Adaption of Refugees During Cross-Cultural Transitions: Bosnian Refugees In Upstate New York

This paper presents the results of a study of a Bosnian refugee community in upstate New York. A region of upstate New York has been host to a large contingent of refugees, most recently from the former Yugoslavia. Because of the existence of a refugee resettlement center supported by the Lutheran Immigration Refugee Service (LIRS) nationally, this area has one of the highest densities of refugee populations in the United States.

The study addressed the site of resettlement of 8759 refugees between 1979 and 1999, with nearly 3500 Bosnian refugees coming between 1993 and 1999. From an annual total of 79 refugees from Bosnia in 1993, there was a peak of 1145 arriving during 1997, and a decline to 501 in 1999. Refugees from Bosnia currently entering the United States are joining family members under the auspices of a reunification program; their numbers will therefore probably continue to dwindle. We became interested in the psychological, socio-cultural and economic adaptations of the Bosnian refugees to this community and the strategies they have used for successful adjustment.

Table 1. Bosnian Refugee Arrivals in an Upstate New York City

This research project focused on the lives and experiences of a sample of 100 Bosnian families. The initial sample was chosen for having shown signs of successful adjustment or adaptation from those refugees who had either achieved United States citizenship, for which application is allowed after five years in residence, and those who had purchased homes in the United States. The interviews were semi-structured and dealt with their lives before the war, their experiences during and after the war, and their efforts to adapt to life in upstate New York.

Background and Approach to Research

The researchers come from different theoretical and experiential backgrounds, which influenced both the direction of the research and the lenses through which it was viewed. One is a sociologist with an expertise and interest in ethnic conflict, which drew us to focus on the origins of the war and the Bosnians' understandings of what the war was about. The other is a social worker and psychotherapist with an expertise and interest in psychological trauma, which focused us on the disruptions or displacement, mental health issues, and the impact for both refugees and the community in adapting to a new culture. We drew from the literature on refugees to provide a basis for understanding cross-cultural transitions in the areas of psychological, sociocultural, and economic adaptation.

Questions of Method

Survey questionnaires were personally administered during in-home interviews, often with other family members, friends or neighbors in attendance. Interviews were conducted in English, and interpretation, when needed, was initially supplied by another relative. In later interviews, a paid interpreter was used. One page of the questionnaire, the Hopkins-25 Symptom Checklist,ⁱ was given directly to respondents to check off in their native language. Many of the people being interviewed spontaneously supplemented their accounts of their lives prior to or during the war in Bosnia, at times, with photographs or videotapes. These visual materials might show their towns or villages and landmarks they were proud of, but were as likely to illustrate signs of destruction or mass graves, or the exodus from those towns or from prison camps. Interviews took approximately 1 hour to 1-1/2 hours.

Second interviews were arranged with twenty families and were targeted to those families showing distress on the Symptom Checklist. These second interviews lasted between 1 ½ hours and 3 hours and allowed us to explore adaptation issues in more depth. Second interviews were also used to screen for difficulties in adjustment that needed more attention and to make referrals for services in the community where appropriate.

Our Sample of Refugee Citizens and Homeowners

Out of the 100 Bosnian heads of household interviewed in the sample, 82 are homeowners. The average age of a head of household is 38, while 50 percent are younger than 36, and only 4 in the sample are over 60. Over 90 percent of the households have children, and the average number of children per household is less than two (1.75). In addition, the children of Bosnian families are relatively young. Fully 45 percent of families have one or more children under the age of 6, 34 percent have children between the ages of 7 and 12, and 27 percent have children between the ages of 13 and 18. About 18 percent have older children or young adults between the ages of 19 and 25. Language is one of the biggest barriers to integration for Bosnians. Therefore, English as a Second Language has been an important aspect of resettlement. The average number of months of ESL for a Bosnian refugee is 3.10, but 75 percent of the sample had less than 4 months of English training. The longest amount of time spent in ESL classes by a refugee in the sample was 12 months. By the interviewer's estimation, 36 percent of the sample was at a beginner level of English skill, 30 percent were at an intermediate level, and 34 percent were at an advanced level.

