Early Child Development and Care, 2014 http://dx.doi.org/10.1080/03004430.2014.916074
Impact of conflict in Syria on Syrian children at the Zaatari refugee camp in Jordan Sinaria Abdel Jabbara* and Haidar Ibrahim Zazab a
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b
Curriculum & Instruction Department, University of Jordan, Amman 11942, Jordan; Department of Educational Psychology, University of Jordan, Amman 11942, Jordan
(Received 27 March 2014; final version received 15 April 2014) This paper describes a study performed to investigate the impact of the conflict in Syria on Syrian refugee children. The Zaatari refugee camp in Jordan was chosen for this task. Two control (comparison) groups of children were selected: one from the Jordanian Ramtha district, which is just across the border from Syria, and that indirectly feel the consequences of the Syrian conflict, and the other from Amman, the capital of Jordan, which is far away from the border. The study compared the Zaatari, Ramtha and Amman groups in terms of expressed anxiety and depression symptoms. They were also compared with respect to their gender and age. The Zaatari children were more distressed than the others, and the symptom ‘thoughts of ending your life’ was expressed only by this group. The Ramtha group also expressed some distress. The fact that this group indirectly experiences the consequences of violence emphasises the dire circumstances of children inside Syria who are trapped between fighting groups. Keywords: Zaatari camp; refugees; Jordan; Syrian children; Syrian conflict; anxiety; depression; asylum seekers
Introduction Inspired by the ideals of the so-called Arab Spring, and after the collapse of the entrenched regimes in Tunisia, Libya, Yemen and Egypt, an increasing number of Syrian citizens began taking to the streets. Their demonstrations were peaceful and their demands focused on achieving political and economic reform; positive changes in the regime leading to justice, human rights, equal opportunities and democracy for all citizens. The peaceful character of the demonstrations quickly gave way to violence. The Syrian population began taking opposing sides, for or against the regime. This divide engulfed other regimes in and outside the region, thus polarising them into two camps striving to achieve military victory over each other. The ongoing war in Syria has all the characteristics of a bloody and ugly conflict. It is a civil war, as described in official and non-official reports. It is a war supported diplomatically, financially and militarily by regional and world powers. It has a sectarian element in it: Sunni vs. Shia and Alawi, (Anzalone, 2013). It attracted foreign fighters and radicalised Syrian fighters as well. It is a war that is fought mostly inside urban centres: cities, town and villages, with the result that most of the damage occurs to the country’s infrastructure and economic sectors, and most of the victims are non-militant civilians. *Corresponding author. Email:
[email protected] © 2014 Taylor & Francis
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According to the United Nations, the death toll surpassed 100,000 in June 2013 and reached 120,000 by September 2013 (Alliance News, 2013). As many as 3.6 million Syrians may be internally displaced, i.e. left their homes and are living somewhere inside Syria (Sharp & Blanchard, 2013). In addition, international relief agencies estimated that as of April 2013, more than 1,380,406 Syrians fled the country. Of those more than 1.1 million had left since September 2012 to so-called safe areas outside the Syrian borders. Turkey had 313,332 and Jordan had 441,756 registered refugees. Over 80,000 refugees live in Zaatari refugee camp, which was opened in 28 June 2012 in Northern Jordan near the Mafraq Governorate according to United Nations High Commissioner for Refugees officials who run the camp. Life in refugee camps can be harsh with individuals and families living with uncertainty over their future and anxiety for any members of the family still inside the war-torn areas. The impact on children in terms of their future is of continuing concern – occasioned by what they witnessed prior to fleeing Syria as well as by the insecurity of life in the camps. Literature review In 2000, an estimated 1.6 million people worldwide lost their lives to violence, a rate of nearly 28.8 per 100,000 (WHO, 2002). According to information supplied by the US Agency for International Development and the Office of Foreign Disaster Assistance, the number of worldwide disasters causing complex humanitarian emergencies, i.e. internal conflicts with large-scale displacements of people (refugees) has been increasing, with children less than five years of age making up more than 50% of them. According to Nicolai (2003), more than half of the people affected by war and conflicts are children or adolescents. War and conflict have damaging effects on children and their education (Al Zaroo & Hundt, 2003; Davies, 2004; Macksoud & Aber, 1996). This point is made by Evans, Garner, and Honig (2014) in their introductory chapter to this special issue. The grave consequences for children entail their very survival as well as their development. They may be killed, injured, imprisoned, abused, starved, humiliated and traumatised by direct negative experiences or indirectly by what happens to their parents, relatives and friends. The children may experience psychological problems, such as nightmares, panic attacks, self-withdrawal, aggressive behaviour, insecurity and violence towards family members and friends (Affouneh, 2007). According to Elbedour, Baker, and Charlesworth (1997), children exposed to conflict situations may become adversely influenced by violence, hatred and aggression. For example, the United Nations Children’s Fund (UNICEF, 2003) reported that Palestinian children who witnessed the death or injury of relatives and friends consequently suffered from psychological problems, such as self-doubt, withdrawal and a sense of hopelessness. The findings by UNICEF (2004) showed that 60% of Palestinian children suffered from emotional problems or behavioural changes. The same research carried out in 2002 on children aged 5–17 years reports that 73% of children suffered from psychological symptoms, 48% of children had a change in play behaviour, 46% of children suffered from negative social behaviour and 6% had current thoughts of death and revenge (UNICEF, 2004, p. 16). Moreover, teaching, most probably, becomes interrupted, and the schools become unable to teach the children moral values or good citizenship (cf. Halstead & Pike, 2006). Research in different contexts shows that wars and internal violence carry negative consequences on children, including heightened aggression and violence, revenge seeking, insecurity, anxiety, depression, withdrawal, post-traumatic stress and somatic
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complaints, sleep disorders, fear and panic, poor school performance and engagement in political violence (Qouta, Punamaki, & El Sarraj, 2008; Sagi-Schwartz, Seginer, & Abdeen, 2008). The relation between armed conflict and child development is not dependent only on the violence level, but also affected by changes occurring in the families, communities and societies of the children as a consequence of the violence (Feerick & Prinz, 2003). The termination of hostilities and associated violence is unlikely of itself to bring about a rehabilitation of the psychological impact on children of the horrors that they and young people have witnessed or experienced (Darby, 2006).Experience drawn from the troubles in Northern Ireland illustrates how successive generations of young children develop polarised views of the society they live in, which reflect the views and actions of the factions involved in civil strife (Leavitt & Fox, 1993). With the rise in international terrorism and other types of violence at the outset of the twenty-first century, more attention has been paid to the consequences of violence for children and youth (La Greca, Silverman, Vernberg, & Roberts, 2002; Masten & Obradovic, 2008; Osofsky, Osofsky, & Harris 2007; Sagi-Schwarz, 2008). Various studies tried to examine those consequences in relation to the development of children in different age groups, experiences, cultures and contexts. Invariably, researchers encountered the following obstacles: (1) Longitudinal studies continue to be rare, making comparison between post- and pre-conflict situations untenable. (2) Most of the available research in developmental sciences has been concentrated on the more economically advanced societies, whereas most of the violence occurs in the developing countries. (3) The cultural traditions and bureaucratic procedures in the developing countries tend to hinder data collection and interpretation. Research literature which examines the long-term consequences of violence or the effective interventions which were