SAN DIEGO COUNTY, Calif. — San Diego’s Karen refugees, an ethnic minority of Burma, are used to uncertainty.
They were persecuted, their villages burned. They fled through jungles, not knowing if they would meet life or death. The survivors waited for decades in refugee camps for permission to start over somewhere new.
That’s why for the Karen people and for other refugees and asylum seekers from around the world who have resettled in San Diego, COVID-19 has been one more blow, said Nao Kabashima, executive director of the nonprofit Karen Organization of San Diego.
The pandemic has left them unemployed, reluctant to seek medical care and at risk for eviction. The children of these refugees, like many others, aren’t adjusting well to online education, but their parents are less equipped than others to guide them.
Some of these challenges will be long-lasting, Kabashima fears.
“I am afraid that it would take a long time for many refugees to get jobs again,” she said. “I think about that every day.”
Until recently, many of these concerns were anecdotal. But a first of its kind survey, released Thursday by the San Diego Refugee Communities Coalition, concretely details how deeply the pandemic has impacted immigrants and refugees from across the region — from healthcare to education to imperiled basic needs such as housing, food and physical safety.
Amina Sheik Mohamed, the director of the Refugee Health Unit with the University of California San Diego’s Center for Community Health, and one of the survey’s facilitators said it was carried out in a unique way.
“This is different,” Sheik Mohamed said. “It’s very much engaged with the community. … It was not like a typical researcher coming and doing research to the community, but it was really co-designed. The community leaders are conducting it.”
The communities tapped their own members to conduct extensive phone and in-person interviews in 12 languages about the pandemic’s impact on 306 families, granting the researchers unprecedented access to people who might otherwise not have been listened to. Because of that, Sheik Mohamed said, the findings reach across communities to learn about problems and gaps in services that have affected thousands of immigrants from different backgrounds.
The survey found that during the pandemic:
- Almost a third of families canceled or missed health appointments.
- In more than 40% of families, at least one member lost a job or was laid off.
- 60% of families couldn’t pay all of their rent.
- Over a third of families said they are afraid they’ll be evicted. More recent immigrants and families with bigger households are at greater risk.
The family members interviewed were from countries including Afghanistan, Burma, the Democratic Republic of the Congo, Haiti, Somalia, Sudan and Syria. Because the survey asked about their entire households, researchers learned about the situations of more than 1,400 people.
Some problems were acute.
“I was paying rent up until now, but now I can’t since the rental assistance program is over, I do not know what I can do,” one person told an interviewer. Another said, “I need help with rent. PLEASE.”
A concern underlying the survey’s findings is refugees will have a hard time bouncing back after the pandemic.
“Families with school-age children are concerned about the impact that school closures and changes to how education is delivered will have a long-term impact on learning,” the report said. “Community leaders are concerned that inequities that existed pre COVID-19 will be exacerbated.”
The report also identified areas where needs are being met within the communities themselves or by public programs and nonprofits. But it also found gaps between the support and resources being offered and what is needed and proposed solutions.
Kabashima, who coordinated the survey and outreach for Karen and other refugees from Burma, said the results were concerning but not surprising, revealing how widespread problems are.
The survey, she said, confirmed that all of the region’s refugee communities are suffering and struggling with the same issues as the Karen people.
“It was also shocking to know how many families actually are struggling from unemployment,” she added.
A grassroots survey
One reason the survey is unusual is that it was designed and carried out by a grassroots group of ethnic community-based organizations that make up the San Diego Refugee Communities Coalition.
This survey is the first time that these discrete refugee ethnic organizations and nonprofits have come together to examine from the grassroots the circumstances and concerns around the impact of the coronavirus pandemic on their communities.
Valerie Nash, a consultant who helped develop the survey’s report, said that in the past City Heights, a diverse mid-city neighborhood where many of San Diego’s refugees live, has been studied and examined extensively but typically by outside entities.
She said the grassroots nature of this survey, with people interviewing members of their own communities, meant refugees could identify and investigate the issues they deemed important.
Rebecca Fielding-Miller, an assistant professor of infectious disease and global public health at UCSD, said this kind of research helps ensure that the response to the pandemic protects society’s more vulnerable members, which in turn helps everybody.
“None of us are safe until the people at the highest risk are safe. It's an airborne infectious disease. To me, as a public health social scientist, the thing that we always need to be building for is ensuring that the people at the margins are taken care of,” Fielding-Miller said. “Because when they're taken care of, everybody is taken care of.”
Research, she added, can also shape policy.
“Policy responds to data, right?” Fielding-Miller said.
In this case, she said, being able to “translate a known, lived experience amongst a marginalized community” to something that can be demonstrated and measured is key because it helps create policy and direct where money should go to help these refugees.
The report states its goal is to understand the pandemic’s impact on refugees, inform solutions and “mobilize action.” It concludes with dozens of recommendations for addressing those needs and gaps in services.
For education, improving parents’ digital literacy and providing more tech support to families would help children better adjust to online schooling.
For healthcare, one of the long-term recommendations is investment in “culturally responsive services and treatment,” while under housing, a short-term solution the report identified is to extend rental relief programs past October, the report said.
