the theoretical analysis performed by the writer.

Table 1: Theoretical Analysis of Post-Colonial Theory/Trauma Theory/Refugee Theory/Feminist

Theory Theorist/Concepts Observations

Post- Hyndman, 2006 & 2000 Colonial ‚ Policy analysis; politics of indifference ‚ Individual & state responsibility need to be addressed. Theory Philip, 2004 & Harding, 2000 ‚ Science & colonialism in colonized ‚ Not any scientific research to prove the link between world colonization and refugee issues; fails to address how science should respond to migrant communities in the Western world. Gagne, 1998 ‚ Colonial policies and trauma ‚ Doesn’t establish any connection between First Nations development among First Nations community and refugees

Trauma Mollica, 2006 Theory ‚ Self-healing ‚ How effective is this concept specifically with refugees?

Kroll, 2003 ‚ Incorporating cultural implications into ‚ What is the validity of the PTSD definition used to assess PTSD assessment & treatment refugees from different cultural & ethnic backgrounds?

Burstow, 2000 ‚ Radical understanding of trauma ‚ Is it possible to intervene the refugees with only radical psychotherapy & no pharmacotherapy? More scientific studies needed.

Refugee Kunz, 1973 & 1981 Theory ‚ Differentiation between acute & ‚ More research needed to include refugee behaviours in anticipatory refugees camps & settlement experiences. ‚ Differentiation between majority identified, event related & self alienated refugees

Paludan, 1974 & 1981 ‚ More research needed to determine connection between ‚ Differentiation between new & mental health & new/traditional refugees. traditional refugees

40 Theory Theorist/Concepts Observations

Feminist Hyndman, 2000 Theory ‚ Politics of gender ‚ More studies needed to assess gender roles in different cultures & how different cultures deal with refugee issues. Burstow, 2005 ‚ Anti-social structures ‚ Need to address the degree of power feminist theorists have in conducting research, funding issues, ethics protocols & conference presentations in patriarchal society. Crosby, 2006 ‚ Politics of categorization ‚ There is no single definition feminist theorists have agreed upon to address refugee women.

Table 1

Post-Colonial theorists critique social, political and historical structures for constructing refugees, but they ignore the impact of the lack of interpersonal communication between people, which can lead to violence (Mollica, 2006). Post-colonial theorists also fail to accept the responsibility of refugees’ home nations for their own citizens. Wealthier host nations should be able to give importance to keeping their welfare state stable. What would happen if there was a transnational state? Anyone could go anywhere without immigration policies, creating chaos everywhere. Kunz’s theoretical explanations have enabled us to identify certain specific refugee behaviours based on their categorization as acute or anticipatory, and majority-identified or self-alienated. But the impact of individual, social, political and historical factors on refugee’s lives and the time spent in refugee camps are crucial for refugees. There is not enough analysis on these themes and their connection with refugee mental health.

Mollica’s Trauma Theory does not contribute anything new to the medical and psychiatric fields. Although he intended to bring spirituality into the intervention, he still categorizes refugees with trauma under the PTSD definition, which fails to pay any attention to the insidious trauma facing oppressed people in the community in their everyday lives (Burstow, 2003). Another important theme in Mollica’s Trauma Theory is the concept of self-healing. I believe that Mollica oversimplifies the refugee experience. Often refugees are unable to communicate their traumatic events due to re- traumatization, anger, cultural habits, family status, and linguistic difficulties. In such scenarios, how

41 could a refugee communicate clearly to a therapist in order to “create self-healing by telling their stories without overwhelming listeners with horrifying details” (Mollica, 2006).

Hyndman asserts that most of the theories in refugee mental health research do not consider the unique experiences of gender (2000). However, she supports using the category of “women” for unitary integration into society, even though it ignores the diversity of race, culture, ethnicity, and class. Both are not mutually exclusive. Meanwhile, Feminist theorists are at an extreme disadvantage when it comes to conducting research. "Feminist research consists of no single set of agreed upon research guidelines or methods, nor have feminists agreed upon one definition of feminist research"

(Maguire, 1987). This significantly affects the decisions made pertaining to the research process. Also, having to conform to societal expectations based on gender that are contradictory to one’s own identity can be difficult for Feminist theorists. I believe that using one’s identity as a woman to access research data or information may be a strategy available to the feminist, but it is one that comes into conflict with feminist thoughts on non-gendered research.

In short, these theories provide insight on refugee typology, trauma and policies; however this author believes that the notion of "refugee" just does not fit any theory as there are some experiences too deep and too painful for other individuals to fully comprehend. Too much gets lost in translation because of different cultural expectations. For example, how do you express the tragedy of a refugee mother who has spent most of her life successfully managing a home, and whose child dies in the terrifying flight from everything known – home, family, friends, and community? Experiences like these have convinced me to never assume that a routine theoretical analysis of refugees is always possible. Society, culture, history, and politics are such an intimate part of refugee experiences, and never desert a refugee even as they wander homeless in a strange land.

42 EMPIRICAL LITERATURE

Refugees can face a potentially long process of unsettling and/or settling, often carrying with them the pain that caused them to leave their countries of origin. For many refugees, the experience of settling and integrating into the community can be equally traumatic (White, 2004). Most immigrants have basic settlement needs when they come to a new country. However, refugees facing difficult pre- migration and migration experiences have greater such needs. Many social scientists and researchers have studied and analyzed refugee settlement programs, uncovering system-based issues like gender bias, culture discrimination and racism. Schriver (2001) points to the importance of understanding the social environment that affects human behaviour. In the case of refugees, service providers need to understand the individual’s as well as the host community’s social, cultural and political environments.

Refugee resettlement and integration are complex processes (Stein, 1998). There is more literature on refugee settlement experiences than on any other aspect of being a refugee. Most of the social work literature looks primarily at social policies and settlement programs (Rutter, 2006;

Hopkins, 2007; Levine, Esnard & Sapat, 2007; Moore, 2007; Fung & Wong, 2007; Bosive, 2004;

Voltomen, 2004; Tomlinson & Egan, 2002; Majka, 1997).

After the difficult experience of migration, a refugee approaches the new land with mixed feelings. The refugee left home to escape danger with no destination in mind, no "positive original motivation to settle elsewhere" (Collins, 1996). Often the country of settlement is chosen against or despite their wishes by UNHCR authorities (Hyndman, 2000), and the refugee is forced to take their chances based on the United Nations quota to fill for each host country. In the initial period, refugees will be confronted by the loss of their culture – their identity, their habits and their place. Every action that used to be routine will require careful examination and consideration (White, 2004). There will be interpersonal struggles at home, because they are not sure how to adapt to the new culture (George &

Tsang, 2000). Nostalgia, loneliness, depression, anxiety, guilt, anger and frustration are so severe that many refugees may want to go back to their country of origin even though they fear the violent

43 consequences (Mollica, 2000). Refugees today often come from countries where they practice a different way of seeking help. People from developing nations have the impression that Western governments provide social and economic services to their citizens without any obligation (Reese,

2004; White, 2004; Hyndman, 2000). When refugees learn the difficult realities about settlement services, it greatly increases their anxiety and feelings of exclusion from their host country (George,

2003). Research by White (2004) and Reese (2004) on refugees shows that the intersection of racism, classism and sexism lead to even more difficulty in obtaining the services they need.

Most of the refugee service agencies in Canada are funded by the government and managed by community organizations (CCR, 2006). Unfortunately, refugee claimants are generally not eligible to receive these services. Refugee claimants must wait in limbo until they sort out their legal challenges.

Many cannot even think about settling into society due to their ongoing legal battles for permanent resident status in Canada (Burgess, 2004). Refugee claimants often do not have adequate government- sanctioned documents to prove their identity, having lost their documents during the flight from danger. There is a group of unsettled refugees referred to as security threats, who are not able to settle down because of the continuous interrogation by police (Burgess, 2004). Refugees who get legal status are eligible to receive settlement services, which include language training, housing, securing identity documents, etc. (Valtonen, 2004). Until refugees’ receive their status, their life will be controlled by the government or refugee board.

Lack of coordination among refugee settlement support systems often increases the difficulty refugees face during the settlement process (Keung, 2006). An example would be the lack of communication between the Immigration and Refugee Board which is under the Federal Government of Canada and the Ontario Health Insurance Program which is under the provincial government. I believe lack of coordination between many federal and provincial agencies is one of the key issues facing refugees. To make things worse, many community-based agencies have suffered from budget cuts that have further reduced their capacity to respond effectively to the refugees’ plight. Informal

44 support systems can have a huge impact on the successful integration of refugees (Michlski, 2001).

Refugees are often stigmatized by their own communities, as well as by society in general, for utilizing the social welfare services. Compounding these issues, refugees find themselves isolated from the mainstream community due to their poor language skills and lack of knowledge on how to seek medical and psychological help (Fung & Wong, 2007; Hopkins, 2007; Levine, Esnard & Sapat, 2007;

Moore, 2007).

A phenomenon of particular importance with respect to refugee behaviour during resettlement is many refugees’ strong belief that they are owed something by someone. Since their persecutors are unavailable, many refugees shift their demands to the host government and the helping agencies. They continually complain of not receiving enough (Hyndman, 1999). This can create a feeling among refugees of being controlled by agencies (Crosby, 1999), causing them to become aggressive and demanding of resources. This is a re-traumatizing experience for refugees, who often feel a loss of their identity during this period, and are not sure what behaviour is appropriate in the host country

(Collins, 1996). It is a general observation that whatever behaviour they put forward will be assumed to be due to cultural difference. The tension between culture as a basis of universal human experience and culture as the primary basis of difference has important social and political implications for humanitarian practices (Hyndman, 2000).

After the initial period of struggle, many refugees display an impressive drive to rebuild their lives (Pipher, 2001). The key factor for refugee resiliency is the refugee experience itself, which may make them more aggressive and innovative (Stein, 1998). The strength gained from their traumatic migration experiences enables them to learn the new language and new culture, and to achieve a certain level of stability (White, 2004; George & Tsang, 2000; Weaver, 2005; Stein, 1998). A considerable degree of integration occurs simply because life must go on. The recovery of lost status will continue, but at a much slower pace. Most researchers agree on the factors hindering adjustment which eventually contribute to mental health problems. Several clusters of factors either beneficial to

45 adjustment or tending toward an increase in mental problems have been identified: isolation, status changes, gender related issues, inter-generational conflict, host-refugee relationships, and culture shock

(Ehntholt & Yule, 2006; Dyregror & Yule, 2006; Mollica, 2006; White, 2004). There have not been enough studies examining the considerable interaction among these factors. Single refugees, female refugees, refugees in rural areas, and those in lonely, isolated situations lacking company, community and support have all been identified as highly susceptible to mental health problems (White, 2004;

George & Maiter, 2003).

Torn from one's homeland, a refugee’s need for knowing about family members back in their home country is often unsatisfied, ending with volumes of unanswered letters and telephone calls. At the macro level, poverty, discrimination, racism, language difficulties, migration law, and illegal/legal status characterize refuge experiences (Majka, 1997). At the micro level, loss of authority for the head of the household, employment problems, and/or difficulties in school for children can cause trouble within the family (Majka, 1997; Bosive, 2004; Tomlinson & Egan, 2002; Fong, 2004; Stein, 1998).

The pressures on refugees do not remain constant over time; they change as refugees go through the process of integration. Most studies have focused on the early years of resettlement (Michalski, 2001;

Majka, 1997; Bosive, 2004; Tomlinson & Egan, 2002). Later periods of refugee settlement have received the least amount of study and there is a particular dearth of longitudinal studies, even though delayed reaction to earlier pre- and post-migration trauma often emerge after initial periods of settlement.

Migration Traumatic Events and Refugee Psychological Distress

Refugee health care issues can be quite complex and wide-ranging. Being a refugee is clearly a category of risk for physical and psychological distress because surrounded within this state is often- unspeakable violence (Keller, Lhewa, Rosenfield, Sachs, Aladjem, Cohen, Smith & Porterfield, 2006).

Many refugees from the Eastern hemisphere have had little experiences with Western medicine (Stein,

1998). At the same time, refugees from Africa or Southeast Asia arrive from areas where "tropical

46 diseases" like Chicken Guinea or Denki Fever are endemic, and yet are virtually unknown to physicians in the Western world (The Hindu, 2007). Most refugees also share a common characteristic

– they have fled with very little advanced preparation, having brought no medical documents with them to the host country. Often they have been destroyed or are otherwise unobtainable from a hostile home country (Silove, 2006; Stein, 1998).

Large-scale studies (Burgess, 2004; Mollica et al., 1993; Garrett, 2006; Gavagan & Brodyaga,

1998; Ackerman, 1997) have been conducted to examine the physical and psychological needs within refugee communities. Many refugees have experienced torture in their home land, which inflicts severe psychological and physical pain. The first interaction new arrivals have with the health care system is with a refugee medical assessment conducted by health departments (Garrett, 2006). The basis for this assessment is to eliminate health-related barriers before granting refugee status. Injuries to the skin and muscular-skeletal system from blunt trauma, burns, and electrical shock, severe internal bleeding due to rupture of the liver and spleen, head trauma due to brain hemorrhage, and contraction of the HIV virus are widespread physical conditions among refugees (Quiroga & Berthold, 2004). Refugee women are especially at risk for Sexually Transmitted Diseases (STD’s) because of the sexual violence that may have occurred during their flight (LaFraniere, 2005).

Violence experienced by refugees not only causes physical suffering, but also serious social and psychological harm. Many volumes of research have been completed on refugee trauma (Mollica,

2007, 2006, 2000 & 1999; Steel, Silove, et al., 2006; Levin, Blanch & Jennings, 1999; White, 2004).

Studies conducted by Mollica et al. (1993), White (2000), and Steel & Zachary (2006) look at the impact of the migration process on developing trauma among refugees. Refugees need to confront the losses in their life, as well as develop a new sense of hope for the future (Hunt, 2004). In the meantime, they are also required to pass through the asylum-seeking process, which is intensely re-traumatizing

(Quiroga & Berthold, 2004). Dr. Esther Elliot (Keung, 2006) points out that most refugees are here in complete isolation, without friends or families. She asserts that they may suffer from Post-Traumatic

47 Stress Disorder (Keung, 2006), but were never treated in refugee camps. Most refugees realize their loss after they have moved to refugee camps. By this time, they are typically separated from their families and friends, which creates increased anxiety and depression (Mollica, 2006). To the stresses and traumas inflicted on refugees before escape, during flight, and in refugee camps, one must add the difficulties and fears that face refugees during resettlement. Acculturation, loss of status, identity confusion, language difficulties, poverty, concern for separated or lost family members, feelings of guilt and isolation, host hostility, and countless other factors add to the pressures on the refugee in a strange land (Weine & Henderson, 2005). These pressures don't remain constant over time; they change as the refugee goes through the process of adjustment.

Torture survivors have significantly higher rates of trauma symptomatology than the other groups of traumatized individuals (Mollica, 2002). A systematic review by Fazel, Wheeler & Danesh

(2005) of 7,000 refugees showed that those resettling in Western countries could be about ten times more likely to have Post-Traumatic Stress Disorder than age-matched general populations in those countries. Most often they get treatment for their health conditions months or years after their exposure to torture (Miller, 2004). Refugees often approach health care providers with severe headaches, abdominal pain, and severe anxiety. Simultaneously, they face harsh judgement from the host society, and are not able to meet their social, economic, legal and health care needs (White, 2004). Interviews conducted for one quantitative study shows that 65% of theYugoslavian refugee women developed

Post-Traumatic Stress Disorder (Kang et al., 1998). Other quantitative studies conducted in refugee clinic populations (Kinzie et al., 1986, 1989) and in refugee camps (Mollica et al., 1993) found greater than 50 percent prevalence of PTSD. Professor Judy White at the University of Regina conducted a qualitative study (2004) in Saskatoon, interviewing and surveying health care professionals treating refugee women from visible minorities who were suffering from PTSD. There were accounts of the devastating effects of racism and discrimination on the lives of these women, many of whom had lived in Canada for several years and had never accessed help to deal with unresolved issues of trauma. This

48 research shows that refugee women may experience additional burden due to their uniqueness as females. This study is an excellent example of how the structural barriers, including refugee board hearings, can exacerbate the trauma experienced by refugee women (2004).

The effort to treat victims of torture is not a modern one. As Kirk and Kutchins (1997) have documented, after the Vietnam War American veterans lobbied the American Psychiatric Association to construct a diagnosis that would recognize the long-term psychological damage incurred by soldiers in combat and would pave the way for them to receive therapeutic services (Burstow, 1998; Lumsden,

1999). The similar symptoms of these different types of psychological distress earned them the label

Post-Traumatic Stress Disorder, or PTSD for short (Burstow, 1998). The Diagnostic and Statistical

Manual IV, the “bible” of psychological diagnosis, says that PTSD can result from undergoing or witnessing torture, combat, or violent personal assault (Mollica, 2000). PTSD is classified as an anxiety disorder in DSM IV and the listed common symptoms of PTSD include “feelings of intense fear, helplessness, horror and guilt for having survived, recurrent and intrusive memories or dreams of the event, outbursts of anger, difficulty concentrating, and exaggerated response to reminders of the trauma” (DSM, 2000). Special psychosocial problems like loss of social role and social networks, loss of property, acculturation stress, anger, language problems and socio-political factors can complicate diagnosis of PTSD (DSM, 2000). Symptoms of traumatic stress among refugees have commonly been assessed using the diagnostic criteria of PTSD (Mollica, 2006; Miller, Weine et al., 2005).

Burstow argues that PTSD is one of the few DSM categories that was created and became widely accepted as a result of people other than psychiatrists wanting it (2005). She reasons that the term “post-traumatic” suggests that the disorder comes after the trauma, and not that it was caused by the trauma or a reaction to the trauma; also no type of causal relationship between external factors and trauma is specified in the criteria (Burstow, 2005). It is simply stated that there are causes of mental disorders that are essentially biological and/or psychological, though external events may sometimes play a contributing role (Brown, 1995). Although the cross-cultural validity of the PTSD construct and

49 its appropriateness in situations of ongoing violence represent sources of ongoing controversy, the constellation of symptoms that comprise the PTSD syndrome have been documented in numerous studies of refugees representing diverse national and ethnic backgrounds. This does not mean that the

PTSD construct adequately captures the totality of the trauma experience (Burstow, 2005). Rather, the salience of the PTSD syndrome in a wide spectrum of refugee studies merely suggests that there exists across diverse cultures a set of highly correlated symptoms of distress that develop in the wake of exposure to terrifying experiences over which people have little or no control (Summerfield, 1995;

Wessells & Monteiro, 2001).

Although psychiatrists, such as Jerome Kroll (2003), encourage service providers to pay attention to cultural and emotional factors, these factors have not been given much consideration by society in general. Western science was developed during the colonial period in Britain and other

European countries using a set of practices and bureaucratic structures which served the ideological needs of the colonized empires (Philip, 2004). DSM-formulated PTSD was created as a form of controlling human behaviour based on Western European ideology. Western mental health professionals and "mainstream" services often have little understanding of new refugee beliefs, practices, culture, and perspectives regarding mental health (Alcock, 2003). The new refugees’ culturally-defined ways of seeking help may cause reluctance to using Western mental health facilities, and may result in significantly different expectations about the types of help and treatment made available to them (White, 2004).

In examining refugee mental health, one can clearly see a difference of opinion among researchers and clinicians regarding the effects of trauma (Burstow, 1999). Some state unequivocally that there are traits in individuals that produce specific symptoms secondary to the stress of migration, and that these individuals are likely candidates to experience mental health problems (Mollica, 2007 &

2006). Others believe that the similarity of problems in refugees almost everywhere indicates that severe trauma in and of itself is the cause of the symptoms (Stein, 1998). The controversy boils down

50 to situational response tendencies. Kunz’s research focuses on those who make the decision to leave, but much more research is needed on how the decision to leave affects a refugee’s mental health.

Keller (1975) and Scudder & Colson (1982) have explored the refugee reaction to threats and the impact of stress and trauma on refugee behaviour. Keller strongly argues that the trauma of flight produces residual psychological states in refugees that will affect behaviour for years to come. Because they usually endure the greatest hardship and loss, those who are late to flee are likely to come out of the experience with residual characteristics of guilt, vulnerability, and aggressiveness. This research has identified specific circumstances that should be taken into account during clinical interventions with refugees. This is an important area that requires more study.

Richard Mollica’s Trauma Theory integrates the socio-cultural and biological approaches to intervening with refugees with trauma. Mollica emphasizes identifying all potential socio-cultural factors that place refugees at risk for mental illness through continuous communication, which eventually leads to self-healing (2006). Although Mollica does not specifically mention refugee resiliency, he suggests using an agent-host-environment triad to effectively work with refugees who have trauma (2000). According to Molllica, mental health workers can work as agents in refugee camps to help prevent additional trauma (1996). Refugees can improve their mental health not only through food (including eating their traditional foods), shelter and clothing, but also through meditation and spiritual activity (1996). A stable and supportive host country environment is essential to refugee mental health. Mollica states that good mental health requires: 1) Work – to make refugees feel that they are still useful, independent and can care for their families; 2) Altruistic Activity – not only receiving, but also giving help to others greatly enhances refugees’ self esteem and dignity; 3)

Spirituality – through spiritual activity, refugees can strengthen their hope as well as their inner sense of belonging to a group, which is very important for overcoming difficulties (Mollica, 2001). Although

Mollica proposes that integration of all these aspects can make a greater contribution to the refugee intervention, his approach completely ignores refugees’ historical and cultural awareness, which can be

51 extremely beneficial for refugee mental health intervention. Mollica also fails to address in his theoretical writings the feelings of extreme discomfort felt by refugees and their attempts to avoid conversations about their trauma in order to escape from re-traumatization.

Jerome Kroll discussed another dimension to the experience of trauma (2003). Refugees tend to assess their experience from a moral framework, and display emotions such as guilt, shame, regret and remorse. The components of traumatic experiences are descriptively clear. However, there are a number of personal and cultural/religious meanings ascribed to the traumas and subsequent responses that determine their long-term impact (Kroll, 2003). Kroll’s thoughts on giving personal meaning to the refugee trauma have led to the understanding of refugee trauma as a complex phenomenon that resists easy formulation and categorization (Burstow, 2001). Most often, refugees’ own unique experiences can create complications in assigning them to the “PTSD category”, as defined by Western medicine (Burstow, 2001; Hyndman, 2000). Feminist theorists argue that the PTSD diagnosis does not even accomplish the mission for which it was created. Vietnam veterans and therapists wanted a disorder that would demonstrate the profound harm done by certain types of events, situations, and conditions. What they got instead was a diagnosis with implicit meanings and implications that subvert the very validation that it appears to offer (Breggin, 1991). The PTSD diagnosis turns the aftermath of the violence into a disorder and turns the violence itself into nothing but a preceding event. In short, it pathologizes people’s expectable response to violence.

In all situations, the challenge for the health care professional is to approach refugee trauma in a scientifically sound, systematic manner, providing the basis for incorporating political, social and historical components into the assessment, as well as in medical interventions. There has not been any research examining the considerable interaction between pre-migration and post-migration traumatic experiences and refugee psychological distress. Also, analysis of refugee literature leads to the conclusion that more research needs to be done on the role of typology of refugees, typology of

52 refugee settlement, gender and host country status, which influence refugees’ migration experiences and their psychological distress.

Typology of Refugee and Typology of Refugee Settlement

Research by Kunz (1973 & 1981) and Paludan (1974 & 1981) provides a different perspective on refugees’ settlement service seeking patterns. Kunz described two different patterns of refugee flight – acute and anticipatory – from their country of origin, which may be predictors of how they settle down and receive help from host countries (1973). Acute refugees leave their home country within a few days or hours of disaster striking them. Silove, Steel, Bauman, Chey & MacFarlane’s quantitative study shows that 85% of the refugees fleeing from war-torn Vietnam during the 1970’s made the decision to leave their homeland two days to two hours before their departure. Acute refugees may have no resources and no support from anyone, which may lead them to seek help more frequently. But because of their direct experience with trauma, they sometimes try to avoid contact with strangers out of fear of re-traumatization (Mollica, 2006), even though they may need immediate help. Anticipatory refugees, on the other hand, are those who leave their home country prior to the disaster, most often with their families and personal resources intact. They tend to seek less help than acute refugees (Paludan, 1974).

Another factor in the refugee experience that deserves more attention from researchers is the emergence of what Paludan (1974) calls “the new refugees”. Until the 1960s refugee settlement was focused on traditional refugees, primarily Eastern Europeans, who were products of the Cold War

(Colic-Persker, 2005). Now the weight of concern and interest is shifting to new refugees from Africa,

Asia, and Latin America. The key differences between new and traditional refugees are that new refugees are culturally, racially and ethnically vastly different from their hosts, come from less- developed countries, and are likely to lack kin or potential support groups in their country of resettlement, whereas traditional refugees are culturally and ethnically similar to their host, come from

53 more developed countries, and are likely to be welcomed and assisted by family and friends who speak their language and can cushion their adjustment (Paludan, 1981; Stein, 1998). Examples of these types of refugees are Sri Lankan Tamil refugees who have resettled in the state of Tamil Nadu in India, and

Sri Lankan refugees who have resettled in Toronto, Canada. Sri Lankan refugees in Tamil Nadu

(traditional refugees) live in the same cultural, social, and linguistic environment as they did in Sri

Lanka. They or their ancestors originally left India to find a better life in Sri Lanka, which at one time was a wealthy British colony. So, by returning to India as refugees, they may be able to enjoy similar cultural, social and linguistic connections. Sri Lankan Tamil refugees in Toronto (new refugees) live in a culturally, socially, and linguistically different environment. The behavioural and material aspects of

Western culture are alien to new refugees (Weaver, 2005), and they may experience more traumatic post-migration experiences.

Refugee-host relationships can create an atmosphere that either aids or hinders the personal adjustment of refugees (George, 2003). Loss of all that is familiar may represent a threat to one's identity, and can lead to strong feelings of grief, despair and nostalgia for the refugee (Mollica, 2006).

Culture shock will particularly affect those refugees who did not think about, intend, or prepare for exodus, and who were caught up in panic, hysteria, or even adventure (Mollica, 2007, 2006 & 1999).

However, contrary to expectations, Porter and Haslam’s meta analysis demonstrated worse mental health outcomes for refugees who repatriated to a country they had previously left (2005). This means there is a possibility that Sri Lankan Tamil refugees returning to India have worse mental health outcomes. Refugee experience outcomes have been the subject of very few studies (Collins, 1996;

Mollica, 2000; Stein, 1981; Kilbride, Anisef & Khattar, 2001). More research needs to be conducted to examine settlement experiences based on typology of refugee and refugee settlement. Researchers should pay attention to the uniqueness of individual experiences along with complex systems-based issues.

54 Gender

The international definition of “refugee” has been interpreted primarily in the context of male asylum-seekers, to the prejudice of women refugees. A classic image of a refugee is that of the male individual who was persecuted for political reasons. The claims of women refugees often differ from those of men in several respects. First, women often suffer harms which are either unique to their gender, such as female genital mutilation or forcible abortion, or which are more commonly inflicted upon women than men, such as rape or domestic violence. Second, women’s claims differ from those of men in that they may suffer policy-induced harms solely or exclusively because they are women, i.e., as a result of their gender (such as the policies of the Taliban in Afghanistan). And third, women often suffer harm at the hands of private individuals (such as family members who threaten them with

"honor killings" or abusive spouses who batter them), rather than governmental actors (Centre for

Gender and Refugee Studies, 2008). The distinctions between the more traditional claims of male asylum seekers and those of women have often adversely impacted women asylum-seekers. Although they tend to suffer the most serious consequences of war and immigration, women and children remain an often hidden population among refugees in general (UNHCR, 1998). Approximately 80% of the refugees immigrating to North America are women or children (Brady, 1998). Many have left most of their family and support systems behind. A large percentage of women refugees have spent time in refugee camps where conditions are crowded and frequently unsanitary.

Language barriers, limited transportation, and their limited knowledge of social and health care resources in the host country are the leading causes for refugee women not accessing the host country’s system of care (Rees, 2004; White, 2004). Also, refugee women may not know about the financial assistance offered through various agencies in their new host countries (IISF, 1999). Personal and cultural issues may cause a woman hesitate to seek the health care (White, 2004). Many refugee women are not comfortable allowing someone outside their culture to examine or treat them. Others have always relied on traditional methods of treating illness, and may distrust Western medicine

55 (Weaver, 2005; Downs, Bernstein & Marchese, 1997). They are immediately faced with major role changes, which further increase their vulnerability. Because of this vulnerability, rape and sexual abuse are extremely common against female refugees (Rees, 2004). Though few are willing to report these crimes, horrifying stories of cruelty and rape have been recounted by the few who will speak out

(White, 2004). They may address their psychological and physical trauma after many years or may never do so (Mollica, 2006; Caruth, 2006).

