Abstract

Context and objective: Migration by women is accompanied by a multifaceted exploitation that affects women, particularly when it is “illegal”. The aim of this study is to identify the forms of exploitation suffered by Ivorian women during their “illegal” migration to Kuwait, and to describe the post-traumatic stress disorders that resulted. Methodology: This was a transversal and qualitative by saturation study with a descriptive aim with 15 Ivorian women repatriated from Kuwait in 2020 during the Covid-19 pandemic. These were selected by reasoned choice and subjected to a semi-structured interview in Abidjan. Results: The results indicate that these women were aged between 19 and 34, with an average age of 25.6; 53.33% had dropped out of lower secondary school; the majority were Muslims (66.66%), with no children (73.33%) and were of modest means (100%). In terms of the forms of exploitation suffered, 40% of the respondents had been victims of sexual, physical and domestic exploitation, 26.67% of sexual exploitation, 20% of domestic exploitation and 13.33% of physical exploitation. These forms of exploitation had caused PTSD in all of them (100%), which was associated with depressive disorders among 33.33% of them, with sexual disorders among 26.67% of them and with anxiety disorders among 13.33%. Conclusion: These results underline the interest in setting up a psychological support and social reintegration system to better assist these migrant women.

Keywords

Women, Migration, Exploitation, Post-Traumatic Stress Disorder, Abidjan

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1. Introduction

Women make up a significant proportion of the migrant population. Figures show that women account for 232 million or 48% of the world’s migrants, and that their share by region is 51.9% in Europe, 51.6% in Latin America and the Caribbean, 51.2% in North America, 50.2% in Oceania, 45.9% in Africa and 41.6% in Asia (OCDE-UN/DAES, 2013: p. 2). Among women, migration for economic reasons is on the rise, both nationally and internationally, in the era of globalisation (Robinson, 2002: p. 45). Migration has become a widespread survival and livelihood strategy for many women around the world. However, they are often synonymous with exploitation, especially when they are “illegal”. Even if the extent of this exploitation cannot be accurately described, due to the illegality of migration (Lisborg, 2002: p. 45), it is described as multifaceted. It includes, at the very least, the exploitation of the prostitution of others or other forms of sexual exploitation, forced labour or services, slavery or practices similar to slavery, servitude or the removal of organs (Chureau, 2010: p. 150). Trauma caused by human hands is more likely to lead to the development of PTSD (Brillon, 2004: p. 24).

Post-traumatic stress disorder (PTSD) is now a public health problem (Sagnin, 2022: p. 43). PTSD falls into the category of “trauma- and stress-related disorders” and is characterised by the appearance of psychiatric symptoms following exposure to one or more traumatic events. These symptoms develop under four aspects, namely intrusion, avoidance, disturbance on cognitions and mood and changes in arousal and reactivity (APA, 2013: p. 271).

PTSD can take a variety of forms. A distinction is made between PTSD of short duration, delayed onset, with relapses, chronic (Chapot et al., 2019: p. 177). They may also be accompanied by psychiatric disorders such as depression, anxiety disorders, psychotic disorders, physical damage, personality changes, substance misuse and difficulties with social integration (Prieur et al., 2022: p. 2; Auxemery, 2019: p. 245). Their prevalence varies, although everyone is at risk of suffering from them. It is low in the general population and high in specific populations (Robjant, & Fazel, 2010: p. 1030). These specific groups include migrants, particularly when they are in an irregular situation (Andersson et al., 2018: p. 1). In France, for example, data from the Premiers pas survey show that the proportion of undocumented migrants suffering from PTSD is 16%, and that those from Sub-Saharan Africa and North Africa have the highest prevalence (Wittwer et al., 2019: p. 4), due to the living conditions in the host country (Jusot et al., 2019: p. 3; Vignier et al., 2017: p. 115).

