Johnston Vanessa, Allotey Pascale, Mulholland Kim, Markovic Milica
Menzies School of Health Research and Institute of Advanced Studies, Charles Darwin University, PO Box 41096, Casuarina, NT 0811, Australia.
BMC Int Health Hum Rights. 2009 Feb 3;9:1. doi: 10.1186/1472-698X-9-1.
Human rights violations have adverse consequences for health. However, to date, there remains little empirical evidence documenting this association, beyond the obvious physical and psychological effects of torture. The primary aim of this study was to investigate whether Australian asylum policies and practices, which arguably violate human rights, are associated with adverse health outcomes.
We designed a mixed methods study to address the study aim. A cross-sectional survey was conducted with 71 Iraqi Temporary Protection Visa (TPV) refugees and 60 Iraqi Permanent Humanitarian Visa (PHV) refugees, residing in Melbourne, Australia. Prior to a recent policy amendment, TPV refugees were only given temporary residency status and had restricted access to a range of government funded benefits and services that permanent refugees are automatically entitled to. The quantitative results were triangulated with semi-structured interviews with TPV refugees and service providers. The main outcome measures were self-reported physical and psychological health. Standardised self-report instruments, validated in an Arabic population, were used to measure health and wellbeing outcomes.
Forty-six percent of TPV refugees compared with 25% of PHV refugees reported symptoms consistent with a diagnosis of clinical depression (p = 0.003). After controlling for the effects of age, gender and marital status, TPV status made a statistically significant contribution to psychological distress (B = 0.5, 95% CI 0.3 to 0.71, p <or= 0.001) amongst Iraqi refugees. Qualitative data revealed that TPV refugees generally felt socially isolated and lacking in control over their life circumstances, because of their experiences in detention and on a temporary visa. This sense of powerlessness and, for some, an implicit awareness they were being denied basic human rights, culminated in a strong sense of injustice.
Government asylum policies and practices violating human rights norms are associated with demonstrable psychological health impacts. This link between policy, rights violations and health outcomes offers a framework for addressing the impact of socio-political structures on health.
侵犯人权行为会对健康产生不良后果。然而，迄今为止，除了酷刑带来的明显身体和心理影响外，几乎没有实证证据证明这种关联。本研究的主要目的是调查澳大利亚的庇护政策和做法（可以说是侵犯人权的）是否与不良健康结果相关。
我们设计了一项混合方法研究以实现研究目的。对居住在澳大利亚墨尔本的71名伊拉克临时保护签证（TPV）难民和60名伊拉克永久人道主义签证（PHV）难民进行了横断面调查。在最近的政策修订之前，TPV难民仅获得临时居住身份，并且获得一系列政府资助福利和服务的机会有限，而永久难民可自动享有这些福利和服务。通过对TPV难民和服务提供者进行半结构化访谈，对定量结果进行了三角验证。主要结局指标是自我报告的身心健康状况。使用在阿拉伯人群中经过验证的标准化自我报告工具来测量健康和幸福状况。
46%的TPV难民报告有与临床抑郁症诊断相符的症状，而PHV难民的这一比例为25%（p = 0.003）。在控制了年龄、性别和婚姻状况的影响后，TPV身份对伊拉克难民的心理困扰有统计学上的显著影响（B = 0.5，95%置信区间0.3至0.71，p≤0.001）。定性数据显示，由于他们在拘留期间和持临时签证期间的经历，TPV难民普遍感到社会孤立，对自己的生活状况缺乏掌控感。这种无力感，以及对一些人来说，他们隐隐意识到自己的基本人权被剥夺，最终导致了强烈的不公正感。
违反人权规范的政府庇护政策和做法与明显的心理健康影响相关。政策、侵犯人权行为和健康结果之间的这种联系为解决社会政治结构对健康的影响提供了一个框架。
