First Session WiSe2016

Please join us for this semester’s Global Health AG:

Tuesday, 25.10 at 7pm,
Seminarraum 2 Innere Medizin, Sauerbruchweg 2, CCM

We will be looking at Kenia’s health system with three main focuses:
1. Health System Financing + Ethical Analysis
2. Historical Background + Political Economy
3. Burden of Disease + Health Care Delivery

Further, we look forward to a cooperation with the Public Health Student Group Nairobi.

Please join us on Tuesday or get in touch for more information.

Poverty Inc.: Screening and panel discussion

Global Health AG and AG WelcomeMed, in cooperation with f.ize (Forum Internationale Zusammenarbeit für nachhaltige Entwicklung), invite you to a screening of the award-winning documentary, Poverty, Inc. on Tuesday, July 5th at 7:00 PM in Kopsch-Hörsaal (lecture hall) Charite Campus Mitte, Philippstraße 12, 10115 Berlin.

Watch the trailer

Following the screening there will be a panel discussion with the following panelists:

  • MP Uwe Kekeritz (Bündnis 90 die Grüne, Commitee of Economic Cooperation and Development)
  • Heino Güllemann (Deutsche Plattform für Globale Gesundheit)
  • Peter Rauch (Professor, Centre for Development Studies, Free University Berlin)
  • Moderated by: Susanne Neubert (Director, Centre for Rural Development Humboldt University Berlin)

Poverty, Inc. has earned 40 international film festival honors including a “Best of Fests” selection at IDFA Amsterdam – the biggest documentary festival in the world. Drawing from over 200 interviews filmed in 20 countries, Poverty, Inc. unearths an uncomfortable side of charity we can no longer ignore. From TOMs Shoes to international adoptions, from solar panels to U.S. agricultural subsidies, the film challenges each of us to ask the tough question: Could I be part of the problem?

For more information on this event, please view the invitation flyer (PDF) or visit our site on

Note: There has been a change in the location. The event now takes place in Kopsch-Hörsaal (instead of Oscar-Hertwig-Hörsaal)!

Global Health Systems: Framework Convention on Tobacco Control

On our next session, we look at the topic of

Framework Convention on Tobacco Control

There exists many health system analyses on how to improve the efficiency or effectiveness of respective system. However, implementing those suggestions often prove difficult as the interaction between different federal and private institutions influence the process of decision-making. Next week, we will take a look at the organizations involved, with our focus on the tobacco industry. If you are interested, join us on Tuesday 28th June in Sauerbruchweg 3, Innere Medizin, Seminarraum 4.

Global Health Systems: Ethics in Public Health and Health Systems

Listed under Goal 3.8 of the Sustainable Development Goals of the United Nations is the following target:

“Achieve universal health coverage, including financial risk protection, access to quality essential health-care services and access to safe, effective, quality and affordable essential medicines and vaccines for all”

Universal Health Coverage (UHC) is thus an essential goal to improving “(Good) Health and Well-Being”. As Boerma et al. have worked out, monitoring UHC is a task that incorporates the following major indicators: Firstly, having complete health service coverage, which includes both treatment and prevention. Secondly, offering financial protection against catastrophic expenditure (high out-of-pocket-payments, compared to household resources) as well as impoverishing expenditure. Data can disaggregated to compare household differences by wealth, place of residence, or sex. These recommendations allow for uniform monitoring of country progress, in the hopes of achieving at least 80% health coverage and 100% financial protection by 2030.

Next week, we will cover a less pragmatic and a more ethics-oriented perspective on health systems. By applying different philosophical schools of thought, we will discuss an ethical framework for assessing health action and system. To tie up our session from last time, we are going start with country case studies on China, Bangladesh, Tunesia, India, and Thailand. If you are interested, come join us on our fourth session on Tuesday, 14th June at 7pm at Charité Campus Mitte, Sauerbruchweg 3, Innere Medizin, Seminarraum 4 to discuss

Ethics in Public Health and Health Systems

Side note: During the World Health Summit in May 2016, only the recommended tracer indicators regarding health service coverage by Boerma et al. were incorporated as actual indicators in measuring UHC. Due to constraints in data gathering, financial protection is now measured by the number of people covered by insurance.

