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Physical Health

Mental Health

Educational Concerns

Learning English

Women’s Issues

Community-building

Afghans believe that health is maintained through regular exercise, fresh food,
and a balanced diet.

Cross-Cultural and Adjustment Challenges

Afghans in the United States, like other newcomer groups, face a host of adjustment challenges in their new land. For newly arrived Afghans, the most pressing problems are the physical and psychological aftermath of war and economic hardship and the education of children who have had little or no previous education. The role of women is a particularly sensitive issue, and community-building poses challenges to a population fragmented by political, ethnic, and social differences. One bright spot in Afghan resettlement is the relative ease with which Afghans learn English.

How newly arrived refugees and immigrants adjust to their new communities depends to some extent on where they settle. For example, many of those who came to Northern Virginia in the 1980s tended to learn English and take available jobs faster than those in Northern California, who accessed the social welfare system. As with other groups, family sponsors also guide new arrivals into different paths – to education, for example, or to a particular occupation.

Physical Health

The most common physical ailments of Afghan refugees coming to the United States from refugee camps in Pakistan are diarrhea, acute respiratory infection, and measles. Malnutrition is usually the root cause of these conditions, as it lowers resistance, especially in the case of children. Among Afghans in this country, health care and refugee service providers have observed various health problems, many of which relate to mental health. A study done in the early 1980s by the San Francisco General Hospital Refugee Clinic found typical new refugee conditions – dental caries (41%), dermatologic disorders (39%), intestinal parasites (36%), gastrointestinal disorders (23%), and musculoskeletal pain (joints, back, 12%). Those who have been in the United States longer, especially the middle-aged and elderly, have high rates of heart disease and mental health-related problems, particularly depression and such psychosomatic symptoms as headaches and joint and back pain.

The majority of Afghans do not trust the U.S. health care system, believing it to rely on technology rather than health professionals’ skill in hands-on examination and diagnosis. Being told that "nothing is wrong" because of negative test results is upsetting when one feels sick.

Afghans believe that health is maintained through regular exercise, fresh food, and a balanced diet and by staying warm and getting enough rest. "Natural" illnesses can be prevented by following the precepts of Islam, which strongly emphasizes cleanliness and personal hygiene. Illness may be interpreted as the will of God and the result of not adhering to the principles of Islam or not maintaining proper balance of hot and cold in food or drink. For example, hot illnesses, such as fever or measles, are treated with cold foods and medicines. Home remedies include a variety of herbs and roots made into teas or poultices. Causes of "unnatural" illnesses include nazar (the evil eye) and jinns (ghosts or spirits). An unnatural illness must be treated with a curing ritual, such as prayers, Koranic verses, or eggs, because Western medicine is seen as useless in such cases.

Access to health care is blocked by a lack of health insurance and almost no culturally specific services. Language is a barrier, and very few hospitals or clinics employ trained interpreters. The most useful interventions would be to help people obtain health insurance and to hire and train bicultural and bilingual interpreters of both genders, women often being uncomfortable with a male health care provider or interpreter. There is an enormous need for health education in Pashto and Dari, not only in print form but also in other media, such as television, radio, and video, for those who cannot read. Afghans are responsive to and enthusiastic about health education.

The need for mental health care is often considered shameful.

Mental Health

Psychological problems are especially challenging. Refugees have seen family members abducted or killed and watched as their homes were looted and destroyed. They have lived under the threat of death and spent long periods of time in hiding. Most have lived in refugee camps for more than 4 years.

Very few Afghan refugees received treatment for psychological problems in war-torn Afghanistan, where there has been virtually no psychological support. For a population of about 25 million, the reported number of psychiatrists is just 8 and the number of psychiatric nurses and psychologists is 18.

Not surprisingly, there is a high incidence of post-traumatic stress disorder (PTSD) among Afghan refugees in the United States. Common PTSD symptoms include sleep disorders and nightmares, re-experiencing of the traumatic event, numbing or heightened responses to external stimuli, poor concentration, and persecution reactions. Depression, anxiety, and psychosomatic symptoms of stress are also common. Children suffer anxiety, grief, and nightmares and may experience bedwetting. However, there seems to be relatively little serious psychological disease such as schizophrenia or other psychotic disorders.

