This post was written by Nicholas J. Diamond, JD, MBE. Nicholas is trained in both law and bioethics, and frequently speaks and writes on various issues in public health law. He is also a LL.M. candidate in global health law at Georgetown Law. Any questions should be directed to firstname.lastname@example.org.
I was struck by a recent blog post in the Canadian edition of The Huffington Post, which offered a compassionate perspective on the mental health challenges confronting the growing number of Syrian refugees that the Canadian government has wholeheartedly welcomed into the country. I have written elsewhere about the need to focus greater attention on the public health crisis that attends the forced migration of approximately 4 million Syrians and the internal displacement of an additional over 7 million Syrians. Mental health must be a major component of any public health response to the refugee crisis.
Reports from multiple international organizations providing mental health services to Syrian refugees have noted the prevalence of a wide spectrum of mental health disorders. For example, using a 6,000-person caseload of refugees in Syria and along its border, the International Medical Corps found that 31 percent suffered from severe emotional disorders, such as biopolar disorders, and 10 percent suffered from schizophrenia. As a further example, a 2015 study focusing on approximately 300,000 Syrian refugees in Germany concluded that as many as half could be suffering from post-traumatic stress disorder.
Organizations like Médecins Sans Frontières (MSF), among others, have helped to provide mental health services to Syrian refugees, but the international community must bind together to address the difficult challenges ahead.
Average global spending on mental health has always been lower than spending on physical health, with mental health spending as low as US$0.25 per person per year in low income countries. Mental health services for Syrian refugees require, among other vital components, skilled professionals and access to appropriate medicines. Because many refugees have settled in countries with already strained health care systems, such as Jordan, the role of the international community in securing appropriate funding through, for example, both public and private sources, is ever more crucial.
Language and cultural barriers. Differences in language, cultural norms, and religion can create barriers to the provision of appropriate and effective mental health services. The United Nations High Commissioner for Refugees (UNHCR) has published a report that provides valuable information on the sociocultural background of the Syrian population, as well as cultural aspects of mental health and wellbeing germane to care and support. Mental health treatment efforts must incorporate cultural competency through available educational materials like that from the UNHCR and training for mental health professionals who treat the refugees.
Current data available through the UNHCR indicates that a significant portion of the Syrian refugee population is under age 18 (approximately 26 percent of all males and approximately 25 percent of all females). As MSF has emphasized, children are particularly vulnerable in the refugee crisis, with many having experienced highly traumatic events, such as killings and beatings, and having to leave their homes under dangerous conditions. Mental health professionals should be attuned to and experienced in treating common mental health issues for refugee children and adolescents, such as mutism, bedwetting, regressive or aggressive behavior, and constant fear and anxiety. Special emphasis must also be placed on providing for appropriate educational settings, which is especially difficult for refugees, because schools are uniquely situated to play a primary preventive role in the mental health of refugee children.
These challenges exist within a complex and uncertain legal framework. As Gostin and Roberts rightly argue, the lack of a comprehensive international system to hold states accountable for how they treat refugees places millions at risk. This is particularly worrisome for the large number of internally displaced Syrians, who remain under the purview of national law. As others have noted, national laws respecting the treatment of internally displaced persons (IDPs) in accordance with the Guiding Principles on Internal Displacement vary widely, and suffer from implementation, monitoring, and enforcement difficulties.
At a normative level, the international legal community must remain mindful of the fundamental fact that the right to health clearly incorporates mental health, suggesting that the mental health rights of Syrian refugees must not go unnoticed at either the international or national level. More practically, the international legal community must include mental health in any monitoring and evaluation efforts, in order to ensure that mental health protections receive appropriate attention. Particularly for national laws regarding IDPs, the international legal community should play a more active role in ensuring that mental health not only receives equal attention in the fundamental protections outlined in those national laws, but also that implementation efforts do in fact sufficiently support mental health needs.
The views reflected in this expert column are those of the individual authors and do not necessarily represent those of the O’Neill Institute for National and Global Health Law or Georgetown University. This blog is solely informational in nature, and not intended as a substitute for competent legal advice from a licensed and retained attorney in your state or country.