Interview – March 15 2019

How ‘toxic stress’ affects Syrian children

Treating the impact of conflict, hatred and loss of parental care takes dedication and a long-term commitment

Teresa Ngigi travels regularly to Syria to train the mental health and psychological and social support team for SOS Children’s Villages Syria, and provides support for Syrian children in SOS care.

Ms Ngigi has also trained mental health specialists at SOS Children’s Villages Sierra Leone and Somalia. She was also part of the emergency team responding to the landslide near Freetown, Sierra Leone, in August 2017.

In the following interview, the SOS Children’s Villages mental health and psychosocial support (MHPSS) advisor talks about the impact the eight-year civil war in Syria has on children, and the vital role of SOS Children’s Villages in providing care for children who have lost parental care or are separated from their loved ones.

What are your general observations about the mental health of children you have worked with in Syria?

Almost all of the children in our care have experienced toxic stress in one way or another. Many have suffered the consequences of war, hatred, and disaster, and all have suffered some form of abandonment. Sometimes some of these children are quite hyperactive – not the normal hyperactivity of toddlers or children, but hyperactivity characterised by a lot of aggression. That is especially evident with the boys.

How does ‘toxic stress’ manifest itself?

We have one boy in SOS care who was about six or so when the war started. He saw his father killed when a bomb hit their house. His mother disappeared and his brother ran away, and this boy was left there alone. He was captured and underwent difficult experiences. Eventually he ended up in the streets. SOS Children’s Villages rescued him when he was around 12.

This boy has a lot of symptoms of post-traumatic stress disorder as well as other co-morbid mental health challenges, meaning more than one disorder occurring at the same time. His behaviour was extremely aggressive. We are working closely with him in order to reassure him of our unconditional acceptance. It is a long process that requires dedication. What is striking is the SOS caregivers who dedicate their life and their efforts to making sure that children like this boy get all that they need, while working in very difficult circumstances, and that makes you feel there is hope.

Does the stress of war affect children in other ways?

I was in Damascus during a bombardment in the middle of the night. You could see the horror that the children were experiencing, hearing those explosions. You could see the helplessness, the rigidity and the freezing of some of the children during these scary bombings.

It is true that children can bounce back to resilience quite fast after such experiences. However, I find it quite a challenge, especially when children are still living with this toxic stress. They are still being terrorised internally, they are horrified, they feel very uncertain. Life is so unpredictable.

This conflict has caused mass disruption to families. What effect does that have?

We see cases of children whose parents died, or simply disappeared, and the children were left alone. Sometimes they moved from one caregiver to another, or they lived in the streets until they found a loving home through SOS programmes. Some of the children don’t understand their circumstances. It is very unnerving for a child not to know whether their parent is alive or dead. Uncertainty about the whereabouts of their parents or loved ones is more unnerving for a child – even for an adult – than knowing someone is dead.

Children need to be connected with their families – even if they are distant relatives – because a child who is not connected to a family may experience an identity crisis. They don’t have a sense of belonging.

I have seen this not just in Syria, but also in Somalia. An identity crisis can lead to aggressiveness or behaviour that is harmful to the child and to others. I knew of Somalia children who did not have any contact with their family, who were abandoned or were born out of wedlock, who start getting into drugs and lifestyles that were not conducive to them.

This is why it is so important to invest in family tracing in Syria. Knowing where the parents are, even if they are dead, will give the child closure.

Photo of Teresa Ngigi by Lur Katt


An estimated 3 million have missed out on education in Syria and hundreds of schools have been destroyed during the war. How does this affect children?

School plays a very important part in a child’s development. The school is not just a place to learn how to read and write. It is a place to socialise, to learn to live in a community. Schools have a lot of other positive aspects that are not only academic.

However, there is very little that has been done in schools in Syria to address the psychological needs of the children. Looking at it from the psychological aspect, children have been exposed to a lot of toxic stress - even at school. There is a lack of resources and the state is concentrating on other issues. So there is a big gap when it comes to support children psychologically within the school or community context.

What does working in Syria mean for you professionally?

