Role of Rehabilitation Professionals in Camps for Displaced Persons

Original Editor - Laura Gueron and Stanley Malonza from The Center for Victims of Torture as part of the PREP Content Development Project

Top Contributors - Naomi O'Reilly, Kim Jackson, Jess Bell, Ewa Jaraczewska and Wanda van Niekerk  

Introduction[edit | edit source]

The United Nations High Commission for Refugees (UNHCR) reported that at the end of 2021, there were 89.3 million people who were forced to flee their homes due to conflict, violence, fear of persecution and human rights violations. This included 27.1 million refugees and 4.6 million asylum seekers across the globe, in addition to 53.2 million internally displaced people. Turkey is currently the host of the largest number of displaced persons globally, hosting more than 3.8 million people.[1]

Camps for displaced persons are temporary facilities built to provide immediate protection and assistance to people who have been forced to flee their homes due to war, persecution or violence. While camps are not established to provide permanent solutions, they offer a safe haven for displaced persons and meet their most basic needs such as food, water, shelter, medical treatment and other basic services during emergencies.

In situations of long-term displacement, the services provided in camps are expanded to include educational and livelihood opportunities, as well as materials to build more permanent homes to help people rebuild their lives. These services are also offered to host communities.

There are camps for displaced persons all over the world. Many of these camps were built quickly to serve the immediate needs of those forced to flee, but have grown to host hundreds of thousands of displaced people. Some of the world's largest camps for displaced persons are: Kutupalong-Balukhali Expansion Site (Bangladesh), Bidi Bidi Refugee Camp (Uganda), Dadaab and Kakuma Refugee Camps (Kenya), Azraq and Zaatari Refugee Camps (Jordan), Nyarugusu, Nduta, and Mtendeli Refugee Camps (Tanzania) and Kebribeyah; Aw-barre and Sheder Refugee Camps (Ethiopia).

Data on Camps for Displaced Persons[edit | edit source]

According to UNHCR, 6 million displaced persons in the world live in camps, which is 22% of the world's overall displaced person population. More than half of displaced persons live in urban or semi-urban areas. Many of the camps for displaced persons have been around for so many years that they are basically like cities with schools, clinics, shops and other infrastructure.[2] While many of the world’s camps for displaced persons had been intended to be temporary, there are so many protracted displacement situations in the world, a large number of camps have been in existence for much longer than planned.

Many of the biggest camps were begun in the 1980s and 1990s, so there are generations of families who have lived their entire lives in camps for displaced persons. According to the UNHCR Global Report 2021, the top hosting countries of the world are: Turkey (3.6 million), Colombia (1.8 million), Pakistan and Uganda (both 1.5 million) and Germany (1.3 million). More than 80% of displaced persons are hosted in low and middle-income countries, and the average displaced person lives in settlement situations for nearly 20 years. The top “source countries” where displaced persons originate from are: Syria (6.8 million), Venezuela (4.6 million), Afghanistan (2.7 million), South Sudan (2.4 million), and Myanmar (1.2 million).[2] The number of displaced persons from Ukraine has also grown exponentially since the outbreak of conflict in March 2022, so these figures are not included in the UNHCR Global Report 2021. Current data suggests more than 5 million people have been forced to leave the country and seek protection in other countries, and a further 7 million are internally displaced.[3]

People living in camps for displaced persons face a range of health, social and environmental hazards that can impact their well-being. For example, poor water and sanitation, food insecurity, lack of essential healthcare, lack of primary health caregivers and exposure to extreme temperatures.

It is estimated by the World Health Organization and by UNHCR that ten percent of displaced persons have some sort of disability, and these individuals can benefit greatly from receiving rehabilitation services.[4] In addition, research studies show that between 15 and 44 percent of displaced persons have experienced some form of torture. A systemic review by Sigvardsdotter et al.[5] found that an average of 27% of forced migrants have a torture history. While the exact prevalence of torture among displaced persons living in camps is not known, it is likely that this would vary by country of origin, gender and other factors. Survivors of torture can benefit greatly from rehabilitation services, such as those outlined in the Physiopedia article: Rehabilitation for Survivors of Torture.

Displaced persons have higher rates of many non-communicable diseases. In some camps for displaced persons where the International Committee of the Red Cross (ICRC) works, more than 17% of displaced persons aged 18 and over have a diagnosis of diabetes.[6] Rehabilitation professionals working in camps for displaced persons need to be aware that the incidence of diabetes, hypertension, cardiovascular diseases and cancer are typically quite high among the camp populations. They need to tailor their interventions to include education about self-care and the role of exercise and nutrition in helping to prevent and treat these co-morbidities. The incidence of depression, post-traumatic stress disorder, and anxiety disorders are higher in displaced person populations than in the general population.[7][8] It is important that rehabilitation professionals are comfortable providing services to individuals who have mental health conditions. Rehabilitation professionals working with those living in camps must also be familiar with “Trauma-Informed Care” and how to adapt their programming to meet the needs of displaced persons who have been through traumatic experiences.[9][10][11]

As so many displaced persons live in camps for many years with little possibility of being permanently resettled, it is crucial that the residents of these camps have access to quality medical care. This must also include rehabilitation services because of their higher risk of developing many chronic illnesses, which can benefit from rehabilitation services. 

