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MUSLIM REFUGEES IN THE UNITED STATES CULTURE PROFILE  
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Housing

Employment

Education

Health Care

Safety and Security

CHAPTER 3
Challenges in Resettlement and Adaptation of Muslim Refugees

Like other refugee groups, Muslim refugees struggle with problems related to housing, income, education, health, and security. They face the challenges of reestablishing their families in a country with traditions and lifestyles that are very different and may sometimes seem at odds with their beliefs: learning about and obtaining access to education, health, and social services for themselves and their children; protecting themselves and their children from becoming victims of prejudice and hostility; managing conflicts within their own households that arise from changing cultures, lifestyles, and family roles; and learning to take advantage of the opportunities available to them in their new home.

Muslim refugees are becoming more aware of their basic human rights and the systems that protect those rights, but they still require support in a number of areas from service providers. This chapter will look at five components of successful resettlement as they relate to Muslim refugees in the United States: housing, employment and income, education, access to health care, and safety and security. A case study is presented for each component, with discussion questions for service provision.

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For Muslims, life is defined by the interdependence of the family rather than the independence of individuals or nuclear family units.

 

Housing

For Muslims, life is defined by the interdependence of the family rather than the independence of individuals or nuclear family units. Muslim refugees, like others who have lived in extended families in their countries of origin, are likely to feel uncomfortable living in apartments that accommodate only nuclear families. They may prefer to reside together in a single housing unit, even if it is too small by U.S. standards or by local housing regulations.

However, refugee families may have to learn to adjust to living in available units without extended family members. Service providers need to be sensitive to the challenges arising from refugees’ desire to live with their extended families, addressing this challenge during the orientation period and again during follow-up work, with clear explanations about housing regulations and lease stipulations that indicate the number of people who may stay in a housing unit. Whenever possible, service providers can try to find larger units or large single-family dwellings to accommodate extended families. If larger affordable units or a single large house are not available, then placing members of the extended families in separate units in close proximity to one another may be helpful.

As with other refugee groups, Muslim families are likely to be most comfortable around people with whom they share their culture, language, and traditions. Placing such families in close proximity helps to lessen feelings of isolation and allows the refugees to develop their own networks of interaction and support.

Many Muslims are not accustomed to living in the same dwelling with non-family members of a different gender. Arrangements where males and females share apartments may be a source of stress and resultant adaptation problems for many Muslims from the Middle East, Africa, and Asia. Sensitivity to this issue can be addressed by planning ahead so that non-related single Muslim refugees are housed only with people of the same sex.

When setting up a household for new Muslim arrivals, service providers need to be sensitive to the possibility that the refugees will prefer to eat only halal food, and bring in only items that do not contain animal byproducts, stock vegetarian items, and buy vegetable cooking oil. If a meal is prepared to welcome the new arrivals, it can be a vegetarian meal or prepared with halal meat. Fresh fruits and vegetables will be welcome. If a family does only eat halal food, then it would be good to reassure them that the pots and pans have been purchased new, or, if they have been donated by a Muslim family, that they have not been used to cook pork.

If the family does prefer to eat halal, then the caseworker can help them to identify the closest halal market and show them how to get there on public transportation. For some refugees who come from Muslim countries where everything is already halal, it may be necessary to explain how to read ingredients so as to avoid those foods and ingredients that are not permitted.

Some Muslims choose to keep dogs in their homes, while others view dogs as very unclean. For the latter, if a dog touches a person’s clothes, those clothes must be washed before they can be used for prayers. If a Muslim wants to pray in the house, then the dog must be kept away from the area used for prayer.

Two other issues that concern service providers relate to clothing and jewelry. Like other refugees, Muslims may refuse used clothing for any number of reasons. For many refugees, it reflects a loss of status because they are not able to buy their own new clothing as they did in the past. Refugees may also feel that used clothing is unclean, and a few may believe that the essence of the prior wearer remains with the clothes and can bring bad luck if they do not know who previously wore them.

Muslim and other refugee women from some cultures receive gold jewelry at marriage, and this jewelry carries powerful emotional value for them. They will sell it to obtain food or meet other needs only when all else fails. If they have not had to use their gold jewelry to support themselves and their families during flight, when they arrive in the United States these women will try to keep it. Service providers need to be sensitive to the emotional value that gold jewelry carries for refugee women and understand that selling it is not an option.

Whenever possible after the refugees have found jobs, they should have the option to relocate to an area that is closer to their jobs, in neighborhoods with better schools, and/or closer to a mosque or people of similar background. The local Islamic community has many resources that can support new arrivals as they adjust to life in the United States, and relocation may help Muslim refugees take advantage of these.

