As the Syrian crisis enters its tenth year, severity and complexity of humanitarian needs remain extensive. Years of continued bombardment, attacks on civilians, doctors, health workers, and healthcare facilities have left an extremely vulnerable population in Syria. The healthcare infrastructure has been decimated leaving people with limited to no access to emergency and specialized medical care as they are struggling with disease and malnutrition among other illnesses. Countless Syrians, less visibly, whether they remained inside Syria or sought refuge in Turkey, Jordan, or Lebanon, are in need of mental health care after being exposed to the traumatic experiences they have faced for the past 10 years.
The United Nations High Commissioner for Refugees (UNHCR) notes that “the most prevalent and most significant clinical problems among Syrians are emotional disorders, such as: depression, prolonged grief disorder, posttraumatic stress disorder and various forms of anxiety disorders.”
The demand of Mental Health and Psychosocial Support (MHPSS) services in the area will continue for a long period of time according to field assessments done by UN agencies (WHO – UNICEF- UNFPA - & UNHCR) as the consequences of the war will remain especially for the new generation. “No Lost Generation” UNICEF 2018 Annual Report. MHPSS is a vital ongoing adaptation process that needs to be conducted with high standards of care according to WHO and Inter-Agency Standing Committee (IASC).
UOSSM’s ROLE IN MENTAL HEALTH IN THE SYRIAN CRISIS
UOSSM has played an integral role in mental health, as a leader, expert, and innovator, in the Syrian crisis, and led the way by taking strategic mental health initiatives since 2013, to find constantly evolving solutions for the growing mental health issues arising among the Syrian people due to the armed conflict. UOSSM:
- Established the first Mental Health and Psycho-Social Support (MHPSS) centers in Reyhanli in Turkey late 2013, and in northwest Syria early 2014, with Tele-Psychiatry support, in addition to establishment of the only inpatient acute mental health unit in northern Syria.
- Initiated an operating model and pathways to be able to provide MHPSS and protection services from a single facility to cover the multiple needs of beneficiaries, in coordination with the other service providers in the field.
- Trained hundreds of Syrian service providers on MHPSS and protection services, who became experts in this field in the native language of the beneficiaries.
- Played a major role in establishing MHPSS strategy within the Syrian context in WHO cluster, Turkish Hub.
The goal of the MHPSS and Protection programs is to improve the psychosocial well-being and resilience of the vulnerable people affected by the Syrian crisis, in addition to focusing on adaptation and cohesion of the Syrian refugees in Turkey to enhance social integration among the refugees and the Turkish communities.
MENTAL HEALTH AND PROTECTION IN TURKEY
Child with speech disorders trained at the special education department of MHPSS in Istanbul, Turkey
UOSSM Turkey launched the Mental Health and Psycho-Social Support (MHPSS) Program in late 2013 to reduce the migration and the negative effects of the conflict on Syrian refugees in Turkey, by operating the first MHPSS center in Reyhanli in Turkey, followed by an expansion of the MHPSS program to several locations in Turkey.
Over the last 7 years, UOSSM Turkey established five (5) MHPSS centers, including Reyhanli, Gaziantep, Kilis, Ankara, Istanbul. It currently operates four (4) of these MPHSS centers in Turkey. Each center has a team of psychiatrists (Syrian and Turkish), psychologists, clinical psychologists, child psychologists, speech therapists, Special Need Rehabilitation (SNR) facilitator, a nurse, and case workers.
The MHPSS program aims to improve access to Syrian refugees and Arabic-speaking people in Turkey for comprehensive Mental Health (MH) and Psycho-Social Support (PSS) services for all age groups, as well as Special Need Rehabilitation (SNR) services for children with special needs. The MHPSS program includes capacity building of the local community in mental health issues, in addition to adaptation and cohesion services to enhance the integration among refugees and local Turkish communities.
