The Syrian regime's apparatus for systemic torture: A qualitative narrative study of testimonies from survivors.

BACKGROUND: Despite broad interest of the Syrian refugee plight in the academic and media circles, there are still limited studies analyzing the lived experiences of torture survivors under the Syrian regime. This qualitative study interviewed torture survivors to examine the form and function of the Syrian regime's security apparatus, and the personal aftermath of survivors. METHODS: Thirteen in-depth interviews were conducted in Arabic with Syrian refugees who endured torture. Study participants were at least 19 years of age, resided as refugees in Jordan, and voluntarily agreed to participate in the study. Participation was anonymous and no incentives were provided. Only oral consent was required. Audio-recorded interviews were transcribed and translated to English, and then analyzed for repetitive themes utilizing the narrative approach. RESULTS: Major themes were observed across three experience-phases: pre-captivity, during captivity, and post-captivity. The pre-captivity phase included two sub-themes: the Syrian regime's initial detection and arrest system, and the intelligence system. The captivity phase was also divided into two sub-themes: environmental conditions in detention facilities, and torture methods including physical and psychological torture. Some of the environmental conditions in detention facilities included lack of sanitation, crowding, starvation, and withholding of medical care. Torture methods encompassed beatings, electric shocks, nail-pulling, hanging, drowning, suffocation, rape, and the witnessing of killing, sexual assault, or torture of others. The post-captivity phase included their release from captivity, escaping Syria, and post-displacement conditions and activism. CONCLUSIONS: The Syrian regime employs a vast security apparatus to track, detain, interrogate, torture, and subjugate its civilian population. A systematic mechanism commences even before captivity and continues for years after release, with negative implications on the well-being of survivors, their families, and the Syrian people as a collective community. The Syrian war saw a shift toward mass detention, torture as a form of social punishment, subjugation, and indeterminate imprisonment. Intervention agencies, host countries, and policymakers must be informed of survivors' experiences to better address their needs. Moreover, the international community must advocate for a firm stance against torture, demand justice, and prosecute all parties engaged in perpetuating such extreme forms of suffering and trauma.

Challenges of Researchers in Conducting International Study during the Eruption of COVID-19: Student and Mentor Perspectives.

Conducting an international research study may bear various challenges; however, during the global COVID-19 crisis, such a study undertakes unpredictable trajectories. This paper explores the challenges experienced by researchers studying Syrian refugees' physical and mental health and aid workers serving under humanitarian organizations in Lebanon. It includes information about the changes in the study's goals and design with the emergence and spread of SARS-CoV-2, as necessitated by the circumstances COVID-19 imposed. It focuses on the unique perspectives of the research team of two students and their mentor who faced multiple challenges while involved in the study, and their narratives and subjective experiences that led to new opportunities for growth in the project. The research team specifically engaged in humanistic and existential psychology in order to conduct research in a manner conducive to personal and professional development, productivity and growth. To conclude, the researchers propose recommendations to the academic community on mitigating some of the challenges faced when conducting international research, and suggestions to the humanitarian sector serving vulnerable populations in conflict zones during COVID-19.

Manzuaat wa Musharadat, Uprooted and Scattered: Refugee Women Escape Journey and the Longing to Return to Syria.

OBJECTIVE: Violent conflict forced millions of Syrians to flee their homes to host countries. This study examines Syrian refugee women's experiences from the war's outset through their journey to Jordan. It addresses the toll this journey had on their lives. METHODS: Twenty-four in-depth interviews were completed with Syrian refugee women who currently reside in urban areas of Jordan. Researchers translated, transcribed, and analyzed the interviews using group narrative methodology. RESULTS: The Syrian women had unique nostalgic memories of times before the war. They experienced atrocities during the war that forced their decision to escape Syria. Their journey narratives testify of internal displacement, personal and collective traumatic journeys via legal and illegal routes. Almost all the women were placed in refugee camps during their transitions to host country residency. In Jordan, they faced diverse hurdles of displacement and extremely different realities compared to the ones they had in Syria. Despite how very different but difficult each of their journeys were, every single woman longed to return home to Syria. CONCLUSIONS: This study presents a new understanding of the role and process of the journeys undertaken and highlights the concept of "return" as the defining element for Syrian refugee women. Regardless of the hardships women endured to escape their homeland to find safety, "return" marks an ending to their horror journey and the beginning of a new journey of hope for a better future.

