Submission from the Forum of Australian Services for Survivors of Torture and Trauma to the proposals of the Australian Government to strengthen the requirements to become an Australian citizen

Introduction

The Forum of Australian Services for Survivors of Torture and Trauma (FASSTT) welcomes the opportunity to provide this submission in response to the proposals of the Australian Government to strengthen the requirements to become an Australian citizen. Given the nature of our work, outlined below, the submission focuses on the implications of the Government’s proposals for people of refugee backgrounds settled in Australia.

FASSTT is the national representative body of Australia’s torture and trauma rehabilitation agencies, providing services for people of refugee backgrounds under the Commonwealth Program of Assistance or Survivors of Torture and Trauma (PASTT). There is an agency in each state and territory.

The pre-arrival experiences of our clients are characterised by exposure to violence and loss, persecution and forced displacement. The impacts are commonly both physical and mental. They may persist long after the causal events. The legacy of such experiences shapes psychological and social functioning at individual, family and community levels.  A detailed overview of the work of FASSTT members to assist clients to recover and rebuild their lives is provided in the Appendix.

Refugees and other humanitarian entrants, and women in particular, often face barriers to settlement such as disrupted formal education in their countries of origin and temporary residence, and limited English proficiency prior to arrival.  For example, a study of a large cohort of recently arrived humanitarian migrants settling in Australia reports that many had never attended school (males 13%; females 20%), did not understand spoken English before arrival (33% males; 44% females) and were illiterate in their own language (17% males; 23% females). [1]

However, over time the great majority of humanitarian entrants and their children have dealt effectively with the challenges and contributed very significantly to Australian society in a number of ways, as documented in the major study by Professor Graeme Hugo.[2]

People of refugee backgrounds value citizenship greatly. Of the more than 15,000 people assisted by FASSTT agencies in 2015/16, nearly two thirds had already become Australian citizens.  They express great pride when they take on Australian citizenship and understand that with the rights conferred by citizenship come responsibilities.

As a formal signifier of acceptance by the nation, citizenship restores dignity and a sense of belonging to people who have been subjected to profound human rights violations and harsh rejection.

On a practical level, the citizenship means that people are able to acquire Australian passports.  Without this privilege, they are frequently unable to travel to reunite with family members who have been dispersed across the globe.

As stated by the Government, “pathways to citizenship give new migrants the opportunity to be full and active participants in Australian society.”[3] It is therefore critical that the pathways are well designed and do not present unnecessary and unreasonable impediments to people who aspire to become full and active participants doing so. For the reasons detailed in this submission, FASSTT considers that the package of measures the Government is proposing will impose unduly difficult barriers to citizenship, in particular for people of refugee backgrounds.

Our concerns relate in particular to:

  • The proposed new English language test – the Government has not provided evidence to that is necessary for citizens to write, speak, read and listen at a proficiency level that is significantly higher than comparable countries and similar to the entry level for tertiary study;
  • The proposal to assess people ‘for any conduct that is inconsistent with Australian values’ – this goes a requirement to behave within the law; rather than reflecting the stated value of valuing diversity, it represents an extremely vague and potentially arbitrary requirement, demanding conformity with unspecified norms of behaviour.

From our extensive contact with many thousands of people over several decades, it is certain that if implemented the proposed measures will deny citizenship to many individuals who are actively  contributing to Australia’s economic, communal and cultural life, and who are fully cognisant and appreciative  of   Australian laws and values. In other words, people who would make an excellent ongoing contribution to the community as Australian citizens. Such a consequence would have significantly adverse impacts on the people affected and their exclusion from full membership of Australian society would undermine rather than promote the goals of integration and social cohesion that pathways to citizenship are intended to serve.

 

Proposed changes to English language testing

The current test

The Australian Citizenship Act 2007 requires applicants for citizenship to “possess a basic knowledge of the English language.” (section 21(2)(e)). Applicants are tested when they sit the citizenship test with certain forms of assistance if required.[4] There is not a separate English language test and it is expected that applicants need a basic knowledge of English to pass the test.[5]

The Government’s Citizenship Policy, published in 2016, “provides guidance on the interpretation of, and the exercise of powers under” the legislation relating to the granting of citizenship. With respect to the testing of English proficiency it states that:

The requirement for citizenship applicants to ‘possess a basic knowledge of the English language’ is understood as having a sufficient knowledge of English to be able to live independently in the wider Australian community.[6]

The proposed changes

The Government proposes to change the level of proficiency and the method of testing. Applicants will be required to “demonstrate competent English language listening, speaking, reading and writing skills before being able to sit the citizenship test.”[7]

The changes therefore involve:

  • A far higher level of proficiency.
  • Separate testing of each of four components of proficiency.
  • Applicants demonstrating English proficiency prior to other elements of testing.

