CASE STUDY: EXILED NICARAGUAN HUMAN RIGHTS DEFENDERS IN COSTA RICA Do the HRDs receive medical and psychosocial attention? HRDs experience extreme psychological pressure not only in the process of exile and migration to a new country, but from suffering persecution and reprisal for their work. For those who came after April 2018, most HRDs have directly suffered and experienced violence at the hands of the government and paramilitary groups. Many have witnessed murders of fellow protestors and were themselves attacked and injured, arrested, and detained. They face stress in the refugee application process, and despite the assurance from the Costa Rican government that it will not expel Nicaraguans seeking refugee status, many report suffering depression and anxiety from the struggle to acclimate to their new surroundings and find security and stability in their lives. This creates a need for psychosocial attention and care in the host country. As can be seen in Graph 4, Nicaraguan HRDs in Costa Rica received a diverse set of services. According to the survey results, only 16% of the HRD respondents said they received both medical and psychosocial attention, while 21% said they did not receive either medical or psychosocial attention. Similarly, nearly two-thirds of the HRD respondents said they received only psychological services, while 5% said they received medical only. Moreover, the providers of these services are diverse. For example: private doctors and psychologists, NGOs (e.g., CENDEROS, SOS Nicaragua, People in Need, IM Defensoras, RET, Fundación Mujer, CEJIL), faithbased organizations (e.g., Lutheran Church, Jesuit Service for Migrants), universities (e.g., University of Costa RicaUCR), international NGOs (e.g., World Organization Against Torture), and international organizations (e.g., UNHCR). In Costa Rica, psychological support for Nicaraguan HRDs is provided by CSOs that support migrants in general (e.g., CENDEROS, Fundación Acceso, Doctors without Borders while they were in Costa Rica, Peace Brigades International, SOS Nicaragua, among others). Some HRDs received individual attention, but the majority mentioned therapeutic and self-help groups, as well as ludo therapy. Sometimes, psychosocial teams from the UCR and Association of Psychologists lend a hand. HRDs recognized that while rights in Costa Rica are violated, the intensity and intent is unlike what they experience in Nicaragua. Nicaraguan HRDs mentioned that they often experience xenophobia, particularly when they try to integrate into communities. Some have mentioned that when they speak with a distinguishable different accent than the locals, they have experienced verbal attacks or derogatory comments. Also, Nicaraguans HRDs in Costa Rica mentioned that when they are looking for a house or temporary shelter, only because they are Nicaraguans the requirements and conditions are often difficult to fulfill (rigid contracts, restrictions on the number of people that can be in the house, and higher than normal prices). Similarly, Nicaraguan HRDs mentioned that they are often asked to leave their homes without giving them much time to find another place, in violation of Costa Rican laws. GRAPH 4: HAVE YOU BEEN ABLE TO RECEIVE MEDICAL AND PSYCHOSOCIAL SERVICES IN COSTA RICA? 70% 60% 50% 58% 40% 30% 20% 21% 10% 0% 14 @FreedomHouse 16% 5% Only Psychosocial None Both Only Medical