INVISIBLE WOUNDS, VISIBLE OBLIGATIONS: LEGAL PROVISION FOR REFUGEE MENTAL HEALTH
DOI:
https://doi.org/10.18372/2307-9061.78.21134Keywords:
migration, mental health, PTSD, interdisciplinary approach, asylum policy, international protectionAbstract
The purpose of the study is to provide a synthetic analysis of both the legal and psycho-social dimensions of the refugee crisis, aiming to reveal systemic flaws in the protection of refugees' mental health. Furthermore, the study seeks to identify and analyze key problems within this field, including the limited availability of psychological services, the deficit of culturally sensitive approaches, chronic stress caused by legal status uncertainty, and the social barriers encountered during the integration process. Research methods: in the article, the research was conducted by using historical, comparative-legal, and normative methods, dictated by the complex nature of the issue. The historical method was applied to identify the root causes of forced displacement and to evaluate how international policy has transformed into legal norms over time. The comparative-legal method was utilized to analyze the migration and asylum policies of various countries, alongside their legal and institutional mechanisms for protecting refugee mental health, thereby highlighting best practices and identifying legal and administrative barriers. The normative method was used to focus on the normative content of the law, outlining refugee rights within the Georgian Law "On International Protection," international conventions, and European legislation to assess how clearly mental health guarantees and special procedural needs are defined at the normative level. Results: empirical research indicates a significantly increased risk among refugees of developing mental health disorders, including depression, anxiety disorders, and post-traumatic stress disorder (PTSD), as well as facing crises of adaptation, identity, and belonging. The findings highlight that these psychological burdens are frequently the direct result of traumatic experiences (such as violence, persecution, and the loss of family members), forced displacement, legal uncertainty, and severe difficulties in integrating into host societies. Discussion: considering the destructive trends in the modern world, including political instability, economic crises, numerous localized wars and armed conflicts, climate change, and natural disasters, the issue of migration and its associated challenges is becoming increasingly urgent. The refugee issue is inherently interdisciplinary. On one hand, it encompasses a legal dimension involving migration procedures, legal status determination, asylum mechanisms, and state obligations. On the other hand, it represents a complex medical and psycho-social problem that directly impacts the physical and mental well-being of refugees, falling squarely within the competence of social protection, healthcare, psychology, and psychiatry. Reconciling these two dimensions is crucial for overcoming the administrative and social barriers that hinder effective psychosocial support.
References
United Nations. Convention relating to the Status of Refugees(A/CONF.2/108). Geneva: United Nations; 1951 July 28. URL: https://www.un.org/en/development/desa/population/migration/generalassembly/docs/globalcompact/A_CONF.2_108.pdf
Goodwin-Gill, Guy S., and Jane McAdam. The Refugee in International Law. 4ᵗʰ ed., Ox-ford University Press, Sept. 2021, pp. 37-41.
World Health Organization. ICD-11 for Mortality and Morbidity Statistics. Geneva: World Health Organization; 2025 Jan URL: https://icd. who.int/browse/2025-01/mms/en#334423054
World Health Organization. "Over a Billion People Living with Mental Health Conditions – Services Require Urgent Scale-Up." World Health Organization, 2 Sept. 2025. URL: www.who.int/news/item/02-09-2025-over-a-billion-people-living-with-mental-health-conditions-services-require-urgent-scale-up.
"Posttraumatic Stress Disorder." APA Dictionary of Psychology, American Psychological Association. URL: https://dictionary.apa.org/ posttraumatic-stress-disorder
“Major Depressive Disorder." APA Dic-tionary of Psychology, American Psychological Association. URL: https://dictionary.apa.org/major-depressive-disorder
"Generalized Anxiety Disorder." APA Dic-tionary of Psychology, American Psychological Association. URL: https://dictionary.apa.org/ generalized-anxiety-disorder
Marmot M, Friel S, Bell R, Houweling TAJ, Taylor S. Closing the gap in a generation: health equity through action on the social determinants of health. Lancet. 2008; 372(9650):1661–1669. DOI:10.1016/S0140-6736(08)61690-6
World Health Organization. World mental health report: transforming mental health for all. Geneva: World Health Organization; 2022 p. 44. URL: https://iris.who.int/server/api/core/ bit-streams/40e5a13a-fe50-4efa-b56d-6e8cf00d5bfa/content
United Nations. General Assembly. Inter-national Covenant on Economic, Social and Cul-tural Rights. New York: United Nations; 1966 Dec 16. URL: https://www.ohchr.org/en/instruments-mechanisms/instruments/international-covenant-economic-social-and-cultural-rights
UN Committee on Economic, Social and Cultural Rights (CESCR). General comment No. 14: The right to the highest attainable standard of health (Art. 12 of the Covenant). Geneva: Unit-ed Nations; 2000 Aug Paragraph 34. URL: https://www.ohchr.org/sites/default/files/Documents/Issues/Women/WRGS/Health/GC14.pdf
UN General Assembly. Universal Decla-ration of Human Rights. United Nations, 10 Dec. 1948. URL: www.un.org/en/about-us/universal-declaration-of-human-rights.
