By
Stephen Dockery
AIN
AL-HILWEH, Lebanon: During the height of one feud in the Ain al-Hilweh
Palestinian refugee camp months ago, a bomb targeting fighters was discovered
under a house. The bomb was defused; no harm done.But not quite. The family
that lived in the building the bomb was planted under could not stop thinking
about what could have been.
Francois
Kazour, a psychiatrist who works with Medecins Sans Frontieres, the only mental
health provider in the camp, is treating the husband and wife for sleeping
problems, and he expects their child may eventually need some type of treatment
as well.
A
long string of armed clashes and assassinations has shaken Ain al-Hilweh over
the past several years, leaving several dead and many more wounded. Here in the
largest Palestinian camp, factionalism and periodic communal fighting in the
camp are taking a toll in other ways as well; mental health issues like
post-traumatic stress disorder and acute stress syndrome, seen rarely in other
camps, are being diagnosed in noteworthy numbers.
Mental
health professionals say they can break down Ain al-Hilweh’s mental health
diagnoses into two categories: Cases like depression and anxiety related to
overcrowding and unemployment seen in many of the region’s poor refugee camps,
and those cases directly related to living in a constant fear of violence.
“It’s
a very difficult camp and a unique community,” Kazour says.
Unique
to Ain al-Hilweh, the armed leadership struggles of the ’70s and ’80s remain
simmering. Split-offs of the Fatah Palestinian faction, Islamist organizations
and other groups who have set up shop in the relative lawless environs vie for
power in the 1-square-kilometer camp that houses around 50,000 people.
Along
the camp’s narrow, unmaintained streets, the signs of instability are not
hidden. Young and old gunmen sit in shade and at checkpoints holding weathered
rifles. Near one mechanic’s shop, a man shakes a battered AK-47 to punctuate
his arguments.
Those
guns take their toll on the militia fighters and the people.
One
man was struck by a bullet after being caught between gunfire in the camp’s narrow
streets. Weeks later he came to a camp hospital looking for help. He couldn’t
stop thinking that he was going to die.
Kazour
diagnosed him with acute stress disorder and prescribed medication for his
condition.
“There
were clashes between military factions in the camp and several weeks afterward
we had acute stress disorder and PTSD cases directly related to the clash,”
explains Kazour “It can be an acute feeling days or weeks after military
clashes.”
Mental
health treatment in the camp generally divides along two lines: Psychiatry
treatment like Kazour offers that involves the prescription of drugs by
doctors, and more hands-on treatment from psychologists that involves therapy
extended over long periods of time.
Psychologist
Manal Kassem helps families and individuals work through mental health issues
through discussion and therapeutic exercises.
Kassem
says many cases she sees are made worse by just how tight security is. The
level of militia security in the camp and Lebanese Army security outside make
Ain al-Hilweh feel like sealed off area, she says. Kassem says it’s healthier
for residents if they can have interaction with their surroundings.
That
tight security has a broad range of impacts on people.
Kassem
says some people have developed phobias of police because of their limited
range of movement; others have experienced so much violence that a loud noise
sends them into a panic.
“It
relates to what they have passed through all these years,” Kassem says.
The
closed camp is also causing a resurgence in the traditional practice of
marrying first cousins due to the difficulty of finding spouses, she says.
Kassem says that can create a broad range of genetically derived psychological
problems.
In
a largely poor, largely unemployed diaspora community, the toils of living in a
crowded refugee camp for decades is stress enough.
“Of
course security and stability plays a very important role and increases, maybe,
the prevalence of depression and anxiety, but at the same time the first cause
of these kinds of disorders is socio-economic status,” says Rola Sharkieh, a
coordinator for MSF in the camp.
The
camp’s unusual politics have constantly presented a challenge to the operation
of clinics, from the people who need treatment to the support needed to launch
mental health operations in the first place.
MSF
officials met with over 20 political and religious parties, a number of which
only exist in the Ain al-Hilweh camp, before opening operations to make sure
their new services were welcomed.
Since
they opened a year ago the response has been significant. They have reached out
with house visits and information sessions, and so far over 200 people have
sought aid at the camp, including men, women, spouses and even militia
fighters.
“People were calling for
this service,” she says.
http://www.dailystar.com.lb/News/Local-News/2012/May-21/174080-ain-al-hilweh-deals-with-psychological-impact-of-camp-violence.ashx#axzz1vOo9WVnp
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