After Jordan went into lockdown last year due to COVID-19, Hadeel Nasser’s caseload increased significantly. As the senior mental health officer for Azraq refugee camp in Jordan, she was responsible for coordinating mental health services for the International Medical Corps (IMC), an NGO supported by UNHCR.

“From the beginning of the pandemic we saw a lot of people who were suffering from symptoms of anxiety and depression, and adjustment disorder, which is continued emotional distress after a traumatic event,” she says.

There were already high levels of mental illness among Syrian refugees in Jordan. While there are now fewer diagnoses of immediate trauma-related issues such as PTSD, rates of anxiety and depressions remain elevated. One recent IMC report found a strong sense of hopelessness and helplessness among many Syrian refugees in Jordan as hopes of a return home continued to fade.

Hadeel Nasser, senior mental health officer for Azraq refugee camp in Jordan

But thanks to the continued support of UNHCR and its donors, Hadeel and her colleagues are doing everything they can to help. Last year, their organisation assisted more than 7,000 vulnerable refugees and Jordanians to receive the treatment they need.

As UNHCR’s partner agency for refugee mental health, IMC runs a range of clinics in camps and urban centres throughout Jordan. It’s the largest mental health provider after the Jordanian government and fills an important gap in the system. Pressure on health services in Jordan is intense. According to Ahmad al Shibi, the Mental Health and Psychosocial Support Coordinator for IMC Jordan, there is one public health psychiatrist for every 100,000-150,000 people, and private health remains out of reach for even middle-income Jordanians.

“Over 80 per cent of Syrian refugees in Jordan live below the poverty line, and the average daily wage for refugees is $USD3 a day, which isn’t considered enough to feed one person, let alone a family,” he says. Not only does this make it difficult to fund medical costs, but it also adds to the stress felt in many refugee households, which in turn exacerbates feelings of despair and hopelessness.

Refugee women are particularly at risk here, partly because the cultural stigma around poor mental health prevents them from seeking help. Away from their network of friends and family, they can also feel very isolated.

“In my experience, women can be reluctant to say in front of other people that they’re struggling with their mental health – certainly, when I started working in the camp eight years ago, that was the case,” Hadeel says.

“In some respects they aren’t alone in this, as stigma around poor mental health exists everywhere. But recently, I’ve noticed more women walking into our clinics to seek support and help, and they feel proud of themselves for doing that. In some cases, they’re telling their friends about the treatment they’ve received.”

Both Hadeel and Ahmad attribute this change in attitude to IMC’s outreach work, which includes inviting women to education events, training community volunteers in mental health awareness and building capacity in GP clinics. “We really emphasise the message that we respect women’s privacy and confidentiality,” Ahmad say.

Samira, Itidal, Kholoud and Samaher, Syrian refugees living in Azraq camp in Jordan. They are part of the SEP Jordan artisan collective which is supported by UNHCR’s MADE51 livelihoods programme to help refugees access global markets with the crafts they produce.

Funding continues to be a challenge, he adds, but the IMC teams work creatively to manage their resources, providing peer-to-peer supervision for training and sharing their experience and learning with each other.

One of the aims of UNHCR’s Connecting World’s app is to help provide peer-to-peer support for Syrian refugee women living in Jordan. Through the app, refugee women are connected directly with members of the Leading Women Fund, sharing texts and swapping photos and recipes. But the emotional benefits are a vital part of the initiative too.

“One thing that strikes me so much is that, overwhelmingly, it’s the emotional support that is so beneficial for the refugee women who take part,” says Lara Schlotterbeck, UNHCR’s project lead for the Connecting World’s app.

“Having someone check in with them means a huge amount, more than we can imagine.”

For Hadeel, there’s a special joy in seeing vulnerable women regain hope and stability after treatment for their mental health issues.

“When I see a smile return to the face of someone who has struggled, that is success for me,” she says. “So, too, when someone can resume their daily life and cope with the circumstances they’re in. Life for refugees is not their ‘normal’ life – they are still in crisis, away from their homes, their relatives, they families. But if they can accommodate these stressors and live productively, we feel satisfied.”

Find out more about the Leading Women Fund and the Connecting World’s app.

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