Syrians registering at UNHCR's Cairo offices in 2016. (Photo by UNHCR/Scott Nelson)

“Stuck” in Transit: Systematic limitations on the integration of Syrian refugees in Egypt and its impact on mental health and well-being

10/18/2019 . By Diana Rayes

According to the most recent report from the Office of the United Nations High Commissioner for Refugees (UNHCR), nearly 50 percent of the refugee and asylum-seeking population in Egypt is from Syria. A total of 250,000 Syrians have resettled across Egypt since the onset of the Syrian conflict in 2011, a number that has fluctuated significantly over the last eight years as a result of Egypt’s function as both a destination and a transit country for refugees and asylum seekers.

In 2015, the World Health Organization forewarned that Syrian refugees living in Egypt were at a higher risk of developing mental health disorders than members of the host population due to chronic unemployment, financial hardship, violations of individual rights, as well as the residual effects of trauma they experienced during conflict and as a result of recent displacement. Today, the same risks factors have been met and exacerbated by the lack of social protection mechanisms and legal enforcement in place to prevent and penalize abuse and discrimination towards refugees across Egypt.

The recent closure of a popular Syrian-owned restaurant in Alexandria is a microcosm and example of escalating tensions between Syrian refugees and members of the host community. This incident, along with the rise of deportations of Syrian refugees in Egypt and across the region, highlights an increase in hostility reminiscent of the scrutiny imposed on the Syrian population in early 2013, when perceptions of Syrian support for President Morsi led to harassment and arbitrary detentions. Nearly six years later, popular cities such as Cairo, Alexandria, and the 6th of October have become a second home for Syrian inhabitants in Egypt. However, a rapidly deteriorating economy and systematic restrictions placed on Syrian nationals have led many to consider fleeing the uncertainty, discrimination, and insecurity they face in Egypt for other countries. Thousands have already pursued both conventional and unconventional means to leave Egypt, including waiting out long periods for resettlement to Canada or the United States, or embarking on desperate journeys across the Mediterranean to reach Turkey or Europe. While the latter attempts have decreased since 2013 due to higher rates of detention and deportation along Egypt’s border, the European Union’s agreement with Egypt to stem migration flows continues to empower Egypt to instrumentalize migration for political gain.

As a result of these circumstances, Syrian refugees in Egypt have reported feeling imprisoned by restrictive policies imposed by the Egyptian government that have hindered their ability to feel safe or to feel integrated into Egyptian society. As uncertainty about a future in Egypt becomes a primary concern for Syrian refugees and asylum seekers, the Egyptian government should take heed of the traumatic impacts of its policies on the mental health and well-being of this vulnerable population.

Domestic and Legal Frameworks for Syrian Refugees in Egypt

Promises from Egypt to welcome refugees as “guests” and “neighbors” have not held true. Instead, the government has gradually imposed stricter limitations on Syrian refugees, including policies related to access to education, healthcare, labor market entry, and the right to asylum for refugees of Syrian origin. Despite being a signatory to the 1951 Refugee Convention and its 1967 Protocol, Egypt has ratified the clauses in the conventions pertaining to the aforementioned sectors with the stipulation that they are in ordinance with Egyptian law. As a result, Egypt considers refugee populations as “foreigners” and therefore places the same restrictions on rights and services as it does for non-Egyptian visitors. This severely limits refugee access to formal employment and forces those looking for jobs to pursue work informally, leaving them vulnerable to exploitation and lower wages. It also places limitations on public school access for refugee students, who are competing with Egyptian students for under-resourced classrooms and limited seats, leaving private education as the only alternative for families who may not be able to afford it. These restrictions have social ramifications on refugees, who are, as a result, subject to harassment and discrimination across all sectors. In addition, refugees from Syria of Palestinian origin face particular barriers due to policies that prohibit their registration with the UNHCR and therefore, severely restricts their access to protection and provisions and are subject to arbitrary criteria.

Egypt has reportedly violated its obligation to principles of non-refoulement (or the return of refugees to countries where they face serious threats to their lives or freedoms), with reports of arbitrary deportations and arrests of refugees of Syrian origin in-country. These violations of international law have resulted in widespread fear among Syrian refugees about their futures in Egypt, exacerbating feelings of flux, loss of control, and the likelihood of developing mental health problems that could further hinder their integration.

