Andreas Gebert / AFP / Getty Images

Refugees go from surviving war to fighting PTSD

Germany struggles to cope with the influx of refugees, many escaping war zones and suffering from psychological trauma

BERLIN — Like many other refugees, Mustafa experienced traumatic events before fleeing his homeland of Syria.

In Damascus he was detained for two months and tortured by the authorities. On his long journey to freedom, he witnessed streets and bombed out buildings filled with dead bodies.

Since January 2015, Mustafa (who asked to conceal his real identity for the safety of his family members in Syria) has taken refuge in Germany, far from any war zones. But the horrors he saw and felt in Syria continue to influence his daily life.

He has had occasional panic attacks, loss of appetite, weight loss, depression and a recurring sense of hopelessness, particularly during half a year in Berlin when he knew little German and was living in refugee hostels.

“I don’t go out a lot,” said Mustafa, 28, who recently moved into his own apartment. “I have problems with trust. I cannot trust people because in Syria you cannot trust anyone.”

More than half the people who escape war zones suffer from mental illness, according to research done by Germany’s chamber of psychotherapists. 

‘I am an educated guy, I speak languages, and I had problems getting any kind of treatment. What about other refugees who don’t speak the language and don’t have anyone to help them?’


Syrian asylum seeker

These asylum seekers have post-traumatic stress disorder (PTSD) or other trauma-related conditions, and about 40 percent of them have suicidal thoughts.

A study by doctors at the Technical University of Munich found that at least a third of Syrian children and adolescents in Germany suffer emotional disorders, stress or PTSD.

But at a time when Europe faces a dramatically large influx of refugees and governmental resources are overstretched, some European countries are neglecting to provide sufficient mental care for those who fled war and other violence, campaigners say.

On Feb.10, the European Commission, the authority responsible for enforcing EU laws, announced it is pursuing infringement proceedings against Germany and several other member states for their failure to comply with the Asylum Procedures Directive and Reception Conditions Directive — two EU laws regulating what conditions must be made available to asylum seekers and refugees.

These directives state that EU member states must screen asylum applicants for mental illnesses and put in place supportive measures for vulnerable people such as torture victims or people with mental health problems.

In Mustafa’s case, for example, German authorities have provided him with housing, language classes and emergency medical services.

But he has not been screened for PTSD or other mental health problems, even though in his asylum interview he talked extensively about his experiences in Syria. In his first few months in Germany, when he sought psychological support, he encountered a complicated and slow bureaucratic procedure.

The one social worker available in the refugee hostel where Mustafa was staying at the time was overwhelmed and unhelpful.

‘Limited options’

Nora Berneis is employed at a hostel for refugees managed by the German Red Cross. She works as a Sozialbetreuer, or caretaker, a profession recently invented by the group to compensate for the fact there are not enough official social workers for all the refugees.

She has a bachelor’s degree in political science, has done an apprenticeship as a medical assistant, speaks some Arabic and appears to be doing her job with a lot of enthusiasm and compassion. But she has not studied or been trained as a social worker and is underqualified to provide sufficient mental support for traumatized people.

About 330 asylum seekers from war-torn countries like Syria, Iraq and Afghanistan live in the 67-room hostel where Berneis works, in the western part of Berlin. 

She said it is rare for residents to request psychological support because people fear being stigmatized as crazy and because of language barriers. When someone does approach her and asks to meet a psychologist or other kind of professional mental treatment, she is frustrated because she cannot do much to help.

“Unfortunately, there are really limited options,” she said.

Berneis said that for children, she sometimes gets free appointments with psychologists, but it is much more complicated for adults, whose health insurance does not cover psychological care except in emergency situations.

When adult asylum seekers request mental support, all she can do is suggest that they contact Xenion or the Berlin Center for Torture Victims (BZFO), the only two Berlin-based clinics whose expertise includes treatment of traumatized refugees and survivors of torture and other serious human rights abuses.

However, these clinics, Berneis said, are “overstretched at the moment.”

Berlin has seen a massive upswing in registered refugees, which is in line with the rest of Germany. The country received over 1 million applications from asylum seekers in 2015.

“We have more than 10 times more requests for places for treatment than we can offer,” said Dr. Mechthild Wenk-Ansohn, the BZFO’s outpatient clinic head. “We are trying to shorten treatments in order to treat more people. We do not have enough capacity for the people who seek help."

About 600 refugees are being treated at the BZFO. She said that requests for therapy always exceed capacity and that now is the most challenging time in the 21 years she has been working with traumatized refugees.

Wenk-Ansohn said that there is an urgent need to hire and train interpreters, psychiatrists, psychotherapists and social workers in order to be able to offer refugees sufficient treatment and rehabilitation but that the BZFO and other similar nongovernmental organizations cannot hire additional staff because they are underfinanced.

“We could have here 10 times more professionals working, but we don’t have the money,” she said.

The BZFO receives some federal and municipal funding, but for the most part, the center depends on donations. In 2015 the BZFO received about 150,000 euros from the city, and this year the sum will be increased to 250,000 euros, according to Monika Hebbinghaus, a spokeswoman for Berlin’s Office of Health and Social Affairs.

She acknowledged that the mental care system available for refugees in Berlin is geared toward the treatment of acute situations rather than long-term therapy but insisted that psychiatric hospitals and ambulances are accessible in case of trauma-related emergencies.

“At the moment, a number of additional programs for the care of traumatized refugees are being planned and set up by the Berlin municipality to cater to the growing demand,” said Hebbinghaus.

PTSD’s boomerang effect

A policy paper, “Making Integration Work,” published Jan. 28 by the Organization for Economic Cooperation and Development, has urged countries to take necessary measures to ensure early identification of mental health issues among refugees and provide adequate support.

In September, Katja Angeli, a spokeswoman for the Federal Ministry of Health, called for improvements in the area of trauma treatment for refugees and highlighted a need for authorization of more psychotherapists and treatment institutions.

Not providing such services and treatment to traumatized refugees is harmful to the individuals as well as to the economy, according to Asger Kjaerum, the director of advocacy for the International Rehabilitation Council for Torture Victims, a nongovernmental organization.

“If you have constant flashbacks, severe anxiety, insomnia, nightmares, depression, memory lapses or other symptoms of PTSD and torture trauma, it can be very difficult to maintain social relationships or a job,” he said. “It may be difficult just to get out of bed in the morning.”

“We also know that war and torture trauma rarely goes away by itself, that it is often exacerbated if left unaddressed, especially where people are living in asylum-seeking conditions ,and that it often gets transferred to spouses and children,” Kjaerum added.

Wenk-Ansohn emphasized that not making mental care available for traumatized refugees will have a long-lasting and growing impact on German society because people who need treatment now and don’t get it are likely to have significant health care needs in the future. She said some of the patients being treated today in the BZFO are people who fled Kosovo in the 1990s, did not get treatment in their first few years in Germany and now require intensive long-term therapy.

But there is some good news. For Mustafa, the situation is much better now.

After his German improved and he became more familiar with the bureaucratic hurdles to getting treatment, he applied for psychiatric care. His doctor recently prescribed him anti-depression pills, which have helped.

He still has not seen a psychologist or received therapy, but he feels it is not needed anymore because he is now able to deal with his trauma. His main concern is for other possibly traumatized refugees, who continue to arrive in Germany en masse.

“I am an educated guy, I speak languages, and I had problems getting any kind of treatment,” Mustafa said. “What about other refugees who don’t speak the language and don't have anyone to help them?” he asked.

“Sometimes I help new people who come here because I know maybe they will experience the same problem,” he said.

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