Global Health Systems: Universal Health Coverage

We invite you to our third session on Tuesday, 31st May at 7pm at Charité Campus Mitte, Sauerbruchweg 3, Innere Medizin, Seminarraum 4 to discuss the topic

Universal Health Coverage

Last meeting, we discussed a proposal for an empirical way to measure health system performance as described by Murray. By identifying the main goals of health systems (health improvement, responsiveness, financial fairness), a common ground was created for discussing health system performance. The efficiency of such systems is evaluated by comparing goal attainment through health actions taken with their available resources. To explain intersystemic differences in efficiency, one has to consider the organizations and subsystems involved and their effectiveness in executing their respecting function.

With this framework in mind, we are going to look at the concept of Universal Health Coverage next week. We’ll discuss the definition of Universal Health Coverage (and its implications) as well as methods to monitor Universal Health Coverage in different countries. If you are interested, join us next Tuesday at our journal club!


Global Health Systems: 2nd session

Following our introductory session, the Global Health Student Group will be meeting on Tuesday, 17th May at 7pm at Charité Campus Mitte, Sauerbruchweg 3, Innere Medizin, Seminarraum 4 to discuss the topic

Market fails? Government fails? –  Comparison of health care organization models of two countries

What constitutes a health care system? How does one evaluate and compare the effectiveness of such systems? Join us to discuss these topics and more. After the session, we will be having a cosy get-together with beverages. Get in touch via for more information on the session and required readings.

Global Health Systems

We will be starting our next semester soon and will be focusing on:

Global Health Systems – Concepts, Challenges and Comparisons of Health System Organisation

The first introductory session will take place on Tuesday, 03.05 at 6pm at Charité Campus Mitte, Sauerbruchweg 3, Innere Medizin, Seminarraum 4. Join us or get in touch ( for further information.

post conference note – mental healthcare for refugees in berlin

On 16th January, the Global Health AG organized a conference and workshops on mental health care services for refugees in Berlin.
We were happy to host about 80 participants from NGOs, the political sector, from hospitals, practices and universities that got together to hear about and to discuss the challenges of mental health care services for refugees in Berlin. For the first part, our speakers approached the topic form different perspectives highlighting administrative, political, scientific as well as cultural dimensions. For the afternoon and the second part of the event, we split into two workshops groups that discussed research in mental health care for refugees and the current situation of mental health care services for refugees in Berlin. Aside from connecting different stakeholders involved in the provision of mental health care, the latter workshop formulated claims against the Senate of Berlin asking for:
1. guidelines regarding mental health care services for emergency accommodation providers,
2. a concept for the financing of qualified interpreters as well as
3. a unification of existing services through comprehensive coordination across districts.
For a more detailed account check out the website of Mechthild Rawert, Member of the Bundestag, or simply get in touch (

Mental Healthcare for Refugees in Berlin – Conference and Workshop

January 16 @ 9:00 am4:30 pm | 7€

Mental healthcare services for refugees in Berlin remain very restricted and fragmented. Many different institutions (psychosocial centres, clinics, charities, more) make great efforts to overcome legal and systemic barriers.

After a term of sessions analyzing mental healthcare for refugees in Berlin, the Global Health AG brings these aforementioned stakeholders together to share perspectives on various challenges and promising programs in Berlin and elsewhere in Germany.  Two workshops further target to find concrete ways to collaborate in research and services as well as to recommend courses of action for politics!

The event will be hold in German. Please find the program below and register with!

