Sophie Yohani spoke with a soft, soothing voice as she described her first encounter with genocide.
From a young age in her native Tanzania, she had always known that she wanted to study psychology. And it was while working as a counsellor at a walk-in clinic in Dar es Salaam that she was first exposed to the trauma faced by refugees from neighbouring Rwanda.
"We received quite a number of youth who had managed to flee Rwanda and ended up in our treatment centre," said Dr. Yohani, who now teaches in the department of educational psychology at the University of Alberta. Tanzania was one of the largest destinations for refugees of the Rwandan genocide.
That was in 1994. Her career as a psychologist moved to specializing in treating refugee trauma. Fast-forward 22 years, and she is now starting a new study with a local Rwandan organization in Edmonton, the Memory Keepers Association, to look at the effects of the horror of genocide still felt by a Rwandan community in Canada.
The aim is to study resilience, that is, how the community has been dealing with its recovery, what can work, but also the problems that remain and are now affecting a new generation. "What's unique about it is that we are studying the whole community of survivors, not just individuals or families," she said.
The crux of any study, whether of refugees from Rwanda or Syria or any country torn apart, is understanding the premigration and postmigration traumas.
For instance, someone who has suffered extreme violence in their country of origin and who then migrates to the safety of Canada won't likely have had the opportunity to redress the injustice perpetrated on them, as did those who stayed. This was the case with the reconciliation efforts in Rwanda, Dr. Yohani said.
And then, once arriving in Canada, if the refugee experiences racism or harassment, that can reactivate the previous injury. So, refugees find themselves recovering from the trauma they came from, which is sometimes a life-long recovery process, while being forced into the difficulties of acculturating to the new land. This is unlike immigrants, as Dr. Yohani defines them, who have a choice to migrate or not (such as herself, having left Tanzania to pursue graduate education in Canada).
The majority of refugees, roughly 80 per cent or so, according to a study in the Canadian Medical Association Journal in 2011, are able to recover naturally in a new land. Only a small percentage typically have post-traumatic stress disorder (about 9 per cent, the study said) or major depression (about 5 per cent).
Yet these numbers can vary widely, depending on when a study is conducted. "When you catch people right when they first arrive, the majority are going to look like they have post-traumatic stress just because they're still very much in crisis mode," she said. "But once they've settled, and over time, you'll get to see many will have recovered. But there will be a portion who will definitely require intervention and support."
A major area of her studies is about solutions, such as the use of cultural brokers. These are go-betweens who are able to understand the culture and language of the refugees, and may be part of their community, but who also understand how to work with support groups and social programs in the larger, mainstream society.
"This is definitely something that's been of some concern with the Syrian refugees coming here," Dr. Yohani said. "Do we have enough people with this expertise in this area? It does require not only an understanding of general mental health and mental wellness, but also an understanding of trauma and the unique experiences of immigrants and refugees.
In a new research paper she said she is about to submit, Dr. Yohani studied the experience of mental-health practitioners working with African women who had suffered sexual violence and rape before coming to Canada.
"What we found was that the women were not necessarily immediately interested in directly addressing trauma in their treatment. They have some more immediate needs," Dr. Yohani said. These were problems of housing, childcare, schooling and integrating into the community. It's a situation in which cultural brokers can help as a link to larger support services.
For the women, ensuring those basic needs was critical "before they were able to start working on or addressing traumatic experiences directly," Dr. Yohani said.
"This is something that people in general need to understand, that if you are going to work with refugees, they're not going to launch directly into talking about trauma. In fact, that can be really upsetting to them, to start treatment with a trauma focus."
Linda Kreitzer, in the faculty of social work at the University of Calgary, is partnering in the Rwandan refugee community study, having had more than 20 years of experience in Africa refugee issues, including researching the role of women from inside refugee camps in Ghana.
"What the research is saying now is that often when you're fleeing your country and going to another one to live, you're in survival mode. You need to keep your children eating and clothed, and have a roof over your head," Dr. Kreitzer said.
It can be only afterward that the lingering effects of trauma come out, creating a tangle of premigration and postmigration issues. Professional care workers will know to expect this, but it may not be expected by the refugees themselves.
But little can work if conditions remain unstable for resettled refugees. "The important thing is that you've got to get people safe. You have to deal with their housing, the fact that they have to get food, that they have a job. … Then you have to deal with the more emotional stuff later on when they feel safe and settled," Dr. Kreitzer said.
For some African refugees and, as Dr. Kreitzer noted, the current wave of Syrian refugees in particular, family members who are already in Canada can be a major advantage.
Yet trauma can continue, changing over time, affecting the children of refugees and unfolding into post-postmigration issues. The threat of landing into poverty is one very real concern, Dr. Yohani said. The ability of refugees to move out of poverty "has become next to impossible. Historically, it would take up to ten years, and then a refugee family would be at the same level as an average Canadian-born family. That's not happening any more."
And that is a major factor that can perpetuate the difficulties of postmigration issues over decades. They are the longer-term effects Dr. Yohani and Dr. Kreitzer now hope to explore as they use their previous research to understand what they discover in their Rwandan community study.