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Psychosocial concerns reported by Syrian refugees living in Jordan: Systematic review of unpublished needs assessments

  • Ruth Wells (a1), Zachary Steel (a2), Mohammad Abo-Hilal (a3), Abdul Halim Hassan (a4) and Catalina Lawsin (a5)...
Abstract
Background

Humanitarian organisations supporting Syrian refugees in Jordan have conducted needs assessments to direct resources appropriately.

Aims

To present a model of psychosocial concerns reported by Syrian refugees and a peer review of research practices.

Method

Academic and grey literature databases, the United Nations Syria Regional Response website, key humanitarian organisation websites and Google were searched for needs assessments with Syrian refugees in Jordan between February 2011 and June 2015. Information directly reporting the views of Syrian refugees regarding psychosocial needs was extracted and a qualitative synthesis was conducted.

Results

Respondents reported that psychological distress was exacerbated by both environmental (financial, housing, employment) and psychosocial outcomes (loss of role and social support, inactivity), which are themselves stressors. Need for improvement in research methodology, participatory engagement and ethical reporting was evident.

Conclusions

Participatory engagement strategies might help to address identified psychosocial outcomes. More rigorous qualitative methods are required to ensure accuracy of findings.

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Copyright
Corresponding author
Ruth Wells, Level 2 (M02F), 94 Mallett St, Camperdown, NSW 2050, Australia. Email: rwel3411@uni.sydney.edu.au
Footnotes
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Declaration of interest

None.