Case Study

An extended family of twelve persons from Kosovo arrived in Phoenix, Arizona. The grandmother, one son with his wife, and their three children composed one core family. A second son with his wife and four children composed the second core family. Of the seven children, four were school-aged, two were toddlers, and one was an infant. The resettlement agency had arranged for each core family to have its own apartment, but the apartments were in two different buildings within the same apartment complex. The management promised the resettlement office that, as soon as an apartment opened in either building, one of the core families could move into the same building with the others. Nevertheless, the refugees in both core families insisted on living together. In the evening, all 12 people would come to one apartment for dinner and then spend the night together. During the day, all family members who were not in school or looking for a job would be in one apartment.

The family was also dissatisfied with this living arrangement because they were too far from the mosque and the halal market. They did not mind taking public transportation, but it was expensive and the ride took 1 1/2 hours each way.

After several months of warnings, the management office lost patience with the family for being out of compliance with the lease, since one core family had essentially moved in with the other. The occupancy rules did not allow for this many people in one apartment of the size that they had. There were repeated warnings and discussions with the resettlement office and the refugees. Eventually, eviction was threatened.

The resettlement agency staff had explained the situation several times to the refugees. The case manager had even had them sign a statement for their file indicating that they knew they were in violation of their lease and that this could cause them to face eviction. The refugees had signed the statement willingly. They were very clear on what they wanted—they wanted to live together. They told the caseworker that, regardless of the consequences, they would not comply.

Finally, with the help of the mosque, the family’s caseworker was able to find a large apartment closer to the mosque and the halal market for the family.

Possible Questions for Discussion:

  1. What happened in this scenario from the perspective of the refugee family?
  2. What happened from the perspective of the landlord?
  3. Why do you think the family continued to share the apartment, in spite of being warned of the possible consequences?
  4. What are some possible approaches that the caseworkers might take to this problem?
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All refugees hope to find work that matches their skills, abilities, and interests while providing sufficient income and benefits to meet their needs and those of their families.

 

Employment

All refugees hope to find work that matches their skills, abilities, and interests while providing sufficient income and benefits to meet their needs and those of their families. Service providers face the challenge of helping refugees be realistic about available opportunities while taking into account the sociocultural and religious considerations relevant to each individual. In the case of Muslim refugees, the following considerations may affect decisions and guidance regarding employment.

Need for Dual Income

The types of job opportunities available to refugees, especially those with limited English language skills, often mean that families need the income from two working adults in order to meet basic needs. In the case of Muslims from some cultural backgrounds, family members, especially husbands or fathers, may be resistant to having women work outside the home in an unfamiliar environment. Islam stresses the role of the husband as the provider for the family, and Muslim men from some cultural groups may regard the need for the wife to work as an embarrassment, although this is not always the case.

In addition, Muslim women from some cultural backgrounds may be uncomfortable with the idea of interacting on a regular basis with strangers, particularly with men who are not family members. These women may be ill at ease with jobs that require frequent contact with the public, and may express the desire to stay at home. The feelings of these Muslim men and women do not necessarily arise solely from religious considerations; they also grow out of a complex blend of cultural traditions, the desire to be protective of women in the family, and the insecurities that remain from being refugees who have faced serious dangers.

Service providers need to be sensitive to this issue and help Muslim families find ways to meet their financial needs in ways that are comfortable for them. Some families may be willing to accept the idea of the wife or daughters working outside the home, as long as they do not have to travel too far alone to go to work or interact with the public a great deal. In other cases, the solution may be to secure jobs on two different shifts so that a husband and wife can both care for their children at home. Employment that allows women to work from home may be another option.

Some women may want to work, but may initially find it very difficult to leave their children in day care with strangers. If these women worked in the home country, family members probably helped to take care of the children. In such cases, finding a day care provider of the same religion and/or ethnicity may make the transition easier for the woman.

Employment for any refugee is a matter of individual assessment and placement. Certainly there are many Muslim refugee women who are accustomed to working outside the home and are comfortable doing so. These women do not face the same challenges as women who have little experience in the public sector when it comes to employment.

Workplace Relationships

As is the case with some other groups, Muslim men from some cultural backgrounds may have difficulty with the fact that, in many workplaces, women are supervisors or hold other positions of authority. Resistance to the idea of working under a woman can be especially problematic when a man from a culture in which men and women work in separate professional spheres must take a low level service position because of limited English language or other skills. In the United States, women frequently hold supervisory positions in such contexts. This is not an issue for all Muslim men, and service providers need to raise the matter with each refugee individually, in order to determine whether it is a consideration in helping the refugee find employment.

