John P. J. Dussich

Helmut Kury

World Society of Victimology

16th International Symposium on Victimology

Hong Kong, China

June 10-14, 2018

NOT FOR PUBLICATION

The Horrors of Civil War

The Search for Safety

The Need to Escape Fear, Suffering and Death

A global perspective

“Over 65 million people around the world have been forced from their homes to escape famine, climate change and war in the greatest human displacement since World War II…the staggering scale of the refugee crisis and its profoundly personal human impact…stretches across the globe in countries including Afghanistan, Bangladesh, France, Greece, Germany, Iraq, Israel, Italy, Kenya, Mexico, and Turkey”(Weiwei 2017, p. 1).

By comparison, the population of France is about 65 million.

(Edwards 2016)

AbstractOne of the most compelling challenges of the 21st Century is the massive number of refugees across the globe today. Of special note are those from the civil war-torn nation of Syria. Many of these refugees arrived by foot in Germany with significant trauma mostly the result of three separate victimizations: the terror they felt in their own country which prompted their escape, the sufferings which occurred along their difficult journey, and the negative experiences some endured after arriving. In this study, demographic and trauma data were gathered in Germany mostly from 691 Syrian refugees during the period from October 2015 to July 2016. The primary focus was to measure levels of PTSD using an American standardized scale translated into Arabic using opportunistic sampling which canvased these refugees at different stages of their journey from those who were: just arrived, still traveling, and residing in refugee camps. The results showed that approximately one third had measured levels of PTSD; that roughly two thirds were young males, and that about three quarters intend to return to Syria after peace comes to their country. The dominant responses by the German authorities to these refugees were to: insure they were well fed, comfortably housed, provided medical attention, given the opportunity to learn the German language and counseled to help them find jobs. For the most part, there was a paucity of attention given to measuring and treating their PTSD.

The Escape Journey Begins:A Refugee Camp in Turkey

The impact of the Syrian Refugee crisis in the Levant Region

Of course Syria's civil war has been a national catastrophe for it own country, but it has also had a major impact on its neighboring countries. Millions of Syrians were early displaced throughout the rest of the Middle East (mostly the Levant plus Turkey and Egypt) and later into parts of Europe, where they survive in refugee camps that severely strain already scarce resources of these host nations. The first map below shows the location and numbers of the Syrian refugees throughout the region shortly after the conflict started as of 2013; it does not show the 6.5 million Syrians displaced within Syria. The second map shows the refugee situation at its peak, in May of 2015. The third map shows the situation today. “Their impact is [was] especially felt in Jordan and Lebanon… as many as one in five people in those two countries is [was] a refugee” (Fisher 2015, #23). While the US and other distant countries have provided some aid for refugees, the United Nations says it's not nearly enough to provide them only with basic essentials.

(UNHC 2018)

(UNHCR 2018)

(Pew Research Center 2018)

(Dark Horse News 2018)

Considering Germany

In 2014 the German Federal Office for Migration and Refugees (BAMF) reported that from 2014, 202,834 asylum applications were filed and by 2015 that number had jumped 135% to 476,649 (BAMF 2016). The original increase in 2015 prompted the United Nations to comment that Germany had become the “the world’s largest recipient of new individual applications” (UN 2017 p. 2). The bulk of these refugee applications from 2014, were from Syria (BAMF 2016).

The Dangerous Trek

The distance from Syria to Germany is 2,922 kilometres or about 1,816 US miles (the US

is 2, 680 miles wide from sea to sea). For most persons this journey took about two

months. The routes change the police were different, the laws were different. Some had

extra money and could take the train, or a taxi or a bus or a boat; each method had

advantages and risks. Some refugees were sprayed with water, some were beaten, some

were chased, some were treated kindly, most had no food and relied on good Sumarians

along the way. Many went without food for many days.

The Perilous Voyage from Turkey to Greece

A Tragedy of the Risks Taken

In the Balkans, walking toward an uncertain future.

A Processing Center in Southern Germany

Research methods

Armed with the PTSD Check List – Civilian version translated into Arabic the researchers developed a strategy to canvass Syrian refugees throughout Germany first during the months of October and November of 2015 (Freilassing, Rosenheim and Munich), then again in March of 2016 in northern Germany (Hannover and Berlin) and in southwestern Germany in Freiberg; and, finally again in Frieberg, and in the mideastern town of Thüringen in in May of 2016.

