The Consultation

Held on the 26^th of October 2000 at Bankstown Council Chambers. The aims of the consultation were to:

• Hear from the Arabic speaking community members and   workers about the needs/ issues and concerns of the communities.
• Discuss the concept and perceptions of counselling in the Arabic speaking communities.
• Receive feedback on STARTTS services from the Arabic speaking communities and workers.
• Identify health issues affecting members of the Arabic speaking communities, and receive feedback on health services.
• Provide information about STARTTS and the NSW Refugee Health Service

Approximately 30 community members and community workers attended the consultation. The program included information about STARTTS services to the Arabic speaking communities, services provided by the NSW Refugee Health Service and information about counselling and impact of torture and refugee trauma on individuals, families and communities.

Issues raised following the Presentations

• Lack of STARTTS and RHS presence in the Villawood Detention Centre
• Lengthy discussion about Arabic speaking women’s perceived low access to STARTTS services – causes and strategies for change were discussed
• A need to increase promotion of STARTTS services within Arabic speaking communities
• Questions about the process and extent of STARTTS and RHS advocacy within the NSW Health System

In relation to STARTTS providing services in Immigration Detention, the response was provided to the participants explaining that STARTTS was not funded to provide the direct service in detention and that Australasian Correctional Management (ACM) has employed staff to address the mental health needs of the people in detention. Additionally, Immigration Detention is considered a Commonwealth Facility/Land. Consequently, State services such as STARTTS do not have automatic access and jurisdiction over such facilities and services can only be provided on an invitation basis. However, STARTTS offered to provide training and support for the ACM counselling staff and we already provide training for other ACM personnel as a component of their induction process.

There were 3 small-group discussions focusing on a variety of topics including:

1. Feedback on STARTTS Services
2. Understanding of the concept of counselling
3. Health issues Arabic speaking communities are facing
4. Health services Arabic speaking communities are accessing and feedback on these services
5. General settlement issues

The groups included women’s group, community workers’ group and community members’ group.

Arabic speaking communities in NSW

The earliest record of Arabic-Lebanese speaking people arriving in Australia goes back to the 1870’s with the first official record of Lebanese born to land in Australia, “they were called Syrian or Turks”.

This is due to the fact that from the 16^th Century until the end of the 1^st World War, Lebanon and Syria were part of the Ottoman Empire. Also Syrian and Lebanese migrants before 1918 had Turkish passports and were grouped as Syrian, whether they arrived from an area, which were called greater Syria or Mount Lebanon region which later became Lebanon.

Official records of migrants from Arabic speaking background community other then Lebanese or (Syrian), indicate that the 1901 census recorded 108 Egyptian born persons lives in Australia, by 1947, the number of Lebanese born in Australia totalled 1886, while the number of Egyptian has increased 803 persons.

By 1966, the number of Lebanese born living in Australia reached 10668 persons. By 1974 have increased to 33,424 persons, while the number of the Egyptian Coptic living in Australia has increased significantly (DIMA).

By 1991, the Egyptian living in Australia rose to 28228 persons, few years later and according to the 1996 Sencus the number of Egyptian born people living in Australia reached 34154 (DIMA). The same census of 1996 recorded 70219 Lebanese born person living in Australia, adding to this number the second Lebanese generation or Australian born to Lebanese parentage, the number would jump to 153000.

The Demographic distribution of the Lebanese people in Australia according to the 1996 sencus, N.S.W. had the largest number of Lebanese and other Arabic speaking born persons. (DIMA, ABS, 1996 cencus).

The focus of this paragraph was primarily on the Lebanese and Egyptian born communities living in Australia and NSW, to give an idea about the migration history of the Arabic speaking people to Australia. These communities are the only Arabic speaking communities in Australia with the early migration records.

The Refugee settlement in Australia

The first Arab-Israeli conflict began in the late thirties of the 20^th century. This conflict resulted in the 1948 Arab-Israeli war that gave birth to the "Jewish State of Israel ", and created a huge number of displaced Palestinains who fled their homes to the neighbouring Arabic speaking countries.  The second Arab-Israeli war occurred in 1967 and resulted in the occupation of the reminder of the Palastinians’ lands by the Israeli army thus increasing the number of Palestinian refugees. Further refugees in the Middle East were created through the Lebanese civil war lasted from 1975 to 1991, the Iraq-Iran war which lasted from 1980 to 1988, and the second Golf war in 1991.

