Unseen Wounds: Mental health is not a priority in northern Syria

War in Syria has left profound visible and invisible impacts on the Syrian people. While the physical toll of the war is readily observed and measured, we must not forget the invisible scars it has inflicted, particularly on the children. Syrian children may not have directly experienced the horrors of the war. However, many are afflicted with challenges and traumatic experiences, profoundly affecting their mental well-being.

Many children have been exposed to violence, including bombings and shootings. Some have grappled with the grief of losing close family members. At the same time, millions have been uprooted from their homes, disrupting their lives, education and sense of stability. Tragically, others have been forced into child labour, their childhoods stolen for the purpose of survival.

In a MedGlobal study, examining mental disorders and post-traumatic stress disorder (PTSD) among Syrians enduring the wartime conditions in Syria, a staggering 89.2% exhibited symptoms of PTSD and signs of mental disorders. In Syria, multiple factors contribute to the challenges in the field of mental health. Factors include the protracted nature of the conflict, mass displacement, stigma surrounding mental health issues, and misunderstanding about psychosocial support. These issues are compounded by a shortage of qualified personnel and an inability to provide the much-needed services effectively.

Alarming statistics reveal that over 6.5 million children are in need, with the number of children needing help rising by more than 7% in the past two years. Children in Syria continue to struggle with both physical and psychological injuries. If their trauma remains unaddressed and untreated, they will likely to be scarred for life, severely affecting their health and future.

“The two most common barriers to accessing mental health support are cultural factors and economic constraints,” says Ahmed Abdurrahman, a Syrian Psychological Counselor with experience in both Syria and Türkiye. “Often, the stigma attached to seeking help for mental health concerns prevents individuals from seeking this assistance. Even those willing to seek support may encounter financial obstacles on their journey toward healing.”

In Syria you need to prioritise necessities

In the heart of war-torn Syria, a shelling incident obliterated a home, taking the life of a husband and leaving a wife injured. Amidst the chaos, their children remained trapped beneath the debris, unnoticed and unheard. It was a moment that would shape their destinies, and the future of a compassionate man named Ali.

In a war-ravaged town in northern Syria, Ali’s life was simple, he shared his home with his wife and their three children, while earning a living as a car trader and owning two houses.

In 2015, Ali was sitting with his family when shelling rocked his home, reducing it to ruins. “My cars were burnt, my houses were destroyed, and my wife lost her life,” Ali recalls. “114 pieces of shrapnel were scattered all over my body when I was trying to shield my children, leaving me unable to lift anything heavier than a cup of tea.”

Amidst the devastation, Ali was cleaning the rubble when he heard a baby’s cries. “I found four children, the eldest was five years old and the youngest was two weeks old only,” he recounts. Without hesitation, Ali took them into his care, vowing to take care of them until their parents showed up, even in the face of doubts and objections from his community about raising children not biologically his own.

In 2016, he remarried and had two daughters with his new wife. Sadly, this marriage didn’t last. After four years, Ali found himself alone raising his five children and the four he had taken in. He continued his tireless quest to locate the children’s parents, posting their pictures on social media desperately attempting to reunite them with their family.

In another place, a woman who had been going through her own hell:

“A shelling happened,” Amina* recounts, her voice trembling with the memories of that fateful day.

In 2015, Amina was sitting with her husband and her children when a shell hit her house, destroying the house and claiming her husband’s life. Severely injured Amina was rushed to the hospital. “All I could think about was my children. Where are they now? Are they still alive?” she adds. “The second I left the hospital, I returned to the ruins of our house with an unwavering belief that my children are still alive but no trace of them was found.”

“Those who survived were returned to their families, while the deceased were buried together,” this is what Amina* was hearing every time she asked for her children’s whereabouts. The hope that was once there was slightly fading as her family and friends were asking her to give up on finding them. “I had this strong feeling that they were still alive, I did not give up on looking for my children, I refused to believe that they were dead!”

It is 2019 in northern Syria, and Ali is still looking for the children’s parents:

“I was walking in the street when a stranger approached me and told me he knew a woman who had lost her children,” Ali says. “I rushed to that woman armed with photographs of the children. Could that be the moment? Did I finally locate their mother?”

“When I saw the photographs, I immediately recognised my eldest sons; they were 5 and 3 years old when I last saw them. They were brought to me the following day,” Amina adds.

The boys recognised their mother immediately, but the younger girls were confused, having been infants at the time of their separation. “I didn’t know how to react. Should I cry or laugh? I was in utter shock. The moment of our reunion compensated for the four years I was away from them,” she explains.

I couldn’t sleep at night for an entire month. Staying away from them was unbearable; I had raised them for four years. They even call me ‘baba’!” Ali says.

“My two youngest daughters were always crying, asking for their dad, he is all they ever knew and I was a stranger. I didn’t know what to do,” Amina says.

“After a month, I decided that was it! I could endure no more separation from them,” Ali claims.

“He proposed,” she adds smiling.

“Now, we all live together and have a daughter together,” he adds.

“His wife died, and I lost my husband, but this crisis has brought us together at the end,” she concludes.

