Exploring the Mental Health and Psychosocial Needs And

Exploring the MHPSS Needs and Associated Factors of Ethiopian Male Returnees from Kingdom Of Saudi Arabia

Exploring the Mental Health and Psychosocial Needs and Associated Factors of Ethiopian Male Returnees from Kingdom Of Saudi Arabia: The Case of Shirka Woreda, Arsi Zone, Oromia, Ethiopia

A Thesis Submitted To Addis Ababa University School of Social Work in Partial Fulfillment of the Requirements for the Degree of Masters in Social Work

By Esmail Yesuf Awolu

Advisor Dr. Mengistu Legesse (Ph.D.)

Addis Ababa University

School of Social Work (MSSW)

October, 2020 Addis Ababa, Ethiopia

Addis Ababa University

School of Graduate Studies

This is to certify that the thesis prepared by Esmail Yesuf Awolu, entitled: Exploring the Mental Health and Psychosocial Needs and Associated Factors of Ethiopian Male Returnees from Kingdom Of Saudi Arabia: The Case of Shirka Woreda, Arsi Zone, Oromia, Ethiopia and submitted in partial fulfillment of the requirements for the Degree of Master of social work complies with the regulations of the University and meets the accepted standards with respect to originality and quality.

Signed by the Examining Committee:

External Examiner Signature Date

Internal Examiner Signature Date

Advisor Signature Date

Chair of Department or Graduate Program Coordinator

Exploring the MHPSS Needs and Associated Factors of Ethiopian Male Returnees from Kingdom Of Saudi Arabia

Acknowledgment

First and foremost, my heartfelt gratitude goes to my beloved family and all friends for helping me to this day and for all their boundless support in my life. I would also like to give gratitude to the staffs and faculty members of Addis Ababa University school of Social work for making my journey worthwhile.

My appreciation and gratitude goes to my adviser Dr. Mengistu Legesse for guiding me throughout the writing process of this thesis.

I am also very grateful to my colleagues, Sally Mohammed (ERCS-Arsi branch Migration project PSS field officer), Jamal Berisso (ERCS-Arsi branch Migration project Livelihood field officer) and Haile Mekonen (ERCS-Arsi branch Migration project coordinator) for their unrelenting support.

Last but most importantly, I would like to thank the thirty five returnees in Shirka for taking the time to share their stories regardless of the fact that it was not easy. You gave the theses a meaning and without your support, it wouldn't have been completed. Thank you all.

Exploring the MHPSS Needs and Associated Factors of Ethiopian Male Returnees from Kingdom Of Saudi Arabia

Abbreviation /Acronyms

ARRA: Agency for Return Migrants Administration

CBPSS: Community Based Psychosocial Support

CBOs: Community Based Organizations

EMHS: Ethiopian Mental Health Strategy

EMoH: Ethiopian Ministry of Health

ERCS: Ethiopia Red Cross Society

FGD: Focus Group Discussion

GBV: Gender Based Violence

IFRC: International Federation of Red Cross

IGA: Income Generating Activities

ILO: International Labor Organization

IASC: Inter Agency Standing Committee

JCA: Job Creation Agency

KSA: Kingdom of Saudi Arabia

MHPSS: Mental Health & Psycho Social Support

MoE: Ministry of Education

MoEF: Ministry Economy and Finance Minister

MoH: Ministry of Health (MoH)

MoLSA: Ministry of Labor and Social Affairs

NDRMC: National Disaster Rehabilitation and Management Council

Exploring the MHPSS Needs and Associated Factors of Ethiopian Male Returnees from Kingdom Of Saudi Arabia

NGO: Non-Governmental Organization

PTSD: Post Traumatic Stress Disorder

SMFE: Small Micro-Finance Enterprise

TVETA: Technical & Vocational Education and Training Agency

WCYA: Women, Children & Youth Affairs

WHO: World Health Organization

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Exploring the MHPSS Needs and Associated Factors of Ethiopian Male Returnees from Kingdom Of Saudi Arabia

Table of content

Contents page Acknowledgment ...... i Abbreviation /Acronyms ...... ii Table of content ...... iv List of tables ...... vii List of Figures ...... viii Abstract ...... ix CHAPTER ONE: INTRODUCTION ...... 1 1.1. Background of the Study ...... 1 1.2. Statement of the problem ...... 3 1.3. Objectives of the Study ...... 6 1.3.1. General Objectives ...... 6 1.3.2. Specific Objectives ...... 6 1.4. Research questions ...... 6 1.5. Significance of the study ...... 6 1.6. Scope of the study ...... 7 1.7. Limitation of the Study ...... 7 1.8. Operational Definition of terms...... 7 CHAPTER TWO: LITERATURE REVIEW ...... 9 2.1. Ethiopian migration and return migration ...... 9 2.2. Existing Support System for reintegration of Return migrants in Ethiopia...... 12 2.3. Sector context: policies and challenges ...... 14 2.4. Return migration and psychosocial wellbeing ...... 18 2.5. Violence and trauma ...... 20 2.6. How to respond to psychosocial needs a community-based approach ...... 21 2.7. Models of Psychosocial Responses ...... 21 2.7.1. Psychosocial response models ...... 22 2.7.2. Stand-alone psychosocial program ...... 22

Exploring the MHPSS Needs and Associated Factors of Ethiopian Male Returnees from Kingdom Of Saudi Arabia

2.7.3. Psychosocial plus ...... 22 2.7.3.1. Integrated model A ...... 22 2.7.3.2. Integrated model B ...... 23 2.8. International standards and guidelines...... 24 2.9. Guidelines on Mental Health and Psychosocial Support ...... 24 2.10. Ethiopia and Returnees ...... 25 2.11. Prevention and Suppression of Trafficking and Smuggling Proclamation (2015) ...... 26 2.12. Reintegration of Return Migrants ...... 26 CHAPTER THREE: METHODOLOGY ...... 28 3.1. Study design ...... 28 3.2. Tools and Techniques of Data collection ...... 29 3.2.1. Data Collection Tools ...... 29 3.2.2. Data Collection Techniques ...... 30 3.3. Data Analysis Techniques ...... 30 3.4. Assuring the Trustworthiness of the Data ...... 30 3.5. Ethical Considerations ...... 31 CHAPTER FOUR: FINDINGS ...... 32 4.1. Description of participants of the study ...... 32 4.1.1. Number of study population and participants of the study ...... 32 4.1.2. Socio-Economic Description of Participants of Study ...... 33 4.1.3. Source of income of the study participants ...... 35 4.1.4. Employment status of study participants ...... 35 4.1.5. Housing condition of study participants ...... 36 4.1.6. Ownership of Asset by Study Participants ...... 37 4.2. Occupations held while Abroad ...... 38 4.3. Supporting of their family members while in abroad /Remittance ...... 38 4.4. Prevalence of Mental health and PSS problems of study participants ...... 39 4.5. Prevalence of Psychosocial Problems ...... 41 4.6. The proportion of male migrant returnees who received psychosocial and reintegration Services ...... 43

Exploring the MHPSS Needs and Associated Factors of Ethiopian Male Returnees from Kingdom Of Saudi Arabia

4.7. Occupational Preference of Respondents ...... 44 4.8. Finding of the focus group discussion (Revise findings of the in-depth interview) ...... 45 4.8.1. Social Cohesion ...... 45 4.8.2. Distress levels ...... 46 4.9. Findings of In-depth Interview ...... 46 4.9.1. Challenges /Barriers for Psychosocial and Reintegration Services Psychosocial needs as a crosscutting challenge ...... 52 CHAPTER FIVE: DISCUSSION ...... 60 5.1. Male returnees were young, lower in educational level and had dependents ...... 60 5.2. Male returnees faced many challenges and few opportunities ...... 60 5.3. Male Returnees Were Provided with Limited MHPSS, health, economic and reintegration Services ...... 62 CHAPTER SIX: CONCLUSION & RECOMMANDATION ...... 63 6.1. Conclusion ...... 63 6.2. Recommendations ...... 64 6.3. Social work implications ...... 64 6.3.1 Interventions for the returnees ...... 65 6.3.2 Community level Intervention ...... 65 6.3.3 Intervention for Social services ...... 65 6.3.4 Interventions for community youths and vulnerable returnees ...... 66 6.3.5 Implications for Policy ...... 66 References ...... 67 Annex‟s ...... 69

Exploring the MHPSS Needs and Associated Factors of Ethiopian Male Returnees from Kingdom Of Saudi Arabia

List of tables

Table 1 Number of the Woreda population, registered returnees and participants of study in Shirka Woreda of Arsi Zone, Oromia, Ethiopia ...... 32

Table 2 Socio-demographic Characteristics of study participants ...... 33

Table 3 Study participants occupation engaged while in abroad ...... 38

Table 4: Respondents supporting of their family members while in abroad ...... 38

Table 5: Prevalence of mental health problems among study participants ...... 40

Table 6: Prevalence of psychosocial & stress problems on Study Participants ...... 42

Table 7: Types of support returnees received from Government, International & Local NGO ... 44

Table 8: Occupational Preference of respondents ...... 45

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Exploring the MHPSS Needs and Associated Factors of Ethiopian Male Returnees from Kingdom Of Saudi Arabia

List of Figures

Figure 1: Map-Migration routes between Ethiopia and Saudi Arabia (Human Rights Watch, 2019) ...... 10

Figure 2 Psycho social models ...... 22

Figure 3: PSS Integrated services under 1 Umbrella Source: IFRC_ Psychosocial intervention handbook ...... 23

Figure 4: Source of Income the study participants ...... 35

Figure 5: Employment status of study participants in Shirka Woreda of Arsi Zone Oromia, Ethiopia ...... 36

Figure 6: Distribution of study participants by housing condition, Shirka Woreda of Aris Zone of Ormia Ethiopia...... 37

Figure 7: Description of Asset of study participants ...... 37

Figure 8: Proportion of study participants, they received PSS or any integration support ...... 43

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Exploring the MHPSS Needs and Associated Factors of Ethiopian Male Returnees from Kingdom Of Saudi Arabia

Abstract

The study was done with the main purpose of exploring the mental health and psychosocial needs and associated factors of male migrant returnees from Kingdom of Saudi Arabia and now living in Shirka Woreda of Arsi Zone of Oromia regional state. The study employed a mixed-methods approach. For the quantitative part, a systematic random sampling technique was used to select a sample of 35 male migrant returnees. An interviewer-administered closed ended questionnaire used to collect the quantitative data from respondents. The participants of this study were 35 male migrant returnees from Kingdom of Saudi Arabia. The qualitative study employed Focus Group Discussion and In-depth interview. Thus, two Focus Group Discussion session consisting of five members per FGD and In-depth interview with 5 key informants were conducted to collect the qualitative dat. Participants of the qualitative study were selected using purposive sampling methods of research. Findings of the study indicated that male migrant returnees from Kingdom of Saudi Arabia faced various problems related to mental health & psychosocial, health, social and economic challenges. The study identified the common mental problems prevail on returnees include; headache, easily frightened, poor appetite , nervousness, worried feeling , poor digestion , feeling of valueless person, trouble thinking and unhappy feeling, loss of interest in things etc. The study identified that the overwhelming majority of respondents (97%) were suffering from stress and over 80% the study participants feels that they are stigmatized by their respective family and community members. Apart from these, the proportion of respondents who received any types of mental health and psychosocial support services from the relevant GO, NGOs and community members were only 26%. Barriers that hinder the provision of integrated MHPSS services, includes restricted access to MPSS services, limited access to health, education, land and housing. Absence of comprehensive and long term reintegration services is the main barrier for not addressing the MHPSS, social, health, economic needs of male migrant returnees.

Exploring the MHPSS Needs and Associated Factors of Ethiopian Male Returnees from Kingdom Of Saudi Arabia

CHAPTER ONE: INTRODUCTION

1.1. Background of the Study

There is no health without mental health. Positive mental health and wellbeing enable people to realize their potential, cope with normal stresses of life, work productively, and contribute to their communities. (WHO, 2013) Mental health is an area which until recently has been given less attention, and continues to be seen as secondary to the promotion of physical health goals. Mental health is the chief predictor of both physical health and quality of life, and good mental health provides individuals with an underpinning for well-being and effective functioning (WHO, 2005).

Since March 2017, 350,000 Ethiopians have been returned from the Kingdom of Saudi Arabia (KSA) to Ethiopia: 79% males and 21% females. 10,000 returnees arrived at Bole Airport on average each month. Due to the overwhelming number of returnees, the Government of Ethiopia is struggling to fulfil basic human rights and services to these vulnerable populations. As a result, Ethiopian returnees continue to see their living conditions deteriorate, impacting their mental health and psychosocial wellbeing. The negative consequences of the Ethiopian irregular migration on mental health and psychosocial wellbeing are profound; both due to traumatic events experienced during their journey, destination, and return and due to daily stressors of life and feeling bad for their unsuccessful attempt to reach KA and feelings of guilt over coming back empty-handed. Migration-related experiences include psychological abuse, torture, kidnappings, denial of salary, working in harsh condition, very long working hours and sexual violence. Daily stressors of returning include poverty, lack of basic needs and services, lack of acceptance, discrimination, loss of family and community supports, loss of identity and uncertainty about the future. A high proportion of traumatic events in life may lead to a need for psychosocial support or therapy. Studies have shown that exposure to physical violence correlates with mental health disorders such as post-traumatic stress disorder (PTSD), depression and anxiety. Studies on Ethiopian returnees have shown that the loss of friends is correlated with high numbers of psychological distress outcomes. Few literature reviews on imprisoned or kidnapped migrants shown that mental health consequences of these experiences can be detrimental in terms of PTSD, depression, anxiety and suicidal ideations, even when the imprisonment effect is isolated and a trauma history is taken into account.

Exploring the MHPSS Needs and Associated Factors of Ethiopian Male Returnees from Kingdom Of Saudi Arabia

Ethiopian returnees are at high risk for experiencing a wide range of mental health problems. Mental health consequences that may be found among Ethiopian returnees are psychological distress including emotional problems such as grief, fear, frustration and anxiety, as well as emotional problems including loss of control, helplessness and hopelessness. Furthermore, they may also experience physical symptoms such as fatigue, loss of appetite, pain, as well as social and behavioral aggression and interpersonal difficulties. All these consequences of distress are widely documented. Mental health and psychosocial problems might eventually determine the future well-being of numerous returnees across the country. Considering the various sources of distress and the well-documented negative long-term consequences, there is an urgent need for preventive, evidence based Mental Health and Psychosocial Support (MHPSS) interventions targeting returnees and other vulnerable populations in Ethiopia.

Currently the MHPSS needs among the returnees far exceed the amount of services offered, and despite some MHPSS services provided by government hospitals and NGOs, there is limited capacity within MHPSS service delivery in Ethiopia. Furthermore, challenges exist to accessing MHPSS services that are available. These include lack of knowledge about available services, cost and transportation issues, as well as not being accepted at the health facility. Personal challenges that deter returnees from seeking help, include stigma around psychological distress, cultural misconception on mental health and psychosocial wellbeing problems and feeling emotionally isolated.

In order to address the mental health needs of returnees, as well as the host communities, the Ministry of Health launched the first Ethiopian Mental Health Strategy (EMHS) in 2012-2016 to ensure the development of a sustainable mental health system that guarantees the provision and accessibility of affordable, quality mental health services. This national strategy revised again for 2019-2025 mental health in line with the World Health Organization (WHO) Mental health action plan 2013-2020 focusing on developing community-based mental health services through evidence-based approaches and interventions. It is of high priority to the Ethiopian government and mental health system to address this enormous challenge of responding to the needs of the returnees and the host community, as well as for the international community (NGOs) supporting the mental health system through comprehensive services for returnees and the general public.

Exploring the MHPSS Needs and Associated Factors of Ethiopian Male Returnees from Kingdom Of Saudi Arabia

1.2. Statement of the problem

In Ethiopia, research studies, including surveys conducted by the Ethiopian Ministry of Health (EMoH), consistently show that mental illnesses are seldom recognized by the communities, except very severe cases of mental illnesses.(Monteiro & Balogun, 2014). Often cases are attributed to supernatural causes, such as punishment by God, spirit possessions and witchcraft, leading individuals and families to seek help from religious and traditional healers rather than modern mental health facilities. The health policy of the country has for years made it clear that one of its priority areas is to develop, research and gradually integrate traditional medicine and cultural beliefs into the modern health care system. However, when it comes to mental health there is still an opportunity for integrating traditional and religious care with modern mental health practices. The second strategy launched by the EMoH in 2019 and run until 2025.

The EMoH have, since 2012, launched a National Mental Health Strategy which is seen as a critical milestone aiming at improving the mental health care in Ethiopia in order to ensure the development of accessible, affordable and acceptable mental health care for all Ethiopians. (EMoH, EMHS, 2012).

In Ethiopia, mental disorders are the leading non-communicable disorder in terms of burden of diseases. Among every five persons, one will be affected by mental disorders at some point in their life. According to a large community-based study conducted in a predominantly rural area of Ethiopia, mental illness was found to comprise 11% of the total burden of disease, with schizophrenia and depression included in the top ten most burdensome conditions, out-ranking HIV/AIDS. (Selamu, L. G. and Singhe, 2017)

Many Ethiopian migrant returnees develop Post-Traumatic Stress Disorder (PTSD) from facing events either en-route on the migratory trail or in the country of destination. (Abawa, Mastewal 2018); Ethiopian Red Cross Society a key community based actor with presence all over Ethiopia, Ethiopian Red Cross Society has the potential and opportunity to become a relevant stakeholder for EMoH to work with basic psychosocial support services, working closely with religious and community leaders, educational and health care institutions and mental health specialists. ERCS‟s ambulance service and strong presence in the communities, as well as its auxiliary role to the government, can serve as the key community based actor in addressing the increasing mental

Exploring the MHPSS Needs and Associated Factors of Ethiopian Male Returnees from Kingdom Of Saudi Arabia health needs identified in the country and thereby contribute to fulfilling the EMoH‟s ambitions of providing mental health care to Ethiopians.

ERCS‟ preliminary assessment and in-depth assessments to select project sites also reveal that many returnees show symptoms of depression and lack hope for the future when arriving back in their communities of origin. This is closely linked to not having access to basic support services and livelihood opportunities, and to feelings of uselessness, failure and stigma from the families and other community members. Local health facilities also report increased trends of returnees with signs of severe mental disorders such as schizophrenia or suicidal thoughts. The returnees themselves explain that their inability to become a useful resource for their families and the community negatively affects their wellbeing, in particular affecting their feelings of self-esteem and self-efficacy. These negative effects are worsened with the development of feelings of sadness, anxiety and aggressiveness, which in turn leads returnees to experience social isolation and discrimination from the remaining community. (Ethiopian Red Cross Society; ERCS assessment reports from the “Assistance and

Returnees in Ethiopia arrive primarily through mass deportation from KSA in Addis Ababa Airport, or by slow return influx from other Gulf States, by self-initiated return from migratory routes towards Djibouti and Somalia (final destination Yemen and KSA) and from Sudan. Some of returnees to Ethiopia are regarded as ´accepted return„, differing from the mass deportations from KSA, where IOM and the Government of Ethiopia´s Ministry of Foreign Affairs act as key stakeholders and support the return and arrival of the migrants.

