Integration
The index for integration of refugees in Germany, who are going to return to their country of origin, was low. Considering that the average duration of stay was 13 years, this low index is remarkable. An important reason for this result is the high percentage of participants with unstable residential status which prohibits people from working legally. Also, a quarter of the group was under the pressure to leave the country within the next month. Interestingly the group of stayers was significantly better integrated even though the percentage of unstable residence situations was almost as high as in the group of returnees. Thus, other factors must be responsible for the difference between groups. These are, according to our analyses, work status, age and education. In the group of stayers a higher number of people were working, whether their permit allowed for this or not. This probably opened up more possibilities to integrate into the host society. On the other hand, returnees were significantly older on average, which promotes a number of difficulties. Thus, with advanced age it is more difficult to integrate just as it is more difficult to find work, to learn a new language, to contact other people or to simply move around in the environment without physical limitations. They also tend not to have children in school – a place which would provide another point of contact with the host society.
Regardless of age, education played an important role for integration in the group of returnees. Again, older people were disadvantaged here, as many of them grew up in rural areas where access to education was either limited or where the school system was not yet as developed as it may be today. In addition, in terms of education, women are more disadvantaged than men. This finding is notable if education turns out to be a key factor for integration. Overall the findings on integration provide us with two conclusions. First, a large number of refugees in Germany are isolated from German society even though they have been living here for an extended period of time. This affects the mental health and wellbeing of the people concerned. Besides the problematic humanitarian consequences of a situation in which migrants are isolated from the host society it also means a loss for the receiving country. Migrants are entering the country with a number of skills and often a high motivation to work from which the receiving country could benefit if these people would be allowed to work and to integrate in society. Second, the intention to prevent migrants from integration and to promote voluntary return by means of political instruments (such as prolonged unstable visa status, the prohibition to work or financial incentives for returnees) is not successful. The vast majority of refugees prefer to stay in Germany no matter under which conditions. That means that neither 'Push Factors' in the form of poor living conditions and low level of integration nor money offered by voluntary return programs seem to be factors that are strong enough to persuade people to leave safe countries such as Germany.
Return
The findings regarding participants' attitude towards 'voluntary return' turned out to be complex. There is a large discrepancy between participant opinions towards voluntary return and the facts they are confronted with by German immigration authorities. In the study we therefore had to differentiate between general attitudes for and against voluntary return, voluntariness of the decision to return and willingness to return under the current circumstances.
When asked about their general attitude towards voluntary return, homesickness was mentioned most frequently as an aspect which made people consider returning. But even though participants seemed to miss their home country very much, this was not the activating key motive which made them opt to return.
More than any other reason, participants cited their children's futures as the key motive in the decision. However, this motive was actually against return, which at first sight is surprising in a group of voluntary returnees. It is less surprising once the voluntariness of the decision to return is included in the analysis. The majority of the participants made their decision under external pressure such as the threat of deportation. This fact contradicts the requirement of voluntary assisted return programs, in which the decision is supposed to be voluntary. It also explains why there is a subgroup of refugees from Iraq in our study who are participating in voluntary return programmes even though they are expressing a fear to return because of the ongoing war in their country of origin. At this point it is important to consider which definition of voluntariness is applied.
As cited in the introduction, in the UNHCR definition external pressure and the lack of permanent residential status – as found in the majority of our sample – are contradictory to a voluntary decision as well as a voluntary return. In contrast, in the definition of IOM the requirement of voluntariness is already fulfilled with the absence of active resistance during the actual return process. The decision process is not included here at all. German immigration authorities and organisations concerned with voluntary assisted return, define their activities based on the definition of IOM. Clinical psychologists, whose interventions are based on the experience and behaviour of the individual, can relate more easily to the definition by the UNCHR as it puts more emphasis on the subjective perspective of the people concerned. From that perspective for the majority of our participants the requirement of voluntariness is not fulfilled.
In our opinion in the discussion about 'voluntary assisted return' it is very important to differentiate between the different players involved. National Voluntary Return Programs are a political instrument which is implemented by receiving countries. On the one hand they are designed for the benefit of the implementing country – they reduce the number of dependents on the welfare system and send a clear signal to future migrants. They can also provide a humanitarian solution to the situation of refugees who will have to return to their country of origin in the near future. But in comparison to this political perspective the actual decision to return affects the individual on a personal level including the life changing consequences following it. So, it seems very difficult to meet the interests of both -those who imply the programs and those who the programs are made for- at the same time. This may be one reason why the assessment of VARPs differs so strongly depending on the perspective of the evaluator.
