By definition all refugees have experienced traumatic life events of extraordinary brutality. Increasingly, civilian populations carry the burden of ethnic conflict and mass violence. It is now estimated that more than 80 per cent of casualties caused by the recent violence in Africa, Asia, and Europe have primarily affected non-combatants.(21) Extensive research has revealed the major trauma events experienced by refugee populations. These trauma events fall into eight groups:
1. material deprivation
2. war-like conditions
3. bodily injury
4. forced confinement and coercion
5. forced to harm others
6. disappearance, death, or injury of loved ones
7. witnessing violence to others
Every refugee situation will have a range of traumatic events that will fall into each of these categories that are unique or characteristic of a specific conflict. It is essential that the specific types of violence experienced by a given refugee population are well known to the psychiatric clinician who can use this knowledge to assess potential traumatic outcomes.(14) In addition to many unique forms of violence occurring in different refugee settings, the meaning of violent events also differs across cultures. Although still unproven, anecdotal, clinical, and epidemiological evidence suggests that certain categories of refugee trauma are more potent than others in producing psychiatric morbidity and other traumatic outcomes. Brain injury, sexual violence, torture and other forms of bodily injury, coercion, and forced confinement have great potential of causing psychiatric harm in refugees exposed to these events. Consistent with indicators of the 'potency' of specific trauma events, evidence is emerging that there is a dose-effect relationship between cumulative trauma and psychiatric symptomatology. The personal aspects of human suffering associated with specific types of trauma, such as the murder of a child or the disappearance, of a family member are still relatively undefined.
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