Post-resettlement context matters: a qualitative study of refugee parents' responses to child trauma in low-resource...

Background: Despite evidence that post-resettlement socio-environmental factors affect parenting, refugee parents' experiences of meeting children's posttrauma needs in resource-poor settings remain severely underexplored in LMICs.Objective: This study aimed to explore parental understanding of child posttrauma distress and caregiving responses in the context of displacement and resource limitations in Iran, one of the world's largest refugee-hosting countries.Methods: Thirty refugee parents were recruited from deprived communities in Iran. Data were collected using semi-structured interviews and questionnaires. Parents were mainly from Afghanistan, most were illiterate, and all reported at least moderate PTSD symptoms. Data were analysed using thematic analysis.Results: Four themes were generated regarding: (1) parents' understanding and interpretation of children's distress; (2) parenting under displacement; (3) intra-family dynamics; and (4) support needs, help-seeking, and care pathways. Parents lacked a basic understanding of their child's trauma-related difficulties, describing extreme uncertainty about how to respond to their child's emotional needs, as well as limited insight into those needs, coupled with a severely limited capacity to support their children and a lack of access to wider resources. Ongoing post-resettlement stressors appeared to deplete parents' coping capacity and trigger harsh, reactive parenting, in contrast to more supportive parenting practices described before displacement. Material deprivation also influenced parent-child interactions: many children withheld trauma-related mental or physical consequences to avoid healthcare costs, and some adopted parenting-like roles, including income generation, sibling care, and emotional support for their distressed parents. Finally, parents' priorities were wholly focused on material needs essential for their children's basic survival, rather than psychosocial support.Conclusion: Our findings provide novel insight into the profound influence that markedly low mental health literacy, material deprivation, and limited internal and external support resources have on how refugee parents understand and respond to their child's posttrauma needs in deprived, low-resource post-resettlement settings.