White’s research (2004) shows that many refugee women hesitate to seek and utilize help, and have a strong chance of developing Post-Traumatic Stress Disorder (PTSD). Studies show that refugee women are affected differently than men by the events of their past, and have unique concerns stemming from these events and responses (Kang, Kahler & Tesar, 1998). Regardless of the circumstances that drove refugee women to flee their homes, they typically come to countries of refuge with all-encompassing human needs – i.e., physiological, psychological, sociological, and spiritual needs (Kang, Kahler & Tesar, 1998). Their physical and mental health may suffer at this stage. The result of this path is often lack of independence, unemployment, family dysfunction and disintegration, and a minimal social support system (Kramer, Ivey & Ying, 1997). Refugee women have extreme difficulty in dealing with the challenges facing them and need additional assistance (LaFraniere, 2005).

It is vital when dealing with them for professionals to not essentialize the locations of women. It is important to consider gender, culture, class and race as plural expressions of diversity, providing women with equal decision-making power instead of treating them as silent consumers.

Host Country Status

The word “refugee” is used in ordinary conversation to refer to someone fleeing various ills, including war, natural disaster and even the stresses of modern life (CCR, 2002). Only after recognition of the refugee claimant’s protection needs by the host government is he or she entitled to refugee status, which carries certain rights and obligations according to the legislation of the receiving

56 country (Crepeau, Foxen, Houle & Rousseau, 2000). Unfortunately, refugee claimants are generally not eligible to receive settlement services like language training, housing, or securing identity documents. Refugee claimants must wait in limbo until they sort out their legal challenges. Many cannot even think about settling into society due to their ongoing legal battles for permanent resident status in the host country (Burgess, 2004).

These refugee claimants often do not have adequate government-sanctioned documents to prove their identity, having lost their documents during the flight from danger. Fong and Mokuau

(1994) claim that many of the terms related to refugees – such as asylum seekers, refugee claimants, and displaced persons – exemplify the complexity of the systems ascribing status and conditions of treatment. Also these statuses reflect the variety of migration experiences and affect the ways refugees settle in the new country. Therefore, this dissertation will examine the effects of refugees’ traumatic struggles to achieve refugee status within their host country on their psychological distress.

SYNTHESIS OF EMPIRICAL LITERATURE ANALYSIS

Table 2 provides a synopsis of the empirical analysis of the refugee literature. Major themes selected for analysis are refugee displacement, refugee health and refugee position of settlement or unsettlement. This table offers a transparent picture of how these selected experiences can affect refugees’ lives during their pre-migration, migration and post-migration period.

57 Table 2: Empirical Analysis of Refugee Pre-Migration/Migration/Post-Migration Experiences

Experience Pre-Migration Migration Post-Migration

Displacement ‚ Colonization leaves behind ‚ Complexity of refugee review ‚ Efficacy of the settlement anarchy and rivalry board programs

‚ Imbalance of international ‚ Failed claimants who go ‚ Typology of refugee settlement & domestic policies underground

‚ Acute/anticipatory refugees ‚ Activities of employers who use illegal refugees ‚ Comparison between refugees with pro-Western ‚ Illegal trafficking policies vs. values vs. pro-Eastern women refugees values ‚ Perception of transnationalism

Health ‚ Assessment of immediate ‚ Long delays & rejection ‚ Impact of prolonged separation health care needs not from family & friends possible ‚ No access to health services for illegal refugees ‚ Influence of trauma on ‚ Pre-migration screening & settlement & integration by testing ‚ Influence of trauma & lack of mental health system proper interventions during the claim process ‚ Inadequate trauma diagnosis

‚ Impact of under- employment / high risk jobs / isolation / language barriers / culture shock

‚ Lack of social, political & historical understanding by health care providers

Settlement/ ‚ Systematic process in ‚ Classification of refugee ‚ Settlement assessment Unsettlement selection of place of settlement ‚ Assessment of settlement needs ‚ Socio-political / socio-cultural settlement ‚ Priority assessment ‚ Active citizenship ‚ Racialization of policies ‚ Participation of refugees in ‚ Influence of culture on settlement decision making

‚ Gender & age differences ‚ “Us” and “Them”

‚ Systematic barriers ‚ Exclusion in research & policy

‚ Societal support system

‚ Reciprocal effect of identity/place

Table 2

58 The empirical literature section provided an analysis of refugees’ pre-migration and post- migration traumatic events and the impact on their psychological distress. It detailed not only micro issues but also the macro-level problems like host country policies and the Diagnostic and Statistical

Manual‘s influence over individuals with mental illness. This section also identified major themes from the refugee literature like typology of refugees, typology of refugee settlement, gender and host country status. Another observation from the analysis was the importance of social and political factors in refugee issues. To properly examine refugee issues, the concepts of globalization and post- colonialism need to be reviewed to understand how social, political, economic and cultural biases were formed and operate in relation to, and through, other systems of exclusion, marginalization, abuse, and oppression. This would highlight the need for creating a process that respects every individual regardless of where they were born.

Philips’ research shows the diverse ways science and colonialism acted as systems of control and management (2004) and she contends that the impact of the imperialistic practices of colonization and later science on the quality of life of individuals is seldom analyzed. White’s 2004 research shows that structural barriers act as a contributing factor in the development of trauma among refugees.

Mollica’s 2006 research shows that refugee populations experience higher rates of PTSD than any other community. These research findings suggest an important connection:

Colonialism → Anarchy in the Country of Origin → Refugee → Colonialism-

Influenced Policies in Host Countries → Psychological Distress

However further scientific analysis is needed to substantiate this causal relationship. The conceptual framework proposed will attempt to pull together political, historical, social and psychological experiences of refugees, and develop a comprehensive and integrated knowledge of refugees.

59 CONCEPTUAL FRAMEWORK FOR UNDERSTANDING IMPACT OF PRE- AND POST- MIGRATION TRAUMATIC EVENTS ON SRI LANKAN TAMIL REFUGEES’ PSYCHOLOGICAL DISTRESS

Analysis of the theoretical and empirical literature on refugees leads to the conclusion that this important area of research requires more coordinated and consolidated attention from researchers, incorporating both medical and social perspectives. Figure 6 illustrates the conceptual framework for understanding refugees’ psychological distress.

Figure 6: Conceptual Framework for Understanding Impact of Pre- and Post-Migration Traumatic Events on Psychological Distress of Sri Lankan Tamil Refugees

Figure 6

When considering the refugee experiences that contribute to psychological distress, pre- migration traumatic events in the refugee’s home country and during the migration period and post-

60 migration traumatic events in the refugee’s host country, viewed within their respective socio-political contexts, must be taken into consideration. Refugees’ pre- and post-migration traumatic events and psychological distress are also moderated by typology of refugee, typology of refugee settlement, gender and host country status.

This in-depth understanding of refugees’ psychological distress as influenced by their social and political backgrounds and pre- and post-migration traumatic experiences will provide more insight into refugees’ unique struggles, and will enable governments and health care workers to provide more effective refugee services. Consideration of the social and political history of refugees on a local and global level will help service providers to recognize the influence of these contexts on refugee psychological distress. Acknowledging the migratory journey, which includes pre- and post-migration traumatic events, moderated by typology of refugees (Kunz, 1973 & 1980), typology of refugee settlement (Paludan, 1974 & 1981), gender (White, 2004), and host country status (Stein, 1998), will assist service providers in comprehending refugees’ experiences which may affect their psychological distress. Aspects of Post-Colonial Theory, Refugee Theory, Trauma Theory and Feminist Theory have been combined to create this comprehensive framework for working with refugees holistically. This model represents a departure from the fully medical model that has guided most refugee mental health research and interventions with refugees by emphasizing provision of services such as psychotherapy and psychiatric medication by highly trained professionals (Mollica, 2007).

On a clinical practice level, this conceptual framework focuses on the importance of understanding the social and political backgrounds of refugees which influenced their decision to leave their homeland, their pre- and post-migration experiences, difficulties with host government refugee policies, and any physiological and psychological factors contributing to their mental distress. This framework will provide health care workers with a knowledge base to intervene with refugees suffering from psychological distress. Additionally, this model highlights the importance of social and scientific awareness during intervention with refugees and their families. On a social policy level, this

61 conceptual framework examines the related support currently offered by the host country governments.

An examination of the gap between the effects of refugee traumatic migration experiences and the available government settlement services is relevant for policy makers at all levels in countries like

Canada because of the huge influx and settlement of refugees from all over the world that continues unabated. Every step of the migratory journey has its special features and mental health consequences, all of which require much attention from health care providers. The goal of this dissertation based on this conceptual framework is to make an argument for refugee identity – including social and political environments from which refugees have fled, refugees’ pre- and post-migration traumatic events and their psychological distress – to be considered a distinct field of social science research.

62 CHAPTER 4: BACKGROUND TO THE STUDY

This chapter describes the context of the study, which includes the complexities of the war in

Sri Lanka between the Sinhalese and Tamil communities, Sri Lankan Tamil migration to Canada and

India, and the settlement struggles of Sri Lankan Tamils and their psychological distress. The largest concentration of Sri Lankan Tamils outside of Sri Lanka is in Canada. More than 250,000 Tamils live in Canada now. Of these, more than 200,000 Tamils live in the greater Toronto area. Toronto is the largest Sri Lankan Tamil “city” in the global Tamil diaspora (Cheran, 2000). The Tamil population here is greater than in large Northeastern Sri Lankan cities and towns like Jaffna, Killinochi,

Batticaloa, Vavuniya, and Trincomalee. During the 20th century, a significant number of Sri Lankan

Tamils fled Sri Lanka due to the violent civil war between the minority Tamils and the majority

Sinhalese (Tambiah, 1986). The conflict between the Sinhalese-controlled government and Sri Lankan

Tamils led by the Liberation Tigers of Tamil Elam (LTTE) is commonly identified as a primordial ethnic conflict.

The first section of this chapter provides an examination of the historical, social and political context of Sri Lanka . More specifically, the legacy of colonization and its effects on the political and religious underpinnings of this conflict is explored. The next section of this chapter reviews the historical, social and political conditions facing Sri Lankan Tamil refugees in India and Canada. The chapter concludes with a discussion of the need for research to analyze the mental health needs of Sri

Lankan Tamil refugees.

HISTORICAL, SOCIAL AND POLITICAL CONTEXT OF SRI LANKA

Sri Lanka is a small island about 270 miles long and 150 miles wide, lying near the southern tip of India. It has been often called the “pearl” of the Indian Ocean, with its tea plantations and endless coastline(Tambiah, 1986). The Sri Lankan population can be divided into three subgroups: the majority Sinhalese (74% of the population), and the minority Tamils (18.2 %) and Muslims (7.4%)

63 (Tambiah, 1986). Although the primary identity components of the Sinhalese are their Sinhalese language and their Buddhist religion, while the Tamils are identifiable by their Tamil language and their Hindu religion, both these populations share many parallel features such as traditional castes, popular religious cults, and customs (Tambiah, 1986). Since Sri Lanka gained independence from

Britain in 1948, relations between the majority Sinhalese and minority Tamil communities have been strained. Rising ethnic and political tensions led to riots in 1958, 1977, 1981 and 1983, and have resulted in the formation of strong militant groups advocating a separate nation for Sri Lankan Tamils.

The world views the Sri Lankan conflict as a purely domestic ethnic conflict, but in fact it was evolved from, and continues to be, a South Asian regional conflict strongly influenced by neighbouring countries, primarily India. This conflict garnered much international attention due to its implications for global peace and security.

An understanding of the geographical distribution of the Tamils and Sinhalese in Sri Lanka is important to assess which parts of the island may expect ethnic conflicts to occur. Figure 7 provides a political map of Sri Lanka that pinpoints the primary areas of conflict between the Sinhalese and

Tamils. The first sensitive area is the capital city of Colombo and its suburbs where a large number of

Sri Lankan Tamils, who used to work in administrative positions in the early 1970’s, have settled.

Another highly vulnerable northern area is the Jaffna Peninsula, where Sri Lankan Tamils (otherwise known as Jaffna Tamils) have demanded the creation of their own separate nation. Jaffna Tamils came from Southern India between the early centuries of the A.D. and the 15th century. The territory constitutes 69% of Sri Lankan Tamils and is politically explosive and economically weak (Tambiah,

1986). The northern region has the support of the Tamil diaspora who reside in the western world as well as Australia, and who are affluent, intelligent, well-educated, articulate and good at networking.

The last vulnerable area is the eastern region of Sri Lankan Tamils (otherwise known as Indian Tamils) who are from economically deprived classes, not well-educated and discriminated against by both the

Northern Tamils as well as the Sinhalese community. Indian Tamils trace their origins to South India

64 from where they were brought by British Colonizers as labourers to work in the coffee and tea plantations (Tambiah, 1986) and have the support of the Tamil Diaspora in India.

Figure 7: Political Map of Sri Lanka

Figure 7

65 Colonization, Political Religions, Liberation Tigers of Tamil Elam and Global Politics

The modern conflict between Sinhalese and Tamils was created during the colonial period by the British through their policy of “Divide and Rule”. The policy, the same one employed by the

British in India, severely damaged the internal peace between the Tamil and Sinhalese communities in

Sri Lanka between 1815 and 1948 (Tambiah, 1992). Around the first century A.D., the island was fragmented between various kingdoms. Until the fifth century there was a strong presence of

Buddhism, but around that time the Hindu devotional revival and the subsequent persecution of

Buddhist communities, which continued until the nineteenth century, created two ethnic blocs in Sri

Lanka, as well as in Southern India. In the nineteenth century, colonization by the British progressively enumerated and aggregated caste systems within the Buddhist and Hindu religions (Tambiah, 1992).

Also, conversion to Christianity during the period of colonization complicated the unitary identity of each caste or religion. At the same time, as part of the Divide and Rule policy of the British, a strong division was created between Aryans (those with fair skin) and Dravidians (those with dark skin) in Sri

Lanka and India. There is an assumption that Sinhalese are descendants of the Aryans and Tamils are descendants of the Dravidians. However, Stanley Tambiah, Professor of Anthropology at Harvard

University, believes the fact that the ancestries of both the Sinhalese and Tamil population are tied to

Southern India means both communities are of Dravidian lineage (1992,1986).

British rule has been blamed for damaging Buddhism in Sri Lanka and India, and Buddhists have encouraged the community to support the need to restore Buddhism to its rightful place in society, which includes giving them their own sovereign country. Sinhalese monks fled Southern India centuries ago and created a triumphant civilization in Sri Lanka. Sri Lankan Tamils also left Southern

India centuries later in search of a better life. This created two diverse ethnic blocs in Sri Lanka, with a differing history of origin, religion, ideology and even political agenda. Sri Lankan Tamils highly valued education, and therefore had more educational and economic opportunities available to them than the Sinhalese while Sri Lanka was under British colonial rule (Tambiah, 1992). The British

66 themselves were said to prefer Tamils, leading to disenchantment and resentment among the majority

Sinhalese, and ultimately to the current ethnic conflict. Like many other ethnic clashes around the world, this conflict emerged with democratization and the shift of power from privileged Sri Lankan

Tamil minority to the Sinhalese Buddhist majority, who had been marginalized under colonial rule

(Bandarage, 2008).

In his book, Buddhism Betrayed: Religion, Politics and Violence in Sri Lanka (1999), Tambia explains the volatile nature of religion mixed with national politics and the successful transformation of Buddhism in Sri Lanka into a political religion by the Buddhist-controlled government and society.

Tambiah explores the interpretations of Buddhist monks, many of whom believe that much of ancient

Sinhalese Buddhist texts are being misinterpreted to legitimize the current social and political situation in Sri Lanka.

Although historians hold responsible Sinhalese governmental policies for creating a disturbed nation, it is important to understand the role of Vellupillai Prabhakaran and the Liberation Tigers of

Tamil Elam (LTTE) in the Sri Lankan conflict. The LTTE has positioned itself as the sole representative of Sri Lankan Tamils, however, there is much internal tension between the Jaffna

Tamils from the northern region and the Indian Tamils from the eastern region of Sri Lanka. The northern region is fiercely loyal to Prabakaran and LTTE while the eastern region Tamils are staunch followers of Karuna, Pillaiyan and Devananda, political leaders from the Sri Lankan Tamil community. According to Prof. Bandarage (2008), the LTTE has killed more Tamils than the Sri

Lankan armed forces to gain control and power over the Sri Lankan Tamil community. Furthermore, the Sri Lankan Tamils in the Sinhalese-dominated regions of Sri Lanka (47% of the entire Tamil population) are economically well off, primarily due to their commitment to higher education which enables them to secure good jobs and earn a decent living (Bandarage, 2008). This questions the true intentions of the LTTE whose demand for a separate nation for Sri Lankan Tamils may be based on economic opportunities.

67 The refugee problem in Sri Lanka has significantly worsened in recent years. The long standing armed conflict initially forced people to leave their own country, making it impossible for Sri

Lankan Tamils to stay in Sri Lanka, and subsequently for Sri Lankan refugees in other countries to return to their homeland. The Sri Lankan civil war has also generated political discord between various countries, while international interests have failed to bring about any permanent resolution. In the early

1980’s, Sri Lankan politics became the focus of global attention when, for strategic reasons, the United

States expressed its interest in the Sri Lankan Trincomalee Port. The Indian prime minister at the time,

Mrs. Indira Gandhi, opposed and objected to American infilteration of the region and thus lent support to the LTTE in the formal armed training to achieve independence, including the Port of Trincomalee, and be considered a sister country to India (Vaiko, 2006). However, following the assassination of

Mrs. Gandhi in 1984, her son and successor, Rajiv Gandhi, withdrew India’s support to the Sri Lankan

Tamils and forced them to sign a peace treaty with Sri Lanka in 1987. According to Vaiko (2006), a

Sri Lankan Tamil leader, the underlying reason for such action was ”to divert the attention of the

Indian people from Rajiv Gandhi’s role in the Bofors scandal, and also he wanted to show the world that he has settled the Tamil problem that was not possible for his mother”. However, this treaty was soon breached. The Indian army lent its support to the Sri Lankan government to fight the LTTE which eventually led to the mass killing and gang rapes of Sri Lankan Tamils in Sri Lanka. It was during this period that Rajiv Gandhi was assassinated by a victim of gang rape, which resulted in the withdrawal of India’s support of the Sri Lankan Tamils. At the same time, the Sri Lankan government was offered and accepted military support from Pakistan, funding from China and diplomatic support from the United States to marginalize India in South Asia and to acquire control over Trincomalee

Port, a strategic natural harbor. This escalated the Sri Lankan conflict into a global struggle for power and control. Sri Lanka is now bankrupt with accelerated war expenditures. Tourism, which was an economic strength of the country, has failed to generate any revenue since the beginning of the war.

Both Sri Lankan Tamils and Sinhalese have been displaced and are suffering.

68 HISTORICAL, SOCIAL AND POLITICAL CONTEXT OF SRI LANKAN TAMIL

REFUGEES IN INDIA AND CANADA

Canada and India have the highest number of Tamils outside of Sri Lanka. Wealthy and educated Tamil refugees from the Northern Province of Sri Lanka flee to wealthy western nations, while the unemployed and poor Tamil refugees from the Eastern Province end up in refugee camps in

India. Approximately 200,000 Sri Lankan Tamil live in Toronto, and they represent the second largest refugee group in Toronto (Jeyaraj, 2007). In 1999, there were more refugees from Sri Lanka seeking asylum in Canada than from any other country (Canadian Council for Refugees, 2000). The main impetus for Sri Lankan Tamil migration to Canada was the liberal immigration policies adopted by

Canada around the time the Sri Lankan civil war began in 1981. At that time, Canada had an excellent relationship with Sri Lanka, with Canada home to the largest Sri Lankan Tamil diaspora in the world.

After the terrorist attacks on the United States in September, 2001, Canada announced that the

Liberation Tigers of Tamil Eelam would be classified as a terrorist group, which caused Sri Lankan

Tamils to come under intense investigation. The LTTE, based in the Northern Province of Sri Lanka, always received tremendous support from western world, however, it lost much of its monetary and emotional support after 2001. In recent years, the intimidation tactics of the LTTE’s administrative wing for collecting money for its war efforts has created a great deal of anxiety among Sri Lankan

Tamils living around the world including Toronto, Canada. Many human rights organizations have condemned this intimidation and extortion taking place in Sri Lankan Tamil communities around the world. They also denounce the use of children as soldiers by the LTTE. Meanwhile, there is much suspicion in Tamil communities over how much of the funds they are contributing to the LTTE, forcibly or otherwise, actually going to the root cause. It is no secret that many Tamil businesses including Television channels, temples and movie theatres, in Toronto, Canada are funded by the local

LTTE. Many Tamils work two to three jobs to provide funds for the LTTE; however they resent the

69 intimidation and corruption. The LTTE administration denies receiving any funding from abroad, but it is hard to fathom how the LTTE could otherwise finance such a technically advanced fighting force.

Sri Lankan Tamil refugees who settled in Toronto mostly came through Moscow, Switzerland, and the United States to reach Canada. After 2001, the Immigration and Refugee Board of Canada significantly tightened control of refugee movement. Arriving refugees must remain in detention centres for 2-4 dayuntil they go through the review process to apply for refugee status and become refugee claimants. If the refugees’ claims are deemed valid, they can file an application for refugee status and eventually can get permanent resident status. If their refugee status is denied by the review board, they are no longer allowed to stay in Canada and will be deported. Canada has a very large number of undocumented Sri Lankan Tamil refugees who remain here with the help of family and friends.

Approximately 100,000 Sri Lankan Tamil lives in India (Offerr, 2009). Approximately, 20,000

Sri Lankan Tamil refugees come to Southern India every year in boats which are often overloaded and unseaworthy (UNHCR, 2006). Because of the geographical, cultural and linguistic similarities, 95% of the Sri Lankan Tamil refugees in India settle in the state of Tamil Nadu. Around 70,000 refugees are currently living in 123 refugee camps in Southern India. Another 100,000 are estimated to be living illegally outside camps. India does not allow the UNHCR into the refugee camps out of fear that the government may lose control over the camps if they are opened to humanitarian agencies. There is also a suspicion that the Indian government does not want the unsanitary conditions of these camps to be exposed to international scrutiny.

In India, all refugees and their children arriving there will be refugees forever. They will never get the opportunity to become permanent residents of India unless they can provide documentation showing that their ancestors were from India, which for most refugees is nearly impossible without any documents. And so they will be confined to live in refugee camps for the rest of their lives. Individuals who do not get refugee status are required to return to Sri Lanka immediately, as they have no legal

70 right to live in India. When refugees reach the Indian shore near Dhanushkodi in boats, they are taken to Mandapam camp for interrogation. Men and women are initially kept separate, and a security debriefing follows (The Indian Express, 2008). According to the Indian Express newspaper (2009), in the first 10 months of 2008, 2,471 Sri Lankan Tamils belonging to 877 families have come to

Mandapam camp, and the numbers are likely to go up as the crisis worsens on the island. Once they reach one of the 122 camps in Tamil Nadu, things do not get any better for the refugees. As long as they live inside the camp, they receive rations of water, rice and electricity. Every individual is given

400 rupees monthly support and families a maximum of 1500 rupees a month. They are free to look for work in nearby towns and villages and relocate outside the camp if they can afford it, which very few can. The shelters in the camp are only 10’ x 10’ and not fit to live in. These “houses” were built at the end of the 1980’s and no renovation has been done since then. During summer, the scorching heat is unbearable, while during the rainy season the water pours in through damaged roofs. The camps lack proper bathroom amenities, drinking water facilities and electricity (Federation of People’s Rights,

2004). The UNHCR has no official mandate to operate directly in India. Figure 8 details the Tamil

Nadu refugee camps’ organizational structure as observed by the author:

71 Figure 8: Organizational Structure of Refugee Camps in Tamil Nadu

Figure 8

Sri Lankan Tamil refugees arriving in both Canada and India face severe mental distress. Two of the main reasons for the host governments’ resistance to refugee settlement amongst the host community are security issues and the drain on resources. Refugees are often blamed for pre-existing social or economic problems because they access available resources. Many host countries today are experiencing a range of rapid and disorienting economic, social and political changes that have resulted in increased crime and insecurity, and declining standards of living. The political situation of the host country further complicates the response to refugees. Host country governments hold different political views about the country of origin. For example, in the case of Sri Lankan Tamils, host countries like India may support the Sinhalese-controlled Sri Lankan government, which may influence its decision to refuse status to Sri Lankan Tamil refugees. Regardless of the security threats, scarcity of resources or host country attitudes, refugee claimants may find themselves in double jeopardy; they must deal with all these systemic barriers while at the same time have no legal right to stay in the host country. Most Sri Lankan Tamil refugees have been subject to complex conflict and have therefore already experienced significant pre migration trauma. Refugees and refugee claimants

72 in India have to face similar post migration experiences because of the lack of support from the Indian government to provide them with permanent resident status. Refugee claimants in Canada, on the other hand, experience post-migration trauma when they are subject to extensive interrogation by the

Refugee Hearing Board.

MENTAL HEALTH NEEDS OF SRI LANKAN TAMIL REFUGEES

At the end of the 20th century, a large number of Sri Lankan Tamil refugees found their way to host countries including Canada and India. The literature presents a great deal of evidence that Sri

Lankan Tamil refugees face the greatest exposure to traumatic events, along with Central American,

Cambodian/Khmer, Bosnian, and Cuban refugees (Hermansson, Timpka & Thyberg, 2003; Holman,

Silver & Waitzkin, 2000; Rothe, Castillo-Matos & Busquets, 2002; Silove, Steel, McGorry, Miles &

Drobny, 2002). Gronseth’s research with Sri Lankan Tamil refugees in Norway showed that they have the experience of continuously living in war zone areas in Sri Lanka (Gronseth, 2006). Pre-migration and post-migration experiences of Sri Lankan Tamil refugees have led to trauma, breakdown of support networks, loss of identity, depletion of resources and absence of professional assistance from their own community, which have contributed to grief, anger and a sense of disillusionment (Dasgupta,

2006).

Experiences of ill health, loss and bereavement, and violence have resulted in psychological distress among Sri Lankan Tamil refugees. Many studies have focused on the mental health of adult refugees from Southeast Asia (Beiser & Fleming, 1986; Beiser et al., 1993), however, Sri Lankan

Tamil refugees have received very little attention in terms of examining how their pre and post migration traumatic experiences impact their psychological distress. Both Gronseth’s (2006) and Steel and Zachary’s (1998) work focuses on post migration traumatic experiences. However, these studies are from the Anthropology and Psychology fields and conducted in Norway and Australia. Hilary

Weaver (2009) discussed the concerns from social work professionals over Sri Lankan Tamil refugee

73 trauma and the lack of culturally appropriate tools to assess such traumatic experiences were the main reasons for developing the Tamil version of the Harvard Trauma Questionnaire (2009). This paved the way for researcher’s interest in developing a social work research based in Canada and India – two largest Sri Lankan Tamil refugee settlements in the world. Psychosocial rehabilitation of distressed Sri

Lankan Tamil refugees is very challenging. However, this dissertation can provide the groundwork for developing socially, politically, historically and medically integrated comprehensive mental health services for Sri Lankan Tamil refugees

SUMMARY

In Sri Lanka, individuals experience living in the midst of bloody and ongoing civil war. Sri

Lankan Tamil refugees face multiple traumatic experiences including lack of food, water, shelter, access to medical care, and sexual and physical assault (Weaver, 2009). The traumatic experiences do not end once they have left Sri Lanka. They must face difficulties in refugee camps as well as in their new host countries, where their lives will be in limbo until they receive legal refugee status. However, analysis of the literature on Sri Lankan Tamil refugees leads to the conclusion that this important area of research requires more coordinated and consolidated attention from researchers, incorporating both medical, social, political and historical perspectives. This research study will highlight the importance of considering historical, social and political factors in Sri Lanka and host countries like India or

Canada, which create refugees’ pre- and post-migration traumatic experiences and psychological distress.

74 CHAPTER 5: RESEARCH METHODOLOGY

The current study is based on my interest in learning directly from Sri Lankan Tamil refugees about their pre-migration and post-migration experiences. The study was focussed on highlighting the importance of bridging the complex interplay of social, political and historical factors in Sri Lankan

Tamil refugees lives. Drawing from the works of Tambiah (1992), White (2004), Mollica (2006),

Silove and Steele (2006), Porter and Haslam (2005), and Fazel (2005), this study makes a further exploration specifically into the difficult realities facing Sri Lankan Tamil refugees. The following chapter provides a definition of several terms that appear in this dissertation, as well as an overview of the research questions, hypotheses, sampling and data collection procedures, and methods of data analysis used for conducting this study.

