The Syrian Civil War continues unabated, lasting longer and killing more people than anyone could have predicted when it began in March 2011. Like all wars it will one day end. Yet the challenges which will face Syrian society during the peace to follow may be as unsurmountable as the horrors raging today.
The death toll of more than 300,000 people killed in the war means millions of Syrians who have lost family members in violent circumstances. Nearly ten million displaced Syrians ensures that almost an entire culture has experienced the harrowing ordeals of life as an unwelcome refugee. Out of such an apocalyptic scenario Syrian society cannot reemerge without carrying a heavy burden of trauma that could affect the country for decades to come.
Although human beings have been aware of the damaging mental effects of violence since as far back as when we began raiding our neighbors’ villages armed with spears, it was the industrial violence of the First World War that taught us how truly debilitating to an individual’s psyche violence could be. The term ‘shell shocked’ entered our vocabulary.
But it was with the treatment of veterans following their return to the United States from conflict in the jungles of Vietnam in the 1960’s and 70’s that psychologists’ understanding advanced and the terms ‘trauma’ and ‘Post-Traumatic Stress Disorder’ (PTSD) were developed.
A generation of American culture and media addressed the impact this trauma carried back from Vietnam had on their young soldiers. And yet that was a war taking place far from home in which only a minority of the country’s total population participated. The violence of Syria’s upheavals on the other hand is something that no person there, be they civilian or combatant, male or female, young or old, is likely to be excluded from.
“If we look at the average Syria civilian then we can expect very high rates of Post-Traumatic Stress Disorder (PTSD),” Danny Horesh, a licensed clinical psychologist and assistant professor at Bar-Ilan University in Israel, told The Media Line. Symptoms of the disorder can include hyper arousal, a constant sense of alertness, avoidance of traumatic reminders, depression, and flash backs to events in the war, the psychologist said.
Essentially there are four different levels Syria will be traumatized on, functioning as overlapping circles of difficulties – the individual, the family, the community and the society – necessitating mental health intervention in the years to come, Horesh said.
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How such large levels of trauma is dealt with will affect the path a future Syria – whether it be a unified state or several splintered new nations – takes. Paul Jackson, a professor of politics specializing in post-conflict studies at the University of Birmingham in England, identified two key areas where trauma could shape the future -- memory and displacement.
Trauma can have so severe an impact on a person’s mind that numerous individuals present at a single event can remember it from vastly different angles, Jackson told The Media Line. A Syrian civilian might remember government artillery shells landing in the village square killing many local people; while a Syrian government soldier recalls the sniper fire from a tower in a rebel held village which necessitated return fire. Two versions of the same event -- both engrained in survivors’ understandings of what happened.
A phenomenon known as ‘contested memory,’ if extrapolated out over an entire nation can create huge lasting divisions within the society which make peace moving forward very difficult to maintain.
Displacement of large sections of the population can also have a debilitating impact post-conflict, Jackson, who conducted studies in the aftermath of wars in Sierra Leone, Nepal and Columbia and who travelled in Syria prior to the uprising, said. In Sierra Leone entire cities emptied and were later filled by new people, as locals simply found the location too stained in their memory to continue living in. “If you think about what a lot of those Syrian cities look like now, what are people going to go back to?” the professor said, adding in rare cases he had seen cities that experienced 100% population displacement.
Treatment will be essential for much of the population in order to avoid such problems affecting Syria as it moves on in the decades to come. Citing the four levels of trauma mentioned earlier, Horesh explained that society as a whole cannot be treated directly. Instead, the remaining three circles are targeted through therapy for individuals and investment in psychological resources for the family and the community.
Therapy for individuals suffering from trauma often comes in the form of either Prolonged Exposure sessions or Cognitive Processing Therapy. Exposure is conducted by a psychologist in a controlled environment by opening a patient up to the memories that they are suppressing, Horesh explained. Cognitive processing on the other hand, addresses a patient’s understanding of themselves and the meaning they take from their memories, rather than directly addressing the traumatic incident.
For the family and the community, treatment for trauma is through re-development of resources that have been depleted by violence. This can be concrete resources such as financial and food security, or it can be intangible elements such as strong leadership or communal cohesion. Trauma makes an individual feel isolated – by boosting the resources of the community this sense of vulnerability can be counteracted, Horesh explained.
But if any such treatment or community outreach is to take place Syria is likely to need outside assistance. After years of warfare it is unlikely that the country’s health infrastructure will be up to the job of treating so many traumatized people.
While humanitarian aid is important, it would be a mistake for international charitable organizations to neglect mental health and trauma recovery initiatives as Western countries have a large pool of knowledge which could be a boon to those in need, Horesh suggested.
It is possible however that so many people were affected by Syria’s violence that not all those needing psychological help in the years after the war will find it. This conjures up images once again from American cinema of a generation left haunted and untreated by a war which has long ago ended.
Recent history offers some lessons learned. Africa’s Sierra Leone, a country once synonymous with child soldiers and blood diamonds, is now on a path to recovery with a growing economy, having several years ago held its first independent (without UN assistance) elections since the end of the decade-long war in 2002. There was widespread trauma there following the civil war, due to the widespread targeting of civilians, but through key measures some of the issues associated with trauma have been mitigated against, Jackson said.
Treatment for PTSD focused upon the country’s children, enabling the finite resources available for therapy to be efficiently invested in the country’s future, the professor explained.
Other options taken included measures designed to boost the people’s sense of security such as placing UN peace keeping soldiers in every village and town. While this did not directly address the psychological effects of trauma, it sought to reassure civilians that they were finally safe.
A strategy of this sort might be a necessary part of any solution to PTSD in Syria due to the masses of people likely affected by the scale of the country’s war. If such actions are not taken in the years to come, peace in a future Syria might be better than today but still a hell for many.
As Jackson said, “All wars end eventually but they don’t all end well.”
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