Tag Archives: trauma

A nurse struggled with COVID-19 trauma. He was found dead in his car

By Gabriella Borter

(Reuters) – Becoming a nurse in 2018 was a dream come true for William Coddington.

He loved helping people and feeling needed at his West Palm Beach, Florida hospital. The 32-year-old was on the upswing of a decade-long battle with opioid addiction and other substance abuse, according to friends and family, who said he was committed to his recovery.

It all started to unravel in March, as fatally ill COVID-19 patients showed up in his intensive care unit.

It rattled Coddington to see patients his age die, his mother Carolyn said. He could no longer attend his 12-step recovery meetings in person. He was scared about how little personal protective equipment he had. He had nightmares about alarms going off on ventilators in the ICU.

On the night of April 24, he spoke by phone to his best friend Robert Marks and sounded distraught, Marks said. Coddington was caught between the war zone at work and his confinement at home.

“Don’t take unnecessary risks but hang in there,” Marks texted him.

The next morning, Coddington was found dead in his car in a hotel parking lot in Deerfield Beach, Florida.

His family suspects a drug overdose. A spokeswoman for the Broward County Medical Examiner’s office said the case is pending. The Broward County Sheriff’s Office said it is still investigating but does not suspect foul play.

Reuters reconstructed Coddington’s last weeks through some of his text messages, Facebook posts and interviews with his parents, brother and two close friends. Reuters could not independently verify Coddington’s cause of death.

Frontline healthcare workers are trying to cope with the trauma of treating the novel coronavirus, which has inundated U.S. hospitals with desperately ill patients and killed more than 90,000 Americans in less than three months.

Healthcare workers with histories of substance abuse may have more difficulty coping with fear, isolation and witnessing so much death during the pandemic, psychiatrists told Reuters. Those factors could provoke relapses in workers recovering from addiction, they said.

“Patients who are being treated for opioid use disorder have reported increased stress and opioid craving since this pandemic began,” said Kelly Dunn, a psychiatrist at Johns Hopkins University who researches opioid use.

SCARED, BUT COMMITTED

Coddington grew up living with his mother, an executive assistant at a healthcare company, in Deerfield Beach after his parents got divorced in 2001.

Coddington’s family said he was addicted to opioids from a young age. It started with painkillers he received after a leg surgery, Coddington told his friend Skye Alexander, whom he met in nursing school.

Coddington entered inpatient rehabilitation at age 21, his mother said. When he emerged, he joined 12-step fellowships, self-help healing groups, and therapy.

“He was always trying different things to find the stability to interact with the world,” said Marks, a resident of Miami Beach who knew Coddington for 10 years.

When COVID-19 patients in March started arriving at JFK Medical Center’s North campus, where Coddington worked for 3 months, he volunteered for the coronavirus unit.

He did it because he was younger than some of his colleagues, and so potentially less likely to become severely ill, and because he was not a parent, said his friend Alexander.

“That was the type of person Will was,” she said.

Still, Coddington was scared, his friends said. He risked exposure and infecting his 65-year-old mother, with whom he still lived.

Palm Beach County ranks third in Florida behind Miami-Dade and Broward counties for confirmed coronavirus cases; nearly 300 people have died of COVID-19 there.

Coddington said in an April 13 Facebook post that his hospital had a shortage of protective equipment, especially crucial N95 respirator masks. He said he didn’t blame his employer because the issue was widespread.

“In my hospital we are rationing 1 n95 mask for my whole shift,” Coddington wrote. “We are running out of gowns. We are having people make makeshift face shields that end up snapping.”

Days before he died, his face shield fell off while he was helping with an intubation, which involves putting tubes into patients’ airways to assist breathing, said his father Ronald, a port engineer in Palm Beach.

“He literally felt things splash on his face,” Ronald recalled his son telling him.

Kathryn Walton, a spokeswoman for JFK Medical Center, part of the hospital group HCA Healthcare, declined to comment on Coddington’s death except to extend condolences to his family. She said the hospital’s goal was always to protect employees.

The hospital has “adequate supplies of PPE” and is “taking steps to conserve PPE because we do not know what our future needs will be,” Walton said.