According to the UNHCR Comprehensive Refugee Response Framework: From the New York Declaration to a Global Compact on Refugees, part #59, the world community has a special obligation towards meeting the needs of children, survivors of torture and other forms of trauma, and helping those with special needs, including those with disabilities. Rehabilitation professionals, thus, have an obligation to help meet the rehabilitation needs of those who live in camps for displaced persons. As per Article 26 of the Universal Declaration of Human Rights, many displaced persons have war-related injuries such as amputations, spinal cord injuries, head injuries and other traumatic injuries, which require quality access to rehabilitation services.[12]

An important role for rehabilitation professionals working in displaced persons camps is to provide training for community-based rehabilitation workers who work for other non-governmental organisations (NGO). This training enables these community-based workers to understand who to identify for further support from rehabilitation. Moreover, since many displaced persons might not receive much-needed rehabilitation due to staff shortages, it is beneficial for rehabilitation professionals to provide psycho-education and psychological first aid for teachers, counsellors and others working in camps. Ideally, this education would include some basic concepts of exercise, pain reduction and sleep hygiene so that other care providers are able to help those who are unable to access rehabilitation services.

As many displaced persons living in camps have complex needs, it is important that the rehabilitation professionals working in camps form close connections with community leaders and colleagues who work in other NGOs. They should learn how to make appropriate referrals for other medical services, education, counselling, livelihood and security programmes, and to address many other needs.[9][11]

Another possible role of rehabilitation professionals working in camps is to help to organise opportunities for displaced persons of all ages and genders to participate in physical activity, such as walking, running, bicycling and football (soccer), as well as stretching. Several studies on physical activity for displaced persons who have post-traumatic stress disorder and pain have found that participants benefit from activity.[13][14]

There needs to be sensitivity when arranging group physical activities to try to have ethnically mixed teams. This can help to minimise the perception of exclusion and nationalism. In addition, it is beneficial to offer a variety of different physical activities so that participants have choice.[14] If possible, offer programmes for men, women and children. In some camps for displaced persons, there are specific NGOs which focus on physical activity, such as Right to Play. However, rehabilitation professionals can still play an important role in helping to develop and support physical activity programmes. 

Group rehabilitation sessions can be very beneficial for those living in displaced persons camps. Groups can help to build trust, and establish connections, and help individuals to encourage and support each other. There is a great deal of research showing that group physiotherapy can be as effective as individual physiotherapy for those with musculoskeletal pain and injuries, including a study which was conducted in Cambodia.[15][16] With the shortage of trained rehabilitation professionals working in camps for displaced persons around the world, working with groups can also be an efficient way of reaching more patients. 

According to the UNHCR, half of the displaced persons in the world are younger than 18 years. Rehabilitation professionals should make efforts to provide needed services to children as well as to adults. They could potentially work with other NGOs, schools and family members to best engage children who have been displaced. 

With 80 to 85 percent of displaced persons being housed in developing countries, ideally the rehabilitation team will provide services to host community members as well, as there is typically a lack of resources and poverty among the host community.[2]

The influx of displaced persons has had a great impact on the social, economic and health sectors of many countries. Increasing numbers of displaced persons has increased the pressure and demand on both primary and secondary health care services, across all rehabilitation professions.[17][18][19][20] There is also a shift toward providing medical care based on evidence-based research, which is guided by principles of effectiveness, safety, timeliness, patient-centredness, equity and efficiency. Research also indicates that patient expectations have changed, with patients becoming active participants rather than passive receivers of care. Health care providers, therefore, need to make sure there are enough health and rehabilitation professionals to deliver optimum and timely services to clients.[21][22]  

Chronic Pain and Sleep Issues[edit | edit source]

There are multiple studies showing that displaced persons have higher rates of pain than the general population.[22][23][24] However, very few studies have been conducted exclusively in camps settings, so it is difficult to know exactly how pervasive pain issues are in displaced persons. The Center for Victims of Torture (CVT) conducted large representative surveys in its programmes in Kenya, Ethiopia and Uganda (there were more than 500 respondents in each survery):

  • In a 2018 representative survey of host and displaced person community members conducted by CVT in Kalobeyei Settlement just outside of Kakuma Camp, 35% of displaced persons and 32% of host community respondents indicated that they had chronic pain.[25] In the same survey, 51% of displaced persons and 44% of host community members indicated that they had trouble falling asleep.[25]
  • In a similar survey from 2017, which was conducted by CVT staff members in two camps in Ethiopia, 44% of respondents reported difficulty sleeping, and 28% of displaced persons at Adi Harush Camp and 31% at Mai Ani Camp reported that they had chronic pain.[26]
  • In a 2020 CVT representative survey of displaced persons in Bidi Bidi settlement in Uganda, 56% of displaced persons reported difficulty sleeping and 51% reported having issues with chronic pain.[27] 

It is crucial that rehabilitation professionals who work with displaced persons, both in and outside of camps, focus on providing pain education and other pain relieving treatment and psychoeducation.[10][16][22][23][24][28] The following Physiopedia pages on Evidence Based Assessment of Pain in Displaced Persons and Evidence-based Management of Pain in Displaced Persons provide detailed discussions on this topic area. 

