In 2008, Micheal G. Wessels, professor of clinical population and family health at Columbia University, published an article on psychosocial support. “Psychosocial support,” he said, “ought to occur at the same time one applies the most immediate life-saving measures.”
While mental disorders continue to carry a fair degree of stigma in many countries, psychosocial support – as part of the battery of help humanitarian assistance organizations offer – is gaining more awareness.
In Syria, the United Nations High Commissioner for Refugees (UNHCR) realized an overwhelming need for psychosocial support among refugees and founded a psychosocial support outreach counseling center (PSS center) in October 2009. The center is not part of the UNHCR’s classical approach to post-conflict rehabilitation. Previously, they referred refugees to local psychiatrists or family counseling through organizations like UNICEF.
The center offers four separate peer-support groups for adolescent girls and boys, and men and women. Besides these groups, the center runs a series of activities such as play therapy for children and yoga and sewing for adults. Since its opening, the center has registered 400 participants. The center is also coordinated by the refugees themselves, supervised and supported by the UNHCR Psychosocial and Mental Health Program. A UNCHR psychosocial counselor, who is assisting the center, describes it as a “safe place where people can meet, talk and learn.”
Amira*, an Iraqi refugee, began coming to the center in January 2010. She describes her new life as living “between a clear future and the death of a child.” In 2005, she was forced to flee Iraq and seek asylum in Syria. She paints a dismal picture of her new home: her husband cannot work and is being treated for severe depression, which affects their relationship; unable to study, her eldest son threatens to return to Iraq where she fears he might become victim of continued violence. While they were recently interviewed at the US embassy for resettlement, her son reminds her that there is no guarantee that life in the US will be any easier.
Re-starting her life elsewhere, with limited support from her traumatized family, left her “isolated and scared.” In Iraq, her main duties were to take care of the household and raise the children while her husband worked. Now in Syria, their roles have changed and Amira must act as the strong family leader. At first, faced with all these new burdens, Amira was paralyzed and could not leave the house. However, after registering as a refugee with the UNHCR, she was referred through the Psychosocial and Mental Health Program to the PSS center and her situation began to change.
Amira’s initial symptoms of depression – particularly having difficulty interacting with others – have lessened. She has becomes a spirited woman with pointed questions and does not hesitate to talk about the problems that have been affecting her family. She attributes her positive new attitude to the support and new skills she receives at the center: “I started talking with others and feel more confident now. I used to have some skills, but after taking sewing I can now make my own clothes. This will be useful when I re-settle.”
Whatever the location or cause, depression can often be alleviated by structure that offers daily activities and tasks to look forward to and complete. Sanaa*, a psychosocial outreach volunteer who conducts home visits with refugees in Damascus for the center, highlights this as one of the main benefits offered by the center: “Iraqis are here in the second country and they are not organized,” she explains. “When they come to the center on time, have activities at a certain time, they leave their home… there is a schedule. When they return home their life is also more organized and they notice this within the families.”
Sanaa also remarked about how the center gives participants a sense of perspective to their own problems. “When someone sees the problems of others, their own seem small,” she says, “They meet together and sit and talk about their personal experience and listen to others. They see they have the same experiences as others and see how others solved theirs.”
Psycho-social treatment also goes beyond individual healing. Moses Okello is head researcher at Refugee Law Project in Kampala, Uganda, a region seeing a huge influx of refugees. One thing he notices among all refugees is the need to restore trust between the state and its citizens. “Trust in state institutions is a key element in post-conflict recovery and it does not matter how much ‘development’ or ‘development aid’ is poured into a situation. If and when people do not relate, from a psychological as well as physical perspective, to the state, regardless of whether it is a persecuting state or not, whatever else is done in a post-conflict context is bound to fail.”
In the long run, emergency aid is a band-aid solution. At some point, in order to stop the flow of refugees and begin internal reconstruction, the post-conflict state should step in and provide the services that international organizations have been temporarily assisting with. However, in order to do so, refugees need to meet the state half-way by understanding their relationship to the state and the role, if any, they play in its future. Getting to this point first requires dealing with an often traumatic past.
As Okello says, psychosocial support plays an important role in this process: “Not only are people asking how a state in which they put their trust suddenly lets them down so badly, they are also grappling with the meaning of the new context, the new state, the loss of a citizenship (of their former state) and home, and the acquisition of a new legal status (refugee, IDPs, homeless, stateless). All are profoundly distressing and people need to be helped to deal with that distress.”
In the long run, psychosocial support encourages refugees to share their experiences and concerns with fellow refugees and psychosocial professionals, and, in the process, begin considering the possibility of returning home.
The PSS center is breaking new ground in Syria and providing a service that refugees are increasingly needing in all post-conflict regions. Most importantly, the outreach center is looked at primarily as a place offering recreational activities for new refugees in Syria. Psychosocial support and healing is a by-product of the center’s activities. This approach to psychosocial support removes some of the stigma and offers people a safe place to get back on their feet.
* Names have been changed to protect the identity of interviewees.
Siena Anstis is a Swedish-Canadian freelance journalist, development communications consultant and law student currently based in Montreal, Canada and Kampala, Uganda. She recently finished a consultancy with Battery Operated Systems for Community Outreach (BOSCO) in Northern Uganda and an 8-month fellowship with the Aga Khan Foundation in Nairobi, Kenya. Recipient of the 2009 Canadian International Development Agency (CIDA) Journalism and Development Award, she has written about ICT4D, human rights and other social issues in Kenya, Uganda and Kosovo. She is also founder and advisor for Women of Kireka, a women’s jewelry business in the Kireka quarry in Kampala and Project Diaspora team member.
Photo from UNHCR