Lack of expertise leaves refugees without proper mental care, say NGOs

Jordan’s public mental health institutions lack expertise, according to aid agencies, prompting Iraqi refugees or Jordanians suffering from mental disorders to rely on NGOs under the umbrella of the UN Refugee Agency (UNHCR).

Marwa el-Ansary, refugee team leader for CARE, an aid agency, said Jordan lacked the capacity to treat the increasing number of Iraqi refugees with mental health symptoms.

According to the UNHCR, there are an estimated 750,000 Iraqi refugees in Jordan, accounting for more than 10 percent of the population. In addition to the Palestinians, this means Jordan now hosts the largest number of refugees, per capita, of any country in the world.

“The Jordanian government has been extremely cooperative and has done an excellent job as it struggles to cope with the massive influx of Iraqi refugees. More investment should go into preparing the mental health sector to respond to refugees’ needs,” El-Ansary said.

At present, there are only two psychiatric hospitals in Jordan: a public one in Fuheis town, 18km west of the capital, Amman, and the al-Rashid hospital in Amman, which charges fees that Iraqi refugees cannot afford, according to local NGOs.

Although Iraqi refugees in Jordan can be treated at public hospitals, when it comes to mental healthcare, many prefer psycho-social counselling services provided by CARE and its local NGO partners.

“Iraqi refugees in need of psychological help are breaking the taboo and have started coming to us,” a counsellor from a CARE community centre told IRIN.

Coping with trauma

According to counsellors at the CARE centre, many mental disorders in Jordan relate to gender based violence (GBV) among Iraqi refugees. A counsellor at the centre run by CARE told IRIN: “There are many Iraqi refugees living in Jordan under extremely poor conditions, a situation that can lead a frustrated husband who cannot find a job to beat his wife.”

Photo: Mohammad Ben Hussein/IRIN

An impoverished neighbourhood in downtown Amman, Jordan, where many Iraqis live

Also prevalent is Post Traumatic Symptom Disorder (PTSD), affecting men, women and children, who were exposed to torture or witnessed the killing of a family member.

A six-year-old boy who witnessed his father’s murder while driving with him has since developed PTSD. According to counsellors, the child keeps drawing graves with his father’s face, as well as red and black cars. “His father’s car was red and the one of the murderers was black. Because immediately after the murder he did not receive psychological help the boy started to talk to imaginary creatures,” a counsellor explained.

Overload

CARE officials say that since the beginning of the year, their counselling unit at the community centre has assisted about 7,000 Iraqi refugees.

Due to this overload of patients and the fact that counsellors do not have the means to undertake more than three therapy sessions, the centre refers patients to more specialised professionals for severe cases that need medication.

“We are not specialised psychologists offering deep solutions but we can detect the problem and refer it to specialists,” el-Ansary said.

In those cases fees for psychological consultations and medication, prescribed by a psychiatrist, are covered by NGOs such as CARE or the Jordanian Women Union, a local CARE partner.

However, UNHCR medical specialists agree that clinical treatment with medication alone does not solve the problem as the symptoms may reappear once the treatment is over.

“The main need is for psycho-social counselling. Cognitive-behaviour therapy does much more than just medication, or at least, when these are needed, both therapies should go hand in hand,” Riad al-Akour, a medical officer at UNHCR, told IRIN. “In addition, anti-depressants are much more expensive and therefore unaffordable for refugees who decide to go on their own to a doctor,” he added.

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