Syrian refugees adjusting to U.S. bring complex health needs

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    President Obama has pledged to accept 10,000 Syrian refugees by October, despite resistance playing out in many communities.

    Refugees, many of them rootless for years, often arrive with significant medical problems and psychological trauma.

    Special correspondent Sarah Varney brings us this report about how one city — Buffalo, New York — is adapting. Her story was produced in collaboration with our partner Kaiser Health News.

  • SARAH VARNEY, Kaiser Health News:

    Since Murhaf, Ghenwa, and their children moved here from Syria, even mundane tasks like cooking and homework have become more complicated.

  • MAN:

    They have 10 airplanes.


    Unaccustomed to this new life, the family relies on help from Hassan Alishaqi, from a local resettlement agency called Journey's End.

    Refugee agencies help families like this one find housing and jobs, get medical care and health insurance and enroll in English classes and schools.

    They fled Syria after civil war erupted there in 2011, unleashing an exodus of more than four million refugees. The destruction and violence came close to Murhaf's family during one of their last nights in the city of Homs.

  • MURHAF, Syrian Refugee (through translator):

    Some bullets came to my house through the window. And I was afraid for the safety of my kids. They never sleep because of — it's just very hard for them to sleep.


    After a year in Cairo and exhaustive security checks, the family arrived in Buffalo, a quiet city on the edge of Lake Erie. And like many new arrivals here, they're struggling with the aftermath of their horrific journey as they attempt to build healthier lives in their new home.

    More than 90 percent of the refugees who resettle to New York live in upstate New York. The city of Buffalo has become a welcoming haven for many of them. But over the last 15 years, the countries and conflicts they come from have changed. And the health care needs of refugees are changing, too.

    Jericho Road is a community health center in Buffalo that has long treated refugees from some of the world's poorest countries, including Myanmar, Bhutan, Sudan and Somalia. The clinic is a crossroads of languages and customs.

    New refugees receive free medical assistance from the federal government for eight months. Then they can buy private insurance or enroll in Medicaid.

  • DR. MYRON GLICK, Jericho Road Community Health Center:

    When you came, we found that your T.B. test was positive. So I think you are now taking medicine for that, right?


    The clinic's founder, Dr. Myron Glick, often treats refugees for tuberculosis, malaria and childhood malnutrition. But he says the more recent arrivals from Iraq and Syria, which are middle-income countries, typically don't suffer from diseases of poverty, but instead have been traumatized by war.

    A critical report by local leaders that examined the area's safety net found that health care providers urgently needed to improve culturally appropriate mental health services. And more clinics needed to follow Jericho Road's model of hiring refugees who can help new arrivals adjust.

    Kowsar Ali, a Somali and Arabic interpreter, says just figuring out how to explain a patient's symptoms and a doctor's diagnosis is a puzzle — words and phrases with no English equivalent, medical terms like PTSD and depression that are unfamiliar.

  • KOWSAR ALI, Jericho Road Community Health Center:

    It's actually hard for them because there's nothing as depression. They say, "OK, because that never existed in my country. There's nothing as depression."


    Dr. Glick says the initial relief refugees feel when they reach safety often gives way to a new reality.


    All the horrible things that happen to people along their journey to America, and yet really they come with hope. And a year, two years in, you see that hope dissipate. It's really challenging here in America to deal with the stresses that are thrust upon them without the support of their home community.


    That sense of isolation is easing for some. Ali Kadhum arrived in Buffalo in 2008, just as the fledgling Iraqi community was taking root. Back then, Kadhum says there were just 25 families.

  • ALI KADHUM, Lake Shore Behavioral Health:

    Now it's almost 750 Iraqi families.


    Today, he says Iraqis bump into each other around town.


    They feel they are not alone. They feel they are still living in Iraq, because people … there's restaurants, cook their food here. There is some people speak their language, at least, and they can communicate.


    So many refugees have moved here that the population of Erie County, home to Buffalo, is growing for the first time since the 1960s. And they are reshaping a city that has struggled to find its way in the modern economy. Old factories now house English language classes.

