Faith and Mental Health Help Shape the Integration of Muslim Refugees in Germany
Large influxes of asylum seekers and other migrants to Europe from Muslim-majority countries have inevitably led to a significant rise in the number of Muslims in Germany, who in 2016 made up nearly 6 percent of Germany’s population. Even with no future net migration, Muslims will likely represent 9 percent of the country’s population by 2050, the Pew Research Center estimates. The rapid scale of arrival of nearly 1 million asylum seekers from Syria, Iraq, and Afghanistan—all Muslim-majority countries—to Germany in recent years has significantly affected the sociopolitical landscape, partly leading to a growing populist and nationalist backlash with groups advancing anti-immigration agendas. This has also reduced religious tolerance towards the growing Muslim community in Germany, particularly in eastern parts of the country where fewer Muslims live and where about 57 percent of the population perceive Islam as a threat; it also continues to have significant national implications for promoting social cohesion and integration of recently arrived refugees.
These developments come in a country that has long invested in immigrant integration programs and citizenship policies built on the premise of economic and population growth, and encouraged by public consensus surrounding declining birth and increasing death rates witnessed in Germany since the 1970s. Decades of small-scale labor migration policies have attracted millions of migrants from Turkey, Russia, Poland, and Italy to address both short- and long-term labor shortages, making Germany the second most popular destination for migrants in the world after the United States as of 2019. Promotion of a “culture of welcome” (or Willkommenskultur) undergirds efforts to attract new immigrants, as does a culture of recognition (or Anerkennungskultur) to foster inclusion. As a result, Germany has been a model country for immigration and integration practice and policy, and the government has actively played a role in the economic and social integration of asylum seekers and other migrants arriving within the past two decades.
Many of the 1.77 million refugees and asylum seekers in Germany are from Syria. Recent studies report high prevalence of mental distress among Syrian refugees resettled in Germany and an increased risk among refugees, in comparison to the host population, for developing a severe mental illness. More broadly, research by Thomas Elbert et al. suggests that more than 50 percent of asylum seekers who arrived in Germany during the 2015-16 migration crisis showed signs of a mental disorder, one-quarter of them with diagnosable post-traumatic stress disorder (PTSD), anxiety, or depression. Discrimination and stereotyping of refugees and migrants, particularly those from Muslim-majority countries, often are propagated by negative media coverage and misinformation campaigns, and can lead to feelings of discrimination or isolation. This can exacerbate pre-existing psychological conditions, such as trauma, depression, and anxiety, and lead to additional isolation and alienation, further complicating the integration process for refugee communities.
Faith as a component of and contributor to mental health plays a significant role in the social integration and inclusion of refugees and asylum seekers. This is particularly the case for those who fled their countries due to political or religious persecution, have experienced traumatic events throughout their displacement journey, and are experiencing discrimination or difficulties integrating in their new host country. Yet many Germans’ perceptions of migrants from Muslim-majority countries and concerns about Islam that predate the refugee crisis have complicated modern integration and social cohesion efforts. Surveys from the early 2010s found that Germans held some of the deepest anti-Muslim sentiments in Europe, ushering in policies and programs (such as the Deutsche Islam Konferenz, or the German Islam Conference, in 2006) focused on promoting dialogue between Germans and Muslims living in Germany, and preventing attitudes of bias and discrimination towards the Muslim population. However, lingering anti-Muslim sentiments exacerbated by the tense immigration rhetoric continues to create an alienating environment for new arrivals, potentially exacerbating poor mental health and preventing successful integration.
Based on the author’s interviews with Syrian and Iraqi refugee adults in Berlin in early 2019, this article provides an overview of the role of faith and mental health in refugees’ integration and wellbeing, and describes how faith is used as a coping mechanism by these newcomers in Germany, with implications for humanitarian migrants across Europe. A fuller rendering of the author's research methodology and findings can be found in Frontiers in Psychiatry.
