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Barbara Lopes Cardozo, MD MPH, Medical Officer with the Emergency Response and Recovery Branch, Division of Global Health Protection (proposed)
The Syrian refugee crisis has been two years in the making. It represents the culmination of the conflict between the Syrian government and its own people, a violent conflict that has greatly affected the civilian population and caused Syrians to flee in large numbers. Up to 1,000 people are now leaving the country each day; many are heading to Jordan but some have also fled to Turkey, Lebanon, and even Iraq. There is no end in sight as the conflict continues, and even if the regime were to fall, most people are pessimistic that violence would end immediately.
The Syrian refugee camp in Jordan is right along the border of the two countries. It is in the middle of the desert, a flat, featureless, dusty landscape that is hot in the summer and cold in the winter. I have seen many refugee camps throughout my career, and while this is certainly not the worst, it is not the best situation either. Many of the families in the camps are from Syria’s middle class, so they are not used to the rougher conditions and shared pit latrines. There have been sanitation problems as families, in attempts to avoid the communal toilets, have dug holes in their tents which end up flooding when it rains. Some are so unprepared for rough living that there have been reports of people creating open fires within their tents in efforts to keep warm. This is not a population familiar with this style of living, unlike African refugees, many of whom are used to moving from camp to camp.Image may be NSFW.
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Around 800,000 Syrians have now settled within Jordan. Jordan itself has been extremely hospitable, possibly due to its Bedouin heritage, a nomadic desert culture used to helping others. The country and its population have many connections with Syrians, so not everyone lives in the camps; many refugees instead choose to live with friends and relatives in neighboring towns and cities. The single refugee camp is still fairly crowded, and attitudes there, while not openly hostile, still render it unsafe for outsiders. The United Nations Children’ Fund (UNICEF) health officials fear that riots may erupt in the camp, and as a result we must remain in the van when traveling throughout the camp, children looking in the van as we pass.
For a week in late March of this year I helped facilitate a training organized by UNICEF in collaboration with the World Health Organization, the United Nations High Commissioner for Refugees, and local non-governmental organizations to discuss and plan for the public health needs of the refugee community. Subjects discussed ranged from a measles vaccination campaign, mortality surveillance, to shelter provision; we were also able to begin to address the psychological needs of the community. For refugees being driven out by a very violent situation, addressing the psychological wounds of war in the community as well as the (often neglected) mental health of aid workers is an important component of public health interventions. It is an area that is often overlooked in the haste to address more immediate health problems.
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After the training in Jordan, I collaborated with the International Medical Corps (IMC) in order to establish an outcome evaluation to assess the effectiveness of their mental health intervention. Using a case management approach, the IMC team of experts, which includes psychologists, psychiatrists, nurses, and social workers, assess each new case individually in order to create a tailored treatment plan according to the needs of the patient. Because of the strength of evidence based interventions, and the lack of those that specifically address mental health, this outcome evaluation is especially important for demonstrating the effectiveness of the case management approach; an approach that we hope to continue using in this population. Remembering my work in Kosovo during the late 1990’s, where decades later there are still psychological issues and cycles of violence, the importance of addressing mental health early on cannot be stressed enough. By caring not only for a population’s physical health, but also for the psychological wounds caused by the violence, we can begin to take a more holistic approach with our public health interventions that allows for healing on multiple levels.