applied remains limited. A wide-ranging search across multiple data bases indicated that many papers and sources dealt with the subject but many of them were 20 and more years old. While in a real sense these are not irrelevant, the nature of conflicts in the twenty-first century has changed – in so far as many are internal conflicts between factional groups where the ideological basis is often religious and confined to a single country. An important recent source is provided by Werner (2012) who discusses ideas of risk, resiliency and recovery for children who experience war. She notes however (Werner, 2012) that more longitudinal research with large-scale studies are required to better understand the course and direction of risk and resilience in children who experience war. The purpose of such studies would be to better understand mental health issues and interventions that are likely to prove effective over the longer term. Much available research indicates that children living in war-zone areas are at a high risk for developing various types of psychopathology, especially post-traumatic stress disorder (PTSD; AACAP; Tamar & Zahava, 2005; Yule, 1999). It also indicates that it is common for co-morbid disorders to exist, such as PTSD and depression, or anxiety and traumatic grief (AACAP, 1998; Laurel & Zimmerman, 2001; Pfefferbaum, 1997; Shear, 2005). Research results suggest that PTSD is a direct response to traumatic war experiences. If the warrelated trauma is prolonged and severe, it can lead to an initial grief reaction or the individual may develop co-morbid depression (Goenjian et al., 1995; Najarian, Goenjan, Pelcovitz, Mandel, & Najarian, 1996; Terr et al., 1999). Some researchers claim that
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the overlap between PTSD and co-morbid psychological symptoms, such as depression, may be due to the fact that these symptoms are either direct responses to trauma or that depression is a reaction to PTSD through mediating life events (Eisenbrauch, 1991; Thabet, Abed, & Vostanis, 2004; Weems, Saltzman, Reiss, & Carrion, 2003; Weine et al., 1995). Other researchers believe that co-morbidity is the result of a complex interaction of many factors (Macksoud & Aber, 1996). Observations and clinical interviews with children in Uganda and Mozambique contradicted the simple conclusion that violent years caused a generation of violent children (Raboteg-šaric, Žužul, & Keresteš, 1994). Many of the children neither identified with the aggressors nor adapted their moral standards. Most of the children wanted peace (Raundalenand & Dyregrov, 1991). The experiences of war could increase the pro-social behaviour of violence victims as a result of increased empathy for the victims of violence. The pro-social and aggressive behaviours of victimised children in Uganda and Mozambique were investigated using the Pro-social Behavior Rating Scale designed by Zuzul, Kerestes, and Vlahovic-Stetic (1990). In Iraq, as a consequence of the 2003 American invasion the UN Integrated Regional Information Network (IRIN) was informed that almost 50% of children did not go to school because their parents were too scared to send them ‘school attendance falling due to fear of abduction’ (IRIN, 2007). In the late 2004, a UNICEF spokeswoman told IRIN that because of poverty more than one million children were out in the streets trying to work to support their families and, in the process, becoming vulnerable to exploitation and sexual abuse. And according to a May 2006 UNICEF report, 25% of Iraqi children between six months and fiveyears suffered from either acute or chronic malnutrition. In February 2003, an armed conflict erupted in Darfur, between two Sudanese rebel groups on the one hand and the Sudanese Government aided by a militia on the other (Morgos, Worder, & Gupta, 2008). The armed conflict was long standing and highly intensive. Among other results, it displaced a great number of adults and children, many of whom ended up in refugee camps. A group of 331 internally displaced persons children, ages 6–17 years from Southern Darfur were the subject of a research to identify the impact of the armed conflict there. The researchers used the Child Post-Traumatic Stress Reaction Index (Pynoos, Frederick, & Nader, 1987), the Children’s Depression Inventory (CDI; Kovacs, 1992) and the Extended Grief Inventory (Layne, Savjak, Saltzman, & Pynoos, 2001). The results indicated that the most frequently mentioned war exposures were: forced to abandon homes, home invasions and witnessing homes burned. There were no significant gender differences in total exposure to war experiences. On the other hand, older children were more aware of war experiences than younger children. Girls were found to have higher depression levels than boys. However, age did not have a significant effect on the depression level. On the other hand, gender had no significant effect on the grief level, whereas age had a significant effect: older children showed higher grief levels than younger children. Regarding trauma levels, gender showed no differences, but age did, whereby older children showed higher clinical levels than younger children. The results also indicated that the strongest relationship between war exposure and depression as well as grief is mediated through trauma. The Republic of Croatia, which was part of former Yugoslavia, was recognised as an independent state by the United Nations in January 1992. The Croatian designation for independence was announced in 1991 and was followed by an armed attack on it by the Yugoslav army. Among the many consequences of the war, there were large numbers of displaced children who faced a whole range of losses: loss of home, loss
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of parental support and protection, loss of traditional way of living, living with distressed adults, loss of educational structure, poor physical environment, malnutrition and changes in the community (Ajdukovic & Ajdukovic, 1998). The most extensive screenings looking at the psychological impact of war upon Croatian children (9–14 years old) were made through the UNICEF project ‘Psychological and Educational Assistance to War Affected Children’ (Kuterovac, Dyregrov, & Stuvland, 1994; Spoljaric, 1993). The children’s distress was measured by the Impact of Events Scale (Horowitz, Wilner, & Alvarez, 1979). Three indicators were used: mothers’ assessment of children’s stress reactions; the post-traumatic stress reactions of children and the level of depression of children during displacement. The psychological assessment by means of interviews was done at three successive dates. The instruments used during interviews with children were the Post-Traumatic Stress Reaction Scale (Child Version, PTSR-D: Ajdukovic, 1993), CDI (Kovacs, 1992) and Parental Acceptance–Rejection Questionnaire (Rohner, 1984). The assessment of stress symptoms among Croatian children indicated that war-related stress had a negative impact on the psychological well-being of children from babies to adolescents, and displaced and refugee children were especially affected. This result agrees with the contention of (Mccallin & Fozzard, 1990), namely that exposure to living in displacement is likely to result in a number of stress-related symptoms in children. Children who experienced traumatic situations immediately before displacement were potentially at risk. So were children who lived without or with parents who coped poorly in displacement, or who lived with families that encountered many stressful experiences or those who were housed in large collective refugee centres. Intervention measures are normally implemented to help traumatised refugees cope with their problems. One study investigated the effect of adding physical activity to biofeedback-based cognitive behavioural therapy (CBT-BF) intervention for refugees suffering from chronic pain (Liedl et al., 2011). The findings indicated that physical activity helped those refugees in coping with pain. It reduced their muscle tension and heart rate in stressful situations. Instead of being overwhelmed by pain, the refugees learned to respond with coping strategies, including self-competence and counter activities. Other effects of physical activity were also observed, namely improvements in anxiety symptoms, development of controllability and self-efficacy. It seems that physical activity acts as mood elevator whereby the biochemical changes which result from it contribute to positive mood and help people to deal with pain in the same manner as antidepressant medications. In essence, physical activity can be a promising additional treatment component within a CBT-BF approach to chronic pain management in survivors of war and torture. Another study highlighted the importance of psychological needs for the PTSD and displaced children in schools (Uguak, 2001). The study focused on children (8–14 years old) in especially difficult circumstances. It describes a therapeutic programme designed to recognise and reduce the ill-effects and adverse consequences of trauma among affected children and to integrate them into social institutions to lead normal lives. The programme was developed by specialised psychologists and implemented by a team consisting of applied psychologists, social workers, animators or pedagogical personnel, community leaders, medical assistants and nurses. The programme consists of the following activities: music, drawing, computer games, collective sport activities, story-telling, constructive plays and puzzles. Those activities constitute psychological treatments which bring about a change in behaviour of children, give them moral support and develop a sense of boldness, credibility and democratic atmosphere among them (Cohen, Mannarino, & Rogal, 2001).The programme was flexible
