Psychological “First Aid” for Refugee Families; Disseminating Information Via Bread Delivery As a Preventive Strategy in the Syrian Context

Introduction: The scale of the Syrian crisis and the short and long term mental health risks to children and families exposed to conflict and displacement represents a massive challenge for preventive interventions. There is an urgent need for research into the scope for provision of “psychological first aid” as refugees flee and cross continents in search of safety. This study tested the feasibility of a novel approach to distributing information and collecting data in refugee settings.

Methods: Questionnaires were distributed to 3000 parents and other caregivers living with children in conflict zones in Syria close to the Turkish border. Families were regular recipients of bread which was routinely provided by the local humanitarian assistance organisations WATAN and Khayr to listed families.    WATAN facilitated the employment of a local project worker who also co-ordinated volunteers. Study materials and a detailed research protocol were emailed to Turkey, where leaflets and questionnaires were printed, then transported alongside bakery supplies into Syria to three participating bakeries.  Alongside their bread distribution, identified families received a parenting information leaflet, a numbered questionnaire and a pen sealed inside the transparent plastic bag containing their bread.  The bakery staff then supervised the return of questionnaires into boxes at the bakeries.  Questionnaires were taken back to Turkey and despatched to the UK.

Results: Despite delays and difficulties associated with achieving delivery of the bakery supplies into Syria, 3000 packs were distributed successfully. Questionnaire return, which took place in less than a week, yielded 1780 responses, a return rate of 59.3%. Parents rated the leaflet positively.  Overall, the majority of families, both internally displaced people in neighbourhoods (IDP’s) and existing residents (ER’s) rated the usefulness of the leaflet as ‘quite a lot’ IDPs: 774 (60∙9%); ER’s 274 (55∙7%),  or ‘a great deal’ IDPs:262 (20∙6%); ER’s 75 (15∙2%).  400 respondents wrote comments about the leaflet, which were analysed thematically. Most comments were postive; caregivers described increased positivity, motivation and self-confidence on receiving the leaflet. Caregivers suggested modifications to address high levels of fear, bedwetting, anxiety and dealing with bereavement.  Many comments contained religious references and supplications.

Conclusions: The study demonstrates the scope for using existing humanitarian supply chains to distribute information and receive feedback directly from recipients even in high risk settings, and both the willingness of staff in NGO’s to support valued research, and the remarkable willingness of parents to respond via questionnaire, despite exceptionally challenging conditions.