Impact of conflict in Syria on Syrian children at the Zaatarirefugee camp in Jordan

Sinaria Abdel Jabbara* and Haidar Ibrahim Zazab

aCurriculum & Instruction Department, University of Jordan, Amman 11942, Jordan;bDepartment of Educational Psychology, University of Jordan, Amman 11942, Jordan

(Received 27 March 2014; final version received 15 April 2014)

This paper describes a study performed to investigate the impact of the conflict inSyria on Syrian refugee children. The Zaatari refugee camp in Jordan was chosenfor this task. Two control (comparison) groups of children were selected: one fromthe Jordanian Ramtha district, which is just across the border from Syria, and thatindirectly feel the consequences of the Syrian conflict, and the other from Amman,the capital of Jordan, which is far away from the border. The study compared theZaatari, Ramtha and Amman groups in terms of expressed anxiety anddepression symptoms. They were also compared with respect to their gender andage. The Zaatari children were more distressed than the others, and the symptom‘thoughts of ending your life’ was expressed only by this group. The Ramthagroup also expressed some distress. The fact that this group indirectlyexperiences the consequences of violence emphasises the dire circumstances ofchildren inside Syria who are trapped between fighting groups.

Keywords: Zaatari camp; refugees; Jordan; Syrian children; Syrian conflict;anxiety; depression; asylum seekers

IntroductionInspired by the ideals of the so-called Arab Spring, and after the collapse of theentrenched regimes in Tunisia, Libya, Yemen and Egypt, an increasing number ofSyrian citizens began taking to the streets. Their demonstrations were peaceful andtheir demands focused on achieving political and economic reform; positive changesin the regime leading to justice, human rights, equal opportunities and democracy forall citizens.

The peaceful character of the demonstrations quickly gave way to violence. TheSyrian population began taking opposing sides, for or against the regime. Thisdivide engulfed other regimes in and outside the region, thus polarising them intotwo camps striving to achieve military victory over each other. The ongoing war inSyria has all the characteristics of a bloody and ugly conflict. It is a civil war, asdescribed in official and non-official reports. It is a war supported diplomatically, finan-cially and militarily by regional and world powers. It has a sectarian element in it: Sunnivs. Shia and Alawi, (Anzalone, 2013). It attracted foreign fighters and radicalisedSyrian fighters as well. It is a war that is fought mostly inside urban centres: cities,town and villages, with the result that most of the damage occurs to the country’s infra-structure and economic sectors, and most of the victims are non-militant civilians.

© 2014 Taylor & Francis

*Corresponding author. Email: sinariajabbar@hotmail.com

Early Child Development and Care, 2014http://dx.doi.org/10.1080/03004430.2014.916074

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According to the United Nations, the death toll surpassed 100,000 in June 2013 andreached 120,000 by September 2013 (Alliance News, 2013). As many as 3.6 millionSyrians may be internally displaced, i.e. left their homes and are living somewhereinside Syria (Sharp & Blanchard, 2013). In addition, international relief agencies esti-mated that as of April 2013, more than 1,380,406 Syrians fled the country. Of thosemore than 1.1 million had left since September 2012 to so-called safe areas outsidethe Syrian borders. Turkey had 313,332 and Jordan had 441,756 registered refugees.Over 80,000 refugees live in Zaatari refugee camp, which was opened in 28 June2012 in Northern Jordan near the Mafraq Governorate according to United NationsHigh Commissioner for Refugees officials who run the camp. Life in refugee campscan be harsh with individuals and families living with uncertainty over their futureand anxiety for any members of the family still inside the war-torn areas. The impacton children in terms of their future is of continuing concern – occasioned by whatthey witnessed prior to fleeing Syria as well as by the insecurity of life in the camps.

Literature reviewIn 2000, an estimated 1.6 million people worldwide lost their lives to violence, a rate ofnearly 28.8 per 100,000 (WHO, 2002). According to information supplied by the USAgency for International Development and the Office of Foreign Disaster Assistance,the number of worldwide disasters causing complex humanitarian emergencies,i.e. internal conflicts with large-scale displacements of people (refugees) has beenincreasing, with children less than five years of age making up more than 50% ofthem. According to Nicolai (2003), more than half of the people affected by war andconflicts are children or adolescents.