RESEARCH QUESTIONS AND HYPOTHESES

1. Are pre-migration and post-migration traumatic events different between acute and anticipatory refugees, new and traditional refugees, male and female refugees, and refugees and refugee claimants?

Hypothesis One

H0 = There is no difference in pre-migration and post-migration traumatic event scores between acute and anticipatory participants.

H1 = Acute participants will have higher pre-migration and post-migration traumatic event scores than anticipatory participants.

Hypothesis Two

H0 = There is no difference in pre-migration and post-migration traumatic event scores between new and traditional participants.

H1 = New participants will have higher pre-migration and post-migration traumatic event scores than traditional participants.

75 Hypothesis Three

H0 = There is no difference in pre-migration and post-migration traumatic event scores between male and female participants.

H1 = Female participants will have higher pre-migration and post-migration traumatic event scores than male participants.

Hypothesis Four

H0 = There is no difference in pre-migration and post-migration traumatic event scores between participants with refugee status and participants with refugee claimant status.

H1 = Participants with refugee claimant status will have higher pre-migration and post-migration traumatic event scores than participants with refugee status.

2. Do refugee pre-migration and post-migration traumatic events predict refugees’ psychological distress?

Hypothesis Five

H0 = Participants’ pre-migration and post-migration traumatic events do not predict their psychological distress.

H1 = Participants’ pre-migration and post-migration traumatic events will positively predict their psychological distress.

3. Is this prediction moderated by typology of refugees, typology of refugee settlement, gender and host country status?

Hypothesis Six

H0 = Participants’ psychological distress predicted by their pre-migration and post-migration traumatic events is not moderated by typology of refugee.

H1 = Participants’ psychological distress predicted by their pre-migration and post-migration traumatic events is moderated by typology of refugee.

76 Hypothesis Seven

H0 = Participants’ psychological distress predicted by their pre-migration and post-migration traumatic events is not moderated by typology of refugee settlement.

H1 = Participants’ psychological distress predicted by their pre-migration and post-migration traumatic events is moderated by typology of refugee settlement.

Hypothesis Eight

H0 = Participants’ psychological distress predicted by their pre-migration and post-migration traumatic events is not moderated by gender.

H1 = Participants’ psychological distress predicted by their pre-migration and post-migration traumatic events is moderated by gender.

Hypothesis Nine

H0 = Participants’ psychological distress predicted by their pre-migration and post-migration traumatic events is not moderated by host country status.

H1 = Participants’ psychological distress predicted by their pre-migration and post-migration traumatic events is moderated by host country status.

STUDY DEFINITIONS

• Refugees: Refugees are people who have sought and received refugee status in a host country because of war and violence in their home country or out of fear of persecution on account of race, religion, nationality, political opinion, or membership in a particular social group (Crosby, 2006).

• Refugee Claimants: Refugee claimants are those with temporary protective status that allows them short term legal entry and residences in a host country while their petitions for permanent asylum is being considered (Crepeau, Foxen, Houle & Rousseau, 2000).

• Pre-Migration Traumatic Events: Pre-migration traumatic events are life events that occur during refugees’ pre-migration period in their country of origin (Delgado, Jones & Rohani, 2005; Casanova, 1996; Hyman, Vu & Beiser, 2000).

77 • Post-Migration Traumatic Events: Post-migration traumatic events are life events that occur during refugees’ flight from country of origin and in refugee interment camps, and during resettlement (Delgado, Jones & Rohani, 2005; Casanova, 1996; Hyman, Vu & Beiser, 2000).

• Psychological Distress: Psychological distress is a lack of psychological wellbeing affecting a person’s thoughts, feelings, behaviour and functioning (Leekassa, Bizuneh & Alem, 2002).

• Acute Refugees: Acute refugees are those who leave their home country within a few days or hours of disaster striking them, most often with no resources or support (Kunz, 1973).

• Anticipatory Refugees: Anticipatory refugees are those who leave their home country prior to the disaster, most often with their families and personal resources intact (Kunz, 1973).

• New Refugees: New refugees are those who are culturally, racially and ethnically vastly different from their hosts, come from less-developed countries, and are likely to lack kin or potential support groups in their country of resettlement (Paludan, 1974).

• Traditional Refugees: Traditional refugees are those who are culturally, racially and ethnically similar to their hosts, and are likely to be welcomed and assisted by family and friends who speak their language and can cushion their adjustment (Paludan, 1974).

RESEARCH DESIGN

A two-group comparison, cross-sectional design was selected to determine what factors impact refugee traumatic events and psychological distress. The outcome variable (psychological distress) and predictor variables (pre-migration traumatic events and post-migration traumatic events) were both continuous variables. The moderators – typology of refugee, typology of refugee settlement, host country status and gender – were categorical variables. Participants were Tamil refugees from Sri

Lanka currently living in Toronto, Canada or Chennai, India.

The demographics sheet, three questionnaires (the Harvard Trauma Questionnaire, the Post-

Migration Living Difficulties Questionnaire and the Symptoms Check List - 90R), debriefing schedule, flyer, participant information sheet and consent form were translated into Tamil using established

78 translation and back-translation procedures (Bontempo, 1993). The translation was performed by a certified Tamil interpreter and back-translated by a Tamil-speaking mental health professional. This procedure was followed to address concerns over the additional stress potentially caused by language difficulties common among refugees living in a “new” host country (Wenzel, 2002), and concerns expressed by those who criticize the limited attention paid by researchers to non-war related traumatic experiences of refugees (Hollifield, et al., 2002).

Various methods of evaluation were integrated within the research design to address reliability, validity and trustworthiness. Reliability and validity are supported by the selection of instruments that have been tested among refugees with greater significance. The Harvard Trauma Questionnaire (Tamil version) has seven structured open-ended questions on which a simple content analysis was conducted to triangulate the data. Interpretations from the written responses to these questions helped to triangulate the quantitative data. The researcher speaks Tamil, which helped in the data collection process.

SAMPLING

The study used convenience sampling to recruit 50 Sri Lankan Tamil refugee participants from

Toronto, Canada and 50 Sri Lankan Tamil refugee participants from Chennai, India who have lived in their respective host countries for at least 12 months, were 18 years of age or older, and have the capacity to consent. Exclusion criteria include the requirement that participants should not be from the same family, and aimed for proportional stratification by gender. The sample size of 100 (50 in each group) accommodated the possibility of attrition by ensuring a minimum subgroup size of 25 to assure normal distributions. Sampling continued until target numbers were reached.

Of the 50 participants selected from Toronto, Canada, half came from community sampling and the other half from an organizational sampling of the Tamil Elam Society of Canada and Canadian

Mental Health Association - Scarborough Division. To obtain the community sample, the researcher

79 connected with several immigration lawyers and obtained their support in securing participants. The

Tamil Elam Society of Canada was registered in 1978 as a non-profit organization under Ontario’s corporation act. It helps Tamil immigrants and refugees with settlement and adaptation in Canada. The

Canadian Mental Health Association - Scarborough Division offers rehabilitation action programs to provide support and resources that consumers need to achieve their goals, and stabilize and improve the quality of their life. The Toronto-based community sample consisted of mostly refugee claimants, while the organizational sample consisted mostly of refugees.

Of the 50 participants selected from Chennai, India, 25 were from the Maviran Refugee Camp

(started 2 years ago), Gokulam Refugee Camp (started 12 years ago) and Old Refugee Camp (started

18 years ago) all of which are located in Gummidi Pundi, approximately 2 ½ hours by train from

Chennai, India. There are 1500 families (4000 individuals) living in these camps. The remaining 25 participants selected from an organizational sampling of the Organization for Elam Refugee

Rehabilitation (OFERR). OFERR was founded in 1984 with the main objective of assisting and providing relief to Tamil refugees from Sri Lanka who had taken refugee in India. OFERR is a non- profit organization working for capacity building and empowerment, the key elements in its visions to ensure sustainable development with equal rights and justice for all Sri Lankan refugees.

DATA COLLECTION/INSTRUMENTATION

The data collection instruments were combined into one document (see Appendix A) which included a demographic section and three psychometrically-tested questionnaires: 1) the Harvard

Trauma Questionnaire; 2) the Post-Migration Living Difficulties Questionnaire; and 3) the Symptoms

Check List - 90R. Also included in this document is a debriefing section. In recognition of the significant traumatic events experienced by Sri Lankan Tamil refugees and the importance of employing culturally appropriate assessment to obtain in-depth information on their struggles during

80 their pre- and post-migration periods, the researcher used versions of these research tools which have been translated into the Tamil language.

Demographics

Respondents were requested to provide information about their age, gender, marital status, children, education level, host country and host country status. This section also included questions regarding when they left Sri Lanka, when they reached their host country, and the region of the country they lived in Sri Lanka. This section helped to better analyze respondents’ answers to the questionnaires.

Harvard Trauma Questionnaire - Tamil (HTQ-T)

The Harvard Trauma Questionnaire (HTQ) is probably the most commonly used tool for assessing refugee pre- and post-migration traumatic events (Weaver, 2005). The scale was developed from clinical samples. HTQ is a self-report questionnaire with three parts. HTQ administered in the

South Asian population (Mollica, 1992) and the Tibetan population (Lhewa, Banu, Rosenfeld and

Keller, 2007) with greater significance. Weaver (2006) developed a Tamil version (HTQ-T), with input from the Tamil community and also from health care professionals who work with the Tamil community, to ensure criterion validity and to specifically tailor the questions to address the common experiences of Tamil refugees (2007). This study is the first investigation to use the HTQ-T. Part 1 of

HTQ-T (“Things That Happened”) contains a list of 17 traumatic events using Likert scaling

(1=experienced, 2=witnessed, 3=no) to assess respondent’s traumatic events. Part II (“Personal

Description”) asks respondents 7 structured questions to ensure in-depth information on participant experiences with policy and settlement issues) and 10 dichotomous (yes/no) questions related to the traumatic events that happened after fleeing Sri Lanka. Content analysis will be used to triangulate this data, which will identify themes regarding torture, discrimination by the Sri Lankan government and military officials, danger faced in Sri Lanka, and the efficacy of host country refugee policies and

81 settlement programs. Part III (“Thoughts and Feelings”) has 24 questions using Likert scaling (1=not at all, 2=a little, 3=all the time) to assess the thoughts and feelings related to refugee experiences.

Post -Migration Living Difficulties Questionnaire - Tamil (PMLDQ-T)

The Post-Migration Living Difficulties Questionnaire - Tamil Version (PMLDQ-T) is a 24- item listing of post-migration living difficulties using 5-point Likert scaling (1=no problem at all, 2=a bit of a problem, 3=moderately serious problem, 4=a serious problem, 5=a very serious problem) to measure refugee settlement difficulties (Steel & Silove, 1998). This instrument is specifically intended to be used during the post-migration period as a life events questionnaire, and each item is treated as a separate incident or stressor, with a count of those indicated by the respondent as being a serious or very serious problem used as an overall index of post-migration stress. The tool has been demonstrated to be reliable with clinical samples. Steel and Silove (1998) used this scale with Tamil refugees in

Australia. They received input from the Tamil community and also from health care professionals working with this community to determine criterion validity.

Symptoms Check List - 90R (SCL-90R)

The Symptom Checklist - 90R (SCL-90R) instrument is useful as an objective method for psychological symptom assessment (Kieger & Murphy, 1987). The SCL-90R contains 90 items and can be completed in 15 minutes. It is designed to provide an overview of a patient's symptoms and their intensity at a specific point in time. By providing an index of symptom severity, the assessment helps to facilitate treatment decisions and to identify patients before problems become acute. SCL uses a 5-point Likert scale, ranging from “not at all distressing” (0) to “extremely distressing” (4). The

SCL-90R can be used for clinical as well as research applications. It has been used in different cultural communities; however, the validity and usefulness of the SCL-90R with the Sri Lankan population has not been established. This study will be the first one to investigate reliability of SCL-90R in the Sri

Lankan Tamil community.

82 Debriefing

A short debriefing procedure used to assess client’s mental status and determine whether respondents need any referral resources (Appendix F). A referral resource list maintained in case a request was made by a respondent. The privacy measures established for the collected information also enclosed and handed over the honorariums during the debriefing session.

PROCEDURES

Ethics Approval

Ethics approval received from the Ethics Office of the University of Toronto (Appendix G).

There is no standard ethics body for research in India. Administrative approval received from Dr.

Shiva Nambi, a professor at the Institute of Mental Health in Chennai, India, and also a past president of the Indian Psychiatric Society, to conduct this study (Appendix H).

Recruitment

A flyer (see Appendix B), which was translated into Tamil, prepared and posted with permission in various social service agencies and immigration law offices. A participant information letter (Appendix C) was prepared and translated into Tamil and distributed to social service agencies and immigration law offices to give to their clients. Interested individuals contacted the researcher using local phone numbers in Toronto (905-737-6963) and Chennai (044-5378145). The researcher explained the study to, and screened, potential participants using a telephone interview guide

(Appendix D), with phone calls conducted in Tamil or English based on their preferences. The researcher then contacted selected participants to agree on a date and time to sign the Tamil-translated consent form (Appendix E) and attend the face-to-face interview. Interviews with Toronto participants were conducted at offices at the University of Toronto’s Faculty of Social Work, the Tamil Elam

Society of Canada and the Canadian Mental Health Association - Scarborough Division, and with

Chennai participants at the Organization for Elam Refugees Rehabilitation as well as in several refugee

83 camps. All locations had telephone access. Although there are emergency procedures established for people in crisis, none occurred during the study.

Emergency Procedures

For any emergency in Chennai, the researcher was required to contact Dr. Shiva Nambi at the

Institute of Mental Health for immediate assistance, and to take the participant to the hospital emergency department if there is any need. For emergencies in Toronto, the researcher was required to contact 911 for immediate assistance, and to take the participant to the emergency department at the

Centre for Addiction and Mental Health if there is any need. Fortunately, the researcher did not have to follow any of these emergency procedures during the data collection period.

Participant Withdrawal

Participation in this research was completely voluntary. This is outlined in the information sheet (Appendix C) and consent form (Appendix E). Participants could withdraw from the study at any time, and be assured that their services would not be affected. Even though they signed the consent form, they were free to withdraw from the study at any time without any negative consequences. Any identified information collected from them would be destroyed immediately.

Confidentiality

Any information provided by participants as part of this doctoral study remains confidential, and can be viewed only by the principal investigator and her doctoral dissertation committee. The completed questionnaires are kept in a locked cabinet at the University of Toronto’s Faculty of Social

Work. The data was encrypted, and any information that identified the participants destroyed after it was entered into a database for statistical analysis. All the data collected in India was encrypted before being brought to Canada. Only the results of the analysis of the encrypted data will be disseminated.

Encrypted data will be stored for 6 years following the completion of this study. Confidentiality was

84 maintained except in the following potential situations: 1) Intention of harm to self; 2) Intention of harm to others; 3) Information regarding child abuse. There is an obligation by law to report any of these circumstances and intervene, but fortunately no such situations were encountered.

Compensation

In recognition of their contribution, participants from Toronto were given a $20.00 honorarium.

Participants from Chennai received 200 rupees, which is the customary amount for such research honorariums in India. If at any point participants chose not to continue with the study, they could withdraw at any time and would still receive the honorarium (any data already collected would be destroyed). None of the participants in either Toronto or Chennai actually withdrew before the end of the study.

POSSIBLE RISKS AND BENEFITS

Risks

This study might have been upsetting for some participants because it required them to recall and reflect on difficult experiences. There was also a chance that participating in this study might create stigmatization within the Sri Lankan Tamil refugee community. Measures being taken to minimize these risks. The face-to-face interviews were conducted in a supportive environment, by providing participants with assurance that they would receive follow-up counselling if they became emotionally upset. They could also stop the interview and withdraw from the study if they wished to do so at any time. Interviews with Toronto participants were conducted at the researcher’s office at the

University of Toronto’s Faculty of Social Work, and with Chennai participants at the offices of the

Organization for Eelam Refugees Rehabilitation. Both of these neutral locations had telephone access.

There were emergency procedures in place as described in a previous section. If participants felt extremely disturbed, they could discuss their concerns with the researcher, and additional third party

85 counselling would be arranged as needed. Fortunately, none of the participants required follow-up counselling or withdrew from the study prematurely.

Benefits

There were no explicit benefits for the participants; however, participants got the opportunity to share their experiences, with the knowledge that they were helping others in the same situation. The information collected has added to the current understanding and knowledge of refugee migration events and psychological distress, and will ultimately enable service providers to respond more effectively to refugee needs.

DATA MANAGEMENT

Participants were assigned identification numbers and all identifying information was removed and stored separately, so that all relevant data was handled and entered into the database without knowledge of participant identity. The data was managed as follows:

ƒ Identification numbers were used to construct a quantitative database using SPSS software.

ƒ All of the quantitative data entered into the SPSS database.

ƒ Qualitative data from the demographics section and open-ended questions in the HTQ were

transcribed into Microsoft Word text files. Answers to open-ended questions were analyzed

using content analysis, the results of which were used to triangulate the quantitative data.

DATA ANALYSIS

The raw quantitative data was analyzed using the Statistical Package for the Social Sciences

(SPSS) Version 16 software for Windows. Reliability analysis was used to demonstrate the reliability of the instruments. Descriptive statistical analysis performed on all demographic variables. Qualitative data was collected in written form from open-ended questions in the Harvard Trauma Questionnaire.

The questions dealt with the refugees’ pre-migration experiences and post-migration experiences

86 (including settlement issues). Examples of the questions include: 1) Please tell us the most hurtful or frightening events you experienced in Sri Lanka; 2) Describe any bad things that happened to you after you left Sri Lanka and before coming to this country; 3) How do you evaluate the success of your settlement in the host country? Most of the participants wrote on the questionnaire, and a few asked the writer to document their answers. Thirty five participants answered the open-ended questions. Of these 35 participants, 28 were from India and 7 were from Canada, and 22 were males while 13 were females. Information gathered from these data were sorted and trustworthiness was verified by an independent coder enlisted from the thesis committee. Major themes that affected their psychological distress were identified by checking how many times these themes were repeated in the data.

Table 3: Summary of Research Questions and Quantitative Methodology

Research Questions Method

1. Are pre-migration and post-migration ƒ Multivariate Analysis of Variance (MANOVA) traumatic events different between acute and performed to identify the differences between acute anticipatory refugees, new and traditional and anticipatory refugees, new and traditional refugees, male and female refugees, and refugees, male and female refugees, and refugees and refugees and refugee claimants? refugee claimants.

ƒ 35 participants answered the 7 open-ended questions which focus on the migration experiences of refugees.

2. Do refugee pre-migration and post-migration ƒ Linear Regression used to examine the impact of traumatic events predict refugees’ migration traumatic events on refugees’ psychological distress? psychological distress.

ƒ 35 participants answered the 7 open-ended questions which focus on the migration experiences of refugees.

87 Research Questions Method

3. Is this prediction moderated by typology of ƒ Block Regression used to determine the role of refugee, typology of refugee settlement, gender typology of refugee, typology of refugee settlement, and host country status? gender and host country status in moderating the impact of traumatic events on psychological distress.

ƒ 35 participants answered the 7 open-ended questions which focus on the migration experiences of refugees.

Table 3

88 CHAPTER 6: FINDINGS

This study analyzed the impact of pre-migration and post-migration traumatic events on refugees’ psychological distress. It also examined the role of typology of refugee settlement

(new/traditional), typology of refugee (acute/anticipatory), gender (male/female) and host country status (refugee/refugee claimant) in predicting refugee psychological distress. The results of this study reflect that post-migration traumatic event scores are the highest positive predictor for psychological distress. They also show that host country status is significant in predicting psychological distress – refugee claimants in Canada have the highest scores for pre-migration and post-migration traumatic events. Contrary to my hypothesis, the results show that gender does not have a significant role in predicting pre-migration traumatic events, post-migration traumatic events and psychological distress.

The variable Typology of refugee – acute and anticipatory – was not included in the statistical analysis due to lack of participants in the anticipatory category (N=3).

The discussion of the results of the study is divided into six sections: 1) Descriptive analysis of the participants; 2) Descriptive analysis of the scale scores – Harvard Trauma Questionnaire score,

Post-Migration Living Difficulty Checklist score and Symptoms Checklist score; 3) Scale reliability analysis; 4) Correlation between scales; 5) Findings based on each hypothesis using Multivariate

Analysis of Variance, Linear Regression and Block Regression; and 6) Content analysis using qualitative data from the Harvard Trauma Questionnaire – Tamil version.

DESCRIPTIVE ANALYSIS OF PARTICIPANTS

One hundred (N=100) Sri Lankan Tamil refugees participated in this study. Fifty participants

(n=50) were from Toronto, Canada and fifty participants (n=50) were from Chennai, India. Participants were selected from both Toronto and Chennai to meet the criteria with respect to the variable typology of refugee settlement. Toronto, Canada would be considered a new settlement and Chennai, India a traditional settlement for Sri Lankan Tamil refugees. Toronto participants were recruited from the

Tamil Elam Society, the Canadian Mental Health Association – Scarborough Division, and two

89 Toronto immigration law offices. Chennai Participants were recruited from the Organization for Elam

Refugees Rehabilitation and the Maviran, Old, and Gokulam refugee camps at Kumudipoondi village in Chennai.

Table 4 provides descriptions on participant age, gender, education, employment, family, etc.

Table 5 provides the chi square and t-test scores and their significance for continuous and categorical variables. Most of the participants from India have refugee status (80%) and live with family (80%).

Most of the participants, whether they have refugee or refugee claimant status, are working (61%) –to make a life for themselves and their family. A television report by the Canadian Broadcasting

Corporation on March 18 , 2008 substantiates this result by stating that the majority of refugee claimants work underground until their refugee status is approved, which can take years (2008). It should be noted that most of the participants are acute in terms of refugee typology, having left Sri

Lanka between 1982 and 2001 (97%). The civil war in Sri Lanka escalated after 1981, which greatly intensified the difficult socio-political and economic circumstances there (Tambiah, 1991). Sixty two percent (62%) of the participants were living in either India or Canada for between five to ten years.

Descriptive Analysis of Toronto, Canada Participants

Among the Toronto participants, twenty-nine were males and twenty-one were females, with a mean age of forty years. Most of the participants landed in Toronto between 1997 and 2007 (88%).

Only two of the participants came before 1981, and they were both anticipatory refugees. The rest of the forty-eight participants were acute refugees (96%). None of the participants had post-secondary education, and twenty-two had secondary education (44%). Thirty-four participants were Hindus and sixteen participants were Christians. Twenty-eight of the participants had refugee status (56%), and twenty-two had refugee claimant status (44%), meaning they were not legally allowed to work.

However, thirty-seven of the participants were working (74%), so that several of them were undocumented workers. Twenty participants were married (40%), and thirty-three of the fifty participants were without children (66%). Fifty percent (50%) of the participants had lived in Toronto

90 for between five to ten years. Twenty-five participants were living with family (50%). Twenty-seven participants had come from urban Sri Lankan communities (54%).

Descriptive Analysis of Chennai, India Participants

Among the Chennai participants, thirty-one were males and nineteen were females, with a mean age of thirty years. Most of the participants left Sri Lanka between 1982 and 2001 (66%). Only one of the participants came before 1981, and that participant was an anticipatory refugee. The rest of the forty-nine participants were acute refugees (98%). Three of the participants had post-secondary education (6%) and thirty-one had secondary education (62%). Thirty-four participants were Hindus and sixteen were Christians. Forty of the participants have refugee status (80%) and ten of them had refugee claimant status (20%), so they could not work legally. However, twenty-six of the fifty participants were working (52%), mostly in the brick-making factories in and around Chennai. Thirty participants were not married (60%), and nineteen had children (38%). Forty participants were living with family (80%). Twenty-six participants had come from rural Sri Lankan communities (52%). 34% of the participants had lived in Chennai for more than ten years. The descriptive data for both Toronto and Chennai participants are captured in Table 4 below.

Table 4: Study Participant Characteristics Variables Total Participants Toronto Participants Chennai Participants (N=100) (n=50) (n=50) Age 18-28 34 11 23 29-38 33 19 14 39-48 24 15 9 49-58 4 2 2 59-68 5 3 2 Over 68 0 0 0 t (df) = 29.51 (99) , p = .000 Gender Male 60 29 31 Female 40 21 19 χ2 (df) = 2.86 (1), p = .091 Host Country Status Refugee 68 28 40 Refugee Claimant 32 22 10 χ2 (df) = 17.86 (1), p= .000

91 Variables Total Participants Toronto Participants Chennai Participants (N=100) (n=50) (n=50) Marital Status Married 39 20 19 Unmarried 57 27 30 Widowed 3 2 1 Separated 1 1 0 χ2 (df) = 91.2 (3), p= .000 Children With 36 17 19 Without 64 33 31 χ2 (df) = 7.84 (1), p= .005 Number of Children 0 children 64 33 31 1-2 18 13 5 3-4 7 1 6 4 or more 11 3 8 t (df) = 6.09 (99) , p = .005 Education Primary 27 18 9 Secondary 53 22 31 College 17 10 7 University 3 0 3 χ2 (df) = 53.44 (3), p = .000 Employment Yes 61 37 24 No 39 13 26 χ2 (df) = 4.84 (1), p = .028 Living with Family Yes 65 25 40 No 35 25 10 χ2 (df) = 9.00 (1), p = .003 Sri Lankan Province Tamil majority 66 38 28 Sinhalese majority 34 12 22 χ2 (df) = 16.45 (1), p = .000 Religion Hindu 68 34 34 Buddhist 0 0 0 Christian 32 16 16 Muslim 0 0 0 Other 0 0 0 χ2 (df) = 12.96 (1), p = .000 Sri Lankan Community Urban 51 27 24 Rural 49 23 26 χ2 (df) = .040 (1), p = .841 Leaving Sri Lanka Before 1981 3 2 1 1982-1991 22 6 16 1992-2001 41 24 17 After 2002 34 18 16 t (df) = 42.85 (139) , p = .000 Typology of Refugees Acute 97 48 49 Anticipatory 3 2 1 χ2 (df) = 120.72 (1), p = .000

92 Variables Total Participants Toronto Participants Chennai Participants (N=100) (n=50) (n=50)

Living in the Host Country 20 or more 3 2 1 10 or more 21 4 17 5 or more 41 25 16 Less than 5 35 19 16 t (df) = 18.48 (99) , p = .000

Table 4

DESCRIPTIVE ANALYSIS OF SCALE SCORES

The mean score for the Harvard Trauma Questionnaire - Tamil version (HTQ-T) is 62.81; for the Post-Migration Living Difficulty Checklist (PMLDC) it is 44.51, and for the Symptoms Checklist

(SCL) it is 144.08. The Harvard Trauma Questionnaire (HTQ) was selected to measure pre-migration and post-migration traumatic events; the PMLDC was chosen to measure post-migration traumatic events. The researcher could not locate in the previous research literature any suitable questionnaire that had been used other than the HTQ which covers pre-migration traumatic events. The HTQ-T was developed after a pilot study and was not tested scientifically before this study. The PMLDC has been used previously with Sri Lankan Tamil refugees in Australia. Thus the combined use of the two scales to measure pre-and post migration trauma. The SCL was selected to measure psychological distress.

Table 6 below provides a descriptive analysis of the three instruments.

Table 5: Descriptive Analysis of HTQ, PMLDC, SCL-90R

HTQ Score PMLDC Score SCL-90R Score Valid 100 100 100 N Missing 0 0 0

Mean 62.8100 44.5100 144.0800

Median 58.0000 50.0000 132.0000

Std. Deviation 12.31710 18.36416 34.65433

Variance 151.711 337.242 1200.923

Table 5

93 SCALE RELIABILITY ANALYSIS

As part of the data analysis, the researcher decided to analyze the reliability and assess the correlation of the three scales. To perform reliability analysis on the Harvard Trauma Questionnaire, the scale was divided into three subscales based on the three sections of the questionnaire: HTQ Pre-

Migration, HTQ Post-Migration, and HTQ Feelings and Thoughts. The Cronbach’s alpha score for the

Pre-Migration HTQ section is .874; for the Post-Migration HTQ section it is .925; and for the Feelings and Thoughts section it is .977. All have alphas above .85, which indicates that the HTQ is reliable to use for this study. The Cronbach’s alpha score for the Post Migration Living Difficulty Checklist is

.971, and for the Symptoms Checklist 90-R it is .988, which means both of these instruments are also reliable for use in this study. Table 7 below summarizes the results.

