War trauma rehabilitation is a first step to successful integration

Photo Vesa Koivunen

Some of the roughly one thousand quota refugees coming to Finland  each year need rehabilitation for the physical and mental problems caused by war and being a refugee. Rehabilitation is an interprofessional and multidisciplinary special expertise that is scarce in Finland. Prerequisites for successful rehabilitation are individuality, timeliness and the care, rehabilitation and support available to your own community. In Finland, the biggest challenges are in managing cooperation and the short-term nature of project funding.

Finland is committed to receiving about a thousand quota refugees for 2021. Some of them will need trauma rehabilitation due to the physical and psychological harm they have endured from war, violence and the refugee experience. For them, part of the integration process is getting adequate care and rehabilitation.

“As a result of living in war zones, persecution or dangerous escape, traumas can be physical injuries, but they often also manifest themselves in mood, life management difficulties, insomnia or learning difficulties due to concentration disorders – or a combination of these,” explains project manager Mari Tikkanen.

The Deaconess Foundation’s Centre for Psychotraumatology has run the War Trauma Rehabilitation project for the past three years. This involves a working group of six multi-professional specialists, which has designed needs assessment periods for quota refugees living in different parts of Finland and rehabilitation plans suitable for each person’s situation.

In addition to work with clients, the working group has provided consultations, work guidance and training for professionals who in their work encounter refugees suffering from trauma. The project has been funded for the years 2018-2021 by the EU’s Asylum, Migration and Integration Fund (AMIF).

Equal consultations and individual help

War trauma rehabilitation involves meeting with and listening to clients and their stories as they are, and trying to find ways to make it possible to improve their quality of life. Equitable consultations are held with the aim of finding suitable forms of rehabilitation together with the clients.

“Treating the trauma based problems of refugees requires information, including about the experience of being a refugee, because you don’t find situations typical to them among the majority population. Quota refugees have been placed in different parts of the country, so rehabilitation must also be planned individually according to an individual’s needs and life situation. It is not possible to plan a service for people living in Kainuu that is only available in Helsinki,” says Mari.

Nationwide counselling, work guidance and training are the key to smooth rehabilitation. When a traumatised person transfers to the services of their own municipality, it is important to do the change in an ‘accompanied’ manner.

Under the project, a physiotherapist who specialised in war traumas guides a physiotherapist working in the municipality, and a psychiatric specialist, occupational therapist and service counsellor similarly provides support for their counterparts their in the municipalities.

Multidisciplinary and interprofessional networking does not work without effective leadership and coordination. This is a challenge in Finland, because work is often done on fixed-term projects.

Recommendations for the successful rehabilitation of refugees suffering trauma:

Individuality and timeliness are crucial. One solution does not work for everyone: every traumatised person needs a one-on-one consultation when needed. We cannot predict when.

1. Interprofessional and multidisciplinary collaboration is paramount in the treatment of trauma. A person is a single entity, whose every aspect must be taken into account on the treatment path. Some need more rehabilitation for physical injuries, others for psychological support and still others possibly for help managing with everyday life.
2. Attention to managing and coordinating cooperation. Multidisciplinarity and interprofessionalism that take into account the needs of the individual require optimal management and coordination, and networking cooperation is also mentioned in the state integration programme. Efforts should be made for cross-administrative cooperation.
3. Municipalities must not be left to cope alone. Quota refugees are placed in many different municipalities around Finland, and the traumatised person must receive support close to home. The same applies to those traumatised by the war who come to Finland through the asylum process. Supporting the municipalities’ own professionals, through training, consulting and work supervision, are important.
4. Rehabilitation of war trauma victims is a multidisciplinary specialty that must be secured on a permanent basis. Proactive work and rehabilitation are far cheaper than restorative treatment. Rehabilitation assessment, training and municipal consultation have been dealt with as a project, and so it will end in this form when the project funding ends. Even if funding were provided for the new project, the specialists have already switched to other jobs and so the sustainability of the work will be lost.

Basic facts about war trauma rehabilitation:

• A quota refugee is a person who has had to leave their country of origin and cannot remain in a country to which he or she has fled and has been identified as a refugee by the United Nations High Commissioner for Refugees (UNHCR). Quota refugees are placed in municipalities around the country: refugees selected in the quota do not live in the reception centre, but move directly to the municipality to live. Finland is committed to receiving 1,050 quota refugees in 2021. In 2020 the number was 850.
• Rehabilitation of people with war trauma is a feature of successful integration. Some refugees need rehabilitation to deal with the trauma of war and refugee induction. It is not always possible to map the need in advance, as it may only become apparent after a long time.
• The War Trauma Rehabilitation project is a three-year initiative in which an interprofessional working group has provided quota refugees and beneficiaries of international protection with needs assessment periods and rehabilitation plans. In addition, the working group has provided counselling, work guidance and training for professionals who encounter traumatised refugees in their work. The project has been implemented at the Deaconess Foundation’s Centre for Psychotraumatology and has been funded by the EU Asylum, Migration and Integration Fund (AMIF) in 2018–2021. The funding period ended on 31 March 2021.

Further information and interview requests:

Mari Tikkanen
Project Manager
tel. +358 50 314 2014
mari.tikkanen@hdl.fi

Laura Niemi
Communications Director
tel. +358 50 373 8602
laura.niemi@hdl.fi