Mental health for Syrian refugees: Triumphing over trauma

The refugee crisis isn’t just a crisis of displacement; it’s a crisis of mental health. Moving is statistically regarded as one of the three most stressful things that can happen in a person’s life, and that’s without the compound interest of being forced to move – often with little else besides the clothes on your back.

Refugees face harsh conditions and often multiple traumas in order to survive. Many witness violence and conflict within their communities – multiple times over – before leaving, and many also have to make the choice to leave behind family, friends, careers, and the only way of life they’ve known. 

Children who aren’t old enough to drive a car or serve in their country’s military often journey alone and face many of the same shocks that lead military personnel and veterans to grapple with post-traumatic stress disorder. Their mental well-being is another casualty of war. Sometimes they’re sent away by their families who remain at home; sometimes they’re separated in the chaos of leaving, or because of a fatal tragedy along the way. 

People who become refugees may face harsher conditions in their host communities – many of which are located in countries also dealing with their own conflicts and displacement crises. Or they may make it to a high-income country but face difficulties integrating into the community due to language barriers, culture shock, or restrictions on where they can and can’t live, work, and move around. Most critically, many refugees lack access to basic psychosocial support and mental health services.

Ibrahim* is a large, 52-year-old man with an expressive face. He was a gentle, poetry-loving teacher when he married Khadija* and began a family; he still talks about his students with a special tenderness. But the Syrian war left him a refugee with no job and a sense of worthlessness — heightened by his family’s displacement in Lebanon, where they made a small home in a camp built by refugees on a former garbage heap. Amid an ongoing sense of responsibility for his wife, their seven children, and his mother, despite the new conditions of their lives, that gentleness fled.

“He began to beat me,” Khadija, 42, says without any hesitation or shyness. “I remember him as so nice before, so affectionate. I know life has been hard and he’s under a lot of pressure. But this became too much.”

Still in easy touch with his emotions, Ibrahim cries when he talks about the atrocities of war that he witnessed in his home in the west of Syria. “The war changed our life from…  I don’t want to say heaven, but it definitely became hell. We used to argue, my wife and I, but we could make things work. After we left Syria, it wasn’t working any more.”

There are plenty of reasons to struggle, even after you’ve fled a war. For Syrian refugees, this has been the reality for over a decade. Many struggle to access basic health care, both physical and mental. The trauma of displacement, which begins with the events that cause a person to leave home can continue in host communities for many reasons: 

• Refugees often struggle to integrate or fit into their host communities.
• Language barriers can be an issue (such as Arabic-speaking Syrians hosted in Turkish-speaking Turkey).
• Depending on the host community, Syrian refugees often face restrictions on movement and work opportunities.
• Refugees often face poor living conditions – Syrian refugees living in Lebanon are in informal communities, often little more than tents.
• Refugees are also separated from family members and the support networks of their home communities.
• Even if a refugee reaches a host community, this isn’t the final stop in their journey. Many travel on after they’ve received an asylum application, but this process can take months – if not years. 
• In some cases, refugees and asylum-seekers can also face immigration detention or other forms of discrimination. 

At the baseline of all refugee experiences is a sense that there is no longer a “normal” way of life. Traditionally, moving is thought to be one of the three most stressful things a person can go through in life (along with a divorce and the death of a loved one). Imagine having to do that with little planning and while also giving up most of what you’ve had in your life in terms of material goods, physical spaces, and personal relationships. 

Situations such as this are what lead people like Ibrahim to lash out or behave in ways they never would have at home. Of the nearly 4 million people who have fled Syria to live in neighbouring countries, four out of five are women and children. Surveys show that refugee men, who feel it is their duty to support their families but can’t find the means, often resort to gender-based violence. 

Many Syrian refugees have grown up with a set of gender roles and norms that traditionally paint men as strong — and emotions as a sign of weakness. Recognising that you’ve undergone a traumatic event is not always easy, but it is an essential first step to getting better. 

This is the foundation of a unique programme that Concern ran for Syrian refugees in Lebanon. The programme is based on the belief that helping men recognise their own trauma is key to improving the lives of women and children refugees. Through organised “men’s committees,” the idea is to change men’s attitudes in order to change their lives, as well as the lives of their families and communities. The programme is the first of its kind in Lebanon. 

Over the course of three months, these community-developed committees meet to discuss their own experiences, feelings of helplessness and powerlessness, and methods of what Marshall Rosenberg, the American psychologist coined, non-violent conflict resolution. These methods introduce concepts that are new to many Syrian men: self-empathy, empathy for others, and honest self-expression. 

“Perpetrators are largely victims of their circumstances and they need support to change,” said Concern's Protection Programme Director in Lebanon, Samantha Hutt, who designed the project. “The other aspect of protection programming I am really passionate about is empowering people to be the authors of their own life, whether they be children, people with disabilities, or people living in tents.”

The project is definitely accomplishing that: Of the 45 men’s groups in northern Lebanon, the men Concern has interviewed uniformly felt the project gave them critically-needed help to change their own lives in a way that none of the other available refugee services had. “I won’t say he never gets angry,” Khadija says of Ibrahim following the programme, “but now he counts to ten aloud, or he simply walks away. Sometimes he manages to laugh.”

“These sessions made us feel that someone cared for us on an emotional level. This doesn’t happen often in our masculine society, where we are driven by the idea that we must be machines and provide for our families,” says Hassan*, a father of three.

The former owner of a clothing shop, Hassan used to write in his free time — poetry, stories, and the beginnings of a novel. After becoming a refugee, he says, he stopped writing. “I felt as if my arm had been cut off.” He lost nearly 50 pounds in the first two months of displacement, and his feeling of worthlessness was not lessened when he began to get day jobs as a tiler.

In December of 2014, he had a heart attack. He credits the men’s programme with returning him to himself. His conversations with his wife improved, and he began to write again, as well as draw. “Almost 90 percent of solving these problems is simply understanding ourselves and the pressures we face,” he said.

The programme includes videos, guest speakers, worksheets, references to the Quran and more to help spur discussion. Men also consider issues of early marriage, weigh refugee community priorities, talk about strategies to deal with exploitative employers and other concerns. Very quickly the men, who often reported feeling isolated, now find themselves part of a trusted community.

Equally as critical, they recapture a sense of having some control over their own lives in the midst of a civil war that sent them fleeing from their homes and robbed them of a feeling of self-determination.

“This programme gave us the fishing rod, which is much better than giving us the fish,” says Rashad*, a father of two originally from western Syria. “Being a refugee is something very hard. I had lost my identity. This gave us the chance to take control of our own lives.”

*All names changed for privacy and security