Psychological and Cognitive Implications of Displacement

by Noor Haidar and Mona Noureddin

Migration is defined as “the geographic movement of individuals across a specified boundary for the purpose of establishing a new residence” (Xu et al., 2018). The number of immigrants, both those who migrate internally and externally, has increased in the past few decades, notably in the Middle East, where war, poverty, and political instability are very prominent. Migration is recognized as an issue with important implications for global health: it can have significant and lasting effects on individuals’ health and well-being. Cognitive function is an essential area of well-being associated with migration, whereby immigrants are at increased risk of cognitive impairment (Xu et al., 2018). 

Mental Health Realities Pre, During, and Post-Migration

Middle Eastern refugees face many adversities, both pre- and post-migration. The Middle East has a known history of political violence (Samara et al., 2020). Citizens of Middle Eastern nations have experienced traumatic war-related events and forced displacement from their homes, which have negative cognitive implications on exposed individuals. Hazer and Gredebäck (2023) emphasize that the premigration phase illustrates a high risk of war-related potentially traumatic events (PTEs), including the lack of shelter and necessities, witnessing combat, forced evacuation, near-death experiences, and losing family members. In particular, as a vulnerable population, children are susceptible to psychological trauma leading to cognitive and emotional impairments. Children’s continuous and prolonged trauma and stress are associated with post-traumatic stress disorder (PTSD), emotional dysregulation, depression, and suicidal ideation (Samara et al., 2020). Similarly, prolonged adversity has been found to potentially cause toxic stress and lead to cognitive problems, such as stuttering, learning disabilities, and feeding difficulties. The children would struggle to engage in daily activities, perform adequately in school, and form healthy relationships. 

As a result, refugees experience traumatic events not only during wartime but also during and post-migration. During their flight from their countries, refugees are subjected to traumatizing events that exacerbate pre-existing trauma (Mahmood et al., 2019). They must escape the tragic circumstances, travel, and determine who to trust when displaced. Among 100 Syrian refugees surveyed in Jordan, Turkey, and Greece, 49% were held against their will, 46% returned across the border, and 18% were displaced away from family or friends (Hazer & Gredebäck, 2023). It has been discovered that the refugee camps and host countries may not provide refugees with adequate living conditions and humane treatment, which can contribute to their psychological and physical ailments. 

Furthermore, socioeconomic factors substantially impact refugees’ experiences as they transition and adapt to a new environment in search of asylum in other countries. Feyissa et al. (2022) recognize that asylum seekers are vulnerable groups due to pre- and post-migration adversities that drastically affect their mental health, potentially resulting in PTSD, depression, and anxiety. Having a sense of social exclusion and loss of networks could reinforce refugees’ negative experiences, as they may perceive themselves as outsiders, not feel a sense of belonging, lose their family members, especially if separated, and face language barriers. As is proven by anecdotal evidence in Toronto, Ontario, the financial status of newcomers to a country depends on government assistance. For this reason, they cannot meet their basic needs, and refugee shelters and support systems lack sufficient funding. Feyissa et al. (2022) highlight that post-migration stressors, such as social isolation and discrimination, fuel depression and anxiety more than pre-migration traumatic experiences. 

The Association Between Cognitive Status and Migration

Individuals forced to migrate due to war, poverty, or political instability face many long-term consequences, including an increased risk of inhibited healthy cognitive development (Demis et al., 2022). In their study, Kindratt et al. (2022) aimed to estimate and compare the prevalence of cognitive deficits, such as memory and attention problems, among Middle Eastern and North African (MENA) immigrants compared to US and foreign-born non-Hispanic Whites from Europe. They found that MENA immigrants had a higher prevalence of cognitive limitations (17.3%) as opposed to US (9.6%) and foreign-born (13.6%) non-Hispanic Whites from Europe. This significant difference can be explained by the fact that MENA immigrants are more likely to have faced experiences of trauma and violence and, after migration, frequent racial discrimination. Thus, trauma and discrimination are two risk factors that are associated with limited cognitive functioning and ability in immigrants.

 Yeter et al. (2024) investigated the effect of migration on the cognitive status and language development of Syrian children who migrated to Turkey. Their study found that having experienced forced displacement had adverse effects on Syrian children’s cognitive status: they had significantly lower scores on working memory, shifting, and fluid intelligence tasks compared to non-refugee control groups. Their language development was also negatively affected by forced displacement, whereby they had a smaller Turkish vocabulary and lower scores on language tests compared to non-refugee children. 

