UNICEF recently announced [PDF] that the war-worn Syrian population faces the possibility that a new “lost generation” of children may result from the current stressful environment, repeated exposure to traumatic events, and poor services found in Syria and surrounding host countries today.
Many schools have been damaged, destroyed or occupied by displaced people seeking shelter. Countless numbers of suffering children are experiencing a variety of psychological traumas, brought on by the killing of family members, separation from their parents, and witnessing the terrifying thunder of repeated bombings.
The original ” Lost Generation ” came of age during World War I. The events of World War I undermined the belief that if one acted virtuously, good things would follow. Many upstanding young men went to war and either died or returned home physically wounded and psychologically damaged, no longer finding comfort or solace in their previous moral and religious beliefs – they were disillusioned, ungrounded, and “lost”.
Jusoor, a different kind of aid
While many local and international organisations are trying to address the immediate health needs of both refugees and internally displaced persons (IDPs) [PDF] by providing medical and support services, a new Syrian initiative called Jusoor is focusing exclusively on education and training as a way to help the Syrian youth. Jusoor’s first phase of projects provided technical assistance, scholarships , mentors and career counseling to higher education students located inside Syria who were looking to complete their degree programmes elsewhere.
Jusoor recently announced a new initiative for Syrian refugees in Lebanon that will implement their goals through the creation of local educational centres and programmes in four ways: 1) Childrens’ basic literacy camps, to teach students to read and write as well as basic arithmetic; 2) Job placement services to help Syrians find employment with NGOs operating in Lebanon in support of Syrian refugees; 3) A business start-up programme that will provide micro loans and advice for those wishing to start small businesses; and 4) Informal community centres that will provide youth with educational resources, including access to computers, books, and mentors.
This initiative accords with other programmes that deal with trauma in refugees’ situations, most notably the Harvard Program in Refugee Trauma (HPRT) which advocates altruism, work and spiritual activities, for example, as an important social instrument for the community to start their self-healing process. It has been demonstrated that trauma survivors have an intrinsic desire – despite a general scarcity of resources – to “help others”. By helping others they in effect are helping themselves. This is an important response to the crippling loss of personal power caused by the humiliation of the trauma experience.
Work for adults and school for children are also fundamental pieces of the recovery process. It has been shown [subscription required] that most persons with acute stress reactions show spontaneous improvement if social conditions are favourable. In this light, facilitating the self-healing process could be seen as way to help the community deal with their stress reactions. By identifying local problems and solving them with local solutions, communities become empowered.
Essential elements of trauma interventions
A widely-held maxim in psychology is that having a sense of control over events is one of the main sources of safety. One of the primary traumatic symptoms in those suffering with PTSD is a sense of helplessness, a lack of the basic senses of trust, predictability and safety. The concept of self-efficacy, or personal agency , is found whenever an individual believes that his actions will likely lead to positive outcomes. This concept can be expanded to collective efficacy, which denotes the condition of a group that feels that they are likely to produce good outcomes.
The concept of self and community efficacy was recently identified by a panel of experts as one of the five ” Essential Elements of Immediate and Mid-Term Mass Trauma Intervention “: 1) a sense of safety, 2) calming, 3) a sense of self- and community efficacy, 4) connectedness, and 5) hope. While safety and calming are addressed within traditional clinical and counseling services, standard interventions for building self- and community efficacy are not. The remainder of this essay is devoted to explain the panel’s recommendations regarding this domain of interventions.
Evidence shows that people who have experienced trauma are at risk of losing their sense of competency and the skills required to deal with problems they encounter, so successful interventions aim at empowering social groups to overcome hardships. The specific case of refugee communities provides one such group toward whom such interventions might be beneficial. Since it is somewhat unrealistic to expect individuals to create this sense of competency in war-like environments on their own, communities need to come together to solve the problems that affect them collectively.