Australia has received few waves of Arabic speaking migrants, refugees and humanitarian entrants. They came primarily from Lebanon, Palestine, Syria, Iraq and minorities from other Arabic speaking countries such as Algeria, Eritrea, Somalia and Sudan.

However, the majority of Arabic speaking refugees arrived from Iraq due to the harsh political and economic situation in Iraq following the Gulf war in 1991. Consequently, Iraqi born population is one of the fastest growing population groups in Australia.

The number of Iraqi  – born persons in Australia has increased form 3260 according to the 1981 census, to 14000 at the time of the 1987 census. 

The total number of Arabic-speaking born population in Australia is estimated at 162 000 persons according to the 1996 census. This number is made up of 83 700 males and 78 300 females. This is not including the second generation born to Arabic speaking parentage and those who arrived since the time of that census.

Furthermore, the 1996 census indicates that Arabic Language (including Lebanese) is the highest language spoken at home after the English language.  That census recorded 125 661 persons speaking Arabic at home.

Refugee and humanitarian arrivals from Arabic speaking background in NSW

It is difficult to determine the exact number of refugee and humanitarian entrants of Arabic speaking background living in NSW. Firstly, there are a number of minority groups who arrived in Australia from Arabic speaking countries, but they do not identify themselves as Arabic speaking. Secondly, the data provided by the 1996 census, do not show the number of refugees from Arabic speaking background. The data provided by DIMA do not reflect the real figures of the refugees living in NSW because they do not account for interstate movement of refugee and humanitarian arrivals.

According to DIMA’s data, the number of humanitarian entrants to Australia between 1994 and 1999 is 64 479 out of which 26168 settled in NSW. 

5758 of those arrived from Iraq, and 1213 from Sudan. There were also small numbers arriving from Egypt, Lebanon, Palestine, Algeria, Syria, Kuwait and other Arabic speaking countries.

Until the results of the 2001 Census are released, the exact numbers will be difficult to locate. However, the true reflection of the correct number of refugee living in NSW depends on whether people would identify themselves as refugee and humanitarian entrants or not.

Organisations within Arabic speaking communities

Although most Arabic speaking communities are well established in Australia particularly in NSW, a certain level of fragmentation exists due to the impact of trauma on these communities coupled with an ever-increasing ethnic, cultural, religious and political diversity. This fragmentation occasionally impacts on the effectiveness in community self-organisation when assisting newly arrived refugees.

Some of the organisations involved in welfare work include:

• Al-Zahra Muslim Women’s Association
• Islamic Council of NSW
• Australian Lebanese Welfare Group
• Assyrian Australian Association
• Australian Arabic Communities Council
• Lebanese Community Council of NSW
• Lebanese Moslem Association

However, this list is far from exhaustive, as there are numerous organisations and associations providing welfare and cultural services to Arabic speaking communities. Additionally, there are Arabic speaking workers employed in a variety of government and non-government services.

Services

Refugee Health Service

The NSW Refugee Health Service aims to protect and promote the health of refugees and people of refugee-like background living in NSW.

The Refugee Health Service is keen to hear from members of the Spanish speaking community as to particular health needs  and to receive  feedback on health services.

Roles of the service include:

• Consultation and support to mainstream health care workers working with refugees
• Training for health service providers on refugee health and related issues, including development of resource materials
• Liaising between agencies that work with refugees and local health services
• Delivering health information to refugees, including orientation to the health system in NSW
• Providing clinical health assessments, advice and referrals
• Facilitating and conducting research in refugee health needs, problems and service delivery issues
• Advocacy at the health policy level and on a case-by-case basis, to promote health equity for refugees

The Refugee Health Service aims to assist recent refugee arrivals as well as those here for longer times, depending on need.  It also offers services to asylum seekers living in NSW whilst their case for residency on humanitarian grounds is being processed.

Most of the Service’s activities are conducted through partnerships with the wide range of specialised and mainstream health services that help to address the needs of refugees and others of non-English speaking background in NSW.  Collaborations with agencies beyond the health system also form an important part of the unit’s function.

