Syrian Refugees' Traumatic Experiences and Mental Health in Jordanian Host Communities

Background/Purpose: The Syrian Civil War has created a mass exodus of its citizens to the neighboring countries of Turkey, Lebanon, Jordan, Iraq and Egypt. People seeking refuge have been exposed to atrocities and trauma beyond the comprehension of most. Human rights violations associated with political displacement, armed conflict, ethnic cleansing, genocide and cultural persecution have been recognized as extremely traumatizing events with major impacts to the mental health of civilian populations. This study seeks to document the extent of the traumatic experiences suffered by Syrian refugees who fled to Jordanian host communities and to assess their mental health, health and social service needs.

Methods: Between March and June 2014, structured interviews were completed with Syrian refugees seeking services from NGOs in Jordan. The interviewees reported on their current social circumstance, their exodus from Syria, and their conflict/war experiences, documented with the War Events Questionnaire. Interviewees were assessed on the Harvard Trauma Questionnaire (HTQ), the Personal Assessment of Intimacy in Relationships (PAIR) scale, and the Post-traumatic Growth Inventory (PTGI). All questionnaires used were in Arabic and only oral consent was required. Univariate statistics were used to provide a descriptive overview of the refugee experience.

Results: The sample (N=270) included 48% males and 52% females; their mean age was 35.5 years; 60% were married, 24% single, 11% widowed and 5% divorced. 94% were Muslim. The mean years of education is 10.5 and mean children per family, 3.2.

19.2% described their physical health as poor. 57.4% experienced physical pain or discomfort, 46.8% reported having a medical condition; and 40.4% described their overall well-being as poor.

As to service in Jordan: 23.9% used emergency clinics, 68.6% general health clinics, and only 8% mental health clinics. 24.2% reported lack of clinic access/usage. 13.9% reported being content with the services provided in Jordan, 48.5% moderately content, and 37.6% discontent.

Regarding participants’ unmet needs: 84.4% reported economic needs; 38.5% survival/living necessities, 34.8% medical needs; 19.6% psychological and emotional support needs; 18.9% educational needs; and 14.1% social service needs.   

The HTQ revealed that 84.4% experienced combat situations, 80.7% forced evacuation, 70.4% economic impoverishment, 69.3% forced separation from family members, 65.2% confiscation or destruction of personal property, 58.5% murder or death of a family member or friend, 55.2% witnessed beating to head or body, 54.4% were forced to hide, 52.6% lacked food or water, 49.6% suffered ill health without access to medical care, and 48.5% a lack of shelter.

According to the Harvard-PTSD case classification 38.1% suffer PTSD. The number of traumatic events experienced by refugees was associated with elevated Harvard-PTSD scores (r= .50), impaired PAIR-intimacy scores (r = -.33) and degraded PTGI scores (r = -.21). Encouragingly, stronger religious beliefs and more accepting attitudes towards mental illness were associated with lower PTSD scores respectively (r = -.14; r = -.21). All correlations were significant at the 0.01 level.   

Implications for practice: It is essential to address the overwhelming needs of Syrian refugees and the demands that this population is placing on the host country and its humanitarian organizations.