The Struggle Continues: Syrian Refugees Pre- and Post-Migration

Syrian sniper on top of a building in a destroyed city. The New York Times, September 18, 2016. Fair use.

The 2011 Syrian uprising against the regime of Syrian president Bashar al-Assad began as a non-violent movement, but quickly transformed into a lethal civil war.1 This uprising has displaced 6.6 million Syrians.2 The displaced populations migrated to multiple different cities around the world where they continue to face challenges such as cultural integration issues, loss of family members and experiences of discrimination, along with their long-lasting traumas of having experienced war.

Syrian civilians experienced distressing events during the war. For instance, soldiers at government check points stopped civilians, many of whom were arrested, as they moved from one place to another.3 There are also cases of people being arrested and tortured like the Syrian couple who explained, “a lot of arrests and kidnappings were happening. They were taking civilians depending on their living area, so if they’re from this area, no matter if they’re an adult, woman, child they still get arrested.”4 Other systemic changes during the heat of the uprising included little to no access to healthcare or food, and the use of chemical weapons, physical and sexual violence, bombings, and massacres.5 Syrian civilians reported systematic killing of families in their city: “[they] choose a family, and just kill all of them. And they started with the child to the mother, to the dad. . .so they didn’t just kill the mom and dad, they killed them like five times, because they killed their children before them.”6

Trauma of war: man holds a dead child after airstrikes in Syria. The Gospel Herald, October 6, 2016. Fair use.

The Syrian civil war killed over 500,000 people and is the worst humanitarian crisis of our time with over six million Syrian refugees worldwide.7 Many Syrians experience significant loss: loved ones, homes, cultural identity, relationships and support systems as they resettle in new countries.8 Many adults seeking refuge find it hard to move to a different country as they have built a life for themselves in Syria and leaving everything behind is difficult. However, studies suggest children have a hard time when it comes to being welcomed and having a smooth integration process into the education system of their new country.9 A psychiatric study conducted in 2018 compared the impact of age on 1) the levels of trauma centrality, posttraumatic stress disorder and psychiatric co-morbidity, and 2) models depicting the association between trauma centrality and distress outcomes among Syrian refugees.10 1197 refugees completed the Centrality of Event Scale, Harvard Trauma Questionnaire and General Health Questionnaire-28.11 Age groups were divided into young adults, middle-aged adults and adults forty-five or older.12 Trauma centrality states that memories of war can act as a daily reminder of previous experiences of traumatic events and can have a re-traumatizing effect.13 Young adults reported significantly less trauma centrality and psychiatric co-morbidity (having more than one diagnosis in an individual at an occurring time) than the other groups because “compared to those who were older, the war seemed to have impacted to a lesser degree the way young adults attributed meaning to other events in their lives, their outlook on life and personal identity, and psychological wellbeing.”14 Findings showed that trauma centrality was significantly correlated with PTSD and psychiatric co-morbidity.15 Multi-group analysis showed the model for the young adult group to be significantly different from the middle-aged group model.16 Findings suggest age did not seem to influence the severity of PTSD among Syrian refugees. The war had a less severe impact on young adults’ sense of self and other psychological problems than those who were older.17

Syrian and Iraqi refugees arrive from Turkey to Skala Sykamias, Lesbos island, Greece. Volunteers (life rescue team - with yellow-red clothes) from the Spanish NGO Proactiva Open Arms help the refugees. From Wikimedia Commons.

