x Abu Dhabi, UAESunday 21 January 2018

Healing the scars inside: addressing the mental health problems of Syrian refugees

The clinical psychologist Charlotte Yence spent five months in Iraqi Kurdistan, where Doctors Without Borders has worked in Syrian refugee camps since 2013. In the mental healthcare programmes she set up there, she encounters the despairing and the deranged – but also, surprisingly, the hopeful.

Young refugees do their homework at the Kawargosk refugee camp, 20 kilometres east of Erbil in northern Iraq, in February this year. Safin Hamed / AFP
Young refugees do their homework at the Kawargosk refugee camp, 20 kilometres east of Erbil in northern Iraq, in February this year. Safin Hamed / AFP

Winter is cold in Iraqi Kurdistan, but the people give me warmth, which compensates for the frozen wind that blows through the camp.

Each morning I gather my courage to start my day’s work. Every day is a challenge, I have chills that never leave me anymore; I don’t dare to imagine what they have to bear in the tents, on top of the double exile they had to endure. They first fled Damascus, then war-torn Aleppo to find refuge in Syrian Kurdistan, where they are originally from. And then when the bombing reached there, they fled again for Iraq. They lost everything twice, saw their families scattered, lost loved ones and are now reduced to living in precarious conditions with an uncertain future.

It is hard, agonising; they don’t feel welcomed by their Kurdish cousins, they don’t speak the same language, don’t have work or an income. Their distress is palpable but they are focused on adapting to their new living conditions. Camping in rain, snow and mud is not easy, and when words are too difficult, their bodies express their deep malaise.

The patients’ smiles when they see me warm my heart; their calm and radiant faces at the end of a session – which are always intense and liberating – are the best encouragement to carry on. The men shake my hand shyly, then touch it to their heart or forehead, or both in quick succession. Daily I am blessed to the seventh generation with flurries of “saatchava saatroch”, which broadly means “under my watchful eyes”. The women squeeze me like good bread, a kiss on the left cheek, three kisses pressed quickly on the right, an arm gripped around my neck and the other crushing my head.

“Running Mama”; I nicknamed her this because she runs to see me every week, such is her haste to see me, and she laughs uproariously when I use the name. She is 47 and she looks 60, except when she smiles, and then she looks like a schoolgirl. She speaks eagerly, with urgency and detail, about her 11 children, of which one 27-year-old is seriously disabled and is not, and never will be, independent, her two grandchildren who she looks after, her illiteracy, which prevents her from understanding who to approach for food aid … Her husband stayed in Syria; she curses him because he is overwhelmed and terrified far from her daily life, and at the same time she doesn’t want to tell him everything – it would be a burden rather than a support.

She leaves to rejoin her family after our meeting without running but lighter, relieved from the overwhelming pains which make her old before her time. A strong relationship has developed between us, and it is heartbreaking to tell her, at the end of my mission, that I am leaving. For her, it is another loss, which revives all those that she has already suffered. Fat, silent tears run down her wrinkled cheeks, as she turns to the interpreter and asks: “What will become of me? The only blessing that I have had since I came to Iraq was meeting her!”

She is reassured to meet my replacement, she can envisage continuity in the care that she receives and, against all odds, she believes that she can break the cycles of disappointment that have marked her rough life.

Selma is 10 years old. She survived a bombardment on her village but her cousin, whose head she saw rolling at her feet, did not. She has had a bald spot on top of her skull since, where she lost a touch of hair; a little bit like the one she pulled in her cousin’s scalp recovering what was left of him. At first she did magnificent, stunningly detailed drawings using only the black felt-tip from among all the available colours. Slowly she introduced other colours, and her final creation is a veritable rainbow.

Selma’s hair has started to grow again. She explained that she didn’t need to come and see me again, even if her eyes were full of tears as she said it. I replied that even if we didn’t see each other anymore I would always carry her in my heart. Her father, there with her in that meeting, explained sweetly how proud he was of her and her progress. They have since moved to Erbil; they don’t live in a tent anymore but in an actual house, and soon Selma will be able to go back to school, which was her greatest wish.

Mustafa is 27 and has been paralysed from the waist down for two years, since he spent weeks being tortured in prison. He recounts his symbolic dreams of freedom, his first lost love, his perseverance doing his daily exercises in the muddy alleys of the camp, his pride in being sought out to sing at weddings. He also speaks to me about his suicidal thoughts; what is the point of living like this? “Nothing will ever be the same again.” His handsome face marked with an infinite sadness, he speaks as much about his legs as his homeland.

Gradually during our meetings he rediscovers hope in his future. One day he is happy to announce that he has fallen in love again and wants to marry this young woman whom he has met in the camp. He almost forgets his anger at never being able to walk again.

Sakina is visibly deranged. I gain her trust by asking if she ever sees or hears things which no one else can (in other words, if she has hallucinations). Bullseye! Not one of her family of friends wants to believe her when she claims that she can see people floating in the sky. Her parents are at their wits’ end with her, they worry about her future once they are gone. She monopolises, even tyrannises, her whole family.

It is true that every session is a battle, a verbal joust between them. But even if this is how the family functions normally, it is even more difficult here. Sakina no longer has her routines and doesn’t take regular medication anymore; she is very unhappy. Finally they decide to send her back to Syria since, in a crazy situation, you have to be twice as crazy.

Jewan, 22, can’t sleep. He continuously lives and relives the torture he suffered in detention. He feels like he no longer belongs to the world of men since he lives in such proximity to death. He is estranged from himself and others. Outside of the therapeutic space of our sessions he is incapable of sharing with his close friends and family what he suffered. His way to battle against his massive anguish is to start physical fights for no real reason.

His future prospects consist of returning to Syria, which he freely admits is a kind of suicide. I weave a restrained, soothing, maternal relationship with him, which allows him to abandon himself to sleep a little each night, and restart the search for his sister and his beloved nephews (displaced like him) rather than responding to the call of death.

A fragile relationship, which can’t cope with change or the unexpected, which he depends on like a baby needs its mother.

They are all between 9 and 12 years old, and come happily to the group meetings which I organise weekly after school. It is their head teacher who introduces me to them, and who has identified them (justifiably) as suffering psychologically. Witnesses of war in Syria, these children have lost family members, have hastily fled the ruins of their homes. I am always stunned to see the precision with which these children of war can draw a Kalashnikov, bombers on fire, tanks, bodies lying in their own blood …

In the course of our meetings, they experience sharing their harrowing experiences, find themselves allies, friends, and learn to express their feelings. Through the communal drawing “exercises” which I suggest, they discover that it is much more difficult to relate their experiences of peace than those of war! So, they understand, through many hands drawing, that they have lived through the same trauma and their revenge is that they are in charge of their own rebuilding and that, despite their individual difference, they can help each other.

I have confidence in the Syrian children of today, the adults of tomorrow. But the task ahead will be long and difficult for them.

Names have been changed.

Charlotte Yence is a clinical ­psychologist who has worked with Doctors Without Borders in Haiti, Sri Lanka, Syria and Erbil since 2011. She lives in France.

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