Sociodemographic Characteristics and Mental and Physical Health Diagnoses of Yazidi Refugees Who Survived the Daesh Genocide and Resettled in Canada

Abstract

ImportanceThe health status of Yazidi refugees, a group of ethnoreligious minority individuals from northern Iraq who resettled in Canada between 2017 and 2018 after experiencing genocide, displacement, and enslavement by the Islamic State (Daesh), is unknown but important to guide health care and future resettlement planning for Yazidi refugees and other genocide victims. In addition, resettled Yazidi refugees requested documentation of the health impacts of the Daesh genocide.ObjectiveTo characterize sociodemographic characteristics, mental and physical health conditions, and family separations among Yazidi refugees who resettled in Canada.Design, Setting, and ParticipantsThis retrospective clinician- and community-engaged cross-sectional study included 242 Yazidi refugees seen at a Canadian refugee clinic between February 24, 2017, and August 24, 2018. Sociodemographic and clinical diagnoses were extracted through review of electronic medical records. Two reviewers independently categorized patients’ diagnoses by International Statistical Classification of Diseases, Tenth Revision, Clinical Modification (ICD-10-CM) codes and ICD-10-CM chapter groups. Diagnosis frequencies were calculated and stratified by age group and sex. Five expert refugee clinicians used a modified Delphi approach to identify diagnoses likely to be associated with Daesh exposure, then corroborated these findings with Yazidi leader coinvestigators. A total of 12 patients without identified diagnoses during the study period were excluded from the analysis of health conditions. Data were analyzed from September 1, 2019, to November 30, 2022.Main Outcomes and MeasuresSociodemographic characteristics; exposure to Daesh captivity, torture, or violence (hereinafter, Daesh exposure); mental and physical health diagnoses; and family separations.ResultsAmong 242 Yazidi refugees, the median (IQR) age was 19.5 (10.0-30.0) years, and 141 (58.3%) were female. A total of 124 refugees (51.2%) had direct Daesh exposure, and 60 of 63 families (95.2%) experienced family separations after resettlement. Among 230 refugees included in the health conditions analysis, the most common clinical diagnoses were abdominal and pelvic pain (47 patients [20.4%]), iron deficiency (43 patients [18.7%]), anemia (36 patients [15.7%]), and posttraumatic stress disorder (33 patients [14.3%]). Frequently identified ICD-10-CM chapters were symptoms and signs (113 patients [49.1%]), nutritional diseases (86 patients [37.4%]), mental and behavioral disorders (77 patients [33.5%]), and infectious and parasitic diseases (72 patients [31.3%]). Clinicians identified mental health conditions (74 patients [32.2%]), suspected somatoform disorders (111 patients [48.3%]), and sexual and physical violence (26 patients [11.3%]) as likely to be associated with Daesh exposure.Conclusions and RelevanceIn this cross-sectional study, Yazidi refugees who resettled in Canada after surviving the Daesh genocide experienced substantial trauma, complex mental and physical health conditions, and nearly universal family separations. These findings highlight the need for comprehensive health care, community engagement, and family reunification and may inform care for other refugees and genocide victims.

Health status and care utilization among Afghan refugees newly resettled in Calgary, Canada between 2011-2020

“…Overall, 18% of total diagnoses coded among our cohort (285/1535 diagnoses) were physical symptoms recently identified as suspected somatoform disorders by refugee clinician consensus. 22 Table 4 shows the prevalence of ICD-10 diagnoses identified as clinician consensus-derived suspected somatoform disorders by age group. The most frequently coded diagnosis suspicious for a somatoform disorder by clinicians for both adults and children was abdominal and pelvic pain (26·3%, 60/228 adults; 6·32%, 11/174 pediatric patients), followed by low back pain for adults (20·2%, 46/228) and joint pain for children (4·0%, 7/174).…”

“…20,21 When compared with a recent Yazidi refugee analysis using expert clinician consensus to identify potential trauma-related conditions, we found that one-fifth of diagnoses (18%) made among our cohort were on a consensus list of non-specific diagnoses clinicians suspected represented somatoform disorders. 22 This proportion suggest the importance of adopting a culturally sensitive approach to diagnosing mental health illnesses among Afghan and other refugees despite potential reluctance, at times, to openly discuss mental health. 33 Following the Taliban's takeover, our team has observed a significant linguistic and cultural shift among Afghan refugees settled locally.…”

“…20–22 This list had been revised using a modified Delphi method for 3 rounds of voting and discussion to reach unanimous consensus between 5 clinician experts with experience in refugee clinical care. 22…”

“…19 Given the short clinic follow up period and limitations of standardized coding diagnoses in capturing possible trauma-related health conditions, we compared our cohort's ICD-10 diagnoses with a clinician consensus list of 18 ICD-10 diagnoses identified as suspected somatoform disorders among refugee patients that was generated during a recent analysis of trauma-related conditions among Yazidi patients. [20][21][22] This list had been revised using a modified Delphi method for 3 rounds of voting and discussion to reach unanimous consensus between 5 clinician experts with experience in refugee clinical care. 22 We summarized data using frequencies, means, standard deviation, median, quartiles, and range for continuous variables.…”

“…[20][21][22] This list had been revised using a modified Delphi method for 3 rounds of voting and discussion to reach unanimous consensus between 5 clinician experts with experience in refugee clinical care. 22 We summarized data using frequencies, means, standard deviation, median, quartiles, and range for continuous variables. We used World Health Organization age categories to stratify our data into four age groups (younger children aged 0-4 years, older children aged 5-11 years, adolescents aged 12-17 years and adults 18 years and older), and by sex among adults.…”