Whereas the role of supporting the Ethiopian citizens in the re-integration process during and after arrival in Ethiopia also lies with IOM and the Government authorities, there are significant gaps in assistance and reintegration support to those returning from non-EU member states or through unofficial channels. Under the IFRC Migration Policy, a clear mandate for the RC movement has been carved to support migrants with re-integration as it is clear that the challenges with migration-related vulnerabilities, especially at community level after return, are substantial. Especially in terms of addressing livelihood and MHPSS gaps for returned migrants whose families may not be willing to accept the returnee who returns empty-handed.

Exploring the MHPSS Needs and Associated Factors of Ethiopian Male Returnees from Kingdom Of Saudi Arabia

The most vulnerable groups of migrants are the (deported) returnees, in particular teenagers and young adults (male and female), returnees with physical or mental disabilities, returnees with economic disadvantage and no resources, returnees with significant debts (personal and/or family), and returnees who survived abuse by smugglers/authorities/employees.

ERCS assessments reveal that many returnees show symptoms of depression and feel a lack of hope for the future when they arrive in their communities of origin. This is closely linked to the lack of basic support services and which led to feelings of uselessness, failure and stigma from the families and the remaining community members. Returnees are a forgotten vulnerable group in the community. Local health facilities report increased trends of returnees with signs of severe mental disorders such as psychosis, schizophrenia or suicidal thoughts. Local health facilities also report about increased trends of returnees who have signs of severe mental disorders such as psychosis, schizophrenia or suicidal thoughts. The returnees themselves explain how their inability to become a useful resource for their families and the remaining community, negatively affects their wellbeing in particular with low self-esteem and self-efficacy. These negative effects are further complicated by the negative development of depressions, anxiety and aggressiveness that leads returnees into social isolation and stigma from the remaining community. Returnees and community members additionally report that many returnees have experienced behavioral change upon return, which has caused for friction and increased conflicts between community members. These are often a result of accumulated debt, behavioral change and rumors concerning conversion from one religion to another.

Based on ERCS migration project experience, there is very limited, if not a complete absence of returnee psychosocial support provided by government institutions. There is only one psychiatric hospital in the country, so when hospitalization is needed there is a challenge regarding available space. The Government therefore relies on NGOs and other civil society organizations to provide this type of support. Psychosocial assistance is provided mainly through NGOs. Services are uneven across the country, and depend on the scope, mandate, and resources of the NGO. Some local NGOs working on the wellbeing of youth and children may provide support to young returnees among their activities. Projects aimed at women‟s empowerment may also indirectly target returnees. In terms of specific support for returnees, there are few key providers of community based psychosocial support(CBPS) like AGAR, CVT, IOM and ILO which are in the capital city Addis Ababa and work for returnees living in different camps across the country.

Exploring the MHPSS Needs and Associated Factors of Ethiopian Male Returnees from Kingdom Of Saudi Arabia

1.3. Objectives of the Study

1.3.1. General Objectives

The main objective of study is to explore the mental health and psychosocial needs and associated factors of male returnees from Kingdom of Saudi Arabia in Shirka, Arsi, and Oromia, Ethiopia

1.3.2. Specific Objectives

 To identify the Mental Health and Psychosocial Problems and needs of returnees

 To identify the proportion of returnees who received Mental Health Psychosocial and other services

 To investigate barriers on reintegration efforts of returnees.

 To provide recommendations that help to tackle barriers with the aim of maintaining mental health and psychosocial wellbeing of returnees

1.4. Research questions

This study attempt to address the following research questions

 What are the mental health & psychosocial problems of male migrant returnees from KSA?

 What are the barriers /challenges encountered by male migrant returnees to receive MHPSS/reintegration?

 What are the effort being exerted by the community and stakeholders in the provision of MHPSS for male migrant returnees from KSA?

1.5. Significance of the study

This study gives better understanding on the Mental Health Psychosocial Problems as well as needs among male migrants return. The study also identify the existing barriers to address Mental Health Psychosocial Support needs of male migrants, and appropriate approaches to reintegrate returnees in their community from a holistic approach. Besides, the study also assesse the effort which is currently being exerted by the community and stakeholders to reintegrate returnees

Exploring the MHPSS Needs and Associated Factors of Ethiopian Male Returnees from Kingdom Of Saudi Arabia through the provision of MHPSS for with the aim of maintaining mental health and psychosocial wellbeing of returnees.

The finding will serve as an input for different stakeholders and community members to have insight on how to intervene the reintegration efforts/initiatives by identifying challenges, opportunities and appropriate holistic approaches. In addition, the finding will be used as an input for policy makers and program managers to make evidence based decision on the effort to integrate male migrants return through the provision of integrated and holistic MHPSS. Apart from these, the recommendations of the study may help other researchers and professionals to undertake a research on the issue /MHPSS and identify the responsible bodies and their tasks specifically.

1.6. Scope of the study

The study mainly focused and limited to migrants who returned from Kingdom of Saudi Arabia by the year 2020 at in Shirka Woreda, Arsi Zone, and Oromia region of Ethiopia. The participants of this study were male migrants‟ returnees selected from those currently residing at Shirka Woreda of Arsi Zone. To investigate the level of participation of community and stakeholders, the study assess the MHPSS support being rendered by communities, NGOs and other stakeholders in the study area.

1.7. Limitation of the Study

The study has limitation to generalize the findings to the larger public in other regions as the situations, diverse survivors of irregular migration and subjective circumstances of each returnees are diverse in nature and the limited 35 sample size. Despite these limitations, this work attempts to explore constraints and study the issue based on the contexts of the study setting.

1.8. Operational Definition of terms

Mental health and Psychosocial Support: is a broad term that may encompass specific mental health care, as well as related non-therapeutic interventions. Counseling and psychosocial support may include addressing issues related to family difficulties, economic difficulties, and other difficulties encountered at the social level. (IFRC; Mental Health Guiding Principles and

Exploring the MHPSS Needs and Associated Factors of Ethiopian Male Returnees from Kingdom Of Saudi Arabia

Approaches. Page 29. 2017)

Psychosocial support : “A process of facilitating resilience within individuals, families and communities enabling families to bounce back from the impact of crises and helping them to deal with such events in the future. By respecting the independence, dignity and coping mechanisms of individuals and communities, psychosocial support promotes the restoration of social cohesion and infrastructure”. Psychosocial support refers to the actions that address both the emotional and social needs of individuals, with the aim to help people use their resources and to enhance resilience. (IFRC; Mental Health Guiding Principles and Approaches. Page 29. 2017)

Mental health: mental health is not just the absence of mental disorder. It is defined as a state of well-being in which every individual realizes his or her own potential, can cope with the normal stresses of life, can work productively and fruitfully, and is able to make a contribution to her or his community.

Mental health disorders mental disorders comprise a broad range of problems, with different symptoms. However, they are generally characterized by some combination of abnormal thoughts, emotions, behavior and relationships with others. Examples are schizophrenia, depression, intellectual disabilities and disorders due to drug abuse. Most of these disorders can be successfully

Psychosocial problems resulting from the interaction between psychological (e.g., internal thought processes, feelings, reactions) and social (e.g., relationships, family, community, culture, environment) dimensions of a person.

. Resilience is the ability of individuals, communities, organizations or countries exposed to disasters, crises and underlying vulnerabilities to anticipate, prepare for, reduce the impact of, cope with and recover from the effects of shocks and stresses without compromising their long term prospects.

Stigma the negative labelling of persons, groups or concepts seen as being different from a majority.

Well-being All relevant types of well-being such as psychosocial well-being or economical and physical well-being. It is a multidimensional construct that includes all aspects of a person‟s quality of life.

Exploring the MHPSS Needs and Associated Factors of Ethiopian Male Returnees from Kingdom Of Saudi Arabia

CHAPTER TWO: LITERATURE REVIEW

2.1. Ethiopian migration and return migration

Ethiopian migration journeys are commonly made to the Middle East, particularly in countries such as the Kingdom of Saudi Arabia, United Arab Emirates, Lebanon, Qatar, Jordan, Bahrain and Kuwait including African countries with aims of local employment and in fewer instances with ambitions of reaching Europe (ILO, 2019).

There are three main irregular migration routes out of Ethiopia. To the east, migrants take desert and sea routes from Afar, Dire Dawa, and Jijiga, often through Djibouti across the Bab el-Mandeb strait or Somalia. From there, they venture into Yemen and transit onwards to the Gulf States. An interviewee explained his two-month route from Ethiopia to Saudi Arabia as going from his home in Wellega, on to Addis Ababa and further onto Harar before travelling to the border town of Wajaale in Somaliland. From there, a group of 26 people were taken in a vehicle to coastal town of Bossaso, where they went on a boat with 200 others, travelling for two consecutive days without food or water before reaching the Yemeni coast. They travelled through Yemen for a month, through the dangerous mountains, before being confronted by Saudi border patrols, and subsequently facing prison and deportation from Jeddah. Another migrant explained about the routes through Djibouti, travelling through the Djibouti railway station and overseas into Yemen before being forced back into Somaliland and the „safer‟ route through Bossaso. Despite the conflict in Yemen 20.000 migrants regularly arrive from the Horn every month, most of whom are Ethiopians. In the first three months of 2019 alone, 150.000 migrants arrived at the war-torn country in hopes of transition to other Gulf States. Crossing the sea into Yemen is highly perilous. As recently as January 2019, two boats capsized on their way to the country, leaving 58 Ethiopians dead.

The second route is to the south. Here, migrants often travel to the city of Moyale on the border to Kenya and into the neighboring country, where they are typically helped by brokers, jumping on freight trains or trafficking Lorries that take them down through Tanzania and Mozambique before they reach their frequent final destination of South Africa. Many migrants reportedly die because they are transported in Lorries meant for gasoline, making breathing difficult. Great parts of the journey may also be taken on foot, a journey that can take several months as the migrants have to

Exploring the MHPSS Needs and Associated Factors of Ethiopian Male Returnees from Kingdom Of Saudi Arabia hitch rides, pay for passage, gather funds for further travels and stay hidden from the watchful eye of local authorities that may choose to detain and deport them back.

The third and northwestern route takes migrants past Gonder and through the cities of Metema or Asosa (a widely used transit city) on the border to Sudan. In Sudan, many travel through Bunj and towards Malakal and from there all the way down to Juba. From here, they can travel through the northwestern corridor into Libya and further into Europe over the sea. Others go to Egypt through Sudan and then on to Israel and utilize religious ties to obtain employment (Minaye, 2012).

Figure 1: Map-Migration routes between Ethiopia and Saudi Arabia (Human Rights Watch, 2019) All of these routes are highly dangerous, in different ways. Some only give way for precarious forms of employment whereas others form extremely dangerous roads by itself.. Common for all of them is that they predominantly facilitate irregular migration because of the few legal routes and opportunities. Ethiopian migrants are generally young, single (or married and quickly divorced to strengthen local cultural legitimacy), and increasingly female. Many come from Oromia and Amhara. Their migration journeys are facilitated by different mechanisms: many depend on brokers, typically from Addis Ababa, while others (mostly women) use Private Employment Agencies from the capital who facilitate the transit (Busza et. Al 2017). The brokers typically manage a jurisdiction or territory, e.g. being responsible for taking migrants from Adama to Awash, at which point a new broker takes over and leads the group on to Logia, each broker demanding an amount for every new part of the route. In many instances, brokers arrive at villages

Exploring the MHPSS Needs and Associated Factors of Ethiopian Male Returnees from Kingdom Of Saudi Arabia and advertise positions as maids or waitresses in the Gulf States, hiding the harsh realities that leave smuggled or trafficked migrants with no legal rights, often combined with high (sometimes made-up) debts to the smugglers.

In 2008, Lebanon initiated the first of several bans from Middles East countries, prohibiting Ethiopians from migrating for work. The argument from Lebanon was mainly the high number of reported abuses, deaths and suicides among Ethiopian women employed as domestic workers there. In early 2013, as told, Saudi King Abdullah and Saudi authorities set in motion a set of initiatives to deal with „irregular migration‟ to the country. An amnesty period of seven months was given for migrants either to formalize their stay with residency and employment permissions or to leave the country. After the amnesty period, authorities started searching for irregular migrants, who were now detained in one of the 64 deportation centers, primarily in Riyadh and Jeddah (Regional Mixed Migration Secretariat, 2014). More than a million migrants (most from Yemen but more than 150.000 from Ethiopia) were lifted out of Saudi Arabia by air, many of whom came through the notoriously violent deportation centers or were rushed aboard planes without belongings. The return started as a trickle with a small number of arrivals per day but then suddenly rose to some 7,000 returnees per day, greatly stretching the logistical preparations of the humanitarian response. The highest number of returnees arrived in Ethiopia between November 2013 and December 2013. Subsequently, there was a steady flow of returnees arriving from January 2014 which tapered off by March 2014 when all those who had been immediately expelled from the KSA seem to have been returned. The first flight arriving at Bole Airport came with 35 migrants on the 13 of November 2013 and by March 2014 the number of arrivals had reached 163,018. Most of the returnees arrived between mid-November and the third week of December 2013.

The relief operation surrounding the reception of the migrants, conducted between Ethiopian authorities, IOM and other UN agencies as well as NGOs, expectedly encountered challenges due to the unprecedented nature of the emergency, the large and overwhelming number of returnees of varying ages and needs, and the short time frame. These challenges included capacity of accommodation of the transit centers, difficulty of accurate plans and execution of humanitarian responses due to inadequate prior returnee information (very limited information was provided by the KSA), and limited availability of funding leading to cuts to the transport allowances provided

Exploring the MHPSS Needs and Associated Factors of Ethiopian Male Returnees from Kingdom Of Saudi Arabia to refugees.

This process was repeated in 2017, with more than 230.000 Ethiopian forcibly returned from March 2017 to January 2019. These returnees are also being provided support services by IOM in Addis Ababa and its agencies in the regions of Ethiopia. However, the existing agencies and organizations meant to provide support services, both addressing emergency needs and longer- term reintegration support services are not fully capacitated to provide comprehensive rehabilitation and reintegration support services.

The rushed and forced return saw the Ethiopian government institute a temporary ban on migration to the Gulf States with the explicit aim of preventing harassment, trauma and intimidation on Ethiopians seeking work there, upheld until when in 2018, a new law targeting the many irregular private employment agencies, many of whom function as de facto human traffickers, and aiming to guard the rights and conditions of labor migrants was set in place. Despite the policy and law, the Ethiopian government has weak enforcement capabilities against infringements (Fernandez, 2019).

Ethiopian migrants working for households of a different religion than their own are likely to both suffer increased abuse during their time , but also to face challenges upon returning home with communities fearing they have been „polluted‟ by working abroad in a different religious setting. Ethiopian Muslims also seem to be a little less likely to be mentally affected by the migration work in the Middle East, sharing some (though not many) religious, cultural and linguistic bonds with the employers (Habtamu et.al. 2017).

2.2. Existing Support System for reintegration of Return migrants in Ethiopia

The existing support and reintegration system for return migrants in Ethiopia is constituted by a cross-sectoral approach. This approach involves a wide range of governmental and non- governmental actors. The different government institutions involved in provision of support services and facilitation of reintegration of return migrants include; The Office of The Federal General Attorney, Federal Job Creation Agency (JCA), Ministry of Labor and Social Affairs (MoLSA), Ministry of Health (MoH), Ministry of Education (MoE), Federal Technical & Vocational Education and Training Agency (TVETA), Small Micro-Finance Enterprise ( SMFE), Women, Children & Youth Affairs( WCYA) Ministry Economy and Finance Minister( MoEF),

Exploring the MHPSS Needs and Associated Factors of Ethiopian Male Returnees from Kingdom Of Saudi Arabia

Agency for Return migrants Administration (ARRA), Ethiopian Red Cross (ERCS), Danish Red Cross(ERCS), National Disaster Rehabilitation and Management Council (NDRMC) and media outlets.

The Ministry of Labor and Social Affairs (MoLSA) holds two major responsibilities; facilitation of the deployment of Ethiopian labor migrants overseas and provision of enabling conditions for these migrants upon return, assisting them with the process of reintegrating into the domestic economy. The second responsibility of the ministry is mainly related to irregular migrants, those who have left the country or have returned through irregular channels. The national task force presided over by the deputy Prime Minster is composed of representatives of all the major federal public agencies whose institutional profile and mandate have direct relevance supporting and reintegrating return migrants. Whereas the task force is primarily meant to coordinate and lead the support and reintegration efforts of all the major governmental and non- governmental organizations, the enabling legislation requires the Office of the General Attorney to lead and coordinate the works of the federal task force on a regular basis, operating under the deputy Prime Minister. The national task force is divided into four Work Teams; 1) Irregular Migration Prevention Work Team, 2) Return migrants Rehabilitation &Reintegration Work Team, 3) Law – Enforcement Work Team and 4) Irregular Migration Research Work Team. While the Job Creation Agency (JCA) and MoLSA are coordinators and deputy coordinators of the Return migrants Rehabilitation and Reintegration Work Team, IOM is a member of the work team.

In addition, MoLSA is also mandated to devise ways and facilitating conditions under which return migrants could be able to formally and legally rehabilitate and reintegrate into the national economy. A serious challenge that MoLSA faces in the course of discharging its responsibilities is the lack of proper documentation, organization, management and dissemination of data related to return migrants. In order to alleviate the problem, MoLSA has recently conducted a project in collaboration with IOM which aimed at encoding and organizing returnee data for the years 2017- 2019. In accord with this data, MoLSA in collaboration with IOM provided support for a total of 206,920 return migrants of whom 157,681 are male return migrants and 47,579 are female return migrants. And of the total number of the return migrants 205,260 of them were returnees from Saudi Arabia and 1,660 of them returned from Yemen. Though the data is not disaggregated by country in the 2017/18 Ethiopian Fiscal Year, a total of 125,000 return migrants (Male: 69,954

Exploring the MHPSS Needs and Associated Factors of Ethiopian Male Returnees from Kingdom Of Saudi Arabia and Female: 55,497) were confirmed having received psycho-social supports, skills trainings and has been reported as reintegrated into the domestic economy by starting their own businesses.

The JCA (Job Creation Agency) claims to have created 14,000 new jobs for return migrants in 2018/19, though we do not know which jobs or the prospects for job security over time and wage levels. In the same year, JCA provided rehabilitation and social –integration support for 203 male returnees from Tanzania. Of these returnees, it further provided an economic reintegration support for 99 returnees. The Ministry of Health, on its part, planned in the year 2018/19 to provide general health care support for 40,000 returned migrants and ended up helping 17,457 return migrants. The Ministry screened 15,457 returnees for medical services need, provided youth-centered medical support for 950 returnees (involving HIV Test, Family Planning and other related medical services) and helped in counseling and provision of psycho-social support for 1,050 returned migrants in the year.

