Breaking the cycle of trauma and illness among Syrian refugees

Stripped of her money and possessions by her ex-husband, she lives with two sons in a small tent, so fragile that it flaps with the wind. She is well aware of the negative impact of these experiences on her mental and physical health, and on her ability to care and provide for her children. 

Like millions of refugees, living either in camps in South West Asia or resettled in North America, Mohamad suffers from emotional trauma, which likely negatively impacts her physical health. Current treatments for trauma are not always helpful because of cultural stigma and cost. 

Researchers try to overcome these barriers by exploring the known but unclear correlation between mental and physical health, with the hopes of treating one to ameliorate the other. For now, organisations have been filling the gap in mental healthcare by providing assistance and community activities known to alleviate some symptoms.

Mental and physical health are tightly interdependent. The more they are studied in relation to each other, the more complex they are revealed to be. Chronic stress might increase the risk of disease. Simultaneously, a malfunctioning immune system might worsen mental health.

Mental and physical health are tightly interdependent. The more they are studied in relation to each other, the more complex they are revealed to be

Studies have shown that Syrian refugees of all ages have a high chance of suffering from posttraumatic stress disorder (PTSD), depression, and anxiety. For every ten refugees, three might suffer from depression, four will have anxiety, and almost half develop PTSD, according to a recent study.

Dr. Arash Javanbakhth has been working with refugee populations in the US as the director of the Stress, Trauma, and Anxiety Research Clinic (STARC) at Wayne University in Dearborn, MI. He has led many studies evaluating the mental health of refugees and says the risk of trauma-related illnesses is very high.

Read more: A house but not a home: Refugees in Britain long for community amid Covid-19

Dr Javanbakht's clinic has been following the refugee population in Dearborn, where the Arab American community is concentrated. The clinicians and researchers try to come up with ways to improve both the physical and mental wellbeing of the refugees who resettle in the US. 

It is known that chronic stress can suppress the immune system and induce inflammation, thus increasing the risk and damage of diseases. In parallel, new research suggests that inflammation may also worsen mental health problems. These findings are still preliminary, but they are a promising frontline of research according to Lana Grasser, a graduate research fellow who works in Dr Javabakht's clinic.

"We still don't have a good understanding of how that happens," said Dr. Kapczinski, a psychiatrist who studies the impact of trauma and stress on inflammation at the McMaster University in Canada. "But we know that it is a problem," he added.

For Mohamad, who suffers from irritable bowel syndrome and a number of other health complications that she attributes to her declining mental health and tough living environment, the physiological effects of trauma are very real. The need for treatment for her physical condition is evident, but what she identifies as a crucial need is mental healthcare.

If further research confirms the relationship between physical and mental health, treating one would ameliorate the other

If further research confirms the relationship between physical and mental health, treating one would ameliorate the other. Several studies for example have tried to alleviate depression symptoms by treating patients with common anti-inflammatory drugs like aspirin. Ideally, this would serve as a cheaper and more accessible treatment. Unfortunately, results are mixed and need further investigation.

When research tries to come up with interventions or medications, ethnicity and culture are important elements to consider. Differences in side effects and cultural barriers to treatment have been observed but are still not well studied, according to researchers.

Mohamad is familiar with these obstacles. She recalls the stigma she was subjected to when seeking help. "They [other refugees] call you crazy, and if you try to see a psychiatrist, they will say you went to the doctor who treats mad people," she said. She added that the care she receives through the United Nations Relief and Works Agency for Palestine Refugees in the Near East, or UNRWA, is minimal and doesn't always cover all her conditions. She struggles to afford medication. 

Read more: For Middle East refugees, social distancing is a privilege few can afford

Instead of visits to the psychiatrist, and in addition to some pills she takes for inflammation, Mohamad finds comfort in her community, the kindness of some neighbours, and the volunteer groups who try their best to help through food donations and activities. She too, despite her own difficulties, is always quick and determined to jump in and help, said Mrs. Rawda, who also lives in the camp. 

The interview was interrupted a couple of times by a neighbour passing by to say hello or a friend bringing bread. They don't always get along perfectly, she said, but they know the importance of community.

Mohamad said what she needs the most is awareness, acceptance, and support to those with mental health issues. "We are in dire need of educators and counsellors to come talk to the people and show them that it is normal and necessary to reach out for help to cope with mental illnesses," she said. "People need to stand together and help each other heal," she added. The need for food and shelter, even though essential, were the last thing she mentioned.

We believe one meal is not going to end their poverty. But building relationships, showing them we care, that's a major thing

In an effort to address these needs, the Beirut-based hunger and food-waste relief NGO FoodBlessed brings more than meals when they visit the camp. One frequent volunteer, or hunger hero as FoodBlessed calls its members, told The New Arab they usually bring food to cook on location, eat together, and play with the children. Without calling it so, they actually try to cater for the mental healthcare needs of families through community activities.

"We believe one meal is not going to end their poverty," the volunteer said. "But building relationships, showing them we care, that's a major thing," they added, recalling how often they are thanked for their presence more than for the food they offer.

Read more: Moria camp tragedy is a wake-up call for Europe's failed migration policy

In the spirit of building community and helping refugees break out of the cycle of trauma, STARC in Dearborn has been doing dance, photography, and art sessions as a less formal and more approachable intervention with children. It breaks the stigma and encourages them to take control of their recovery.  

"It's hard to share these traumatic experiences and thoughts and feelings, but they are always willing to contribute," Grasser said.  

One of the most recent projects was focused on photography. In a pre-coronavirus world, it would have resulted in an exhibition in partnership with the Arab American National Museum in Michigan and the Arab Community Center for Economic and Social Services. 

The goal of sharing the lived experiences of the participants was more than therapy. The photographs were meant to be shared with community members and policymakers. Dr. Javanbakht explained that policies that affect the health of refugees are as important as the actual interventions in reducing their stress and anxiety.

Ultimately, along with therapy, medication, and community activities, the health and well-being of refugees involves political decisions that shape their daily lives.

Yara El Murr is a biologist-turned-journalist and a Fulbright alumna based in Beirut. She covers the intersection of health and social issues, with a focus on the SWANA region and its diasporas, both in writing and film.

Follow her on Twitter: @yaralmurr