Aala El-Khani
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Worldwide, over 1.5 billion people experience armed conflict. In response, people are forced to flee their country, leaving over 15 million refugees. Children, without a doubt, are the most innocent and vulnerable victims ... but not just from the obvious physical dangers, but from the often unspoken effects that wars have on their families. The experiences of war leave children at a real high risk for the development of emotional and behavioral problems. Children, as we can only imagine, will feel worried, threatened and at risk. But there is good news. The quality of care that children receive in their families can have a more significant effect on their well-being than from the actual experiences of war that they have been exposed to. So actually, children can be protected by warm, secure parenting during and after conflict.

In 2011, I was a first-year PhD student in the University of Manchester School of Psychological Sciences. Like many of you here, I watched the crisis in Syria unfold in front of me on the TV. My family is originally from Syria, and very early on, I lost several family members in really horrifying ways. I'd sit and I'd gather with my family and watch the TV. We've all seen those scenes: bombs destroying buildings, chaos, destruction and people screaming and running. It was always the people screaming and running that really got me the most, especially those terrified-looking children. I was a mother to two young, typically inquisitive children. They were five and six then, at an age where they typically asked lots and lots of questions, and expected real, convincing answers. So, I began to wonder what it might be like to parent my children in a war zone and a refugee camp. Would my children change? Would my daughter's bright, happy eyes lose their shine? Would my son's really relaxed and carefree nature become fearful and withdrawn? How would I cope? Would I change?

As psychologists and parent trainers, we know that arming parents with skills in caring for their children can have a huge effect on their well-being, and we call this parent training. The question I had was, could parent training programs be useful for families while they were still in war zones or refugee camps? Could we reach them with advice or training that would help them through these struggles? So I approached my PhD supervisor, Professor Rachel Calam, with the idea of using my academic skills to make some change in the real world. I wasn't quite sure what exactly I wanted to do. She listened carefully and patiently, and then to my joy she said, "If that's what you want to do, and it means so much to you, then let's do it. Let's find ways to see if parent programs can be useful for families in these contexts."

So for the past five years, myself and my colleagues — Prof. Calam and Dr. Kim Cartwright — have been working on ways to support families that have experienced war and displacement. Now, to know how to help families that have been through conflict support their children, the first step must obviously be to ask them what they're struggling with, right? I mean, it seems obvious. But it's often those that are the most vulnerable, that we're trying to support, that we actually don't ask. How many times have we just assumed we know exactly the right thing that's going to help someone or something without actually asking them first?

So I travelled to refugee camps in Syria and in Turkey, and I sat with families, and I listened. I listened to their parenting challenges, I listened to their parenting struggles and I listened to their call for help. And sometimes that was just paused, as all I could do was hold hands with them and just join them in silent crying and prayer. They told me about their struggles, they told me about the rough, harsh refugee camp conditions that made it hard to focus on anything but practical chores like collecting clean water. They told me how they watched their children withdraw; the sadness, depression, anger, bed-wetting, thumb-sucking, fear of loud noises, fear of nightmares — terrifying, terrifying nightmares. These families had been through what we had been watching on the TV. The mothers — almost half of them were now widows of war, or didn't even know if their husbands were dead or alive — described how they felt they were coping so badly. They watched their children change and they had no idea how to help them. They didn't know how to answer their children's questions.

What I found incredibly astonishing and so motivational was that these families were so motivated to support their children. Despite all these challenges they faced, they were trying to help their children. They were making attempts at seeking support from NGO workers, from refugee camp teachers, professional medics, other parents. One mother I met had only been in a camp for four days, and had already made two attempts at seeking support for her eight-year-old daughter who was having terrifying nightmares. But sadly, these attempts are almost always useless. Refugee camp doctors, when available, are almost always too busy, or don't have the knowledge or the time for basic parenting supports. Refugee camp teachers and other parents are just like them — part of a new refugee community who's struggling with new needs.

So then we began to think. How could we help these families? The families were struggling with things much bigger than they could cope with. The Syrian crisis made it clear how incredibly impossible it would be to reach families on an individual level. How else could we help them? How would we reach families at a population level and low costs in these terrifying, terrifying times?

After hours of speaking to NGO workers, one suggested a fantastic innovative idea of distributing parenting information leaflets via bread wrappers — bread wrappers that were being delivered to families in a conflict zone in Syria by humanitarian workers. So that's what we did. The bread wrappers haven't changed at all in their appearance, except for the addition of two pieces of paper. One was a parenting information leaflet that had basic advice and information that normalized to the parent what they might be experiencing, and what their child might be experiencing. And information on how they could support themselves and their children, such as information like spending time talking to your child, showing them more affection, being more patient with your child, talking to your children. The other piece of paper was a feedback questionnaire, and of course, there was a pen. So is this simply leaflet distribution, or is this actually a possible means of delivering psychological first aid that provides warm, secure, loving parenting?

