living an uncertain future: an ethnography of displacement, health, psychosocial well-being and the

369 Pages·2012·1.62 MB·English

by  Case User

LIVING AN UNCERTAIN FUTURE: AN ETHNOGRAPHY OF
DISPLACEMENT, HEALTH, PSYCHOSOCIAL WELL-BEING AND
THE SEARCH FOR DURABLE SOLUTIONS AMONG IRAQI
REFUGEES IN EGYPT

by
NADIA ROSE EL-SHAARAWI

Submitted in partial fulfillment of the requirements
For the degree of Doctor of Philosophy

Department of Anthropology
CASE WESTERN RESERVE UNIVERSITY
January 2012
CASE WESTERN RESERVE UNIVERSITY
SCHOOL OF GRADUATE STUDIES
We hereby approve the thesis/dissertation of
______________________________________________________
candidate for the ________________________________degree *.
(signed)_______________________________________________
(chair of the committee)
_
_
_
_
_
(date) _______________________
*We also certify that written approval has been obtained for any
proprietary material contained therein.
Copyright © 2011 by Nadia Rose El-Shaarawi
All rights reserved

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For Iraqi refugees in Egypt

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Table of Contents
List of Tables .............................................................................................................................. 7
List of Figures............................................................................................................................. 8
Acknowledgements ..................................................................................................................... 9
List of Acronyms and Abbreviations ......................................................................................... 11
Chapter 1: Introduction ............................................................................................................. 14
Objectives and Research Questions ....................................................................................... 15
Significance .......................................................................................................................... 17
Outline of chapters ................................................................................................................ 23
Chapter 2: Literature Review .................................................................................................... 25
Anthropology of the Middle East and North Africa ............................................................... 25
Early work on the Middle East and North Africa ............................................................... 26
Space and Identity in the Middle East and North Africa ..................................................... 29
Experiential and Reflexive Approaches ............................................................................. 31
Gendered Approaches ....................................................................................................... 34
Globalization, Transnationalism and the Middle East......................................................... 39
The Anthropology of Forced Migration ................................................................................. 43
Defining Forced migration ................................................................................................ 44
Early Anthropological Perspectives on Migration .............................................................. 50
New Perspectives in Migration Theory .............................................................................. 57
The study of refugees and forced migrants within anthropology ......................................... 64
Forced Migration in the Middle East ................................................................................. 69
Forced migration, health and psychosocial well-being ........................................................... 72
Forced Migration and Health ............................................................................................. 74
The Mental Health and Psychosocial Well-Being of Refugees ........................................... 75
Chapter 3: Theoretical framework – Culture, mental health and experience in contexts of
uncertainty ................................................................................................................................ 79
Experience-near approaches in medical and psychological anthropology ........................... 80
Suffering and subjectivity in states of crisis and uncertainty ............................................... 84
Exile and experiences of liminality .................................................................................... 85
Ethnopsychology and Ethnopsychiatry in the Middle East and North Africa .......................... 89
Mental Health and Illness .................................................................................................. 93
Idioms of Distress ............................................................................................................. 97
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Social and cultural factors that impact mental illness ....................................................... 101
Chapter 4: Background ........................................................................................................... 103
Introduction ........................................................................................................................ 103
Background on the situation in Iraq ..................................................................................... 104
Periods of Iraqi forced migration ......................................................................................... 110
Iraqi refugees in the Middle East ......................................................................................... 113
Iraqi refugees in Egypt ........................................................................................................ 117
Fieldsite .............................................................................................................................. 121
The Resettlement Legal Aid Project ................................................................................ 121
Cairo, Egypt .................................................................................................................... 123
Entering the field ............................................................................................................. 125
Chapter 5: Methods ................................................................................................................. 127
Methodology ....................................................................................................................... 127
Study Procedures ................................................................................................................ 129
Sampling Procedures ........................................................................................................... 129
Recruitment ........................................................................................................................ 132
Data Collection ................................................................................................................... 134
Data Analysis Procedures .................................................................................................... 138
Ethics .................................................................................................................................. 142
Sample Characteristics ........................................................................................................ 142
CHAPTER 6: Life in Egypt .................................................................................................... 146
Introduction ........................................................................................................................ 146
Travel to Egypt and Arrival ................................................................................................. 149
Date of arrival to Egypt ................................................................................................... 149
Mode of travel ................................................................................................................. 150
Reason for travel to Egypt ............................................................................................... 151
Daily Life in Egypt ............................................................................................................. 161
Employment in Egypt ...................................................................................................... 166
Income ............................................................................................................................ 169
Living Conditions in Egypt compared to Living Conditions in Iraq .................................. 173
Education ........................................................................................................................ 179
Family life in exile .............................................................................................................. 192
Family Size ..................................................................................................................... 192
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Importance of the family ................................................................................................. 193
Family dynamics ............................................................................................................. 195
Social life ............................................................................................................................ 199
Social Relations with Egyptians ...................................................................................... 199
Social Relations between Iraqis ....................................................................................... 208
From Iraq to Egypt: Insecurity to Instability ........................................................................ 213
Chapter 7: Instability and Hala Nufsia: Psychosocial well-being among Iraqi refugees in Egypt
............................................................................................................................................... 220
The prevalence of poor hala nufsia ...................................................................................... 226
Manifestation and effects of poor hala nufsia ...................................................................... 228
Gendered dimensions of health and hala nufsia ................................................................... 250
Perceived causes of poor hala nufsia ................................................................................... 253
Instability is making us tired: Instability as a cause of poor hala nufsia ................................ 260
Chapter 8: Seeking Resettlement ............................................................................................. 267
Introduction ........................................................................................................................ 267
‘Durable solutions’ .............................................................................................................. 270
Introduction to Paradoxes of the Resettlement Process: Lubna’s Story ................................. 279
Refugees’ Desire for Resettlement....................................................................................... 280
The Paradox of Vulnerability in the Refugee Resettlement Process ...................................... 286
The Paradox of Liminality and Instability in the Resettlement-Seeking Process ................... 296
Chapter 9: Conclusion ............................................................................................................. 309
Summary of main findings .................................................................................................. 309
Summary of Contributions .................................................................................................. 316
Strengths and limitations ..................................................................................................... 317
Research implications ......................................................................................................... 320
Appendix A: Interview Guides ................................................................................................ 325
Appendix B: Codebook ........................................................................................................... 329
Appendix C: Self-Identified Health Conditions of Iraqi Refugees ............................................ 338
Appendix D: Self-Identified problems with hala nufsia for Iraqi refugees ................................ 339
Bibliography ........................................................................................................................... 341

