BACKGROUND

In early 1999 significant media attention was directed towards the "unauthorized arrivals" of people by boat on Australian shores. Following this, in October 1999, the Department of Immigration and Multicultural Affairs (DIMA) declared that "unauthorised arrivals", successful in their application for refugee status in Australia, would be granted a three years Temporary Protection Visa (Visa Subclass 785).

Prior to October 1999 people arriving without valid documents but with authentic claims for refugee status were eligible for Permanent Protection Visas (PPV). However, this new category (785) effectively created two classes of refugees. While on a Temporary Protection Visa (TPV) refugees would be eligible for only a restricted range of benefits and services. Holders of permanent protection visas (PPV) are eligible for the same range of benefits and support as permanent residents or citizens of this country.

Significant differences in entitlements between TPV holders and PPV holders are outlined in Appendix A. TPV holders who do not have any financial support are provided with a "Special Benefit" through Centrelink and are also eligible for Medicare benefits. However, they are not eligible for any English language programs or employment assistance.

In addition they are not entitled to family reunion. Hence they cannot sponsor immediate family members who they claim live under treacherous conditions in their country of origin or a neighbouring country. Further they cannot travel overseas to visit their immediate family as they are not granted multiple entry visas. Many claim to have had no contact with their families and are unaware of their whereabouts since they left their homes. This 'loss of contact' with family varies between a few months and a few years.

The Early Health Assessment and Intervention program is the only[2] Commonwealth funded service permitted to assist this group. As a result various community welfare and religious organizations have come forward to assist them. These organizations, mostly run by volunteers, are already beginning to feel the pressures of working with the TPV holders, particularly in certain parts of NSW where a majority seem to reside.

Characteristics of this group

TPV holders are predominantly men from Afghanistan and Iraq. They have arrived in Australia, on their own and without their families. A majority claim to have been traumatised and endured hazardous journeys to escape oppressive regimes or have a well-founded fear of persecution. In addition, many claim to have risked their lives in perilous fishing boats to reach what they thought was a libertarian, fair society. However, upon arrival in Australia, just when they believed their nightmarish odyssey may have ended, they have instead been placed in detention centres in different parts of the country.

As their refugee claims have been substantiated TPV holders have been released from the three main detention centres: Port Hedland and Curtin in Western Australia and Woomera in South Australia. Upon release TPV holders have been provided passage by DIMA (usually by bus) to all capital cities in Australia except Sydney. However, as they have limited knowledge of the language or surroundings they have found their way to New South Wales (NSW) in search of employment or community from a similar background.

In addition, NSW is host to TPV holders released from the local detention centre at Villawood who have arrived by air and are from a wider range of countries including Iran, Somalia, Algeria, Kuwait and Sri Lanka.

At October 2001 the Department had granted 5,721 TPVs. Recent Centrelink figures indicate that of the 4,363 TPV holders receiving a Special Benefit 1,824 (over 41%) are in NSW. This data also indicates that nationally 1,358 TPV holders are likely to have gained employment.

Early Intervention Program (EIP) experience with Temporary Protection Visa (TPV) holders

At November 2001 the Early Intervention Program (EIP), Service for The Treatment And Rehabilitation of Torture and Trauma Survivors (STARTTS) has provided a service to at least 748 TPV holders. Of these 55 have so far attended individual counselling. Approximately 230 TPV holders have attended group sessions.

Working with this group of clients has posed a unique set of challenges to the EIP. TPV holders are not eligible for any DIMA funded settlement services and other common referral avenues of the EIP. Further, TPV holders did not seem to follow regular patterns of service usage. The majority repeatedly failed to keep appointments and were reluctant to accept individual assessments and counselling. Persecuted by officials in their own countries and feeling that they have been persecuted by officials in detention centres, a majority appeared to be suspicious of counsellors inquiring into their backgrounds.

In addition many were beginning to drop in at the EIP on an ad hoc basis. Disoriented and confused, their requests included information related to their visa, family reunion, Centrelink payments, Medicare cards, language classes and even assistance with filling in forms. If not provided with immediate assistance they usually became agitated and very upset.