Programm_WS_Psychosoziale Versorgung Geflüchteter in Berlin_16.1.16

Interfaces of Flight, Mental Health and postmigration stressors

We tried to examine the psychosocial strains and support for refugees in the area of conflict between psychology, politics and an intercultural scope.

Why should we care about this topic as a global health group?

War, torture, rape and death threats are global health risks, which can lead to long lasting consequences. Man-made disasters often leave deep tracks in body and soul and the suffering is not over when the actual threat ceases. Although the topic is in media focus at the moment, it has been existing for centuries.

Psychological Strains

Following the international classification system for Diseases (ICD-10), the two most prominent psychological strains regarding refugees are PTSD (post-traumatic stress disorder; F43.1) and Enduring personality change after catastrophic experience (F62.0).

Besides that, a lot of other strains often occur as a consequence of a catastrophic event, e.g. somatization disorder, depression, sleep and concentration disturbance, anxiety disorders and addiction. Post-migration stressors just shortly got recognition but are influencing mental health intensely (vi.).

The PTSD prevalence amongst victims of torture and war varies a lot. A study of Gaebel (2004) found that 40% of the asylum seekers and war refugees in Germany suffer from PTSD.

Generally speaking, 10-20% of victims of catastrophic events develop a PTSD. The durance (single vs. constant threat) and type of a traumatic event (accident vs. man-made disasters, e.g. torture or rape) are essential for developing a PTSD; 3-11% show PTSD symptoms after a single traffic accident and 50-55% after rape (Kessler et al., 1995; Perkonigg et al, 2000).

PTSD is the only psychological disorder characterised by an initiating event. The ICD-10 defines it as an Exposure to a stressful event or situation (either short or long lasting) of exceptionally threatening or catastrophic nature, which is likely to cause pervasive distress in almost anyone“ (Graubner, B; ICD-10-GM, 2014).

Suffering from the emotional impact of a traumatic event, even after some months have passed, is a normal reaction to an abnormal experience. If transient, the described afflictions are normal reactions to a shocking experience that would cause deep despair and intrusive, distressing memories in nearly every individual. Post-traumatic stress symptoms can also affect a previously healthy individual if unexpectedly exposed to an extremely distressing situation.

Post-migration stressors have a huge influence regarding coping and recovery from those situations.

Post-traumatic stress symptoms are:

A) Persistent remembering or “reliving” the stressor by intrusive flash backs, vivid memories, recurring dreams, or by experiencing distress when exposed to circumstances resembling or associated with the stressor. 

B) Actual or preferred avoidance of circumstances resembling or associated with the stressor (not present before exposure to the stressor). 

C) Either (1) or (2):

       (1)Inability to recall, either partially or completely, some of the period of exposure to the stressor 

       (2) Persistent symptoms of increased psychological sensitivity and arousal exposure to the stressor)    shown by any two of the following: 
staying asleep; anger; irritability or outbursts of difficulty in concentrating; hyper-vigilance; exaggerated startle difficulty in falling or response.

D) Criteria B, C
 (For some purposes, onset delayed more than six months may be included but this should be clearly specified separately.)

Traumatized people often have fragmented memories of the traumatic event and difficulties verbalising them. Incomplete memories as a symptom is often interpreted as non authentic in front of courts. For deciding if asylum is granted or not, courts demand a consistent story.

Post-migration stressors

People who left their countries because of threat or dramatic events as well as people who experienced distressing moments during their escape and after the arrival have to cope with post-migration-stressors.

Post-migration stressors include aspects of the right of residence (durance of process, insecurity during the process), health and care (unemployment, group accommodations, poor psychosocial support) and family aspects as well as acculturation stress (changes in the roles within the family, loss of cultural frame, difficulties in communication). Acculturation stress describes the conflict of new learned behaviour/attitudes and originating values.

