ApartTogether survey. An interview with Eva Spiritus-Beerden

by Tamara Hegyi, 4th October 2021

The COVID-19 pandemic has had serious impacts on our lives. We have never experienced a phenomenon like this before, so studying its effects is crucial in order to better understand what is happening and what we can do in the future to better help and support those people that were the most affected by it.

However, there is a group that usually gets forgotten about by the studies – migrants and refugees. This is why projects, such as the ApartTogether survey, are extremely important.

ApartTogether

“ApartTogether is a global study to assess the public health social impact of the COVID-19 pandemic on refugees and migrants. It is a collaboration between World Health Organization, across its regional offices, the UN System, and a collaboration of research centres led by Ghent University (Belgium) and the University of Copenhagen (Denmark).
The study – based on a survey that closed on 31st of October – aims to better understand how refugees and migrants experience the impact of COVID-19 and how they deal with any challenges that have arisen.”[1]

The interview

Eva Spiritus-Beerden, who participated in the data analysis of the ApartTogether survey, is a PhD student at Ghent University, Department of Social Work and Social Pedagogy. I sat down with her to discuss the results of the survey.

Why do you think that the preparation of this survey was important?
I think the initiative of this project is truly important and it is remarkable what my colleagues have been able to achieve in such a short time – in a matter of a month they managed to set up a survey that would be distributed worldwide.
I was not involved in the making of the survey, but my colleagues have made it possible that refugees and migrants could voice their concerns by April 2020 already, meaning that not much time was lost. The most important thing about the survey is of course that refugees and migrants are not forgotten or left out of the conversation, which happens way too often. It was crucial to make sure that this group was included in the research since the beginning, because, as we saw in the survey, they were very much influenced by the pandemic.
ApartTogether is an important step in identifying problems that have been created by the pandemic, but also in identifying underlying problems that have existed for years.

What was your impression, were the participants happy to see that someone cared about their experiences with COVID-19?
Overall, I would say that they were happy to see the ApartTogether initiative. The participants were given the opportunity to enter some last thoughts at the end of the survey, some of them explicitly said “Thank you for this survey” and “You’re doing important work. We cannot be forgotten. We exist”.
So I think for them it was nice to see that people were interested and that their experiences were heard in some way.

The survey is dealing with refugees and migrants having various living conditions, some of them have their own houses, some live in asylum centres, refugee camps or on the streets. Which group was the most affected by the COVID-19 pandemic?
It was very clear that those living in more precarious situations have it the most difficult. Respondents living on the streets or in insecure accommodations and, in many cases, also those living in asylum centres and refugee camps were definitely more impacted by the pandemic on almost all aspects of the survey – discrimination, mental health, social impact and daily difficulties.
This result is of course very concerning, as these groups are already greatly disadvantaged in their normal daily lives. Now their situation is even worse and it was very noticeable in the survey results.

Which age group was the most affected by the COVID-19 pandemic? Why was that group the most vulnerable?
It is a bit difficult to say what exactly were the differences regarding age. The mean age of the respondents, overall, was pretty young, it was around 34 or 38; in the group of 75+ we had only 5 people. So we missed a big fraction of the older people, mainly because the survey was online.
We saw that respondents between the age of 25 and 35 had some difficulties in daily living situations. Mainly, I think, because they have just started their jobs and the pandemic has made their situations even more insecure.

Apart from age, what do you think were the limitations of the survey?
I think the biggest limitation was that the survey was done online, because we are reaching a group that has very precarious living conditions and, in most cases, they don’t have access to internet at all times. It is very difficult to reach these people and we saw in the number of participants that the group of people living on the streets was smaller than the group of those living in houses.
We tried to ask for the help of some local enumerators to go to people but since it was COVID this was more difficult.
This was the biggest limitation, but overall we had a really big dataset so it levels up a little bit.