She said the hospital offers mental health counseling by phone and video. Coddington’s friends and family say they don’t know if he used those services.

‘BRACING FOR IMPACT’

Coddington suffered from the social isolation imposed by the pandemic, his family and friends said.

He loved being around people, said Marks, who first met Coddington at a diner. Coddington’s “wacky” impersonations of TV characters endeared him to Marks right away.

“He was like a character all on his own,” Marks said.

Coddington relied on 12-step meetings to stay sober, but after one virtual video gathering, he told his mother it was not as helpful.

“He couldn’t meet with his sponsor,” she said. “And his friends, nobody wanted to see him because he worked in a hospital, not even to sit 6 feet apart.”

In his last weeks, Coddington came home from work, spoke little and played video games in his room, Carolyn said. His impersonations – including one of her Southern accent that always made them laugh – stopped.

His friend Alexander, of Sunrise, Florida, said she noticed the change too: “It was despair … creeping in.”

Coddington had relapsed before. In 2017, while on a break from nursing school, he had ended up on a ventilator, according to Alexander, who said she visited him in the hospital. She said Coddington told her he had overdosed on the club drug Gamma-Hydroxybutyrate (GHb).

With the pandemic weighing on Coddington, his loved ones were “bracing for impact,” Marks said. Carolyn checked on him constantly. His father and friends called and texted.

“You are so needed right now by others. You can be great,” Ronald Coddington said to his son in text messages on April 1. “Please please bury me some day. Don’t make me bury you … I love you.”

“I love you too,” Coddington replied.

CRAVING RELIEF

The night of April 24, Coddington argued with his mother, who feared a relapse was coming. They made up, but he announced he was heading to a hotel for a good night’s sleep.

Coddington kissed Carolyn and assured her she could track his location on her phone. He called Marks that evening, expressing how trapped he felt between the chaos at work and being cooped up at home.

“I couldn’t stop thinking about him because of how upset he sounded,” Marks said. Sleepless at 1:24 a.m., Marks sent his friend $20 on Apple Pay to buy himself coffee before his shift.

Coddington never responded. Carolyn checked his location the morning of April 25. He wasn’t at the hospital. She drove to the hotel and found him dead in his car.

Ronald Coddington said police told him they obtained a video, likely hotel security footage, showing his son sitting in his car in the parking lot that night when another car briefly pulled alongside. Ronald said there was “some kind of exchange” between his son and the other vehicle’s driver that he suspects was a drug deal.

The Broward County Sheriff’s office did not respond to Reuters’ request for the video.

Family members think the toxicology report, expected in a few weeks, will confirm an overdose – a temporary escape gone wrong.

“Do I think he wanted to die that night? 100% no,” said his friend Marks. “I would bet every dollar I have that it was in an effort to have some relief.”

(Reporting by Gabriella Borter; Editing by Ross Colvin and Marla Dickerson)

‘Humor is healing’: Laughter soothes nerves during COVID-19 trauma

By Barbara Goldberg

NEW YORK (Reuters) – Americans are employing humor as a balm to soothe nerves during the coronavirus pandemic, flocking to new Instagram stars like Quentin Quarantino and sharing Facebook memes about taking off bras and pants and putting on weight in self-quarantine.

Late-night TV hosts and hometown comedians are providing a mental health safety net for Americans living amid COVID-19 trauma, and medical experts say humor is a vital part of surviving the cascading catastrophe.

“We’re just trying to find the lighter side of the crisis with articles that tell readers that this is temporary, ‘Let’s just get through it together,'” said Jonathan Jaffe, whose New Jersey-based satirical newsletter, The Jaffe Briefing, has had a 40 percent spike in readership since the first coronavirus patient died in the United States on Feb. 28.

Snarky but very positive, the daily bulletin updates readers on such news as Anheuser-Busch’s efforts to switch production from beer to antiseptics.

“NEWARK – The Sultan of Sanitizer? The Highness of Hand Hygiene? The Ayatollah of Antiseptic? Someone has to devise a new, snappy nickname now that The King of Beers is mass producing hand sanitizer.”