Coping with a traumatic event relies on the possibility to evolvement in the exile, the capacity to act as well as self-determination. The science of post-migration-stressors is in its infancy, but it shows its impact on mental health. There is a positive correlation between post-migration stressors and PTSD, depression and anxiety symptoms (Laban, Gernaat, Kamproe, van der Tweel & De Jong, 2005; Silove, Sinnerbrink, Field, Manicavasagar & Steel, 1997). The durance of the procedure for granting the right of asylum is a relevant risk factor for mental stress as well (Laban, Gernaat, Komproe, Schreuders & De Jong, 2004).

Heeren et al. (2014) show an association of differences in resident status and mental health outcomes. This results stress the importance of current socio-political living conditions for mental health.

Mueller, Schmidt, Steahell and Maier (2011) compared failed asylum seekers with pending and temporarily accepted asylum seekers and the high rates of psychopathology amongst failed asylum seekers indicate that refugee and humanitarian decision-making procedures may be failing to identify those most in need of protection.

Challenges in the field of psychology, politics and interculturality

Psychotherapy for refugees encouters special challenges as it is an interdisciplinary field of psychology, politics and interculturality.

There are systematic barriers. For example there is only access to medical care for acute disorders (§4 AsylbLG). Consequently, people getting treatment often have complex and chronic psychological symptoms.

Psychotherapy for refugees demands intercultural competence. The group of refugees is very heterogenic, so it is impossible to know everything about the client’s cultural background. Intercultural sensitivity demands to consideration of ones own values in terms of health and illness as one perspective and not as a universal concept. Dealing with ones stereotypes and prejudices is crucial. Clients might not be familiar with the concept of psychotherapy as an internal reflection process, so there can be misunderstandings and stress on the client’s and care giver’s side. As a result, psychotherapy should focus on an individual level and has to be flexible for a wide spectrum of interventions. Besides the treatment of symptoms, therapy has to consider influences on a political as well as a cultural level and post-migration stressors.

People who experienced man-made disasters often loose confidence their social surrounding. As a normal reaction they distrust people and withdraw themselves. Distrust makes a trustful client-therapist relationship – which is essential – difficult. This is a reason why a lot of people leave therapy.

Psychotherapists working in this field have to deal with more than the psychological inner world of the patient. The neutral position of a therapist is difficult and questionable when encountering health and human rights. Neutrality is of little use when it comes to man-made disasters such as torture or rape.

As psychotherapists have to write reports that influence the process of asylum, they encounter working dilemmas. They need a professional credibility, while at the same time it is difficult to be responsible for the decision of return. Who can decide if a return is possible for an individual as the feeling of threat is subjective even if there is no actual threat anymore?

The clinical and diagnostic instruments we use often misinterpret or overestimate symptoms. As an example in the SCL-90 the question 43 „do you have the feeling that people observe and talk about you“ is not a hint for a paranoid symptom – it is a fact that people of a different background are unfortunately often still considered „foreign“. So there is a need for new diagnostic instruments!

Another aspect is the language barrier, which is mainly overcome by using interpreters. Interpreters are a very important linguistic as well as cultural bridge. They have to manage the difficulties of translating literally while regarding cultural aspects. The Turkish saying „my liver is getting big“ is not an organic description, but a way to express dolefulness. Interpreters working in these areas encounter special challenges as well. It can be very difficult to translate emotional content and not exact influence on the results of the talk. Consequently, the therapist and interpreter have to cooperate intensively and maintain their professional roles.


There is a complex relationship between stressing factors before, during, and after the flight. This causes complex symptoms and demands a subjective approach and trauma therapy is just a little part of it. There is need for multi-modale and integrative methods for interdisciplinary care givers. Psychological consequences of e.g. accommodations or the procedure for granting the right of asylum should be considered in politics. Fragmented memory caused by traumas have to be recognized in front of courts. There are many other barriers such as access to mental health, resources like psychosocial workers with intercultural sensitivity. There is still a long way to go, but humanity and human rights require us to overcome these obstacles.

Author: Anna Kanitz