Mental health: Illustrations of trauma and hope from Lebanon's Shatila refugee camp

MSF psychologist Miriam Slikhanian shares her story along with artwork from illustrator Ella Baron

17 Jan 19

Miriam Slikhanian is an MSF psychologist currently working in Lebanon’s Shatila refugee camp, home to people fleeing conflict and insecurity in Syria and Palestine. Together with illustrations from Ella Baron – a cartoonist on assignment with the Guardian* – she shares her experience of providing mental healthcare for women in the camp.

“Two years ago, I started working as a clinical psychologist at MSF’s clinic in Shatila refugee camp, in Beirut.

I had expected that most of my work would be related to psychological trauma. But I soon learned that it was mostly related to the daily challenges of living as a refugee.

Life in Shatila

Shatila camp was originally set up for Palestinian refugees in 1949. The camp now hosts Syrians and Palestinians refugees, as well as other minorities such as Ethiopians and Filipinos. All live in deplorable conditions.

"For me, to see one smile on a broken face, one glimpse of hope in a hopeless heart, or one word of gratitude from lips that were silent, is enough to know that this work is worthwhile."
Miriam SlikhanianMSF psychologist

People here are deprived of their basic needs. To be a refugee generally means to struggle every day to find something to eat, to be in a safe place, to be respected, and to have the space to develop into the person one could potentially be.

Patient: "When the bomb fell on our home, it trapped my legs. I couldn’t do anything; I watched my family die in front of my eyes. Since we arrived in Lebanon, I just stay in the room with the children. It’s been almost five weeks since my last day out."

Apart from their dark history of trauma, their loss of loved ones and possessions, and their displacement to a foreign land, they face a daily struggle to meet their basic needs.

They also face humiliation and discrimination and live with constant uncertainty about the future.

Syrian women

Among the patients at MSF’s clinic in Shatila are a large number of Syrian refugees, especially women, seeking mental health services.

Patient: "I was sent out to work at the age of 13 in a warehouse just outside Shatila. One night when I was working alone, my employer raped me. I could not say anything, but, eventually, my older sister noticed the bruises. She brought me to MSF."

Women, here, are sometimes used by their husbands to vent their own distress. Many of them suffer violence on a regular basis – whether social, economic, verbal or physical.

They are sometimes told to remain silent and strong, no matter what they feel inside. They toil for their husband and children while carrying the pain in their heart.

Women, whose voices and tears can barely be heard, absorb care and compassion like a dry soil absorbs the rain.

Midwife: "Is it a boy or a girl?’ This is the first question at every ultrasound. If a lady is expecting a girl it may cause tension with her family, so we always say we don’t know. I tell her our priority is the health of the baby."

As victims of violence, some also tend to take it out on their children. But through their tears of regret, I can see the love and compassion they have for their little ones.

Depression and anxiety

MSF has been providing free psychological support for refugees in Shatila since 2013. A number of psychologists – including me – provide individual, family and group support for individuals of all ages.

In 2017, over 3,000 individual mental health sessions were offered to the patients in Shatila and another neighbouring refugee camp called Burj Al Barajneh.

Psychologist: "Sometimes I say that coming to terms with trauma is like opening a packed wardrobe. When you open the door a tangled mess pours out at you; you must sort through it before it can be carefully folded away."

The patients I see every day have a variety of symptoms. Their mental health problems are largely precipitated by stressful events and by the situations they live.

Depression, anxiety and post-traumatic stress disorder are very common reactions.

"It’s challenging to help a person with a mental health issue if their larger problem is that they are unable to feed their children or to find a safe place to stay."

Miriam SlikhanianMSF psychologist

I help them cope with their emotional or psychological problems by listening empathically and providing validation of their feelings. I educate them about their symptoms and the impact of stressful events, and I teach them ways to overcome their mental health difficulties.

Confidentiality and privacy are key in our sessions. We often work in multidisciplinary groups of social workers, doctors and nurses, to ensure the physical, psychological and social wellbeing of our patients.

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Stuck in limbo

Working as a psychologist in Shatila is challenging because, unlike other places where I’ve worked, the problems here are not purely related to mental health.

It’s challenging to help a person with a mental health issue if their larger problem is that they are unable to feed their children or to find a safe place to stay.

Patient: "My six-year-old daughter was kidnapped on her way back from the camp kindergarten. My husband is in prison for debt, so I have to raise the children alone. I don’t have time to walk them home from school."

Working here with MSF, I have learned that refugees are stuck in a limbo between the past and the present.

On the one hand, they yearn to be in their countries, in their own houses, with their loved ones. But it is not a choice for them when their houses no longer exist, when they are at constant risk of death or have no means to sustain themselves.

On the other hand, they wish to be in a safe place. But they are fighting daily to find enough food to eat, a safe place to shelter and people who regard them with respect.

Hope in humanity

In many ways, my work with refugees has a healing effect on me.

I remember days when I had to fight back tears while at work. But at the same time, welcoming patients through my door, showing compassion towards their pain, receiving their gratitude for being listened to and receiving their smile afterwards, lifted my spirits.

Patient: "A good memory of my country? The night I finished my university exams. We all went to the public park to have a BBQ and chill."

My reward for working here is to see how people’s lives are changed after receiving our services.

I’ve seen people start to accept the reality of their situation and develop resilience. I’ve seen people who have been able to change their circumstances through psychological support.

And I’ve seen people who have started to have hope in humanity after realising that there was someone who cared.

One smile on a broken face

My friends often ask me why, when I could work in a much better place, I choose to work here. My answer is always the same: ‘If everyone said this, no one would reach out to people who suffer every day of their lives.’

Psychologist: "Working here can be difficult. When I need a break, I come up to the roof of our clinic. You can see how many birds – people feed them! Strange, when they themselves have so little. Perhaps they find in this a form of freedom."

I believe that I am here for a reason, and I will do my tiny part for the wellbeing of people who suffer.

For me, to see one smile on a broken face, one glimpse of hope in a hopeless heart, or one word of gratitude from lips that were silent, is enough to know that this work is worthwhile.”

* Illustrations by Ella Baron originally published by the Guardian in October 2018

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