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Displaced Syrians living in the Al-Hol camp are suffering from unprecedented high rates of mental health. ������ discovers what the inhabitants have been going through, and what’s being done to undo some of the psychological damage caused by the war.

Described as a "massive outdoor prison", the Al-Hol camp sits in northeast Syria, close to the border of Iraq. Some 40,000 people have been detained in the camp since 2018 following displacement during fighting between the Syrian Democratic Forces (SDF) and Islamic State (ISIS/ISIL).

The majority of those living there are children, many born in the camp,��robbed of their childhoods, and condemned to a life exposed to violence and exploitation, with no education, limited medical support and no hope in sight.

For those who have experienced traumatic events, such as violence and displacement, the camp has only exacerbated their anguish.

The symptoms of post-traumatic stress disorder, depression, and anxiety loom large over the camp, casting a shadow over the mental well-being of its residents.

“We had to eat grass to survive”

Recognising the need to offer more psychological support,��Médecins Sans Frontières (MSF)��began offering mental health services within the camp in 2021. Since then, they have helped over 10,000 detainees inside Al-Hol camp with psychosocial group activities and provided 2000 consultations during individual therapeutic counselling sessions.

“The current living conditions, unmet needs, and pervasive uncertainty about the future, coupled with the constant threat of violence, have become significant stressors for the people living in the camp," explains Nadia Fredj, a Mental Health Advisor at MSF.

“Most commonly reported symptoms and this emphasises the need for Mental Health and Psychosocial Support (MHPSS). Feedback from some of our patients indicates a sense of relief and an improvement of their mental well-being after the counselling sessions,” adds Nadia.

“We’ve heard children express their excitement about attending our clinic's play sessions, which aim to provide them with a positive child-friendly place despite the incredibly challenging circumstances.”

Um Othman, a 42-year-old mother of six and detainee at the Al-Hol camp recounts how she was split up from her family and children.

“During displacement, the family was split due to shelling, my 11-year-old son with his uncles in the village, and me with my five daughters in Hajin town. For six months, I did not know anything about my son and my siblings. We were so poor and helpless. We had to eat grass to survive. No one came to help us.”

After spending three years in the camp Um Othman travelled out to a hospital in Hassakeh after her 6-year-old daughter suffered severe burns.

“It was a stressful experience especially as there was an armed man escorting us in the ambulance” she recounts. Unfortunately, after 19 days in hospital, her daughter succumbed to her injuries and passed away."

Abu Omar, a 43-year-old Iraqi refugee, was displaced with his family in 2015 following intense shelling between Iraqi forces and ISIS.��“The bombardment was non-stop, day and night,” he recounts. “We saw people getting killed before our eyes. My kids would come to me seeking safety, but I was helpless as well. We ate leaves and grass at some point out of hunger on our three-day trip to Syria."

Since then, Abu Omar has mental health has suffered greatly. “The circumstances around our displacement were harsh and it negatively affected my mental health,” he explains.

“Can you imagine we left our houses and everything behind? When a person changes his place of sleeping, he cannot sleep, how about that, we changed a whole��country!"

Coping mechanisms

From just a glance at the waiting room of the MSF mental health clinic, it’s clear that the detainees at Al-Hol camp are suffering great mental distress.

“On average, we have 25 patients coming for individual counselling sessions every day, and around 40 patients for other mental health activities,”��says Sama, an MSF Mental Health Activities Manager at Al-Hol camp.

“In our society when someone is depressed, they say that his spirit is possessed and that he needs exorcism”

Mental health activities are a crucial part of any medical response. They can provide a safe and supportive environment for people to express their feelings, process their experiences, and learn coping mechanisms.

These activities can include individual counselling for mild to severe mental conditions (including identification and referral of psychiatric cases), psychosocial group sessions including psychoeducation, living well groups, and recreational activities.

For children in particular the clinic offers��a range of recreational and psychosocial activities, including play sessions with a dedicated playground inside the clinic. This safe space allows them to colour, draw pictures and play age-adapted games, as part of play therapy techniques.

“The goal is to provide a supportive environment that not only addresses mental health needs but also promotes active and positive engagement for the well-being of the children amid challenging circumstances,” adds Nadia.

Destigmatising mental health in Syria

In MSF’s pursuit to address the mental health crisis at Al-Hol, it has been imperative to destigmatise mental health and psychosocial care.

Encouraging open conversations about mental health is a crucial step in fostering a supportive community where seeking help is seen as a sign of strength, not weakness.

Um Khaled, a detainee at the camp has attended therapy sessions to help her deal with the psychological effects of war and can see the clear benefits of it.

“In our society when someone is depressed, they say that his spirit is possessed and that he needs exorcism,” she explains. “I was embarrassed to tell my neighbours and friends that I was seeking mental health sessions out of fear that they would consider me crazy.

“However, I really get benefits from these sessions because I now know life isn’t only about taking care of others, it is taking care of yourself too.”��

Sami Rahman is a freelance writer based in London

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