‘Where Are All the People I Know?’

What’s the trauma of forced displacement doing to the world’s millions of refugees? Essam Daod on the scale and challenge of a global mental-health crisis. “No one wants to leave their country. We leave because we have to.” Not Themselves What’s the trauma of forced displacement doing to the world’s millions of refugees? Essam Daod on the scale and challenge of a global mental-health crisis. Since Afghanistan fell back under Taliban rule in August, tens of thousands of Afghans have fled their country. The United Nation’s refugee agency, UNHCR, estimates the total number of refugees after the Taliban began fighting to retake control early in the year at [more than 635,000]( to the now more than two-and-a-half million Afghans displaced from their country, and the millions more displaced internally, by decades of strife. Globally, UNHCR determines that by the end of 2020, there were [24.6 million refugees]( out of 82.4 million displaced people worldwide. It’s intuitive that the toll of forced displacement would mean mental-health challenges for the displaced—but while at least [one in three refugees]( experience high rates of depression, anxiety, or post-traumatic stress, the issue has remained, in the words of UNHCR’s senior mental-health officer Pieter Ventevogel, “severely overlooked and under-prioritized.” Just to what extent has the global refugee crisis created a global mental-health crisis? Essam Daod is a psychiatrist and psychoanalytic therapist from an Arab Palestinian village in Galilee, Israel, who co-founded [Humanity Crew]( an international-aid organization providing first-response mental-health support for refugees around the world. To Daod, the experience of forced displacement doesn’t just bring the risk of serious mental-health problems; it’s inherently a serious mental-health problem. And the more relief organizations, governments, and communities come to terms with this spreading global reality, he suggests, the more effectively and sustainably they’ll be able to address it—in humanitarian aid, in the national debates of host countries, and in the experience of refugee populations in local life. ——— Eve Olivette: With so many Afghans escaping conflict and the restoration of Taliban rule this year, what kinds of mental-health issues would they be facing as refugees? Essam Daod: You know, Afghans have been seeking asylum in Europe and the United States for many years, sometimes in larger numbers than we’re seeing now. Unfortunately, they were like the black sheep of the refugees; there was a lot of stigma attached to them. Even in the humanitarian world, organizations often didn’t want to deal with them, focusing aid much more on refugees from the Syrian civil war, for example. In Greece, where we do most of our work, if you were Afghan, you had almost no chance of being resettled. No one would protect you or care about you. Now, for the moment, Afghans have become almost the celebrities of forced displacement. But because of what happened in Kabul with the departure of the Americans, many of the Afghans seeking asylum now are even more exposed to mental-health issues—not only because they’ve gone through displacement but because it was very immediate. There was no time to process anything. With Afghan refugees from the previous decade—they were going through forced displacement, but they could generally take their time. They could save money; they could plan their journeys and their timing; they could say goodbye to their beloved. With the new refugees, their displacement was almost immediate, because no one thought the Taliban would take control that fast. So people didn’t prepare. We all then ended up seeing a lot of traumatic images—of people desperate to get out, trying to hold onto aircraft as they took off, and so on. In a situation like this—where there’s no process, no preparation, where there’s immediate displacement—this increases the chances of more severe mental-health disorders, like depression, anxiety, or, post-traumatic stress. And without help, people will resort to what we call self-treatment—with alcohol or drugs, resulting in addiction, sometimes violence and criminality. Some will be also recruited into terrorism, because, terror movements, they recruit people by filling gaps—and mental health is a huge gap. More from Essam Daod at The Signal: “When you understand a psychology like this, you understand that the first thing you need to do when you encounter a group of people from the East who’ve been through complex trauma—Palestinians, people from Gaza, Bangladeshis, Afghans—is to recreate community, because it’s the first thing all of these people lose in their experience of trauma. When you are in a situation of forced displacement, when you are running for your life, you will become an animal. Your prefrontal cortex, this very new part of your brain, the part the other animals don’t have that makes you more humane and empathic and capable of reasoning, and planning, and all of these new human things—this shuts down. Your brain is in a state of fight or flight. And when that subsides, and you open your eyes, and you’re Greece, you think, Wait, what? What happened? Where is my tribe? Where is my family? Where are all the people I know?” “If you enter a camp of 2,000 or 3,000 people, it’s chaotic, nothing’s organized. If you want to detect the problems there and start to provide help, you can’t—you’d need hundreds of psychologists. But if you bring in volunteers—five or ten of them—and train them, so they’re informed about trauma and mental-health, along with two or three social workers and a clinical psychologist, then you can make things happen. Then you can start to help people, and you can start to detect the really vulnerable cases. A lot of the time you can’t reach the vulnerable person directly, because he’s sitting in his tent, and he’s destroyed totally. But when you work with the community, the community will bring him to you.” “This refugee from Syria, why is he drinking now? It’s the trauma, it’s the depression. Why are maybe 90 percent of the terror attacks in Europe over the last 10 years by asylum seekers or second-generation immigrants? Because they were vulnerable and someone took advantage of that. Almost all of them have drug abuse in their background. Almost all of them suffered from mental-health issues that went neglected for years. No one saw them. These are the people who are easily recruited. And, you know, this is all part of what’s at stake in the mental health of people who’ve gone through forced displacement—or whose families have gone through forced displacement.” ——— Free Article This Week [Can’t Get You Out of My Head]( Is Facebook fixable? Sandeep Vaheesan on the underlying problem of surveillance advertising. For Subscribers [Power and Glory]( Does religion now belong to the right in U.S. politics? Matthew Sitman on Joe Biden’s Catholicism and the broad potential of religious tradition in American democracy. [Common Ground]( How divided are Americans in arguments over public education? Daniel Cox on the surprising consensus lost in the conflict. 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