A child in an art therapy program in Amman, Jordan, run by the Syrian American Medical Society expresses memories of destruction in her community.
Courtesy: Syrian American Medical Society
The civil war wracking Syria began two years ago this month and has taken a massive toll in lives, health, and minds, a toll that has provoked a widespread humanitarian response.
More than 100,000 Syrians are believed to have died, 9.3 million people are in need of assistance overall, 6.5 million inside the country have been displaced, and 2.4 million have sought refuge in nearby Jordan, Turkey, Lebanon, Iraq, and Egypt, according to figures from the United Nations.
“The war has brought trauma, displacement, torture, rape, loss of limbs, and loss of relatives to all of these people,” said Mayada Akil, M.D., a graduate of the University of Damascus and now a professor of clinical psychiatry and vice chair of education at Georgetown University School of Medicine.
Many of those people live in refugee camps located just beyond the Syrian border, while others have moved to cities and towns farther away.
The refugees need food, clothing, shelter, and general medical care, but their mental health needs should not be put off, said Akil, in an interview. “The needs are great, but there is a shortage of providers and psychotropic medications.”
Akil recently discussed the situation in Syria with APA President Jeffrey Lieberman, M.D., and APA has posted on its website the names of agencies and organizations responding to the emergency (see end of article).
“I’m grateful to the APA staff for putting the list together,” Akil told Psychiatric News.
The overall humanitarian response has been largely coordinated by the United Nations High Commissioner for Refugees (UNHCR). The United States government has provided more than $1.7 billion.
Much of the work on the ground is managed by nongovernmental organizations in the surrounding countries or even within Syria, when circumstances permit. They provide some direct services but also spend much of their effort training local personnel.
One such organization is the International Medical Corps, whose representatives serve in countries bordering Syria (Psychiatric News, May 1, 2009). The group works in large refugee camps as well as in cities, said Zeinab Hijazi, a psychosocial advisor for the group.
“We offer child-friendly spaces in cities and camps, life-skills training for adolescents, and case management,” said Hijazi in an interview. “We also train the frontline relief workers in psychological first aid, so that when they first encounter refugees crossing the border, they can link them to basic and mental health services right away.”
The organization also integrates mental health training into existing general health facilities in the host countries, said Inka Weissbecker, Ph.D., M.P.H., International Medical Corps’ global mental health and psychosocial advisor.
“We train local doctors and nurses to help them increase their capacity for treating mental health problems,” Weissbecker told Psychiatric News. “The trainers are all Arabic-speaking psychiatrists who also provide on-the-job supervision of the primary care providers.”
The Syrian American Medical Society (SAMS), an association of clinicians with roots in that Middle Eastern country, has also been active.
“Not all refugees have physical wounds, but all have some psychological wounds,” said Katrina Jorgensen, media and communications coordinator at SAMS’ Washington, D.C., office. Depression and posttraumatic stress disorder are the most common diagnoses.
Child and adolescent psychiatrist Yassar Kanawati, M.D., medical director of Family Intervention Specialists in Marietta, Ga., went to Amman, Jordan, on behalf of SAMS in November 2012 to establish a clinic.
While refugees in camps are being helped by U.N. agencies and others, those in the cities like Amman are often on their own, she said. She trained a psychosocial team consisting of a psychiatrist, two psychotherapists, and six social workers—all from Syria—to visit apartments where refugees were staying. Often the team has to deal with basic needs first, bringing the families food, powdered milk, blankets, or winter coats.
Back in the United States, Kanawati supports the team, using phone, Skype, or email to supervise individual cases or provide additional training in cognitive-behavioral therapy. Nearly all therapy is done in groups since there are insufficient resources for individual psychotherapy.
“We can supply some generic antidepressants and antipsychotics,” she said. “I wish we had more choices.”
Children are a special concern of all the organizations working with the refugees. “Unless you want highly traumatized, potentially violent, or severely mentally ill adults in 20 years, you have to intervene now,” said Akil. “The small interventions you can do now; otherwise, these traumatized children can have a huge impact down the line.” ■