“Where are all the people in your boat?” Shireen Yaish asks the little boy who drew a picture of a refugee boat all in black. “They all died,” he responded.
“Where are all the kindergarten children in the playground you drew?” Yaish asked a girl. “They were killed,” came the answer.
Yaish is a Jordanian psychologist who established the Kaynouna art therapy center in 2012, about a year after the slaughter of the Syrian civil war began. Now she treats hundreds of refugee children living in camps in Jordan, in addition to mothers who have experienced trauma.
One of the center’s projects is called Selfie Kuna (meaning a selfie about what we are). Women send their artwork to the project, art in which they express the suffering that they have experienced in war or in their family life. The work is then posted on the center's Facebook page.
Tamara Awad drew herself with her hand covering half of her face and with the title “The Hidden Half.” She explained it as follows: “Selfie does not express myself. I am the hidden half.”
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The women's art and photographs that they have submitted are judged by visitors to the website. The work is eligible for a $500 prize, but the main goal is to encourage women to use art to express their experiences and the suffering that they have endured. The center also offers empowerment courses and guidance on how to establish support groups for women throughout the Arab world.
Art therapy is not new to the Middle East, but in recent years it has taken new directions in an effort to meet the huge need for psychiatric and psychology professionals. One of the centers was recently opened in the city of Duhok, in the Kurdish region of Iraq. The center’s director is Deldar Murad, who is not a psychologist. He's a family physician who has been using art therapy to treat 14 women from Iraq's Yazidi religious minority who have suffered physical, sexual and psychological trauma. According to Murad, the goal of the treatment is to give these women a channel through which they can get an outside perspective on their suffering rather than keeping it bottled up.
One of the greatest obstacles therapists encounter is people’s hesitation to come to the treatment centers. According to research conducted in the Netherlands, where some 42,000 Syrian refugees have relocated, about 75 percent of them have suffered psychological trauma as a result of the horrors of war, of the difficulties that they faced in getting to the Netherlands, the harsh attitudes they encountered along the way and the culture shock and inability to adjust to their new country. Some 13 percent suffer from severe psychological harm that can be deemed mental illness.
But as Ali al-Tamimi, a member of the Netherlands Psychiatric Association, sees it, a good many of these people refuse to go to treatment centers because of the fear they will be stigmatized as mentally ill.
People do not differentiate between emotional and cognitive damage, he said. Many also have language problems and can’t fully express their feelings to a therapist. What’s more, he said, the number of Arabic-speaking therapists in the Netherlands is very small — inadequate for the large number of victims.
The German city of Schweinfurt in Bavaria is home to another center offering psychological treatment to refugees through counselling — to help them integrate into the country. But there, too, it turns out that only a small percentage of the refugees in need of help have sought it at the center.
Many have preferred to seek help from refugees from their own country to find out about employment opportunities, education and making ends meet. These are all psychological burdens that they face on top of the trauma that they carry from the war.
One apparently less efficient means through which help can be sought is a collection of phone apps in Arabic and English that attempt to provide guidance to those in need about how to deal with anger, tension and grief. One of these apps, called Almhar, was developed with the assistance of the German Foreign Ministry and includes a series of questions designed to direct users to identify the kinds of distress that they are experiencing. From that point, they can get additional information pertaining to their situation.
For example, people feeling guilt can talk about it with close friends and family and ask themselves whether they are responsible for their situation and whether they are to blame for their decision to flee their homeland.
Most importantly, it is suggested: “Talking will help you overcome the shame of talking about your feelings. Sometimes people feel shame because they took advantage of the situation or managed to flee while their loved ones remained behind. In retrospect, we overestimate our ability to influence events. You should examine the extent to which the justifications for your feelings are well-founded. You must ask yourself, did you have a choice? Did you have other options?”
The app does not presume to provide treatment, but it does direct users about how to analyze their situation on their own and urges them to get professional help. The problem is that even those who are helped by the app later need to overcome the social and psychological obstacles to their getting ongoing psychological help.
The tragedy of millions of Syrians who have been displaced from their homes, whether or not they have remained in Syria, is usually defined in terms of a roof over their heads, food, medicine and education. The treatment for psychological trauma, which in many cases has a greater impact than economic distress, is perceived as secondary at best and as unnecessary in normal circumstances. But that is the aspect with the greatest long-term effects on their lives after the war is over.
Professional reception and training centers in Europe have touted their successes in taking in refugees and finding regular work for many of them. But the lasting image of the refugees' parents being murdered in front of them, of countrymen who have met their deaths at sea or the mangled limbs of relatives killed in bombings will continue to torture them for the rest of their lives.