Integration Policies and Practices since 2015
Although immigrant integration policy in Germany was evolving well before 2015, and indeed traces back to the late 1990s and early 2000s, the arrival of large numbers of asylum seekers in 2015 and 2016 has demonstrated the importance of developing policies that consider both the short- and long-term needs of refugee and asylum-seeking populations. These lessons were learned the hard way, when national, regional, and local governments and nongovernmental organizations (NGOs) found themselves unprepared for the influx of arrivals in 2015, and responded reactively to arrange temporary housing, provide emergency health services, and create ad-hoc employment options for new arrivals.
Recent efforts to better tailor integration programming and policies to fit the needs of new arrivals have paid off. Studies have demonstrated that the economic and social integration of refugees has improved substantially in the last five years, with greater numbers of asylum seekers enrolled in schools or working. Furthermore, while most refugees in Germany qualify for public welfare payments, enrollment has dropped in recent years, indicating a growing sense of self-sufficiency.
Germany had more than 1.77 million refugees and asylum seekers as of December 2020, of whom nearly 93,800 sought asylum between January and November 2020. The largest group of these new applicants was from Syria, followed by Iraq and Afghanistan. This is a significant drop from the 722,000 applications from asylum seekers of all nationalities who came to Germany in 2016. Backlogs in asylum applications, as well as the onset of the COVID-19 pandemic, have slowed migration and refugee processing systems. However, Germany remains a top destination for individuals seeking asylum in Europe and serves as a useful case study to observe integration issues that have resonance across Europe.
In the period since the migration crisis, policymakers and practitioners have focused on refugees’ access to health care—and particularly mental-health care—as an integral part of forward-looking integration plans, given the fact new asylum seekers have historically been restricted in their access to care and paid high costs over the long term.
Studies have demonstrated that factors such as employment, interactions with members of the host society, and proficiency in host-country language skills are correlated with lower levels of distress among refugee populations in Germany, therefore facilitating integration. To this end, the 2016 Integration Act and other policies put in place after 2015 require asylum seekers to undergo extensive formal integration instruction before they can access the labor market and apply for permanent residency permits. This has placed significant stress on them to integrate quickly, regardless of their mental health needs. Asylum seekers who flee conflict often experience shock, upheaval, and psychological burdens before, during, and after their journeys. Often, they find it difficult to concentrate in the classroom or to feel motivated to learn a language or seek employment.
Box 1. Interview Methods
In collaboration with the Charité University of Medicine, the author conducted in-person interviews between December 2018 and May 2019 with 17 Arabic-speaking Syrian and Iraqi Muslim refugee adults (11 male, 6 female) seeking services at a mental health clinic in Berlin. Interviews were conducted in tandem with the Mental Health in Refugees and Asylum Seekers (MEHIRA) project funded by the German Ministry of Health, which, in addition to identifying trends in mental-health diagnoses among this population, is exploring how mental-health care can be delivered in a manner that is culturally sensitive and overcomes the social, cultural, and linguistic barriers that can be found in the German health system. The project has researched the efficacy of offering health-care services in the client’s native language and by a provider of similar cultural background.
Research questions were designed to solicit comprehensive perspectives from refugees on their mental health, with an emphasis on spiritual and religious or faith-based coping, and how this facilitated or impeded their integration into German society.
Interviewees’ Integration Challenges
Among the main challenges interviewees identified to their integration process were the difficulty of learning the German language and issues with finding employment and securing adequate housing, including leaving crowded refugee accommodation centers and moving into private apartments. The refugees’ perceived inability or actual hurdles to their ability to integrate into German society were also intertwined with diagnosed and self-described overall negative emotions and poor mental health.
For example, study participants who worked as highly skilled professionals in their countries of origin described the difficulty of not being able to work in their field of practice in Germany and the negative impact this had on their mental health. A 28-year-old man who studied industrial engineering in Syria said:
The main challenge was language, and finding an apartment is very difficult. Also, being able to work in the field that I studied. I have to transfer my degree here and receive accreditation through an exam I have to take in Berlin. I registered for the exam, but right before the exam I became extremely distressed. I decided that after this I will not pursue this option.
Finding employment in my field of study and barriers related to language; I usually have high expectations, so this is what is making me depressed. I am looking for work that I want to help push and develop myself further.
