Syria’s war fueled a nationwide mental health crisis, and eroded the institutions needed to deal with it. And yet the country has key assets needed to start filling the gap. The subject of mental health, which used to be taboo, is more socially accepted than ever before. A formidable array of Syrian NGOs has developed extensive, hands-on expertise in this field. Both the government and its international partners are open to devoting more attention and funds to this long-neglected sector. For now, though, the result is chaos: Rare are the Syrians who find the psychological support they need, in a bewildering maze of scattered services and amateur self-help tips. For the sector to deliver on its promise, its architects must shift from scattered initiatives to more sustained, systematic institution building. In the meantime, Syrian communities are improvising ways to support themselves and each other.
Insight
“What Syria really needs,” argued a small business owner during a stroll around Aleppo’s citadel, “is psychological support.” The remark was a non-sequitur: It came unexpectedly in the midst of a conversation about the country’s battered manufacturing sector. But it was also typical of Syria today: In interviews and casual conversations, concerns around mental health crop up everywhere, and extend far beyond the direct effects of war. Mothers and teachers speak openly about the pain of dealing with traumatized, sometimes aggressive children. Fathers out of work acknowledge the shame of being unable to provide for their families, or of being too short on cash to maintain social relationships. “Financial problems have really made friendships difficult,” said an unemployed man in Homs. “I go for walks with my wife and child in public spaces, and avoid friends because I don’t want to spend money in cafes and restaurants.”
The frequency of these acknowledgments is striking, in a society where stigma is often cited as an obstacle to scaling up mental healthcare. And, to be sure, the levels of openness vary widely, along lines visible globally: Educated youth, steeped in globalized culture and social media, are more plugged into the vocabulary of mental health than their older or less affluent counterparts. Social mores make it easier for women to open up about their emotions than men, although in conservative spheres husbands might prevent their wives and daughters from speaking to professionals. A woman mentioned that she quit therapy under pressure from her husband, who disapproved of her sitting alone with a male therapist behind closed doors. A pharmacist recalled a mother who surreptitiously came in with a prescription to medicate her severely depressed daughter; when her husband found out, he forced their daughter to abruptly discontinue treatment.
And yet the unmistakable trend is toward more open discussion of psychological ills, and recognition of the need to tackle them. This reflects a mix of worldwide and distinctly Syrian transformations. Globally, Syria’s war coincided with an era of growing public awareness around mental health. This happened as Syrian society became ever more exposed to the outside world, through both social media and the migration of millions of Syrians. Many fled to countries where the language of mental health was more mainstream than back home; some have now returned to Syria, bringing with them an updated set of perspectives and experiences. “The patients who come to our clinic for psychiatric support are generally returnees,” said an international employee with a medical NGO. “Many of those were prescribed something outside Syria, and come back wanting follow-up and medication.”
Within Syria, meanwhile, mental health imposed itself: first via an explosion of wartime trauma, then through the quieter misery of economic collapse. Even before the regime’s fall, the topic was gaining momentum. “The stigma has clearly declined because the needs are so unmistakable,” argued a psychiatrist in Damascus, speaking in 2019. “People from all different social backgrounds come into my clinic. Some initially resisted asking for help, but eventually realized that it was necessary.” The slow dissipation of stigma only accelerated with the abrupt opening of Syria’s public space: “Since the regime fell, suddenly people can speak out,” said an NGO worker who provides counseling for men. “This is good, but it also means things that were covered up get unleashed all at once.”
The war itself had also triggered a surge in humanitarian funding for mental health programs. The proliferation and professionalization of Syrian NGOs included medical outfits with specialized competence in mental health, alongside countless other organizations delivering more basic forms of “psychosocial support.” Many took shape in rebel-held Syria and refugee-hosting states like Germany and Türkiye, where they benefited from steady funds, freedom of operation, and up-to-date training. Providers in regime-controlled Syria faced tighter constraints, but evolved nonetheless. Interventions like the World Health Organization’s Mental Health Gap Action Programme (mhGAP) trained general practitioners in core mental health principles.
Syrian practitioners rightly critique these initiatives, which suffered all the familiar shortcomings of donor-funded aid programs. The sector’s emphasis on quantitative metrics led organizations to focus on maximizing the number of providers trained and “beneficiaries” treated—sometimes at the expense of adequate follow through. “The mhGAP training is very relevant,” argued a psychiatrist in Damascus, “but most of the time there is no follow-up to see how it’s being applied. Many NGOs participate in order to be able to say they’ve done it.” Another psychiatrist noted how donor dependence threatened the continuity of programs where longevity is paramount: “If donors support us, we work. If not, we stop.”