Mental health professionals say humor is a balm for soothing nerves, not just by tickling funny bones but also by decreasing stress hormones. Clinical evidence shows high levels of stress can weaken immune systems.

Jokes at a time of crisis, however, should be rooted in commonalities rather than in differences. If not, they risk the resounding criticism directed at comedian Ari Shaffir after he tweeted sarcastic humor about the January death of basketball great Kobe Bryant.

MENTAL ARMOR

At an otherwise grim news conference to update on the state’s COVID-19 death toll and infection numbers, Kentucky officials this week showed photographs of sidewalks chalked with light-hearted sayings, and Public Health Commissioner Dr. Steven Stack told reporters, “Humor is healing.”

Comedy can serve as mental armor to ensure safe passage through tragic times, says psychologist Sean Truman of St. Paul, Minnesota.

“It’s a really powerful way to manage the unmanageable. Just to make fun of it and to gain control by laughing at it. That’s a really powerful psychological move we can make,” Truman said.

With New York at the epicenter of the U.S. crisis, Governor Andrew Cuomo enlisted comic actor Danny DeVito to drive home the very serious message about self-quarantining.

“Stay home,” DeVito, 75, said in a widely aired public service announcement. “We got this virus, this pandemic, and you know young people can get it, and they can transmit it to old people, and the next thing you know – ‘Gghhhhkk, I’m outta there!'”

After production of their late-night television talk shows was shut down, comedians Jimmy Kimmel, Jimmy Fallon, Stephen Colbert and Trevor Noah are streaming their monologues online.

Millions watched as Fallon sat on his front porch and rewarded himself for landing jokes told only to his laptop computer by pressing a button that delivered canned laughter and applause.

A recent episode of “The Light Show with Stephen Colb-Air – We’re All In This Together,” recorded on Colbert’s front porch, featured a mock horse race.

One thoroughbred “Does This Cough Mean Anything?” vied for the lead with “Maybe This Will All Blow Over.” And the winner “by three lengths!” announced the breathless sportscaster, was “Generalized Anxiety.”

(Reporting by Barbara Goldberg; Editing by Dan Grebler)

Schools work to restore routine to children of lost Paradise

FILE PHOTO: Statues are seen on a property damaged by the Camp Fire in Paradise, California, U.S. November 21, 2018. REUTERS/Elijah Nouvelage

By Lee Van Der Voo

CHICO, Calif. (Reuters) – For two dozen third-graders who survived the massive wildfire that largely obliterated Paradise, California, school is now the small home of their teacher, Sheri Eichar: Reading center on the couch, math in the kitchen nook, language in the corner.

When it’s time for recess, the pupils jog around the block of Eichar’s suburban neighborhood in Chico, a 20-minute drive from Paradise.

Of the 24 kids in Eichar’s class at Children’s Community Charter School, 20 lost their homes in the Camp Fire, which broke out near Paradise on November 8 and swept through the small mountain community, killing at least 88 people.

The blaze, which is now fully contained, is already the deadliest U.S. wildfire in a century, with 158 people still unaccounted for as search and rescue teams comb through the rubble and ash for human remains.

Many of Paradise’s 27,000 residents are now settled in and around Chico after the firestorm that consumed the town and destroyed the elementary school.

Within days of the evacuation, Eichar notified her students that classes would resume in her three-bedroom home and she and her husband moved the couches around so the children can sit on the floor of their living room.

On the first day, “The kids walked in like they did it every day of their lives,” Eichar said, and lined up side by side on the couches. Ten to 12 students come most days, although 18 turned up on Tuesday.

“They just needed each other so bad. This fire has created such isolation for the families and these children. They just need to be together,” she said.

MORE FUN

Eleanor Weddig, 8, says the home is more fun than a schoolhouse.

“Well, I love it. It’s like more comfortable than our classroom, the chairs are cushy,” Weddig said. “And anyway it’s a house so it’s like more fancy and stuff, and she cooks us great lunches.”

All told, 5,000 students have been displaced from Paradise schools. Eight of nine schools in the Paradise Unified School District are damaged or destroyed.

Students left homeless are eligible under federal law to re-enroll in a school wherever they temporarily reside, said Tom DeLapp of the Butte County Office of Education.

