Case presentation for MSc GUH oral exam

1. Mhd Samer Alkarkoukly
Freiburg | May 22nd, 2018
Scaling up mental
health services for
IDPs* inside Syria
*Internally Displaced Persons

2.  Introduction to Syria Crisis
 Current status of Mental health
 Causes of mental health disorders
 Linkage between migration & mental disorders
 The new approach
Outline:

3. Entering the seventh year of the crisis, the scale, severity, and complexity of
needs across Syria remain overwhelming. Some 13.1 million people in Syria
require humanitarian assistance (UN OCHA, 2017).
Introduction to Syria Crisis:

4. WHO has reported that more than
half of all Syrians are estimated to
be in need of mental health and
psychosocial support services,
And
one in 4 children is at risk
of developing a mental health
disorder (WHO, 2017).
Current status of Mental health:

5. A household survey on Syrian refugees in Lebanon indicates that the
lifetime prevalence of PTSD* within the refugees is 35.4%
and the point prevalence of 27.2% (Kazour, et al., 2017). Another
study of Syrian refugees in Kurdistan region in Iraq indicates that the
prevalence of PTSD symptoms is between 35% and 38% (Ibrahim &
Q. Hassan, 2017).
Hence, a worse state is expected for population inside Syria.
Before the current crisis Mental health care services were available
in just 2 cities, and only 70 psychiatrists and a limited number of
psychologists were available for a pre-war population of 22 million
people (WHO, 2017).
Current status of Mental health:
* Post Traumatic Stress Disorder

6. • Death of one or more of family members, relatives or friends
• Detention, kidnapping or disappearance
• Amputation of one of the limbs or severe war injuries
• Destructions of homes
• Lose of livelihoods or assists
• Displacement
• Poverty and food insecurity
• Witnessing death, explosions and violence
• Economical and social insecurity
Causes of mental health disorders:

7. Linkage between migration & mental disorders:
All of the aggravating factors are
highly linked with
Migration
( internal & to neighbouring
countries)
(UNICEF, 2015)
• Death of one or more of family
• Detention, kidnapping
• Amputation or severe war injuries
• Destructions of homes
• Lose of livelihoods or assists
• Displacement
• Poverty and food insecurity
• Witnessing death and violence
• Economical and social insecurity

8. The new approach:
A new approach is based on the suggestion of WHO and the experience of
pilot projects for mental health services in EU:
Task Shifting
Task-shifting means that a
task that is originally
performed by a highly-
qualified specialist is
transferred to a less
specialized worker with
fewer qualifications.
E-mental
health services
E-mental health is a new approach
to provide health services using
information technology such as
smartphones apps and classic
websites. These services may
include health awareness, primary
diagnosis, direct contact with health
professionals and many others.
3.PM+
4.(Problem Management
plus)
5.developed by WHO for use in
communities affected by adversity. It
may be delivered by non-
professional helpers in community
or primary care settings or by lay
people such as peer-refugees after
approximately 10 days of training
followed by weekly group
supervision by a trained clinician.

9. References:
• Ibrahim, H. & Q. Hassan, C., 2017. Post-traumatic Stress Disorder Symptoms Resulting
from Torture and Other Traumatic Events among Syrian Kurdish Refugees in Kurdistan
Region, Iraq. Frontiers in Psychology, 8(10.3389/fpsyg.2017.00241), p. 241.
• Kazour, F. et al., 2017. Post-traumatic stress disorder in a sample of Syrian refugees in
Lebanon. Comprehensive Psychiatry, Volume 72, pp. 41-47.
• UN OCHA, 2017. Humanitarian Needs Overview 2018, Damascus, Syria: UN OCHA.
• WHO, 2010. mhGAP intervention guide for mental, neurological and substance use
disorders in non-specialized health settings, Geneva, Switzerland: WHO.
• WHO, 2017. Syrian Arab Republic | News | Addressing the silent impact of war: WHO
expands mental health care services across Syria. [Online]
Available at: http://www.emro.who.int/syr/syria-news/who-expands-mental-health-
care-services-across-syria.html
[Accessed 30 April 2018].

10. Thank you
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