In the past, most refugees who permanently resettled in the traditional
recipient countries of North America, Europe, and Australasia were screened
prior to arrival in a host country. In the last decade, increasing numbers
of unauthorized refugees or asylum seekers, those who formally lodge application
for refugee status in the country in which they are residing, have applied
for protection after crossing the borders of these countries. Concerns about
uncontrolled migration have encouraged host countries to adopt policies of
deterrence in which increasingly restrictive measures are being imposed on
persons seeking asylum. These measures include, variously, confinement in
detention centers, enforced dispersal within the community, the implementation
of more stringent refugee determination procedures, and temporary forms of
asylum. In several countries, asylum seekers living in the community face
restricted access to work, education, housing, welfare, and, in some situations,
to basic health care services. Allegations of abuse, untreated medical and
psychiatric illnesses, suicidal behavior, hunger strikes, and outbreaks of
violence among asylum seekers in detention centers have been reported. Although
systematic research into the mental health of asylum seekers is in its infancy,
and methods are limited by sampling difficulties, there is growing evidence
that salient postmigration stress facing asylum seekers adds to the effect
of previous trauma in creating risk of ongoing posttraumatic stress disorder
and other psychiatric symptoms. The medical profession has a role in educating
governments and the public about the potential risks of imposing excessively
harsh policies of deterrence on the mental health of asylum seekers.