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Learning Outcome 1: Competency Standard 1.2

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Learning Outcome 1: Competency Standard 1.2

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For me, the most essential aspect of competency standard 1.2 is the need to acknowledge the traumatic backgrounds of refugees, including experiences of displacement, war, or poverty. Having developed my understanding of the Culturally Responsive Clinical Practice Framework (2019), I feel more knowledgeable in understanding why a refugee's experiences may cause a deep-rooted mistrust of the health care system. Because I have not yet been on placement, the thought of working with someone as vulnerable as a refugee makes me nervous. However, having analysed the framework, I have learnt that I need to be culturally responsive by avoiding assumptions, asking respectful questions and clarifying information. Similarly, I need to be able to recognise that antisocial behaviours may be linked to anxiety or trauma responses. As a student nurse, this framework benefits me as it has changed my perspective and will guide me in delivering positive health outcomes to my patients.

References

Migrant and Refugee Women’s Health Partnership. (2019). Culturally Responsive Clinical Practice: Working with People from Migrant and Refugee Backgrounds COMPETENCY STANDARDS FRAMEWORK FOR CLINICIANS. https://culturaldiversityhealth.org.au/wp-content/uploads/2019/02/Culturally-responsive-clinical-practice-Working-with-people-from-migrant-and-refugee-backgrounds-Jan2019.pdf

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Learning Outcome 2: Social Inclusion and Non-Discrimination 

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Learning Outcome 2: Social Inclusion and Non-Discrimination 

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Social inclusion and non-discrimination are key social determinants of health outlined by the World Health Organisation (WHO, 2025), particularly relevant to Iraqi refugees when addressing health inequities. Language barriers, lack of Western education, and religious discrimination all contribute massively to social exclusion and discrimination. Zajda (2008) found that Iraqi refugees were often reluctant to engage with the education system due to trauma and language barriers, which limit the development of health literacy skills. Another study conducted by Coates (2005) found that the wearing of traditional Muslim clothing, like the Hijab, led to targeted racism and sexism, increasing Iraqi women’s levels of depression, anxiety and distress. In a 2017 study, from the Iraqi refugees surveyed, 46.4% reported experiencing discrimination, which had a direct link with poorer mental health (Abir 2017). The AIHW (2025) states that mental disorders are associated with poorer health; therefore, the importance of addressing social exclusion and discrimination in Iraqi refugees is essential to their physical and mental wellbeing.

References

Dhalimi, A., Wright, A. M., Yamin, J., Jamil, H., & Arnetz, B. B. (2018). Perception of discrimination in employment and health in refugees and immigrants. Stigma and Health, ₃(4), 325–329. https://doi.org/10.1037/sah0000068

Ilaj, M. (2014). What are the obstacles to the integration of Iraqi Muslim Shiite refugees in Sydney, Australia? https://researchers-admin.westernsydney.edu.au/ws/portalfiles/portal/94891368/uws_29757.pdf

Physical Health Of People With Mental Illness. (2025, May 20). Australian Institute of Health and Welfare. https://www.aihw.gov.au/reports/physical-health-of-people-with-mental-illness

WHO. (2025). Social determinants of health. World Health Organization. https://www.who.int/health-topics/social-determinants-of-health#tab=tab_1

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Both urban and rural Iraq rely on the use of herbal medicines, made from over 363 different medicinal plant species, to cure a wide range of illnesses (Nedhal, 2014). For acute issues, such as tonsillitis or the common cold, herbs such as cinnamon and black pepper are often used. For chronic conditions, like cardiovascular disease, catnip and hibiscus are used (Alabbody, 2022). In Northern Iraq, in 1960, the first evidence was discovered of herbal remedies being used, dating back 60,000 years to the Mesopotamian era (Bashar, 2005). For this reason, although traditional medicine is readily available in Iraq, many people choose to embrace medicinal remedies as their main form of primary healthcare (Nedhal, 2014). However, the market for these medicines is mostly unregulated, which leads to no concerns about the quality and safety of the products, which may pose health risks (Nedhal, 2014). To combat this, however, a standardised reporting system was created by the Iraqi Pharmacovigilance Centre to allow people to report adverse effects associated with different herbal remedies (Younus, 2022).