Other interviewees similarly identified mental-health issues as the cause of their inability to learn German, leading to challenges finding employment and integrating more fully. A 31-year-old woman who had fled Syria following the onset of the conflict explained:
I cannot focus on learning the language. When I try to focus, I explode. I get a migraine. I do feel the barrier of language. If you do not speak well, some Germans do not try and help you speak. They make themselves seem like they do not understand.
Some interviewees cited their mental-health problems as a barrier to integration more broadly. A 26-year old man who had fled Iraq as a young child, following the onset of the Gulf War, and has been displaced multiple times, said:
My main challenge is myself. My sickness and my mental-health condition is what I am battling now. I wake up early in the morning and I do not have a routine. I am trying to fight myself, to fight my condition and the nightmares I am enduring. Some of this is happening because of the situation I faced in Iraq, and ongoing stress, and always being a foreigner; between Syria, Turkey, to Europe, we are not living a normal life. This is 100 percent the reason. I feel as if my personality ended in Iraq, such as having a free personality.
A 45-year-old man from Iraq who had been exiled and lost a number of family members since arriving in Germany shared additional challenges regarding integration and wellbeing:
I do not have any control over my life. I am not sure what the purpose is. I cannot decide what is right or wrong, what has a benefit and what doesn’t. I cannot understand. I have been here in Germany for four years, the only thing I do have is passing the driver’s license exam and having my license now. I want to work.
Still, not all study participants pointed to mental health as a source of their difficulties integrating. Others cited external forms of distress such as changes in environment and lack of support from the host community. But the repeated mentions of mental health as a barrier to refugees’ ability to integrate suggests that the complaint is significant.
Challenges for Female Asylum Seekers
A 30-year-old, headscarf-wearing Syrian woman shared how she felt discriminated against and was afraid of walking around in public, particularly because of her hijab:
As Germans, they do not want you to integrate with them. They do not give you the opportunity to integrate with them. When you walk by a group of people and everyone is looking at you in a way that is unwelcome, would this not impact you psychologically? There was also the issue of the hijab, this is a huge problem. Now, they have acclimated a bit. But before, the way I would be looked at would make me afraid.
These comments echo challenges that many female Muslim immigrants have faced regarding their integration in German society amid its attitudes and legal restrictions on head and face coverings such as hijabs, niqabs, and burkas. A blanket ban on head coverings—though not full face coverings such as the burqa and niqab—was lifted in 2015, but some municipal governments have maintained “neutrality” laws that forbid public servants such as teachers, police officers, and court officials from wearing headscarves at work. This bias and other factors—including patriarchal family structures and less work experience in their countries of origin—may contribute to the unique difficulties facing refugee women in Germany, who were 12 percent less likely to be employed than their male counterparts as of 2019.
Faith as a Factor in Integration
The challenges of head scarf-wearing women suggest that embracing visible symbols of the Muslim faith can make some refugees feel isolated and alienated from their new community. Yet most interviewees described their faith as a source of comfort and reassurance throughout their mental distress and integration experience in Germany. They reported religious services, making supplications, meeting other Muslims, and seeking help from religious leaders as important events in both assuring their mental health and addressing existing mental-health conditions.
The 31-year-old woman from Syria shared that her faith had grown stronger since her arrival. What she referred to as “the permanence” of God was a source of continuity, protection, and company in her new surroundings:
In Syria, honestly, I was a bit more distracted with the world. I was living my normal life. Here, I am trusting of God, since I felt that my God is permanent, more so than people. In terms of my faith, God is everlasting and always there for me.
Interviewees said they felt that their integration was not necessarily contingent on or impeded by their faith, though their attachment to faith practices had been affected by the flight from their countries of origin. When prompted to answer how his faith practice had changed since arriving in Germany, a 26-year-old Syrian man suggested the importance of staying true to one’s faith and cultural identity:
If a German is to accept me, they will accept me as I am. I am not going to change so someone else can accept me. For those who are changing religiously, ethically, or culturally for others to accept them... I think that when Germans see someone like this, then they will not respect them.