Former Life and Displacement

We begin with some observations about life in the former Yugoslavia, or as it is typically portrayed, "the beautiful life." In the sample of families interviewed, almost half (43%) were from cities in Bosnia. City dwellers describe a specifically European cityscape in which evening strolls along the streets of one's town were a common event and in which young and old alike frequented cafes and bars to chat and meet with neighbors and friends. Schools, workplaces, and apartment buildings were all characterized as multiethnic. A set of common and insistent themes reverberated throughout the interviews: "I didn't know who was what, I didn't care about ethnicity. It was not allowed to ask about religion. We never expected war to come to Bosnia.ⁱⁱ " The literature suggests that about 30-40 percent of marriages in Sarajevo and other large cities in Bosnia were mixed (Donia and Fine, 1994). Our sample seems roughly representative of larger demographic patterns since about a third of our respondents from urban areas reported that they were either in mixed marriages or were the products of a mixed marriage.

The other half of the interview sample included people from rural areas who typically reported that they had lived "in the country" or "in a village." Villages were more ethnically homogenous, but regional schools were typically mixed. Here again, respondents denied that the other's ethnic identity had any significance to them. Some respondents said that ethnic distinctions became evident only after war broke out: "I never thought to ask before." Everyday life was marked by the rhythms of the seasons, specifically because most villagers and country dwellers had large gardens and numerous barnyard animals. Many reported that they were virtually self-sufficient in their subsistence agricultural activities. They talked about the crops they raised, the chickens, sheep, and cattle they had, though most families had only one or two cows for the milk, butter and cheese needed for family consumption. Mixed marriages were much less common in the villages and countryside, but more than half of the entire sample indicated they had a relative who had married someone from another religion.

Our respondents came from varied socio-economic backgrounds ranging from agriculturists and working classes (miners and laborers) to lower middle class (office workers) and middle classes (teachers and lawyers). A significant number worked abroad or who had family members who worked abroad in Croatia, Slovenia, Austria, or Germany. In spite of the very high rates of inflation which are known to have plagued Yugoslavia's economy in the years before the war, most of our respondents reported a comfortable life style and standard of living in the 1980s.

Ethnic Conflict and Wartime Experiences

In considering the adaptation of refugees, we were particularly interested in the experiences of ethnic conflict and ethnic cleansing, in wartime experiences, and how adapting to a new country and new community might be impacted by those traumas and the resultant displacement from home and country. The literature suggests that negative life events, both pre and post-migratory, continue to have an impact on economic, social, and psychological adaptation, years after the initial events. (Pernice and Brook, 1996; Uba and Chung, 1990)ⁱⁱⁱ

Ethnic cleansing is a nasty and brutal tool of war, but it also must be understood as a form of political calculus. In the run up to war in Bosnia, referendums were used to establish the political will of the people in a given territory no less than five times. The referendums which were held to justify the secession of Slovenia, Croatia and Bosnia from Yugoslavia, and then the referendums which Serbs held in Croatia and Bosnia to document their desires for autonomy or annexation to Serbia, contributed to the use of ethnic cleansing by making it seem an expedient tool of war. It would do no good to conquer an area of Bosnia in war, if, after the war, a referendum were held which ended up returning that territory to its original occupants. Rather, it would be politically expedient and logical to ensure the desired outcome of any future referendum by clearing the land altogether and then resettling it with co-nationals.

Some respondents reported watching their homes burn to the ground, an especially painful sight to Bosnian Muslims for whom home ownership occupies such a central place in their culture. This value was evident in many interviews, especially among subjects from the countryside, and it is born out in ethnographic literature on village life in central Bosnia. Before the war newly married couples apparently expected to invest many years of labor and a great deal of money in the construction of their own home. (Bringa, 1995, 85-6). The special value attached to home ownership in Bosnia made ethnic cleansing all the more painful for those who witnessed destruction of their homes by the Serb militia.^iv Even for those who left Bosnia before ethnic cleansing began in earnest, the agony of watching nightly newscasts in which fellow Muslims were forcibly moved, imprisoned in concentration camps or killed in massacres had a terrible impact.

Displacement and Trauma

As a part of the post-migratory process, most Bosnians must deal with loss of home and country and traumatic stress related to war experiences, in addition to new employment experiences and demands in a strange cultural setting for adaptation and resettlement. The experience of displacement may be stronger with refugees than any other group, in that their emigration was not chosen or executed with any sense of order. Refugees often flee without funds or belongings, and the separation from family and other attachments may be abrupt, forced, and unplanned. These distinctions between immigrants and refugees have been well noted in the literature.^v

Knowing that one has a place in the world may be a fundamental requirement for security and identity. Fullilove (1996) writes of the experience of displacement as one in which a sense of belonging is disrupted and in which the loss of even that material and relational world can be devastating. One's home, Fullilove explains, represents "the accumulation of many relationships and much history" (1996, p.1519). Refugees, by definition, have suffered losses of relationship and history, and the Bosnians that we interviewed were no exception. One refugee explained,

Can you imagine our lives after losing (parents, home, neighborhood, school, church, nation, country) in a short period of time, almost instantly? This chain can not be fixed ever. We can just pretend that we are doing well, but all these lost links are like amputated arms; they do not grow again.