The Minister for Immigration and Border Protection has explained the reason for changing the level of proficiency on these grounds:

There’s a significant change in relation to the English language requirement which at the moment is basic. We increase that to IELTS Level 6 equivalent, so that is at a competent English language proficiency level and I think there would be wide support for that…[8]

Further background to the decision was recently provided by officials of the Department of Immigration and Border Protection (DIBP) to the Senate Legal and Constitutional Affairs Legislation Committee.[9] They indicated that the Government had particular regard to:

  • the findings and advice of the National Consultation on Citizenship led by Senator Fierravanti-Wells and Mr Phillip Ruddock, which reported in 2016; and
  • the language testing approaches of other countries.

As detailed in the following sections, none of these grounds provides a compelling argument for the proposed changes that, if implemented, would create a significant barrier to citizenship for many people.

The National Consultation on Australian Citizenship

The background paper, “Australian citizenship – your right, your responsibility,” inviting community views stated that the Government was considering a number of areas for strengthening the citizenship framework, including:

Standardising English language requirements to ensure new citizens have adequate language ability…[10]

The background paper did not provide an explanation of the current test or explain what “adequate” meant for the purposes of citizenship.[11] The clear implication was that the current test is “inadequate” so it is not surprising that many respondents considered that the standard should be raised.

The Final Report of the National Consultation on Citizenship reported that:

A strong theme of the consultation was the importance of English language testing to being a citizen and full integration in Australian society. There was support for raising the minimum standard of English required to sit the Citizenship Test from ‘basic’ to ‘adequate.’ [12]

Accordingly the authors concluded:

In view of the strong emphasis the community places on English language, the Government should improve the Adult Migration English Program (AMEP) and ensure new citizens have adequate not just basic English language ability, taking into account particular circumstances. (Recommendation 15)

As was the case with the background paper, the report did not provide an explanation of what was meant by “adequate” proficiency and how that should be tested.

The National Consultation on Citizenship therefore does not indicate support for the adoption of ‘IELTS Level 6 equivalent’ as an appropriate requirement for people to become citizens.

It is important to note as well that Senator Fierravanti-Wells’ and Mr Ruddock’s recommendation to raise the proficiency level of English also recommended that the AMEP be improved, clearly to assist aspiring citizens to meet the higher standard.

The AMEP does not prepare students for the formal literacy and vocabulary requirements of what constitutes ‘competent’ English proficiency for IELTS assessment. The financial and organisational implications for AMEP providers to undertake this role would be very significant.  A major evaluation of the AMEP completed in 2015 suggested that AMEP should retain its current curriculum framework and that other subsidised training opportunities should be considered to teach participants beyond the current AMEP benchmark of functional English.[13]

However, the Government’s proposed changing of the test has not been accompanied by a commitment to allocate additional resources to assist people to prepare for the new test. The Commonwealth Budget 2017-18 does not allocate additional funds for people to be assisted to study for the proposed new test.

The language testing approaches of other countries

DIBP advised the Senate Legal and Constitutional Affairs Legislation Committee that the Government had looked at the English language test models of comparable countries such as Canada, the UK, New Zealand and the USA.[14]

Our understanding is that IELTS is a significantly higher benchmark than such countries apply. For example, Canada requires that citizenship applicants have “an adequate knowledge” of one of the official languages of Canada i.e. English or French.[15]  “Adequate knowledge” is defined as having speaking and listening ability assessed at Level 4 of the Canadian Language Benchmarks assessment system. The Canadian government specifies that the acceptable equivalent standard is International English Language Testing System general training, with a score of 4.0 or higher in speaking, and 4.5 or higher in listening.[16]

Is ‘IELTS 6’ an appropriate test for people to become citizens?