And they lived happily ever after... The end?

Ali’s and Amina’s story might sound like a fairy tale, but this could not be further from reality.

“The major thing we lost in this war is our sense of security and safety. Fear of destruction always haunts us,” he reveals.

Ali’s family was among the 13,000 families benefitting from our food voucher support.

“Before this support, we had nothing to eat. One of my daughters suffers from diabetes and hepatitis; I borrowed money from all my neighbours to cover her treatment,” Ali explains. “We had to vacate our previous residence because I couldn’t pay the rent anymore. We are now living in the janitor’s room, fearing eviction again.”

“Securing food for your family is like fighting with death; you don’t know when you will lose,” Ali noted. “When I started receiving food vouchers, I regained hope.”

The rising poverty in northern Syria forces parents to choose between their children’s mental well-being and physical survival.

“My children have never attended school. They want to learn to read and write; I want them to enjoy their childhood. Unfortunately, we can barely afford to put food on the table, let alone buy them books and pens,” Amina wonders.

Amina explains that one of their children suffers from mental health issues. The child "doesn't speak or play with their siblings, and is very traumatised. PIN referred them to an external service provider for one-on-one support". We referred Amina and her child to an external service provider for one-on-one support." Amina is concerned, though, that the transportation fees will constitute a barrier affecting her child's ability to access to the needed treatment.

Ahmad, a psychological counsellor in northern Syria explains that parents in northern Syria sometimes share violent stories or images with their children, involving them in the harsh realities of life. Consequently, children exhibit troubling signs such as nightmares, bedwetting, weight loss, etc.

“It is very important for the parents to recognise the signs that their child is struggling. They also need to learn how to minimise their exposure to any potential additional trauma,” Ahmad emphasises.

People in Need, with the support of the European Civil Protection and Humanitarian Aid Operations (ECHO), Swiss Agency for Development and Cooperation (SDC), European Neighbourhood Instrument (ENI), and Syria Cross-border Humanitarian Fund (SCHF), has taken many steps to address these pressing issues, referring around 600 individuals to external service providers for vital protection support.

We have initiated community-based outreach efforts to address some of the most urgent humanitarian needs of vulnerable communities in northern Syria. Additionally, we facilitate access to quality education and psychosocial support services. Furthermore, parenting sessions are conducted to guide caregivers of the children receiving support.

On top of these efforts, we have organised social cohesion events. More than 5,000 people attended these events in the past year. These events serve as an opportunity to gather people from diverse social backgrounds and engage them in various communal activities. Such activities contribute to forming relationships among participants and help strengthen social bonds.

In 2023, hundreds of individuals have also benefitted from individual assistance programmes, wherein PIN, with funding from USAID’s Bureau for Humanitarian Assistance (BHA), European Civil Protection and Humanitarian Aid Operations (ECHO), Swiss Agency for Development and Cooperation (SDC), European Neighbourhood Instrument (ENI), and Syria Cross-border Humanitarian Fund (SCHF), has provided essential devices such as hearing aids, medical glasses, wheelchairs and all other necessities.

“This form of aid is designed to uphold the dignity, safety and overall well-being of individuals. It reflects our commitment to inclusivity, empowerment and accountability in the humanitarian work,” affirms Hasan, our Psychosocial Support Officer in northern Syria.

Mental Health Support Should not be a Privilege:

In one of our Psychosocial Support (PSS) centres in northern Syria, we met Meteb and Amani, who live in a tented settlement and attend our education centre. Geography is often a significant obstacle to accessing education and protection support. In response, we have established informal education centres within tented settlements in rural areas to ensure the inclusion of all. “We also hired guards and cleaners from within the settlement to ensure everyone benefits,” Hasan adds.

“I was playing with my siblings when I saw the school. I immediately ran and asked them if I could attend, I was so happy,” says Meteb, a 10-year-old Syrian boy who lives in a tented settlement in northern Syria. “The teachers here encourage everyone, especially the shy students.”

Meteb has been living in this camp for three years, having endured multiple displacements and losing his father during their journey before ending in this settlement with his mum and siblings. “Now, I teach my siblings at home and grab their hands to help them learn how to write. I want to tell children who don’t go to school that I can offer to teach them!” he adds.

Amani, a 7-year-old Syrian girl, was sitting on the swing in the informal education centre watching and smiling. When approached, she shared her story her story. “I have two brothers and I am the eldest. I help my mum with house chores and my dad in taking care of the sheep,” she explains. “When my mum told me I was going to school, I was very excited! I want to become a doctor so I can heal people, and this can only happen if I go to school.”

According to a Médecins sans frontières (MSF) report, children in northern Syria have exhibited changes in their behaviour, including restlessness, irritability, aggression, and silence. They suffer from insomnia and sometimes regression to a previous stage of life. The difficult access to northern Syria and the scarcity of resources contributed to the region's underserved psychiatry sector.

Access to mental health is not a privilege; it is a universal human right and must be available to all. The scars, both seen and unseen, must be acknowledged, treated, and healed through the increasing securing access to mental health support, access to education, protection services and humanitarian aid to the children and their families.

*names are changed for protection purposes