Migration Policies As Social Determinants of Health: A Qualitative Study Among Adult Afghan Refugees in Turkiye

Background and Purpose: By mid-2024, the global displacement crisis remained one of the most significant challenges in the world, with 1 in 67 people forcibly displaced, including refugees. Afghans constitute one of the largest refugee populations, with 6.1 million who were forced to flee their homes. Reports indicate that Türkiye, a country signatory to the 1951 Refugee Convention, hosted 118,790 registered Afghan refugees and asylum seekers by the end of 2023. However, with the recent policy shift in Türkiye, Afghans must go through the refugee status determination (RSD) process by the Turkish authorities, which leaves them with unresolved asylum claims and an increased risk of deportation. Research indicates that refugees are at heightened risk of developing mental health issues due to the traumatic events they experience before, during, and after migration. Post-displacement stressors for Afghan refugees, especially considering Türkiye’s policies regarding the recognition of Afghan refugees, increase their risk for negative mental health symptoms. This study aimed to conduct an in-depth analysis of migration policies in Türkiye as social determinants of health and discuss how these policy changes have influenced the health outcomes of Afghan refugees and asylum seekers.

Methods: This study used a phenomenological approach to explore the experiences of adult Afghan refugees and asylum seekers in Türkiye, particularly emphasizing their health-related experiences. 25 Dari-speaking Afghan refugees residing in Kayseri, aged between 18 and 65, participated in the study. Semi-structured interviews were conducted with the study participants between December 2023 and June 2024. Each interview lasted around 45 minutes and was conducted in either Dari or English. Verbatim transcripts of the interviews were analyzed using reflexive thematic analysis by two independent bilingual researchers.

Results: Three important and overlapping themes emerged from the analysis: 1) desperation and hopelessness from economic hardship, instability, and social exclusion; 2) frustration with the recent restrictive migration policies; and 3) widespread psychological distress, health issues, and limited social support. The findings indicated that the study participants experienced increased stress levels, mainly stemming from adverse post-migration difficulties. The results aligned with previous research as the participants emphasized the daily struggles and feelings of uncertainty regarding their legal status in Türkiye while also reflecting on traumatic events encountered before and during their migration.

Conclusions and Implications: The current study's findings were in line with previous research suggesting that Afghan refugees experience psychological, social, and financial difficulties post-migration. Their limited access to basic services and feelings of uncertainty regarding their legal status due to migration policies further contribute to their vulnerability. Such findings highlight the urgent need for culturally sensitive prevention and intervention programs that promote resilience. Integrating such interventions with cash assistance may also address post-migration challenges for refugees and improve their well-being.