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Syria ER: Mental Health Care for One Syrian Town

Medecins sans Frontieres’ Declan Barry, a U.K.-based pediatric physician, spent July and August in a small town in the north Syrian mountains, treating the members of one community affected by the war.

Written by Karen Leigh Published on Read time Approx. 3 minutes

In July, when fighting was calm, his team focused on primary care, which has been all but lost in Syria. In August, as the front lines near his field hospital exploded, Barry and his team focused on trauma patients. His team also focused on providing mental-health care, often overlooked in Syria.

“What we were seeing,” he said, “had a lot to do with the activities in our area, on the front lines.”

I’m a pediatric doctor, but my role here was as medical team leader, running the medical team’s day to day activities.

We were in an area that was closed off from the main hospitals, and there were no secondary health facilities nearby. A few field hospitals grew around the area to help treat war trauma, but basic primary healthcare had been removed from the area:  the structure, staff and supplies were all gone.

We focused on primary healthcare, including women’s health. We also had an emergency room and an operating theater. Originally it was built for trauma management, but also used to perform things like Caesarian sections. There was no one else in the area doing C-sections.

We were really trying to provide the primary healthcare that has been lost. Not a lot of burns came our way, but we saw a lot of blast injuries. We had mental health treatment. We had an inpatient unit, but it wasn’t doing speciality procedures [like dialysis] at all. We didn’t have the staff or materials for that. Throughout July, our real focus was on basic medicine. The trauma was always there in the background, but the bulk of our work was delivering babies in a safe place, having C-sections available, natal care. A lot of the outpatient work was chronic disease, such as hypertension and diabetes, whose supply chains are gone. We had people coming with their medicine boxes saying “Do you have this? Do you have that?” And when we did, they were ecstatic.

In August, the level of trauma increased massively because of fighting on the front lines. We had a lot of mass casualty events. At that point, we got our extra staff in, we reorganized the hospital [to handle it]. It was heavy, heavy fighting on the front line. Some of the local villages and towns had been bombed, and [those patients] would come in all at the same time. Shrapnel injuries, penetrating injuries to the head, abdomen, limbs. We had mass casualty event after event. There were nine of them in two weeks, which is a lot. For all of August, our focus on basic outpatient care and chronic disease was brought down to second place, because everything had to be focused on saving the trauma victims.

There were people coming in with heart attacks and strokes, so we were trying to juggle all these things at the same. We would refer them to a hospital, to another unit that could care for them. We were able to negotiate getting these patients to a  facility where they got really good care.

MSF puts mental health in its package of general trauma management. Every time we go into a new community, it’s received differently. In Syria, it was unusual. Our staff was traumatized: the line between staff and victim is very blurred. Some in the community are desensitized to the violence, but some are not.

When we tried to access the people who were injured in the hospital to provide them with mental health care, we got a good response. Trying to draw people in from the community was hard. Once they were in our service, we had good focus, a good follow-up rate. The men had very good follow up. Everyone has been traumatized, for sure, after two and a half years of this.

One day in the outpatient department, there were quite a few children who’d started bedwetting. The psychiatrist got a group of them together and started talking to them and their mothers. And the mothers themselves found a huge benefit in addressing their children’s behavior from the mental health perspective. And the women started talking about how it affected them. They hadn’t come to the psychiatrist for themselves, but when we addressed the mental health aspect of the crisis, they were responsive.

There’s a huge need for mental health care in Syria, and we don’t have the access we need to people, and people don’t have access to us. It’s one of the challenges we need to focus on. The community is traumatized, and so is our medical staff. There were times they’d be treating a mass casualty and their relatives and friends were coming in as victims. And it was nonstop. We’ve managed to access parts of the community, but we need to engage with them regularly on how to work through these very traumatic events.

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