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

For nursing students

Study summary

Millions of Afghans have been displaced by decades of war, and the crisis deepened after the Taliban retook power in 2021, when women and children made up as much as 80% of those forced to flee. Canada alone resettled 55,195 Afghan refugees after 2021, well past its original commitment of 40,000, with more than half settling in the Greater Toronto Area. This scoping review, led by Hasina Amanzai and colleagues at Toronto Metropolitan University's Daphne Cockwell School of Nursing, asked a simple but important question: what does the research literature actually tell us about how these newcomers are doing once they arrive in North America?

The team followed Arksey and O'Malley's scoping review framework, searching six databases (CINAHL, EBSCOHost, EMBASE, Medline, ProQuest, and PubMed) for studies published between 2014 and 2024. They started with 1,217 references, removed 114 duplicates, screened 1,003 titles and abstracts, and narrowed the field down to 17 studies that met their criteria for Afghan refugees resettled in Canada, the United States, or Mexico.

Mental health was by far the most studied topic, and the picture is sobering. In one Canadian sample, 53.1% of Afghan refugees screened positive for post-traumatic stress disorder, rising to 80% among those older than 45 compared to 36.8% in those 30 or younger. Risk factors for poorer mental health included being a woman, being older, being widowed, financial strain, unemployment, perceived discrimination, and belonging to certain ethnic minority groups (Tajik, Hazara, Nuristani, Uzbek). Protective factors included younger age, English proficiency, having a job, and strong social support. Women consistently reported more distress than men, and interestingly, staying closely connected to extended family reduced distress for women but increased it for men. Depression was often explained by refugees themselves through culturally specific ideas like asabi (irritability), gham (sadness), and goshagiry (withdrawing and isolating oneself), and women were about twice as likely as men to report depression.

When it came to healthcare, the reviewed studies found that Afghan refugees generally described their experiences as positive overall, but real barriers kept showing up: language differences, low health literacy, transportation problems, and financial constraints. Afghan women often preferred female providers and trained interpreters, and many avoided cancer screening because they viewed cancer as an especially frightening, dangerous disease rather than something to be screened for early. Chronic conditions such as diabetes, hypertension, and arthritis were common among older Afghan women, and children showed troubling rates of malnutrition (25%), dental cavities (74%), and infectious disease.

The review also touched on food insecurity (families struggled with unfamiliar grocery systems, cost, and limited halal options, and many avoided food banks because the offerings didn't fit their diets), and on family and identity: households tried to hold onto Afghan values while adjusting to Canadian or American life, which sometimes created tension between generations over technology, religion, and gender roles. Young people who kept a strong connection to Farsi language and Afghan identity tended to report better mental health and family relationships.

For nursing students, the biggest takeaway is where the evidence is thin. The authors are clear that this literature leans heavily toward mental health and toward the U.S. context; Canadian data is more limited, and no studies at all were found on Afghan refugees settling in Mexico. There is essentially no research on Afghan men's healthcare experiences, on how families access mental health services (as opposed to how much distress they experience), or on children and youth in their own right. Nobody has yet tested whether any psychosocial intervention actually helps this population in North America. That gap matters clinically: nurses working with Afghan newcomer families are often working from incomplete evidence, especially when the patient is a man, a child, or someone navigating the system for the first time. This review is a useful map of what we know and, just as importantly, an honest list of what we still don't know.

For educators

Teaching and appraisal notes

This scoping review by Amanzai and colleagues (Canadian Journal of Nursing Research, 2026) maps the state of evidence on Afghan refugees' post-resettlement experiences in Canada and the United States, using Arksey and O'Malley's methodological framework. The team searched CINAHL, EBSCOHost, EMBASE, Medline, ProQuest, and PubMed for literature published 2014-2024, retrieving 1,217 references, removing 114 duplicates, screening 1,003 titles/abstracts, and ultimately including 17 studies. The review is timely: Canada has resettled 55,195 Afghan refugees since the 2021 Taliban takeover, exceeding its 40,000 commitment, with over half settling in the Greater Toronto Area, and women and children have represented up to 80% of those displaced since that political shift.

The synthesis is organized primarily around mental health, which dominated the included literature. Findings include a 53.1% PTSD prevalence in one Canadian sample, rising sharply with age (80% in refugees over 45 vs. 36.8% in those 30 or younger), and consistently higher distress among women than men. The review surfaces a nuanced, teachable finding on family structure: strong extended-family ties reduced distress for women but increased it for men, a reminder that 'social support' is not a uniform protective factor and needs to be assessed by gender and role within the family system. Depression was explored partly through emic (insider) language -- asabi, gham, goshagiry -- which offers faculty a concrete example for teaching culturally responsive mental health assessment rather than imposing DSM-framed vocabulary by default.

On healthcare access, the review found generally positive experiences layered over persistent structural barriers: language, health literacy, transportation, and cost. Notable practice-relevant findings include a preference among Afghan women for female providers and professional interpreters, underuse of cancer screening tied to cultural framing of cancer as uniquely frightening, and high rates of malnutrition (25%), dental caries (74%), and infectious disease among refugee children -- findings that support a case discussion on pediatric and preventive screening protocols for newly arrived refugee families.

Methodologically, this is a scoping review, not a systematic review or meta-analysis: it maps and characterizes existing evidence rather than pooling effect sizes or grading study quality via GRADE. Instructors should have students distinguish this purpose (identifying what exists and what is missing) from an intervention-effectiveness question. The authors are explicit and appropriately cautious about limitations: only 17 eligible studies existed after a decade of searching; the literature is skewed toward U.S. settings with comparatively little Canadian data and zero Mexican studies; samples were heterogeneous and predominantly adult; and some instruments used were not validated for Afghan populations specifically, raising measurement-validity questions worth raising in a research methods seminar.

The identified gaps are themselves a strong teaching resource: no studies on Afghan men's healthcare experiences, minimal Canadian data on anxiety/depression prevalence, no studies on mental healthcare utilization barriers, thin data on children and youth, and no evaluations of psychosocial interventions in the North American context. This makes the article well suited to a critical appraisal exercise on refugee and immigrant health, a discussion of gendered and intergenerational determinants of mental health, or a research-gaps mapping assignment where students propose a study design to address one of the five gaps identified by the authors.