Attention should be given to Afghan refugee children and especially to minor children in foster families. Experience has shown that among boys there is a great deal of frustration, anger, aggression, and resistance to rules, whereas girls tend to withdraw and fatalistically accept their situation, showing little willingness or ability to envision a bright future. The energy of these girls and boys should be channeled toward positive goals in programs that provide a support system to replace the community and family the children have lost. Placement preference should be given to families with an understanding of Afghan culture and Islam.

Many Afghans suffer physical symptoms of stress caused by culture conflict, family role change, isolation, financial and job problems, and loss of family, property, privacy, and social status. Common symptoms include back pain, other body aches, asthma or breathing problems, headaches, and stomach problems. An increase in mental problems among the educated elite is associated with a severe drop in social status.

For men, the sense that they have lost control over their lives and over their wives and children is a source of great stress. Alcohol abuse is not uncommon. Domestic abuse has been an issue all along, but until recently it was not acknowledged. Afghan Domestic Violence Prevention in Fremont, California is currently educating families on how to live together in peace and to accept each other as individuals.

Although it is agreed that mental health is a problem in the community, families seek psychiatric care only as a last resort, as the need for mental health care is often considered shameful. There is a fear that those seeking psychological treatment will be the source of gossip or that a therapist may share personal information about the family. Many would prefer a medication – a quick cure – to talk therapy.

Because most Afghans do not seek help for mental problems, the resettlement community may not think that they need psychological care. Yet the need clearly exists. As one Afghan noted, "We don’t believe in psychiatry, although after 22 years of war, more than 50% of us have some mental health problems."

Despite the pressing need for mental health services for this population, culturally sensitive mental health services are not available. The Afghan Women Association International (AWAI) has developed effective women’s support groups to reduce isolation and help women learn new coping methods. Group approaches with time for socializing are preferable to individual counseling. Other methods of stress reduction, such as physical activity (e.g., walking groups), are often effective in reducing depression. Self-help must be an important component, to build confidence, channel skills and energies in a constructive manner, and give a new and positive direction to lives that have been severely disrupted.

It is important to assume that Afghan refugee children are normal in terms of intelligence and ability to learn.

Educational Concerns

The U.S. educational system was not really designed for older children who cannot read or write and do not know how to learn in a classroom situation. Even those systems with well-developed English as a second language (ESL) or bilingual education programs have struggled when faced with students with little or no previous education. In the past decade, however, a small but growing number of school systems with increasing enrollments of these students have developed newcomer programs to address their academic, linguistic and cultural orientation needs. These programs offer a special educational program for students for a limited period of time (usually 9-18 months) before the students enter the regular ESL or bilingual education program. These newcomer programs help acclimate students to schooling in the United States, develop academic English skills, and teach some subject matter content. (see Bibliography).

It is crucially important to assume that Afghan refugee children are normal in terms of intelligence and their ability to learn. Many of them, in fact, will have become experienced in their struggle to survive. If there are signs of possible learning disabilities, however, the school system should use interpreters and assessments that are not dependent on language to determine a student’s need for special services. It is also important to inform the school system if some of the children show evidence of PTSD.

If there are enough new Afghan refugee children in an area, special classes, roughly grouped by age, can be formed. The focus of these classes could be English, literacy, and classroom behavior together, with accelerated work in arithmetic and other subjects. If there aren't enough children to form classes, extensive tutoring is probably in order.

Young teenagers between 12 and 16 will be the most problematic group. Those who have missed many years of formal education will find it very difficult to acquire all the required credits for high school graduation, especially on a college preparatory track. Yet they are required by law to be in school. Some school systems have developed alternative high schools for these older learners that may prepare them for the world of work or provide instruction that could lead students into GED courses or adult basic education programs. Some states have also extended the age for which schooling would be provided free of charge.

