How do we ensure the best possible health and welfare for Ukrainian refugee children and young people seeking a safe place in the Nordic countries? - Six recommendations based on Nordic research findings

Authors: Signe Smith Jervelund & Allan Krasnik

Project: Coming of Age in Exile (CAGE)

In the light of the current refugee influx from Ukraine following Russia’s attack in February 2022, much can be learnt from previous research on refugee experiences and trajectories in the Nordic countries that may inform Nordic decision makers, civil servants and practitioners in the reception of these newcomers in the Nordic countries. Refugees are not a homogeneous group of people. Yet, they have many shared needs and challenges that need to be addressed once they arrive in their destination country.

Refugee children and young people are an especially vulnerable group (1-3) due to their pre-migration experiences, such as witnessing violence and war, traumatic experiences during migration such as perilous journeys and separation from family members, as well as post-migration experiences due to lengthy asylum procedures, temporary residence permits in the destination country, and poor parental mental health (4, 5). Despite the adversities that characterise the group, refugee children also possess a high degree of resilience (4, 6), defined as their ability to cope with stressful life events while maintaining a positive outlook (7). This diversity of refugee children and young people in terms of their age on arrival, gender, country of origin, migration experiences and parental resources, etc. underscores the importance of bearing in mind that these children and young people also have very different psychosocial and educational needs and strengths when arriving in the Nordic countries.

In this article, we will draw on research findings from Nordic research, including recent results from a multidisciplinary research project titled “Coming of Age in Exile” (CAGE) funded by NordForsk between 2015 and 2020. CAGE investigated issues related to the integration of young refugees within the welfare areas of education, labour market participation and health within and across the Nordic countries, and the importance of tackling these challenges in the context of resettlement in order to facilitate the integration of young refugee newcomers (8). Inspired by the insights from research results on these issues, we will present six recommendations to guide the reception, resettlement and integration of Ukrainian refugee children and young people in the Nordic countries and beyond.

1) Ensure a good reception and early support

How young refugees are received right after arriving in a Nordic country has strong implications for their life chances in terms of education, labour market attachment and health in their resettlement country. Reducing resettlement stress by minimising the length of asylum procedures, insecurity about residence permits and transitions within the country is key (9, 10). Research has shown that conditions in the resettlement country such as perceived discrimination, social support and Nordic language proficiency may be even more important than pre-migration experiences for successful integration in the Nordic countries (3). Consequently, policies that address a good and welcoming reception, and minimise insecurity about residence permits and further integration structures are crucial.

The interventions during the first phase after arrival are especially important. In spite of the relief related to finally being in a safe place (the so-called “honeymoon effect”), the later-life trajectory regarding education, labour market attachment and well-being seems to be strongly influenced by the early and well-planned initiation of interventions (8). These include Nordic language training, quality education, majority peer interactions and mental health support. Research on children, young people and adults has emphasised that learning the resettlement language is especially important for a successful resettlement, including long-term educational achievements, labour market attachment, well-being and integration. A Nordic language appears to be acquired most successfully through intense teaching combined with everyday practice in the form of regular encounters with majority peers (8).

Finally, an introduction to the healthcare system and services may facilitate good health and reduce health issues in the long term. Arriving in a Nordic country as a refugee family with a newborn or very small children poses a special challenge. Results from Denmark indicate that early and repeated encounters with child health nurses can play an important role for ensuring compassionate, flexible, collaborative, and empowering care that appears to reduce a family’s day-to-day stress and also facilitate access to the general healthcare services (8, 11). Structural adaptation in terms of translators, extra time set aside for the encounter and training in diversity skills among child health nurses seem to be important facilitators (11) that should be considered in policies.

2) Safeguard mental health reception procedures

Since refugee children and young people may have been exposed to traumatising events both before and during migration, their mental health may be impaired. Consequently, policy initiatives need to ensure efficient health reception procedures including a clear focus on mental health. Until now, the focus of policies on health reception upon arrival in the Nordic countries has primarily been on infectious disease control and acute healthcare needs, while mental and social well-being have received less attention (8). One exception is Denmark, which has routinely offered mental health screening to asylum seeking children since 2009, however the systematic transfer of information on children’s mental health status from the asylum system to the receiving resettlement municipality and health service is not in place (8). Ensuring the communication of health information including mental health needs across the different reception levels is essential.

Research has documented that refugee children and young people who have been separated from family members are particularly at risk of mental health issues (2, 5). As most Ukrainian children have been separated from their fathers and other male family members, it is important that civil servants and practitioners pay special attention to this issue. Those arriving as unaccompanied minors have been found to be particularly vulnerable compared with accompanied refugee minors, often with special mental health needs and obstacles to accessing care (3, 5, 8) that require early attention. This is likely due to poor social support, separation stress and experiences of daily hassles with potential long-standing negative effects on their ongoing health and welfare. Their special needs should be addressed in policy and practice.