Table 6: Reliability Statistics for HTQ, PMLDC & SCL 90-R

Harvard Trauma Questionnaire Post-Migration Living Symptoms Feelings & Pre-Migration Post-Migration Difficulties Checklist – 90R Thoughts Section Section Checklist Section

Chronbach’s .874 .925 .977 .971 .988 Alpha

Chronbach’s Alpha Based on .851 .923 .980 .973 .989 Standardized Items

Number of Items 21 10 24 24 80 (N) Table 6

CORRELATION BETWEEN HTQ, PMLDC AND SCL-90R

The correlation between the 3 instruments (with HTQ split into its 3 sections) is shown in Table

8. The correlation between the Post-Migration section of the HTQ (alpha = .925) and the Post

Migration Living Difficulty Checklist (alpha = .971) is .772. Based on this result, the researcher had to eliminate one of these post-migration scales. It was decided that the Post-Migration section of the HTQ 94 would be eliminated because the Post Migration Living Difficulty Checklist (PMLDC) has been scientifically tested with Sri Lankan Tamil refugees in Australia. The researcher also came to the conclusion that the Feelings and Thoughts section of the HTQ correlates negatively with all the other measures. Refugees’ resiliency in moving beyond past traumatic experiences may be the reason for this negative correlation. Although it has good reliability (alpha = .977), this scale addresses only Post-

Traumatic Stress Disorder symptoms, whereas this study looks at psychological distress. So the HTQ

Feelings and thoughts section will also be eliminated from group comparisons. Therefore, the analysis will be performed using the Pre-Migration section of the HTQ (alpha = .874), the Post-Migration

Living Difficulty Checklist (alpha = .971) and the Symptoms Check List 90-R (alpha = .988).

Table 7: Pearson Correlation Table for HTQ, PMLDC & SCL-90R Scores

HTQ HTQ HTQ Post- Feelings & Symptoms Pre-Migration Post-Migration Migration Thoughts Checklist Section Section Checklist Section

** ** ** HTQ Pearson Correlation 1.000 .345 -.412 .595 .184 Pre-Migration Sig. (2-tailed) .000 .000 .000 .066 Section N 100 100 100 100 100

** ** ** ** HTQ Pearson Correlation .345 1.000 -.366 .772 .326 Post-Migration Sig. (2-tailed) .000 .000 .000 .001 Section N 100 100 100 100 100

HTQ Pearson Correlation -.412** -.366** 1.000 -.640** -.310** Feelings & Sig. (2-tailed) .000 .000 .000 .002 Thoughts Section N 100 100 100 100 100

Pearson Correlation .595** .772** -.640** 1.000 .622** Post-Migration Sig. (2-tailed) .000 .000 .000 .000 Checklist N 100 100 100 100 100

Pearson Correlation .184 .326** -.310** .622** 1.000 Symptoms Sig. (2-tailed) .066 .001 .002 .000 Checklist N 100 100 100 100 100

95 Table 7

FINDINGS BASED ON RESEARCH QUESTIONS

Research Question One

Are pre-migration and post-migration traumatic events different between new and traditional refugees, male and female refugees, and refugees and refugee claimants?

MANOVA was used to conduct and evaluate the relationship between HTQ and PMLDC scores (dependent variables) and three fixed factors: typology of refugee settlement (new vs. traditional), host country status (refugee vs. refugee claimant) and gender (male vs. female). Fifty participants were selected using convenience sampling from both Canada and India, which represent the two possible types of refugee settlement. Among the 100 participants in the study, there were 68 refugees and 32 refugee claimants, and there were 60 males and 40 females.

Descriptive Statistics

The pre-migration mean score for newly settled Canadian participants was 33.98 and for Indian participants (traditional settlement) was 33.52. The post-migration mean score for Canadian participants was 39.52 and for Indian participants it was 49.50. The pre-migration mean score for male participants was 34.46 and for female participants it was 32.67. The post-migration mean score for male participants was 45.63 and for female participants it was 42.82. The pre-migration mean score for refugee participants was 49.35 and for refugee claimant participants it was 50.10. The post-migration mean score for refugee participants was 38.44 and for refugee claimant participants it was 57.40.

Hypothesis Testing

Table 9 describes the multivariate model used to illustrate the differences in pre-migration and post- migration traumatic event scores between variables.

96 Table 8: Multivariate Model Showing Differences in Pre-and Post-Migration Trauma Scores between Variables

Source Dependent Variable F(df1,df2) Sig.

HTQ Pre-Migration Section score .142 (1,92) .707 Host Post-Migration Checklist score 8.863 (1,92) .004

HTQ Pre-Migration Section score 24.918 (1,92) .000 Status Post-Migration Checklist score 49.583 (1,92) .000

HTQ Pre-Migration Section score 1.089 (1,92) .299 Gender Post-Migration Checklist score .745 (1,92) .390

HTQ Pre-Migration Section score 13.046 (1,92) .000 Host * Status Post-Migration Checklist score 47.783 (1,92) .000

HTQ Pre-Migration Section score .021(1,92) .884 Host * Gender Post-Migration Checklist score .321(1,92) .572

HTQ Pre-Migration Section score .000 (1,92) .992 Status * Gender Post-Migration Checklist score .023 (1,92) .879

HTQ Pre-Migration Section score .342 (1,92) .560 Host * Status * 4Gender Post-Migration Checklist score .687 (1,92) .409

Table 8

Hypothesis One: Typology of refugees – acute and anticipatory - not included in the statistical analysis due to the low number of participants in the anticipatory category (N=3).

Hypothesis Two: The results show that typology of refugee settlement has no significant effect on pre- migration trauma, but typology of refugee settlement does have significant effects on post-migration trauma (sig. < .05 and with an effect size of .838) Based on the descriptive analysis, participants from

Canada (new) and India (traditional) have similar pre-migration trauma scores of 33.98 and 33.52, respectively. However, participants from India have higher post-migration traumatic event scores

(49.50) than participants from Canada (39.52). Restricted refugee rights in India as compared to

Canada may be the main reason for this difference.

97 Hypothesis Three: Findings show that there is no difference in pre-migration and post-migration traumatic event scores between male and female participants. Gender has no significance on pre- migration trauma score (.299) and post-migration trauma score (.390). Pre-migration mean score for male participants was 34.46 and for females was 32.67. Post-migration mean score for male participants was 45.63 and for female participants was 42.82. So the results show that male and female participants have close to similar pre-migration and post-migration traumatic experiences. Male participants’ traumatic experiences include fighting with the rebel army in Sri Lanka and adapting to new culture and unemployment in their host country. Female participants’ traumatic experiences include rape and family killings in Sri Lanka, and role reversal in the new host country.

Hypothesis Four: The results confirmed that participants with refugee claimant status have higher pre- migration and post-migration traumatic event scores than participants with refugee status. Host country status has significant effect on both pre- migration (sig <. 05 and with an effect size of .999) and post- migration traumatic events (sig < .05 and with an effect size of 1.000). Pre-migration mean score for refugee participants was 49.35 and for refugee claimant participants was 50.10. Post-migration mean score for refugee participants was 38.44 and for refugee claimant participants was 57.40. Pre-migration scores between refugees and refugee claimants are not much different, but post-migration scores are higher for refugee claimants than for refugees. This shows that refugee claimants’ struggle to get refugee status and their restricted rights to lead a free life drastically increase their traumatic scores.

Profile Plots

The MANOVA model showed that interaction between host country and host country status had significant effect on developing pre-migration traumatic experiences (sig. < .05) and on post- migration difficulties (sig < .05). Profile plots in Figure 9 and 10 demonstrate the interaction between host country and host country status. Typology of refugee settlement and host country status interaction with gender provided non-significant results.

98 Figure 9: Profile Plot for Host Country Status & Typology of Refugee Settlement Interaction on Pre-Migration Traumatic Events

Figure 9

Figure 10: Profile Plot for Host Country Status & Typology of Refugee Settlement Interaction on Post- Migration Traumatic Events

Figure 10

99 These profile plots shows that refugee claimants in Canada (new settlement) have the highest number of pre- and post-migration traumatic events than refugees in either country and refugee claimants in India. There is a chance that their post-migration experiences, including living without any rights and painful review board hearings, and reliving the details of their past events increase the likelihood of having more traumatic events. The pre-migration score was not significant for Canadian refugees – pre-migration traumatic experiences are past events and Canadian refugees move on with great resiliency.

The difference in mean score between refugees (49.35) and refugee claimants (50.10) was insignificant. However, the profile plots identify a large difference in pre-migration trauma experiences between Canadian refugees and refugee claimants. Both plots go in opposite directions. It is important to note that refugees and refugee claimants in India have a similar post-migration difficulty score, which emphasizes the fact that refugee status does not afford these individuals any rights in India.

They are considered refugees regardless of their official status, which leads to a greater number of post-migration traumatic events.

Conclusion

The MANOVA testing concludes that both host country status and host country have significant effect on pre-migration and post-migration traumatic event scores. However, host country status is the highest positive predictor of having pre-and post-migration traumatic events.

Research Question Two

Do refugee pre-migration and post-migration traumatic events predict refugees’ psychological distress?

Linear Regression was performed to predict the impact of pre-migration traumatic events and post-migration traumatic events on psychological distress. The dependent variable was the SCL 90-R score, which measures psychological distress. Predictor variables were the HTQ Pre-Migration section

100 score and the Post-Migration Checklist score. The mean SCL score was 144.08; for the HTQ Pre-

Migration section it was 33.75; and for the Post-Migration Checklist, it was 44.51.

Hypothesis Testing

Hypothesis Five: The findings confirmed that participants’ pre-migration and post-migration traumatic events predict their psychological distress. The Pearson Correlation between pre-migration traumatic events and psychological distress is .184, and the Pearson Correlation between post-migration trauma and psychological distress is .622 (see Table 9). Post-Migration traumatic event is the highest positive predictor with a one tailed significance of p < .05 (see Table 10). The beta value for post-migration traumatic events is .794. The smaller the significant value and the bigger the t value for post migration difficulties (t = 8.402, p < .001) shows the greater contribution of this predictor. This regression model also shows that there is a .664 correlation between pre- and post-migration traumatic events and psychological distress. Pre- and post-migration traumatic events account for 44% of the variation in psychological distress.

Table 9: Pearson Correlation Model Examining Participants’ Pre- & Post-Migration Traumatic Events Prediction of Psychological Distress

HTQ Pre- PMLDC

Migration Score Score

Pearson Correlation SCL 90-R Score .184 (p<.005) .622 (p<.005)

Table 9

Table 10: Linear Regression Model Examining Participants’ Pre- & Post-Migration Traumatic Events Prediction of Psychological Distress

Standardized Unstandardized Coefficients Coefficients t Sig.

Constant 112.716 9.721 11.596 .000

HTQ Pre-Migration Score -1.046 .343 -.288 -3.050 .003

PMLDC Score 1.498 .178 .794 8.402 .000 r = .664; r square = .441; adjusted r square = .429; F = 38.247; Sig = .000

Table 10 101 Conclusion

The findings from the model indicate that post-migration living difficulties may have greater positive effect on refugees’ psychological distress than pre-migration traumatic events. This may be the result of participants’ current post-migration traumatic experiences providing added impact. Recall bias may be another reason to consider in explaining the higher positive effect of post-migration traumatic events than pre-migration traumatic events. Participants may consider pre-migration traumatic experiences as past history, and may have gained strength and resiliency from their hardships to move on with their lives.

Research Question Three

Is this prediction of psychological distress moderated by typology of refugee, typology of refugee settlement, gender and host country status?

Block regression was used to predict the impact of typology of refugee settlement, gender and host country status on psychological distress. The Symptoms Checklist 90-R was used to measure psychological distress. Typology of refugee settlement can be new or traditional, host country status can be refugee or refugee claimant, and gender can be male or female.

Descriptive Statistics

Descriptive statistics show that the mean score for SCL 90-R, used to measure psychological distress, is 144.08, HTQ Pre Migration Score is 62.81 and PMLDC Score is 44.51. Predictors are: typology of refugee settlement, host country status, and gender. There were 50 participants from India

(traditional) and 50 from Canada (new). 68 of the participants were refugees and 32 were refugee claimants, while 60 were male and 40 were female.

Hypothesis Testing

Table 12 details the blocked regression model used to investigate the impact of the HTQ pre- migration score and PMLDC score on psychological distress, as well as the impact of variables in predicting the psychological distress score. 102 Table 11: Block Regression Model Used for Investigating Predictors’ Impact on Psychological Distress

Model Beta t Sig.

Block 1; Constant 11.596 .000 adjusted HTQ Pre-Migration -.288 -3.050 .003 R square Score = .429 PMLDC Score .794 8.402 .000

Constant 5.503 .000 Block 2; adjusted Host Country Status .291 2.901 .005 R square Refugee Settlement .172 1.712 .090 = .067 Gender -.078 -.802 .424

Table 11

Hypothesis Six: Typology of refugee – acute and anticipatory – was not included in the statistical analysis due to the lack of participants in the anticipatory category.

Hypothesis Seven: The results from the block regression supported that typology of refugee settlement is a positive predictor for psychological distress than the gender. The Beta value of .172 with a minimal significance of .090 points to the impact of typology of refugee settlement on psychological distress. Based on the hypothesis two results, participants in India and Canada have similar pre migration events score, however, participants from India have more post migration event score.

Hypothesis Eight: The findings show that gender has a negative effect on psychological distress. The

Beta value for the impact of gender on psychological distress is -.078. This means that participants have psychological distress regardless of the gender they belong to.

Hypothesis Nine: The results supported that participant’s psychological distress predicted by their pre- migration and post-migration traumatic events is moderated by host country status. The Beta value of

.291 with a significance level of p = .05 indicates the impact of host country status on psychological

103 distress. The R Square value shows that host country status accounts for .061 variation in psychological distress. However, when the other two predictors – refugee settlement and gender – are included in the model, this value increases to .089 and .096 of variance in psychological distress. The

Adjusted R Square value for host country status shows only .06% of shrinkage, which means that if the model were derived from the population rather than a sample, it would account for approximately

.06% less variance in the outcome. This means that the cross validity of this model is good.

Conclusion

In conclusion, post-migration score is more significant in predicting psychological distress than pre-migration score. Also, both host country status and typology of refugee settlement positively predict psychological distress.

THEMES FROM QUALITATIVE ANALYSIS

As part of the study, analysis of the qualitative data on the seven open ended questions

(Harvard Trauma Questionnaire) revealed major themes as follows: 1) Civil War and Genocide; 2)

Settlement/Kudiyettam; and 3) U.N. Ineffectiveness 4) Hardship of Refugee Review Process.

Dependability of this content analysis was ensured through independent coding by a member of the doctoral committee who confirmed major themes derived from the participants’ responses.

Civil War and Genocide

The Sri Lankan civil war is the major theme that emerged through content analysis. Participant responses on why the civil war caused them to leave Sri Lanka included:

ƒ “Military attacks, explosions.” ƒ “Jail life.” ƒ “Mass killings.” ƒ “No support from law.” ƒ “Separated from family.” ƒ “We can’t explain how bad it is; we don’t want to think about it. Now we want to live.”

104 The origins of the Sri Lankan civil war lie in sharp disagreements over religion, language, and education between Sinhalese and Tamils. During the colonial period, Tamils had benefited from favouritism by the British, and many agree that this "divide and rule" policy planted the seeds of the conflict. After achieving independence in 1948, the minority Tamils no longer had support from the

British. Since 1983, there have been four Elam wars. Ethnic cleansing, bombings and mass killings have taken place in Sri Lanka. All but two of the participants in this study moved to either Canada or

India after 1983. These Sri Lankan Tamils were facing terrible distress due to the civil war and genocide in Sri Lanka.

Ninety-seven of the study participants either witnessed or experienced traumatic events prior to their departure from Sri Lanka as acute refugees. However, the results from this study show that post- migration traumatic events have more significant impact on psychological distress than pre-migration traumatic events. Refugee mental health may be explained within the context of refugee resiliency.

Most refugees may have experienced traumatic events, but perhaps they developed great resilience and survival skills, and these attributes are being observed in the results of this study.

Settlement/Kudiyettam

This theme emerged from answers to the questions: 1) “Please tell us what you understand settlement to mean.” and 2) “How do you evaluate the success of the settlement in your host country?”

Most of the Sri Lankan Tamil refugees in India rejected the use of the term “settlement”

(“Kudiyettam” in Tamil). Participant responses included:

ƒ “What does it mean?” ƒ “They didn’t let us settle here.” ƒ “We are in between.” ƒ “This is not settling.”

Sri Lankan Tamil refugees in India live in refugee camps without any rights as Indian residents.

These refugees, as well as their future generations, will be considered refugees. They are not entitled to

105 get resident or citizenship status, regardless of their length of stay in India or country of birth. This theme parallels results from the Post Migration Living Difficulty Checklist (PMLDC). There was no difference in Post-Migration Checklist scores between refugees and refugee claimants in India; both groups have similar post-migration traumatic events because neither has social or political rights in

India. The only difference between refugee status and refugee claimant status in India is that those individuals with refugee status get a 10’ x 10’ tent to live in and 400 rupees a month.

Based on their continuing refugee status, Sri Lankan Tamil refugees in India refused to call their stay there as settlement/ kudiyettam. Sri Lankan Tamil’s refugees in India are not able to settle in

India legally. They can be in limbo for generations. They live in refugee camps; if they move out of these camps, they won’t receive the 400 rupee allowance. It is illegal for them to work. So they end up working illegally in one of the many construction sites nearby, receiving very little money as daily wages/ “kooli”.

The Indian government is clear in their decision to withold giving resident status to Sri Lankan

Tamil refugees. They expect Sri Lankan refugees to return to their homeland when the war is over. So, from the refugees’ perspective the word “settlement” or “kudiyettam” does not truly describe their current status. This theme substantiates the result from the quantitative analysis that typology of refugee settlement has a significant effect on refugee’s lives. Lives of refugees in India are markedly different compared to Canadian refugees. It is important to understand the impact of typology of refugee settlement on refugee’s lives and provide interventions based on their unique needs.

U.N. as Ineffective?

“Is there nobody in our political leadership with a vision for the future of our country, where people of all faiths, of all ethnic groups and of all social classes can live with equal rights, with equal opportunities and with equal dignity? And is there nobody with the courage to say so?” (Shamie, 1996)

106 A third theme emerged from responses to the question about the role of the United Nations in

Sri Lanka. Participants believed that the U.N. has become ineffective and call for major reforms of the

United Nations seem to have reached an apex. Participant responses included:

ƒ “I don’t know anything about the United Nations.” ƒ “Are they there?” ƒ “I didn’t see any United Nations people there.”

In creating the United Nations in 1945, the United States, along with the other World War II victors, consciously sought to make the institution an instrument of their collective desire to maintain both peace and control in the post-war world. In the post-Cold War period, regional and economic factions have emerged. One major split is between "developed" and "developing nations." These two sides often disagree on trade and environmental issues. The ongoing factional disagreements and internal political maneuvering have hampered the U.N.'s ability to reach consensus and to implement change.

This criticism reached a peak in the 1990s after U.N. peacekeeping troops were not nable to prevent the slaughter of civilians in Rwanda, Bosnia and Iraq. The United Nations now has little effective enforcement capability without action by individual member nations or coalitions. It often uses troops provided by members of the Security Council. In effect, the U.N. is forced to follow the ideologies of these nations. Considering these facts, U.N. involvement in Sri Lanka was not a major concern for members of the U.N. Security Council, which often supports the Indian government because it is the leader in South Asian economics and politics. This means that the Sri Lankan government and Sri Lankan Tamil refugees are receiving little help from the United Nations. Most of the U.N.’s assistance comes down to providing food and water to refugees from the Sri Lankan shores.

The Indian government does not allow the United Nations to visit Sri Lankan Tamil refugee camps.

Refugee Board policies

Another theme related to the United Nations is the influence of colonial powers on host country refugee migration policies to control the movement of refugees, including the Sri Lankan Tamils. This 107 result substantiates the study findings of Crepeau, Foxen, Houle & Rousseau (2000) regarding the lack of tolerance in many of the refugee board policies in Canada. Participants’ responses included:

ƒ “Canadians think we are lying.” ƒ “Review board treats us like we are criminals; we didn’t do anything wrong.” ƒ “Each policy is giving us a lot of mental stress.” ƒ “We don’t know what our life is going to be.” ƒ “We cannot live in our own country that’s why we are here; we are not intruders”

Many refugees experience additional trauma from policies which involve third party agreement; Canada will not grant refugee status to persons who have been denied acceptance by a country with whom Canada has a partnership. Trauma is also heightened by the burden of proof policy whereby during the process of determining eligibility, the onus is on the claimant to provide a medical certificate to prove their claims of having been physically, mentally or sexually abused. Refugee claimants in Canada have the highest scores for pre-migration and post-migration traumatic events.

These traumatic events often stem from not having legal rights to stay in the host country, as well as adjusting to a new country with a new culture.

SUMMARY

The results of this study concludes that the typology of refugees, both acute and anticipatory, typology of refugee settlement, new and traditional, host country as well as refugee and refugee claimant status, all significantly impact refugees’ psychological distress. It is striking to note that only three participants were from the anticipatory category; they foresaw events and fled Sri Lanka prior to the civil war. Ninety-seven of the hundred participants were acute refugees who witnessed or experienced trauma in Sri Lanka as a result of the aftermath of many historical, social and political events, including colonization and the ongoing war between the Tamils and the Sinhalese. This has huge clinical implications for practitioners who need to be aware that most of the refugees they provide service to have witnessed or experienced trauma prior to their migration. However, the results of the

108 study also showed that post-migration traumatic experiences have higher significance for refugees to develop psychological distress than pre-migration trauma. This suggests that refugees gain resiliency from their pre-migration traumatic experiences and move forward with their post-migration activities by focusing on how to survive in their new host countries. An equally significant relationship was identified between gender and pre- and post-migration trauma; the unique oppressive experiences of both men and women during their migration period is an important consideration for practitioners. The positive correlation between psychological distress and refugee status highlights the importance of reviving eurocentric migration and refugee board policies. Host country status in India is of little value in the absence of support for refugees or refugee claimants and whose policies or programs do not recognize their existence; the establishment of long-term support programs for Sri Lankan Tamil refugees in India is essential. Refugee claimants in Canada also showed higher psychological distress among the total participants on account of the rigourous interrogation by the refugee board. In summary, the study results reflect the effects of continued use of eurocentric influenced policies, which emphasize restraint and power over refugees’ lives, and which consequently and detrimentally affect their mental health.

109 CHAPTER 7: DISCUSSION AND CONCLUSION

The impetus for this research was the desire to learn directly from refugees about the factors associated with their psychological distress. This study used several theoretical perspectives to more fully develop a framework for understanding refugees’ migration traumatic events and psychological distress. Public perceptions about refugees continue to be laden with a sense of tragedy and the belief that their life is inherently difficult and painful. Drawing on a theoretical framework based on post- colonial and refugee theories, this study began by questioning whether the difficulties faced by refugees originate to a greater extent from their historical, social and political situations, in particular the control of powerful nations/policies on refugees’ psychological distress. The role of culture was not analyzed in this study. From a personal and theoretical perspective, there is limited analysis on the relation of power and control on an individual’s mental distress, but many more on the importance of understanding cultural identity on mental distress, such as Kroll (2003), Mollica (1998), Kiramayor

(2000) and Klienman (1997). This study explores the influence of social, political and historical factors to psychological distress and provides a unique contribution in an area where there is a dearth of research. Furthermore, a feminist analysis of these traumatic experiences suggests that gender plays an important role in shaping both male and female refugees’ experiences, while the Trauma theory gives full recognition to the impact of trauma on human functioning.

Combining these theoretical perspectives with a review of the research literature, four key variables were chosen for investigation in this study: 1) Typology of refugee – acute and anticipatory;

2) Typology of refugee settlement - new and traditional; 3) Gender – male and female; and 4) Host country status – refugee and refugee claimant. The study involved a total of 100 participants. Fifty were from Toronto, Canada (new refugee settlement) and fifty were from Chennai, India (traditional refugee settlement). This study answered the following questions: 1) Are pre-migration and post- migration traumatic events different based on typology of refugee, typology of refugee settlement, gender, and host country status?; 2) Do refugee pre-migration and post-migration traumatic events

110 predict refugees’ psychological distress?; and 3) Is this prediction moderated by typology of refugee, typology of refugee settlement, gender and host country status?

This chapter begins with a summary of the findings from quantitative and content analysis. The summary also outlines the implications of these findings for practice and policy. This is followed by a discussion of the major themes that emerged from the findings and while referencing the research literature. Next, the implications of the findings for social work practice, policy, and research in a global context are covered. The chapter ends with a discussion on the limitations of the study.

SUMMARY OF THE FINDINGS

The findings from the data analysis employed in this study provided a complementary role in extending our understanding of refugee mental health. Table 13 summarizes these findings. The findings categorized into five broad issues: 1) Refugee status, 2) Pre-migration traumatic events and refugee resiliency, 3) Acute refugees, 4) Gender analysis, 5) Reformation of the U.N. Eeach of these themes discussed in the next section.

Table 13: Integration of Findings from Data Analysis and Practice/Policy Implications

Implication for Implications for Quantitative Analysis Content Analysis Practice Policy Pre- and post-migration Civil War; ineffective Integration of assessing Reformation of United traumatic events both U.N. and host country pre- and post-migration Nations and host country need attention; However, policies traumatic experiences for refugee policies post- migration traumatic intervention; integration events may have more of policy into practice effects on refugee’s psychological distress

Positive prediction Refugees are in a limbo Identity issues during Reformation of host between typology of state for generations in their settlement; role of country refugee refugee settlement (new India resiliency in the settlement policies and traditional) and migration experience psychological distress

111 Implication for Implications for Quantitative Analysis Content Analysis Practice Policy Positive prediction Restricted refugee rights Recognize refugees’ Reformation of refugee between host country as refugee claimant struggle based on their review board policies status (refugee and status refugee claimant) and psychological distress

Gender did not show any Eight out of thirteen Clinical practice should Gender-based policies significance for having females responded to the reflect the thought that and clinical practices pre-migration and post- open ended questions men and women have migration traumatic being victims of sexual their own unique events and psychological assault; men being in the experiences as refugees distress army starting from their childhood Typology of refugee Most of the participants Incorporate the Policy change to (acute (n=97) and witnessed or experienced knowledge that most acknowledge review anticipatory (n=3)) is not violence, mass killings refugees either witnessed board members and included in the statistical and bomb explosions or experienced trauma health care workers that model because of the before coming to host refugees may be exposed lack of participants in the country; refugee to violence before their anticipatory group resiliency arrival, that intervention should be planned accordingly. Table 13

THEMES EMERGING FROM THE FINDINGS

Refugee Status

Refugee policies in both Canada and India require discourse. Post-migration traumatic events were significantly related to psychological distress among Sri Lankan Tamil refugees. Within the

Indian refugee context, host country status as refugees or refugee claimants did not affect their mental health. Indian refugee camps are like warehouses, where neither refugees nor refugee claimants have any social or political rights (Flynn, 2005). These camps are an exceptional example of human beings who are treated as objects for control. The rationale for the Indian government to refuse any rights is its expectation that Sri Lankan Tamil refugees will return to Sri Lanka once the war is ended. The assassination of Prime Minister Rajiv Gandhi in May, 1991 by a suicide bomber belonging to the

Liberation Tigers of Tamil Eelam (LTTE), further turned public sentiment against the Tamil refugees.

Shortly thereafter, India began a program of "voluntary" repatriation and more than 23,000 refugees

112 were repatriated without international supervision. It is now apparent that most of those refugees were coerced in various overt and covert ways to leave the refugee camps in India (Xavier, 2008). Most of the study participants from India reported that their lives were in limbo and were unsure of what would become of their lives due to Indian refugee policies. A study by the South Asia Forum for Human

Rights (SAFHR) in 1997 details the systematic violations of Tamil refugee rights and the implicit involvement of the Government of India. It reports that “the Indian Government appears determined to allow oppressive conditions to deteriorate to the point where refugees would rather return to the violence of Sri Lanka than stay in the camps”. The Indian government’s consistent attitude of it’s

‘their’ problem, not ‘ours’ created an atmosphere of lack recognition of human rights violation.

In the context of Canadian refugee policies, the results of this study substantiate the research conducted by Crepeau, Foxen, Houle and Rousseau (2000) which analyzed legal, cultural and psychological factors involved in the decision-making process for several IRB cases in Canada. The study found that Canadian refugee claimants have higher psychological distress levels and this may be attributed to the interrogations of the refugee review board. Often refugee review board members’ lack of knowledge of international refugee law, ambivalence toward traumatization, ignorance regarding trauma and lack of understanding of refugees’ historical, social, cultural and political backgrounds adversely affect the decision making process (Crepeau, Foxen, Houle & Rousseau, 2000). These factors clearly affect Sri Lankan Tamil refugees during their post-migration period, leading to increased psychological distress. The results of the current study will promote the need for improved efficacy of Canada Immigration and Refugee Board policies and the social welfare system to better service refugee claimant needs. An analysis of refugee policies in relation to refugee status is much needed.