Initially, Afghan adults will need assistance in learning enough oral English to get work and to function in the community. Then they will need to develop the necessary reading and writing skills to function in our literacy-based society. Special ESL programs exist, or can be set up, for students who cannot read in their native language. Such programs usually present the language orally, through activities, and teach literacy skills in a special, separate class. This kind of approach differs from that of ESL classes for learners who have literacy skills in the native language. In these classes, instruction uses the students' ability to read their native language to facilitate the development of reading and writing skills in English.

Dari and Pashto have many grammatical elements that correspond to elements in English.

Learning English

In general, speakers of Dari and Pashto will have fewer problems learning English than the speakers of many other languages due to the distant relationship between English, Dari and Pashto.   

Pronunciation

Neither Dari nor Pashto speakers will have much trouble with the pronunciation of English. Although they will speak with an "accent," their pronunciation of English will be quite easy to understand and will require no special pronunciation work. Speakers of both languages will have trouble with our th as in thank and this, and with the distinction between w and v as in wine and vine. Pashtuns will have trouble distinguishing oy and ay so that lawyer and liar come out the same, and they might have trouble with the difference between f and p. These are truly minor problems, however, and will not interfere significantly with communication.

Grammar

As Iranian languages that are distantly related to English, both Dari and Pashto have many grammatical elements that correspond to elements in English, for example, verb systems which make a distinction between past tenses (I went to the store) and perfect tenses (I have gone to the store).

There are some fundamental differences in structure. Dari and Pashto both put direct objects before the verb (John Mary saw), whereas in English we put direct objects after the verb (John saw Mary). Pashto has prepositions before, after, and both before and after the noun (in the house, the house in, in the house in) whereas English has prepositions before the noun only (in the house). Afghan refugees will learn the English structures as a matter of course in ESL classes or pick them up in interactions in English with Americans.

Vocabulary

English vocabulary will pose a problem. There are relatively few cognates between English and Dari/Pashto. (A cognate is a word used to mean the same thing in two languages, e.g., House/Haus in English and German.) Curiously, there are more English cognates in Pashto than there are in Dari. English is widely used in Pakistan, and the Pashto spoken there has adopted many English words, which have spread to the Pashto in Afghanistan.

Reading

Afghan refugees will have trouble developing English reading skills, even if they are readers of Dari or Pashto. First, they will have trouble with the new alphabet and irregular spelling system. Lack of vocabulary and the complexity of written English structures as compared with spoken structures will pose further problems.

Afghan refugees will have to learn at least to decode words, as a simple matter of survival in this country. Beyond that, the necessity for reading skills will vary widely from refugee to refugee and depend on reading level in Dari or Pashto, education level, and the refugee’s goals in the United States.

Writing

Afghan refugees who are literate in Dari or Pashto will need special help in handwriting, as writers of Arabic alphabets universally have difficulty with the left-to-right, every-letter-on-the-line nature of handwriting in a Roman alphabet. Refugees who are not literate will have to learn some kind of signature, even if they never learn to write. Among nonliterate refugees, women, who have fine motor skills from embroidery and sewing, are often far more successful at developing handwriting than are men.

Names

Considering how computerized our society is, and how inflexible computers are with regard to misspellings and inconsistencies, the Afghan refugee unused to having a last name is courting bureaucratic disaster. One of the most valuable services to provide for a newly arrived refugee family is to establish with each one of the members first and last names, complete with the spelling noted on the I-94 refugee status document. When this is, it should be impressed on them how important it is to give this information consistently. If they speak little or no English, special cards can be developed for use if they become lost or if they need to give their names to someone.

The topic of women's rights is a touchy one.

Women’s Issues

Afghan women have been coming to the United States since the late 1970s. Thus, as a group they provide a striking picture of the transition from a very traditional, patriarchal, family- and home-centered society to a technologically oriented, individualistic, egalitarian society marked by social isolation and a focus on obtaining material goods.