The Community MHPSS centers provides a wide range of services, including assessment, treatment, counseling, case management, special needs rehabilitation (SNR), training, follow-up, surveys, family and caregivers counseling, and other services to the refugees - predominantly Syrians. In addition, MHPSS centers provide outreach services at schools, displacement camps, houses, orphanages, clinics, hospitals, and others.
UOSSM-Turkey incorporates many protection services within its current MHPSS centers and services in Turkey.
UOSSM Turkey provides the following services at its 4 MH Centers in İstanbul, Gaziantep, Kilis, and Reyhanli, in Turkey:
- Mental healthcare (MH), including psychiatric interventions, as well as individualized and group PSS counselling sessions to refugees who present with signs and symptoms of mental health issues and disorders, including but not limited to, depression, anxiety, PTSD, and survivors of Gender-Based Violence (GBV).
- Provision of Psychotropic medications, prescribed by licensed psychiatrists, which are dispensed to the patients free of charge at designated pharmacies in Turkey.
- Provision of mental health services to GBV survivors
- Special Needs Rehabilitation (SNR) services to children with special needs, developmental disorders (such as Autism), mental retardation (such as Down Syndrome), language, hearing and speech disorders, Attention Deficit Hyperactivity Disorder (ADHD), adaptation difficulties, learning difficulties, and behavior modifications.
- Referral of beneficiaries with protection concerns to appropriate services available in the area after initial assessment.
- Capacity building and training of staff and service providers of government and nongovernment organizations (NGOs) on MHPSS and related topics, developing capacity to provide and expand specialized MHPSS services to the local communities in years to come.
- Capacity building and training on MHPSS and SNR topics of different types of groups, including school administrators, teachers, administrators and caregivers at orphanages, community centers, and others.
- Outreach services and educational sessions to raise awareness on mental health concerns in the community, directed to school teachers, families and caregivers in orphanages, child friendly spaces, and local PSS centers. In particular, training of parents, caregivers and family members on how to deal with children with special needs (SNR); guided through individual and group awareness sessions.
MENTAL HEALTH AND PROTECTION IN SYRIA
Child with special needs trained at the special education department of MHPSS in north Syria
I. MENTAL HEALTH AND PSYCHOSOCIAL SUPPORT PROGRAM IN SYRIA
UOSSM launched the Mental Health and Psychosocial Support (MHPSS) Program in early 2014 in north Syria, to reduce the negative effects of the conflict on the Syrian people.
Due to the lack of Syrian psychiatrists, (only one psychiatrist remains in northwest Syria at UOSSM’s MHPSS referral center), a tele-referral service was established, to address the high demands and needs. This Tele-Psychiatry service continuous to support the work of UOSSM’s psychiatrist in Syria and provides the technical support needed.
Training on World Mental Health Day by the only psychiatrist in northwest Syria at UOSSM Mental Health Center
To build and improve MHPSS work strategies, UOSSM coordinates with a variety of partners in different sectors, led by different UN agencies, and plays an important role in these sectors. Because of UOSSM’s expertise with wartime mental health concerns, UOSSM participated in in the design of a specialized psychosocial support guide, in partnership with WHO, that is being deployed to all the social workers in Syria. The guide includes many skills, techniques, and programs that are necessary in approaching mental support. In addition, UOSSM was elected to serve on the technical advisory committee for the mental health sector for Syria in Turkey and worked with the UN Refugee Agency initiative to establish communication between protection and mental health sectors.