Clinical assessments for newly arrived refugees or for asylum-seekers

Information was given regarding the Health Information Program that provides information about health services to newly arriving refugee groups in a number of community languages.

STARTTS

Arabic speaking clients have been seen at STARTTS since 1989. However, there was a significant increase in referral numbers since STARTTS employed an Arabic speaking Counsellor (1996). In total, 241 Arabic speaking clients were referred to STARTTS since 1989. Out of 241, 17 clients are currently on the waiting list and 33 are receiving counselling.

In terms of gender, 171 referrals were male while only 70 were female. This differs from general STARTTS gender ratio where at least 40 % of clients are female. There were few referrals of children and elderly with most referrals falling in the 20-50 years old bracket. This could reflect the composition of the community and nature of the Arabic-speaking humanitarian intake (predominantly single males in their 20s and 30s). However, there could be other issues involved to result in low numbers of female referrals in comparison with male referrals. This has been discussed during the consultation at great length.

Majority of the referrals were self-referrals and referrals by community-welfare agencies.

With STARTTS Early Intervention Program, 413 clients were seen since the inception of the Program in 1998. The most significant referrals sources include Department of Immigration and Multicultural Affairs (DIMA) and self-referrals

There were 325 male referrals and 88 female referrals.  There was significant number of children and young people referred (80). However, the most frequent age group remains 20-50 years old.

In addition to individuals counselling, Arabic speaking clients at STARTTS accessed the following programs:

• English classes for Temporary Protection Visa Holders (TPVs)
• Vocational Courses for TPVs – hospitality and forklift courses
• EIP Psychoeducational groups and information sessions
• Information sessions provided at English classes
• Middle-Eastern Youth Video Project
• Youth Program in general – residential
• Specialist Migrant Placement Officer Program (SMPO)

STARTTS also engages in a significant amount of community education (often using ethnic media, Arabic Workers’ Training) and community liaison. Additionally, STARTTS produced a number of psychoeducational materials in Arabic language.

Feedback on the recommendations and issues raised at the 1997 Consultation

1. Transport and Access to STARTTS' Facility – it was suggested that STARTTS improves transport links with railway stations and/or increases Outreach.

· Establishment of STARTTS Auburn Office  which is in a close proximity to the Auburn train station

· STARTTS Early Intervention Program (EIP) Outreach in Liverpool, Blacktown, St. George and Canterbury

· STARTTS General Services Outreach in Campbelltown

· In total there are 14 outreach locations within NSW

2. Promotion of the Service in a culturally appropriate manner

· Information sessions were conducted at Adult Migrant English Service and Arabic groups organised by various community organisations – these were run in Arabic and simple language was used

· A number of talks (some were talk-back programs) on Arabic language radio programs were organised covering: STARTTS services, UN Day in Support of Victims of Torture, Refugee Week, and effects of refugee experience on individuals and families. The most recent talks included two talks in October 2000.

· Translations of STARTTS materials into Arabic including: Information for Clients; Early Intervention Program; and a self-help booklet called “Becoming Ourselves Again”.

· Inclusion of STARTTS Arabic translations on www.startts.org web site

· EIP information sessions for Temporary Protection Visa holders in Arabic

3. Community Education and Training

· Mainstream community and services – STARTTS general training program continues to cover this area and included training for Centrelink, Department of Housing, Health and staff of other agencies. Other strategies included activities organised by Friends of STARTTS such as the event held on the UN Day in Support of Victims of Torture; STARTTS Magazine Transitions; and STARTTS web-page.

· Arabic speaking communities – in addition to the above mentioned strategies:

-    STARTTS Arabic speaking counsellor (ASC) attending Arabic Workers’ Network;

- ASC giving a talk at the Arabic Culture Workshop (June 2000);

- ASC attending community gatherings.

· Arabic speaking health and welfare workers – specific 1-day training session was conducted for these workers covering: torture and trauma issues; counselling and vicarious trauma. The training was held in August 2000.

4. Culturally Appropriate Services

· On intake all clients are offered a choice regarding the gender of the interpreter and counsellor. These wishes are respected whenever possible.

·  Health Care Interpreter Service training – conducted regularly usually by EIP.