How could migrants and refugees cope with illness? If they suspected to have or had COVID-19, did they seek medical care? If not, what was the reason for not asking for help?
There are a lot of aspects to this questions.
First of all, it is very dependable on which country they are in. For instance, undocumented migrants are not entitled to healthcare or social welfare in every country. Just a handful of countries provide these basic needs for people without documents. The same goes for entitlement to work and/or housing, this is very difficult without the right documents.
On top of that comes the fact that the information regarding COVID-19 and the government-initiated measures in the beginning were chaotic and difficult to understand, even as native speakers. Migrants and refugees that are not proficient in the language of the country they are residing in often miss important information. So, I think, as respect to that, they were very scared to get ill and didn’t really know what to do.
However, we did see that the majority of the respondents would seek medical healthcare in case they suspected symptoms. Only 5% said that they would not, which is a very good thing, in my opinion.
The reasons for not seeking medical healthcare were fear of deportation and the lack of financial needs.

You mentioned that it was quite difficult for migrants and refugees to get information about COVID-19. What happened when they could finally get access to, for instance, health guidelines? Did they have the means and the possibility to implement and follow the preventive measures? I imagine that in refugee camps it was more challenging.
Yes, indeed. We saw that following the measures in refugee camps and asylum centres was difficult, keeping physical distance was the hardest.
But, overall, it was very nice to see that refugees and migrants were very keen on following the measures. Around 70% reported that they wash their hands and cover their nose and mouth all the time. Also 63% of the respondents reported that they keep physical distance at all times.
We found that of all the prescribed measures, avoiding leaving the house and avoiding using public transport were the most difficult for some, 20% of the respondents indicated they were unable to avoid leaving the house and 15% reported they were unable to avoid public transport.
Keeping physical distance was not possible for 5.4% of the respondents.

I think it was a problem in many countries that as the pandemic continued over the months many people decided not the follow the health guidelines (for instance they did not wear a mask). Since the survey was prepared quite early on in the pandemic, do you have any data on if the participants reported this kind of behaviour as well?
For that we have to do more analysis. It was indeed noticeable that the general population after the summer had more of a “I’m not going follow the measures” attitude but we do not see that yet in the first analysis we did.
Our survey ran from April 2020 until November 2020 and in this time only 3.4% reported that they did not want to wear a mask. For handwashing and keeping physical distance, only 1% of the respondents indicated that they did not want to do this.
Of course, this could have changed from November 2020 onwards, but we did feel a real sense of fear within the refugee and migrant population of the coronavirus and to fall ill or have a loved one fall ill.  It could be because they are in a strange country and don’t speak the language, their situation makes it so that they are scared to get sick.

What were the differences across the WHO regions? Which regions had the biggest difficulty in implementing the preventive measures?
The African region reported the most difficulties throughout the survey.
In the African region most of the people reported difficulties with following preventive measures – avoiding the use of public transport was not possible for 30% of the respondents.

Did the respondents report the pandemic having a detrimental effect on their mental health? What kind of mental health problems did they experience?
Yes, the detrimental effect of COVID was noticeable for all respondents. We asked the participants about 11 items concerning mental health and all of them were doing quite bad. 60% of the respondents indicated that their feelings of depression, anxiety and worry was worse since before the pandemic. In addition, between 40 and 50 percent of the respondents indicated a deterioration of their mental health on the other items, such as loneliness, hopelessness, anger and irritation. Regarding the use of drugs and substances, 1 out of 5 people said that their usage increased.
I think mental health has had a really big blow.

What can be the long-term effects if these mental health issues are not treated properly?
To see what the long-term mental health effects will be of this pandemic, more research is necessary. In the general population some long-term effects of the pandemic have already been found, but not enough studies have taken place yet.
For now, we can base our speculations about the mental health repercussions on other crises of the past. We did see in situations, like the Ebola epidemic or HIV, that getting infected or quarantining is very detrimental for mental health also on the long term. For example, even one year after the Ebola-outbreak, increased symptoms of PTSD, depression and anxiety were found in the general population.
Unfortunately, in many (if not all) of these research cases, however, the refugee and migrant population has often been forgotten. Especially when it comes to their mental health. So research on refugee and migrant mental health within the context of this pandemic is therefore very valuable.
The ApartTogether survey was an opportunity for us to gain insight into their mental health and see what we need to do in the long-term.

