Quality of life for Internally Displaced Teenagers in Rania City

Aims of the study: To determine the quality of life domains and the level of quality of life for internally displaced teenage students in Rania city. And to find out the relationship between the quality life domains and some of their sociodemographic characteristics of the sample such as age, level of education of students, and family income. Methodology: Methodology: A descriptive study, using the assessment approach was conducted on Internally Displaced teenage students from the 2 nd of August 2015 to the 3rd of February 2016. To achieve the objectives of the study, non-probability sample of (165) students selected for the study. A questionnaire was adapted from the world health organization quality of life (WHOQOL-BREF), a questionnaire (1) , for the purpose of the study. The WHOQOL-BREF questionnaire contains two items from the overall quality of life and general Health with (24) items of satisfaction that divided into four domains: Physical health, psychological health, social relationships, and environmental health. Each item is rated on a 5-point Likert scale. Each item of the WHOQOL-BREF scored from 1 to 5 on a response scale. A pilot study was carried out on (10) students for the study questionnaire's reliability through the use of stability (test-retest method). A panel of (5) experts was involved in the determination of the questionnaire's content validity. Data were analyzed through the application of the descriptive statistical data analysis approach (frequency, percentage, mean of scores) and inferential statistical data analysis approach (Pearson correlation coefficient and chi-square). Result: The study indicated that the majority of the students are aged between (14-16) years old, (77%) of family are nuclear. Concerning the students' educational level (39.4%), of them was in 3 rd class in secondary school. Also the study shows (42.4%), of family income are sufficient, and the majority of the samples were displaced from Al-Anbar province (87.3%). Regarding receiving help from the Iraqi government, the majority of them did not receive help from the Iraqi government. The findings of the study indicated that quality of life was affected by physical, and environmental domain. Age, level of education of students, and family income had significant relationship with quality of life domains. Conclusion: The quality of life of female teenagers displaced persons affected by their displaced, especially (environmental domain, physical domain, and psychological domain). Recommendation: Establishing a humanitarian program helps to raise their Qol of displaced persons in all dimensions. Organize a plan of action by the Iraqi government with Iraqi civil society 1 PhD Assistant Professor, College of Nursing, University of Raparin 2 Msc Lecturer, College of Nursing, University of Raparin Email:blend.ameen@raparinuni.org 3 Msc Assistant Lecturerr, College of Nursing, University of Raparin Email: m.mahmood@uor.edu.krd Article information Article history: Received January 4, 2016 Accepted October 9, 2016 Available online June 30, 2019 Mosul Journal of Nursing, Vol. 7, No. 1, 2019 ( 21-29 ) 22 organizations (internal and external organizations) to support teenagers displaced people in all domains of quality of life Keyword: Quality of life, Teenagers, internal displacement. Introduction The displacement or forced migration of people within their own countries is today a common international phenomenon. Such migration may be caused by internal armed conflicts, situations of general violence, ethnic fights, and mass violation of human rights, violations of international humanitarian law or natural disasters. Displaced people are highly vulnerable. They suffer from discrimination, experience significant deprivation and are frequently impoverished. Marginalized within their own society and facing the emotional trauma of their uprooting experience, displaced people turn into excluded people who suffer loss of economic opportunities, breakdown of cultural identity, loosening of social and familial structures, interruption of schooling and increased poverty levels. They also suffer from grief relating to dead or missing family members and, in extreme cases, resort to delinquency and begging in order to survive (2) . As of the end of 2014, 38 million people around the world had been forced to flee their homes by armed conflict and generalized violence, and were living in displacement within the borders of their own country. This represents a 15 per cent increase on 2013, and includes 11 million people who were newly displaced during the year, the equivalent of 30,000 people a day. Iraq suffered most new displacement, with at least 2.2 million people fleeing from areas that fell under the Islamic State (ISIL) control (3) . The UN Refugee Agency, the UNHCR, distinguishes between refugees and internally displaced persons as follows: “Both groups often leave their homes for similar reasons. Civilians are recognized as ‘refugees’ when they cross an international frontier to seek sanctuary in another country. The internally displaced, for whatever reason, remain in their own states (4) . Since the onset of violence in December 2013, Sulaymaniah saw the arrival of new IDPs fleeing in the aftermath of three security incidents: the January Anbar Crisis, the June Mosul Crisis and the August Sinjar offensive. Currently, the Governorate is a safe haven for almost 180,000 IDP individuals,in addition to 30,000 Syrian refugees. Sulaymaniyah enjoys stable security, which was the main pull factor for those who displaced there. However, an increasing population has placed a strain on the local economy, services and local infrastructure, impeding the delivery of basic services and stretching the economic capacity of the KRG to its limit. Sulaymaniah was facing problems with regards to the central budget allocation that caused delays in salary payments. Notably, the poverty rate in the KRI has increased from 3.5% to 8.1% since 2013 (5) . According to (6) , study on Postconflict internally displaced persons in Ethiopia. Over 50% of the continent’s population is below 18 years of age that needs proper attention and care. And yet, young women and children are susceptible to all forms of human-made misery. Therefore, necessary attention should be given to the most vulnerable and affected groups of the society. Method A descriptive study, using the assessment approach was conducted on internally displaced teenage students from 1st of August 2015 to the end of February 2016. In order to determine the quality of life domains and the level of quality of life of students in Rania city, which is located in the Sulaymaniyah governorate Kurdistan region/Iraq. Non-probability purposive sample of (165) students’ selected for the study. A questionnaire was adapted from the world health organization quality of life (WHOQOLBREF). Questionnaire (WHO, 1998) for the purpose of the study. The WHOQOL-BREF questionnaire contains two items from the overall quality of life and general health and 24 items of satisfaction that divided into four domains: Physical health with 7 items (DOM1), psychological health with 6 items (DOM2), social relationships with 3 items (DOM3) and environmental health with 8 items (DOM4). Each item is rated on a 5-point Likert scale. Each item of the WHOQOL-BREF is scored from 1 to 5 on a response scale. The two items Mosul Journal of Nursing, Vol. 7, No. 1, 2019 ( 21-29 ) 23 for the overall quality of life and general health calculate sparely with other four domains. A pilot study was carried out on (10) students for the study questionnaire's reliability through the use of stability (test-retest method). A panel of (5) experts was involved in the determination of the questionnaire's content validity. Data were analyzed through the application of the descriptive statistical data analysis approach (frequency, percentage, mean of scores) and inferential statistical data analysis approach (Pearson correlation coefficient and chi-square) and (SPSS).