Many participants described feeling more religious in their country of origin and less so now, although others reported not feeling changed at all in terms of personal religious beliefs. These experiences were heightened for some respondents who reported praying less throughout the week, especially for those who worked full-time and could no longer attend Friday prayer or had limited access to an Arabic-speaking mosque or mosque of their sect.
Participants, mainly males, were also concerned about the social backgrounds and political motivations of imams in German mosques and expressed distrust of them. A 26-year-old Syrian described his hesitancy:
One of the main reasons I do not go to the mosques in Germany is because there is no imams in Germany like there were in Syria. Imams that I can ask questions, have trust in their advice, give us a religious lesson. We do not know their political backgrounds. They may be really good, but I do not know where they came from or the environment in which they live in. I do not know the education they received to become an imam… In Syria, the society, and not the government, had this organized. The imam was known by the village or city he lived in: Who is this person? Someone who is good, someone who is a hafiz, or has studied this—you know that the society has nominated this person. Here, you do not know his background, he could be supported by Qatar or Saudi Arabia, has Wahabi or Ikhawni ideologies, I do not trust in his background.
Despite some of these barriers, these findings demonstrated the potential for faith-based groups and mental-health providers to aid or facilitate inclusion of refugee and asylum-seeking populations. This could be in the form of large-scale collaborations with local hospitals, clinics, and mental-health professionals offering mental-health services to refugees or convening members of the refugee community in order to provide mental-health awareness sessions in mosque settings. However, according to the largest Islamic organization in Germany, the Turkish-Islamic Union for Religious Affairs, government financial resources for the support of refugee aid and service provision are largely provided to church-based organizations. As a result, Islamic faith-based organizations are much less experienced in refugee health and integration efforts in comparison to their Christian or secular counterparts, such as Caritas or Diakonie.
The Value of Considering Faith Identities and Mental Health
These findings indicate the impact that faith identities can have on mental health and integration. Acknowledging these ties to refugees’ religious backgrounds, as well as their cultural identities and displacement experiences, can be used by government agencies, aid organizations, and mosques to optimize Germany’s refugee integration.
Results from interviews regarding positive forms of faith-based coping demonstrate opportunities for local engagement from mosques and Islamic organizations with the Syrian, Iraqi, or broader Muslim refugee population, particularly in providing basic psychosocial support, mental-health awareness, and expanding referrals to mental-health professionals. Refugees’ stated preference for Arabic-speaking mental-health professionals suggests a demand for more of these services. Despite some ambivalence about the culture of German mosques, there appears to be an opening for faith institutions to work in tandem with mental-health professionals. Providers working with Syrian and other Arab-speaking refugee populations could implement and incorporate culturally sensitive care practices and explore how their work can overlap with humanitarian organizations, faith actors, and policymakers.
Faith appears to have significant ties to mental health for refugees from Muslim-majority countries, yet the ways in which these factors interact is often neglected in broader discussions of refugee integration. Experiences of Syrian refugees in Germany suggest that these relationships should be considered more seriously and with greater sensitivity when developing integration programming and policies.
Additional details regarding the research methodology and findings are available in Frontiers in Psychiatry.
Al Jazeera. 2020. German Court Upholds Headscarf Ban for Legal Clerks. Al Jazeera, February 27, 2020. Available online.
BBC News. 2018. Berlin Court Bars Muslim Teacher from Wearing Headscarf. BBC News, May 9, 2018. Available online.
Benton, Meghan. 2020. The Rocky Road to a Mobile World after COVID-19. Migration Policy Institute commentary, May 2020. Available online.
Bozorgmehr, Kayvan and Oliver Razum. 2015. Effect of Restricting Access to Health Care on Health Expenditures among Asylum-Seekers and Refugees: A Quasi-Experimental Study in Germany, 1994–2013. PLoS ONE 10 (7): e0131483. Available online.
Brandt, Lasse et al. 2019. Risk of Psychosis among Refugees: A Systematic Review and Meta-Analysis. JAMA Psychiatry 14; 76 (11): 1133-40. Available online.
Brücker, Herbert, Philipp Jaschke, and Yuliya Kosyakova. 2019. Integrating Refugees and Asylum Seekers into the German Economy and Society: Empirical Evidence and Policy Objectives. Washington, DC: Migration Policy Institute. Available online.