As far as support services disaggregated gender and legal status is concerned, most return migrants that MoLSA and JCA supported were male returnees and all those who received support were irregular migrants deported primarily from Saudi Arabia and Yemen, African Countries and Europe. The Ministry of Health provided support mainly for female return migrants.

2.3. Sector context: policies and challenges

Ethiopian being at the early stages of economic transformation and with more than two million young Ethiopians entering the labor force every year, ensuring productive employment opportunities for them poses a challenge in both rural and urban areas. As a result, growing numbers of Ethiopians have been looking for job opportunities either in other regions within the country or abroad, through regular and irregular channels. Since 2009, 459,810 regular migrants have left Ethiopia, of whom 94.3% were women domestic workers according to the Ministry of Labour and Social Affairs (MoLSA). The preferred destination of regular migrants is Saudi Arabia (79%), followed by Kuwait (20%) and Dubai (1%).

There is no reliable number of irregular migrants, but the number is estimated to be significantly higher than that of regular migration. With the help of traffickers and smugglers, hundreds of thousands of irregular migrants from Ethiopia follow three main migratory routes: the Northern, Southern and Eastern routes. The Northern route extends through Sudan, Egypt and Libya and

Exploring the MHPSS Needs and Associated Factors of Ethiopian Male Returnees from Kingdom Of Saudi Arabia other countries in that region. Although Egypt and Libya are final destinations for some migrants, for most they serve as transit countries to reach Europe. Using smugglers to cross borders, most of the migrants who use this route come from Oromia, Amhara and Tigray regional states. Of the three, this route is the most deadly, especially for those who go far north and get trafficked or smuggled by boat from Libya to Lampedusa, Italy and other places in southern Europe. Migrants from Southern Nations, Nationalities and People‟s region (SNNPR) dominate the Southern route. The migrants cross through Kenya, Tanzania, Zambia and Malawi to South Africa, while some trying to migrate to North America and Europe from there. Ethiopian migrants also use the Eastern route through Somalia and Djibouti, the Gulf of Aden and Yemen to reach the Middle East, mostly the Kingdom of Saudi Arabia, while some continue their journey to Turkey and Europe.

In Ethiopia, the push factors for migration differ from region to region but the main factors are lack of economic opportunity; peer pressure; social and cultural factors such as early and arranged marriage; natural disasters such as flooding, drought due to climate change; and lack of basic social services.

Due to mass deportation from KSA in 2013/2014 and in 2017, totaling around 270,000 returnees and other returns from different parts of the world, reintegration of returnees in the Ethiopian labor market as well as their reinsertion into their communities and reunification with their families has become a major challenge for the Government of Ethiopia. Although the Government of Ethiopia recognizes that reintegration is a key aspect of return migration and that reintegration of returnees should be considered through individual, community and structural dimensions in order to achieve sustainable return and avoid re-migration, to date there is no national comprehensive migratory policy, nor a reintegration policy or national strategy in the country. However, some proclamations recently adopted, and some policy tools are relevant to the reintegration of returnees such as those related to the management of labor migration and protection of migrant workers' rights abroad (Overseas Employment Proclamation No. 923/2016 and Employment Exchanges Services Proclamation No. 629/2009), which include trafficking and smuggling issues, as well as non- migration national policies relevant to return and 5 Despite having a policy framework relevant to return and reintegration, lack of adequate and comprehensive support and coordination by government and development actors is creating frustration among the returnees and also encouraging re-migration by some of the returnees. Urgent cooperation with the Government of

Exploring the MHPSS Needs and Associated Factors of Ethiopian Male Returnees from Kingdom Of Saudi Arabia

Ethiopia appears particularly relevant in a context where irregular migration is increasing and some returnees are reportedly re-migrating. A national needs assessment of Saudi Arabia returnees conducted by the ILO in 2014 concluded that 57.6% out of the 2039 respondents are considering re-migrating.

With regards to current reintegration actions, most of which are funded by the EU, it is noted that the committees that are established at sub-city and Woreda levels to facilitate reintegration lacks coordination and fail to meet the expectations of returnees. Further, the reintegration committees appear to struggle with budget shortages, poor capacity and an inability to control irregular brokers. There is thus a need to strengthen these committees at all levels and to make all stakeholders part of the reintegration effort. There is the need for a plan of action that clearly sets out the specific roles and responsibilities of each stakeholder and put in place a system for sustainable reintegration.

What we know: Return migrants and wellbeing

The notion and multifaceted nature of „returning home‟, and not least the dualities between expectation, anticipation and the realities facing return migrants upon return, has been well- covered in migration studies over the past decades. We know from other studies that returning often evokes an initial period of significant adjustment stress and trauma (Erdal & Oeppen 2018; Majidi, 2009; Erdal et. Al. 2018). Return migration is typically understood from diverse social, economic and psychological processes of reintegration, and not as the end of a linear trajectory, but rather as another phase in the migration life cycle. There are deep emotional complexities of returning at play, whether it is to a place associated as home, or merely to what can be considered the point (or even just country) of origin or birth. The returnee may have anticipated as a process of individual stabilization (against the bearable and unbearable dynamism of migration journeys), recognition and development, facilitating a change in maturity, status and appreciation. But it is often seen to form an illusion that may instead be an experience of rupture and disillusionment (Christou & King, 2014; Vathi 2018). Atnafu & Adamek (2016) report of Ethiopian women who saw their immediate returns as „freedom of life‟, a freedom to move, eat, sleep, and work as they pleased. At the moment their planes left Bahraini ground (they were all „voluntarily‟ deported by the local authorities, because they did not have funds for return air tickets), a weight fell off their shoulders. From the relief of escaping what is described by many as a prison (for some literally

Exploring the MHPSS Needs and Associated Factors of Ethiopian Male Returnees from Kingdom Of Saudi Arabia and for others figuratively), the process of reintegration often turns out to be difficult and protracted, if at all with an end state. These particular women were seen by their communities as „diaspora‟, having lived and worked abroad for a few years, a status identified with which wealth and prestige is associated. Returning without either, was difficult for the family to accept.

Returning back may provide as much of a culture shock as the process of migrating to a foreign and unknown country, not least when the return ends in a foreign city or one different than from where the migrant left, as is the case for most of the interviewees in this study. Return to what, is the question that ensues. There is no returning to exactly what was before migrating.. Migrants, as all people, develop over the course of new experiences, and may personally have moved far past the position and the place they left. Upon return then, the question is whether they are expected, or find themselves, returning to past positions that may be bad or impossible to adapt into. Migration trajectories are complex, and particularly forced return migrants may well see their migration efforts as unfinished and incomplete, their return thus mainly functioning as preparation for new mobility. This may have important consequences for the idea of homemaking, i.e. that if return migrants do not see their return as final, homemaking in its many forms does not seem to make much sense, potentially pushing some return migrants into voluntary states of uncertainty.. We should be careful of defining a definite inside and outside, i.e. either return migrants are fully reintegrated into their families and communities, or they are not.

For the return migrant, a huge number of individual matters shape reintegration. This includes their degrees of agency – do they reassume a position with no or little autonomy, do they have agency to move, or do they feel fixated in a certain context? Returning to a situation of vulnerability is likely for many Ethiopian migrants, most of whom are low skilled and do not return with economic savings, greatly shaping their prospects for resource mobilization for themselves and their families. Most of the return migrants who took part in this research, for one, did not attain their goals of living and working abroad. The reality of being unable to bring improvements to their families weighs heavily on the migrants upon returning home, sometimes worsening their status and for others greatly inciting efforts to migrate again quickly, in hopes of eventual success (Birke et.al. 2009). Returning to financial instability and reverting back to a situation of dependency on the family is far from the initial idea of migrating to support the family. Likewise, many families‟ pool resources, selling houses or land, to finance the migratory journeys of their children, making

Exploring the MHPSS Needs and Associated Factors of Ethiopian Male Returnees from Kingdom Of Saudi Arabia emptyhanded return even more difficult. This may be reinforced or aggravated by the potential inability to work because of their traumatic journey, work and life experience in their destination and lead to emotional regret for unsuccessful years abroad. But individual factors also include volition, which may go in many directions. Volition to reintegrate and reassume a position once held in the community, or the volition to break from earlier expectations and roles to define a new course in life. We know that strong social networks and the ability to sustain these and gain access to them again upon return are crucial for reintegration efforts. Creating new and renegotiating existing or old relationships can help strengthen a sense of belonging.

In the space between perceived failure and success, whether by the migrant or the migrant‟s family and community, the form of returning home can also be accentuated as important. The somewhat assumed boundaries between voluntary and forced migration, i.e. that the first should be safe and with few negative consequences whilst the second is problematic and holds far greater potential for psychosocial issues, should not be taken at face value. First, because return migration in its many forms may revoke effects that can be unforeseen and difficult to understand no matter the voluntary or coerced form. But perhaps more importantly because the imagined borders between voluntary and forced return migration can be seen as fluid. „Voluntary‟ migration may very well be pushed or nudged by factors that shape the individual migrant‟s choice of migration. Voluntary return, while obviously challenging, can also form a relief, seeing as many of the Ethiopian migrants may be locked in unbearable situations of hardship with few opportunities to return home voluntarily, even if they wanted to. Voluntary, self-decided return rarely seems to be an option, and many Ethiopian migrants have been seen to turn themselves in to local authorities, in order to „force‟ a return that is in essence voluntary (see Atnafu & Adamek, 2016).

2.4. Return migration and psychosocial wellbeing

Even though psychosocial wellbeing of return migrants is central to successful efforts of return migration and reintegration, research on the concept is still limited (Vathi, 2018). Psychosocial wellbeing is best considered along a continuum, as an unfolding and developing experience of life. It is not an outcome, but a „state of being that arises from the dynamic interplay of outcomes and processes‟ (McGregor, 2007). In research on poverty, wellbeing is often conceptualized as combining the „objective‟ circumstances of a person and their „subjective‟ perception of their condition. That is, in its broadest form, it encompasses a combination of what a person has, what

Exploring the MHPSS Needs and Associated Factors of Ethiopian Male Returnees from Kingdom Of Saudi Arabia they can do with what they have, and how they think about what they have and what they can do. We do not need to engage in a conceptual debate here, but merely note that we approach wellbeing from a psychosocial perspective to accentuate emotional, social and cultural aspects of return migration. Wellbeing is shaped by a host of different individual, structural and circumstantial factors that are difficult to separate, both in form and in their effect. The focus on the individual migration experience naturally gives premise for the unique experiences of migration and potentially disallows us the ability to generalize. Nonetheless, it is not the aim of this report to create an axiomatic understanding of the factors and experiences of return migration for Ethiopians, but rather to provide a glimpse into the nature of their experiences.

The return experience, adjusting to the dynamics of the return context, is intricately linked to notions of the past, the present, and the future, three concerns that cannot be separated. Migrants will relate to current events based on past experiences, but also on future-expectations or imaginaries. We might implicitly expect migrants returning to their place of departure to be going „home‟, but we cannot assume that the place is still afforded such qualities by the migrant. Spaces and places never remain the exact same over the course of years, both regarding objective conditions of physical infrastructure, housing etc. but also to the relationality of the point of return. Many different forms of social and economic capital are spatially tied to a place – access to credit, employment opportunities, education, self-sufficiency or subsistence agriculture etc. This evokes important questions of what return migrants associate with their new old place of living, as well as how it and their relations to it has changed through the course of the migration journey, perhaps challenging their memory of what they left behind, which could very well have been idealized during the time they spent away from it.

Psychosocial wellbeing accentuates how instrumental (economically driven) and emotional dimensions of migrant life intersect and complement each other deeply (Boccagni & Baldassar, 2015). Inability to provide financially for a family leads to frustration, just as social concerns over declining family care, peer pressure and pressures from families, or community misconceptions can lead to social isolation and thus inability to take up employment, forming a problematic cycle of aggravation. Stigma and blaming from families, because of unfulfilled expectations, may lead to failure of support and reassurance (Atnafu & Adamek, 2016). The complexity of reintegration is substantial then, with successful reintegration efforts depending on different forms of human

Exploring the MHPSS Needs and Associated Factors of Ethiopian Male Returnees from Kingdom Of Saudi Arabia and financial capital, power relations and networks, time and space, traditions and values in the locations of return.

Identity and subjectivities greatly shape motivations and life expectations. Individuals react differently to events, depending on some of the factors already described. Their coping mechanisms and ways of interpreting and reacting to the world vary greatly, influenced by their individuality, their upbringing and the events they have experienced in their life thus far, unique to them. All migrants will have different degrees of resilience to different events. Some might see minor events reactivate past emotions, instilling forms of trauma in them, while they can experience terrifying events less conflictual because of cultural backgrounds or past experiences. It is difficult, if not impossible, to find patterns of reaction to events across such large groups as Ethiopian return migrants. Though individual subjectivities are important, relationality also remains a core feature of psychosocial wellbeing, strongly influenced by relationships and interaction, with positive outlooks depending on migrants‟ abilities to reestablish and -access network and support upon return.

Another appreciable factor is that limited preparation of the journey before it takes place (e.g. lack of awareness about the jobs to be undertaken, low cultural awareness or limited skills), seems to have exacerbated the risks for mental stressors to influence the migrants‟ psychosocial wellbeing (Habtamu et.al. 2017), and thus also affect return migration at a later stage, particularly for migratory journeys that are short or medium term in length. As we will see, this study also shows that while migratory journeys may be initiated with few to no financial resources, this greatly increases the likelihood of violence and abuse along the routes.

2.5. Violence and trauma

Finally, it is impossible to apprehend Ethiopian migration without recognizing the impact of abuse, violence and trauma. The majority of Ethiopian migrants are irregular migrants who both travel perilous roads to their destinations, and engage in precarious low-skilled work there, seldom with legal papers or an ability to uphold rights through formal institutions. The violent and traumatic migration experience, not just the process of returning, is a key factor in shaping the return experience (Bilgili et.al, 2018). This means Bilgili, O, Kuschminder, K., Siegel, M. consider the process of returning or reintegration without understanding the conditions under which the men

Exploring the MHPSS Needs and Associated Factors of Ethiopian Male Returnees from Kingdom Of Saudi Arabia migrated. The journeys and eventual stay and employment in countries of arrival to be dominated by social, physical, psychological and economic hardship.

Men rarely take up migrant employment as domestic workers, but they are still exposed to abuse, violence and trauma. They travel and live under extremely precarious conditions, with regular deaths on migrant boats to Yemen or in Lorries going south towards South Africa, just as they are often locked up in magazine as soon as they leave Ethiopia (no matter whether they travel east, west or north). Coupled with knowledge of how severe life events of humiliation and defeat, as those evidently experienced by many Ethiopian migrants, these conditions greatly affect psychosocial wellbeing, with traumatic experiences potentially leading to failure of reintegration, especially with the limited access to mental health provisions, counselling or support upon return.

2.6. How to respond to psychosocial needs a community-based approach

Red Cross and Red Crescent National Societies primarily use a community-based approach in responding to psychosocial needs. This is based on the premise that communities will be empowered to take care of themselves and each other. In this way dependency on outside resources is reduced, through community mobilization and strengthening of community relationships and networks.

The term „community-based‟ does not in fact refer to the physical location of activities. Rather it stresses that the approach strives to involve the community itself as much as possible in the planning, implementation and monitoring and evaluation of the response. It is an approach that encourages the affected community to gain ownership of and take responsibility for the responses to their challenges. Community participation is therefore an integral aspect of a community-based approach.

2.7. Models of Psychosocial Responses

Given the uniqueness of every crisis, there is no blueprint on how best to respond to psychosocial needs. At present, there are four main models of psychosocial responses practiced by Red Cross Red Crescent National Societies, as illustrated in the diagram on the next page.

Exploring the MHPSS Needs and Associated Factors of Ethiopian Male Returnees from Kingdom Of Saudi Arabia

2.7.1. Psychosocial response models

critical event

Figure 2 Psycho social models 2.7.2. Stand-alone psychosocial program

The first model is a stand-alone psychosocial program, focusing solely on psychosocial needs. Usually this type of program has an independent staff and budget, and although administratively it may be run separately, it is implemented in collaboration and cooperation with other areas of response.

2.7.3. Psychosocial plus

The second model is also called a psychosocial program, but it typically integrates psychosocial needs with others, such as food, shelter, water, clothing or livelihood, all needed for basic survival. It is based on the principle of integration and provides a holistic response, but is administratively managed as a psychosocial program.

2.7.3.1. Integrated model A

In this model psychosocial activities are included in other response program, such as health and care, or disaster management. Psychosocial activities here are a component of a much larger and broader program that addresses additional needs and aspects. In these types of program, staff may

Exploring the MHPSS Needs and Associated Factors of Ethiopian Male Returnees from Kingdom Of Saudi Arabia not be specifically recruited to focus on psychosocial activities, and the administrative and financial management of the program lies with the larger focus area.

2.7.3.2. Integrated model B

The fourth model uses psychosocial support as an entry point to the affected population, as a platform for all other responses. The multi-sectoral responses needed to assist communities are identified and responded to, based on the outcome of initial psychosocial activities. This integrated approach aims to provide a holistic „umbrella of support‟ to the individual, family and community.

Psycho- social Support

Integrated approach Umbrella of support

individual Family community

Figure 3: PSS Integrated services under 1 Umbrella Source: IFRC_ Psychosocial intervention handbook Which model is used depends on needs and resources, the context and the realistic opportunities available. It may be that one model is chosen at the beginning of a response, and another later on. It can, for example, be appropriate to start a response with a stand-alone psychosocial program (model 1) and, with time, work towards integrating psychosocial actions and activities into another area of response, such as health and care (model 3), as the needs in the affected population change. Psychosocial needs change all the time, and it is important to make sure chosen interventions are always relevant.

Exploring the MHPSS Needs and Associated Factors of Ethiopian Male Returnees from Kingdom Of Saudi Arabia

2.8. International standards and guidelines

A number of specific documents exist, that are relevant for planning and implementing psychosocial interventions. It is important to be familiar with these documents and to use the guidelines, principles and suggestions as much as possible in planning all work, whilst adhering to specified standards.

Universal Declaration of Human Rights

Most humanitarian responses are based on the aim to fulfil the rights in this declaration. Individuals, families and communities are at heightened risk of human rights violations during crises. It is vital that staff and volunteers promote the human rights of all those in their care. For example, access to psychosocial support should be on the basis of equity and non-discrimination.

Humanitarian Charter and Minimum standards in a Disaster Response

Actions for acute phases following crises are presented in the section on mental and social aspects of health in the chapter on “standards on control of non-communicable diseases”. The standard reads:

“People have access to social and mental health services to reduce mental health morbidity, disability and social problems. Supporting this standard, the Sphere Handbook lists key access points across the community. These access points combine external assistance alongside engaging family, community and cultural resources. In this way, they provide a good example of psychosocial support. For example, the family tracing service, which is an example of external assistance, in the list of social interventions stands alongside cultural and religious events being maintained, which is an example of community and cultural resources.

