RUNNING HEAD: THE SYRIAN MIGRANT CRISIS 1

The Syrian Migrant Crisis :

PTSD and Mental Illness, and their Effects on the Syrian Refugee

Melissa Alfaro

Bon Secours Memorial College of Nursing

THE SYRIAN MIGRANT CRISIS 2

The Syrian Migrant Crisis :

PTSD and Mental Illness, and their Effects on the Syrian Refugee

Since the outbreak of the Syrian civil war in 2011, almost half of the population was

displaced more half of them children and have fled their home country in search of a place free of

violence for themselves and their families. Syrian refugees have fled from Lebanon, Jordan Turkey,

the UK and the US for a chance at a peaceful, new beginning. Since their search for asylum, Syrians

have been suffering in an unspeakable silence. The prevalence of PTSD in this population has

exponentially increased, and by multifactorial aspects which makes these cases on a whole very

complex. This mental distress has been at all angles, the United Nations High Commissioner for

Refugees (UNHCR) identifies three as the daily stressors of displacement loss of family and

community supports, and uncertainty about the future (Hassan et. al, 2015, p.14). The topics to be

most sensitive to with Syrians and their struggle with PTSD are the emotional distress brought on by

moving to a new country; the violence witnessed that was inflicted by war before immigrating; and

the introduction of mental and psychosocial health in an appropriate cultural context, where the idea

of mental illness is stigmatized and culturally misinterpreted.

The impact of the refugee status on an individual is multi-dimensional, and is best looked at

from not only an emotional, cognitive and psychological aspect. One must consider the basic needs

that are most likely unmet in these refugee camps and otherwise. Before mental health professionals

and psychosocial support staff consider an intervention on an intellectual level, the Syrian refugee

must be looked at holistically; non-clinical interventions such as better living conditions could do

more to improve their mental health than any psychological or psychiatric interventions (Jackson,

2015). Interventions on the most elementary of needs are deemed to be more influential on mental

illness than intellectual, abstract ideas, in this point of the refugee status.
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With half the population of the refugees from Syria being children, their mental status must

be considered as of high importance as well. Although violence may be witnessed at a young age,

they are at a position advantageous to adult refugees, because of their chance to be normalized by

attending school. Given the support to the children by schools in the transition period, and with a

program that smoothly integrates children of different cultures in place, children may have a very

different experience of exile than the adults. They will be able to adapt much faster than their

parents, even if at home they suffer symptoms of trauma and are having to take on adult roles

(Jackson, 2015). That idea is very promising to what is half the population of Syrian refugees. By

socializing, and being exposed to different cultures in a safe environment, the transition to another

country serves to be helpful given the circumstances.

While normalization through socializing seems to create a positive outlook for many Syrians

who have immigrated, some children do not get to reap those benefits; the UNHCR estimated that a

quarter of all Syrian refugee marriages registered in Jordan involve a girl under the age of 18

(Hassan et. al, 2015, p.32). Parents are under the pretense that arranging child marriages reduces the

chances of the girls being victimized by rape in a refugee camp. However, this is fruitful soil for

gender based violence; positive correlations were found between being a young female and having

characteristics that indicated PTSD, regardless of marital status (Alpak, 2015).

Another facet of this gender based violence runs much deeper, and more unfortunate, as it

may be an attitude of culture; some pre-Islamic beliefs continue to thrive after the inception of Islam

e.g., beliefs related to the subordinate status of women (Okasha, 2003, p.39). The implications of

the idea of women as inferior is devastating. The mere fact of being a female lends itself to

submission, and any deviance away from submission met with violence, meaning that regardless of a

search for asylum in marriage, a female still has a chance for abuse and mental illness.

A creating safety for those affected and socialization are important to consider, as well as the
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plethora of factors such as treatment of physical injury and infectious diseases; on the other hand, it

also creates a climate where mental health is easily overlooked. Furthermore, mental illness is not

something that is recognized by many people of Middle Eastern descent. When Syrian refugees in the

largest refugee camp in Jordan were asked of their coping strategies, the largest percentage, at forty-

one percent, said they did nothing to cope (Baker, 2015).

Therefore, the treatment services should revolve around culturally competent care, based on

the social and religious dynamics of Syrians. The role played by traditional healers in Arab countries

define the basic tenets of spiritual healing. Mental illnesses are portrayed as a struggle between good

and evil Arab countries; cultural beliefs of possessions and the impact of sorcery or the evil eye

affect patients interpretation of mental illness (Okasha, 2003, p.39). This means that the treatment

must satisfy from not only a medical point of view but from a religious or spiritual model as well.

Also, the idioms of distress are different than what westerners would interpret as a call for

help. Words like mental health or mental illness are not met with openness, as the cultural

perception is that life is a part of suffering. UNHCR states that in a medical setting when patients are

asked about their mental health, it may be indirect or vague, saying Ana taban (I am tired) or

hasses rouhiam tetla (I feel my soul is going out) (Hassan et. al, 2015, p.22). Statements like

these should alert medical professionals to assess further the context, as body and mind are not two

separate entities in Syrian culture.

The inferences of having such a strong identity in religion and spirituality is that the

rehabilitation option span more than psychosocial support medically; UNHCR suggests that activities

that are non-medical such as community-based support groups, and social work are instrumental in

the success of Syrians in their search for asylum (Hassan et. al, 2015, p.31). Those treatments that

can restore familial support and community support through the refugees in the host country are

deemed to be most helpful.