Despite the frequency and severity of PTSD among irregular migrants, few studies have focused on it (Prieur et al., 2022: p. 4). Given this lack of interest in the problem of PTSD in relation to migration, we felt the need to study the case of Ivorian women who were victims of exploitation during their “illegal” migration to Kuwait and who were repatriated to Abidjan as a result of the coronavirus health crisis. This study aims to answer the following questions:

1) What are the forms of exploitation suffered by Ivorian women during their “illegal” migration to Kuwait?

2) Is the PTSD developed by these women, the result of these forms of migratory exploitation? These questions form the basis of the present study, which is in line with Janoff-Bulman’s (1992: p. 70) theory of widespread beliefs, which is based on the postulate that the degree of trauma results from the gap between each individual’s own conceptions of the world and of him/herself, constructed since childhood, and the traumatic event to which he/she was exposed.

The aim of this study is, on the one hand, to identify the various forms of exploitation suffered by Ivorian women repatriated from Kuwait during their “illegal” migration to Kuwait and, on the other hand, to describe the associated PTSD. It is based on the general hypothesis that the PTSD presented by Ivorian women repatriated from Kuwait result from the forms of exploitation suffered during their migration to that country.

2. Methodology

2.1. Background to the Study

This study was carried out with migrant women repatriated in 2020 from certain foreign countries during the Covid-19 pandemic and quarantined at the National Institute of Youth and Sports (NIYS) in Abidjan (Côte d’Ivoire). The psychosocial care of the contact cases and the repatriated subjects was entrusted to multidisciplinary teams (psychologists, psychiatrists, anthropologists, sociologists). The diagnoses of PTSD and other disorders mentioned in the study were made by the psychiatrists who examined the women surveyed. The methodological approach used to carry out the study is transversal and qualitative by saturation with a descriptive aim.

2.2. Presentation of the Variables

There are two variables in this study. These are the independent variable and the dependent variable.

2.2.1. Independent Variable

The independent variable is the migratory exploitation of women and refers to the act of abusing them, subjecting them to bonded labour or turning them into domestic or sexual slaves during their migration (Perruchoud, 2007: p. 31). It is qualitative in nature and comprises two modalities. The first concerns women who suffered an isolated form of exploitation during their migration. The second, on the other hand, relates to women who experienced more than one form of exploitation during their migration.

2.2.2. Dependent Variable

The dependent variable relates to the post-traumatic stress disorders presented by the migrant women repatriated from Kuwait. It refers to the various symptoms characteristic of PTSD reported by them as a result of the form of migratory exploitation suffered. It is qualitative in nature and also admits two modalities. The first, relating to the existence of PTSD in the migrant, reflects the effectiveness of the disorder in her /him. The second, on the other hand, refers to the non-existence of PTSD in the migrant.

All these modalities described above were evaluated by means of a semi-structured interview.

2.3. Study Sample

The study sample was constituted by means of purposive sampling during the psychosocial care of case contacts and subjects repatriated from other countries because of Covid-19 in Abidjan. Out of 35 migrant women met at the NIYS during the study period, only 15 were included in the study. Indeed, the listening carried out with these migrant women allowed us to realize the scientific scope of the study. Thus, we requested authorization from the coordinating-director of the National Mental Health Program to conduct the study. We explained to the migrant women the objectives of the study, by guaranting their anonymity and the confidentiality of the information which would only be used for purely scientific purposes and we obtained their verbal consent to select them.

Excluded were female migrants from Kuwait who did not give their consent to participate in the study, women whose migration was linked to health reasons or commercial activities, and male migrants.

2.4. Data Collection Instrument

The data for this study were collected by means of a semi-structured, individual interview, lasting an average of half an hour, which we conducted with all the participants in the study. There were three main points. The first focused on the socio-demographic characteristics of the interviewees, the second on the forms of exploitation to which they were subjected, and the third and final point, on the symptoms they reported.

The aim was firstly to identify the forms of exploitation suffered by these women during their migration to Kuwait, and secondly to describe the associated PTSD.

