Dr. Essam Daod is a Palestinian psychiatrist, psychotherapist and medical doctor who currently resides in Haifa, Israel. This year, he became the first-ever Palestinian citizen of Israel inducted into the TED Fellows program. Also a longtime human rights activist, Essam and his wife, Maria Jammal, traveled to the Greek island of Lesvos in late 2015 to join other aid workers there in providing humanitarian relief to Syrian refugees arriving by sea after fleeing their country’s brutal civil war. What he and Maria encountered on this trip drastically changed the trajectory of their lives and work: death, suffering, despair, dehumanization—every terrible consequence that war—which is “the total failure of the human spirit,” as veteran Middle East and war correspondent Robert Fisk has put it—inevitably produces. (One of Essam’s first interactions with refugees on Lesvos found him trying in vain to resuscitate a woman who had drowned while trapped facedown in an overcrowded, flooded dinghy.)
Yet, amid rafts and ships frequently capsizing and corpses of all ages washing up on the beach, Essam relentlessly spent several weeks rescuing refugees at sea, administering medical aid on the shore and treating, when he could, the psychological traumas sustained by the newly arrived. Maria, meanwhile, tirelessly devoted herself to rehabilitating refugees in the island’s hospitals and camps.
Back in Haifa after their initial trip to Lesvos, Essam and Maria realized what was (and still is) severely lacking in humanitarian relief for refugees: comprehensive mental health treatment. The couple says that despite the fact that psychological trauma is inherent to becoming and living as a refugee, mental health treatment remains marginalized, even stigmatized, in humanitarian work in crisis zones. That crucial realization catalyzed Essam and Maria’s decision to start Humanity Crew, an international aid organization that, as its website states, “deploy[s] mental health and psychosocial support to displaced populations in order to improve their mental health and wellbeing, to restore order in their lives, and to prevent further psychological escalation.” For almost three years now, Humanity Crew—which consists of nearly a dozen trained professionals, including Essam and Maria, as well as hundreds of qualified volunteers—has been carrying out its mission on the various frontlines of the refugee plight in Europe, from rescue boats and shorelines to hospitals and camps. And the organization has achieved considerable results by any measure: According to its website, Humanity Crew has provided “over 26,000 hours of mental health support to an estimate of over 10,000 refugees.”
Earlier this year, at TED2018, Essam delivered a powerful, poignant, undeniably urgent talk— “How we can bring mental health support to refugees”—that not only highlights Humanity Crew and its work, but also gives us a sobering glimpse into the magnitude of the refugee crisis in Europe and how extremely vital mental health treatment is to mitigating the psychic toll this catastrophe takes on its victims. Certainly, Essam and Humanity Crew’s extraordinary efforts are reason enough for us to want to talk in depth with him about how he and his colleagues are tackling psychological trauma among refugees; but there’s also an element of translation intrinsic in their work that might not immediately reveal itself to us, but which we’d all be the better for discerning and understanding: the translation of trauma into empowerment. Essam was generous enough to discuss all of this and more with us over email. Check out our conversation below.
Before founding Humanity Crew, you and your wife, Maria, traveled to Lesvos, a Greek island in the Aegean Sea, in order to provide aid (medical aid, in your case) to Syrian refugees arriving there after desperate, treacherous journeys from Turkey. Although words cannot fully convey the horror you witnessed and tried to ameliorate on the island’s shore, can you recount—for those of us who haven’t experienced the refugee crisis first-hand—some of your initial encounters with refugees on Lesvos?
Many stories come to mind whenever I’m asked about that early trip to Lesvos, but this is the first time—and I don’t know why—that the question has elicited my memory of an exchange I witnessed between an elderly Syrian man who had just been rescued from a refugee boat and a young European man who was working at a clothes-distribution station on the shore. The Syrian man was about 70 years old, shivering and practically begging the European man, who was about 20, for a different dry jacket because the one he’d been given was a woman’s jacket—which humiliated the elderly man. The young man refused the request, saying, “This is no time for choosing what you like; just take the jacket and say ‘thank you.’” The Syrian man returned the dry jacket and took back the soaked one he’d traveled in. He put it on and told the young man in Arabic, “I may have lost my house, but I haven’t lost my dignity.”