Bundesamt für Migration und Flüchtlinge (BAMF). 2020. Aktuelle Zahlen: Ausgabe November 2020. Available online.
Charité MEHIRA Health Service Research. N.d. Modul “Health Service Research”– MEHIRA. Accessed July 17, 2020. Available online.
El-Menouar, Yasemin. 2019. Religious Tolerance Is Widespread—But It Does Not Extend to Islam. Bertelsmann Stiftung article, July 19, 2019. Available online.
Elbert, Thomas, S. Wilker, M. Schauer, and F. Neuner. 2017. Dissemination Psychotherapeutischer Module für Traumatisierte Geflüchtete. Der Nervenarzt 88 (1), 26-33. Available online.
Foroutan, Naika. 2013. Identity and (Muslim) Integration in Germany. Washington, DC: Migration Policy Institute. Available online.
Georgiadou, Ekaterini, Ali Zbidat, Gregor M. Schmitt, and Yesim Erim. 2018. Prevalence of Mental Distress among Syrian Refugees with Residence Permission in Germany: A Registry-Based Study. Frontiers in Psychiatry 9: 393. Available online.
Hanewinkel, Vera and Jochen Oltmer. 2018. Integration and Integration Policies in Germany. Bundeszentrale für politische Bildung, December 1, 2018. Available online.
Heckmann, Friedrich. 2016. Understanding the Creation of Public Consensus: Migration and Integration in Germany, 2005 to 2015. Washington, DC: Migration Policy Institute. Available online.
Helbling, Marc et al. 2017. Attitudes Towards National Identity, Immigration and Refugees in Germany. Paris: More in Common.
Kaltenbach, Elisa, Eva Härdtner, Katharin Hermenau, Maggie Schauer, and Thomas Elbert. 2017. Efficient Identification of Mental Health Problems in Refugees in Germany: The Refugee Health Screener. European Journal of Psychotraumatology 8 (sup2): 1389205. Available online.
Mosel, Irina, Christopher Smart, Marta Foresti, Gemma Hennessy, and Amy Leach. 2019. Public Narratives and Attitudes Towards Refugees and Other Migrants: Germany Country Profile. London: Overseas Development Institute. Available online.
Pew Research Center. 2017. Europe’s Growing Muslim Population. Washington, DC: Pew Research Center. Available online.
Rayes, Diana, Carine Karnouk, Dana Churbaji, Lena Walther, and Malek Bajbouj. Forthcoming. Faith-Based Coping among Arabic-Speaking Refugees Seeking Mental Health Services in Berlin, Germany: An Exploratory Qualitative Study. Frontiers in Psychology. Available online.
Sandalio, Rocío Naranjo. 2018. Life After Trauma: The Mental-Health Needs of Asylum Seekers in Europe. Migration Information Source, January 30, 2018. Available online.
Silove, Derrick, Peter Ventevogel, and Susan Rees. 2017. The Contemporary Refugee Crisis: An Overview of Mental Health Challenges. World Psychiatry 16 (2): 130-39.
Stichs, Anja. 2016. How Many Muslims Live in Germany? Working Paper 71, Federal Office for Migration and Refugees, Nuremberg, December 2016. Available online.
Su, Alice. 2017. In Germany, Some Syrian Refugees Avoid Going to the Mosque. The Atlantic, July 26, 2017. Available online.
Trines, Stefan. 2019. The State of Refugee Integration in Germany in 2019. World Education News and Reviews, August 8, 2019. Available online.
United Nations High Commission for Refugees (UNHCR). N.d. Global Trends: Forced Displacement in 2019. Geneva: UNHCR. Available online.
Vohra, Anchal. 2019. Hijab-Wearing Women Struggle to Find Work in Germany. TRT World, July 23, 2019. Available online.
Walther, Lena, Lukas M. Fuchs, Jürgen Schupp, and Christian von Scheve. 2020. Living Conditions and the Mental Health and Well-Being of Refugees: Evidence from a Large-Scale German Survey. Journal of Immigrant Minority Health, 2020. Available online.