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enough to allow children to select activities of their choice and move to other activities later on. Music is a therapeutic activity, which reduces tension of PSDT among the traumatised (EMDH, 2001; Mayers, 1995). It consists of songs, dances and drama and enhances self-confidence, self-expression and creativity in a child. Drawing is an activity that relates mainly to psychosocial needs. Children may be organised in pairs and asked to do certain tasks such as colouring. In this context, they are forced to talk to each other and become more sociable. Psychologists can identify the problems affecting the children and any improvement they make by examining their drawings at different time intervals. Computer games that employ more language, rather than fun games, were used in this programme. Collective sports are important activities, particularly football, running, volleyball and other competitive games. They provide entertainment for the children and enhance their self-confidence and social behaviour. Children were free to select the sport of their choice. This provided good feedback on their behaviour to the administrators of the programme. Tales (talk) Theatre allows children to re-enact their experiences. The activity of storytelling promotes good behaviour. Constructive play encourages children to do tasks with the help of one another (Rigby, 2002; Smith, 1995). It helps children become sociable and gain good interpersonal skills as they grow up. Puzzles enhance the children’s word recognition ability and logical thinking in the process of solving a puzzle. If done in pairs, it can additionally encourage partner children to talk to one another and become more sociable. Turning to the situation in Syria, it seems that the provision of support for the psychological and social well-being and recovery of children (psychosocial support) has been inadequate. According to a report by the Global Child Protection Group, 98% of Syrian children surveyed reported deterioration in their psychosocial wellbeing. Out of the 2 million Syrian refugees,1 only 20% received some form of psychosocial support. In Jordan as of October 2013, about 113,000 children were able to continue their education at KG and other levels, whereas about 87,000 children were out of school. Thus, the enrolment rate stood at about 45% in the camps and 58% outside the camps with an overall rate of about 55%. In addition, about 10,000 children with specific needs had access to specialised education and psychological services in camps and host communities, and about 32,000 school-aged children benefited from informal and non-formal education services in camps and in host communities (Syrian Refugees Education Country Profile, 2013). Syrian children experience problems both in their home in Syria and as refugees in other countries, as attested by War Child Holland in Lebanon.2 Those problems include: (1) Fear of direct violence in their home communities in Syria (fear of attack, fear of buildings on fire and fear at check points). (2) Displacement (lack of sense of belonging, resentment in the host countries against refugees, limited privacy and fear of physical and sexual abuse). (3). Lack of access to education. This does not allow them to socialise, develop skills and get away from the stress of their daily lives. 4. Lack of recreation and play. This deprives them of a means of distraction from their unhappy lives. It does not allow them to let out their energies and share feelings with their playmates. Children in the camps were unable to play because the camps lacked safe places and because they needed to work. The International Labor Organization (ILO) estimated earlier in 2013 that 30,000 Syrian children in Jordan were working rather than attending school. UNICEF has launched an initial conditional cash transfer programme to promote school attendance (Syrian Refugees Education, 2013, p. 2). The psychosocial impact on the Syrian refugee children may be profound and long lasting. The mental health of children may be evidenced through feelings of social
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isolation, poor self-image, self-harm, aggression and depression. According to the Child Protection Working Group’s Syria Child Protection Assessment published in September 2013, the main behaviour changes experienced by Syrian children include:
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Unusual crying/screaming, disruption in sleep patterns, sadness, bedwetting and unwillingness to go to school. Boys are more likely to display aggressive behaviour, including the desire to join armed forces and armed groups. Girls are reported to show more self-harm and fear. Carers tend to limit children’s mobility outside of home and are not always able to provide attention to children’s needs. Their main sources of stress are the deteriorated security and also access to basic needs (food, electricity, water and livelihoods), children’s safety and access to health care. Main factors contributing to deterioration are change in behaviour of carers, lack of access to education and recreation. (War Child Holland, 2013, p. 8)
The purpose of this study is to investigate some aspects of the impact of the war in Syria on displaced children living in Zaatari refugee camp in Jordan. In particular, the study aims: To identify types and levels of anxiety and depression symptoms experienced by the Syrian refugee children with reference to similar-age children in non-conflict areas close by. Method In the absence of pre-conflict data about the status of Syrian refugees, it was not possible to adopt the longitudinal method (comparison of post- to pre-conflict status of refugees). Therefore, a reference group is used in which a sample of refugee children is compared to a similar group of non-refugee children. And since it was not possible to travel to Syria to collect data about children who had not been exposed to violence, the control group, it was decided to do the following: (1) To select a sample of 120 Syrian refugee children from Zaatari refugee camp between 7 and 12 years of age that would include male and female children. All the children must have lived in the Syrian Daraa district, on the other side of the Jordanian–Syrian border, before the Syrian conflict erupted. (2) To select a sample of 120 Jordanian children with the same age and gender composition from the Jordanian Ramtha district, which is across the border from the Daraa district and has similar socio-economic characteristics, i.e. people are mainly engaged in farming or small-scale businesses, and the communities are mostly tribal. This sample would serve as the reference group. (3) As the fieldwork was begun, i.e. interviews conducted with Syrian refugee children in Zaatari as well as with the comparison group (Jordanian children in Ramtha), the violence in Syria became more intense and closer to the border. And although the children in Ramtha did not directly experience violence, they sometimes were able to hear gun and artillery explosions nearby. Thus, it was decided to select a second comparison group of children, with similar age and gender characteristics, but who lived far away from the border. We chose 120 children from Amman, the capital of Jordan. Sampling A snowball sampling technique was used to select the Zaatari Syrian refugee camp sample, with randomly chosen starting point in the camp. The sample included 120
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Syrian refugee children (43 boys and 77 girls) aged between 7 and 12 years. All of those children used to live in the Syrian Daraa district. The samples of the two control or comparison groups, from Ramtha and Amman, were selected using a quota sampling technique. The children were randomly selected from schools and were all between 7 and 12 years old. The Ramtha sample included 120 children (64 boys and 56 girls) and the Amman sample included 120 children (69 boys and 51 girls). We designated children from 7 to 9 years of age as ‘younger’ while those from 10 to 12 years of age as ‘older’.
