The fight for mental health support for Lebanon's destitute refugees

Syrian carpenter Adnan Mouazzen has come a long way since breaking his back tumbling from the roof of his house in 2012. Paralysed by the accident and forced to use a wheelchair, the 35-year-old slipped into a spiral of depression made worse by his bleak perception of his future. Today though, the father-of-two faces far more promising prospects having escaped war-torn Syria with his young family to the relative sanctuary of Beirut. And despite not having the financial means to pay for treatment to improve his mobility, he is now being looked after by specialists at the International Committee of the Red Cross. The change, by his own admission, has bolstered his outlook immeasurably. The critical intervention of psychologists and others has got his life back on track. "I have accepted what happened to me was God's will," Mr Mouazzen told The National . “When doctors told me I would be in a wheelchair I didn’t speak to anyone about how I felt. “I was depressed and the ideas [of suicide] I was having were scaring me. For months I would just stare at the wall.” Mr Mouazzen damaged several vertebrae and broke his legs after falling more than 20 feet from his house in Homs, western Syria, while making repairs. Initial surgery was performed in Syria, but since moving to Lebanon he found himself facing a new set of challenges as well as more treatment. Living in a cramped apartment block while using his wheelchair became a daily struggle. But ongoing assistance from the ICRC - which treated 183,000 patients in Lebanon last year - has helped improve his mental state. “When I left the hospital [in Beirut] eight days after another surgery I needed, I was offered physio but I didn’t turn up for the first two sessions as I was lost,” he admits. “I was in a state of shock and sleep deprived because I was worrying about my family and how I would provide for them.” On arriving in Beirut, Mr Mouazzen summoned the strength to visit the Rafic Hariri University Hospital, a government unit which is supported by the ICRC. A doctor recognised he was presenting signs of serious mental trauma and enrolled him in a course of therapy. For the last two months, Mr Mouazzen has attended four psychological sessions a week. The treatment has proved a lifeline, providing a fresh perspective on how he can better cope with his injuries. “When I left hospital I was not communicating with my family at all,” he said. “They were asking questions but I didn’t know what to say. “I didn’t know how to deal with what had happened. I was having suicidal thoughts but I didn’t know who to speak with or what to do. “I had never spoken about my mental health issues with anyone before. I haven’t spoken about it with my family until recently.” The National visited Beirut earlier this month as part of its work with the Carter Centre, a US non-government organisation. It was founded by former president Jimmy Carter and his wife Rosalynn to help improve understanding of different health concerns around the world. With a huge influx of about 1.5 million refugees into Lebanon since 2011, the country has become increasingly aware of the mental health crisis it now faces. Many of those who fled the devastation of Syria remain deeply impacted by the conflict there, having witnessed scenes of appalling violence. Today, however, the country’s Ministry of Public Health is co-ordinating a task force of charities and NGOs to address the most pressing mental health cases. A National Mental Health Programme was also launched in May 2014 with the support of the World Health Organisation, UNICEF and the International Medical Corps. The combined programme promises universal access to high quality mental health treatment to meet the increasingly acute need. “One of the main barriers to people accessing good mental healthcare is the stigma that remains attached to it in the region,” said Fiona Allen, a mental health worker for the ICRC. “We’re still getting the same responses [from patients] that they do not want to be labelled crazy or dangerous. “We try to focus on [their] day-to-day life and how it can be made worse from the conditions they are living in. [It can] make them feel hopeless or react in an angry way to situations.” Much of the work of ICRC’s support staff is spent in the north of Lebanon, where there are fewer government public health services than in the capital. Workers try to visit tented communities or more isolated, rundown areas of the country which can be largely ignored by existing health infrastructure. Not everyone is in psychological distress but the ICRC is still able to demonstrate to communities how they can better protect their mental wellbeing. Even simple steps like encouraging community events through music and cooking can be a huge help to those struggling with depression. “It is important to raise the messages [of mental health] and normalise some of these issues,” said Ms Allen, from Glasgow, Scotland. “We try to explain [that patient] reactions are often a result of trauma they have been through. “The staff tell individuals where our outreach centres are so they can go and get help. Anything that encourages people to talk to someone can work well.”

The fight for mental health support for Lebanon's destitute refugees

Adnan Mouazzen, 35, now a refugee in Lebanon, was left traumatised following an accident in Syria