Reeling from the effects of civil war and natural disaster, northern Syria is in the grip of a mental health crisis, as suicide rates soar and funding for services falls short.
A dearth of treatment centers and trained psychiatrists mean most of those affected find themselves isolated, in a country where mental illness is still stigmatized, patients and specialists tell SciDev.Net.
The long civil war that started in 2011, along with a series of devastating earthquakes that killed more than 55,000 people in Turkey and Syria in February 2023, have left deep scars among survivors.
Stifling economic crises, unemployment and poverty are compounding the impacts of these events, adding to the psychological damage, observers say.
According to Syrian Response Coordinators, suicide rates have risen significantly this year, with 104 suicides and 87 suicide attempts recorded throughout the country.
Many of these were in northwest Syria, where responders have recorded 37 suicide deaths and 21 suicide attempts so far in 2024, representing a 14 per cent increase compared to the same period last year, according to Doctors Without Borders (Médecins Sans Frontières/MSF).
Memories of torture
Forty-one-year-old Amer is one of many citizens imprisoned by the Syrian regime during the conflict who have now been released, left with the memories of the horrors they faced.
Amer, who prefers not to disclose his full name for fear of repercussions, tells SciDev.Net: “I was subjected to all kinds of torture, including beating, hanging, and burning.
“When I left prison [after three years], I tended to live in isolation and spent most of my time sleeping to escape the harshness of reality. Even my dreams turned into nightmares.”
Others are shackled by disabilities left by the war, such as 23-year-old Dalal, displaced in a makeshift camp on the outskirts of the city of Idlib in northwestern Syria.
“A missile from a warplane fell close to me and changed the course of my life forever,” Dalal tells SciDev.Net.
“I went from being a determined and optimistic young woman to a victim of war and a victim of psychological and physical illness.”
For Dalal, who now suffers from severe depression, this bitter experience is impossible to forget. “I live in my own hell, isolated from everyone,” she says. “I feel very tense when I hear loud noises, because they remind me of the sounds of shells and explosives.”
Children traumatized
Many of those bearing the brunt of these crises are children, who have grown up among ruins and devastation, experiencing terror and loss.
Eight-year-old M.S., whose real name is withheld to protect her, lost all her family members in the 2023 earthquake and now lives with her aunt.
The aunt tells SciDev.Net: “My niece remained under the rubble for more than five hours until she was rescued. Since that day, she has been disconnected from reality.
“She suffers from panic attacks and screams from time to time. The doctor confirmed that she suffers from post-traumatic stress disorder.”
Baraa Al-Juma, a mental health specialist at the Mental Wellness Unit of the Syrian Civil Defence, known as the White Helmets, tells SciDev.Net: “Difficult living conditions, ongoing displacement, arrests, injuries and loss are all factors that have increased the prevalence of mental illnesses, but early intervention can limit the aggravation of these conditions and help promote mental health.
“The groups most at risk are those facing ongoing hardship, such as displaced people, women and children, as well as frontline workers, such as volunteers in rescue teams,” he adds, noting the need to focus not only on treating mental illness, but also on building psychological resilience and adaptability among these groups.
Social stigma
Al-Juma says the social stigma associated with mental illness prevents many people from admitting they have a problem.
Some do not realise that mental illnesses are medical conditions that require therapeutic interventions, he adds.
During more than 13 years of conflict in Syria, mental health has been sidelined in favour of emergency health care, leaving a dearth of mental health centres and services in the northwest of the country, where hostilities are ongoing.
The World Health Organization notes that mental health services in northwest Syria remain extremely limited, “available in only four health facilities, and there are only two psychiatrists to serve a population of 4.5 million.”
It estimates that nearly 1 million people there suffer from some form of mental health disorder.
Ayham Khattab, a psychiatrist with MSF in northwestern Syria, tells SciDev.Net that the charity is providing psychological support sessions as well as activities for children aimed at promoting mental health.
Among other things, the sessions aim to break down the stigma associated with psychiatric medications and the false perception that mental disorders are a sign of weakness, he explains.
Funding crisis
However, humanitarian support to tackle the impacts of Syria’s multiple crises faces a major funding deficit.
According to the United Nations Office for the Coordination of Humanitarian Affairs, only a quarter of the US$4.1 billion needed to fund the humanitarian response plan in northwest Syria has been received this year to date.
The health sector also faces a funding gap of US$471 million, with only around ten per cent of needs met, according to MSF. It says the shortfall threatens essential health services, with mental health care most likely to be deprioritised.
“People in northwest Syria have endured years of violence, displacement and deprivation. They need the opportunity to heal not only from physical wounds but also from the deep, unseen psychological scars left by this crisis,” said Thomas Balivet, MSF’s head of mission in northwest Syria, in a report released last month.
“Investing in mental health is an investment in a more stable future where people can regain their lives.”
Al-Juma added: “This is not limited to Syria alone but extends to all countries in conflict in the region that are facing the same fate.”
New insights on the association between genes, gut microbiota, and mental health