Key note presentation of Prof. Levent Küey at Supporting Refugees' Mental Health, EU side event, 11-12 December 2019, THL, Helsinki.

1. Levent Küey
Associate Professor of Psychiatry
European Psychiatric Association Board Member (2015-2019)
former Chair, EPA Task Force on
Needs of Refugee and Asylum Seeker Patients in Europe (2016-2019)
World Psychiatric Association Secretary General (2008-2014)
Istanbul Bilgi University, Istanbul, Turkey
Forced displacement:
dimensions, psychosocial context and
situation in Turkey
Supporting Refugees’ Mental Health, EU Side Event
Finnish Institute for Health and Welfare (THL), 11-12 December 2019, Helsinki

2. küey, 2017

3. Forced displacement and mental health
Forced displacement / Forcibly displaced people:
IDPs, Refugees, Asylum Seekers
due to
armed conflicts, persecution, general violence, wars,
human rights violations, related poverty and trauma

4. IDPs
Forcibly
Displaced
People
Stateless
People,
Lost, Died
Refugees / asylum
seekers
Refugee
/asylum
seeker
Voluntary /
involuntary
return
Integration
Re-
settlement

5. Forced displacement and mental health
Main challenge for mental health workers:
both consolidating the psychiatric / medical
and mental health services
and
avoiding the medicalization of social phenomena

6. Forced displacement and mental health
Dimensions of the challenge
a world-wide humanitarian disaster
Psychosocial Context
shaped by human-made traumas
Situation in Turkey
dilemma: temporary or permanant?
Recommendations
a paradigm shift towards a
transnational humanitarian action

7. UN, UNHCR, IOM, WHO, WMA , WPA, EPA, MsF, IDMC, Eurostat, BBC, photojournalists, scientific studies
World at War

8. by the end of 2018
70.8 million
Forcibly displaced people worldwide
due to
persecution, armed conflicts, general violence, wars,
or human rights violations

9. by the end of 2018
70.8 million
Forcibly displaced people worldwide
due to
58,3 % (41.3 mil.)
Internally Displaced People (IDPs)
36,6 % (25.9 mil.)
Refugees
(in 2013 over 10 million)
5,1 % (3.5 mil.)
Asylum seekers

10. in 2018
37, 000
forced to flee their homes everyday
26 people per minute
by 2018
1 out of 109 people in the world

11. Globally
If this 70.8 million were the
population of a country:
the World’s 20th.
and
Europe’s 4th.
most populated country
(less than Russia, Germany, Turkey more than UK, France, Italy)
https://www.wikizeroo.org/index.php?q=aHR0cHM6Ly9lbi53aWtpcGVkaWEub3JnL3dpa2kvTGlzdF9vZl9j
b3VudHJpZXNfYnlfcG9wdWxhdGlvbl8oVW5pdGVkX05hdGlvbnMp

12. The Flight of Refugees Around the Globe
Peçanha S, Wallce T, 2015
from to

13. by 2018
top 5 countries (67%) top 5 countries

14. Ethiopia pays most in relation to the size of its economy with
469 refugees for every dollar of GNP.

15. 84% of all refugees
are living in Africa, ME, SE Asia
Where are refugees living?
6%
Europe
10%
Americas

16. UNHCR regions 2014 2015 2016
Africa 26 20 16
Americas -5 -3 -7
Asia & Pasific 9 -2 -10
Europe 74 43 19
ME & N. Africa 13 -8 -2
Increase in refugee populations (%)

17. Global responsibility for receiving refugees
continues to be carried by countries
immediately bordering zones of conflict:
LAMIC
are shouldering the highest burden
Where are refugees living?

18. 51% of all refugees
are under the age of 18

21. The psychosocial context
in which health / mental health
consequences for the
forcibly displaced people are shaped

22. childhood memories of
a new pair of shoes

23. a child giving a hug to his new pair of shoes in Austria 1946, published in LIFE, December 30, 1946, with the following caption:
For many of Europe’s children there was a Santa Claus this Christmas. When a big box from the American Red Cross arrived at Vienna’s Am Himmel orphanage, shoes and
coats and dresses tumbled out. Like the youngster (above), the children who had seen no new clothes throughout the war smiled to high heaven.