The World Health Organisation (WHO) recognises the capacity of efficacy as essential for recovery, so they emphasise the promotion of self-sufficiency and self-government among refugee populations. Activities that are conceptualised and implemented by the community itself may contribute to a sense of community efficacy. Among the major mental health interventions following the tsunami in Asia, for example, were community efforts to support rebuilding fishing boats, allowing fishermen to resume their livelihoods. Similarly, for children and adolescents, the restoration of the school community is recognised by the WHO and the United Nations Children’s Fund (UNICEF) as an essential step in reestablishing a sense of self-efficacy among children.
Two aspects of self- and collective efficacy are critical, but often ignored, when planning any intervention. The first of these is that the development of self-efficacy requires the acquisition of specific behavioural skills that form the basis of efficacy beliefs. Jusoor focuses their programmes on teaching English and computer skills as one way to achieve self-efficacy, but such generic skills are not always the ones most needed in every case: skills that are useful in one context may not be so in another. The skills needed should be determined based on a needs assessment of the community.
The second aspect of self- and collective efficacy that is often ignored is that empowerment without resources is often highly counter-productive and demoralising. Individuals will wrongly blame themselves, rather than the circumstances in which they live, for the failure of such interventions. Therefore securing resources for the initiative is essential. Additionally, it is only through successful action and project implementation that efficacy beliefs become internalised and reinforced; otherwise, such beliefs are quickly compromised.
These projects must address the basic needs of the community. In the refugee context in particular, research suggests that programmes should aim at improving living conditions and providing more secure livelihoods. Improving the conditions of the camps (or neighbourhoods), developing housing projects, and securing basic services help local populations to enhance their survival capacities, and increase their resiliency and quality of life. The report cites an example from Iran, following an earthquake, where communities were provided resources and guidance to help restore sanitation services, which in turn led to empowerment and restored dignity among citizens.
Success stories in community efficacy
I don’t want to convey the impression that nothing is currently being done. Several groups and communities have come together successfully to create new projects that not only sustain the groups financially but also develop self- and collective efficacy, which are needed in order to deal with their traumas. These initiatives and similar ones should be encouraged, and communities should be assisted to develop such initiatives.
Interestingly, and very encouragingly, these projects are usually led by women. At the Syrian refugee camp of Zaatari, UN Women Jordan is supporting a ” cash for work ” programme that enables female Syrian refugees who are professional tailors and hairdressers to work six hours a day in workshops in order to earn a living. This programme allows women to play different and unexpected roles in the camp’s social life as well as within their own family’s structure. They have become the breadwinners, and their contribution to their households is welcomed by their husbands.
Another initiative is a project led by several female Syrian entrepreneurs in Alexandria, Egypt, where the community’s cooking skills have been utilised to establish a small catering business, with its own Facebook page on which customers can send orders. The project is aptly named “We are not Refugees but Productive Women”. Not all projects led by women involve traditional skills. A new initiative led by a Syrian software engineer [AR] who lives in Paris, in collaboration with a team of Syrian developers who are in Syria and Egypt, will lead to the creation of a game application for smartphones called ” ducky op “. They are currently raising funds in order to be able to finish the project.
To sum up, increased self- and community efficacy is one essential element facilitating the healing process in populations exposed to mass trauma. Understandably, this tends to be a low priority for NGOs, whose attention is correctly paid to the delivery of immediate services and meeting acute needs. Yet there are many ways to encourage efficacy and agency, to guide communities to find local solutions to their problems rather than relying on outside agencies. Such interventions should provide the necessary skills required to initiate change, and the resources that will make it happen. Jusoor, with its recent initiative in Lebanon, is well-positioned to help the refugee community help itself, and to extend its solutions to communities throughout the region.
[Disclosure: The writer is not affiliated with Jusoor]
Andres Barkil-Oteo is an assistant professor of psychiatry at Yale School of Medicine. His interests lay in the intersection between mental health, healthcare systems and education.
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