Rape Crisis Counseling: Trauma Contagion and Supervision.

This study of rape crisis counselors considers whether increased exposure to victims' trauma is associated with increased supervision-believed necessary to combat trauma contagion-and whether such supervision will reduce the negative impact of such exposure. One hundred six women counselors in seven of nine rape crisis centers in Israel completed anonymous questionnaires documenting their work and trauma exposure. Trauma exposure was defined by counselors' number of victim-contact hours per week and their assessment of the trauma severity they experienced. Supervision was measured by the number of hours received. Counselors trauma outcome indicators included sexual intimacy, secondary traumatization (evidenced in posttraumatic stress disorder [PTSD]-type symptomology), and vicarious traumatization (expressed as a disturbance in cognitive schemes that undermine the self and others). Hypotheses were evaluated in fully recursive path analyses via ordinary least squares (OLS) regression. Participants' mean age was 43.4 years; 58% were married, 26% single, 13% divorced, and 3% widowed; 81% had a college degree or more; 18.9% reported being exposed to victims-trauma at a minimal level, 54.7% moderate and 26.4% extreme; and 43.4% were abused at some time in their lives. Job exposure to victims' trauma was significantly associated with increases in supervision time (ß = .33, p = .002). Supervision time fully mediated the relationship between duration of exposure to victims' trauma and counselors' secondary traumatization reports such that increased supervision was associated with degrading sexual intimacy (ß = .22; p = .032) and increased Secondary Trauma Scale scores (ß = .44; p = .004) after taking into account counselors' education level, history of abuse, anger management in intimate relationship, and posttraumatic growth scores. The study results raise concern about counselors' mental health in that the supervision effect exacerbated the trauma contagion impacts. The study suggests a need for documenting the nature of the supervision and considering different types of supervision methods.

"Children Are Not Children Anymore; They Are a Lost Generation": Adverse Physical and Mental Health Consequences on Syrian Refugee Children.

This research examines Syrian refugee mothers' accounts of the physical and mental health of their children being affected by war traumas and displacement challenges. Open-ended audio-recorded interviews were conducted in Arabic with 23 mothers residing in Jordan. Using a narrative approach in the data collection and analysis, five major themes were identified: (1) children were exposed to diverse war traumatic experiences in Syria; (2) the escape journey and refugee camps threatened children's lives; (3) displacement and family stressors exposed children to poverty, hostility from local peers, educational and recreational challenges, child labor, and domestic violence (these three major themes were considered as trauma related variables); (4) children were not only directly affected physically and mentally by their own traumatic experiences and displacement stressors, but these experiences were mediated and magnified by familial interrelated processes, evidenced in intergenerational transmission of trauma, harsh parenting style, parental control, and parentification; and (5) adverse consequences of both trauma related variables and family processes directly and indirectly traumatized children and adversely impacted their physical and mental health. We examined the themes that emerged from the data in view of three theoretical frameworks and the impact of trauma in the family system on child development. To conclude, humanitarian organizations that provide services and interventions to refugees need to take into account familial processes and not only individual factors affecting refugee children's physical and mental health. Further implications on policies and trauma research are discussed.

Refugee trauma work: Effects on intimate relationships and vicarious posttraumatic growth.

BACKGROUND: Bearing witness to Syrian refugee atrocities may result in aid-workers' vicarious traumatization (VT). This study examined work stressors and organizational support and their associations with vicarious posttraumatic growth (VPTG) and intimate relationships. It also examined the potential mediating effects of differentiation of the self and finding meaning in trauma-work. METHODS: Aid-workers (N = 317) from organizations in Jordan were surveyed. Univariate statistics and structural equation modeling (SEM) were utilized to test hypothesized relationships. RESULTS: Increased VT was associated with increased VPTG, decreased intimacy and decreased differentiation. Increased needs addressed by NGOs was associated with increased VPTG, differentiation, and finding meaning. Increased trauma-exposure was associated with increased finding meaning. Increased co-workers support was associated with increased intimacy and finding meaning. Higher differentiation was associated with decreased VPTG, and increased intimacy. Whereas, increased finding meaning was associated with increased VPTG and intimacy. Differentiation partially mediated the associations between VT, and both VPTG and intimacy, and between needs at work and VPTG. Differentiation fully mediated the association between needs at work and intimacy. Finding meaning fully mediated the associations between extent of trauma-exposure, and both VPTG and intimacy, and between co-workers support and VPTG; needs at work and intimacy. It partially mediated the associations between needs at work and VPTG; co-workers support and intimacy. LIMITATIONS: The study is cross-sectional and generalization is limited to aid-workers who provide services to Syrian refugees in Jordan. CONCLUSIONS: Organizational support is crucial in mitigating the negative impacts of trauma-work, and in enabling a nurturing space for potential growth.

