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Stanford University School of Medicine

Dispatch from Lebanon: Refugee children need education, as well as health care

I’m writing from Lebanon, which is now home to approximately 2 million Syrians, all of whom are not recognized as refugees. This includes hundreds of thousands of children and teens, who are not receiving adequate mental health care, much less the education they need to flourish.

They live in informal tented settlements, because Lebanon has not built any official refugee camps for Syrians. These groupings of makeshift tents are scattered throughout the country of which a large proportion is in Beka’a Valley. Last month, as a global mental health research assistant in Stanford Medicine's Early Life Stress & Pediatric Anxiety Program, I was invited by the Palestine Children’s Relief Fund (PCRF), an NGO dedicated to healing the wounds of war and occupation in the Middle East through humanitarian aid, to evaluate the mental health of Syrian child and adolescent refugees. I also met with key stakeholders (including Doctors Without Borders, the Syrian American Medical Society, and other NGOs) to discuss gaps in the delivery of mental health care.

Seven years into the civil war, Syrian children and adolescents in Lebanon still have trauma-related symptoms. Twenty mothers with whom I met recounted a similar narrative: their children, between 5 and 7 years old, hid petrified and shook uncontrollably in the tents the second they heard a helicopter soaring in the skies above. A girl I’ll call Asma, 10 years old, discussed how, three years since the incident, she still has intrusive thoughts of her mother being raped and tortured in front of her. A large proportion of teenagers across all settlements I visited expressed anxiety and depression symptoms; they spoke passionately about the desire to go back to Syria — or perhaps to go back in time when war was not even within the realm of possibility in Syria.

Social workers and clinicians working with NGOs discussed the overwhelming rise in child marriage, behavioral problems in children and suicidal ideation in teenagers. They spoke of the lack of resources, including human personnel, governing the delivery of mental health services, the majority of which still depends heavily on a specialist (psychiatrist or certified psychologist) for psychoeducation and treatment and does not incorporate sufficiently community-based resources.

Everywhere in Lebanon, in almost every informal settlement across the country, one reality becomes blatantly clear: even if we dramatically increase young refugees’ access to mental health treatment, it is not enough. It is not enough when more than half of Syrian children and adolescents in Lebanon do not have access to any type of education, pivotal in normalizing the appalling conditions and ensuring better mental health outcomes. It is not enough when an optimistic and capable generation of adolescents — a generation that once dreamed of becoming lawyers and journalists and doctors — now cannot read or write.

Any successful mental health intervention in this setting must thus also provide greater access to education, which remains exceedingly difficult due to overcrowded schools. Now, we must all work hard together to ensure we support a generation of children and adolescents who are healthy and educated, for they will be the generation to rebuild Syria in the future.

Laila Soudi is a research assistant in global mental health in Stanford Medicine's Early Life Stress & Pediatric Anxiety Program. Originally from the Middle East, Laila has been working extensively with refugee populations from and in the Middle East.

Photo courtesy of Laila Soudi

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