Arriving after war and flight
Impressions stick with us. Everyone recognises stimuli that find their way into our memory via our nose, ears or eyes. For example, the smell of freshly mown grass can awaken inner images and feelings: happy hours at the football pitch, summer days at the outdoor pool or holidays on the farm. Some of these impressions become part of our identity. And they go way back to our childhood.
There are children who experience how their parents or loved ones are torn apart by bombs, tortured or kidnapped. These impressions can also become ingrained, even traumatising. We speak of trauma when people experience an existential threat and despair. Susanne Attassi from the Happiness Again trauma therapy centre in Amman, Jordan, reports on Syrian children who have seen «how their father or mother was killed». Others have been victims of rape.
Trauma as a constant companion
Experts call post-traumatic stress disorder, PTSD, a form of trauma disorder characterised by persistent symptoms. It manifests itself, for example, through uncontrollable «flashbacks». These are images in the mind's eye of traumatic scenes that suddenly appear. These can be triggered by sudden stimuli, such as sounds or odours, which are associated with traumatic memories. This results in severe psychological and physical stress. People with PTSD suffer from constant tension, irritability, sleep problems and difficulty concentrating. Depression, anxiety disorders, drug addiction or an increased risk of suicide can also be associated with the clinical picture.
The tensions of Syrian refugee children
In the case of war traumatisation, the probability of PTSD increases significantly. In addition to the war experiences themselves, experiences of flight can also traumatise people.
Dealing with trauma differs between older and younger people. «Although children are more vulnerable, they are also more capable of learning and adapting than adults,» explains Matthis Schick, Head of the Outpatient Centre for Torture and War Victims at Zurich University Hospital. However, parental trauma can also cause stress and conflict in children, for example if parents are irritable, impulsive or emotionally unavailable. Tensions can also arise if the trauma has a greater impact on the parents and they are unable to integrate. This can lead to conflicts of values. For example, when Syrian children change their style of dress in their new environment.
In addition, children often find themselves in role conflicts: because they often master the language more quickly, they take on responsibility for their parents at an early age. Without the support of their children, many parents are unable to visit the authorities or the doctor. Experts call this effect the «parentification» of children. Finally, children can find themselves in conflicts of conscience and under pressure of expectations: for example, when parents say that, unlike their children, everything was taken from them in their old home country. Now, in their new home, the children should make the most of every opportunity.
Arriving in a new home, with heavy luggage
However, in addition to the parent-child dynamic, there are other hurdles that stand in the way of the integration of refugee families. Even in a safe, stable country like Switzerland, as Matthis Schick describes: «Factors such as uncertain residence status, difficulties with social and linguistic integration, separation from relatives and precarious living conditions have a strong psychopathological impact. These stress factors create post-migratory stress, which weighs heavily and increases the risk of mental illness». It is also problematic that many refugees do not receive trauma treatment. Mental suffering and the underlying traumatic experiences are often highly stigmatising. This means that those affected feel ashamed and fear social ostracism. It is «very touching how much effort is sometimes made to hide the trauma, even though the symptoms are very severe». For example, when those affected react in panic as soon as the doorbell rings. It is therefore important to build trust before trauma therapy can begin. This also applies to state institutions. After all, children and their parents in Syria have experienced state persecution, torture and killing. The first step in building this trust is through social workers and teachers. They have permanent and crucial access to the families.
The everyday school life of refugee children
Accordingly, school plays a central role for refugee children. It provides daily structure and social contact. These two resources offer children advantages that their parents are largely denied. This is because they usually live in isolation in the refugee centre, without work or a circle of friends, in the middle of the asylum process.
Maram, who fled from Syria to Switzerland at the age of 12, remembers: «There was no one with an Arabic background in my class that I could talk to. So at the beginning I was very scared and had very low self-confidence, a lot of self-doubt. I was always afraid of making mistakes»
One key to both integration and trauma therapy is the German language. Markus Busin, a teacher in Zurich's Langstrasse neighbourhood, remembers that around 15 years ago there were still so-called «reception classes». These only included children from abroad, who were taught alongside the regular school classes. They were led by individual, experienced teachers and aimed to enable them to join the regular classes. Occasionally, such classes still exist today, for example when there is a larger group of affected children. In general, however, the children are now placed directly in regular classes in the nearest school building. There they receive additional German lessons, for example, or are accompanied by teaching assistants.
Integration challenges
«You do worry when a new child comes to school with little or no knowledge of German,» explains Thomas Gerber, whose son Leon had Syrian refugee children in his class. "But I'm not worried about whether it could affect the quality of teaching.
There is a clear guideline for teachers. They should limit themselves to their pedagogical role, which is not always easy. «We can't deal with war traumas. We are not trained for that and the setting in a school class is simply wrong for that,» explains Markus Busin.
Recognising which child is traumatised depends on prior information. If a child comes from a war context, teachers usually pay particular attention to possible traumatisation. Children who are loud are then referred to the school psychology service. Children without behavioural problems in the classroom, on the other hand, escape the radar and therefore also therapy.
Classmate Leon describes it like this: «Perhaps the refugee children were a bit more anxious and reserved than other children. They didn't trust everyone, but that improved over time. What I really liked about them was that they were always so obliging, helpful and nice. That was really special and cool.»