European Court of Human Rights. Case of Bensaid v. the United Kingdom (Application no. 44599/98). Strasbourg: Council of Europe; 2001 Feb 6. URL: https://hudoc.echr.coe.int/eng?i=001-59206
Guterres A. Secretary-General's message on World Mental Health Day: "It’s time to priori-tise mental health in the workplace". New York: United Nations; 2024 Oct 10. URL: https://www.un. org/sg/en/content/sg/statements/2024-10-10/secretary-generals-message-world-mental-health-day-its-time-prioritise-mental-health-the-workplace-scroll-down-for-french-version
Rosas A., Eide A., Krause C., eds. Eco-nomic, Social and Cultural Rights : A Textbook; Second Revised Edition / Edited by Asbjørn Ei-de, Catarina Krause, Allan Rosas. 2nd rev. ed. Brill; 2001.
American Psychological Association. Trauma. In: APA Dictionary of Psychology. Washington (DC): American Psychological Association; 2024. URL: https://dictionary.apa.org/trauma
Ao, T., Shetty, S., Sivilli, T., Blanton, C., Ellis, H., Geltman, P. L., Cochran, J., Taylor, E., Lankau, E. W., & Cardozo, B. L. Suicidal ideation and mental health of Bhutanese refugees in the United States. Journal of Immigrant and Mi-nority Health, 2015); 18(4), 828-835. https://doi. org/10.1007/s10903-015-0325-7; Constantino G, Pierson MK, Ponterotto JG. Identifying and interpreting trauma in qualitative research. Qual Rep. 2022; 27(12):2714-2733. https://doi.org/10.46743/ 2160-3715/2024.5555
Henkelmann, J. R., de Best, S., Deckers, C., Jensen, K., Shahab, M., Elzinga, B., & Mo-lendijk, M. Anxiety, depression and post-traumatic stress disorder in refugees resettling in high-income countries: systematic review and meta-analysis. BJPsych Open, 6(4), 68. 2020; https://doi.org/ 10.1192/bjo.2020.54
Giacco, D., Laxhman, N., & Priebe, S. (2018). Prevalence of and risk factors for mental disorders in refugees. Seminars in Cell & Devel-opmental Biology,2018; 77, 144-152. https://doi.org/10.1016/j.semcdb.2017.11.030
Ellis BH, Murray K, Barrett C. Under-standing the mental health of refugees: trauma, stress, and the cultural context. In: The Massa-chusetts General Hospital Textbook on Diversity and Cultural ensitivity in Mental Health; Spring-er; New York; 2014 p. 167-168. DOI: 10.1007/978-1-4614-8918-4
Act LXXX of 2007 on Asylum, 1 Jan. 2008. URL: https://www.asylumlawdatabase.eu/sites/ de-fault/files/aldfiles/EN%20-%20Act%20LXXX%20 of%202007%20on%20Asylum%20Hungary.pdf.
United Nations High Commissioner for Refugees. “Applying for Asylum.” HELP: Hun-gary, UNHCR. URL: https://help.unhcr.org/hungary/ asylum/applying-for-asylum/.