Instruments The instruments used in the study were selected for their ability to be used in the population of children making it possible to obtain information directly from the children (Appendix 1 refers) This information is divided into two parts: (1) Part one solicits demographic information regarding the children’s gender, place of birth and age. (2) Part two consists of Arabic translation of the Hopkins Symptom Checklist-25 (HSCL-25), which assesses symptoms of anxiety and depression for 7–12 years of age. It was originally designed by Parloff, Kelman, and Frank (1954) at Johns Hopkins University. It consists of 24 questions after one question (No.14: Loss of sexual interest or pleasure) was omitted because it is not appropriate in the Arabian cultural context. Questions 1–10 relate to anxiety symptoms, whereas questions 11–24 relate to depression symptoms, which the children may have experienced during the week preceding the interviews. The responses measure the symptoms on a 4-point Likert scale, which includes 1 = Not at all, 2 = A little, 3 = Quite a bit and 4 = Extremely. The checklist was addressed to the children individually and directly during the interviews without the presence of their parents. A score was computed for each scale by averaging the scale value for responses to all the items in the scale, allowing responses to be ordered from no symptoms to extreme symptoms based on the average score. Characteristics of samples (n = 360). Sample N
Age group – years
Gender
N
Zaatari (120)
Younger (7–9) Younger (7–9) Older (10–12) Older (10–12) Younger (7–9) Younger (7–9) Older (10–12) Older (10–12) Younger (7–9) Younger (7–9) Older (10–12) Older (10–12)
Boys Girls Boys Girls Boys Girls Boys Girls Boys Girls Boys Girls
11 20 32 57 10 23 54 33 28 12 41 39
Ramtha (120)
Amman (120)
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The Checklist (HSCL-25) is well documented in terms of reliability and validity. It has been validated against several instruments such as: the mini international neuro-psychiatric interview (Mahfoud et al., 2013), Harvard Trauma Questionnaire (Oruca et al., 2008), Present State Examination (Nettelbladt, Hansson, Stefansson, Borgquist, & Nordström, 1993; Lee, Kaaya, Mbwambo, Smith-Fawzi, & Leshabari, 2008).
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Data analysis Independent t-tests were used to compare the total and subtotal scores between boys and girls and between older and younger children. For the comparison of anxiety and depression symptoms between boys and girls and between older and younger children, the Pearson chi-squared statistic χ2 was used. Results (1) The Zaatari sample, as given in Tables 1 and 2, shows results of the HSCL-25, including total scores as well as gender and age subscales. There were no significant differences in the total score or in the anxiety and depression subscales between boys and girls. At the symptoms level, the symptom ‘poor appetite’ ranked first while the symptom ‘blaming yourself for things’ ranked last. There were no differences between boys and girls except in two depression symptoms: (1) ‘feeling everything is an effort’, (2) ‘feeling low in energy, slowed down’. In both of these depression symptoms, boys were more inclined to indicate than girls. There were significant differences in total score as well as in the anxiety subscale between younger and older children. Older children (10–12 yrs) evidenced more symptomology than younger children (7–9 yrs). At the symptom level, the symptom ‘poor appetite’ ranked first while ‘blaming yourself for things’ ranked last. There were differences between younger and older children in three symptoms: (1) ‘nervousness or shakiness inside’. (2) ‘heart pounding or racing’ and (3) ‘thoughts of ending your life’. In all those anxiety and depression symptoms, older children were more indicated for than younger children. (2) The Ramtha sample is presented in Tables 3 and 4. There were no statistically significant differences in the total score or in the anxiety and depression subscales which can be attributed to gender. The symptom ‘suddenly scared for no reason’ ranked first, while the symptom ‘thoughts of ending your life’ ranked last. There was one anxiety symptom ‘nervousness or shakiness inside’ in which there was a statistically significant difference between boys and girls. Girls reported more distress than boys. There were no significant differences in total score or in anxiety and depression subscales between younger and older children. At the symptom level, ‘suddenly scared for no reason’ ranked first, while ‘thoughts of ending your life’ ranked last. There were statistically significant differences between younger and older children in two anxiety and depression symptoms: (1). ‘nervousness or shakiness inside’, (2). ‘crying easily’. Older children were more distressed than younger children. (3) The Amman sample is given in Tables 5 and 6. There were statistically significant differences in the total score and in the anxiety and depression subscales. Girls were more distressed than boys. The symptom ‘difficulty falling asleep,
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Not at all (%) Symptoms! Poor appetite Feeling everything is an effort Feeling low in energy, slowed down Nervousness or shakiness inside Heart pounding or racing Feeling fearful Headaches Difficulty falling asleep, staying asleep Suddenly scared for no reason Feeling blue Worrying too much about things Feeling no interest in things Feeling of being trapped or caught Feeling lonely Feeling tense or keyed up Crying easily Feelings of worthlessness Felling restless, cannot sit still Trembling Faintness, dizziness or weakness Thoughts of ending your life Spells of terror or panic Feeling hopeless about the future Blaming yourself for things HSCL general anxiety HSCL general depression HSCL total !: in descending order by average. *p < .05
A little (%)
Quite a bit (%)
Extremely (%)
M
SD
Boys
Girls
Boys
Girls
Boys
Girls
Boys
girls
χ2
2.53 2.38 2.31 2.24 2.18 2.11 2.10 2.07 2.03 1.94 1.94 1.94 1.94 1.93 1.90 1.88 1.86 1.84 1.84 1.83 1.79 1.78 1.75 1.43
.978 1.021 .906 1.061 1.012 .994 .947 .981 1.100 .863 .955 .866 .876 1.014 .920 1.014 .929 .917 .698 1.007 .934 .835 .981 .785
36.8 29.6 26.9 23.7 25.6 41.0 42.1 35.7 37.0 41.5 40.8 31.8 26.7 33.3 33.3 38.6 31.4 34.5 28.9 35.5 33.9 36.4 31.8 36.8
63.2 70.4 73.1 76.3 74.4 59.0 57.9 64.3 63.0 58.5 59.2 68.2 73.3 66.7 66.7 61.4 68.6 65.5 71.1 64.5 66.1 63.6 68.2 63.2
35.7 21.4 22.0 33.3 45.5 37.2 40.5 28.9 45.8 28.8 23.7 42.9 32.5 50.0 36.1 37.5 31.1 42.9 38.5 26.9 28.6 35.0 42.9 21.1
64.3 78.6 78.0 66.7 54.5 62.8 59.5 71.1 54.2 71.2 76.3 57.1 67.5 50.0 63.9 62.5 68.9 57.1 61.5 73.1 71.4 65.0 57.1 78.9
33.3 50.0 44.2 35.5 40.0 33.3 26.7 39.3 23.1 40.0 37.5 34.5 56.7 30.0 40.7 36.8 42.9 29.2 40.0 45.5 44.4 40.9 31.3 40.0
66.7 50.0 55.8 64.5 60.0 66.7 73.3 60.7 76.9 60.0 62.5 65.5 43.3 70.0 59.3 63.2 57.1 70.8 60.0 54.5 55.6 59.1 68.8 60.0 Boys Girls Boys Girls Boys Girls
39.1 52.4 80.0 66.7 30.8 21.4 20.0 45.5 37.5 42.9 55.6 25.0 25.0 33.3 33.3 16.7 70.0 33.3 50.0 40.0 62.5 0 50.0 75.0 M = 2.00 M = 1.97 M = 2.07 M = 1.91 M = 2.04 M = 1.94
60.9 47.6 20.0 33.3 69.2 78.6 80.0 54.5 62.5 57.1 44.4 75.0 75.0 66.7 66.7 83.3 30.0 66.7 50.0 60.0 37.5 100.0 50.0 25.0 SD = .53 SD = .51 SD = .47 SD = .93 SD = .43 SD = .39
0.215 9.362* 14.123* 9.973 3.5 1.821 3.231 1.366 2.937 1.971 4.52 1.427 7.672 2.718 0.439 2.154 6.255 1.271 1.267 1.862 3.953 1.941 2.083 4.584
t
.295 1.942 1.345
S.A. Jabbar and H.I. Zaza
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Table 1. Anxiety and depression symptoms among Zaatari children and differences on screening instruments HSCL-25 by gender (n = 120).
