When sadness doesn’t stop: helping Syrians with depression

WHO/Sheahen

At an event for Syrian refugees on World Health Day in Gaziantep, Turkey, a refugee girl performs in a skit about moods and mental health.

In a city in southeastern Turkey, a Syrian refugee woman in a blue headscarf stands up during a question and answer session with a psychologist. “One of my relatives suffers from severe sadness – loss of pleasure, loss of appetite. He doesn’t sleep well. He doesn’t want to talk to others,” she says. “I tried to help him by taking him out in nature, to change his mood. I don’t criticize or blame him, I try to make him forget.”

In the room full of 40 refugees, other participants nod. At the front of the room – a refugee community centre in the city of Şanlıurfa – 4 mental health experts listen carefully.

The session is 1 of more than 20 carried out for Syrians in conjunction with World Health Day 2017, with the theme of depression. Working with WHO’s Gaziantep field office, local organizations throughout Turkey hosted April events for small and large groups, focusing on how to cope with depression and get help when it is overwhelming.

Connecting Syrians with mental health resources

“If I’ve left my country, if a loved one has died, I’ll feel sad for sure,” says a counsellor at the same session. But when long-term sadness interferes too much with day-to-day activities and doesn’t ease up, counsellors urge the refugees to seek help.

When talking to Syrians who have experienced the worst of war, counsellors distinguish between depression and post-traumatic stress disorder. “We were in a besieged area of Syria, hungry,” says another woman at the Şanlıurfa session. “Then we came to Urfa and there was an earthquake.” It was too much for her 12-year-old son, who felt the family could not outrun danger. “He says, ‘If we don’t die in Syria, we’ll die here.’ Does he need counselling?”

During the sessions, refugees learn what help is available. At a discussion hosted by the International Blue Crescent (IBC) in Şanlıurfa, refugees reviewed Arabic-language information about depression produced by WHO. “After the session, 4 people asked for counsellors,” says an IBC psychiatrist.

“They were without hope”

Other World Health Day events focused on activities that can fight depression, like physical fitness, music and art. At the Sankari Centre in Gaziantep, dozens of Syrian refugee children sang songs, drew pictures for a contest, and performed a skit about sadness and joy using emojis. The skit was developed with help from child psychologists at a nearby centre for refugees.

“Many of the children, when they arrived here from Syria, they were without hope. They didn’t just need education, they needed activities,” says Abdulrahman Dadam, Executive Manager of Sankari Humanitarian Foundation. His Gaziantep centre for refugees has astronomy classes, mosaic-making workshops, martial arts classes and more. “We’re working to make the children happier.”

At a different event, children watched puppet shows developed with Syrian psychiatrist Fuad Almossa. In one, a puppet elephant was sad because his friend was moving to Germany – a common situation that refugee children in Turkey face. “They’re displaced too much and they lose each other,” says Dr Almossa. While the children participated in activities, their widowed mothers talked about depression, including its symptoms in children. Two female psychologists demonstrated a therapy visit via role playing and answered questions from the mothers.

Reaching across borders

Despite ongoing violence, WHO partners were also able to hold World Health Day events inside northern Syria itself. In schools, clinics and community centres – and even in besieged areas like eastern Ghouta – parents, teachers, health-care staff and students learned about ways to combat depression.

For those whose depression is not severe, experts recommend simple self-help steps for preventing depression: physical exercise, good sleep and spending social time with friends.

People who need more help sometimes need persuading. “At first, many Syrians say, ‘Oh, we’re not crazy.’ We faced a lot of problems with stigma,” says a mental health worker at the IBC. “At first, our centre was called a mental health centre. We changed it to community centre.”

Help for Syrian and Turkish people in need

WHO continues to strengthen mental health services for Syrians inside their country and in Turkey, as well as for Turkish people. In the capital city of Ankara, WHO hosted a panel in Turkish about depression in collaboration with Turkey’s Ministry of Health and with Ankara University.

WHO trains both Turkish and Syrian physicians in its Mental Health Gap programme, which teaches doctors to identify and treat psychological diseases. These doctors are also distributing Arabic- and Turkish-language versions of WHO depression materials in their communities.

“We want people to know that there is help available if they or a loved one are experiencing depression, which saps energy and joy from life,” says Dr Manuel de Lara, Mental Health Officer at WHO’s Gaziantep field office. “Throughout the year and beyond, we’ll continue training health-care workers – and talking about resources for people who are suffering.”

“These awareness-raising events are part of WHO’s ongoing commitment to improving not just the physical health, but the mental health of people in Turkey and northern Syria,” says de Lara. “We’re glad we’ve already reached thousands of people with the important message that, if you’re depressed, there is help.”

WHO’s mental health programmes for Syrians are supported by the United Kingdom’s Department for International Development and the Directorate-General for European Civil Protection and Humanitarian Aid Operations (ECHO).