As a therapist, you read a lot about trauma, you study it, analyse it, and research on it. But working here is different because you are constantly in touch with people who are living with the effects of trauma, and still living within the trauma context. It is eye-opening.

What impresses me most is to see the resilience of the people and what we call PTG – post-traumatic growth. People in Syria are going through very, very difficult experiences – experiences that would crush other people – yet there is a lot of resilience. We see this at SOS Children’s Villages. We have caregivers who have dedicated their life to helping the children, and shielding them as much as possible from anything that is going to destabilise them.

This is one of the greatest lessons I have learnt in Syria: the resilience, the post-traumatic growth, the capacity to find meaning when there is no meaning.

Syria: Key points of our work

SOS Children’s Villages opened its first village in Syria in 1981. After the war began in March 2011, the organisation extended its support to war-affected families while also responding to the refugee emergency stemming from the war and other regional unrest.

Our emergency programmes are being transformed into long-term support for children who have lost parental care or are awaiting reunification with their loved ones.


SeptemberSOS Children’s Village in Aleppo evacuated as fighting around the city intensifies; 60 children and their caregivers are safely moved to Damascus
DecemberEmergency relief programme launched to address the urgent needs of children in Aleppo and Damascus


July – SOS Children’s Village Child Friendly Space opens in Aleppo
August – SOS Children’s Villages launches campaign to get 6,000 children off the streets and back to school in Damascus


January/February – Winter coats distributed to 10,000 children in Damascus, and meals supplied to 7,500 people in Aleppo as families struggle to find warmth and shelter
October – Thousands of bags of school supplies distributed to students in Damascus, many of whom are displaced from other parts of the country


May – Expansion of emergency help to Syria’s coastal communities as the internally displaced population grows
October – Launch of assistance to Syrians and other refugees along the ‘Balkan Route’ in FYR Macedonia and Serbia
December – Hungary and Greece launch emergency projects to address the urgent needs of children and families amongst the refugee communities


January – SOS Children’s Villages joins the international aid effort to relieve the besieged town of Madaya, northwest of Damascus
September – More than 150 children and young people, along with nearly 50 employees, are safely evacuated from the SOS Children’s Village in Damascus because of shelling in the area.
October – Following a safety assessment, SOS families return to the SOS Children’s Village in Damascus after nearly a month of living in temporary facilities
November/December – SOS Children’s Villages provides more than 15,000 meals and other relief supplies daily to families in Aleppo displaced by intense fighting
December – Planning begins for a second SOS Children’s Village in Damascus with 10 family apartments and capacity for around 80 children


January – Winter clothing distribution for thousands of children begins in Aleppo area; preparations are underway to open the first of two child friendly spaces and other programmes in coastal Tartous
August – SOS Children’s Villages Syria opens a new Interim Care Centre (ICC) in Tartous for 450 unaccompanied and separated children, as well as those who have lost parental care.
October – The first of 70 children begin to move into the new SOS Children’s Village in Damascus
November – SOS Children’s Villages, in partnership with UNICEF, opens the Jaramana Drop-in Centre in the eastern Ghouta district to help around 100 children displaced by growing fighting near the capital.


February – The Jaramana Drop-in Centre, closed for a week as a safety precaution because of heavy fighting in the nearby eastern Ghouta district, re-opens for children displaced by the fighting. 
September – Al Thawra Banin School in Aleppo, heavily damaged during battles for the city, reopens for 1,800 students following a year-long reconstruction made possible by SOS Children’s Villages Syria


March – SOS Children’s Villages, which first began working Syria in 1981, continues its support for children as the country enters its ninth year of conflict. Family reunification support continues and children who have been living in interim care centres begin moving to small-group homes until they can be reunited with loved ones

[Main photo] Millions of Syrian children have been exposed to traumatic events throughout the war. [Classroom photo] Classes resume at the rebuilt Al Thawra Banin School in Aleppo, September 2018. The school suffered heavy damaged before the reconstruction project carried out by SOS Children’s Villages. Photos by Fares Haj Ebrahee