WHO - Mental health of refugees and mi-grants: Risk and protective factors and access to care. URL: https://www.who.int/news-room/fact-sheets/detail/refugee-and-migrant-mental-health
Office of the United Nations High Com-missioner for Human Rights and World Health Organization. The Right to Health. Fact Sheet No. 31, United Nations, 2008, p. 10. URL: www.ohchr.org/sites/default/files/Documents/Publications/Factsheet31.pdf
Convention Relating to the Status of Refugees, art. 23, July 28, 1951, 189 U.N.T.S. 137. URL: https://www.unhcr.org/media/refugee-convention-1951-travaux-preparatoires-analysed-commentary-dr-paul-weis
UNHCR, Mental Health and Psychosocial Support for Refugees, Asylum Seekers and Mi-grants on the Move in Europe, 2017. URL: https://emergency.unhcr.org/sites/default/files/Men-tal%20Health%20for%20People%20on%20the%20Move%20in%20Europe.pdf
M.S.S. v. Belgium and Greece [GC], App no. 30696/09, European Court of Human Rights, Judgment of 21 January 2011. M.S.S. v. Bel-gium and Greece [GC], App no. 30696/09, Eu-ropean Court of Human Rights, Judgment of 21 January 2011. URL: https://hudoc.echr.coe.int/eng?i=001-103050
BVerfG, Judgment of the First Senate of 18 July 2012 - 1 BvL 10/10, (Asylbewerber-leistungsgesetz). URL: https://www.bundesverfass ungsgericht.de/SharedDocs/Entscheidungen/EN/2012/07/ls20120718_1bvl001010en.html
Chiaberashvili Z. Health - a right or an individual responsibility? Tbilisi; Economic Pol-icy Research Center (EPRC); 2020; pp.7-9. URL: https://eprc.ge/wp-content/uploads/2022/02/small_book-3.pdf
Kriegsflüchtlinge aus der Ukraine in Deutschland. Statista. 2025. URL: https://de.statista.com/statistik/daten/studie/1294820/umfrage/kriegsfluechtlinge-aus-der-ukraine-in-deutschland/
International Covenant on Economic, Social and Cultural Rights (adopted 16 December 1966, entered into force 3 January 1976) 993 UNTS 3 (ICESCR), Article 12.
UN Committee on Economic, Social and Cultural Rights (CESCR), General Comment No. 14: The Right to the Highest Attainable Standard of Health (Art. 12 of the Covenant), 11 August 2000, E/C.12/2000/4, para 8.
Office of the United Nations High Commissioner for Human Rights (OHCHR), The Right to Health, Fact Sheet No. 31, p. 4.
Fazel, M., Wheeler, J., & Danesh, J. (2005). Prevalence of serious mental disorder in 7000 refugees resettled in western countries: a systematic review. The Lancet, 365(9467), 1309-1314. URL: https://www.thelancet.com/journals/lancet/article/ PIIS0140-6736(05)61027-6/fulltext
CESCR, General Comment No. 14, supra note 2, para 12(c).
Kirmayer, L. J., et al. Common mental health problems in immigrants and refugees: general approach in primary care. CMAJ, 2011; 183(12). URL: https://www.cmaj.ca/content/ cmaj/183/12/E 959.full.pdf
World Health Organization (WHO), Mental Health Promotion and Mental Health Care in Refugees and Migrants, Technical Guidance 2018, p. 14. URL: https://iris.who.int/server/api/core/ bit-streams/45dc2215-554e-453c-b255-ac3c0021075 a/content
Li, S. S., & Liddell, B. J. The Interplay between Post-Migration Stress and Psychological Sequelae in Refugees. Current Psychiatry Reports, 2016; 18(9), 80. URL: https://www.researchgate. net/profile/Angela-Nickerson/publication/ 305460557_The_Relationship_Between_Post-Migration_Stress_and_Psychological_Disorders_ in_Refugees_and_Asylum_Seekers/links/600ce20c45851553a0679449/The-Relationship-Between-Post-Migration-Stress-and-Psychological-Disorders-in-Refugees-and-Asylum-Seekers.pdf
Downloads
Published
How to Cite
Issue
Section
License
This work is licensed under a Creative Commons Attribution 4.0 International License.
The scientific journal adheres to the principles of Open Access and provides free, immediate, and permanent access to all published materials without financial, technical, or legal barriers for readers.
All articles are published in Open Access under the Creative Commons Attribution 4.0 International (CC BY 4.0) license.
Copyright
Authors who publish their works in the journal:
-
retain the copyright to their publications;
-
grant the journal the right of first publication of the article;
-
agree to the distribution of their materials under the CC BY 4.0 license;
-
have the right to reuse, archive, and distribute their works (including in institutional and subject repositories), provided that proper reference is made to the original publication in the journal.
