Treating former child soldiers and refugees is tough yet fascinating

My first client of the day is Ahmed. He witnessed around 30 people, including family members, drowning when the boat in which they were crossing to Europe, sank in a storm. He feels guilty for surviving. He was one of the youngest on the boat, so was wearing one of the few life jackets.

This morning I’ll try to help Ahmed with the flashbacks he has every time it rains, with the nightmares that wake him every night about drowning, people calling his name in the darkness, bombs falling, bodies on the street. He is claiming asylum in the UK. He knows that some people don’t want him here, but he’s frightened of going home. His home town is being bombed, and he doesn’t feel wanted there either.

For all the stories of human suffering, these are also narratives of survival

After Ahmed, I’ll see Erica, who was beaten so badly by her husband that she has a metal plate in her skull; Louise, who regained consciousness in the middle of an operation, able to feel everything but unable to move or raise the alarm; and Alex, who dreams every night about the colleague he could not save when their vehicle was hit by an IED in Afghanistan.

As a trauma therapist, this is a normal day for me. Some people associate post-traumatic stress disorder (PTSD) only with military veterans, but my clients come from a huge range of backgrounds. Almost any life-threatening experience can cause PTSD, as can sexual assaults, witnessing terrible things happen to someone else, or hearing about them repeatedly as part of your job.

There is still a stigma associated with many mental health problems, and PTSD is no exception. Some people feel it is a sign of weakness, and they should just be able to get over what has happened. Others are unaware that help is available, or that treatments are effective.

There is no shortage of referrals, and managing the waiting list is a constant struggle. Trauma therapists spend their days listening to some of the most heartbreaking and horrifying stories imaginable. Confidentiality prevents us talking about what we have heard outside of the therapy room, but we support each other with time, care, biscuits and humour.

NHS trauma services exist in various cities across the UK, but service provision is patchy and postcode-dependent. Cuts over the years have put further pressure on mental health services which are already spread thin, leaving many therapists feeling burnt out by unachievable targets and endless waiting lists. Insidious measures to cut costs, such as limited session numbers, freezes on recruitment and service restructures (another word for cuts) continue to whittle away services, and lead to patients waiting longer for less treatment.

Why would I choose to work in this field? It is fascinating. I’ve heard firsthand accounts of what it is like to be recruited as a child soldier, to survive the Rwandan genocide, to travel Basra’s road of death. Perhaps not experiences everyone would want to hear but, for all the stories of human suffering, these are also narratives of survival. My clients have escaped, endured and overcome events which can, and have, killed many others. I bear witness to their fortitude, and help them mend the mental scars.

Thankfully, many of my clients recover. Trauma memories are not forgotten, but they can fade. Through treatment, clients achieve goals which many of us take for granted, like sleeping through the night without nightmares, or meeting new people without fearing they will be attacked. Things which were previously out of reach because of their symptoms, like working and having relationships, become achievable.

There is no magic pill or quick fix to treat PTSD. The most effective treatments are trauma-focused. Rather than avoiding the horrific memories, therapy involves talking about them, processing what happened, and making sense of what can feel senseless. We spend some sessions out of the office, helping clients to overcome situations and places which they have been avoiding, teaching them to discriminate the past from the present.

As a therapist, seeing someone who has been so mentally, emotionally, and often physically, damaged, begin to heal is incredibly rewarding. On a gloomy day, I read the cards and letters that clients have written to me after treatment. They tell stories of recovery and hope.

Knowing the potential for recovery will help me in my session with Ahmed today. At the moment he feels that he lost everything worth living for in that storm over the Mediterranean. Today, we’ll start picking up the pieces. We’ll talk about what happened, and grieve for the losses. We’ll try to put the bad memories in the past, so that he can look towards a future. When that happens, it will remind me again why I do my job.

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Treating former child soldiers and refugees is tough yet fascinating

Tortured Syrian refugees need specialist help | Letters

A reported 55% of the Syrians who have been given protection in the UK under the Syrian resettlement programme are torture survivors, according to the National Audit Office. The NAO report, a review of the progress of the Syrian Vulnerable Persons Relocation Scheme (VPRS), highlights concerns of human rights charity Freedom from Torture that these vulnerable people are not able to access specialist help so that they can begin a journey of rehabilitation and rebuilding their shattered lives. Freedom from Torture provided input to the report after raising repeatedly with the former minister for Syrian refugees the need to ensure that all of those resettled under this scheme can access specialist support including torture rehabilitation.

