Four blocks away from the Syrian consulate in Vancouver, the front door sits ajar as clients slip in and out. Two plush couches and a pile of kids’ toys sit under the dim lights of the waiting room. A single patient waits in the corner with her hood up. She buries her face in her hands.
This is the office of the Vancouver Association for Survivors of Torture — the only organization in B.C. that specializes in trauma counselling. It is the group best placed to provide trauma counselling to the hundreds of Syrian refugees who will likely need professional help, say experts.
But it has no money to help them.
Last year, the federal government did not renew the nearly $300,000 in funding it had given the association in previous years.
“This is the thing that might surprise people. There is no plan. We have two counsellors that see 300 people a year. That’s a maximum. We can’t see more people,” said Dylan Mazur, the association’s director.
When federal funding ended, the association continued to operate with money from the city, the province, the B.C. Lottery Corporation and the United Nations.
Today VAST runs on $300,000 annually. This money is almost entirely destined for refugee claimants, otherwise known as asylum claimants.
But the Syrian refugees bound for Canada are classified as government-assisted and privately sponsored refugees. This will leave the Vancouver association only able to provide a fraction of the specialized trauma counselling the new arrivals are expected to require.
Settlement organizations are working towards building support systems that will outlive the current influx of refugees.
“It has to be a much broader approach,” said Chris Friesen, director of the Immigrant Services Society of B.C., the largest settlement organization for refugees in the province.
The details of how trauma care will be funded remain unanswered, despite Immigration Minister John McCallum’s assurance on Tuesday that it will be a priority.
Friesen is currently working to pull together more funding from all levels of government.
“We are exploring a province-wide support system. We hope to use some of Christy Clark’s million-dollar fund for refugees to educate healthcare professionals,” said Friesen.
Without support for trauma counselling, refugees struggle to get started with settlement and integration.
At this time, there are no provincial standards for refugee mental-health assessment. That’s a problem for incoming refugees, but also for people like Mohammed Alsaleh.
He was one of 28 government-assisted refugees from Syria to settle in B.C. in 2014.
The former medical student fled Syria after three years of civil war and, at the end, four months of torture. The scars that cover his body tell the story.
“I had to see my friends die. I had to carry their bodies,” said Alsaleh. “I don’t want to remember that.”
Alsaleh said that conditions got worse when disease started spreading through the detention centre.
“We had 15 to 20 people die every day. Prisoners would get diarrhea and defecate on themselves until they became like walking skeletons.”
Alsaleh’s traumatic story is not unique. A 2013 systematic review of Syrian refugee camps in Lebanon found that rates of post-traumatic stress disorder ranged from 36 to 62 per cent in adult refugees, while affecting up to three-quarters of children.
“Those are the best numbers we have,” said Mazur.
But he is confident that with renewed funding his organization can handle the worst cases of trauma among the more than 2,000 refugees expected in B.C. in the coming months.
“I know a handful of counsellors who could do it right away,” said Mazur, who is careful to highlight that putting off trauma counselling will only delay the integration process.
Funding would go towards stemming the nightmares, sleep and eating disorders, and intrusive memories that prevent trauma victims from settling in a new society.
VAST counsellors start with grounding techniques that allow patients to work through intrusive memories. They are often introduced to group therapy where they can talk with other victims of trauma.
These services act as a linchpin for integration, said Friesen. For him, trauma care and housing are the biggest challenges facing the resettlement of refugees.
“It’s usually when they settle, let their guard down and register in school when the trauma starts to exhibit itself,” said Friesen.
Alsaleh says that he avoided some of the fallout of trauma because he spoke English before he arrived. That helped him gain access to emotional support from the local community.
“Don’t underestimate the power of hugs,” said Alsaleh.
“Providing [Syrian refugees] with a normal life — a simple house and an English course — will actually motivate them to do a lot of things,” said Alsaleh, who also believes in the importance of trauma care.
“It would have helped a lot if I had had professional help from an organization whose main concern is survivors of torture. I have never heard of that.”
He also agrees with Friesen that a holistic approach must be taken in order to integrate refugees.
“Refugees will be assessed physically only, but there is the mental, social, intellectual and spiritual,” said Alsaleh.
For Mazur, trauma counselling is a big step on the road to integration.
“If you can get early intervention — stabilizing yourself and your psychological state — you are able to do some more of the basic work around learning a language,” said Mazur.
“Take the trauma piece away and just look at the settlement piece. It’s hard enough. Then put the trauma piece on top and it’s incredibly daunting.”