The invisible wounds of Syria that quietly deepen

After more than 13 years of war, displacement and ongoing humanitarian crises, the inevitable outcome of this suffering is a widespread mental health crisis that is affecting countless people. ​ 

The impact of a prolonged war  

More than 4 million people in northwest Syria are living in dire conditions, and 3.5 million are internally displaced. In addition to living in worn-out tents for years, parents struggle to find food for their children, healthcare is difficult to reach and shelter is a luxury. ​ 

Post-traumatic stress disorder (PTSD), anxiety and depression are widespread among conflict-affected and displaced people. Ongoing violence, loss of loved ones, poor living conditions, multiple displacements and disruption of daily life have severe psychological impacts, with PTSD manifesting through flashbacks, nightmares and anxiety. ​ 

The impact of the February 2023 earthquake and the subsequent ones in August 2024 only compounded the psychological toll on people in northwest Syria. ​ ​ 

As a result, suicide rates are rising in northwest Syria. Since the beginning of 2024, Syria’s response coordinators have recorded 37 deaths by suicide, including 21 failed attempts, representing a 14 per cent increase compared to the same period last year. ​ 

MSF has also supported 11 people who attempted suicide, the majority involving women aged 20 to 45, along with two children under 15. 

Women constitute 63 per cent of our patients and the most reported stressors by patients include daily living conditions, violence and family related problems. 

“Most of the patients are women, who are especially impacted by economic struggles, limited opportunities and violence. This troubling rise highlights the urgent need for mental health and economic support to tackle the issues,” says Romeza. ​ 

Mental health, security and stability  

According to OCHA, the humanitarian response plan in northwest Syria is critically underfunded. As of October 2024, only 26 per cent of the Syria Response Plan had been funded, leaving a deficit of $3 billion across the humanitarian sectors. The health sector faces a massive funding gap of $471 million, with only 10.5% of needs being met. 

This shortfall in funding threatens the availability of essential health services and, unfortunately, mental health care is often among the first to be deprioritised. The lack of mental health care services can lead to more violence, substance abuse and the collapse of a social structure, further destabilising vulnerable communities. ​ ​ 

Stigma and violence  

Sadly, access to psychological support for survivors of violence and abuse is limited due to the absence of an integrated support system, including legal frameworks and inaction. While people are changing their attitude towards mental health issues and becoming more inclined to talk about their experiences and seek help, many still feel the need to hide due to fear of their perpetrators or social judgment. 

Naseem and Raghda, two wives married to the same man, come to one of the MSF-supported health centres in northwest Syria for antidepressants because of the physical and verbal abuse they receive from their husband. They use their children's illnesses as an excuse to leave the house because their husband prevents them from consulting with a mental health professional. ​ 

This kind of stigma creates a barrier for patients to access mental health services in the community and further complicates the situation. Many people avoid seeking help due to societal perceptions, fear of judgment or misunderstanding of mental health issues. 

“One of the challenges facing the mental health sector is the stigma associated with mental disorders, treatments and psychiatric medications,” says Dr. Ayham Al-Khatab, an MSF doctor in northwest Syria. “At MSF facilities, the dignity and privacy of patients are protected”. 

Psychiatric medication suffers from a poor reputation, with people being afraid of addiction, which prevents them from seeking help from doctors and mental health specialists. 

A holistic approach to mental and physical wellness  

In northwest Syria, MSF combines psychological support with medical treatment services, making sure that both physical and mental health are treated together. MSF runs eight mobile clinics in displacement camps, and non-communicable diseases (NCDs) clinics at two primary healthcare centres. In these mobile clinics, mental health support is provided to people as well. ​ 

In 2024, MSF teams provided mental health services to more than 12,000 people in face-to-face consultations and more than 69,000 patients attended mental health group sessions. ​ 

At the burn hospital in Atmeh area, MSF offers psychosocial support, individual and group counselling and psychoeducation. These services are vital for patients dealing with trauma, pain and disfigurement. 

MSF also plays a crucial role in supporting nine safe spaces for women and children. Within the Idlib and Aleppo governorates in northwest Syria, our teams directly manage four of these safe spaces, ensuring they offer essential services. We collaborate with local partner organisations to support the other five safe spaces. ​ 

These collective efforts help to create a safe environment for women and children, thus promoting their wellbeing through recreational activities, referrals to vital services for physical and mental health, and socio-economic assistance. ​ ​ 

“People in northwest Syria have endured years of violence, displacement and deprivation. They need the opportunity to heal not only from physical wounds but also from the deep, unseen psychological scars left by this crisis,” says Thomas Balivet, MSF head of mission in northwest Syria. “Investing in mental health is an investment in a more stable future where people can regain their lives.” ​ 

 *Some names have been changed to respect confidentiality.