I think this interaction sticks with me because it shows how both refugees and those who help them are traumatized by what they experience. I could tell that the young man had a big heart and was doing the best he could with what little training he might have had, but he was also exhausted and shocked by everything happening around him and unprepared to negotiate the cultural gap between the Syrian man and himself; in other words, the young man was too traumatized to empathize with the elderly man. But perhaps more poignant for me was the Syrian man’s ability to maintain his amour propre during this exchange—especially after all he’d endured to reach Lesvos.
How did this direct engagement with refugees’ extreme traumas affect you (or translate for you)?
Overall, the engagement was, and remains, more so with the refugees themselves rather than their traumas. Of course Humanity Crew focuses on mitigating each person’s respective traumas, but we regard the refugees first and foremost as people, not tragedies. That said, I think my interactions with refugees, whether at sea or on the beach or in a camp, are the kind that rarely occur in everyday life: meetings between two human beings without any shields or concerns about identity; encounters based on pure empathy. These are not easy engagements, to be sure, but I think each one has made me a better person.
In an interview with Haaretz, you said that as vital as the medical aid you were providing on the shoreline was, Maria’s work at the time “was far more significant.” Can you describe what she was doing, as well as how she and her tireless efforts helped to catalyze the creation of Humanity Crew?
About a week after we returned home to Haifa from our first mission on Lesvos, Maria and I were sharing stories about our time in Greece with a few friends. At some point, I showed them a widely published newspaper picture of a child whom I had resuscitated after a large shipwreck on October 28, 2015. Maria looked at the photo and said, “This is Ahmed.” That was the first time I could put a name to any of the refugees I’d helped. Maria went on to tell us how Ahmed had arrived at the hospital in a catatonic state due to trauma: He barely reacted when an IV was inserted into his hand; doctors had to close his eyes at night to prevent them from getting too dry and so hopefully he could sleep. Maria slept beside Ahmed for three days, hugging and gently talking to him in Arabic. After he finally started moving again, he took Maria’s hand, led her to the glass door of the hospital room, put his hand against the pane and said in Arabic, “I want to go home.” I started crying once I heard this, because I realized right then that, despite my efforts to rescue refugees, I had neglected their psyches, their souls; yes, I’d provided lifesaving CPR, but I hadn’t done anything to address the refugees’ psychological traumas. So, both Maria’s story and her work on Lesvos woke me up to the fact that refugees need mental health treatment as urgently as they need medical aid; I was also reminded that I’m not only a medical doctor, but a psychiatrist too. This epiphany, if you will, happened on November 7, 2015; on November 28, Humanity Crew sent its first delegation of therapists to Greece. This is why I say that Humanity Crew is the spirit of Maria.
Why did you and Maria choose to name your organization Humanity Crew?
We wanted a name that did not identify in any way with race, religion or politics—a welcoming name that would not make refugees or volunteers feel uncomfortable or exploited.
Humanity Crew’s website states that the organization’s mission is “to translate trauma and suffering to healing and resilience.” What kinds of mental health treatments does Humanity Crew utilize to accomplish this translation?
The success of this translation doesn’t depend so much on the types of treatments we provide as it does on how, where and when we provide them. The traumas that refugees endure are most responsive to treatment when they’re addressed as soon as possible, whether on rescue boats, on the shore or early in the camps. In these small, crucial timeframes, we can both prevent post-traumatic stress disorder and transform traumas into empowering experiences. The longer mental health treatment is delayed, however, the more embedded traumas become and the more at risk refugees are of developing PTSD and other mental health issues.
In your talk at TED2018, you tell the story of Omar, a 5-year-old Syrian boy, and the emergency intervention you administered to him. What are some of the important, or even necessary, differences between how you approach child refugees and how you approach adult refugees?
Children’s brains are still developing, which gives them much more plasticity than adults’ brains. This allows for not just the prevention or reduction of trauma in kids, but also the opportunity to transform their traumas into empowering experiences. But, as with Omar, it’s vital to treat child refugees as soon as possible, before trauma can permanently and immutably take root in their psyches.
Adults are a different story. Their brains are fully developed and absorb the traumas of their journeys wholesale. As with child refugees, time is of the essence when treating adult refugees, but interventions with the latter focus more so on assisting these women and men process their traumas in ways that attenuate the inevitable psychological damage that refugees sustain.
In the end, whether I’m treating a child or an adult, the goal is to maximize the individual’s capacity to cope with the trauma they’ve experienced.
Can you explain the importance of communicating with refugees in Arabic, as well as why individual therapy sessions are “always done in the mother tongue of the refugee with no interpreter present”?