24. the shoes of refugees
A Long Walk: Refugees’ shoes in South Sudan by Shannon Jensen
https://photojournalismlinks.com/2012/08/29/tearsheet-of-the-day-refugees-shoes-in-south-sudan-by-shannon-jensen-in-
newsweek

25. Marko Risovic: the shoes of refugees at the border between Serbia and Croatia
they face low temperatures and mud in the fields around the border crossing,
and their shoes / improvised footwear are barely surviving the harsh conditions,
October 15, 2015.
Photo by Marko Risovic http://exploregram.com/this-series-of-photos-by-marko-risovic-captures-the-shoes-refugees-wear-8/

26. let us put ourselves in the shoes of refugees

27. When your relatives are wounded or dead in your arms?
When is it the right time to flee?
When do you decide flee?
When you watch the war news on TV?
When you hear the bombings in your city?
When you witness the gunfire down the road in your
neighbourhood?

28. No body ???
After deciding to flee,
from whom could you ask for help?
Officials ? Armed forces ?
Civil society / NGOs
Friends / neighbours ??
Human smugglers !?

29. What could you take with you if you had to flee?
What would you leave behind?
Any personal belongings ?
Official Documents / photographs?
(diplomas, keys, land register, docs to claim asylum)
Children; sick ones?
Relatives / elderly / sick ones ?
ID and Money
Medications? Which ones? How much?
A mobile phone and a charger

30. the one who has to manage with what he had got
a painting by Ingrid Philippens

31. • nobody wants to flee forcibly
• not pre-planned
• not on free will
A forcibly displaced person is experiencing
a psycho-social earthquake / trauma, i.e.,
a human made psycho-social disaster
Psychosocial contextual factors: 1/5

32. • almost all attachments are left behind,
• degree of mastery over one’s own life is decreased,
• the nutrition of the self and
the self-image are devastated.
Basic needs for survival maintained
mostly in the mercy of others.
Psychosocial contextual factors: 2/5

33. Forced displacement
challenges five core adaptive systems
subserving the functions of
•safety
•attachment
•justice
•identity-role
•existential-meaning
Psychosocial contextual factors: 3/5

34. Psychosocial contextual factors: 4/5
Forcibly displaced people
face many life threatening risks on the way,
as they have nowhere to turn
A forcibly displaced person is a person who has
lost the past for an unknown future
Experiences of loss and the threat of loss
are imprinted in their selves
A situation of ‘die or fly’

35. Victims of human made trauma and
organizational violence (wars!)
are more likely to result in PTSD
than
accidental / nature made traumas
Forcibly displaced people
face human made traumas
Flatten G, Gast U, Hofmann A, Knaevelsrud Ch, Lampe A, Liebermann P, Maercker A, Reddemann L,
Wöller W (2011): S3 - Leitlinie Posttraumatische Belastungsstörung. Trauma & Gewalt 3: 202-210
Psychosocial contextual factors: 5/5

36. Faculty Disclosure
X No, nothing to disclose
Yes, please specify:
"Guernica 2015", by Javcho Savov
http://ecflabs.org/lab/hacking-veil/guernica-2015-javcho-savov

37. T
the situation in Turkey: general

38. 3.7 million
80% live in 10 urban provinces,
less than 10% in camps
.
the situation in Turkey: general
Migration Statistics 2017. Turkish Ministry of Interior, Department General of Migration Management.
http://www.goc.gov.tr/icerik6/temporary-protection_915_1024_4748_icerik

39. T
the situation in Turkey: general
Cengiz Kılıç, Edip Kaya, Özge Karadağ Çaman, Özlem Şeyda Uluğ. Mental Health Profile of Syrian Refugees in Turkey: an
Epidemiological Study (Project proposal) https://r4hc-mena.org/wp1/wp-content/uploads/2019/02/December-2018-Mental-
Health-Profile-of-Syrian-Refugees-in-Turkey-An-Epidemiological-Study.pdf

40. not “refugees” but
“people under temporary protection”
1951 Geneva Convention, with a reservation:
Foreigners from Europe gain a “refugee” status,
the rest ?
“Temporary Protection Regulation” of 2014
duration of temporary protection: no information
the situation in Turkey: general
Republic of Turkey Ministry of Interior. 2014. Regulation No. 29153 on Temporary Protection. [Available online:
http://www.goc.gov.tr/files/_dokuman28.pdf]

