A unique migrant health center in Cologne has become a kind of one-stop shop for advice for migrants from all over Germany. The center's director, Musa Deli, gave InfoMigrants an insight into the center and its work.
Musa Deli comes into the room with a big smile and an air of dynamism. After a brief hello and a handshake, he goes off to make coffee. A few minutes later, he's back, settling on to one of three colorful armchairs in his bright airy office. He talks about the center he has been running since June 2019.
The Gesundheitszentrum für Migrantinnen und Migranten (GfM) (The Health Center for Migrants) was set up in Cologne in 1995. About 40% of the population in Cologne has a migration background, says Deli, which is higher than the German national average. His center mostly concentrates on Turkish-, Kurdish- and Russian-speaking people but they are open to everyone and can get help with translation into other languages via the Social and Psychiatric Center (SPZ) in Cologne.
In total, ten people work at the GfM. There is a medical doctor, and several advisors who specialize in social, psychosocial and health questions. Any migrant can call or attend the center for free. It is funded by three local bodies and works in conjunction with state and charitable entities.
Deli himself studied sociology with a focus on social psychology. He then worked for several years as a therapist for patients with addiction problems, running a project in that area. Later he directed a center for people with intellectual disabilities for the Rhineland Regional Association and then moved to working with the Cologne authorities in the field of mental health and forensics.
Who uses the center?
"In the last quarter we provided about 1,100 telephone advice sessions for people all over Germany, and around 150 personal consultations," says Deli proudly. Each session lasts on average 90 minutes, Deli clarifies, and that adds up to a total of 230 sessions in all. The majority of their clients – about 75% – are women, says Deli.
For the center, the term "migrants" means everyone who was born outside Germany and now lives here. That means that many of the center’s clients are first, second and third generations, stemming from the original Gastarbeiter (guest workers) from Italy and Turkey. "We also have a lot of clients from the Balkans, after the wars in ex-Yugoslavia, and more recently from countries like Albania […] and the former eastern bloc states in the former-USSR." The center also welcomes calls from migrants, refugees and asylum seekers who have arrived in Germany since 2015. For those who need a consultation in Arabic or Dari, the GfM makes an appointment for the consultation to take place at the SPZ so that a professional translator can be present.
The aim of the GfM is to improve access to basic health care and to help remove some of the language and cultural barriers that are present for many migrants.
"People ring us for all sorts of reasons," says Deli. "Sometimes it can be for help filling out a form for work, or a form to receive unemployment benefit.Then, as we help with that, we uncover some of the other problems that someone might have and we can offer advice about who to turn to, in order to deal with these things."
Some clients have been coming on and off for ten years, says Deli. Others might just come once.
A high gambling addiction rate
"Often their problems are linked. Depression might be one thing, or domestic violence or a divorce but then we’ll find that they have other problems that need sorting too." There is a relatively high gambling addiction rate among migrants, says Deli. "Women tend to gamble via their smartphones, from home, online poker and that kind of thing, men might be more likely to frequent gambling halls and casinos."
Deli thinks that the suffering of the first generation of migrants can have impacts much further down the generations. The dislocation and disconnection from the family can lead to social problems and a high divorce rate in the second generation, for instance. Addiction is another thing that can develop from these social problems and poverty. Gambling can also represent "the last possibility to get access to money, and alleviate the situation of poverty," concludes Deli.
"We find Turkish clients tend to be addicted to gambling and Arabic and Russian clients might have more problems with drugs or alcohol respectively." Often these addictions mask other problems like depression and the simple fact of missing home, being uprooted, Deli thinks.
Arrivals since 2015
"We do get some more recent migrants and refugees, who arrived after 2015 and have a lot of trauma and mental health problems because of their experiences. Most people who want to talk to us are looking for support and most of all, someone to listen to them." A lot of the same problems are common to both communities. "A lot of refugees and asylum seekers experience sleep disturbances, a lack of drive, mental health problems, trauma, anxiety and addiction; people are always looking for a way to forget their problems and that is where the addiction comes in."
Work also tends to be a theme among refugees and asylum seekers. "So many people who come in are really well qualified and they just want to work," says Deli. "I’ve had doctors sitting in front of me, years of training and they are having to work as cleaners or can’t work at all."
Accommodation is another problem that many migrants face. Society is just different for them, eating, drinking, the way we communicate, that all takes time to get used to for migrants, Deli says. But mental health and anxiety are really at the forefront of many migrants' concerns.
The biggest problem we face is that the waiting lists for psychiatrists and counselors are often very long, says Deli. "[At the center] we try and offer emergency intervention, four or five sessions, so that we can get to the bottom of what’s wrong and what their next steps might be."