I believe the term “mother tongue” speaks for itself: What else in the world can comfort us in times of intense crisis as much as our mothers’ words, the language or languages we’ve heard since birth? In addition, research has demonstrated that psychosocial intervention in the mother tongue of the patient is four times more effective than an intervention administered in a foreign language or through a translator.
Many people don’t realize that traveling across seas on dilapidated, overcrowded rafts and boats is only one part of the trauma inflicted upon refugees in their migrations. Why are the periods before and after the sea journey often their own nightmares?
More often than not, refugees are fleeing countries destroyed by war; they’ve witnessed and endured onslaughts of some of the worst acts human beings can commit against each other: indiscriminate bombing and shelling, executions, torture, rape, slavery. Compounding the nearly indescribable psychological distress refugees suffer as a result of the carnage in their countries is the loss of their homes, families, friends, work, finances, education—all of the “normal” things that anchor us and provide us a solid sense of self—in essence, their lives as they know them. And refugees are risking their lives to leave their countries not because they want to, but because they’ve lost everything and fleeing to Greece or other European nations is their only chance to possibly rebuild their lives.
Then, of course, comes the nightmare of arranging and making the sea journey. This involves negotiating exorbitant costs with shady smugglers who typically lie about the ease of the trip and provide refugees with fake, non-buoyant life vests. Then come the rubber dinghies so flimsy and overcrowded that water starts entering the rafts right after they’re seaborne, forcing some refugees to toss their luggage into the sea to reduce weight, while others will actually get into the water and hang on to the sides of the rafts to lighten the load. Sometimes, the dinghies are so crammed that passengers can barely move an inch and people in the middle of the rafts end up trapped face-down in the accumulated water and drown. Or the rafts, as with the overcrowded, unseaworthy boats and ships refugees travel on too, capsize and sink because these vessels simply cannot handle sailing when over capacity. This is usually when we witness refugees drowning by the hundreds.
Those refugees who are lucky enough to reach shore and survive then must confront segregation and isolation in ramshackle camps where their lives are stripped of identity and dignity: Obtaining citizenship and employment, for example, is almost impossible for refugees who land in Europe. These grave circumstances tend to feed on and fuel themselves, leading to massive poverty, and hatred, extremism and violence directed against or by refugees. Our mission at Humanity Crew is to prevent, as much as we can, refugees from falling into such socioeconomic and -political black holes.
Many people are also unaware that a considerable number of refugees trying to get to Europe belonged to the middle and upper-middle classes in their home countries. You’ve rescued and treated a lot of such individuals. What have you learned from them about their circumstances? What are some of their stories?
I’ve learnt that war does not distinguish between rich and poor. Moreover, the fact that somebody belongs to the middle- or upper-class doesn’t afford them any more of a right to pursue survival and protect their family than someone who belongs to the lower class. The stories told to me by refugees I’ve treated are very similar, regardless of their previous class affiliations. And they could just as well be my stories or yours—stories, really, of people who want only to live in peace, comfort and security.
Sadly, finding funding to support our kind of humanitarian work is extremely difficult; even in the realm of philanthropy, mental health is largely marginalized. Because of a lack of funding, we had to make the difficult decision to close down our operations in Lesvos and Thessaloniki late last year.
On a positive note, our Athens operation has remained open and has expanded to include seven different locations throughout the city. We’ve also launched our online clinic and our training program, both of which extend Humanity Crew’s work beyond our Athens sites.
You and Humanity Crew are proof that ordinary people, people outside of governmental geopolitics, can do something about the refugee crisis—and something positive at that. From your perspective, then, how can people the world over gain a better understanding of the crisis, and what can they do to alleviate it?
Close your eyes and imagine you and all the people you love fleeing bombs, snipers, summary executions, torture, rape, slavery—all the horrors of war I mentioned earlier. Imagine then having to make a quite potentially fatal sea crossing like those I described above—only to reach shore safely and come face to face with hostile people, people who fear you’re a terrorist or a criminal or an economic threat, people who would rather push you back to your death. Now, contrast this response to that of Humanity Crew: We’re a small but dedicated group who will greet you with hugs, comfort, support, and a commitment to helping you regain your dignity and humanity. So, decide who you want to be in this crisis: the one who turns desperate people back to their deaths, or the one who embraces and shelters them?
Watch Dr. Essam Daod’s talk at TED2018 below.