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Treatment services have also widely been through volunteers and humanitarian efforts.

Firstly, the primary service to provide would have to be through efforts to ensure safety and basic

needs. This still proves to be an obstacle, as their difficulties navigating housing, health services,

language barriers, employment and gainful documentation leads for higher chances of exploitation.

There has been a glimmer of hope for refugees in Ottawa; in Canada, a willingness of volunteers,

including Arabic speaking international medical students, are willing to aid in the process with

cultural interpretation (Okasha, 2003, p.39).

Some services that could be pertinent to Syrian refugees in America could be the guidelines

to Social Determinants of Health. Healthy People 2020 defines social determinants of health are

defined as conditions in the environments in which people are born, live, learn, work, play, worship,

and age that affect a wide range of health, functioning, and quality-of-life outcomes and risks, an

example being social norms and attitudes (discrimination, racism and distrust of government)

(Healthy People 2020, n.d.). Anecdotal evidence that social determinants in American proves to be

fruitful for health is the story of Faez al Sharaa, a Syrian refugee whose family fled to Dallas, Texas.

Amongst his biggest adjustments, one of them is the acceptance of who he is in this country; in the

TIME article by Altman, A Syrian Refugee Story, I go about my daily activities without any

discrimination, Faez says. When I apply for a job, I am treated fairly (2015).

Another Healthy People 2020 guideline that can be related to Syrian refugees in America is

Mental Health and Mental Disorders. As Syrian children who families are seeking refuge fall under

one of the target groups of HP2020, the people in communities with large-scale psychological

trauma caused by disaster, the most pertinent objective would be MHMD-6, Increase the Proportion

of Children with Mental Health Illnesses who Receive Treatment (Healthy People 2020, n.d.). Since

children account for almost half of all Syrian refugees, some of which are now in America, the

screening for distress and PTSD are imperative.

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Since one of psychological stressors of Syrian refugees is uncertainty related to being

transplanted in another country, including access to health care and insurance, one Healthy People

2020 objective that would target that is Access to Health Services. ASH-6 objective is to reduce

the proportions of persons who are unable to obtain or delay in obtaining necessary health care,

dental care, or prescription medicines (Healthy People 2020, n.d.) Because of Syrians unique

situation, access and insurance to obtain primary health care should be facilitated.

Those still in Syria have been aided by the World Health Organization (WHO). Before 2011,

the Syrian mental illness support was in 3 hospitals, with only 70 psychiatrists serving the whole

country. After the crises fraught upon by war, WHO has successfully decentralized mental health

access, and is now in small towns and villages, available at the primary care level (Gavlak, 2015).

Responding to the stigma of receiving help for mental illnesses in Arabic cultures, WHO was

able to create a self-help program available to all Syrians, especially in rural areas and those places

that are still hard to reach. Even physicians are able to access literature provided by WHO in order

train themselves to serve their patients who are suffering from PTSD (Gavlak, 2015).

These two actions are acting under the umbrella of the WHO guideline and program, Mental

Health and Psychosocial Support in Emergencies; WHO recognizes the tribulations of Syrians and

of other populations who are living the consequences of humanitarian crimes. A program is under

way to train non-specialist health workers to recognize signs of PTSD and mental illness. At this

point in time, 500 and growing non-specialist health-care professionals in Syria have been trained to

help the people of Syria with their mental health needs.

Although given a somber situation, Syrian refugees and those still in the Syrian Arab

Republic no longer have to suffer without support. Under pressure from such horrible circumstances

that terrorism and wartime brings, many programs tending to the easily overlooked issue of mental
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illness have responded in droves. Although it is impossible to aid a country divided and displaced in

foreign lands of all mental illness, it is the most humanitarian effort to try.
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References

Alpak, G. (2015). Post-traumatic stress disorder among Syrian refugees in Turkey: A cross-sectional

study. International Journal of Psychiatry in Clinical Practice, 19(1), 45-50. Retrieved April

14, 2016.

Altman, A. (2015). A syrian refugee story. Retrieved April 14, 2016, from http://time.com/a-

syrian-refugee-story/

Baker, N. (2015). Current Research on the Mental Health of Syrian Refugees. New York, NY:

Columbia University.

Gavlak, D. (2016). Healing invisible wounds of the Syrian conflict. Retrieved April 14, 2016, from

http://who.int/bulletin/volumes/94/1/16-020116/en/

Hassan, G, Kirmayer, L.J., MekkiBerrada A., Quosh, C., el Chammay, R., Deville-Stoetzel, J.B.,

Youssef, A., Jefee-Bahloul, H., Barkeel-Oteo, A., Coutts, A., Song, S. & Ventevogel, P. (2015).

Culture, Context and the Mental Health and Psychosocial Wellbeing of Syrians: A Review for

Mental Health and Psychosocial Support staff working with Syrians Affected by Armed Conflict.

Geneva: UNHCR.

Healthy People 2020 (n.d.). Retrieved April 14, 2016, from http://www.healthypeople.gov/

Jackson, C. (2015). The migrant crisis: Helping syrian refugees. Therapy Today, 26(8). Retrieved April

14, 2016.

Okasha, A. (2003). Mental health services in the Arab world. Arab Studies Quarterly, 25(4), 39+.

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