2.5. Data Analysis and Processing

The data collected were analysed manually. Categorical content analysis was used to analyse the respondents’ accounts of their migration experiences and the symptoms they reported.

3. Results

The results of the study are based on three points. The first concerns the presentation of the socio-demographic characteristics of the respondents, the second the forms of exploitation to which they were subjected, and the third and final point, the reported symptomatology.

3.1. Presentation of the Socio-Demographic Characteristics of the Study Participants

These are set out in Table 1.

Table 1. Socio-demographic characteristics of respondents.

Source: Author’ field survey, 14-31 May 2020.

Table 1 shows that the 15 migrant women who took part in the survey ranged in age from 19 to 34, with a maximum of 25 - 29 year-old, who numbered 09, or 60% of the study sample, and an average age of 25.6. In terms of their level of education, they had all dropped out of school, 40% of them in primary education, 53.33% in lower secondary education and 06.67% in higher education.

The majority were Muslim (10: 66.66%) compared with Christian (04: 26.66%) and Animist (01: 06.67%). Most (73.33%) were childless, and all were from modest socio-economic backgrounds.

3.2. Presentation of the Forms of Exploitation Suffered by the Interviewees during Their Migration

The table below presents the characteristics of the forms of exploitation suffered by these women during their “illegal” migration to Kuwait.

According to Table 2, the forms of exploitation suffered by the Ivorian women during their migration to Kuwait were as follows: 06 respondents (40%) had been victims of sexual, physical and domestic exploitation at the same time, 04 respondents (26.67%) had been victims of sexual exploitation, 03 respondents (20%) had been victims of domestic exploitation and 02 respondents (13.33%) had been victims of physical exploitation. For all of them, it began as soon as they arrived, and had been repeated every day for more than a year for 93.33% of them, as the following testimonies attest.

O.A., 24 years old: “Before I got to the town where I was told here to be leaving in, I was as if sold along the way to a family who came to fetch me. They took everything I had, clothes, passport and papers. They gave me clothes from their

Table 2. Forms and characteristics of migratory exploitation suffered by the respondents.

Source: Authors’ field survey, 14-31 May 2020.

house, sent me to their house, and started making me work as a domestic, even though I didn’t understand their language”.

T.F., 23 years old: “You can’t say everything, in other words, when you have black skin, you’re not a human being for the Arabs. Even animals are better than you. I did everything in the family home where I was placed, I cooked, but I wasn’t allowed to eat either. I even had to hide to go and get myself something to eat. I was beaten and raped every day by my boss’ brother without any reaction, and I wasn’t paid for all that work. And as they had taken away all my papers from the start, I couldn’t go to the police to complain. The only day they were a bit nice to me was Friday, because that’s the day of prayer, and they wanted their prayers to reach God. I’m really thinking of those who couldn’t get a seat on the plane that took us back and stayed there”.

3.3. Description of Symptoms Reported by Respondents

Table 3 shows the symptoms reported by the migrant women surveyed.

Table 3 shows that all the respondents developed symptoms, regardless of the form of migratory exploitation they had experienced. In order of frequency, the symptoms they reported were intrusion, cognitive and mood disturbance, excitement and reactivity, insomnia, lack of appetite, avoidance, sexual perversions, crying spells, fear and trembling. The same woman presented several of these symptoms.

These reported symptoms made it possible to group them into four categories of psychopathological disorders, which were also, in order of frequency, PTSD (100%), associated depressive disorders (33.33%), sexual disorders (26.67%) and anxiety disorders (13.33%).

These disorders were linked to their migratory exploitation, as the following testimonies attest:

Table 3. Symptoms reported by respondents.

Source: Authors’ field survey, 14-31 May 2020.

G.M., 32 years old: “I’m crying because I still don’t realise that I’ve come back home. You can’t understand, because for me it’s like being in a dream. And I’m afraid that when I leave here, I’ll meet my son and my boyfriend, whom I’ve abandoned here to leave, after everything I’ve been through, and come back empty-handed, even though I left for Kuwait in the hope of working as a care assistant and improving all our lives. How am I going to look at them?”