A brief scan of information in the public domain about the use of IELTS indicates that an overall score of 6, whether Academic or General, is a requirement for certain professional and tertiary education pathways. For example:

  • Engineers Australia, the ‘designated authority for assessing skills and competencies related to engineering occupations in Australia’, specifies that applicants must have a minimum score of 6.0 in each of the four modules of speaking, listening, reading and writing, and both the General Training and Academic versions of the test are acceptable.[17]
  • Those responsible for IELTS provide guidance for educational institutions, which advises that IELTS band score 6 is ‘probably acceptable’ for ‘linguistically demanding training courses’ and ‘acceptable’ for ‘less linguistically demanding training courses’;[18]
  • RMIT University specifies IELTS (Academic 6) as the minimum English language requirement for international students wishing to study for Associate Degrees;[19]
  • Australian Catholic University specifies IELTS (Academic) overall band score 6 as the minimum requirement for business courses, Arts courses, and Education courses. [20]

These institutions have determined that IELTS is an appropriate assessment method for their purposes and that an overall band score of 6 (with various component scores) is the required level of proficiency for people wanting to work in a particular profession and to study at advanced levels.  The government has not provided any evidence that the same assessment method and level of proficiency is appropriate for the very different task of assessing suitability for citizenship.

Conclusion

The introduction of such a significant change to the test for English language proficiency should be based on robust evidence that it is a necessary and appropriate response to significant failings of the current test. The Government has not provided such evidence.

The imposition of the proposed changes will have a particularly adverse impact on many people of refugee backgrounds who commonly have had limited and disrupted formal education. As summed up by academics Sally Baker and Rachel Burke:

For many adult refugees – who have minimal first language literacy, fragmented educational experiences, and limited opportunities to gain feedback on their written English – ‘competency’ may be prohibitive to gaining citizenship. This is also more likely to impact refugee women, who are less likely to have had formal schooling and more likely to assume caring duties.

The challenges faced in re/settlement contexts, such as pressure of work and financial responsibilities to extended family, often combine to make learning a language difficult, and by extension, prevent refugees from completing the citizenship test.[21]

People of refugee backgrounds are already less likely to pass the current test than people migrating to Australia in the Skill and Family Streams and have to sit the test more often.[22]  The gap is very likely to become much greater.

FASSTT therefore submits that:

  1. the Government should not proceed with the proposal to impose a requirement of IELTS 6 or equivalent for citizenship; and
  2. there should be further consultation including with language experts about the level of proficiency appropriate for citizenship, how this should be tested and what would be required for implementation.

 

The proposed introduction of a “requirement for applicants to demonstrate their integration into the Australian community”

The Australian Citizenship Act requires that applicants aged 18 and over must be of “good character” at the time of the decision on their application. The term is not defined in the Act and has been interpreted very broadly as referring to “the enduring moral qualities of a person.”[23]

The Citizenship Policy guidance for the operation of the legislation provides a list of behaviours that an applicant should demonstrate to show they are of good character e.g. abiding by the law in Australia and other countries; paying their taxes and not being in dishonest receipt of public funds; not being violent, involved in drugs or unlawful sexual activity and not causing harm to others through their conduct; not being associated with others who are involved in anti-social behaviour. The list is “not exhaustive,” the document states.[24]

The Government proposes the introduction of an additional requirement, that applicants must demonstrate evidence of “integration into the Australian community.”[25] The paper Strengthening the test for Australian Citizenship outlines a variety of possible indicators of this requirement, involving both:

  • actions applicants should undertake e.g. work if able to, active involvement in community or voluntary organisations; and
  • actions they do not undertake e.g. committing criminal offences.[26]

Mr Pezullo, Secretary of the Department of Immigration and Border Protection, has advised that this requirement would involve “a positive assessment” using both “objective factors such as…a criminal record as well as the factor of character-like assessment in relation to which you would provide positive evidence,” and that further details would be provided when the legislation to implement the proposal is presented to the parliament.[27]

A number of the actions a person should not do, in particular breaches of criminal law, are clearly the same as the actions that are already considered to be relevant indicators for determining whether a person satisfies the current “good character” requirement. To this extent, the new requirement appears to duplicate the current requirement.

Two aspects suggest that the proposed new requirement is significantly broader.

One is that the Government states that “in addition to existing police checks which are undertaken as part of any application for citizenship, an applicant will be assessed for any conduct that is inconsistent with Australian values….”[28]

The implication is that this encompasses conduct that is not contrary to any law.  How will prospective applicants know what a decision-maker might consider to be conduct that is inconsistent with Australian values, apart from what it proscribed and required by law? In our view, it would be improper to impose such a vague new requirement as a condition of eligibility for citizenship.