Footnotes
References
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1 The Lancet. The war on Syrian civilians. Lancet 2014; 383: 383.
2 United Nations High Commissioner for Refugees. Syria Regional Response Plan. UNHCR, 2015 (http://data.unhcr.org/syrianrefugees/regional.php).
3 Murshidi, MM, Hijjawi, MQ, Jeriesat, S, Eltom, A. Syrian refugees and Jordan's health sector. Lancet 2013; 382: 206–7.
4 Syria Needs Analysis Project. Legal Status of Individuals Fleeing Syria. Assessment Capacities Project, 2013.
5 Wessells, MG. Do no harm: toward contextually appropriate psychosocial support in international emergencies. Am Psychol 2009; 64: 842–54.
6 Steel, Z, Chey, T, Silove, D, Marnane, C, Bryant, A, van Ommeren, N. Association of torture and other potentially traumatic events with mental health outcomes among populations exposed to mass conflict and displacement: a systematic review and meta-analysis. JAMA 2009; 302: 537–49.
7 Miller, KE, Rasmussen, A. War exposure, daily stressors, and mental health in conflict and post-conflict settings: bridging the divide between trauma-focused and psychosocial frameworks. Soc Sci Med 2010; 70: 716.
8 Charlson, FJ, Steel, Z, Degenhardt, L, Chey, T, Silove, D, Marnane, C, et al. Predicting the impact of the 2011 conflict in Libya on population mental health: PTSD and depression prevalence and mental health service requirements. PLoS One 2012; 7: e40593.
9 Quosh, C, Eloul, L, Ajlani, R. Mental health of refugees and displaced persons in Syria and surrounding countries: a systematic review. Intervention 2013; 11: 276–94.
10 Tol, WA, Barbui, C, Galappatti, A, Silove, D, Betancourt, TS, Souza, R, et al. Mental health and psychosocial support in humanitarian settings: linking practice and research. Lancet 2011; 378: 1581–91.
11 Ager, A, Burnham, G, Checchi, F, Gayer, M, Grais, RF, Henkens, M, et al. Strengthening the evidence base for health programming in humanitarian crises. Science 2014; 345: 1290–2.
12 Tol, WA, Patel, V, Tomlinson, M, Baingana, F, Galappatti, A, Silove, D, et al. Relevance or excellence? Setting research priorities for mental health and psychosocial support in humanitarian settings. Harv Rev Psychiatry 2012; 20: 2536.
13 World Health Organization. Assessing Mental Health and Psychosocial Needs and Resources: Toolkit for Major Humanitarian Settings. WHO, 2012.
14 Inter-Agency Standing Committee Reference Group for Mental Health and Psychosocial Support in Emergency Settings. IASC Reference Group Mental Health and Psychosocial Support Assessment Guide. IASC, 2012.
15 United Nations High Commissioner for Refugees. Participatory Assessment in Operations. UNHCR, 2006.
16 Tol, WA, Patel, V, Tomlinson, M, Baingana, F, Galappatti, A, Panter-Brick, C, et al. Research priorities for mental health and psychosocial support in humanitarian settings. PLoS Med 2011; 8: 1182.
17 Evans, D, Pearson, A. Systematic reviews of qualitative research. Clin Eff Nurs 2001; 5: 111–9.
18 Braun, V, Clarke, V. Using thematic analysis in psychology. Qual Res Psychol 2006; 3: 77101.
19 Blaxter, M. Criteria for the evaluation of qualitative research papers. Med Sociol News 1996; 22: 47.
20 Inter-Agency Standing Committee Reference Group for Mental Health and Psychosocial Support in Emergency Settings. Recommendations for Conducting Ethical Mental Health and Psychosocial Research in Emergency Settings. IASC, 2014.
21 Myohanen, L, Taylor, E, Keith, L. Accessing grey literature in public health: New York Academy of Medicine's Grey Literature report. Publ Res Q 2005; 21: 4452.
22 Schopfel, J, Prost, H. Document supply of grey literature and open access: an update. Interlend Doc Supply 2009; 37: 181–91.
23 National Technical Library. National Repository of Grey Literature. University of. Economics, Prague, National Technical Library, Academy of Sciencies of the Czech Republic, University of South Bohemia in Èeské Budejivoce, 2014 (http://roar.eprints.org/3496/).
24 United Nations High Commissioner for Refugees. Syria Regional Refugee Response. UNHCR (http://data.unhcr.org/syrianrefugees/country.php?id=107).
25 Inter-Agency Standing Committee. IASC Guidelines on Mental Health and Psychosocial Support in Emergency Settings. IASC, 2007.
26 United Nations High Commissioner for Refugees. Operational Guidance for Mental Health and Psychosocial Support Programming for Refugee Operations. UNHCR, 2013.
27 World Health Organization, King's College London. The Humanitarian Emergency Settings Perceived Needs Scale (HESPER): Manual with Scale: 89. WHO, 2011.
28 Taleb, ZB, Bahelah, R, Fouad, FM, Coutts, A, Wilcox, M, Maziak, W. Syria: health in a country undergoing tragic transition. Int J Public Health 2015; 60 (suppl 1): 6372.
29 Hannes, K. Critical appraisal of qualitative research. In Supplementary Guidance for Inclusion of Qualitative Research in Cochrane Systematic Reviews of Interventions (eds Noyes, J, Booth, A, Hannes, K, et al): 114. Cochrane Collaboration Qualitative Methods Group, 2011.
30 Popay, J, Rogers, A, Williams, G. Rationale and standards for the systematic review of qualitative literature in health services research. Qual Health Res 1998; 8: 341–51.
31 Silove, D. The ADAPT model: a conceptual framework for mental health and psychosocial programming in post conflict settings. Intervention 2011; 11: 237–48.
32 Hobfoll, SE, Watson, P, Bell, CC, Bryant, RA, Brymer, MJ, Friedman, MJ, et al. Five essential elements of immediate and mid-term mass trauma intervention: empirical evidence. Psychiatry 2007; 70: 269–83.
33 Ryan, D, Dooley, B, Benson, C. Theoretical perspectives on post-migration adaptation and psychological well-being among refugees: towards a resource-based model. J Refug Stud 2008; 21: 118.
34 Hobfoll, SE. The influence of culture, community, and the nested-self in the stress process: advancing conservation of resources theory. Appl Psychol 2001; 50: 337421.
35 Care Jordan. Lives Unseen: Urban Syrian Refugees and Jordanian Host Communities Three Years into the Syrian Crisis. Care Jordan, 2014.
36 Questscope. Participatory Reflection and Action (PRA) Report. Factors Affecting the Education Situation of Syrian Refugees in Jordan. Questscope, 2013.
37 International Rescue Committee. Jordan Country Program Cross-Sectoral Assessment of Syrian Refugees in Urban Areas of South and Central Jordan. IRC, 2013.
