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Recent estimates put the number of people displaced by organised violence at 60 million (UNHCR, 2015). This includes at least 32 million internally displaced people (IDPs), forced to abandon their homes and communities but still living within the borders of their home countries. Violence-related displacement is at a 20 year high, while the number of IDPs is at its highest level in 50 years. European governments and civil societies are actively, and at times contentiously, debating how to best respond to the dramatic increase in asylum seekers from protracted wars in Syria, Iraq and Afghanistan; meanwhile, the great majority of refugees from those and other conflicts seek shelter not in Europe but in neighbouring countries bordering their embattled homelands. [For the sake of ease, except where explicitly indicated, we use the term 'refugee' inclusively in this paper, to include anyone displaced by armed conflict.]
Paralleling this marked increase in forced migration has been a significant growth in research on the mental health of civilians displaced by armed conflict. Studies have examined diverse subgroups of displaced populations: children, adults, unaccompanied minors, torture survivors, IDPs, asylum seekers held in detention centres pending the outcome of their asylum claims, refugees resettled in high-income countries and the far greater number living in refugee camps or urban areas in low- and middle-income countries. Several excellent reviews have synthesised the findings of this extensive literature (Lustig et al. 2004; Porter & Haslam, 2005; Fazel et al. 2011; Siriwardhana et al. 2014; Tyrer & Fazel, 2015), and all suggest that the mental health impact of armed conflict is compounded or alleviated by contexts of migration and resettlement. In other words, the mental health of refugees is powerfully influenced by war-related violence and loss combined with the conditions they encounter en route to and within their host countries.
Our aim in this paper is to highlight an empirically robust risk model that specifies the primary threats to mental health faced by survivors of conflict-driven displacement. The model includes pre-migration exposure to the violence and destruction of war, as well as a constellation of stressors related to the experience of displacement itself. Examples of 'post-migration' or displacement-related stressors that have been shown to influence mental health include social...