From 2012 to 2013 the number of refugees in Germany increased by 70 percent, trend: upwards. At least half of them need psychological treatment. But care centers are overloaded.
Rema Salty will never forget the day she decided to leave Syria. The young woman was at home with her four-year-old daughter Yara when the first round of bullets went off outside. From her window Rema witnessed how the terrorists were firing at a school complex just across the street. Her ten-year-old son Fares was a student there. For the next hours, Rema did not know if he was still alive.
When Fares came home that night, he seemed alright - at least on the surface. Only his knee was bleeding from a fall in the forest where he had been hiding from the terrorists. But his whole body was shaking and he did not speak a word. "I just held him in my arms, I couldn't do anything else," Rema says as she wipes away a tear running down her cheek.
Psychological care centers overrun
Today, Rema lives in the north of Germany and calls Hamburg her "new home". She is one of 110.000 refugees that came to Germany in 2013. This is an increase of about 70 percent compared to the figures from 2012. And with the crises continuing unabated in the Middle East and North Africa, more will come. More than half of these refugees have suffered traumatic experiences and need psychological treatment. However, only few of them receive it. Experts are discussing the problem at this year's German Congress for Psychosomatic Medicine and Psychotherapy in Berlin.
There are no official statistics on the topic for Germany. But the psychological care centers are overrun. Mostly, refugees do not get a spot there or have to wait for several months. From a judicial point of view, they are eligible for basic, acute health care while their asylum is pending.
Ingo Schäfer, head of the trauma clinic in Hamburg, says the capacities of the clinic are completely overloaded. "At the moment, we are being overrun by requests to treat refugees. We get up to ten inquiries per week. And we can only handle a fraction of these," Schäfer told DW. More often than not the clinic has to pay for the translators out of its own budget, health insurance does not cover this. "Translators are indispensable for our work," says Schäfer, adding that the current situation of traumatized refugees was deplorable. "It is pure chance if a refugee gets to see a psychologist."
At the LRV clinic Düsseldorf, the situation is similar. Specialized psychologists take care of refugees at the clinic. Ljiliana Joksimovic, head of the Institute for psychosomatic medicine and psychotherapy, says her team is often overburdened. "When we take a refugee in as a patient, this spot is taken for the next three years," she said to DW. "We have to plan long-term here."
Nipping trauma in the bud
Most of the refugees only come in when their mental illness has a drastic impact on their lives that makes a normal everyday life impossible. "Often, we find symptoms of a posttraumatic stress disorder," Joksimovic says. "The refugees have had horrible experiences. Torture, the loss of relatives, gang rape."
Having had a traumatic experience does not necessarily mean developing a mental illness. However, the trauma alters the way you deal with everyday situations, says Joksimovic. "Moving out, losing your job: This might be enough to cause a severe depression in this situation."
If psychological treatment does not start immediately after the traumatic experience, the trauma can become chronic. "In these patients we see panic attacks, depressions and anxiety disorders." Treatment becomes more difficult and - at any rate - protracted. Children are especially prone to suffer from long-term consequences, if they are not treated right away.
Integration becomes impossible
Once the mental illness has become chronic, it affects the refugee's whole life. "Integration becomes even harder, if not impossible at that point," Joksimovic says.
Rema and her family have never been to a doctor in Germany, let alone a psychologist. They made the harsh transition from the refugee camp into their own apartment without any counseling. Rema hopes that the future holds mostly good things for her and her family. It might include a visit at the psychologist, helping them process their traumatic experiences.