The study results are prime examples of how policies influence an individual’s psychological health. Policies should work to protect individuals, and developed and implemented in a way that helps

113 the people it aims to assist. Policies that do not meet these goals create psychological distress and need to be re-evaluated and re-developed. Many of the host countries’ policies are highly Eurocentric and not applicable to the diverse cultural, social and political nature of individuals. These policies need to be expanded and negotiated to provide meaning to human experiences.

Pre and Post-Migration Traumatic Events and Refugee Resiliency

Nintey seven of the hundred participants in this study witnessed or experienced violence and mass killings before they left Sri Lanka. This finding coincides with Gagne’s (1998) work on collective colonial experiences and anarchy among the First Nations community. Colonial-influenced policies and related socio-political conditions also created imbalance in Sri Lanka. With the departure of the colonizers from Sri Lanka, the country was left without social or political leadership or policies to succeed as a nation. The division between the Tamils and the Sinhalese continued to grow and culminated in an ongoing civil war, which led the Tamils to flee the nation as refugees.

One of the most interesting findings of this study was that pre-migration traumatic events were less significant to refugees’ psychological distress than post-migration traumatic events. This is substantiated by refugee theories that acute refugees tend to have greater post-migration traumatic experiences due to the lack of resources at hand to survive in the new country and the need to focus on present means of survival. They may also have developed resilience and survival skills from their pre- migration traumatic experiences, which likely supports this finding. Gronseth’s (2006) research with

Sri Lankan Tamil refugees in Norway produced similar results where the focus of refugees was on

“being in the present world.” The Tamils are used to living in an atmosphere of high conflict and are forced to reorient themselves in the new social world and focus on their surviving skills.

Jaranson, Martin & Ekblad (2001) postulate that refugee mental health challenges may be better understood within the context of refugee resilience and coping capacity (2001). According to

Lumsden (1999), “If there was symptomatology in the first phase of exile, then such distress may well

114 decline or disappear (pp.31)”. Refugee resiliency serves to counter the social constructions of migrants as victims without agency, and enables refugees, despite their traumatic experiences, to succeed in their new society. The resiliency perspective provides the context that lendds meaning to their suffering and a focus on their strengths and experiences. A refugee’s life is most often marked by pain and oppression. Most intervention strategies focus on problem identification rather than simultaneously recognizing the strengths of these individuals to overcome their pre-migration traumatic events.

According to Charles Rapp (1998), people who suffer from mental distress are able to continue to learn, grow and change. The following protective factors have been identified for refugees (Jablensky et al., 1994): 1) availability of extended family and friends; 2) access to employment; 3) participation in self-help groups; and 4) situational transcendence, or the ability of individuals and groups to frame their status and problems in terms that transcend the immediate situation and give it meaning (e.g. ethnic identity and cultural history). Pre-existing demographic and personality factors may also affect eventual functioning and mental health (McKelvey, Webb & Mao, 1993).

These study findings further support Mollica’s (2006) concept of self-healing. According to

Mollica, adopting a new perspective or meaning of the traumatic experience could be a crucial resource for healing victims of violence. It helps survivors to deal with their loss and contributes to their healing. The opportunity to practice traditions, beliefs and customs without restraint, and to recreate social institutions, also serves as protection factors for self-healing. Canada and India have the largest Sri Lankan Tamil refugee settlements in the world. Sri Lankan Tamil refugees who come to these two countries are not only accepted by the new host society but are also welcomed by social networks that are familiar to them, and this allows them to share their experiences and encourage each other as they start a new life. Refugees who successfully overcome the hurdle of a refugee board hearing and obtain refugee status are able to settle down in the host country aided by their strong resiliency. In traditional routine interactions with refugees, interventions focus on their acculturation issues, poverty, unemployment, racism and mental illness. It is just as important to address their pre-

115 migration traumatic experiences and the strength they have gained from these experiences to deal with the hardships and successfully settle in their new host country.

Typology of Refugees and Typology of Refugee Settlement

Other important study outcomes arise from the variables typology of refugees and typology of refugee settlement. Typology of refugees, developed from Kunz’s Refugee Theory (1973), provides many insights on a refugee’s attitudes towards displacement (Colin, 1996). Kunz views the flight and settlement patterns of most refugees as conforming to two types, either anticipatory or acute refugee movement (Colin, 1996). Anticipatory refugees foresee the danger early, prepare for a new life and leave with resources. Acute refugees flee their homeland after disaster has struck, with minimal resources, including any documents that prove their identity. The results of this study substantiate the argument by Stein (1998), that acute refugees may experience more post-migration traumatic experiences. Ninety-seven of the 100 participants in this study were acute refugees, and post-migration traumatic event scores showed high significance to their psychological distress. This also supports the research by Silove, Steel, Bauman, Chey & MacFarlane (2007) which found that 85% of refugees fleeing from war-torn countries made the decision to leave their homeland two days to two hours before their departure. However, typology of refugee could not be included in the statistical model due to an inadequate number of participants in the anticipatory category. The large number of participants in the acute refugee category is reflective of the many refugees encounteredd within social work practice who may have experienced pre-migration traumatic events and highlights the importance of integrating pre-migration events, especially for acute refugees, into intervention plans. Effective interventions should be driven not only from the perspective of the service deliverers, but must also actively integrate refugees’ pre-migration and post-migration traumatic experiences.

Typology of refugee settlement encompasses two categories, new and traditional settlement, within which most refugeese fall. There is lack of concern, however, towards internally displaced refugees (IDP). Based on the UNHCR reports, there are 26 million internally displaced populations,

116 which are not receiving the adequate support on account of their IDP status. Their lives are therefore in limbo where they are not accepted by their own country, host countries or the United Nations.

Categorization under the refugee theory raises another question regarding the policies related to who fits the category as refugees and who do not and subsequently the Eurocentric focus of dividing people into categories to control and oppress them. This suggests that Eurocentric colonization continues even after the end of the historic colonization.

Gender Analysis

An unanticipated finding of this study was the lack of significance of gender difference on pre- and post-migration traumatic events and manifestation of psychological distress. Both males and females were subjected to unique traumatic experiences; they witnessed or experienced violence, mass killings and loss of family members. Eight female participants responded to the open-ended questions and reported to have been sexually assaulted; all nineteen male participants who responded to the open ended questions were members of the rebel army from childhood. Kang, Kahler & Tesar’s (1998) study shows that refugee women and men have unique concerns stemming from their gender. This result also emphasizes the importance of not politicising policies only for women, but rather developing gender based policies for both men and women. An understanding of gender and gender- based analysis is central to identifying the nature of problems related to male and female refugees.

According to Jessica Pierce of Johns Hopkins University (1998), refugee men experience similar numbers of traumatic events as women, with between 60-80% of men having had at least 1 traumatic experience and an average of 5 traumas, and 50-75% of women having had at least 1 traumatic experience and an average of 4 traumas. Male refugees struggle with physical assault, review board hearings and issues related to bringing their family over from their country of origin (Keung,

2006). A study by Takeda (2000) in Japan shows that male refugees especially suffer from economic hardship during settlement. Female refugees are more likely to face sexual assault and domestic violence, and struggle with dependency on male refugees as well as limited access to social services

117 (Jiwani, 2001). Kaapanda & Fenn (2000) found that many refugee women have had to adopt not only to new familial roles, but also to new social and economic responsibilities and to new ways of thinking, lifestyles and occupations. Both male and female refugees grieve for the loss of their immediate family and other support systems (George, 2000) and both also deal with interpersonal struggles at home because they are not sure how to adapt to the new culture (George& Tsang, 2000).

The results from the current study demonstrate that a full understanding of both male and female traumatic migration experiences is necessary to provide successful settlement services. As a social work practitioner, the writer has witnessed the special attention female individuals receive relative to males. This may be explained in part by their physical appearanceor the communication style of women. Nonetheless, the results of this study emphasize the importance for health care providers to not undermine the unique experiences of both genders during the intervention period. Health care providers needs to focus on the unique gender based experiences, gender relations in the specific community as well as gender based contributions to the family and community (Lacroix, 2006).

Reformation of the U.N.

The United Nations is an organization that responds to both the protective and practical needs of refugees. However, the U.N. has increasingly faced economic and political pressure to rethink the terms of its operational mandate. Hyndman (2000) explains that western governments have power over the United Nations and lobby for their choice of Secretary General and demand reforms to meet their needs. Sri Lanka has been a victim of violence for centuries. All the participants who responded to the open-ended questions in the Harvard Trauma Questionnaire about the United Nations’ policies identified the ineffectiveness of the U.N. in this part of the world.

What is the concept of nationhood by UN or wealthier countries like Canada? Do they contribute to a political economy that is supported by western capitalist views? Is Canada able to provide guidance in this matter? Canada is respected world wide for its recognition and acceptance of

118 diverse communities firmly established in the Multiculturalism Act in 1988. How well, though, does this Act safeguard all communities in Canada? The Canadian Multiculturalism Act is considered a breakthrough and many countries have followed suit by amending their immigration policies to adapt the Canadian way. This Act not only brought respect and opportunity for immigrants, but also tremendous resources for immigrants and a large number of votes for Pierre Trudeau, the Canadian

Prime Minister at the time. This Act may therefore be seen as a strategic tool for politicising migration and creating an economy to fulfill Canada’s goals. There is much discourse of the French fact in

Canada, equal to the Tamil Eelam in Sri Lanka. In the French Canadian fact, both the English and

French value each others’ historical, economical and social contribution. The French Province of

Quebec enjoys some sort of asymmetrical federalism strategy where they enjoy a larger degree of autonomy. While Canada values individuals’ interest to learn more about others’ culture, this is not the case in Sri Lanka. There is no respect for Sri Lankan Tamil contribution to Sri Lankan history. The major civil war in 1981 commenced with the destruction of a library which held tremendous amounts of Sri Lankan Tamil literature (Tambiah, 1998). So, is Canada an ideal nation to follow and is the

United Nations fulfilling its honourable act of maintaining social justice in all countries? This question draws attention to the oppressive experiences of the indigenous population in Canada by the mainstream Eurocentric community. Indigenous populations are still denied their rights in Canada and may be likened to the Tamil Eelam in Sri Lanka. The lack of support from United Nations and Canada to the Indigenous population is equally reflected in scenario for the Tamil Eelam in Sri Lanka; both are not Eurocentric communities, but both deserve respect and human dignity from the United Nations.

Hyndman (2000, 2006) and Hathaway (1992) have written extensively about the United

Nations’ lack of support for non-Western countries and marginalised populations. The United Nation’s response in Sri Lanka is an example of its attitude towards countries that do not reflect Eurocentric culture and customs similar to western nations. There is no doubt that the United Nations is controlled by the Unites States and other wealthier western countries. There is speculation that the interest of the

119 United States to obtain access to the Trincomalee Port in Sri Lanka explains their lack of support for

Sri Lankan Tamil refugees. While it is to be expected that individual countries like the U.S. will have established foreign policies, the United Nations should not have a foreign policy and certainly not one driven by western nations (Crosby, 2006). The values of the United Nations should not be limited to specific countries or regions or Eurocentric communities, nor should it support or legitimize wealthier countries. Rather, it should maintain universal values for universal subjects. Its policies should integrate every human subject regardless of race, culture and region (Hyndman, 2006). The United

Nations should work as tool for change, not a tool for political strategies by utilizing Eurocentric policies and programs.

. IMPLICATIONS FOR SOCIAL WORK PRACTICE AND POLICY

The social work profession has been changing continuously to adapt to international influences.

Social workers assist large numbers of refugees, providing support in their new country. Social workers play a central role on the team of professionals (medical, legal, judicial) that collaboratively respond to refugee needs. Social workers often have the role of initiating all other types of support received by refugees. The findings from this study should be of particular interest to social workers who are working with refugees or in the area of mental health. At the outset of this study, it was observed that while the social work profession has great potential to offer more complex understanding of refugee experiences, the contributions to date of social workers to the professional literature on refugee traumatic migration experiences and refugee psychological distress are lacking. The bibliographic listing for this paper reflects the absence of social work representation in the clinical literature. This contrasts sharply with my clinical experiences, in which many social workers are strong advocates of looking at the sociological factors of refugee psychological distress and often challenge the medical model of understanding of refugee traumatic events. Although it is important to value the opinions of professionals from other fields, it is necessary for social workers to provide a unique contribution to this area and to adopt a leadership role in meeting refugee needs. Social work has

120 played a major role in questioning canonical knowledge and standards. Social work provides standards for developing postures which everyone can embrace, in an effort to compensate for sexual, racial, or other biases that have been called into question. Social workers should create a united front to provide significant research and community practice contributions for the clinical intervention of refugee trauma.

Of primary importance for social workers to note is the fact that the refugees in this study, in keeping with the majority of research in this area, displayed a strong resiliency. Refugees gain resiliency from the experiences they go through before settling in. As Harter (1996) suggests, overestimating one’s abilities (within reason) is associated with positive mental health. However, recognizing refugee’s internal strength should not lead to underestimating the difficulties they continue to face in their new country. Nevertheless, it is important for social workers to realize the necessity of maximizing the resiliency power of each refugee. The following discussion offers a multi-level approach to social workers, in keeping with the foundations of social work practice, focusing on: 1)

Working with individuals; and 2) Working for social advocacy.

Working with Individuals

This study’s findings demonstrate that on a clinical practice level, social workers need to understand the major contextual issues affecting the everyday lives of refugees, particularly their impact on refugee trauma. The information derived from this study provides social workers with a knowledge base for intervening with refugees and their families. It would be most advantageous for social workers to connect with refugees immediately upon their arrival, and this could be facilitated as part of a complete medical assessment by the Ministry of Health. Social workers may be able to address the discrepancies in physical appearance and the importance of providing interventions at an early stage. Refugees may physically appear to be healthy, but there may be unobservable problems.

Due to refugees’ diverse backgrounds, they may be hesitant to seek or not given the opportunity to

121 express their concerns. The data from this study supports this by offering compelling evidence that refugees’ psychological distress levels are greatly influenced by migration traumatic experiences caused by typology of refugee and host country status. This further lends credence to the need to develop treatment interventions for each refugee based on their gender, host country status, typology of refugee settlement, typology of refugee, as well as their unique pre- and post-migration traumatic events.

It is very important that social workers bring in-depth understanding of refugee mental distress when they connect with refugees. Understanding each refugee requires an iterative process involving dialogue between the social work practitioner and the refugee. Drawing on Post-Colonial Theory and

Feminist Theory, social workers need to address the oppression faced by refugees, caused by dominant ideals and invisible pressures. Individualized interventions that take into consideration all these factors contribute to a complete assessment.

A critical theme for social workers to take away from this study is the importance of integrating policies into practice. This study’s results show that policies from the country of origin, the United

Nations and host countries significantly affect refugees’ lives. Again, this leads to the need bring community into the discussion when working with refugees. Intervention should start with an understanding of the social, political, and historical aspects of the community to which each refugee belongs, including the impact of various policies. These aspects play an important role in these individuals becoming refugees, and affect their pre- and post-migration experiences, which lead to physical and psychological distress. This study proposes a unique practice model for social workers that integrate both policies and practice, as shown in Figure 11 below

122 Figure 11: An Integrated Framework for Social Work Practice

Figure 11

Working for Social Advocacy

On a social policy level, this study’s specific examination of refugee migration concerns and psychological distress are relevant to the community because of the huge influx and settlement of refugees in Canada from all over the world that continues unabated. Participants in this study discussed needs and concerns that were relevant not only to micro level practice with individuals and families, but also to macro level practice with communities and systems. Social work has consistently practiced under the premise that individuals are linked to an environment that must be viewed as an equally important target of intervention (De Hoyos, 1989; Haynes & White, 1999; Mizio, 1998; Baskind, F.,

Shank, B. & Ferraro, E. 2001). Social work literature around refugee settlement services provided a macro level focus (George & Maiter, 2003; George, 2003; George & Fuller-Thompson, 2001; George

& Tsang, 2000), however, there is evidence that macro and micro level interventions have not been well integrated in practice.

123 Although social work is a multilevel practice profession, integration of individuals and various systems has not successfully occurred. The data from this study sends a strong message that social workers need to advocate changes at both the individual and systems levels. These findings also suggest that social work should be careful in adapting traditional single intervention models; instead through integration of both micro and macro levels, social workers can accommodate the unique dimensions of social work practice.

It is also important to reflect on what this research says about the social systems we live in. As has been revealed through both the literature review and the research data, there is still debate over whether or not the aid for refugees currently offered by the United Nations, as well as the Indian and

Canadian governments, supports the objectives of social work practice. The findings of this study indicate that participants’ psychological distress is affected by clinical as well as historical, political and social factors. Theoretical analysis can give social work practitioners an ideal means for reflecting on and understanding complex social issues. Social workers have the educational background and professional orientation to facilitate larger systems change. Further, it is the essence of social work practice to ensure larger systems meet the needs of the individuals they were created to serve.

A key theoretical viewpoint informing this research is a post-colonial perspective which highlights that the problems encountered by refugees are rooted in dominant culture. In promoting and facilitating a positive sense of self for refugees, systems need to change to target the world as a place to live rather than a place to oppress and control. Social workers should not only be encouraged to address the individual needs of refugees, but should also work with the system to improve the organizational culture that surrounds refugees. Advocacy roles for social workers may also include connecting with people at the bureaucratic levels and generating systematic approaches to support the positive development of refugees’ social welfare system. Research results from this study and from others can form the foundation for such actions. In short, there should be a balance between supporting

124 “what is” helping refugees to sustain their positive selves and advocating for “what ought to be”, helping to create communities that are more appreciative and supportive of refugee experiences.

STUDY IMPLICATIONS FOR FUTURE RESEARCH

This study began with an interest in learning more about refugees and their migration experiences. Theoretical and empirical analysis was used to analyze variables like typology of refugee, typology of refugee settlement, gender and host country status. Unfortunately, only 100 participants could be included in the study, which limited the further investigation of many other variables. These other variables will require further study, and given the researcher’s experiences, either a different design or a different sample. The use of quantitative methods in this study was particularly successful in understanding the experiences of refugees. While the quantitative methods provided the numbers and statistics, adding a qualitative component to this research would have added value providing in- depth stories of refugees’ lives. A multi-method study with a larger sample would allow the integration of both statistical and personal factors that contribute to the psychological distress of refugees.

Further, replicating this study with children under the age of eighteen would provide a deeper understanding of their issues. The writer witnessed many refugee children who had dropped out of school at a young age to work in order to meet their families’ needs. This theme was not touched on in this study. The study participants were limited to those aged eighteen years and older. Examining the experiences and perceptions of the younger generation will provide a more detailed understanding of refugee life.

Internally Displaced Populations (IDP) is another area that requires further exploration in relation to their migration experiences and psychological distress level. This group of individuals are not receiving much attention from the United Nations. Based on the internally displaced monitoring service, there are 495,000 internally displaced individuals in Sri Lanka. Future research could take a different direction by employing a longitudinal design that would accurately reflect the long-term

125 cumulative effects of historical, social, and political changes on refugees' psychological distress level.

Historical factors can include historical analysis of both the country of origin and host countries; social factors can include any settlement barriers like unemployment, poverty, language difficulties, being in a new host country with different cultural values; and political factors include political changes in the host country as well as in the country of origin. It is important to take into account the role of time and local changes in the lives of refugees (Lumsden, 1999). Changes in any of these factors or the intersection between one or more of these factors and pre-migration trauma can adversely or positively affect symptom levels, and will have implications for the current service delivery model. There are very few longitudinal studies that have examined the long-term effects of these factors on refugee mental health.

In this study, Sri Lankan Tamil participants were chosen to represent refugees with psychological distress. Replication of this study involving other refugee groups is recommended to determine whether these findings are representative of all refugee communities. Research with other refugee communities may show that the experiences of Sri Lankan Tamil refugees are significantly different from the experiences of Eritrean refugees.

There is also a need for greater understanding of the central role of family life in refugee lives.

Including the perceptions of parents and children of family life will provide a more concrete analysis of the social support networks for families. Further research might provide valuable insights into the nature of the relationship between refugee parents and children, and the development of strong values and beliefs in the family unit. Many parents expressed their concerns about children losing their moral values in refugee camps. An understanding of refugee parents and children’s impressions of family life and the potential obstacles they face would help social workers to more effectively assist refugees in their struggle.

Last, but not least, it is crucial to look more closely at refugee resiliency. This study’s results suggest that refugee resiliency is the key factor motivating refugees to succeed in the host country by

126 encouraging them to look beyond their pre-migration traumatic experiences. Most of the refugee research focuses on problems related to refugee’s lives. However, more studies are needed to examine refugee resiliency.

LIMITATIONS OF THE STUDY

The findings of this research study need to be considered in light of the limitations discussed below:

ƒ The sample is a convenience sample with participants located in various parts of Toronto,

Canada and Chennai, India. The results of the research can be generalized to refugees from

similar social, geographical and cultural environments, but unique elements of each

environment and each individual will limit generalizability.

ƒ The Harvard Trauma Questionnaire - Tamil version was designed by Weaver and colleagues

(2005) in the United States based on the experiences of Sri Lankan Tamil refugees living in

Buffalo, NY. Weaver and colleagues recommended using this questionnaire for Sri Lankan

Tamils elsewhere, and this research study is the first to use this questionnaire since its

development. While in my judgement the questions in the questionnaire are relevant based on

my clinical experience with this population, it is important to note that there are unique factors

and words related to specific Sri Lankan Tamil refugee experiences that are not captured by

this questionnaire. For example, words like “settlement” and “common-law” were beyond the

understanding of Sri Lankan Tamils living in Indian refugee camps. A pilot study should have

been conducted in India before the HTQ-T was employed in a research study.

ƒ One drawback of this study was the lack of numbers in the anticipatory refugee category.

Ninety seven out of the hundred participants were acute refugees, which means they witnessed

or experienced traumatic events prior to their departure from Sri Lanka. Lack of participants in

127 the anticipatory category led to the problem of not being able to compare the pre- and post-

migration traumatic experience scores with the acute refugee category.

ƒ Another very important drawback of this study is the response bias. Refugee Board hearings

are an intense process. Many refugees go through intense training to answer the questions in the

“right” way to get their refugee status. Because the researcher could not control such

extraneous factors, one may not necessarily infer causality from the findings. The study results

may also have been affected by recall bias because refugees reach their host country after a

long and difficult migration process that may cause them to forget some of the details of their

journey experiences. Research incorporating reported data about past experiences is always

subject to the limitations of individuals' memory and the influence of disease/exposure on the

recall process. Standardized well-structured questionnaires were used to minimize recall bias in

this study.

ƒ An additional limitation of this study is the lack of a qualitative research component. Although

the quantitative results and the inclusion of a few open-ended questions brought several

important themes to light, a more extensive qualitative component would have been beneficial

for better understanding and responding to the participants’ unique struggles and experiences as

refugees. Such experiences cannot be adequately described in a few words.

Despite these limitations, the conclusions drawn from the research study have important larger

implications in a global context, and in a social work practice, policy and research context.

CONCLUSION

The historical, social and political construction of refugees is one of the most profound destructive forces in today’s world. The Sri Lankan Tamil refugee migration analysis in this

128 dissertation addresses several important issues flagged in recent scholarship on migration traumatic experiences, the United Nations and host countries, and mental health. The Sri Lankan Tamil refugee issue is a complex historical, social and political formation that is shaped by pre- and post-migration experiences including civil wars, the process of adjustment to host societies, and the lack of response by the United Nations to solve the Sri Lankan crisis. Most of the Sri Lankan Tamil refugee participants in this study witnessed or experienced unimaginable horrors such as mass killings, bombings, losing their homes, witnessing the murders of family members, being orphaned, being forced to fight as soldiers, torture, and separation from their families. Refugee camps provide a life of prolonged suffering and enduring psychological abuse. Sri Lankan Tamil refugees must try to rebuild their lives without a sense of belonging or cultural, social, spiritual, and economic resources in a host country.

This research study provides a bridge between historical, social and political constructionism and the medical model, with perceptions of Sri Lankan Tamil refugees’ self being viewed as evolving through a complex interplay of historical, social and political environments. Despite these enormous challenges, there are refugees who do survive and rebuild their lives after suffering through traumatic experiences. In an effort to provide quality service delivery for refugees to assist them in their survival, our understanding of their unique experiences needs to be broadened beyond narrow formulations. To achieve this, a clear picture of the life journey of the refugee population should be captured as they interact with service providers.

It is the hope of this researcher that this dissertation research provides a more complete analysis of refugees’ psychological distress than what already exists. The voices of refugees must be heard so that service providers can better understand and effectively alleviate the stresses on refugees by providing appropriate support, including policy/practice integrated therapeutic intervention, to rebuild their lives.

129 CHAPTER 8: EPILOGUE

What should be the last section of my dissertation? How can I conclude such a huge life- altering endeavour? I decided that this final section should provide a clear and coherent picture of my experiences in a doctoral program, one which enabled me to undertake this complex study that helped me to fully understand the plight of Sri Lankan Tamil refugees. I believe that integration of these thoughts will strengthen the account of my intellectual journey.

TRANSFORMING CURIOSITY INTO AN INTELLECTUAL EXPLORATION

As mentioned in the introduction, I witnessed many of the struggles of Sri Lankan refugees while growing up in South India. I had my own beliefs about power, control and dominance in South

Asian society, and I was curious about and confused by societal practices against Sri Lankan Tamil refugees that worked in opposition to equity and inclusion. Hartman and Laird (1983) discuss the importance of quality relationships and environmental contingencies at developmental transition points in shaping the persons we become. My experiences and curiosity consolidated with my intellectual journey when I decided to join the doctoral program.

While considering many areas of interest for my research, I came up with three questions: 1)

What is my area of practice? 2) What is the area of urgent need in my South Asian community? 3)

What is the best way I can convey to the social work community the importance of integrating social work practice and social policies? These questions helped me to see the strength of the social work profession and the value of social workers to society, particularly my South Asian community. When I finally decided to explore Sri Lankan Tamil refugees’ mental distress, I felt I had chosen a research topic that would require me to passionately examine the multiple and complex related problems that were not being addressed by the professional social work community, and to systematically question oppressive societal practices. I felt that I was prepared to view the world through a more objective lens.

130 Before I started writing this dissertation, I wanted to create a framework to follow. I felt that having a consistent writing framework would help me to provide a clear and in-depth picture of refugees’ lives. While providing research details systematically, I wanted the readers to feel the passion I felt for this research subject as they read. I vividly remember how my father’s brilliant narrative expression on many societal issues captured and held my attention. To me, portraying the complexities of this research in narrative form helps to explain the way I see the world. I believe that narrative accounts can be effectively used to explain the realities of refugee issues with either quantitative or qualitative research designs. For this dissertation, I have used them to provide closing remarks to this research.

East Meets West

My life experiences were influenced to a large extent by South Asian history. While this history is important to consider, my personal experiences within my community formed the basis of my evolving world view. My firsthand knowledge of gender, race, class and religious oppression contributed to my evolution as a social worker. When I left India, I hoped I would be freeing myself from the societal oppression I experienced there. However, it was merely replaced by marginalization and social exclusion as I became a “brown Indian” in another country. I slowly came to recognize the various identities and the external factors that affect my sense of self. I realized that Western philosophy was not going to ease the oppressiveness. I searched for personal and institutional direction to rescue me from feeling helpless for not being able to contribute to my community.

Looking back, I realized that what sustained me through difficult times were the stories and experiences of various historical events that happened within and outside of my community. These stories, especially the events in colonial India, instilled pride as they were passed on from one generation to the next, recalling each time the strength and resiliency of my forefathers to fight for social justice. In fact, the colonial framework became an integral part of my thinking, and it came to

131 fill the gap I felt in my thinking. For me, it was a defining moment that crystallized the meaning of social justice and my childhood experiences with oppression. By integrating the colonial framework into many other social theories, I was able to interconnect Western and Eastern philosophies in a way that I believe will be a guiding source for the rest of my academic career. It is what paved the way for this dissertation.

Here I Go…

As part of my data collection, I interviewed participants from Toronto, Canada as well as

Chennai, India. I connected with and learned a great deal about Sri Lankan Tamil refugees in Toronto while collecting data. My journey to collect data from Sri Lankan Tamil refugees inside refugee camps in India was an experience I will never forget. It was extremely challenging to undertake all the required measures to complete the data collection in the short time period that I had.

Sri Lankan refugees, as foreigners resident in India – which does not agree with the 1951 UN

Convention on the status of refugees – have no social or political rights. India does not have any laws concerning the status of refugees. Since the assassination of Indian Prime Minister Rajiv Gandhi, a government order has banned non-governmental organizations from working in refugee camps for

“security reasons”. Even UNHCR officials are not permitted access. This was the scenario I had to deal with in deciding to proceed with this study. From the beginning, I had to plan every step carefully to successfully collect my Indian data. These added layers of difficulty made it easier for me to understand the struggles of social welfare groups attempting to get inside these camps.

