PTSD; The Hidden Consequence of The Syrian War

On the 10th year of the Syrian war, Syrians are reviewing the gains and losses caused by the transformation from the people’s democratic demands of rights to an armed conflict that has destroyed everything. Many reports have assessed the extent of the destruction, infrastructure damages, and economic losses after these bloody years.

Local and international media have conveyed images of physical destruction, entire towns reduced to rubble, bombed schools, hospitals, and marketplaces, people fleeing from their homes, the injured, and the dead. But even the most professional lens of photographers have not been able to capture the psychological damage and destruction of millions of Syrians who have been subjected to inhuman conditions, some of which amount to war crimes.

The media reported a lot of human stories and showed images of the Syrian people suffering, but it couldn't report their emotional and mental scars and the dreadful memory that they could not overcome.

Traumatic numbers         

Wars leave many psychological problems for those who witness it, the most common of which being post-traumatic stress disorder (PTSD), which is an anxiety disorder that may develop after being involved in, or witnessing traumatic events.

PTSD symptoms may be delayed for more than six months after a certain trauma, or it may last from an early age for a long time, and sometimes it may also appear as a secondary trauma (developed by people caring for someone who has experienced a traumatic incident). PTSD is frequently comorbid with other psychiatric disorders, which can worsen the outcome and complicate possible treatment.

Syria Relief issued a report entitled "The Devastation that You Can't See", which tried to measure the PTSD symptoms prevalence degree among Syrian refugees in Turkey and Lebanon, and among the forcibly displaced in Idlib^[1].

The report analyzed PTSD symptoms by gathering the data of 721 research participants in Syria, Lebanon and Turkey. It found that 88% of respondents have experienced at least one life-threatening event and show at least one PTSD symptom thus need to be seen by a medical professional. 42% of them have experienced at least one life-threatening event and have more than 10 out of 15 possible PTSD symptoms (37% in Idlib, 50% in Lebanon, 52% in Turkey). 84% have seven or more symptoms (88% in Idlib, 73% in Lebanon, 80% in Turkey).

The report showed that health efforts to follow up these cases seem to be very mediocre, with support falling year by year. 64% of refugees in Turkey said that they have better access to mental health services, while only 15% in Lebanon and 1% IDPs in Idlib said that there is some mental health support available to them.

According to the report, refugees are 10 times more likely to develop PTSD than people from non-refugee communities in their respective host countries. This is because they are more likely to have been exposed to traumatic events such as witnessing, experiencing, or becoming victims of violence in the conflict, witnessing or becoming victims of torture, enduring dangerous migration journeys, stresses due to resettlement process, and becoming victims of racism, discrimination and/or prejudice in their host country.

In regards to PTSD symptoms according to the age group, the report said that:

- 96% of people over 60 show PTSD symptoms in the whole sample (88% in Lebanon, 100% in Turkey and Idlib).

- 87% of people aged 31-59 show PTSD symptoms in the whole sample (84% in Lebanon, 79% in Turkey, 99% in Idlib).

- 83% of people aged 18-30 show PTSD symptoms in the whole sample (82% in Lebanon, 68% in Turkey, 100% in Idlib).

- 76% of people under 18 show PTSD symptom in the whole sample (60% in Lebanon, 69% in Turkey, 100% in Idlib)

The most prevalent symptoms reported are the “feeling of constantly on guard,” “blanking on important parts of the traumatic event(s),” “avoiding thoughts, feelings or conversations about the event(s)” and “acting or feeling as if the event(s) were happening again”.

Future responsibilities and challenges

In wars, the perpetrator usually bears responsibility for the occurrence of all losses. But in the Syrian case, the Assad regime bears double responsibility as it confronted its people and punished them instead of listening to their demands, on top of the heavy material and human losses as a result of its policy.

On the other hand, the international community may not be interested in pushing for a political solution to end the Syrian crisis, and it may not be interested in punishing those involved in war crimes and crimes against humanity. But this does not exempt the international community from providing the necessary assistance to those affected, especially those who suffer from damages that may affect their future lives.

Psychological support should be one of the most prominent priorities for the war victims, whether by providing psychological service support to those affected or by qualifying trained cadres capable to deal with these cases, especially with the scarcity of specialists in this field. Like most health issues, PTSD does not go away by living it untreated – in fact, it is likely to get worse.

The sooner the mental health crisis of these people gets treated, the better chance these people have in their future. We are talking about some of the most vulnerable people in the world, having fled their home - at least once  - and then having to live in poverty, not to mention that they also have to deal with the trauma and social stigma that comes with it. People with PTSD will also suffer from further negative impacts on other aspects of their lives such as marital/relationship issues, domestic abuse, substance abuse, self-harm, harming others, even suicide.

The Syrians face difficult future challenges. Assuming that the war has stopped and the political process has begun, with the best scenario of a reconstruction process, managing these psychological and social war effects will remain very difficult. Therapists will be faced with severe challenges in finding the necessary programs and projects in order to treat the psychological rifts and their repercussions.

And even if the best has been done for these victims, all these exerted efforts will remain inadequate and will not achieve their results unless an accountability process for those involved is launched alongside them. A sustainable peace process must be based on transitional justice projects that hold the perpetrators and those involved accountable and restores the material and moral rights of the victims.