Alexandra Chen, a specialist in childhood trauma, is on her way from the Lebanese capital, Beirut, to the southern town of Nabatiyeh, where she's running a workshop for teachers, child psychologists and sports coaches who are dealing with the Syrian children scarred by war in their homeland.
"All of the children have experienced trauma to varying degree," explains Chen, who works for Mercy Corps and is training a dozen new hires for her aid group.
Her intense five-day workshop is based on skills and techniques developed in other conflict zones, used for the first time here.
"They need to know enough to understand exactly what's going on in the brain of the children they are working with," Chen says of her trainees. Her course stresses the science of severe trauma, which can be toxic for the brain.
"The human memory remembers negative memories almost four times more strongly than positive ones," she says.
Some 2 million Syrian children have been displaced by the war and more than 1 million of them are now refugees in neighboring countries. One of the biggest challenges for international aid agencies is healing the invisible scars of war in the youngest victims.
"These children have seen terrible things, like bombings and people screaming and people dying, and they've smelled blood and smoke," Chen says as she opens the course. "For them, to be connected to the world feels like a very dangerous thing."
PTSD In Children
Chen tells the trainees that long-term exposure to violence can lead to post-traumatic stress disorder, which is difficult to treat in adults and even harder to manage in kids. Children can remain hyper-alert, with an "inability to step out of survival mode," which is often expressed as anger or aggression.
This group has already seen signs of severe trauma in Syrian children who recently arrived. Chen teaches them key skills to build a sense of safety for children.
But these newly trained Mercy Corps outreach workers face an overwhelming task. More than 85,000 Syrian refugees have migrated to this part of southern Lebanon, living in the poorest neighborhoods. Aid programs are underfunded and basic needs often go unmet.
Still, international aid organizations are raising the alarm over the newest arrivals. They have lived under traumatic conditions for much longer, surviving continuous bombardments, witnessing deaths firsthand, and many need immediate help.
Chen moves between workshops in Lebanon and refugee camps in Jordan to tackle the same problem.
A Camp Where Most Refugees Are Children
We met again in Zaatari, the sprawling camp in Jordan's desert with more than 120,000 residents, 65 percent of them under 18. Here, children seem dangerously aggressive, punching, fighting or throwing rocks in the open spaces between the refugee tents and trailers.
"Acting aggressively, in many ways, is the mind's way of making sense of what happened before," says Chen, who adds that she has seen behavior change. Many have made progress in a program run by Mercy Corps in a place called Dream Land.
It's in the middle of Zaatari, where kids can feel secure. They play soccer or build sandcastles in soft sand under a large tent that protects them from the sun.
Here, kids hammer on Legos in nearby trailers, while others sit, quietly, watching Tom and Jerry cartoons.
"The fact that they can sit there for an hour of Tom and Jerry is quite remarkable" says Chen, calling it a sign of healing.
But for some, the terrible memories can still become a trigger in daily life.
"The misunderstanding about trauma is that it is an event we have been unable to deal with in the past," she explains. In severe cases of PTSD, she says, "it is the person's inability to engage with the present that is the problem."
There have been some children who sneak into Dream Land in the middle of the night, she says.
"There was a little boy who would come at 3 a.m.," she says. "He would hide in the corner of the tent and shake. The stress that he was expressing was too much in his own little mind. He was unable to sleep. So, this is where he came to find refuge."
And that was a small success, that he had found a safe place.
AUDIE CORNISH, HOST:
In Syria, some two million children have been displaced by the war. More than a million of them are now living among refugees in neighboring countries, according to the U.N. Children's Fund. Many of these children have experienced horrific trauma, which could have life-long consequences. NPR's Deborah Amos reports that one of the biggest challenges for international aid agencies is healing the emotional scars of war.
ALEXANDRA CHEN: Can I get three volunteers?
DEBORAH AMOS, BYLINE: Alexandra Chen, a specialist in childhood trauma, runs a workshop for a dozen teachers, coaches and child psychologists in Nabatieh, in southern Lebanon.
CHEN: Okay. So, Anna(ph), I'm going to be crying and you want to stop me, OK?
AMOS: The five-day course is run by Mercy Corps, based on skills developed in others conflict zones used for the first time here.
CHEN: The children have seen terrible things like bombings and people screaming and people dying, and they've smelled blood and smoke.
AMOS: Chen explains the science of trauma, why some children are unable to cope.
CHEN: For them to be connected to the world feels a very dangerous thing.
AMOS: She says long-term exposure to violence can lead to post-traumatic stress disorder - difficult to treat in adults, even harder to manage in kids.
CHEN: Think about the brain. OK. Let's draw it, actually.
AMOS: She explains to the group that trauma can change the brain. Children remain hyper alert, angry and aggressive, often unable to sleep or feel emotion.
CHEN: Hippocampus, OK?
A lot of them are learning about the brain, they're learning about what exactly profound stress means for the first time.
AMOS: Are all of them dealing with children?
CHEN: Yes, all of them will be dealing with children, and by that, I mean from ages five to 18.
AMOS: This group has already seen signs of severe trauma in children recently arrived. Chen teaches them key skills to build a sense of safety.
CHEN: So if you are running after a child, 'cause you will be running after many children, you want to try to get in front of the child and hold them. It feels dangerous as if there is someone grabbing them from behind.
AMOS: But her newly trained team faces an overwhelming task. There are more than 85,000 refugees that have moved to this part of Lebanon, living in the poorest neighborhoods. Aid programs are underfunded and basic needs often go unmet. The newest arrivals have lived under horrific conditions for much longer, and many need immediate care. And international aid organizations are raising the alarm.
CHEN: The human memory remembers negative memories almost four times more strongly than positives.
AMOS: Alexandra Chen moves between workshops in Lebanon and refugee camps in Jordan to tackle the same problems.
In Zaatari, the sprawling camp in Jordan's desert near the Syrian border, children are often dangerously aggressive, punching or fighting in the open spaces between the refugee tents and trailers. It's how children behaved when they first came here to a place called Dreamland.
It's in the middle of the camp, a place where kids can feel secure. They play soccer or build sandcastles in the soft sand under a large tent that protects them from the sun. Chen says she's seen behavior change.
CHEN: There were some who were taking rocks and really, you know, hitting each other with them in a way that was very alarming. Acting aggressively in many ways is the mind's way of trying to make sense of what happened to them before.
AMOS: Now kids hammer on Legos in a nearby trailer, some sit quietly to watch cartoons.
CHEN: The fact that they are able to sit there really for an hour of "Tom and Jerry," is quite remarkable.
AMOS: She says it's a sign of healing when a child can focus again. But for some, the terrible memories can return again and again.
CHEN: There was actually a little boy who would come 3:00 a.m. every morning. He would come and hide in the corner of Dreamland, in the tent, and he would just sit there and shake and need to be alone. His parents weren't even aware. The stress that he was experiencing in his own little mind was too much. He was unable to sleep. And so this is where he came to find refuge.
AMOS: That alone is a small success. He found a safe place. Deborah Amos, NPR News. Transcript provided by NPR, Copyright NPR.