Syrians who migrated to parts of the Middle East stated they still felt stressed dealing with financial hardships and fear of violence.18 Those who spent time in refugee camps in the Middle East described limited access to water for bathing, small living quarters, lack of privacy, no ability to cook for themselves, and the use of tear gas in the camp.19 Syrians who migrated to the United States stated they felt lost and confused at first and found that adapting to a new language was difficult.20 Syrian refugees in the United States also faced racial prejudice and were often accused of being a “danger.”21

Syrian refugees in Canada can access resources through the federal government to help with their mental health. Canada offers services from the Canadian Centre for Victims of Torture (CCVT) where they provide doctors, lawyers, and social workers to help with traumas and integration.22 The CCVT also offers English-as-a-Second Language (ESL) classes as well as music and art therapy support groups,23 whereas IG Vital Health Services offers psychotherapy services performed by skilled professionals.24 There are also other resources such as health care coverage, health lines, community resources for youth, and tips for caregivers of Syrian children.25 The Mental Health Commission of Canada (MHCC) created a Services System Advisory Committee and Diverse Task Group to examine mental health

improvements for immigrants, refugees, ethno cultural and racialized groups in Canada.26 Canada’s federal government and the programs it has established have a major influence on the psychological well-being of new refugees. In Canada, there are several factors that increase mental health problems in Syrian refugees, these include: internment, unclear resident status, poor housing, multiple moves, poor access to jobs and education, and poor social support.27 Plans that are sensitive to these needs will promote wellness and decrease mental health problems.28

Over thirteen months, 350 communities across Canada welcomed 40,081 Syrian refugees. The Tyee, April 4, 2017. Fair use.

A study by public health bearing age to be five times more likely to develop postpartum depression than Canadian-born women. several difficulties these women face before coming to Canada as well as challenges encountered during the resettlement process.30 Refugee women usually face many obstacles when accessing health services, including language and cultural barriers.31 UN Women has noted that the humanitarian crisis in Syria had had many negative consequences for women and girls.32 These include food insecurity, loss of educational opportunities, lack of safe water and health services, and high rates of violence towards them.

Jehan Sayed Issa tells the story of a Syrian woman from Damascus who fled to the US in the wake of war. was pregnant and was with her wounded son (whose age is not stated but he is a minor as he is not allowed to stay at home unaccompanied) who had been shot in the leg. She had to leave behind her husband and four other children to seek medical attention. Once the baby was born, she was still without her other family members and could not contact her husband as he did not have a cellphone in the camp. She got a job as a supermarket cashier so she could send money to her husband and children but “the job was not deemed appropriate according to her cultural background, so she decided not to tell her husband or children about it.” Neighbours noticed that the woman was not home to look after her son: the police got involved and she had to quit her job. Her husband and four children managed to leave the camp because her husband got a job in Amman where her eighthgrade son had to stop going to school in order to help his father out to ensure his three younger sisters could continue to go to school. The family has been separated for four years and has still not been reunited. The story of this woman and her family shows the resilience of both men and women and the difficulties they face in relocating. It is harder for people in their age group (mid-thirties) as young children are usually involved.

Traumatic events in war such as terrorist attacks, kidnapping, torture, and rape cause refugees to suffer from mental health issues such as, depression, anxiety, sleeps disturbances and PTSD. show that 65% of them have moderate to high levels of untreated sleep disturbances. exposure and PTSD symptoms affected post-migration stress and caused sleep disturbances after migrating. showed a decrease in symptoms of PTSD, anxiety, depression and insomnia after a year of migrating, but an increase in postmigration stress.40 A study conducted in Germany in 2016 shows the health of pre-migration refugees of high socioeconomic status (SES) differs from those of low SES. with health than those who came from low SES backgrounds. provides limited protection against the adverse health effects of migration passage.” conclude that Syrian people from poorer parts of the Syrian society seem to be less affected by migration and might even benefit from the current conditions as a refugee in Germany, the same conditions appear to be harmful for individuals previously living in higher classes of the Syrian society.

