Cities of Refugees

Why refugees need new interventions for tackling social adversity.

Posted Feb 03, 2020

If you want to learn more about the social drivers of mental health, then I suggest you go to Kilis and Gaziantep, two Turkish towns along the Syrian border where mass numbers of Syrians have been given refuge.

Gaziantep took in more than 500,000 Syrians, growing its population by 30 percent, whereas Kilis, a city of 130,000, now hosts more Syrians then its original population. 

The Turkish government has welcomed more than 3.5 million Syrians making it the largest refugee-hosting country in the world. The vast majority are urban refugees and do not live in camps. In these border towns, the municipal government refers to them not as refugees but guests and draws on historically strong and positive relationships with Syrians.

The Syrians I met described the adverse social conditions which are driving child and adult mental health. They spoke of unemployment, insufficient family finances, unsafe housing, childhood labor, bullying, and discrimination. These are the unfortunate realities impacting millions of lives.

At the same time, these Syrians were all aware of how much worse it could be if they weren’t in Turkey and receiving humanitarian aid. Turkish and international NGO’s are providing services for the Syrians such as Turkish language classes, job training, computer classes, early childhood development, and psychosocial support.

When asked, what else they needed in terms of psychosocial support, they answered, “The best way to improve our mental health is to get us jobs,” or “Stop the bullying and discrimination in schools.”

These are not surprising answers. In part, they reflect the reality that most Syrians would not look to mental health professionals to solve problems through offering services. This was just not a part of their worldview. But it is precisely what mental health professionals are trying to modify.

Now in cities of refugees, NGOs ask the Syrians to open up to new alternatives including mental health or psychosocial services for PTSD, depression, and anxiety.

But what I took away from visiting Kilis and Gaziantep is that we, as mental health professionals, also have some rethinking to do about the social drivers of mental health. We need to better understand not just how the adverse conditions impact mental health but how interventions can disrupt the ways they cause mental health problems.

What we really need is to expand our toolkit of evidence-based strategies for refugees beyond cognitive behavioral therapy and narrative exposure therapy for individuals. We especially need interventions that can work at the family, school, and community levels. 

One extraordinary example of what is needed is a new initiative of Sesame Street and the International Rescue Committee (IRC), funded by a $100 million grant from the MacArthur Foundation, to help Syrian refugee children not just with Elmo, but also Basha and Jad. Beginning in February 2020, “Welcome Sesame” will be shown in Iraq, Jordan, Lebanon, and Syria, accompanied by safe spaces for children to play and learn and parenting sessions to support their families. Simply put, this will be the largest early-childhood intervention in the history of humanitarian response. Beyond that, it will be rigorously evaluated to see what works and how.

Given that the Syrian refugee crisis is the defining humanitarian disaster or our era, it behooves mental health professionals to not just work around social adversity but to commit to developing additional cutting edge interventions that target the social drivers through innovate programs that could improve discrimination, jobs, schools, neighborhoods, and households.

Mental health professionals can’t hope to bring change to the scores of refugees in Kilis, Gaziantep, and beyond unless we first let ourselves be changed. We can provide individual treatment but not only that. We need to come up with new perspectives, new ideas, and new scalable interventions that seriously grapple with the social adversities that shape refugees’ lives.