The impact caused by trauma experiences is said to be "one of the most critical clinical, societal and research challenges facing the health communities in the decade of the nineties" (Miller, 1996, p.xxii). We have every reason to expect that to continue into this next century. Judith Herman (1992) argues that although traumatic experiences have been defined as "out of the ordinary", this is sadly, untrue. Herman describes rape, domestic violence, assault, and even military trauma as now "a common part of human experience; only the fortunate find it unusual" (1992, p.33) Indeed, in our interviews, respondents frequently seemed to regard their traumatic experiences as almost commonplace as family after family suffered personal loss of life, prison and concentration camps, combat in one, two or possibly three different armies, and terrible conditions of hunger and deprivation in refugee camps. Even families relatively unaffected by direct combat suffered the deprivations of war in experiencing fear for themselves and their loved ones, hunger and other restrictions on the essentials of everyday life, and the dismantling of a way of life that had been experienced as good and solid.

Adjustment and Adaptation

Pre-migratory traumas, significant in the refugee populations, have been found to have important effects on financial and physical health, both of which are key determinants of self-sufficiency and well-being (Uba & Chung, 1990). Models of the process of acculturation for refugees have emphasized psychological adaptation, socio-cultural adaptation, and economic adaptation as three distinct and equally important measures of successful adjustment in a new host country (Aycan & Berry, 1996). Our attempts to study adaptation of refugees in upstate New York considered how refugees were feeling about their lives and their futures, how well they were adjusting to new demands and changed circumstances, and how they were faring economically.

Refugees who came to this area were met at the airport by employees of a refugee center, which then provided an apartment with the first month's rent paid, food in the refrigerator, and minimal furniture and household goods to begin a new life here. The center contracts with the State of New York to provide supportive services to refugees such as English as a Second Language (ESL) training, employment counseling and support, school enrollment for the children, and connections with public welfare for cash assistance, Food Stamps, and health insurance.

Life Is Not So Bad

Most refugees reported being relatively satisfied with their lives. However, a leader in the Bosnian community cautioned us that refugees are being polite and are much more dissatisfied than they revealed. Although still working for some of the important things they want, and acknowledging that conditions are not excellent, many refugees described the United States as a place that has offered support and one that offers opportunity. One refugee reports "We take (U.S. support) to build positive futures for our children." And another states "We're healthy, it's okay." For others, however, "life is a struggle still."

Some refugees who had lived in Germany for several years prior to their arrival in the U.S. complained that, although Germany had provided temporary support and respite, it became a place of limbo where they couldn't get on with their lives in a permanent way:

I felt like a baby there, very helpless. We wasted 6 years in Germany and in two years here have big accomplishments.

Refugees talked to us about having had a good life and a normal life that changed completely and unexpectedly. Their hometowns are described in glowing terms and with a sense of nostalgia. Descriptions of lives that were comfortable, home construction "better than here", with good food, "Euro-style" cities", and plentiful rivers, trees, and parks are common.

Some want that life back and have homesickness, but others have seen the change as opportunity. There is also a genuine feeling of loss among many refugees for Bosnian cities and countryside: " We all miss our European city; this is different concept of city. . . "I would like my prior life and my own house. I miss former life and own language, I had better job there." There is a sense, though, of a willingness to start again, and some enterprising individuals had always planned to leave: "I always thought I would leave Bosnia and go to Germany or the US. . . I'm waiting to start my life. Not too bad to start again. . .Who wants to learn here can."

The future is spoken of as belonging to the next generation and includes plans for citizenship for most. Consistent strategies are observed to work their way up the economic ladder and replace the financial and material security they had lost. Families members often work more than one job to save money, they live together and pool resources, try not to rely on credit and pay cash, and work different shifts to minimize the need for child care outside of the family. Children's education and family's health resonated as themes to be concerned about as well as better jobs and planning for retirement.