5. Establishment of new services to cater to the Arabic speaking communities – particular emphasis on group interventions

· The ASC attempted to start a group twice. The leaflets were sent to all Arabic-speaking community organisations and the groups were advertised through ethnic media. However, the level of referrals was insufficient to start a group. Arabic-speaking support group remains a goal for the next year.

· STARTTS continues to organise English classes and vocational training courses (Hospitality, Forklift) for TPV Holders many of them being Arabic speakers.

· In partnership with Departement of Education – Arabic speaking Families in Cultural Transition Groups (FICT) were run.

6. Working with other Health Services

· Training continues to be conducted for a variety of health professionals – the data about numbers of participants and services trained are available through STARTTS Training Program statistics.

· In collaboration with a number of other services STARTTS participated in development of GP Standards for management of refugees/torture and trauma survivors.  Additionally, a refugee assessment tool was piloted with a number of GPs in Fairfield and Liverpool divisions. Currently, the NSW Refugee Health Service has the primary responsibility of GP training.

7. Youth Services

· STARTTS Middle-Eastern Video Project – most children involved were Arabic speaking (from Iraq) – this is a training tool for teachers filmed by the young people, addressing the issues of refugee children and difficulties at school.

· STARTTS is in the process of employing another Youth Worker to work with refugee young women.

· Regular participation of Arabic speaking young people in STARTTS Multicultural Youth Program

8. Waiting List

· EIP – there is no waiting list

· General Services – Arabic speaking waiting list is reasonably short in comparison with other communities (please refer to the statistics)

· STARTTS has introduced a number of strategies to address the waiting list issues. So far, the strategies have been successful in that the waiting list has been reduced.

9. Other Recommendations

It has been suggested that STARTTS may need to review critical issues like size of the rooms given the conerns raised by one client that rooms were too small and may re-tramautise people who have been imprisoned or confined in small spaces.

a) There are rooms of different sizes at STARTTS and we are currently looking into building an extension to the Carramar Office

There is a need to develop after hours services for STARTTS to meet the increasing demand for services and to cater to those who are working.

b) STARTTS has enough flexibility to see clients after hours if required (eg. the clients are working)

There is a need for STARTTS to strengthen Case Co‑ordination and management with other services involved in assisting refugee clients.

c) This has been systematically implemented particularly through the Early Intervention Program.

STARTTS needs to reinforce its messages about a commitment to confidentiality about all aspects of the client servicing process.  STARTTS should explain this clearly to its clients.

d) This is being done through all interactions with clients including the group context.

RECOMMENDATIONS

STARTTS

NSW REFUGEE HEALTH SERVICE

Transcription of the issues reaised in small groups

Small group questions focused on the following themes: understanding of counselling and STARTTS services; feedback on STARTTS Services; community health needs; access to health services and the experience of these services.

Women’s Group

· Counselling and trauma

- Many people in the community believe that only “crazy” people attend counselling

- Trauma can also occur in people’s homes and is often culture-bound (eg. domestic violence, women being punished for disobaying cultural mores)

- Men in the community feel uncomfortable with their wives seeking counselling as they could be disclosing family problems. They also worry that a medical record is something akin to a criminal record (ie. It is written somewhere that a particular person has experienced difficulties)

- Women would like to use STARTTS services but they are not supported by men and on some occasions they are actively prevented from doing so.

· STARTTS Services

- Even though the participants acknowledged the good work STARTTS Arabic speaking counsellor has been doing, they agreed that there were certain issues they could not discuss with a male counsellor. They also believed that male counsellors could not fully understand and appreciate women’s issues. They also felt that the experiences of sexual assault severely impacted on their reltionships with their husbands and they could not discuss their experiences with them.

- The same as the above applies to interepreters.

- Additionally, participants expressed concerns regarding interpreters and confidentiality.

- Political and religious differences between a client and a counsellor and/or an interpreter could be treatment blocks, particularly if a counsellor wishes to discuss religious issues.

- Due to the nature of persecution many people in the community are reluctant for their names and/or issues to be recorded

- Need for STARTTS to provide further training to Arabic speaking community/welfare/health workers.

- Concern about STARTTS raising awareness of its services while not being able to meet the demand + length of the waiting list.

- Suggested use of bi-lingual community educators to educate the community about STARTTS, trauma and counselling. Outreach needs to be done in the community meeting places.

- Need for Campbelltown Outreach to be extended.