41. Eleni Diker, MiReKoc Working
Papers Bibliographies on Syrian
Refugees in Turkey: Health, FMRC
Series Report, 2018, Istanbul.
Available at
https://mirekoc.ku.edu.tr/wp-
content/uploads/2016/05/Mirek
oc_Bibliographies_on_Syrian_Ref
ugees_in_Turkey_30.07.2018-
WEB.pdf

42. the situation in Turkey: studies on health / mental health
General health
Turkish Medical Association. 2014. Suriyeli Sığınmacılar ve Sağlık Hizmetleri Raporu. Turkish Medical Association Publications. [Available online:
https://www.ttb.org.tr/kutuphane/siginmacirpr.pdf ]
Turkish Medical Association. 2016. War, Migration, and Health: Experience of Turkey. Turkish Medical Association Publications. [Available online:
https://www.ttb.org.tr/kutuphane/siginmacilar_rpr_e n.pdf ]
Kalkan, Orhun, Mehmet Gülay, İlknur Vatan, Fatma Tuba Engindeniz, Betül Bakış, Melda Mutlu Özyürek & Resul Özbek. 2014. The Evaluation of the Primary
Health Status of Syrian Immigrants Residing in Osmangazi District of Bursa. [In Turkish] [Bursa İli Osmangazi İlçesinde İkamet Eden Suriyeli Göçmenlerin Temel
Sağlık Durumlarının Değerlendirilmesi] In: Book of Proceedings of 17th National Public Health Congress, Edirne. [Available online:
http://halksagligiokulu.org/anasayfa/components/co m_booklibrary/ebooks/17UHSKK.pdf ]
Esin, Melek Nihal, Aysun Ardıç, Şerife Nar, Bilge Yıldırım & Nihal Sunal. 2014. The Living Conditions of Syrian Refugees Residing in a Region in Istanbul. [In
Turkish] [İstanbul’un bir bölgesinde yaşayan Suriyeli göçmenlerin yaşam koşulları] In: Book of Proceedings of 17th National Public Health Congress, Edirne.
[Available online: http://halksagligiokulu.org/anasayfa/components/co m_booklibrary/ebooks/17UHSKK.pdf ]
Baş, Duygu, Ceren Arkant, Amir Muqat, Mariam Arafa, Tammam Sipahi & Muzaffer Eskiocak. 2015. The Circumstances of Syrian Refugees in Edirne. [In Turkish]
[Edirne’deki Suriyeli Sığınmacıların Durumu] In: Book of Proceedings of 18th National Public Health Congress. [Available online:
http://halksagligiokulu.org/anasayfa/components/co m_booklibrary/ebooks/18_UHSK_KONGRE_KITABI.pdf
Ozaras, Resat, Hakan Leblebicioglu, Mustafa Sunbul, Fehmi Tabak, Ilker Inanc Balkan, Mucahit Yemisen, Irfan Sencan & Recep Ozturk. 2016. "The Syrian conflict
and infectious diseases." Expert Review of Anti-Infective Therapy 14(6): 547-555. [Available online with subscription:
https://www.tandfonline.com/doi/abs/10.1080/147872 10.2016.1177457?journalCode=ierz20 ]
Köse Şükran, İlker Ödemiş , Didem Çelik , Bengü Gireniz Tatar, İlkay Akbulut & Dilek Yılmaz Çiftdoğan. 2017. "Hepatitis A, B, C and HIV seroprevalence among
Syrian refugee children admitted to outpatient clinics." Infez Med 25(4): 339-343. [Available online with subscription:
https://www.infezmed.it/index.php/article?Anno=2017 &numero=4&ArticoloDaVisualizzare=Vol_25_4_2017_339 ]
Koçarslan, Sezen, Enver Turan, Turan Ekinci, Yavuz Yesilova & Rabia Apari. 2013. "Clinical and histopathological characteristics of cutaneous Leishmaniasis in
Sanliurfa City of Turkey including Syrian refugees." Indian Journal of Pathology & Microbiology 56(3): 211-215. [Available online with subscription:
http://www.ijpmonline.org/article.asp?issn=0377-49 29;year=2013;volume=56;issue=3;spage=211;epage =215;aulast=Ko%E7arslan ]
Keklik, Muzaffer, Ugur Kalan, Serdal Korkmaz, Ozerhan Ozer, Pinar Ipek, Adile Ortakoyluoglu & Ertugrul Keklik. 2017. "Vitamin B12 deficiency among Newly-
Arrived Syrian Refugees in Central Anatolia of Turkey." Journal of Anatolian Medical Research 2017; 2(1): 22-30. [Available online:
https://www.researchgate.net/publication/3186616 83_Vitamin_B12_deficiency_among_Newly-Arrived_S yrian_Refugees_in_Central_Anatolia_of_Turkey ]
Bakkal Temi, Yasemin, Ali Murat Sedef, Serkan Gokcay, Hatice Coskun, Sedenay Oskeroglu Kaplan, Ozlem Ozkul, Huseyin Mertsoylu & Fatih Kose. 2017. "A study
on basic demographic and disease characteristics of cancer-diagnosed Syrian refugees treated in the border city of Turkey, Sanliurfa; a hospital-based
retrospective case series study." Journal of BUON 22(6): 1591-1594. [Available online: https://www.ncbi.nlm.nih.gov/pubmed/29332358 ]
Demirci, Hakan, Nevruz Yildirim Topak, Gokhan Ocakoglu, Mehtap Karakulak Gomleksiz, Emin Ustunyurt & Ayse Ulku Turker. 2016. "Birth characteristics of
Syrian refugees and Turkish citizens in Turkey in 2015." International Journal of Gynecology and Obstetrics 137(1): 63-66. [Available online:
https://obgyn.onlinelibrary.wiley.com/doi/abs/10.100 2/ijgo.12088 ]
Villasana, Danielle. 2016. "Picturing health: challenges for Syrian refugees in Turkey." Lancet 388(10056): 2096-2103. [Available online:
https://www.thelancet.com/journals/lancet/article/P IIS0140-6736(16)31647-6/abstract ]

