Refugees experience many diseases and chronic debilitating conditions, such as starvation and landmine injuries that have both immediate and long-term effects on their physical health. Every refugee situation involves many unique but common acts of violence leading to major medical sequelae. For example, gender-based violence and rape, which were instruments of ethnic cleansing in the Balkans, resulted in pregnancy, medically complicated self-administered abortions, and sexually transmitted diseases.⁽¹⁷⁾ Extensive documentation of refugee survivors of torture describes the medical sequelae of torture and the causal link between refugee trauma and medical mortality and morbidity over time.

Throughout the process of migration, refugees are frequently exposed to infectious diseases and physical or psychological trauma that can have a profound impact on their overall health and well-being. Refugees are at increased risk for diseases such as obesity, diabetes, and heart disease, and often encounter significant barriers to employment and health care when attempting resettle. For these reasons, programmes implemented in the refugees’ country of resettlement designed to improve health-seeking behaviours and overall self-care can have a positive, lasting impact on refugees’ physical and mental health.⁽¹⁸⁾

Observations since Kinzie et al.⁽¹⁹⁾ and Mollica et al.⁽²⁰⁾ first diagnosed PTSD in Cambodian refugees, have made the cultural validity of PTSD seem almost certain. However, this reality does not negate the importance of culture-specific symptoms related to trauma that are independent of PTSD criteria. Recent large-scale epidemiological studies of refugee populations have confirmed the high prevalence of major depression and PTSD in Western (e.g. Bosnian⁽²¹⁾) and non-Western (e.g. Cambodian⁽²²⁾ and Bhutanese⁽²³⁾) refugee communities. The mental health impact of major depression, which presents both as a comorbid disorder with PTSD and alone, is chronic, severely disabling and demands the attention of the clinician working with refugees. Longitudinal data indicates that 45 per cent of Bosnian refugees who met criteria for PTSD, depression or both continued to meet criteria for these disorders 3 years later.⁽²⁴⁾ Similar results were found in a longitudinal study of Cambodian refugees 20 years after resettling in the United States.⁽²⁵⁾ As with Western populations, depression in refugees tends to be under-diagnosed and can be expressed as somatic complaints. A study of Vietnamese refugees showed high prevalence based on self-report, but high rate of physician under-diagnosis. Most patients with depression (95 per cent) presented with physical complaints.⁽²⁶⁾ These finding underscore the importance of depression screening especially in the primary care setting.

New research indicates that there may be memory problems in refugees with PTSD. When asked to recall traumatic events refugees with PTSD reported an increased number of traumatic or torture events over their baseline report, as compared to those with other psychiatric disorders who showed no change or decreases in number of events reported.⁽²⁷⁾ Substance use disorders are often overlooked in refugee populations but are often comorbid with PTSD.⁽²⁸⁾ Early in the 1980s reports of Hmong refugees using opium emerged.⁽²⁹⁾ Substance use disorders have been shown to have a delayed presentation of 5 to 10 years after the initial settlement of the refugee.⁽³⁰⁾ However, substance use disorders may vary by population. One recent study of Cambodian refugees in the United States reports low rates of alcohol use in the past 30 days.⁽³¹⁾ Screening for substance use disorders especially in primary care is important. Complex grief reaction and chronic insomnia are also prevalent in this population.