In the Al Zaatari refugee camp — a sprawl of improvised homes in northern Jordan that has been growing since the beginning of the Syrian conflict in 2011 — approximately 15,710 babies and children are among the residents whose lives have been thrown into chaos and violence.
The World Health Organisation (WHO) has expressed a special concern for the mental health of Syrian children living in refugee camps. The UN Refugee Agency reported that of all the refugees seeking support for dealing with mental illnesses and trauma, 32% are children. And with an average of 80 births per week in Al Zaatari alone, babies start life in a traumatic environment even if they did not witness the war in Syria.
It makes sense that the international aid community would focus efforts on rehabilitating children whose lives have been thrown into chaos. But could supporting the healing of parents and caregivers be as important to restoring children’s health as any program directed specifically at babies and children themselves?
A report published by The Lancet in 2016 showed that young children’s most developmentally important experiences come from “nurturing care received from parents, other family members, caregivers, and community-based services.”
The concept of “nurturing care” is broad. It includes health and nutrition, a stable environment for learning and development, protection from danger, and affectionate connections and interactions with parents and caregivers.
Cecilia Vaca Jones, program director at the Bernard van Leer Foundation and Ecuador’s former Coordinating Minister of Social Development, has experience of implementing parent support programs in some of the world’s poorest areas. (Full disclosure: Apolitical partners with Bernard van Leer on our coverage of early childhood development,)
Vaca Jones’s programs recognise that parent behaviours in the early days of a child’s life are just as important as the factors that health protocols have prioritised for years, such as birth weight, breastfeeding, or vaccination.
Criança Feliz is one such initiative. Through working with the the Ministry of Social Development in Brazil, the program workers identified the poorest families in the region: those who are enrolled in a cash transfer program that gives them financial support from the government.
The program then selected the families in this group who have children under three years old and began offering them home visits from coaches who are trained in the Care for Child Development method developed by UNICEF and the WHO.
Coaches support parents by encouraging specific behaviours that are known to improve outcomes for children living in difficult circumstances. Many of these behaviours centre around “responsive caregiving”: where the parent or caregiver pays attention to what a child is signalling and responds by meeting the child’s needs.
“Balanced, stable, and affectionate care is as important for parents as it is for their children”
Vaca Jones explains that “the way you feed a baby, eye contact, relating to your baby, singing, storytelling, playing – all of those things are part of a natural behaviour that we should enforce for parents”.
Promoting these behaviours can sometimes mean helping mothers and caregivers first overcome their own difficulties, which often get in the way of a nurturing relationship with their child. “If you can identify that the caregiver has depression and can refer them to the right service, this will have an immediate impact in the wellbeing of the baby”, says Vaca Jones.
Caregiver support in refugee camps
Similar programs are even more important in the context of refugee camps, where parents and children alike often have significant distress to overcome.
Natalie Turgut is the Child Rights Policy Adviser at the charity War Child, which has been working in camps in Jordan since 2013.
Turgut explains that the effects of fleeing war zones can be devastating for young children, but “while the war itself and the fighting and the violence can cause mental health conditions for children, as big an impact is the daily environment that they’re living in”.
The traumatic effects of war, as well as the strain of living in camps, often leads to an increase in domestic abuse and general family tensions that can arise from poverty and hardship. From a mental health point of view, this can render life in refugee camps at least as damaging for children as war situations.
Many programs in refugee camps in Jordan and beyond have recognised the importance of providing child-friendly spaces where kids can play, make friends, and process some of their pain. These projects often include some element of support for parents and caregivers, too.
But Turgut explains that experimental new programs might be uncovering better ways to help parents overcome their own difficulties, so they can, in turn, offer their children the affectionate care that’s needed for healthy development.
War Child ran one such program in the Occupied Palestinian Territories in 2017.
The trial offered support for parents as people, rather than specifically as parents. Instead of being coached in practices that could improve their interactions with their children, they were given space to express their own grief, frustration, and anger, and were offered strategies to better manage negative feelings.
Turgut says that the response rates from this trial showed a huge improvement in impact. She attributes this to the fact that these people often suffer from their own stresses and pressures that get swept aside because of a focus on their children.
Data from the program predicts that allowing them to address their own issues first will better equip these parents to care for the impact of war and the camps on their children.
Where the evidence now shows that parents have the power to mitigate the lasting effects of violence and poverty on their children, more experiments for what works best to help them do so are urgently needed. Early data shows that balanced, stable, and affectionate care is as important for parents as it is for their children. — Megan Dent