43. the situation in Turkey: studies on health / mental health
Access to health care
Sahlool, Zaher, Abdul Ghani Sankri-Tarbichi & Mazen Kherallah. 2012. "Evaluation report of health care services at the Syrian refugee camps in Turkey."
Avicenna Journal of Medicine 2(2): 25-28. [Available online: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC350 7073/ ]
Demirtas, Unal & Aslan Ozden. 2015. "Syrian refugees: health services support and hospitality in Turkey." Public Health 129(11): 1549-1550. [Available online
with subscription: https://www.publichealthjrnl.com/article/S0033-3 506(15)00307-8/fulltext ]
Ekmekci, Perihan Elif. 2017. "Syrian Refugees, Health and Migration Legislation in Turkey." Journal of Immigrant and Minority Health 19(6): 1434-1441.
[Available online with subscription: https://link.springer.com/article/10.1007%2Fs10903- 016-0405-3 ]
Mardin, Deniz F. 2017. "Right to Health and Access to Health Services for Syrian Refugees in Turkey" MiReKoc Policy Brief Series 2017/01. [Available online:
https://mirekoc.ku.edu.tr/wp-content/uploads/sites/ 22/2016/11/PB_Right-to-Health.pdf ]
Bilecen, Başak & Dilara Yurtseven. 2018. “Temporarily protected Syrians’ access to the healthcare system in Turkey: Changing policies and remaining
challenges." Migration Letters, 15(1), 113-124. [Available online with subscription: http://www.tplondon.com/journal/index.php/ml/arti cle/view/925 ]
Kara, Fatih & Nedim Akgün. 2015. The Barriers to Healthcare Utilization among Syrian Refugees Settled in Konya. [In Turkish] [Konya’ya Yerleşen Suriyeli
Mültecilerin Sağlık Hizmetlerinden Yararlanmalarının Önündeki Engeller] In: Book of Proceedings of 18th National Public Health Congress. [Available online:
http://halksagligiokulu.org/anasayfa/components/co m_booklibrary/ebooks/18_UHSK_KONGRE_KITABI.pdf ]
Ozcurumez, Saime. 2017. "Lessons from Turkey: Syrians under Temporary Protection, Health Services and NGOs." European Journal of Public Health 27.
[Available online with subscription: https://academic.oup.com/eurpub/article-abstract/27/ suppl_3/ckx187.577/4556543?redirectedFrom=fulltext ] [Book
chapter version with Deniz Yildirim available online: https://www.ncbi.nlm.nih.gov/books/NBK459037/ ]
Yavuz, Ömer. 2015. Legal and Ethical Foundations of Health Assistances to Syrian Refugees in Turkey. [In Turkish] [Türkiye’deki Suriyeli Mültecilere Yapılan
Sağlık Yardımlarının Yasal ve Etik Temelleri] Mustafa Kemal University Journal of Social Sciences Institute, 265-280. [Available online:
http://dergipark.gov.tr/download/article-file/183377 ]
Koçarslan, Sezen, Enver Turan, Turan Ekinci, Yavuz Yesilova & Rabia Apari. 2013. "Clinical and histopathological characteristics of cutaneous Leishmaniasis in
Sanliurfa City of Turkey including Syrian refugees." Indian Journal of Pathology & Microbiology 56(3): 211-215. [Available online with subscription:
http://www.ijpmonline.org/article.asp?issn=0377-49 29;year=2013;volume=56;issue=3;spage=211;epage =215;aulast=Ko%E7arslan ]
Keklik, Muzaffer, Ugur Kalan, Serdal Korkmaz, Ozerhan Ozer, Pinar Ipek, Adile Ortakoyluoglu & Ertugrul Keklik. 2017. "Vitamin B12 deficiency among Newly-
Arrived Syrian Refugees in Central Anatolia of Turkey." Journal of Anatolian Medical Research 2017; 2(1): 22-30. [Available online:
https://www.researchgate.net/publication/3186616 83_Vitamin_B12_deficiency_among_Newly-Arrived_S yrian_Refugees_in_Central_Anatolia_of_Turkey ]
Bakkal Temi, Yasemin, Ali Murat Sedef, Serkan Gokcay, Hatice Coskun, Sedenay Oskeroglu Kaplan, Ozlem Ozkul, Huseyin Mertsoylu & Fatih Kose. 2017. "A study
on basic demographic and disease characteristics of cancer-diagnosed Syrian refugees treated in the border city of Turkey, Sanliurfa; a hospital-based
retrospective case series study." Journal of BUON 22(6): 1591-1594. [Available online: https://www.ncbi.nlm.nih.gov/pubmed/29332358 ]
Demirci, Hakan, Nevruz Yildirim Topak, Gokhan Ocakoglu, Mehtap Karakulak Gomleksiz, Emin Ustunyurt & Ayse Ulku Turker. 2016. "Birth characteristics of
Syrian refugees and Turkish citizens in Turkey in 2015." International Journal of Gynecology and Obstetrics 137(1): 63-66. [Available online:
https://obgyn.onlinelibrary.wiley.com/doi/abs/10.100 2/ijgo.12088 ]
Esin, Melek Nihal, Aysun Ardıç, Şerife Nar, Bilge Yıldırım & Nihal Sunal. 2014. The Living Conditions of Syrian Refugees Residing in a Region in Istanbul. [In
Turkish] [İstanbul’un bir bölgesinde yaşayan Suriyeli göçmenlerin yaşam koşulları] In: Book of Proceedings of 17th National Public Health Congress, Edirne.
[Available online: http://halksagligiokulu.org/anasayfa/components/co m_booklibrary/ebooks/17UHSKK.pdf ]