Table 2. Anxiety and depression symptoms among Zaatari children and differences on screening instruments HSCL-25 by age (n = 120).
Symptoms Poor appetite Feeling everything is an effort Feeling low in energy, slowed down Nervousness or shakiness inside Heart pounding or racing Feeling fearful Headaches Difficulty falling asleep, staying asleep Suddenly scared for no reason Feeling blue Worrying too much about things Feeling no interest in things Feeling of being trapped or caught Feeling lonely Feeling tense or keyed up Crying easily Feelings of worthlessness Felling restless, cannot sit still Trembling Faintness, dizziness or weakness Thoughts of ending your life Spells of terror or panic Feeling hopeless about the future Blaming yourself for things HSCL general anxiety HSCL general depression HSCL total
M
SD
2.53 2.38 2.31 2.24 2.18 2.11 2.10 2.07 2.03 1.94 1.94 1.94 1.94 1.93 1.90 1.88 1.86 1.84 1.84 1.83 1.79 1.78 1.75 1.43
0.98 1.02 0.91 1.06 1.01 0.99 0.95 0.98 1.10 0.86 0.96 0.87 0.88 1.01 0.92 1.01 0.93 0.92 0.70 1.01 0.93 0.83 0.98 0.78
A little (%)
Quite a bit (%)
Younger Older Younger Older Younger 42.1 22.2 23.1 44.7 48.7 25.6 31.6 38.1 25.9 31.7 34.7 25.0 31.1 31.6 37.3 26.3 27.5 36.4 28.9 25.8 22.0 34.5 24.2 23.0
57.9 77.8 76.9 55.3 51.3 74.4 68.4 61.9 74.1 68.3 65.3 75.0 68.9 68.4 62.7 73.7 72.5 63.6 71.1 74.2 78.0 65.5 75.8 77.0
28.6 19.0 31.7 21.2 15.2 30.2 19.0 18.4 29.2 30.8 13.2 33.3 22.5 29.2 19.4 28.1 20.0 20.0 24.6 26.9 42.9 20.0 28.6 42.1
71.4 81.0 68.3 78.8 84.8 69.8 81.0 81.6 70.8 69.2 86.8 66.7 77.5 70.8 80.6 71.9 80.0 80.0 75.4 73.1 57.1 80.0 71.4 57.9
25.0 33.3 25.6 12.9 11.4 25.0 33.3 25.0 19.2 10.0 33.3 13.8 13.3 16.7 14.8 31.6 42.9 12.5 26.7 27.3 16.7 18.2 31.3 30.0
Extremely (%) Younger
75.0 66.7 74.4 87.1 88.6 75.0 66.7 75.0 80.8 90.0 66.7 86.2 86.7 83.3 85.2 68.4 57.1 87.5 73.3 72.7 83.3 81.8 68.8 70.0 Younger Older Younger Older Younger older
8.7 33.3 10.0 16.7 23.1 14.3 10.0 9.1 31.3 0.00 11.1 50.0 100.0 11.1 16.7 8.3 20.0 16.7 0.00 20.0 0.00 0.00 20.0 0.00 M = 1.77 M = 2.06 M = 1.87 M = 2.00 M = 1.83 M = 2.03
Older
χ2
t
91.3 6.329 66.7 2.690 90.0 2.151 83.3 10.950* 76.9 16.467* 85.7 1.418 90.0 3.853 90.9 5.970 68.8 .976 100.0 6.455 88.9 6.917 50.0 4.634 0.00 14.733* 88.9 3.455 83.3 6.213 91.7 2.340 80.0 3.164 83.3 6.295 100.0 .945 80.0 .218 100.0 9.315* 100.0 4.606 80.0 .619 100.0 4.477 SD = .44 −2.74* SD = .52 SD = .36 −1.56 SD = .44 SD = .33 −2.43* SD = .414
11
Older
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Table 3. Anxiety and depression symptoms among Ramtha children and differences on screening instruments HSCL-25 by age (n = 120).