The very first Australian value in the current Australian values statement is commitment to the “rule of law.”[29] Central to the rule of law, as the Commonwealth Attorney-General’s Department states, is that “laws are clear, predictable and accessible.”[30] The Government should comply with this principle in drafting the new requirements for citizenship. We are mindful that the current requirement of “good character” is not clear and specific – the uncertainty that creates would be compounded if an additional criterion of “conduct inconsistent with Australian values” was added.

The other aspect indicating the potential breadth and uncertainty of the proposed new requirement is that aspiring citizens demonstrate they are actively involved in community and voluntary organisations. This is contrary to the advice of Senator Fierravanti-Wells and Mr Ruddock who conducted the National Consultation on Citizenship. They concluded:

We welcome public interest in strengthening Australians’ sense of community. We believe, however, that participation in community life should not be forced or directed. (emphasis added) Instead, experience has shown that the most effective approach to foster a richer community life is for the Government to provide support for community-driven events…[31]

In our view, Senator Fierravanti-Wells and Mr Ruddock are correct:  people should be encouraged and assisted to engage because they are genuinely motivated to do so not because they are concerned about qualifying for citizenship. The Government has not explained the reason for rejecting that advice.

However, if “Integration” is included as a criterion for citizenship, the Government should promptly publish guidance on the indicators and the type of evidence that applicants will have to provide to satisfy it e.g. if it is required that a person is actively looking for work, presumably that would be satisfied if the person meets Centrelink’s requirements for the purposes of receiving Newstart? This is important for applicants so that they are aware of what they need to do in order to be eligible for citizenship and important for individuals and agencies who may be requested to provide documentary evidence to support applications.

Conclusion

FASSTT therefore submits that:

  1. the Government should not include a criterion of “conduct inconsistent with Australian values”; and
  2. if “integration” is included as a criterion for citizenship,
    1. the legislation should include specific and clear criteria as to what the term is intended to cover; and
    2. the Government should provide guidance on the indicators and the type of evidence that applicants will have to provide to satisfy it.

 

 

Appendix

 

FASSTT SERVICES AND THEIR CLIENTS

 

What is FASSTT

FASSTT is the national representative body of Australia’s eight, not-for-profit, torture and trauma rehabilitation and support agencies. There is an agency in each state and territory and their contact details are at the end of this document.

FASSTT agencies respond to the needs of survivors of torture and trauma who have come to Australia as refugee or humanitarian entrants.  In the 12 month period 2015– 2016, FASSTT member agencies provided individual and group based therapeutic psychological support to more than 15,000 people who  arrived in Australia under the Refugee and Humanitarian Program from more than 100 countries.  Approximately 40% of these clients were 25 years or younger.

FASSTT agencies assist survivors to recover and rebuild their lives after having been tortured and experienced other traumatic events in countries of origin, while in flight, or during their stay in countries to which they fled. This is achieved by:

  • providing high level specialist trauma clinical counselling and casework services and facilitating referrals into mainstream health and educational services (for example, early intervention programs with children and adolescents to minimise longer term mental health problems and the trans- generational effects of torture and trauma);
  • increasing the capacity of mainstream health, community and educational sectors to be more responsive to the needs of refugees and survivors of torture and trauma;
  • training and consulting with other service providers (e.g. doctors, allied health professionals, community workers, teachers);
  • producing resources for health, community and educational services about working with refugees and survivors of torture and trauma (for example, resource guides for general practitioners and primary health care workers, guides for group work with primary and secondary age children and young people);
  • developing innovative programs for assisting clients and the community (for example, establishing mental and physical health clinics, undertaking group work with clients, conducting research, working in schools); and
  • building the capacity of newly arrived communities to integrate more effectively into Australian society.

FASSTT agencies have been delivering services to survivors of torture and trauma and to other services for more nearly 30 years. They are regarded as expert specialists both nationally and internationally. FASSTT agencies are all not-for-profit organisations and receive funding from the Commonwealth and State and territory governments, philanthropic trusts and private donations. FASSTT agencies are also the principal contractors to the Department of Health to provide services under the Program of Assistance for Survivors of Torture and Trauma. This program provides services to torture and trauma survivors at any time after their arrival in Australia and allows for short term, as well as medium–long term psychosocial interventions.

