Fear, Distress and Grief: Türkiye and Syria Earthquakes May Fuel Severe Mental Health Needs in the Region

FAIRFIELD, Conn. (Feb. 17, 2023)—The mental health and wellbeing of 7 million children is at risk for years to come after last week’s devastating earthquakes in Türkiye and Syria, with psychologists telling Save the Children some are showing signs of acute distress including nightmares, aggression, or being withdrawn.

Around 23 million people have been impacted by the earthquakes in Türkiye and Syria, including at least 7 million children, many of whom have witnessed their friends and family members die before their eyes. Others have been buried under the rubble of their collapsed homes. Many now still don’t have anywhere safe to go.

Children who have experienced extremely distressing events or repeated stress are more likely to have long-lasting impacts for months or even years to come unless more mental health and psychosocial support is urgently provided alongside humanitarian aid.

Aiida*, a psychologist working for Save the Children, said:

“In these cases, children are at risk of developing mental health difficulties, particularly as there were several events one after another, earthquakes with ongoing aftershocks, with no period for recovery.

“In the long term, this can impact many aspects of a child’s life, including difficulties with learning, concentration, and school performance. A child who has experienced life-threatening events may remain primarily focused on feeling safe and function in survival mode—what we can also call a flight, fight, or freeze response.”

Exposure to prolonged stress can have a devastating effect on children's mental health and wellbeing, and lead to what is commonly referred to as 'toxic stress'—the most dangerous form of stress a child can experience.

Zehra,* a mental health officer working for Save the Children in Türkiye, explained that the emotional impact of the earthquakes is taking a heavy toll on children in the country.  

“The children we’re speaking to are showing signs of aggression, being withdrawn, and not speaking much, while some others show the opposite: they want a lot of attention. Parents are also telling us that children are having nightmares.”

In Antakya, Hatay, and remote villages hard-hit in Türkiye, Save the Children teams have set up child-friendly activities for children aged five to 12 so they have a safe place to play, learn, and express their grief and loss.

“During a psychosocial support activity, two children drew images of dead bodies. It’s a common reaction after an event like this,” said Zehra.* “Drawings are the children’s language, their way of talking and expressing how they feel, and to process what has happened to them. That’s why it’s crucial to scale up the response and open more child-friendly spaces so all children have access to these types of activities.”

In northern Syria, Nadia,* 23, grabbed her three children and fled their home when the ground started shaking in the early hours of February 6. They had no lights, no phones, and barely enough time to take any personal items. 

While escaping, a rock hit her son Samer’s* head, severely injuring the six-year-old. 

“My son’s head kept bleeding. They stitched his head and his leg is broken, and he kept crying in pain,” said Nadia. “One week after the earthquake, [he] keeps saying: ‘Thank God we have no walls, so nothing can fall on us.’ He’s traumatized because he was injured. And his father sometimes spaces out and sheds tears when he contemplates what happened to us.”

The family of five is now living in a temporary shelter that is being supported by a local Save the Children partner in Aleppo, Syria, where the children also have access to psychosocial support and child-friendly activities.

After 12 years of conflict and economic crisis, the mental health needs in Syria were already significant before the earthquakes. According to UN data from December 2022, nearly half of all children surveyed were showing signs of psychological distress, and 26% of households reported the reason their children did not want to go to school was because they felt depressed, unhappy, or lacked motivation.

The escalating mental health concerns fueled by the earthquakes are not only being felt in Syria and Türkiye. In Lebanon, shockwaves from the earthquakes triggered harrowing memories of the Beirut port explosion in 2020, which killed at least 218 people and injured over 7,000.

Children severely affected by the Beirut Blast are more likely to be impacted by the earthquake and aftershocks, explained Aiida*.

“Even the small details of the earthquake were triggers–seeing items shake or be knocked from shelves, this is what happened during the Beirut explosion,” she said. “We have seen similar cases of this. For example, children who link the sounds of thunder and lightning to the sound of the blast, which could be an indication of lasting impacts.”

The fact that the earthquakes and shockwaves took place when people were in their homes at night increased their sense of fear. Many families around Lebanon opted to sleep in cars as they did not feel safe at home or fled to mountains in fear of a tsunami.

For young children, increased clinginess and anxiety upon separation is being observed, with children needing to sleep next to their caregivers at night and stay next to them during the day. Overexposure to distressing news and images circulating through social media is also playing a role in children’s stress levels, especially among teenagers.

Compounding the heightened need for mental health and psychosocial support is the lack of information available to the caregivers on how to deal with this situation.

Save the Children’s mental health and psychosocial support teams in Lebanon, Syria, and Türkiye are working together to share hands-on experience to ensure children get access to the support they need. In all three countries, Save the Children has developed messaging for caregivers, teachers, and frontline workers on how to support children who have experienced distressing events and how to talk to them about it.

In close collaboration with the local government in Türkiye and through local partners in Syria, Save the Children is setting up child-friendly spaces and child-focused psychosocial support activities in parallel with life-saving assistance to children and families.

With the right help, most children psychologically impacted by the earthquakes will eventually be able to recover. But without urgent attention to mental health and psychosocial support during the earthquake response, a generation of children in the region is at risk of being left with long-term negative impacts.

*Names changed to protect privacy

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Notes to Editors:

• In Türkiye and Syria, Save the Children is planning to reach a total of 1.6 million people, including 675,000 children, through its earthquake response. This includes 1.1 million people, including 550,000, children in Syria, and 500,000 people, including 125,000 children, in Türkiye.
• Syrian Arab Republic: 2023 Humanitarian Needs Overview (December 2022) - Syrian Arab Republic | ReliefWeb 
• The UN launched a US $1 billion flash appeal for Türkiye on Feb. 16.
• On Feb. 14, the UN launched a US $397.6 million flash appeal to reach 4.9 million people with the most urgent humanitarian needs, covering an initial period of three months, until May.