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Symptoms Suddenly scared for no reason Heart pounding or racing Feeling fearful Felling restless, cannot sit still Nervousness or shakiness inside Feeling everything is an effort Crying easily Headaches Difficulty Falling asleep, staying asleep Feeling tense or keyed up Worrying too much about things Faintness, dizziness or weakness Poor appetite Feeling low in energy, slowed down Spells of terror or panic Feeling blue Feeling no interest in things Trembling Feeling lonely feeling hopeless about the future Feelings of worthlessness Feeling of being trapped or caught Blaming yourself for things Thoughts of ending your life HSCL general anxiety HSCL general depression HSCL total
M
SD
2.35 2.27 2.23 2.23 2.16 1.92 1.9 1.88 1.88 1.8 1.75 1.67 1.64 1.64 1.62 1.61 1.61 1.58 1.48 1.47 1.44 1.35 1.29 1.27
1.05 0.99 1.04 0.92 1.04 0.77 0.97 0.87 0.99 0.76 0.76 0.93 0.72 0.84 0.79 0.75 0.76 0.71 0.78 0.70 0.74 0.56 0.67 0.51
A little (%)
Quite a bit (%)
Younger Older Younger Older Younger 31.3 22.6 40.0 29.0 42.5 25.6 39.6 19.6 29.8 36.2 32.7 23.6 23.7 30.9 27.7 28.6 32.3 33.8 26.3 27.6 24.7 24.1 24.7 23.9
68.8 77.4 60.0 71.0 57.5 74.4 60.4 80.4 70.2 63.8 67.3 76.4 76.3 69.1 72.3 71.4 67.7 66.2 73.8 72.4 75.3 75.9 75.3 76.1
17.6 40.0 28.6 30.0 21.6 31.5 22.9 36.7 29.0 21.2 28.9 40.9 30.4 23.3 27.5 31.8 23.7 20.0 24.0 31.3 27.6 31.3 46.2 41.7
82.4 60.0 71.4 70.0 78.4 68.5 77.1 63.3 71.0 78.8 71.1 59.1 69.6 76.7 72.5 68.2 76.3 80.0 76.0 68.8 72.4 68.8 53.8 58.3
38.2 21.2 16.7 22.5 25.9 20.0 17.4 27.8 18.2 26.3 10.0 30.0 35.7 21.1 27.3 10.0 21.4 20.0 50.0 18.2 33.3 60.0 37.5 25.0
Extremely (%)
Older
Younger
Older
χ2
61.8 78.8 83.3 77.5 74.1 80.0 82.6 72.2 81.8 73.7 90.0 70.0 64.3 78.9 72.7 90.0 78.6 80.0 50.0 81.8 66.7 40.0 62.5 75.0 Younger Older Younger Older Younger Older
20.0 20.0 15.8 33.3 6.3 50.0 0.00 14.3 30.0 0.00 100.0 16.7 0.00 33.3 25.0 0.00 0.00 0.00 0.00 0.00 75.0 0.00 0.00 0.00 M = 1.86 M = 2.01 M = 1.55 M = 1.59 M = 1.68 M = 1.77
80.0 80.0 84.2 66.7 93.8 50.0 100.0 85.7 70.0 100.0 0.00 83.3 100.0 66.7 75.0 100.0 100.0 0.00 100.0 100.0 25.0 0.00 100.0 0.00 SD = .46 SD = .51 SD = .33 SD = .44 SD = .32 SD = .36
4.411 4.562 5.487 .817 8.813* 1.710 8.878* 4.162 1.180 3.594 6.376 2.946 1.473 1.099 .014 3.122 2.035 2.865 4.401 1.085 4.950 3.357 3.799 3.022
t
−1.171 −1.48 −.559
S.A. Jabbar and H.I. Zaza
Not at all (%)
Table 4. Anxiety and depression symptoms among Ramtha children and differences on screening instruments HSCL-25 by gender (n = 120).
Symptoms Suddenly scared for no reason Heart pounding or racing Feeling fearful Felling restless, cannot sit still Nervousness or shakiness inside Feeling everything is an effort Crying easily Headaches Difficulty falling asleep, staying asleep Feeling tense or keyed up Worrying too much about things Faintness, dizziness or weakness Poor appetite Feeling low in energy, slowed down Spells of terror or panic Feeling blue Feeling no interest in things Trembling Feeling lonely Feeling hopeless about the future Feelings of worthlessness Feeling of being trapped or caught Blaming yourself for things Thoughts of ending your life HSCL general anxiety HSCL general depression HSCL total
A little (%)
Quite a bit (%)
Extremely%
SD
Boys
Girls
Boys
Girls
Boys
Girls
Boys
Girls
χ2
2.35 2.27 2.23 2.23 2.16 1.92 1.9 1.88 1.88 1.8 1.75 1.67 1.64 1.64 1.62 1.61 1.61 1.58 1.48 1.47 1.44 1.35 1.29 1.27
1.05 0.989 1.041 0.921 1.037 0.773 0.965 0.871 0.992 0.763 0.764 0.929 0.719 0.838 0.791 0.748 0.762 0.705 0.778 0.698 0.742 0.56 0.666 0.514
56.3 64.5 51.4 61.3 42.5 59.0 50.9 60.9 50.9 46.8 61.5 51.4 55.9 47.1 53.8 47.6 50.8 47.7 53.8 48.7 50.6 51.8 49.5 50.0
43.8 35.5 48.6 38.7 57.5 41.0 49.1 39.1 49.1 53.2 38.5 48.6 44.1 52.9 46.2 52.4 49.2 52.3 46.3 51.3 49.4 48.2 50.5 50.0
61.8 45.0 57.1 55.0 64.9 53.7 60.0 51.0 58.1 57.7 42.2 59.1 47.8 53.3 47.5 59.1 60.5 57.5 44.0 62.5 65.5 56.3 69.2 62.5
38.2 55.0 42.9 45.0 35.1 46.3 40.0 49.0 41.9 42.3 57.8 40.9 52.2 46.7 52.5 40.9 39.5 42.5
52.9 60.6 62.5 50.0 70.4 48.0 52.2 44.4 54.5 57.9 60.0 60.0 64.3 73.7 72.7 70.0 50.0 66.7 58.3 54.5 50.0 60.0 62.5 75.0
47.1 39.4 37.5 50.0 29.6 52.0 47.8 55.6 45.5 42.1 40.0 40.0 35.7 26.3 27.3 30.0 50.0 33.3 41.7 45.5 50.0 40.0 37.5 25.0 Boys Girls Boys Girls Boys girls
35.0 40.0 36.8 33.3 25.0 0.00 44.4 42.9 50.0 50.0 0.00 33.3 0.00 66.7 50.0 33.3 0.00 0.00 100.0 100.0 25.0 0.00 100.0 0.00 M = 1.95 M = 2.01 M = 1.61 M = 1.56 M = 1.75 M = 1.75
65.0 60.0 63.2 66.7 75.0 100.0 55.6 57.1 50.0 50.0 100.0 66.7 100.0 33.3 50.0 66.7 100.0 0.00 0.00 0.00 75.0 0.00 0.00 0.00 SD = .52 SD = .49 SD = .36 SD = .29 SD = .39 SD = .31
3.783 4.442 3.182 2.458 12.173* 3.073 1.045 2.035 .475 1.369 5.139 1.724 2.538 4.452 2.234 3.011 3.299 2.181 3.626 2.622 3.287 .276 3.917 1.975
37.5 34.5 43.8 30.8 37.5
t
.295 1.942 0.036
13
M
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14
