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Adam Coutts
Adam Coutts
Dr Adam Coutts is a UK and Lebanon-based policy consultant specialising in social welfare, employment and public health.
The hidden injuries of Iraqi refugees
Psychological health and well-being issues plague one of the largest refugee populations in the world.
Last Modified: 03 Jun 2011 08:39
Some 4.5 million refugees have been uprooted from their homes since the Iraq conflict began in 2003 [GALLO/GETTY]

Little attention has been given in the post-conflict reconstruction of Iraq to the health and well-being of refugees and their children. Indeed, with the advent of the Arab Spring, the situation of displaced Iraqi refugees has left media, public and national policy agendas altogether. But almost a decade after US and British troops first touched down on Iraqi soil, families continue to lack basic resources. Children are living in a very fragile and tense social environment - which in countries such as Syria, Jordan and Lebanon is getting worse by the day, given the current social uprisings.

The devastating social effects in terms of increased civilian mortality of the invasion and reconstruction of Iraq has been demonstrated by research such as that produced by the Iraq Family Health Survey and the Johns Hopkins Bloomberg School of Public Health studies published in the Lancet. However, scant research or policy attention has been given to the suffering, death and psychological impacts caused by displacement and the poverty experienced by one of the largest refugee populations in modern history.

It is estimated that some 4.5 million refugees have been uprooted from their homes since the Iraq conflict began in 2003 and escalated in 2006, almost half of whom sought asylum in countries such as Syria, Jordan, Lebanon, Egypt and Turkey. In Syria, the government estimates that there are between one and 1.2 million Iraqis, approximately half of whom are children and adolescents. In many cases, they are neither able to go back, nor forward with their lives, as experiences of torture, kidnapping, severe violence, and grief continue to fill their lives.

Lack of policy and public focus

The lack of psychosocial support means that Iraqi refugee families are left unaided to cope with the trauma they have faced in Iraq. This situation is further exacerbated by the increasing economic hardship and poverty they face whilst residing in host countries - such as a lack of access to the formal labour market and unemployment. Research shows that many Iraqi refugee children, especially teenagers, work in restaurants, shops and construction firms in order to contribute to - or be the sole provider of - the family income. Insecurity and hopelessness due to an uncertain future all have a significant impact upon the family unit, which in turn affects the health and well-being of the younger generations of Iraqi refugees.

The lack of policy and public focus on these issues and the ongoing deterioration of children's living conditions represent a significant threat to Iraqi children: low school enrolment, drop-out, child labour, separation and prostitution are among the main protection risks. A small number of surveys such as those carried out by the International Catholic Migration Committee, the International Rescue CommitteeDr Al Obaidi in Egypt, the Iraqi Mental Health Survey and Johns Hopkins have provided general assessments of the health problems that children in Iraq and displaced Iraqis face.

A recent unpublished UNICEF report on the psychological health and well-being of Iraqi refugee children in Syria provides strong evidence of the adverse circumstances in which children find themselves.

The large-scale representative study of UNICEF's Child Friendly Spaces found that the majority of Iraqi children in Syria have suffered from a significantly high-level of distressing experiences such as witnessing the death of parents or siblings as well as being kidnapped or tortured themselves. These experiences continue to haunt them months and years after their families were displaced from Iraq to Syria. Children and adolescents are mentally exhausted and lack coping resources and other protective factors. Those experiences appear to significantly increase the vulnerability for mental health and social problems, and hence signify tremendous challenges to the well-being and development of this young generation.

A humanitarian issue

Significantly more than half of the assessed children and adolescents displayed psychological problems such as depression and anxiety; approximately half expressed social problems and approximately a third reported general health problems. Children were also found to have elevated levels of fear, aggression and sleeping problems as well as isolation, withdrawal and sadness, particularly amongst females.

The situation of Iraqi refugee children in terms of their health and well-being is an urgent humanitarian issue that requires effective and immediate intervention. Psychological health issues such as depression may not manifest themselves for years to come, thereby generating future and continuing trauma, for the children themselves - and also creating a burden on the health and social service systems of their host countries in the Middle East, Europe and the United States.

Countries such as the UK which admit pitifully low numbers of refugees for resettlement (according to United Nations High Commissioner for Refugees - 68 people have been allowed settlement in the UK since 2007, out of hundreds of thousands of applicants) would do well to increase their already low UN budget allocations to the support of programmes to protect the health and well-being of Iraqi refugee children. Countries such as Sweden and Denmark currently donate far more to UN Iraqi refugee budgets than the UK. Given that country's significant role in the invasion and reconstruction of Iraq, perhaps an increase in funding and a renewed focus on the issue of refugees and the social conditions in which they live would help to soften its Iraq legacy.

Dr Adam Coutts is a policy consultant specialising in social welfare, employment and public health. He is based in the UK and Lebanon.

The views expressed in this article are the author's own and do not necessarily reflect Al Jazeera's editorial policy.

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