UN estimates indicate that one in five people living in an area experiencing armed conflict suffers from post-traumatic stress disorder and poor health indicators, which applies to millions of Syrians who have suffered from the horrors of war for more than a decade.
In Syria, the health sector suffers from a gap in information related to the psychological aspect. The website of the Ministry of Health concerned with the matter is devoid of data or statistics on the rates of prevalence of psychological and nervous disorders among Syrians during the war period.
The World Health Organization estimates – in a survey conducted in 2020 – that 44% of participants residing inside Syria suffer from severe mental disorder, and 27% suffer from full symptoms of severe mental disorder associated with post-traumatic stress disorder.
Other UN sources believe that about 50% of the total population, especially women and children, are in need of mental health services and psychosocial support.
What is post-traumatic stress disorder?
The National Institute of Mental Health defines post-traumatic stress disorder as “psychological disorders that develop in some people who have experienced a traumatic, frightening, or dangerous event.”
According to the American Psychological Association, those affected suffer from disturbing feelings related to previous experiences that may last for a long time, and they may relive the event through memories of the past or nightmares.
They may also feel sad, afraid, or angry, and may feel disconnected or alienated from others. They may have strong negative reactions to ordinary things, such as loud noises.
The manifestations of post-traumatic stress disorder in Syria are related to severe stressors resulting from the war and its tragedies. Human and material losses come before other factors affecting the mental health of most of the population.
Abdullah Mousalli, a Syrian researcher specializing in psychology and residing in Paris, believes that the military conflict, emergencies, and livelihood challenges that have prevailed for more than a decade have led to the deterioration of the health conditions of millions of Syrians, whether in areas controlled by the Bashar al-Assad government, or in areas under the control of armed opposition factions in the north of the country.
Speaking to Al Jazeera Net, the researcher expected that there would be large numbers of people from different age groups suffering from these symptoms, more than what is announced, some of whom live in the shadows due to a negative view prevailing in society about neurological and psychological diseases, which prevents them from declaring their condition or seeing a specialist doctor.
He added that the war environment, scenes of bombing and destruction, the remains of the dead, and the sounds of explosions, caused psychological trauma among the residents whose areas were attacked by the regular army, and who lived through the horrors of war without protection, pointing out that post-traumatic stress symptoms have become common, even among those who left the country to neighboring countries, “where they carried with them their pain, feelings of terror, fear, instability, and anxiety about the future.”
Fleeing from death
On the other hand, a working group concerned with protection affairs in northwestern Syria, which includes UN agencies and independent international organizations, conducted an assessment in early March of last year, which included meetings with about 1,600 individuals from about 260 residential communities in northwestern Syria, in which 65% of those included in the assessment expressed their need for mental health services and psychosocial support.
- Germany
In the same context, a study conducted by the German Federal Chamber of Psychotherapists, earlier, showed that half of the Syrian refugees there suffer from mental problems.
- Türkiye
While the Turkish authorities reported that 55% of Syrian refugees on its territory are in need of psychological support.
- Jordan
The mental health conditions of the Kingdom’s refugees are not very different. A study published by the World Health Organization quoted an assessment conducted by a national Australian institution that found that 13% of young people aged 16 to 24 showed similar clinical symptoms and sought help, compared to a third of young women. The rest refrained from seeking help due to barriers and factors that hindered their access.
- Lebanon
Iraqi researcher Lina Azzam Ali conducted a survey study – in cooperation with the American University of Beirut and Wilfrid Laurier University in Ontario, Canada – to assess the mental and psychological health of Syrian refugees in refugee camps in Lebanon.
(Lana), a specialist in psychology and neuroscience, concluded that the first symptoms of “post-traumatic stress disorder” she encountered when she visited one of the camps were the feelings of “anger, caution, and fear” she was met with.
“Among the signs, I noticed other symptoms related to depression, anxiety and post-traumatic stress disorder. During a visit to a family, I met a mother who was unable to move her legs due to paralysis, while the condition was diagnosed as one of the psychosomatic symptoms of post-traumatic stress disorder,” she added.
Psychosomatic diseases are considered physical disorders, and the psychological factor plays a fundamental role in them.
The researcher quoted another woman who trembled in terror whenever she heard a disturbing sound, and all the events associated with her escape from the war came to her mind, and the smell of gunpowder and smoke invaded her nose, and she had physical reactions associated with the event.
