Staring out into the Idlib countryside, Umm Amal gazes at the young children walking through the muddy roads of northwest Syria and tearfully remembers her own daughter will never return home.
Her daughter, Amal, took her own life earlier this year at 21, having spent her adolescence in a war zone, then survived child marriage, and then been forced to flee her home and settle in a displacement camp.
“Amal was the joy of my life. She was loved by everyone. How I long to see her smile again,” said Umm Amal, who asked that neither her real name nor that of her daughter be published because of the sensitivity of the issue.
Experts say Amal’s death is part of a worrying rise in depression and suicide amongst girls and women in rebel-held northwest Syria, which includes Idlib province and its surroundings. While there is no complete data on the problem, three practitioners and researchers all told The New Humanitarian they had witnessed a significant increase in attempts and deaths by suicide of girls and women over the past year or so in the region, where there are few trained professionals available to help.
After so many years of war, mental health problems are likely prevalent in men – and across Syria – but the experts said that suicide was of particular concern for women and girls in the northwest due to the extra burdens, abuses, and marriages they face. Nearly a third of people interviewed for a new report released last week by the NGO Plan International, conducted with Women Now For Development, said the latter factor, child marriage, is a “key reason” for the rise in self-harm and suicide among adolescent girls in the rebel-held region.
“Many women feel that they are persecuted against in their new communities and lack support, since their families reside in other areas.”
The region is home to some 4.4 million people, including 2.8 million who have been internally displaced, many of whom lack access to decent housing, clean water, and jobs. While violence has abated since its height in early January 2020 – when President Bashar al-Assad’s forces and his Russian allies went on the offensive against the rebels that control Idlib and its surroundings – there are still occasional airstrikes, and civilian lives remain at risk.
In a late April statement, Save the Children said the majority of deaths by suicide in the region (out of a total 246 deaths and 1,748 attempts in 2020) were among internally displaced people. Sondos Felfela, a Syrian psychosocial support expert who has worked with various NGOs on mental health and gender-based violence in northwest Syria but asked that her current employer not be named because she wasn’t authorised to speak to the media, emphasised that forced displacement is especially hard on women.
“Many women feel that they are persecuted against in their new communities and lack support, since their families reside in other areas,” she told The New Humanitarian. “Women have also been forced to take on traditionally male responsibilities, becoming the sole provider. This leads to... pressures on women that can be difficult to handle.”
As Felfela pointed out, while the level of overall violence has decreased in most parts of Syria, many people – after more than 10 years of war – are dealing with trauma and struggling to get by due to a rapidly deteriorating economy. In Idlib, times are even harder than usual as the Turkish lira, which was partially adopted in June 2020 to avoid the Syrian currency’s inflation, crashes to new lows. All of these problems put extra pressure on those who have had to flee home and are separated from support systems like family, friends, and co-workers.
Amal dealt with all these issues and more: She was first married at 13 – her mother said the family believed this would provide her with a better life than they could give her – but divorced shortly after. She was never able to go to school, remarried at 17, became a mother to three children, and had to flee her home in southern Idlib two years ago, at the height of a government assault on the rebel-held region.
Umm Amal said her daughter’s family struggled with money in the camp where she lived, and her husband wouldn’t allow her to leave her tent. She eventually divorced him, but feared she would lose custody of her kids. “After my daughter’s divorce, our community started speaking negatively about my daughter and about me. It affected her greatly,” said Umm Amal.
It is usually impossible to pinpoint the cause of a suicide, as there are often multiple factors involved, but Hanin al-Sayd, a Syrian journalist and aid worker who publishes under a pseudonym and requested that it be used here, said Amal’s life follows a sadly familiar pattern.
While all Syrians are dealing with the scars of war, al-Sayd, who has been researching and writing about suicide amongst women in northern Aleppo, said women and girls in camps often struggle with a lack of privacy, are unable to move freely due to safety concerns or restrictions from their families, and many are unable to attend school.
