Mental health of Syrian refugees: looking backwards and forwards

Abstract

The conflict in Syria, now in its fourth year, is almost unprecedented in the magnitude of humanitarian and public health catastrophe. More than 220 000 people are estimated to have been killed, most of whom were civilians with a high proportion of women and children. An estimated 9 million Syrians have fled their homes and the UN High Commissioner for Refugees (UNHCR) estimates that more than 4 million have fled to Syria's immediate neighbouring countries. Studies into the mental health of refugees and displaced persons in Syria and surrounding countries suggest rising levels of psychosocial distress. Coverage of mental health and psychosocial support services (MHPSS) for internally displaced people and refugees in difficult to access areas is minimal. In light of the ongoing violence, demand for services—particularly reinforced, culturally appropriate services—is expected to continue to grow. Nadim Almoshmosh, a UK psychiatrist of Syrian origin, reported his experience of working on mental health needs of Syrian refugees in Jordan and Turkey. “Initially refugees felt that this would be a short ordeal. People were defiant, angry and frustrated. Life was difficult in adjusting to the new reality of refugee life and its indignities. With time there is now despair and hopelessness. Many cases of mental health problems continue to suffer in silence for reasons of stigma and also lack of trained mental health professionals to turn to. Many humanitarian agencies have lacked coordination amongst themselves and different approaches leading to less than ideal care. Jordan and Lebanon have made strides in MHPSS delivery to the refugees”. Humanitarian programmes provide MHPSS for refugees and internally displaced people in Syria and surrounding countries. Redwan Al-Khayat, a UK psychiatrist of Syrian origin, works with the charity Syria Relief, and helped establish the National Centre for Mental Health (NCMH) in Reyhanli, Turkey. “We managed to provide access to care for people with mental disorders in Reyhanli in Turkey, Tripoli, and Bekaa in Lebanon. We have worked in liaison and cooperation with a variety of non-governmental organisations, such as Save the Children. We have been providing psychosocial support for affected populations, working to improve resilience and protection of vulnerable groups and providing specific support to three schools in southern Turkey,” he said. “We have been working with families to give displaced populations better coping strategies, with teachers, and to provide regular training and supervision for frontline staff”, Al-Khayat continues. “We have managed to ensure sustainable supplies of psychotropic medication. In our centre, we deliver specialist mental health care for children and adults. We have a children's department, which provides service for children with special needs, autistic spectrum, and speech difficulties, as well as emotional and behavioural disorders”. Maria Chambers, a UK-based therapist, describes working as a volunteer in Rehanlyi. She supported training and service delivery to 132 children with mental and physical health needs. “What I liked about the project is it is Syrians providing mental health services for Syrians with strong clinical basis, well-resourced in spite of very difficult circumstances.” Mamoun Mobayed is a UK psychiatrist based in Qatar and vice president of the Syrian Association for Mental Health (SAMH): he shared his experience. “We established SAMH as a multidisciplinary, non-profit, mental health organisation in 2012. Many members of SAMH have been working on various psychiatric and psychosocial programmes inside Syria and the neighbouring countries (especially in Turkey, Jordan, and Lebanon), providing training workshops for young Syrian mental health trainee professionals from inside Syria and the refugee camps. We saw many cases of post-traumatic stress disorder in children and adults, severe depression of wives following the death of their husbands, addiction to prescribed medicines, and children who were very sad that they have missed schools. The situation has been very difficult for women and children, people with mental illness and survivors of rape or sexual abuse. Family support has been very important and faith has played a major role with many people.” All agree that efforts are needed to improve geographical coverage of MHPSS nationwide. “Governments must change attitudes toward the refugees, facilitate access to mental health care and MHPSS staff to the refugees' camps, and provide more help in offering formal education to the many Syrian children, the lost generation”, says Mobayed. WHO is advocating integration of mental health into provision of basic health services. Meanwhile, the UNHCR has reported on MHPSS assessment for Syrian refugees in Lebanon, highlighting the need for a coordinated effort. To assist the humanitarian community, UNHCR have published a review on culture and mental health of Syrians. Peter Ventevogel, senior mental health officer with UNHCR, remarks that the effects of the armed struggle on the mental health and psychosocial wellbeing of people are profound, but warns that mental health professionals should not focus unilaterally on post-traumatic stress disorder: “I personally think that loss and grief are central issues for most refugees. They may grieve for deceased family members but also for emotional, relational, or material losses. The emotional problems related to the past are often compounded by daily stressors of living in chronic adversity due to forced migration and lack of basic needs. On top of that, the social fabric is torn apart by the conflict, and many Syrian families have become isolated from their usual support structures such as family, friends, and community.” He adds that this has important consequences for the way that mental health care for Syrians is organised: “Mental health and psychosocial support services need to go beyond clinical services and include efforts to strengthen community support mechanisms and non-clinical interventions to strengthen coping mechanisms”. To assist Syrian clients, mental health workers need to develop competence in understanding local illness models and idioms of distress. For the systematic review by Quosh and colleagues about mental health of refugees and displaced persons in Syria and surrounding countries see Intervention 2013; 11: 276–94 For the systematic review by Quosh and colleagues about mental health of refugees and displaced persons in Syria and surrounding countries see Intervention 2013; 11: 276–94 Mental health reform in Lebanon and the Syrian crisisLebanon is a small, middle-income country with a total population estimated at 4 million including 400 000 Palestinian refugees. The recent hosting of more than 1·2 million Syrian refugees has placed an enormous strain on the health system. However, both public and private health care institutions have remained functional and able to respond to the increase in demand. Full-Text PDF