In late 2018, Ella Baron, a cartoonist on assignment with The Guardian, visited a Doctors Without Borders/Médecins Sans Frontières (MSF) clinic in Shatila refugee camp in Lebanon. She listened to stories from our patients—mostly Syrian women—and from MSF staff. Her vivid illustrations provide a glimpse into the lives of people living in Shatila, and the range of mental health care needs there. Alongside these pictures, MSF psychologist Miriam Slikhanian shares her personal experiences of working with refugees in the camp.
Patient: A good memory of Syria? The night I finished my university exams. We all went to the public park to have a barbecue and chill.
Miriam: Good memories sustain us when things are hard. I say to dedicate a specific time every day to remember the places and people you have lost. But in order to make the most of the present, it is important to accept the reality that you cannot go back to the past.
Two years ago, I started working as a clinical psychologist at MSF’s clinic in Shatila refugee camp, in Beirut. I had expected that most of my work would be related to psychological trauma. But I soon learned that it was mostly related to the daily challenges of living as a refugee.
Shatila camp was originally set up for Palestinian refugees in 1949. The camp now hosts Syrian and Palestinian refugees, as well as other minorities such as Ethiopians and Filipinos. All live in deplorable conditions.
A history of trauma, and a future of uncertainty
Apart from their history of trauma, their loss of loved ones and possessions, and their displacement to a foreign land, Shatila refugees face a daily struggle to meet basic needs. They also face humiliation and discrimination and live with constant uncertainty about the future.
Among the patients at MSF’s clinic in Shatila are a large number of Syrian refugees, especially women, seeking mental health services.
Patient: When the bomb fell on our home, it trapped my legs. I couldn’t do anything. I watched my family die in front of my eyes. My mother, sister, my two children dying, and I did nothing. Since we arrived in Lebanon, most days I just stay in the room with the children. It’s been almost five weeks since my last day out.
Miriam: I try to help her to let go of this guilt, to see that her family would understand she did everything she could. We’re still working on the difference between forgetting and moving on.
Identifying symptoms and solutions
MSF has been giving free psychological support for refugees in Shatila since 2013. A number of psychologists—including me—provide individual, family, and group support for individuals of all ages. In 2017, over 3,000 individual mental health sessions were offered to the patients in Shatila and Burj Al Barajneh, a neighboring refugee camp.
The patients I see every day have a variety of symptoms. Their mental health problems are precipitated by stressful events and by the situations in which they live. Depression, anxiety, and post-traumatic stress disorder are very common reactions.
I help them cope with their emotional or psychological problems by listening empathically and validating their feelings. I educate them about their symptoms and the impact of stressful events, and I teach them ways to overcome their mental health difficulties. Confidentiality and privacy are key in our sessions. We often work in multidisciplinary groups of social workers, doctors, and nurses, to ensure the physical, psychological, and social well-being of our patients.
|Miriam: Sometimes I say that coming to terms with trauma is like opening a packed wardrobe. When you open the door a tangled mess pours out at you; you must sort through it before it can be carefully folded away.|
A glimpse of hope
Working as a psychologist in Shatila is challenging because, unlike other places where I’ve worked, the problems here are not purely related to mental health. It’s challenging to help a person with a mental health issue if their larger problem is that they are unable to feed their children or to find a safe place to stay.
Working here with MSF, I have learned that refugees are stuck in a limbo between the past and the present. On the one hand, they yearn to be in their countries, in their own houses, with their loved ones. But it is not a choice for them when their houses no longer exist, when they are at constant risk of death, or have no means to sustain themselves. On the other hand, they wish to be in a safe place. But they are fighting daily to find enough food to eat, a safe place to shelter, and people who regard them with respect.
My reward for working here is to see how people’s lives change after receiving our services. I’ve seen people start to accept the reality of their situation and develop resilience. I’ve seen people who have been able to change their circumstances through psychological support. And I’ve seen people who have started to have hope in humanity after realizing that there was someone who cared.
To see one smile on a broken face, one glimpse of hope in a hopeless heart, or one word of gratitude from lips that were silent, is enough for me to know that this work is worthwhile.