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A non-neglectable portion of people that have fled to Germany have been subjected to expulsion, violence, torture and grave human loss. In some of them, signs of secondary mental problems are obvious. In the light of the efforts at integration, these diseases must not be neglected. Outlined are the federal legal requirements and how the cost coverage, as well as the admission to health care system, is structured. Additionally, 2 exemplary regional models for psychosomatic health care are being introduced: Dresden's "Stepped Care Model for Psychologically Vulnerable Refugees" includes phased offers for prevention and treatment of acute mental crises, as well as somatoform disorders in refugees and their volunteer helpers. The PSZ in Bielefeld unites already existing expertise of social work and trauma therapy to form a shared project and favors, among other things, training courses and the instruction of language mediators. The local circumstances and differences lead to individual, sometimes totally new solutions. Already existing clinical care offers as well as concepts of trauma therapy are focal points for the development of a comprehensive health care provision. Most effective is a combination of medicinal care, psychosocial networking and psychosomatic treatment. For a working health care provision without parallel structures it is indispensible to use expertise in trauma therapy that is already in place. While being very resource-saving psychosomatic centers offer targeted applications in the network of all actors in refugee care especially when combined with well-trained volunteers and language mediators, informed on the issue of trauma.

Theories of dissociation emphasize that symptoms of dissociation are correlated with traumatic events. Although the association of dissociative symptoms and retrospective reports of child abuse with a focus on mainly sexual and physical abuse has been well documented, investigation of the contribution of emotional or psychological types of maltreatment to the prediction of dissociation has been neglected to a great extent. The aim of this study was to determine the differential impact of different types of maltreatment on dissociative symptoms in a sample of 203 female residential patients treated for posttraumatic stress disorder linked to child maltreatment. Moreover, it was examined whether the link between dissociation and child maltreatment is direct or indirect. Subjects completed questionnaires on child maltreatment, posttraumatic stress, and dissociative symptoms. Although all types of maltreatment were related to dissociative symptoms, emotional abuse was the strongest and most direct predictor of dissociation in multivariate hierarchical analyses with the influence of other trauma types being confounded by emotional abuse. This study highlights the importance of emotional types of maltreatment for the genesis of dissociative symptoms in patients with posttraumatic stress disorder.

Anfang der 1950er Jahre wurden aus Italien, Griechenland, Spanien, Portugal, der Turkei, Jugoslawien und Marokko »Gastarbeiter« geworben, um dem damals in Deutschland herrschenden Arbeitskraftemangel zu begegnen. Heutzutage klingt der Begriff »Gastarbeiter« veraltet, weil fur die Mehrheit der Arbeitsmigranten inzwischen gilt, dass sie ihre Lebensziele und Familien nach Deutschland verlagert haben und dauerhaft hier zu leben planen. Inzwischen gibt es mehrere Generationen von Migranten, d.h. von Mitburgern auslandischer kultureller Zugehorigkeit,die in Deutschland geboren und aufgewachsen sind. Die erste Zuwanderungswelle von Arbeitsmigranten nach Deutschland setzt sich heute mit dem Zuzug von deutschstammigen Spataussiedlern und von Fluchtlingen fort. Entsprechend dieser Entwicklung wurde die Arbeit mit Migranten im Verlauf der letzten funfzig Jahre ein immer wichtigerer Bestandteil der Gesundheitsversorgung insgesamt und der psychosozialen Versorgungspraxis im Besonderen. Der soziokulturelle Kontext formt grundlegende Einstellungen und Uberzeugungen, auf die bei unerwarteten und unerklarlichen Ereignissen zuruckgegriffen wird. Daraus ergeben sich Besonderheiten fur das Verstandnis fur Migranten in Notfallsituationen.