Furthermore, studies have sought to understand how exposure to war and forced displacement affected the cognitive functioning of young Syrian immigrants living in Jordan. In one study, cognitive tasks measuring working memory and inhibitory control were administered to young Syrian refugees and Jordanian non-refugees. The results revealed that the Syrian refugees performed significantly worse on cognitive tasks than Jordanian non-refugees, notably on tests measuring working memory (Chen et al., 2019). Unexpectedly, the study found that only poverty, and not exposure to trauma, mediated the relationship between migration and cognitive functioning in Syrian refugees. This finding suggests that among the factors that characterize forced displacement, only poverty was responsible for inhibited cognitive development in Syrian young refugees. Consequently, it would be wise to focus interventions on improving refugee families’ financial situations to reduce migration’s impact on their cognitive development. 

Additionally, it has been proposed that post-migration cognitive difficulties may be correlated with the year of arrival and birthplace among Arab Americans born abroad and in the United States. War-affected Arab migrants reported more cognitive difficulty than those from politically stable countries. As such, a meta-analysis demonstrated that survivors of war with PTSD illustrated poorer performance in tasks that require “processing speed, executive function, attention, working memory, and learning”. Furthermore, refugees have higher rates of “traumatic brain injury, stress, sleep disturbances, and perceived discrimination,” which all contribute to cognitive decline. Migrants’ migration experiences increase cognitive difficulties, including the recall of traumatic events (Al-Rousen et al., 2022). 

Displaced People and Resilience

Arab refugees and asylum seekers remain resilient despite their adversities. Feyissa et al. (2022) define resilience as the ability to “bounce back following adversity and challenge and connotes inner strength, competence, optimism, flexibility and the ability to cope effectively when faced with adversity.” Consequently, they deemed that refugees adapt and survive adversity with strength and resilience, which helps them thrive in their new environments. Heeding that refugees, especially children, are exceptionally resilient, it is imperative that first-level interventions, such as psychoeducation and trauma-informed approaches, strengthen resilience and recovery techniques (Sarama et al., 2020; Hazer & Gredebäck, 2023). Even though these interventions are targeted toward children, as they are particularly vulnerable, they could also be modified or implemented for adults to promote their resilience. If not addressed, these traumatic experiences could negatively impact cognitive and psychological functioning in the long term. 

Several studies have found that migration and forced displacement are negatively associated with cognitive function, whereby migrants and refugees exhibit an increased rate of cognitive limitations compared to non-refugee groups. The Middle East is a region in which war, poverty, and political instability have dramatically increased migration rates. Refugees, despite adverse pre- and post-migration experiences, show great resilience, especially in children, when trauma-informed approaches are implemented (Samara et al., 2020). 

These various findings highlight the impact of migration on the cognitive functioning of refugees and emphasize the urgent need for implementing strategies and interventions that protect their cognitive functioning from the adverse effects of migration. More humane treatment of refugees is essential for their protection and the prevention of long-term pejorative effects on psychological and cognitive health.

References

• Ajrouch, K. J., AlHeresh, R., Al-Rousan, T., Argeros, G., Bernstein Sideman, A., Kamalyan, L., Marquine, M. J., Miller, B., & Moore, A. (2023). Migration and Cognitive Health Disparities: The Arab American and Refugee Case. The Journals of Gerontology. Series B, Psychological Sciences and Social Sciences, 78(1), 111–123. https://doi.org/10.1093/geronb/gbac129 
• Chen, A., Dajani, R., Hadfield, K., Hamoudi, A., Panter‐Brick, C., & Sheridan, M. (2019). Minds under siege: Cognitive Signatures of poverty and trauma in refugee and non‐refugee adolescents. Child Development, 90(6), 1856–1865. https://doi.org/10.1111/cdev.13320) 
• Feyissa, I. F., Noh, Y., & Yoon, M. S. (2022). Post-Migration Life Adversity and Mental Health of Refugees and Asylum Seekers: The Mediating Role of Resilience between Perceived Discrimination, Socio-Economic Strains, Structural Strains, and Mental Health. Behavioral Sciences, 12(7). https://doi.org/10.3390/bs12070208 
• Hazer, L., & Gredebäck, G. (2023). The effects of war, displacement, and trauma on child development. Humanities & Social Sciences Communications, 10(1), 909–919. https://doi.org/10.1057/s41599-023-02438-8 
• Kindratt, T. B., Dallo, F. J., Zahodne, L. B., & Ajrouch, K. J. (2022). Cognitive limitations among Middle Eastern and North African immigrants. Journal of Aging and Health, 34(9–10), 1244–1253. https://doi.org/10.1177/08982643221103712 
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• Samara, M., Hammuda, S., Vostanis, P., El-Khodary, B., & Al-Dewik, N. (2020). Children’s prolonged exposure to the toxic stress of war trauma in the Middle East. BMJ, 371. https://doi.org/10.1136/bmj.m3155 
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