Co-Author: Dr. Hana Abu-Hassan
Syrian refugees both in the Middle East and Europe face harrowing adversity from escaping war and persecution to being resettled to ill-equipped, often uninhabitable, refugee camps and urban communities. As a direct result of this adversity, Syrian refugees exhibit alarmingly high levels of mental illness, including post-traumatic stress disorder (PTSD), depression, and anxiety. Some health care workers offering services to refugees on the ground are developing stress responses as a direct result of their experiences with Syrian refugees. These stress responses are secondary traumatic stress (STS) and burnout. STS symptoms parallel those who have had direct exposure to the traumatic event and include intrusive images, avoidant behavior, and physiological arousal. An associated process, burnout entails elements of emotional exhaustion and reduced personal accomplishment. Emerging either while still on the field or, more often, after having finished their service trips and returned home, the stress responses of health workers are as a result of several factors. The principal contributing factor is their acute and overwhelming exposure to Syrians' stories of excruciating adversity, severe levels of psychiatric illness, and as well as their harsh living conditions. Furthermore, still on the ground, health care workers' stress responses are exacerbated by long days of service with limited time for breaks. On average, as a direct result of an overwhelming need and an acute shortage of resources and personnel across refugee camps in Greece, health-care workers are on the ground 10 hours a day. Lastly, the process of reintegration back home -- pretending to have been left unscathed after witnessing trauma -- has proven difficult for some health care workers. Danielle, now back from a medical mission, walks the streets of London looking for refugees walking along train tracks and tents on roadsides and old buildings. Matthew, back in California, has been experiencing acute sadness, hopelessness, and social withdrawal. In the face of seemingly insurmountable adversity, he questions what he has actually done -- or can do -- to alleviate conditions for refugees when the world has utterly and inexcusably failed them. Organizations to which health care workers belong must step up and address these mental health needs. Prior to deployment, organizations must provide accurate, descriptive information on the situation in refugee communities across Greece to prepare health care workers. This information must be specific to the country, as the health needs and living conditions of refugees there are drastically different than Syrian refugees living elsewhere. Also, while cognizant of the shortage of resources and personnel, organizations must establish longer breaks and appropriate, evidence-based debriefing sessions at the end of every day to ensure health care workers have space to process their experiences and share them. Lastly, organizations must ensure all health care workers have access to mental health services upon their return to their home countries to ensure better assimilation. At a time of incredible adversity and ineffable conditions, organizations must step up not only to meet the mental health needs of Syrian refugees but also, equally importantly, their health care workers.