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List of Tables

Table 1: Demographic Characteristics of the Refugee Sample………………………...145
Table 2: Date of Arrival in Egypt………………………………………………………150
Table 3: Health and Psychological Issues………………………………………………221
Table 4: “How Does Your Psychological Situation Affect You?”……………………..232
Table 5: Health and Hala Nufsia, by Gender…………………………………………...252
Table 6: Common Responses to Question about Hala Nufsia………………………….252
Table 7: Resettlement Reasons…………………………………………………………289

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List of Figures
Figure 1: Relationships between Instability and Psychological Suffering……………..226
Figure 2: The Process of Seeking Resettlement………………………………………..278

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Acknowledgements

The kindness and assistance of so many people and organizations made this
project possible and I am incredibly thankful for their help. I would first like to thank the
many Iraqis who I met in Egypt for sharing your time, welcoming me into your homes
and lives, and sharing your stories and experiences. I have often been inspired by the
strength and dignity you possess under difficult conditions and in the face of suffering
and loss. It is my hope that I have done some small measure of justice to your
experiences and accounts, and that you achieve the stability and future you so deserve.
This work was supported by a National Science Foundation Doctoral Dissertation
Improvement Grant, which made the field research possible. Portions of the project, as
well as support before and after fieldwork, were funded by a Canadian Institutes of
Health Research Doctoral Research Award. The Case Western Reserve University
College of Arts and Sciences provided partial funding for write-up through the Arts and
Sciences Dissertation Writing Fellowships and the Richard B. Zdanis Award.
I would like to thank my committee, Professors Eileen Anderson-Fye, Atwood
Gaines, Janet McGrath and Scott Frank for their excellent guidance, mentorship and
support. You have all been supportive of me throughout my graduate career, and I have
learned so much from your own exceptional scholarship. Thanks in particular are due to
Eileen Anderson-Fye for her insightful critique, thoughtful ideas, and tireless
encouragement over the years.
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