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CAMH Stories Centre for Addiction
and Mental Health

Bolstering the long-term health of Syrian refugees

TORONTO, January 24, 2017 - In little more than a year, Canada has welcomed nearly 40,000 Syrian refugees in hopes of providing an opportunity for a better life. For these hopes to become a reality, ensuring the long-term health of Syrian refugees is key, particularly because earlier research with refugees has shown that their initial optimism tends to fade over time as they experience challenges in a new country, affecting mental and physical health.

CAMH’s Dr. Branka Agic is a researcher on three of the first studies on the health of Syrian refugees in Canada. For the past year, she’s been tracking immediate health needs to help local decision-makers plan appropriate health services. Now, she’s extending this research to understand how needs change in the crucial period between the first and second year after arrival.

As Manager of CAMH’s Health Equity Office, Dr. Agic draws on her own experience in her work on refugee and immigrant health. Trained as a medical doctor in her native Sarajevo, she fled her home during the Bosnian War and came to Canada in 1994, completing a PhD in Public Health at the University of Toronto. Her CAMH role involves research and education, and she is a project lead on CAMH’s Refugee Mental Health Project, an evidence-based online course for health-care, settlement and social services providers.

Dr. Branka Agic and Anna Oda
From left: Dr. Branka Agic and Anna Oda from CAMH’s Health Equity Office

A unique opportunity

“In general, we know very little about the health services use and needs of newly arrived refugees in Canada,” says Dr. Agic. “This was a unique opportunity because we had a large cohort coming within a short period of time.”

“The goal is to use our findings to improve services because we expect more Syrian refugees will settle here,” she says. “We’re also learning what needs to change so we can develop a model of health services that can be adapted for different groups of refugees.”

After the honeymoon period

As the first Syrian newcomers enter their second year in Canada, Dr. Agic and her research colleagues at the University of Toronto, the Wellesley Institute and York University are starting to examine how refugees’ mental and physical health needs change a year after arriving. Supported by the federal Social Sciences and Humanities Research Council, the initiative builds on a 2016 study that captured the early health needs of 400 Syrian refugees (see “Learning about immediate needs,” below). The researchers are following up with 200 individuals from the first study.

“In the first six months to one year after arriving in a new country, refugees often experience a honeymoon period – people come full of hope for a better life,” says Dr. Agic. However, outlooks can change over time as the realities of living in a new country set in, and refugees tend to report poorer self-perceived health after two years.

For some refugees, contributing factors may include a change in financial security, as federal income support for refugees ends a year after settlement. “In the long term, the social determinants of health – including access to housing, access to jobs and experiences of racism or other forms of discrimination – are the most important post-migration factors affecting the health of refugees,” says Dr. Agic.

As in the earlier study, the research team is interviewing Syrian refugees about their perceived mental and physical health needs and their use of health services, using quantitative measures. The team is also conducting focus groups to hear about refugees’ experiences in their own words.

In Canada, resettled refugees arrive as government-assisted or privately sponsored refugees or under the Blended Visa Office-Referred (BVOR) Program. Canada’s private sponsorship program is unique in the world. The study is also examining if health needs differ for government-assisted refugees versus private-sponsored refugees, an area for which no research exists.



 Learning about immediate health needs


​Throughout 2016, Dr. Agic was part of a CAMH-led, multicentre study to understand the health needs of Syrian refugees as they began to settle in Canada. The Toronto Central Local Health Integration Network (LHIN) funded the research to help guide planning the city’s health services. From April to September 2016, the research team interviewed 400 Syrian refugees to learn about their mental and physical health needs and their use of health services.

Access to health care services was high – most Syrian refugees had been able to see a doctor or other health care professional in Canada. Still, nearly half reported that they had unmet health needs. “The self-perceived health of Syrian refugees was better than that of Canadians in general,” says Dr. Agic. This finding is consistent with earlier studies of refugees, reflecting a high level of optimism in the initial period after arrival.

The research team has presented its findings to the Toronto Central LHIN and, at the provincial level, to the Ministry of Health and Long-Term Care, the Ministry of Citizenship and Immigration and the Ministry of Children and Youth Services. Community events will also take place in February and March to share the findings.

Headed by Dr. Kwame McKenzie, Director of Health Equity at CAMH, the study involved researchers from CAMH, the Wellesley Institute, the Centre for Refugee Studies at York University, Crossroads Clinic at Women’s College Hospital and St. Michael’s Hospital. The researchers worked closely with COSTI Immigrant Services, the Arab Community Centre of Toronto, the Canadian Centre for Victims of Torture and the Armenian Community Centre to reach refugees, and collected data using Arabic versions of three questionnaires. CAMH Research Analyst Anna Oda conducted all interviews in the Syrian dialect of Arabic, frequently meeting with participants in hotels serving as their temporary residences or in community centres. Research Coordinator Andrew Tuck was also part of the CAMH team.


 A national project


Dr. Branka Agic is also an investigator on a five-year study of Syrian refugees in Ontario, Quebec and British Columbia. Led by York University and supported by the Canadian Institutes of Health Research, the multicentre study will examine the long-term social and health impacts of settling in Canada as a government-assisted refugee versus as a private-sponsored refugee.

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