44. the situation in Turkey: studies on health / mental health
Access to health care (cont.)
Baş, Duygu, Ceren Arkant, Amir Muqat, Mariam Arafa, Tammam Sipahi & Muzaffer Eskiocak. 2015. The Circumstances of Syrian Refugees in Edirne. [In Turkish]
[Edirne’deki Suriyeli Sığınmacıların Durumu] In: Book of Proceedings of 18th National Public Health Congress. [Available online:
http://halksagligiokulu.org/anasayfa/components/co m_booklibrary/ebooks/18_UHSK_KONGRE_KITABI.pdf ]
Ozaras, Resat, Hakan Leblebicioglu, Mustafa Sunbul, Fehmi Tabak, Ilker Inanc Balkan, Mucahit Yemisen, Irfan Sencan & Recep Ozturk. 2016. "The Syrian conflict
and infectious diseases." Expert Review of Anti-Infective Therapy 14(6): 547-555. [Available online with subscription:
https://www.tandfonline.com/doi/abs/10.1080/147872 10.2016.1177457?journalCode=ierz20 ]
Köse Şükran, İlker Ödemiş , Didem Çelik , Bengü Gireniz Tatar, İlkay Akbulut & Dilek Yılmaz Çiftdoğan. 2017. "Hepatitis A, B, C and HIV seroprevalence among
Syrian refugee children admitted to outpatient clinics." Infez Med 25(4): 339-343. [Available online with subscription:
https://www.infezmed.it/index.php/article?Anno=2017 &numero=4&ArticoloDaVisualizzare=Vol_25_4_2017_339 ]
Demirtas, Unal & Aslan Ozden. 2015. "Syrian refugees: health services support and hospitality in Turkey." Public Health 129(11): 1549-1550. [Available online
with subscription: https://www.publichealthjrnl.com/article/S0033-3 506(15)00307-8/fulltext ]
Ekmekci, Perihan Elif. 2017. "Syrian Refugees, Health and Migration Legislation in Turkey." Journal of Immigrant and Minority Health 19(6): 1434-1441.
[Available online with subscription: https://link.springer.com/article/10.1007%2Fs10903- 016-0405-3 ]
Mardin, Deniz F. 2017. "Right to Health and Access to Health Services for Syrian Refugees in Turkey" MiReKoc Policy Brief Series 2017/01. [Available online:
https://mirekoc.ku.edu.tr/wp-content/uploads/sites/ 22/2016/11/PB_Right-to-Health.pdf ]
Bilecen, Başak & Dilara Yurtseven. 2018. “Temporarily protected Syrians’ access to the healthcare system in Turkey: Changing policies and remaining
challenges." Migration Letters, 15(1), 113-124. [Available online with subscription: http://www.tplondon.com/journal/index.php/ml/arti cle/view/925 ]
Kara, Fatih & Nedim Akgün. 2015. The Barriers to Healthcare Utilization among Syrian Refugees Settled in Konya. [In Turkish] [Konya’ya Yerleşen Suriyeli
Mültecilerin Sağlık Hizmetlerinden Yararlanmalarının Önündeki Engeller] In: Book of Proceedings of 18th National Public Health Congress. [Available online:
http://halksagligiokulu.org/anasayfa/components/co m_booklibrary/ebooks/18_UHSK_KONGRE_KITABI.pdf ]
Ozcurumez, Saime. 2017. "Lessons from Turkey: Syrians under Temporary Protection, Health Services and NGOs." European Journal of Public Health 27.
[Available online with subscription: https://academic.oup.com/eurpub/article-abstract/27/ suppl_3/ckx187.577/4556543?redirectedFrom=fulltext ] [Book
chapter version with Deniz Yildirim available online: https://www.ncbi.nlm.nih.gov/books/NBK459037/ ]
Yavuz, Ömer. 2015. Legal and Ethical Foundations of Health Assistances to Syrian Refugees in Turkey. [In Turkish] [Türkiye’deki Suriyeli Mültecilere Yapılan
Sağlık Yardımlarının Yasal ve Etik Temelleri] Mustafa Kemal University Journal of Social Sciences Institute, 265-280. [Available online:
http://dergipark.gov.tr/download/article-file/183377 ]