Officials are scrambling to identify commercial buildings, available real estate, mobile classrooms and partnerships with other agencies to keep classrooms and kids together.

“It could be years,” before schools are rebuilt in Paradise, DeLapp said. “While the place burned down in 24 hours, we can’t rebuild it in 24 hours.”

TEST SCORES

Families and staff at Children’s Community Charter School gathered at the Grace Community Church in Chico on Tuesday to hear about plans for recovery.

Starting Monday, the school’s 220 students will begin holding classes at a church gym in Chico. On Friday, a second charter school will squeeze into the same space.

Principal Steve Hitchko says it will be tricky. There is only one restroom, and students have missed a lot of classes.

“Will our test scores suffer? Yeah. I’m just going to be honest with you. We’re going through trauma,” Hitchko said.

At the meeting, parents voiced concerns about long commutes from new or temporary homes, counseling services and after-school programs. Children wondered whether there would be books and computers.

For many, the meeting was an emotional reunion. Some parents and children were seeing each other for the first time since the fire.

Staff members there included Jessica Hamack, the school’s office manager, who was applauded by parents for canceling classes when the fire rapidly overtook Paradise. Some credit her cancellation notice for alerting them to the flames.

Hamack said she issued the alert after seeing flames behind the school when she arrived for work, adding: “There were already kids in my office and that made me nervous.”

(Reporting by Lee Van Der Voo in Chico, California; Writing by Dan Whitcomb in Los Angeles; Editing by Bill Tarrant and Sonya Hepinstall)

Yemen orphanage braves nearby air strikes

Boys play football in the yard of The al-Shawkani Foundation for Orphans Care in Sanaa, Yemen, January 24, 2017. REUTERS/Khaled Abdullah

By Khaled Abdullah

SANAA (Reuters) – After two years of war, orphans in the Yemeni capital Sanaa have only one dream – to survive.

The al-Shawkani Foundation for Orphan Care is located around 100 meters (yards) from the al-Nahdain mountain, widely believed to be an arms depot that has been repeatedly bombarded by Saudi-led coalition’s fighter jets.

Bombardment of the explosive-laden peak send huge mushroom clouds erupting into Sanaa’s skies and shake the whole city.

As the war rages on, the orphans suffer through a constant state of fear and trauma.

“We were scared, and every time we hear the plane’s noise, they (orphanage staff) would rush us quickly to the basement fearing for our safety,” said Mousa Saleh Munassar, 14.

“Many of my friends have left the orphanage and returned to their relatives,” he added. “I expect strikes nearby at any time.”

Mousa once dreamt of becoming a doctor, but describes the only dream he and his friends now share: “We want the war to calm down for us to see security and stability come back.”

Orphanage director Muhammad al-Qadhi says it relies on the generosity of private donors and charity groups.

But the war has devastated the economy and unleashed a humanitarian crisis, depleting savings and public resources.

“We are going through a pressing need for aid for these orphans amid the scarcity of resources that used to provide for them due to the ongoing war,” he said.

The foundation used to host around 350 orphans before the conflict began. Now only around one-third remain after most left for the relative safety of living with family members in the countryside.

Yemen’s conflict pits the Iran-allied Houthi movement and elements of the military against the Saudi-backed government of President Abd-Rabbu Mansour Hadi.

Saudi-led air strikes have repeatedly hit hospitals, homes and markets, but the kingdom denies targeting civilians.

Largely stalemated in nationwide battlefronts, the war has plunged millions into poverty, displaced millions of others and killed more than 10,000 people.

Children have born the brunt of the country’s collapse.

According to UNICEF, one child dies in Yemen every ten minutes from preventable diseases including malnutrition, respiratory infections and diarrhea.

Nine-year-old Abdulaziz Badr al-Faisari of the orphanage said he and his fellow orphans were terrified when bombs shake the whole building, but appeared resigned to his fate.

“We have had nowhere to flee.”

