Exploring Afghan Refugees’ Post-Resettlement Experiences in North America: A Scoping Review

The following electronic databases were searched for relevant articles: CINAHL, EBSCOHost, EMBASE, Medline, ProQuest and PubMed. A comprehensive list of search terms was developed based on the key concepts of the research question. Thesauri were used to retrieve synonyms and related terms. Medical Subject Headings (MeSH) were used when available. The following key terms were utilized to conduct the search: “Afghan”, “refugee”, “immigrant”, “migrant”, “emigrant”, “settlement”, “resettlement”, “experiences”, “challenges”, “barriers”, and “difficulties”. Search terms were combined using Boolean operators and wildcards (*) were used to account for different spellings and pluralizations. Table 1 details the search strategy used.

The inclusion criteria for this study were carefully defined to ensure relevance and applicability. Studies written in English, focusing on Afghan refugees, conducted in the North American context (Canada, United States, and Mexico), and published between 2014 and 2024 were eligible. Acceptable study designs included quantitative, qualitative, mixed methods, systematic reviews, scoping reviews, meta-analyses, dissertations, and grey literature. Articles published prior to 2014 and those written in languages other than English were also excluded.

A total of 1,217 references were imported to Covidence for screening, and 114 references were removed as duplicates. The resulting 1,003 articles were subjected to title and abstract screening for relevance by two independent reviewers (BW and PJ). During the initial screening, 930 studies were excluded as they did not meet the inclusion criteria. Level 1 screening of Titles and Abstracts sought articles that were: …Level 2 screening of full text sought articles that were … Seventy studies were subjected to full-text review by two independent reviewers. Disagreements were resolved by discussions among the research team. Seventeen articles were included in the final review. Consistent with the Arksey and O’Malley scoping review methodology, no formal appraisal of study quality was conducted to capture a broad range of available evidence. The selection process is captured in the PRISMA diagram as seen in Figure 1.

Data charting and extraction was independently conducted by two reviewers (BW and PJ) using a table developed and reviewed by the research team. The table captured details of each study, including author(s), year, country, setting/discipline, purpose, study design, population and sample size, data collection and analysis methods, results, and conclusions.

All included studies were charted and analyzed using an inductive thematic approach., Using the data that had been charted, two independent reviewers (BW and PJ) conducted inductive coding of the extracted data in order to develop themes. Each reviewer coded the findings separately, then compared and reconciled discrepancies through regular discussions. The finalized codes were grouped into overarching themes that captured key aspects of Afghan refugees’ post-settlement experiences.

Mental health emerged as the most extensively examined and central aspect of the settlement experience for Afghan refugees. The literature consistently highlighted a range of challenges and contextual factors that shaped psychological well-being and influenced adaptation within host communities. These findings are summarized below.

Six studies investigated healthcare experiences and psychosocial factors or barriers to healthcare access among Afghan women (n = 3) or children (n = 3) in North America (Abuali et al., 2024; Rosenberg et al., 2022; Rosenberg et al., 2024; Siddiq et al., 2020; 2023; Worabo et al., 2024). There were no studies included in this review that explored the healthcare experiences of men. The most frequently cited barriers to healthcare access were language, miscommunications, lack of health literacy, lower levels of education, transportation, and financial constraints (Abuali et al., 2024; Siddiq et al., 2020). Women consistently express a preference for female providers and interpreters when seeking healthcare (Siddiq et al., 2020; Worabo et al., 2024). Worabo et al. (2024) found that Afghan women who accessed maternal services in the United States generally reported positive and pleasant experiences. They expressed appreciation for high-quality care, attentive providers, and the wide availability of resources that supported their prenatal, birthing, and postpartum needs. They highlighted contrasts with Afghanistan, where economic hardship, limited access to prenatal care, and heavy physical work were common challenges. While the majority described their experiences as overwhelmingly positive, some reported discomfort with male healthcare providers and a need for better contraceptive education. Women cited language barriers as the most challenging issue. While interpretation services were often available, some women expressed discomfort with male interpreters when discussing sensitive reproductive health topics. Women also highlighted the importance of respecting their cultural preferences. Lack of transportation and financial constraints were identified as structural barriers. Several women noted their inability to operate vehicles and reliance on their husbands for transportation (Worabo et al., 2024). Afghan women underutilize preventive cancer screening, as many women reported limited knowledge about cancer and screening recommendations. Some women perceived cancer as a “dangerous and deadly disease” and viewed screening as a confirmatory diagnosis (Siddiq et al., 2022, p. 355). They often avoided discussions of cancer due to fear and shame and often kept them private to minimize worries among close family. When accessing screening services, women experienced language barriers, miscommunications, communication delays, and unclear explanations of the screening process or results. These negative healthcare experiences led to frustration and further deterred women from accessing preventive services. As one participant stated, “it's not the religion - it's the language”, highlighting the importance of language in shaping healthcare behaviours and access (Siddiq et al., 2022, p. 359). Women also described sources of empowerment that encouraged them to navigate the stressful screening process. These factors are family support, reminders from healthcare providers, and prayers (duaas) (Siddiq et al., 2022).

