Even when refugees remove themselves from the imminent physical dangers of war zones, their problems are far from over. If refugees relocate to camps within their own country, they often face issues like poverty, and physical and sexual abuse. If they flee abroad, racial and religious discrimination, along with cultural isolation, are often added to their list of woes.
Less talked about than physical and social issues, mental health problems are extremely prevalent in refugee populations, whether they are located in their home country or abroad. Civilian experiences in a war zone can lead to post-traumatic stress disorder (PTSD), depression, and physical manifestations of stress like the loss of the ability to move parts of the body. According to a report by the German Federal Chamber of Psychotherapists, more than half the number of refugees from war zones suffer from some kind of mental illness.
The Syrian Civil War, which began in 2011 and has so far displaced over 12 million people, with 4 million seeking refuge abroad in Turkey, Lebanon, Jordan, Iraq and Egypt, has brought about a greater awareness of the mental issues experienced by refugees, especially children. Around half of Syrian refugees are under 18 years old, and around 40 percent are under 12. Three major reports — Save The Children’s March 2017 report, “Invisible Wounds,” the Migration Policy Institute’s (MPI) 2015 report, and a 2015 UNHCR report focus on the mental health issues of Syrian refugees.
The three reports range far and wide, and uncover a host of mental health problems faced by refugees. PTSD, a serious condition brought about by the experience of violence or sexual violence, and depression, are particularly prevalent, with 45 percent of Syrian child refugees in Turkey suffering from the former, and 44 percent suffering from the latter.
Grief, over relatives killed in the conflict, material losses, or the situation in general, was a significant source of stress for all. Fear, too, is obviously a stressor. Refugees located in Syria continue to fear violence, while women and girls in camps at home and abroad fear rape and physical abuse. (Fear of rape is a major reason for fleeing war zones in the first place.)
Children are especially at risk from mental illness during wartime, as this quotation from a teacher in the Syrian town of Madaya, in Invisible Wounds, makes clear: “The children are psychologically crushed and tired. When we do activities like singing with them, they don’t respond at all…they draw images of children being butchered in the war, or tanks, or the siege and lack of food.” Another mother talks of the psychological problems of her child who witnessed the beheading of another child by an assailant.
Fear is to be expected, especially as around 3 million Syrian children still live in areas subjected to high explosive weapons. Screaming nightmares are common, as is bedwetting, a symptom of PTSD. But children also become angry and aggressive as a result of their wartime experiences, desiring revenge on those who have murdered their friends or families.
Children also become desensitized to violence, and can be recruited as soldiers for some of the many armed groups in Syria — something which also gives them an income to support their poverty-stricken parents. “Children exposed to multiple sources of violence may become desensitized and emotionally numb, which increases the possibility of them imitating aggressive behavior,” says Save the Children.
For girl refugees, security is an even greater issue, and parents worry about the rape, abduction, or kidnapping of their daughters. This has led to hastily conducted arranged marriages, as parents hope that marriage will provide a greater degree of safety for the girl. Girls as young as 12 have been married off, and this has led to fear, depression, and sometimes even suicide. Fearful parents also won’t allow their daughters to leave their sides, especially in the refugee camps, and the resulting sense of confinement leads to anxiety.
So what can be done, and what is being done? There is a growing realization that aid agencies must take account of refugees’ mental health needs, as well as their physical ones. “We have seen the aftermath of enough civil wars to know this about refugees: providing food and water is not enough,” says the MPI report. For refugees inside Syria, or encamped on its borders, the problem is clear — there are simply not enough mental health practitioners around to give them the help they need.
There are only about 70 psychiatrists left in Syria. The situation is exacerbated by a Syrian cultural taboo about mental health care that leads to many refugees avoiding help, both inside and outside of the country, although the extent of the Syrian mental health problem has seen attitudes begin to change.
As for refugees abroad, government agencies in the host country should ensure they are diagnosed for mental health issues and treated. For instance, European Union nations must, by law, screen asylum applicants for mental illness, and put in place supportive measures to help them. A lack of resources, however, means that this system often fails.
Along with traditional therapy, measures like art therapy have been used to treat refugees. A Jordan-based organization called Syria Bright Future has developed “culturally sensitive” psychological therapy methods of dealing with mental illnesses caused by the war, especially instances of PTSD in children, and these are reportedly having some success.
But, as UNHCR points out, the only way to combat the growing crisis of mental illness for refugees is for the combatants to stop fighting. In Syria, that seemingly is not going to happen in the immediate future and, until then, we must do more to provide mental health services to those who survive the horror in their homeland and brave dangerous journey in search of safety. Otherwise the crisis will have real, irreversible consequences for an entire generation scarred by the trauma of war.