I gave myself a window of two-and-a-half weeks to complete my data collection from the refugee camps. The encouragement I received from the refugees and their eagerness to participate in this research was overwhelming. They welcomed me into their lives, sharing their shelter and meagre rations of food with me, and made me feel like a member of their community. I realized that I could

132 make a positive change in their lives not only through dissemination of my study results to the academic world, but also by being part of their journey.

Indian Refugee Camps for Sri Lankan Tamil Refugees

Mathew, 2008

It is coincidental that I started this research at the time when the Eelam war in Sri Lanka entered to a decisive phase. Thousands of Sri Lankan Tamil refugees are fleeing to India and close to

100,000 refugees are living in 123 camps spread across the state of Tamil Nadu. Sri Lankan Tamil refugees residing in these camps are classified into two categories: those who live in camps set up by the state government, and those who are considered a security threat and are kept in special camps.

It was heart breaking to listen to the plight of these refugees’ hardships they endured to flee their homeland. They are expected to pay large sums of money to be dropped near Indian waters where they are picked up by Indian fishermen who secretly ferry them to the knee-deep waters of the shores of Tamil Nadu. Sometimes, the Sri Lankan refugees are dropped on the sand dunes that emerge in the water during low tide. Those who are not picked up from there get washed away by the sea during high

133 tide. On average, a journey from Sri Lanka to India by boat will cost between 35,000 to 50,000 rupees.

The living conditions in Sri Lankan Tamil refugee camps in India are very poor. Refugee camps have no infrastructure or proper facilities for personal hygiene. Accumulated waste, cramped quarters, lack of electricity and poor sanitation contribute to the miserable state of these camps. Refugees have very little interaction with the public. Visitors are not allowed and to outsiders the camps look like open prisons due to the strict vigilance of the government authorities stationed there. Additionally, the

Indian government restricts the movement of Tamil refugees in Tamil Nadu. Although Sri Lankan

Tamil refugees experience poor living conditions, they are happy for at least a space to stay.

According to the refugee authorities I spoke with in the refugee camp, the Tamil Nadu state government is sympathetic to the plight of Sri Lankan Tamil refugees. However, they are not able to provide well equipped camps due to the lack of support from the central government. The Indian government does not allow non-governmental agencies to access the camp to provide medical, psychological and educational assistance. Are the responsibilities of host countries limited to providing sticks, plastic sheeting, mud and stones for refugees to make tents? Or should they include accepting refugees as “one of us” rather than “one of them”? This brings to the forefront the questions raised by study participants: Where is the United Nations? Are they there? The United Nations should arm itself with the international conventions necessary to take a more proactive role in the protection of the Sri

Lankan Tamil refugees in host countries including India.

Political Religions

An important observation during this investigation was the religion of study participants and its role in the Sri Lankan civil war. Sri Lankan politics are influenced by two prevailing religions:

Buddhism and Hinduism. The majority of Sinhalese belong to Buddhism while the majority of Tamils practice Hinduism. In this study, 68 participants out of a hundred were Hindus; the rest were

Christians, with none belonging to the Buddhist community. This may lend some truth to the

134 suggestsion that religion played a role in the Sri Lankan civil war and the associated violence. Both religions advocated their own ideologies and worked towards achieving political control of the country. Eventually, the nature of this participation by religious leaders in national politics created two

“political religions” in Sri Lanka (Tambiah, 1986). An examination of current religious ideologies and the location of religious politics around the world reveals historical factors as the impetus for the transformation of religions into international and national politics, as has happened in countries such as

Pakistan, India, Afghanistan, Britain and the United States. The war between the United States and

Afghanistan, for example, or between the United States and Iraq, is viewed by many as a war between

Christianity and Islam.

Religious politics bring to the forefront many theoretical questions regarding the position of community in today’s religions, which in reality is based in multiple locations and evolved through the integration of complex configurations of culture and power (George, 2008). Is religion meant to meet a community’s spiritual needs or should the community meet a religion’s needs? Although religion may provide the community with spiritual empowerment, it could also be a monolithic source of oppression. Examining the impact of religious domination on the community promises to broaden our understanding of the phenomenon. Sri Lankan politics is a perfect illustration of the use of religious power and control to treat communities as objects for personal gain. Linking violence to conflict between two communities to achieve political control is problematic due to the clear evidence of the religious involvement in this region (Tambiah, 1991). Within a global context, therefore, the Sri

Lankan civil war and political and social anarchy cannot simply be represented as a fight for power, but rather more of religious creations representing continuous oppression by various religious ideologies, with politics employed as a tool of implementation.

135 Child Labour, Child Marriage and Child Soldiers

This thought emerged during my visit to refugee camps in Chennai for data collection. I came across many children who had dropped out of school to work in nearby construction sites to support their families. From my communication with many refugees, parents, children and refugee authorities, it appears that the number of child labourers is very high in these camps. The two main reasons for this are social factors and lack of awareness. Social factors include the standard of living in India. The

Indian government provide an allowance to refugees, but this allowance is not enough for them to survive and leads to refugees of all ages, including children, to find employment. In countries like

India, where Sri Lankan Tamil refugees never receive legal status and their socio-economic conditions never change, children often have to find illegal employment to help their family. Lack of awareness about children’s needs is the other reason for the prevalence of child labour. Humanitarian assistance for children is usually minimal to children’s needs (such as education, health and safety) are not given recognition.

I also learned that migration trauma may have produced strange new behaviour patterns for children, and their new lives present new perils. Girls may be threatened with rape and boys with recruitment into military gangs. Adolescents may get pregnant, and to avoid stigma the families arrange their marriages regardless of their young age. Child soldiers are a big problem in the Sri

Lankan Tamil refugee community. I learned from many refugee parents that their children, many under the age of sixteen, were recruited as child soldiers by the Liberation Tigers of Tamil Eelam in Sri

Lanka. Parents often do not know if their children are alive or not. However, many of these parents believe that their young children are serving for the noble cause of saving their community from the

Sinhalese. The lives of refugee children can fall apart very quickly, and parents are usually unprepared, unaware or unable to directly address the range of problems that suddenly surface. Recruiting educators from refugee communities who are aware of the social and cultural needs of their community can bring much needed help for situation. This is an area where global attention is sorely

136 needed to provide outreach programs to promote education, and to help ensure that all school-aged refugee children have educational access.

Arranged Forced Marriages and Honour Killings

The concept of arranged forced marriages and honour killings is not a new phenomenon but a common occurrence in many South Asian countries, including India and Sri Lanka. An “honour victim” is typically a woman whose liberty and wellbeing is threatened, or whose life is ended, as the outcome of a forced marriage somehow gone awry. A forced marriage is one that is contracted, without consent of either the bride or the groom, for economic or social gain. The issue of forced marriages among Sri Lankan Tamil refugees came to my attention during a meeting with a women’s activist group in an Indian refugee camp. Many honour victims are killed, sometimes by their own family members, and many disappear from the camps. According to a recent report published by The

Centre for Social Cohesion, many honour victims (exact toll unknown) suffer anxiety, deep depression, and other psychological problems ((Easton, 2008). Their anguish at not being able to comply with family expectations often leads them to self-harm, schizophrenia, and suicide (Easton, 2008).

It is very striking to note that honour victims are typically daughters. When sons find themselves in the same situation, families tend to accept their decision for fear there will be no son to take care of them when they are old and to bury them when they die, as called for in Vedic scriptures.

Families take brutal exception, however, when a daughter rebels against a forced marriage or appears to be succumbing to the corrupt values of Western culture. Dating – or worse, falling in love with someone outside the family religion – is also unacceptable. Honour killings are usually carried out by irate fathers or a combination of brothers, uncles, or male cousins, and the murders are usually disguised as suicides or accidents.

Forced arranged marriages are a human rights issue. It is a cultural practice that brings forth a tragic set of unforeseen consequences for the victims. Many argue that this is not a product of religion,

137 but of cultural practices. In this researcher’s opinion, it may be a cultural tradition, but religion is successfully implementing this practice to gain support from other countries where this practice is followed, such as India. Those critical of the practice are, predictably, cast away from society. Two questions confront us: 1) When will a worldwide action program against forced arranged marriages be formed? and 2) How many more women have to die or suffer before the international community wakes up?

Civil War Ends (1981-2009); Political War Begins (2009 -?)!

The Tamil diaspora has yet to come to terms with the final war in 2008-2009, the consequences of the death of their leader, Vellupillai Prabakaran, and the future struggle for dignity and equality.

While the violence has been officially declared as over, propaganda for equal rights for Sri Lankan

Tamils continues. Victory may only be claimed in military terms until and unless Tamils are treated as equal citizens in Sri Lanka. The government needs to emphasize that the war was not against the Sri

Lankan Tamil community but against the Liberation Tigers of Tamil Eelam led by Vellupillai

Prabakaran.

Civil society leaders worry that the country’s mood of blind patriotism will encourage the government to ignore the need for repatriation and reintegration. In the victory speech (a portion of the speech delivered in Tamil language) Sri Lankan President Rajpaksa identified plans for the integration of Sri Lankan Tamils: (1) Establish a separate northern based province for the Sri Lankan Tamil community headed by a Tamil Chief Minister; (2) No merger of the Northern and Eastern Provinces due to the clash between various groups inside Sri Lankan Tamils; (3) No change to the present unitary status of the country into a genuine federal state. The Sri Lankan government will keep defense, internal security, the police, communications and taxation in the hands of the central government and devolve other powers to the constituent states. Sri Lanka will seek the support of other countries to

138 make Sri Lanka a union of equally empowered states, but not a federation. There are reports that Sri

Lankan may expect insurgency from the eastern region on account of the internal war between the leaders Karuna, Pillaiyan and Devananda. The Sri Lankan government manipulated these leaders and their groups to work against Prabhakaran, leader of the LTTE; it is anticipated that these three leaders will now fight for control of the Sri Lankan Tamil community. Such upheaval will test the solidarity and wellbeing of the Sri Lankan Tamil community. Along with this political confusion, there are confirmed reports from the Red Cross Society that aid and humanitarian agencies have been denied access to most of the refugee camps. The Red Cross has been kept away since May 9, 2009 and the

United Nations reported that all its agencies, including the High Commission for Refugees and

UNICEF, have been denied entry to the largest camps. The presence of refugees in Sri Lanka may be also linked to the fact that host countries as well as the UNHCR have given so little attention to the solution of local integration during the past 15 years. During my visits to refugee camps, many refugees expressed that the role of the United Nations has been reduced to humanitarian efforts only, such as providing water and rice and questioned why there was no call for repatriation by the U.N.?

Was this because earlier efforts to promote local settlement and self-reliance had achieved limited results; because refugees are increasingly regarded as an economic and environmental burden on the world’s more prosperous countries or because of concerns for international, national and local security? The UNHCR and host countries should implement programs in conjunction with the Sri

Lankan government to promote self-reliance among refugees to facilitate positive interactions between the exiled and local populations. “Rather than talking in Tamil, they should be talking to Tamils,” is the comment from the Sri Lankan Tamil community about the repatriation and reintegration plans by the Sinhalese majority run Sri Lankan government. This is extremely important in the current political condition of Sri Lanka, where Sri Lankan Tamils feel they do not have any decision making power.

139 Repatriation is only a beginning; it does not necessarily restore the bond of trust and loyalty between citizen and state. People who remain in their homeland but who do not participate in the economic and political life of their country are still uprooted persons. Reintegration of returning refugees is a complex political, economic, social and cultural process that goes beyond simple physical acceptance into their home communities. The long-term obstacles to reintegration are only partially rooted in economics. The root causes for the original fleeing of refugees are deeply entwined around resentment of power and privilege, mutual suspicions, and fundamental economic and social injustices.

Peace agreements and providing assistance for repatriation will help returnees to rebuild their lives in their home country.

There are many things we can do to help alleviate the pain and suffering of refugees. I have found that listening to refugee life stories is a refreshing, enriching, and useful approach to unifying their experiences, while helping the listener to better understand the storytellers’ thoughts and feelings.

“The stories people tell have a way of taking care of them. If stories come to you, care for them. And learn to give them away where they are needed. Sometimes a person needs a story more than food to stay alive (Lopez, 1992).” I conclude this dissertation with a narrative from one of the many refugees I met in the camps who shared her story with me.

“Me and my son took the boat from Lanka to Rameswaram. I paid

50,000 rupees for me and 35,000 rupees for my six-month-old son. I left my

husband and three-year-old son back home to arrange the money for the boat

to Rameswaram. After several hours in the boat, my son got severe chorukku

(sea sickness). He died in my arms. I didn’t have any breast milk to feed him. I

couldn’t even give him a drop of good water before his death. I held him in my

arms for hours, holding him close to my breath to give him warmth. The boat

mates did not want to travel with a dead body which would attract eagles.

140 Furthermore it will create trouble with the Indian authorities if they see a dead body in the boat. I was forced to throw my son’s body into the sea. I saw his body float in the water and then sink down to the bottom. Kadalamma

(Sea Mother) took my son. What did he do to die at such a young age? He was supposed to play with his brother, and grow up to be a happy child. Why this happened to me? Why? Why?”

(Name withheld to maintain anonymity)

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153 APPENDIX A: QUESTIONNAIRES

Instructions: This package includes a Demographics section, the Harvard Trauma Questionnaire, the Post-Migration Living Difficulties Questionnaire, the Symptoms Check List - 90R and a debriefing script to assess migration events and the way participants feel now. This information will be used as part of the research and the answers to the questions will be kept private and confidential.

Demographics

Age: ______

Host Country: ______

Host Country Status: ______

Gender: Male ______Female ______

Marital Status: Married ______Unmarried ______Widowed ______Separated ______

Common-law ______

Children: Yes ______No______

If yes, how many: ______

Education: ______

Employment: Yes ______No ______

Are you currently with your family? Yes ______No ______

Which province in Sri Lanka you are from? ______

Community you were living when in Sri Lanka: Urban ______Rural ______

When did you leave Sri Lanka? ______

Did you leave Sri Lanka before or after the frightening events? ______

How long have you been in India or Canada? ______

Religion: ______

Would you be interested in participating future research study? ______

If yes, Please provide us your contact information: ______

154 Harvard Trauma Questionnaire – Tamil Version

Part 1: Things That Happened

Please tell us whether you have experienced or witnessed any of the following events. Check all that apply. “Experienced” means something that happened to you. “Witnessed” means something you saw or heard happen to someone else. “No” means you did not experience or witness the event.

Experienced Witnessed No 1. Lack of food or clean water.

2. Ill health without access to medical care.

3. Lack of shelter.

4. Being displaced within your country.

5. Detained or imprisoned.

5a. How long? (Write the amount of time here)

6. Serious injury.

7. War or fighting situation.

8. Bomb blasts.

9. Landmines.

10. Threatened or disrespected because you were a woman, or sexually abused.

11. Forced isolation from family members or others.

12. Being close to death.

13. Murder of family member or someone you knew.

14. Murder of someone you did not know.

15. Disappeared or kidnapped.

155 Experienced Witnessed No 16. Drowning.

17. Suffocation.

18. Beating to the head.

19. Beatings to other parts of the body.

19a. Explain what happened: (Write answer here)

20. Loss of consciousness.

21. Torture.

21a. Explain what happened:

22. Any other situation that was very frightening, where you felt your life or the life of someone dear to you was in danger.

23. Explain what happened: (Write answer here)

156 Part II: Personal Description

1) Why did you leave Sri Lanka?

2) Please tell us the most hurtful or frightening events you experienced in Sri Lanka.

3) Please tell us what you understand to be hurtful or frightening events.

Sometimes bad or frightening things happen in different places, for example, when refugees travel from their homes to other countries on their way to Canada.

4) Describe any bad things that happened to you after you left Sri Lanka and before coming to this country:

157 5) Please tell us what you understand “settlement” to mean.

6) How do you evaluate the success of the settlement in your host country?

7) Please tell us how policies of the United Nations and the host country influenced your life.

8) Have you had any of the following experiences since coming to this country?

Yes No 1. Worries about your refugee claim.

2. Problems with representation by your consultant or attorney.

3. Fewer economic opportunities.

4. Fears of being sent home.

5. Delays in processing your application.

6. Separation from family/ homesickness.

7. Worries about family back home.

8. Language difficulties.

9. Discrimination.

158 Yes No

10. Adjusting to differences in climate, food, and culture.

Part III: Thoughts and Feelings

The following are thoughts and feelings that people sometimes have after experiencing bad or frightening events in their lives. Please tell us whether you have experienced any of the following:

Not at All A Little All the Time 1. Recurrent thoughts or memories of the worst things that happened to you.

2. Feeling as though the event is happening again.

3. Recurrent bad dreams.

4. Feeling detached or withdrawn from people.

5. Feeling like your heart is empty

6. Easily startled at loud noises or people in uniform.

7. Difficulty concentrating or focusing.

8. Trouble sleeping or staying in bed too much.

9. Feeling watchful or afraid of people or situations.

10. Avoiding activities that remind you of frightening or hurtful events.

11. Sudden emotional or physical reactions when reminded of the worst events.

12. Unable to remember parts of the worst events.

13. Less interest or involvement in daily activities.

14. Feeling as if you don’t have hope.

159 Not at All A Little All the Time 15. Feeling that people do not understand what happened to you.

16. Blaming yourself for things that have happened or things you have done.

17. Feeling guilty for having reached a safe place.

18. Feeling ashamed of the bad things that have happened to you.

19. Spending time thinking about why these things have happened to you.

20. Feeling as if you are losing your mind.

21. Feeling as if others are talking or whispering about you.

22. Feeling that you have no one to trust.

23. Feeling sad or depressed.

24. Feeling someone you trusted betrayed you.

160 Post-Migration Living Difficulties Checklist – Tamil Version

Below is a list of living difficulties that asylum seekers who have arrived in host countries sometimes experience. During the past 12 months have any of the difficulties listed below been a problem for you?

No A Bit A Moder- A Serious A Very Problem of a ately Problem Serious At All Problem Serious Problem Problem 1. Communication difficulties. 2. Discrimination. 3. Separation from family. 4. Worries about family back at home. 5. Unable to return home in an emergency. 6. No permission to work 7. Not being able to find work. 8. Bad job conditions. 9. Being in detention. 10. Interviews by immigration. 11. Delays in processing your application. 12. Conflict with immigration officials. 13. Fears of being sent home. 14. Worries about not getting treatment for health problems. 15. Poor access to emergency medical care. 16. Poor access to long term medical care. 17. Poor access to dentistry care. 18. Poor access to counselling services. 19. Little Government help with welfare. 20. Little help with welfare from Charities (e.g., Red Cross, St. Vincent de Paul, etc.) 21. Poverty. 22. Loneliness and boredom. 23. Isolation. 24. Poor access to the foods you like.

161 Symptoms Check List - 90R

How much were you distressed by the following: (0=Not at all, 1=A little bit, 2= Moderately, 3= Quite a bit, 4=Extremely)

0 1 2 3 4 1. Headaches. 2. Nervousness or shakiness inside. 3. Repeated unpleasant thoughts that won’t leave your mind. 4. Faintness or dizziness. 5. Loss of sexual interest or pleasure. 6. Feeling critical of others. 7. The idea that someone else can control your thoughts. 8. Feeling others are to blame for most of your troubles. 9. Trouble remembering things. 10. Worried about sloppiness or carelessness. 11. Feeling easily annoyed or irritated. 12. Pains in heart or chest. 13. Feeling afraid in open spaces or on the streets. 14. Feeling low in energy or slowed down. 15. Thoughts of ending your life. 16. Hearing voices that other people do not hear. 17. Trembling. 18. Feeling that most people cannot be trusted. 19. Poor appetite. 20. Crying easily. 21. Feeling shy or uneasy with opposite sex. 22. Feelings of being trapped or caught. 23. Suddenly scared for no reason. 24. Temper outbursts that you could not control. 25. Feeling afraid to go out of your house alone. 26. Blaming yourself for things. 27. Pains in lower back. 28. Feeling blocked in getting things done. 29. Feeling lonely. 30. Feeling blue. 31. Worrying too much about things. 32. Feeling no interest in things. 33. Feeling fearful. 34. Your feelings being easily hurt. 35. Other people being aware of your private thoughts. 36. Feeling others do not understand you or are unsympathetic.

162 0 1 2 3 4 37. Feeling that people are unfriendly or dislike you. 38. Having to do things very slowly to insure correctness. 39. Heart pounding or racing. 40. Nausea or upset stomach. 41. Feeling inferior to others. 42. Soreness of your muscles. 43. Feeling that you are watched or talked about by others. 44. Trouble falling asleep. 45. Having to check and double-check what you do. 46. Difficulty making decisions. 47. Feeling afraid to travel on buses, subways, or trains. 48. Trouble getting your breath. 49. Hot or cold spells. 50. Having to avoid certain things, places, or activities because they frighten you. 51. Your mind going blank. 52. Numbness or tingling in parts of your body. 53. A lump in your throat. 54. Feeling weak in parts of your body. 55. Trouble concentrating. 56. Feeling weak in parts of your body. 57. Feeling tense or keyed up. 58. Heavy feelings in your arms or legs. 59. Thoughts of death or dying. 60. Overeating. 61. Feeling uneasy when people are watching or talking about you. 62. Having thoughts that are not your own. 63. Having urges to beat, injure or harm someone. 64. Awakening in the early morning. 65. Having to repeat the same actions such as touching, counting or washing. 66. Sleep that is restless or disturbed. 67. Having urges to break or smash things. 68. Having ideas or beliefs that others do not share. 69. Feeling very self-conscious with others. 70. Feeling uneasy in crowds, such as shopping or at a movie. 71. Feeling everything is an effort. 72. Spells of terror or panic.

163 0 1 2 3 4 73. Feeling uncomfortable about eating or drinking in public. 74. Getting into frequent arguments. 75. Feeling nervous when you are left alone. 76. Others not giving you proper credit for your achievements. 77. Feeling lonely even when you are with people. 78. Feeling so restless you couldn’t sit still. 79. Feelings of worthlessness. 80. The feeling that something bad is going to happen to you. 81. Shouting or throwing things. 82. Feeling afraid you will faint in public. 83. Feeling that people will take advantage of you if you let them. 84. Having thoughts about sex that bother you a lot. 85. The idea that you should be punished for your sins. 86. Thoughts and images of a frightening nature. 87. The idea that something serious is wrong with your body. 88. Never feeling close to another person. 89. Feelings of guilt. 90. The idea that something is wrong with your mind.

164 Debriefing Script for Participants

Thank you very much for helping with this project. Our study objective was to examine how refugees experience migration to a new country, the impact of events before and after migration and the levels of distress different individual’s experience. Did you feel disturbed to discuss your migration events with me? If you found that this study made you extremely upset, please discuss your concerns with me. If you are interested, I can arrange counselling follow- up at your request.

Any information I received as part of the study is confidential and will only be seen by me and my doctoral dissertation committee. All the data collected will be encrypted to avoid using identifying information. I am giving you $20 CDN or 200.00 Indian rupees in recognition of your time. Please let me know if you have any questions that I can answer for you.

Your time and thoughtfulness are greatly appreciated. The project team wishes you well in your new home.

165 வினாவரிைசகள் அறிவுைரகள்: குடிெபயர்தல் நிகழ்வுகள் மற்றும் பங்ேகற்பாளர்கள் தற்ேபாது எவ்வாறு உணருகிறார்கள் ஆகியவற்ைற மதிப்பீடு ெசய்வதற்கான ஒரு மக்கள் வாழ்க்ைக கணக்கியல் பகுதி, ஹார்ேவர்டின் ேபரதிர்ச்சி ெதாடர்பான வினாவரிைச, குடிெபயர்ந்த பின் வாழ்க்ைகயில் ஏற்படும் சிரமங்கள் குறித்த வினாவரிைச, அறிகுறிகள் சரிபார்க்கும் பட்டியல்- 90 R மற்றும் ேகள்வி ேகட்கும் எழுத்துப் படிவம் ஆகியவற்ைற இந்த பின் இைணப்பு உள்ளடக்குகிறது.இந்தத் தகவல் ஆராய்ச்சியின் ஒரு பகுதியாகப் பயன்படுத்தப்படும் மற்றும் ேகள்விகளுக்கானப் பதில்கள் அந்தரங்கமாகவும் இரகசியமாகவும் ைவக்கப்படும்.

1. மக்கள் வாழ்க்ைக கணக்கியல்கள்

Age: ______வயது: _____

Host Country: ______தங்க இடம் அளிக்கும் நாடு:______

Host Country Status: தங்க இடம் அளிக்கும் நாடு நிைல:______

Gender: Male ______Female ______பாலினம்: ஆண்_____ ெபண்______

Marital Status: Married ______Unmarried ______Widowed ______Separated ______திருமண நிைல: திருமணம் ஆனவர்______திருமணம் ஆகாதவர்______கணவைன இழந்தவர்____ பிரிந்து வாழ்பவர்______

Common-law ______ெபாது- சட்டம் Children: Yes ______No______குழந்ைதகள்: ஆம்_____ இல்ைல_____

If yes, how many: ______

166 ஆம் எனில், எத்தைன: ______

Education: ______கல்வி:______

Community you were living when you were in Sri Lanka: Urban ______Rural ______நீங்கள் இலங்ைகயில் இருந்தேபாது நீங்கள் வாழ்ந்த சமூகம்: நகரம்_____ கிராமம்_____

Are you currently with your family? Yes ______No ______தற்ேபாது நீங்கள் உங்கள் குடும்பத்துடன் உள்ளர்களாீ ? ஆம்___ இல்ைல_____

Which province in Sri Lanka you are from? ______நீங்கள் இலங்ைகயில் எந்த மகாணத்ைதச் சார்ந்தவர்?______

When did you leave Sri Lanka? ______இலங்ைகைய விட்டு நீங்கள் எப்ேபாது ெவளிேயறினர்கள்ீ ? ______

How long have you been in India or Canada? ______நீங்கள் இந்தியா அல்லது கனடாவில் எவ்வளவு காலம் இருந்துள்ளர்கள்ீ ? ______

Arrival Date: ______வந்து ேசர்ந்த ேததி:______

Religion: ______ேசர்ந்த ேத: ______

Are you interested in participating in the same research study in future? ______எதிர்காலத்தில் இேத ஆராய்ச்சியில் கலந்து ெகாள்ள விருப்பத்துடன் உள்ளர்களாீ ? ______

If yes, Please provide us your contact information: ______ஆம் எனில், தயவு ெசய்து உங்கைளத் ெதாடர்பு ெகாள்வதற்கானத் தகவைல எங்களுக்கு அளிக்கவும்:______-

167 2. ஹார்ேவர்டு ேபரதிர்ச்சி ெதாடர்பான வினாவரிைச- தமிழ் பதிப்பு 2

பகுதி 1 : நடந்த காரியங்கள்

பின் வரும் ஏதாவது நிகழ்வுகைள நீங்கள் அனுபவித்துள்ளர்களாீ அல்லது பார்த்துள்ளர்களாீ என்பைத தயவு ெசய்து எங்களிடம் கூறுங்கள். ெபாருந்தக்கூடிய அைனத்திற்கும் பதில் அளிக்கவும். “அனுபவித்துள்ளர்களாீ ” என்பது உங்களுக்கு நடந்த ஏேதனும் ஒன்ைறக் குறிக்கும். “பார்த்துள்ளர்களாீ ” என்பது பிறர் ஒருவருக்கு நடந்த ஏேதனும் ஒன்ைற நீங்கள் பார்த்தைத அல்லது ேகட்டைதக் குறிக்கும். “இல்ைல” என்பது நிகழ்ைவ நீங்கள் அனுபவிக்கவில்ைல அல்லது பார்க்கவில்ைல என்பைதக் குறிக்கும்.

அனுபவித் பார்த்துள் இல்ைல துள்ேளன் ேளன் 1. உணவு அல்லது சுத்தமானத் தண்ண ீர் இல்லாைம.

2. மருவத்துவப் பராமரிப்பு ெபற இயலாத நிைலயில் உள்ள சுகவனம் ீ .

3. புகலிடம் இல்லாைம.

4. உங்கள் நாட்டுக்குள் இடம்ெபயர்தல்.

5. காவலில் ைவக்கப்படுதல் அல்லது சிைறயில் ைவக்கப்படுதல்.

168

அனுபவித் பார்த்துள் இல்ைல துள்ேளன் ேளன் 5a. எவ்வளவு காலம்? (காலத்தின் அளைவ இங்கு எழுதவும்)

6. தீவிர காயம்.

7. ேபார் அல்லது சண்ைடயிடும் நிைல.

8. குண்டு ெவடிப்புகள்.

9. கண்ணிெவடிகள்.