Service providers working with male Muslim refugees who are uncomfortable with the idea of working under a woman can try different approaches:

  • They can help the man secure a job where he will report to another man, but women are also present in supervisory positions. This gives the refugee an opportunity to observe and become more comfortable with the types of male-female interactions that characterize the American workplace before a situation arises in which he must handle such interactions directly himself.

  • They can reach out to other refugees, particularly those from the man’s own cultural background or country of origin, who have made this transition successfully, and ask them to mentor the man during the initial stages of his employment. Service providers may have potential mentor contacts among refugees they have worked with previously, or may be able to find some through local mosques and Islamic service organizations.

Accommodation

Service providers need to help observant Muslim employees understand their workplace rights as these relate to Islamic practice, so that they will be able to work with an employer when in need of religious accommodation. Providers also need to help these employees understand the limits of reasonable accommodation and the ways in which they may need to adjust their own expectations in order to succeed in the American workplace.

Sumayya Allen (2002) discusses the pursuit and protection of rights in the workplace for Muslims. She makes the following points as she addresses Muslim readers:

  • You have the right to fairness in hiring, firing, and promotions
  • You have the right to a non-hostile work environment
  • You have the right to complain about discrimination without the fear of retaliation
  • You have the right to reasonable religious accommodation

The reasonable accommodation referred to in the last statement may include wearing hijab or kufi, having a beard, being able to pray on the job, and attending Friday prayers. Reasonable accommodation varies from job to job, just as the need for accommodation varies from refugee to refugee. Service providers can help to ensure a good match between refugee and job opportunity by interviewing each refugee to determine which observances are essential to that person (i.e., cannot be adapted), which the refugee is willing to adapt, and which the refugee is willing to forgo. With this information in hand, the service provider will be able to identify employers who are able and willing to accommodate the refugee’s needs, and to avoid sending the refugee into situations that will not work for either the refugee or the potential employer.

Sample Situations

The remainder of this chapter addresses specific situations that have been encountered by Muslim refugees in the United States. These examples do not describe all Muslim refugees, since practices vary widely. They are meant merely to provide insight into situations that may arise.

Shaking hands

Shaking hands upon meeting is a Western gesture. Americans in particular believe that a handshake tells a great deal about a person: A firm, steady handshake with a direct look into the other person’s eyes means that the person is honest and self-confident, while a so-called “limp” handshake leaves a bad impression. The impression made by the handshake is especially important in job interviews.

However, for many Muslims, as for many people from other cultures, the customary greeting is a gesture other than the handshake. In addition, some Muslim refugees may be uncomfortable shaking hands with a person of the opposite sex. For many Muslim refugees, this may not be an issue at all, while for others it may create challenges.

Job developers have options for working with refugees who are uncomfortable in shaking hands. If a refugee is not uncomfortable with the action of shaking hands, but simply is not accustomed to the gesture, the job developer can practice with the refugee before a job interview takes place. If the refugee is truly not comfortable with this form of physical contact with a stranger, a job developer can explain the situation ahead of time to the potential employer. Alternatively, to ease what may be an awkward first meeting between employer and employees, the job developer can give the applicant a résumé or application form that the applicant can hand to the employer instead of shaking hands. Some service providers have developed a technique to block shaking hands by standing between the refugee and the potential employer while handing the employer the résumé or application form; these providers stress that they explain the situation to the potential employer later. Whatever strategy is adopted, the service provider needs to help the refugee understand that the handshake is a common gesture and should be respected, if possible.

Pork and alcohol

When it comes to the identification of appropriate job settings, the presence of pork and alcohol is a consideration. Some Muslims may not be comfortable working in a restaurant that also has a bar. An observant Muslim working in food service may feel uncomfortable having to serve or touch pork products. For some, the option to wear rubber gloves while preparing the food (for example, putting pork toppings on a pizza) is acceptable. For others, any contact with pork is unacceptable.

Office parties or events at which alcohol is served are common in the United States. In the case of formal events such as client luncheons or employee recognition banquets, employees may be strongly encouraged or even required to attend. Some observant Muslims may be willing to attend such gatherings and drink non-alcoholic beverages, while others will not wish to attend at all. Job developers can work with observant Muslims who are not comfortable attending such gatherings to help them find work where they will not be required to do so.

Wearing hijab, kufi, or beard

An employer can neither refuse employment to a woman who wears hijab nor ask her to remove it. The same is true for men who wear kufi. A woman who covers her head should be prepared to make modifications (e.g., tuck in loose ends so that they are not caught in machinery) as needed in the interest of safety and uniform policies, and the employer can ask that the hijab be a color or fabric that is consistent with the corporate image. If other employees wear a cap, it is permissible to wear the same cap on top of the hijab.