(Editing by Tom Heneghan)

Iraqis who escaped Islamic State grapple with trauma

Displaced people, who fled Islamic State militants, cross the bridge in Al-Muthanna neighborhood of Mosul, Iraq,

By Stephen Kalin

DEBAGA, Iraq (Reuters) – While fleeing Islamic State rule in northern Iraq three months ago, Laila saw two of her daughters die in front of her. Crippled by grief and the trauma of that night, she now struggles to walk and hardly eats.

Running under the cover of darkness after more than two years under the jihadists’ harsh rule in Shirqat town, south of Mosul, Laila’s children stepped on a mine. The youngest one died on the spot, covered in blood and partially buried in the dirt.

Her 16-year-old daughter had a leg blown off and lost consciousness. Laila tied the girl’s leg with her own headscarf, then carried her on her back for several kilometers to the Iraqi army’s frontline.

“I could hear her soul leaving her body, her head on my shoulder,” she recounted earlier this month at a nearby camp for internally displaced people (IDPs) where she now struggles with depression and post-traumatic stress disorder (PTSD).

The battle to retake Mosul, Islamic State’s last major stronghold in Iraq, is playing out among the city’s nearly 1.5 million residents who have spent 2-1/2 years under the ultra-hardline group’s repression.

The militants have employed extreme violence to impose their strict interpretation of Islamic law in territories they seized in 2014, whipping people for smoking, cutting off hands for stealing, stoning women for adultery, and throwing men off of buildings for homosexuality.

Several thousand civilians have been killed or wounded in the street-to-street fighting since the U.S.-backed offensive began in October.

Nearby camps are full of civilians displaced from in and around Mosul and many suffer from depression and anxiety disorders, aid groups say.

“I feel lost, my life has no meaning anymore,” said Laila. “If your car is stolen, you can buy another one. If your house is destroyed you can build another one. But a life cannot be replaced.”

She is taking psychotropic medication and attends weekly counseling sessions run by aid group Medecins Sans Frontieres (MSF), but she says nothing helps.

“Treatment cannot heal a heart in pain,” she said.

MASS TRAUMA

In a nearby tent at Debaga sits a young mother of three, from another village south of Mosul. She looks about twice her 20 years and speaks in a monotone, rarely making eye contact.

It was during their escape last autumn that she went into labor, giving birth to twins. The couple declined to go into details about the circumstances of the birth, but the woman has since been diagnosed with depression and PTSD.

A counselor says she has struck her husband and tried to kill one of her babies. She also has suicidal feelings but refuses medication.

“She is talking to you normally right now, but sometimes she chokes the baby and tells me, ‘I don’t want him, you take him’,” her husband said. Their names are withheld by Reuters to protect their safety.

Their flight is just one of a raft of deeply traumatic events suffered by their family in recent years, and by many others like them.

They had not yet fled their village when Islamic State fighters stormed their home, accusing the husband of sedition. A former policeman, he had worked with U.S. forces following the 2003 invasion.

The militants shot in the air around him, then put a machine gun to his head and dragged him off to a mosque where they beat him.

Another time, an air strike destroyed a neighbor’s house. Their dog picked through the rubble and dragged back human remains.

“There were parts left there, a hand or a leg,” the woman said. “The dog brought them to our front yard and chewed on them in front of our kids.”

LIMITED ACCESS TO MEDICATION

Pre-existing mental health conditions affecting IDPs have been exacerbated by limited access to medication under IS rule and the trauma of displacement.

Those still in Mosul have even fewer opportunities for treatment, as is the case for those affected by physical illness and the wounded.

A resident of Muharibeen district told Reuters last week that his mother fell into a coma more than a month ago when Islamic State fighters stormed their house.

He pleaded in vain for an ambulance to transport her to nearby Erbil, the capital of the relatively peaceful, autonomous Kurdish region, where hospitals treat those of Mosul’s wounded civilians who make it there. As of Friday, his mother was still at home in Mosul, and still unconscious.

Another local man said his five-year-old daughter, who has a brain defect due to premature birth, has been unable to obtain medicine for more than two years. She can barely speak.

Treatment of the displaced is hampered by the continued violence in Mosul.

“The rate of relapse is very high… because the IDPs on a daily basis receive painful news and stories,” said Bilal Budair, MSF’s mental health manager.