Without these services it can be difficult for survivors to address the trauma they have faced and to access other opportunities that are being provided, such as English language lessons. Since the launch of the scheme we have received only a few referrals for resettled Syrians and we are concerned that many more are being resettled in areas where they cannot access support. Our concerns are shared by local authorities, which highlighted that those refugees with physical or mental health needs require substantial support, especially in the long-term, which is not covered by existing funding arrangements.

We welcome the UK’s commitment to provide sanctuary to torture survivors and other vulnerable Syrians through this programme and to meet its arguably modest goal of accepting 20,000 Syrian refugees by 2020. As the only UK-based human rights organisation dedicated to the treatment and rehabilitation of torture survivors, we know that torture is widespread in Syria. This scheme’s objective is to help the most vulnerable, so we are surprised not to have more being referred to our centres. Torture survivors risk being either identified too late or missed entirely. The government needs to immediately improve its coordination with specialist voluntary sector providers. The amount of funding given to local authorities to support each refugee will be reviewed after the programme has been in operation for a year. We strongly recommend that mental health services are included in the programme without delay so that torture survivors coming in the next wave of the refugee resettlement scheme get the vital support and services they need and deserve.
Susan Munroe
Chief executive, Freedom from Torture

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Tortured Syrian refugees need specialist help | Letters

Kid marriage soars amid Syrian refugees in Jordan

Maha, a 13-year-outdated Syrian refugee in Jordan, says she was pressured to marry her 23-year-old husband due to financial issues. Photograph: Save the Children

Child marriage among Syrian refugees in Jordan has a lot more than doubled since the begin of the conflict, leaving girls vulnerable to overall health difficulties, domestic abuse and poverty, the UN has warned.

According to a report by the UN children’s company, Unicef, virtually a third of registered marriages between Syrian refugees in Jordan between January and March this yr involved ladies beneath 18. Jordan is home to much more than 600,000 registered Syrian refugees.

The prevalance of such unions has been growing because 2011: ahead of the war, 13% of registered marriages concerned youngsters. The surge is likely to have a damaging result on the girls’ future, the UN warns, jeopardising their wellness as nicely as their educational and monetary prospects.

According to the report, 48% of ladies marry men at least ten years older. “Girls who marry just before 18 many years of age are at increased danger of complications throughout pregnancy and of being victims of abuse,” explained Robert Jenkins, Unicef’s Jordan representative. “They also have much more constrained financial options due to reduction of schooling and can get trapped in a vicious cycle of poverty.”

The review identifies many aspects accountable for little one marriage: alleviating poverty or the burden of a big family with numerous daughters supplying protection for younger ladies continuing traditions, cultural or household and serving as an escape for girls residing in an abusive property environment.

Yasmine, a sixteen-12 months-old Syrian refugee who lives in a camp in Jordan, advised Unicef she married a 24-yr-previous guy nine months ago. She is 5 months pregnant. “When I was younger I was dreaming about becoming a style designer, but now I cannot achieve that simply because of my predicament,” she said.

Yasmine’s mom mentioned Syria’s civil war had brought on many child refugees to drop out of college, which had enhanced prices of child marriage between refugees.

“Some respondents reported that a teenage daughter’s poor functionality at school could be reason adequate to get started searching for a husband for her. In their see, there was tiny stage in continuing with her training,” the report says.

Interviews with Syrian refugees in Jordan, carried out by Unicef and Conserve the Youngsters, suggest social and familial stress lie at the root of many kid marriages.

Maha, 13, said: “My father forced me to get married simply because he heard about a rape situation close by. He was frightened the identical would happen to my sister and me. He forced my sister to get married initial, and then he made me get married right after that. It was all very forceful and I had no decision. I did not want to get married. I would’ve liked to finish my scientific studies, but I could not do that.”

Her husband, Abdullah, 23, explained he married Maha right after her father approached him through mutual acquaintances. “Her father desired her to get married,” he stated. “She was going to register for college but there were a great deal of rapes taking place in the camps. Her father was scared anything like that would come about to her, so he married her off. Also, it is so difficult for a Syrian to locate employment right here – he was struggling with payments and rent.”

Abdullah said the humanitarian crisis in his home nation had impacted social conventions. “If we were in Syria and Maha was around this age, her father wouldn’t marry her off,” he stated. “She’s as well younger at 13. No one particular marries off their daughters at this age in Syria.”