38 United Nations High Commissioner for Refugees. Report of the Participatory Assessment UNHCR, Amman December 2012. UN, 2012.
39 Serrato, BC. Refugee Perceptions Study. Za'atari Camp and Host Communities in Jordan. Oxfam, 2014.
40 Save the Children, King Hussein Foundation Information and Research Centre. Kinship Care Report. Syrian Refugee Children in Jordan. Save the Children, 2015.
41 International Medical Corps. Rapid Camp Assessment: Improving the Well-Being of Syrians in Za'atari. IMC, 2012.
42 UK Aid, UNICEF, International Medical Committee. Mental Health Psychosocial and Child Protection for Syrian Adolescent Refugees in Jordan. 2014.
43 Mercy Corps. Syrian Adolescents: Their Tomorrow Begins Today. Mercy Corps, 2014.
44 United Nations High Commissioner for Refugees. Woman Alone. The Fight For Survival by Syria's Refugee Women. UN, 2014.
45 International Rescue Committee. Are We Listening? Acting on Our Commitments to Women and Girls Affected by the Syrian Conflict. IRC, 2014.
46 Care Jordan. Baseline Assessment of Community Identified Vulnerabilities among Syrian Refugees living in Amman. Rapid Participatory Community Assessment. Care Jordan, 2012.
47 Care Jordan. Syrian Refugees in Urban Jordan. Baseline Assessment of Community-Identified Vulnerabilities Among Syrian Refugees Living in Irbid, Madaba, Mufra, and Zarqa. Care Jordan, 2013.
48 Doedens, W, Giga, N, Krause, S, Onyango, MA, Sami, S, Stone, E, et al. Reproductive Health Services for Syrian Refugees in Zaatri Refugee Camp and Irbid City, Jordan An Evaluation of the Minimum Initial Service Package. Boston University School of Public Health, UN Population Fund, US Centers for Disease Control and Prevention, and Women's Refugee Commission, 2013.
49 United Nations High Commissioner for Refugees, UNFPA, International Medical Corps. Population-based health access assessment for Syrian refugees in non-camp settings throughout Jordan: with sub-investigation on non-communicable disease management. A qualitative cross-sectional cluster survey. UN, 2014.
50 Joint Education Needs Assessment Education Sector Working Group. Access to Education for Syrian Refugee Children and Youth in Jordan Host Communities. Joint Education Needs Assessment Report. JENA, 2015.
51 Un Ponte Per. Comprehensive Assessment on Syrian Refugees Residing in the Community in Northern Jordan. UPP, 2012.
52 Ministry of Health Jordan, Aide Medicale Internationale. Hashemite Kingdom of Jordan Syrian Crisis Health Needs Assessment. Report to the Ministry of Health. 2014.
53 Joint Education Needs Assessment (JENA) Education Sector Working Group. Access to Education for Syrian Refugee Children in Zaatari Camp, Jordan. JENA, 2014.
54 Handicap International, HelpAge International. Hidden Victims of the Syrian Crisis: Disabled, Injured and Older Refugees. Handicap International, HelpAge International, 2014.
55 World Health Organization, International Medical Corps, Jordanian Ministry of Health. Assessment of Mental Health and Psychosocial Support Needs of Displaced Syrians in Jordan. WHO, 2015.
56 United Nations High Commissioner for Refugees. Participatory Needs Assessment EJC Refugee Camp November 2013. UN, 2013.
57 Jordan Health Aid Society. Displaced Syrians in Jordan: A Mental Health and Psychosocial Information Gathering Exercise. Analysis and Interpretations of Findings. Jordan Health Aid Society, 2012.
58 International Medical Committee, UNICEF. Mental Health/Psychosocial and Child Protection Assessment for Syrian Refugee Adolescents in Za'atari Refugee Camp, Jordan July 2013. IMC, 2013.
59 Joint Education Needs Assessment (JENA) Task Force, Education Sector Working Group. Joint Education Needs Assessment. Za'atari Refugee Camp. JENA, 2013.
60 Women's Refugee Commission. Unpacking Gender: The Humanitarian Response to the Syrian Refugee Crisis in Jordan. WRC, 2014.
61 International Rescue Committee. Assessment Report Cash Transfer Program to Syrian Refugees in Jordan. IRC, 2012.
62 World Vision. Children's Report. Stand with Me. Our Uncertain Future. World Vision, 2014.
63 Maziak, W, Asfar, T, Mzayek, F, Fouad, FM, Kilzieh, N. Socio-demographic correlates of psychiatric morbidity among low-income women in Aleppo, Syria. Soc Sci Med 2002; 54: 1419–27.
64 Brooks, R, Silove, D, Steel, Z, Steel, CB, Rees, S. Explosive anger in postconflict Timor Leste: interaction of socio-economic disadvantage and past human rights-related trauma. J Affect Disord 2011; 31: 268–76.
65 Al-Hamzawi, AO, Rosellini, AJ, Lindberg, M, Petukhova, M, Kessler, RC, Bruffaerts, R. The role of common mental and physical disorders in days out of role in the Iraqi general population: results from the WHO World Mental Health Surveys. J Psychiatr Res 2014; 53: 23–9.
66 Quosh, C. Mental health, forced displacement and recovery: integrated mental health and psychosocial support for urban refugees in Syria. Intervention 2013; 11: 295320.
67 Silove, D, Steel, Z, Susljik, I, Frommer, N, Loneragan, C, Chey, T, et al. The impact of the refugee decision on the trajectory of PTSD, anxiety, and depressive symptoms among asylum seekers: a longitudinal study. Am J Disaster Med 2007; 2: 321–9.
68 Cummings, S, Sull, L, Davis, C, Worley, N. Correlates of depression among older Kurdish refugees. Soc Work 2011; 56: 159–68.
69 Van Ommeren, M, Saxena, S, Saraceno, B. Mental and social health during and after acute emergencies: emerging consensus? Bull WHO 2005; 83: 71–5.
70 Bou Khalil, R. Where all and nothing is about mental health: beyond posttraumatic stress disorder for displaced Syrians. Am J Psychiatry 2013; 170: 1396–7.
71 Jacobsen, K. Refugees and asylum seekers in urban areas: a livelihoods perspective. J Refug Stud 2006; 19: 273–86.
72 Critical Appraisal Skills Program. Qualitative Research Checklist. CASP, 2013.
73 Bearman, M, Dawson, P. Qualitative synthesis and systematic review in health professions education. Med Educ 2013; 47: 252–60.
74 Mackenzie, C, McDowell, C, Pittaway, E. Beyond ‘do no harm’: the challenge of constructing ethical relationships in refugee research. J Refug Stud 2007; 20: 299319.
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Psychosocial concerns reported by Syrian refugees living in Jordan: Systematic review of unpublished needs assessments