“So we treat and support them, but the bad news has an opposite effect and sets back some of the patients to zero.”

(Editing by Raissa Kasolowsky)

Trauma of Islamic State rule follows Iraqi women out of Mosul

displaced woman rescued from ISIS

By Stephen Kalin

KHAZIR, Iraq (Reuters) – One wrong word to an Islamic State fighter in Mosul last year was all it took to set in motion a harrowing chain of events for an Iraqi woman who became so traumatized that she trembled in fear even after escaping the group’s control.

The widowed mother was being vetted to receive a pension from the ultra-hardline Islamists a few months after they seized the northern city in 2014 and turned it into the Iraqi capital of their self-styled caliphate.

“I made the mistake of telling them my husband had been a victim of terrorism,” she said in an interview on Tuesday at a government-run camp in Khazir, east of Mosul. “One of them hit me and broke my teeth. Then they took me to a house and held me for three days.”

The jihadists locked her up in a filthy room with rats and bugs. She was blindfolded and her arms and legs were bound by chains as one of the men – or perhaps several, she couldn’t tell – raped her over and over again, she said.

Islamic State, which is putting up fierce resistance to a U.S.-backed offensive to retake Mosul, the group’s last major stronghold in Iraq, has been accused of massacre, enslavement and rape since it swept across large swathes of the country’s north and west in 2014.

There was no way of verifying her story, but it reflected others’ experiences coming to light as civilians from the most populous city ever controlled by the jihadists emerge from their grip and grapple with 2-1/2 years of suffering.

A 13-year-old girl who also spoke to Reuters on the condition of anonymity said her father had married her to a neighbor four years her senior who turned out to be with Islamic State.

The slender adolescent now clutching a pink sequined purse said he had threatened to kill her and permitted his brothers to sexually assault her.

After escaping Mosul a few weeks ago, she learned he had made it to a nearby camp and informed the authorities. They detained him, but the pair remain married.

The 37-year-old widow fled last month to Khazir camp, where she receives counseling from UNFPA, a United Nations agency focused on gender-based violence. She asked that her name be withheld for fear of retribution and donned a face veil that revealed only her eyes.

When Islamic State released her after the assault, the diminutive, round-faced woman returned home thinking her nightmare was over.

She sent her two younger children – now 9 and 11 – to stay with relatives in the nearby Kurdish city of Erbil and planned to join them as soon as she could save enough money to smuggle herself and her eldest son.

But a few weeks later she discovered she was pregnant with the child of one of her Islamic State tormentors. In addition to the trauma of being raped, she feared the stigma in Iraq’s conservative society of an unmarried woman giving birth. Within two months she had rushed into marriage with a man who had agreed to adopt the child as his own.

“DIE OF HUNGER OR GET MARRIED”

“They were forcing widows to get married. This was one of their rules: either die of hunger or get married,” said the woman, who occasionally wept and fidgeted with her hands underneath a loose-fitting garment.

Her new husband, though, also had a troubled past. An engineering student in his last year of university, he had been sentenced to death in connection with a crime of honor before Islamic State seized Mosul. In jail, he befriended jihadists who helped him escape when the group routed government forces in 2014.

Soon after the pair married, Islamic State gave the man an ultimatum: fight with us or we kill you. He yielded, and his new wife found herself back in the militants’ clutches.

When her family living outside Mosul learned that she was now married to an Islamic State member, they severed all connections with her. Her late husband’s brother took custody of her two young children and moved them to Baghdad, vowing never to let her see them again.

When Iraqi forces reached her neighborhood last month, she said, they detained her new husband to investigate his jihadist ties.

She took her eldest son with her to the camp but left the baby, now just over a year old, with her new husband’s second wife who remains in Mosul. His fate and that of hundreds or perhaps thousands of other children born to the jihadists remains unclear as the group loses much of its territory and its bid for statehood.

“They think this is the son of their father, they don’t know the truth,” the mother said of the second wife’s family. “The boy doesn’t look like me.”

She has resolved never to return to Mosul, even if Islamic State is eliminated. “I want to go somewhere far away where nobody knows me.”