An often overlooked fact in the debate at hand is the duration of stay in the Receiving Country. Refugees in Germany are usually in flight for political reasons – which is why Germany accepted them. Whereas immigration policy only considers one's motives at the time of arrival in Germany, in many people reasons for a life away from the country of origin change overtime.
After the flight refugees are trying to continue their life in exile, to tie up to former plans or to realize new live models. Children are born, families grow and people adjust to their new environment. Upon closer examination, we see that it is even more complex. The participants of our study lived in Germany for more than a decade, with only temporary residential status and all the insecurities that come with such status. They spent this time waiting for a decision about where their lives would continue, all the while adapting to Germany and becoming more distanced from their country of origin. In this sense, the aftermath of war continues. Moreover, their home country has often undergone massive changes. For example, the former Yugoslavia, a socialist republic, has divided into several nation states with a free market economy. They lost their possessions and often family members. Often, those who did not leave during the war are blaming those who are returning now for having escaped and benefited from richer countries. At the same time, in Germany, they are only accepted temporarily and prevented from integrating and starting a new live for themselves. These people find themselves in a no-win situation, and many reported they no longer expected much from their own lives. In this situation they make the decision based on the needs of their children. So, a key motive in the decision to return concerns children born and raised in Germany. Despite strong pull factors like 'family ties in the home country' and 'homesickness' as well as strong push factors like 'temporary residential status' and 'prohibition to work', people decide to stay for their children. Supposedly, other factors, such as the higher standard of living in Germany also play an important role. But interestingly, neither these nor worries regarding the living situation in the home country were mentioned. Even the fear of a confrontation with traumatic stressors in the homeland does not seem to play a role at all in the group. Considering the high prevalence of PTSD in the group this result is significant. It seems that after 13 years in exile refugees do not take on the perspective of the home country even when it comes to return.
To sum up, the abolition of the Push Factor war does not automatically incite a desire to return in all refugees. Considering that participants spent some 13 years of their life time in Germany it can be better understood that reasons against a return change from the political to the personal level. Across such long time periods, we would expect that differences between stayers and returnees will level out, which would explain the similarity between both groups in the present investigation.
An important observation for policy makers may be that people who reported a high willingness to return were those who had visited their homeland after the conflict and crisis and those who were significantly more homesick. Restrictions in travel permission to refugees with temporary residence status as it seems are neither humanitarian nor do they increase the willingness to return.
Finally, we want to pose the question: who are the people willing to return voluntarily? Eleven participants expressed voluntariness and a high willingness to return. Their reasons were homesickness, the expectation of support from the return program and acceptance that one has to leave and to make the best of it. In the end, four of them did not leave Germany. According to our data, those who really returned voluntarily were older than 70 or terminally ill and had a desire to die and be buried in their homeland. As demonstrated in several sections of this study, old people compose a special subgroup among returnees. On the one hand, their level of integration as well as their subjective quality of life tends to be lower. At the same time, they fulfil the criteria of a voluntary return. Left aside that more efforts should be made to integrate elderly migrants into German society for humanitarian reasons alone, Assisted Voluntary Return Programs could create specific guidelines for handling this group. In contrast to all other returnees these elderly people were the only participants in our study who left Germany as truly voluntary returnees.
Among the limitations of our study is the size of the studied sample. Participants were recruited through all varieties of programs dealing with assisted 'voluntary' return in Germany. Despite extensive efforts, the group of returnees examined for this report is relatively small. In cases of low feedback, organisations which did not refer clients to us were asked to explain why. Four organisations did not want to cooperate for fear the data could be misused for political reasons such as a campaign for or against the practice of VARP. Other organisations argued that the interview would be stressful for their clients (especially when a mental disorder has already been diagnosed). In some refugees the fear of the return was very high and organisations were not willing to refer them to the study. Interestingly, the majority of organisations did not have any clients who fit our inclusion criteria. They reported to have very few clients in general as the demand for VARP was very low during the study period.
