8/12/2019 A Tidal Wave of Trauma

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A Tidal Wave of TraumaFrom PTSD to depression, the war in Syria has spawned a massive mentalhealth crisis — and there are neither the doctors nor the money to stem its

crushing effects.

BY LAUREN WOLFE-MAY 27, 2014

There are as many guises of trauma as there are Syrians who have experienced the war still

ravaging their country. The dead-eyed mask is common, often in children. I saw it in a refugee

house in Amman, Jordan, where, seated on scratchy nylon mats that said !"#$%,& seven or

so 'oys and girls stared at me stonily. Their mother cried until her whole face and neck turned

red as she told stories of massacres and family mem'ers who had disappeared. The father sat

(uietly in a near'y room, praying.

There is another ga)e, one full of grief, which I sawin a hospital in *ilis, a town inside Turkey

near the Syrian 'order. A woman, +, was 'edridden with a spinal inury she incurred on the

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outskirts of Aleppo. xplosives had fallen on her house, crushing not only her 'ack, 'ut also

her daughter, Ayah. A 'lond, /-year-old child with plastic glasses, Ayah died that day. The pain

of her death pulsed in her mother0s eyes.

There is also the drawn face of exhaustion, a wounded look I witnessed on a woman I met in a

 park  in *ilis. The park housed 1,222 Syrians in makeshift tents. The woman tried to hand me

her young son. #e had sca'ies up and down his legs. 3hen will all of this end4& she 'egged.

The (uestion of when the fighting will end is ever present in the minds of those hurting. So,

too, are memories of torture, killing, rape, and deprivation. A loss of home and country plagues

refugees, as do the difficulties of trying to incorporate themselves into communities that are

sometimes hostile to their presence. 5any have physical pro'lems from inuries in the war.

ven more have internal, emotional damage. Suffering for Syrians has a cascade effect, one

with no tangi'le end in sight.

The 3orld #ealth 6rgani)ation estimates that + to 1 percent of people affected 'y an

emergency 7like the war in Syria8 will develop severe mental health disorders, such as

 psychosis or severe depression. 7That0s compared to 9 to + percent 'efore an emergency8. The

organi)ation also says that :; to 92 percent of people in an emergency will develop mild or

moderate anxiety or depression disorders or post-traumatic stress disorder 7<TS=8 > as

compared to :2 percent 'eforehand > and that a large percentage& of people will experience

normal distress& during an emergency.

%ight now, there are a'out / million Syrians who have fled their homes, 9.? million of whom

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have taken refuge in neigh'oring Turkey, Jordan, @e'anon, gypt, and Ira(. And, of course,

there are millions of Syrians still suffering inside their country. =o the math, and it0s easy to see

the enormity of the mental health crisis this war has created.

ut amid a litany of humanitarian needs that aren0t even remotely 'eing met, can this crisis

 possi'ly 'e addressed4 $an its long-term effects > illnesses that could tear apart families and

reduce (uality of life > 'e mitigated in a meaningful way4 3hile there are international and

local groups attempting to do ust that, the need is still heart'reaking and huge.

6n 5ay :;, <hysicians for #uman %ights 7<#%8 released a map with comprehensive

information on attacks on medical facilities and personnel inside Syria. It did not, however,

include information a'out people who provide mental health care specifically. rin Ballagher,

<#%0s director of emergency investigations and response, said the organi)ation is well aware of

the mental health crisis at hand, 'ut that it lacks statistics for psychologists and other providers.

This seems to 'e a trendC In reporting, I could not find an organi)ation with a good sense of

where or how many mental health practitioners are working inside or around Syria right now.

Ballagher says what0s clearly known, however, is that so many adults and children are

suffering from trauma and are not getting help.&

DThere is a 'ig, 'ig gap in accessing care for mental health for all Syrian refugees,D echoes Ana

5aria Tierino, a mental health advisor for 5Edecins Sans FrontiGres 75SF8 Suisse 7that is, the

Swiss 'ranch of =octors 3ithout orders8.&3e need to do more, definitely.&

D3e need,D she adds emphatically, Dto do more.&

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HHH=uring a conversation one evening in %eyhanli, on the Turkish side of the Syrian 'order, a psychologist named 5ohamed Suleiman from Idli', Syria, pulled out a large tripod topped 'y ahori)ontal metal 'ar with little green lights running across it. #e handed headphones to acolleague of mine, and we watched as the lights started 'linking, one 'y one.

This was an 5=%  7eye movement desensiti)ation and reprocessing8 machine, a method usedto treat <TS= that has people recall difficult memories while receiving different kinds ofsensory input the idea is to help the 'rain reprocess traumatic information to make it lessupsetting. 5any 3estern specialists consider it to 'e cutting edge. ut it is unusual to find onein a place as 'ereft as the Syrian 'order. Suleiman, who said that he and his wife are 'asicallythe only therapists in the area, descri'ed toting the machine from tent to tent in refugee camps.They can help only one person at a time.

6n various trips to the region in which Syrian refugees are scattered, I have met with many psychologists who similarly say they are the only ones for miles around > in some cases,

 perhaps the one medical practitioner licensed to treat mental health pro'lems in a refugee campof thousands of people. And all of these professionals have said the num'er of peopleexperiencing symptoms of depression or anxiety is staggering.