Older Afghan women recognized the importance of family involvement and religion in maintaining their health and health practices. They viewed health holistically and identified family as a motivating factor in promoting their health. Over half reported at least one chronic health condition, including diabetes, cancer, hypertension, arthritis, chronic pain, or mobility challenges. Mental health was cited as a significant concern, compounded by pre-migration trauma, resettlement hardships, cultural challenges, family conflicts, and social isolation. Older Afghan women highlighted the critical role of family members in their healthcare experiences, often relying on relatives for decision-making, language interpretation, transportation, advocacy, and support. While community resources were available in Afghan communities, not all women had access to these supports, and frailty or chronic health conditions often limited their participation in community activities. Miscommunication with healthcare providers and unmet treatment expectations led to distrust and dissatisfaction among older Afghan women (Siddiq et al., 2023). Two studies examined families’ perspectives on the access and implementation of pediatric mental health services. Similar to Afghan women who utilized maternal healthcare services, parents shared appreciation for consistent, coordinated visits and reported trust in the U.S. healthcare system. The same parents also described a gradual transition from initial social isolation to building a growing, robust local support system (Rosenberg et al., 2022). The same authors further explored determinants of successful preventive mental health interventions. The main recommendations were to promote the normalization of discussing emotions through cultural humility, bridge communication gaps between children and parents, maintain support networks to minimize miscommunications, and ensure timely cultural adaptation of interventions (Rosenberg et al., 2024).

In the post-migration setting, researchers have investigated other pertinent areas such as food insecurity, integration and acculturation, leisure activities, and information practices using qualitative research methods. For example, Goliaei et al. (2023) conducted a qualitative study on the experiences accessing food resources among recently (re)settled Afghan refugees accessing food resources in the United States. The study emphasized several individual, environmental, and systemic barriers that refugees faced, including difficulties navigating grocery stores, lack of transportation, language barriers, high costs, limited availability of culture-specific foods (e.g., Halal), and low financial literacy to manage monthly budgets. Additionally, Afghan refugees were found to underutilize food support programs, often due to unfamiliarity with local selection, scarcity of culturally appropriate options, and discomfort participating in these programs. Families reported a preference for shopping at ethnic stores, despite the higher pricing and lower availability of items (Goliaei et al., 2023).

Similar to other age groups, Afghan newcomer youths faced post-settlement stressors, including language barriers, cultural conflicts, legal status challenges, social isolation, family separation, and being minors with adult responsibilities. Afghan youths relied heavily on family, friends, settlement workers, and social media to exchange information. Unaccompanied youths often maintained secrecy and were reluctant to discuss information with families back home. The same youths engaged in leisure activities such as being with friends and family, participating in religious activities, mehmani (Afghan visiting ritual), writing poetry, attending school, and playing sports. These information practices and leisure activities shape how youths maintain their distinct Afghan cultural identity while integrating a Canadian identity (Quirke, 2014).

As Afghan refugees resettle in host societies, distinct integration practices emerged in North American societies, highlighting the intricate relationship between cultural identity and adaptation. Many families maintained solid connections to their Afghan heritage and identity through language, traditional attire and decorations, and participation in religious festivities. Similarly, many changes were also evident as gender roles, traditional norms, and educational priorities began to shift. For example, families permitted children and young adults to independently decide on their religion, marriage, education, and careers. While parents reported accepting their children's choices, this did not prevent them from imparting their values and traditions. Patriarchal norms are increasingly challenged as families prioritize higher education for girls and move away from traditional gender expectations. Most refugees described religion as a source of strength, comfort, and familiarity. Some have denounced this practice as they perceived religion as constrictive, obsolete, and a cause of suffering in Afghanistan (Nourpanah, 2014). As younger generations readily adapted to the dominant Western culture, this often created generational differences that disrupted family cohesiveness and promoted feelings of estrangement (Alemi et al., 2016; Soltan et al., 2023). Young adults with stronger Farsi fluency and a deeper understanding of Afghan culture reported more positive family relationships and increased subjective well-being. Parents more acculturated to Canadian culture were better able to guide their children through the adaptation process, thereby improving their children's subjective well-being (Soltan et al., 2023). Overall, Afghan refugees have demonstrated significant resilience in overcoming the challenges of resettlement and adapting to host societies.

This review has several limitations. The number of eligible studies was small (n = 17), which restricts the breadth of available evidence. The review focused exclusively on the North American context, which may have excluded potentially relevant findings from other high-income countries, such as, Australia and Europe. This geographic constraint limits the global applicability of the findings, particularly as refugee experiences may vary significantly depending on immigration policies, societal attitudes, and settlement infrastructures. Even within North America, the evidence heavily skewed towards U.S. experiences with relatively few Canadian research and zero studies conducted in Mexico. Most included studies examined mental health, leaving important areas such as employment, acculturation, language acquisition, and broader health needs underexplored. Study samples were heterogeneous and composed of mostly adults, offering limited insight into the distinct experiences of Afghan children and youth.