The invisible wounds of the Syrian conflict

21 October 2019

Even before the Syrian conflict, the availability of public mental health services in Syria was extremely limited. A lack of funding meant that they were understaffed and underdeveloped. Neither the state nor humanitarian agencies provided enough support for these services. The conflict in Syria inevitably made the situation worse and in January 2013, just two years in, only 3 public mental health facilities remained in Syria due to severe shelling and bombardment.

With a constant fear of bombardment and a lack of psychiatric services, mental health of those living in Syria has deteriorated. The mental health of those who fled Syria to other countries is sadly not much better, for example, the German Federal Chamber of Psychotherapists reported that around 50% of Syrian refugees living in Germany experienced mental health issues. Additionally, the International Medical Corps (IMC) found that 50% of people using the mental health facilities in Syrian refugee camps had emotional disorders and 25% of children had intellectual and development issues.

Interestingly, it was found that female Syrian refugees in Jordan and Lebanon were significantly more likely than men to pin the cause of their fear and distress on explosive weapons. Another cause of mental health issues amongst women is the fear of Sexual and Gender Based Violence (SGBV), which the International Committee of the Red Cross (ICRC) states to be the least addressed mental health issue by services in refugee camps. SGBV has been utilised by ISIS as a weapon in previous years to instil fear and control.  For many Syrian women who remain in Syria, especially Yazidi women who have been targeted by ISIS, the intense fear of the group returning and continuing to inflict mental and physical pain is ever-increasing especially now due to the recent reports of ISIS escapees from Kurdish control after the chaos in the prisons caused by the Turkish offensive on the north-east region.

Men and boys affected by the conflict are likely to experience mental health issues by unlikely to seek help.

Obviously, there is an overdue need for psychiatric services in Syria. Thankfully, the Syrian Arab Red Crescent (SARC) has opened up clinics that include psychiatrists, psychotherapists and a speech therapist, to deal with widespread mental health issues. Additionally, to enable health services to maximise availability, they have also introduced mobile support teams to travel to and from the worst affected areas. IMC has also set up mental health services especially for mothers and children in refugee camps.

Although these services have been put into place, gender norms have been found to limit those who access the facilities. For women who traditionally had not spent much time outside of the home or in public spaces prior to the conflict, may find accessing mental health services difficult and untrustworthy due to the unfamiliarity. This is amplified by the fear of explosive weapons being used, leading women to isolate themselves and stay indoors. Despite this, women are more likely than men to use the mental health facilities provided by SARC and IMC.

The global stigma of mental health issues combined with Syrian gender norms hinders men from getting help of any kind. Instead, the report found that men would use sleep, social isolation and expressions of anger as coping mechanisms. Therefore, it is unsurprising that domestic violence against women and children during the conflict has increased. One Syrian woman talked about her experience: “Men are becoming angry — they can’t provide for their family. My husband wasn’t a smoker— now he is. He is extremely irritated all the time and takes it out on the kids. He is violent towards the kids; he is violent towards me.”

It is important not to forget about groups of people that have perhaps been side-lined in the conquest for improved mental health services. The elderly and disabled are the two groups who experience mental health issues more than average. However, the integration of mental health services into social activities in community centres or sports potentially excludes victims who have either been injured during the war or are unable to participate due to old age or previously existing ailments.

Finally, the barriers to mental health facilities for those who are part of the LGBT+ community are severe. They have been the subject of targeted abuse by extremist groups over the course of the war with one victim stating: “I was detained in Syria for four months. We didn’t have food. They would torture us, violate us. They used sticks. After I was released I could not sit without pain. I still have problems, but I am scared to tell the doctor because he might report me for being gay.” Societal norms affect people all over the world from coming forward about their physical and mental pain due to their sexuality, even more so in deeply religious or conservative nations such as Syria.

Stigma can often be the most overwhelming barrier to seeking and getting help. We must remember that some of the deepest and long-lasting injuries of any trauma are in the mind and do not display themselves physically. It is important for people who are most likely to be affected by mental health issues, especially those in conflict zones, to be educated about the causes, prevalence of their problems amongst wider society and how they are able to deal with them individually and as a community. With the continuation of the conflict and an increasing number of Syrian refugees, the services provided by SARC and IMC in camps and around the region will be stretched significantly, highlighting the increasing need for support for mental health services and facilities.

The dramatic impact of bombardment has a life-changing impact on both the physical and mental well-being for those people affected
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