Syrian Refugees Living on the Edge: Policy and Practice Implications for Mental Health and Psychosocial Wellbeing
| Published date | 01 April 2019 |
| Author | Duygu Cantekin |
| Date | 01 April 2019 |
| DOI | http://doi.org/10.1111/imig.12508 |
Syrian Refugees Living on the Edge: Policy
and Practice Implications for Mental Health
and Psychosocial Wellbeing
Duygu Cantekin*
ABSTRACT
This qualitative study aims to explore the difficulties experienced by Syrian refugees living in
the camps of Turkey in the pre-migration and post-migration environment and the impacts
thereof on their mental wellbeing. Semi-structured interviews were conducted with Syrian refu-
gees living in three different camps on the Syrian border of Turkey. Syrian refugees were
highly exposed to traumatic events in the pre-migration period, including armed conflicts,
human rights violations, and social and economic devastation. Participants reported a wide
range of difficulties in the post-migration environment, including separation from and loss of
close ones, camp difficulties, gender-based, adaptational and economic adversities. They
reported a number of psychological and social effects of these pre-migration and post-migra-
tion difficulties. The implications of the findings are discussed and recommendations are made
concerning the necessity of a rights-based approach to policies and interventions for mental
health and psychosocial wellbeing of Syrian refugees.
INTRODUCTION
Over the past two decades, there has been a massive increase in the global total of people forced
by organized violence to flee their homes, rising from 33.9 million in 1997 to 68.5 million in
2017, the highest level ever recorded (UNHCR, 2017). The main contributing factor to this dra-
matic increase has been the war in the Syrian Arab Republic, now the world’s largest source coun-
try of refugees. The countries neighbouring Syria continue to be heavily impacted by the crisis in
Syria. In particular, with more than 3.4 million registered Syrians, Turkey hosts the largest number
of refugees worldwide (ibid).
The mental health of refugees and asylum seekers, many of whom face war and experience vio-
lence, torture, and profound deprivation, is adversely affected. Quantitative research has shown a
positive relationship between pre-migration traumatic events and mental health problems (Bhui
et al., 2003; Lien etal., 2010). However, these catastrophic events cannot be considered as sole
causes of the psychological problems of forced migrants. There is a growing recognition that post-
migration conditions are also significantly related to mental health problems (Porter and Haslam,
2005; Ryan et al., 2009). Some studies indicate that post-migration difficulties can have even more
impact on mental health than pre-migration events (Carswell et al., 2011; Cantekin and Gencß
€
oz,
2017).
* Nisantasi University, Turkey
doi: 10.1111/imig.12508
©2018 The Authors
International Migration ©2018 IOM
International Migration Vol. 57 (2) 2019
ISSN 0020-7985Published by John Wiley & Sons Ltd.
Because there is an increased prevalence of mental health problems in refugees, in particular
post-traumatic stress disorder (PTSD), depression, and anxiety, for many years after resettlement
(Huijts et al., 2012; Bogic et al., 2015), policy and intervention development for the mental health
and psychosocial wellbeing of refugees should be considered with a long-term, holistic, rights-
based focus, also bearing in mind post-migration determinants. Post-migration adversities can exac-
erbate the effects of pre-migration stressors. For sustainable, consistent and effective mental health
and psychosocial support (MHPSS), policies and interventions should not be confined to a needs-
based approach, even though basic needs must be met: they must also employ a rights-based
approach, which basically emphasizes the use of international human rights standards, participation,
empowerment, non-discrimination, and accountability of stakeholders (Dufvenmark, 2015). A
rights-based approach is recognized as part of an ongoing shift from needs-based approach “to-
wards a system where people are empowered to make their own choices and claims, and where
policy-makers and service providers are obligated to address those claims”(Bloom, 2010). Such an
approach regards people as active, responsible agents rather than as passive recipients of aid; it
involves them in decision-making processes and services that affect them and enables them to
shape their own future. It ensures the availability, accessibility and affordability of services while
respecting and promoting their rights, dignity, autonomy and independence. In the current pro-
tracted situation of Syrian refugees, a rights-based approach is essential for transition from a
humanitarian emergency to a long-term development phase in refugee response, so as to generate
durable solutions and resilience-based programmes mitigating mental health and psychosocial prob-
lems of refugees.
Recognizing refugees’rights requires contextualising their experiences. Refugee research has
been more “theory driven”than “problem-driven”(Ingleby, 2005). From this point of view, reli-
ance on solely quantitative methods, which generally examine a set of variables by relying on a
priori assumptions, can fail to capture diverse human experiences associated with extreme events.
These a priori assumptions may create problems in certain areas where there is insufficient knowl-
edge about the case at hand (Schweitzer et al., 2007). Furthermore, the experiences of refugees and
asylum seekers have a temporal nature (Miller et al., 2002). They are faced with a wide range of
difficulties in each migration phase, which pave the way for various psychological and social
effects. A deeper look into a refugee’s situation is necessary in order to understand the gaps and
challenges in policies and interventions through a rights-based approach. This study, by utilising
qualitative investigation, aims to explore the difficulties faced by Syrian refugees living in the
camps of Turkey and the psychosocial effects thereof in the pre-migration and post-migration envi-
ronment.
METHOD
Context and setting
Turkey is party to the 1951 Geneva Convention and its 1967 Protocol relating to the Status of
Refugees (United Nations General Assembly, 1951, 1967). However, due to its ‘geographical limi-
tation’under Article 1 (B) of the Convention, for those asylum seekers who do not come from
European countries, Turkey provides a temporary asylum but not a permanent refuge. The Turkish
Government adopted the Law on Foreigners and International Protection in 2014 and introduced a
temporary protection policy specifically for Syrians (Republic of Turkey Ministry of Interior Direc-
torate General of Migration Management [DGMM], 2014). This policy on the one hand ensures
that the border remains open, that there are no forced returns or limits on duration of stay, and that
refugees have access to basic rights and services, but on the other hand entails that the refugee
Syrians living on the edge201
©2018 The Authors. International Migration ©2018 IOM
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