Analysis by Francesco Pitzalis, Staff Writer

March 15th, 2021

“To be rooted is perhaps the most important and least recognized need of the human soul”. 

The Syrian refugee crisis has entered its 10th year and continues to exert a severe and deleterious effect on refugee mental health. This can be pinned not only on war-related trauma but on post-migratory psychological stress in host countries. As the conflict has extended, post-migratory stress has dominated the sphere of mental health. This is predictive of worsened mental health amongst female refugees. Thus, a closer look is required to inspect the disruptive, traumatic influence of post-migratory stress on female refugees. The following article considers this question for the case of Syrian female refugees in Lebanon.  

 

The inspection of post-migratory stress entails the workings of refugees in society, including their employment, family units and relationship to the state in which they reside. In all of the above, the role of women is either altered or denigrated. 

Let us first consider employment. Numerous studies have pointed to an increase in female employment amongst Syrian refugees in Lebanon. This is caused by familial financial constraints and male unemployment, which is fostered by lack of opportunity and the perception that male refugees are more likely to get revoked of their residency permits 1. 

Employment provides autonomy, competency and relatedness to fellow employees. Consequently, this shift would superficially seem prognostic of better mental health in female refugees. However, female employment elicits a disruption of family dynamics and changing of “gender roles” in the family unit. Studies have consistently implicated this change as causing a rise in intimate partner violence (IPV) amongst Syrian refugees. This occurs according to Lebanese scholar, Jinan Usta, as a lengthening of the power imbalance existing in male-dominated societies. The outcome is greater expression of hegemonic masculine traits, seen in the form of IPV. IPV is qualified from the male perspective as a “stress release” 2, an attempt to dominate their domestic lives 3 and to counteract feelings of redundancy and emasculation 4. This hyper-aggressive reaction is typical of patriarchal environments in which inter-gender “power-play” is more pronounced 2. 

 

IPV is correlated with severe outcomes for the victim’s mental health including depression, anxiety and PTSD 5. This was corroborated by a systematic review and meta-analysis 6 that concluded IPV increased the likelihood of depression and PTSD by 300% and 700% respectively. 

 

In addition to IPV, Syrian female refugees in Lebanon are subject to high rates of sexual harassment. This includes sexual harassment in the public domain, such as in taxis and shops 2. Furthermore, sexual harassment is perpetrated by figures of authority, such as policemen and healthcare workers (Amnesty, 2016). This dire situation is festered unabashedly by Lebanese politicians who disseminate crude slogans directed against Syrians. Such rhetoric is often sexist, deprecating female refugees as “cheap wives” and “baby-making machines”. This not only fuels abusive sexual harassment on Lebanon’s streets, but also counteracts the reporting and penalisation of such abuse. Likewise, this institutionalised harassment may lead Syrian female refugees to settle for “familiar” violence at home and avoid help-seeking 2.

Sexual harassment is a potent psychological stressor that is predictive of mental health issues 9. Psychopathology is also noted in a refugee study investigating “institutional abuse” perpetrated by people in positions of authority 10. This is particularly pertinent for Syrian refugee women in Lebanon considering the top-down directed discrimination of Syrians. 

 

Another variable worth discussing is early marriage. Early marriage occurred at a rate of 13% in pre-war Syria 11, as marriage above age 13 was lawful when consented to by an adult (HRGJ, 2016). Nonetheless, studies convey a rise in child marriage to 35% amongst Syrian refugee populations in Lebanon 13. For instance, UN habitat reported that 71.4% of non-Lebanese girls aged 15-19 are currently married in the neighbourhood of Hayy El-Blat. The literature further indicates this change is provoked by lack of education, decreasing socio-economic status and sexual harassment. These variables incite early marriage as families may envision a husband offering greater security (financial or otherwise) for young girls than male guardians 11. In reality, the practice of early marriage is inherently problematic. Early marriage obstructs girls’ access to primary education 14 15, detriments mother and child health 16 17 and predisposes women to IPV 18 19. 