The unique context of FASSTT

Torture[32] has a specific definition and methods of torture are well documented.[33]  It is estimated that world-wide up to 35% of refugees have been physically or psychologically tortured.[34]  Many refugees have experienced other traumatic events in countries of origin, during flight and in transit countries.  A comprehensive body of research indicates that survivors of torture are a particularly vulnerable group for health disorders of different kinds.[35]  FASSTT member agencies provide a specialist service response to refugee survivors of torture and trauma based on the rationale that it is not only the demonstrated prevalence of mental health concerns associated with the legacy of the refugee experience but also their enduring vulnerability in the course of settlement at an individual family and community level, that requires a specialist response. [36]

The majority of FASSTT clients have physical and mental health problems related directly to torture experiences or other traumatic events associated with their refugee experience.

 

Client profiles and characteristics

Refugee and humanitarian entrants, particularly survivors of torture and trauma, have particular needs and accordingly are appropriately treated as a special needs group within the mental health service context.  These needs arise from the fact that their circumstances are commonly characterised by the following:

  • extreme adverse life circumstances such as experience of war, persecution, torture, displacement and prolonged periods in refugee camps or countries of asylum prior to resettlement
  • multiple losses of significant others
  • limited or disrupted schooling
  • family dislocation
  • limited health care before arrival in Australia
  • stressful nature of settlement demands
  • limited employment opportunities for new arrivals
  • limited social support and networks because of the small size of refugee communities and fragmentation within those communities
  • cultural and language barriers to accessing mainstream health services and lack of culturally responsive service provision in the mainstream services and
  • for asylum seekers and people on temporary protection visas, uncertainty about their future status and ability to remain in Australia.

 

There is now a large body of evidence demonstrating that people who are exposed to horrific life threatening events typically may experience psychological symptoms that persist long after the event has taken place[37].  The experience of survivors of refugee related trauma is further complicated by the fact that they are unlikely to have experienced one single traumatic event, but rather will have been exposed to a prolonged experience of political and civil repression, armed conflict and dislocation.  Such experiences and the symptoms they can cause can be a significant barrier to the settlement and community participation of survivors of refugee-related trauma.

In addition to recovering from these traumatising experiences, on arrival in Australia these clients face the stress of establishing themselves in a new country (e.g. securing housing and employment, learning a new language) and of making the transition to a new culture, society and school system.

 

FASSTT Member Agencies

 

ASeTTS: Association of Services to Torture and Trauma Survivors

Address: 286 Beaufort St,

Perth, WA 6000

Telephone: 08 9325 6272

 

Companion House

Address: 41 Templeton Street, Cook, ACT 2614

Telephone: 02 6251 4550

 

Melaleuca Refugee Centre: Torture and Trauma Survivors Service of the Northern Territory

Address: 24 McLachlan Street, Darwin NT 0800

Telephone: 08 8985 3311

 

Phoenix Centre

Address: Level 2
1a Anfield Street
Glenorchy Tas 7010

Telephone: 03 6234 9138

 

QPASTT: Queensland Program of Assistance to Survivors of Torture and Trauma

Address: 28 Dibley, Street, Woolloongabba, QLD 4102

Telephone: 07 3391 6677

 

STARTTS: Service for the Treatment and Rehabilitation of Torture and Trauma Survivors

Address: 152 The Horsley Drive, Carramar, NSW 2163

Telephone: 02 9794 1900

 

STTARS: Survivors of Torture and Trauma Assistance and Rehabilitation Service

Address: 81 Angas Street, Adelaide, SA 5000

Telephone: 08 8346 5433

 

VFST: Victorian Foundation for Survivors of Torture

Address: 6 Gardiner St, Brunswick, VIC 3056

Telephone: 03 9388 0022

 

Correspondence to:

FASSTT: P.O. 6254, Fairfield, Brisbane 4103

[1] “Building a New Life in Australia” is a longitudinal study of a large cohort of recently arrived humanitarian migrants settling in Australia.

https://www.dss.gov.au/sites/default/files/documents/09_2015/data-highlight-no-2-2015-bnla_pdf.pdf

[2] Economic, social and civic contributions of first and second generation humanitarian entrants, https://www.border.gov.au/ReportsandPublications/Documents/research/economic-social-civic-contributions-about-the-research2011.pdf

[3] Australian Government, (2017) “Strengthening the test for Australian Citizenship”, page 5.

