There are 51.2 million refugees in the world who've had to abandoned their homes, their countries, and the lives they built in hopes of finding a better existence somewhere else. Some of these people have suffered gang rapes, been locked in a cell and beaten for days on end, or had to watch as their entire family was slaughtered.
This kind of intense trauma obviously merits some time on a therapists couch. However, in and around the sprawling camps that have emerged to support the growing refugee populations in Jordan, Turkey, Kenya, and around the world, very few receive the psychological support they desperately need. The consequences of this neglect can have very real security implications, along with the obvious humanitarian ones.
"There is probably no group of people more in need of psychological care than refugees," United Nations High Commissioner for Refugees Melissa Fleming told me in an email. "They are traumatized by violence and scarred by loss. And very often, their uncertain life in exile exposes them to more challenges than they are mentally prepared to handle."
An oft-overlooked aspect of the bleak lives of refugees is the security threat their untreated trauma can pose. The psychological neglect of desperate refugees gives recruiters for extremist groups like ISIS and Boko Haram an opportunity to use intense emotional turmoil as a recruitment tool. "One of the key concepts that has emerged in the study of radicalization is that of the cognitive opening," explained Alexander Meleagrou-Hitchens, Head of Research and Information at the International Center for the Study of Radicalization. "It's a moment in someone's life that makes them question their identity, their understanding of the world. That moment can be a natural progression for someone who never integrated into society, but it can also be sparked by a traumatic event."
Children and teenagers are particularly likely to find their cognitive openings steering them towards violence. "There is clear evidence that at any age, but particularly as an adolescent, when you don't have access to school or dignified forms of employment, you are at risk of being exploited and tempted into anti-social behavior," Robinson said. "When you have a trauma-related disorder, you may be so disturbed as a young person that you want to go back to Syria to fight," Dragoul agreed. Recruiters know this. As Meleagrou-Hitchens elaborated, "Areas near refugee camps, many of which have now become permanent towns, are major recruitment grounds."
Another factor complicating access to treatment is the stigma surrounding mental health in many refugee communities. Robinson once treated migrant workers on the Thai-Burma border, many of whom had been victims of torture. She learned quickly that "if you had a clinic with a sign over the door that said 'Mental Health Clinic,' no one would go. Mental health was for 'crazy' people."
But perhaps the most significant reason refugees' psychological needs are so vastly unmet is because of the intangible nature of those needs. "There is not a lot of funding or attention given to mental health," Robinson said. "The priorities are food and medicine and shelter, and basic protection against forced repatriation. Mental health is seen as a 'softer' service, like education or reproductive health."
Unlike other priorities, the outcome of offering psychological counseling is uncertain. If you give someone food, they will not starve. If you give someone heated shelter, they will not freeze to death. If you give someone counseling, they may still be depressed, abusive, or recruited by militants. Donors and relief agencies seek to spend their limited resources on initiatives that are as risk-free as possible. Counseling, however important, offers far from certain redress.
But investing in refugees' mental health could have a significant positive impact on these sprawling populations, in the long run. Refugees treated for trauma might re-acquire the cognitive capacity to re-build their lives, to move out of camps and into more stable lives. It is highly unlikely that those who do not get treatment will be able to do so. People who feel vulnerable and shattered will turn to whoever makes them feel safe. Offering refugees psychological care is one way to make civil society seem more like that safe haven, rather than the ever-welcoming arms of the world's extremist recruiters.
Follow Elizabeth Nicholas on Twitter.