Problems for the children's integration arise when they are insecure: due to their experiences, but also because they don't speak the language. Markus Busin is therefore careful not to expose the new children unnecessarily. He also avoids asking direct questions about traumatising experiences. Instead, he makes sure that the children can talk about their experiences later on their own initiative if they want to.
«I sensed that teachers and pupils were afraid to ask me about my past and were very reserved, almost cautious; they probably thought that I myself was afraid to talk about my experiences,» explains refugee child Maram.
For integration into the school class, shared experiences are sometimes even more important than language. A new, shared identity can also emerge at a class camp lasting several days, at a sports festival or bake sale. Without any additional effort, the daily structure of the school day and shared experiences can provide an important protective space for the children. At the same time, however, Markus Busin sees a major deficit in psychological measures for refugee families: «Families and children are left very much on their own. I think it would be important for these children to receive support as quickly as possible. It doesn't have to be psychological therapy, but simply someone to help them get back into everyday life».
Thomas Gerber has a similar view: «You somehow had the feeling that the child was looking for support, and it got it from the children and not from any institutional help.» Thomas Gerber sees added value for the classmates: «This activates the children's social behaviour in a way that would certainly not otherwise be the case. What's more, the children get a completely different picture from the stories than from the news. The people you see on the news are suddenly no longer strangers.»
Trauma treatment
Christina Gunsch, Head Psychologist for Child Psychiatry and Psychotherapy at the Psychiatric University Hospital Zurich, assumes that around 30 to 50 per cent of all Syrian refugee children are traumatised. «Those affected are registered with me for treatment when they are out of control at school». The children are aggressive or cannot concentrate. The teachers' assessment of the situation is crucial here. To support them, the «Zürcher Arbeitsgruppe Kind und Trauma» (Zurich Working Group Child and Trauma) has published the brochure «Flucht und Trauma» (Escape and Trauma). Christina Gunsch is co-author of the brochure. It explains trauma, conspicuous behaviour and possible interventions.
The main aim of various therapeutic approaches is to counteract the suffering. The therapy methods that Christina Gunsch chooses for this are scientifically proven. She ventures into the lion's den with her young patients, because: «We now know that you have to go through the most difficult experiences again in order to heal a trauma». Exactly how this process takes place depends on the child concerned. Some children record the traumatising experiences. But writing them down, replaying them or working through the experiences in their mind again and again also helps. It is important to remember with all the senses: what did it look like, what did it smell like, what did the child hear? Many children complete this form of therapy over several weeks without any problems.
Refugee child Maram would have liked to talk more about Syria, she explains. That's why she wrote her dissertation on the subject to tell a little about her experiences in Syria. «Many people don't know what's happening there, and I just felt the need to talk about it.»
Creating development prospects
Whether the children and their families succeed in arriving in their new home depends on many factors. Christina Gunsch and Matthis Schick share this view: trauma therapy is most successful when there is a stable school environment and support from the child's private environment. It is also crucial that there is a prospect of a «liveable» future. If this realisable perspective can be conveyed, ways and means of dealing with the past can be found. In addition to a stable school and family environment, it is important to promote personal resources such as talents and professional skills: In other words, «to take up and support what patients bring with them».
For Maram, it was her Swiss teacher in particular who made her feel that she was no stranger. «She talked to me a lot, told me that I didn't need to worry, that this was a new beginning for me, that I had talent. That really encouraged me.»
It is important to prevent Syrian refugee children and children from other crisis regions from becoming part of a «lost generation». The risks and potential long-term consequences for the children and for society are too high. According to both experts, it is therefore important to ensure good preparatory work on the ground: By already sensitising parents and children in Syria and neighbouring countries to psychiatric and psychotherapeutic work. Just as is done at the Happiness Again trauma therapy centre in Amman, Jordan, for example. In addition, according to Christina Gunsch, a psychological examination would also be important on admission to Switzerland, alongside a physical and medical examination. This would make it easier to recognise trauma at an early stage and treat it in good time.
Children who have experienced war are not only the ones who suffer the most, but also shoulder the burdens of a new everyday life. It is therefore crucial to relieve these children of some of their heavy baggage along the way and give them a hopeful outlook for their future.
Maram has a clear plan. «I want a good education for the future. I want to feel part of society. I'm about to start training as a medical practice assistant. If that works out, I would like to become a doctor myself.»
Links
- Brochure: Flight and trauma - Dealing with refugees, traumatised children & adolescents in socio-educational institutions and foster families
- The services of the School Psychological Service of the City of Zurich (SPD) are available free of charge to children and young people attending primary school in the city of Zurich, as well as to their parents and teachers.
Syrian war: facts and figures
According to the United Nations, the Syrian war that has been going on since 2011 has triggered the greatest humanitarian catastrophe since the end of the Second World War. So far, the war has claimed over 400,000 lives. With around 13 million refugees (6 million outside Syria and 7 million internally displaced persons), more than half of the Syrian population is directly affected by the war. 44 per cent of the refugees are children and young people under the age of 18. Syrian children under the age of 9 know no life without war. According to estimates, 30 to 50 per cent of Syrian refugee children are traumatised by war. While Syria was considered a country with a high level of education before the war (99.6 per cent primary school rate), over 4,000 schools have been destroyed since 2011.
Sources: UNICEF, UNHCR, Human Rights Watch
