War-wounded refugees : A prospective study of well-being and social integration

Sammanfattning: This thesis is a prospective study of a culturally heterogenous group of war-wounded refugees, who arrived in Sweden in the late 1980s. The general aim was to describe the situation of warwounded refugees from medical, psychological and social perspectives after arrival and aftertwo years in Sweden and, if possible, to identify factors of significance for their well-being and social integration. The study group comprised 61 war-wounded patients admitted to somatic care. The patients were investigated during hospitalization, shortly after arrival in Sweden, andfollowed up after two years. The data collection covered medical, psychological and social conditions and was performed by personnel on the ward using interviews and rating scales. All data collection was performed with the help of interpreters.From clinical experience and a pilot study, it was expected that war-wounded refugees would be specially vulnerable. In addition, the literature on refugee migration and war trauma suggested that war-wounded refugees could be a high risk group for decreased well-being and adjustment difficulties in countries of resettlement. The type of injuries and medical complications observed in the study group were representative of small unit operations of war with poor access to early medical care. Characteristics of the refugees' background were:obstructed or interrupted schooling and working life; long periods of duty as guerillas, or other political activities; a high frequency of death and separation of family members; a high frequency of imprisonment and torture; unfavourable conditions prior to the flight. Thus, the group was heavily burdened with respect to risk factors for decreased well-being after resettlement. However, the quantitative data analysis showed that these factors had not had the influence expected on well-being following arrival or after two years in the host country.Instead, the analysis indicated that life circumstances and events related to the present situation, "here and now", were more important for their well-being and social integration. With respect to labour market attachment, the war-wounded group was found to follow wellthe expected labour market integration process for refugees. On group level, well-being had not improved after two years compared with well-being following arrival. The qualitative findings suggest that in this early stage of migration, the refugees are mourning their losses but are not observably occupied by working through the pre-migration war traumas.