By Emilie Touma

Overcrowded, impoverished,  and devoid of safe drinking water, Syrian refugee camp conditions are a topic of great concern. Since the Syrian Civil War began in 2011, it is estimated that over 240,000 people have perished in the conflict,while nearly 9 million Syrians have been forced to relocate to camps in Syria and neighboring countries.1,2

The inadequacies of these refugee camps, which include unsanitary living conditions, limited access to vaccinations, and poor-quality housing, often negatively affect the health of its residents. Research has shown that Syrian refugees suffer from high rates of emotional disorders including anxiety, depression, and post-traumatic stress disorder (PTSD).3

Unfortunately, the topic of the mental health of Syrian individuals is often marginalized or omitted from the discussion of this international crisis. These health concerns pose a serious threat to the quality of life of Syrian refugees, and therefore demand immediate and comprehensive attention from all health care professionals.

Effects of Living in a Refugee Camp

For Syrians living in refugee camps, the tough conditions make it next to impossible to care for their physical and mental health needs. The hardship begins with the journey from their native country. Many are forced to travel long distances to reach an available camp, often doing so without adequate food and water supplies. When they arrive at the camps after enduring the burdens of travel, they are met with unsafe conditions including insufficient shelter, high population density, and a lack of clean water.

Furthermore, struggles such as waiting in line at the water tap or bathing in makeshift bathtubs can also have a negative effect on mental health. For children, these stressors pose the most serious threat as the scant conditions frequently contribute to disorders such as depression, generalized anxiety disorder, and behavioral issues.4

Moreover, those who have already endured traumatic experiences before fleeing to refugee camps are at a greater risk for developing mental health disorders. Torture, physical malformations, amputations, and the death of loved ones are all too familiar for refugees and can result in psychological vulnerability.

The most common disorders for those who have previously experienced such circumstances are PTSD and depression. PTSD occurs in people who have lived through shocking or dangerous events and exhibit vivid flashbacks, arousal sensitivity, and emotional numbness.5 Depression is defined as a mood disorder caused by an imbalance of neurotransmitters within the brain.

Because many Syrians have fled the nightmarish, war-torn conditions of their home country, both PTSD and depression are very common within the refugee community.

Biological Responses to Refugee Camp Environments

Emotional disorders make up about 54% of the mental health disorders affecting Syrian refugees.6 Out of this large percentage, the two most common disorders are depression and anxiety. Because these disorders are exhibited across a large population, the biological basis of each must not be ignored.

Symptoms of depression, including apathy, guilt, hopelessness, and thoughts of suicide, are primarily controlled by three neurotransmitters – serotonin, norepinephrine, and dopamine.7 Together, these neurotransmitters act to control stress, regulate emotion, and drive physical desires, including hunger. When these chemicals are disrupted in the brain, the individual will most likely exhibit depressive symptoms.

Anxiety disorders have also been linked to neurological chemical imbalances. While scientists acknowledge that genetics play a role in the onset of this condition, anxiety that manifests later in life is viewed as a result of the surrounding environment.

The neurotransmitters that play the largest role in anxiety disorders are serotonin, norepinephrine, and gamma-aminobutyric acid. It remains unclear if the imbalances appear first and result in the physical manifestations of anxiety, or if the imbalances are due to an inability to rationally react to stress.8

Many refugees also experience PTSD. Each individual responds to PTSD differently. However, it is widely acknowledged that this disorder results primarily in difficulty with emotional arousal, as well as impaired memory production. This is due to damage in areas such as the hippocampus — the part of the brain that plays a role in the creation of new memories.

Because PTSD can greatly affect biological, physical, and social abilities, if left untreated, this disorder can cause long-term issues. These include detrimental changes in the quality of life for the individual exhibiting the illness, as well as problems for friends and family of the individual who are indirectly affected.

Additionally, it is vital for there to be a greater focus on the general development of a child’s brain under stressful conditions. Because children experience dramatic cognitive development from the prenatal stage through puberty, the distressing environments of refugee camps can impact the anatomical and chemical make-up of a child’s brain.

When high levels of stress and anxiety are experienced over an extended period of time, increased levels of cortisol (a stress hormone) are detected in the brain. This prolonged hormonal imbalance during development can permanently damage the hippocampus, resulting in deficits in short-term memory.

