The conflict in Syria cripples the soul, not just the body

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Syrian refugee children in Gaziantep, 50 kilometres from the Turkish-Syrian border. [Dimitar Iv. Ganev]

The mental health of refugees in Turkey remains a controversial topic surrounded by cultural taboos, writes Dimitar Iv. Ganev.

Dimitar Iv. Ganev is a young Bulgarian journalist who recently returned from a press trip to Turkey organized by the European Journalism Centre and DG ECHO.

Her name – Amal – means “hope” in Arabic. But the 34-year old Syrian refugee, living in the Turkish city of Gaziantep, just 50 kilometres from the Syrian border with her 5 children, bursts into tears when speaking about her husbands’ mental problems. Her story resembles that of hundreds of thousands of Syrians with spouses or close relatives, suffering from psychological illnesses. About 66 % of Syrian refugees in Turkey – a country hosting a total of 3.1 million asylum seekers – have serious mental problems, according to a study by the World Health Organization. The international institution had observed more than 1200 patients to reach this figure, explained the WHO Emergency Health Coordinator in Gaziantep Dr. Alaa AbouZeid.

The intensive air strikes, on-the-ground clashes, the widespread loss of family members and friends, the displacements and the other horrors of the 5-year war have created an impossible situation for many Syrians. The conflict has also spilled over a grave humanitarian disaster to neighbouring countries – a situation which the world is yet to address adequately.

The EU’s plan to distribute €3 billion to Turkey in 2016 and 2017 for humanitarian and development projects is already on track. One billion comes directly from the EU budget, and the other €2 billion – from the EU countries. The first €90 million in contracts for humanitarian aid were signed in March and April this year. The focus of the Facility for Refugees in Turkey is on the refugees living outside camps, which make about 90 % of all refugees in Turkey. But in the EU-Turkey war of words, Turkish officials often claim they still haven’t gotten a euro of the money promised.

Previous efforts of the international community, albeit not so generous, show some satisfactory results. The EU is the largest donor in a scheme for feeding the most vulnerable Syrian families in Turkey. When identified, with the help of the UN’s World Food Programme and the Turkish Red Crescent, they are distributed a card, which they can use to buy food in certain stores. The monthly limit per person is 62 Turkish Liras per month – about €19 – or €95 for a 5-member family. The sum hardly secures survival, but it does help, refugees say. EU officials acknowledge there are negotiations for loading more funds into the Kizilaykart. The idea is to expand the assistance from food only to other necessities such as utility bills, rent and so on.

“Our humanitarian strategy in Turkey aims at responding to the basic needs of 1 million refugees through the implementation of an Emergency Social Safety Net (ESSN)”, says the EU Commissioner for Humanitarian Aid and Crisis Management Christos Stylianides. “This system will allow the most vulnerable refugees to put bread on the table, to help families, those most in need and also contribute towards their rent. Hand-in-hand with this flagship initiative, the European Commission will also implement a robust protection framework as well as health and non-formal education activities.”

On top of the 3.1 million refugees in Turkey, some 547, 000 internally displaced persons are living around the Turkey – Northern Syria borders, according to the Turkish Red Crescent. In April, Human Rights Watch accused the Turkish authorities that they are shooting at asylum seekers to prevent them from entering the country. For the moment, the borders may seem sealed, but in the face of such humanitarian disaster as the Syrian war, it is only a matter of time before people start flowing in again in large numbers.

Despite the EU-provided humanitarian aid which was substantially boosted, the mental health of refugees in Turkey remain a controversial topic surrounded by cultural taboos. Hakan Bilgin, General Coordinator of Medicines du Monde, explains the problem from a medical point of view: “The Syrians have been through a traumatizing experience. But it is very difficult to find mental health professionals without the barrier of the language and the knowhow – in Syria, or in Turkey. In Syria, before the war, there were not a lot of psychiatrists and mental health specialists. And it is also a cultural issue. In Turkey, we do have very good professionals, but also we do have the problem of the language, they do not speak Arabic.”

Mr. Bilgin goes on to elaborate that some refugees don’t even realize they need mental health assistance. “It’s more than a taboo. It’s about accepting the facts and going through such a trauma – one loses a friend, family members, etc. Sometimes they don’t realize they might be helped by other people who can make them feel better.”

As dire as the situation is, the Ankara DG ECHO Head of Office Jane Lewis spots a positive trend. “My understanding is that given that the conflict in Syria has been going on for a number of years, what may have normally been a taboo in the Syrian culture is changing,”  she says. “Actually there has been a huge demand for these types of services. People are asking for help.”

Mrs. Lewis adds that providing support for mental health is definitely part of the EU strategy, but it is an area that she characterizes as “a glaring gap in Turkey”. And she believes that the government of Turkey and the Minister of Health are quite concerned about this too. “It’s something that we’re working with partners to address. To be quite honest, it’s difficult, given the limited amount of qualified services available.” Efforts will be made to expand them, but she warns that it will take time.

Indeed, it seems to be a long way before refugees start to feel the positive effects in the field of mental health. The 37-year old Amal admits they didn’t seek assistance or therapy for her husband, and explains that he was born with his condition. Their family fled the bombings in Aleppo. The decision to leave Syria came after their oldest 15-year old boy was hit by a shrapnel and had to be treated. Several times they tried to cross the Turkish border, and when they finally made it, they had to stay hungry for 2 days, she recalls. Upon arriving in their new country, Amal’s husband couldn’t work because of his condition, and the weight for the daily bread fell on the their 5 children.

Currently, only Amal’s 15-year old boy is employed. His schedule is demanding for a minor, to say the least. He spends 12 hours per day, 6 days a week in construction, working without a contract and making 140 per week or about €43. He is the main provider of income for the family, but because of his job, he cannot go to school. Amal also works, but only sporadically when she can find employment as a house cleaner.

Psychologist Bilgen Kumral, from an Istanbul-based clinic supported by the EU, shares her experience with refugee children who are working: “It is not depression, but I can see some children are not laughing. Their attitude is very blank. I think they learning from their parents who are not laughing, playing with them or speaking to them. The biggest problem for me is that they are not sending them to school. What we want to do is change the mentality that the children should work.”

However, some families claim that they cannot afford not to send their children to work. The 29-year old Zahra from Aleppo experiences problems quite similar to that of Amal’s. Her husband also cannot get a job because of health mental issues. Despite that he can go to the Turkish hospital and get his medications, Zahra believes this is only a short-term solution.

Refugee child labor in Turkey is very common and by far not restricted to families with parents with psychological problems. However, in the ones in which such parent is present, the lives of the kids are to become tough. Zahra’s 9-year daughter Hadice and 10-year old son Salih also work. Her only child that is not employed is the 7-year old Yusuf and his mother hopes that he will go to school. “It is not acceptable that my children are working”, Zahra admits. “They need to go to school, but if they do, who is going to feed us?”, she asks, shrugging her shoulders.

When Amal is asked about her dreams of the future, she becomes more distant. “The future is becoming very dark, very black. We hope to go back to Syria if this conflict ends. I have lost many dear people. Yesterday, my cousin passed away in a Russian or Syrian air strike on Aleppo. And another family member died 3 days ago.” She stares down and drily repeats, “Everybody is killing each other. Everybody is killing each other.”

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