2.9. Guidelines on Mental Health and Psychosocial Support

The Psychological Support Policy of the International Federation of Red Cross and Red Crescent Societies. Psychological support applies across the range of the services provided by the Red Cross and Red Crescent National Societies. The International Federation psychological support policy establishes a basis of Red Cross and Red Crescent action, both in emergency response operations and in the implementation of long-term developmental programs. It outlines the main

Exploring the MHPSS Needs and Associated Factors of Ethiopian Male Returnees from Kingdom Of Saudi Arabia responsibilities of the International Federation and all its National Societies in the field of psychosocial support. The policy applies to any type of psychological support activity carried out by an individual National Society or any of its branches, staff or volunteers or by the International Federation acting collectively. It should be considered in conjunction with all other Federation policies.

2.10. Ethiopia and Returnees

Ethiopia's Policy on Migration to kingdom of Saudi Arabia. The mass return of over 160,000 Ethiopian migrant workers from Saudi Arabia on the year 2013 was the primary cause for FDRE governments ban on migration of unskilled workers to the Middle East. This temporary ban was put in place by the government with the aim of “preventing harassment, intimidation and trauma suffered by those working abroad, particularly in the Middle East, as domestic employees.” Even though the ban is presumed to give a breathing space by allowing the legal framework to be revisited and to better regulate and mange labor migration in the future, its impacts has also been left to criticisms by many for further exacerbating irregular migration.

With respect to negotiations and relations with Gulf countries, Ethiopia has signed bilateral agreements with Jordan, Djibouti, Qatar and Kuwait. To date however, Ethiopia did not sign bilateral agreements regarding labor migration to Saudi regardless of the fact that huge numbers of migrants are subjected to degrading treatment and mass forced returns as in the 2013s Saudi crackdown on irregular migrants. In an attempt to give protection to migrants workers in Saudi and particularly that of domestic workers, legislative responses were put forth in two major areas. The first relates to the 2009 amendments to the Private Employment Agency Proclamation of 1998. This amendment proclamation demands migrant workers to register with MOLSA, providing their employment contract, a work permit for destination countries, a medical examination certificate and insurance. Employment agencies are also obligated to register with MOLSA and are thus held accountable to the workers they recruit to employment overseas.

The second relates to the Employment Exchange Services proclamation No 632/2009 which obligates Employment Agencies to place funds beforehand in order to facilitate assistance in events whereby workers contract is terminated. Nevertheless, whether these deposits have been put to use to pay for transportation back to Ethiopia has been left to doubt. The government has

Exploring the MHPSS Needs and Associated Factors of Ethiopian Male Returnees from Kingdom Of Saudi Arabia not yet opened the legal route to Saudi which has been banned since the 2013 crackdown due to lack of lawfully established PEAs, growing number of migrants and limited capacity of MOLSA

2.11. Prevention and Suppression of Trafficking and Smuggling Proclamation (2015)

It concerns various components of anti-trafficking response: penalty for smugglers, promotion of awareness-raising and assistance and protection measures towards reintegration of returnees.

Overseas Employment Proclamation (2016)

It establishes compulsory pre-departure and pre-employment orientation and training for aspiring migrants, and it reinforces protection of Ethiopian overseas workers.

Directive on National Reintegration (2018)

It addresses the assistance to returnees, with a focus on their economic reintegration.

2.12. Reintegration of Return Migrants

Kuschminder (2013) under the study on “Female return migration and reintegration strategies in Ethiopia” established that reintegration is a terminology that has different implications for different types of return migrants and a concept that has much to do with sustainable return. Various factors such as individual experiences and social status prior to migration, their experiences in the country of migration and the condition of their return are factors that influence reintegration. However, regardless of the manner of return, reintegration is a process that has deep interconnections with the structural conditions of the return environment. The same study also maintains that reintegration is an all-inclusive aspect requiring the efforts of governments, local population and labor markets to be open and accepting of returnees‟ cultural and social identities in order for the returnees to have an optimal reintegration. The author identifies four core elements that shape the reintegration strategies of returnees. These include cultural orientation, social networks, self- identification and access to rights, institutions and the labor market.

Exploring the MHPSS Needs and Associated Factors of Ethiopian Male Returnees from Kingdom Of Saudi Arabia

On the same token, Naami (2014) also investigated the migration, return migration and reintegration experiences of Ethiopian female domestic workers and assessed various aspects in return migration such as receiving of returnees‟economic betterment, personal relationships and empowerment. Naami‟s findings reveal that there is uneven distribution of incomes among the returnees. While some returnees discovered a new sense of empowerment and self-worth others felt deterioration in their confidence that they regret their decision to have migrated in the first place.

In her findings on the mass deportations of female Ethiopian Migrant workers from Saudi Arabia, Hanna (2014) reveals various challenges faced by women deportees during reintegration. These include social impacts (i.e. breakdown of family, unemployment, change of behavior and habits), psychological impacts and economic impacts. She also indicates that scarcity of funding and lack of national policy hindered the reintegration efforts as well as the sustainability of the return program. The study concluded by asserting that there is a need to enact a migration policy, facilitate ways in which migrants could take legal routes to migration, advancements in the educational and employment policy.

Likewise, Michael (2014) in his assessment undertaken on exploring the reintegration challenges of irregular migrant men returnees from KSA, Michael (2014) laid out several economic, organizational and social challenges faced by returnees. The economic challenges faced by these repatriates include inadequacy of the loan repayment period, inability to get interest free start-up loan, excessive size of members in a business, market problem of the sheds allocated and failure to fulfill infrastructures for allocated business sheds.

Reintegration of return migrants could pose serious challenges to the absorption capacity of the country of return especially in the case of mass influx of return migrants. Thus it is a matter that requires careful planning as well as cooperation between sending and receiving countries. A book published by IOM also maintains that reintegration measures should be able to address and mitigate factors that lead migrants to migrate in the first place. Otherwise, returnees will further be encouraged to emigrate again especially if the return was involuntary (IOM, 2010).

Exploring the MHPSS Needs and Associated Factors of Ethiopian Male Returnees from Kingdom Of Saudi Arabia

CHAPTER THREE: METHODOLOGY

3.1. Study design

Study Area and Period: The study was conducted in Shirka Woreda, Arsi Zone of Oromia regional State. Sherka is bordered on the south by the Shebelle River which separates it from the Bale Zone, on the southwest by Bekoji, on the west by Digeluna Tijo, on the north by Tena, and on the east by Robe. According to Oromia Reginal State Bureau of Finance and Economic Development (BEFOD), the total population of Shirka Woreda was estimated to be 197,547 in 2020. On March 2020 there were 700 registered male returnees from Kingdom of Saudi Arabia.

The researcher used quantitative research design.

Participant selection: the researcher used purposive or judgmental method to select FGD and in-depth interview participants. Accordingly, male returnees from KSA are implicitly chosen for the fulfillment of the research needs.

By using judgement method, the researcher takes the advantage of being time-and cost-effective to perform whilst resulting in a range of responses.

35 Participants used for the in-depth interview. The number of participants does not seem representative. We have to limit the number of respondents because of data saturation have been reached. Since most of the participants responds similar answers as further interview were unnecessary.

Qualitative Study Design: It was used to answer research questions like barriers and other factors for MHPSS, current MHPSS services provisions and trends of service provisions given by communities and stakeholders for returnees, as well as get a deeper understanding about these issues. The qualitative data was collected through conducting Focus Group Discussions (FGDs) and In-depth Interview with key informants.

Focus Group Discussions: Two FGDs each consisting 5 members was conducted with returnees in Shirka town in ERCS safe space. Participants of the FGD includes selected family &community members, representative from relevant GO, NGO and returnees. Each group has a homogeneous member who be able to talk on similar issues on the same perspective. They were selected using

Exploring the MHPSS Needs and Associated Factors of Ethiopian Male Returnees from Kingdom Of Saudi Arabia purposive sampling methods of research. In order to conduct the FGD the researcher used FGD interview guide and check list. The FGDs allowed the respondents to openly discuss and reflect on their psychosocial wellbeing and provided the researchers with in-depth knowledge of the challenges faced by the respondents.

In-depth interview

The in-depth interviews were held with 5 key informants who were returnees from Kingdom of Saudi Arabia. Key informants were selected using a purposeful sampling technique. Initially, the principal researcher communicated the research participants by telephone and met them via phone call conversation. In the first meeting, the participants were briefed about the purpose of the study; and based on mutual consensus arrangements were made to meet up for the actual interview.

Following confirmation of the participants to share their life experiences, interviews were held in place respondents felt comfortable and ERCS safe space. To put it clearly, the interviews were conducted in Shirka Woreda migration intervention kebeles in the ERCS safe space and places where comfortable for participants. The interview sessions with the male migrant returnees ranged from forty minutes to one hour, and each interviewee was recorded on a sound recorder.

Quantitative Study Design: The quantitative study design was used for answering research questions like the proportion of the mental health problems and needs male migrant returnees including their socioeconomic characteristics and other related factors. . A cross-sectional study design was applied by selecting 35 respondents using systematic random sampling technique from 700 registered male returnees in Shirka Woreda on March 2020. An interviewer-administered closed ended questionnaire used to collect the quantitative data from respondents.

3.2. Tools and Techniques of Data collection

3.2.1. Data Collection Tools

Individuals or groups allow the researcher to attain rich, personalized information. The researcher develops an interview guide which is open ended for FGD and In-depth interview. This guide identifies appropriate open ended questions that the researcher asks each interviewees. For Quantitative study design the data collection instrument was closed-ended questionnaire to be interviewed by data collectors

Exploring the MHPSS Needs and Associated Factors of Ethiopian Male Returnees from Kingdom Of Saudi Arabia

3.2.2. Data Collection Techniques

Data collection techniques allow us to systematically collect information about our objects of study (people, objects, phenomena) and about the settings in which they occur. In qualitative research data are obtained from a relatively small group of respondents and are not analyzed with statistical techniques. It involves detailed, verbal descriptions of characteristics, cases, and settings, and it uses observation and interviewing as source of data. It differs from traditional quantitative research through its use of less structured data-gathering instruments and its use of open-ended questioning. In this study, FGD and observation techniques have been used to collect the qualitative data. On the other hand, for quantitative study survey was conducted at 35 randomly selected study participants.Observation technique have been employed to capture information which was not able to be gathered through FGD and in-depth interviews. Checklist were used to collect information through observations.

3.3. Data Analysis Techniques

. Qualitative data was coded and analyzed to explore the predominant themes that arose during focus group discussions with male returnees/respondents. Coding was done for each nominal, categorical and continuous variables. The type of variable that is used to name, label, or categorize attributes are known as nominal variables where the categorical variables are (sometimes called a nominal variable) is one that has two or more categories, but there is no intrinsic ordering to the categories. This coding has been used for qualitative method data collections. Relevant quotations were highlighted to substantiate the quantitative results.

3.4. Assuring the Trustworthiness of the Data

In order to ensure the trustworthiness of the data, the study employed a variety of procedures like pre- tested the survey questionnaires before the actual data collection. For quantitative data quality, a standard WHO questionnaire with acceptable validity and reliability was used to collect data from respondents. The researcher selected two Interviewer as it was difficult to collect the required data during the study time due to geographical disparity of respondents. In addition, prior to data collection, interviewers were received short briefing us on the objectives of the study, the specific requirements for administering MHPSS related questionnaires, and the interview process

Exploring the MHPSS Needs and Associated Factors of Ethiopian Male Returnees from Kingdom Of Saudi Arabia regarding informed consent, relaying interview questions and identification of cases to refer to specialized services. The principal investigator checked the completeness and consistency of the questionnaire after interview at field level before submission.

3.5. Ethical Considerations

Ethical considerations – Referral

All respondents were informed about the purpose study and were notified of the sensitive nature of the questions and their right to withdraw at any time. Oral consent was given. Thus, ethical standards were maintained throughout the course of the project by considering the issue of oral consent, confidentiality, anonymity, potential vulnerability, and sensitivity. To ensure their consent, in addition to the oral consent, I read the written consent prior to conducting the interview. This offered me another opportunity to explain the all over purpose of the study. Besides, to ensure anonymity; pseudonyms were substituted for the participants.

Exploring the MHPSS Needs and Associated Factors of Ethiopian Male Returnees from Kingdom Of Saudi Arabia

CHAPTER FOUR: FINDINGS

4.1. Description of participants of the study

4.1.1. Number of study population and participants of the study

Of the registered 700 male migrant returnees, 35 respondents participated in the cross-sectional survey with a response rate of 100%. This cross-sectional survey collects data to make inferences about a population of interest (universe) at one point in time.

Table 1 Number of the Woreda population, registered returnees and participants of study in Shirka Woreda of Arsi Zone, Oromia, Ethiopia

Region Zone Woreda Population # of Registered # of sampled Returnees Returnees Oromia Arsi Shirka 197,547 700 35

Exploring the MHPSS Needs and Associated Factors of Ethiopian Male Returnees from Kingdom Of Saudi Arabia

4.1.2. Socio-Economic Description of Participants of Study

Table 2 Socio-demographic Characteristics of study participants

Variables Category Frequency Percentage Age 15-24 11 31% 25-34 21 60% 35-44 1 3% 45-54 1 3% >55 1 3% Marital Status Married 18 51 Single 16 46 Divorced 1 3 Religion Muslim 30 86 Orthodox 5 14 Educational level Illiterate 2 6 Able to write and read 2 6 Primary (Grade 1-4) 11 31 Primary (Grade 5-8) 9 26 Secondary (Grade 9-10) 8 23 Preparatory ( Grade 11-12) 3 9 Diploma and Above 0 0 Head of Family Yes 18 51 No 17 49 No Children & Elderly 15 43 Number of 1 Children 8 23 Dependents (children 2 Children 5 14 & Elderly) 3 Children 3 9 4 & Above Children 2 5.5 Elderly Dependent Only 2 5.5 0-200 15 43 201-400 9 26 401-600 8 23

Monthly Income 601-800 2 6 801-1000 1 3 >1000 0 0

Exploring the MHPSS Needs and Associated Factors of Ethiopian Male Returnees from Kingdom Of Saudi Arabia

Age is an important demographic characteristic that affects the mobility of the population. As has been depicted in Table 2 presents the broad age-distribution of surveyed returnees. The research participants were between the ages of 18 to 59 years. The mean age of the respondents was 27.57 years. The majority (60%) of the respondents were in the age category of 25-34, followed by 31

% in the age category of 15-24. The remaining sum of age categories 35-44, 45-54 and >55 accounts only 9 %. Hence, the study shows that the highest percentage of respondents under age 30 shows that returnees are in their young age group.

Regarding marital status, the 54% of male migrant returnees study participants were married while 43% of them were single and only 3% were divorced. In term of religion, the great majority (86%) were Muslim followed by Orthodox (14%).

The result of the socio-economic description presented in Table 2 also showed the level of education of the study participants. As a result, those who attended Primary level (Grade 1-4) accounts 31% followed by Primary (Grade 5-8) 26%, Secondary (Grade 9-10) 23 % and Preparatory 9%. The remaining 6% study participants were able to write Arabic language and read but not attended a formal education rather non formal Islamic religious studies and 6% of them were illiterate. On the other hand, none of the study participates attended a higher level of education. The study indicates that one of the reason for migrating to other country for search of work was absence of attending adequate level of education, which is a prerequisite to access job in their homeland to support livelihood.

Asked about head of a family, over half (51%) of the study participants were head of a family while 49% not head of a family. With regard to the number of living children they have, over half (51.5%) of them were has one or more children. Of these, 23% of them has one child, 14 % had two children, 9% had 3 children and the remaining 5.5% had over 4 children. On the other hand, 43% of the study participants had no children and elderly dependent. The least (5.5%) proportion of them had no children but with elderly dependent.

Regarding the monthly income of the study participants, it ranges from 0 to 1000 ETB. Close to half (43%) of the study participants earn a least monthly income (0-200 ETB) followed by 26% (201-400 ETB), 23 % (401-600 ETB). Only a small proportion 6 % had a monthly income (601- 800 ETB) and 3% (801-1000ETB). Consequently, the study indicates that male migrant returnees

Exploring the MHPSS Needs and Associated Factors of Ethiopian Male Returnees from Kingdom Of Saudi Arabia do not have adequate amount of monthly income that help sufficiently support their livelihood. They are part of the poorest society who need a social and other support.

4.1.3. Source of income of the study participants

As clearly presented in Figure 4, respondents were able to report some income sources. Thus, 40% of the study participants had no any source of income during the period of the study. On the other hand, working a daily laborer work (26%), followed by support obtained from family relatives (14%), remittance from friends and family abroad, and self-employment (9%) were the source of income of the study participants. The study indicated that majority of male migrant returnees from KSA.

Source of Income of Study participants Shirka woreda of Arsie Zone of Oromia, Ethiopia 16 14 (40%) 14 12 10 9(126%) 8 6 5(14%) 3(9%) 4(11%) 4

2 Number studyof participants 0 Daily laborer From family & Self Employment No Income Source Remittance from relatives Friends & family abroad Types of Source of Income

Figure 4: Source of Income the study participants

4.1.4. Employment status of study participants

As has been depicted in Figure 5, respondents reported their employment status. Accordingly, the great majority (80%) of the study participants were unemployed. On the other hand, only 11% of them were engaged in informal employment while 9% involved in casual or temporarily work

Exploring the MHPSS Needs and Associated Factors of Ethiopian Male Returnees from Kingdom Of Saudi Arabia round their residence area. The study indicated that unemployment is the major push factor for male migrant returnees to leave their home land and migrated to foreign country in search of work.

Figure 5: Employment status of study participants in Shirka Woreda of Arsi Zone Oromia,

Ethiopia

4.1.5. Housing condition of study participants

Asked about the housing condition i.e. the place where they were living, close to half (46%) of them were living along with their respective family members followed by rental house (37%), with friend (11%). It is only 6% of them were living in their own residence house. The study indicated that the great majority of male migrant returnees do not access to their own house which forced them to live as dependent with families or relatives and to rent a house.

Exploring the MHPSS Needs and Associated Factors of Ethiopian Male Returnees from Kingdom Of Saudi Arabia

With Family With Friends Own House Rental House

37 % 46 %

6 % 11 %

Figure 6: Distribution of study participants by housing condition, Shirka Woreda of Aris Zone of

Ormia Ethiopia.

4.1.6. Ownership of Asset by Study Participants

Respondents were also asked about the types of asset they have or not. In this regard, as presented in Figure 7, the majority (73%) of study participants did not have any types of asset. On the other hand, only 9% had a land, 6% House, 6% money in the bank and 6% livestock. The study indicated that the highest proportion of male migrant returnees from KSA do not have asset that can used as a coping mechanism.