Data collection begins

Monitoring completion of the questionnaires

Syrian Youth Hanging out on the streets of Berlin

End station: BERLIN’s

mothballed Tempelhof

Airport

Findings

Recall that the primary focus of this study was to measure the levels of PTSD among the Syrian

refugees who entered Germany since approximately 2011 up to late 2015 to early 2016 as

measured by an American standardized scale translated into Arabic using opportunistic

sampling which canvased these refugees at different stages of their journey from those who

were: recently arrived, continuing their travels, and now living in refugee camps. In general, our

results showed that approximately one third had measured levels of PTSD; that roughly two

thirds of the refugees we measured were young males, and that about three quarters intend to

return to Syria after peace returns to their country. From the 691 Syrians we tested, within a

range of 17 to 85, the average PCL-C score was 43.01 points (as 50 points was the threshold for

PTSD, this is a remarkably high average for a large proportion of the sample).

Our Findings

• Total number on the PCL-C scale (total sample=691 Syrians + 134 other groups)

Total scores N %___ trauma levels

• 16 – 25 109 3.2 lowest

• 26 - 40 256 31.0 low

• 41 - 49 171 20.8 moderate

• 50 - 70 244 29.6 significant PTSD

• 71 - 85 43 5.2 highest PTSD

• No info. 2 0.2_

• Total N 825 100.0

Total number Refugees and their PCL-C- points

109

256

171

244

43

2

0

50

100

150

200

250

300

16 - 25 26 – 40 41 – 49 50 – 70 71 – 85 no inform.

tota

l nu

mb

erN

total PCL-C points

Findings continued…

Among the 17 PCL-C trauma items, Syrians

identified “mental stress by remembering

previous events” as the most serious component

part of their PTSD. When adding together all 825

refugees (of which Syrians were 84%), the average

rose slightly to 43.85 points.

Findings continued…

To add context to our 17-item PTSD questionnaire, a

factor analysis demonstrated that two separate

dimensions with significant differences emerged.

The first factor we described as “irritability,

concentration difficulties, and being frightened.”

The second factor we characterized as “mental

stress, stressful dreams from previous events, and

avoidance activities.”

Findings continued…Factor 1 presents the highest loading from items dealing with the dimensions of “irritability and tendency to tantrums, concentration difficulties, and being easily irritated and frightened.” This factor also included being excessively suspicious and alert, difficulties falling and staying asleep, feelings of alienation and isolated from others, feelings that plans for the future have changed, limited ability to experience certain feelings, and less interested in activities which used to be gratifying.

Findings continued…

Factor 2 presented the highest loadings from items dealing with a sense

of mental stress remembering previous events, repeated stressful

dreams from previous events, and avoidance activities, situations and

places; including, such aspects as repeated stressful memories, sudden

flashbacks of burdening events,, avoidance of conversations, thoughts

and feelings from prior experiences; physical reactions prompted by

remembering previous events, and difficulty remembering key parts of

their past.

Safe at last; contemplating

their prospects.

Conclusions

Our study has confirmed that the Syrian refugees we tested in Germany have levels of PTSD that are of serious concern. It is not surprising that their recent victimizations, whether it was their exposure to or fear of death in their home country; the sufferings and fears during their escape journey, and/or the insecurities and sufferings during their stay in German refugee camps, resulted in high levels of PTSD. Among most societies, the percentage of PTSD in the population is usually in the single digits (Burri and Maercker, 2014; Nebraska 2007; Van Amerigen et al. 2008; DeVries and Olff2009; and Frans 2005). so for this sample of refugees to have an averge percentage of 34.8 is remarkably high.

Conclusions continued…

In spite of a large percentage of Germans who were not in favor of

Angela Merkel’s support for refugees especially those in eastern

Germany (Klein 2017), this study showed that almost three

quarters (72.1%) of those refugees tested stated that they “felt

welcomed in Germany.” This attests to the quality of services, the

positive attitudes of those caring for them at the various camps,

the more positive attitudes of citizens who provided services

outside these camps especially volunteers teaching German.

Conclusions continued…

If these refugees are expected to become integrated into Germany society, their mental

wellbeing should also be systematically addressed by professional mental health practitioners.

Mental health treatment of refugees in other countries have shown successful outcomes (Amri &

Bemak 2012). For them to be able to cope at their maximum level, those with high levels of PTSD

must be treated, especially since for many this disorder can last indefinitely. The handicap of high

levels of PTSD, its likely continuation if untreated, and the many negative manifestations of this

condition will surely and unnecessarily hamper the success of their possible integration in the

German society. We believe if professional mental health treatment would be provided to these

Syrian refugees, both the Syrians and the German community would greatly benefit.

