According to World Vision, more than 12 million are affected by the crisis in Syria. That is far more than those affected by Hurricane Katrina, the Haiti earthquake, and the Indian Ocean tsunami combined.
Recent events remind us of a dark time in Europe when other refugees were denied haven and abandoned to fate. Once again, large numbers of people are targets of violence and trauma. After years of suffering, they have left their homes and everything they love and care for because life has become intolerable. They have endured a hellish journey to find safety. And then they have been greeted by faces and hearts of stone.
Thankfully, it seems that voices of compassion are prevailing and refugees are being allowed to proceed to refuge, as international law guarantees civilians fleeing war.
Further challenges are to come. No countries are prepared to deal with such large numbers of people.
Basic survival needs must of course hold first priority for some time. Ensuring safety and providing water, food, health care, and a place to stay takes precedence over everything else.
But now is also the time to prepare structures of ongoing psychosocial support. Attention to several key concerns can make a huge difference in enhancing the resiliency of individuals and communities to cope with life in the new realities that follow trauma.
A study about the genetic effect of trauma recently has been released. Untreated trauma creates enduring anxiety, fear, instability, and hopelessness, fertile ground for reactionaries and extremists. So the most horrifying results of today’s conflicts may be visible only in the future, as hundreds of thousands of children and young people who grew up amid chronic fear, violence and disruption become adults.
Whatever our politics, there is no ignoring the fact that the number of conflicts in the world (not just in the Middle East) is growing. If we care for the future of all children, we need to give proper care to those who are suffering today.
Recently, German experts spoke out about their lack of readiness to provide trauma therapy. About 800,000 refugees are expected to enter Germany alone in the coming year. No country can provide proper trauma therapy and care for that many people.
It is possible to provide resources to facilitate resiliency and post-traumatic growth and provide effective intervention that supports trauma integration. Community leaders, social workers, nursing and medical personnel and therapists can deliver such programs, but careful preparations for this must be made. One in five Syrian children is likely to suffer from PTSD, so the scale of the required response will be large. A good heart alone is hardly sufficient qualification, for without proper training, service providers may cause more harm than good. Additionally, unprepared caregivers themselves are at greater risk to suffer from secondary traumatic stress.
In recent years, governments and NGOs have increasingly recognized the need for psychosocial support. Yet a great deal of uncertainty and confusion is evident among professionals regarding what it means, what activities are involved, how it relates to psychological first aid and where it differs, and who is equipped to provide what.
In diverse settings I have encountered numerous instances of well-intentioned aid workers and professionals who were not trauma-informed ending up causing more harm than good. The danger of retraumatization, that is, triggering unhealed wounds, is high. If caregivers are not properly trained, their interventions may add to the already-existing burdens that trauma survivors carry.
In 2002, Psychologists for Social Responsibility came out with a report that provided guidelines for providing psychosocial support. One of the guidelines proposed a “do no harm” intervention approach. A first step to achieving this is the use of a well-being model rather than a pathology model.
First responders and professionals who are recruited should be educated about the targeted population’s ideas and practices regarding gender, religion, social structures, and beliefs about healing. In addition, psychosocial support interventions should be linked to other basic services in all phases of interventions, in order to promote sustainable development.
My own reading and practice have brought me to a perspective held by a growing number of researchers — that trauma creates nonverbal mental responses that dominate verbal thinking. Survivors often are unable to translate their feelings into words. Even when they can, the act of doing so often brings little relief.
This perspective points toward interventions rich in use of expressive arts, which enable trauma survivors to engage with their experiences in indirect and symbolic ways rather than the better-known, cognitively-based talk approaches. All communities have individuals gifted in art, music, dance, poetry, and rituals. So a bias toward expressive arts supports the critical goal of supporting communities to connect to their existing resources.
In the past two decades, much has been learned about the impact of trauma and what to do about it. The current refugee crisis provides an opportunity to put these learnings into practice in a situation with ramifications for millions — not just for the survivors but also for the nations and regions which they and their children will inhabit.
This will not happen if we offer the same old practices of the past, reacting only to extreme individual cases of psychiatric breakdown. The entire world will benefit from a more creative and proactive approach. Now is the time to prepare and support networks of locally-based individuals competent to lead groups around them in experiential workshops based on evidence-based approaches. This will assist large numbers of people in integrating their traumatic experiences.
Gertel Kraybill, O. (2013). Expressive Trauma Integration Training with Aid Personnel in Lesotho (unpublished PhD pilot research). Cambridge, MA: Lesley University.
Gertel Kraybill, O. (2015). Experiential Training to Address Secondary Traumatic Stress in Aid Personnel. (Doctoral Dissertation). Cambridge, MA: Lesley University.
Psychologists for Social Responsibility (2002). Conference Report: Integrating Approaches to Psychosocial Humanitarian Assistance. Retrieved from: http://www.psysr.org/about/pubs_resources/PsySR%20Maine%20Conference%20Report%202002.pdf
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