To meet the increasing demands on the Service and to provide a more efficient and effective way to manage the needs of this client group, it was decided to trial group sessions. A group ambience was perceived as relatively safe for these clients to ventilate their feelings and overcome obstacles related to individual counselling and assessments. The following themes emerged from participants in the groups.

COMMON THEMES

A Process of Frustration and Righteous Indignation

785 Visa

The detention experiences and discriminatory experiences following release aroused significant anger in the TPV clients. Many were furious when informed that there was very little the EIP could do regarding altering the restrictions imposed by the 785 Visa. They made repeated requests for support for family reunion or permission to travel overseas and at least to contact family members whose whereabouts were unknown. Many TPV holders, particularly those from Afghanistan, claimed to have had no contact with family for over a year. Comments like the following capture their feelings:

"With God as my witness I say it is very difficult to express myself. Because of a fear of persecution I left my property and family and came to a society I believed upheld democracy and human rights without discrimination. But here they expect us to kill our feelings about human relationships, family life and responsibilities".

"My wife and my children are directly facing threat and under pressure. How can I calm myself?"

Detention Experiences

Besides the visa considerable attention was focused on detention experiences during the groups. This was more so around the time when certain atrocities in the detention centres received widespread media attention. Detention experiences were unexpected and clients expressed significant anger about the conditions in these "camps" and the behaviours of the staff therein. They claimed to have been treated like criminals, and in some "camps" even pregnant women and children were denied food and water for extended periods. Proper medical attention was out of the question and many claim to have noticed a slow deterioration in their psychological health around this period.

Some "camps" lacked basic facilities and physical and sanitary conditions left much to be desired. Clients claimed to have been stripped of their belongings and foreign currency (mostly American Dollars) which was not returned by staff at the time of release. Deliberate efforts at humiliation by staff (for example, being addressed by a number instead of a name, continuous flashing of torchlights especially at night so that they could not sleep.) were frequently mentioned. They also mentioned a segregated part of the camp where some were held in isolation if their behaviour was 'improper'. The barbed wire around these camps completed the prison-like atmosphere in which these clients were held.

Discriminatory experiences

The TPV holders felt discriminated against when they realised they had no access to language classes or educational courses. They believed this was a deliberate attempt to ruin their chances of gainful employment. Many felt it would be more beneficial to them if they were provided some form of assistance to find employment rather than the Special Benefit. Many viewed this benefit as a 'minor indulgence' and in fact considered it discriminatory and humiliating.

Other events that angered them were being asked their residency status or when mention was made about their visa. In addition difficulties finding suitable rental accommodation and initial difficulties and long delays encountered obtaining Medicare cards made these clients very angry.

Major Practical/Settlement related Need Areas

Besides help with Medicare and Housing, English language classes were almost universally mentioned as a need area. English was important as some felt:

"We are like blind (and mute) people because we cannot read or speak English".

"There is an iron gate between me and this new society because of language".

English classes were accorded considerable significance also because knowledge of the language was perceived as an essential requirement for employment.

Employment, as expected, was perhaps equally important as clients disliked receiving a handout in the form of a Special Benefit. They also believed employment would keep them occupied and was a good antidote for their symptoms.

However, not all clients were so easily convinced about the importance of learning English. These clients saw no benefit in learning a foreign language if they were permitted to stay in the country for only a few years. Further they believed that they could not concentrate sufficiently, being constantly distracted by recurrent thoughts. Some were depressed and lacked the motivation to attend English classes.

The majority believed that English, vocational courses and employment were important. Underlying this is the belief that if they manage to obtain employment they could make a contribution to society and it would reflect favourably on them when their status was evaluated at the end of the three years period.

Separation From Family

Although always mentioned, clients had tremendous difficulties discussing their families. It was obvious they found it extremely difficult coping with the emotions which thoughts related to family members aroused. Their sense of grief and loss are illustrated in the following comments:

"We are in the middle of a turbulent ocean".

"Our hearts are broken. Australia is not fulfilling its international obligations".

"We have no happiness. This is a jail".

