“We’re doctors but we’re also human”: helping Syrian health workers handle severe stress

WHO

Muhammed, a Syrian nurse, suffered many traumatic experiences in Homs before coming to Turkey, where he now works alongside Turkish colleagues to treat his fellow Syrians.

Health professionals working in northern Syria face constant fear and worry – for their patients, for their families, even for their own lives. “The medical staff were trying to encourage each other, so the patients knew their doctors were still standing,” says one doctor who worked at a bombarded hospital. Though he survived the experience and now lives in Turkey, he and many other health staff from northern Syria bear psychological scars. For those still in the country, the constant pressure translates into a clear need for mental health support.

A doctor still working in northern Syria, who prefers to use the name Abulaman, says he has experienced a 180 degree turn in his life since the conflict began. Before the conflict, he remembers going for walks with his family after work. Now, he says, “Many days we can’t speak to our families when we get home, because of what we see [at work]… When we get home, we can’t look at our children. We think, ‘What if this happens to them?’”

“We’re doctors but we’re also human,” he concludes.

As renewed fighting makes the situation in northern Syria ever more challenging, WHO and its health partners continue to develop ways to mitigate the mental toll taken on health workers.

The mental health impact of working in danger zones

“I feel depressed because of the traumatic experiences of the people I help” and “I find it difficult to separate my personal life from my life as a helper” – these are 2 of the statements gathered from a WHO psychological assessment survey taken by more than 200 Syrian health workers. The survey measures burnout, defined as “work-related hopelessness and feelings of inefficacy”, as well as the effects of secondary exposure to extremely stressful events – for example, seeing images of the victims of an attack.

The survey found differences between Syrian health workers inside northern Syria and those working in neighbouring Turkey. This is partly related to health workers in northern Syria being under direct attack: more than 62 verified attacks were carried out on health-care facilities in the first half of 2017 alone.

However, the conflict has had serious consequences for both groups. According to Dr Manuel de Lara, Public Health Officer for WHO’s field office in Gaziantep, Turkey, secondary stress can include being afraid, having difficulty sleeping, having images of the upsetting event pop into your mind, or avoiding things that remind you of the event. Dr de Lara also points out that many humanitarian workers feel frustrated by the fact that the lives of Syrians are not improving, in spite of all they are doing to help.

The survey is part of ongoing activities led by the WHO field office in Gaziantep, located close to the Syrian border. WHO work aims to address and reduce the psychological toll that the crisis is taking on aid workers. These efforts include:

  • seminars for medical and humanitarian staff to reinforce good self-care (i.e. what aid workers can do for themselves to stay healthy and handle stress);
  • a workshop held in May 2017 encouraging local non-governmental organizations to prioritize staff care and resulting in a common policy;
  • a training manual entitled Self-care among humanitarian aid workers in Turkey, developed by WHO and partners;
  • plans to create a 24-hour hotline offering counselling and support for Syrian humanitarian aid workers who are working and living in Turkey;
  • plans to train trainers who can then lead workshops on self-care for humanitarian aid workers.

This focus on self-care and staff care complements WHO’s ongoing work to support the mental health of Syrians. In the early months of 2017, WHO trained hundreds of family physicians, community health workers and mental health staff in both Turkey and northern Syria in its Mental Health Gap (MHGap) programme, helping them identify and treat common psychological conditions.This activity was carried out with support from the Ministry of Health of Turkey.

Discouraging isolation, encouraging interaction

Both self-care and staff care are urgently needed in the context of the Syrian response. “So many health staff are themselves displaced,” says Dr Fuad Almossa, a Syrian psychiatrist. “We encourage them not to be isolated. We say, ‘Don’t just see patients. At least one day a week, socialize with family and friends.’”

“We need to support the well-being of humanitarian staff,” emphasizes Dr de Lara. For supervisors of stressed-out workers, something as simple as starting a one-on-one meeting by asking “How are you?” can make a difference.
Improving staff care can have an important ripple effect. “If we as doctors get psychological support, we can deal better with our patients,” says a Turkish doctor who attended a MHGap course.

World Mental Health Day 2017: mental health in the workplace

This year, World Mental Health Day, marked on 10 October annually, focuses on mental health in the workplace. A recent WHO-led study estimates that depression and anxiety disorders cost the global economy US$ 1 trillion each year in lost productivity. Some jobs may carry a higher personal risk than others (e.g. first responders and humanitarian workers), which can have an impact on mental health and be a cause of symptoms of mental disorders, or lead to harmful use of alcohol or psychoactive drugs. Risk may be increased in situations where team cohesion or social support are lacking.

Additionally, this year’s World Health Day “Let’s Talk” campaign focused on raising awareness about depression and reducing stigma by educating people about how to support those living with depression – including through the simple act of talking with them and having an open dialogue about what they are experiencing.

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