Depression and mental illness are now starting to be recognized by the UN and aid agencies as problems that many Syrian refugees face. And it is children who are in the firing line, as Martin Jay reports from Lebanon.
Since the outbreak of civil war in 2011, nearly 9 million Syrians have been displaced, with 3 million fleeing to Lebanon, Jordan and Turkey. A number of studies have recently identified mental illness, depression and stress as a serious concern in refugees arriving both in Europe and the United States.
Yet mental health issues are hardly a new experience for aid agencies on the ground in Syria and its neighboring countries. "Most people suffer from long-term profound stress, which makes them go into survival mode," Jane MacPhail, of Mercy Corps in Jordan, told DW via Skype. Children are particularly vulnerable, and donors are placing great emphasis on education. "We do a lot of informal learning, which keeps kids engaged so they continue to be lifelong learners," MacPhail said, "and the donors recognize this."
"A lot of the young people we talk to have low-level depression, which comes from chemical change…but when we talk about long-term depression with these kids, there's clear evidence that it can trigger long term mental illness," MacPhail said.
Stress and depression
Young men are especially susceptible. A number of projects are being organized to give boys "adventure" to stimulate their brains and thus possibly avoid the early stages of mental health problems.
According to the research of Helen Verdeli, a professor of clinical psychology at Columbia University's Teachers College, the most common stress that Syrians living in refugee camps have is worrying about the well-being of relatives "who have dispersed to other refugee camps, moved to other countries, or remained in Syria and might have been tortured or killed."
This was particularly evident in the case of a 15-year-old girl who was separated from her mother and whom DW recently interviewed in a camp in Zahle, eastern Lebanon.
Even inside the camps themselves, there are ways for mental health and stress to take root, according to the study. "Although refugees residing inside the camps are protected from military violence, inside the camps they are vulnerable to physical violence, torture, sexual assault, and rape," it reads. "Many adults and children have been victims of or witnessed multiple acts of violence."
Children, and in particular girls, are subject to high levels of stress. Approximately half of the Syrians living in refugee camps are children, who experience "interpersonal violence along with their parents, and many girls, under the age of 18 years, must confront the extra burden of being married off," the academic paper states.
It is widely reported by journalists that around a quarter of all Syrian refugee marriages registered in Jordan involve a girl under the age of 18. Parents often resort to arranging marriages for their daughters at a young age, believing that this reduces the girls' chances of being victimized by rape in the camps.
From as early as 2013, the Rome-based crisis group Caritas estimated that approximately one-fifth of refugees needed help with psychological disorders. This year, the UK-based Save the Children put the figure higher and estimated that one in four refugee children were suffering from one form or another of mental health.
In Lebanon, Caritas reports that many people are suffering different kinds of trauma and need therapy. Caritas Lebanon social workers say they have noticed "many social and family problems, such as domestic violence, couples breaking apart and children who are traumatized after experiencing being kidnapped in Syria," according to a recent report.
Violence within the refugee communities is both a result of depression and a cause. It is a downward spiral that the United Nations and aid agencies struggle with as many refugees battle against all the odds just to survive harsh conditions.
In a recent interview, UNICEF's Lebanon boss, Tanya Chapuisat, admitted to DW that depression and violence were both getting worse, especially for children. "We're very conscious of depression and on-going levels of violence in the family as a direct consequence of despair and depression and lack of hope," she said.
"The violence gets internalized as men and families are not earning incomes, the tensions rise and so there's more domestic violence - so kids are experiencing high levels of violence in their families and not just having to cope with their past experiences and what they've lived through now as a result of very difficult circumstances."