3) Promote early interaction with majority population peers

Policy initiatives need to promote early interaction with majority population peers. This is especially important for teenage refugees and unaccompanied minors. While reception classes may create a feeling of safety and togetherness and promote newcomers’ resettlement language acquisition (12, 13), initiatives for early interaction with majority peers through peer-mentorships, for example, as well as creative and physical activities where no verbal language is needed are recommended. Peer interactions are also sought by refugee young people themselves and may also foster an enhanced understanding of the social codes and life in their resettlement country, while also building a social network that may help in promoting wellbeing and support further social achievements (14).

4) Enhance the competences of professionals

Research has shown that schools and teachers have varying and sometimes insufficient knowledge and competences to support young refugee students (8). Teachers also often go beyond their teaching role to face and handle needs of their students(13). This is due to the complex educational and psychosocial needs of this very diverse group (8) and the fact that support structures are not always in place (13). Results also suggest that other professionals, such as school health nurses and social workers, often play an important additional psychosocial role for refugee students (8). Schools should be allocated the necessary resources to strengthen teachers’ and other staff members’ refugee competences and support their availability for newcomer students beyond their normal roles. ‘Refugee-competent’ schools can make a decisive difference to young refugees in their way into the Nordic societies (8, 15). Similarly, it is important to improve diversity competences among other professionals in the Nordic welfare institutions (e.g. healthcare system and municipalities). Although experience and co-worker support may help, systematic training of professionals is required.

5) Be flexible in the provision of education, and aim for the completion of upper secondary school

Flexibility in education in order to provide opportunities to continue with an education beyond the compulsory school age is warranted. This is especially true for refugee children and young people arriving at an older age as they are in a particularly challenging situation, since they need to learn the resettlement language and often catch up academically with their majority peers in a critical period which can result in a high risk of dropping out of upper secondary school. Completing upper secondary school increases young refugees’ opportunities for embarking on higher education and/or more stable labour market attachment, which enhance stronger social and economic ties to the Nordic society (8). Therefore, flexible educational provision and policies, which facilitate secondary education attainment, should be given a high priority in the Nordic countries.

6) Ensure continuous psychosocial and mental health support

Continuous psychosocial support seems to be important for the successful resettlement of young refugees. Many young refugees, including unaccompanied minors, prefer this kind of support through meaningful social activities that allows for building close ties (16, 17). The fact that schools have a psychosocial supportive environment also seems to play an important role for refugee children (8, 12, 14). Some studies propose the establishment of mental health services with specialist knowledge of refugee health in the educational system in order to support refugee children and young people in tackling their mental health problems. Additionally, minimising the underlying access barriers to the healthcare system and doing so in the stages soon after arrival, where families experience the most barriers that influence their future motivations for seeking (psychiatric) healthcare, is important for supporting young refugees’ mental health (8).

Conclusion

From our Nordic research, we have learnt that post-migration experiences seem to be even more important for the life chances of refugee children and young people than their experiences from before and during their migration. We have also learnt that education, employment and health outcomes are closely related and interdependent. Consequently, elevating and supporting the reception of refugee children and young people can be the conduit of better long-term health and socioeconomic outcomes among these children and young people. In contrast, poor reception and experiences as a newcomer may follow refugee children and young people for their whole lives. If they already stumble upon their arrival, this may reduce their abilities to fulfil their potential for successful life trajectories and for contributing positively to their new society or their country of origin if they later return.

Our recommendations highlight the importance of taking an inclusive, integrated approach in the reception of Ukrainian refugee children and young people and other newcomers in order to give them better life chances to achieve a good socioeconomic position, health and wellbeing. This implies that the Nordic countries need to have strategies and guidelines in place upon the arrival of refugee children and young people that include a focus on mental health issues as well as an introduction to health services in the respective countries. Furthermore, the Nordic countries are recommended to offer ongoing psychosocial and mental health support, which is especially important for unaccompanied refugee minors who seem to be at highest risk due to lack of social support as well as separation and resettlement stress. Inclusion in schools is also crucial. This includes early Nordic resettlement language training and interaction with majority peers, which further promote the acquisition of the Nordic language and peer support. Teachers’ caring role for refugee children and young people needs to be supported by school management. The flexible and tailored provision of education that also takes into account refugee children and young people’s otherwise vulnerable situation and their psychosocial needs is essential for supporting their educational paths. As secondary level education completion has been found to be key to labour marked attachment and integration, this is especially important for refugees arriving as teenagers, who seem to face a double burden through the need to acquire the resettlement language and not lag behind academically in school in order to be ready to continue their schooling with their native-born counterparts.

Our recommendations can be considered a guideline for reception, resettlement and integration policies for Ukrainian refugee children and young people as well as those from any other part of the world coming to the Nordic countries today and in the future with regard to our fundamental common values on welfare and equality for all residents.

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