Forgoing education due to early marriage exerts an insidious and significant impact on female mental health. Assuming that education is an investment, women generally reap the economic benefits of education more than men 20. As such, female financial autonomy is hindered to a greater extent than in males, when primary education is absented due to early marriage. This lack of financial independence that is commonplace in early marriage explains the helplessness of child wives subject to IPV 19. A sense of helplessness and financial deprivation concurrently contribute to the aetiology of mental health issues in refugees 21.

Worryingly, forgoing education as a consequence of early marriage is part of a vicious cycle. Firstly, less educated women are more likely to rationalise the actions of their abusers 22, propagating female subjugation. Secondly, mothers who marry early are less likely to enrol their daughters in school which perpetuates the poverty and vulnerability of women in future generations 19. Lastly, poor education in Syrian refugees increases the likelihood of women utilising “negative coping strategies” for IPV, such as beating children, which engenders violence in Syrian youth 2. Early marriage also foretells a host of other psychological stressors, including: premature and forced loss of virginity and increased risk of gestational and post-partum complications 23.

 

The post-migratory psychological stressors mentioned are of course subject to the all-encompassing influence of the oppressive Lebanese state and the patriarchy. This toxic mix has paradoxically propagated division amongst Lebanese whilst simultaneously enhancing discrimination of foreign ‘others.’ 

Firstly, current anti-refugee/Syrian rhetoric further destabilises the lives of Syrian refugees. This has manifested an increased effort to thwart Syrian presence in Lebanon; including banning of further entry, destruction of settlements and deportations (HRW, 2019). Moreover, refugees are being evicted from towns by xenophobic mobs, including in Bcharre and Minieh seen recently. This heightened deportation risk evokes greater psychological stress by reifying Syrians’ sense of uprootedness and helplessness.

 

Secondly, there is patriarchy – an ever-present intrusion into the lives of women throughout the Middle East and a fallacy that designates the woman as secondary to her husband in her role as homemaker, as well as a secondary citizen. Besides fuelling sexist rhetoric amongst the Lebanese political class, the patriarchy is also responsible for initiating early marriage, provoking IPV, and rationalising IPV amongst victims.  

 

Further research should consider how these cultural and societal variables contribute to the development of mental health in Syrian female refugees and women in general. Likewise, longitudinal studies should be employed to determine psychological stress in refugee populations in order to fully delineate its impact. As the reader may be aware, it is difficult to fully disentangle the interlocking psychological impacts of early marriage, violence against women, and low female primary education enrolment rates. However, it is clear that the net impact in Lebanon on the mental health of female Syrian refugees is highly destructive. 

 

In summary, 10 years of displacement of Lebanon have exerted an immeasurable psychological burden on Syrian female refugees. Thus, any programme designed to rehabilitate and reequip refugees must place a substantial emphasis on the mental health of women. It is this author’s opinion that an empowerment of women as pillars of Syrian refugee society is essential towards the development of an educated, prosperous Syrian population. This would aid the rebuilding of Syria post-conflict. Indeed, the Syrian conflict is the region’s “festering sore” and will not be solved without human potential amongst refugee cohorts. 

References 

1.        Syam H, Venables E, Sousse B, Severy N, Saavedra L, Kazour F. “with every passing day i feel like a candle, melting little by little.” experiences of long-term displacement amongst Syrian refugees in Shatila, Lebanon. Confl Health. 2019;13(1):1-12. doi:10.1186/s13031-019-0228-7

2.        Usta J, Masterson AR, Farver JAM. Violence Against Displaced Syrian Women in Lebanon. J Interpers Violence. 2019;34(18):3767-3779. doi:10.1177/0886260516670881

3.        Munn J. The hegemonic male and Kosovar nationalism, 2000-2005. Men Masc. 2008. doi:10.1177/1097184X07306744

4.        El-Masri R, Harvey C, Garwood R. Shifting Sands: Changing gender roles among refugees in Lebanon. 2013;(SEPTEMBER):44.