Unfortunately there is very little information on the mental health of refugees in Germany which makes it difficult to estimate the representativeness of our results. This in fact stimulated us to perform this study. The only data which exists in Germany comes from an earlier study, which found a PTSD-prevalence rate of 40% among asylum seekers in Germany [
20]. This is comparable to the PTSD-rates found in the present study. As far as we know there is no data available on demographic characteristics of refugees living in Germany. For returnees we also could not obtain general, i.e. nation-wide, information on demographic characteristics. Therefore we examined the demographic statistics of those organisations involved in VARP [
10,
11,
24]. According to these statistics our sample is representative for returnees in Germany regarding age, gender, marital status, residence status and country of origin.
Given that the study includes returnees from a variety of organisations, particularly those, which are more confident in their programs, effects for all the organisations might be even stronger and the current conclusions are likely to be valid. The number of people with a high degree of mental illness is not rare among returnees. For reasons of representativeness we included such participants as well, even though they were not all able to complete the whole interview. The group of returnees from Turkey and Iraq in the present sample is small. For this reason, these groups were not examined independently from the large group of participants from former Yugoslavia. Statistical analysis excluding participants from these two countries came to the same results as when they were included in the analysis.
Taking into consideration the general lack of information on refugees in Germany we limit our findings to the group of returnees in Germany who came as refugees and are returning now with assisted programs of voluntary return. Within that frame our findings are representative. In terms of voluntary return in Germany in general our study has the character of a pilot study. Further investigations with larger samples from different countries of origin should be performed to assure and deepen the results of the study presented in this paper.
The debate on mental health among refugees often addresses how much importance should be given to simulation, i.e. the assumption that refugees with uncertain residence status are simulating a negative mental state in order to avoid a forced return. If simulation or aggravations play an important role prevalence rates reported in this study would have to be questioned. Ruf et al. conducted a longitudinal study examining refugees diagnosed with PTSD and depression before and after they had received a permanent visa. The study reveals a decrease in depression but not of PTSD in the second assessment [
41]. Also participants in our study had already commenced the return process and would not benefit from aggravation. We therefore assume that the described prevalence rates are realistic.
Since a number of organisations did not refer clients to us who have already been diagnosed with a mental disorder, we suppose that the prevalence of mental disorders among returnees is probably higher than presented in this study. In this respect, the numbers presented here can probably be interpreted as a conservative estimate.
Another limitation of the study is the lack of validated translations of the applied questionnaires. In order to compensate for this problem we used instruments which have been translated back and forth by clinical psychologists in Germany and the countries of origin. Also we employed interpreters who were experienced translating in a clinical setting as well as in the use of structured interviews and gave them further training for the instruments used in our study. For further investigation it would be recommendable to apply questionnaires which are validated in the respective language.
Regarding motivations for and against return, this study shows that refugees consider return from many perspectives. Even though prevalence rates of mental disorders are highly elevated in returnees in comparison to the average population, their mental health status does not seem to play a key role in the decision. Considering that for the majority the decision to return is strongly influenced by external factors such as the unstable residential status it is clear why the political level is so much more influential in the return process than the personal level.
Nonetheless, it is important to study the phenomenon of return from a psychological and individual perspective: Mental health is not only relevant from a humanitarian perspective, where it is a prerequisite for individual wellbeing. It is also a key in achieving successful reintegration. Clinical studies show that treatment opportunities in the countries included in our study are limited and expensive. Sometimes, they do not exist at all. The cost of medication is often prohibitive. Due to symptoms related to their diagnosis (such as withdrawal, sadness, distrust etc.) people with mental disorders encounter far more integration challenges. This is especially difficult in people with PTSD as their symptoms include the fear of all triggers related to the original trauma and a lack of a perspective for the future. These considerations touch the political-societal perspective as well, as a post war society as a whole benefits from the successful reintegration of former refugees. It is obviously important to have healthy citizens in a post-war society in order to rebuild the nation physically and politically. However, the limited number of studies in this field makes it difficult to frame a prognosis. Certain stressors which have been influential in exile become less important – such as homesickness or inability to attain a work permit-, while new stressors could turn up after the return – economical insecurity, being stranger in their own country, confrontation with triggers of traumatic experiences. To get a better picture of mental health of refugees in the return process, the participants of this study will be interviewed again nine months after return.