As noted in the surveys above, sleep difficulties are common among displaced persons. Camps for displaced persons are typically noisy and crowded. Many family members can be crammed into one small room to sleep, and they may not have comfortable bedding or electricity to heat / cool the room. These factors, as well as security issues, can make sleep very difficult. However, it is essential for rehabilitation professionals to work with their clients in these settings to improve positioning and comfort, and to teach them breathing, relaxation and grounding techniques and other ways to improve sleep hygiene.[28][29][30]

Gender-Based Violence[edit | edit source]

It is important to be aware that many displaced persons have issues with constipation, incontinence and with painful sexual functioning. Issues with incontinence and sexual functioning commonly occur as a result of gender-based violence. These are areas that some rehabilitation professionals can help to address. For more information on these issues, please see these Physiopedia pages: Considerations for Working with Survivors of Sexual Violence and Considerations for Working with LGBTQIA+ Displaced Persons.

The Center for Victims of Torture offers physiotherapy group sessions that are divided by gender. In these group sessions, physiotherapists discuss pelvic floor concerns / issues in order to normalise them. The therapists do not separate out those who are known survivors of gender-based violence from those who are not. Instead, for instance, they offer psycho-education to all displaced males on ways to decrease erectile dysfunction. Similarly, they provide information to all displaced persons in the group on ways to decrease urinary incontinence and urgency, bowel incontinence and constipation, and painful sexual functioning. Rehabilitation workers at the Center for Victims of Torture have found that clients are usually very receptive to learning how to improve these issues, through techniques such as: performing pelvic floor strengthening and relaxation exercises; improving the intake of foods and beverages; learning physiological quieting techniques when feeling urgency, doing relaxation exercises and modifying positioning when engaging in sexual activities. There are some excellent reviews and articles about the efficacy of these activities in both group and individual physiotherapy sessions.[31][32][33][34][35][36] 

Shortage of Rehabilitation Professionals[edit | edit source]

The World Health Organization (WHO) estimates that for every one million people who live in low- or middle-income countries, there are less than ten qualified rehabilitation professionals, including speech language therapists, occupational therapists and physiotherapists. There are tremendous shortages of physiotherapists and other rehabilitation therapists in displaced persons camp settings. To help to fill this gap, WHO designed the strategy of Community-Based Rehabilitation (CBR). There are CBR programmes in more than 90 countries, and many operate in camps for displaced persons. WHO describes three levels of workers in CBR settings:[37]

  • The grass-root level of volunteers who have several weeks of initial training and then ongoing supervision
  • Mid-level workers who have some form of accreditation
  • Professional level therapists


There are ethical issues posed by the shortage of rehabilitation professionals and, at times, CBR workers such as rehabilitation assistants, are asked to perform tasks, which may be beyond their scope of practice.

A preliminary preprint by Mitchell-Gillespie et al.[38] describes the use of telehealth in displaced persons camps in Jordan. With the onset of COVID-19, qualified rehabilitation professionals often left displaced persons camps. This left CBR workers, such as rehabilitation assistants (who are often displaced persons living in the camp), as the only rehabilitation workers on-site. In situations like these, telehealth can be a useful solution.

In the study by Mitchell-Gillespie et al.,[38] CBR staff working on site in the camp in Jordan performed telehealth sessions using Zoom while occupational therapists, operating in the United States, provided clinical support remotely during the call. The occupational therapists were able to observe and participate in the session in real time, viewing the session via iPad video.[38] Thus, the qualified therapist is “present” remotely during the entire session to observe, assist and participate in the session. Potential barriers to using telehealth in camps for displaced persons include inconsistent internet connectivity. However, the study by Mitchell-Gillespie et al.[38] indicated that telehealth was well-received by both clients and staff members.

Rehabilitation Assistants in Camps for Displaced Persons[edit | edit source]

In both long- and short-term camps, rehabilitation assistants provide support to rehabilitation professionals in many clinical and non-clinical tasks. Being able to work alongside rehabilitation assistants enables rehabilitation professionals to focus on more complex tasks in order to best meet the needs of the clients. About 80% of community-based rehabilitation organisations employ rehabilitation assistants. These assistants provide, on average, 36% of the direct care provision. There are over 300 job titles used to describe support workers or assistants.[19][21][39] For this article, the term "rehabilitation assistants" is used to describe those who work alongside professionally qualified rehabilitation professionals. 

There has been a growing trend to tap into the available human resources within community-based rehabilitation programmes and to build displaced persons capacity for long-term programme sustainability. A male rehabilitation assistant, who was one of the two first rehabilitation assistant’s with the Center for Victims of Torture Kakuma, stated:

"My goals and dreams is to be someone who can change the world - To assist, to help many people having problems in their bodies and those who have been tortured, went through war, acts of violence and other conflicts. When I took time to think back to what is happening and to how people are suffering in my country, and that there is no assistance, it is clear that my future is to apply all of my experience, skills, and pieces of knowledge to my country, or to a different country. So many people are having problems including pain, and this is often caused by how they do things in a wrong way, including how they sit, how they sleep, and how they walk. Many of them are having difficulties with sleep, trouble controlling their bladder or bowel and many are having sexual problems. I have learned techniques and ways to help those who are having bad conditions in their bodies. Wherever I will be going I should be applying all of my experience, skills, and knowledge to assist people who need assistance in the community." Quote by a rehabilitation assistant in Kalobeyei camp-Kakuma Kenya (Amani), Center for Victims of Torture.

However, it is also important to ensure that rehabilitation assistants have appropriate training and supervision. They should not be asked to do activities which are beyond their capacity, and/or outside of the regulation concerning specific rehabilitation professionals within the country where the camp is located. 