10. நீங்கள் ஒரு ெபண் என்பதால் மிரட்டப்படுதல் அல்லது அவமதிக்கப்படுதல் அல்லது பாலியல் ரீதியாக தவறாக பயன்படுத்தப்படுதல்.

11. குடும்ப உறுப்பினர்களிடமிருந்து அல்லது மற்றவர்களிடமிருந்து வலுக்கட்டாயமாக தனிைமப்படுத்தப்படுதல்.

12. சாவிற்கு அருகில் இருத்தல்.

169

அனுபவித் பார்த்துள் இல்ைல துள்ேளன் ேளன் 13. குடும்ப உறுப்பினர் அல்லது உங்களுக்குத் ெதரிந்த ஒரு சிலர் படுெகாைல ெசய்யப்படுதல்.

14. உங்களுக்குத் ெதரியாத ஒரு சிலர் படுெகாைல ெசய்யப்படுதல்.

15. காணாமல் ேபாவது அல்லது கடத்தப்படுவது.

16. மூழ்கடித்தல்.

17. மூச்சுத்திணறல்.

18. தைலயில் அடித்தல்.

19. உடலின் பிற பாகங்களில் அடிகள்.

19a. என்ன நடந்தது என்பைத விவரிக்கவும்: (பதிைல இங்ேக எழுதவும்)

20. சுய உணர்வு இழத்தல்.

21. சித்திரவைத.

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அனுபவித் பார்த்துள் இல்ைல துள்ேளன் ேளன் 21a. என்ன நடந்தது என்பைத விவரிக்கவும்:

22. உங்கள் உயிர் அல்லது உங்களுக்கு ெநருக்கமான ஒரு சிலரின் உயிர் ஆபத்தில் உள்ளதாக நீங்கள் எண்ணிய, மிகவும் அச்சுறுத்தல் ஏற்படுத்திய ஏேதனும் பிற சந்தர்ப்பம்.

23. என்ன நடந்தது என்பைத விவரிக்கவும் : (பதிைல இங்ேக எழுதவும்)

171 பகுதி II : தனிமனித விளக்கம்

1) இலங்ைகைய விட்டு நீங்கள் ஏன் ெவளிேயறினர்கள்ீ ?

2) இலங்ைகயில் நீங்கள் அனுபவித்த மிகவும் மனேவதைன ஏற்படுத்திய அல்லது அச்சுறுத்திய நிகழ்வுகைள தயவுெசய்து எங்களுக்குச் ெசால்லுங்கள்.

3) மனேவதைன ஏற்படுத்தும் அல்லது அச்சுறுத்தும் நிகழ்வுகள் என்று எைத நீங்கள் புரிந்து ெகாண்டிருக்கிறர்கள்ீ என்பைத தயவுெசய்து எங்களுக்குச் ெசால்லவும்.

சில சமயங்களில் ேமாசமான அல்லது அச்சுறுத்தும் நிகழ்வுகள் ேவறுபட்ட இடங்களில் நடக்கின்றன, எடுத்துக்காட்டாக அகதிகள் அவர்கள் வடுகளில் ீ இருந்து பிறநாடுகள் வழியாக கனடாவிற்கு ெசல்லும் வழியில்.

172 4) நீங்கள் இலங்ைகைய விட்டு ெவளிேயறிய பின் மற்றும் இந்த நாட்டிற்கு வருவதற்கு முன் உங்களுக்கு ஏற்பட்ட ஏேதனும் ேமாசமான சம்பவங்கள் குறித்து விளக்கவும்:

5) “குடிேயற்றம்” என்பதன் அர்த்தத்ைத நீங்கள் எவ்வாறு புரிந்து ெகாள்கிறர்கள்ீ என்பைத தயவுெசய்து எங்களுக்குச் ெசால்லவும்.

6) உங்களுக்கு தங்க இடமளித்த நாட்டில் குடிேயற்றத்தின் ெவற்றிைய நீங்கள் எவ்வாறு மதிப்பிடுகிறர்கள்ீ ?

7) ஐக்கிய நாடுகள் மற்றும் தங்க இடமளித்த நாடுகளின் ெகாள்ைககள் உங்கள் வாழ்க்ைகயில் எவ்வித தாக்கத்ைத ஏற்படுத்தியுள்ளது என்பைத தயவுெசய்து எங்களுக்குச் ெசால்லவும்.

173

8) இந்த நாட்டிற்கு வந்தது முதல், உங்களுக்கு பின்வரும் ஏேதனும் அனுபவங்கள் இருந்துள்ளதா?

ஆம் இல்ைல 1. உங்களின் அகதிகளுக்கான உரிைம ேகாரிக்ைக குறித்த கவைலகள்.

2. உங்கள் ஆேலாசகர் அல்லது வழக்குைரஞரால் எடுத்துைரக்கப்பட்ட பிரச்சிைனகள்.

3. குைறவான ெபாருளாதார வாய்ப்புகள்.

4. தாய்நாட்டிற்கு அனுப்பப்படலாம் என்ற அச்சங்கள்.

5. உங்கள் விண்ணப்பத்ைத நைடமுைறப்படுத்துவதில் தாமதங்கள்.

6. குடும்பத்திலிருந்து பிரிந்து இருத்தல்/ வட்டு ீ ஞாபகம்.

7. குடும்பம் வட்டிற்கு ீ திரும்பவருதல் குறித்த கவைலகள்.

8. ெமாழி கஷ்டங்கள்.

9. பாகுபாடு.

10. தட்பெவப்பநிைல, உணவு மற்றும் பண்பாடு ஆகியவற்றில் உள்ள ேவறுபாடுகளுக்கு இணங்கிச் ெசல்லுதல்.

174

பகுதி III : எண்ணங்கள் மற்றும் உணர்வுகள்

பின்வருவன, ேமாசமான அல்லது அச்சுறுத்திய நிகழ்வுகைள வாழ்க்ைகயில் அனுபவித்த பின்பு சில சமயங்களில் மக்களுக்கு ஏற்படும் எண்ணங்கள் மற்றும் உணர்வுகள்::

இல்ல சிறிதளவு அைனத்து ேவ ேநரங்களி இல்ைல லும் 1. உங்களுக்கு ஏற்பட்ட மிக ேமாசமான காரியங்கள் குறித்து மீண்டும் மீண்டும் வருகின்ற எண்ணங்கள் அல்லது நிைனவுகள்.

2. அந்த நிகழ்வு மீண்டும் நடப்பது ேபான்ற ஒரு உணர்வு.

3. மீண்டும் மீண்டும் வருகின்ற ேமாசமான கனவுகள்.

4. மக்களிடமிருந்து தனிைமப்படுத்தப்பட்ட அல்லது விலக்கப்பட்ட உணர்வு.

5. உங்கள் இதயம் ெவறுைமயாக இருப்பது ேபான்ற உணர்வு.

6. உரத்தச் சத்தங்கள் அல்லது சீருைடயில் உள்ள நபர்கைளக் கண்டு எளிதில் திடுக்கிடுதல்.

7. கவனம் ெசலுத்துவதில் அல்லது கவனத்ைதக் குவிப்பதில் சிரமம்.

175

இல்ல சிறிதளவு அைனத்து ேவ ேநரங்களி இல்ைல லும்

8. ெதால்ைலகள் நிைறந்த தூக்கம் அல்லது படுக்ைகயில் அதிக ேநரம் இருப்பது.

9. விழிப்பாக இருப்பதாக உணர்தல் அல்லது மக்கள் அல்லது சந்தர்ப்பசூழ்நிைலகள் குறித்து அச்சம் ெகாள்ளுதல்.

10. அச்சுறுத்தும் அல்லது மனேவதைன ஏற்படுத்தும் நிகழ்வுகைள உங்களுக்கு ஞாபகப்படுத்தும் நடவடிக்ைககைளத் தவிர்த்தல்.

11. மிக ேமாசமான நிகழ்வுகள் குறித்து ஞாபகப்படுத்தும் ேபாது திடீெரன உணர்ச்சிபூர்வமான அல்லது உடல்ரீதியான விைளவுகள்.

12. மிக ேமாசமான நிகழ்வுகளின் பகுதிகைள ஞாபகம் ைவத்துக்ெகாள்ள இயலாைம.

13. தினசரி நடவடிக்ைககளில் குைறந்த அளவு ஆர்வம் அல்லது ஈடுபாடு.

14. உங்களுக்கு நம்பிக்ைக இல்லாதது ேபான்று உணர்தல்.

176

இல்ல சிறிதளவு அைனத்து ேவ ேநரங்களி இல்ைல லும்

15. உங்களுக்கு என்ன நடந்தது என்பது குறித்து மக்கள் புரிந்து ெகாள்ளவில்ைல என உணர்தல்.

16. உங்களுக்கு ஏற்பட்ட நிகழ்வுகள் அல்லது நீங்கள் ெசய்த காரியங்களுக்கு உங்கைளேய குற்றம் சாட்டுவது.

17. ஒரு பாதுகாப்பான இடத்ைத அைடந்ததற்காக குற்ற உணர்வு ெகாள்ளுதல்.

18. உங்கள் ஏற்பட்டுள்ள ேமாசமான நிகழ்வுகள் குறித்து அவமானமாக உணர்தல்.

19. ஏன் இைவ உங்களுக்கு ஏற்பட்டுள்ளது என்பது குறித்து சிந்திப்பதில் ேநரம் ெசலவு ெசய்தல்.

20. நீங்கள் உங்கள் மனைத இழந்து ெகாண்டிருப்பது ேபான்று உணர்தல்.

177

இல்ல சிறிதளவு அைனத்து ேவ ேநரங்களி இல்ைல லும் 21. மற்றவர்கள் உங்கைளக் குறித்து ேபசிக்ெகாண்டிருக்கிறார்கள் அல்லது முனங்கிக்ெகாண்டிருக்கிறார்கள் என்பது ேபான்று உணர்தல்.

22. நம்பிக்ைகக்குரிய ஒருவரும் உங்களுக்கு இல்ைல என உணர்தல்.

23. கவைலயாக அல்லது மனஅழுத்தமாக உணர்தல்.

24. நீங்கள் நம்பிய ஒருவர் உங்களுக்கு நம்பிக்ைகத் துேராகம் ெசய்து விட்டதாக உணர்தல்.

178 3. குடிெபயர்ந்த பின் வாழ்க்ைகயில் ஏற்படும் சிரமங்கள் குறித்த வினாவரிைச - தமிழ் வடிவம்

புகலிடம் ேதடி, தங்க இடமளித்த நாடுகளுக்கு வந்தவர்கள் சில சமயங்களில் அனுபவிக்கும் சிரமங்களின் பட்டியல் கீேழ உள்ளது. கடந்த 12 மாதங்களில் கீேழ பட்டியலிடப்பட்டுள்ள ஏேதனும் சிரமங்கள் உங்களுக்கு ஒரு பிரச்சிைனயாக இருந்துள்ளதா?

பிரச்சி சிறிதள மிதமா தீவிரப் மிகவும் ைன வு ன பிரச்சி தீவிரமா இல்ல பிரச்சி அளவு ைன னப் ேவ ைன பிரச்சி பிரச்சி இல்ைல ைன ைன 1. ெதாடர்பு ெகாள்வதில் சிரமங்கள். 2. பாகுபாடு. 3. குடும்பத்திலிருந்து பிரிதல். 4. குடும்பம் வட்டிற்கு ீ திரும்ப வருதல் குறித்த கவைலகள். 5. அவசரநிைலகளில் வட்டிற்கு ீ திரும்ப இயலாைம. 6. பணி ெசய்ய அனுமதி இல்ைல. 7. ேவைல ேதட இயலாைம. 8. ேமாசமான பணிெசய்யும் நிைலகள். 9. தடுப்புக் காவலில் இருத்தல். 10. குடிேயற்றத்தால் நிகழும் ேநர்காணல்கள். 11. உங்கள் விண்ணப்பத்ைத ெசயல்முைறப்படுத்துவதில் தாமதங்கள். 12. குடிேயற்ற அலுவலர்களுடன் முரண்பாடு.

179

பிரச்சி சிறிதள மிதமா தீவிரப் மிகவும் ைன வு ன பிரச்சி தீவிரமா இல்ல பிரச்சி அளவு ைன னப் ேவ ைன பிரச்சி பிரச்சி இல்ைல ைன ைன 13. தாய்நாட்டிற்கு திரும்ப அனுப்பப்படும் அச்சங்கள். 14. உடல்நலப் பிரச்சிைனகளுக்கு சிசிச்ைச கிைடக்காமல் இருப்பது குறித்த கவைலகள். 15. அவசரநிைல மருத்துவப் பராமரிப்பு ெபறுவதில் சிரமம். 16. நீண்ட கால மருத்துவப்பராமரிப்பு ெபறுவதில் சிரமம். 17. பல் பராமரிப்பு ெபறுவதில் சிரமம். 18. கலந்தாய்வு ேசைவகள் ெபறுவதில் சிரமம். 19. நலவாழ்விற்கு சிறிதளேவ அரசு உதவி. 20. நல வாழ்விற்கு ெதாண்டுநிறுவனங்களில் (உ.ம்., ெரட் கிராஸ், ெசயிண்ட். வின்ெசன்ட் ேத பவுல், மற்றும் பல) இருந்து சிறிதளேவ உதவி 21. வறுைம. 22. தனிைம உணர்வு மற்றும் சலிப்புத்தன்ைம. 23. தனித்திருத்தல். 24. நீங்கள் விரும்பும் உணவுகைளப் ெபறுவதில் சிரமம்.

180 4: அறிகுறிகள் சரிபார்க்கும் பட்டியல் - 90R

பின்வருவனவற்றால் நீங்கள் எந்த அளவு மன அழுத்தத்திற்கு உள்ளானர்கள்ீ : (0=இல்லேவ இல்ைல,1=சிறிதளவு,2=மிதமான அளவு, 3=ஒரளவிற்கு, 4=உச்ச பட்சம்)

0 1 2 3 4 1. தைலவலிகள். 2. உள்ளுக்குள் பதட்டம் அல்லது குலுக்கம். 3. உங்கள் மனைத விட்டு அகலாமல் மீண்டும் மீண்டும் வரும் மகிழ்ச்சியற்ற எண்ணங்கள். 4. மயக்கம் அல்லது தைலச்சுற்றல். 5. பாலியல் ஆைச அல்லது இன்பத்ைத இழத்தல். 6. பிறைரக் குறித்து இக்கட்டாக உணர்தல். 7. யாேரனும் ஒருவர் உங்கள் எண்ணங்கைள கட்டுப்படுத்த இயலும் என்ற கருத்து. 8. உங்களின் ெபரும்பாலான பிரச்சிைனக்களுக்கு பிற நபர்கேள காரணம் என உணர்தல். 9. காரியங்கைள ஞாபகம் ைவத்துக் ெகாள்வதில் பிரச்சிைன. 10. ஒழுங்கின்ைம அல்லது கவனக்குைறவு குறித்து கவைலப்படுதல். 11. எளிதாக சினமைடயும் அல்லது எரிச்சலைடயும் உணர்வு. 12. இதயம் அல்லது மார்பு பகுதியில் வலிகள்.

181 0 1 2 3 4 13. திறந்த ெவளிகள் அல்லது ெதருக்களில் பயத்ைத உணர்தல். 14. ஆற்றல் குைறவாக அல்லது ேசார்வாகி விட்டது ேபான்று உணர்தல். 15. உங்கள் வாழ்க்ைகைய முடித்து ெகாள்ளத் ேதான்றும் எண்ணங்கள். 16. மற்ற நபர்களுக்கு ேகட்காத குரல்கைள ேகட்டல். 17. நடுங்குதல். 18. ெபரும்பாலான நபர்கைள நம்ப இயலாது என உணர்தல். 19. குைறந்த அளவு பசி . 20. எளிதாக அழுதல். 21. எதிர் பாலினத்தவரிடம் ெவட்கமாக அல்லது அெசௗகரியமாக உணர்தல். 22. சிக்கிக்ெகாள்வது அல்லது பிடிக்கப்படுவது ேபான்ற உணர்வுகள். 23. ஒரு காரணமும் இல்லாமல் திடீெரனப் அச்சம் ெகாள்ளுதல். 24. உங்களால் கட்டுப்படுத்த இயலாத ெபாறுைமயிழத்தல்கள். 25. உங்கள் வட்ைட ீ விட்டு ெவளிேய ெசல்ல பயமாக உணர்தல். 26. நிகழ்வுகளுக்கு உங்கைள நீங்கேள குற்றம் சாற்றுவது. 27. பின்புறத்தில் கீழ்ப்பகுதியில் வலிகள்.

182 0 1 2 3 4 28. காரியங்கள் நடப்பது தைடபட்டதாக உணர்தல். 29. தனிைமயாக உணர்தல். 30. மனத்தளர்ச்சியாக உணர்தல். 31. காரியங்கள் குறித்து மிக அதிகமாக கவைலப்படுதல். 32. காரியங்களில் ஆர்வம் இல்லாதது ேபான்று உணர்தல். 33. அச்சமாக உணர்தல். 34. உங்கள் உணர்வுகள் எளிதில் காயப்படுத்தப்படுகின்றன. 35. உங்களின் அந்தரங்கள் எண்ணங்கள் குறித்து பிற நபர்கள் அறிந்துள்ளனர். 36. பிற நபர்கள் உங்கைள புரிந்து ெகாள்ளவில்ைல அல்லது உங்களிடம் இரக்கமில்லாமல் உள்ளனர் என உணர்தல். 37. மக்கள் நட்புத்தன்ைமயுடன் இல்ைல அல்லது அவர்கள் உங்கைள ெவறுக்கிறார்கள் என உணர்தல். 38. சரியானத் தன்ைமக்கு உத்திரவாதம் அளிக்க காரியங்கைள ெமதுவாக ெசய்தல். 39. இதயம் படபடெவன்று அல்லது ேவகமாக அடித்தல். 40. குமட்டல் அல்லது வயிற்றுக் ேகாளாறு. 41. பிறைரக் காட்டிலும் தாழ்வாக உணர்வதால்.

183 0 1 2 3 4 42. உங்கள் தைசகளில் வலி. 43. நீங்கள் மற்றவர்களால் கண்காணிக்கப்படுகிறர்கள்ீ அல்லது மற்றவர்கள் உங்கைளப்பற்றி ேபசுகிறார்கள் என உணர்தல். 44. ஆழ்ந்து உறங்குவதில் பிரச்சிைன. 45. நீங்கள் ெசய்வைத சரிபார்த்தல் அல்லது இரண்டு முைற சரிபார்த்தல். 46. முடிவுகள் எடுப்பதில் சிரமம். 47. ேபருந்துகள், சுரங்கப்பாைதகள் அல்லது ெரயில்கள் ஆகியவற்றில் பயணம் ெசய்ய பயமாக உணர்தல். 48. சுவாசம் ெபறுவதில் பிரச்சிைன. 49. ெவப்பமான அல்லது குளிரான காலங்கள். 50. உங்கைள அச்சுறுத்துகிறது என்பதற்காக சில காரியங்கள், இடங்கள், நடவடிக்ைககள் ஆகியவற்ைறத் தவிர்த்தல். 51. உங்கள் மனது ெவறுைமயாகுதல். 52. உங்கள் உடல்பாகங்களில் மரத்துப்ேபாதல் அல்லது சிலிர்த்தல். 53. உங்கள் ெதாண்ைடயில் ஒரு திரள். 54. உங்கள் உடல் பாகங்களில் பலவனத்ைதீ உணர்தல். 55. கவனம் ெசலுத்துவதில் பிரச்சிைன.

184 0 1 2 3 4 56. உங்கள் உடல் பாகங்களில் பலவனத்ைதீ உணர்தல். 57. இறுக்கமாக அல்லது சாவி ெகாடுத்தது ேபான்று உணர்தல். 58. உங்கள் கரங்கள் அல்லது கால்களில் கனமான உணர்வுகள். 59. சாவு அல்லது இறத்தல் குறித்த எண்ணங்கள். 60. அதிகமாக சாப்பிடுதல். 61. மக்கள் உங்கைளப் பார்த்துக்ெகாண்டிருக்கும் ேபாது அல்லது உங்கைளப் பற்றிப் ேபசும் ேபாது அெசௗகரியமாக உணர்தல். 62. உங்களுக்குச் ெசாந்தமில்லாத எண்ணங்கள் வருதல். 63. ஒரு சிலைர அடிப்பதற்கான, காயப்படுத்துவதற்கான அல்லது அவருக்கு தீங்கு விைளவிப்பதற்கான உந்துதல்கள். 64. அதிகாைலயில் விழித்தல். 65. ெதாடுதல்,எண்ணுதல் அல்லது கழுவுதல் ேபான்ற ெசயல்கைள திரும்பச் ெசய்தல். 66. அைமதியற்ற அல்லது ெதாந்தரவு நிைறந்த தூக்கம். 67. ெபாருட்கைள உைடக்க அல்லது தூள்தூளாக்க ேவண்டுெமன்ற உந்துதல்கள்.

185 0 1 2 3 4 68. மற்றவர்கள் பகிர்ந்து ெகாள்ளமாட்டார்கள் என்ற கருத்துக்கைள அல்லது நம்பிக்ைககைள ெகாண்டிருத்தல். 69. மற்றவர்களுடன் இருக்கும்ேபாது மிகவும் சுய உணர்வுடன் இருத்தல். 70. வணிக ைமயங்கள் அல்லது திைரப்படம் ேபான்ற கூட்டங்களில் அெசௗகரியமாக உணர்தல். 71. எல்லாேம ஒரு முயற்சி என உணர்தல். 72. வன்முைற அல்லது பீதி ஏற்படுத்தும் காலங்கள். 73. ெபாதுஇடத்தில் சாப்பிடுவது அல்லது பருகுவது குறித்து அெசௗகரியமாக உணர்தல். 74. அடிக்கடி விவாதங்களில் ஈடுபடுதல். 75. நீங்கள் தனித்து விடப்படும் ேபாது பதட்டமாக உணர்தல். 76. உங்கள் சாதைனகளுக்கு மற்றவர்கள் சரியான பாரட்டுகைள அளிக்காமல் இருப்பது. 77. நீங்கள் மக்கேளாடு இருக்கும்ேபாேத தனிைமயாக உணர்வது. 78. அைசவில்லாமல் உட்கார கூட இயலாமல் மிகவும் அைமதியின்றி உணர்தல். 79. பயனற்ற உணர்வுகள்.

186 0 1 2 3 4 80. ேமாசமான ஒன்று உங்களுக்கு நடக்கப்ேபாகிறது என்ற உணர்வு. 81. சத்தம்ேபாடுதல் அல்லது ெபாருட்கைள தூற வசி ீ எறிதல். 82. ெபாது இடத்தில் நீங்கள் மயக்கமைடந்து விடுவர்கள்ீ என்ற பயத்ைத உணர்தல். 83. நீங்கள் அனுமதித்தால் மக்கள் உங்கைள அளவுக்கதிகமாக பயன்படுத்திக் ெகாள்வார்கள் என்ற உணர்வு. 84. உங்களுக்கு அதிக ெதால்ைலெகாடுக்கும் பாலியல் எண்ணங்கள். 85. உங்கள் பாவங்களுக்காக நீங்கள் தண்டிக்கப்பட ேவண்டும் என்ற கருத்து. 86. அச்சுறுத்தும் வைகயிலான எண்ணங்கள் அல்லது உருவங்கள். 87. உங்கள் உடலில் ஆபத்து உண்டாக்கும் வைகயில் எேதா ஒன்று தவறாக உள்ளது என்னும் கருத்து. 88. மற்ெறாரு நபருடன் ஒருேபாதும் ெநருக்கமாக உணராமல் ேபாதல். 89. குற்ற உணர்வுகள். 90. உங்கள் மனதில் ஏேதா ஒன்று தவறாக இருக்கிறது என்னும் கருத்து.

5: பங்ேகற்பாளர்களுக்கான ேகள்விேகட்கும் எழுத்துப் படிவம்

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அளிக்கிேறன். உங்களுக்கு ஏேதனும் ேகள்விகள் இருந்தால் தயவுெசய்து

தயக்கமின்றி என்ைனத் ெதாடர்பு ெகாள்ளவும்.

நீங்கள் ெசலவளித்த ேநரம் மற்றும் உங்களின் சிந்தைன ஆக்கங்கள் ஆகியைவ பாராட்டுக்குரியது. உங்கள் புதிய வ ீட்டில் உங்களின் நலவாழ்விற்கு திட்ட அணி தனது வாழ்த்துக்கைளத் ெதரிவித்துக்ெகாள்கிறது.

188 APPENDIX B: FLYER

Refugee Migration Research

• Are you a Tamil refugee from Sri Lanka? • Have you been living in Chennai, India or Toronto, Canada for at least 12 months? • Are you 18 years of age or older? • Would you be willing to discuss your experiences in a confidential research interview?

This Refugee Migration research study, being conducted by a Doctoral candidate at the University of Toronto, is seeking individuals to help understand the migration and settlement experiences of refugees. We are hoping that knowledge gained will be used to provide effective services to meet refugee needs.

If you are interested in participating, please contact the researcher at: 905- 737-6963 (Toronto)/044-5378145 (Chennai). All communication will be confidential. Please leave a message indicating your interest to participate, and provide your first name and where/when you may be contacted.

Participants will be compensated $20.00/200.00 rupees for their time.

189 அகதியின் குடிெபயர்தல் குறித்த ஆராய்ச்சி

• நீங்கள் இலங்ைகயிலிருந்து வந்த தமிழ் அகதியா? • நீங்கள் ெசன்ைன, இந்தியா அல்லது ெடாேராண்ேடா, கனடாவில் 12 மாதங்கள் அல்லது அதற்கு ேமல் வசித்திருந்து இருக்கிறர்களாீ ? • நீங்கள் 18 வயதுைடயவரா அல்லது அதற்கு ேமல் வயதுைடயவரா? • உங்கள் அனுபவங்கள் குறித்து ஒரு தனியான ஆராய்ச்சி ேநர்காணலில் ேபசுவதற்கு நீங்கள் ஆர்வமாக உள்ளர்களாீ ?

அகதியின் குடிெபயர்தல் மீதான இந்த ஆராய்ச்சி ஆய்வானது அகதிகளின் குடிெபயர்தல் மற்றும் குடிேயற்ற அனுபவங்கைள அறிந்து ெகாள்ள உதவி ெசய்யும் நபர்கைளத் ேதடிக் ெகாண்டிருக்கிறது. இதன் மூலம் நாம் ெபறும் அறிவானது அகதிகளின் ேதைவகைளப் பூர்த்தி ெசய்யக்கூடிய சிறந்த ேசைவகைள அளிக்கப் பயன்படும் என நம்பப்படுகிறது.

இந்த ஆய்வில் பங்குெபற நீங்கள் ஆர்வத்துடன் இருந்தால் தயவுெசய்து 905- 737-6963 (ெடாேராண்ேடா) என்பதில் என்ைன அைழக்கவும். அைனத்துத் ெதாடர்புகளும் அந்தரங்கமாக ைவக்கப்படும். 190 பங்ெகடுப்பதற்கான உங்கள் ஆர்வம் குறித்த ஒரு தகவைல தயவு ெசய்து அளித்துவிட்டுச் ெசல்லவும் மற்றும் உங்கள் ெபயர் மற்றும் நான் உங்கைள எங்ேக/எப்ேபாது ெதாடர்பு ெகாள்ள இயலும் என்பனவற்ைறயும் அளிக்கவும்.

பங்குெபறுபவர்கள் ேநரம் ெசலவளிப்பதற்காக அவர்களுக்கு நன்றி ெசலுத்தும் வைகயில் $20.00/200.00 ரூபாய் அளிக்கப்படும்.

191

APPENDIX C: INFORMATION SHEET FOR PARTICIPANT

November 1, 2008

TITLE OF STUDY: The Impact of Refugee Migration Traumatic Events on Psychological Distress

PRINCIPAL INVESTIGATOR: Miriam M. George M.S.W., R.S.W. Ph.D Candidate Factor-Inwentash Faculty of Social Work University of Toronto Phone: (905) 737-6963 (Toronto) (044) 5378145 (Chennai) E-Mail: [email protected]

RESEARCH SUPERVISOR: Prof. Ramona Alaggia M.S.W., Ph.D Associate Professor Factor-Inwentash Faculty of Social Work University of Toronto Phone: (416) 978-1923

192 E-Mail: [email protected]

PURPOSE OF THIS STUDY?

The purpose of this study is to examine how refugees experience migration to a new country, the impact of their experiences before and after migration and the levels of psychological distress different individuals’ experience.

WHAT HAPPENS IN THIS STUDY?

You can decide if you want to participate in this study. If you decide not to participate in the study, you can withdraw anytime even after you sign the consent form. If you choose to participate in the study, you should contact the researcher at: 905- 737-69639 (Toronto)/044-5378145 (Chennai). The researcher will contact interested individuals to explain and select potential participants for the study. The researcher will arrange a mutually agreeable time and place for potential participants to sign the consent form and be interviewed.