In Jordan hospital, mental trauma scars children blown apart by bombs

Rachid Jassam, 15, who nearly had his leg amputated after he was injured by an airstrike outside his house in Falluja, Iraq, sits on a hospital bed inside a Medecins Sans Frontieres hospital in Amman, Jordan

By Lin Taylor

AMMAN (Thomson Reuters Foundation) – As soon as the bombs exploded outside his house in the Iraqi town of Falluja, Rachid Jassam rushed onto the street to rescue the injured.

As the teenager ran out, another plane swooped overhead and dropped more bombs, the shrapnel tearing his right leg so severely local doctors wanted to amputate it.

His father refused the amputation to spare his son from a life of disability, and opted for basic surgery instead.

“When I got injured, I didn’t lose consciousness. I witnessed the whole thing when the people came and took me to the hospital. I remember everything,” 15-year-old Jassam said through an interpreter at a Medecins Sans Frontieres (MSF) hospital in Amman in Jordan.

“I lost five centimetres of my bone from my right leg and I couldn’t move it anymore.”

More than 20 per cent of all patients at the MSF hospital are children just like Rachid – blown apart, severely burnt and disfigured by conflicts in Iraq, Syria, Yemen and Gaza.

Since it opened in 2006, the hospital has treated almost 4,400 patients free of charge, and remains the only hospital in the Middle East to perform advanced reconstructive surgery on victims of war.

But as conflicts rage across Middle East, hospital staff say resources have been stretched in recent years, with most patients coming from Syria and Yemen.

For Jassam, the clinic has been his lifeline. Sitting on his hospital bed in the Jordanian capital after receiving specialised surgery on his leg, he smiles broadly as he holds onto his crutches.

“Thank God, it’s God that preserved my leg.”

“YOU SEE WAR EVERY DAY”

Not all children are so lucky.

In a small pink room on the upper levels of the hospital, young girls with disfigured faces and missing limbs grow increasingly agitated as they try to solve puzzles and play board games.

“Sometimes the trauma affects their memory skills or problem-solving, and it also has psychological effects like low attention span. They can get frustrated easily and they have low self-esteem,” said occupational therapist Nour Al-Khaleeb, 24, who is part of a team of mental health specialists.

“You see war every day, you see their injuries, you see how it’s affecting their lives – and sometimes it has an effect on you too,” she said, talking loudly over the girls’ screams and chatter.

“Maybe they will remember that someone did something good for them, and this will give them hope later on in life.”

Around 60 people, mainly young men, undergo complex orthopaedic, facial and burn reconstructive surgery at the hospital each month, according to MSF. They also receive psychological care and counselling during their stay.

Mohammed, 11, said his family was fleeing the city of Homs in Syria by car when an airstrike hit, injuring him and his two brothers. He watched as his mother died in the explosion.

“A part of the bomb went into my leg and fractured my bone into pieces – it cut into my nerves and tendons,” he said through an interpreter, insisting he wasn’t scared when the bombs fell overhead.

Hobbling down the hospital corridor on crutches after a recent operation on his leg, Mohammed said he will get on with his life when he is discharged, and return to join his family in Jordan’s Zataari refugee camp, which hosts almost 80,000 Syrian refugees.

RESILIENCE

Clinical psychologist Elisa Birri, who heads the mental health team, said it was common for children in the hospital, especially boys, to put on a brave front.

But sooner or later, psychological symptoms like bedwetting, depression, anxiety, aggression and insomnia can crop up, said Birri. At the severe end of the spectrum, patients can experience flashbacks, panic attacks and disassociation, where they lose their sense of reality.

“Children show in their drawings and during free play what they have experienced, it’s like a mirror. For example, they will draw themselves playing with guns because of the war context they came from,” said Birri, adding that children will sometimes regress to an infantile state to cope with the trauma.

But having worked in Libya and Syria, the Italian psychologist added that the maturity and resilience of children living in war-torn countries were beyond their years.

“They go through really big events, but you see them smiling every day, playing every day. They never stop having motivation to go on.”

This rings true for 15-year-old Jassam. Even after being severely injured and besieged by Islamic State militants for eight months, Jassam said he can’t wait to return to Falluja once he leaves the hospital.