45. the situation in Turkey: studies on health / mental health
Mental health
Önen, Cihan, Gülsen Güneş, Ali Türeme & Pınar Ağaç. 2014. Depression and Anxiety Case among in Syrians that Live in a Refugee Camp. [In Turkish] [Bir Mülteci
Kampında Yaşaya Suriyelilerde Depresyon ve Anksiyete Durumu] The Journal of Academic Social Science, 2(6), 223-230. [Available online:
http://www.asosjournal.com/Makaleler/105916345_ 307%20C%C4%B0HAN%20%C3%96NEN.pdf ]
Alpak, Gökay, Ahmet Unal, Feridun Bulbul, Eser Sagaltici, Yasin Bez, Abdurrahman Altindag, Alican Dalkilic & Haluk A. Savas. 2015. "Post-traumatic stress
disorder among Syrian refugees in Turkey: a cross-sectional study." International Journal of Psychiatry in Clinical Practice 19(1): 45-50. [Available online with
subscription: https://www.tandfonline.com/doi/abs/10.3109/136 51501.2014.961930?journalCode=ijpc20 ]
Sirin, Selcuk R. & Lauren Rogers-Sirin. 2015. The Educational and Mental Health Needs of Syrian Refugee Children. Washington, DC: Migration Policy Institute.
[Available online: https://www.migrationpolicy.org/research/educational -and-mental-health-needs-syrian-refugee-children ]
Al-Nuaimi, Saleem, Samer Aldandashi, Abdul Kadir Saed & Easa Maher Saqqur. 2018. "Psychiatric morbidity among physically injured Syrian refugees in Turkey."
Comprehensive Psychiatry 80: 34-38. [Available online: https://www.sciencedirect.com/science/article/pii/S 0010440X1630654X?via%3Dihub ]
Karadag, Mehmet, Cem Gokcen, Funda Dandil & Baran Calisgan. 2017. "Our experience with Syrian refugee patients at the child and adolescent psychiatry clinic
in Gaziantep, Turkey." International Journal of Psychiatry in Clinical Practice: 1-3. [Available online with subscription:
https://www.tandfonline.com/doi/full/10.1080/136515 01.2017.1387269?scroll=top&needAccess=true ]
Moustafa, Moustafa. 2015. Telepsychiatry And Mental Health Care For Syrian Refugees In Turkey. Yale Medicine Thesis Digital Library. [Available online:
http://elischolar.library.yale.edu/ymtdl/2002 ]
Smeekes, Anouk, Maykel Verkuyten, Elif Çelebi, Ceren Acartürk & Samed Onkun. 2017. "Social identity continuity and mental health among Syrian refugees in
Turkey." Social Psychiatry and Psychiatric Epidemiology 52(10): 1317-1324. [Available online: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5617 874/ ]
Hassan, G, Kirmayer, LJ, Mekki Berrada A., Quosh, C., el Chammay, R., Deville-Stoetzel, J.B., Youssef, A., Jefee-Bahloul, H., Barkeel-Oteo, A., Coutts, A., Song, S. &
Ventevogel, P. 2015. Culture, Context and the Mental Health and Psychosocial Wellbeing of Syrians: A Review for Mental Health and Psychosocial Support staff
working with Syrians Affected by Armed Conflict. Geneva: UNHCR. [Available online : http://www.unhcr.org/55f6b90f9.pdf ]