This article has highlighted the traumas experienced by Syrian refugees before and after they left Syria. Findings conclude that the displaced population continues to face challenges regarding their mental health even when seeking refuge. Findings show that middle aged Syrian refugees had a more challenging time migrating than younger refugees. The mental health of younger refugees has also progressed compared to those of older people. The traumas of war will have long-lasting effects on refugees, although their post-migration stressors should get better over some time. Findings show Syrian refugee women had a more challenging time with pre- and post-migration compared to men. In Canada, many resources are available for Syrian refugees. These resources once accessed will help aid their mental health, familial issues, language barriers, integration stress and healthcare. These resources will also address the traumas they have experienced. The importance of resources in addressing refugees’ traumas through psychotherapy and medical care help the emotional and physical healing process. It is important for countries to have services that are easily accessible to promote trauma recovery and resilience in Syrian refugees that are culturally proper.

health researchers at the University of Saskatchewan in 2015 identified Syrian refugee women of childfive times more likely to develop postpartum depression than Canadian-born women.29 This is due to several difficulties these women face before coming to Canada as well as challenges encountered during the resettlement Refugee women usually face many obstacles when accessing health services, including language and cultural UN Women has noted that the humanitarian crisis in Syria had had many negative consequences for women and These include food insecurity, loss of educational opportunities, lack of safe water and health services, and high rates of violence towards them.33 Early marriage is reported as a concern in many communities within Jordan.34

Jehan Sayed Issa tells the story of a Syrian woman from Damascus who fled to the US in the wake of war.35 At the time, she was pregnant and was with her wounded son (whose age is not stated but he is a minor as he is not allowed to stay at home unaccompanied) who had been shot in the leg. She had to leave behind her husband and four other children to seek medical attention. Once the baby was born, she was still without her other family members and could not contact her husband as he did not have a cellphone in the camp. She got a job as a supermarket cashier so she could send money to her husband and children but “the job was not deemed appropriate according to her cultural background, so she decided not to tell her husband or children about it.”36 The story does not elaborate on the details about why it was “not deemed appropriate.” Neighbours noticed that the woman was not home to look after her son: the police got involved and she had to quit her job. Her husband and four children managed to leave the camp because her husband got a job in Amman where her eighthgrade son had to stop going to school in order to help his father out to ensure his three younger sisters could continue to go to school. The family has been separated for four years and has still not been reunited. The story of this woman and her family shows the resilience of both men and women and the difficulties they face in relocating. It is harder for people in their age group (mid-thirties) as young children are usually involved.

Traumatic events in war such as terrorist attacks, kidnapping, torture, and rape cause refugees to suffer from mental health issues such as, depression, anxiety, sleeps disturbances and PTSD.37 A sample of sixty-nine Syrian Refugees in Australia show that 65% of them have moderate to high levels of untreated sleep disturbances.38 The sample found that the trauma exposure and PTSD symptoms affected post-migration stress and caused sleep disturbances after migrating.39 Participants showed a decrease in symptoms of PTSD, anxiety, depression and insomnia after a year of migrating, but an increase in post A study conducted in Germany in 2016 shows the health of pre-migration refugees of high socioeconomic status (SES) differs from those of low SES.41 Once migrating to Germany, Syrians of higher SES in Syria had greater difficulties with health than those who came from low SES backgrounds.42 This could be because “high SES before crisis and migration provides limited protection against the adverse health effects of migration passage.”43 Findings from the study in Germany conclude that Syrian people from poorer parts of the Syrian society seem to be less affected by migration and might even benefit from the current conditions as a refugee in Germany, the same conditions appear to be harmful for individuals previously living in higher classes of the Syrian society.44

This article has highlighted the traumas experienced by Syrian refugees before and after they left Syria. Findings conclude that the displaced population continues to face challenges regarding their mental health even when seeking refuge. Findings show that middle aged Syrian refugees had a more challenging time migrating than younger refugees. The mental health of younger refugees has also progressed compared to those of older people. The traumas of war will have long-lasting effects on refugees, although their post-migration stressors should get better over some time. Findings show Syrian refugee women had a more challenging time with pre- and post-migration compared to men. In Canada, many resources are available for Syrian refugees. These resources once accessed will help aid their mental health, familial issues, language barriers, integration stress and healthcare. These resources will also address the traumas they have experienced. The importance of resources in addressing refugees’ traumas through psychotherapy and medical care help the emotional and physical healing process. It is important for countries to have services that are easily accessible to promote trauma recovery and resilience in Syrian refugees that are culturally proper.

Education major; History and Psychology minors