A Muslim man who keeps a beard for religious reasons cannot be required to shave his beard. He may be asked to wear a covering such as a hair net or mask for safety or health reasons.

Praying and holy day observance

Muslims who observe the practice of praying five times each day will need to take brief breaks from work at the proper times and have a private space where they can go to pray. In a regular 9-to-5 workday, this will only be necessary for the noon and late afternoon prayers. Not all Muslims pray five times a day; some combine the five prayer times into morning and evening prayers, while others do not feel compelled to meet this requirement at all.

Ritual cleansing with water is performed before each prayer time. Job counselors can ask a local imam or other Muslim community leader to make refugees aware that they need to perform this cleansing without leaving a great deal of water around the sink in the restroom, and to help them understand that the practice of washing feet in the sink may be offensive to members of other cultural groups. The imam can encourage refugees to bring a small pitcher, a bowl, and a towel to work to use in ritual cleansing, and can also help refugees recall that it is possible to avoid washing their feet at work. If a Muslim takes an ablution and then immediately wears socks, foot washing does not need to be repeated for 24 hours. All that is required is to wipe off the socks with the palm of a wet hand. This type of information is best conveyed to refugees by another Muslim, rather than by a non-Muslim service provider.

Friday is the holy day for Muslims. Some employers allow flexible time so that Muslim employees can leave early on Friday or leave for an extended period on Friday in order to participate in communal prayers at the mosque. Another accommodation is for a Muslim employee to work on Saturday or Sunday and have Friday off for prayers.

Observance of Ramadan can be challenging for Muslim employees. Preparing the food for the breaking of the fast each evening is an important part of Ramadan observance, and it is difficult for women who work all day to maintain this tradition. Although most Muslim refugees quickly find ways to adjust to the demands of job and observance, service providers can help Muslim women in particular with this challenge by helping them understand the expectations of the workplace, by identifying employment situations with flexible or otherwise appropriate schedules, and by helping women build support networks so that they are able to help one another. Through their partnerships with local mosques, service providers can also help refugees become connected with Islamic community organizations that host nightly fast-breaking dinners and other Ramadan activities. Refugees may also locate such resources for themselves and develop ways of making necessary accommodations as they discuss matters of observance with extended family members and others in the Islamic community.

It can be difficult for Muslims to be able to celebrate the yearly Eid holy days when working because these days fall at different times each year and rarely coincide with the holy days of other religions or with secular holidays. With enough notice and flexibility, employers have been known to work out schedules where Muslim employees have their holy days off and then cover for other employees on the holy days of other religions.

The great majority of refugees and immigrants to the United States who are observant Muslims have successfully integrated the observances that are important to them with the expectations and requirements of the workplace. They can be an invaluable resource for service providers needing to give guidance and support to newly arrived refugees. For service providers working with employers, RefugeeWorks has a helpful brochure titled Islam and Work.

Case Study

Two single sisters from the Sudan were resettled in Seattle, Washington. During employment orientation, the job developer at their resettlement agency discussed the issue of wearing hijab in the workplace, explaining that, for safety reasons, the women might need to make some accommodations in their attire while at work.

A few weeks later, the job developer took one of the sisters to an interview at a hotel. She was surprised to see her client come to the interview without the hijab. The employer was very pleased with the interview, and the Sudanese woman was hired to work as a housekeeper at the hotel.

The following day, however, the job developer got a call from the employer. The employer said that the Sudanese woman had arrived for her orientation at the hotel that morning with her head covered, and had explained to the employer that her religion required her to cover her head and to wear long sleeves under her uniform. The employer wanted to know why the woman and the job developer had not addressed this need during the interview.

In the meantime, the other sister had found a job at a fast food restaurant with the help of her job developer. During the interview, the refugee woman and the job developer explained to the employer that the woman was planning to wear a hijab and long sleeves at work, and inquired whether this would be a problem. The employer was hesitant at first, but the job developer suggested that the woman could wear the hijab under her cap and a long-sleeved shirt as a part of her uniform. The employer seemed pleased with this suggestion, and the woman was hired to work as a cashier.

Possible Questions for Discussion

  1. Compare the two scenarios in this case study. How are they different? How are they similar?
  2. Why was the first employer upset with the new employee and the job developer?
  3. Why do you think the first sister came to the job interview without her hijab?
  4. How do you explain the second employer being more accommodating than the first one?
  5. What successful orientation strategies on the part of the job developer can you identify? What less successful ones?
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Teachers, counselors, and school social workers who are knowledgeable and sensitive to cultural and religious needs of children can be helpful in developing relationships with parents in the interest of children.