References

Alabbody, H. H. K. (2022). Herbal Medicine in Iraq Advantage and Disadvantage: A Scientific Review. NeuroQuantology, ₂₀(4), 46–51. https://doi.org/10.14704/nq.2022.20.4.NQ22093

Al -Douri, N. (2014). SOME IMPORTANT MEDICINAL PLANTS IN IRAQ. ASJ International Journal of Advances in Herbal and Alternative Medicine (IJAHAM), ₂(1), 10–20. https://www.academiascholarlyjournal.org/ijaham/publications/aug14/Nedhal_A_Al_Douri.pdf

Saad, B., Azaizeh, H., & Said, O. (2005). Tradition and Perspectives of Arab Herbal Medicine: A Review. Evidence-Based Complementary and Alternative Medicine, ₂(4), 475–479. https://doi.org/10.1093/ecam/neh133

Younus, M. M., Ibrahim, I. R., & Barnes, J. (2022). Pharmacovigilance for Herbal Medicines in Iraq. In Pharmacovigilance for Herbal and Traditional Medicines (pp. 385–394). Springer International Publishing. https://doi.org/10.1007/978-3-031-07275-8_25

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Taiz herbal medicine (MEE&Nasser al-Sakkaf)

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Learning Outcome 4: PTSD in Iraqi Refugees

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Learning Outcome 4: PTSD in Iraqi Refugees

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According to the Australian Refugee Health Practice Guide (2025), mental health disorders, such as post-traumatic stress disorder (PTSD), are prevalent among refugees due to trauma and the disruption of resettlement. For many Iraqi refugees, PTSD is a prevalent mental disorder due to exposure to war and violence. PTSD is a chronic condition caused by exposure to an individual or a series of traumatic events, and has severe symptoms, such as depression, flashbacks and memory problems (American Psychiatric Association, 2025). A 2013 study found that 37.2% of Iraqi refugees living in Western countries had developed PTSD (Shameran, 2015). Another study found that Iraqi refugees in Australia had poor overall health and struggled to access services due to low health literacy (Tomasi, 2022). An evidence-based way to treat PTSD is to screen Iraqi refugees using tools such as the Harvard Trauma Questionnaire (HTQ) to assess PTSD levels (NIH, 2015). This allows for appropriate referrals to trauma-informed specialists trained in treatments such as TF-CBT (Mehdi, 2022).

References

Arnetz, B. B., Broadbridge, C. L., Jamil, H., Lumley, M. A., Pole, N., Barkho, E., Fakhouri, M., Talia, Y. R., & Arnetz, J. E. (2014). Specific Trauma Subtypes Improve the Predictive Validity of the Harvard Trauma Questionnaire in Iraqi Refugees. Journal of Immigrant and Minority Health, ₁₆(6), 1055–1061. https://doi.org/10.1007/s10903-014-9995-9

Slewa-Younan, S., Uribe Guajardo, M. G., Heriseanu, A., & Hasan, T. (2014). Systematic Review of Post-traumatic Stress Disorder and Depression Amongst Iraqi Refugees Located in Western Countries. Journal of Immigrant and Minority Health, ₁₇(4), 1231–1239. https://doi.org/10.1007/s10903-014-0046-3

Taylor-Desir, M. (2025, March). What is posttraumatic stress disorder (PTSD)? American Psychiatric Association; American Psychiatric Association. https://www.psychiatry.org/patients-families/ptsd/what-is-ptsd

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Tomasi, A.-M., Slewa-Younan, S., Narchal, R., & Rioseco, P. (2022). Professional Mental Health Help-Seeking Amongst Afghan and Iraqi Refugees in Australia: Understanding Predictors Five Years Post Resettlement. International Journal of Environmental Research and Public Health, ₁₉(3), 1896. https://doi.org/10.3390/ijerph19031896

Zemestani, M., Faiq Mohammed, A., Ali Ismael, A., & Vujanovic, A. A. (2022). A Pilot Randomized Clinical Trial of a Novel, Culturally Adapted, Trauma-Focused Cognitive-Behavioral Intervention for War-Related PTSD in Iraqi Women. Behavior Therapy, ₅₃(4). https://doi.org/10.1016/j.beth.2022.01.009