NEWS | May 20, 2013

Past trauma, poor understanding of health-care services common among Sacramento Iraqi refugees


Past trauma and a lack of understanding of the U.S. health-care system are key factors affecting the mental and physical health of Iraqi refugees in Sacramento, according to a new report released by UC Davis’ Center for Reducing Health Disparities and Clinical and Translational Science Center, as well as Opening Doors Inc. and the Mesopotamia Organization (MESO) —  two community groups  that serve refugee populations.

MESO staff member Rusul Tawffeq interviewed Iraqi refugees to learn about their current health conditions and challenges in accessing health care. MESO staff member Rusul Tawffeq interviewed Iraqi refugees to learn about their current health conditions and challenges in accessing health care.

The report, entitled “Mental and Physical Health of Recent Iraqi Refugees in Sacramento, California,” represents the views of 34 Iraqi men and women who lived in the Sacramento area from December 2008 to August 2012 and agreed to share details about their current health conditions and the challenges they encountered while accessing health-care services. It is the first study to assess the unmet health-care needs of the Iraqi refugee population in Sacramento, one of the fastest growing refugee groups in the region.

Report findings and recommendations

The study found that 79 percent of Iraqi refugees reported trauma as a major health concern, with insomnia (59 percent), depression (44 percent), headaches (41 percent), and fear (38 percent) as the most common physical and psychological symptoms experienced. These findings mirror previous health assessments of Iraqi refugees conducted in other U.S. cities, which also found depression, anxiety and post-traumatic stress disorder among the most common conditions affecting individuals who have fled war-torn Iraq.

Sacramento Iraqi refugees also believe the U.S. health care system is costly and difficult to understand and access. They were especially confused by the specialty care referral process, the separation of dental and vision care services, and the seemingly arbitrary nature regarding conditions that insurance plans cover. These factors, they said, were compounded by their inability to understand medical terminology, as many were still learning to speak English, and primary care providers’ lack of knowledge of Iraqi refugees, their health needs and the effects of trauma on mental and physical health.

The report also found that the vast majority of Iraqi refugees did not access mental health care, either due to a lack of knowledge about options, unwillingness to bring up the subject of trauma with providers, or cultural and linguistic barriers to understanding how mental health is viewed and treated in the U.S. To cope with their mental health needs, the group relied most on friends and family members (91 percent), religion and faith in God (65 percent) and exercise and sports (44 percent).

“Untreated mental health needs are very common problems, creating significant burdens for individuals and their families and reducing productivity and quality of life,” said Linda Ziegahn, community engagement and research program manager at the UC Davis Center for Reducing Health Disparities and an author of the study.

“For Iraqi refugees, the usual problems that underserved populations experience in receiving quality and timely health-care services are compounded by refugees’ lack of understanding about how the U.S. health-care system works and how they can best communicate with health-care providers to obtain care for mental and physical conditions.

“Health-care institutions should have trained Arabic-speaking health navigators and interpreters to foster effective provider-patient communication and reduce the stigma of receiving care for mental health conditions.”

The UC Davis research team jointly planned and carried out all phases of the interview-based study with MESO and Opening Doors staff. The Iraqi project staff set a climate that made it clear to participants that they could talk freely about their health, without fear of stigma around particular conditions. The team asked open-ended questions, balancing the need for sensitivity and lack of bias. The interviews were conducted in Arabic by Iraqi interviewers who had been trained in qualitative interviewing techniques and who all helped analyze results within the framework of Iraqi culture and the specific context of recently arrived refugees.

About the Iraqi refugee population

According to the Office of the United Nations High Commissioner for Refugees, 4.7 million Iraqi refugees have fled their homes since 2006, including 64,000 who were admitted to the U.S. between 2007 and 2012. The California Department of Public Health estimates that more than 2,000 refugees arrived in California between October 2010 and September 2011. Approximately 2,500 Iraqi immigrants and refugees currently  live in Sacramento, according to MESO, a nonprofit group that supports Iraqi refugees and helps them establish new lives.

“Iraqi refugees are a strong and resilient population who have left much behind in their home countries and are eager to work and establish new lives here in the U.S.,” said Debra DeBondt, a co-investigator of the UC Davis study and chief executive officer of Opening Doors, Inc.,  a nonprofit agency serving refugees and immigrant populations in Sacramento. “This study describes how we can help further their progress.”

The study was funded with a pilot project grant from the UC Davis Clinical and Translational Science Center (UL1 TR000002), Molina Health of California, Health Net of California, and a gift from Dr. Rafael Amaro.

The UC Davis Center for Reducing Health Disparities, in alliance with the UC Davis Clinical and Translational Science Center, provides leadership and support within and beyond UC Davis Health System to promote the health and well-being of ethnically diverse populations. The center focuses on raising awareness of the unique cultural and linguistic attributes of minority populations, developing culturally and linguistically sensitive communications for health-care professionals, and working with policymakers, administrators, practitioners, consumers and families to reduce health-care disparities and improve quality of care. The center’s ultimate goal is to improve health outcomes for all. For more information, visit