D.M., 19 years old: “I don’t want to go home to my family when I leave here. I don’t even want anyone from my family to see me, because that would be a disgrace, a failure for me. I’ve sold everything I had, my family has contributed to give me money so that I can leave to make my fortune, and then I’m going back just like that, empty-handed, after the ordeal I’ve been through over there. No, I’m going to stay with friends until I find enough money… by any means necessary… to leave for another country like Senegal, but not Kuwait”.

4. Discussion

The aim of this study was to identify the forms of exploitation suffered by Ivorian women during their migration to Kuwait and to describe the associated PTSD. To do this, we presented the socio-demographic characteristics of the women, identified the forms of migratory exploitation they experienced and listed the symptoms they reported in support of PTSD. The results of our study showed that the women were aged between 19 and 34, with an average age of 25.6, 53.33% had dropped out of lower secondary school, the majority were Muslim (66.66%), had no children (73.33%) and were of modest means (100%). In terms of the forms of exploitation suffered, it was noted that (40%) of them had been victims of sexual, physical and domestic exploitation, (26.67%) victims of sexual exploitation, (20%) victims of domestic exploitation and (13.33%) victims of physical exploitation. These forms of exploitation had caused PTSD in all of them (100%), which was associated in 33.33% of them with depressive disorders, in 26.67% of them with sexual disorders and in 13.33% of them with anxiety disorders.

These results, in the light of Janoff-Bulman’s (1992: p. 70) theory of widespread beliefs, can be explained by the fact that exploitation, whatever its form, duration or frequency, is always a painful experience for the victim. As such, it destroys their previous beliefs. For all the women interviewed, the belief that they would be able to go to Kuwait to find a promising job, to make their fortune and improve their lives and those of their loved ones back home, was at the root of their plans to migrate. We are indeed witnessing the evolution of the roles of Ivorian women. Formerly more stable and confined to traditional roles such as marrying, procreating and taking care of the house, they are increasingly freeing themselves from men to go on adventures beyond the borders of the country, in search of a promising job. Several factors such as the employment crisis, increasing poverty, family or socio-political crises often push women to engage in often illegal migration experiences.

For this to happen, they had to make sometimes painful sacrifices, both financially and emotionally, such as selling all their possessions, sometimes asking family members to contribute, getting into debt with friends, abandoning their homeland and their loved ones. Sometimes, the plan to migrate comes from the family due to the positive social representations constructed with regard to cross-border migration. The member who leaves does not leave for himself alone, but for the whole family. He is invited to earn money to improve the life of the whole family.

But in the case of these women, their cherished dream was brutally transformed into a nightmare as soon as they entered the host country, with the bitter reality of trafficking and exploitation. The illusion of a better life suddenly turned into a multi-faceted and permanent exploitation, apart from Fridays, which are days of prayer in the Muslim religion, and when their masters needed to make themselves pleasing to God so that their prayers would be answered.

The unexpected exploitation confronted these women in their fundamental beliefs and provoked PTSD in all of them. In this respect, our results corroborate those of previous studies which highlight the increase in the number of women in international migration (Avril & Cartier, 2019; ILO, 2021) with more precision with the ILO which maintains that for more than half century and without interruption, one in two migrant people in the world has been a woman (ILO, 2015). Our results are similar too to previous studies which indicate that economic migration is a circuit of survival for those concerned (Sassen, 2006), and that economic and “family” trajectories are therefore intimately linked (Leroy, 2023).

Our results also corroborate those of previous studies which report a high prevalence of PTSD among irregular migrants (Andersson et al., 2018: p. 1), that the encounter between a migrant community and a host community is, on a psychological level, the encounter between two traumas: the trauma of migration (for migrants) and the trauma of integration (for the hosts) (Lingiah, 2005: p. 31), and particularly among those from Sub-Saharan Africa and North Africa (Wittwer et al., 2019: p. 4).

