Mental health care will be a priority for physicians
Hundreds of docs volunteer services to help
The Syrian refugees who pour into Canada during the next few months will have overcome incredible odds.
They avoided death in a civil war that has killed more than 200,000, trekked enormous distances to get out of Syria and now are among the lucky few to be resettled in a wealthy, peaceful Western nation.
But the ordeal that led them here has taken a hefty toll on their health, a fact Canadian medical providers will soon have to confront.
Many Syrians have amputations and other war injuries, are nursing chronic diseases that have gone under- treated for years or cope with psychological conditions from insomnia to post- traumatic stress and severe depression.
Aid organizations report children struck mute by their encounters with violence.
“Most of them left either after their house was destroyed, or they had at least one or two close relatives or friends who died,” said Paul Yon, who heads the Medecins sans frontieres mission in Lebanon. “We have people who have quite a lot of signs of stress, depression and so on.”
The good news for the refugees headed to Canada is that help awaits. “Hundreds” of physicians have volunteered their services, says Dr. Phillip Berger, co- chairman of Canadian Doctors for Refugee Care.
In Toronto alone, 10 clinics have agreed to treat refugees.
“In many ways, a migration like this is unprecedented … the numbers could be staggering,” said Dr. Meb Rashid, medical director of the Crossroads Clinic, one of Canada’s few health facilities dedicated to refugees. “( But) there are a lot of health- care workers who really want to contribute.”
The government, meanwhile, says it will ensure the previous Conservative administration’s controversial cuts to health services for some refugees will be restored.
Berger, medical director of the inner- city health program at Toronto’s St. Michael’s Hospital, said he is still concerned, though, that Ottawa has provided limited information about the Syrians to physicians.
“You can’t leave it to local doctors to organize health services,” he said.
Exactly what medical services the refugees will need is unclear.
Things could certainly be worse for the 4.2 million Syrian migrants spread throughout the Middle East. Tuberculosis and other infectious diseases are not major issues. Syrians come from a middle- income country where — until “the bottom fell out of their world” — they had relatively good health and health care, said Rashid.
But in safe havens such as Lebanon, Iraq and Jordan, treatment for diabetes, hypertension and other chronic diseases has been limited. And neglected, those illnesses become more lethal, said Yon.
German doctors writing in the New England Journal of Medicine last month reported on other types of physical problems among the Syrians they screened: A boy tortured by ISIL with cigarette burns, a girl with an untreated jaw fracture, burns and shrapnel wounds.
Psychological trouble, though, may be the migrants’ most significant health problem.
The rate of actual serious emotional disorders is only up slightly from normal levels, to about five per cent, said Mohamed Elshazly of the California- based International Medical Corps. But four in 10 of the Syrians are suffering some sort of more transitory mental- health symptom — from insomnia to loss of appetite or depression, he said from Lebanon.
It is not just the horrors they endured in Syria that torment them, but the loss of dignity and other difficulties of being on the run, said Elshazly.
Academics in Jordan found ample evidence of emotional suffering when they interviewed Syrian migrants there.
“They are in desperate need of serious psychological help and support to overcome the trauma and the horror they have been through,” their study said this year.
Of those refugees treated by the IMC across the region, 54 per cent had a severe emotional disorder like depression or anxiety, 27 per cent epilepsy and 17 per cent a psychotic condition such as schizophrenia, according to a report by the group.
Though there is evidence that refugees are at higher risk for psychosis and epilepsy, the large numbers probably have more to do with the fact only the sickest people sought out the corps’ specialized services, said Elshazly.
As for what Canada will have to provide in health care, he believes only about five per cent of the Syrians who end up here will need treatment from a mental health professional.
Some others will see their emotional problems resolve with help from primary health care. But about half the mental- health issues are likely to be cured with much simpler remedies: stability, decent housing, community support and help integrating into Canadian society, said Elshazly.
“I saw a lot of Syrian refugees who came to Turkey and they did not receive what they expected in support … They decided by themselves to go back to Syria, to areas in the middle of the conflict, putting themselves in 100 per cent risk of death,” he said.
“They decided to do this rather than stay in a country that provided them with a safe environment, but no other type of understanding or support.”