Amid the gleeful shouts and happy laughter filling the Maliki-SCM Center in Amman, Jordan, it's hard to imagine the stories. Seeing the tiny bodies in postures of play — sprawled on the floor with toys, or standing together for a song — it's hard to picture them contorted in fear. How can such small frames bear the weight of such anguish?
Yet they do.
A nine year-old boy saw his uncle murdered in Hommes, Syria. After the Assad regime destroyed ther family's home, his relatives escaped to Damascus, then Daraa, before finally walking across the border into Jordan. He hasn't seen his father in two years, says the center's psychologist, Dr. Shafik Amer. Another boy, 13, remembered being raped 14 times in a Syrian prison. "This is a baby, a child," says Amer, in halting English. "I have stories about patients, about our children..." He stops.
"Sometimes," he says, "I cannot speak."
The Maliki-SCM Children's Center is largely the work of Seattleite Rita Zawaideh. Funded entirely by donations, the center is dedicated to helping the youngest victims of the wars in neighboring Syria and Iraq. With a staff including social workers, teachers, and a psychologist, the nondescript white building in this quiet neighborhood in Jordan's capital is the first of 10 Zawaideh plans to open. A second center is scheduled to open in March, Zawaideh says, and funding is lined up for eight more to open around the country, one-to-two months apart.
The centers, according to Zawaideh, will focus on the behavioral and emotional needs of traumatized children. They are treatment programs, not schools. Instead of working on math or reading, children play, receive behavioral therapy and one-on-one sessions with psychologists, and have structured free time.
Opened in January of this year, the Amman center serves about 25-30 children every quarter, year-round. The children often arrive displaying one or more symptoms of trauma: aggression, bed wetting, a refusal to interact with others. Most leave the programs after a single quarter. Those who don't show improvement have the opportunity to stay on. When all 10 centers are operating they will be able to serve more than 1,000 children every year.
While the program might seem short, three months "is absolutely enough time" to make a difference for children dealing with trauma, says Dr. Katie McLaughlin, a psychologist and assistant professor at the University of Washington who studies trauma and PTSD in children. In three-months time, says McLaughlin, an effective program can not only help children understand the intense fear and other emotions that stem from trauma, but also teach them the skills they need to cope with their feelings long after they leave the program.
In the center's gaily painted playroom, dappled morning light falls through large windows. Trees loom just outside. "They've had so much instability in their lives," says the center's co-director Reem Atassi about the children. "The center is a place where they can feel stable, where they can feel safe."
The refugee crisis unfolding across the Middle East is of a scale that is difficult to comprehend. More than 3 million have fled Syria since the start of the war there, according to the UN, and although exact numbers are few and constantly changing, between 20 and 30 percent of those refugees have ended up in Jordan. Since ISIL crossed into Iraq, more than 10,000 Iraqis have now fled to Jordan as well. Altogether, those seeking safety in Jordan have swiollen the small country's population by about 10 percent.
It's as if the entire population of Canada suddenly walked across the border into the U.S.
The result, in a country which even before the war was struggling with a lack of natural resources, persistent unemployment and a looming debt crisis, is a massive need, and there is little save the work of outside aid groups to to meet it.
As glaring as the issue of mental health can seem from the outside, it can end up as an afterthought in the programs of the biggest international aid organizations, says Dr. Elizabeth Ferris, a senior fellow at the Brookings Institution and co-director of the institution's project on internal displacement, which it runs in coordination with the London School of Economics. Ferris is writing a book on the Syrian refugee crisis. She explains that big aid groups tend to prioritize immediate, life-saving assistance like food, water and shelter. When there are large numbers of people in need, the focus can shift simply to maintaining and expanding those services.
"Across the board there's a recognition that mental health needs are simply not being addressed adequately throughout the region," says Ferris. "Mental health, as is usually the case, is falling through the cracks."
For Zawaideh, the centers and their programs grew out of what had been an effort to preserve the cultures of the Middle East, well before protests in Syria turned violent and boiled over into the war that spawned ISIL and the worst humanitarian disaster in a generation.
In fact, the centers began with silver.
In the mid-seventies, while Zawaideh was a tour guide bringing American tourists to the region, she noticed a dismaying trend. The boom in international silver prices was prompting buyers to set up shop in local markets, where they bought traditional Bedouin silver jewelry by the pound, to be melted down and re-sold. Generations of craftsmanship seemed destined to be turned into ingots, so Zawaideh acted.
"I just went to the market and started buying," she recalls.
Next it was baskets.
Long an art form in the region, hand-woven baskets traditionally bore designs unique to their village of origin. But in the early 1980s, Zawaideh noticed that the baskets were disappearing, replaced by imported plastic containers, another casualty in the relentless march of globalization. So she started buying baskets, too.
"Little by little I just kept collecting," she says. In 1996, after years collecting and showing the pieces informally, Zawaideh founded the non-profit Salaam Cultural Museum to formalize her efforts. Through the museum, she held exhibitions of Arab art around the Northwest, and hosted visiting Arab artists at local venues. All along, her goal was to protect and share Arab culture and heritage.
When the Syrian refugee crisis started, it was immediately clear to her what she had to do. She had to go beyond protecting the artifacts of the culture, and start protecting its people.
The new Maliki-SCM Children's Center in Amman helps kids cope with PTSD and other symptoms of trauma. Credit: Tom James
The first thing that meant was medical missions. During the first Gulf War she raised funds to send boxes of medical supplies to Iraq, but when the Syrian war started in 2011, Zawaideh doubled down. Without any medical training herself, she drummed up a team of doctors, nurses and support staff, stuffed suitcases full of medicines and medical supplies and headed for Jordan.
Today, through the Salaam Cultural Museum, Zawaideh runs one six-day mission into the country about every 40 days. The effort is staffed completely by volunteers who pay for their own airfare and lodging. Each group brings along large boxes of medical supplies, in addition to what the volunteers carry in their suitcases.
The centers, Zawaideh says, were a natural next step. The medical missions help. They are still what Zawaideh spends most of her time on; last week's mission was her seventh this year. But their benefits are often temporary, sometimes lasting only as long as the medicines she and her colleagues hand out. Creating programs that can support patients for months at a time, on the other hand, and in an area as profound as mental health, she says, has the potential for a more lasting effect.
Beyond helping individuals, says UW's Dr. McLaughlin, therapy work in situations where large numbers of people have been traumatized has the potential to create real positive change at a societal level. Without treatment, PTSD symptoms can interfere with a person's ability to be a productive member of society, holding him or her back in everything from relationships to parenting to holding a steady job or getting through college. And the risk is especially acute for the youngest sufferers, says McLaughlin, because the symptoms have the potential to disrupt not only their daily lives, but critical phases of their emotional and intellectual development.
"Treating kids is going to have many, many meaningful impacts at a societal level," says McLaughlin. "The return on investment for intervening early is going to be the biggest."
Speaking by phone from a hotel in Lebanon, Zawaideh sounds tired. After a day delivering medical supplies and visiting a factory where artificial limbs are made, she had just been on another call, hammering out the last details standing in the way of opening the second children's center.
She's flying home a day earlier than planned, she says. She'll take a break for a few weeks, before coming back to do it all over again.