Training of Rehabilitation Assistants[edit | edit source]

Every organisation differs in its approach based on its mandate. However, each organisation has a training programme that has been developed to ensure that rehabilitation assistants learn the necessary basic rehabilitation principles and techniques. In Kenya, training for rehabilitation assistants has not yet been accredited by the regulating bodies and a standardised curriculum is now being developed. If the rehabilitation assistant role does become accredited in Kenya, it will make it easier for rehabilitation assistants to join tertiary colleges with the knowledge and skills they have acquired.  

Depending on which NGO they work for, rehabilitation assistants undergo rigorous training for the first 3 to 12 months after recruitment. This is complimented by ongoing on-the-job training from senior rehabilitation assistants and rehabilitation professionals such as physiotherapists and occupational therapists. During this period, they are assigned non-clinical duties such as welcoming and receiving clients, preparation of treatment areas, inventory taking etc. Delegation of duties depends on the rehabilitation professional's experience, the training background of the rehabilitation assistant and the period of time that the two have interacted.[37] 

Roles of Rehabilitation Assistants [edit | edit source]

The roles vary from organisation to organisation and from country to country. It is crucial that the NGO and the rehabilitation team who is supervising the rehabilitation assistants ensure that they do not work beyond their level of training and beyond their specific scope (this scope depends on what is allowed by the specific rehabilitation organisation of the country in which they work). Common job responsibilities of rehabilitation assistants who are working in the area of physiotherapy include, but are not limited to:

  • Working with patients towards individual rehabilitation goals, as prescribed by rehabilitation professionals.
  • Supporting and supervising patients in activities of daily living.
  • Promoting patient rights and identity.
  • Helping rehabilitation professionals to monitor clients’ progress.
  • Providing feedback to the rehabilitation professionals on patients' progress and services provision.
  • Assisting clinicians in the identification, provision, fitting and safe use of equipment for patients and caregivers.
  • Educating patients on how to exercise properly by giving clear instructions on posture, frequency, benefits of exercises, etc.
  • Participating in community outreach activities to create awareness of rehabilitation.
  • Ensuring that the cleanliness and safety of the therapeutic equipment in the department is maintained. 
  • Helping to maintain records of work undertaken with patients.[38] 

Advantages of Rehabilitation Assistants [edit | edit source]

Useful in Inter-Professional Linkages[edit | edit source]

In camp settings, patients present with diverse needs including shelter and protection, collection and distribution of firewood, soap, and sanitary pads, eligibility tests, healthcare, and attending school, and work. Often, there are mandatory activities, such as fingerprinting by UNHCR staff, which need to be done for the displaced persons to access food rations and tokens. These competing demands can prevent clients from attending rehabilitation activities. The rehabilitation assistants are often able to link up with other inter-agency staff and, together with clients, set or reschedule appointments so that the clients can receive several services on the same day. This helps them to improve their rehabilitation attendance.   

Rehabilitation assistants are perceived as a focal point for care delivery and serve as conduits for clients.

Provide Faster, More Accessible Care[edit | edit source]

Most rehabilitation assistants are also displaced persons who live within the same camps as the patients. This enables them to interact with patients and to provide timely care that is also culturally sensitive. Rehabilitation assistants are also able to follow up with patients at their homes. Thus, in consultation with qualified rehabilitation staff, they can provide further support on home exercises programmes and help with simple modifications and recommendations to address clients’ needs. Care is taken to consult with national rehabilitation professionals and not to go beyond the scope of practice for a rehabilitation assistant. 

"The rehabilitation assistants are living in the camp together with the clients. Our clients came from different countries and cultures and you may find that rehabilitation assistants are from the same country and even the same culture. For the rehabilitation assistants it will be easy to know some of client’s behaviours and problems. Rehabilitation assistants respect the confidentiality of clients and you may find that within the week we can meet on the way in the community and maybe the clients may be having some problems and the rehabilitation assistants can direct the clients. Many of the clients know where some of rehabilitation assistants are living and some of the rehabilitation assistants know where some of the clients are living. You may find that there are some of the exercises that we did in the sessions and maybe the clients didn't understand it well so the clients may have time to ask some questions and rehabilitation assistants may have time to explain to the clients and tell them how they should be doing it. That is an advantage of the rehabilitation assistant and clients living in the same camp.” Quote by a rehabilitation assistant in Kalobeyei camp-Kakuma Kenya (Amani), Center for Victims of Torture.

Provide Protocol-Based Care [edit | edit source]

Many organisations have developed health care protocols that identify how common conditions should be managed. This has helped to enhance patient care. There are also protocols and recommendations to make sure that rehabilitation professionals are assessing for Red Flags, which would necessitate onward referrals to other medical professionals. 

Provide Rehabilitation and Intermediate Care - Joining Up Health and Social Care[edit | edit source]

When clients need extra services in addition to rehabilitation (e.g. shelter and protection, livelihood support, and medical appointments), rehabilitation assistants are able to accompany these clients and help advocate for them. If clients are unable to access rehabilitation centres (i.e. they live too far away to walk to the clinic, they are unable to afford the fare for a motorbike, which is often the only form of transportation in camps), rehabilitation assistants are sometimes able to provide home-based exercise programmes under the direction of the rehabilitation professional. 