Trauma during humanitarian work: the effects on intimacy, wellbeing and PTSD-symptoms.

Background: Organizations assisting refugees are over burdened with the Syrian humanitarian catastrophe and encounter diverse difficulties facing the consequences of this massive displacement. Aid-workers experience the horrors of war through their efforts to alleviate suffering of Syrian refugees. Objective: This study of Syrian refugee aid-workers in Jordan examined work-stressors identified as secondary traumatic stress (STS), number of refugees assisted, worker feelings towards the organization, and their associations to PTSD-symptoms, wellbeing and intimacy. It also examined whether self-differentiation, physical health, and physical pain were associated with these variables. Method: Syrian refugee aid-workers (N = 317) in Jordan's NGOs were surveyed. Univariate statistics and structural equation modeling (SEM) were utilized to test study hypotheses. Results: Increased STS was associated with lower self-differentiation, decreased physical health and increased physical pain, as well as elevated PTSD-symptoms and decreased intimacy. Decreased connection to the NGO was associated with lower self-differentiation, decreased physical health, increased physical pain, and with decreased intimacy and wellbeing. Lower self-differentiation was associated with increased PTSD-symptoms, decreased wellbeing and intimacy. Elevated physical pain was associated with increased PTSD-symptoms, and decreased wellbeing. Diverse mediation effects of physical health, physical pain and self-differentiation were found among the study's variables. Conclusions: Aid-workers who assist refugees were at risk of physical and mental sequelae as well as suffering from degraded self-differentiation, intimacy and wellbeing. Organizations need to develop prevention policies and tailor interventions to better support their aid-workers while operating in such stressful fieldwork.

Antecedentes: Las organizaciones que ayudan a los refugiados están sobrecargadas con la ayuda humanitaria siria catástrofe y encontrar diversas dificultades que enfrentan las consecuencias de esta masiva. Los trabajadores de ayuda al desplazamiento experimentan los horrores de la guerra a través de sus esfuerzos para alivian el sufrimiento de los refugiados sirios.Objetivo: Este estudio de trabajadores humanitarios de refugiados sirios en Jordania examinó los estresores laborales identificados como el estrés traumático secundario (STS en sus siglas en inglés), el número de refugiados asistidos, los sentimientos del trabajador con respecto a la organización, y sus asociaciones con los síntomas del TEPT, bienestar e intimidad. Se examinó también si la auto-diferenciación, la salud física, y el dolor físico se asociaban con estas variables.Método: Se encuestaron los trabajadores humanitarios de refugiados sirios (N=317) de organizaciones no gubernamentales (ONGs) en Jordania. Se utilizaron las estadísticas univariadas y el modelamiento de ecuaciones estructurales (SEM en sus siglas en inglés) para probar las hipótesis del estudio.Resultados: El aumento en el STS se asoció con una más baja auto-diferenciación, una disminuida salud física y un aumento del dolor físico, como también con síntomas elevados de TEPT y una intimidad disminuida. Una conexión disminuida con la ONG se asoció con una más baja auto-diferenciación, una disminuida salud física, un aumento de dolor físico, y con una disminuida intimidad y bienestar. Una más baja auto-diferenciación se asoció con un aumento en los síntomas del TEPT, y un disminuido bienestar e intimidad. El dolor físico elevado fue asociado con un aumento en los síntomas del TEPT, y un disminuido bienestar. Se encontraron diversos efectos mediadores de la salud física, dolor físico y la auto-diferenciación entre las variables del estudio.Conclusiones: Los trabajadores humanitarios que asisten a los refugiados se encuentran en riesgo de secuelas físicas y mentales como también de sufrir un deterioro en su auto-diferenciación, intimidad y bienestar. Las organizaciones necesitan desarrollar políticas de prevención y adaptar intervenciones para apoyar mejor a sus trabajadores humanitarios mientras operan en tan estresante campo laboral.