Introduction
The displacement or forced migration of people within their own countries is today a common international phenomenon. Such migration may be caused by internal armed conflicts, situations of general violence, ethnic fights, and mass violation of human rights, violations of international humanitarian law or natural disasters. Displaced people are highly vulnerable. They suffer from discrimination, experience significant deprivation and are frequently impoverished. Marginalized within their own society and facing the emotional trauma of their uprooting experience, displaced people turn into excluded people who suffer loss of economic opportunities, breakdown of cultural identity, loosening of social and familial structures, interruption of schooling and increased poverty levels. They also suffer from grief relating to dead or missing family members and, in extreme cases, resort to delinquency and begging in order to survive (2) .
As of the end of 2014, 38 million people around the world had been forced to flee their homes by armed conflict and generalized violence, and were living in displacement within the borders of their own country. This represents a 15 per cent increase on 2013, and includes 11 million people who were newly displaced during the year, the equivalent of 30,000 people a day. Iraq suffered most new displacement, with at least 2.2 million people fleeing from areas that fell under the Islamic State (ISIL) control (3) . The UN Refugee Agency, the UNHCR, distinguishes between refugees and internally displaced persons as follows: "Both groups often leave their homes for similar reasons. Civilians are recognized as 'refugees' when they cross an international frontier to seek sanctuary in another country. The internally displaced, for whatever reason, remain in their own states (4) .
Since the onset of violence in December 2013, Sulaymaniah saw the arrival of new IDPs fleeing in the aftermath of three security incidents: the January Anbar Crisis, the June Mosul Crisis and the August Sinjar offensive. Currently, the Governorate is a safe haven for almost 180,000 IDP individuals,in addition to 30,000 Syrian refugees. Sulaymaniyah enjoys stable security, which was the main pull factor for those who displaced there. However, an increasing population has placed a strain on the local economy, services and local infrastructure, impeding the delivery of basic services and stretching the economic capacity of the KRG to its limit. Sulaymaniah was facing problems with regards to the central budget allocation that caused delays in salary payments. Notably, the poverty rate in the KRI has increased from 3.5% to 8.1% since 2013 (5) .
According to (6) , study on Postconflict internally displaced persons in Ethiopia. Over 50% of the continent's population is below 18 years of age that needs proper attention and care. And yet, young women and children are susceptible to all forms of human-made misery. Therefore, necessary attention should be given to the most vulnerable and affected groups of the society.

