Healing the Invisible Wounds of Syrian Children

In March 2018, the Syrian conflict entered its eighth year with no end in sight. This war has stolen the right to childhood from millions of Syrian children. An entire generation is growing up with the ‘toxic stress’ caused by seven years of bombing, bloodshed and displacement.

In this interview, SOS Children’s Villages psychologist Dr. Teresa Ngigi explains the impact disasters and wars have on children and families, and tells us about the importance of the healing process.

Is there a difference between trauma from natural disaster and trauma caused by mass displacement or conflict?

“When you have continuous disaster – such as war, epidemic, or extreme poverty – children tend to develop resilience that sometimes makes them almost numb to the trauma. This isn’t good but it’s a coping mechanism. Those experiencing disaster for the first time have not previously had the need to create such defence mechanisms.”

How does treatment differ for one-off disasters compared to prolonged emergencies? 

“Developmental trauma and continuous trauma create a basis for serious health, mental and relationship problems or learning disabilities – even though externally the individual may appear resilient.

Event trauma – from an earthquake for example – may result in post-traumatic stress disorder (PTSD). The person becomes disorientated. They cannot put their life back together and this interferes with their wellbeing in different ways, including physical and mental health problems. 

In both instances, it is important to understand that there’s a difference between treatment and healing. Healing is a long-term process, but treatment can come in the form of medication to address symptoms without necessarily helping the healing process. We need to be able to assess the individual’s situation, identify their needs, create a treatment plan, and then evaluate whether we are able to achieve the appropriate objectives.” 

A drop-in center in Syria, providing unaccompanied and vulnerable children with shelter, food, health and hygiene services, and psychosocial support. Credit: SOS Children’s Villages

Does toxic stress impact girls & boys differently?

“The way the brain copes and processes toxic stress differs between boys and girls. The insula – the brain region that processes emotions and empathy – is smaller in girls and larger in boys who have experienced toxic stress. The functions controlled by this part of the brain include perception, motor control, self-awareness, cognitive functioning and interpersonal experiences. Girls who experience toxic stress may suffer from a faster than normal ageing of one of the part of the insula which puts them at higher risk of developing PTSD. High levels of stress could also contribute to early puberty in girls.

It’s important to put these findings into consideration when designing healing approaches. Girls may be more susceptible to PTSD than boys, hence they need specific interventions.”

How important is a long-term perspective in treating trauma like you see in Syria?

“Very important! If you start a process with a child who has been traumatized and you leave that process halfway, you are going to worsen the situation for that child. 

An assessment is extremely important to establish the needs of the child, as well as to assess whether we have the resources, time, and expertise to start and continue the healing process. Healing trauma is a demanding endeavor, and mental health specialists need to work diligently with a traumatized person to create a solid and reassuring relationship and guide them towards taking their power back.”

The initial phase of a humanitarian response typically involves reaching as many people in need as quickly as possible. Would you say that dealing with deeper mental health issues, especially of children, is more complex? 

“Yes, and this is why SOS Children’s Villages works with partner organizations to divide duties and responsibilities. There are organizations better able to address the immediate large-scale needs in a disaster zone. We use our expertise in caring for vulnerable children and helping their families to address their very specialized needs with a long-term perspective.

Through training local social workers and other specialists, SOS Children’s Villages can improve local capacity and strengthen the ability to respond to the needs of children and their families.”

Child Friendly Spaces (CFS) have been a central feature of SOS Children’s Villages’ work in emergency situations. How important are these facilities? 

“Child friendly spaces are a central part of our emergency response work. They offer a great environment to deal with trauma because you have caregivers who are trained, a secure and safe place, and an environment where children can express themselves. After trauma it is very important to be able to express yourself. Even without verbalizing experiences, children are involved in drawing, art therapy, singing, dancing and other activities.

It is also important that parents take part in activities so that they can participate in the healing process. Participating with their children is therapeutic for parents. We help address the needs of the parents through the children.” 