Not at all (%) Symptoms Difficulty falling asleep, staying asleep Feeling fearful Trembling Feeling tense or keyed up Heart pounding or racing Crying easily Worrying too much about things Felling restless, cannot sit still poor appetite Nervousness or shakiness inside Feeling hopeless about the future Feeling blue Suddenly scared for no reason Feeling everything is an effort Headaches Feeling lonely Feeling of being trapped or caught Spells of terror or panic Blaming yourself for things Feeling low in energy, slowed down Feeling no interest in things Feelings of worthlessness Faintness, dizziness or weakness Thoughts of ending your life HSCL general anxiety HSCL general depression HSCL total
A little (%)
Quite a bit (%)
Extremely (%)
M
SD
Boys
Girls
Boys
Girls
Boys
Girls
Boys
Girls
χ2
1.71 1.58 1.58 1.56 1.55 1.53 1.5 1.49 1.49 1.48 1.48 1.46 1.46 1.39 1.37 1.36 1.33 1.33 1.32 1.29 1.27 1.27 1.27 1.23
0.974 0.729 0.849 0.824 0.765 0.864 0.842 0.82 0.84 0.788 0.907 0.819 0.721 0.749 0.662 0.754 0.781 0.7 0.815 0.6 0.59 0.695 0.67 0.658
58.2 63.5 64.3 60.0 64.3 64.9 58.2 64.6 57.3 58.8 62.1 61.4 58.4 59.8 54.8 62.0 59.4 62.4 59.2 60.9 57.9 57.0 59.6 59.6
41.8 36.5 35.7 40.0 35.7 35.1 41.8 35.4 42.7 41.3 37.9 38.6 41.6 40.2 45.2 38.0 40.6 37.6 40.8 39.1 42.1 43.0 40.4 40.4
60.6 58.3 54.1 64.7 60.5 53.6 72.4 56.7 69.6 73.1 64.7 65.4 60.0 65.2 75.9 55.6 66.7 47.4 70.0 47.8 65.0 92.3 57.1 85.7
39.4 41.7 45.9 35.3 39.5 46.4 27.6 43.3 30.4 26.9 35.3 34.6 40.0 34.8 24.1 44.4 33.3 52.6 30.0 52.2 35.0 7.7 42.9 14.3
62.5 00.0 25.0 28.6 12.5 60.0 00.0 00.0 44.4 30.0 28.6 00.0 25.0 50.0 33.3 20.0 50.0 25.0 00.0 00.0 00.0 00.0 33.3 16.7
37.5 100.0 75.0 71.4 87.5 40.0 100.0 100.0 55.6 70.0 71.4 100.0 75.0 50.0 66.7 80.0 50.0 75.0 100.0 100.0 100.0 100.0 66.7 83.3 Boys Girls Boys Girls Boys Girls
41.7 25.0 25.0 16.7 00.0 00.0 25.0 14.3 33.3 00.0 22.2 14.3 50.0 00.0 00.0 20.0 14.3 25.0 50.0 100.0 50.0 00.0 25.0 00.0 M = 1.35 M = 1.63 M = 1.29 M = 1.54 M = 1.31 M = 1.57
58.3 75.0 75.0 83.3 100.0 100.0 75.0 85.7 66.7 100.0 77.8 85.7 50.0 100.0 100.0 80.0 85.7 75.0 50.0 00.0 50.0 100.0 75.0 100.0 SD = .34 SD = .66 SD = .34 SD = .68 SD = .32 SD = .66
1.457 9.433* 6.665 7.379 13.502* 12.764* 10.193* 12.380* 3.433 11.139* 8.085* 11.951* 1.938 7.613 9.051* 6.530 6.049 5.157 3.620 6.845 4.571 15.926* 2.625 10.623*
t
3.058* 2.539* −2.848*
S.A. Jabbar and H.I. Zaza
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Table 5. Anxiety and depression symptoms among Amman children and differences on screening instruments HSCL-25 by gender (n= 120).
Table 6. Anxiety and depression symptoms among Amman children and differences on screening instruments HSCL-25 by age (n = 120).
Symptoms Difficulty falling asleep, staying asleep Feeling fearful Trembling Feeling tense or keyed up Heart pounding or racing Crying easily Worrying too much about things Felling restless, cannot sit still Poor appetite Nervousness or shakiness inside Feeling hopeless about the future Feeling blue Suddenly scared for no reason Feeling everything is an effort Headaches Feeling lonely Feeling of being trapped or caught Spells of terror or panic Blaming yourself for things Feeling low in energy, slowed down Feeling no interest in things Feelings of worthlessness Faintness, dizziness or weakness Thoughts of ending your life HSCL general anxiety HSCL general depression HSCL total
M
SD
1.71 1.58 1.58 1.56 1.55 1.53 1.5 1.49 1.49 1.48 1.48 1.46 1.46 1.39 1.37 1.36 1.33 1.33 1.32 1.29 1.27 1.27 1.27 1.23
0.97 0.73 0.85 0.82 0.77 0.86 0.84 0.82 0.84 0.79 0.91 0.82 0.72 0.75 0.66 0.75 0.78 0.70 0.82 0.60 0.59 0.70 0.67 0.66
A little (%)
Quite a bit (%)
Younger Older Younger Older Younger 32.8 31.7 34.3 35.7 30.0 37.7 36.7 36.7 29.3 33.8 39.1 41.0 23.4 37.9 32.1 34.8 36.5 31.2 34.7 29.3 33.7 35.0 32.3 36.5
67.2 68.3 65.7 64.3 70.0 62.3 63.3 63.3 70.7 66.3 60.9 59.0 76.6 62.1 67.9 65.2 63.5 68.8 65.3 70.7 66.3 65.0 67.7 63.5
33.3 39.6 37.8 35.3 50.0 25.0 31.0 30.0 43.5 34.6 11.8 19.2 54.3 21.7 41.4 33.3 20.0 42.1 30.0 47.8 35.0 38.5 42.9 28.6
66.7 60.4 62.2 64.7 50.0 75.0 69.0 70.0 56.5 65.4 88.2 80.8 45.7 78.3 58.6 66.7 80.0 57.9 70.0 52.2 65.0 61.5 57.1 71.4
37.5 20.0 25.0 28.6 60.0 25.0 33.3 40.0 28.6 25.0 50.0 33.3 20.0 50.0 50.0
33.3
Older
Younger 33.3 12.5 16.7 25.0 14.3 50.0 22.2 14.3 50.0 20.0 14.3 25.0 25.0 100.0 50.0 25.0 M = 1.44 M = 1.48 M = 1.30 M = 1.48 M = 1.36 M = 1.45
Older
χ2
66.7 100.0 87.5 83.3 100.0 100.0 75.0 85.7 50.0 100.0 77.8 85.7 50.0 100.0 100.0 80.0 85.7 75.0 75.0
.070 3.315 2.041 1.008 11.100* 7.151 2.211 1.823 2.425 2.225 5.423 7.644 10.974* 5.193 2.384 .887 3.015 1.476 1.383 8.332 1.780 3.779 .742 5.052
50.0 100.0 75.0 100.0 SD = .37 SD = .57 SD = .40 SD = .57 SD = .36 SD = .56
t
−.414 −1.34 −.946
15
62.5 80.0 75.0 71.4 100.0 40.0 100.0 75.0 66.7 60.0 71.4 100.0 75.0 50.0 66.7 80.0 50.0 50.0 100.0 100.0 100.0 100.0 66.7 100.0 Younger Older Younger Older Younger Older
Extremely (%)
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S.A. Jabbar and H.I. Zaza
Table 7.