Deep economic pain
Meshate Mengistu, the community health coordinator at United Women of East Africa, one of 11 San Diego refugee groups that helped conduct the survey, said the families she spoke with in August and September were struggling to afford basic needs.
“Do they feed their children (or) decide whether they buy diapers for their young children,” she said.
The pandemic has exacerbated the financial difficulties of refugees, who already were more likely to struggle to meet basic needs, the survey noted.
“Our community members were working in the very industries which were hard hit by this: the restaurant industry, hotel industry and tourism industry,” said Kabashima with the Karen nonprofit.
Among those who answered questions about income and employment, about a quarter said they worked fewer hours, more than 40% lost jobs or were laid off and others were expecting to lose a job. Twelve people said their families had to close businesses because of the pandemic.
These findings, compared with the high unemployment figures for areas of the county where refugees and immigrants tend to live, are another window into how low-income and immigrant communities have disproportionately borne the brunt of the pandemic’s economic devastation.
Some of the families surveyed estimated their income shortly before and during the pandemic — in January and July. Almost three-quarters of them lost income, with an average decrease of 29%, or $846 a month.
The survey also found that 23% of all the families interviewed were “extremely concerned” about being able to afford food, and almost all received some kind of assistance, including an economic stimulus check, Pandemic EBT — one-time funding to cover children’s meals — or unemployment.
Education and health gaps
For refugees new to the U.S. who are trying to figure out unfamiliar school and health systems, the pandemic has made adjusting harder.
Access to healthcare is complex, with more than half of the people surveyed saying they prefer in-person medical visits over video and phone consultations. About a third said they have skipped or canceled medical appointments because they were afraid of contracting COVID-19, didn’t have childcare, were concerned about privacy and language barriers, or were quarantining with coronavirus symptoms.
More than 50,000 people in San Diego County have tested positive for the coronavirus. It’s not known how many were refugees, but COVID-19 case counts have been higher in ZIP codes where those who took the survey live, including El Cajon, the College Area and City Heights.
The pandemic has “really amplified and magnified things that we know were already happening,” Fielding-Miller with UCSD said. “Those issues are now happening through the lens of COVID, and they are even more obvious than they were.”
She said even when refugees and immigrants “do have access to insurance, we know that finding a provider who is culturally competent is difficult.”
”We know that getting care from a provider that is on par with what essentially an affluent white peer would get is difficult because systemic racism is inherent in the medical system,” Fielding-Miller said.
Some immigrants, she added, avoid COVID-19 testing and contact tracing because they are afraid they might be deported.
The result is “a pandemic response that breaks, that doesn't work and that puts everybody at risk,” she said. “So it's really important to make sure that the system works for everybody so that everybody can stay healthy.”
Among problems with education, the report said, are language skills, isolation, cultural norms and other factors that “dramatically compound” the difficulty families face with online schooling.
Parents described technology and technology literacy challenges:
“The internet speed is not sufficient and is expensive.”
“Not enough internet or computers for all my children at same time, they share and take turns.”
“The District is assuming that everyone knows how to use technology and we don’t.”
“I am not able to help my children with their schoolwork.”
In the families Mengistu interviewed, she said parents told her they “have no idea what technology even looks like, for the most part … so they're lost on what to do and how to help their kids.” They are wondering, she said, “How do I go back and check they're doing their homework?”
Refugee families also talked about the tough settings in which their children are trying to attend remote school and how hard it is to get help. They don’t have quiet places to do their schoolwork, and families aren’t always skilled enough in English or familiar enough with the education system to ask for help or understand what help they do have.
The survey also found that most parents, 85%, said their children are not getting enough support with online learning, but 71% said they feel supported by their school and have adequate resources.
The report said the coalition is working now with the San Diego Unified School District to address these concerns.
Lonely and disoriented
The temporary closures of religious and community organizations also left refugees unmoored, Mengistu said. This was not just because those were social hubs, but because that’s where people went to get information and support before the pandemic.
“In our community, people go to faith-based organizations to get community members to talk to, to get help in whatever way they need. Not being able to go to church or a mosque to seek out help was tough for the community,” Mengistu said.
Put simply, she said: “Humans need humans.”
While 80% of those surveyed said they had at least one source of support to help them cope with the pandemic — often a spouse, friend or refugee organization — 71% said they were worried about their ability to connect to friends and their community.
Like with the Karen refugees, the uncertainty has been hard on the families Mengistu spoke with.
“A lot of families come here so that their kids can have a better future,” she said. “So seeing what they see and the difficulties that they themselves are now facing, I think they think, ‘What else awaits our children?’ You know what I mean? The unknown is definitely scary for them.”
With her organization’s offices in the College-Rolando area temporarily closed, the nonprofit now offers weekly remote tutoring for kids. The group also has given emergency grants to help people pay their rent.
“One of the great things about the community is that they're very resilient,” Mengistu said. “They are people that came from hardship to make a better life for themselves, so it's do or die for them here. They’re gonna make a way, one way or another. If it's together or by themselves, they're gonna do it.”