The Realities of Refugee Screening

How professionals navigate differences in humanitarian responses.

Reviewed by Gary Drevitch

Key points

• Humanitarian workers face high stress from trauma screening, risking compassion fatigue and vicarious trauma.
• Effective refugee care requires understanding cultural differences and tailoring interventions accordingly.
• Collaboration within multidisciplinary teams enhances problem-solving and reduces burnout.
• Culturally competent care builds trust and improves assessment accuracy in refugee trauma interventions.

Humanitarian work with refugees presents unique challenges, particularly for those involved in trauma screening. These professionals face high stress levels due to the complexity of their tasks and the distressing experiences of the refugees. This exposure can result in psychological issues such as compassion fatigue and vicarious trauma (Figley, 1995; Newell & MacNeil, 2010)

At London’s Centre for Anxiety, Stress & Trauma (CAST), screenings for Afghan and Ukrainian refugees revealed the psychological toll on both groups, despite using different methods. Afghan refugees were primarily screened in hotels, while Ukrainian refugees were screened through schools, with these settings shaping how trauma symptoms were documented and care was integrated to access the National Health Service (NHS).

I have served both as a screener in the Afghan program and as someone managing the screeners in the Ukrainian program. Here, I'll explore the psychological challenges faced by professionals, including compassion fatigue and vicarious trauma, and emphasize the importance of maintaining staff well-being through work-life balance and supervision. I'll also highlight the role of collaboration and cultural competency in delivering an effective trauma screening program.

Psychological Impact

Working with trauma survivors can severely affect staff’s mental health, causing conditions like compassion fatigue and vicarious trauma. These issues arise from repeatedly listening to the traumatic stories of refugees, whose experiences of war, violence, and displacement place immense emotional demands on caregivers.

1. Compassion Fatigue

Compassion fatigue is a common issue for professionals in trauma care, especially in refugee settings. It manifests as emotional and physical exhaustion due to constant exposure to others' trauma (Figley, 1995).

During the Afghan trauma screening program, we frequently met individuals struggling with uncertainty and separation from family members still in Afghanistan. Families, often cut off from communication, would ask if screeners had any information about when their loved ones could join them, revealing the deep emotional toll of displacement.

Screeners heard stories from nearly 710 refugees, many describing their chaotic escapes from Kabul and the desperate separations that occurred. Although their role was mainly to document trauma symptoms for NHS access, staff often felt overwhelmed by the magnitude of the crisis and the emotional weight of these accounts.

In contrast, Ukrainian trauma screening was conducted in schools by educational support workers, offering some relief from the emotional strain. However, compassion fatigue remains a risk in any refugee program, especially when professionals feel powerless to meet the refugees’ needs (Joinson, 1992). Addressing compassion fatigue requires strong organizational support, including mental health resources and a work culture.

2. Vicarious Trauma

Vicarious trauma affects professionals on a deeper emotional level, altering their worldviews and sense of safety (McCann & Pearlman, 1990). Unlike compassion fatigue, it involves shifts in one’s cognitive and emotional state, often leading to symptoms like hypervigilance and intrusive thoughts (Pearlman & Saakvitne, 1995).

In refugee screening, staff frequently encounter stories of violence and displacement, which can lead to PTSD-like symptoms. During the Afghan screening program, screeners faced a situation in which a refugee family wanted to show a disturbing video of Taliban violence. This visual exposure added another level of emotional strain, which underscored the importance of setting boundaries and seeking supervision.

In the Ukrainian program, screeners also faced trauma narratives, though to a lesser extent due to different organizational structures in which educational support workers were trained in schools to do these screenings. These experiences highlight the importance of incorporating emotional processing into team discussions to mitigate vicarious trauma.

Staff Well-Being

Maintaining staff well-being is essential for effective refugee trauma screening programs. The emotional demands of this work require strategies like work-life balance, and supervision support to prevent burnout. A healthy work-life balance is crucial for helping professionals manage emotional exhaustion and maintain job satisfaction (Maslach & Leiter, 2016). During the Afghan program, screenings were scheduled over the weekend, allowing staff to balance their primary responsibilities with this work.

Regular group supervision is another key component of staff well-being, offering a safe space to share experiences, receive support, and discuss challenges. This collective support normalizes emotional responses and reduces the stigma of seeking help (Thomas & Wilson, 2004). In both programs, supervision played a critical role in managing the heavy emotional toll.

Group supervision was vital for staff well-being during the Afghan screening program, with Sunday sessions providing a space to reflect and process emotional challenges. These breaks prevented exhaustion, allowing screeners to approach each session with renewed focus. This sharing reduced the stigma of seeking help and fostered resilience, helping staff manage the toll of hearing refugees' traumatic stories.

In the Ukrainian program, my role shifted to overseeing the screening process, highlighting the importance of structured support systems and organizational backing. Starting each Friday with a 2:1 supervision session helped manage tasks and facilitated multidisciplinary meetings. These sessions ensured proper referrals for high-trauma cases, reinforcing organizational support’s crucial role in maintaining staff well-being and effective service delivery while emphasizing the value of supervision and teamwork in addressing the emotional demands of trauma screening.

Cultural Competency and Collaboration

Cultural competency is crucial in refugee trauma screening, as it helps professionals understand the unique experiences of different refugee groups. For instance, interpreters played a vital role in the Afghan program, while bilingual educational support workers helped streamline communication in the Ukrainian program. This cultural awareness builds trust and leads to better care.

Collaboration within multidisciplinary teams is also key to delivering comprehensive care. Working together allows professionals to address the multifaceted needs of refugees and distribute the emotional load, reducing burnout. In both refugee programs, collaboration with multidisciplinary professionals improved problem-solving and outcomes, enhancing the overall effectiveness of care.

Refugee trauma screening programs require a comprehensive approach to address the psychological impact and manage well-being. Strategies such as work-life balance and group supervision are crucial for maintaining emotional resilience and ensuring high-quality care. Cultural competency and collaboration further enhance the effectiveness of these programs, ultimately benefiting both staff and refugees.