Those problems notwithstanding, the flurry of aid programs was one factor among several that helped spread the logic and language of mental health within Syria. The shift is now visible within a transitional government heavily infused with Syrians who raised their profiles through the NGO sector. Hence the fact that Syria’s current Minister of Health—a German-trained neurosurgeon and veteran of the wartime aid response—has made a well-publicized effort to embrace mental health as a government priority. Fairly enough, skeptics ask whether such acknowledgment reflects a serious strategy versus an appeal for donor funds. Whatever the answer, what’s undeniable is that the vocabulary of mental health is now front and center: from cafes and community centers to Syrian state media.
Disorder
This normalization helps explain the fluency with which ordinary Syrians speak not just about their own distress, but about the abysmal state of a sector struggling to meet the needs of virtually anyone: from the severely ill to those with milder conditions. Indeed, plenty of Syrians decline to seek professional help not for lack of awareness, but because they are all too conscious of the sector’s shortcomings. Many complain, for example, of having made the difficult choice to consult a psychiatrist—only to encounter a professional who gives them five minutes of his time, prescribes medication, and charges a painfully high price. An elderly woman in Damascus shared a common view: “Psychiatrists don’t want to talk to you. They just listen briefly and write a prescription.”
Her frustration echoes global critiques of Western psychiatry, a field that emphasizes individual, pharmacological solutions to what are often complex, collective problems. Syria, though, is an extreme case. Its acute shortage of licensed psychiatrists—widely estimated at less than 100, countrywide—means most Syrians would never see one even if they wished. Those that exist are heavily concentrated in the capital and perennially overbooked. “Psychiatrists are so backed up with appointments they can’t give patients more than five minutes,” said a therapist in Aleppo. “There’s no follow-up on the impact of medication. And many psychiatrists don’t believe in the importance of therapy. They keep the patient medicated until the last day in his life.”
This lack of attention to therapy—that is, the diverse repertoire of mental health interventions that either complement or replace psychiatric medication—is not confined to individual providers. It is a structural feature of Syria’s mental health sector, whose antiquated legal framework does not recognize therapy as a professional field. The country nonetheless has practicing therapists, who emerge in response to the very real demand for their services. But they work outside the law and with no formal oversight, constituting a kind of black market for care. Providers themselves are the first to acknowledge the problems with this setup: “Anyone can do this without any regulation or control,” said the same therapist in Aleppo. She herself works under the auspices of a local NGO, while others work from home or in the clinics of psychiatrists who take a cut of their earnings.
In Syria, as elsewhere, this market extends to the digital realm—which is even more anarchic than the physical one. Some put their questions to AI chatbots, though the practice is limited by weak internet and the fact that models like ChatGPT remain blocked by the lingering impact of sanctions. More often, they tune into mental health or wellness influencers on Instagram and YouTube. “Lately we have more and more people hearing tips from social media,” grumbled a therapist in Damascus, who works out of a psychiatrist’s office. “Maybe 20% of that advice comes from specialists, and the rest does not. These days, anyone thinks he can advise on psychological issues, and you get trends like everyone talking about narcissistic personality disorder.” Other Syrians anonymously seek advice on Facebook groups, eliciting a mix of constructive advice, bullying, and pop psychology. In response to a question about a difficult long-distance relationship, one Facebook user was alternately told: “You have a pathological attachment” and “He is a narcissist.”
This sense of disorder seeps into virtually all corners of Syria’s mental health landscape. University curricula for psychiatrists and social workers are outdated. The teaching corps has been depleted by brain-drain. Psychiatric drugs are manufactured domestically, but often rely on low-quality ingredients that undermine their efficacy. Public hospitals employ designated social workers, but they tend to be as under-equipped as the public health sector more generally: In one illustrative case, an NGO worker described the unnerving experience of watching such a social worker sit passively while a new mother sobbed anxiously over the fate of her premature newborn. Public schools likewise staff counselors, but lack credible referral mechanisms that would enable them to fulfill their role: “Students often get upset when I try to send them to the counselor,” sighed a school administrator in Damascus. “They’ll tell me, ‘I’m not crazy!’ Sometimes their parents will even come to the school, furious.”