Distribution of ownership of Asset in Sherka Woreda of Arsi Zone , Oromia Ethiopia

No Asset 74 % Land 9 % Money in the bank 6 % House 6 Livestock/Cattle %

0 10 20 30 40 50 60 70 80 % % % % % % % % %

Figure 7: Description of Asset of study participants

Exploring the MHPSS Needs and Associated Factors of Ethiopian Male Returnees from Kingdom Of Saudi Arabia

4.2. Occupations held while Abroad

As shown in Table 3 below, while they were abroad, 31 % of respondents were engaged in Labor work followed by domestic related work (26%), Agriculture/Livestock (23%) and Construction (6%). On the other, 6% were not started any type of work and only 3% were engaged in other work

Table 3 Study participants occupation engaged while in abroad

Types of work Frequency Percent Labor 11 31% Domestic 9 26% Agriculture/Livestock 8 23% Construction 4 11% Do not stat work 2 6% Other 1 3% Total 35 100%

4.3. Supporting of their family members while in abroad /Remittance

The study indicated that one of the push factors for study participants to migrate to abroad is there keen interest to support their family members. As shown in Table-4 below 51% of respondents indicated that they were supporting their families through sending money back to their families. In addition, the average number of family members that have been received a remittance supported by per respondent were four dependents in Ethiopia. Asked about saving after return, only 9% of respondents reported that they were saving some amount of money upon return.

Table 4: Respondents supporting of their family members while in abroad

Description Response Frequency Percent Supporting family members Yes 18 51% No 17 49% Saving upon return Yes 3 9% No 32 91% Average number of family 4 members supported

Exploring the MHPSS Needs and Associated Factors of Ethiopian Male Returnees from Kingdom Of Saudi Arabia

4.4. Prevalence of Mental health and PSS problems of study participants

The descriptive study was also assessed the prevalence of mental health problems among respondents thorough asking questions related to mental problems. Mental illnesses are health conditions involving changes in emotion, thinking or behavior (or a combination of these). Mental illnesses are associated with distress and/or problems functioning in social, work or family activities (Parekh, 2018). Examples of mental illness include depression, anxiety disorders, schizophrenia, eating disorders and addictive behaviors. Thus, as depicted in Table 5 below mental health problems were common among male migrant returnees from KSA. For instance, the prevalence of mental health problems such as suffering from Headache was 54%, Poor appetite (60%), Sleep badly (60%), Easily frightened (54%), Hands shake (60%), Nervous, tense or worried feeling (69%), Poor digestion (60%), Trouble thinking (60%) and unhappy feeling (57%)

The prevalence of mental health problems like difficulty to make decisions prevail among 74% of the respondents while suffering from daily work (71%), practice of unable to play a useful life (63%), Lost of interest in things (57%).

Apart from these the prevalence of other mental health problems like feeling of valueless person ( 69%), thought of ending life on mind (69%), Feeling of tired all the time (69%), uncomfortable feelings in stomach(66%) and tendency of easily tired (63%) were common among the study participants.

Therefore, the study indicated their life condition male migrant returnees from abroad were exposed to varieties of mental health problems that need due attention to be resolved through integrated efforts of themselves, families & relatives, community members and relevant GO, NGO & stakeholders. However, since this analysis has been done by using the one of the SRQ which only shows the portion of the mental health condition of male returnees. This may not guarantee the existence of mental health problems because the analysis has not been conducted by dependent expertise or professional of mental illness. Still SRQ can be used to screen psychiatric disturbance, especially in developing countries (WHO, 1994). SRQ helps to question respondents about symptoms and problems likely to be present in those with mental illness.

Exploring the MHPSS Needs and Associated Factors of Ethiopian Male Returnees from Kingdom Of Saudi Arabia

Table 5: Prevalence of mental health problems among study participants

MH Factors Response Frequency Percent Headache Yes 19 54% No 16 46% Poor appetite Yes 21 60% No 14 40% Sleep badly Yes 21 60% No 14 40% Easily frightened Yes 19 54% No 16 46% Hands shake Yes 21 60% No 14 40% Nervous, tense or worried feeling Yes 24 69% No 11 31% Poor digestion Yes 21 60% No 14 40% Trouble thinking Yes 21 60% No 14 40% Unhappy feeling Yes 20 57% No 15 43% Crying more Yes 4 11% No 31 89% Yes 23 66% Enjoying of daily activities No 12 34% Yes 26 74% Difficult to make decisions No 9 26% Suffering from daily work Yes 25 71% No 10 29% Unable to play a useful life Yes 22 63% No 13 37% Loss of interest in things Yes 20 57% No 15 43% Feeling of worthless person Yes 24 69% No 11 31% Thought of ending life on mind Yes 24 69% No 11 31% Feeling of tired all the time Yes 24 69% No 11 31% Uncomfortable feelings in your stomach Yes 23 66% No 12 34% Easily tired Yes 22 63% No 13 37%

Exploring the MHPSS Needs and Associated Factors of Ethiopian Male Returnees from Kingdom Of Saudi Arabia

4.5. Prevalence of Psychosocial Problems

The study assessed the metal health and psychosocial needs of returnees particularly those related to rejection and stigmatization by family and community members, and stress. Consequently, as shown in the Table 6 below the highest proportion (80%) of the study participants felt that their respective family and community did not accept them. On the other hand, 40% of the study participants experienced any sort of stigmatization attached to them by their families and community members.

The other psychosocial problems explored was the prevalence of stress and the reasons or factors behind the stress. Accordingly, as has been depicted in Table 6 below the overwhelming majority of respondents (97%) reported being stressed while only 3% were free from stress. Regarding the reasons for predisposing respondent who experienced stress, close to half (45%) were because of lack of employment followed by shortage of money (36%), life conditions (12%). Only 3 % of them stressed because of problems related to health, factors related to family members and others contribute 6%.

Respondents also identified coping mechanism or methods of dealing with stress. Accordingly, in order to cope up the stress respondents used a varieties of methods like talking to relatives and friends (26%); socializing with friends & family(20%), Speaking to a specialist (11%), Speaking to Red cross volunteers (14%) , Speaking to staff/volunteers from NGO (9%), Exercise , Leisure activities & medication (6%), Smoking & Taking alcohol (9%) and did not have support mechanisms (6%).

As to what support mechanisms they would like to get to deal with stress, they indicated a number of support areas. The main support areas are: employment opportunities; psychosocial and mental health support; trainings; financial support; facilitation of working space; and religious prayers and holy water service.

Therefore, the study clearly identified that returnees are often vulnerable to various psychosocial problems while they returns in their homeland. It is, therefore, advisable for returnees to adjust themselves to the dominant norms and values affects their psychosocial reintegration.

Exploring the MHPSS Needs and Associated Factors of Ethiopian Male Returnees from Kingdom Of Saudi Arabia

Table 6: Prevalence of psychosocial & stress problems on Study Participants

Descriptions Response Frequency Percent Accepted by family and community Yes 7 20% No 2 80% Feeling of any sort of Stigma Yes 14 40% No 21 60% Feeling of Stress Yes 34 97% No 1 3% Factors or reasons for stress from those who experienced stress (N=34) Family 1 3% Shortage of Money 13 38% Health 1 3% Luck of Employment 15 45% Life Conditions 4 12% Others 1 2%

Methods of dealing with stress Talking to relatives & Friends 9 26% Socializing with Friends & Family 7 20% Speaking to a specialist 4 11% Speaking to Red cross volunteers 5 14% Speaking to staff/volunteers from NGO 3 9% Exercise , Leisure activities & medication 2 6% Smoking & Taking alcohol 3 9% I don‟t have support mechanisms 2 6%

Exploring the MHPSS Needs and Associated Factors of Ethiopian Male Returnees from Kingdom Of Saudi Arabia

4.6. The proportion of male migrant returnees who received psychosocial and reintegration Services

One of the specific objective of the study is to identify the proportion of respondents who obtained mental health and psychosocial support services. As a result, as shown in Figure 5 the proportion of respondents who obtained any types of mental health and psychosocial support services was only 26%. These mental health and psychosocial support services includes micro-credit, training on income generating, receiving of working space, post-return counseling and health care services

Proportion of respondants who received PSS or any integration support

9(26%)

26(74%)

No Yes

Figure 8: Proportion of study participants, they received PSS or any integration support Relevant government organization, NGOs and community members provided the psychosocial support and reintegration services. The types of support returnees received from these organization clearly stated in the Table 7 below. Accordingly, these services includes training on income generating (11%), provision of finance for micro credit (6%), Post return counseling (6%) and Health Care Services (3%). These services were rendered by government organization like Oromia Micro Finance Office , International NGO like ILO and local NGO namely Ethiopian Red Cross Society.

Exploring the MHPSS Needs and Associated Factors of Ethiopian Male Returnees from Kingdom Of Saudi Arabia

Table 7: Types of support returnees received from Government, International & Local NGO

Types of support received from Frequency Percent Government & International & Local NGO Training 4 11% Micro-credit 2 6% Counseling (Post-return) 2 6% Health Care 1 3% No Support Received so far 24 76%

4.7. Occupational Preference of Respondents

Respondents were asked about preferred occupation that they want to engage in the future. Consequently, the finding is presented in Table-8 below. The preferred occupation for 43 percent of respondents was to start own business. Seventeen percent of respondents are interested to engage in animal husbandry such as poultry and fattening (goats, sheep and cattle). Only 4 percent of respondents seek employment in the public service or governmental jobs.

The respondent also listed a number of training and financial support need that they would like to receive either from government or NGOs including business management, training on animal husbandry with a focus on fattening; credit access to start own business; and provision of working. Some of the skills returnees acquired while abroad include masonry, driving skills, ability to speak other language, and operation of some construction machineries.

Exploring the MHPSS Needs and Associated Factors of Ethiopian Male Returnees from Kingdom Of Saudi Arabia

Table 8: Occupational Preference of respondents

Ideal occupation preferences Frequency Percent Farming 1 3% Civil servant 4 11% To be employed 2 6% Livestock bearer 6 17% Craftsman 4 11% Business 15 43% Others 3 9% Total 35 100

4.8. Finding of the focus group discussion (Revise findings of the in-depth interview)

Two-focus discussion held in March 2020 at Shirka Woreda with a group consisting of selected Iddir leaders, Government representatives, family members, NGO representatives and representatives from returnees. The focus group discussion mainly focused on issues pertaining to extent of community involvement, social cohesion, distress level, barriers for providing psycho social and reintegration services and recommendations to strengthen the services in the future.

4.8.1. Social Cohesion

FGD participants identified that social networks are a vital component to successfully integrate male migrant returnees from Saudi Arabia. These networks pave the way to access resources and social capital that can play essential roles in the process of reintegration of male migrant returnees. They also mentioned that involvement and membership of returnee in the existing community- based organizations (Idir, Eqkub and Mahiber/Senbete) were essential to integrate returnees particularly to access a startup fund important to start income generating activities as well as provision of psychosocial support counseling at time of mourning. Idir is a traditional and local self-help group/association through which the community members try to support each other at specific events such as mourning or weddings. On the other hand, Eqkub is a traditional saving and credit group through which community members try to save and lend money. In Ethiopia, they

Exploring the MHPSS Needs and Associated Factors of Ethiopian Male Returnees from Kingdom Of Saudi Arabia are the strongest indicators of social bondage and cohesion.

As such FGD participants recommended that retunes should be part or members of the above mentioned community-based organizations (CBOs).

4.8.2. Distress levels

Regarding the question on the extent or level of distress on returnees, FGD participants explained that is high among male returnees because they feel nervous, tense and worried anxious most of or all the time as well as faced difficulty to make decision. They also explained the underlying causes of high level of distress is due to shortage of adequate finance, feeling of failure and guilt, as well as their inability to afford basic needs and meet the household needs. “Our living conditions are very bad: no hope no future”. (Male FGD participant, Gobesa, Shirka, March 2020).

The challenging living conditions are also affecting the family dynamics and relations. “Family problems between the husband and his wife are due to the economic situation, and inability to meet our families‟ needs or rent.” (Male FGD participant, Hassen, Shirka, March 2020).

Returnees felt the most distressed after they had exhausted all the solutions available to them, increased their debt levels and were still unable to meet the basic needs, including employment and health. “We feel less distressed when we have some money to ensure the basic needs of the family.” (Male FGD participant, Shirka, Mohammed, March 2020). They have consequently felt more at ease and less distressed when they managed to afford all expenses and provide for their families.

4.9. Findings of In-depth Interview

Apart from the FGD, in-depth interview with 5 male migrant returnees were conducted in Shirka Woreda Kebele 5. The in-depth interview was conducted to obtained information on the feeling, attitude, experiences, value etc of male migrant returnees as stated as follow

Original migration drivers and the journey back home anticipated return challenges

Poverty, peer pressure, unemployment, Pseudo stories by brokers and success stories of migrants frequently influence the initial decision to migrate through irregular means. Interviews with returnees found the same. All the five returnees interviewed for this study cited poverty, peer

Exploring the MHPSS Needs and Associated Factors of Ethiopian Male Returnees from Kingdom Of Saudi Arabia pressure, unemployment or government prosecution as reasons for their original migration. Top factors influencing destination preferences include better living standards and access to employment and migration cost and yet the achievability of reaching the destination and presence of local networks in the destination plays into where Ethiopians actually go. Most Ethiopians leaving the country travel to KSA or Gulf countries. Interviewed returnees shared multiple reasons for their initial migration that aligned with the robust research on migration motivations in Ethiopia. They reported poverty and peer pressure and seeking better employment opportunities abroad, or a combination of the two factors. Other returnees had spent most or all their lives abroad and recounted the migration stories of their parents.

Most conditions that prompted the original decision to leave continued to be present in how returnees described their present life in Ethiopia. For example, returnees cited financial concerns

E.g. Unemployment and having a debt from the family or near relatives as key concerns upon return. One returnee described his original migration motivation: “Because of poverty and unemployment in Ethiopia, we had to leave our homes and we decided to migrate.” The returnee later described his present situation in similar terms: “The problems we are currently facing are worse than before like stigma and discrimination, unpaid debt of family, unemployment, our poor support system – especially for returnees– and a lack of basic items” (Abdu,Shirka, 25).

Faced with the same matrix of migration motivations, much of the literature on returnees indicates that Ethiopian returnees would again choose to leave. This is a cyclical model consistent with rational choice theory. However, emerging return and reintegration literature indicates that reintegration experiences – and returnees‟ corresponding aspirations and intentions – are a product of original migration drivers, migratory experiences, reception in destination countries and experiences during return. While environmental factors in Ethiopian may look similar pre- departure and post-return, returnees themselves are frequently changed by their migration and return experiences. These experiences may change how returnees interact with their environment and make future decisions.

Exploring the MHPSS Needs and Associated Factors of Ethiopian Male Returnees from Kingdom Of Saudi Arabia

Delayed effects of trauma are widespread

Returns are rarely planned and may present a shock for returnees. Migration and return stories shared by returnees revealed traumatic experiences during migration. Many returnees associated these experiences with poor mental health and psychosocial wellbeing at the time of their interviews. Each returnee had a unique perspective but a pattern of hardship and trauma was evidence across multiple contexts. Extended periods of fear, perceptions of imminent danger, and chronic anxiety were common throughout returnee narratives. Many also included physical violence and torture.

The nature of these traumatic experiences varied in relation to the country, character of the job and behavior of the employer from which respondents returned and worked but protection challenges were widespread. Some returnees focused their narratives on experiences of physical discomfort, thirst, hunger, and violence experienced during migration journeys and immediately prior to return. One respondent recounted highly traumatic experiences: “Thieves stopped us and beat us. They took the 50,000 ETB that we had. After that, we didn‟t eat for two days. One man brought us some food. I was sick” (Men, Gudina, 22).

Returnees also described being shot at, being afraid for their lives, experiencing torture, and witnessing violence. Two returnees were threatened with forced recruitment to armed groups in Yemen.

Returnees from KSA reported major instances of violence and hardships during initial migration journeys. Many viewed their circumstances in KSA unfavorably and had broken ties with their families‟ communities. However, others reported chronic uncertainty due to a lack of documentation, hostile relations with hosts, anxiety and fear of the police, experiences of imprisonment and challenges during return. One returnee said, “We were always afraid of being arrested at any possible time. Where we were living, the police used to constantly arrest migrants, which eventually caused us to return” (Male, Hela Mekana, 25). Some returnees from KSA reported feeling fear during their return journey.

“It's really hard living in a KSA because as migrants you are not considered a human… A few people treat you badly and you cannot even respond. Otherwise you would be punished. They use bad words, as I experienced when living in KSA. They used to call me „Habesha alkalb‟ [Ethiopian

Exploring the MHPSS Needs and Associated Factors of Ethiopian Male Returnees from Kingdom Of Saudi Arabia

Dog immigrant]. When I heard that, I started crying, but I had no other option but staying there and listening because of the poverty and unemployment and failed dream.Male, Gobessa, 25)

Returnees from KSA and Gulf countries often felt positive emotions during their time abroad and particularly a sense of safety among those who successfully arrived at their destinations. Yet their narratives included loneliness integration issues, danger during KSA border crossings, periods of fatigue and hunger, experiences of violence and abrupt deportation. One returnee said, “I didn‟t speak their language, I didn‟t have permission to work, I lived in a rural area and I felt like my future was lost… I was away from family and friends, which were negative things about living abroad” (Male, Gobessa 2, 24).

Returnees cited challenges with host communities, poor local integration and loneliness. Respondents mentioned difficulty learning the Arabic language and finding work. One returnee said, “Finding a job [in KSA] was a challenge itself, and when I found a job they would not pay my salary. I was working in a herdsman for camel [300 USD] per month” (Male, Jawa, 29). Multiple returnees said they felt homesickness while abroad. Some described extended periods in difficult economic circumstances or detention, including one respondent who was in prison for eight months.

“I could no longer deal with the hardship and loneliness in KSA. There was no hope, no matter how long I stayed. I earned very little money in exchange for my services at the goat and camel herdsman and I worked all day long” Male, Hela Mekena, 25.

These kinds of traumatic migration and return experiences are frequently accompanied by „toxic stress‟ and can have psychological consequences that remain long after return. Returnees may see still present migration drivers in a new light after their traumatic experiences. This has a profound impact on reintegration and long-term decision-making.

The decision to return and mode of arrival

It is challenging to determine causal links between experiences abroad, the decision to return, and the action of returning. Negative experiences abroad motivate diverse migration behaviors. For example, discrimination, restrictions on internal movement and economic hardship motivate some Ethiopians to migrate onwards to other gulf countries but encourage others to return. Among those

Exploring the MHPSS Needs and Associated Factors of Ethiopian Male Returnees from Kingdom Of Saudi Arabia who have decided to return, social pressures to remain abroad may stop them from executing their decision.

While return rates have significantly Increased since 2013 (when fears, protection gaps, pressure from KSA kingdom on deporting undocumented migrants led to a large spike in returns), there is still substantial pressure on Ethiopians to return from KSA.

