Bekaa Valley, Lebanon - As the number of Syrians fleeing to Lebanon grows and the scramble to find housing, work and food intensifies, many refugees from the country's civil war are also grappling with the invisible but severe effects of psychological stress and trauma.
Maryam, 27, is crouched in her small camping tent. The cramped space - with a rug laid across the dirt ground for warmth - doubles as a living room and bedroom for her, her husband Mohammed, and their three energetic young children.
|Syrian refugees left to die at sea
Their tent is located in one of 30 clusters at this camp in Lebanon's fertile Bekaa Valley. Men sit outside on cinderblocks and talk, and washed clothes hang from the barbed-wire fence near the entrance. All the families share one shower and one cooking area.
There is no privacy. Maryam said even taking a shower is an ordeal. "It means I have had sex with my husband. It is very public and I feel shame walking by all the men. Mohammed is very angry everyone can see me."
They have no money left and Mohammed, hampered by a leg injury, is unable to find work. A former fighter with the Free Syrian Army (FSA), he left the conflict to join his wife. He wants his family to return to Syria, but Maryam refuses because their home is now destroyed.
"Yesterday we asked our neighbour - a widow - for bread, and I felt shame", said Maryam. "The situation is really, really bad. The cooking gas is finished and we are not able to pay for more."
Maryam has sleepless nights and worries about her children, who have little to eat and don't go to school. "The FSA killed someone, and my oldest son saw a dog eating him. Because of that he started having nightmares. He clings to his dad, so that he won't flee."
"There is nothing good about this situation," she said. "I struggle with Mohammed, and he struggles with me. I tell him he has to calm down."
Zeina Hassan, a counsellor with the International Medical Corps, says severe depression and anxiety are common among the refugees. "They make comparisons between how they were living and how they are now. There is a lot of hopelessness, which is very extreme. There is this feeling there is no return after the destruction they've seen."
With a daily reminder of what effect the political struggle next door is having on you, while you see your own livelihood decline and physical mental well-being challenged…this underlines a strong need for support.
The refugee population in Lebanon has topped 800,000, according to the conservative figures of the United Nations High Commissioner for Refugees, but only 44,000 of them are receiving some form of mental support from the agency and other charities this year - a small fraction of the total refugee population.
Meanwhile, daily life in the makeshift, overcrowded shelters often feels like living in a pressure cooker.
"The war has caused a very delicate division socially and politically", said Neil Sammonds, Amnesty International's researcher for Lebanon, Syria and Jordan. "With a daily reminder of what effect the political struggle next door is having on you, while you see your own livelihood decline and physical mental well-being challenged… this underlines a strong need for support."
Most refugees have little money left, and are forced to rely on charitable handouts to get by. There are few jobs, little access to education and health care, and an increasingly hostile Lebanese population, who blame the refugees for the country's economic ills.
"There is no privacy, no security, and they have been persecuted," said Syrian psychologist Khalil Yosef, now in Lebanon.
Yosef works mostly with Syrian children in Lebanon, helping them to express their feelings through drawing. His own father was arrested years before, and the trauma of his disappearance on the family propels his work.
The children's images are usually in red and black, depicting tanks, guns and their own destroyed homes and families. "Most symptoms they have are aggression, sleeping problems and speech problems like stuttering - not being able to say words correctly", Yosef said. "I saw many children faint in front of me because they don't eat properly."
Two of the children he works with come from the city of Tal Kalkh, just over Lebanon's northern border in Syria. Their mother was accused of spying for the regime and killed by the FSA. Their father ran away soon thereafter, and the children ended up with their grandparents in Akka, in northern Lebanon.
"Now they are stamped as children of the spy", Yosef said. "They are traumatised - not eating, sleeping and they are peeing in their beds. They only say their mother is in heaven."
'I am very angry all the time'
Anger is mounting among many refugees. Unable to find work, men often feel inadequate, and women are sometimes forced to beg or exchange sex for services to provide for their families. Children become especially vulnerable as targets of verbal and physical abuse.
Selma, a middle-aged mother, fled Damascus after spending months in prison on accusations of aiding the FSA. During her interrogations she was blindfolded, beaten with an electric rod, and told lies that her son had been killed and her home destroyed. "I wanted to die", she said. "A woman who loses her son and home has nothing."
But now, Selma describes herself as being in another kind of prison - an overcrowded multi-story structure in Baalbek that houses refugees. Her Lebanese neighbours curse her, and Selma's younger son, now living with her, recently had an argument with another tenant over water rations that resulted in a bloody fight, stitches and a fine.
"I am very angry all the time, and people are starting to complain about me", Selma said. "I don't take anything lightly. The other day I couldn't deal with anyone - so I went to a gravesite and just talked to the dead."