[4] For example, DIBP staff may assist someone with poor computer or literacy skills by reading out aloud to them the test questions and possible answers.

[5] https://www.border.gov.au/Trav/Citi/pathways-processes/Citizenship-test/About-the-citizenship-test, viewed 31 May 2017.

[6] Page 69.

[7] Page 6.

[8] https://malcolmturnbull.com.au/media/press-conference-with-the minister-for-immigration-and-border-protection. 20 April 2017. There are two distinct IELTS tests, ‘Academic’ and ‘General Training.’ The Minister did not indicate whether one or both of these will be acceptable.

[9] Hansard, 23 May 2017.

[10] Department of Immigration and Border Protection, Australian citizenship – Your right, your responsibility. Emphasis added.

[11] We are advised that this is not a validated language proficiency term.

[12] Senator Fierravanti-Wells and Philip Ruddock MP, Australian Citizenship – Your right, your responsibility, page 18.

[13] Acil Allen Consulting 2015, ‘AMEP Evaluation’, for the Department of Education and Training, Melbourne., pages X1-XII

[14] Op cit, Pages 8-9.

[15] http://www.cic.gc.ca/english/helpcentre/answer.asp?qnum=569&top=5, viewed 30 May 2017.

[16] http://www.cic.gc.ca/english/information/applications/guides/CIT0002ETOC.asp#CIT0002E4, viewed 30 May 2015.

[17] https://www.engineersaustralia.org.au/For-Migrants/Migration-Frequently-Asked-Questions, viewed 25 May 2017.

[18] https://www.ielts.org/ielts-for-organisations/setting-ielts-entry-scores, viewed 25 May 2017. Presumably this is for the Academic IELTS test, which is not specified.

[19] RMIT University, “English language proficiency tests for international students” viewed 25 May 2017.

[20] Admission to Coursework Programs Policy – Handbook – Australian Catholic University, viewed 25 May 2017.

[21] Sally Baker, Rachel Burke, “English language bar for citizenship likely to further disadvantage refugees” The Conversation, 25 April, 2017. http://theconversation.com/engliush/language-bar-for-citizenship-likely-to-further-disadvantage-refugees-76520?utm­_medium=email&utm_campaign=Lates

[22] Department of Immigration and Border Protection, “Australian Citizenship Test Snapshot Report,” 30 June 2015.

[23] Full Court judgment in Irving v Minister for Immigration, Local Government and Ethnic Affairs (1996) 68 FCR 422 at 431-432.

[24] Page 147.

[25] We assume it is additional because the Government has not indicated that this will replace the character requirement.

[26] Page 15.

[27] Hansard, Senate Legal and Constitutional Affairs Legislation Committee, 23 May 2017, pages 44-45.

[28] Emphasis added, Page 15.

[29] “Strengthening the test for Australian Citizenship,” Page 16.

[30] https://www.ag.gov.au/About/Pages/Ruleoflaw.aspx  viewed 30 May 2017.

[31] Page 15.

[32] Torture is the intentional infliction of severe mental or physical pain or suffering by or with the consent of the state authorities for a specific purpose. It is often used to punish, to obtain information or a confession, to take revenge on a person or persons or create terror and fear within a population. Some of the most common methods of physical torture include beating, electric shocks, stretching, submersion, suffocation, burns, rape and sexual assault. Psychological forms of torture and ill-treatment, which very often have the most long-lasting consequences for victims, commonly include: isolation, threats, humiliation, mock executions, mock amputations, and witnessing the torture and/or death of others.

[33] IRCT http://www.irct.org/what-is-torture/defining-torture.aspx

[34] R Baker, ‘Psychosocial consequences of tortured refugees seeking asylum and refugee status in Europe’, in M Basaglu (ed), Torture and its consequences: current treatment approaches, Cambridge University Press, Glasgow, 1992, p85.

[35] UNHCR, Refugee resettlement: an international handbook to guide reception and integration, UNHCR and VFST, Melbourne, 2002, p233.

[36] Kaplan, I.,  Stow, H., Szwarc, J., “Responding to the Challenges of Providing Mental Health Services to Refugees”  Journal of Health Care for the Poor and Underserved 27 (2016) pp 1159-1170.

[37] Herman, J., Trauma and Recovery; From Domestic Abuse to Political Terror, Great Britain: Pandora, 1992

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