Children participating in educational and psychosocial activities at one of SOS Children’s Villages child friendly spaces in Aleppo, Syria. Credit: SOS Children’s Villages

How do Child Friendly Spaces help in providing ‘normalcy’? 

“Child Friendly Spaces offer a place for children to play, talk with other children, learn and tell stories. These activities help the children get in touch with themselves and feel a sense of belonging. When you bring them together, they feel they are a part of a community that is safe and protected.”

You can learn more and support SOS Children’s Villages Syria here!

Mental health and women’s health: Eyeing the ‘treatment gap’

Originally published on Devex

Mental health has attracted little attention considering the huge size of the problem. Ranging from mild depression to major psychosis, it is estimated that one in four people suffer from a mental illness, and estimates from the World Health Organization state that around 400-500 million people worldwide are affected.

Among sufferers, many go undiagnosed and untreated. In developed countries, the “treatment gap” can be as high as 50 percent, while in developing countries it can skyrocket to 90 percent. The dearth of medical attention can be traced to a lack of awareness, a fear of the stigma attached to mental illness, or barriers to treatment such as access or finances.

Within these astonishing figures, another little-discussed fact is that women are at greater risk for certain mental health issues. Partly attributed to biological factors, but also partly because of sociocultural factors — including a lower social status than men and different cultural expectations — women suffer from a higher risk of anxiety, depression and eating disorders.

In addition, women are at risk of gender-specific afflictions such as post-partum depression. Intimate partner violence, sexual assault or sexual abuse, which women experience more frequently than men, are also risk factors for developing mental illness later in life.

Image c/o Adi Sujiwo
Image c/o Adi Sujiwo

The ramifications of mental illness extend beyond the individual. Women — often having a greater role in child rearing — suffer additional stress and the responsibilities of parenting can take its toll on mothers. While some studies have found that parenthood can act as a balancing force for individuals, others show that adding mental illness on top of the stress of parenting presents unique challenges.

One case worker described the difficulty of balancing treatment with child care, saying, “I’ve seen a lot of mothers go into crisis, needing hospitalizations and debating which should come first, their mental health or child care, because they had no one in the community that could help them.” Another described the guilt mothers go through when feeling stressed by parental duties, or by witnessing behaviors in their children that they worry is hereditary mental illness, or a sign of failure in their own parenting.

Further compounding the issue is that many — on some level — assume that mental illness is a condition that can be willed away or cured by logical thinking. This fallacy shames sufferers into silence — often with fatal results.

Suicide, often the tragic final outcome of these diseases, is one of the leading causes of death globally: more than 800,000 people a year die by suicide, or one every 40 seconds. Women are two to three times more likely than men to attempt suicide, though men are four times as likely to die from it. Among suicides, a disproportionate number of the victims are found to have a mental illness, most commonly depression or a mood disorder.

With such a profound effect, mental health in both men and women deserves greater attention and resources. More urgently, it requires an eradication of the stigma that prevents most people from seeking help. A greater focus on raising awareness and channeling resources could have a profound positive effect for men as well as women, as well as the families who rely on them.

Join Girl’s Globe’s #HealthyMeans Twitter chat today, November 13th at 11:00 EST to discuss how neurological and psychiatric disorders impact women and girls. To learn more about mental illness or how to help a loved one who suffers, please visit the National Alliance on Mental Illness. Read more on how gender disparities impact mental health at the World Health Organization.

Want to learn more? Check out the Healthy Means campaign site and tweet using #HealthyMeans.

Healthy Means is an online conversation hosted by Devex in partnership with Concern Worldwide, Gavi, GlaxoSmithKline, International Federation of Pharmaceutical Manufacturers & Associations, International Federation of Red Cross and Red Crescent Societies, Johnson & Johnson and the United Nations Population Fund to showcase new ideas and ways we can work together to expand health care and live better lives.