Whenever discussed, details of family separation and the pain it caused were almost always accompanied by emotional breakdown during the group sessions. Once the floodgates were opened there was no holding back. Clients however managed to provide tremendous support to one another on such occasions. During one such cathartic experience in an Arabic group, clients shared family photographs whilst exchanging information regarding ages of their children.

Most clients mentioned how they tried to avoid thinking about the families they had left behind. However this was almost impossible to achieve as the sight of children belonging to the same age group as their own children always triggered thoughts of their family. One client told of missing his train-stop as he was carried away by thoughts of his new-born child, when a young mother carrying a new- born infant boarded the train. He was not sure if his child was a boy or girl as he left his 9 months pregnant wife before she delivered.

Recurrent intrusive thoughts about family were also interfering with concentration in language classes and causing sleep difficulties as well. In the words of one client:

"I cannot sleep till 4am because of my anxiety. Thoughts of my children are driving me insane. To add to this I share my room with 12 people".

A few clients did mention that they often tried to visualize family members safe and happy in moments of solitude. This helped them calm down. However they also mentioned that they grew angry and agitated if disturbed during these quieter moments.

Thoughts about family in general induced a sense of guilt. Whilst clients believed they were relatively safe and comfortable, their wives and children were in constant danger. Clients from Afghanistan faced the additional guilt of their families facing starvation. Many clients mentioned that even the sight of supermarkets full of food made them feel guilty as their children perhaps did not have sufficient food to eat. Typical comments were as follows:

"It was better to have been killed by the Taliban. We do not live twice. What's the use of this (own relative safety and comfort)".

"Is this fair? What is the use of living here while our families are burning in Afghanistan?"

In addition, thoughts about family induced a sense of helplessness and despair as clients began to lose hope of ever reuniting with family. In one session they compared themselves to small animals (mice) being preyed on, and the Minister to the predator (cat). They often said things like:

"We will never be able to see our families again. They will be killed by the Taliban or die of starvation".

"In Afghanistan death was always lurking around the corner. But here every step I take makes me feel I am slowly approaching my death".

"We are not God's creatures. Even He has abandoned us".

Whilst clients claimed they had lost the ability to feel, or a sense of numbness, they also described a very deep feeling that they could not easily express. Akin to a burning or a different kind of pain, it was omnipresent, unpleasant and something they could not shake off.

"The pain is like a cancer in our bones".

"I feel like a snake writhing in pain".

"We are burning in the fire but still do not die".

Other common themes

Media coverage of relevant "news" was seldom missed. The destruction of the 'Buddhas' had a general impact as clients went through a kind of 'cultural bereavement' over what they considered a treasure that belonged to the entire human race. They used this as clear evidence that the Taliban government 'had no concerns for humanitarian rights, was illogical and irrational and very clearly a puppet government of Pakistan'.

The documentaries aired on National TV that illustrated the difficulties in their homeland or focused on their current living conditions were also mentioned often. Many clients believed the media was a good instrument to express their views and perhaps even reach the Australian public to inform them about themselves. However, many felt that such exposure could also pose a threat to the safety of their families in their countries of origin.

Other themes were related to problems in their own country; for example, the civil war in Afghanistan and Sri Lanka, the oppressive regime in Iraq. At times personal experiences like loss of close family members or imprisonment and torture were touched on. Flight experiences and the hazardous voyage in fishing boats were often mentioned. Somatic complaints like headaches, other bodily aches and pains, minor skin rashes, and gastrointestinal difficulties were spoken of.

IMPACT OF RECENT EVENTS

The groups were relatively unstructured to accommodate the complexity of the processes involved and the cultural perceptions and needs of the client group. However, in the past few months even the bare structure of these groups was torn apart due to the impact and media coverage of recent events. These included the Australian Government's stance on the asylum seekers stranded on the Norwegian freighter 'Tampa', the terrorist attack on the Twin towers of the World Trade Centre in New York, America and its Allies's 'war against terrorism', the sinking of a boat from Indonesia with over 350 asylum seekers on board, and the recent Border Protection Legislation.

