April 22nd, 2008
Ethiopian refugees in the UK: migration, adaptation and settlement experiences and their relevance to health
by: Papadopolous, I; Lees, S; Lay, M; Gebrehiwot, A
This study explores the migration histories of Ethiopian refugees and asylum seekers, their experiences of settling and adapting to UK society, and looks in particular at their health beliefs and practices and their experiences of the UK health and social care system.
Semi-structured interviews were held with 106 Ethiopian informants. Interviewees were also asked to complete a semi-structured questionnaire in order to collect quantifiable and supplementary data. The majority of respondents lived in Greater London, particularly in the boroughs of Haringey, Islington and Westminster. Members of the Ethiopian community were recruited to work with the researchers at Middlesex University and were involved in all parts of the research process, including conducting interviews [mainly in Amharic], identifying respondents and transcribing interviews. Interviewees were recruited through a combination of quota and snowballing sampling techniques, ensuring representation of all age groups over 12 years and gender. Data were analysed thematically and validated through researcher triangulation and comparisons with published literature. Quantitative data were analysed using SPSS software.
Key findings include:
• respondents noted that adapting to British culture was a cause of stress, depression and poor health. Some said that women adapted better to life in the UK than men because they may have been liberated from a position of subjugation and men may have experienced the loss of social status. Young people were felt to adapt more quickly to the UK culture and picked up the language and accent with greater ease than the older generations;
• immigration status amongst the respondents was closely associated with employment: those with refugee status were the most likely to be employed, followed by those with indefinite leave to remain and those with exceptional leave to remain;
• forty-eight percent of the respondents were not satisfied with their current accommodation arrangements, especially those who were homeless, living with friends, in private rented accommodation or in bed-and-breakfast hostels. Complaints centred mainly around lack of privacy, poor housing condition and insecurity;
• low use of formal support agencies in the UK was attributed to their reluctance to receive help from strangers and because they were not seen to always be sensitive to their plight.
• respondents noted that Ethiopian community organisations played a crucial role in enabling them to access statutory services;
• health was conceptualised by the respondents as happiness, the ability to fulfil material needs and ambitions, harmonious relationships, physical, mental and spiritual well-being, a healthy environment and positive personal qualities. Happiness is seen to be a cause of health; causes for sickness reported by the respondents included: eating the wrong foods, disease, climate, accidents and poor socio-economic conditions;
• 61% of the respondents noted that stress or worry made them feel ill. This was also the case for socio-economic factors such as lack of money, family problems and housing problems. Coping with mental health problems did not usually involve using mental health services due to the stigma attached to these within the Ethiopian community; some of the respondents noted that political and social solutions were the answer to these problems;
• most of the respondents were registered with a GP and their knowledge of the primary and secondary healthcare system was good. The main problems with services arose from lack of interpreters;
• over half of the informants had used traditional medicine in Ethiopia and less than half had used a hospital or medical doctor in Ethiopia. Self-care was reported to be used equally in the UK and in Ethiopia, although family and friends were more likely to be used as a source of informal care in Ethiopia; lack of contact with family and friends for informal support in the UK was seen as a negative aspect of living there.
Conclusions and recommendations
Removing the barriers to settlement and adaptation, such as poverty, poor accommodation and isolation, is crucial for the health and well-being of refugees living in the UK. Culturally competent care should be provided based on a knowledge of refugees’ traditional health beliefs.