Torture Treatment Literature Selection, Q1 2014

This study used focus groups of Colombian refugees in Ecuador to assess the influences of physical and structural violence in the sending and receiving countries on refugee health and behavior. The analysis of societal perceptions and survival needs in the host country, Ecuador, highlights particular needs of Colombian refugee populations. Due to a 40-year armed conflict in Colombia, there has been a massive influx of displaced citizens to neighboring Ecuador, where an estimated 450,000 Colombian refugees are believed to live currently. 700-1,000 cross without documents monthly, adding to a population of vulnerable individuals who are largely young, female, and in poverty. Semi-structured, qualitative interviews were conducted with 96 male and female Colombian refugees who were at least 18 years old, had lived in Ecuador for at least 3 years, and who had left for violence-related reasons. Observations were conducted in working-class neighborhoods in different parts of Quito, the Ecuadorian capital. Participants listed among their reasons for displacement threats from police/armed forces, pressure to join paramilitary groups, and violence around properties or homes. Most did not have friends or family in Ecuador and named discrimination as a primary obstacle to basic needs of livelihood, healthcare, and employment. The undocumented status of many Colombian refugees further confounded the trouble in finding work. Lack of transportation, discrimination, higher fee charges, and lack of identifying documents were barriers to seeking healthcare. Study participants reported a wide variety of experiences in seeking healthcare, and some obstacles to health access were due to inherent inadequacies of the Ecuadorian health system. From Ecuadorian society, Colombian refugees were often perceived with specific negative characteristics: as members of gangs or guerrilla groups and “violent and criminal.” This discrimination took a gendered form with ideas that Colombian women are sexually promiscuous, with many women having experience of sexual demands in order to receive work. Many women began sex work as a means of survival, and drug and alcohol use as a means of coping with the nature of that industry. This article addresses some aspects of the structural violence experienced by Colombian refugees after fleeing home country violence. These factors are prominent in influencing health outcomes and the qualitative analysis brought to light some of the community-level issues faced by Colombians after fleeing to Ecuador. An understanding of such daily challenges and frustrations provides insight for direct providers working with the affected population and those who work on organizational and policy-level to address the needs of Colombian refugees. Narrative therapy has been found to promote self-development among young refugees. The Tree of Life program, a type of narrative therapy, addresses young people's traumatic experiences by helping them "re-author" their self-narratives. The goal is to displace the "problem self-stories" that build-up over time because of negative experiences with more hopeful stories that link the past to a preferred understanding of the present and future. This study employs a group approach that allows individuals in the program to feel that their "distress is emotionally 'held'" by others. The seven-week study was conducted in Australia with 8 young Liberian refugees whose families were displaced by civil war and violent conflict. The participants ranged in age from 12 to 17 years; four were males and four were females. Participants in the program met as a group once-a-week for seven weeks. Over the course of the program, participants built up a personal narrative and collage using the metaphor of a tree. The first session introduced the participants to the metaphor of the tree and focused on the notion of "home" and "belonging." During the second session, participants developed the "roots" and soil or "ground" of their tree; these represent participants' personal histories and everyday activities respectively. The third session focused on the "trunk" and "branches," which represent personal strengths and future hopes. The fourth session focused on the "leaves" and "fruit," which represent people who are important to the participants. During the fifth session, participants finalized and shared their trees. During the sixth session, participants discussed "storms," which represent difficult moments in life. The seventh and final session was a certificate ceremony. The authors do not offer quantitative measures of the program's efficacy. They do note, however, that school teachers of the eight participants reported improvement in the participants' classroom behavior and relationships with peers. Mariam, a 14-year-old Liberian refugee, developed a story that highlighted that she was a good friend to others; members of the group also helped her see that she was valued for being a good singer and dancer. This affirmed for Mariam her value to others and helped her "develop a capacity to see herself as a caring, loving person, who is able to make positive impacts upon others' lives." There are obvious limitations to this study. It focuses on a single, small group of young refugees from only one nation, Liberia. It also relies on anecdotal and impressionistic information to evaluate the efficacy of the Tree of Life program. It does, however, effectively highlight the processes of narrative therapy and