Content warning: This article contains references to suicide.
“At the end of a suicide awareness session, my patients told me, ‘We love life if we find a way to it,’ quoting the renowned Palestinian poet Mahmoud Darwish,” says Rumeysa Seyh, a Doctors Without Borders/Médecins Sans Frontières (MSF) mental health activity manager in northwest Syria. “People have a deep attachment to life, even in the face of so much suffering.”
After more than 13 years of war, displacement, and ongoing humanitarian crises, a widespread mental health crisis is affecting countless people in northwest Syria. MSF is combining psychological support with medical services, making sure that both physical and mental health are treated together. Our teams run eight mobile clinics in displacement camps, and non-communicable diseases clinics at two primary health care centers. These mobile clinics also provide mental health support.
In 2024, MSF teams provided mental health services to more than 12,000 people in consultations and more than 69,000 patients attended mental health group sessions.
The impact of a prolonged war in Syria
More than 4 million people in northwest Syria are living in dire conditions, and 3.5 million are internally displaced. In addition to living in worn-out tents for years, parents struggle to find food for their children, health care is difficult to reach, and shelter is a luxury.
Post-traumatic stress disorder (PTSD), anxiety, and depression are widespread among conflict-affected and displaced people. Ongoing violence, loss of loved ones, poor living conditions, multiple displacements, and disruption of daily life have had severe psychological impacts, with PTSD manifesting through flashbacks, nightmares, and anxiety.
The impact of the earthquakes of February 2023, and another that hit in August this year, has only compounded the psychological toll on people in northwest Syria. As a result, suicide rates are rising in the region. Since the beginning of 2024, Syrian response coordinators have recorded 37 deaths by suicide, including 21 failed attempts, representing a 14 percent increase compared to the same period last year.
MSF has also supported 11 people who attempted suicide, the majority involving women aged 20 to 45, along with two children under 15.
Women constitute 63 percent of our patients and the most reported stressors by patients include daily living conditions, violence and family related problems.
“Most of the patients are women, who are especially impacted by economic struggles, limited opportunities, and violence,” says Seyh. “This troubling rise highlights the urgent need for mental health and economic support to tackle the issues.”
Mental health, security, and stability
According to OCHA, the humanitarian response plan in northwest Syria is critically underfunded. As of October 2024, only 26 percent of the Syria response plan had been funded, leaving a deficit of $3 billion across humanitarian sectors. The health sector faces a massive funding gap of $471 million, with only 10.5 percent of needs being met.
This short fall in funding threatens the availability of essential health services and, unfortunately, mental health care is often among the first to be deprioritized. The lack of mental health care services can lead to more violence, substance abuse, and the collapse of social structures, further destabilizing vulnerable communities.
Stigma is a barrier to accessing mental health care
Access to psychological support for survivors of violence and abuse is limited due to the absence of an integrated support system, including legal frameworks, and inaction. While people are changing attitudes toward mental health issues and becoming more inclined to talk about their experiences and seek help, many still feel the need to hide due to fear of their perpetrators or social judgment.
This stigma creates a barrier for patients to access mental health services in the community and further complicates the situation. Many people avoid seeking help due to societal perceptions, fear of judgment, or misunderstanding of mental health issues.
“One of the challenges facing the mental health sector is the stigma associated with mental disorders, treatments, and psychiatric medications,” says Dr. Ayham Al-Khatab, an MSF doctor in northwest Syria. “At MSF facilities, the dignity and privacy of patients are protected.”
Many people hold a negative view of psychiatric medication out of fear of addiction, which prevents them from seeking help from doctors and mental health specialists.
A holistic approach to mental and physical wellness
At a hospital for burns in the Atmeh area, MSF offers psychosocial support, individual and group counseling, and psychoeducation. These services are vital for patients dealing with trauma, pain, and disfigurement.
MSF also plays a crucial role in supporting nine safe spaces for women and children. Within the Idlib and Aleppo governorates in northwest Syria, our teams directly manage four of these safe spaces, ensuring they offer essential services. We collaborate with local partner organizations to support the other five safe spaces.
These collective efforts help to create a safe environment for women and children, thus promoting their well-being through recreational activities, referrals to vital services for physical and mental health, and socio-economic assistance.
“People in northwest Syria have endured years of violence, displacement, and deprivation,” says Thomas Balivet, MSF head of mission in northwest Syria. “They need the opportunity to heal not only from physical wounds but also from the deep, unseen psychological scars left by this crisis.” Investing in mental health is an investment in a more stable future where people can regain their lives.”