The New Flag of Syrian Refugees

This flag of the Syrian Refugee Nation was designed by the artist Yara Said, a Syrian refugee who found asylum in Amsterdam. "Black and orange is a symbol of solidarity with all these brave souls that had to wear life-vests to cross the sea to look for safety in a new country. Since I had to wear one, I have a personal engagement ...”

Facing the challenges of integration: new language, sights, food, clothing, customs, etc. and waiting for Syria to heal…

• These Syrians have been given official identification cards; they continue to receive the basic needs of life, including language lessons, cell phones and jobs.

• As a result of their recent sufferings, PTSD levels among these refugees is high and greatly hinders their ability to function in normal ways.

• The sequela of traumatic stress continue: flashbacks, insomnia, hypervigilance, interpersonal conflicts, drug and alcohol abuse, depression, anxiety, etc.

• For them to face their new challenges effectively, they also need to receive psychosocial treatment for the traumas they’ve endured…

• We recommend each refugee be screened for PTSD and, if needed, be provided with social and mental health interventions.

Angela Merkel, Die Zeit (Aug. 31, 2015)

Thank you for your attention

ReferencesAmri, S., and Bemak, F. (2012) Mental Health Help-Seeking Behaviours of Muslim Immigrants in the United States: Overcoming Social Stigma and Cultural Mistrust. Journal of Muslim Mental Health, 7, 1: 1-21.

Bundesamt für Migration und Flüchtlinge – BAMF (2016). Migrationsbericht 2015. Zentrale Ergebnisse. Forschungszentrum Migration, Integration und Asyl. Nürnberg from www.bamf.bund.de, retrieved on November 17, 2016.

Dark Horse News (2018) Migrant Roiute to Germany, June 2, 2018, from: http://darkhorsenews.com/bulgarian-hero-chases-down-gangs-of-muslim-border-jumpers/migrant-route-to-germany/, retrieved on June 2, 2018.

Edwards, A. (2016) UNHCR – Global fored displacement hits record high, June 20, 2016, from: http://www.unhcr.org/afr/news/latest/2016/6/5763b65a4/global-forced-displacement-hits-record-high.html, retrieved on June 2, 2018.

Fisher, M. (2015) Mapn #23 UNHCR, 40 maps that explain the Middle East on March 26, 2015, Retrieved on May 4, 2018 from: www.vox.com/a/maps-explain-the-middle-east, retrieved April 4, 2018.

Google maps(2018) Syrian density and displacements, from: https://www.google.com/search?q=syrian+refugees+2015&source=lnms&tbm=isch&sa=X&ved=0ahUKEwiNobLi_bTbAhWKw4MKHTAKCp4Q_AUICigB&biw=2176&bih=1052#imgrc=UOWX_mMAZY3AlM: , retrieved on June 2, 2018.

Merkel, A. (2015) In the Eye of the Storm, “We can do it!” Die Zeit Online (Aug. 31, 2015), from: https://www.zeit.de/politik/deutschland/2015-09/angela-merkel-refugees-crisis-chancellor/seite-4, retrieved on June 2, 2018.

Pew Research Center (2018) Most displaced Syrians are in the Middle East, with about a million in Europe, Januaryi 29, 2018 from:http://www.pewresearch.org/fact-tank/2018/01/29/where-displaced-syrians-have-resettled/ft_18-01-26_syriarefugees_map/,

retrieved on June 2, 2018.

Quaranta.de (2018) A perilous journey from Syria to Germany, from: en.qantara.de/content/a-perilous-trek-refugees-journey-from-syria-to-germany, retrieved on May 4, 2018.

UNHCR (2018) Syrian Refugees in the Region as of ‘December 15, 2013 from: https://reliefweb.int/map/lebanon/syrian-refugees-region-dec-15-2013, retrieved on June 2, 2018.

UNHCR (2018) Map of Syrian refugee density and camp placements in border hosting countries as at 3 November 2015, from: https://www.researchgate.net/publication/289521695_Syrian_Humanitarian_Disaster/figures?lo=1, retrieved on June 2, 2018.

Weiwei, A. (2017) Human Flow, NFP Marketing and Distribution, Germany, from: https://youtu.be/n9i4vvKEWSA, retrieved May 3, 2017.

NOT FOR PUBLICATION