Toronto participants will be interviewed at the faculty of social work and Chennai participants will be interviewed in AASHA counselling centre. Participation in this study involves providing personal information and answering three questionnaires during an interview session, scheduled based on your availability. In recognition of your time commitment, I will provide Canadian participants with a $20.00 reimbursement, and 200.00 rupees for participants from India.

PARTICIPATION IN THIS STUDY IS FULLY VOLUNTARY

It is your choice to participate in this study. If you choose not to participate, your services will not be affected. Even though you sign the consent form, you are free to withdraw from the study at any time without any negative results. You can decide to withdraw from the study at any time, and any information collected about you will be destroyed.

IS THIS CONFIDENTIAL?

Any information that you give to the researcher kept in secret and will only be seen by the principal investigator and her committee members. The questionnaires will be stored inside a locked cabinet at the Faculty of Social Work, University of Toronto, and will be destroyed at the end of the study. The researcher will use numerical codes in place of real names for all information, and all information that identifies the participant will be destroyed after entering the data for analysis. Privacy will be maintained except in the following situations: 1) Intention of harm to self; 2) Intention of harm to others; 3) Information regarding child abuse. The researcher is obligated by law to report any of these circumstances and intervene.

WILL THERE BE ANY BENEFITS?

There are no direct benefits for the participants. However, you will have the opportunity to share your experiences which helps others in the same situation.

WILL THERE BE ANY RISKS?

This study may be upsetting for some of you because it requires talking about your personal experiences. If this is the case, please discuss your concerns with the researcher and follow-up counselling will be arranged as needed. For example, the Canadian Centre for Victims of Torture in Toronto, Canada and AASHA counselling centre in Chennai, India have agreed to provide follow-up if required.

Researcher has a crisis procedure. If there is an emergency in Chennai, researcher will contact counselling staff at the AASHA for immediate assistance, and will take to hospital emergency if there is a need. If there

193 is an emergency in Toronto, researcher will contact 911 for immediate assistance, and will take to college site emergency department of Centre for Addiction and Mental Health for assistance. The researcher is also an experienced clinician to arrange referral call based on participants answers during the interview. If participants feel very disturbed, they can discuss their concerns with the researcher, and follow-up counselling will be arranged as needed. For example, the Canadian Centre for Victims of Torture in Toronto, Canada and AASHA in Chennai, India have agreed to provide follow-up intervention if required

HOW DO I FIND OUT THE RESULTS OF THE STUDY?

If you would like to receive a copy of the research report you can contact the researcher, who will mail the report to participants to their given contact address.

WHO DO I CONTACT IF I HAVE QUESTIONS OR CONCERNS?

Miriam M. George M.S.W.; R.S.W. Prof. Ramona Alaggia M.S.W; Ph.D Phone: (905) 737-6963 (Toronto) Phone: (416) 978-1923 (044) 5378145 (Chennai) E-mail: [email protected] E-mail: [email protected]

Jill Parson Research Ethics Officer Health Sciences Phone: (416) 946-5806 E-mail: [email protected]

பங்ேகற்பாளருக்கானத் தகவல் தாள் க்ேடாபர்1,2008

ஆய்வுத் தைலப்பு: மனத்துயரத்தின் மீது அகதியின் குடிெபயர்தல் ெதாடர்பான ேபரதிர்ச்சி நிகழ்வுகளின் தாக்கம்

முதன்ைம ஆய்வாளார்: மிரியம் எம்.ஜார்ஜ் எம்.எஸ்.டபிள்யூ., ஆர்.எஸ்.டபிள்யூ. பிஎச் டி ேதர்வு எழுதுபவர் சமூகப் பணி கல்விப்பிரிவு ெடாேராண்ேடா பல்கைலக்கழகம் ெதாைலேபசி: (905) 737-6963 (ெடாேராண்ேடா) மின்னஞ்சல்: [email protected]

ஆராய்ச்சி ேமற்பார்ைவயாளர்: ேபராசிரியர்.ரேமானா அலாக்கியா எம்.எஸ்.டபிள்யூ., பிஎச்.டி இைணப் ேபராசிரியர் 194 சமூகப் பணி கல்விப் பிரிவு ெடாேராண்ேடா பல்கைலக்கழகம் ெதாைலேபசி : (416) 978-1923 மின்னஞ்சல் : [email protected] இந்த ஆய்வின் ேநாக்கம்?

ஒரு புதிய நாட்டிற்கு இடம் ெபயர்ந்து ெசல்லுதைல அகதிகள் எவ்வாறு ைகயாளுகிறார்கள், இடம்ெபயர்தலுக்கு முன் மற்றும் பின் அவர்களது அனுபவங்களின் விைளவுகள் மற்றும் ேவறுபட்ட அகதிகள் அனுபவிக்கும் பிரச்சிைனகள் ஆகியவற்ைற ேசாதைன ெசய்வேத இந்த ஆய்வின் ேநாக்கம் ஆகும்.

இந்த ஆய்வில் என்ன நடக்கிறது?

இந்த ஆய்வில் பங்ெகடுக்க ேவண்டுமா என்பது குறித்து நீங்கள் தான் முடிவு ெசய்ய ேவண்டும். இந்த ஆய்வில் நீங்கள் பங்குெபற முடிவு ெசய்தால், நீங்கள் ஆராய்ச்சியாளைர 905-737-6963 (ெடாேராண்ேடா) என்பதில் ெதாடர்பு ெகாள்ள ேவண்டும். ஆராய்ச்சியாளர் ஆர்வமுள்ள நபர்கைள ெதாடர்பு ெகாள்வார் மற்றும் ஆய்வுக்கான பங்ேகற்பாளர்கைள ேதர்ந்ெதடுப்பார் . ேதர்வு ெசய்யப்பட்ட பங்ேகற்பாளர்கள் ஒப்புதல் படிவத்தில் ைகெயழுத்திடவும் , ேநர்காணல் ெசய்யப்படவும் அவர்களுக்கு வசதியான ேநரம் மற்றும் இடத்ைத ஆராய்ச்சியாளர் ஏற்பாடு ெசய்வார். இந்த ஆய்வில் பங்ெகடுக்க ேவண்டாம் என்று நீங்கள் முடிவு ெசய்தால், ஒப்புதல் படிவத்தில் ைகெயழுத்திட்ட பிறகும் கூட எந்த ேநரத்திலும் நீங்கள் விலகிக்ெகாள்ளலாம்.

ேநர்காணல் அமர்வின்ேபாது சில தனிப்பட்ட தகவல்கைள அளிக்குமாறும், மூன்று வினாவரிைசகளுக்கு பதில் அளிக்குமாறும் பங்ேகற்பாளர்கள் ேகட்டுக்ெகாள்ளப்படுவார்கள் . உங்களின் ேநரத்ைத ஒதுக்கியதற்கு நன்றி ெசலுத்தும் வைகயில் , கனடா பங்ேகற்பாளர்களுக்கு $20.00 ம் இந்தியாவில் இருந்து வந்த பங்ேகற்பாளர்களுக்கு ரூபாய் 200.00 ம் நான் பணமாக அளிப்ேபன்.

இந்த ஆய்வில் பங்ேகற்பது முற்றிலும் தன்னார்வமானது

இந்த ஆய்வில் பங்ேகற்பது உங்களின் விருப்பம் ஆகும். பங்ேகற்க ேவண்டாம் என நீங்கள் முடிவு ெசய்தால் உங்களுக்கானச் ேசைவகள் பாதிக்கப்படாது. ஒப்புதல் படிவத்தில் ைகெயழுத்திட்ட பின்பு கூட எந்த ஒரு பிரச்சிைனையயும் சந்திக்காமல் எந்த ேநரத்திலும் இந்த ஆய்விலிருந்து நீங்கள் சுதந்திரமாக விலகிக்ெகாள்ளலாம். உங்கைளப் பற்றி ேசகரிக்கப்பட்ட அைனத்து தகவலும் அழிக்கப்படும்.

195 இது இரகசியமானதா?

ஆராய்ச்சியாளரிடம் நீங்கள் அளிக்கும் எந்தத் தகவலும் அந்தரங்கமாக ைவக்கப்படும் மற்றும் அது முதன்ைம ஆய்வாளர் மற்றும் அவரின் ேமற்பார்ைவயாளர்கள் ஆகிேயாரால் மட்டுேம பார்க்கப்படும். வினாவரிைசகள் ெடாராண்ேடா பல்கைலக்கழகத்தின் சமூகப் பணி கல்விப் பிரிவில் உள்ள பூட்டப்பட்ட ெபட்டியினுள் ேசமிக்கப்படும் மற்றும் இது ஆய்வின் முடிவில் அழிக்கப்படும். பின் வரும் சந்தர்ப்பங்கைளத் தவிர மற்ற ேநரங்களில் அந்தரங்கம் ெதாடர்ந்து காக்கப்படும்: 1) உங்களுக்கு தீங்கு ஏற்படுத்தும் ேநாக்கம்; 2)பிறருக்கு தீங்கு ஏற்படுத்தும் ேநாக்கம்; 3) குழந்ைதகைள தவறாகப் பயன்படுத்துதல் குறித்த தகவல். இது ேபான்ற ஏதாவது சந்தர்ப்பசூழ்நிைலகள் குறித்து அறிக்ைகயிட ேவண்டும் மற்றும் அதில் தைலயிடேவண்டும் என ஆராய்ச்சியாளர் சட்டத்தால் ேகட்டுக்ெகாள்ளப்படுகிறார்.

எதாவது பயன்கள் இருக்கிறதா? இந்த ஆய்வில் பங்ேகற்பதால் ேநரடியான பயன்கள் எதுவுமில்ைல ஆனால், உங்கள் அனுபவங்கைள பகிர்ந்து ெகாள்ள உங்களுக்கு ஒரு வாய்ப்பு கிைடக்கும் மற்றும் இது இேத சூழ்நிைலகளில் உள்ள மற்றவர்களுக்கு உதவி ெசய்யக்கூடும்.

ஏேதனும் ஆபத்துக்கள் உள்ளனவா?

இந்த ஆய்வு உங்களில் சிலருக்கு வருத்தம் அளிக்கக்கூடியதாக இருக்கலாம். இது ேபான்ற நிகழ்வுகளில் உங்கள் கரிசனங்கள் குறித்து தயவுெசய்து ஆராய்ச்சியாளரிடம் கலந்தாேலாசைன ெசய்யுங்கள் மற்றும் ேதைவக்ேகற்றவாறு பின் ெதாடர் – கலந்தாய்வுகள் ஏற்பாடு ெசய்யப்படும்.

ஆராய்ச்சியாளர் ஒரு அனுபவம் மிக்க சிகிச்ைச மருத்துவர் ஆவார். ேநர்காணல் மற்றும் ேகள்விகள் ேகட்கும் காலத்தில், பங்ேகற்பாளர்கள் அளிக்கும் பதில்களின் அடிப்பைடயில் உதவிகளின் ேதைவைய அவரால் மதிப்பிட இயலும். ேநர்காணலின் ேபாது ஒரு பங்ேகற்பாளர் உச்ச பட்சமான ெதால்ைலக்கு உட்பட்டால் அவர், அவருைடய கவைலகள் குறித்து ஆராய்ச்சியாளரிடம் கலந்தாேலாசிக்கலாம் மற்றும் ேதைவப்படும் பின்-ெதாடர் கலந்தாய்வுகளுக்கு ஏற்பாடு ெசய்யப்படும்.

ஆய்வின் முடிவுகைள நான் எவ்வாறு கண்டறிவது?

ஆராய்ச்சி அறிக்ைகயின் ஒரு நகைல ெபற விரும்பினால், நீங்கள் ஆராய்ச்சியாளைர ெதாடர்பு ெகாள்ளலாம். அவர் ெகாடுக்கப்பட்டுள்ள பங்ேகற்பாளர்களின் முகவரிக்கு அறிக்ைகைய அஞ்சல் ெசய்வார்.

196 ேகள்விகள் அல்லது கவைலகள் இருந்தால் யாைர நான் ெதாடர்பு ெகாள்ள ேவண்டும்?

மிரியம் எம். ஜார்ஜ் எம்.எஸ்.டபிள்யூ.; ேபராசிரியர். ரேமானா அலாக்கியா ஆர்.எஸ்.டபிள்யூ. எம்.எஸ்.டபிள்யூ; பிஎச்.டி ெதாைலேபசி: (905) 737-6963 (ெடாேராண்ேடா) ெதாைலேபசி: (416) 978-1923 மின்னஞ்சல்: [email protected] மின்னஞ்சல்: [email protected]

ஜில் பார்சன் ஆராய்ச்சி நன்ெனறி அலுவலர் உடல் நல அறிவியல் ெதாைலேபசி: (416) 946-5806 மின்னஞ்சல்: [email protected]

197 APPENDIX D: TELEPHONE SCREEN INTERVIEW GUIDE

Thank you for your interest in this research study. Before we can confirm your participation, I would like to ask you some questions to ensure your eligibility for the study. I would also like to give you an opportunity to ask any questions related to study.

Points to Cover

• Purpose of the study: The purpose of this study is to examine how refugees experience migration to a new country, the impact of events before and after migration and the levels of distress different individual’s experience. • Age: Are you 18 of age or older? • Country of origin: Are you coming from Sri Lanka? • Arrival period: How long have you been in India or Canada? • Family participation: Are you aware of any of your family members participating in this study? • Procedure: If you are eligible for participation in this study, the interviewer will contact you to sign the consent form and be interviewed. The interview includes four sections – the first collecting personal information, followed by three questionnaires. The entire interview will take approximately 2 hours and will be conducted in a mutually acceptable location. In recognition of your time commitment, I will provide Canadian participants with a $20.00 reimbursement, and 200.00 rupees for participants from India. It is your choice to participate in this study. If you choose not to participate, your services will not be affected. Even though you sign the consent form, you are free to withdraw from the study at any time without any negative consequences. • Safety: Prior to participation in the study, the interviewer will ensure that you understand the study procedures, any risks or benefits of participation, and your rights as a voluntary participant. • Privacy: Any information that participants give to the researcher in this study is confidential and will only be seen by principal investigator and my doctoral dissertation committee. The questionnaires will be stored inside the locked cabinet at the Faculty of Social work, University of Toronto. Researcher will use numerical codes in place of real names for all information, and all information that identifies the participant will be destroyed before entering the data for analysis. Encrypted data will be stored at the locked cabinet at the Faculty of Social work, University of Toronto for 6 years following the study. Confidentiality will be maintained except in the following situations: 1) Intention of harm to self; 2) Intention of harm to others; 3) Information regarding child abuse. The researcher is obligated by law to report any of these circumstances and intervene. • Honorariums: You will receive $20 CDN or 200.00 Indian rupees in recognition of your time.

198 • Participation interest: Do you believe you will feel comfortable discussing your migration events with a researcher? • Counselling: You may find that this study upsets you because we are asking about difficult and stressful experiences. If this happens, please discuss your concerns with the researcher. If you are interested, researcher will arrange counselling follow- up at your request. • Crisis procedure: Researcher has a crisis procedure. If there is an emergency in Chennai, researcher will contact counselling staff at the AASHA for immediate assistance, and will take to hospital emergency if there is a need. If there is an emergency in Toronto, researcher will contact 911 for immediate assistance, and will take to college site emergency department of Centre for Addiction and Mental Health for assistance. The researcher is also an experienced clinician to make a judgment call based on their answers during the interview as well as during the debriefing period. If participants feel extremely disturbed, they can discuss their concerns with the researcher, and follow-up counselling will be arranged as needed. For example, the Canadian Centre for Victims of Torture in Toronto, Canada and The Banyan in Chennai, India have agreed to provide follow-up intervention if required • Time: Can you comfortably participate in an approximately 2-hour interview? • Further questions: Are there any questions that I can answer for you about the study?

199 APPENDIX E: CONSENT FORM FOR PARTICIPANTS

November 1, 2008

Title of Research Project: The Impact of Refugee Migration Traumatic Events on Psychological Distress

Investigator: Miriam M. George M.S.W., R.S.W. (905) 737-6963 (Toronto) / (044) 5378145 (Chennai)

Purpose of the Research

The purpose of this study is to examine how refugees experience migration to a new country, the impact of their experiences before and after migration and the levels of psychological distress different individuals’ experience.

Description of the Research

You can decide if you want to participate in this study. If you decide not to participate in the study, you can withdraw anytime even after you sign the consent form. If you choose to participate in the study, you should contact the researcher at: 905- 737-69639 (Toronto)/044-5378145 (Chennai). The researcher will contact interested individuals to explain and select potential participants for the study. The researcher will arrange a mutually agreeable time and place for potential participants to sign the consent form and be interviewed.

Toronto participants will be interviewed at the faculty of social work and Chennai participants will be interviewed in AASHA counselling centre. Participation in this study involves providing personal information and answering three questionnaires during an interview session, scheduled based on your availability. In recognition of your time commitment, I will provide Canadian participants with a $20.00 reimbursement, and 200.00 rupees for participants from India.

Potential Benefits and Risks

There are no direct benefits for the participants. However, you will have the opportunity to share your experiences that are helping others in the same situation.

This study may be upsetting for some of you because it requires talking about your personal experiences. If this is the case, please discuss your concerns with the researcher and follow-up counselling will be arranged as needed. For example, the Canadian Centre for Victims of Torture in Toronto, Canada and AASHA Counselling Centre in Chennai, India have agreed to provide follow-up intervention if required. If participants who are concerned about stigmatization by their community, they can chose not to participate in this study.

Confidentiality Any information that you provide to the researcher in this study is confidential and will only be seen by the principal investigator and her committee members. The questionnaires will be stored inside a locked cabinet at the Faculty of Social Work, University of Toronto, and will be destroyed at the end of the study. The researcher will use numerical codes in place of real names for all information, and all information that identifies the participant will be destroyed after entering the data for analysis. Privacy will be maintained, except in the following situations: 1) Intention of harm to self; 2) Intention of harm to others; 3) Information regarding child abuse. The researcher is obligated by law to report any of these circumstances and intervene.

200 Participation Participation in this study is fully voluntary. It is your choice to participate in this study. If you choose not to participate, your services will not be affected. Even though you sign the consent form, you are free to withdraw from the study at any time without any negative consequences. If you decide to withdraw from the study at any time, any information collected about you will be destroyed.

Contact Information

If you have any complaints or concerns about how you have been treated as a research participant, please contact :

Prof. Ramona Alaggia M.S.W; Ph.D Phone: (416) 978-1923 E-mail: [email protected]

Jill Parson Research Ethics Officer Health Sciences Phone: (416) 946-5806 E-mail: [email protected]

Please provide your name and signature in the space provided below to indicate your consent:

PARTICIPATION CONSENT

I hereby consent to participate in this research study.

……………………………… ……………………………… Name of participant Signature of participant

……………………………… ……………………………… Name of witness Signature of witness

201 பங்ேகற்பாளர்களுக்கான ஒப்புதல் படிவம்

அக்ேடாபர், 1, 2008

ஆராய்ச்சித் திட்டத்தின் தைலப்பு: மனத்துயரத்தின் மீது அகதியின் குடிேயற்றம் ெதாடர்பான ேபரதிர்ச்சி நிகழ்வுகளின் தாக்கம்

ஆய்வாளர்: மிரியம் எம். ஜார்ஜ் எம்.எஸ்.டபிள்யூ., ஆர்.எஸ்.டபிள்யூ .

இந்த ஆய்வின் ேநாக்கம்

ஒரு புதிய நாட்டிற்கு இடம் ெபயர்ந்து ெசல்லுதைல அகதிகள் எவ்வாறு ைகயாளுகிறார்கள், இடம்ெபயர்தலுக்கு முன் மற்றும் பின் அவர்களது அனுபவங்களின் விைளவுகள் மற்றும் அகதிகள் அனுபவிக்கும் பிரச்சிைனகள் ஆகியவற்ைற புரிந்து ெகாள்வேத இந்த ஆய்வின் ேநாக்கம் ஆகும்.

ஆராய்ச்சியின் விளக்கம்

இந்த ஆய்வில் பங்ெகடுக்க ேவண்டுமா என்பது குறித்து நீங்கேள முடிவு ெசய்யலாம். இந்த ஆய்வில் பங்ெகடுக்க ேவண்டாம் என நீங்கள் முடிவு ெசய்தால், ஒப்புதல் படிவத்தில் ைகெயழுத்திட்ட பின்பு கூட எந்த ேநரத்திலும் இந்த ஆய்விலிருந்து நீங்கள் விலகிக்ெகாள்ளலாம். இந்த ஆய்வில் நீங்கள் பங்குெபற முடிவு ெசய்தால் நீங்கள் ஆராய்ச்சியாளைர 905-737-6963 (ெடாேராண்ேடா) என்பதில் ெதாடர்பு ெகாள்ள ேவண்டும். விளக்கம் அளிப்பதற்காக ஆராய்ச்சியாளர் ஆர்வமுள்ள நபர்கைள ெதாடர்பு ெகாள்வார் மற்றும் ஆய்வுக்குத் தகுதியான பங்ேகற்பாளர்கைள ேதர்ந்ெதடுப்பார். தகுதியுள்ள பங்ேகற்பாளர்கள் ஒப்புதல் படிவத்தில் ைகெயழுத்திடவும் , ேநர்காணல் ெசய்யப்படவும் வசதியான ேநரம் மற்றும் இடத்ைத ஆராய்ச்சியாளர் ஏற்பாடு ெசய்வார்.

ேநர்காணல் அமர்வின்ேபாது சில தனிப்பட்ட தகவல்கள் அளிக்குமாறும் பின்னர் மூன்று வினாவரிைசகளுக்கு பதில் அளிக்குமாறும் பங்ேகற்பாளர்கள் ேகட்டுக்ெகாள்ளப்படுவார்கள். உங்களின் ேநரத்ைத ஒதுக்கியதற்கு நன்றி ெசலுத்தும் வைகயில் , கனடா பங்ேகற்பாளர்களுக்கு $20.00 ம் இந்தியாவில் இருந்து வந்த பங்ேகற்பாளர்களுக்கு ரூபாய் 200.00 ம் நான் பணமாக அளிப்ேபன்.

202 நிைலயானப் பயன்கள் மற்றும் ஆபத்துக்கள்

இந்த ஆய்வில் பங்ேகற்பதால் ேநரடியான பயன்கள் எதுவுமில்ைல ஆனால், உங்கள் அனுபவங்கைள பகிர்ந்து ெகாள்ள உங்களுக்கு ஒரு வாய்ப்பு கிைடக்கும் மற்றும் இது இேத சூழ்நிைலகளில் உள்ள மற்றவர்களுக்கு உதவி ெசய்யக்கூடும்.

ஆராய்ச்சியாளர் ஒரு அனுபவம் மிக்க சிகிச்ைச மருத்துவர் ஆவார். ேநர்காணல் மற்றும் ேகள்விகள் ேகட்கும் காலத்தில் பங்ேகற்பாளர்கள் அளிக்கும் பதில்களின் அடிப்பைடயில் உதவிகளின் ேதைவைய அவரால் மதிப்பிட இயலும். ேநர்காணலின் ேபாது ஒரு பங்ேகற்பாளர் உச்ச பட்சமான ெதால்ைலக்கு உட்பட்டால் அவர் அவருைடய கவைலகள் குறித்து ஆராய்ச்சியாளரிடம் கலந்தாேலாசிக்கலாம் மற்றும் ேதைவப்படும் பின்-ெதாடர் கலந்தாய்வுகளுக்கு ஏற்பாடு ெசய்யப்படும்.

இரகசியத்தன்ைம

இந்த ஆய்வில் ஆராய்ச்சியாளரிடம் நீங்கள் அளிக்கும் எந்த ஒரு தகவலும் அந்தரங்கமாக ைவக்கப்படும் மற்றும் அது முதன்ைம ஆய்வாளர் மற்றும் அவரின் ேமற்பார்ைவயாளர்கள் ஆகிேயாரால் மட்டுேம பார்க்கப்படும். வினாவரிைசகள் ெடாராண்ேடா பல்கைலக்கழகத்தின் சமூகப் பணி கல்விப் பிரிவில் உள்ள பூட்டப்பட்ட ெபட்டியினுள் ேசமிக்கப்படும் மற்றும் இது ஆய்வின் முடிவில் அழிக்கப்படும். பின் வரும் சந்தர்ப்பங்கைளத் தவிர மற்றேநரங்களில் அந்தரங்கம் ெதாடர்ந்து காக்கப்படும்: 1) உங்களுக்கு தீங்கு ஏற்படுத்தும் ேநாக்கம்; 2)பிறருக்கு தீங்கு ஏற்படுத்தும் ேநாக்கம்; 3) குழந்ைதகைள தவறாகப் பயன்படுத்துதல் குறித்த தகவல். இது ேபான்ற ஏதாவது சந்தர்ப்பசூழ்நிைலகைள அறிக்ைகயிட ேவண்டும் மற்றும் அவற்றில் தைலயிடேவண்டும் என ஆராய்ச்சியாளர் சட்டத்தால் ேகட்டுக்ெகாள்ளபடுகிறார்.

பங்ேகற்பு

இந்த ஆய்வில் பங்ேகற்பது முற்றிலும் தன்னார்வமானது ஆகும். பங்ேகற்க ேவண்டாம் என நீங்கள் முடிவு ெசய்தால் உங்களுக்கானச் ேசைவகள் பாதிக்கப்படாது. ஒப்புதல் படிவத்தில் ைகெயழுத்திட்ட பின்பு கூட எந்த ஒரு பிரச்சிைனையயும் சந்திக்காமல் எந்த ேநரத்திலும் இந்த ஆய்விலிருந்து நீங்கள் சுதந்திரமாக விலகிக்ெகாள்ளலாம். உங்கைளப் பற்றி ேசகரிக்கப்பட்ட அைனத்து தகவலும் அழிக்கப்படும்.

ெதாடர்புக்கானத் தகவல்

203 ஒரு ஆராய்ச்சி பங்ேகற்பாளராக நீங்கள் எவ்வாறு நடத்தப்பட்டுள்ளர்கள்ீ என்பது குறித்து உங்களுக்கு ஏதாவது புகார்கள் அல்லது கவைலகள் இருந்தால் , தயவு ெசய்து ெதாடர்பு ெகாள்ளவும்:

ேபராசிரியர். ரேமானா அலாக்கியா எம்.எஸ்.டபிள்யூ; பிஎச்.டி ெதாைலேபசி: (416) 978-1923 மின்னஞ்சல்: [email protected]

ஜில் பார்சன் ஆராய்ச்சி நன்ெனறி அலுவலர் உடல் நல அறிவியல்கள் ெதாைலேபசி: (416) 946-5806 மின்னஞ்சல்: [email protected]

இந்த ஆய்வில் பங்ேகற்க உங்களின் ஒப்புதைல குறிப்பிடும் வைகயில் கீேழ ெகாடுக்கப்பட்டுள்ள இடத்தில் உங்கள் ெபயர் மற்றும் ைகெயாப்பம் ஆகியவற்ைற தயவு ெசய்து அளிக்கவும்:

பங்ேகற்பு ஒப்புதல்

இதன் மூலம் நான் இந்த ஆராய்ச்சி ஆய்வில் பங்ேகற்க ஒப்புக்ெகா.

……………………………… ……………………………… பங்ேகற்பாளரின் ெபயர் பங்ேகற்பாளரின் ைகெயாப்பம்

……………………………… ……………………………… சாட்சியின் ெபயர் சாட்சியின் ைகெயாப்பம்

204 APPENDIX F: REFERRAL LIST

Agencies you may find helpful when you feel extremely stressful:

Toronto, Canada

1. Canadian Centre for Victims of Torture

194 Jarvis Street; 2nd Floor Toronto M5B 2B7 Phone: 416-363-1066

2425 Eglinton Avenue East Suite 220 Scarborough M1K5G8 Phone: 416-750-3045

2. Vasantham – A Tamil Wellness centre

146 Wellesley Street East Toronto M4X1G3 Phone: 416-324-4185

3. Access Alliance

340 College Street, Suite 500 Toronto M5T3A9 Phone: 416-324-8677

Chennai, India

1. The Banyan

6th Main Road, Mugappair Eri Scheme Mugappair West, Chennai-600037 Phone: 6357049

2. Christian Counselling Centre

Postbag 110, Sainathapuram, Vellore 632001 Phone: 416-2261202

3. AASHA Counselling Centre

Works Road, New Colony, Chromepet, Chennai – 44 Phone: 2403150

205

APPENDIX G: UNIVERSITY OF TORONTO ETHICS APPROVAL SHEET

206

196

APPENDIX H: ADMINISTRATIVE SUPPORT LETTER -INDIA

208

198