5.        Decker MR, Peitzmeier S, Olumide A, et al. Prevalence and health impact of intimate partner violence and non-partner sexual violence among female adolescents aged 15-19 years in vulnerable urban environments: A multi-country study. J Adolesc Heal. 2014. doi:10.1016/j.jadohealth.2014.08.022

6.        Oram S, Trevillion K, Feder G, Howard LM. Prevalence of experiences of domestic violence among psychiatric patients: Systematic review. Br J Psychiatry. 2013. doi:10.1192/bjp.bp.112.109934

7.        Yasmine R, Moughalian C. Systemic violence against Syrian refugee women and the myth of effective intrapersonal interventions. Reprod Health Matters. 2016;24(47):27-35. doi:10.1016/j.rhm.2016.04.008

8.        Amnesty, 2016.

9.        Barber BK, McNeely C, Olsen JA, Spellings C, Belli RF. Effect of chronic exposure to humiliation on wellbeing in the occupied Palestinian territory: an event-history analysis. Lancet. 2013. doi:10.1016/s0140-6736(13)62579-9

10.      Eleftherakos C, Van Den Boogaard W, Barry D, Severy N, Kotsioni I, Roland-Gosselin L. “I prefer dying fast than dying slowly”, how institutional abuse worsens the mental health of stranded Syrian, Afghan and Congolese migrants on Lesbos island following the implementation of EU-Turkey deal. Confl Health. 2018. doi:10.1186/s13031-018-0172-y

11.      Bartels SA, Michael S, Roupetz S, et al. Making sense of child, early and forced marriage among Syrian refugee girls: A mixed methods study in Lebanon. BMJ Glob Heal. 2018;3(1):1-12. doi:10.1136/bmjgh-2017-000509

12.      Human Rights and Gender Justice. Human Rights Violations Against Women and Girls in Syria Submission to the United Nations Universal Periodic Review of THE SYRIAN ARAB REPUBLIC 26 th Session of the UPR Working Group of the Human Rights Council Submitted March 24 , 2016. 2016;41(718):0-15.

13.      Mourtada R, Schlecht J, Dejong J. A qualitative study exploring child marriage practices among Syrian conflict-affected populations in Lebanon. Confl Health. 2017;11(Suppl 1). doi:10.1186/s13031-017-0131-z

14.      Nguyen MC, Wodon Q. Impact of Child Marriage on Literacy and Education Attainment in Africa.; 2014.

15.      Parsons J, Edmeades J, Kes A, Petroni S, Sexton M, Wodon Q. Economic Impacts of Child Marriage: A Review of the Literature. Rev Faith Int Aff. 2015. doi:10.1080/15570274.2015.1075757

16.      UN Women. Gender-based Violence and Child Protection among Syrian refugees in Jordan , with a focus on Early Marriage. 2013:92.

17.      Nove A, Matthews Z, Neal S, Camacho AV. Maternal mortality in adolescents compared with women of other ages: Evidence from 144 countries. Lancet Glob Heal. 2014. doi:10.1016/S2214-109X(13)70179-7

18.      Alelaiwi S. Child marriage in Jordan. Eur J Contracept Reprod Heal Care. 2018. doi:10.1080/13625187.2018.1442911

19.      Charles L, Denman K. Syrian and palestinian syrian refugees in lebanon: The plight of women and children. J Int Womens Stud. 2013;14(5):96-111.

20.      Psacharopoulos G, Patrinos HA. Returns to investment in education: A further update. Educ Econ. 2004. doi:10.1080/0964529042000239140

21.      Li SSY, Liddell BJ, Nickerson A. The Relationship Between Post-Migration Stress and Psychological Disorders in Refugees and Asylum Seekers. Curr Psychiatry Rep. 2016;18(9):1-9. doi:10.1007/s11920-016-0723-0

22.      Wilkinson DL, Hamerschlag SJ. Situational determinants in intimate partner violence. Aggress Violent Behav. 2005. doi:10.1016/j.avb.2004.05.001

23.      El Arab R, Sagbakken M. Child marriage of female Syrian refugees in Jordan and Lebanon: a literature review. Glob Health Action. 2019. doi:10.1080/16549716.2019.1585709

24.      Human Rights Watch, Demolitions.