- Intake – difficulties in disclosing personal information over the phone; intake offficers using a terminology many people do not understand.

· Health and Social Issues

- Change in gender roles and impact on family dynamics

- Settlement: unemployment and financial difficulties. Department of Housing perceived as not understanding refugee issues.

- Lack of awareness of health services and lack of translated materials.

- GPs are the primary source of health service provision

- Other helpers include community workers, family and friends.

- As is the case for STARTTS, many women are reluctant to seek services due to the fear of their husbands’ reactions – community perception is that Australian social and welfare services encourage divorce.

- Psychological Health issues: stress, depression, suicide attempts, sexual issues, family problems and domestic violence.

- There is a perception that most psychosocial problems should be solved within a family or the community (no need for services to be involved)

- Intergenerational conflict – teenagers and their relationships with parents.

- Physical Health: lack of awareness of services and language barriers; physical abuse; lack of support.

- Social isolation particularly affecting women.

Community Leaders and community workers

· Detention, asylum seekers and TPV issues

- General negativity about asylum seekers brought on by TPV related media publicity and governement responses.

- Negative effects of detention

- Need for further research into the effects of detention on refugees and need for more publicity

- Limitations to STARTTS ability to advocate

- Lack of appropriate counselling for people in detention

· STARTTS Services

- Need for STARTTS to promote its services further in the Arabic speaking communities through: community organisations, community workers, 1800 number, and schools. Need for STARTTS Outreach to access mothers with small children – possibly in public housing areas.

- Further community education about trauma and the concept of counselling. Also further training for Arabic speaking workers in order for them to be able to make effective and appopriate referrals.

- Suggestion for STARTTS to increase its advocacy in the settlement services area eg. housing and education.

- Arabic speaking women not accessing STARTTS – reasons discussed included cultural as well as the composition of the Humanitarian intake.

- Importance of trust-building was emphasised as well as the fact that people often seek help from their extended families rather than professionals.

- Need for further training of mainstream service providers on refugee issues.

· Children and education

- Limited education in the country of origin (eg. Iraq).

- Need for advocacy for an increased support for refugee children and young people at schools. Discussion about establishing homework centre with bi-lingual tutors.

- Need for further research into the issues of refugee children and education.

- Refugee children have been affected by defunding of programs for “at risk” students. Need for new programs within schools to assist refugee children and young people.

· General Health

- Need to train GPs on refugee issues and appropriate referrals. Particular attention to be given to “community” GPs.

- Need for further education about the health system

- Expectations of treatment: oral vs. injections; length of surgery waiting lists.

Community members

· Counselling

- Need for further community education about the concept and process.

- Stigma attached to attending counselling (ie. Only “mad” people need counselling)

- Perception that counselling produces no outcomes (ie. “just talking”)

· STARTTS Services

- Seminars/information sessions for clients and potential clients

- Further support for professionals in job-search skills

- Further community education on confidentiality of our services

- Increased use of ethnic media

- Information about torture and trauma services to be given to refugees while overseas by DIMA.

- Awareness raising and training of mainstream service providers to continue

- Information about STARTTS to be given to people in IDCs prior to release.

· New services – STARTTS

- Enabling access to Christmas presents and hampers for families who are STARTTS clients

- Finding a way to reduce the cost of medication for STARTTS clients who take multiple medication.

- Support group for ex-clients (STARTTS can contribute transport and guidance). Using the skills (+ additional training) of ex-clients to support new clients.

- STARTTS to work on improving relationships between the client group and mainstream service providers.

- STARTTS training for mainstream service providers – ongoing

· Health Issues

- Long hospital and specialist waiting lists. Also long wait in emergency departments – emphasised the specific difficulties torture and trauma survivors might have with waiting (irritability, lack of trust, hypervigilance, etc.)

- Connection between lack of adequate and affordable accommodation and clients’ physical and mental health.

- Other settlement issues and impact on health particularly lack of English and unemployment.

- TPV issues – lack of access to settlement support

· Access to services

- Lack of awareness of services available

- Channel 31 to improve and increase time

- Lack of interest in the community for attending information sessions

- Increased use of ethnic media for information dissemination

- Importance of the word of mouth emphasised

- More bi-lingual workers and ethno-specific services within mainstream services.