Last month, a 31-year-old named Ahmad cut himself 150 times all over his body. Stuck in a refugee camp on the border of Greece and Macedonia, he was overwhelmed by a sense of hopelessness about the future. I spoke with Ahmad about his experiences, and he told me, "We've sewn our mouths shut in protest of these conditions. We've committed suicide in desperation. Articles have been written. TV journalists have come and interviewed us. Then what? Nothing is being done. Our world reminds us every day that we are not worthy of life. We are less human than everyone else. We escaped war to be trapped here with literally nothing -- and no one cares."
As a mental-health researcher in the Department of Psychiatry and Behavioral Sciences at Stanford, I decided to join the Syrian American Medical Society (SAMS) Global Response initiative on a medical mission for one week on the border of Greece and Macedonia. There, thousands of refugees who escaped war and conflict most prominently from Syria, Afghanistan, and Iraq are stuck due to Balkan states shutting their borders and preventing refugees from reaching their target countries in Europe. I left for my trip early June, and it was there I met Ahmad.
As a native Syrian whose family lives in Jordan, I've been working with refugee populations in the Middle East for years. Going into Greece, I anticipated the conditions in refugee camps to be similar to those in Jordan, but I was mistaken. It turns out that refugees on the border of Greece and Macedonia are in concentration camps rather than refugee camps. Devoid of basic necessities such as running water, medical care (and translators to ensure understanding if medical care were available), education for any children, and an official evacuation or resettlement plan, refugees on the border of Greece and Macedonia are denied their humanity every day.
While in Greece, I performed a basic mental-health needs assessment. Given the extent of trauma witnessed and lived, every refugee could greatly benefit from psychological support. Hundreds of children in the camps remain too scared to go outside to play. Hundreds of refugees expressed that if it hadn't been for suicidality being a sin in Islam, they would have killed themselves a long time ago. Depression, anxiety, and hopelessness pervade the camps with suicidal ideation rates reaching at least 70 percent.
As the newly appointed director of mental health for SAMS Global Response, I'm now responsible for building an infrastructure to ensure the effective provision of mental-health services on the ground including psychotherapy. Given the acute shortage of resources on the ground, the individualized psychotherapy model used internationally to varying degrees -- and used regularly in psychiatry here at Stanford -- is not applicable. Instead, the provision of services must rely on task-shifting, in which lay refugee community leaders must be trained on basic therapies for dissemination among the broader community.
Although the provision of mental-health services in Greece among refugee populations is necessary, it's not nearly sufficient. Ultimately, the well-being of refugees like Ahmad will be met only when their basic human rights are granted -- only when, having faced ineffable adversity, they get to live with freedom and hope for a better future.
Laila Soudi is a researcher in psychiatry and behavioral sciences at Stanford's School of Medicine, as well as the director of mental health for SAMS Global Response. A native Syrian, Laila has been working with refugee populations for years.
Photo courtesy of Laila Soudi
