The Long-Term Concern of Refugee Mental Health
While much of the humanitarian efforts throughout Europe and the Middle East have been aimed at meeting immediate needs for millions of displaced persons, there is a recognizable need that poses an even greater threat to the well being of refugees: mental health.
The refugees coming out of Syria and Iraq have traumatic reasons for leaving their home countries. Many have witnessed or been subjected to violence, murder and social upheaval. Further trauma comes from having to make long and hazardous journeys to safety. Refugees also struggle with being uprooted from their homes and separated from family members.Once they have reached safer shores, refugees face a process of resettlement that also brings stress and uncertainty. Obstacles such as delayed asylum application processes, inability to work and lack of support systems place further pressure on refugee mental health.
The UNHCR notes that the number of refugees suffering from malnutrition or infectious diseases is very low but psychological issues remain deeply concerning. International Medical Corps conducted a study across refugee populations in Syria, Jordan, Lebanon and Turkey. The results found that 54 percent of those surveyed were struggling with a mental, neurological or substance use problem. According to the Refugee Health Technical Assistance Center, the most common mental health conditions associated with refugee populations include post-traumatic stress disorder (PTSD), depression and anxiety.
These conditions cause great distress, particularly for young people. A 2014 report from Unicef cited a survey that found a third of Syrian children at the Za’atari refugee camp in northern Jordan displayed unusually aggressive behavior and engaged in self-harm. Other reports have highlighted nightmares, constant weeping and inability to engage with other children as consequences of their trauma. The report warned that without help, these children were at risk of drifting into crime, addiction and violence, and that some were already joining criminal gangs.
However, services for chronic diseases and refugee mental health are insufficient, due to a lack of funding and absence of standardized treatment. In addition, cultural context and language barriers have made it difficult for organizations and physicians to carry out effective and standardized treatments. Mental health services are relatively expensive and many host countries in the Middle East lack sufficient qualified mental health professionals to reach every refugee. Additionally, building a relationship with a mental health physician or psychologist is a long-term process. Refugees are not guaranteed to be in any place for a long time, making it difficult to develop therapeutic relationships and keep up with treatments.
Despite the lack of mental health services for refugees, some organizations, and even refugees themselves, are taking on the challenge. Project Amal ou Salam, meaning Project Hope and Peace, helps support schools and workshops for refugee children throughout Jordan, Syria, Turkey and Lebanon. The organization uses “music, art, sports, photography and team-building activities to teach the kids about trust and unity and help them deal with the trauma they have sustained.”
Another such effort, Syria Bright Future, is run by Dr. Mohammad Abo-Hilal, a Syrian psychiatrist. His organization focuses on helping Syrian refugees in Jordan, particularly children. Dr. Abo-Hilal’s youngest clients learn to visualize a safe space, use relaxation techniques and confront bad experiences by drawing them. In this way, he hopes to provide children with a space to vent their experiences, but more importantly to express their dreams for the future. The evidence that such techniques can reliably reduce symptoms of traumatic stress is still unclear, Dr. Abo-Hilal said, many children have learned to cope with some of their stress. However, Dr. Abo-Hilal laments that his services have not done enough, “All that we did, maybe we cover 10,000 or 20,000 children-- but there are millions out there waiting for this help.”
Many of the people who have fled Syria are lawyers, doctors and psychologists-- people who could help address the gap in services for displaced Syrians. However in many host nations in the Middle East, work permits for refugees are unavailable or forbid them to work in certain white-collar sectors, like medicine. In order to find work in Jordan, Syrian doctors work illegally under the cover of Jordanian doctors, often for lesser pay and longer hours. The risk of doing this is high: violations can result in three-year jail sentences, or worse, deportation back to Syria.
In our research for Urban Refuge, we discovered just how dire the need is for long-term services and stability amongst refugees. While immediate needs, like food and shelter, are incredibly important, it is the long term needs that will help the millions of people coming from Syria, Iraq and other nations rebuild their lives . However, it seems that governments have be hesitant to give more assistance to refugees, in part because it would mean giving them more citizenship rights and permanency to their settlement in host communities.
Mental health care is requires more than just therapy. Living a happy, healthy life entails rights such as access to education, ability to work, and safe, permanent living situations-- all the things that refugees are lacking. Addressing the systemic issues that limit mental health care is a difficult task that requires a long-term shift in funding and policy. However, the costs of not addressing this issue are much higher. The children of Syria have the right to become happy, educated adults with fulfilling lives. The longer we ignore their well-being, the further we condemn them to lives of chaos and suffering.