Tampa Crisis

Following the 'Tampa' incident it appeared that clients attending the groups were presenting as increasingly disoriented and confused. Numbers fluctuated ranging between two and thirty in the first few weeks following the crisis. However, gradually attendance patterns became more regular as the sessions progressed. Further, it became obvious that the clients could only focus on the ongoing 'crises' and their own intense emotional turmoil associated with it. Hence any pre-planned agenda could not be adhered to as dealing with current emotional issues was of paramount importance.

The participants found it easy to empathise with the people on the Tampa. Not only did it make them recollect their own perilous journey to Australia (and in a way re-traumatise them), but the saga of the people on the boat seemed to epitomize the entire community of asylum seekers as well. They failed to understand and were shocked by the response of average Australians to the plight of this group. They were also wary of the backlash they suffered as a result of both the government's stance and the media coverage of this incident.

"The Australian government is against us and is encouraging the people to be against us."

A few reported being recipients of comments like :

"Go back ..... boat people......queue jumpers."

This made them feel misunderstood and dehumanised and say:

"All of Australia is a prison.... .This is more than we imagined."

"We were 'mentally' better off in Afghanistan."

"We are not God's creatures, but DIMA's slaves."

A few remembered how it felt like being "born again" when they were rescued by the Australian boats from their sinking fishing boats. They also remembered how this hope has since then been dashed following their experiences in the detention centres and the restrictions imposed on their visa following their release.

The attacks on the World Trade Centre (WTC) and the War against Terrorism

The aftermath of the attacks on the WTC left the clients extremely helpless and with a pathological sense of shame. They reported being targeted by employers, colleagues in the workplace and even by ordinary persons on the street. They were often intimidated and humiliated by remarks such as :

"How come you do not go to fight the USA. You are dangerous. You are Taliban....Bin Laden".

These comments were because of their nationality (Afghan) and religion (Islam) but it was like 'rubbing salt in their wounds'. They found this hard to comprehend as they themselves were victims and had fled from the Taliban and often said :

"We are victims of persecution. We have waited a long time for peace. It is worse now as others are accusing us of being terrorists. It is too much pain being wrongly accused. It is a big burden for us to carry".

"Help! We are human. Take our voice to Australians and make them understand we (Hazare people) are different (from Taliban)".

"We are not terrorists. Terrorists do not risk their lives on leaky, rotting fishing boats".

"Why don't they realise Bin Laden is not even an Afghan".

A few men claimed that being ashamed of their Afghan and Muslim background, they preferred to stay by themselves in their units and not venture outdoors. A few others mentioned that if asked about their Nationality they tried to pass off as Chinese, Korean or Filipino.

However, although made to feel like criminals and dehumanised by this discrimination they believed they would somehow manage to cope. It was nothing compared to their shame and guilt at abandoning their wives and children who were under direct attack in the midst of the war in Afghanistan whilst they were safe here in Australia.

"Even a bird looks after its nest. It will not allow someone to destroy the eggs. Our children are in the nest. They are burning...dying.... It is very difficult..."

Their current sufferings were nothing in comparison to what the helpless women, children and elderly were enduring in their homeland. All the earlier issues surrounding their visa or settlement seemed insignificant. They claimed to be preoccupied with the war, unable to sleep, concentrate or stop thinking about it. They often said:

"My mind is not with me. We are like chooks running around in a big cage"

"This seems like a movie. It is not real".

"Only God can help the women and over 2 million children of Afghanistan".

Some men mentioned being almost hypnotically drawn to their TV sets, unable to look away in the hope that they would perhaps catch a glimpse of a relative or a person they knew amongst the refugees fleeing their country. On the one hand they were relieved that the entire world was now increasingly aware of the atrocities committed by the Taliban but they queried the motives behind the retaliation against the Taliban. Whilst they did condemn the terrorist attacks they could not understand how the world had rallied around America to avenge the death of 5,000 innocent victims when for over 23 years no one cared about Afghanistan when innocent people were being killed every day.

"One day 5,000 people die the whole world is shocked. For 23 years innocent Afghans have been killed and not a word is said by anyone".

"No one cares. There is no difference if we die. American blood is worth a lot more than ours.... We are the forgotten race".