“I want to go back to Falluja, I miss it. I miss everyone there,” he said, smiling and nodding his head in excitement.

“I have a goat and it’s the only surviving goat and she has given birth, so there are babies waiting for me.”

(Reporting by Lin Taylor @linnytayls, Editing by Ros Russell; Please credit the Thomson Reuters Foundation, the charitable arm of Thomson Reuters that covers humanitarian issues, conflicts, global land and property rights, modern slavery and human trafficking, women’s rights, and climate change. Visit http://news.trust.org to see more stories)

Managing mental health for refugees in Greece. ‘People need time to mourn’

A migrant waits for transport at a transit camp in Gevgelija, Macedonia, after entering the country by crossing the border with Greece, November 4, 2015

DAKAR (Thomson Reuters Foundation) – Sam* is a Syrian mental health and psychosocial support trainer for the International Medical Corps in Greece.

“There is no such thing as an average day in my role as a psychosocial support trainer in the ever-changing and chaotic environment that Greece has become.

But my story begins like that of many others – fleeing my home in Syria to seek a better future in Europe.

Already having been detained and tortured twice for humanitarian work in Syria and fearing for my safety, I fled to Turkey in hope of being able to continue helping others.

Unfortunately I found that having fled from Syria and having a degree in international relations and vast experience of working with various NGOs does not guarantee asylum.

Stateless, I eventually left Turkey to cross the Mediterranean to Greece – a crossing that has already taken more than 400 lives this year alone.

For me, the worst part was hiding. Like every other Syrian refugee, I was only looking for safety – and yet I spent two months hiding, jumping at the sight of small animals, terrified of meeting another person.

We made it to Serbia, but things only got worse from there. Somebody overheard me and my companion speaking Arabic at a bus stop in Belgrade, and at 2am the next day we were kidnapped.

For a day these people, who I was convinced were under the influence of drugs, tortured us in every way they could imagine.

When the effects wore off they realized what they were doing and fled, abandoning us to find our way to the nearest hospital.

I did make it to Austria eventually, and then to the Netherlands where I was finally granted asylum.

However my journey was far from over.

BATTLEGROUND

“I have always felt the need to help people, and as Syrians continued risking their lives trying to find sanctuary in Europe, I knew exactly where I belonged.

As soon as I got my documents I applied for jobs with NGOs helping Syrian refugees, and left the Netherlands for Greece.

I go from island to island, training people in psychological first aid and supporting those providing psychosocial services.

It’s chaotic. Things change every day and it is difficult to predict what lies in store for these people.

Military hotspots have been popping up all over the country, making it ever more difficult for NGOs to access those who need our help the most. Many of these hotspots lack sanitation facilities and drinking water.

There is no war in Greece, but to me it is a battleground all the same.

TIME TO MOURN

“Everybody wants to help, but they don’t know that good intentions sometimes do more harm than good when it comes to mental health.

That’s what I am here for – to make sure that the mental health programs are adapted to fit the cultural context.

In Europe, it is acceptable to help somebody get over their grief by distracting them or trying to cheer them up.

But in my culture ignoring grief is considered shameful – we need time to mourn. The people getting off the boats in Greece – traumatized by the journey, homesick and often separated from their friends and families – are rarely given that time.

Being both a Syrian refugee and a mental health worker, I understand why people might fear refugees coming into Europe.

It’s the same fear I experienced on my own journey all that time ago – the fear of the unknown. Even if one single person stops being afraid, I will know I have done my job.”

*Sam asked to omit his surname for safety reasons.

This aid worker profile is one of five commissioned by the Thomson Reuters Foundation ahead of the first ever World Humanitarian Summit on the biggest issues affecting the humanitarian response to disasters and conflict.

For more on the World Humanitarian Summit, please visit: http://news.trust.org/spotlight/reshape-aid

(Editing by Kieran Guilbert and Katie Nguyen; Please credit the Thomson Reuters Foundation, the charitable arm of Thomson Reuters, that covers humanitarian news, women’s rights, trafficking, corruption and climate change. Visit news.trust.org)