Iraqi refugees overwhelm Syria's mental health system

Photo of Iraqi refugees at the Red Crescent Center in Sayda Zeinab, Syria. Photo by Rania Abouzeid/Special to The Chronicle Photo of Iraqi refugees at the Red Crescent Center in Sayda Zeinab, Syria. Photo by Rania Abouzeid/Special to The Chronicle Photo: Rania Abouzeid/Special To The Ch Photo: Rania Abouzeid/Special To The Ch Image 1 of / 1 Caption Close Iraqi refugees overwhelm Syria's mental health system 1 / 1 Back to Gallery

2007-04-14 04:00:00 PDT Sayda Zeinab, Syria -- Omar Mohammad is busy watching Ali, his mentally retarded 4-year-old brother, weave between dozens of other Iraqi refugees at a crowded Red Crescent clinic outside Damascus.

At first glance, Omar seems like any other curious 10-year-old, but his dark eyes conceal a deep unease. Although he is safe in this Shiite town from the sectarian violence that ravaged his Baghdad neighborhood, he can't get the war out of his head.

"I don't want to ever go back to Iraq," Omar said. "But I wonder if I'll see my friends again and if they are safe."

Four months ago, Shiite militiamen stormed into Omar's home in Mashtal in eastern Baghdad, ordering his Sunni family to leave the area. Several days later, they joined the 1.2 million Iraqis who have flocked to Syria since the U.S.-led invasion began in March 2003.

Among the refugees are countless children like Omar who struggle to cope with the emotional wounds of war.

The U.N. High Commissioner for Refugees is working with local nongovernmental organizations to identify, refer and treat the most vulnerable.

"It's challenging in Syria. ... There are no international NGOs (nongovernmental organizations) and limited local ones," said Mai Barazi, the U.N. agency's assistant community services officer in Damascus. "The country itself doesn't have an existing system."

The Syrian Red Crescent in Sayda Zeinab -- one of a handful of NGOs working with the United Nations -- is clearly overwhelmed. Two waiting rooms teem with patients; a woman in her eighth month of pregnancy sits on stairs near the clinic entrance while several middle-aged men perch against a wall waiting to be seen by a doctor.

In addition to treating physical ailments, the clinic refers only the most serious emotional problems to Damascus psychiatrists because of a lack of funding and resources. Abdel-Aziz Taha, the facility's general manager, acknowledges that most of the 250 patients who arrive daily need some kind of counseling.

"We send about five people (to see psychiatrists) every day," he said. "Most of them are very badly off."

Many referrals are for traditional one-on-one therapy in the downtown Damascus clinic of Mohammad Sayed al-Hafez. The 61-year-old psychiatrist says most Iraqi adults are suffering from war trauma compounded by depression stemming from an inability to find work or fit into Syrian society. He typically gives them anti-depressants.

But children like Omar, he says, require a different approach. "They need family support and a community-based approach. They don't need medication."

The Sisters of the Good Shepherd agree.

The nuns, who work with the U.N. agency in the Christian neighborhood of Masaken Barzeh on the outskirts of Damascus, hold group therapy sessions for children, headed by a local psychiatrist who asked not to be named. He incorporates games, puppet shows and artwork into his therapy methods and plans to get more parents involved in helping their children cope with war-related stress.

"The nuns were seeing a lot of disturbed Iraqi children," said the psychiatrist, who said he is not authorized by the state to work with Iraqi refugees. "The aim is to let the community help itself."

Every Saturday for seven months, a tiny chapel has been transformed into a clinic for 28 children, ranging in age from 7 to 14. "The children start laughing. They make friends. They have self-confidence again," said Sister Therese Msallam, a wiry woman with graying hair.

In the meantime, Iraqi refugees are being blamed by many Syrians for straining education and health facilities, taking jobs from local workers and causing rising inflation. Many are also worried the refugees will spark sectarian hatred in this secular society.

"These people came to Syria after sectarian bloodshed," said Mohammad Habash, a member of parliament who also heads the Damascus Center for Islamic Studies. "Maybe they're looking for revenge. The main danger is if they find themselves here with their enemies. Syria cannot carry all these problems."

Since there are no U.N. High Commissioner for Refugees-affiliated clinics in Sunni neighborhoods, Omar's family must seek aid in Shiite towns such as Sayda Zeinab and wait for medical attention alongside Shiites.

"I'm uncomfortable with that," whispered Omar's mother, Huda Mohammed, 41. "I gave my sons a Sunni name (Omar) and a Shiite name (Ali). I didn't know what sectarianism was before."

For now, Omar worries about friends he left behind, misses personal mementos he couldn't bring along, and laments the loss of another school year. He had stopped attending class in Iraq last year because his parents feared he would be kidnapped or killed just for having a Sunni name. Most important, he can't enroll in a Syrian school because his school records also were left behind.

Omar's mother doesn't want her children to feel hatred toward Shiites or any other Iraqi, but she knows Omar is resentful that a Shiite family now lives in their Baghdad home. She is worried that four years of war has deeply traumatized her two sons.

"They were both terrified, 24 hours a day," she said. "If there's a counseling service, I want them in it."