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Refugee Youth Traumatized by War: Overwhelmed, Understudied

his article is the first in a two-part series. The second article, “How to Help Refugee Youth Recover From Trauma,” looks at how health-care workers, educators and others can help youth traumatized by war and violence.

Ongoing conflicts in Yemen, Syria, Libya, Iraq and Palestine are putting generations of the Arab world’s children and teenagers at risk of severe mental health problems and—later on in life—becoming violent adults.

Experts complain that not enough scientists are paying attention to the issue, however, resulting in sparse data and hampering efforts to help. Nevertheless, they say the existing research clearly shows youngsters exposed to violence are more at risk of long-term psychological impacts than adults with the same kind of exposure. Children and teenagers exposed to war, bombings, and violence are more likely to suffer from depression, anxiety, post-traumatic stress disorder, and attention deficit disorder.

The youth at risk are part of the massive forced migrations in the Arab region. “More than half of the displaced people are children,” explains Vania Alves, a psychosocial-support consultant for the nonprofit International Rescue Committee. “It’s a massive, scary problem we’re facing.”

Along with the estimated 11 million Syrians who have left their homes since the war began, millions of Yemenis are internally displaced within their country, and over 180,000 of them have fled the country. Most Yemenis have fled to neighboring Oman, but a large number have also crossed the waters of the Bab al-Mandab Strait to the relative safety of Djibouti. In Libya the number of refugees making the journey to Italy has quadrupled since 2013.

Many of the refugee youth have experienced shocking hardships. A study in Turkey among refugees found that 79 percent of children had experienced a death in their family, and 60 percent had witnessed someone getting shot at, kicked, or otherwise physically hurt.

Traumatized youth could cause more conflicts in the future. “Research shows exposure to violence has consequences,” says Isabella Castrogiovanni, a senior child-protection specialist at UNICEF. “It contributes dramatically to building violent personalities. There is no doubt about that and we are certainly very worried about it.” UNICEF is also getting reports from within Syria that children are committing suicide.

The violence in homes, battlefields and from airstrikes is not the only factor contributing to the mental health problems of refugee youth. “Their daily regimes are disrupted, the journeys are dangerous and some of them travel alone and are at risk of neglect and abuse,” says Alves.  “When you put all this together it exposes children to several cumulative risk factors for their social development.”

To compound matters, most refugee families are unlikely to seek help for mental health issues, say psychologists.

“Parents don’t recognize the symptoms. The concept of a psychological disorder often doesn’t exist in their countries of origin,” explains Frank Neuner, a psychotherapist at Bielefeld University, in Germany, who has treated refugee children in Africa and published studies on his success rate. “Mental illness is still stigmatized here in Germany, but it’s even worse in Syria or Afghanistan.”

The lack of research focussing on the Arab world’s most pressing conflicts means interventions are largely based on research from other conflict zones like Israel or Rwanda. This research may be relevant and can be used to help children escaping any war, but it prevents practitioners like Castrogiovanni and Alves from creating a tailored and evidence-based approach specifically for the Arab world’s refugee youth.

“We’re just assuming the blueprint is entirely transferable,” says Alves. “We need more investment and research that takes into account different belief systems and cultures.”

Selcuk Sirin, a psychologist at New York University who writes about the mental health needs of Syrian refugee children, is editing a special issue of the journal Vulnerable Children and Youth Studies, which will focus on this subject, and sent out a call for papers.

“We couldn’t find more than five people, and two of them were from my team,” he says. “It’s an area that social scientists and psychologists don’t seem to care about.”

Golan Shahar, a clinical-health psychology professor at Ben-Gurion University in Israel, has monitored the psychological development of Israeli children who grew up close to Gaza and were routinely exposed to missile attacks. He says the effects are profound and cause for concern.

“I don’t have any access to Gaza’s youngsters,” he says. “I’ve tried but I couldn’t get it. I suspect they’re going through the same thing on the other side of the border. It’s awful that both sides mirror each other’s tragedy.”

Shahar followed the social progress of 300 teenagers from 2008 through 2011 — during a period when there was protracted violence across Gaza’s border with Israel. He recorded which of his research subjects had been exposed to or witnessed missile attacks and then monitored whether they became violent.

“Severe violence in my study was defined by the extent to which they hit someone else where the victim needed medical attention, the frequency with which they carry weapons and how often they are arrested,” says Shahar.

He notes that the participants most exposed to violence were 121 percent more likely to be violent later on. “We found devastating effects,” he says, “not only on their mental health but also on their propensity to commit severe violence. It’s very alarming, because it feeds back into the political violence.”

He and other scientists studying trauma say the roots of behavior change are biological: “The brain develops very slowly over the first two decades of life, especially the part of the brain in charge of control and decision. Stress adversely impacts this development. Kids in conflicts are under enormous stress.”

He worries that Arab refugees have it much worse than the Israeli teenagers he has studied. “They don’t have a country and their family-support structure is often disrupted. Whatever I’ve found in Israel you should multiple by a factor of I don’t know what—ten?”

But hope threads through Shahar’s results. He says children are surprisingly resistant to violence and can often witness and experience it without developing worrying behavior later in life. But they need the right support systems in place to promote their resilience. The most important part of that support is family structure, says Shahar—those with supportive family members are more likely to develop normally. Unfortunately, many refugee children are orphaned or separated from their parents.

Such routine disruption of families makes early intervention all the more important, says Castrogiovanni from UNICEF.  Global donors need to invest in organizations that can give refugee children as much of a sense of normality as possible when they arrive in the relative safety of refugee camps, she says, such as schooling and counseling.

While some research points toward solutions, that research needs a great deal of refinement, social scientists say.

“The job of the researcher is to identify problems and show solutions so those with the resources and funds can tackle them, but if we’re not doing that then it’s hard to imagine solutions taking form, and when they do, it’s not based on science,” says Sirin, the New York University psychologist.

Alves also says that more research like Shahar’s, which follow study participants over time, is needed. “The overwhelming research at the moment gives you a one-time snapshot of the situation. But we need a long-term effort, which will take a lot of investment.”


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