“The main reason for returning was because I could no longer deal with the hardship and loneliness.” Male, Hela Mena, 25

At KSA, migrants often face discrimination, fear of deportation, crime and violence. Other challenges upon arrival include accessing employment, and protection. Many assume substantial debt to finance migration and cannot earn enough money in KSA to pay back their creditors.

Some, especially male Ethiopians, come to believe their quality of life would be better in Ethiopia in light of their precarious position and rural working as camel and goat herdsman. Ethiopians living abroad who have struggled to integrate describe psychosocial factors including hopelessness, missing family, and marginalization.

The extent of integration at KSA offers a useful way of framing many of these issues. Those who integrate more deeply economically and socially tend to want to remain in KSA, as do those who have been abroad for longer periods of time. Some returnees even feel more at home in their new country than in Ethiopia, having found work and achieved a sense of security. One returnee said, “When I was eighteen year old I immigrated to KSA in 2007… I got job, got some money, got married and had children there. I was accustomed to KSA traditions, which are quite different from Ethiopian‟s” (Male, Gobessa, 38). The Ethiopian diaspora, especially in places where it is well established, often helps ease the transition to living abroad.

Lack of information: a driver of return?

Information and its absence play critical roles in the return process. Most returnees expressed confusion or highlighted a lack of information at returnees from KSA noted that word-of-mouth rumors, television, and social media led to fear of remaining abroad and encouraged return. One interviewed returnee said that he and his friends returned because they were heard better chances for returnees back home, but later learned that the information they had heard was

Exploring the MHPSS Needs and Associated Factors of Ethiopian Male Returnees from Kingdom Of Saudi Arabia

“Fake news, and most of our friends still live in KSA” (Male, Hassen, 22). In such various points before and during return. Some circumstances, returnees often expressed feelings of regret about their return. They also tended to continue to view life abroad positively.

“There was a lot of pressure by the KSA government to return to Ethiopia, but we saw people posting on Ethiopian Televisions‟ that returnees are getting different support from the government and stakeholders and encouraging other people to leave KSA and return to Ethiopia. We were impressed by those stories and finally we decided to return home.” Male, Jawa, 24.

Returnees who were forcibly removed from KSA often lacked access to information during their deportation or while detained by authorities. Some did not know how long legal proceedings would take and others were unclear how long they would remain in prison. Some returnees received conflicting information at the prison on their rights, access to documentation and available assistance. One respondent said that they could not seek assistance during return because organizations “always asked us a lot of documents and passport from KSA that most of us don‟t have since we migrated irregularly. So that‟s why I decided to return without letting anyone know about it” (Male, Gobessa, 35).

The lack of information before and during return left many returnees feeling confused and betrayed. These feelings were linked with a broader lack of trust. Multiple respondents said variations of, “There is no one I turn to for advice or information to help plan the future” (e.g. Male, Hela Mekena, 25). Another returnee said, “Believe me, I don‟t have trust in anybody.

Everyone we have trusted has mistreated us. My family is the only source of advice for me” (Male, Gobessa 01, 26).

A Challenging Reintegration Experience

The physical, emotional and financial well-being of returnees is of intrinsic value and is fundamental to community cohesion. This is especially true in regions where displacement, migration and return have become the norm. The reintegration of returnees can bring development gains to local communities via the skills and connections they have acquired abroad.

On the other hand, barriers to long-term planning, such as fear of discrimination or ongoing psychosocial challenges, can leave returnees isolated, vulnerable and more likely to pursue high-

Exploring the MHPSS Needs and Associated Factors of Ethiopian Male Returnees from Kingdom Of Saudi Arabia risk strategies. Returnees who are able to find decent work, pursue education, start a business or access arable land in Ethiopia may be more financially and emotionally invested in their community of return. They may feel better able to pursue long-term aspirations. Reintegration is important for the GoE and the international community because it may mitigate the drivers of forced migration and lessen the draw of crime or militancy.

Available data on life post-return in Ethiopia is lacking but there are widespread and unmet needs. Initially, reuniting with family, returning to a familiar cultural context or escaping traumatic situations abroad may be positive for returning Ethiopians. Yet they also face significant challenges including psychosocial needs, protection risks, lack of services and inability to support long-term economic needs. While return experiences are diverse, many of these negative experiences are common across return categories.

4.9.1. Challenges /Barriers for Psychosocial and Reintegration Services Psychosocial needs as a crosscutting challenge

Negative psychosocial factors relating to mental health are common after return. The act of return can be extremely jarring, particularly when the return was not (completely) voluntary. The migration experience and life KSA can cause depression, anxiety, loneliness, trauma and psychological distress indicators that worsen over time if not addressed.

“I have newly returned, and there is no doubt I went through severe mental issues and depression during my first week after return. Problems that I encountered [in KSA] are simply unforgettable, and every time I am left alone, all those horrible memories go through my mind. I saw death several times of my Ethiopian fellowmen on the in route to KSA. Frankly, I am still suffering from mental and psychological issues; however, as each day passes, I do sense minor changes in my emotions and feelings.” (Male, Gobesa, 22)

Some returnees report feelings of shame and failure. They reported feeling guiltyabout using family funds for failed migration efforts. Deterioration of mental health and emotional well-being among male returnees is becoming common. Male returnees face real and perceived stigma and discrimination, creating feelings of loneliness and isolation related to masculinity. Male returnees in Ethiopia also display indicators of poor mental health including anger and sadness.

Exploring the MHPSS Needs and Associated Factors of Ethiopian Male Returnees from Kingdom Of Saudi Arabia

Such feelings are not necessarily universal. Returnees often highlight family reunification and return to a familiar cultural context as reasons for feeling happy after returning, particularly when they had stayed in close contact with family or friends. However, returnee narratives consistently reveal a sense of hopelessness in relation to poor conditions as well as more specific needs. The terms “problem” and “need” are two of the most common words in the transcripts and are often used in relation to mental health.

Acute psychosocial needs stemming from traumas experienced in migration and return journeys set returnees apart from other Ethiopian. Community members may share psychosocial needs arising from traumatic experiences in-country. Returnees linked their negative psychosocial wellbeing post-return with traumatic experiences endured during their migration and return journeys. They described how these experiences interact with conditions upon return to amplify and worsen mental health challenges. Returnees mentioned feeling stress, anxiety, depression, sadness, shame, and loneliness after their return. Several even mentioned suicidal ideation. Some respondents linked mental health with health problems stemming from tension and stress.

Returnees highlighted security, economic and social concerns as amplifiers of psychosocial needs after return. Interviewed returnees described anxiety and nervousness about their families who are indebted for financing their migration (Male, Ahmed, 34). Other aspects of life post-return appear affected by psychosocial needs. For example, some returnees attributed their inability to find a job or to move forward with their future plans to their poor mental health. Evidence from their responses suggests that psychosocial needs may be the largest reintegration challenges for returnees. Yet few returnees reported access to psychosocial support.

“On top of not feeling like part of my society, I got sick on my way back home and I am still not feeling well. I was suffering from both physical and psychological illnesses. That caused me to lose my job and lose some skills. Before my departure, I was able to work as a daily laborer and was a good farmer, but due to my psychological illness, I am not able to farm and work other business anymore. In addition to losing my job, I also incurred some unnecessary expenses before I left. Now my financial situation is bad.” Male, Ahmed, 34.

Exploring the MHPSS Needs and Associated Factors of Ethiopian Male Returnees from Kingdom Of Saudi Arabia

Male returnees are particularly impacted by psychosocial challenges

Traumatic experiences and indicators of poor mental health were particularly present among male respondents. Several returnees refer it indirectly the occurances of gender-based violence (GBV) during migration journeys. Just one male respondent was working at the time of the interview. Each narrative shared a different experience that reflects unique mental health challenges facing male returnees, including feelings of abandonment. These narratives align with emerging literature on GBV among male returnees, particularly male.

“My wife still lives in KSA. On the New Year‟s Day, my children ask me when their mother would return home. I tell them she will come home this New Year‟s Day. Every year I tell them their mother will return in the upcoming New Year. I spend my life making excuses for my wife. I feel very depressed because a man alone with children cannot do better, especially in Ethiopia.” (Male, Hela Mekena, 30)

Male returnees also displayed feelings of frustration based on what they describe as “culture” or “tradition” that expect a lot on male as breadwinner and head of his family in Ethiopian.

Economic insecurity

Returnees come back to an Ethiopia that displays many of the same economic and social conditions that led to the initial migration decision. Returnees described Ethiopia‟s economic situation that which unabled to accommodate millions of youth Ethiopian who need to join the labor market and fake information by brokers and peer pressure as a primary driver of their ongoing needs.

Short-term economic stress hides long-term needs

Most returnees said that immediate financial needs were a primary source of stress. They linked a short-term lack of money with psychosocial challenges, food insecurity, and inability to access healthcare. Several male respondents said that they could not find work worse than when the left, while several male respondents pointed to the need for NFI and FI. One male returnee said, “I really need money and a home. I am unemployed, indebt, I need a psychosocial support equally as economic support” (Male, Hela Mekana, 22).

Exploring the MHPSS Needs and Associated Factors of Ethiopian Male Returnees from Kingdom Of Saudi Arabia

While short-term needs were a source of stress, long-term economic well-being was more strongly reflected in the FGDs. Returnees said that their inability to access sustainable livelihoods was a top concern along with underemployment, debt and Psychological distress. Over half of the returnees interviewed were unemployed. High levels of joblessness upon return are also commonly cited by returnees in secondary sources. Economic struggles directly relate to food and shelter insecurity.

Among those who were employed, many interviewed returnees were working temporary or low- paying jobs. There was often a mismatch between a returnee‟s current form of work (e.g. low-skill labor) and their existing skill sets (e.g. masonry/construction). One returnee said, “I didn‟t want to return because I used to hear all the time from my friends and relatives about the bad conditions and a lack of job opportunities. I used to earn [300 USD] per month in KSA, and now that I am here, I wish I had never returned” (Male, Zembaba Hela, 30; mason by profession but currently unemployed). Economic challenges post-return also relate to negative coping mechanisms such as low acceptance in their society or high levels of debt. Lack of family support and poor psychosocial wellbeing can pose a holistic crisis for returnees.

“Due to our financial challenges, I couldn‟t go to school. Even my 7 year-old son needs educational support to continue studying.. Since our financial condition is very bad, none of our relatives are in touch with us. Even when my wife was ill no one borrowed me money. Our relatives are financially better but will not help us. My wife‟s illness was the biggest challenge I have faced after my return to Ethiopia. We spent all our money on her treatment. We even borrowed money for her treatment.” (Male, Hela waji, 38)

Restricted access to services

Little or no documentation: Returnees often lack documentation of their former status, particularly male-returnee households because most of them prefer to live in other towns. Failure to obtain identity Card (Butaka) is a major problem for returnees in Ethiopia.

The influx of returnees has been credited with no supporting movement to the least identification card right which leads to question the national task force which meant to coordinate and lead the support and reintegration of return migrants which is presided over by the Deputy Prime Minister is composed of representatives of all major federal public agencies whose institutional profiles and

Exploring the MHPSS Needs and Associated Factors of Ethiopian Male Returnees from Kingdom Of Saudi Arabia mandates have direct relevance for the support and reintegration of return migrants. Whereas the task force is primarily meant to coordinate and lead the support and reintegration efforts of all the major government and non-government organization, the enabling legislation requires the office of the General Attorney to lead and coordinate the work of the federal task force on a regular basis under the Deputy Prime Minister.

However, at Arsi/Shirka the structure and system doesn‟t exist actually because there is no coordinated effort from government and non-government organization and also there is very few services from the government like BOLSA and few non-governmental organization like ERCS which assists returnees by Livelihood support ,Psychosocial support and social cohesion to increase the resilience and psychosocial wellbeing of returnees and ILO in collaboration with the microfinance enterprises/TVET assist returnees on vocational skill training and creating job for returnees exists in Shirka Woreda but comparing with the huge number of returnees the effort is like a drop to the ocean. In Shirka still supporting of returnees has been slow and uneven. Without appropriate documentation, returnees‟ “ability to claim assistance, enroll in education or seek employment” and access justice is reduced.

Limited access to education:

Returnees often cannot enroll in school due to cost and closed chance to resume education again. Many instead priorities “earning money for survival.

Access to healthcare:

Multiple respondents mentioned longer-term health needs, though few cited health access to healthcare as a challenge. For some, poor health posed a barrier to livelihoods. Several male returnees said that they could not access mental health care or see a Psychiatrist to address their mental health. Mental health treatment was not seen as health problem due to misunderstanding and low awareness as same time its accessibility and affordability is at very low level in Ethiopia, and instead respondents viewed Mental Health and psychosocial wellbeing caused by punishment from God or evil spirit. One returnee said, “Even if I was offered a job I wouldn‟t be able to do it. I‟m sick and I am not able to work… My friend was trained as a mason last year, but due to his emotional problem, he is not able to work anymore. His mental and psychosocial wellbeing get worsen and he has become very ill, and he didn‟t psychiatric treatment only spiritual and traditional

Exploring the MHPSS Needs and Associated Factors of Ethiopian Male Returnees from Kingdom Of Saudi Arabia healing but couldn‟t get better” (Male, Gobessa 01, 35).

Barriers accessing land and housing:

Several respondents pointed to temporary, insufficient or expensive housing as a key problem. Others viewed land and housing as unmet longer-term needs and often a top priority. Several respondents pointed to the lack of land, electricity or running water as an explanation for poor housing.

It was common for returnees to stay with family upon their return, but this dynamic was viewed as challenging for many. For example, many returnees don‟t continue their education and access is very limited for them. Such sentiments may be a result of a mismatch between expectations developed while living abroad and the reality of living in Ethiopia.

Returnees who cannot go home struggle to secure safe and dignified housing or shelter. Family‟s small land may be in the hands of their brothers and families and efforts to allocate new land to returnees have been marked by corruption and slow progress. Many end up in informal settlements and are vulnerable to eviction, particularly who has families. Returnees accustomed to KSA housing norms, such as privacy, may struggle to reintegrate with families who have not lived abroad. Returnees lacking local connections may end up paying higher rent as prices are on the rise due to the influx of returnees and IDPs.

Migration-related psychosocial needs differentiate returnees from other Ethiopians

The areas of need described in this section are not always unique to returnees. Many people in Ethiopia face similar short- and long-term economic insecurity, lack access to services and have unmet psychosocial needs. Many Ethiopians have health, WASH and education needs. More than 22 million of the Ethiopian population lives below the poverty line (UNDP, 2018). Return likely reinforces many of these needs, as large numbers of returnees can place economic strain on already-struggling communities, particularly in rural areas.

However, evidence from returnee interviews makes clear that the primary difference between returnees and other Ethiopians is in psychosocial needs stemming from migration- and return related trauma (Figure 8). Such experiences may leave returnees to interact with the same set of needs in fundamentally different ways from other Ethiopians. Existing support systems – described

Exploring the MHPSS Needs and Associated Factors of Ethiopian Male Returnees from Kingdom Of Saudi Arabia in the following section – can help set returnees on the path to reintegration but available support is often limited.

Returnees are also particularly vulnerable to other challenges in Ethiopia. The lack of informal networks or family in the location of return may make it challenging for returnees to obtain reliable or fairly-paid work. Returnee may not be able to easily integrate. Lack of documentation holds implications for access to justice and land ownership. Needs up on return

Willingness to check or comparison plans and consider re-migration

Most respondents defined their primary long-term goal as either pursuing livelihood opportunities in Ethiopia or attempting to re-migrate. However, most respondents also indicated secondary aspirations in their feedbacks. Many recognized that their primary goal (such as starting a business) may not be achievable or realistic in their current economic situation. In such cases, they often reported a willingness to pursue different plans (e.g. trading livelihood goals for re-migration) and used language like “might” or “maybe” to explain their thinking.

Re-migration was a common secondary or was often seen as an undesirable or reluctant fallbacks option. One respondent said that he hoped to “avoid” the need to go abroad again and highlighted his desire to work in Ethiopia (Male, Gobessa, 32). Others were more ambivalent about staying in

Ethiopia. One respondent said, “I do not have plans for migrating again, but if I do get a good chance then I might migrate.” (Male, Hela Mekenna, 23)

“In the future, I would love to stay in my home country in the community I‟m living in right now. However, I only want to do that if there are more job opportunities and better living condition and economic level increases which can match with the living cost. If this does not happen, I would like to migrate to KSA or one of the Arab countries.”

While some respondents viewed re-migration as their preferred future plan for the sake of migration (i.e. living somewhere better), most actually viewed it as the mechanism through which to achieve other goals. For example, respondents that could not obtain find work in Ethiopia wanted to migrate to find them. In pursuit of the primary goal, respondents were willing to migrate through both legal and irregular means. One respondent said, “I want my kids to study in private schools, but I cannot afford to pay the fees right now. Therefore, I want to travel to KSA or Gulf

Exploring the MHPSS Needs and Associated Factors of Ethiopian Male Returnees from Kingdom Of Saudi Arabia

Countries” (Male, Gobessa, 30).

Re-migration aspirations linked with where and when returnees experienced trauma

Most respondents had traumatic experiences in their past and particularly during migration and return journeys. Where and when returnees experienced trauma influenced their re-migration interest. Those who planned to re-migrate were characterized by traumas experienced specifically during return rather than earlier in the migration journey. For example, they reported largely positive experiences abroad but traumatic encounters with the prison police and during their involuntary return. They also tended to be jobless post-return with no access to income. They often reported feelings of shame and bad relations with their communities (e.g. not liking/trusting).

“I want to leave Ethiopia as soon as possible because I am becoming depressed… Sometimes I feel like committing suicide, but then I get afraid of God. I try to be strong, but I want positive changes in the future.” (Male,Gobessa 02,35) This group often felt like no one helped them and that they had no one to turn to for advice.

In contrast, many of those who were not interested in re-migration had experienced traumatic experiences earlier in the migratory process. They were characterized by negative perceptions of migration and migration actors prior to return. This returnees also tended to have the support of their family and stronger relationships with their communities. They often had a livelihood skill (even if it wasn‟t being used) and at least some access to work. Some had accessed community based psychosocial assistance by ERCS and stakeholders which are working with ERCS. For example, one respondent said, “I have the bad experience of [attempting to] travel to KSA, and because of the problems that I have faced during my journey, I will never think of travelling again” (Male, Gobessa 01, 18). Their experiences abroad included fighting with the employer; feeling discriminated against; not being paid by employer; not trusting smuggler. Last, this returnees felt like they had people in their lives they could turn to for trusted advice, such as family members.

These patterns indicate that it is not traumatic experiences by themselves that foster interest in remigration, but rather what phase of the migration journey the traumas were experienced and how those traumas are amplified by conditions upon return.

Exploring the MHPSS Needs and Associated Factors of Ethiopian Male Returnees from Kingdom Of Saudi Arabia

CHAPTER FIVE: DISCUSSION

In this chapter, information obtained through cross sectional survey, Focus Group Discussion and In-depth interview are discussed in light of the theoretical issues and research questions raised in the study.