46. “Temporary protection” beneficiaries:
the right to access free of charge to public health
care services, incl., mental health services, in
provinces where they have been registered
the ones not yet completed registeration
access only to emergency medical services
Refugee Rights Turkey, 2015
the situation in Turkey: health

47. While Turkey’s response has been adequate with
state and non-state actors taking active roles
in addressing the health needs of
displaced persons, but
there are serious health issues and obstacles
preventing refugees’ access to health care services
within the means of its’ implementation
the situation in Turkey: health

48. determinants of health in refugees:
hygiene, nutrition, education, child labor,
poor income, inadequate housing
health problems of refugees:
communicable and non-communicable diseases,
sexual violence, disabilities, prenatal and postnatal
care, pregnancy follow-up, immunization
health services delivered to refugees:
the problems faced in accessing these services
the situation in Turkey: health

49. unique challenges accessing health care:
language barrier, medication costs, social and
security reasons, discriminatory attitudes,
overcrowded hospitals and emergency services
in camps:
poor sanitation, shelter, hygiene
in urban areas:
crowded living conditions and risky sexual
behaviours and abuse
the situation in Turkey: health

50. Mental health situation
Studies mostly in camps few in cities
PTSD 25%-83.4% (in children 45%)
Anxiety 19,3%; Depression 8.9%
Risks for mental disorders / PTSD:
female gender; severity of traumatization
past psychiatric illness and physical injury
Alpak G, Unal A, Bulbul F et al. Post-traumatic stress disorder among Syrian refugees in Turkey: a cross-
sectional study. Int J Psychiatry Clin Pract, 2015; 19(1):45-50. * Acarturk C, Cetinkaya M, Senay I, Gulen
B, Aker T, Hinton D. Prevalence and Predictors of Posttraumatic Stress and Depression Symptoms Among
Syrian Refugees in a Refugee Camp. J Nerv Ment Dis, 2017, 19; Cengiz Kılıç, Edip Kaya, Özge Karadağ
Çaman, Sarp Üner (2017) Differential Effects of War-Related Adverse and Traumatic Events on Syrian
Population in Turkey. Poster presented at ISTSS Annual Conference, Chicago
the situation in Turkey: mental health

