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Jordan: Healing invisible wounds

19 Jun 2017

Mental health is often overlooked in broader refugee crisis; it is regularly referred to as an invisible wound. The psychological needs of children in particular are very often neglected, causing long-term psychological trauma and suffering. Australian Psychologist Johanna Van Grinsven recently spent time working as a Child Mental Health Manager in Irbid, Jordan, to assist Syrian refugee children who fled to safety. 

The Médecins Sans Frontières Child Mental Health Clinic is in Irbid, Northern Jordan approximately 15km from the Syrian border. Operating since October 2014, the clinic's main priority is to respond to the psychological needs of the Syrian refugee children and their families who had fled to Jordan because of the conflict in Syria.

It is generally the thought that as soon as a refugee flees from the dangers of war and into a place of “safety” that everything will be ok. But even if they are out of immediate danger they are still fleeing from something terrible, still missing their homes, grieving from the separation of loved ones and plagued by memories and nightmares of their past traumas.  

"Jordan isn’t their home, and most are desperately missing and grieving their old life."

The presentations and common symptoms seen in the children in detention and in Jordan are very similar - sleeping disturbances, nightmares, enuresis (bed wetting), anxiety, separation anxiety, intense fear, social withdrawal, stuttering, tics, hyperactivity and lacking hope and future focus. Some parents also describe their children complaining of physical ailments such as stomachaches, headaches and lighted headedness, which is often attributed to anxiety and stress. Jordan isn’t their home, and most are desperately missing and grieving their old life.

The team at the Médecins Sans Frontières Child Mental Health Clinic consisted of an expatriate psychologist, to clinical psychologist, two national psychosocial counsellors, two translators (for the expats), a social worker and myself, the mental health manager. My role included managing my own individual patients for treatment and therapy as well as supporting and building the therapeutic skills of the national counsellors and psychologists. 

Playing is the most powerful form of communication for a child as is it the most natural way for them to express themselves. Toys become their words and the play is their language. As adults, we find it incredibly difficult to verbally describe or explain what has happened to us or how we are feeling so how can we expect a child to articulate it when they don’t have the verbal language? I used play therapy with my patients as it allows the child to feel heard, accepted, validated and empowered. It is through play and in a safe and trusting therapeutic relationship that they can start to process what they have experienced, this may be through role-play, art activities, re-enacting life events or expressing overwhelming emotions (anger, sadness, frustration, jealousy). It is in the play therapy room they can start to try and understand their world again as for most children it has been turned upside down.

Even though our patients are generally children, there is a large focus on supporting the whole family, particularly mothers, through providing family support, parenting strategies and parental self-care.  We run group therapy programs for children with post-traumatic stress disorder symptoms and aggressive behaviours while the psychosocial counsellor runs a psycho-education group to the child's primary caregiver. A father's support group has also been established to cater to the individual needs of the father.