Accordingly, the major points discussed are the mental health and psychosocial needs of and basic needs characteristics of study participants, the extent & prevalence of mental and psychosocial problems they faced after return back in their country, the support provided to them so far, barriers that hinders male returnees for not accessing these services, and the needs for sustainable reintegration.

5.1. Male returnees were young, lower in educational level and had dependents

The descriptive study on the socio economic characteristics identified that the highest proportion (80%) of male migrant returnees were young people below the age of 30 and the mean age of the respondents was 27.5 years. The study also identified that the level of education of participants were low as over half of (57%) were attended only primary level of education, 23 % secondary level of education and 6% were illiterate. In addition, 51% of respondents were supporting four dependents on average while they in abroad. This finding of the study aligned well with the study that found out that over 80 % of returnees from Kingdom of Saudi Arabia were young. Habtamu & Mebratu (2018) researched in Ethiopia and Somalia on situations and needs of returnees from the Kingdom of Saudi Arabia point out that: 77% of the returnees had dependents to support – 1 to 4 dependents per returnee. This finding also depicted that returnees generally had a lower level of education – 15% of the respondents were unable to read and write and were lower skilled.

5.2. Male returnees faced many challenges and few opportunities

The study pointed most of male migrant returnees from Kingdom of Saudi Arabia faced various problems related to mental, psychosocial, health, social and economic challenges. The prevalence of common mental problems such as poor appetite , easily frightened, nervous, tense or worried

Exploring the MHPSS Needs and Associated Factors of Ethiopian Male Returnees from Kingdom Of Saudi Arabia feeling , poor digestion , feeling of valueless person, trouble thinking and unhappy feeling, loss of interest in things etc. Were high among male migrant returnees. In relation to this, the study identified that the overwhelming majority of respondents (97%) were suffering from stressed and over 80% the study participants feels that they were stigmatized by their respective family and community members.

Tilahun (2020) researched in Ethiopia on Common Mental Disorder among Ethiopian migrants returned from the Middle East countries identified that the most frequent symptoms of common mental disorder reported by the respondents were: frequent headache (40.6%), feel unhappy (40.4%), nervousness (40.2%), and bad sleep (39.7%), poor appetite (39.3%), feel tired all the time (35.4%) and easily tired (34.8%). Slightly more than a fifth (21.5%) of the respondents reported that they felt worthless in the past 30 days and suicidal ideation. Similar studies also pointed out that over 60 % of returnees from Middle East were stigmatized from family and community members. Habtamu (2017) researched in Ethiopia indicated that most of the participants faced various challenges after they came to their country. Among the challenges unemployment, health problems mental &psychosocial problems, discrimination from the families and communities.

This study also point out that the mental health care, psychosocial support services and economic support including reintegration are in adequate and highly demanded by to return migrants from Kingdom of Saudi Arabia. In relation to this, the study identified that the proportion of respondents who received any types of mental health and psychosocial support services from the relevant GO, NGOs and community members were only 26%. Apart from these, around 80% of the respondents were unemployed. This is aligned with the ILO assessment report on situations and needs of returnees from the Kingdom of Saudi Arabia (ILO, 2018). Researched in Ethiopia this study found out that over 80% of returnees were not obtained any services. Migrant returnees has received far too little attention in psychosocial, rehabilitation and reintegration services despite a large number of Ethiopian migrants with various mental health and psychosocial issues are returning from KSA. The assessment also indicted that there was a gap between the returnees‟ expectations and the implementation of their sought actions.

Exploring the MHPSS Needs and Associated Factors of Ethiopian Male Returnees from Kingdom Of Saudi Arabia

5.3. Male Returnees Were Provided with Limited MHPSS, health, economic and reintegration Services

The focus group and in-depth interview results of this study identified the major barriers that returnees not receiving integrated and comprehensive mental, psychosocial, social and economic support from the community, relevant GOs and NGOs and government. Accordingly, the common barriers includes restricted access to MPSS services , limited access to education & youth friendly services, limited accessing land and housing. The study also identified absence of reintegration services as the main barrier for not addressing the felt needs of male migrant returnees. Besides, the study clearly sorted out the limited involvement of communities, GO and NGOs that unable to respond the mental, psychosocial, heal and economic insecurity problems of the returnees. Furthermore, the study identified the paramount importance of CBOs like Idir & /Social Networks to successfully integrate returnees in their community. The above study findings are similar with the study that found out that the major barriers for addressing the needs of returnees includes absence of any support from government and its stakeholders, absence of income, provision of working place that was not suitable for business purpose and increasing tax that was not proportional to their income (Habtamu, 2019). In Addis Ababa, although many efforts were made to improve the reintegration of returnees, the desired results were not achieved. In this regard, the stakeholders determined that the major reasons were lack of coordination, lack of responsibility and lack of a clear mandate. Other similar studies also states only few organizations were providing rehabilitation and reintegration services for returnees with a very limited resource reaching a small segment of the larger population of migrant returnees (Waganesh 2015).

The assessment report of ILO recognized that reintegrating and rehabilitating such a large number of returnees, remains an unfinished assignment for all stakeholders (ILO, 2018). The reintegration of an individual does not take place in a vacuum. Any activities supporting reintegration should therefore not only be cognizant of the space in which reintegration will occur but also actively address the broader structural factors that impact local populations‟ self-sufficiency, social stability and psychosocial well-being (ILO,2018).

Exploring the MHPSS Needs and Associated Factors of Ethiopian Male Returnees from Kingdom Of Saudi Arabia

CHAPTER SIX: CONCLUSION & RECOMMANDATION

6.1. Conclusion

This study aimed to amplify the voices of returned Ethiopian returnees and migrants to fill data gaps and understand how humanitarian and development actors can better support the needs of returnees. Evidences from 35

Returnees‟ interviews added to the existing literature on return and reintegration. It found that returnees face significant pressure abroad to return, original migration drivers often persist after return, and traumatic migration and return experiences leave deep impacts affecting reintegration.

Next, the study examined Ethiopian‟s challenging reintegration landscape defined by widespread needs among both returnees and other Ethiopians. Returnees are disproportionately vulnerable due to psychosocial needs and male returnees appeared particularly in need of support. In the following section, few returnees reported receiving assistance and almost all returnees felt unassisted. Returnees emphasized the powerful role of the family in alleviating the effects of traumatic experiences and improving dynamics with their communities. Returnees appeared to prioritize long-term assistance and trusted information over short-term support.

Last, the study analyzed long-term aspirations and identified key factors (e.g. psychosocial and economic) inhibiting or facilitating progress towards those goals. Most returnees hoped to find good jobs, start businesses that used their existing skill set, or pursue education for themselves or their children. Less than half of returnees planned to re-migrate but re-migration was frequently mentioned as a fallback plan. Poor psychosocial well-being and involuntary return appeared to encourage re-migration interest.

There are two main conclusions from this study:

 First, available evidence suggests that Ethiopian returnee reintegration should be approached primarily from a psychosocial perspective. This study echoes current literature in finding that return and reintegration processes involve extensive needs among Ethiopian returnees. However, in an Ethiopia context defined by widespread needs, returnees display unique psychosocial needs stemming from traumatic experiences during migration and return. Conditions upon return may

Exploring the MHPSS Needs and Associated Factors of Ethiopian Male Returnees from Kingdom Of Saudi Arabia

exacerbate the consequences of these traumatic experiences and are linked with depression, anxiety, isolation, loss motivation for life and even suicidal ideation. Short-term needs must continue to be met by a strong humanitarian response. Simultaneously, reintegration-specific programming may benefit from a broader approach that priorities psychosocial support. Returnees who receive psychosocial support may feel more empowered to take steps towards their future goals. Such an approach should be empirically based on psychological best practices and a „do no harm‟ principle. Where possible, humanitarian and development actors can complement counselling with returnee empowerment programming aimed at lessening concrete barriers to their wellbeing and long- term plans, such as access to credit, decent work and affordable housing.

 Second, information gaps at every stage of return and reintegration undermine efforts to support returnees. Rumors can motivate hasty, unwanted or dangerous return journeys and leave returnees feeling regretful. A lack of information upon arrival can decrease the reach of return assistance and pose a barrier to receiving longer-term aid. This suggests the need for comprehensive „reintegration pathways‟

6.2. Recommendations

This study aimed to provide a platform for returnees to directly voice their needs and aspirations to humanitarian and development actors. Based on their narratives and existing literature, the study recommends that humanitarian and development actors involved in the returnee response:

6.3. Social work implications

Social work is a profession that stands for vulnerable group of the society. As this study revealed, returnees including their children are one of the most vulnerable groups of people in Ethiopia. The study indicated those returnees encountered multi-dimensional challenges. As result, holistic intervention is necessary. Some of the interventions that needed to be addressed at different levels are presented below;

Exploring the MHPSS Needs and Associated Factors of Ethiopian Male Returnees from Kingdom Of Saudi Arabia

6.3.1 Interventions for the returnees

Integrates mental health and PSS services into primary health care systems to provide comprehensive, accessible and affordable mental health care for the public does not specifically address the special mental health care need of return migrants by aligning Investigate with informal referrals among traditional healers and psychiatric services at hospital level.

6.3.2 Community level Intervention

Strengthen operational linkage among Adolescent Youth Friendly Services (trained in Psychosocial Support), Social Affairs sector (in charge of returnees) and Youth Centers (informal gatherings for youth managed by Women and Youth Office).

Establish opportunities for returnees to reintegrate into their communities, and society as a whole, in order to restore a sense of hope and goals in life.

6.3.3 Intervention for Social services

Increase Psychosocial support trained staff at Woreda level, involving different sectors (Health, Social Affairs, Women and Youth).Strengthen epilepsy health services as an effective entry- point to increase awareness and access to biomedical services concerning mental health.

Implications for Policy

Improve education quality and increase awareness on technical and vocational skill education benefits as same as higher education and create an educational system where pupils can resume their education. Like when they return to Ethiopia after some period of time to be able access easily to resume their pending education.

Life skill and self-care orientation have to be included in Ethiopian curriculum. Life skill training centers have to be opened in different region and zonal towns where a lot of potential migrants and high number of unemployed youths exist.

Exploring the MHPSS Needs and Associated Factors of Ethiopian Male Returnees from Kingdom Of Saudi Arabia

6.3.4 Interventions for community youths and vulnerable returnees

Integrated response Trained religious and community leaders on integrated response should raise awareness about mental health at all level in collaboration with Psychiatrists and psychologists in their areas.

Pre departure tips have to be given. Assist youths to know themselves well and to have a life goal when they reached junior high school.

6.3.5 Implications for Policy

Government owned Medias and private Medias need work more on pre migration information against the false information that smugglers made.

Government and NGOs have to give the appropriate attention to the returnees and create an opportunity to share their experiences to potential migrants. Government and NGOs have to follow a standardized guideline on MHPSS provisions from ISAC and also CBPSS by considering Ethiopian context. Ethiopian mental health strategy /EMHS have to be cascaded to all level of health institutes, health workers and health offices. Creating an environment have to be strengthen as mentioned on the strategy where traditional healers or religious leaders work together with mental health experts together with referral linkage following do no harm principle.

Finally concerned stakeholders should through their programming address a tackle issues related to MHPSS that will allow returnees to be able to recover and increase their self-efficacy and recover from traumatic events they have been exposed to.

Exploring the MHPSS Needs and Associated Factors of Ethiopian Male Returnees from Kingdom Of Saudi Arabia

References

Abebaw Minaye (2012): Experiences of trafficked Ethiopian domestic workers who returned from the Gulf States: Implications for intervention and policy development. School of Social Work, AAU

A Handbook. (2011): IFRC Reference Centre for Psychosocial Support

Atnafu, A. & Adamek M. (2016): The return migration experiences of Ethiopian women trafficked to Bahrain: „… for richer or poorer, let me be in the hands of my people…‟ African and Black Diaspora: An international Journal, 9:2, 243-256.

Bilgili, O, Kuschminder, K., Siegel, M. (2018): Return migrants‟ perceptions of living conditions in Ethiopia: A gendered analysis. Migration Studies, 6(3): 345-366.

Boccagne P. & Baldassar, L. (2015): Emotions on the move: Mapping the emergent field of emotion and migration. Emotion, Space and Society, 16: 73-80.

Busza, J. Teferra, S.Omer, S., Zimmermann C. (2017). Learning from returnee Ethiopian domestic workers: a qualitative assessment to reduce the risk of human trafficking. Globalization and Health (2017) 13:71

Erdal B, Marta F & Oeppen C. (2018): Forced to leave? The discursive and analytical significance of describing migration as forced and voluntary. Journal of Ethnic and Migration Studies, 44 (6). pp. 981-998. ISSN 1369-183X

EMHS (2016): Ethiopian Mental Health Strategy (EMHS) in 2012-2016

ERCS (2018): Ethiopian Red Cross Society assessment reports from the “Assistance and Resilience to Vulnerable Returnees and theirs Communities” project, May & June 2018

Habtamu D (2019): Investigating the opportunities and challenges of deported women and girls in Addis Ababa who returned from kingdom of Saudi Arabia.

IFRC (2017): Mental Health Guiding Principles and Approaches. Page 29. 2017

Exploring the MHPSS Needs and Associated Factors of Ethiopian Male Returnees from Kingdom Of Saudi Arabia

ILO (2018): Situations and Needs Assessment of Ethiopian returnees from the Kingdom of Saudi Arabia

Internal Displacement Monitoring Centre (2019):Global Report on Internal Displacement (GRID), 2019

IOM (2010): Reintegration measures should be able to address and mitigate factors that lead migrants to migrate in the first place.

Kassahun H, Abebaw M and Waganesh Z. (2017): Prevalence and associated factors of common mental disorders among Ethiopian migrant returnees from the Middle East and South Africa.

Melkie T, Abdulhalik W and Dessie A. (2020): Common mental disorders and its associated factors and mental health care services for Ethiopian labor migrants returned from Middle East countries in Addis Ababa, Ethiopia.

Monteiro G & Balogun K (2014): Perceptions of Mental Illness in Ethiopia: a profile of attitudes, beliefs and practices among community member, healthcare workers and traditional healers. International Journal of Culture and Mental Health. July 2014

Waganesh Z, Abebaw M and Gibbs K. (2017): Mental Health and Somatic Distress among Ethiopian Migrant Returnees from the Middle East

Selamu, L & Singhe M (2017): Mental Illness: Global African and Ethiopian Perspectives Psychology and Psychiatry 3.4, pages 107-110. 2017

Ranna Parekh, 2018: What Is Mental Illness? Retrieved from https://www.psychiatry.org/patients -families/what- is-mental-illness on December 30, 2020. WHO, 1994: A USER GUIDE FOR THE SELF REPORTING QUESTIONNAIRE (SRQ) retrieved Fromhttps://apps.who.int/iris/bitstream/handle/10665/61113/WHO_MNH_ PSF_94.8.pdf;jsessionid =1591D3E2623FEC6F38ED1634CB3C1557? sequence=1 on December 30, 2020

Exploring the MHPSS Needs and Associated Factors of Ethiopian Male Returnees from Kingdom Of Saudi Arabia

Annex’s

Annex 1: Data Collection Tools Introduction to the respondent Hello. My name is ...... from Addis Ababa University, School of Social work. I am asking your permission to ask you a few questions about your current situation. You can choose if you want to participate or not. If you choose to participate, you can at any time during the interview take your decision back and choose not to participate. If you have any questions before, under or after the interview, please feel free to ask them. We will not share any information collected about you in a way that you can be identified. The information will be used for the partial fulfilment of the requirements for the degree of Masters in social work at Addis Ababa University in school of Social work. Participating or not participating in the interview will not affect whether you can receive support from the Red Cross.

The interview will take around XX minutes. Are you willing to participate?

Yes ☐, thank you for your permission. No ☐, thank you for your time talking to us. General information Fill this section before the interview to save time.

1.01 Interviewer‟s name

Questionnaire

Section I: Respondent Identification Section

Questions Choices Respondent ID Region Zone Woreda Kebele Respondent's name

Exploring the MHPSS Needs and Associated Factors of Ethiopian Male Returnees from Kingdom Of Saudi Arabia

Interview Date Supervisor's name Section II: Background Information of Respondents s.no Questions Choices 1 Gender 1. Male 2 Marital Status 1. Married 2. Single 3. Widowed 4. Divorced 3 Age 1. 18-30 2. 31-59 3. 60+ 4 What is your level of education? 1. Illiterate 2. Can read and write 3. Primary school (1-4) 4. Primary school (5-8) 5. High school (9-10) 6. Preparatory school (11-12) 7. Technical and vocational college, Specify type of training

8. University graduate 9. Short term training only Specify type of training 5 Are you a family head? 1. Yes 2. No 6 If yes, how many family members do 1. Children (<5) you currently support? 2. Children (6-11) 3. Adolescents (12-18)

4. Youth (19-29) 5. Adults (30-50) 6. Elderly (>50) 7 Where are you living now? 1. With family 2. With friends 3. My own place 4. Rented a place Others (specify 8 Is there any condition that markedly 1. Yes 2. No restricts your ability to function physically? 9 If yes, please specify the condition

Exploring the MHPSS Needs and Associated Factors of Ethiopian Male Returnees from Kingdom Of Saudi Arabia

Section III: Migration Experience 10 Country/countries you lived in before return?

11 Number of years lived abroad 12 Number of months since return 13 What type of work were you engaged 1. Laborer in while abroad? 2. Domestic work 3. Agriculture 4. Own micro business 5. Construction 6. Parking 7. Others 14 Were you supporting your family while 1. Yes abroad? 2. No 15 If Yes, how many people depended on your support/remittance? 16 Do you still have some saving from 1. Yes 2. No your work abroad? 17 If yes, how are you planning to use your saving for your reintegration? (Specify type of activities) 18 Upon return at your immediate 1. Medical support destination, what type of services did 2. Psychological first aid you receive? 2. Transport services 3. NFI 4. RFL service 5. Temporary Shelter 6. Food 7. Other please specify 19 Who provided the services? Section IV. Livelihood

S.No Questions Choices 20 Please describe your current / earlier 1. Formal employment employment status? 2. Informal employment 3. Temporary/casual employment 4. Unemployed 21 If you are unemployed, what are the main reasons for not finding a job/business? 22 What is your primary source of 1. Salary from employment

Exploring the MHPSS Needs and Associated Factors of Ethiopian Male Returnees from Kingdom Of Saudi Arabia

income? 2. Self-employed (If yes, specify type of business: ) 3. Aid from international organizations/ NGO 4. Remittances from friends and family abroad 5. Personal savings 6. Loan from family and relatives 7. Selling assets 8. Agriculture/farming/livestock If agriculture, specify crops:

9. Daily labor 10. Other please specify 23 What is your secondary source of 1. Salary from employment income? 2. Self-employed (If yes, specify type of business: ) 3. Aid from international organizations/ NGO 4. Remittances from friends and family abroad 5. Personal savings 6. Loan from family and relatives 7. Selling assets 8. Agriculture/farming/livestock 9. Daily labor 10. Other, please specify 24 What is your monthly average income? 25 What are your monthly expenses (rank) 1. Food 2. Clothing 3. Housing/rent 4. Education 5. Medical care 6. Others? 26 Do you have any assets that you can 1. A house use as a coping mechanism? Select all 2. Land specify surface assets available 3. Livestock/cattle specify 4. Money in the bank 5. Others, specify 27 Did you get a loan from micro -finance 1. Yes 2. No 3. I don‟t want loan institutions?

