Out From Damascus: Syrian Refugees and the Increasing Mental Health Crisis

(Editor’s note: This article from the Summer 2017 issue of Brain World magazineIf you enjoy this article, consider a print or digital subscription!)


When affection may be what little a family has, inability to provide even that can harm a child’s development. It is well researched that emotional inattention can lead to higher cholesterol levels, cardiovascular disease, and a host of other physical disorders later in life. Having a toxic childhood environment can lead to higher stress levels in the child, which may alter neural circuits relating to stress responses. This leaves the child’s brain burdened with a higher arousal state. When threatened, even if the threat is a sharp word, the child’s brain will not be able to cope with the emotional distress, and will be less capable of shutting down the reaction.

We know that the orbitofrontal cortex, responsible for moderating threat and stress responses, is sensitive to child-parent attachments. The development of this brain region requires that a parent be responsive to an infant’s needs — this is why the earliest months of our development are often the most important. When a parent is too depressed, or too anxious, to provide for these emotional needs, this hinders the child’s limbic (emotional) development. A condition that later can lead to issues of anxiety and depression — decreasing the likelihood of being able to form healthy bonds with others as the child grows older while increasing their rates of withdrawal and drug addiction.

Psychological distress may also arise from the change in the roles people are now playing in their family’s lives. In some regions of Syria, a woman working beyond the role of a caregiver is frowned upon. Samira, a housewife in Syria, was forced to take a job to support her family after they fled. But instead of the feeling of satisfaction that she was providing for her family, Samira felt uncomfortable taking paid work and working outside of her home.

But not all women feel this way. Noor, a mother of four, found work when she fled Syria. Instead of feeling shame or discomfort, she felt empowered knowing she was providing for her family and rebuilding the life that was ripped from them during the war.

Men, however, could fare worse. Traditionally the providers — sometimes the sole provider — of their families, fathers and husbands are feeling hopeless, depressed, and lethargic as they find themselves unable to provide in their new home. Even when willing to work, some of these men find themselves continually unemployed or underpaid. They end up spiraling deeper into depression and withdrawal; a downward trajectory affecting not only their self-esteem, but their family’s well-being.

Refugees do not suffer only the emotional burden of fleeing their war-encumbered home but may often experience memory and cognitive issues. They complain of not being able to concentrate, or of not being able to learn new things. While this is an issue for anyone, being in a new country and trying to start a new life becomes even more difficult when learning to operate the machine at a job you need to keep, or while slowly picking up the words of a new, unfamiliar language.

The language barrier goes both ways, however. Health care professionals may not understand the refugees when they come into a clinic and describe their ailments. You see, the Arabic language is made up of metaphors. Feelings and emotions, even the symptoms of certain mental illnesses, are described with imagery and symbolism. “My heart is crumbling” (“houbout el qalb”) or “Blindness has my heart” (“in’ama ’ala kalbi”) can signal worry. “I feel like my soul is leaving my body” (“Hassess rouhi ’am tetla’ ”) can indicate hopelessness and depression.

When a patient confides that they feel like “The world is closing in my face” (“Hassess
eddenia msakkra bwishi”), when they are feeling hopeless and despairing, it is important that a health care professional helps their patient open up. Being able to read the truth behind the metaphors can reveal a world of opportunity.


The refugee crisis is not just about feeding a body and providing it with a home and a job. It is about helping the individual who lived a life before the crisis. Medical professionals have to realize that mental health can bring a body down as much as any somatic illness, perhaps even more so. While mental illness is stigmatized in Middle Eastern culture as shameful or as a personal defect, it can be treated. Helping the individual regain control of their lives, even by encouraging prayer, exercise, and socializing, can go a long way in beginning to treat the sufferer.

(Editor’s note: This article from the Summer 2017 issue of Brain World magazineIf you enjoy this article, consider a print or digital subscription!)

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