Office of the Refugee Health Coordinator of Arizona, Arizona Department of Health Services. (n.d.). Community profile. https://www.azrefugeehealth.org

Afghan refugees, predominantly Muslim, follow Islamic practices and avoid pork and alcohol. Medications containing gelatin or pork-based ingredients should be substituted with halal alternatives. The term "Afghan" is preferred over "Afghani." Most Afghans speak Dari or Pashto. For gender-sensitive care, female patients often prefer same-gender clinicians and may avoid eye contact or handshakes with males due to modesty (American College of Emergency Physicians, 2021). We should seek permission before physical contact and ensure minimal exposure during examinations. Respect for elders and use of the right hand for interactions are important cultural norms.

American College of Emergency Physicians. (2021, September 8). Preparing to care for Afghan refugees. Retrieved from https://www.acep.org/home-page-redirects/latest-news/preparing-to-care-for-afghan-refugees

Afghan culture is rich with traditions that are crucial for culturally safe nursing care. Traditional dress like the shalwar kameez and cultural dances such as the Attan symbolize community values and identity. Understanding Dari and Pashto can facilitate better communication with Afghan patients. Islam influences daily routines and healthcare practices, so sensitivity to religious observances is important. Afghan cuisine, including kabuli pulao, highlights communal meals and hospitality. Refugees might face challenges adjusting to new cultural norms, such as differing family dynamics in host countries. Awareness and respect for these cultural aspects help in providing compassionate and effective care (Core Resource Exchange, 2021).

Core Resource Exchange. (2021). Delivery of Cultural Orientation. https://www.coresourceexchange.org/wp-content/uploads/2021/12/Afghan-Backgrounder_Dec.-2021.pdf

Migrant and Refugee Women’s Health Partnership. (2019, January). 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

Social inclusion and non-discrimination are vital WHO social determinants of health affecting Afghan refugees in Australia. Social inclusion enhances refugees' integration into society, improving their access to healthcare, reducing isolation, and supporting better mental health (Refugee Council of Australia, 2022). Conversely, non-discrimination ensures equitable access to services, which is crucial for preventing health disparities and mitigating stress (Staff, 2021). Discriminatory practices can hinder Afghan refugees' ability to access quality healthcare, leading to poorer health outcomes (Rezaei et al., 2021). By promoting inclusivity and addressing discrimination, we can improve health outcomes and support the effective integration of Afghan refugees.

‌Refugee Council of Australia. (2022, December 13). Refugee Response Index (RRI) Australia Review - Pillar 4: Refugees become self-reliant. https://www.refugeecouncil.org.au/rri-refugees-become-self-reliant/

‌‌Rezaei, O., Adibi, H., & Banham, V. (2021). Integration Experiences of Former Afghan Refugees in Australia: What Challenges Still Remain after Becoming Citizens? International Journal of Environmental Research and Public Health, 18(19), 10559. https://doi.org/10.3390/ijerph181910559

Staff, A. (2021, December 13). Afghan refugees face discrimination, employment and social challenges in Australia. ANMJ. https://anmj.org.au/afghan-refugees-face-discrimination-employment-and-social-challenges-in-australia/

Post-Traumatic Stress Disorder (PTSD) and other mental health issues are prominent among Afghan refugees resettling in Australia. The severe trauma experienced during prolonged conflict in Afghanistan often leads to symptoms such as intrusive memories, severe anxiety, and emotional numbness (Australian Institute of Health and Welfare, 2023). Stressors in the host country, including language barriers, social isolation, and fear of asylum application rejection, further exacerbate these issues (Li et al., 2016).

Context from Afghanistan: The ongoing conflict in Afghanistan has resulted in widespread trauma, significantly impacting the mental health of refugees. Research indicates that PTSD, depression, and anxiety are prevalent among these populations, with symptoms persisting even after resettlement (Turrini et al., 2017; Alemi et al., 2014). Post-migration stressors often continue to affect mental health, sometimes exacerbating the impact of pre-migration trauma (Porter & Haslam, 2005; Schweitzer et al., 2011).

Andisha, P., & Lueger-Schuster, B. (2023). Afghan Refugee Populations’ Mental Health: Exploring Pre-migration Environmental Differences and Post-migration Stressors. Journal of Loss & Trauma, 1–28. https://doi.org/10.1080/15325024.2023.2262929

Health of refugees and humanitarian entrants in Australia, Mental health. (2023, November 3). Australian Institute of Health and Welfare. https://www.aihw.gov.au/reports/cald-australians/health-of-refugees-and-humanitarian-entrants/contents/case-study-humanitarian-entrants-born-in-afghanist/mental-health

Trauma-Focused Cognitive Behavioral Therapy (TF-CBT) is an effective, evidence-based treatment for PTSD. It involves several key components:

1. Assessment and Engagement: Initial sessions focus on understanding the individual’s trauma history and building trust.

2. Psychoeducation: Educates patients about PTSD and the benefits of TF-CBT, helping to normalize their symptoms and reduce stigma (Australian Refugee Health Practice Guide, n.d.).

3. Cognitive Restructuring: Targets and challenges negative thoughts related to trauma.

4. Exposure Therapy: Gradual exposure to trauma-related memories helps process and confront these experiences.

5. Skills Training: Teaches coping strategies and relaxation techniques to manage symptoms effectively.

Recent updates to the diagnostic framework, such as the introduction of Complex PTSD (CPTSD) in ICD-11, provide a more nuanced understanding of trauma-related disorders and may enhance the effectiveness of interventions like TF-CBT (Andisha & Lueger-Schuster, 2023). Research supports TF-CBT’s efficacy in reducing PTSD symptoms and improving mental health outcomes (Australian Institute of Health and Welfare, 2023; Smati et al., 2024).

Andisha, P., & Lueger-Schuster, B. (2023). Afghan Refugee Populations’ Mental Health: Exploring Pre-migration Environmental Differences and Post-migration Stressors. Journal of Loss & Trauma, 1–28. https://doi.org/10.1080/15325024.2023.2262929

Health of refugees and humanitarian entrants in Australia, Mental health. (2023, November 3). Australian Institute of Health and Welfare. https://www.aihw.gov.au/reports/cald-australians/health-of-refugees-and-humanitarian-entrants/contents/case-study-humanitarian-entrants-born-in-afghanist/mental-health

Mental Health» Australian Refugee Health. (n.d.). https://refugeehealthguide.org.au/mental-health/

Smati, H., Hassan, N., Mohammad Yasir Essar, Fawzia Abdaly, Noori, S., Grewal, R., Norrie, E., Talavlikar, R., Bietz, J., Kimball, S. L., Coakley, C., Chatterjee, A., & Fabreau, G. E. (2024). Health status and care utilization among Afghan refugees newly resettled in Calgary, Canada between 2011-2020. MedRxiv (Cold Spring Harbor Laboratory). https://doi.org/10.1101/2024.06.21.24309182