    At a small business incubator, women sell Iraqi macrame and Rwandan scarves. And vendors claim to sell the best dim sum in Buffalo. Refugee children pursue music in a program called Buffalo String Works, and are mentored by professional musicians.

    Health systems here are adapting, too. A Catholic church, once filled with Italian and Irish congregants, recently reopened as a health clinic for new immigrants. And with so many arrivals from active war zones, the University at Buffalo tapped Dr. Kim Griswold to help lead the Western New York Center for Survivors of Torture.

    DR. KIM GRISWOLD, University at Buffalo: Some of the folks that we have seen have been horribly tortured physically, with scars to prove it. Amputations, other things that we have seen that are horrific … cigarette burns, whipping.


    Kareem Khaleefah, who worked for the U.S. Army in Baghdad, was kidnapped by a Shia militia, lined up with 20 other men and shot.

  • KAREEM KHALEEFAH, Client, Hope Refugee Drop-In Center (through translator):

    I was like super lucky that the bullets come on the side of my body.


    He fell to the ground and pretended to be dead until nightfall.

    Even in Buffalo's quiet neighborhoods, those memories never fade, says Kadhum, a mental health counselor at Lake Shore Behavioral Health. He says many older Iraqis, like Saja Alnaqeeb and her husband, Mahmoud, once lived prosperous, vibrant lives. Then, in 2005, Saja was tortured and the family fled. Now she stays inside, tormented by her memories.

  • SAJA ALNAQEEB, Iraqi Refugee (through translator):

    My family, sometimes, they wake up, they find me screaming at night with these nightmares.


    The images she sees on the news are a constant reminder of the continuing violence in Iraq. She worries about her children and grandchildren still in Baghdad.

  • SAJA ALNAQEEB, (through translator):

    My mind is about them. Every time they mention to me they are unsafe, they are getting threatened, they move their place from place to place just to make sure that they are — protect their kids and family.


    The recent spate of violent attacks worldwide have fueled anti-immigrant and anti-refugee sentiment. But experts on human migration say these events are rare, and, in fact, it's refugees who often face discrimination and violence.

    Neil Boothby is a professor at Columbia University.

  • NEIL BOOTHBY, Columbia University:

    There's going to be language issues. There's going to be cultural issues. What happens if a girl wants to wear a scarf over her head? How is the community going to respond to that? What if people need to spend a lot of time in the mosques? How are we going to respond to that? So it's going to be an adjustment, I think, for each side.


    In Buffalo, the focus now is to enroll more people in mental health counseling. At a Lake Shore clinic, patients, like Kurd Bllnd struggle to reconcile religion, sectarian and ethnic violence that has persisted for decades.

  • KURD BLLND, Patient, Lake Shore Behavioral Health (through translator):

    What happened to the Kurdish in Iraq, of course you're going to be upset and angry and anxious.


    Bllnd, who grew up in a Kurdish village in Iraq, was jailed and interrogated for three years in the 1980s.

  • KURD BLLND (through translator):

    Since the age of 12 years until now — I'm 67 years of age — I didn't see anything good in life.


    Two years after he arrived in Buffalo, Bllnd reluctantly agreed to seek help.


    They told me, if you go there, somebody talk to you. Maybe you forget past, what happened to you.

  • JESSICA MARMION, Lake Shore Behavioral Health:

    The key stressor, I think, is isolation. So, they come here, they don't speak the language, they really only know their immediate family.


    Jessica Marmion is a clinical social worker who teams up with interpreter Afaf Pickering.

  • AFAF PICKERING, Lake Shore Behavioral Health:

    We have like all kinds of people coming. We have lawyers. We have businesspeople. We have — you need sometimes to talk about your problems, especially coming from a country of war. You went through trauma. You went through death. You went through some violence. So, we're not superhuman.


    As new refugees arrive each day in Buffalo, known as the City of Good Neighbors, health care leaders say they will continue to listen, to reach out, and help refugee families find new opportunities in a changing American city.

    For the "PBS NewsHour" and Kaiser Health News, I'm Sarah Varney in Buffalo.

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