In Afghanistan, marriages were often arranged, and women were generally less educated than men. They generally married young, had many babies (preferably boys), did not work outside the home, and were restricted to socializing mainly with female relatives. Until recently, however, urban educated women worked, and some chose their own husbands, although they were discouraged from socializing with unrelated men. Restrictions on women are recent, enforced by fundamentalist mujahideen groups and the Taliban. King Amanullah Khan (reign 1919-1929) stated, "Religion does not require women to veil their hands, feet and faces or enjoin any special type of veil. Tribal custom must not impose itself on the free will of the individual." Islam also promotes gender equality and respect between husband and wife.

Afghan women in the United States experience some role confusion, and community opinions are divided over the proper role of women. More traditional men expect their wives to stay home and cook for the family, take care of the children, clean house, and socialize only with Afghan female friends. More cosmopolitan women enjoy their freedom and the opportunity to be active in the community. For all Afghan women, however, maintaining a good reputation is a lifelong demand. Once a woman’s reputation is tarnished, she is no longer respected. Gossip, both positive and negative, is very common.

Women’s issues differ strikingly by age and generation. Elderly women are often widows who live with an adult child and family. As they rarely speak English, they are essentially homebound, afraid of going out because they will get lost. Unable to take public transportation to visit friends or other family members, they badly miss the constant visiting that is characteristic of social life in Afghanistan.

Married women between the ages of 25 and 45 struggle to balance Afghan values and the demands of their life in the U.S. They must balance their husbands' expectations of traditional behavior with opportunities for independence, and the Afghan community's disapproval of Americanized behavior with some measure of support for their acculturating children. Many women work a double day. After long hours on the job, their husbands expect them to prepare traditional Afghan food (including hot lunches), conform to high standards of housekeeping, and attend to children's needs, even if the man is not working. Women whose husbands help in the home and allow them to go to meetings consider themselves fortunate.

Divorced women feel the disapproval of the community. Unmarried women of any age are called "girls" and usually continue to live with their parents; it is rare for them to live alone or with peers. In many cases, women who are not married by their early 20s are viewed as having something wrong with them and may be called torshee (‘rotten,’ ‘expired’). Remaining single, however, is gradually, if begrudgingly, becoming slightly more acceptable.

While Afghan women are expected to marry, finding an appropriate mate is difficult for women who have acculturated to life in the United States. Women have pursued higher education at a much greater rate than men have, and they want husbands who are equally well educated and from families of equal or higher social status. Some men perceive acculturated women to be contaminated by American ideas and not properly submissive. Younger men are intimidated by educated women, and men who have been traditionally brought up expect their wives to be less educated than they are. Islam forbids women from marrying out of the faith, so very few Afghan women marry non-Afghans. They are caught in a no-woman's land.

Teens and young adults are expected to maintain modest behavior and chastity to avoid destroying the family's reputation; typical teen dress, speech and behavior are seen as improper, forward, and immoral. Afghan girls are often torn between their family’s wishes and being like their American peers. There are three ways of dealing with this conflict: remaining a "good Afghan girl" who respects her parents’ wishes; leading a double life, hiding American-style behavior or friends (especially American boyfriends) from family members; and open acculturation, possible only in flexible families willing to brave powerful and damaging gossip in the Afghan community.

The topic of women's rights is a touchy one, especially in the aftermath of the Taliban. The vast majority of Afghan women consider themselves as part of their husbands' or fathers' households. American service providers who urge Afghan refugee women to assert their rights are likely simply to confuse or frighten the women. Moreover, the men in the community will very likely take such urgings as an insult to their honor and will withdraw their cooperation.

The process of helping Afghan women become aware of their rights should be a gradual one. They should be made aware in a subtle way of the laws that protect women. For example, they should know that domestic violence is not to be considered a private issue and that there are places where they can report abuse. Many of those who are being resettled are single heads of household. The fact that they have taken the responsibility of caring for the family is a strong indication of their strength and resilience.