The impact of war on youth
In the same context, a survey conducted by Ipsos, a market research company, in January 2021, with a representative sample, in terms of gender and region, of Syrians aged 18 to 25 years, in several countries, including Syria, revealed that 54% of the sample suffered from sleep disorders, 73% from anxiety, 58% from depression, 46% from feelings of isolation, 62% from frustration, and 69% from sadness due to the war.
Response in government-controlled areas
The health system in Syria is suffering from severe and ongoing pressures due to the destruction of its physical assets, the increasing needs of those affected by the repercussions of the conflict, and a significant decrease in funding for the services it provides, according to data from the World Health Organization.
During the first years of Assad’s rule (2001-2005), the annual budget deficit allocated to this sector rose from 1.7% of GDP to 5%, according to the New Humanitarian.
At the beginning of the war, the World Health Organization estimated the percentage of spending on the health sector at about 3.3% of the gross national product, which is a low percentage compared to the spending of neighboring countries during the same period, as it reached about 8.0% in Jordan, 7.5% in Lebanon, and 4.8% in Iraq.
This decline affected the sector’s performance and the overall services it provides in areas under government control, and later indicated its weak response to the health risks to which the country was exposed.
The head of the Syrian Association of Psychiatrists, Dr. Mazen Haidar, acknowledges that there is a huge gap in psychiatric services, as health insurance does not cover mental illness, medication or any other type of psychological treatment, which means that patients have to bear the total cost of treatment even if they have health insurance.
Haidar revealed – in a study published on the website of the International Red Cross – the lack of comprehensive research on the psychological disorders left behind by the war on a national level, at a time when the injuries affected about one million individuals suffering from severe psychological disorders.
He explained that the Syrian Association of Psychiatrists includes 80 doctors. Assuming that they work 5 days a week for 52 weeks a year, and that each one of them can follow up on 15 cases a day, and that they do not follow up on each patient’s case more than 3 times a year, the total number of cases that they can follow up on annually is only 104 thousand cases, or 10% of the severe cases, meaning that more than 90% of the severe cases are not subject to follow-up.
The study noted that mental health services were severely damaged during the conflict, with the number of psychiatrists collapsing at an unusually rapid rate, falling by almost half. The number of resident physicians specializing in psychiatry also fell sharply from 40 to less than 10 doctors overall in the middle of the war years.
The head of the Psychiatric Association criticized the Syrian law, which is still far from the contemporary scientific details of mental health. He said, “To this day, there is no law regulating the sector. Despite various attempts over many years to enact such a law, terms such as crazy, foolish, and stupid are still used in all applicable laws to describe those suffering from mental health disorders.”
Mental health is a right
In 2023, WHO provided mental health initiatives that reached more than 922,000 individuals, and more than 161,000 benefited from psychosocial support services. The organization also invested in training more than 3,000 health and community workers to ensure the sustainability of these services, including integrated and specialized counseling for primary health care centers.
In her speech during a workshop titled “Mental Health is a Universal Human Right” that she opened in Damascus last October, the World Health Organization representative in Syria, Dr. Iman Shanqiti, stressed that it is necessary to emphasize that mental health is not a luxury, but a basic human right. Regardless of who we are, or where we come from, everyone (in Syria) deserves the highest possible standard of mental health.”
At the end of its sessions, the workshop called on the Syrian regime to integrate mental health considerations and psychosocial support into all policies and plans of national institutions, and to provide them with adequate funding.
uncertainty about the future
Extrajudicial killings, repression, torture and displacement have dominated Syrian life since the 2011 protests that began with the Arab Spring. Syrian sociologist Saeed al-Bunni links them to the increasing prevalence of post-traumatic stress disorder, “as the horrors of war, with the systematic destruction and genocide that accompanied them, have affected the psychological state of millions of people and have had negative repercussions on the basic needs of the population.”
He explained – in his interview with Al Jazeera Net – that the psychological distress that most Syrians living under the regime’s authority are experiencing today is a reaction to feelings related to boredom, fear, low mood, and uncertainty about the future.
Al-Bani said: The deterioration of the psychological situation and the nervous disorders that the population is clearly suffering from in various cities reflect the danger of the continuation of the conflict and the deterioration of the social, economic and material environment in which people live in general.