The respondents were mainly women. The biological vulnerability associated with the female gender made them more exposed to migratory exploitation. In this respect, our results are in line with previous studies which show that PTSD is associated with the female sex (Mpembi et al., 2018: p. 3); and that the lifetime prevalence rate of PTSD is 5.6% for men and 10 to 12% for women (Breslau, 1997: p. 1044). They were young, with more than half (60%) aged between 25 and 29 and an average age of 25.6. The various studies mention a greater vulnerability to PTSD in younger subjects (Breslau, 1997: p. 1045).

They had all dropped out of school, more than half of them (53.33%) at lower secondary level. Without qualifications, and because of their gender, they had been integrated into jobs generally reserved for women. This involved domestic and/or sexual work accompanied by physical, sexual and psychological violence, including food deprivation. On this point, our results are similar to those of many previous studies, which indicate that domestic work and sex work are the jobs mostly reserved for unskilled migrant women from disadvantaged countries (Moujoud, & Pourette, 2005: p. 1093), that these jobs described as “3 D jobs”, i.e., disgusting, difficult and dangerous (Lisborg, 2002: p. 105), are migratory strategies (Lavau-Legendre, 2013: p. 4; Guillemaut, 2009: p. 40; Robinston, 2002: p. 48); and that the trafficking and forced labour that accompany the globalisation of the economy, are uses of modern slavery (Botte, 2005: p. 651).

They are also similar to those of studies showing that food insecurity, housing insecurity and relational isolation are linked to high prevalence of PTSD (Prieur et al., 2022: p. 4; Jusot et al., 2019: p. 3).

These forms of exploitation exacerbated the precariousness of the women’s experience of migrating to Kuwait, where the aim was more economic. They were also justified by the colour of their skin. So the Muslim women (66.66%) who shared the same religion as their masters did not receive any differential treatment because of the colour of their skin. In this respect, our results are in line with those of previous studies, which show that most immigrants from sub-Saharan Africa face racial discrimination (Beauchemin et al., 2016: p. 324).

So to return home empty-handed after this domestic and/or sexual slavery was tantamount to an investment at a loss, a failure to achieve the initial objectives, and was unacceptable for many of them. This is why these PTSD were complicated by the presence of depressive, sexual and anxiety Co morbid disorders, in 33, 33%, 26.67% and 13.33% respectively. In this respect, our results corroborate those of previous studies highlighting the importance of psychiatric comorbidities in PTSD (Prieur et al., 2022: p. 2; Auxemery, 2019: p. 245).

5. Conclusion

One of the major consequences of the migratory exploitation of women is the appearance of PTSD. We focused on this through two research questions. The first related to the forms of migratory exploitation suffered by Ivorian women in Kuwait, and the second to the associated PTSD. In order to identify the different forms of exploitation suffered by these Ivorian women during their migration to Kuwait on the one hand, and to describe the associated PTSD on the other hand, the present study was conducted.

The results showed that 40% of the respondents had been victims of sexual, physical and domestic exploitation, 26.67% of sexual exploitation, 20% of domestic exploitation and 13.33% of physical exploitation. These forms of exploitation had caused PTSD in all of them (100%), which was associated in 33.33% of them with depressive disorders, in 26.67% of them with sexual disorders and in 13.33% of them with anxiety disorders.

An important limitation is the small study sample size which limits the generalizability of the study results. Another limitation of the study is that it did not make a comparison with another group of legal migrant women.

However, we make the following suggestions:

-That decision-makers monitor migratory flows, collaborate with their peers in the host countries of their nationals with a view to their security, and strengthen the empowerment of women;

-That field workers increase awareness among women and young people about the dangers of illegal migration and work to provide psychosocial care for migrants who have been victims of exploitation;

-That other studies be carried out with larger samples and using other approaches including the comparative one for a better assessment.

Conflicts of Interest

The authors declare no conflicts of interest regarding the publication of this paper.

References