We managed to distribute 3,000 of these in just one week. What was incredible was we had a 60 percent response rate. 60 percent of the 3,000 families responded. I don't know how many researchers we have here today, but that kind of response rate is fantastic. To have that in Manchester would be a huge achievement, let alone in a conflict zone in Syria — really highlighting how important these kinds of messages were to families. I remember how excited and eager we were for the return of the questionnaires. The families had left hundreds of messages — most incredibly positive and encouraging. But my favorite has got to be, "Thank you for not forgetting about us and our children." This really illustrates the potential means of the delivery of psychological first aid to families, and the return of feedback, too. Just imagine replicating this using other means such as baby milk distribution, or female hygiene kits, or even food baskets.

But let's bring this closer to home, because the refugee crisis is one that is having an effect on every single one of us. We're bombarded with images daily of statistics and of photos, and that's not surprising, because by last month, over one million refugees had reached Europe. One million. Refugees are joining our communities, they're becoming our neighbors, their children are attending our children's schools. So we've adapted the leaflet to meet the needs of European refugees, and we have them online, open-access, in areas with a really high refugee influx. For example, the Swedish healthcare uploaded it onto their website, and within the first 45 minutes, it was downloaded 343 times — really highlighting how important it is for volunteers, practitioners and other parents to have open-access, psychological first-aid messages.

In 2013, I was sitting on the cold, hard floor of a refugee camp tent with mothers sitting around me as I was conducting a focus group. Across from me stood an elderly lady with what seemed to be a 13-year-old girl lying beside her, with her head on the elderly lady's knees. The girl stayed quiet throughout the focus group, not talking at all, with her knees curled up against her chest. Towards the end of the focus group, and as I was thanking the mothers for their time, the elderly lady looked at me while pointing at the young girl, and said to me, "Can you help us with...?" Not quite sure what she expected me to do, I looked at the young girl and smiled, and in Arabic I said, "Salaam alaikum. Shu-ismak?" "What's your name?" She looked at me really confused and unengaged, but then said, "Halul." Halul is the pet's name for the Arabic female name, Hala, and is only really used to refer to really young girls. At that point I realized that actually Hala was probably much older than 13. It turns out Hala was a 25-year-old mother to three young children. Hala had been a confident, bright, bubbly, loving, caring mother to her children, but the war had changed all of that. She had lived through bombs being dropped in her town; she had lived through explosions. When fighter jets were flying around their building, dropping bombs, her children would be screaming, terrified from the noise. Hala would frantically grab pillows and cover her children's ears to block out the noise, all the while screaming herself. When they reached the refugee camp and she knew they were finally in some kind of safety, she completely withdrew to acting like her old childhood self. She completely rejected her family — her children, her husband. Hala simply could no longer cope.

This is a parenting struggle with a really tough ending, but sadly, it's not uncommon. Those who experience armed conflict and displacement will face serious emotional struggles. And that's something we can all relate to. If you have been through a devastating time in your life, if you have lost someone or something you really care about, how would you continue to cope? Could you still be able to care for yourself and for your family?

Given that the first years of a child's life are crucial for healthy physical and emotional development, and that 1.5 billion people are experiencing armed conflict — many of whom are now joining our communities — we cannot afford to turn a blind eye to the needs of those who are experiencing war and displacement. We must prioritize these families' needs — both those who are internally displaced, and those who are refugees worldwide. These needs must be prioritized by NGO workers, policy makers, the WHO, the UNHCR and every single one of us in whatever capacity it is that we function in our society.

When we begin to recognize the individual faces of the conflict, when we begin to notice those intricate emotions on their faces, we begin to see them as humans, too. We begin to see the needs of these families, and these are the real human needs. When these family needs are prioritized, interventions for children in humanitarian settings will prioritize and recognize the primary role of the family in supporting children. Family mental health will be shouting loud and clear in global, international agenda. And children will be less likely to enter social service systems in resettlement countries because their families would have had support earlier on. And we will be more open-minded, more welcoming, more caring and more trusting to those who are joining our communities.

We need to stop wars. We need to build a world where children can dream of planes dropping gifts, and not bombs. Until we stop armed conflicts raging throughout the world, families will continue to be displaced, leaving children vulnerable. But by improving parenting and caregiver support, it may be possible to weaken the links between war and psychological difficulties in children and their families.

Thank you.