Reneem Hezabar, a financial consultant with Middle East Consulting Solutions in Gaziantep, Turkey, expects a phone call any day now with the news that her father has been killed. He is one of the few doctors working in her native city of Idlib in northwest Syria, and the Russian-Syrian alliance has been bombing hospitals in the province, the last stronghold of Syria’s revolution, since the latest offensive began April 28.
The Syrian American Medical Society, one of the few remaining medical relief organizations working on the ground in Syria, said there have been 25 attacks on health facilities, “each of which represents an egregious violation of international humanitarian law.” The Syrian government said it is only targeting the extremist militant group, Hayat Tahrir al-Sham, which, since January, has strengthened its control across the province and in northern Hama, holding most of the region today. The regime has been using a cocktail of arms, including incendiary weapons, cluster munitions and barrel bombs.
The Syrian Observatory for Human Rights said the latest offensive has killed 408 civilians and displaced over 300,000, the greatest amount of displaced people since the start of the conflict, with half of the civilians being displaced for at least a second time. In a press statement released June 11, medical society President Ahmad Tarakji said: “The situation in Idlib continues to worsen by the day, yet the international community remains silent, or unwilling, to act to protect these vulnerable civilians.”
Physicians for Human Rights said that bombing health facilities is part of a broader strategy aimed at “achieving military gains through the collective punishment of civilians, regardless of the human toll.”
Moreover, news outlets describing Idlib province as a “jihadist enclave” parallel the “deeply problematic” rhetoric used by Russia and Syria, according to Elizabeth Tsurkov, a research fellow at the Forum for Regional Thinking specializing in Syria. “Obviously there are tens of thousands of HTS [Hayat Tahrir al-Sham] fighters with a share of the population supporting them, but there are 3 million people,” she told Al-Monitor. “This is why it is incredibly important to distinguish between the jihadists who carry weapons and the population that they rule over, who generally tend to view them very unfavorably. Civilians are tired of the bombings, the death, the lack of services, and the jihadists' oppressive governing.”
Hezabar, the financial consultant awaiting news from her father, fled her native city of Idlib to Gaziantep in 2017 when Hayat Tahrir al-Sham took over and imposed its version of Sharia law, which prohibits women from working. She thought that leaving Idlib would allow her to be much more “relaxed and comfortable.” But she discovered the opposite. “Now, we feel guilty because we live here in safety while my father and half of my family is still there,” she said, scrolling through messages from her family's WhatsApp group chat. “If our group chat is silent for more than one hour, my sister and I get really concerned, thinking something horrible happened.”
The bombing often occurs at night, which causes her insomnia. “Our life is a disaster. The mental health affects my skin. My hair is falling out,” Hezabar told Al-Monitor. “I want to see a psychiatrist, but since most doctors here don’t speak Arabic or even English, it’s tough.”
Her case is representative of the mental health issues many Syrians abroad experience as a result of having family members still in the province. Abdul Qadar, a broadcaster for the Syrian opposition radio station Watan FM, based in Turkey, cannot sleep at night because his mother, sister and brother are in Idlib, in the city of Maarat al-Numaan.
Qadar says he tried to get a gym membership, but even that couldn’t clear his mind. “Unfortunately, every Syrian with family in Idlib, or every Syrian in Idlib, is mentally disabled right now.”
Besher Alhajhusain, the mental health coordinator at UOSSM International-Saving Lives in Syria, the only mental health and psychosocial support currently operating inside Syria, said that mental health is sometimes even more important than basic needs, but unfortunately it is a secondary concern. “Most of the UN agencies and other NGO research is protection-related, not focused on mental health. There is no organized mental health campaign.”
In the town of Atme on the Syrian-Turkish border, thousands of displaced people, including many vulnerable children and women, are living along the olive fields, which function as camps. An International Rescue Committee (IRRC) rapid assessment in Harim, Idlib and Jisr al-Shughour found that children display signs of severe distress after being displaced an average of five times since the conflict began, with over half of parents and guardians reporting that children were showing signs of psychosocial distress since this most recent displacement. “If we don’t start dealing with mental health now, who knows how they’re being raised, how many are aggressive and how many will have tendencies of developing anti-social problems or mental health disorders in the future?” said Alhajusain.
On June 12, Russian news agencies reported that the Russian military had announced a cease-fire agreement brokered with Turkey to curb the violence. But Turkish Foreign Minister Mevlut Cavusoglu reported the following day that the cease-fire had not been fully implemented despite Moscow’s announcement.
Samar Daboul, a photographer from Aleppo now residing in Atme, confirmed the heavy bombing continued that day.
“People are growing so desperate. Two weeks ago, we called for a demonstration of 1 million people to grab the international community’s support. Unfortunately, not many people showed up. But we are going crazy mentally,” said Daboul. At the demonstration, some signs called for the border wall to be broken up, but according to Daboul, this was only symbolic. Human Rights Watch and observers said Turkish border guards fire at, deport and torture Syrians attempting to cross, making people afraid to even try to move across the frontier.
Johan Chevallier, regional Middle East director for Relief International, said the concept of mental health distress is not something well understood or developed in the region. “In the Middle East, mental health is very challenging because people typically prefer to keep emotions inside of them,” Chevallier told Al-Monitor. “We have seven to eight main activities focused inclusively in the neighboring countries on this topic. We believe that if we do not address psychosocial support properly, there will be a very low likelihood that people can still engage with each other and build sympathy with each other in the future.”
“There is an overwhelming sense among people in rebel-held Syria that their life is worthless in the eyes of the world and the powers that are meddling in their country. This is an incredibly difficult feeling to have to endure,” Tsurkov said. “After speaking to hundreds of people in rebel-held Syria, I feel confident in saying that if suicide was not clearly prohibited in Islam, we would be seeing a lot more suicides among Syrians there.”
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