Refugees continue to struggle with separation from family members who are still in Bosnia, Croatia, or in some cases, other countries abroad. This often produces feelings of homesickness, concern about family still dealing with poor economic conditions, and internal conflicts about having left them behind. Many refugees were still struggling to bring family here in a race against time as immigration rules increasingly restrict who can be admitted to the United States. Family members in Bosnia continued to go through prolonged application processes and inconvenient procedures that kept some of them from being able to complete the journey. Respondents also told of years spent in refugee camps in Croatia and the sudden need to go back to Bosnia to obtain more money or do some bit of business that then disqualified their refugee status, since they had left their first country of asylum. Respondents expressed some of their feelings toward their families and family separation in the following:

My parents are in Bosnia and are old and sick. I wish I could be with them, but they don't want to come. I feel I'm not here nor there.

When citizenship is complete, I will go back for visit. Friends in Bosnia tell me, "Be lucky you are there-no job, no money here."

Many refugee families here send money on a regular basis to relatives in Bosnia and say their families would be little able to survive without it.

Economic Adaptation

Central to U.S. Refugee Policy is the requirement that refugees be gainfully employed, and they sign contracts upon arrival in the resettlement city agreeing to accept any work that is available. However, economic adaptation has been defined as a "sense of accomplishment and full participation in the economic life" of the new country (Aycan & Berry, 1996, p.242), and displacement for refugees has been generally noted to be associated with significant underemployment and downward mobility (Aycan & Berry, 1996; Beiser et al., 1993; Young & Evans, 1997; Westermeyer, 1986; Stein, 1986). A report completed by Hagstrom (2000) on the economic impact of refugees in Utica, New York indicates that the duration of intensive English training is dependent on how quickly jobs become available, and limited English skills predict refugees moving into very low level positions.

Bosnians have integrated into many sectors of this city's economy, mainly occupying jobs as operators and laborers. Approximately 22 percent of women and 12 percent of men, however, are currently employed in service occupations, while the majority (60% of women and 68% of men) are operators, fabricators, or laborers. The average starting wage for Bosnians several years ago was $6.36, and it has risen to a current average wage of $8.13. However, there are disparities between the wages earned by men and women. The starting wage for women was $6.03 per hour, and the starting wage for men was $6.49. While the men's average wages rose to $8.89 (a difference of $2.40) over time, the women's average wages only rose to $7.31 (a difference of $1.28). The disparity is even greater in certain occupations. For example, among operators, fabricators and laborers, the average women's rate increased by only $0.77 (from $6.25 to $7.02), while the average men's wage increased by $2.18 (from $6.20 to $8.38). Moreover, within service occupations, women's wages increased by $1.54 while men's increased by $2.30.

There are correlations between wage rates and English skill level. The average wage of males increased directly with English skill level. Bosnians labeled as "beginners" were making, on average, $8.07, while intermediates were making $8.66, and advanced English speakers were making $9.95 per hour. The data concerning the relationship between wage rate and time in the United States, moreover, does not reveal any significant correlation. There are also a significant number of respondents who have higher education and training in their native country and are seriously underemployed here in the United States.

On the consumption side, Bosnians spend much of their earnings on a mortgage or rent, health insurance, and contact with friends and family in Bosnia. The average cost of mortgage or rent for a Bosnian household in the sample is $420, and 90 percent of households have a mortgage or rent below $600. The lowest cost is $227.00, and the highest is $900.00. Workers pay an average of $136 per month for health care coverage when they are covered through employee benefits at work, and this represents about nine percent of the head of household salary. Bosnians are not used to paying for health insurance, and many are generally dissatisfied with the cost and the waiting periods for medical appointments.

Most of the Bosnian families interviewed keep in close contact with their friends and family overseas. The average phone bill per month for households is $95.00, ranging from $30 to $200. In addition, Bosnians send significant amounts of their modest salaries overseas, with an average of $216.00 per month.

Social and Psychological Adaptation

Difficulties in adjustment have come in understanding the system, needing to know better English, and in separation from family members. It was anticipated that refugees might not feel accepted in the community, but most people stated they felt welcomed in some way and did not experience discrimination here. Adjustment appears to be particularly difficult for the elderly. At a time in their lives when familiarity, attachment, and comfort appear to be most important, they have perhaps suffered the greatest losses. One gentleman expresses his concern for his in-laws:

It's tough for my in-laws and the elderly. They can't go back, my mother-in-law is lost. She has no friends here and complains. Has no newspapers to read, there is a big difference between the old and the young. . . the social life is disrupted.

