Canadian party leaders have all pledged to resettle thousands (if not tens of thousands) of Syrian refugees over the next few years, but little has been said to address the fact that for many, the crisis doesn’t necessarily end upon reaching Canadian shores.
A new report commissioned by the UN Refugee Agency (UNHCR) explains that even after refugees have escaped a crisis zone, they must deal with the damaging repercussions of having experienced war-related violence.
If they are able to find safety abroad, refugees still must confront the daily stressors of displacement, which include poverty, a lack of basic needs and services, ongoing risks of violence and exploitation, isolation and discrimination, loss of family and uncertainty about the future.
[T]he UNHCR’s report’s aim is to make mental health and psychosocial support (MHPSS) staff aware of the cultural issues they might encounter when working with refugees.
According to the World Health Organization (WHO), Syria in particular is suffering from a mental health crisis, with two million or more citizens experiencing mild to moderate mental health illnesses.
Titled “Culture, Context and the Mental Health and Psychosocial Wellbeing of Syrians,” the UNHCR’s report’s aim is to make mental health and psychosocial support (MHPSS) staff aware of the cultural issues they might encounter when working with refugees so that they can better address this group’s specific and acute mental health needs.
The report
“The idea really is to help practitioners equip them[selves] with the knowledge, but also the attitude that they need to have with a Syrian refugee,” explains Ghayda Hassan, one of the organizers of the report and an associate professor in the Department of Psychology at Université du Québec à Montréal (UQAM).
Hassan began working on this report two years ago when the UNHCR and the WHO were investigating how to better support mental health and psychosocial services practitioners following a crisis.
The organizations decided to commission professionals in the field to design a primer for MHPSS staff that would guide them through interventions while educating them of the present cultural context and any cultural issues they might face working with Syrian refugees.
Exposure to such devastating events has the potential to create extreme psychological and social distress among refugees.
The report begins by describing how the current conflict in Syria has caused “the largest refugee displacement crisis of our time.” Since March 2011, nearly half of the country’s population has been displaced and over 200,000 people have been killed.
Those who have survived have been witness to massacres, murder, execution without due process, torture, hostage-taking, enforced disappearance, rape and sexual violence, as well as the use children in hostile situations.
Exposure to such devastating events has the potential to create extreme psychological and social distress among refugees.
Many are able to establish healthy coping mechanisms such as talking to friends and family, praying or remembering good times.
However, others might have had their social support systems destabilized during conflict, forcing them to develop less effective or negative coping strategies such as smoking, obsessively watching the news, worrying about others back in Syria or ‘doing nothing’, says the report.
When this lack of support is compounded with the trauma they’ve experienced in crisis zones, these individuals are especially at-risk of developing mental health issues or mental disorders.
Idioms of distress
The report intends to tackle this problem by helping “MHPSS professionals and humanitarian professionals become more sensitive – not to stereotype the Syrians, [but] to make them aware,” Hassan says.
One of the most important ways in which mental health practitioners can support refugees is by understanding and using cultural ‘idioms of distress’, which according to the report, “refer to common modes of expressing distress within a culture or community that may be used for a wide variety of problems, conditions or concerns.”
In order to help mental health practitioners communicate their diagnoses in ways refugees can understand, the report provides specific ways to express common expressions used in Western medical traditions. It also outlines common expressions used by Syrians.
“Even when we talk about anxiety and depression, anxiety and depression and other disorders are not experienced in the same way [in different cultures].”
For example, the phrase in Arabic that translates to “I feel my soul is going out” should be understood as an expression of worry, inability to cope, and a warning sign of a dysphoric mood.
A similar statement, which translates to “It is humiliating to complain to someone other than God” is a reference to shame in asking for help as well as a statement of despair and surrender.
By understanding the true intent behind these expressions, doctors can better understand exactly what a patient is experiencing.
Nevertheless, this issues go beyond simple vocabulary.
“Even when we talk about anxiety and depression, anxiety and depression and other disorders are not experienced in the same way [in different cultures],” Hassan explains. “So we kind of described for instance not only what words a depressed Syrian refugee patient may [use], but also what exactly depression means and how is it existentially experienced.”
Hassan says addressing these issues as complex cultural and emotional experiences rather than solely as diagnoses “really provides the ability for practitioners to be more aware and understand better the emotional and psychological experience of their patients.”
Intervention beyond Syria
While this report is specifically focused on a Syrian context, Hassan explains it has the potential to help mental health practitioners beyond the current refugee crisis.
“The advantage I think to this review is that we have included some advice or information on how to design a contextually appropriate service in terms of mental health and psychosocial support,” she says. “It can be used by any mental health psychosocial service in Canada who is hoping to improve the services that they provide to their population.”
Hassan says this could be especially important for Canada given its multiethnic population.
She ultimately hopes that this report is widely distributed so that both professionals and the public become more aware of the long-term health consequences of refugee situations and how they can get involved.
“Canada has to play [a role] in assisting refugees. And not only waiting here to assist them.”
