Photo credit: British Red Cross
This analysis summarizes and reflects on the following research: Al Ibraheem, B., Kira, I. A., Aljakoub, J., & Al Ibraheem, A. (2017). The health effect of the Syrian conflict on IDPs and refugees. Peace and Conflict: Journal of Peace Psychology, 23(2), 140-152.
- Exposure to the Syrian war is directly associated with high rates of PTSD, suicide, chronic disease, and poor physical and mental health among Syrian refugees and IDPs.
- Rates of depression are much higher among Syrian refugees than among IDPs still living in Syria.
- The percentage of Syrian refugees and IDPs who have either planned or attempted suicide is nearly three times greater than the percentage of those who have in the United States.
Since the Syrian war began, more than half of the country’s population has been displaced, becoming either internally displaced persons (IDPs) or refugees. The experience of being forced from their homes has resulted in long-lasting physical and emotional trauma for affected individuals. This study analyzes a group of 111 Syrian refugees and 195 IDPs, living in either the Netherlands or Syria, to try to understand more about the physical and mental health issues caused by the Syrian war. The research team wanted to identify how, if at all, health effects differed between refugee and internally displaced communities and how the Syrian war may have impacted individual and collective identities.
To measure physical and mental health effects, the research team, comprised of both academics and physicians, constructed a questionnaire asking IDPs in Syria and Syrian refugees living in the Netherlands about their exposure to trauma, classified in this study along the Syrian Oppressive Experience (SOE) scale. The SOE scale was separated into three forms of trauma most likely experienced by victims of the Syrian war: 1) torture and injury due to torture; 2) injuries from violence or during attempts to evade violence or torture; and 3) secondary trauma, including witnessing violence and/or a family member injured or killed due to violence, imprisonment, or torture. To examine ways in which the collective Syrian identity may have been affected by the conflict, the research team used the Cumulative Trauma Scale (CTS), which specifies six trauma types: collective identity trauma, personal identity trauma, survival trauma, attachment trauma, secondary trauma, and gender discrimination. The research team also performed tests to measure for Post-Traumatic Stress Disorder (PTSD) and the general physical health of the respondents.
Viewed together, all participants experienced at least one form of trauma, 95% reported direct exposure to a traumatic event, 91% reported indirect exposure to a traumatic event (a family member experienced trauma), and 28% experienced torture. Around half of the participants experienced collective identity trauma (such as discrimination) or role identity trauma (school disruptions or loss of business), and slightly less than half experienced personal identity trauma (sexual or physical abuse). The rate of PTSD among participants was also high, averaging 25% between refugee and IDP groups. Additionally, 11% of both groups claimed they had a plan, or have attempted, to commit suicide.
Differences between participants from the Syrian refugee group living in the Netherlands and the IDP group in Syria were also noted. The refugee group, on average, was younger, wealthier, and more educated, came from smaller families, had higher levels of general health, but experienced greater levels of depression than the IDP community. The IDP group reported higher levels of PTSD symptoms (including suicidal tendencies), was exposed to more traumatic events and experienced the most trauma types in almost every category.
This is the first study to provide empirical evidence of the high suicidality among refugee and IDP communities, as 11% said they had a plan for or history of attempting suicide (as a contrast, the same rate in the U.S. is around 4%). Also notable are the higher depression rates among refugees compared to IDPs. The authors suggest this may be due to IDPs still living within a conflict zone, forcing them into a “survival mode” where “thoughts, words, and actions are limited to those associated with staying alive in the face of mortal danger,” thus not allowing the mental bandwidth to be depressed. Another possible explanation is that refugees face higher levels of depression since, once resettled in a new country, they are confronted with the reality that they may have lost their homeland, community, and/or family, and now must learn to operate in an entirely new environment.
This research highlights the long-lasting health effects of war, even in those who never pick up a weapon. As victims of one of the largest humanitarian disasters in decades, Syrian refugees and internally displaced people will pay the high costs of war long after the fighting stops through high rates of physical and emotional trauma perpetrated against themselves, their family members, and the collective Syrian identity. Likewise, the high PTSD rates reported in this study are supported by the research of others who have studied PTSD rates of Syrian refugees in Turkey and Lebanon, further validating the importance of these findings. International organizations such as the UNHCR, ICRC, Mercy Corps, and many others have bolstered mental health services in their humanitarian programming. However, as this research shows, there is still an urgent need to expand these services—as well as to allow more Syrian refugees into host countries where they can receive the healthcare and security they desperately require.
Ever since the beginning of the Syrian war, issues relating to refugee resettlement have played a much larger role than they had previously in global political and social discourse. There has been fierce debate around who will, should, or won’t accept refugees. However, this research shows that by not accepting refugees, or by forcing IDPs to remain in conflict zones, the international community may be condemning them to a fate similar to the one that awaits so many on the “battlefield” of the Syrian war. These people are casualties as war. High rates of suicide, PTSD, and physically and emotionally traumatic experiences plague war zones, and countries can immediately and directly prevent trauma exposure, and thus its subsequent symptoms, by permitting more refugees to cross their borders.
Apart from the debate on refugee admittance, it is made clear by this research that more must be done to support the mental health of both these populations. Much of the burden of providing health services falls on the countries that share borders with conflict zones, where financial and personnel resources are already stretched thin. International organizations such as the UNHCR, as well as local and international NGOs, are working to address the health needs of refugees and IDPs, but most of these organizations operate on restricted budgets. This provides an additional avenue for the international community to lend material, human, or financial support to those already poised to help.
Doctors Face Uphill Task to Treat Syria’s Mental Wounds By Charlie Dunmore, ed. Tim Gaynor, UNHCR, 2016. http://www.unhcr.org/enus/news/latest/2016/3/56e2870c9/doctors-face-uphill-task-treat-syrias-mental-wounds.html?query=mental%20health%20in%20syria
Addressing Regional Mental Health Needs and Gaps in the Context of the Syria Crisis By Zeinab Inka Weissbecker Hijazi for International Medical Corps, 2015. https://internationalmedicalcorps.org/wp-content/uploads/2017/07/Syria-Crisis-Addressing-Mental-Health.pdf
Psychological Toll of War and Uncertainty By Crystal Wells for International Medical Corps, 2016. https://internationalmedicalcorps.org/story/psychological-toll-of-war-and-uncertainty/
Keywords: mental health, PTSD, conflict trauma, costs of war, refugees, IDPs
The above analysis is from Volume 2, Issue 4, of the Peace Science Digest.