 

Education

Education for refugee families includes both adult education and education for school age children. With respect to adult education, adult Muslim refugees have some of the same needs and experience the same limitations as other refugee groups. Those who are skilled must learn how to market their skills in a new environment and, in some cases, must augment existing skills or acquire new ones. Current expectations for resettlement in the United States do not allow a refugee to spend much time in skills training. Often refugees do training on their own time while employed in a first job. Some refugees are fortunate enough to be placed in jobs where a training component is provided.

Many refugees need some level of English as a second language instruction. While lack of English language skills may not be a barrier for some types of employment, it does limit a refugee’s job options. Lack of English language skills can also be used as a subtle form of discrimination by potential employers. For most refugees, underemployment is the norm until they can acquire job experience in the United States and more proficient English skills.

Muslim refugee women who choose to work at home also have educational needs. Service providers can help them find ways to learn English, adapt to life in the United States, and be able to participate actively in their children’s education.

Children often adapt more quickly to life in the United States than their parents do. In school, in addition to learning English and other subjects, they are socialized by peers and significant adults (teachers, counselors, and school social workers) to function in U.S. society. However, many children of refugee and immigrant families are expected to function in two different environments—the home environment, which reflects the religious and cultural norms of the countries of origin of their parents, and the school and neighborhood environment, with influences from peers and teachers reflecting American cultural norms. The differing expectations of these two environments require education and accommodation by both parents and teachers to facilitate healthy development of Muslim refugee children. Teachers, counselors, and school social workers who are knowledgeable and sensitive to cultural and religious needs of children can be helpful in developing relationships with parents in the interest of children. Muslim community leaders can also assist with orienting newly arrived refugees to the expectations of educational institutions.

The examples below suggest ways for caseworkers to educate parents and school personnel to meet the needs of Muslim children. These examples also reflect opportunities for educating and socializing refugee parents and increasing their participation in their children’s education.

Work with the local school system to inform them when Islamic holy days take place. Many teachers acknowledge holy days observed by children in their classes, and use them as opportunities to teach about religion and culture.

Teachers are generally willing to accommodate the legitimate needs of children in their classes. As far ahead of time as possible, ask the school to avoid scheduling major exams on holy days, or to allow observant Muslim children to take them at an alternate time. Call the school to let teachers and administrators know that the child will be absent in order to celebrate these holy days. Students are not generally penalized for missing school for legitimate reasons.

Encourage parents to take an active role in their children’s education. Explain the expectations of schools with regard to parents’ participation, and work with the school to provide interpreters for parent-teacher conferences and meetings of the Parent Teacher Association. Help the school to identify mechanisms that they can have in place to support parents in an active role.

Explain to parents who eat only halal food how to read school menus so they can advise their children on eating at school.

Help teachers be sensitive to children who are observing the Ramadan fast. Usually children start observing the fast around the age of puberty, but some may begin earlier. If a child is fasting, it may be helpful to ask the homeroom teacher to provide a lunchtime pass to the library instead of having the child sit in the cafeteria. If the weather is warm during Ramadan and the student is fasting and taking physical education classes toward the end of the day, advise the teacher that the child may not be able to perform at optimum capability. Also, children often stay up past their usual bedtimes during Ramadan, participating in the family’s breaking of the fast. Teachers need to know that these students may be less attentive than usual under these circumstances.

An older child may want to attend Friday prayers during Ramadan. Prayers would be around 1 p.m. Such requests need to be discussed within the context of class schedule, feasibility of transportation, and so on. High school students have been known to make this request.

Concerns about modesty may extend to gym class. If a Muslim girl feels uncomfortable in gym uniforms with short sleeves and short pants, ask if she may wear a long sleeved t-shirt and long sweatpants instead of or under the required uniform. The teacher can designate the color to be worn.

In some public high schools in the United States, Muslim girls have a “girls only” prom where they celebrate their school achievements. However, the school does not necessarily have to make all the adjustments. Students have the option not to participate in a school organized activity such as a prom.

Some Muslim parents may choose to home school their children. Service providers can rely on their partnerships with Muslim community organizations as they seek to provide resources for these parents.

Case Study

The Tahir family arrived in Manchester, New Hampshire, as refugees from northern (Kurdish) Iraq. Although the parents had not attended school, their two daughters had both had some schooling. The daughters, Elham and Mahassin, began attending high school immediately after their arrival. The father, whose English proficiency was limited, worked two jobs to support his family; the mother, who did not speak any English, was a homemaker.

