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ETROIT — Their home is warm and full of richly spiced aromas, a vast improvement from the chaotic tent cities where they lived while fleeing war in Sudan. Refugee advocates have spent months helping them get settled, signing them up for Medicaid and food stamps and dental care.

Maryam Hassan Yahqub is grateful. But she also says this: “We feel lost.”

Her six children and her baby grandson live in a rough stretch of Detroit, next to several boarded-up and burned-out houses. President Trump’s temporary ban on immigration from Sudan and six other predominantly Muslim nations doesn’t enter their conversations. They don’t have time to think about politics.

They are focused on survival: learning how to live in America. And figuring out how to get medical care for the untreated injuries that followed them through the genocide in Darfur, the refugee camps in Chad, and the long journey to Michigan.

Refugees across the US face similar strain as they seek to assimilate into their new homes. In a new effort to quantify the stress, researchers from Wayne State University many of whom are themselves former refugees are conducting psychological evaluations, stress tests, and genetic analyses on hundreds of new arrivals.

The goal: to identify and measure the problems they face, and then to develop low-cost interventions to help. Home visits or phone calls with multilingual social workers, for instance, might ease stress and help the refugees feel less alone.
“We want to provide treatment in a more culturally tailored way,” said Dr. Arash Javanbakht, an assistant professor of psychiatry at Wayne State University.

Sudanese Refugee Family
Maryam Yahqub, her children, and her grandson in their home in Detroit.

Collecting hair, saliva — and stories

There isn’t much research about the impact of sustained trauma on refugees: Most studies focus on the soldiers of war, not the civilian survivors who seek refuge abroad.

Javanbakht’s team has worked with about 400 refugees so far, and found that about half have depression and 30 percent have post-traumatic stress disorder, or PTSD. Their symptoms often manifest as feeling exhausted, scared, and always on alert.

“Immigration is a very highly stressful life event especially when you’re pushed out of your own country,” Javanbakht said. “These people just cannot assimilate well with society if they don’t have support or care.”

One interesting finding: Children’s stress levels strongly reflect how their mothers feel.

“We’ve found that a child’s anxiety directly correlates with a mother’s anxiety, and a mother’s level of trauma,” Javanbakht said. “So when the mother’s distressed, the children are more likely to be distressed.”

The study also found that 81 percent of the children experience separation anxiety.

Helping mothers cope and assimilate to a new country, and overcome their own PTSD, could be a powerful tool in helping refugee children adjust to their new environment.

The study starts with surveying recent refugees about how they’re feeling whether they’re having night sweats, for instance, and what helped them endure both war and migration.

The researchers are also studying the hair and saliva of the refugees, examining their cortisol levels to measure stress. Cortisol, after all, is a stress hormone and if levels are high in saliva, it means a person’s been recently stressed. If it’s high in hair, it means that person has been psychologically stressed for many months.

Javanbakht is also delving into the refugees’ genetics to see if there’s any inherited predisposition that helps or harms people when they’re confronted with trauma.

One problem: Even these simple tests can amplify a refugee’s anxiety. Some are reticent to share samples of hair and saliva, for instance, worrying that this might ultimately be used as a tool to deport them.

Sudanese Refugee Family
Qsma Hassan Yahqub, 12, washes the dishes at her home in Detroit, Mich.

Gratitude, but also profound anxiety

Looking up from his algebra homework, Maryam’s eldest son, Nassaur, speaks of their life in Darfur and the subsequent refugee camps only in broad strokes. It’s tough to speak plainly about the horrors.

“It was a bad life in the camp very tense,” Nassaur, who is 18, said through a translator.

An example: Nearly 10 years ago, Maryam was stabbed by her sister-in-law. The deep gash in her shoulder caused severe nerve damage that contributes to radiating pain down her entire left side. A physician in Detroit told the family that she’ll need surgery to correct the problem but didn’t explain where to get it done, or how to set it up.

Ever since, they’ve been shuffled from doctor to doctor. With the language barrier, it’s difficult to navigate the convoluted US health care system.

Refugees come with a unique set of health problems that many immigrants do not — because they’ve gone largely without good medical care during their years in camps or on the run, said Dr. Zafer Obeid, a primary care doctor who directs a clinic run by the Arab American and Chaldean Council in Detroit. Many have diabetes and high blood pressure, but often they come with untreated war injuries, such as Maryam’s long-wounded shoulder.

Then there’s the disillusionment that refugees often face after coming to America. “These kids won’t die of starvation or bombs in Detroit,” Javanbakht said. So they’re grateful. At the same time, though, the stress can be unrelenting. And in some cases, the refugees end up in dilapidated housing, crawling with bedbugs or in an apartment building crowded with drug dealers.

“When refugees come here, they often don’t feel happier just safer,” he said.

Beyond the language barriers, the isolation, the homesickness, the cold Midwest winters, the difficulty in navigating an unfamiliar bureaucracy, there’s survivor’s guilt: wondering why they were welcomed into the US, leaving so many of their family and friends behind.

Sudanese Refugee Family
Qsma Hassan Yahqub plays with Muntazir Muhajer Yahqub, who is 2 months old.

Maryam’s eldest daughter, Safia, misses her husband, who still lives in Sudan. The rest of the family came here last April. He hoped to follow. Now, with the travel restrictions in place, he has little hope of joining his family in Detroit any time soon.

This lack of a trusted circle exacerbates the symptoms of PTSD and depression that Javanbakht sees in so many refugees.

“All I want is for the kids to learn more English, and get that surgery so I can stand on my feet to take care of my family as best I can,” Maryam said.

Her son also has modest dreams: “All we want is to learn more English,” Nassaur said. “That way, we can help our mother get the operations she needs, so that she can finally feel better.”

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