UOSSM’s MHPSS services in Syria include:
- Mental health, including psychiatry intervention and provision of psychiatric medications, free of charge
- Psychotherapy and psychosocial support (group- individual)
- Special Needs rehabilitation (SNR). The services are provided to children with special needs, pervasive development disorders (such as Autism), mental retardation (such as Down Syndrome), language and speech disorders, Attention Deficit Hyperactivity Disorder (ADHD), and children with learning difficulties in schools. In addition to training of parents and family on how to deal with children with special needs; guided through individual and group awareness sessions
- Provision of mental health to Gender-based Violence (GBV) survivors
- Outreach services and awareness campaigns
- School mental health services
- Training and capacity building in the MHPSS program
- Provision of MHPSS services at UOSSM’s Primary Health Care centers and mobile clinics
- MHPSS hotline phone consultations; 6 days/ week
The training and capacity building in the MHPSS program include:
- Training different types of groups, such as schools, teachers, primary care givers in PHCs, hospitals, rehab centers, orphanages, community centers, and NGOs staff members, in addition to specialized training for psychologists and psychotherapists.
- Some of the specialized training courses, designed under World Health Organization (WHO) include:
- Mental Health Gap Bridging Program (MH-GAP); Special training in psychiatry provided to general practitioners to cover the gap of lack of psychiatric specialists in northern Syria.
- Training MHPSS workers on mental health first aid, supportive communication skills, techniques for clinical interviews, case management in MHPSS, facilitating support groups, problem solving, evaluation skills, different mental support programs (stress mgmt., self-care, recovery techniques), behavioral cognitive therapy (CBT), evaluation of children with development and mental disorders, accelerated therapy for children, and designing behavioral rehabilitation programs and family guidance programs.
UOSSM currently operates the following centers in north Syria:
- The only Inpatient Acute Mental Health Unit of 20 beds in northwest Syria
- The major Outpatient Referral MHPSS Clinic in northwest Syria
- Four Mobile MHPSS Units in the region
- MPHSS center in Al-Bab, in north Syria
UOSSM Al Bab Mental Health and Psychosocial Support Center
II. PROTECTION PROGRAM IN SYRIA
In 2017, UOSSM developed protection interventions focusing on Child Protection (CP) and preventing and responding to Gender-Based Violence (GBV). The program is aimed to enhance the protection of at-risk groups from the effects of conflict, including, but not limited to, protection activities that are specifically designed to prevent and respond to rights violations.
UOSSM builds local capacity in many areas, including psychological first aid, child protection case management, family tracing and reunification, parenting skills training, and protection monitoring. UOSSM participates in the protection sector working group in northern Syria and coordinates with staff to discuss challenges and develop solutions. UOSSM also participates in family reunification and child labor working groups, focusing on the development of intervention and response strategies.
UOSSM’s protection interventions are developed in accordance with standards and guidelines internationally recognized by UNICEF, UNFPA and UNHCR. Since 2017, UOSSM has provided protection services to tens of thousands of people, primarily women and children in north Syria.
UOSSM’S protection services fall into the following categories:
1. COMMUNITY-BASED CHILD PROTECTION:
UOSSM promotes Child Protection (CP) through:
- Structured and sustainable psychosocial support programs within child-friendly centers.
- Awareness campaigns on children's rights and protection concerns, plus establishing community-based child protection committees trained on child protection standards and referral mechanisms
- Awareness campaigns on land mines, ordnances, and explosive material risks
- Parenting Skills Programs. Although, the children are the target group for most services, there are specific guiding programs for the parents to ensure continuity of childcare, after children leave UOSSM facilities
2. SOCIAL PROTECTION SERVICES:
- Community awareness and psychosocial support
- Publicizing available services to activate conversion mechanisms in targeted areas
3. WOMEN AND GIRLS’ EMPOWERMENT:
Women’s empowerment also falls under the umbrella of protection services. The program not only includes Gender-based Violence (GBV) prevention and response, but also includes skills development activities to empower the women and girls in their community.
- Psychosocial support
- Awareness of protection issues
- Specialized services through case management
- Skills development activities such as sewing and basic principles of reading and writing
UOSSM provides protection services in north Syria:
Protection services at UOSSM’s MHPSS center and mobile units, and through UOSSM’s specialized Protection Centers:
- Three child centers
- Five community centers
- One facility specifically for women and children