In addition to 5SF, other international groups, such as the International %escue $ommittee and!"I$F, offer help in various places, and so do local ones. The *irkuk $enter for Tortureictims, recently renamed the Jiyan Foundation for #uman %ights, runs seven reha'ilitationcenters in northern Ira(, including inside the =omi) refugee camp. The num'er of peopleseeking help has 'een extraordinarily high. Salah Ahmad, a psychotherapist and theorgani)ation0s director-general, says that in the =omi) camp, which is estimated to house more

than ?2,222 Syrians, the center saw more than /,222 patients in its first :: months. #is teamhas had to introduce a waiting list.

D"inety percent of families have trauma,D estimates a social worker named 5una inAmman, at theSyrian American 5edical Society7SA5S8.

D"inety percent of families have trauma,D estimates a social worker named 5una in Amman, atthe Syrian American 5edical Society 7SA5S8. The organi)ation, which includes psychologistsand social workers, carries out home visits to assess and help hundreds of new families onarrival each month. 3hen a plane is passing 'y, kids hide under chairs. KI wish I could go 'ackto Syria,0 they say.&

Another social worker in the office says, They0re scared, 'ut they don0t say why. They can0tadapt to their new surroundings, and they0re desperate.&

The psychologists and social workers at SA5S say they do four or five visits with a family, 'ringing food and clothing, through which they hope to alleviate some of the isolation andongoing need for 'asic items. It can take that many visits 'efore, for example, a woman mayfinally open up and say she was raped. Betting to the heart of trauma, in other words, can taketime and the right conditions.D3e tell them that we0re here for them. 3e give them the safety net,D says Lassar *anawati, a

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 psychiatrist who supervises the psychosocial team in SA5S0s Amman office. 7She is 'ased inAtlanta 'ut travels often to Jordan.8

5ost caregivers I spoke to view children as a population of special concern. 5any cannotattend school due to a lack of facilities, and some of those who do go cannot concentrate andlearn. They a'sor' their parents0 pain 7if their parents are still alive8. 5any of those who come

to us cannot sleep anymore, they have nightmares, are oversensitive, many cry a lot childrenare aggressive or stop talking,& says Ahmad.

*anawati descri'es situations in which a mother0s trauma affects children, in turn potentiallymaking them more aggressive and less a'le to learn. She does group therapy sessions withrefugees, mainly children, who she says are either in a da)e 'ecause of the trauma oraggressive or depressed or anxious. Just thinking a'out their losses, thinking a'out their fatherwho ust died or their mother who was raped in front of them. It0s very serious stuff.& *anawatiexplains that while medical treatment for physical issues is certainly important, giving greatersupport for refugees0 emotional and mental health would prevent further decline in function of

the whole society.&

Let organi)ations like SA5S are understaffed and underfunded. *anawati says the group hastrou'le finding the M:22,222 a year it takes to do its work. %esources& > that0s the word sheand others repeated to me as what they need 'ut do not always have.

Adding to the overall predicament is that individual pro'lems usually ust get worse with time.The anti-poverty organi)ation $A% said in an April report on refugees that it clearlyidentified an increase in psychosocial needs the longer the displacement lasted.& Syrianfamilies typically identified a deterioration in their psychological state as a maor change over

the previous year,& $A% said, alongside and exacer'ated 'y preoccupations a'out financialresources to cover 'asic needs and closely related to a deterioration in health.&

Tierino of 5SF, who oversees the group0s mental health care in the =omi) camp, agrees.Some refugees have 'een inside a camp for two years, and it0s not likely to change soon,& shesays. The lack of knowing a'out their future, the uncertainty, is affecting their mental health.&

HHH5aking the situation all the more difficult is a long-standing ta'oo surrounding mental health inthe region. *anawati knows a'out this issue all too well. 3hen she got her medical degree inthe :/2s in Syria and told people she was going into psychiatry, everyone laughed.&

DThanks to Freud,D she says, Dthey thought that therapy is a'out sex and sexuality. In ourculture sex and sexuality is very private. Lou don0t go to someone to talk a'out it.D

Similarly, Ahmad in Ira( says that psychological treatment is still widely unknown in the5iddle ast.&

The ta'oo lingers, *anawati explains, although perceptions are slowly changing. ut in themidst of war, any new desire for assistance has run up against a lack of trained professionals.

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3e0ve 'een depending on paraprofessionals > social workers who didn0t go to school > 'utwe provide them with training to do this kind of work,& *anawati says.

etween the need to educate people a'out mental health treatment and figuring out how toreach so many sufferers with so few professionals, the challenges of this crisis areextraordinary. ut in addition to the dedicated people I spoke to, there are people out there

mulling creative solutions. For instance, there are trauma specialists in "orthernIrelandworking on a we' platform that would crowdsource mental health symptoms of Syrianrefugees, in an attempt to assess needs and pass the information along to practitioners and "B6s, who can in turn then provide treatment. Still, such efforts are only in development >and in the meantime, Syria0s war rages on, sending more and more refugees over the 'orderevery day.

3ith the 5=% machine 'linking away, Suleiman reflects on what lies ahead, and turns dark.DI0m more anxious a'out the future,D he says, Dthan the present.D

#is sentiment, it seems, unfortunately speaks for millions.Fadi al-#ala'iNAF<NBetty Images