Even though child marriage is witnessed as a way of preserving cultures and protecting vulnerable women from the uncertainties of refugee existence, humanitarian companies argue it is a destructive practice. “Youngster marriage is devastating for individuals girls concerned,” said Justin Forsyth, chief executive of Conserve the Children. “These women, who by fleeing the war in Syria have already been subjected to more than any youngster must, are at severe danger of psychological overall health problems resulting from social isolation, pressure and abuse.”

He said the physical effects of little one marriage could at times be fatal. “The consequences for girls’ wellness, of engaging in sexual action even though their bodies are even now creating, are devastating. Ladies below 15 are 5 instances more probably to die in childbirth than totally grown ladies.”

Little one marriage and female genital mutilation will be higher on the agenda at the Lady Summit subsequent week, which aims to galvanise global action to finish both practices within a generation. The summit will be held in London on 22 July and hosted by Unicef and the Uk government, with David Cameron in attendance.

Refugees’ names have been changed to protect their identities

Kid marriage soars amid Syrian refugees in Jordan

WHO warns of risk to Syrian refugees as Mers virus circumstances enhance sharply

Syrian refugee young children in Lebanon’s Bekaa Valley. A health skilled said: ‘It could spread quite rapidly, provided their residing circumstances.’ Photograph: Sam Tarling

The Globe Overall health Organisation (WHO) will hold urgent talks following week on the usually fatal Middle East respiratory syndrome (Mers) virus, soon after a sharp enhance in infections in Saudi Arabia, and the 1st reported case in Lebanon.

The virus has killed 164 individuals in the Middle East in the past two many years – 126 in Saudi Arabia alone – and the quantity of cases in quite a few countries in the region has risen in recent weeks.

There are fears that secondary infections may possibly be growing, raising the potential for a greater global spread, and stirring memories of the Sars virus, which claimed far more than 700 lives in east Asia in 2003, leading to mass concern and disruption.

Mers is a coronavirus, like Sars, but is not transmitted as simply. Nonetheless, much more than 30% of people contaminated with it die, as opposed to a ten% mortality fee with Sars sufferers. The fairly large death fee has alarmed public well being officials across the area, specifically individuals working with vulnerable Syrian refugee populations.

One more 5 deaths and 14 new infections have been announced by Saudi authorities on Friday.

After a reality-locating mission to Jeddah this week, the WHO mentioned there had been no “substantial alter in the tranmissibility of the virus”. The organisation explained most Saudi situations had occurred in healthcare centres and unique screening measures and travel restrictions have been not yet necessary.

Dr Adam Coutts, a public overall health researcher functioning on refugee well being, stated: “It is not inevitable that refugees will become infected but it is extremely very likely they will in locations this kind of as Jordan and Lebanon.

“It could spread very swiftly, provided their living problems, poor sanitation and overcrowding. They are extremely vulnerable and the least in a position to recover.”

There is no vaccine for Mers and specialists are nevertheless struggling to create why it has become so potent. Infected patients usually suffer from a lung infection that brings about fever, coughing and breathing difficulties. Some also suffer fast kidney failure. Most of these who grew to become ill have been both hospital staff or patients who had been admitted for some other cause.

“The significant issue in a nation like Lebanon is that the health system is presently underneath stress. The ministry of public overall health is overstretched in terms of a overall health information technique for monitoring well being trends and hazards,” Coutts mentioned.

Lebanon’s health minister, Wael Abu Faour, mentioned thermal scanners had been put in at Beirut airport in a bid to detect feverish travellers contaminated with the virus. He explained the 1 patient so far diagnosed with Mers had been treated and released from hospital.

The WHO explained 496 instances of Mers had been recorded in the past two many years, 463 of which had been in Saudi Arabia. Only 254 have been confirmed in laboratories. The virus is thought to have originated from camels.

As effectively as refugees, other big transitory populations are also considered to be at danger. Saudi Arabia sees millions of Muslim pilgrims from all around the world travelling to Islamic holy web sites each and every 12 months. A week ago, Public Wellness England put out an alert for airline passengers who could have come into make contact with with a guy later diagnosed with Mers who travelled from Riyadh to Chicago by way of London.

Cases have also been reported in France, Germany, Spain, Italy, Tunisia and Oman.

WHO warns of risk to Syrian refugees as Mers virus circumstances enhance sharply