When the shockwave from Beirut’s port explosion ripped through her home in the nearby Jnah neighbourhood of the Lebanese capital, Fahima was thrown across the room by the force of the blast. In her mind, however, she was transported even further.
“I felt I was back in Syria and the bombing was there,” said the 35-year-old refugee originally from Aleppo. “I forgot I was in Lebanon and that the explosion happened here.”
For Fahima, who lost her middle son Mustafa before the family fled the conflict in Syria, that early August evening in Beirut brought back a flood of painful memories and emotions.
Initially the overwhelming one was panic, when she could not immediately find her youngest daughter Manar, aged four years, who had been playing outside with her brother when the blast struck.
"I felt the world had ended."
“When I went outside, I saw the smoke and I saw the fallen glass and I couldn’t find my daughter,” Fahima explained. “I felt the world had ended. I felt something that can’t be described.”
The girl was found hiding behind a large plant pot in front of a neighbouring building and quickly reunited with her mother, but it soon became clear that the powerful blast had profoundly affected Manar’s mental wellbeing.
The previously fearless young girl with distinctive blue eyes and blonde curls now refuses to sleep unless the door to her bedroom is locked, is terrified by any loud noise and refuses to leave her mother’s side.
“She has changed. She has a fear that was not there before,” Fahima said. “She’s constantly putting her hands over her ears if she hears a sound, and she says there will be another explosion. But she wasn’t like that before. She used to be very brave.”
Worried for her daughter’s state of mind, Fahima approached UNHCR, the UN Refugee Agency, for help. She was referred to the agency’s local NGO partner Makhzoumi Foundation, who provide mental health services to Syrian refugees and vulnerable Lebanese with funding from UNHCR, and was given an appointment to see a psychologist.
On World Mental Health Day (10 October), UNHCR reaffirms its commitment to addressing the mental health needs of refugees, displaced and stateless people under its care, as well as vulnerable members of host communities.
UNHCR strives to integrate mental health and psychosocial support in its work. This has become increasingly important during the COVID-19 pandemic, which threatens to trigger a mental health crisis due to increasing isolation, loss of livelihoods and uncertainty about the future.
Across the Middle East and North Africa region, UNHCR and its partners have stepped up psychosocial support activities in response to alarming reports of increasing mental health issues among forcibly displaced people. These include a three-fold rise in reports of suicide and self-harm to UNHCR’s Lebanon’s national call centre.
Since the explosion two months ago, psychologist Mirna Maawad said she has seen a number of children who lived close to the blast area coming into her clinic in with symptoms of post-traumatic stress disorder (PTSD).
“These children are showing signs of fear – they cry, scream, they remain very close to their parents’ side,” Maawad said. “They have nightmares at night, some wet their beds.”
During her sessions, Maawad uses storytelling to explain to the children that while traumatic events like the explosion can happen, it is something that is now in the past and teaches them ways to try to overcome their fears.
She said the level of distress can be particularly high among Syrian refugees who fled conflict at home and came to Lebanon to find safety. “They were [among] the most affected by this because the current event triggered memories of their previous experiences,” Maawad explained.
While Manar herself was born in Lebanon and has no experience of the conflict in Syria, her young age presents a therapeutic challenge in itself.
“When a person experiences traumatic events at a young age, it’s harder to treat because it occurred at an age when they can’t express themselves well,” Maawad said. “For that reason, we try to get [Manar] to express herself through drawing, playing, we even use music sometimes.”
Fahima says that after only three sessions she has noticed a positive change in Manar when she is with the psychologist, but that she still reverts to her frightened behaviour as soon as they get home.
“The doctor makes her feel safe and that the explosion is in the past, and that it won’t be repeated, Fahima said. “But I feel when she comes back home, she forgets what happened [at the doctor’s] and she returns to her ways.”
Maawad said it was hard to predict how long the healing process will take, but the fact that Fahima had sought help early will make it easier.
“If mental health problems aren’t treated, they will grow with an individual and it will become harder [to overcome],” she said. “Depending on [Manar’s] responses and on how the parents deal with the situation…things take time, we can’t pinpoint how long. But she will definitely benefit.”
"When I see a therapist, I feel that there is hope."
While Manar was referred directly to a mental health professional, many refugees are less fortunate. The psychological needs of refugees often far outstrip the capacity of the mental health system in host countries, including Lebanon.
In response, UNHCR and its partners have adopted other approaches to try to increase the numbers of people they can assist, for example by training networks of refugees to work as community outreach volunteers. They are able to provide basic emotional support to others and refer more serious cases for further treatment when needed.
Despite describing herself as heartbroken by the changes in Manar, Fahima said she is grateful for the opportunity to provide her daughter with professional help, and is herself seeking help for the considerable trauma that she too has suffered. She is also dismissive of any perceived stigma around seeking help for mental health issues.
“My grief over my son and the situation in Syria, and now with Manar’s situation, I’ve changed a lot. Sometimes I don’t sleep at night,” Fahima said. “When I see a therapist, I feel that there is hope. I feel that it improves our situation.”