The Tahir family came from a religious and conservative culture whose traditions they maintained in their new home. The girls were not allowed to appear in public without wearing hijab, and they were not allowed to have male friends.

At school, the social worker observed that the two girls were not socializing with American students. Most of their friends were other refugee girls. The social worker was also aware that the girls were a target of mockery from some of their classmates because of their accent, their demeanor, and their conservative dress. Although the girls were making strides academically, socially they tended to be isolated and act shy around others.

In an effort to help Elham and Mahassin, the social worker decided to invite their parents to come in for a talk. She sent an invitation letter home with the daughters, who translated it for their father. After he had heard the contents of the letter, the father asked his daughters if they were having problems in school. In the Tahir family’s culture of origin, the purpose of school is understood to be academic learning, and socialization is an intra-family matter. Problems in school in this context would mean problems with academic achievement. The girls replied that they were not having any problems in school, and their father decided that he did not need to meet with the social worker. Although the social worker sent the father similar requests later, the parents did not acknowledge her requests at all.

Finally, the social worker contacted the Tahir family case manager at the resettlement agency, and the caseworker arranged for an imam from the community to visit the family. The imam described the differences between the functions of school in the United States and its functions in the family’s culture of origin, and described how observant Muslim parents could meet the expectations of a school system in the U.S. in ways that were consistent with the Qur’an and the teachings of the Prophet Muhammad. He explained that local law required the daughters to be in school, and showed how the basic tenets of Islam supported the father’s involvement in his daughters’ education.

Following this conversation with the imam, the parents agreed to meet with the school social worker. Before they did so, they visited again with the caseworker, who helped them understand more about the school system, especially the importance of non-academic aspects, so that they felt prepared to talk with the social worker. The caseworker also visited with the social worker before the Tahirs’ appointment to discuss the family’s culture and religion.

Possible Questions for Discussion:

  1. How would you explain the behavior of the classmates, the Tahir girls, and the father?
  2. What are the cultural issues in this story?
  3. If you were the social worker, would you deal with this matter differently? How?
  4. Why do you think the parents did not respond to the social worker’s requests at all?
  5. In your opinion, how can service providers prevent situations similar to this one from taking place?
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Muslims are strongly inclined to seek medical care and treatment. The health of each individual is of concern to the family as a whole.

 

Health Care

Like all refugees, Muslims are confronted with understanding the complexity of health care in the United States—the decentralized structure, the principle of choice regarding health care providers and insurance plans, the need for health insurance, the emphasis on preventive health, and more. Further compounding this complexity are the expectations regarding health care and providers that come from experiences with the health care systems in the home countries, the countries of asylum, and the refugee camps.

Knowledge about aspects of Islam that influence health care and health practices may be helpful in understanding Muslim refugee behaviors and choices. Muslims are strongly inclined to seek medical care and treatment. The health of each individual is of concern to the family as a whole; therefore, Muslim men frequently accompany their wives and children to medical appointments. However, Muslim refugees, like members of other refugee groups, do not always follow a particular set of behaviors or make decisions related to their health care based on religious and cultural considerations. For example, some select physicians on the basis of their expertise, while others select physicians based on their gender and ethnicity in addition to their expertise. Individual interpretations of Islam and the influence of cultural practices means there are no universal Islamic health care practices and beliefs.

The following are offered only as guidelines for aiding refugee families. Service providers can discuss these points with each refugee to ascertain individual views and possible constraints regarding health care.

Modesty in all aspects of one’s life is important in Islam. When it comes to health care, Muslim women, like many others, may prefer female health care providers. For them, interpreters of the same sex as the patient would facilitate communication between patient and physician. If a same-sex interpreter is not available, and if there is concern that the female patient is not responsive because she is uncomfortable with a male interpreter, an alternative would be for the interpreter not to be visible to the patient or to interpret by telephone or speaker phone.

Some Muslims may not feel comfortable disclosing detailed information about themselves and their families to strangers. They may try to give as little information as possible, and this may make proper initial diagnosis difficult. Personal questions about the lives, sexual habits, and sexual relations of Muslims can be embarrassing to them, and may be avoided unless the answers are needed by a physician. Caseworkers can seek out culturally sensitive physicians for their Muslim clients in order to avoid embarrassment and problems. Muslim physicians are widely available in the United States.

Dietary restrictions include pork, pork products, and meat that is not halal. This means that observant Muslim refugees need to be served vegetarian meals in hospitals or permitted to eat food brought by family members. Most hospitals have dieticians who are sensitive to the religious and cultural beliefs of patients and will make the necessary accommodations if informed. Alternatively, some Muslim patients and their families may make the necessary accommodations to meet their own health and dietary needs.

