Germany lacks therapists for Syria's children

The results of examination of 100 Syrian refugee children in Germany was published Tuesday by professor Volker Mall at the Technische Universität München. It showed that one in every five children is suffering from post-traumatic stress disorder.

DW spoke with trauma therapist Jan Kizilhan to find out what can be done to help them.

DW: Explosions, death, and a terrifying escape across the Mediterranean - the majority of refugee children have seen awful things. What can help to erase these images from children's minds?

Jan Kizilhan: Children can fall victim to a kind of conditional shock - they get scared and become unsettled.

The other aspect is that their parents, confronted with war, with torture, with soldiers and attacks, are helpless. Up to that point, their children had learned that their parents could defend and protect them. Suddenly, this social configuration is flipped on its head. Their bond to their parents and environment is thereby destroyed.

Fleeing war is, from a psychological perspective, a deep gash, and in the worst case, it can lead to these children never being able to rid themselves of that experience.

How do those experiences manifest themselves?

They can develop depression, retreat into themselves. And they suffer from sleep disorders. They pull away from others, since they believe that something could happen to them. It can also occur that they subsequently get post-traumatic stress disorder, whereby the memories simply come flashing back. Suddenly, they're back in the midst of war or vividly experience their escape and, at that moment, they can't differentiate between reality and nightmare and are therefore always on guard.

Those are the short-term developments that can appear relatively quickly after such an experience. What happens in the long run?

Beyond chronic psychic illnesses, they often suffer physical ailments - diarrhea, persistent colds, but also other psychosomatic illnesses, such as skin problems. The children often get migraines, they wet themselves.

At the psychological level, it can change one's personality in such a way that the kids are never again in a position - even as adults - to establish a healthy relationship with another person, since they're continually distant, on edge, and nervous. Or the kids can't deal with their own feelings and develop an emotionally unstable personality: They become aggressive and insecure, and they can be difficult to integrate into society.

What kind of treatment would help to prevent exactly these kinds of disorders?

You have to clarify to those in the children's immediate environment - meaning at school, in the family - what trauma is, and how to deal with it. Because it's about stability, and with refugees - more than anything - it's about them finally experiencing what safety is. That they don't have to worry anymore about themselves and their parents. The best psychotherapy, actually, is that they go back to school relatively quickly. That structure returns. Kids need a framework where they get a sense of safety. In the bad cases, dream therapists and social therapists have to accompany them.

What do those therapists do?

They speak with children about their fears, so that they have the feeling that they don't need to feel embarrassed about their fears. Fear is something normal. The kids build a relationship with their therapists. Sometimes the kids don't even want to tell their parents about the fears. They don't want their parents to worry about them, to feel grief or sadness. With a therapist, they don't need to have these concerns. There are also different tools like drawing, painting, crafts and games, through which the children can confront their experiences.

800,000 refugees are expected in Germany this year. Many children are among them. Is Germany in a position to offer the necessary therapy?

The question is really: 'Do we have enough trained professionals who can engage themselves with this topic?' The answer is 'no'. Trauma therapy is in its infancy here in Germany. Especially with kids and juveniles, the number of experts who are familiar with this field is very small.

What are the implications for a country with high levels of immigration if the traumas endured by refugee children are not overcome?

The hope is in their resilience, in an inner strength that allows these kids to cope with these experiences within a good environment. This affects roughly half of the children. The rest need psychotherapy. And therein is a decisive point. What do we do with them? Politicians and society have a responsibility to begin considering some concepts.

Jan Kizilhan is a psychologist, author and publisher and an expert in transcultural psychiatry and traumatology.