Do you think that the participants of this survey are likely to ask for psychological support if they need it? Do they even have the means to ask for help?
I think this is going to be a very big problem.
We did not specifically ask the participants whether they would seek psychological help if needed or not, but I do think that the threshold to do so is very high. We know that this is already a problem in the general population, and I do think that, given the difficulty to receive the correct information on where to receive customized care, the cost of customized care and the language barriers, refugees and migrants will not proactively look for help when it comes to their psychological wellbeing.
Also, many of them are living in a state of survival, often neglecting their psychological distress. So I don’t think they will ask for psychological support.
There is a lot of effort needed from policy makers and organisations to reach refugee and migrant groups and give them the help they need, both mental and physical.

What kind of strategies did migrants and refugees use to cope with the effects of the pandemic?
Participants frequently mentioned staying in contact with family and friends, keeping oneself busy, entertaining oneself and seeking information. Lot of people also did some meditating and praying to cope with the pandemic.
As you can see, this really underscores the importance of social connections and the possibilities for finding (reliable) information.

Does the data suggest a worsening in discrimination and xenophobic behaviour towards migrants and refugees as a result of the pandemic? Do you have any information about which people according to their country of birth were the most affected by it?
Overall, most respondents indicated that their experiences with discrimination were the same as before the pandemic. But we did see that there was a difference regarding housing situation, where respondents living on the street or in insecure accommodations were more likely to experience worse discrimination since the pandemic.
We did not do any analysis regarding country of birth. For the preliminary analysis we mainly focused on the WHO regions and in which regions the respondents are living now. Here we did see that respondents currently living in the African region were more likely to say that they experienced more discrimination since the start of the pandemic.

What do you think, what prompted the worsening of discriminative behaviour and attacks towards migrants and refugees?
Well, there are a couple explanations, I think. First, there was a very big spike in discrimination against the Asian community, linked to the virus originating in China.
We also saw that people were scared of those that travelled across countries. So I think that discrimination was worse towards refugees and migrants because they are seen as people “not from here”, people focus on the fact that they must have travelled across countries and with that they place a sort of blame on these groups for bringing diseases into their country of residence.

Due to the pandemic and the consequent school closures all over the world many migrant children struggled to get proper education / continue their education. What do you think will be the short-term and long-term effects of this problem and what can we do to mitigate those effects?
This is a very interesting question. It is not necessarily the focus of the ApartTogether survey, but I think the effects are going to be very interesting and also very bad.
I believe school closures will have unseen detrimental effects on children, especially those that do not live in ideal situations, with harder access to internet and/or computers, but also language barriers can be a problem.
The focus of ApartTogether is not directly on education, but I do think that a lot of research is being done on what these last two years have meant for children. I read some research papers that said that the learning problems children had before the pandemic got even worse. So the gap between the children that can follow the lessons at a regular pace and those children that cannot is getting bigger. I think that’s a very big problem.
To see the long-term effects, we still need to wait because we’ve never seen school closures on this scale, across the world. But I do think that refugee and migrant children, as well as people with learning disabilities are being more affected by it – usually these groups need a bigger support system when it comes to education.
So I believe that in order to mitigate the long term effects, we have to restart the guidance and the support systems as soon as possible. I think a close individual follow-up is necessary. But, of course, I know that that is easier said than done and also dependent upon money available.

