Fleeing War, Traumatized Syrian Refugees Need Mental Health Access More Than Ever

With almost no space safe for refugees in the world, current mental health systems in the Middle East are beyond overloaded. But there are glimmers of hope.

by Mike Niconchuk
Jan 9 2018, 6:45pm

Image via Wikimedia Commons

This is an opinion piece by Mike Niconchuk, #MeWeSyria partner and Senior Researcher of Beyond Conflict, which reflects learnings and insights from recent #MeWeSyria missions in Jordan and Lebanon in October/November 2017, co-led by Niconchuk and Mohsin Mohi Ud Din (Founder of #MeWeSyria/Ashoka’s Youth Venture).

Her hands were clasped tight, holding her phone with pressure and fervor. I understood why. It is where she keeps her secrets, and her compulsions. Her eyes were wide, with varied colors inherited from centuries of colonizers, not including the foreign parties currently fighting in her homeland. She looked at me with bewilderment and curiosity as I said “hi” to her— why does he speak Arabic? What should I tell him? I knew she was pondering these questions because she accidentally said them aloud, deepening her hesitation.

After a half smile, Hanadi began to speak softly, sharing about her former life in Syria. Before….this.

Hanadi’s girlfriends had told her about the training we had hosted today—about how the brain and body record trauma and stress, then prompting any number of responses ranging from anger to depression, from hysteria to numbness.

What happens when millions of people lose their sense of self? When they run for so long, from so much?

Hanadi and I made eye contact for longer than is normal in this part of the world, but, for whatever reason, it calmed her. It can go either way with eye contact. Trustingly, she un-clenched her hands, ready to show me her phone, like a scared patient would show a doctor a confusing wound or rash that had been the source of so much silent and lonely worry.

Hanadi had never seen a psychologist, or anyone who has studied neuroscience, she said. I promised and warned her that I am not a psychologist, that I study the brain and how it works, not how to treat the wounds the mind nurses. Multiple times, I told her that I am not a therapist. She did not care. Her need for expression mountrously outsized the risk of expression to a potentially ineffective listener.

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Look at my daughter,” she said with an unnerving glow while showing me a picture.

I looked at the photo. A beautiful baby girl, just three days old. She is dead. Her stomach was inflated, punctured in three places. The blood was mostly cleaned by the time the photo had been taken. Her face was yellowed, and froth drips from her parted mouth.

“This was from an air strike. She was born three days before,” Hanadi said, still smiling, as would most mothers when thinking of their child. She was glowing but mournful, like a pale sunrise the morning after a decimating battle.

Hanadi scrolled casually through a set of photos. All were photos of the corpses she saw that day, most of them babies. Duaa’, sitting between us, covered the screen with her hands, turning her face away and saying “ Hanadi, no one needs to see this. It’s too shocking.”

Hanadi waited for my response. I obviously had no idea what to say. Did she want me to cry? Did she want me to hold her? Did she want me to ask more questions?

I let the silence go for too long, so Hanadi pressed on eagerly.

I cannot feel anything, Mike.” She looked around the room, as if asking permission or waiting for judgment from one of the women surrounding us.“ I look at old videos of air strikes in Aleppo and Homs. I watch the news. And it does nothing to me. I just look at it and shrug.”

I wanted to hold her hand, but for so many reasons, I could not, in this setting.

Indeed, for all of us, our bodies urge us to reach out physically when we want to convince someone that we are listening. When one sense is not enough, we tend use more.

I told her that what she is saying is okay. That numbness is a normal response to the world’s most abnormal circumstances. She understood, giving a brief nod, but wanted more.

I want to cry. My one wish is to be able to cry. To shed a tear, to feel something. What is wrong with me?” she said.

In the same room, Rana sat smiling throughout Hanadi’s stoic monologue. She waited her turn, but she was rocking back and forth, waiting to jump in at the right opportunity. Rana, a childhood friend of Hanadi, had a different problem, but had a similar urgency to show her worrisome wound to the first thing that resembled the type of “doctor” she needed.

Three years ago, Rana was sitting at home when an air strike killed her husband, father, brother, and brothers-in-law within the span of ten seconds.