Mobilisation and Community Sensitisation[edit | edit source]

Rehabilitation assistants play an integral role in community sensitisation. They typically have a good understanding of cultural differences and communication barriers and often speak many languages. Together with rehabilitation professionals, they are able to package the community sensitisation messages to meet the needs of various target groups. Most persons of concern (another term for persons living within camps), especially newer arrivals, also need to be informed about health care facilities available within the camp. Rehabilitation assistants are able to identify persons of concern with health care needs within the community and to help to refer them to services they may need.  

"Some clients do fear looking for assistance. Therefore, we go after them (approach them) in the community." Quote by a rehabilitation assistant in Kalobeyei Camp - Kakuma Kenya (Jeremy), Center for Victims of Torture.

Supervision of Rehabilitation Assistants[edit | edit source]

Rehabilitation assistants require different amounts of supervision. The frequency and amount of supervision depends on their employer, setting, nature of the work and their specific skills. Rehabilitation assistants working in NGOs dealing with torture and trauma work require close supervision. In most organisations, rehabilitation assistants are mentored and supported by a qualified staff member. They receive both individual and group supervision.

The WHO estimates that there are fewer than ten rehabilitation professionals (physiotherapists, occupational and speech therapists etc.) per one million residents in low- and middle-income countries, so it is clear that there are not enough rehabilitation professionals to meet the needs of all who would benefit from receiving rehabilitation services. Community-based rehabilitation workers and rehabilitation assistants help to fill important gaps in services.[37] 

Quotes from Rehabilitation Assistants[edit | edit source]

It is important for rehabilitation professionals to read first person accounts of displaced persons so that they can try to better understand the experiences of displaced persons. The following are several quotes from rehabilitation assistants from the Center for Victims of Torture, who themselves are displaced persons living in Kalobeyei Settlement and who are often former clients themselves. 

"I was a little bit anxious about the work because CVT clients are torture survivors and I am also a survivor. CVT had the solution - They gave us supervision every week and also gave us training on how to care for our self during and after work so that we are not affected by the client histories." Quote from a female rehabilitation assistant in Kalobeyei Camp - Kakuma Kenya (Chukulisa), Center for Victims of Torture

"Respect is very important while working with others since it helps to maintain good contact and peace at work. I do empathize with my clients since I am aware of the suffering that my clients go through. There is a great impact in the community from clients who have attended physiotherapy sessions; they feel better and the pain and injuries that they’ve had for a long time get to be managed. They acquire strategies to manage their symptoms and become productive people in the community." Quote from a rehabilitation assistant in Kalobeyei Camp - Kakuma Kenya (Jeremy), Center for Victims of Torture.

"The physiotherapist should know that many of refugees have been tortured, and that some of them have money, some went to school, some had been working with the government and for other NGOs. To assist them, the physiotherapist should know how they have been living and understand the causes of the problems or pain that they are having. If the physiotherapists could research to know what is happening in different countries and different culture in Africa it can be easy to assist the clients." Quote from a rehabilitation assistant in Kalobeyei Camp - Kakuma Kenya (Amani), Center for Victims of Torture.

Challenges for Rehabilitation Assistants[edit | edit source]

It is essential that rehabilitation assistants are supported to continue to develop their skills and not be put in situations where they are asked to work beyond the scope of their practice. “They need to be appropriately supported to develop contextually relevant skills, knowledge and competence, and in some cases be a jack of all trades”.[19]

Another issue for rehabilitation assistants is that it can be difficult to establish and to maintain boundaries, as they live in the same camps as their clients. In one of the quotes above (see Provide Faster, More Accessible Care section), rehabilitation assistant, Amani, mentions that clients know where rehabilitation assistants live and at times go to their houses for advice and rehabilitation-related consultation. While this has benefits for rehabilitation, it can also be challenging for rehabilitation assistants. During the COVID-19 pandemic, it was even more problematic. It is difficult to both maintain physical distance and safe practices, but still be accessible to the clients. It is also challenging to convey a caring presence, but to maintain a separation between their work and their home lives. Rehabilitation professionals working in camps typically live in a compound with other NGO workers. They, therefore, have a more natural work-life balance and separation than many of the rehabilitation assistants who are in the camps at all times. 

Self-Care for those Working in Camps[edit | edit source]

It is important that physiotherapists who are working and living in camps pay close attention to their needs for self-care. Often, these are unaccompanied positions, so rehabilitation professionals are far away from their family and friends. The work can be very challenging and they are exposed to a great deal of human suffering and the unmet needs of their clients.

There are many blogs, podcasts, free online courses, Facebook groups and other resources for rehabilitation professionals and others working in humanitarian settings, which may be helpful. One example is the “Awake at Night” Podcast, produced by UNHCR. This podcast has episodes about humanitarian workers, including the joys and difficulties of their work, and what they do to find meaning and comfort.[40]

There is a global Facebook group for physiotherapists who are working with refugees and survivors of torture, with over 200 physiotherapists from more than 30 countries. For information about joining the group, please send a Facebook Message or Facebook friend request to Laura Pizer Gueron, physiotherapist. Physiotherapists share resources in a confidential forum in this group. 

The website, ProQOL.org (Professional Quality of Life), is dedicated to helping humanitarian workers, including rehabilitation professionals, assess their current status and to find resources for improving their self -care. There is a measure there, which rehabilitation professionals can fill out in about 10 minutes and self-score. This measure provides validated and reliable scores in the three areas of:

  1. Burnout
  2. Compassion Fatigue versus Compassion Satisfaction  
  3. Secondary Traumatic Stress/Vicarious Traumatisation versus Vicarious Transformation. 