51. Mental health center for refugees
Non-profit Relief International with funding from
the EU and will be run by the Union of Medical
Care and Relief Organizations (UOSSM)
Serves patients with a wide range of disorders,
including anxiety, psychosis, depression and
post-traumatic stress disorder.
Gaziantep, Ankara, Istanbul (upcoming)
the situation in Turkey: examplary services

52. • WHO trains Syrian health staff to support their
integration in the Turkish health-care system.
Syrian professionals who complete training are recruited
to work in health centers serving refugees.
the Turkish MoH has hired over 400 trained Syrian
health workers
• WHO and MoH are updating the training manual for
medical translators in Arabic and Turkish.
Basic information on depression, suicidal thoughts,
dementia, child and adolescent mental and
behavioural disorders, substance abuse and epilepsy.
the situation in Turkey: examplary services-WHO

53. Belonging to multiple groups (multi-social identity)
before migration
decreases their levels of depression and
enhances satisfaction with life
A humane welcome by the receiving societies
along with providing resources and services
Resilient factors
Smeekes Anouk, Maykel Verkuyten, Elif Çelebi, Ceren Acartürk & Samed Onkun. 2017. "Social identity
continuity and mental health among Syrian refugees in Turkey." Social Psychiatry and Psychiatric
Epidemiology 52(10): 1317-1324.

54. The key discussion:
existence will be “temporary” or “permanent”
shapes
the health and mental health challenges faced
the situation in Turkey: conclusions

55. Health / mental health is an issue of integration
Key issues of integration:
(1) the degree of achievement and access to
employment, housing, education and health;
(2) situation regarding citizenship and rights;
(3) the degree of social connection within and
between groups within the receiving society
(4) culture and the local environment
Ager, A., & Strang, A. (2008). Understanding Integration: A Conceptual Framework. Journal
of Refugee Studies, 166-191
the situation in Turkey: conclusions

56. Existing in a limbo with
improving but limited education, health, work and
housing conditions and
also high possibility of nowhere to return
Avşaroğlu N. Syrian Refugees in Turkey: to what extend have they integrated successfully in
Turkish Society? Bogazici University, Master of Arts in Social Policy, 2017
the situation in Turkey: conclusions

57. “shoes are my home“

58. Recommendations 1/5
We need
to re-conceptualize the problem
not a ‘refugee crisis’ / ‘illegal migration’, but
a human-made global humanitarian disaster
"This not about sharing a burden. It is about sharing a
global responsibility, based not only the broad idea of our
common humanity but also on the very specific obligations
of international law. The root problems are war and
hatred, not people who flee; refugees are among the first
victims of terrorism."
UN Secretary-General, António Guterres, 2017

59. Recommendations 2/5
We need
to improve awareness, knowledge and skills
of health professionals, psychiatrists and
mental health workers

60. Recommendations 3/5
We need
to establish a solid ethical, scientific, humanistic
position
in a principled comprehensive manner,
not on the bases of daily
pragmatic interventions of ‘reel politics’

61. Recommendations 4/5
We need a paradigm shift
from ‘building walls’ to ‘open doors’;
We need transnational humanitarian action.
Forcibly displaced people should not be taken as an
excuse of securing borders or new walls, which only
forces them to take more dangerous routes to
safety in the hands of human smuggling and
trafficking

62. Recommendations 5/5
We need to stop trafficking and racism
Stop blaming refugees and migrants for economic
and social problems, and instead combat all kinds
of xenophobia and racial discrimination.
Refugees and migrants offer us an opportunity of
remedy to overcome many of our current problems.
We need transnational peace
for a better health / mental health for all

63. Residents of Kiel, Germany, welcome a bus carrying refugees arriving in the town, 2015 by Carsten Rehder/EPA