During the month of Ramadan, Muslims at the age of puberty and older fast from dawn to sunset. Fasting includes avoiding food, water, and medicine. There are a number of exemptions from fasting, including illness, menstruation, and old age. Caseworkers may discuss the ramifications of fasting with pregnant or nursing women and parents of young children who may not have recovered physically from malnutrition or other conditions that affect their health. A culturally sensitive health professional, school counselor, and Muslim community leader can be helpful to a worker who believes that it is not in the interest of her client to fast.

Rituals related to dying and funerals may be of concern to caseworkers because observant Muslim refugee families are likely to be upset if these rituals are not followed. These include recitation of Qur’an, burial in an Islamic cemetery or an allocated space within a non-Islamic cemetery, and having funerals take place as quickly as possible unless an autopsy is required by law. Local Muslim clergy and community leaders can be helpful to Muslim refugees who do not have regular contact with their mosques. A caseworker whose assistance is sought by refugee families can help most effectively by connecting refugees with an imam or Muslim community leader from the refugees’ culture or tradition.

Muslim male children are usually circumcised at birth or within the first seven days of life. Islam does not require a comparable procedure for female children.

Female circumcision, known by several terms—female genital cutting (FGC), female circumcision, female genital mutilation, and female genital surgery—is practiced by Christians and Muslims in at least 37 countries throughout Africa, the Middle East, and Southeast Asia. The practice of FGC is sometimes defended on the basis of religion, even though it actually represents a cultural practice that predates Islam by many centuries. If clients ask about this practice, caseworkers can tell them that it is illegal in the United States (Federal Prohibition of Female Genital Mutilation Act of 1995), and that parents who have it done to their daughters in this country may face criminal prosecution. If parents suggest that they might send their daughters out of the United States to have this procedure performed, they need to understand that, while they will not face criminal prosecution for this, they risk having a provider report them to Child Protective Services. If this happens, they may find their child placed in foster care while it is determined whether the parents have been negligent or abusive. It is important for parents to understand the serious physical and psychological consequences of female genital cutting. It may be helpful to have a religious leader in the community explain that Islam does not require it.

Countries where this practice has been reported include: Benin, Burkina Faso, Cameroon, Central African Republic, Chad, Cote d’Ivoire, Democratic Republic of the Congo, Djibouti, Egypt, Eritrea, Ethiopia, Gambia, Ghana, Guinea, Guinea-Bissau, Kenya, Liberia, Mali, Mauritania, Niger, Senegal, Sierra Leone, Somalia, the Sudan, Tanzania, Togo, Uganda, Upper Volta, Zaire, Bahrain, Iraq, Oman, United Arab Emirates, Yemen, Indonesia, and Malaysia (Gruenbaum, 2001, p. 11).

Case Study

A family of nine, mother, father, and seven children aged 3 months to 12 years, arrived in Louisville, Kentucky, from a refugee camp in Kenya. The four school-aged children were soon enrolled in school and seemed to be adjusting well.

A month after the start of the school year, the parents received a phone call from a school administrator, asking them to come to school immediately. The father, who spoke some English, was concerned and called the family case manager at the resettlement agency, but could not reach her.

When the parents arrived at the school, they were led to the nurse’s office, where they were met by the school counselor. She informed them that their 8-year-old son Ali had slipped on the playground and scraped his arm. When the nurse examined him prior to dressing his injury, she noticed burn marks on his stomach. The counselor explained that the school was required to report any signs of suspected child abuse to Child Protective Services, and that the parents could not take their son home until a social worker had had a chance to talk to them.

The concerned parents saw their son talking to a social worker in the next room. They did not understand what kind of “abuse” the counselor was talking about. Soon the social worker came in to interview the parents. He asked about burn marks on Ali’s stomach and forehead. The parents explained that the traditional healer in their village had burned small holes in Ali’s skin in order to cure ailments he had had as a baby and toddler. The father insisted on taking his son home, but the social worker explained that he would have to take Ali to the hospital for further tests, and that the child could not be returned home until it had been determined that he would be safe there.

Possible Questions for Discussion

  1. Why are Ali’s parents suspected of abusing their son?
  2. What is the social worker from Child Protective Services likely to do next?
  3. What are the cultural communication issues in this story?
  4. In your opinion, how could service providers prevent this kind of scenario from happening?
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One issue of safety and security that is distinctive to Muslim refugees is vulnerability to the social prejudices and hostilities that can be directed at Muslims in the United States.

 

Safety and Security

Many of the safety and security challenges that Muslim refugees face are similar to those faced by other refugees and immigrants. Their residence locations are likely to be in low-rent neighborhoods, either because they cannot pay higher rent or because they are trying to be frugal. They may thus be exposed to physical and social dangers that can be present in such locations.