  • Ruth Wells (a1), Zachary Steel (a2), Mohammad Abo-Hilal (a3), Abdul Halim Hassan (a4) and Catalina Lawsin (a5)...
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eLetters

Publishing the Unpublished: What are the Real Needs of the Syrian Refugees?

Mustafa Alachkar, Specialist registrar (ST8) in psychiatry and psychotherapy, Manchester Mental Health and Social Care NHS Trust
24 August 2016

I read with great interest Wells et al’s article in the Journal titled “Psychosocial concerns reported by Syrian refugees living in Jordan 1 and I welcome the publication of this article for more than one reason.

Firstly, this is the first article that concerns Syria to be published in the Journal. A basic search for the word ‘Syria’ or ‘Syrian’ on the Journal website reveals no relevant articles. Secondly, the article is the first review addressing the needs of the Syrian refugees in a neighbouring country to be published in a peer-reviewed journal.

The article tackles two inter-related issues: one is the psychosocial needs of Syrian refugees as reported by the refugees themselves to humanitarian organisations carrying out needs assessment. The second is the quality of these organisations’ reports in terms of ethical standards and participant engagement of in designing and implementing the needs assessment.

What I appreciated the most about the study is that it presents the refugees’ experience in terms of environmental stressors that have psychosocial impact and lead to symptoms of distress which in turn interact with the stressors in a self-perpetuating cycle. This certainly does more justice to the complexity of the refugees’ experience and moves away from a reductionist, medical or a pathologising model that sees refugees as individuals with mental illness, be it PTSD or otherwise.

Another strength of the review is that it draws on existing data and looks closely at quality standards adhered to when collecting this data. It is therefore worrying to see that the reports did not meet the minimum criteria for ethical standards in terms of informed consent, non-expectation of reward for research participation, and participatory engagement. This highlights a serious problem in the way humanitarian organisations conduct their needs assessment and deal with the population that they are there to help and might result in loss of trust between refugees and these organisations.

Furthermore, the study models participant engagement by asking two local Syrian psychiatrists currently working with refugees to review the themes found in this paper. The study also models reflexivity, found to be lacking in the reports included in the review, by acknowledging that the first author might have been influenced in conducting this research by her own work with Syrian refugees.

Finally, the study reflects on a stance of neutrality that humanitarian organisations’ adopt which may lead to failure to address sensitive political issues that could be relevant to the refugees’ difficulties. I wonder if the paper falls in the same trap of ignoring the political context which is the original cause of the refugees’ suffering. In Syria, the crisis is political and ignoring this big part of the picture might risk undermining the experiences and views of the refugees.

Nevertheless, Wells et al’s paper remains a brave and sound attempt at addressing a major issue that seems to be somewhat neglected in published mental health literature despite the enormous suffering endured by the Syrian people for over five years.

References

1. Wells R, Steel Z, Abo-Hilal M, Hassan A, Lawsin C. Psychosocial concerns reported by Syrian refugees living in Jordan: systematic review of unpublished needs assessments. The British Journal of Psychiatry. 2016;209(2):99-106.

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Conflict of interest: Dr Mustafa Alachkar is a Syrian psychiatrist who has collaborated with two of the authors of the original paper (R.W. and M.A.H.) in writing a research paper and conducting training workshops for Syrian mental health workers in Jordan and Turkey.

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