Another woman over 65 explains:

"I have no friends here - nobody would notice if I died."

Another significant area of adjustment problems may be the resolution of trauma and displacement experiences and the symptoms of depression and anxiety that are common to those experiences. Studies of refugees have found high rates of mental health problems (Kinzie et al., 1990; Mollica et al., 1990). More particular to the study of Bosnian refugees are findings by Weine and colleagues that mental health problems are present at the time of resettlement and persist after one year, both of which may come several years after an initial trauma (Weine et al., 1998). Many of our refugee respondents reported quite a bit of nervousness or shakiness inside, feeling tense or keyed up, feeling blue, having headaches, being low in energy, blaming themselves for things, and feeling lonely, trapped or caught. Nearly half of the refugees who have completed these interviews showed signs of depression and anxiety. Some refugees were clearly traumatized by events leading to their refugee status and cried during the interviews. One respondent, for instance, reported a number of severe symptoms, looks about 10 years older than his chronological age, and is balding, with poor teeth and poor health. This sentiment seemed to sum up the feelings of many: "War changed life, we lost everything. I can't forget."

Services Are Mostly Good

Most refugees reported being somewhat satisfied with most of the services that were being provided. There were some complaints about public assistance not being sufficient and taking too long to start, employment assistance being "not so good", and too little information being provided generally. Families had to wait an average of 1 month for their cash assistance to start, but there were reports of some families waiting up to 5 months. For those who had family members here to cushion their arrival and adjustment, there was more satisfaction, but in the earlier years of resettlement in the community some people who came virtually on their own experienced more difficulty. Inadequate transportation and poor housing, furniture and household goods were other complaints. Others were more satisfied and had no complaints now other than homesickness and understanding how things work:

We have no problems with services now, but had to learn to 'understand the system'.

No difficulties in getting help and no problems now, except a little always needing to know better English and severe homesickness.

We are mostly satisfied with services, but we could have used more help with being pretty poor and with cash assistance.

Refugee interviews indicate that although some workers are very satisfied with their employment experiences, others are seriously mismatched and have skills and training that have either do not transition well to the new culture or require more extensive English skills. One woman said:

Before I worked nine years in a financial department at a higher level with more creativity, but here I have English limitations.

Another woman explains the limitations of her English and the response of those around her saying: "I feel most people act as though my accent equals stupidity." Yet another man was dissatisfied with his job as an Assembler:

I worked as medical technician in Bosnia, and I want to work in a health field, but my poor English is the barrier.

Barriers to language acquisition are exacerbated by employment patterns that result in large numbers of Bosnians working in establishments where interaction with other Bosnians does not require them to speak English.

Working conditions are sometimes a problem, and some respondents complained about inadequate employment benefits. Several of the refugees that we've interviewed have been hurt on the job, which is perhaps a greater hazard in low-paying occupations. Problems with physical health compromise both their economic well-being and their psychological well-being. One man explains:

My wife worked for three years, but in a job that was bad for her hands and could not find better. I was a vet with large animals and never worked in a factory. It made me depressed. . . I've been on disability now for 6 months, and my wife receives no money but cannot work.

Also, workers used to benefits in European countries note there is not enough time off, that maternity leaves are "ridiculously short", and that health insurance practices in the United States are "terrible" and keep people from getting the care they need.

A War Within a War

Adaptation to life in America may be made more difficult by virtue of a conflict within the Bosnian refugee community. After we began our research we discovered that about half of the Bosnian Muslims in Utica come from an area in the Northwest of Bosnia which broke away from Izetbegovic's Sarajevo based government in the fall of 1993 and fought against it for almost a year in an attempt to create an Autonomous Province of Northwest Bosnia. Their leader was a businessman named Fikret Abdic who was the director of the largest food-processing conglomerate in Yugoslavia. Abdic and his followers were eventually defeated and routed in battle in August 1995 by fellow Muslims loyal to the Sarajevo government. About 20,000 of "Abdic's people" crossed the borders into Croatia and flooded the already overflowing refugee camps in the Krajina. The significance of this war within a war for the community of Bosnians in Utica is embodied in the antagonisms between the two factions of Muslims which many say are more serious than any between Serb, Croat and Muslims from Bosnia.

