Implementation of mental health services in conflict and post-conflict zones: Lessons from Syria.

OBJECTIVE:We describe the challenges confronted and lessons learned in implementing mental healthcare during the Syrian war to inform effective services for conflict-affected Syrian populations. MATERIALS AND METHODS:We searched the academic and gray literature. We draw on the experiences of Syrian-American mental health professionals with nine years of experience providing clinical and programmatic mental healthcare in combat settings, siege, internally displaced person camps, and refugee camps. RESULTS:Collaboration with nonprofessional personnel was essential due to the shortage of formally trained mental healthcare professionals in Syria. The use of psychological and diagnostic terms increased stigma, whereas asking about the patient's identified problem, "suffering," or "challenges" supported engagement. War-related trauma and horizontal violence commonly affect Syrian children, adolescents, and adults. Resilience and engagement were enhanced by sensitivity to patients' dignity, religious acceptance, and faith. CONCLUSIONS:The Syrian war remains an ongoing public health and humanitarian crisis in which mental healthcare must adapt rapidly to specific needs and resources of the patient and community. Psychiatrists can increase the acceptability and efficacy of their care by being sensitive to Syrian patients' experiences of horizontal violence, loss of dignity, stigma, worldviews in which religion and faith may be important sources of resilience, and culturally acceptable modes of communication.