Mental Health Implications

An important—and often overlooked component in this space—is the long-term impact of policies on the well-being, identity, and feelings of integration among Syrian refugees in Egypt. Amid challenging circumstances for refugees and migrants in Egypt, including job and economic insecurity, refugees experience severe maltreatment, including discrimination, harassment, and lack of support from authorities, which all impact feelings of integration and certainty about the future. Refugees living in Egypt are also subject to severe job and economic insecurity, with more than 77 percent of Syrian families in debt. Poor living conditions and systematic restrictions make it impossible for refugees and asylum seekers to properly integrate and instead, has caused severe distress among the hundreds of thousands of Syrians resettled within the last decade.

While the link between mental health and social integration of refugees has been emphasized in European contexts, few countries in the region have implemented large-scale social integration plans for Syrian refugees. There is a need to shed light on the impact of restrictive policies on the mental health and social well-being of refugees attempting to integrate into a new host community. Long asylum-seeking processes and post-migration stressors can increase the likelihood for the development of mental health disorders. Members of the Syrian refugee community who are still recovering from previous or ongoing trauma inflicted by the conflict in Syria or the journey and experience of displacement, are particularly vulnerable in a context like Egypt, where access to quality mental healthcare is scarce and expensive. The urbanization of Syrian refugees also makes it difficult for NGOs and other institutions to access traumatized populations, substantiated by the stigma of mental illnesses in the Arab world and the lack of trust refugees have for members of the host community.

Even with scarce data on their mental health, other similar experiences of populations coming to Egypt can be instructive. For example, a 2008 report explored the high rates of trauma and mental illness among Iraqis living in Cairo, whose symptoms were exacerbated by intense poverty, a lack of access to education or employment, as well as ongoing stress from news back in Iraq. Long waits during the resettlement process also increased distress and likelihood of chronic heart diseases and diabetes among this population, whose access to healthcare was also contingent on their resettlement status. Similar to the Syrian situation, these circumstances drove many Iraqis to flee from Egypt, and even to return to an unstable Iraq due to the severity of their poverty and life in Egypt. This example demonstrates the difficulties the Egyptian government has exhibited historically in integrating refugee populations and begs the question of why.

Researchers have even highlighted the negative repercussions of trauma on the broader social identities of Syrian refugees living in Egypt. For example, the accumulated effects of trauma are closely interlinked with the fear of losing one’s national or physical identity and can impede the ability of individuals to “self-actualize” or reach their full potential. These results have profound implications for generations of Syrians in Egypt, as conditions continue to limit future prospects for refugee communities and as political unrest in Syria continues with no end in sight.

Significance of this Issue

Although Egypt has a much smaller number of Syrian refugees in comparison to other host countries in the region, the Egyptian government has reportedly overstated the number of Syrian refugees in the country to “nearly 500,000” as well as emphasizing the “tremendous pressure” refugees have placed on the Egyptian economy. This rhetoric has been labelled by critics as a means for the Egyptian government to capture international attention and solicit continued aid from international partners such as the European Union (EU), which remains in talks to fund the Egyptian government for the resettlement of Syrian refugees in order to curb migration to the EU. The UNHCR Commissioner has also stated his support for Egypt to host refugees for similar reasons. Refugee rights advocates, such as UNHCR and Amnesty International, have been critical of the EU supporting migration to Egypt, accusing Egypt of capitalizing on EU’s unwillingness to take on refugees for funds while providing little to support refugees in the country.

As the situation continues to deteriorate for Syrian refugees in Egypt, attention to the mental health and well-being of this population is vital. Egypt must first invest in amending policies that currently restrict the daily movements of Syrian refugees to be more inclusive of a long-term migratory group, as well as develop new policies that aim to improve the livelihoods and overall integration of refugee populations who have been in Egypt for nearly a decade. Secondly, the Ministry of Health and Ministry of Foreign Affairs must then increase access for mental health and psychosocial support services for refugees, particularly those living in urban areas, in order to promote mental health and social cohesion. As the Egyptian Ministry of Foreign Affairs, in collaboration with the UNHCR, carries out the implementation of their 2018-2019 Regional Refugee and Resilience Plan, it is important to incorporate a policy plan that addresses social integration, with a focus on mental health promotion and psychosocial functioning of refugees.

Ignoring the compounded impacts of trauma, discrimination, and systematic disenfranchisement of Syrian refugees in Egypt will lead to devastating consequences for the future, including the marginalization of a particularly able-bodied workforce and potential contributor to both economic and social development in Egypt. As Europe debates the future of Syrian refugee resettlement— with some European states including Sweden and Denmark prematurely insisting that Syria is safe to return to— the spotlight will be on the ability of regional actors to offer protection and secure livelihoods. European donor states who advocate for increasing funds for Egypt to resettle refugees must demand that Egypt invest in the well-being of refugee and asylum-seeker populations in accordance with international law and in the pursuit of sustainable regional stability.