Now that you mentioned support systems, do you think that, based on the data of the survey, migrants and refugees received the necessary help and support from governments, local authorities, NGOs, etc. to lessen the negative impacts of the pandemic or were they left alone?
I think it depends on the country, but also on what kind of help is needed. There have been reports that NGOs were shut down in the beginning and people were left to their own devices. But on the other hand, there have been evolutions since the pandemic and some very remarkable things have happened. Suddenly, organizations were working together, there was more communication between organisations and things were better organised. For instance, I think in Spain, undocumented migrants received more rights than they had before. So suddenly due to the pandemic a lot more things were possible that had not been before.
I think in some cases we went in the good direction but the very beginning of the pandemic, when everything just shut down, was very detrimental to the psychosocial health of refugees and migrants.

In your opinion, is there a correlation between the COVID-19 situation and migration? Do more people decide to leave their country of birth as the COVID-19 situation gets worse in their country?
I think it’s still too early to predict this, since many borders are still closed and among many people there’s still a fear of traveling, so I don’t expect a shift in migration linked to COVID any time soon.
But even if people will start moving, I’m not sure if it will have to do anything with medical care. Mainly because, for instance, in Belgium medical care exists for undocumented migrants, but to get to the point where they get the help they need is still a very big effort. So I don’t know if medical care is a big enough force to make people want to come here.

We already touched upon this a little bit but, in your opinion, why is psychosocial support important and needed in times like this pandemic?
People focus mainly on public health – “do they have symptoms”, “can they go to a doctor”, “will they get the help they need” – but there’s a lot more that comes with this pandemic.
People are really struggling. Sitting at home, alone with your thoughts is very often not a good idea, but this coupled with money problems, social lives being on hold, and the uncertainty of the future is especially detrimental and all of this has an effect on our mental health.
In situations like this what has shown to be helpful in the past is the social network. So when our social network is also getting affected as well, I think, the whole system collapses and needs to be rebuilt and restructured.
Now that the world is getting a bit more open, social life is getting picked up and you can, for instance, work with colleagues again, it helps. Just a little piece of the puzzle is getting back to its place and it already helps. So I think that focusing on the little aspects of the psychosocial needs is very important and we should keep the focus on that.

Do you think further research is needed or are you planning on carrying out further research regarding the effects of COVID-19 on migrants and refugees?
Yes, I very much think so. The ApartTogether survey has given us so much very valuable data across the world with which we can do many analyses other than the now preliminary analysis for the first report.
There’s so much that’s possible and needed as well for further research.
This pandemic was such a new thing and how people looked at it and how governments reacted to it have changed over the years and months, so I think it would be very interesting to see what the differences are between the beginning of the pandemic, the time when the survey was taken, and now.
I think it’s valuable for future research to look at different cases and countries, considering the specific governmental measures during the past two years. In addition, I think more research is necessary to be able to look at the long-term effects of this pandemic.
Moreover, this pandemic has shown and highlighted problems that were already there before the pandemic but only now came to the forefront. The troubles these people – migrants and refugees – have to go through were always there but we see them better now. That’s why I think it’s very important to keep on doing this research because we can change things for the better.
I am convinced that there’s a lot to learn from this period.

You can find the ApartTogether report here: https://apps.who.int/iris/bitstream/handle/10665/337931/9789240017924-eng.pdf?sequence=1&isAllowed=y

Since the ApartTogether report Eva wrote an article based on the data collected for the survey.
At the end of last year, we did the preliminary analysis of the ApartTogether survey, it was very descriptive, just to see what data we have. Then this year I wrote an article on the mental health impacts with regards to discrimination and daily difficulties, to see what happens with mental health when people are experiencing more difficulties in daily life, such as difficulties in access to work or healthcare, food and clothing and also having to face discrimination.
I saw the same things I mentioned before but now it is also very statistically backed up. Respondents in more precarious situations do perceive more discrimination, have more difficult living conditions and also have the worst mental health.

You can find Eva’s article here: https://www.mdpi.com/1660-4601/18/12/6354

The interview took place on the 9th of September.

[1] https://www.aparttogetherstudy.org/