Here is the link to the English Language Version[41] - the ProQOL has official translations available in 26 languages.

Some NGOs have their staff fill out the ProQOL Measure quarterly using the Pocket Card, or at other appropriate intervals, so that they can get a sense of their baseline scores in all three scales. By filling it out regularly, they will get an early warning if they are starting to have difficulties in one or more areas, so that they can get support as needed. 

Disaster Ready[42] has more than 1,000 free resources for humanitarian workers, including many online courses and you can create a free account. While Disaster Ready is not designed specifically for physiotherapists, many of the courses at the site, about self-care, security, management, communication, programme planning, etc. would be of help to rehabilitation professionals who are working in camp or urban refugee settings. 

The Headington Institute[43] also has many free, online resources for humanitarian workers, including training about self-care and other topics which are designed to help the helpers to be happier, healthier, and as effective as possible.

“50 Shades of Aid” is another Facebook group which is geared towards humanitarian workers, including rehabilitation professionals, where members share ideas and support. To join this private group, send a message to the organisers.

Challenges in Provision of Rehabilitation Services in Long Stay Camps[edit | edit source]

Language[edit | edit source]

In some camps, such as Kakuma in northwestern Kenya, there are more than 30 languages spoken by those living in the camps. It can be difficult for NGOs to hire and train interpreters in all of the needed languages so that rehabilitation professionals can adequately communicate with their clients. It is ideal to hire rehabilitation assistants who speak many different languages as well, so that they can interpret during sessions co-led with the rehabilitation professional as well. 

Cultural-Spiritual Beliefs, Illness Perception and Expressions of Pain[edit | edit source]

Rehabilitation professionals working in camps will often work with clients from many different countries, cultures and religious backgrounds. Each client may have very different perceptions of illness, idioms of pain. It is, therefore, crucial for rehabilitation professionals to understand these beliefs as much as possible, so that they can offer relevant instruction and use appropriate metaphors when working to address issues with pain and other issues. Many NGOs cultivate strong connections with community leaders from various displaced persons groups, so that they can continue to learn and optimise their care. 

“When the clients visit our center for physiotherapy, we lead them in some exercises as instructed and prescribed by the physiotherapist. As a refugee also, I can connect well with the clients because I understand the culture and terms to use when giving instructions and health education.” Quote by a rehabilitation assistant in Kalobeyei camp-Kakuma Kenya. (Jeremy), Center for Victims of Torture.

Access and Awareness of Rehabilitation Services[edit | edit source]

Many camps have many NGOs providing many different types of services. Rehabilitation professionals are often in short supply, as mentioned previously. It can, therefore, be difficult for often overstretched rehabilitation team members to sufficiently sensitise community members. It can also be difficult for rehabilitation team members to make themselves visible enough to other NGOs to ensure these NGOs refer their clients for rehabilitation services. By doing external trainings about topics of interest for staff members of other agencies, such as self-care, sleep, pain reduction, proper body mechanics and similar topics, rehabilitation professionals can increase their visibility in the camp.

Conclusion[edit | edit source]

Rehabilitation professionals working in camps for displaced persons often find their work to be extremely rewarding. They need to be well-rounded clinicians who can learn to work closely with other disciplines, both within and outside of health care such as counsellors and teachers, in order to best meet the needs of their clients. In many camps, they will be recruiting, training, supervising and learning from rehabilitation assistants, who are members of displaced communities themselves who live in the camps. Ideally, the relationship between rehabilitation assistants and rehabilitation professionals should be very reciprocal and respectful, where both learn from each other.

Resources[edit | edit source]

Blogs written by Physiotherapists and Rehabilitation Assistants working in a Camp for Displaced Persons in Kenya (Kalobeyei Refugee Settlement next to Kakuma Refugee Camp) The following are some accounts written by Kenyan physiotherapists and an rehabilitation assistant working in Kakuma. Reading blogs, written by the staff members working on the ground in displaced persons camps, can be very powerful and may provide a more “human face” to the work of physiotherapists in these camps. The blogs address the benefits of physiotherapy, difficulties of providing therapy in a refugee camp, finding meaning and preventing burnout and secondary traumatisation and how life and work has changed due to the COVID-19 pandemic.


Blogs about Working with Traumatised Refugees in Camps for Displaced Persons from Counselling, Logistics or General Perspectives 

References[edit | edit source]

