Social Health Care for Healing Syrian Refugees

In June 2014, SHC joined Flying Doctors of America, and IFMSA/Jordan in a collaborative effort to provide medical and psychosocial treatment to Syrian refugees from the Zataari Camp and regionally. Myron Eshowsky, co-director of the Social Health Care Project, led the psychosocial team. In a four day period , over 1800 refugees received medical, dental, and mental health services. Though a large percentage of the refugees are traumatized, virtually no treatment has been available. Additionally, there is a high degree of stigmatization about acknowledging mental health issues which complicates willingness of some to pursue services that are available.

Since more than 50% of the refugees are children under the age of 18, I will share a couple of stories of work with children as sample cases we provided services. We saw over 50 people for psychological assessment and care over the 4 days. The presenting problems included :  nightmares, crying, bed wetting, refusal to eat, difficulty socializing with others, range of post traumatic symtoms, conversion reactions, anxiety, dissociation, traumatic brain injuries, and severe mental illness such as schizophrenia. 

A Syrian boy (picture 1) came to see me with his mother. She told me a story of how her son was being bullied in school by Jordanian boys. They taunted him with words of "stupid Syrian and you are a disgusting animal". There were a number of episodes of physical beatings by these Jordanian boys. Mom reported his having nightmares, episodes of bedwetting, sadness, and withdrawal. She was additionally worried because he would go through periods of not eating. In her attempts to address the bullying at the school, she went to talk with the school principal. His response was to physically punish the bullies, who in turn increased their beatings of her son. When I started to work with Abd Al-Salaam, he had these sad puppy dog eyes and solemn look about him. Through some trauma counseling and teaching him aikido centering practices, he was able to learn some tools that made him feel stronger internally. When he felt the strength in himself, he began to smile. His mother glowed and said he had not smiled in many, many months. He and Italked about how he could be strong inside no matter what others are doing. Fortunately, the Syrian refugee community is developing schools for Syrian children to provide a safe learning environment.

In the midst of wrapping up a session with the family of a six year old girl (picture 2) who would not eat and would not go to school (one of many children treated who were failing to thrive), one the Flying Doctors' pediatricians came and asked if I could see a girl in her office immediately. As I walked in, I saw a small 10 year old girl in torn clothing and very dusty. The doctor told me the little girl had shrapnel in her left eye socket and it was infected. Her worry was without medical treatment the infection would spread to her brain. I sat with the little girl and learned her name is Arabic for "to honor". She told me that her parents were driving and they were shot and killed in front of her. Somehow though wounded she crawled out of the car and a non-related Syrian woman found her and carried her accross the border into Jordan and found us. Despite her worn condition and obvious trauma, she had an inner strength and presence that touched all of the staff working with her. She spoke to me of the pain in her soul and her heart and how she could not speak of this to the people who had carried her into Jordan. I told her she could give me the pain as I would carry it for her. She told me the whole story of what had happened, how she felt, and how much she had cried. As she told her story, Dr. Ghalia a Syrian psychologist colleague and I did a form of EMDR which she said made the soul pain less. I asked her about the best moment in her life and she told me a story of drawing a picture that people thought was so good they applauded. I had her remember the moment and fill herself up internally with the colors of her picture. She shared it made her feel better. I gave her some drawing supplies and a paper book for her to express her feelings through her art. Despite the difficulty of refugees to get medical care, (picture 3, at a Jordanian hospital), we were able to get her into a hospital for antibiotics, surgery, and eventually a prosthetic eye. In her case were able to arrange for psychological follow up services as well.

While SHC, continues to provide grassroots training in trauma treatment to NGO staff , students, and government officials serving the refugee population, we also will continue to provide psychosocial services to the refugees via our students and staff in upcoming collaborations with Flying Doctors, Gesundheit institute, and other NGO's in Jordan and Turkey.

July 16th, 2014 is another matching funds day (until they run out). Donations will be matched at 30%. We hope you will help spread the word.

The massive number of refugees traumatized and displaced by the Syrian conflict continues and is only growing daily. The huge majority of refugees in general, and unfortunately also of those traumatized, are children and women. As a result of the raging civil war, the majority of refugee households are now headed by women as well. As a result our main focus continues to be on assisting children and women, and raising local capacity for their immediate and long term care.

We are continually expanding our efforts and innovating as we go along through our Social Health Care (SHC) humanitarian aide program - thinking outside the box in addressing the sheer size and depth of this unprecedented humanitarian crisis, enlisting collaborating colleagues and organizations to provide a larger, more effective, and faster service, and seeking funds to continue this life saving work.

Much is happening directly because of your support. Here is an update on our recent activities:

1)  We have organized a 4-day emergency health care field clinic in Mafraq City, Jordan in mid-June that will serve approximately 2,000 refugees with both mental health and medical treatment. Medical equipment and remaining medications brought in for this field clinic are given to our partnering local medical student association for use in follow-up medical care to refugee children at a Social Health Care service site in the area.
These clinics will continue to be conducted periodically throughout each year in collaboration with Flying Doctors of America, based on our fundraising success.

2)  In June we also conduct another on-site SHC training in immediate mental health care skills to our wonderful and committed trainees in Jordan. These trainees are already using skills learned on a daily basis to offer healing services to members of the refugee community.

3)  We are organizing weekly Women's Support Groups for refugees in Jordan, conducted by our local Social Health Care trainees, to provide emotional support, conduct stress management and expressive art therapy sessions, offer guidance in understanding trauma symptoms in children and themselves, and to teach mothers and women basic skills in stress management for themselves and their children. Mothers and women are the front line within the refugee community for reaching children with these trauma healing services, and as we provide treatment to them we are also empowering them with coping skills they can help their children with.

4)  We are organizing community gatherings where we engage children in play therapy activities and provide the refugee community in general with positive community strengthening activities to build and support resilience and balance. After being displaced, fleeing their homes and country, and living day to day in unfamiliar, stark surroundings these gatherings are invaluable opportunities to feel connected as a society again.

5)  We continue to conduct regular on-site trainings in trauma treatment skills to our trainees in Jordan, as well as 2 X per week live virtual training classes, and on-going clinical case consultation, supervision, and mentoring to trainees both on-site and through our virtual platform. These are the future healers for their society.

Next Steps:
Each step in replicating our Social Health Care training and treatment service in another country hosting refugees requires establishing reliable, formal partnerships with local registered human service organizations. We have been successfully partnering in Jordan since 2012 and are now establishing these partnerships in Lebanon, Turkey, and Syria.  

1) Within the next month we begin providing training in emergency mental health treatment skills to 15 UNRWA staff in Damascus enabling them to assist thousands of isolated civilians in the Damascus region. Since we cannot get in and they cannot get out, we have tailored an "all-virtual" version of our training program for them until it is feasible to provide on-site trainings.

2) In collaboration with UNRWA staff, we will also begin providing tele-health services directly to isolated civilians in the Damascus region, including both mental health and medical care. Remarkably, although isolated in their neighborhoods and even homes due to the violence around them, many have access to the Internet, and so can be reached for both pscho-social support and guidance on how to self-manage acute and chronic medical conditions.

3) By early July we begin providing on-going, weekly live virtual training classes to SHC trainees in Lebanon. As it is feasible, we will begin conducting on-site trainings and services in Lebanon as well.

4) In October we begin on-site and virtual training for local trauma therapists in Turkey

5) In October we are once again hoping to enlist Patch Adams and his global team of clown medical healers in joining us in Jordan and Turkey to bring the healing power of joy and compassion to the many children and their families. His group went into refugee centers with our team in October of 2013 and had a phenomenal impact. 

Links:

• Social Health Care program