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


Like blood from a wound, refugees pour out of the war-torn nation of Syria. And while international conversation centers on the social and economic toll refugees may have on their adopting countries, very little has been said about how immigration and refugee status may affect the human brain.

Syria was a beautiful country before the conflict broke out. I was there for three months in 2007. Only 17 years old, I was surprised by how “Western” it felt in some ways, while still incensed about the darker part of its history and heritage.

Being Syrian-American, I saw the dust of the streets, the spray-painted address on the side of my grandmother’s home, and the horse-drawn cart filled with peaches and tomatoes as another world. It was a dream, punctuated by the pressing bodies and vibrancy of the bazaar, the muezzin’s prayer call at 5 every morning, and the laughter as people ate, drank, and gossiped at a local cafe. I was proud of its beauty, and still am.

It was the perfect melding of East and West, and I longed to return. But when war hit in 2011, Syria shattered — and so did my hope of visiting again.

As more Syrian refugees flood European and Middle Eastern countries, the more medical-care systems of those nations become strained. Caregivers tend to focus more on somatic ailments — cuts, aches, and heart disease — rather than mental illnesses that can be brought out by the stressors of being a refugee.

Laila, a Syrian refugee, was tortured by authorities before she could leave Syria. Even while escaping, she witnessed the sight of bombed-out buildings, blood, and corpses. Only 16, with her younger siblings in tow, she saw more violence than most people ever do, even if they are avid moviegoers.

Laila was lucky though — she found a way to Germany, a nation that has mercifully let in thousands of Syrian refugees. But with what she saw and heard in Syria, Laila still suffers from panic attacks, restlessness, depression, and bouts of hopelessness. Syria, left behind, still played a part in her new life.

Laila’s story can read as an amalgam of the trials endured by so many displaced refugees. Countless numbers have fled Syria, and many left mentally and emotionally scarred. Germany’s Federal Chamber of Psychotherapists determined that more than 50 percent of those who escape war zones, like Syria, suffer from mental illnesses, including depression and post-traumatic stress disorder. Many of those affected consider suicide.

PTSD is no joke. Though it is often associated with combat victims in the military, those in war zones can just as easily suffer the effects of having experienced too much violence. When affected with PTSD, the individual is neurobiologically at a disadvantage. In such cases the individual is more likely to remain in a high-arousal state, which produces high cortisol levels. Cortisol, a stress hormone, is known to gradually damage neurons. But it is not just hormones that are affected by stress. Neurotransmitters, our brains’ chemical messengers, are also impacted.

Neurochemical features of PTSD include dysregulation of serotonin, opioid, and catecholamine neurotransmitters, among others. To regulate healthy brain functioning, including mood regulation, these neurotransmitters must be kept in balance with each other, and must react appropriately in response to the environment. In those with PTSD, the neurotransmitters are not as well regulated, and their levels may increase or decrease below functional thresholds. Once this occurs, depression, anger, aggression, anxiety, and other mood disorders can surface.

Recent studies show that PTSD is prevalent in 34 percent of Syrian refugees. By comparison, among U.S. combat veterans, PTSD prevalence exhibits itself in 10 to 30 percent of the population; and about 8 percent of Americans have PTSD at any given time. In comparison, depression affects 30 percent of the Syrian refugee population, while in America, about 3 to 5 percent of adults suffer from major depression at any given time.

And it is not just the adults who suffer. A study done at the Technical University of Munich determined that 33 percent of the Syrian adolescents and children who fled to Germany suffer from at least PTSD and depression.

Barring even these statistics, the effects of the Syrian conflict on Syrian mental health are heavy. Studies reveal that psychological and social distress are common among Syrian refugees. Violence, poverty, a lack of basic needs and services, isolation, grief, and uncertainty about life and the future weigh heavily on the Syrian mind. Even after having fled, refugees face growing crises. In their adoptive countries, they can face growing populist resentment when going to school, can have trouble finding jobs, and can be prevented from going about their daily activities. Some people blame the refugees as being a burden on the European countries that let them in, and many taxpayers do not want to see their money going to help these refugees.

But refugees, like us, are humans; and taxpayer burden or not, their struggles are heavy whichever way the picture is drawn. Behavioral problems can arise, including aggression and withdrawal. People suffer from insomnia, fatigue, and loss of appetite. When they need to be at their fittest, Syrian refugees are having a hard time, both psychologically and physically.

When Reem found refuge in Europe after fleeing Syria, she confided that she found it difficult to show her children, even her infant, affection. She was drained emotionally, and her body was always tired. Being present for another person was too much for her, as much as she felt guilty about it.

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