  1. United Nations High Commissioner for Refugees (UNHCR): Global Trends. Forced Displacement in 2021. Available from: https://www.unhcr.org/globaltrends[Accessed 23 June 2022]
  2. 2.0 2.1 2.2 UNHCR. Figures at a Glance. Available from: https://www.unhcr.org/en-ie/figures-at-a-glance.html [Accessed 24 June 2022]
  3. UNHCR. Ukraine Refugee Situation Portal. Available from: https://data.unhcr.org/en/situations/ukraine#_ga=2.174995874.1898281340.1656069316-885200820.1645807158(Accessed 24 June 202).
  4. World Health Organisation Regional Office for Europe. Health Evidence Network Synthesis Report 44 - Public health aspects of migrant health: a review of the evidence on health status for refugees and asylum seekers in the European Region. 2015. Available from:http://www.euro.who.int/__data/assets/pdf_file/0004/289246/WHO-HEN-Report-A5-2-Refugees_FINAL.pdf[Accessed 25 September 2020]
  5. Sigvardsdotter E, Vaez M, Rydholm Hedman AM, Saboonchi F. Prevalence of torture and other war-related traumatic events in forced migrants: A systematic review. Torture 2016;26(2):41-73.
  6. Aebischer Perone SA, Martinez E, du Moriter S, Rossi Ro, Pahud M, Urbaniak V, et al. Non-communicable diseases in humanitarian settings: Ten essential questions. Conf Health 2017; 11(17), 1-11. doi.org.10.1186/s13031-017-0119-8
  7. World Health Organization. Report on the Health of Refugees and Migrants in the WHO European Region. Geneva.  World Health Organization, 2018; Available from: http://www.euro.who.int/data/assets/ [Accessed 25 September 2020]
  8. Bradby H, Humphris R, Newall D, Phillimore J. Public health aspects of migrant health: A review of the evidence on health status for refugees and asylum seekers in the European region. Health Evidence Network Synthesis Report, 2015; 44. Copenhagen: WHO Regional Office For Europe.
  9. 9.0 9.1 Stammel S, Knaevelsud C. Schock K, Walther LCS, Wenk-Ansohm MP, Bottche M. Multidisciplinary treatment for traumatized refugees in a naturalistic setting: Symptom courses and predictors. Eur J Psychotraum 2017;8(2). Available from:https://doi.10.1080/20008198.2017.1377552 [Accessed 25 September 2020]
  10. 10.0 10.1 Dibaj II, Halvorsen JO< Kennair LEO, Stenmak HI. An evaluation of combined narrative exposure therapy and physiotherapy for comorbid PTSD and chronic pain in torture survivors. Torture 2017;27(1:13-27)
  11. 11.0 11.1 McGowan E, Beamish N, Stokes E, Lowe R. Core competencies for physiotherapists working with refugees: A scoping review. Physiotherapy 2020;108:10-21. Available from: https://doi.org/10.1016/j.physio.2019.01.002 [Accessed 25 September 2020]
  12. UNHCR. Global Compact on Refugees. 2 October 2018. Available from: https://www.unhcr.org/gcr/GCR.English.pdf [Accessed 25 September 2020]
  13. Nilsson H, Saboonchi F, Gustavsson C, Malm A, Gottvall M. Trauma-afflicted refugees’ experiences of participating in physical activity and exercise treatment: A qualitative study based on focus group discussions. Eur J Psychotraumatol 2019;10(1):1699327. Available from:https://www.doi.org:10.1080/200008198.2019.1699327 [Accessed 25 September 2020]
  14. 14.0 14.1 Knappe F, Colledge F, Gerber M. Challenges associated with the implementation of an exercise and sport intervention program in a Greek refugee camp: A report of professional practice. Int J Env Res Pub Health. 2019; 16(4926):1-19. Available from: https://www.doi:10.3390/jerph16244926 [Accessed 25 September 2020]
  15. O’Keefie M, Hayes A, McCreesh K, Purtill H, O’Sullivan, K. Are group-based and individual physiotherapy exercise programmes equally effective for musculoskeletal conditions? A systematic review and meta-analysis. Brit J Sports Med 2017;51(2):126-132. Available from: https://doi.org/10.1136/bjsports-2015-045410 [Accessed 25 September 2020]
  16. 16.0 16.1 Harlacher U, Polatin P, Taing S, Phana P, Sok P, Sotherra C. Education as a treatment for chronic pain in survivors of trauma in Cambodia: Results of a randomized controlled outcome trial. Int J Conf Violence 2019;13:1-26. Available from: https://doi.org/10.4119/UNI9/ijcv.655 [Accessed 25 September 2020]
  17. Crosby SS. Primary care management of non-English-speaking refugees who have experienced trauma: A clinical review. JAMA 2013; 310(5): 519-528. Available from: https://doi.org/10.1001/jama2013.8788 [Accessed 25 September 2020]
  18. 21. McMurray J, Breward K, Breward M, Alder R, Arya N. Integrated primary care improves access to healthcare for newly arrived refugees in Canada. J Imm Min Health 2014; 16(4):576-585. Available from: https://doi.org/10.1007/s10903-013-9954-x [Accessed 25 September 2020]
  19. 19.0 19.1 19.2 Rolfe G, Jackson N, Gardner L, Jasper M, Gale A. Developing the role of the generic healthcare support worker: Phase 1 of an action research study. Int J Nurs Stud 1999;36:323–334
  20. Cheng IH, Vasi S, Wahidi S, Russel lG. Rites of passage: improving refugee access to general practice services. Aust Fam Phys, 2015; 44:503–507.
  21. 21.0 21.1 Saks M, Allsop J. Social policy, professional regulation and health support work in the United Kingdom. Soc Pol Soc 2007; 6:165–177.
