BEIRUT: Alma is having trouble sleeping. The 16-year-old says the tent she calls home brings back memories of her cousin’s funeral and she is having nightmares.
“I am scared when I sleep. [Even] when I wake up, I am still scared ... I remember people crying, and I feel that I have dark things in front of my eyes,” she says.
Living in Iraq’s Domiz camp, her experience mirrors the many thousands of refugees whose flight from the civil war in Syria has pushed them into a state of profound psychological distress. Cases of the so-called invisible illness are so extensive in Domiz that Medecins sans Frontieres says the number of refugees suffering from acute mental health conditions has more than doubled in a year, with pre-existing cases such as schizophrenia exacerbated due to lack of access to medicine.
In 2012, 7 percent of mental health patients treated by the charity in the camp demonstrated symptoms of severe mental disorder, including schizophrenia and acute depression. In 2013, 15 percent of patients exhibited these symptoms, said a report released Thursday by MSF for World Mental Health Day.
The jump has been widely attributed to a realization among refugees that the 30-month conflict will not be drawing to a close soon and they will remain displaced for years to come.
“We are really seeing a situation that is getting worse in terms of mental health needs ... When they first arrived, they might have had some hope that the situation would last for a couple of months,” says Dr. Henrike Zellmann, a German psychologist based in the camp. “Now, everybody realizes that the situation is not getting better, and they do not know if or when it will end.”
Some children are reacting to the uncertainty by bedwetting or aggressive behavior in school, while adults in increasing numbers are trying to commit suicide.
“A big percent of depressives have tried to take their own lives. The suicidal tendencies give you an idea of how desperate these people are,” Ana Maria Tijerino, a mental health adviser with the charity, told The Daily Star. Practically everyone here has seen a relative die in Syria and people don’t know how to cope with that.”
Such conditions are not isolated in Iraq, but are prevalent throughout Syrian refugee communities in the Middle East. However, many cases slip under the radar of health workers as taboos around psychological conditions often leaves families too embarrassed to come forward for help.
“Stigma is definitely a barrier and some cases do probably go past unnoticed,” says Zeinab Hijazi, the Middle East Mental Health and Psychosocial Officer at International Medical Corps. “People almost never go to a mental health adviser directly. This is why it is so important that a general doctor can look and say a loss of appetite, or sleeping issues or nightmares may reflect a mental health problem.”
IMC, which operates in Iraq, Jordan, Lebanon, Turkey and within Syria itself, places an emphasis on community-led mental health projects. By integrating mental health work into the wider provision for health care, they hope to move toward normalizing psychological conditions.
The failure to identify cases of mental health disorders has meant statistics on numbers of sufferers are hard to quantify. Both MSF and IMC say that, based on World Health Organization estimates, up to 30 percent of refugees are suffering from some kind of mild to severe psychological condition.
But not all conditions are a direct result of the trauma of displacement, Hijazi says. Many of the psychological disorders charities have identified include pre-existing conditions exacerbated by a lack of access to medicine.
Both in Turkey and among internally displaced Syrians, for example, epilepsy and psychosis, such as manic depression, are among two of the problems seen most often by health workers.
Back in Iraq, meanwhile, Dr. Zellmann says that refugees see little cause for optimism.
“If you are living in a state of uncertainty, your psychological well-being is enormously affected. Refugees here are living in this state continuously. Right now, they don’t have a lot of hope,” he adds.