Differences in screening instruments HSCL-25 by group (n = 360).
Subscale Anxiety Depression Total score
Between Within Between Within Between Within
SS
df
MS
F
Sig.
21.123 94.664 20.747 67.301 18.675 64.796
2 357 2 357 2 357
10.562 0.265 10.373 0.189 9.338 0.182
39.830*
.000
55.026*
.000
51.446*
.000
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*p < .05.
staying asleep’ ranked first, while the symptom ‘thoughts of ending your life’ ranked last. There were differences between boys and girls in 11 symptoms, namely: feeling fearful, heart pounding or racing, crying easily, worrying too much about things, feeling restless and cannot sit still, nervousness or shakiness inside, feeling hopeless about the future, feeling blue, headaches, feeling of worthlessness and thoughts of ending your life. In all these symptoms, girls were more distressed than boys. There were no statistically significant differences in total score or in anxiety and depression subscales attributable to age. The symptom ‘difficulty falling asleep, staying asleep’ ranked first while the symptom ‘thoughts of ending your life’ ranked last. There were statistically significant differences between younger and older children in two symptoms: (1) ‘heart pounding or racing’, (2) ‘suddenly scared for no reason’. In both these anxiety symptoms, older children were more distressed than younger children. A one-way ANOVA was used to test for differences in anxiety and depression subscales as well as the total score among the three groups (samples) of children, (Table 7). The Scheffe post hoc comparisons of the three groups indicated that both the Zaatari and Ramtha children displayed significantly greater anxiety than the Amman children. However, there was no significant difference between the Zaatari and Ramtha children in terms of anxiety symptoms. In terms of depression, the Zaatari children displayed significantly greater depression symptoms than the Ramtha or Amman children. The Ramtha children, on the other hand, displayed significantly greater depression than the Amman children. Discussion and conclusions With respect to depression symptoms, the Zaatari children were more implicated than the Ramtha children, who in turn were more implicated than the Amman children. The symptom ‘thoughts of ending your life’ was expressed only by Zaatari children. This result is perhaps not unexpected since the Zaatari children are the refugees who experienced the consequences of violence first hand. With respect to anxiety symptoms, there were no significant differences between the Zaatari and Ramtha children. Perhaps there is an inference here to the effect that although the Ramtha children were not exposed directly to violence, they nevertheless felt the consequences of violence in Syria: they lived nearby on the other side of the border with hostilities approaching. This
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observation should help to draw attention to the dire circumstances of children inside Syria who are trapped between fighting groups. The Zaatari children did not show any differences with respect to anxiety or depression symptoms attributed to gender. However, there were differences due to age. Older children were more likely to evidence symptoms than younger children. This is in line with the findings of Werner (2012) who noted that ‘The more recent the exposure to war, and the older the child, the higher was the likelihood of reported posttraumatic stress disorder symptoms.’ (p. 664) Further research at the Zaatari camp is planned. The results of this preliminary study are not entirely unexpected. The further the children live away from the conflict and hostilities the more secure they appear to feel and the fewer are the symptoms of anxiety and depression evidenced It is interesting that the older children – those beyond the middle years of childhood – are evidently more susceptible to the implications of violence and strife than the younger children. Unsurprisingly perhaps, the extreme depressive and anxiety symptoms were evidenced mainly in the group of children living in the Zaatari refugee camp – they were the ones who had been at the heart of the conflict and many had experienced quite horrific acts towards members of their own families and others. Here, there were no gender differences – boys and girls being equally influenced and the older more than the younger. With these children, there is clearly a need for positive intervention towards rehabilitation and counselling. The problem however is that resources for habilitation are scarce and the need is great. Syria is not unique in this respect – the need for restoration of positive images of self is immense in all war-torn countries where children are the collateral damage of savagery. Of course, the fear of war is but one aspect of a complex refugee problem – for many children the right to grow in safety, the right to nutrition, water, the right to play and develop as healthy allround individuals are all rights that are daily denied to the refugees in camps. Educational activities during emergencies provide children with a safe space to begin the trauma-healing process and to learn skills and values needed for a more peaceful future. There is general consensus that child protection and education interventions support and promote the well-being of children in emergencies; however, those measures are invariably inadequate in practice. This can be attributed to the usual shortage of funding and to the fact that child protection is neither understood nor prioritised within emergency responses. Funding for education is usually limited. According to the inter-agency network for education in emergencies, only 2% of humanitarian aid goes to education. Too little is known of the social and psychological impact of these deprivations as the children reach maturity – and equally little is known of interventions that could – if deployed – help such children become happy, autonomous and self-actuating adults – committed to peaceful co-existence in complex world of political and sectarian divisions. Future research is being planned that will provide longitudinal data aimed at elucidating the longer term impact of the experience of violence and abuse through internal conflict.
Notes 1. 2.
UN Camps in Iraq, Turkey, Lebanon and Jordan by 2013. An independent and impartial, international non-governmental organisation investing in a peaceful future for children affected by armed conflict.
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Notes on contributors
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Dr Sinaria Kamil Abdel Jabbar is an Assistant Professor of Education at the Department of Curriculum and Instruction, The University of Jordan. Dr Jabbar also serves as Assistant to the Director at the Office of International Relations at the University. She received her BA in English Literature from Petra University in Jordan in 2002 and an M.ED and Ph.D. in Early Childhood Education and Adult Education from The University of Missouri-Saint Louis, in 2005 and 2008, respectively. Her research interests encompass adult education, international education, refugee studies, human rights, women studies, and youth and development and have published over eight papers in world-class journals. Dr Jabbar is an active member in various committees including parliamentary committees for education reform in Jordan. In her free time, Dr Jabbar loves to read, travel and participate in humanitarian activities. Dr Haidar Ibrahim Zaza is an Associate Professor of Educational Psychology/measurement and evaluation. His current research interests include data analytics, Big Data main issues of research, Educational Psychology Issues, scaling and Item Response Theory applications. He received his B.A. degree in Educational Sciences from The University of Jordan (1997), MS and Ph.D. degrees in Educational Psychology from The University of Jordan (2000 and 2006, respectively). Dr Zaza runs a number of local and regional projects, published over 15 papers in local, regional and world-class journals. Dr Zaza’s experience in measurement and evaluation extends to 10 years in service, research, and development. Dr Zaza served in The University of Jordan as a head of Educational Psychology Department. and director of educational psychology program.
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Appendix
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