The Mental Health Crisis in Syria: A Major Gap in Humanitarian Medical Response
The civil war in Syria has led to a significant increase in the number of Syrians battling mental disorders. These include anxiety disorders, depression, post-traumatic stress disorders (PTSD), and developmental problems. Humanitarian medical providers in Syria have had to scale up mental health care on an ad-hoc basis to cope with the large number of patients; but many Syrians have not and will not receive adequate or timely care. It is clear that Syria is facing a major mental health crisis. This is because mental health and psycho-social support are not fully integrated into the global standard for humanitarian medical response. Humanitarian responders must make the provision of sufficient and immediate mental health care standard protocol in emergency services as with any other medical trauma.
The statistics on mental health outcomes in conflict-affected states are shocking. In Syria, available data shows that half of all Syrians need mental health and psycho-social support, and one in four Syrian children are at risk of developing a mental health disorder. Data from past conflicts, like in Yugoslavia, Cambodia, Chechnya, and Lebanon, illustrate the negative ramifications of widespread mental health disorders for societies trying to rebuild. Among people who have lived in war zones, 30-70 percent exhibit symptoms of PTSD and depression. 10 percent of those who experience traumatic events during armed conflict will develop serious mental problems, and an additional 10 percent will develop behavior that inhibits daily functioning. As of June 1, there are over 5 million refugees and 6.5 million internally displaced Syrians, populations that have certainly experienced trauma in the war.
Children exposed to conflict experience the worst psychological trauma. A study in Gaza of children aged 10-19 found that 97.5 percent of children sampled exhibited symptoms of PTSD, and 32.7 percent of those exhibited severe symptoms requiring psychological intervention. Experts say the early trauma of Syrian children will be long lasting. Research already predicts a serious risk of a “lost generation of children” in Syria, in which insufficiently treated mental illness plays a major role.
Addressing mental health immediately and adequately in conflict-affected populations can have important economic and social benefits beyond alleviating widespread suffering. Providing treatment for mental disorders leads to significant economic productivity gains. It can also address risks to social cohesion and stability. Studies have linked untreated patients of violent trauma-related mental disorders with explosive anger, reckless or violent actions, and increased drug use.
Given this evidence, mental health care services should be considered a key component for productive assimilation efforts in host countries’ societies and economies. Mental health care should also be acknowledged as an essential tool for post-conflict state building. Integrating mental health and psycho-social support into humanitarian medical services can be a valuable early investment by donors in securing successful reconstruction processes.
Importantly, providing mental health and psycho-social support is cost-effective. The World Bank and World Health Organization estimate that providing treatment for moderate to severe depression – including the provision of counseling, case management, psychotherapy, and drug – costs only $.08 per person in low-income countries, $0.34 in lower middle-income countries, $1.12 in upper middle-income countries, and $3.89 in high-income countries on average annually over 15 years. The cost-benefit ratios of treatment show a minimum return of $2.30 for every $1 spent. For a full package of basic mental health services, costs are approximated at $2 per person per year in low-income countries and $3-4 per person per year in middle-income countries.
There are immediate steps that humanitarian responders can take both in Syria and globally. Humanitarian providers and services for mental health that do exist vary enormously in quality. Humanitarian funding is also generally short-term. Humanitarian organizations that can only provide funding for short term interventions or limited patient follow-up should partner with organizations that can access longer-term grants. Further, it is crucial that humanitarian providers of emergency mental health care work closely with development organizations that have a long-term presence in conflict-affected countries. These organizations possess a central role in the reconstruction of social support systems and can help ensure emergency mental health care is integrated with rebuilt national health systems.
It may be many years before health systems in Syria are rebuilt or the health systems in countries receiving Syrian refugees are sufficiently expanded. It is therefore more urgent than ever to include mental health and psycho-social support in efforts to mitigate the burden of disease resulting from the country’s conflict. International standards for humanitarian efforts should reflect mental health as a priority. This is necessary to for current humanitarian responders to achieve the goal of sustainable long-term reconstruction and refugee integration.
Emily Foecke Munden is the International Development Fellow at Young Professionals in Foreign Policy (YPFP). She is also a Research Assistant with the Center for Global Development in Washington, DC. Emily earned her Master of International Affairs in 2016 from the University of California-San Diego, where she concentrated on international development policy.