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Refugee children: don’t replace one form of severe adversity with another
  1. E Webb,
  2. M Davies
  1. Department of Child Health, University of Wales College of Medicine, UK
  1. Correspondence to Dr Webb; webbev{at}

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We strongly agree with Fazel and Steinn’s view that refugee families require help that is culturally sensitive.1 Failure to provide appropriate interventions in a culturally sensitive way to these children and their families means we potentially replace one form of severe adversity with another. Contrary to Fazel and Stein’s positive view of school such adversity may include, for some children, integration into the UK educational system.2

While we agree that psychopathology can be identified in significant numbers of refugee children, many will have qualities of “resilience” that will have been highly developed by their experiences of war and other adversities prior to their arrival in this country. Having already contributed so much to their own survival it is inappropriate to perceive refugees simply as victims who require help. Conventional Western responses may be thus inappropriate and ineffective; we need to provide a range of services that are both flexible and innovative. Papadopoulos’ work with Bosnian refugee families is an excellent example of therapeutic innovation.3 He has referred to “therapeutic presence” and “therapeutic witnessing” as opposed to formal psychotherapy. All of these children have a story to tell although for some the story will be more coherent than for others. In Western psychological terms their plight is somewhat comparable to that of abused children in the care system. Making sense of their experiences in a coherent way is a significant developmental task for them.2 It is also potentially a shared experience as it is something these children will have in common with others in their family, peers, and wider refugee community. Life story work is an area in which many child mental health professionals, working with abused children, already have considerable expertise. Finally we would like to draw attention to the importance of a developmental approach when working with refugee children. It is a mistake to assume that their development parallels that of children growing up in the UK. Developmental pathways, as well as having occurred in a different cultural context, may have been significantly, and sometimes adversely, influenced by war and refugee experiences.