From one moment to the next, all the men in my life were gone,” she said. As she spoke, she pressed her thumb and index finger tightly along the bridge of her nose, stopping tears before they started. Her eyes were glazed, and she pressed towards me with unrelenting curiosity—desperate for an answer to question she had yet to ask.

I think I’m going insane,” she said. “ If my daughter has even the slightest sign of illness, I lose my mind. I can’t focus. I can’t breathe. I can’t sleep. I can’t let her experience any pain.”

She asked me what to do. How to calm down. How to control herself. She tried many things, she insisted, but admitted that she had trouble focusing on breathing, or praying, or doing anything that usually settles her nerves.

With almost no space safe for refugees in the world, that moment, that connection, relationship, and conversation was their safe space. I had to respect that.

I began to discuss with her the concept of panic attacks and anxiety, but her focus and patience are low. She insisted, almost immediately as I began, that her sister is worse off than her.“ My sister lost her husband, too. She is depressed. At least I’m not depressed,” she added.

Even in pain, refugee women like Rana and Hanadi often refuse themselves license to feel. Partly from their devout faith, partly from their learned strength from generations of Syrian mothers, they temper their own pain to make room for others. They resiliently and instinctively shelter boundless volumes of others’ pain in their hearts, all the while having nearly no access to mental health care for themselves.

I spoke with the women for ten minutes, repeating what seemed like dulled refrains of, “ You are reacting normally to abnormal circumstances,” and, “You are neither crazy nor weak, and there are ways out of this.” I offered some basic cognitive reframing strategies and self-regulation exercises, aware that doing so is overstepping my qualifications, and equally aware that not doing so is not fair to them, and to the trust they have in me.

With almost no space safe for refugees in the world, that moment, that connection, relationship, and conversation was their safe space. I had to respect that.

Too quickly, I was pulled away from the room by another young man who had been waiting for an hour to speak to me. I waved goodbye to Hanadi and Rana, as this young man began to talk: “ I work with kids as young as 4 or 5 years old, they live on the street. Many of them are assaulted daily…” he trailed off.

I found myself repeating the same phrases, about the link between numbness and psychological trauma; about the link between hypervigilance and gastric problems; about how breath stimulates specific nerves that regulate heartbeat; about how trauma makes you forget the you that was once so clear and close.

“I forget how to describe happiness. Today was the first time in years.”

What happens when millions of people lose their sense of self? When they run for so long, from so much? The current mental health systems in the Middle East are beyond overloaded. Those clinicians who do exist are either overworked, or underqualified, or both. The situation for the region is often bleak, in terms of mental health, emotional health, and ensuring meaning and purpose for millions who live unimaginable loss and injustice. The sheer capacity for survival of Hanadi and Rana provides a glimmer of hope. When we and our systems have failed, they persist.

I ended the day with Sireen, a Shia woman who married a Sunni man in Syria. She is a psychotherapist, and admitted that she has spent two years of refuge helping everyone except herself. “ I self-medicate. I have not allowed myself to feel. I have not been able to, she said. “It has made me cold, self-centered, and difficult to deal with.”

Earlier that day, she was brought to tears as we walked her through a #MeWeSyria exercise of identifying not just negative triggers, but positive ones. We asked, “What makes you smile?” We asked her to write just one paragraph about what positive triggers to her body, about how it feels to smile. She cried intensely, but alone, not wanting anyone to see her. “I forget how to describe happiness. Today was the first time in years.”

Get engaged with #MeWeSyria. Get in touch with @MeWeSyria and on instagram, donate to support #MeWeSyria teams, or volunteer your time and skills to supporting the team or host a #MeWeSyria session in your home or community.

#MeWeSyria is both a methodology and youth platform built in collaboration with local community-building NGOs (such as DARB and Questscope) and technical partners like Ashoka, and Beyond Conflict. #MeWeSyria 2017-2018 is being made possible thanks to UNHCR Innovation, and the Ford Foundation. Previous years of #MeWeSyria were supported in part by the German Government and Porticus Family Foundation.