War can harm intimacy: consequences for refugees who escaped Syria.

BACKGROUND: Syrians seeking refuge have been exposed to atrocities and trauma beyond comprehension. This study examines how personal, interpersonal, displacement and war-related factors have impacted married refugees' intimate lives. METHODS: Data included 158 married Syrian refugee individuals who live in the host communities of Jordan. Refugees reported on their personal, interpersonal, current-displacement and past-war related experiences. Traumatic impacts were assessed using the Harvard Trauma Questionnaire (HTQ), K6 screening scale for serious mental illness (SMI), The War Events Questionnaire (WEQ), and Personal Assessment of Intimacy in Relationships (PAIR). Stepwise multiple regressions were used to determine the factors associated with refugees' intimacy-total score and its six dimensions. RESULTS: Most refugees (94.2%) experienced war events, and 34% screened positive on the PTSD-HTQ scale. Overall intimacy scores were low, scoring M (±standard deviation) = 2.4 (±1.1) of a possible five on average. Intimacy scores were lower for refugees who screened positive on the PTSD-HTQ (M = 1.95 ± 65) compared to the ones screening negative, respectively (M = 2.23 ± 66). Furthermore, the higher the PTSD symptoms reported, the lower the couples' intimacy. PTSD and forced marriage were the strongest factors to predict decreased total-intimacy scores (ß = -0.23, P = 0.002; ß = -0.32, P < 0.001), and decreased scores on four dimensions of intimacy (emotional, sexual, intellectual and recreational). Whereas gender was the second strongest factor associated with decreased total-intimacy scores (ß = -0.29, P < 0.001), and decreased scores on three dimensions of intimacy (emotional, social and anger), meaning that women reported suffering more than men from deteriorated intimacy in their marital relationships. Other displacement and war-related factors associated with intimacy were: decreased sexual intimacy associated with having been raped; increased intellectual intimacy associated with escaped from Syria with one's spouse; decreased recreational intimacy associated with the number of family members lived with; decreased sexual, emotional and total-intimacy scores associated with number of children; and years of education as a seemingly personal protective factor associated with increased intellectual and recreational intimacy. CONCLUSIONS: Addressing Syrian refugees' intimacy issues in interventions is essential, as well as raising the awareness of stakeholders and community leaders to the negative impacts of PTSD, forced marriage, rape, and displacement difficulties endured by the already challenged and distressed married refugees.

Well-Being and Posttraumatic Growth Among Syrian Refugees in Jordan.

The Syrian War has created a mass exodus of Syrian citizens to neighboring countries and exposed them to many atrocities. We explored factors affecting well-being and posttraumatic growth (PTG) of refugees residing in Jordan. Participants (N = 250) were surveyed via nongovernmental organizations (NGOs). Outcome criteria included a global well-being rating and the Posttraumatic Growth Inventory. Trauma exposure assessment included The Harvard Trauma Questionnaire (HTQ) and The War Events Questionnaire. Ordinary least squares regression examined associations between potential contributors to refugee well-being and PTG, including work, age, sex, income, education, posttraumatic stress disorder (PTSD) severity, physical pain, health, NGO assistance, psychotic/affective mental disorder, and length of residence in Jordan. Mean participant score on the PTSD-HTQ scale was 2.37 (SD = 0.63; range: 1 [no symptoms] to 3.88 [extremely severe symptoms]). Additionally, 74.6% of participants received NGO assistance and 92.7% experienced war events. Univariate and multivariate results indicated enhancement of well-being was associated with income, r = .34, ß = .26, p < .001; health, r = .35, ß = .26, p = .001; and absence of affective disorder, r = -.31, ß = -.18, p = .012; and that PTG increased in association with income, r = .28, ß = .20, p = .007; NGO assistance, r = .07, ß = .14, p = .045; and absence of psychosis, r = -.12, ß = -.17, p = .013, and affective disorder, r = -.26; ß = -.16, p = .033. Findings suggest sufficient income and humanitarian assistance can contribute to Syrian refugees' mental health.