Method
A descriptive study, using the assessment approach was conducted on internally displaced teenage students from 1st of August 2015 to the end of February 2016. In order to determine the quality of life domains and the level of quality of life of students in Rania city, which is located in the Sulaymaniyah governorate Kurdistan region/Iraq. Non-probability purposive sample of (165) students' selected for the study. A questionnaire was adapted from the world health organization quality of life (WHOQOL-BREF). Questionnaire (WHO, 1998) for the purpose of the study.
The WHOQOL-BREF questionnaire contains two items from the overall quality of life and general health and 24 items of satisfaction that divided into four domains: Physical health with 7 items (DOM1), psychological health with 6 items (DOM2), social relationships with 3 items (DOM3) and environmental health with 8 items (DOM4). Each item is rated on a 5-point Likert scale. Each item of the WHOQOL-BREF is scored from 1 to 5 on a response scale. The two items for the overall quality of life and general health calculate sparely with other four domains.
A pilot study was carried out on (10) students for the study questionnaire's reliability through the use of stability (test-retest method). A panel of (5) experts was involved in the determination of the questionnaire's content validity.
Data were analyzed through the application of the descriptive statistical data analysis approach (frequency, percentage, mean of scores) and inferential statistical data analysis approach (Pearson correlation coefficient and chi-square) and (SPSS).  at secondary school in 3 rd class. These back to that the family concern mostly for their girls to complete secondary school to gain certification and to insure that they able to read and write.

Result Descriptive Characteristics of Students and Their Parents
Regarding the type of family the findings revealed that the highest percentages of family are nuclear (77%), Iraq people mostly are Muslims and the family is the center of life for most Iraq; it represents honor, and reputation, the family tends to have private home to gain independence and can move freely around the home. Concerning the level of education of father, the study shows that the highest percentages are able to read and write (23% But the teenager satisfies about their social relationship. This maybe back to that the higher percentage of IDPs teenager from Al Anbar provenance, and mostly of them relatives and they houses near each other's. Also This study nearly contrast with study done in French about association between health-related quality of life and being an immigrant among adolescents, and the role of socioeconomic and health-related difficulties, which shows poor health-related QOL (in its four domains: physical health, psychological health, social relationships, and living environment) among European and non-European immigrants in early adolescence, and the concurrent roles of a wide range of socioeconomic difficulties, unhealthy behaviors, and violence sustained. European immigrants, and especially non-European immigrants, were more subject to poor physical health, psychological health, social relationships, and living environment (7) .
( Table 3), shows that there is a significant association between quality of life domains and the students' age groups. (Table  4), shows a significant association has been found between quality of life and the students' family income. The finding of the (table 5), shows that there is a significant association has been found between quality of life and level of education of students'. The World Health Organization (WHO) defines quality of life as 'individuals' perceptions of their position in life in the context of the culture and value systems in which they live and in relation to their goals, expectations, standards and concerns. It is a broad concept incorporating an individual's overall sense of well-being, physical health, psychological health, personal beliefs, social relationships, and their relationship to the salient features of their environment (8) . Quality of life asks individuals how concerned or satisfied they are with their lives. It is more subjective rather than objective, since the individual evaluates his/her own quality of life (9) . The quality of life affected by, lack of fulfillment of basic needs, the problem of health and sanitation, the problem of education, shortage of employment, low income, poverty, conflict within the family members, and high maternal and infant mortality rate. Immigration peoples, especially teenage deprivation from many of these basic needs.
The finding of the (table 6), shows the highest percentage of teenage rate their quality of life as neither poor nor good. The finding of the (table7), shows the highest percentage of teenager were satisfied with their health.

Conclusions
There is a variable effect on the quality of life dimensions between female teenagers displaced persons: there was a mild negative effect in the psychological domain, a moderate negative effect in the physical domain, and severe negative effect in the environmental domain Recommendations Due to the back of services and also government support, it is necessary to arrange an especial plan to help them to save there Qol in good level, establishing a humanitarian program to arise their Qol in all dimensions. In addition to carefully dealing with their situation to able to save them from negative effectiveness on their life. Finally, organize a plan of action by the Iraqi government with Iraqi civil society organizations (internal and external organizations) to support teenagers displaced people in all domains of quality of life