The men were also angry about the food parcels being the same colour as the bombs scattered by the American aircraft and this prompted a few to say :

"Whereever you go they are destroying us. One hand is bombing. The other is throwing food".

Many lamented they were safe here in Australia but dying a slow death. They preferred instead to have become 'shahid' (martyrs) at the hands of the Taliban or died alongside their wives and children rather than continuing to exist in this state.

They shared their feelings of isolation and helplessness in the groups and although difficult to express, it was so intense they repeatedly said their pain was at times "unreal"...it was like "a fire burning within".

The death of asylum seekers on board the fishing boat off Australian shores

Although fully aware that this was not the first time that refugees had lost their lives en route Australia, clients were appalled that relatives were not allowed the opportunity to contact family overseas and at least pay last respects to the dead.

Not everyone who attended the group on the day this tragedy made news was fully aware of what had happened. Those who did know asked questions like the following:

"How closely does this match Australia's commitment to Human Rights?"

Border Protection Legislation

The group was informed about the new legislation by one of the clients who heard about it. Although most of them had put in applications for a permanent visa they felt this new legislation would 'drive them to insanity'. The few who had missed out appeared to be dumbstruck and found it difficult to hide their pain. They expressed their feelings as follows :

"We are now like animals in someone's hands".

"This is slow death, life is like a poison".

"We were living in the hope that some day we would get the opportunity to see our relatives and friends. The light at the end of the tunnel has been put out".

All clients attending the groups believed this legislation was a surprise and failed to understand the rationale behind it.

How do Temporary Protection Visa Holders Cope?

The TPV holders experiences in their countries of origin, the hazardous journeys many have endured to arrive in this country, their experiences and treatment in the detention centres which they perceive as humiliating and unjust, is a sequential representation of trauma (refer to Appendix B: From Multiple Trauma to Coping). Grant of the Temporary Visa is perceived as another failure that adds to the trauma in this sequence of multiple trauma. The resultant levels of anxiety, depression and post-traumatic stress observed amongst this group are substantiated by numerous research studies that indicate a decrease in mental heath and social functioning with increasing amounts of traumatic events. (Lopes C,B; Vergara, A; Agani, F; Gotway, C;2000, Mollica R et al 1998)

Most TPV holders only realize the full implication of their temporary status after release from the detention centres. This is when they commence to feel the impact of the restrictions imposed on them. As many are here to 'save their families', the restriction on family reunion and the temporary status of their visa represents a major failure and many clients refuse to accept (refer to "Denial" in Appendix B) these restrictions. Believing they still have the right to reunite with family they experience significant anger.

The majority of the TPV holders visiting the EIP at STARTTS are initially at this stage of denial, refusing to accept loss of their rights to family reunion. Demanding assistance or means to contact and sponsor immediate family from overseas, their persistent request for support and advocacy is a reflection of their attempts to secure safety and reunion with their families. As they discover the limitations of the service and the inability to obtain legal assistance to assist with family reunion, depressed affects, anxiety and survivor guilt set in.

It should be noted that not all clients visiting the centre were in denial or 'angry'. Many clients, beginning to resign themselves to the restrictions, with a low expectancy of a positive outcome were already experiencing feelings of depression, guilt and anxiety.

The loss of family threatens goals and aspirations to which TPV holders are highly committed , and this fear arouses anxiety and tension. It appears that many TPV holders find it easier to escape this loss as they cannot actively fight it, and in attempts to try and distance themselves from the failure (or loss of family reunion rights) they suppress all thoughts and affects related to it (refer to "Avoidance" in Appendix B). However, the majority understandably reported recurrent intrusive thoughts, concentration difficulties and sleep disturbances.

Almost every TPV reported sleep disturbances and claimed that family related thoughts were hardest to cope with in the late evenings as it was difficult to distract themselves then. These preoccupations prevented them having a good nights rest. Images of wife and children would flash before them the minute 'they shut their eyes'. Images of the past also disturbed them in dreams and nightmares.