For girls, displacement can also lead to child marriage – when parents not only believe it will mean one less mouth to feed but often think it will improve their daughters’ lives. Child marriage has become more common during Syria’s war, and in the last few years particularly in the northwest (as well in refugee communities).
Plan International said its interviews indicate a “dramatic increase” in child marriage, and while 50 percent of mothers they interviewed in the northwest opposed the practice for their daughters, 43 percent were against it in times of peace but supported it during war time. “They explained that it would protect adolescent girls from the increased harassment experienced during displacement and would reduce the economic burden on the family, especially for female-headed households,” the report says.
Umm Amal believed that marrying her daughter at 13 was her only option: “[Marrying daughters young] relieves families from economic burdens, especially for those in the countryside,” she said.
Al-Sayd said this experience is often deeply traumatising for young girls. She said those who marry young are likely to find their dreams cut short, have to deal with domestic abuse, and can end up with a host of (often untreated) psychological issues. “Suddenly, a young girl finds herself in a camp with many suitors trying to marry her,” she said. “She is unable to fulfil her dreams, since she cannot complete her studies.”
Lack of treatment options
Despite the myriad pressures girls and women face in Syria, there is a dire lack of mental health treatment options for displaced people in and around Idlib.
Omar Said Yousef, a psychologist in northwest Syria who has worked with various NGOs and the World Health Organization to develop their mental health and psychosocial support programming, said there is currently only one psychiatrist permanently based in the region. A second travels between Turkey and Syria, but is often not in the country for months at a time.
There are other services available: Felfela and Yousef both pointed out that there are a few centres that help women who are victims of gender-based violence, although Yousef worries that these facilities often don’t refer women on for more comprehensive mental health support, given the lack of options.
“In northwest Syria, there is a lack of clinical specialists, and most psychologists are trained using outdated information that does not cover war trauma.”
Even those facilities that do have mental health treatment on offer may not be fully prepared to deal with the level of violence and disruption that Syrians have been forced to confront over the course of the war.
“In northwest Syria, there is a lack of clinical specialists, and most psychologists are trained using outdated information that does not cover war trauma,” Yousef told The New Humanitarian. “Some of them do not even carry proper licenses to practice.”
‘A community issue’
With Syria’s war in its eleventh year, trauma is often multi-generational, and Yousef said that suicide impacts not only a family, but also entire communities. That’s why he believes its important to put resources towards building awareness of mental health and suicide, including pointing people towards those resources that are available, and reducing stigma for those who seek mental health treatment or have issues.
“The largest misconception about suicide is that it is an individual issue, when really it is a community issue,” Yousef explained. “A community has a shared responsibility of caring for all its people. If we only focus on suicide as a clinical, mental health, or individual issue then we don’t put our full efforts into the right place.”
Felfela said the stigma surrounding mental health often continues after death. She recently dealt with a case of a family that became outcasts in their community after their daughter died by suicide. They were told she had a “lack of faith” or was “diseased”.
In fact, al-Sayd said this sense of shame around mental health and suicide, combined with a highly religious population in the northwest who tend to believe suicide is a sin, means that many deaths do not end up in official statistics.
“It breaks my heart that I didn’t get her help.”
At least in northern Aleppo, where she works, al-Sayd said hospitals often don’t report deaths by suicide at the request of families, meaning the real numbers could be higher than statistics capture. “Religion dominates communities in northern Syria which does not accept suicide as a permissible death,” she explained. “Families of suicide victims are pressured by societal stigmas to lie about the causes of death.”
For her part, Umm Amal wished she had done more to help her daughter. She said she didn’t know about the severity of her problems, and didn’t step in to help.
“It breaks my heart that I didn’t [get her help],” Umm Amal said. “I hope that girls and women who are struggling with mental health seek out support from people who can help them, so that they do not suffer like my Amal.”
Edited by Annie Slemrod.
If you are in crisis, click here to find a helpline near you (via the International Association for Suicide Prevention).