Generations of migration
Deli himself is a second generation migrant. He was born in Germany, studied in Germany and has had a career here. "Germany is my Heimat (home)," says Deli before explaining how much he identifies with some of the problems of discrimination and 'othering' that many of the migrants who come to the center experience, and suffer from. Deli has a German wife, speaks perfect German and has "two half-German children," but nevertheless he says he is constantly made to feel like he doesn’t really belong, "I'm always a foreigner here." Even to the point where he has internalized describing his children as "half-German" although he himself was born in Germany. When asked why? "That’s because other people describe them like that," he answers.
"I’ll give you some examples," Deli says, sighing slightly. "I was parking my car one day, I left some space in front and behind and this man comes by on a bike and he says 'In Germany we park differently.' I don't want my kids to be in the car when that kind of thing happens, to feel like they also don’t belong." Deli says this kind of comment has got worse since 2015. That no matter where he goes, people will always treat him as 'foreign.' "I just want to be accepted," Deli says.
"Another time, I was looking for a house to rent. I would call house after house and each time, when they heard my name, I'd be told that the house had just been rented. Then my wife, with her German name, would call up directly afterwards and she would be offered an appointment to view the property."
‘Why should I justify myself in this way?’
Being asked constantly to give an opinion, and either justify, explain or attack Turkish President Erdogan's policies is also tiring, thinks Deli. "Then people will judge me depending on what I say. If I try and justify Erdogan they will label me a radical extremist, an Islamist. If I attack him then they might accept that I have more liberal views, but why should I be asked to justify myself in this way?"
"This gives fuel to people like Erdogan’s politics actually. Because people like him play on this feeling that 'hey guys, you might have been rejected in Germany but I am here for you;' I wish that just for once a German politician would say: ‘Hey you are German, you are part of us."
Deli notices that institutional barriers arise from the kinds of attitudes he outlines. "People have the right to information in their mother tongue but often in Germany this is not offered," he says, talking about the health and elderly care system. "Or, why aren’t there more courses on diabetes in Turkish say? This is a problem that particularly affects that community."
As well as advice, the GfM offers training courses, helping migrant parents with nutritional questions, diseases which might disproportionately affect some of their communities, like diabetes, and advice for children attending school. As well as helping migrants reach the right kind of psychological and social support for them, the GfM advises migrants who might need elderly care, and their families on how best to do that. "We work a lot in the field of prevention," says Deli, and "advise on people’s rights." They will work with refugee and migrant associations, in mosques, community halls, schools; anywhere where their advice and courses might be needed.
"For instance, many migrants, if they are ill or have a problem, will go first to the emergency room at the hospital. From there they will be sent to their GP, and from there they will be sent on to a specialist. All those steps cost a huge amount in time and money. We want to remove those unnecessary steps," says Deli. From the GfM they can send people with health problems straight to the Malteser hospital in Cologne, and for social and psychological problems to the SPZ.
"The GfM doesn't require any registration or collect any personal information, so anyone can come here, even if they are unregistered or fear being sent home. For medical problems [anyone], even people without papers or any passport, can go to the Malteser clinic for help. It is only for psychological help that you would need to be registered," thinks Deli.
What Deli and his team have seen is that the problems don't stop with the first generation of arrivals. "Sometimes people who were born in Germany might marry someone from their homeland, they then won’t speak such good German. That is often the case for men marrying women and the women are then isolated at home." The difficulties with language, particularly when they are on the part of the mother, notices Deli, have an effect on the children. They won't understand what is required of them at school, perhaps they have attention deficit problems, then the communication between the school and the family can be fraught and that will impact on a third generation.
That's why the GfM tries to offer courses in mother tongue for families to allow them to better navigate the school system too in Germany. We try and keep active on the political level, says Deli. Communicating what we find is important, "we see ourselves as a voice for all migrants," explains Deli.He thinks that the help is present in Germany but a few things need to be changed to make access to that help for migrants and refugees easier. And that those with a migration background need to start being represented at all levels of the health system, so that, like Deli, they understand some of the specific problems from which migrants can suffer. "We are not such a tiny minority nowadays. Even in Germany I think the numbers of people with a migration background is around 26-27%. That means that one in every four people might be suffering from some of these problems, and we need to be better represented throughout society."
If you want to attend the center in Cologne the address is Schaafenstraße 7, 50676 Köln
The telephone number is 0221 42 03 98 0
Email is firstname.lastname@example.orgThe website is: www.parisozial-koeln.de