Making place in refugee health research: An Australian perspective

Earlier this year, UK Prime Minister Rishi Sunak announced the asylum seeker bill to purportedly stop human trafficking. The tagline ‘Stop the boats’, was also the slogan that won former conservative Australian Prime Minister Tony Abbott an election ten years ago. These words are emblematic of Australia’s treatment of refugees and asylum seekers. Australia’s approach is characterised by a sensationalised debate fueled by the country’s two major political parties and their succession of cruel policies obsessed with border control.

The UK’s new bill seeks to forcibly detain all asylum seekers arriving through ‘irregular routes’ in Rwanda. It is modelled on Australia’s longstanding mandate of offshore detention. This policy parallel is one of many reasons refugee settlement researchers in the UK and Australia are asking similar questions and developing shared approaches.

The need for spatial thinking in refugee health

While asylum seekers who arrive in Australia by boat without a valid visa are detained offshore or deported, Australia’s refugee program promised 17,875 places in 2022/23 to those who apply for protection through its visa channels. We know that social isolation and loneliness are higher among refugees and migrants and that these issues lead to poorer mental and physical health. However, refugee health is often discussed in reductive terms, with a focus on ‘barriers’ and ‘enablers’, rather than complex determinants. For example, rather than considering the availability of health services, we may think about how health is impacted by migrants’ proximity to green spaces, or accessibility of appropriate food options – or, the psychological benefits of being among one’s cultural community.

Further, despite refugees typically being settled in specific types of places in Australia – country towns and outer suburbs in major cities – this is not always accounted for as a factor that shapes refugee health. As United Nations high commissioner for refugees Filippo Grandi recently said, countries need to take a panoramic view of population movements and consider geographical complexity.

Our work on refugee settlement brings this geographic thinking to refugee health. We do this by considering the role of placemaking in health and wellbeing when refugees begin life in their country of settlement. We explore how well physical spaces work (for example, safe and appropriate housing, accessible neighbourhoods), as well as investigating immaterial factors related to how the settlement space is used, such as one’s ability to connect with locals or practice their culture. In other words, placemaking is a concept that helps us consider how refugees invest their homes, neighbourhoods and cities with meaning through their everyday activities and thus, shape their relationship to their place of settlement.

In order to understand the links between placemaking and physical and mental health and wellbeing, we undertook a systematic scoping review of literature on these two topics. Our study focused on recently resettled refugees in high-income countries (including Australia, United Kingdom, United States, Iceland, Germany and others). We analysed 65 studies and specifically concentrated on papers that reported the perspectives of refugees, rather than service providers or policy makers.

Physical, psychosocial and structural placemaking has health impacts

Refugees’ experiences of placemaking were closely linked to their mental health and wellbeing. When discussing their housing or local area, respondents touched on their general psychological wellbeing, as well as specific disorders including anxiety, depression, trauma, and suicidal ideation.

We found that placemaking was experienced at multiple scales – physical, psychosocial and structural. Refugees were impacted by the physical aspects of their surroundings, such as housing, public spaces, parks, swimming pools and places of worship. For example, a lack of satisfaction with housing (too small, lack of outdoor areas for children) was associated with depression, stress and anxiety, and exacerbation of existing trauma.

Psychosocial factors were equally important. A sense of belonging, resilience, cultural identity and sociocultural connection and support were integral to health and wellbeing. For example, one study explored the lives of Iraqi women settling in Australia, who found it difficult to put down roots in their new country. They continued to mourn Iraq until a trip to Baghdad revealed how much their former home has changed and enabled them to psychologically begin to form attachment to Australia.

Participants across multiple studies said that social contact improved their feelings of self-worth and helped alleviate some stress. This meant positive interactions with non-migrant neighbours, as well as people who spoke the same language or were from the same country of origin. Refugees described friends as a source of happiness, a way to fight the effects of trauma, moral support, and a form of therapy and mutual understanding.

Young people noted that expressing their cultural identity, particularly at school and through role models, improved their mental health. Refugee parents settling in Australia expressed concern about the need for their child to protect their culture and, at the same time, adapt to Australia.

Finally, structural elements impacted health and wellbeing too: this included visa rights and policies, the resourcing of support services, education and employment opportunities, and racism and discrimination. Achieving refugee status was associated with stability, which reduced worry and stress. In Australia, access to universal health care once resettled had positive impacts on mental health. Unemployed refugees experienced higher rates of psychological distress and poverty-induced physical health impacts.

Discrimination and racism based on skin colour, literacy level or accent, or for Muslim girls and women, wearing a hijab, caused significant mental health stress. One Australian study recorded an incident of verbal abuse on public transport.

What’s next

Together with local settlement organisations, we are now developing a project looking at how place impacts refugee mental health in Australia. We believe placemaking can facilitate social cohesion and a sense of belonging. Research on refugee placemaking has considered place attachment and overcoming alienation, but more work needs to be done to understand how placemaking can promote health and wellbeing.

The full results of the authors' review are published in Health and Place (behind paywall).