Refugee parents are unlikely to understand the dangers, peer pressures, and social dynamics their children experience in school and other social settings. Additionally, some parents’ interactions with their children may be based on experiences of danger in refugee camps or countries of first asylum. Parents may cope by becoming overprotective, restricting their children’s movements and activities, or refusing to recognize their children’s vulnerability. Refugees who have had negative experiences with the authorities in their home countries may refuse to avail themselves of the services of the police. They may be poor advocates for themselves and their children, and so be unable to seek help from school officials or other authorities to resolve dangerous situations. Refugees’ language constraints and lack of knowledge of American culture—especially in low-rent neighborhoods—may constrain their ability to assess and mitigate risks.

One issue of safety and security that is distinctive to Muslim refugees is vulnerability to the social prejudices and hostilities that can be directed at Muslims in the United States. Haddad and Smith (1994) point out that the challenge for all Muslim communities is

the necessity of understanding their [Muslim] identity and role within American society and culture in the context of a long-standing and continuing atmosphere of prejudice and misunderstanding. From such obvious things as continuing government surveillance of the Nation of Islam and Arab Americans, and the recent verbal and physical assault on mosques and groups as a result of international events, to more subtle but continuing “micro-moments of racism” experienced in their daily lives, Muslims see evidence of the realities that face them as they struggle to live as persons of faith and integrity in what is an alien and often hostile environment. (p. xxvii)

Caseworkers can help Muslim refugees to recognize such prejudice and mitigate its effects, especially for women who wear hijab and children who experience discrimination. In some cases, service providers may need to help Muslim refugee individuals or families to seek support from organizations that provide conflict resolution services.

Support from local Islamic community organizations may be solicited in identifying programs that facilitate access to culturally sensitive services and community advocates. For example, a county may have an ethnic affairs committee that includes all foreign-born, including Muslim refugees and immigrants, in its portfolio, or there may be opportunities for special exhibits in the local libraries or at local community festivals to include Muslim refugee groups in the planning and participation. Leaders of churches, synagogues, and mosques around the country have initiated a number of programs designed to build understanding between Muslims and non-Muslims.

Caseworkers in educational settings may be of special assistance not only to refugees but also to teachers, counselors, and youth leaders for whom misunderstanding about the concept of jihad has been corrupted by the media and used to generate fear of Muslims. Jihad means “struggle.” The main reference is in relation to the inner struggle of the individual to strive to be good and to follow the “straight path.” Jihad can also mean to fight on the side of what is right, but it does not allow for being the aggressor.

Case Study

An Afghan refugee family consisting of a widow and seven school-age children resettled in a city in the eastern United States. Service providers found subsidized housing for the family in a public housing complex, which was the only place with an apartment that was both affordable and large enough for the family.

Several weeks after the family moved into the apartment, the children began to be targeted by other children in the housing complex, who called the Afghan children names. On two occasions, rocks were thrown through the window of the family’s apartment. After the first rock-throwing incident, the mother reported the situation to the caseworker, but resisted the idea of going to the housing authority or the police. After the second rock-throwing incident, however, the caseworker was able to persuade the mother that the authorities could help to remedy the situation.

The caseworker was able to convince the housing authority to convene a residents’ meeting to discuss the situation. As can often be the case in public housing, none of the residents had actually had an opportunity to meet the members of the Afghan family face to face. At the meeting, the caseworker talked about the difficulties the Afghan family had endured as refugees and facilitated personal introductions.

The metropolitan police department was also responsive and had an officer stay at the complex overnight. As a result, two children were apprehended in the act of throwing rocks. After these events, the name calling stopped and the Afghan family and some of their neighbors developed more cordial relationships.

While working on the family’s resettlement, the caseworker had contacted a local mosque that ran several programs for newly arrived Muslim refugees. In one of those programs, the mosque partnered with a local Christian church to locate housing for refugee families. The caseworker had asked the head of that program to find a better housing situation for the Afghan family.

After three weeks of calm at the public housing complex, the Afghan family began to be harassed again, and someone sprayed several of the children with mace through the screen door of their apartment. By that time, however, the housing program had found a farmhouse for the family, and the service agency was able to move them out of the public housing complex.

Possible Questions for Discussion

  1. What are the cultural issues in this story?
  2. Why do you think the mother resisted the idea of going to the authorities at first?
  3. Can you suggest other things that the caseworker might have done to help resolve the problem at the public housing complex?
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The Cultural Orientation Project--http://www.culturalorientation.net, for more information contact sanja@cal.org
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