  22. 22.0 22.1 22.2 Amris K, Jones L, Williams A. Pain from torture: Assessment and management. Pain Rep 2019;4(6):e794. Available from:https://doi.org.10.1097/PR9.0000000000000794 [Accessed 25 September 2020]
  23. 23.0 23.1 Nordin I, Perrin S. Pain and posttraumatic stress disorder in refugees who survived torture: The role of pain catastrophizing and trauma-related beliefs. Eur J Pain 2019;23:1497-1506. Available from: https://doi.10.1002/ejp.1415 [Accessed 25 September 2020]
  24. 24.0 24.1 Tsur N, Defrin R, Shahar G, Solomon Z. Dysfunctional pain perception and modulation among torture survivors: The role of pain personification. J Aff Dis 2020;46(4):15(265:10-17. Available from: https://www.hhri-gbv-manual.org or https://doi.10.1016.j.jad.2020.01.031 [Accessed 25 September 2020]
  25. 25.0 25.1 Golden S. Assessing mental health in Kalobeyei: A representative survey of refugees and host communities. St. Paul, MN. The Center for Victims of Torture 2018;1-40.
  26. Golden S. Assessing refugee mental health in Ethiopia: A representative survey of Aid Harush and Mai Ani Camps. St. Paul, MN. The Center for Victims of Trauma 2017. Available from: https://www.cvt.org/sites/default/files/attachments/u93/downloads/Assessing_Refugee_Mental_Health_in_Ethiopia_letter_v1.pdf [Accessed 25 September 2020]
  27. Elshafie R. Assessing mental health in Bidi Bidi, Uganda: A representative survey of South Sudanese refugees in Zone 5. St. Paul, MN. The Center for Victims of Torture 2020. Available from:https://www.cvt.org/sites/default/files/attachments/u93/downloads/cvtbidi_bidi_2019_mhpss_survey_report.pdf [Accessed 25 September 2020]
  28. 28.0 28.1 Nielsen H. Interventions for physiotherapists working with torture survivors, with special focus on chronic pain, PTSD, sleep issues. Dignity Publication Series on Torture and Organized Violence—Praxis Paper 2014. 
  29. Sandahl H, Jennum P, Baandrup L, Pschmann IS, Carlsson J. Treatment of sleep disturbances in trauma-affected refugees: Study protocol for a randomised controlled trial. Trials 2017:18(520). Available from:https://doi.org/10.1186/s13063-017-2260-5 [Accessed 25 September 2020]
  30. Siengsukon CF, Al-dughmi M, Stevens S. Sleep health promotion: Practical information for physical therapists. Phys Ther 2017;97(8):826-836. Available from: https://doi.org/10.1093/ptj/pzx057 [Accessed 25 September 2020]
  31. Albert H. Psychosomatic group treatment helps women with chronic pelvic pain. J Psych Ob Gyn 1999;20(4):216-225. Available from: https://doi.org.10.3109/01673829909075598 [ACcessed 25 September 2020]
  32. Dermain S, Smith JF, Hiller L, Dziedzic K. Comparison of group and individual physiotherapy for female urinary incontinence in primary care: A pilot study. Physiotherapy 2001;87(5):235-242. Available from: https://doi.org/10.1016/S0031-9406(05)60784-5 [Accessed 25 September 2020]
  33. Dorey G, Speakmen M, Feneley FCL, Swinkels A, Dunn. Pelvic floor exercises for erectile dysfunction. Brit J Ur Int 2005;96(4):595-597. Available from: https://doi.org/10.1111/j.1464-410x.2005.05690.x [Accessed 25 September 2020]
  34. Myers C, Smith M. Pelvic floor muscle training training improves erectile dysfunction and premature ejaculation: A systemic review. Physiotherapy 2019;105(2);235-243. Available from:https://doi.org/10.1016/j.physio.2019.01.002 [Accessed 25 September 2020]
  35. Rosenberg TY. Pelvic floor involvement in male and female sexual dysfunction and the role of pelvic foor rehabilitation in treatment: A literature review. Uro Phys Priv Prac 2007. Available from: https://doi:10.1111/j.1743-6109.2006.00339 [Accessed 25 September 2020]
  36. Ussing A, Dahn, II, Due U, Sorensen M, Petrsen J, Bandholm T. Efficacy of supervised pelvic floor muscle training and biofeedback vs. attention-conrol treatment with fecal incontinence. Clin Gast Hep 2019;17:2253-2261.
  37. 37.0 37.1 37.2 The World Health Organization. The Need to Scale Up Rehabilitation. Rehabilitation 2030: A Call for Action. 2018.
  38. 38.0 38.1 38.2 38.3 38.4 Mitchell-Gillespie B, Hashim H, Griffin M, AlHeresh R. Sustainable support solutions for Community-Based Rehabilitation Workers in refugee camps: Piloting telehealth acceptability and implementation. 2020. Research Square-preliminary report. Available from:  https://doi.org/10.21203/rs.3.rs-34117/v1;1-21 [Accessed 25 September 2020]
  39. Moran, AM, Nancarrow, SA, Wiseman L, Maher,K, Boyce RA, Borthwick AM, Murphy K. Assisting role redesign: A qualitative evaluation of the implementation of a podiatry assistant role to a community health setting ultilising a traineeship approach. J of Foot and Ankle Res 2012;5(30). Available from: https://doi.org/10.1186/1757-1146-5-30 [Accessed 25 September 2020[
  40. UNHCR. AWAKE AT NIGHT - A Podcast with Melissa Fleming. Available from: https://www.unhcr.org/awakeatnight/ [Accessed 25 September 2020]
  41. Pro QOL. Professional Quality of Life Measure (ProQOL 5.0). Available from: https://proqol.org/proqol-measure [accessed 2 July 2022]
  42. Disaster Ready. Available from;https://www.disasterready.org/courses [accessed 23 June 2022]
  43. The Headington Institute. Available fromhttps://www.headington-institute.org/ [accessed 2 July 2022]