'They wanted to break us': The silent mental health crisis facing Syria's ex-prisoners

Homs, Syria - When the door to his cell was flung open by armed rebels, Abdullah Wakia learned two things: that the Assad regime, which had held and tortured him there, had fallen, and that – after five years in detention – he was finally free.

Wakia was accused of being a sleeper cell agent, and was tossed into to Syria’s notorious Sednaya prison, known locally as “the human slaughterhouse”, where his family assumed he had died.

The years Wakia spent in darkness and isolation left lasting scars. And after his release from Sednaya came a new struggle to recover from the physical and psychological injuries he suffered there.

“I would never go outside,” he told The New Arab. “Even at home, if my wife came and sat next to me, I would have to sit in another room.”

By the time Wakia got out he found himself alone and homeless. His family had moved to Beirut, and his home had been taken up by his neighbours. Unsurprisingly, this ordeal left him with anger issues, in addition to the trauma he carried from prison.

As Syria attempts to rebuild after 14 ruinous years of civil war, the country remains in the grip of a silent crisis that experts say is not being sufficiently addressed and is hindering societal recovery. 

Roughly 24,000 prisoners were freed the night the regime fell on 8 December 2024.

Most were detained arbitrarily: simply for being from the wrong neighbourhood, or a member of the wrong Facebook group. Along with countless other former detainees, most remain isolated at home due to social stigma and a lack of awareness around mental health.

One in every 10 Syrians is estimated to have a mental health condition, according to the World Health Organisation (WHO). But nearly all of Syria’s former prisoners are grappling with various forms of psychological trauma, mainly PTSD, anxiety, and depression.

In Homs, a clinic run by the US-based medical nonprofit MedGlobal is providing group therapy sessions to former inmates for free, one of just a handful of places in Syria where such care is available.

The clinic was the brainchild of Dr Farouk Wafai, who was a 26-year-old medical graduate when the regime fell. In the frenzy of those first weeks, he went into the streets with a notepad and began gathering the names of former detainees to offer them free therapy sessions.  

Today, the mental health centre is directed by Dr Ahmed Radwan. With MedGlobal’s support, he and the Homs team have treated about 750 former detainees.

During a group therapy session, the former prisoners took turns describing what still haunts them. Some of them already knew each other from prison.

One man had a crippling fear of loud noises. Inmates were not allowed to speak in prison, and the slightest noise could be a death sentence.

Another man suffered from anxiety attacks every time a door closed at home. It reminded him of being locked in solitary confinement. Another described how he had once hallucinated in prison that his hand was a mobile phone and tried to call his son with it.

Hallucinations seemed common. Another member of the group described how one day after he returned home, he saw his wife standing outside in a field, far from the house. He panicked and shouted for her to come back, but when she answered she was stood right behind him. 

“What is anxiety?” asked Alaa Tamr, the psychologist leading the session. The group listened to him intently, eager to learn and to recover. “What causes this? How do the symptoms manifest?”

“Fear,” answered one member of the group.

Most former prisoners don’t realise their conditions can be identified and treated. Giving the nightmares and the anger a name helps in coping with them. Wakia and the other members of his cohort say the therapy has benefited them hugely. After seven weekly sessions, the number of those still in need of clinical support was roughly halved.

“When you see that other people have been through the same thing as you and recovered, it helps,” Wakia said.

But the scale of Syria’s collective trauma means that far more clinics and far greater investment in mental health services are needed to plug the vast gap in available treatment. 

Syria’s healthcare system, including its mental health services, was gutted by years of war, while US and EU sanctions targeting Assad’s regime made it difficult to import essential psychiatric medicines. Many of the country’s hospitals were bombed and left in ruins, and many health staff fled abroad.

Now there are only about 60 psychiatrists in Syria, not nearly enough to serve the country’s 17 million inhabitants. And receiving care remains prohibitively expensive for almost all former prisoners, most of whom come from working-class backgrounds.

Over 112,000 people disappeared into Assad’s detention centres between 2011 and 2024. It is likely that almost all of them were killed over the years, through torture, starvation, or extrajudicial executions.

“The whole of Syria was exposed in some way to war trauma, detention, torture, loss of family members … everyone suffered from something like this,” Dr Wafai told The New Arab.

He added that he was also traumatised by what he heard and saw from former prisoners in the first sessions.

“They wanted to break the human being, to make him forget that he is human,” he said.

Many former prisoners’ bodies were left so badly injured that they can never return to their manual labour jobs. Unable to support their families financially, they often see their psychological distress worsen.

Wakia suffered a vertebral disc prolapse from beatings in prison, a back injury common among former detainees. And, like many others, he also left prison with tuberculosis.

He was treated at a hospital in Homs by MedGlobal, which referred him to the mental health clinic where he also receives advice to find new employment.

Dr Wafai sees mental health as inseparable from Syria’s wider recovery. “One of the main pillars to rebuild society is mental health,” he says.

According to the United Nations Development Programme (UNDP), mental health support is essential to prevent trauma from fuelling further cycles of violence, undermining the very communities Syria is trying to rebuild.

Left unresolved, that trauma rarely stays contained to one generation. Clinicians warn it can pass silently from parent to child, resurfacing as the same fear and anger, despite never having seen the inside of a cell.

Dr Wafai and other mental health practitioners in Syria face a challenge of almost impossible proportions. But he hopes another clinic will open soon. And, one by one, former detainees are becoming human again.

“When I see people I met at the beginning, who couldn’t even speak or look me in the eye, now when I see them regain their health and be able to talk, being sociable, it’s a very big win,” Dr Wafai said.

Alex Martin Astley is a freelance journalist based in Beirut, covering conflict, foreign policy, and social justice issues

Follow him on X: @AlexMAstley

Edited by Charlie Hoyle