Exploring the MHPSS Needs and Associated Factors of Ethiopian Male Returnees from Kingdom Of Saudi Arabia

28 If you apply and you didn't get, what 1. No financial institutions available was the reason? 2. Other 29 Did you have debt to re-pay post- 1. Yes, 2. No return? 30 If yes, how much was that? 31 If yes, have you paid it already? 1. Yes, 2. No 32 What is/are the ideal occupations you 1. Farmer want to engage in? 2. Civil servant 3. To be employed, specify job

4. Livestock breeder specify type 5. Craftsman 6. Merchant/business, specify business 7. Laborer/worker 8. Others (Specify) 33 What do you currently do to achieve 1. Going to school/training/TVET your ideal occupation? Specify type of training 2. Looking for micro-credit loan 3. Looking for government support 4. Looking for family support 5. Waiting for NGO support 6. Others (specify) 34 What are the lessons/best practices/skills you learnt abroad that you brought back? 35 Which type of vocational/skill training would you be interested to receive to be engaged in the occupation that you mentioned? 36 What type of support do/did you 1. Training receive from the government? 2. Micro-credit 3. Job placement 4. Counselling (post-return) 5. Health care 6. Working premises provision 7. Legal support 8. Food-for-work 9. They are planning to support 10. None so far 37 What type of support do/did you 1. Training

Exploring the MHPSS Needs and Associated Factors of Ethiopian Male Returnees from Kingdom Of Saudi Arabia

receive/d from International 2. Micro-credit Organizations or National 3. Job placement organizations? 4. Counselling (post-return) 5. Health care 6. Working premises provision 7. Legal support 8. Food-for-work 9. They are planning to support 10. None so far 38 If yes, please, specify the names of the INGO o local NGO Section V. Social Cohesion and Psychosocial Support

S.No Questions Choices 39 Are you a member of any of the community- based 1. Edir organizations in your area? 2. Equb 3. Mahiber/senbete 4. Religious institutions Others (specify ) 40 Are you aware of any returnee social networks in 1. Yes your areas 2. No 41 If Yes, Are you a member of the network 1. Yes 2. No 42 If no, why not 43 Who do you rely on for your immediate social and 1. Family financial needs 2. Relatives 3. Friends 4. CBOs 5. Other specify 44 Do you feel accepted by your family and 1. Yes community 2. No 45 Have you felt any sort of stigma/stereotype/or 1. Yes 2. No something similar against returnees?

46 What are the main sources of stress in your life? Tick 1. Family all that apply 2. Money 3. Health 4. Lack of employment 5. Living conditions 6. Others

Exploring the MHPSS Needs and Associated Factors of Ethiopian Male Returnees from Kingdom Of Saudi Arabia

7. No sources of stress 47 How do you deal with stress? Please tick all that 1. Talking to relatives and apply friends; 2. Socializing with friends and family 3. speaking to a specialist; 4. speaking to Red Cross volunteers; 5. speaking to staff or volunteers from NGOs; 6. taking medication; 7. exercise; 8. leisure activities; 9. smoking; 10.Taking alcohol 11. I do not have support mechanisms; 12. Others, please specify. 48 What support mechanisms would you want to have to deal with stress?

Exploring the MHPSS Needs and Associated Factors of Ethiopian Male Returnees from Kingdom Of Saudi Arabia

Seensa namoota gaafatamaniif

Heloo. Maqaan kiyya obboo ...... waldaa qaxaamura diimaa itiyoophiyaa irraa yoo ta‟u ani fedhii keessan kan gaafannoo xiqqoo ishii waan qabuuf isiin gaafachuu barbaada gaafannoon kuniiniis haala amma irra jirtaniratti.

Hirmaachuu fi hirmaachuu dhabuu filachuun ni danda‟ama.hirmaachuuf yoo filattan yeroo kamiyyuu murtee murteessuu dandeessuu murteen kuniis murtee gaafannoo addaan kutuufi hirmaachuu dhabuu dha. Gaafannoo dura ,gaafannoo irratti akkasumas gaafannoo booda gaafii yoo qabaattan gaafachuuf hin sodaatinaa.

Odeeffannoo isinirraa argannee qaama kamiifuu dabrsinee hin kenninu.odeeffannoon kuni waldaa qaxaamura diimaa fi deeggartoota isaatiin kan fayyadamnuu fi tajaajila kenninu fooyyessuf kan nu gargaaruu dha..hirmaaachuu fi hirmaachuu dhabuun deeggarsa waldaa qaxaamura diimaa irraa argattanii argatuu baattanii wantti dhiibaa qabu hin jiru. Gaafannoon kuni daqiiqaa xx fudhata.hirmaachuuf heeyyamamaa dha. Eeyyee ☐, heeyyamaa ta‟uu keessaniif dursa galatoomaa miti ☐, yeroo keenna nuwaliin dabarsuuf galatoomaa.

Odeeffannoo waliigalaa Kutaa kana osoo gaafannoo hin jalqabiin haa gaafatamu.

Exploring the MHPSSMHPS S Needs and Associated Factors of Ethiopian Male ReturnReturnees ees from Kingdom Of Saudi AArabia

Dhimmi Gaafannoo Yaadaa bareeffamu seensa Iddoo dhalootaa fi amma eessa akka jiraatan • Sadarkaa baruumsaa • Hojii deemsa duraa • Hojii amma hojjattan • Amantaa Hordoftan • Haala Gaa‟ilaa • Daa‟imman umrii<5 gadii

Yeroo turtii • Biyya Kam Deemttan? Amala turtii biyya alaa alaa/turtii alaa yoo• Hagam turtttan? fi deemsaa hin qabaanne • Yoom deebitan? Yeroo turtii kana karoorfattanii jirtuu? Hojii akkamii hojjachuuf karoorfattan? • hojii akkamii argattan?

• qarshii biyya alaatii ergaa turtee? • Deemsaaf maaltu si kakaase? • Olla fi maatiin si qarqaaruu? Yoo godaanttu eenyutu si qarqaarre? • Akkamitti deebite? • Yeroo hagamii deemte? • Amma deemuuf karoora qabdaa?

xannoo hawaasaan Natti himuu dandeettaa hawaasa keetti deebi‟uun Namoota qolleeffataman walitti makamuu maal fakaata? Rakollee akamiittu isin mudate? hawaasatti makuu Eenyu waliin jalqaba hawaasomatan? • Hiiriyaa haarawa deebitoota ta‟an uumatanii jirtuu? Akkamitti? Hiriyoonni kee hojii akkamii hojjachaa jiru? Hawaasa deebitoota biro waliin akkamitti laalta? Hiriyoonni kee deebitoonni muuxannoo siwaliin walfakaatu ni qabuu?yoo jiraatan ta‟e haa ibsamu?

Exploring the MHPSS Needs and Associated Factors of Ethiopian Male Returnees from Kingdom Of Saudi Arabia

dhimmi Gaafii Yaada Barreeffamu

• Muuxannoo olaan ykn maatiin waliin qabdu erga

deebitee booda garagaramoo akkam?maaliif? Qollafetamuu fi Rakko • Erga deebi‟een booda jiruun kiyya saammu ykn miidhaa garaagarummaa qaba jettaa? sammuu • Maalinni rakooleen namoonni alaa deebi‟an isaan mudatu?keessattu qarshii malee yoo deebi‟an?haa ibsamu? • Wanti gaariin deemsa keessa jiru malidha? • Wantti sukaneessaan maalidha? • Balaan namoota alaa deebi‟an mudatu maal fa‟a? Dhiiraa dubartiitti garaagarummaa qabaa?yoo qabaate maaliin garagara?

• Deegarssi hawaasa keessa jiru jiraa? • Deeggarsi addaa ati argatte jiraa? • Deeggarsa xiin-sammuu fi hawaasumma argattee jirtaa? • Wantti deegarsa argatu qabdu keesssaa hafe kan jettu Maali?

Guduunfaa • Namoota alaa deebi‟an hawaasatti makuuf maaltu dalagamuu qaba jettu? • Galatoomaa!!!

Exploring the MHPSS Needs and Associated Factors of Ethiopian Male Returnees from Kingdom Of Saudi Arabia

QUESTIONNAIRE FOR LOCAL STAKEHOLDERS AND KEY-ACTORS WITHIN RETURNEES AND HOST COMMUNITIES

Date

Interviewee

Age

Sex

Organization/Institution

Role/Position within the Organization/Community

BACKGROUND

1. What is your understanding of the definition of psychosocial?

2. What do you think it means for the people living in your area and your beneficiaries?

3. How is the term psychosocial received within your community or by your beneficiaries?

4. Can you provide me with any document or paper about existing mental health and psychosocial needs in your area, with particular regards to the returnees?

5. Is it possible for your beneficiaries to keep on with traditional rites, weddings and ceremonies, and mourning processes?

6. Can you provide me with any information you have on existing mental health and psychosocial provisions in the area in which you work? Can you refer me to anyone who has such information? This can include non-medical healing.

7. Can you provide me with any information about the activities/projects your organization is running in the psychosocial domain?

NEEDS ASSESSMENT

8. What do you think are the most urgent psychosocial needs to be addressed for the returnees in the near future?

9. Can you list them?

10. What do you think are the main structural psychosocial support systems to be built within a long- term perspective?

11. What do you think are the concrete actions that could be taken to improve the overall psychosocial well-being of the returnees, and the host communities?

Exploring the MHPSS Needs and Associated Factors of Ethiopian Male Returnees from Kingdom Of Saudi Arabia

12. How is the returnees perceived by the local one?

NEEDS RESPONSE

13. Do you have any idea, plan or strategy on addressing psychosocial needs of the returnees?

14. What resources (technical, expertise, financial, logistical, premises, etc.) would be needed to address them?

15. What could be ERCS‟S role in supporting these projects/strategies (financial, technical, training, and other)?

16. Would you be interested in collaborating with ERCS regarding psychosocial issues in the future?

17. If yes, with which role/function (trainee, trainer, technical partner, implementing partner)?

Gaafannoo Dhimmatootaa fi hawaasaa QUESTIONNAIRE FOR LOCAL STAKEHOLDERS AND KEY-ACTORS WITHIN RETURNEES AND HOST COMMUNITIES

Guyyaa

Gaafatamaa

umrii

saala dhaabbata Gahee Hojii SEENSA 1. Hubannoon xiinsammuu fi deeggarsa hawaasaaf qabdan maali? 2. namoota naannoo keessan jiraatanii fi fayyadamtootaatiin hiikaan jiru maali? 3. hawaasa keessatti xiin-sammuu fi deeggarsa hawaasummaa akkamitti hubatama.? 4. yoo danda‟ame ragaa xiin-sammuu fi hawaasummaatiin fedhii jiru gama deebitootaan jiru maal fa‟a? 5. ni danda‟amaa fayyadamtoonni cidha irratti ,du‟a irratti hirkachuun eeggachuun. 6. deeggarsa xiin-sammuu fi hawaasummaa jiru akka naannoo keessanitti jiran osoo keenname?nammoota kana keennan odeefgfannoo osoo nuuf kennamee? Kuni kan dawaa Aadaa kennan ibsaa.

7. yoo danda‟ame odeeffannoo xiin-sammuu akka waajjira keessanitti hojjatamaa jiru akka nuuf ibsitan?

Exploring the MHPSS Needs and Associated Factors of Ethiopian Male Returnees from Kingdom Of Saudi Arabia

QORANNOO FEDHII

8. maali fedhiin dhiyoo namoota ala irraa deebi‟anii kan fuuldurattii hiikamuu danda‟u?

9. Tarreessuu Dandeessuu?

10. caasemmaa xiinsammuu-fi deeggarsa haawaasummaa yeroo dheeraa keessatti maaltu gidhamuu danda‟a?

11. fayyummaa xiin-sammuu fi hawaasaa akkasumas deebitootaa eeguuf ciminaan tarkaanfiin fudhatmu maalta‟uu qaba?

12. deebitoonni hawaasa keessatti bifa kamiin hubatamu?

Deebii fedhii

13. Karoora ,yaadaa fi Tarsimoo fedhii hawaasa kanaaa hiikuuf taasifamu maal jettanii yaaddu? 14.Meeshaalee fi loojastiikii akkamii barbaaddu fedhii hawaasaa fi deebitootaa furuuf ?

15.Gaheen dhaabbata waldaa qaxaamura diimaa deeggarsa isaanii gochuuf maal tu irraa eegama? 16. Xiin-sammuu fi deeggarsa hawaasumaatiin Waldaa qaxaamura diimaa waliin walitti qindoomuu barbaadduu?

17. yoo eeyeen Ta‟e gahee hojii kamiin ( leenjii ,leenjisaa ,hojii hiriyoomaa )

Exploring the MHPSS Needs and Associated Factors of Ethiopian Male Returnees from Kingdom Of Saudi Arabia

English version of the Self Reporting Questionnaire-20 SRQ -20 1. I often have headaches? Yes/no 2. My appetite is poor? Yes/no 3. I sleep badly? Yes/ no 4. I am easily frightened? Yes/no 5. My hands shake? Yes/no 6. I feel nervous, tense or worried? Yes/no 7. My digestion is poor? Yes/no 8. I have trouble thinking clearly? Yes/no 9. I feel unhappy? Yes/no 10. I cry more than usual? Yes/no 11. I find it difficult to enjoy my daily activities? Yes/no 12. I find it difficult to make decisions? Yes/no 13. My daily work is suffering? Yes/no 14. I am unable to play a useful part of my life? Yes/no 15. I lost interest in things? Yes/no 16. I feel I am a worthless person? Yes/no 17. I have thought of ending my own life in my mind? Yes/no 18. I feel tired all the time? Yes/no 19. I have uncomfortable feeling in my stomach? Yes/no 20. I do easily tired? Yes/no

Exploring the MHPSS Needs and Associated Factors of Ethiopian Male Returnees from Kingdom Of Saudi Arabia

Gaayidii Gaafannoo Dhuunfaa ittiin Dhiyaatu (SRQ) WHO/MNH/PSF/94.8 SRQ-20 KOOPIIN ISA AFAAN OROMIFAATIIN DHIYAATE KAN GAAFANNOO DHUUNFAA -20 ASIIN GADIITTI DHIYAATEE JIRA.

1. Bowwoon sammuu isinitti dhagahamaa? Eeyee Miti 2. Nyaata isin cufaa? Eeyee Miti 3. Daftee sodaa keessa galtaa? Eeyee Miti 4. Hirriba isin dhoorkaa? Eeyee Miti 5. Harki isin hollataa? Eeyee Miti 6. Wantti akka aaraa isinitti dhagahamaa? Eeyee Miti 7. Nyaatni isinii daakkamaa? Eeyee Miti 8. Sirritti yaaduuf isin rakkisaa? Eeyee Miti 9. Gammadoo mitii? Eeyee Miti 10. Kan baratameen adda booyicha qabduu? Eeyee Miti 11. Hojii guyyaaa guyyaa keessatti gammaduuf isin rakkisaa? Eeyee Miti 12. Murtee jiruu murteessuuf isin rakkisaa? Eeyee Miti 13. Hojiin guyyaa keetii dadhabsiisaa dhaa? Eeyee Miti 14. Jiruu kee keessatti waan gaarii taphachuuf dandeettaa? Eeyee Miti 15. Wantoota irratti fedhii dahbuun jiraa? Eeyee Miti 16. Ani nama hin fayyannee jettee yaadaa? Eeyee Miti 17. Hin jiraadhu jettee wantti sammuu kee keessatti yaaddu jiraa? Eeyee Miti 18. Yeroo baay‟ee sidadhabsiisaa? Eeyee Miti 19. Naannoo garaachaa irratti dadhabinni sitti dhagahama? Eeyee Miti 20. Daftee dadhabdaa? Eeyee Miti

Exploring the MHPSS Needs and Associated Factors of Ethiopian Male Returnees from Kingdom Of Saudi Arabia

S.No Questions on Social Cohesion part of Returnnes Choices 1 Are you a member of any of the community- based 1. Edir organizations in your area? 2. Equb 3. Mahiber/senbete 4. Religious institutions Others (specify ) 2 Are you aware of any returnee social networks in 1. Yes your areas 2. No 3 If Yes, Are you a member of the network 1. Yes 2. No 4 If no, why not 5 Who do you rely on for your immediate social and 1. Family financial needs 2. Relatives 3. Friends 4. CBOs 5. Other specify 6 Do you feel accepted by your family and community 1. Yes 2. No 7 Have you felt any sort of stigma/stereotype/or 1. Yes 2. No something similar against returnees? 8 What are the main sources of stress in your life? 1. Family Tick all that apply 2. Money 3. Health 4. Lack of employment 5. Living conditions 6. Others 7. No sources of stress 9 How do you deal with stress? Please tick all that 1. Talking to relatives and friends; apply 2. Socializing with friends and family 3. speaking to a specialist; 4. speaking to Red Cross volunteers; 5. speaking to staff or volunteers from NGOs; 6. taking medication; 7. exercise; 8. leisure activities; 9. smoking; 10.Taking alcohol 11. I do not have support mechanisms; 12. Others, please specify. 10 What support mechanisms would you want to have to deal with stress?

Exploring the MHPSS Needs and Associated Factors of Ethiopian Male Returnees from Kingdom Of Saudi Arabia

T.L Gaafii walitti hidhamiinsa hawaasaa fi cinqamaa Fialnnoo 1 Ati dhaabilee hawaasaratti bu‟uureefatan keessatti 1.Afooshaa miseensaa 2.Iqubii 3.Maahibara /Sanbatee 4.Dhaabilee Amantaa Kan Biroo haa ibsamu 2 Ati hubannoo ni qabdaa waa‟ee walitti hidhamiinsa 1.Eeyyee hawaasaa? 2.miti 3 Eeyyee yoo jette walitti hidhamiinsaa kana keessatti 1.Eeeyee miseensaa 2.Miti 4 Yoo miti jette maaliif 5 Enyuratti hirkatta deebii qabeenyaa ti fi 1.maatii hawaasummaatiif 2.ollaa 3.Hiriyaa 4.Waldaalee hawaasaa 5.kan biro haa ibsamu 6 Hawaasaa fi maatii kiyyaan fudhamatama qaba jettee 1.Eeeyyee yaaddaa 2.Miti

7 Rakoolee qolleeffannaa /Gadaantummaa isiin mudate?1. Eeyyee 2. Miti

Exploring the MHPSS Needs and Associated Factors of Ethiopian Male Returnees from Kingdom Of Saudi Arabia

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