Despite the above, many TPV holders gradually re-organise their immediate goals around learning English and employment related skills. Re-organisation perhaps represents a possible avenue to break the vicious cycle of depression, anger, guilt, anxiety and related symptoms of intrusive thoughts and concentration deficits. Notwithstanding, most TPV holders report frustrations when constantly turned away from TAFE, ACL (Australian Centre for Languages) and other educational courses. In addition, they feel disheartened and re-experience feelings of failure when they encounter difficulties learning English and also finding suitable employment. Further, as they are not eligible for most government funded welfare support and are not assisted as expected by non-funded (mostly religious) organizations, they feel humiliated and discriminated against. These ongoing stresses interact with and exacerbate the vicious cycle of anxiety, depression, anger and Post Traumatic Shame Disorder (PTSD) symptoms.

Post Traumatic Shame Disorder?

Recent events have been perceived by clients attending the groups as an ongoing sequence of uncontrollable incidents with debilitating outcomes. This has led to them experiencing extreme feelings of helplessness and a further worsening of their symptoms: in particular depression, anxiety and PTSD. Further the perceived humiliation and discrimination that they experienced in the aftermath of these events has resulted in feeling a pathological sense of shame and a loss of self-esteem. Underlying these feelings (helplessness, shame and loss of esteem) is also a growing sense of anger related to their perception of being ignored and rejected by the rest of the world.

CONCLUSION

Most TPV holders present as anxious and agitated, full of unexpressed anger against the perceived injustice related to their detention experiences and temporary visa status and against those remaining indifferent or perceived as unhelpful. They report insomnia and agitation and also tension headaches, gastro-intestinal disturbances and bodily aches and pains. Through denial, dissociation and thought suppression they have learnt to alter an unbearable reality. The majority are bitter and feel forsaken by both 'man and God'. The psychological losses combine, resulting in a chronic state of depression. Believing they are being held captives at the mercy and control of the Government of Australia, many describe themselves as being reduced to a subhuman/animal life-form. The resultant symptom picture perhaps provides evidence for the existence of a complex form of PTSD.

As a result of prolonged repeated trauma, many TPV holders experience an intense numbing feeling of pain which they find difficult to articulate and express. Many describe this as "Burning in the Fire, but still continuing to Live".

Notes

[1] Personal thanks to: Hartgerink Pam whose support was instrumental in trialling the groups; Dimech Mary Early Intervention Program Coordinator; Hormiz Amal who co-facilitated the Arabic groups; Kerry Denise who co-facilitated a few Dari groups; Coello Mariano my Clinical Supervisor ; Preston-Thomas Cathy and the Community Development team; All the interpreters who worked with me on this project; The volunteers at STARTTS in particular the English Teachers; Employment AMES for their willingness to assist the TPV holders; and The counsellors at EIP.

This paper is an abbreviated version of a chapter (titled "Burning in the Fire") in preparation for a Transcultural Mental Health Centre monograph on mental health among refugee groups in Australia.

[2] Some state Governments have been funding a few services for TPV holders, but not in NSW

Bibliography

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Lubin, H. Loris. M; Burt, J;Johnson, D, R (1998) Efficacy of psychoeducational group therapy in reducing symptoms of post traumatic stress disorder among multiple traumatised women. American Journal of Psychiatry, 155: 1172-1177.

Mikulincer, M.(1994) Human Learned Helplessness: A coping perspective. Plenum Press.New york and London

Mollica, R. F., McInnes, K., Poole, C., Tor, S. (1998) Dose-effect relationships of trauma to symptoms of depression and post-traumatic stress disorder among Cambodian survivors of mass violence. British Journal of Psychiatr, 173: 482-488.

Richman, N. (1992). Looking Before and After: Refugees and Asylum Seekers in the West. Rethinking the Trauma of War. London : Free associations books (Patrick J Bracker ed.).

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Pearl Fernandes, a Clinical Psychologist, has been with STARTTS (Service for the Treatment And Rehabilitation of Torture and Trauma Survivors) for over three years. She is currently a team leader with the EIP (Early Intervention Program), a specialist division of STARTTS that provides counselling and support to newly arrived refugees in Australia.

Paper presented at the International Conference "The Refugee Convention, Where to from Here?" convened by the Centre for Refugee Research (Sydney, December 2001).

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