Afghan men should be involved in this initiative in support of women. Islam can be a useful tool in this regard, as it asserts the rights of women and extols the value of education. Women are often unaware of these principles, but once this reasoning is revealed, Afghan men can rarely argue.

Capacity- and Community-building

The tensions among the various Afghan groups are political, economic, sectarian and ethnic based. Tensions between Pashtuns and the Nothern minorities heightened after the 1979 Soviet invasion of Afghanistan, and continued, although for different reasons, with the Taliban's rise to power (see sidebar).

Ismailis have often asked to be resettled within their own community. Similarly, Shi'a Hazaras prefer to stay together. Both communities have separate worship centers and would not pray in Sunni mosques. They would treat the month of Moharram differently from the Sunnis.(Moharram is a month of grief that marks the martrydom of Imam Hussain, the grandson of Mohammed. The Shi'as give special importance to this month.)

Afghans who have been in the United States for up to two decades are very cautious in relating to newly arrived family members or friends because Afghans prefer to make their own judgements. Some newly arrived refugees may misinterpret advice, viewing it as criticism, so relatives tend to be careful not to offend the newcomers.

Children and young adults who have grown up in the United States often have friends of different ethnic backgrounds, although their primary social group may be Afghan. There is one Afghan gang in Fremont, California called Liwani, made up of 16- to 21-year-olds. However, the gang was formed not for purposes of crime but to defend the Afghan code of honor, particularly the honor of Afghan girls when they are approached by non-Afghan boys. The gang provides help and support to young Afghans making their way in a new and unfamiliar land.

In the past, social service providers perceived Afghans as uninterested in cohesive community action. Until the early 1990s, community organization was difficult because of ideological differences related to the jihad in Afghanistan. Despite these continuing differences, Afghans supported the Afghan Fund to build mosques in New York, Virginia, and California. Community cooperation has increased in the most active Afghan community, the San Francisco Bay Area, largely because of the pioneering efforts of the Afghan Women Association International (AWAI). To address the wider needs of the Afghan community, AWAI founded the Afghan Coalition, which consists of AWAI, the Society of Afghan Professionals, the Afghan Soccer League, and Afghan Domestic Violence Prevention project. Similar Afghan women’s organizations have started in San Diego, California, Washington, D.C., and Atlanta, Georgia.

An overwhelming majority of Afghans in the United States are pleased the Taliban has been ousted.

After September 11

Before the Soviets withdrew from Afghanistan, Afghan communities in the United States were bitterly divided by loyalty to one of the seven Mujahideen parties. Later, tensions continued among Royalists, Fundamentalists, and Moderates, and social class differences began to assume more importance. Five years of Taliban repression exacerbated ethnic tensions, although Pashtuns who supported the Taliban regime did not adhere to its strict rules of behavior. Today, in 2002, an overwhelming majority of Afghans in the United States are pleased that the Taliban have been ousted. The small minority who support the Taliban do so for reasons of language and ethnicity and do not support terrorist acts. Afghans in the United States are excited about the coalition government.

The aftermath of the events of September 11 has been bittersweet, however. Afghans were shocked by the terrorist attacks and felt that both their faith and their homeland had been hijacked. They are shocked to be seen as terrorists and are upset that mainstream Americans don’t know anything about Islam or remember that Afghans spent 10 years fighting the Soviet invasion. Before the events of September 11, some Afghans did not divulge their identity because they did not want to be associated with the Taliban. But they now realize that hiding their identity helps no one, and most now openly state that they are Afghan and Muslim. The attack has stimulated activism among leaders to an unprecedented degree. Afghan Americans have testified in Congress and spoken at universities and church groups to present a more accurate picture of Islam and to distance mainstream Islam from the extremists who perpetrated the September 11 violence.

Many young educated people plan on going to Afghanistan to help rebuild the country. They are politically aware and want to take part in the decisions that will be made in Afghanistan. These young bilingual and bicultural Afghans will form the core of a cadre of new professionals – and a bridge between Afghanistan and the United States.

The Cultural Orientation Project--http://www.culturalorientation.net, for more information contact sanja@cal.org
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