title: [The hardest battles begin after the war].
abstract: BACKGROUND
  While psychic effects of war trauma are well-described, the somatic long-term consequences of war trauma have not previously been described. In three clinical cases from the Migrant Health Clinic at Odense University Hospital, we describe the complicated somatic problems which can be associated with a refugee status.
  
  
  METHODS
  The cross disciplinary team chose three cases that describe the long-term effects of war trauma.
  
  
  RESULTS
  Post-traumatic stress disorder (PTSD) can appear 10-20 years after a primary war-related trauma and secondary trauma after the arrival in Denmark trigger and prolong post-traumatic stress symptoms with a range of somatic symptoms. Warning signs of an underlying PTSD disorder have often been present for many years, but overlooked or ignored. Many patients with PTSD and somatic symptoms loose previously acquired language skills, disintegrate and drop out of the labour market after 3-4 years in Denmark.
  
  
  CONCLUSIONS
  Somatic symptoms along with PTSD can develop into a seriously complicated condition that requires skilled cross-disciplinary management. Experience from the Cross Disciplinary Migrant Health Clinic shows that by investing time in obtaining a full clinical and social history it is possible to increase the quality of life of these patients. Early screening and early specialized cross disciplinary and cross sectorial management are crucial to secure and maintain integration, but unfortunately the long waiting list to institutions that treat PTSD contributes to the high level of disintegration.
authors.affiliation: Indvandrermedicinsk Klinik, Infektionsmedicinsk Afdeling, Odense Universitetshospital, DK-5000 Odense C, Denmark. msodemann@health.sdu.dk
authors.forename: Morten
authors.initials: M
authors.lastname: Sodemann
authors.forename: Arndis
authors.initials: A
authors.lastname: Svabo
authors.forename: Arne
authors.initials: A
authors.lastname: Jacobsen
mesh_terms: D000328:Adult; D003718:Denmark; D005260:Female; D006801:Humans; D008297:Male; D010348:Patient Care Team; D011602:Psychophysiologic Disorders / Q000209:etiology / Q000523:psychology / Q000628:therapy; D011788:Quality of Life; D012036:Refugees / Q000523:psychology*; D012917:Social Adjustment; D013313:Stress Disorders, Post-Traumatic / Q000150:complications / Q000523:psychology / Q000628:therapy; D014857:Warfare