The epidemics of substance misuse and suicide in Syria: casualties of protracted conflict and political instability

Abstract

Abstract Background: The Syrian conflict has resulted in significant displacement and increase in humanitarian needs within the last decade. Reports of increased prevalence of substance misuse and deliberate self-harm among internally-displaced Syrians are concerning, particularly given barriers to care for these conditions due to cultural stigma and legal repercussions for those reporting them. The aim of this study is to provide an overview of prevalence, risk factors and health services available for substance misuse and deliberate self-harm in Syria as well as share findings from a workshop with Syrian mental health stakeholders exploring current challenges with regards to these conditions. Methods: A scoping review was conducted using key search terms regarding substance misuse and suicide and/or self-harm inside Syria. These findings were supplemented by a discussion among 25 Syrian mental health stakeholders, including psychologists, psychiatrists, public health, and policy professionals to highlight key challenges and identify locally appropriate solutions. Results: Data regarding the prevalence of substance misuse and self-harm inside Syria among internally displaced populations varies greatly quality and accuracy. Substance misuse and deliberate self-harm, including suicide, are considered stigmatised and at times, criminalized, in Syria, leading to massive underreporting of prevalence, as well as underutilization of available treatment, which is also limited. The health system response in Syria, which has been compromised by a decade of conflict, is not prepared to cope with increasing rates of mental health disorders and particularly, substance misuse (i.e. Captagon) and instances of self-harm. Key suggestions from the workshop include the following: a) use of telepsychiatry and telepsychology interventions b) adaptation of WHO interventions c) multi-year investment and prioritisation of MHPSS programs and d) utilizing family skills interventions as a key tool in the prevention for substance abuse and self-harm, while embedding social and cultural sensitivities into interventions. Conclusions: Though current evidence gaps around substance misuse and deliberate self-harm in Syria remain, with the current socio-political climate in Syria, alongside significant shortfalls in funding for health, there is a present, urgent need to address these neglected MHPSS concerns. Emphasis must be placed on the needs of vulnerable populations including IDPs, war injured, children and teenagers.