There is a mental health crisis among refugees – here’s how we can help fix it

We must be a voice for all those displaced, by funding and enabling effective support to bring light to those in darkness, writes Eleanor Monbiot

Being displaced is already a vicious cycle of fear, hopelessness and depression (Getty)

When you lose your home as a refugee, you lose everything. The outlook is immediately bleak: most displaced families are not able to afford food to meet their daily nutrition needs; a quarter are keeping children out of school due to the economic hardship they face; a fifth are sending children to work and, in places like Afghanistan and Niger, significant numbers are resorting to child marriage.

These very concrete symptoms of displacement are startling, but what is even more heartbreaking is that there is another growing crisis for the world’s refugees and displaced people – symptoms which are harder to see. The mental health toll of losing it all.

Globally, mental health is gradually being met with more empathy and action, but progress is far from equal. Across the Middle East, which is the source of 54 per cent of the world’s refugees, discrimination, denial, ignorance and stigma of mental health issues are still the norm.

Rarely talked about and even more rarely treated, women and children are left to suffer and often die in silence and alone. Their pain is whitewashed from the dialogue.

Many displaced people I work with tell me how life changes in an instant. A life of stability, happiness, home and family is replaced at a stroke by continuous movement, discrimination, hunger, loss of loved ones, friends, opportunity, shelter, food and access to health care; not knowing if you will make it to the next morning, let alone ever make it home again.

The effects of displacement on mental health are devastating. Studies show that over 22 per cent of conflict-affected people may suffer from some form of mental health disorder. However, the reality is even bleaker in places like northwest Syria’s hard-to-reach “widow camps”. These camps are just for women, girls and boys under 11 years old, and they face chronic and high levels of violence, including neglect, verbal, physical and sexual abuse, as well as child marriage and child labour. In response, those in the camp are regularly choosing to take their own lives when faced with overwhelming levels of deprivation and desperation.

Another study we did in Syria found that suicide rates tripled in just three months. Yet mental health support is virtually non-existent. In Ukraine, 1.5 million children are at risk of PTSD, depression or anxiety. With more than a quarter of parents having no knowledge of available mental health services, we found that almost half of all children in eastern Ukraine say their peers have had their homes damaged or destroyed, and that over half were turning to smoking or drug addiction as a coping mechanism.

Being displaced is already a vicious cycle of fear, hopelessness and depression, but recent events have caused a rise of discrimination and xenophobic rhetoric as economic outlooks worsen and refugees are used as a political and financial weapon. The last few weeks have seen a significant increase in forced return of Syrians from Lebanon, in many cases ripping families apart and leaving children alone – and highly vulnerable.

There is hope. There are effective models to prevent and treat mental health issues that are being used across the world. I have visited many such programmes and have seen the transformation of children from withdrawn shells of their former selves, often rendered mute, drawing dark and disturbing pictures on pieces of paper with crayons, into children bubbling with enthusiasm, imagination and a hundred questions.

Investing just $50 per displaced person now could prevent millions of people affected by the conflict from developing more complex mental health issues such as anxiety, depression, schizophrenia and bipolar disorder. Sounds easy? Not so when a fraction of a percentage point of Overseas Development Aid is spent on mental health, and most current humanitarian appeals are grossly underfunded. In addition, in every context there is a very significant lack of mental health professionals and referral systems.

It is tragically naïve to believe that a generation of children with mental health issues can ever fulfil their potential or bring their countries to levels of stability and sustainability. We must be a voice for all those displaced, by funding and enabling effective mental health support to bring light to those in darkness.

Eleanor Monbiot OBE is currently serving as the regional leader for Middle East and Eastern Europe for World Vision