Furthermore, prolonged exposure to high levels of cortisol can lead to later complications in a person’s ability to regulate stress.9 In refugee camps, the combination of an unfamiliar environment, high population density, and overstimulation are the perfect storm of stressors that can cause permanent neurobiological changes. For this reason, the mental state of children in refugee camps requires more research and must be placed at the center of the conversation in order to foster the growth of a healthy and productive generation of Syrians.

What is being done now and what is the future outlook for mental health in refugee camps?

While mental health issues for refugees may not yet be a popular topic in media coverage, it is an area of concern for many organizations. Recently, the International Medical Corps started a large-scale mental health initiative with the aim of bringing increased medical and non-medical professionals to refugee camps in Jordan, Turkey, Syria, Lebanon, and Iraq.

Additionally, they have started training local workers, religious leaders, and other highly regarded individuals to assist in a community-based support system.10 Other organizations such as Doctors Without Borders have also placed a greater focus on the mental health aspect of the refugee crisis.

Looking at specific mental health disorders from a biological and emotional standpoint can aid in developing treatment and prevention initiatives for Syrian refugees. For emotional disorders such as depression, anxiety, and PTSD, cognitive behavioral therapy is a recommended form of treatment. Access to anti-depressants would help in treating such disorders, but current funding and accessibility require restructuring in order to provide sustainable aid.

Additionally, it could also be beneficial to take a holistic approach to this issue. For those suffering from mental disorders, the presence of a strong support system may be helpful in reducing symptoms and combatting further progression of the illness. For young children especially, a strong relationship with parents and family members may increase future resilience against mental illness.

So, what does the future hold for the mental health of Syrian refugees? While the long-term effects are not yet clear, refugees must rely on their community and the efforts of international organizations to provide some relief. With the recent emergence of conversations regarding Syrian refugees on large media outlets, one could expect to see an increase in dialogue regarding the wellbeing of the affected individuals.

Although the extent of mental harm caused by refugee camps is unpredictable, some reassurance can be found in the recognition of this issue and in the subsequent actions of organizations and healthcare providers in the region.

Raising awareness and educating others about this pressing topic will be key steps toward protecting and improving the mental health of Syrian refugees.

References:

1. Syrian Civil War | Syrian history. Encyclopedia Britannica Online. Available at: http://www.britannica.com/event/syrian-civil- war. Accessed February 16, 2016.

2. Syrian Refugees. Syrian Refugees. Available at: http://syrianrefugees.eu/. Accessed February 16, 2016.

3. Hassan, G, Kirmayer, LJ, Mekki- Berrada A., Quosh, C., el Chammay, R., Deville-Stoetzel, J.B., Youssef, A., Jefee-Bahloul, H., Barkeel-Oteo, A., Coutts, A., Song, S. & Ventevogel, P. Culture, Context and the Mental Health and Psychosocial Wellbeing of Syrians: A Review for Mental Health and Psychosocial Support staff working with Syrians Affected by Armed Con ict. Geneva: UNHCR, 2015. Available at: http://www.unhcr.org/55f6b90f9.pdf

4. Unite For Sight. (n.d.). Retrieved March 20, 2016, from http://www.uniteforsight.org/refugee-health/module2

5. Post-Traumatic Stress Disorder. (n.d.). Retrieved March 20, 2016, from http://www.nimh.nih.gov/health/topics/post-traumatic-stress-disorder-ptsd/index.shtml#part_145371

6. Hijazi, Z., & Weissbecker, I. (n.d.). SYRIA CRISIS Addressing Regional Mental Health Needs and Gaps in the Context of the Syria Crisis. Washington DC: International Medical Corps.

7. All About Depression: Causes. (n.d.). Retrieved March 20, 2016, from http://www.allaboutdepression.com/cau_02.html

8. Anxiety Disorder Causes – Myths & Reality. (n.d.). Retrieved March 20, 2016, from http://www.calmclinic.com/anxiety/causes

9, Syria’s children – how conflict can harm brain development. (2014). Retrieved March 20, 2016, from http://www.wvi.org/experts/article/syria’s-children-–- how-conflict- can-harm- brain-development

10. Mental Health and Psychosocial Support. (n.d.). Retrieved March 20, 2016, from https://internationalmedicalcorps.org/programs/mental-health

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