The depth of feeling, the vehemence and antipathy directed at Abdic and his supporters by Muslims in the rest of Bosnia must be understood in light of Abdic's collusion with the Serbs in the Northwest. It was not merely that Abdic broke off with the Sarajevo government nor that he disagreed with the decision taken by the Bosnian parliament (engineered by Izetbegovic, some would argue) to reject the Vance-Owen peace plan and to continue the war. Rather, Abdic signed treaties with Radovan Karadzic, leader of the Bosnian Serbs and indicted war criminal, which went beyond a cessation of hostilities to encompass active military cooperation between Serb and Abdic military forces. Hence Serb and Abdic military units fought actively side by side against V Corps brigades of the Bosnian army, against their former countrymen, brothers, fathers, relatives, friends and fellow villagers.

Again, this constituted treachery and collusion with the enemy, but the resentments went further. The Serbs in the Northwest of Bosnia had engaged in some of the most brutal acts of ethnic cleansing witnessed in the war and they operated some of the most notorious and barbarous concentration camps in that region. The Omarska Concentration camp near Prijedor and the Manjaca concentration camp and the camp located in the soccer stadium in Ljubija were well known for the horrendous conditions, torture and mass executions inflicted on the Muslim population

Conclusion

Much has been written about the particular experience of the Bosnian Muslims in this war, where their captors and tormentors were former friends, neighbors, business associates with whom they had broken bread, entertained in their homes, worked with side-by-side, and intermingled with in all aspects of everyday life. The ability to have secure attachments in relationships is the basis for human development, and "the damage to the survivor's faith and sense of community is particularly severe when the traumatic events themselves involve the betrayal of important relationships." (Herman, 1992, p.55). Dr. Stevan Weine, (1999) who has done extensive work with Bosnian refugees, observes that "the shattering of trust, so common in traumatized individuals, families, and communities, is pervasive in Bosnians" (p. 166). These alterations in safety and trust affect basic assumptions about life, and change and disruption brought by war also bring traumatic stress to symptomatic levels for many refugees and their families.

One study of recent refugees in Sydney, Australia concluded that "a refugee's greatest need for guidance is during the initial stages of resettlement, with service providers playing a key role during this period of the refugee experience" (Waxman, 1998, p.76). That initial transition is viewed as a critical time for all refugees with a potentially larger impact for long-term adjustment. U.S. Refugee Policy does not provide adequate mental health guidelines or fund mental health efforts sufficiently to screen for and treat stress-related symptoms for refugees in that initial transition, and there is some concern that in the emphasis on rapid employment, we are putting unneeded barriers in the way of truly successful adaptation.

Adjustment and adaptation have been correlated with the quality of an individual's intimate relationships and the care and support he or she receives. Bosnian families in this community in upstate New York have, for the most part, recreated family groups and even community, to some extent. Refugees have tended to cluster in common neighborhoods, not only due to low-cost housing, but also, it is believed, to be close to each other. These adaptive strategies are crucial efforts to counteract the insidious and long term consequences of war related trauma. The stress of transition and recovery could also be greatly alleviated by changing the support systems so as to eliminate or minimize additional pressures of delayed assistance, insufficient English language training, and inadequate health care.

Prolonged depression is the most common finding in nearly all studies of people who have experienced chronic trauma. There is some sense that this is complicated by the rage of helplessness, and a rage towards all who could have helped and failed to do so. For instance, Dizdarevic describes his writings about his own experiences in Sarajevo as "an attempt to tell what is happening to ordinary people, who find it incredible that such events can take place in plain view of the world, under the eyes of those who claim to respect justice, order, law, and liberty" (Dizdarevic, Sarajevo, 1996). We have yet to see, any of us, the long-term affects on Bosnian refugees of a world that didn't intervene soon enough to save thousands of lives and allowed this ethnic cleansing to proceed.

i The Checklist was taken from the Harvard Trauma Manual

ii One leader in the Bosnian community believes this was a misinterpretation and is a misleading statement. She insists religion was not asked about because it was not important when choosing friends and partners.

iii See William and Berry, 1991, for a discussion of a public health perspective on interventionwith refugees as an at risk population due to acculturative stress.

iv The inexpensive and readily available stock of houses in Utica's East Side may also have served as a major attraction for the many Bosnian refugees who moved to Utica in the years following the war.

v See the discussion of the distinctions in the literature in Jeremy Hein's article, Refugees, immigrants, and the state, in the Annual review of Sociology, 1993, 19, 43-59.

Reference List