And yet the most dilapidated elements of this sector are the ones reserved for people who need help most desperately. For patients with debilitating conditions demanding intensive, inpatient care, Syria has just three public mental hospitals. All are infamously under-resourced. Only one is located within an urban center—namely Ibn Rushd in the capital. The other two are located in the hinterlands of Damascus and Aleppo, posing barriers to access for poor families who struggle to afford transport. “Mental patients are put in the countryside, out of sight,” remarked a psychiatrist in Damascus.
Today, as throughout the war, foreign-funded aid programs play a vital role in filling gaps. But they also add to the confusion, as donors bankroll a scattered array of projects with short life cycles and tenuous coordination. Bashar al-Assad’s fall prompted a rush of Syrian and international NGOs eager to register in Damascus: a welcome development to be sure, but one that has also spurred competition. The latter notably takes place between newly arrived players and those who remained in regime territory throughout. “The people who came from Idlib are well-trained by important NGOs,” acknowledged a therapist and aid sector consultant in Damascus. “But they show no openness to exchanging expertise with those of us who were here all along. They see us as ignorant, as fuloul [regime remnants], as traitors who help other traitors.”
This messy changing of the guard, combined with deep cuts to American aid funding, has meant that services scale up in some places and collapse in others. An NGO worker in Damascus noted that his organization had 16 clinics providing free mental health support before December 2024; only three were still open a year and a half later, in May 2026. Among the areas hit hard by funding cuts were the coastal governorates of Tartous and Latakia, whose civic architecture had been hollowed out by the time the region was wracked by sectarian pogroms in March 2025. A therapist and trainer in Damascus summed up the state of things: “The coast is almost completely empty of mental health services.”
Treatment
The scope of this crisis demands forms of support that are already taking shape, on a small scale. Nurses in Aleppo’s Ibn Khaldoun psychiatric hospital have been through an intensive retraining course; local NGOs have undergone a workshop series on community-based mental healthcare; and a new set of government-run addiction treatment centers has been announced, to name just a few. Each is a partial step in the right direction. The danger is that this burst of activity proves fleeting, offering scattered relief without sustained, structured progress.
What would a well-rounded approach entail? One set of answers is clear enough, readily articulated by experts Syrian and foreign alike. Syria needs a countrywide upgrade of its public mental health infrastructure, from its obsolete legal frameworks to its under-developed corps of psychiatrists and social workers. That demands and deserves international support, which must be delivered in ways that bolster domestic institutions rather than replacing them.
These prescriptions are relevant, yet uncomfortably conventional. Some version of them has been written about countless other countries, most of them less battered than Syria. Results usually disappoint, for reasons that are themselves familiar. Public health reform is slow, expensive, and rarely a top priority in cash-strapped economies. The aid and development sector is pathologically disjointed and short-sighted, and thus fits awkwardly into fields that require sustained, coordinated support for complex systems. This weakness doesn’t mean abandoning the quest to bolster vital public institutions; but it does mean reckoning with this model’s limitations, and exploring ways to complement it.
Syrians are already doing so, whether they realize it or not. Across the country, they are probing ways to rebuild forms of community that Syrians need to heal. Indeed, for all the extreme suffering they have survived, many name loneliness as among their greatest daily struggles. War shattered family structures and pitted friends and neighbors against one another. Rather than provide closure, the transitional phase has brought new rounds of violence and vitriol—sometimes ending friendships that survived through years of conflict. Spreading poverty, combined with rising fuel prices, limits who can afford to get in a car or bus to visit friends and relatives, let alone invite them for a meal. As a result, even Syrians who have experienced complex trauma are often looking, above all, for simple forms of connection; some recoil from formal mental healthcare precisely because it feels individualistic and isolating.
This aspect of Syria’s crisis will not be solved by state institutions or NGOs. Healing also takes place as returnees rebuild the cemetery in their ruined hometown, as community leaders raise funds to fix up schools, as farmers transform their fields into spaces to exchange heirloom seeds and technical knowhow. Of course, sound policies and thoughtful aid programs can facilitate community-building, just as bad ones can undermine it: A project that helps locals set up a volunteer-run support group can have a profound and enduring impact—just as an NGO clinic that abruptly shutters after a project cycle can do serious harm. But communities do much in spite of malfunctioning institutions. Many of the down-to-earth projects they pursue are not explicitly framed as mental health initiatives, yet provide the kind of comfort they need as a starting point to recovery.
Grateful illustration credit: Safwan Dahoul, Dream 51 (2011).