War and conflict have damaging effects on children and their education (Al Zaroo &Hundt, 2003; Davies, 2004; Macksoud & Aber, 1996). This point is made by Evans,Garner, and Honig (2014) in their introductory chapter to this special issue. The graveconsequences for children entail their very survival as well as their development. Theymay be killed, injured, imprisoned, abused, starved, humiliated and traumatised bydirect negative experiences or indirectly by what happens to their parents, relatives andfriends. The children may experience psychological problems, such as nightmares,panic attacks, self-withdrawal, aggressive behaviour, insecurity and violence towardsfamily members and friends (Affouneh, 2007). According to Elbedour, Baker, and Char-lesworth (1997), children exposed to conflict situations may become adversely influencedby violence, hatred and aggression. For example, the United Nations Children’s Fund(UNICEF, 2003) reported that Palestinian children who witnessed the death or injuryof relatives and friends consequently suffered from psychological problems, such asself-doubt, withdrawal and a sense of hopelessness. The findings by UNICEF (2004)showed that 60% of Palestinian children suffered from emotional problems or behaviour-al changes. The same research carried out in 2002 on children aged 5–17 years reportsthat 73% of children suffered from psychological symptoms, 48% of children had achange in play behaviour, 46% of children suffered from negative social behaviourand 6% had current thoughts of death and revenge (UNICEF, 2004, p. 16). Moreover,teaching, most probably, becomes interrupted, and the schools become unable to teachthe children moral values or good citizenship (cf. Halstead & Pike, 2006).

Research in different contexts shows that wars and internal violence carry negativeconsequences on children, including heightened aggression and violence, revengeseeking, insecurity, anxiety, depression, withdrawal, post-traumatic stress and somatic

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complaints, sleep disorders, fear and panic, poor school performance and engagement inpolitical violence (Qouta, Punamaki, & El Sarraj, 2008; Sagi-Schwartz, Seginer, &Abdeen, 2008). The relation between armed conflict and child development is not depen-dent only on the violence level, but also affected by changes occurring in the families,communities and societies of the children as a consequence of the violence (Feerick &Prinz, 2003). The termination of hostilities and associated violence is unlikely of itselfto bring about a rehabilitation of the psychological impact on children of the horrorsthat they and young people have witnessed or experienced (Darby, 2006).Experiencedrawn from the troubles in Northern Ireland illustrates how successive generations ofyoung children develop polarised views of the society they live in, which reflect theviews and actions of the factions involved in civil strife (Leavitt & Fox, 1993).

With the rise in international terrorism and other types of violence at the outset ofthe twenty-first century, more attention has been paid to the consequences of violencefor children and youth (La Greca, Silverman, Vernberg, & Roberts, 2002; Masten &Obradovic, 2008; Osofsky, Osofsky, & Harris 2007; Sagi-Schwarz, 2008). Variousstudies tried to examine those consequences in relation to the development of childrenin different age groups, experiences, cultures and contexts. Invariably, researchersencountered the following obstacles:

(1) Longitudinal studies continue to be rare, making comparison between post- andpre-conflict situations untenable.

(2) Most of the available research in developmental sciences has been concentratedon the more economically advanced societies, whereas most of the violenceoccurs in the developing countries.

(3) The cultural traditions and bureaucratic procedures in the developing countriestend to hinder data collection and interpretation.

Research literature which examines the long-term consequences of violence or theeffective interventions which were applied remains limited. A wide-ranging searchacross multiple data bases indicated that many papers and sources dealt with thesubject but many of them were 20 and more years old. While in a real sense theseare not irrelevant, the nature of conflicts in the twenty-first century has changed – inso far as many are internal conflicts between factional groups where the ideologicalbasis is often religious and confined to a single country. An important recent sourceis provided by Werner (2012) who discusses ideas of risk, resiliency and recoveryfor children who experience war. She notes however (Werner, 2012) that more longi-tudinal research with large-scale studies are required to better understand the course anddirection of risk and resilience in children who experience war. The purpose of suchstudies would be to better understand mental health issues and interventions that arelikely to prove effective over the longer term. Much available research indicates thatchildren living in war-zone areas are at a high risk for developing various types of psy-chopathology, especially post-traumatic stress disorder (PTSD; AACAP; Tamar &Zahava, 2005; Yule, 1999). It also indicates that it is common for co-morbid disordersto exist, such as PTSD and depression, or anxiety and traumatic grief (AACAP, 1998;Laurel & Zimmerman, 2001; Pfefferbaum, 1997; Shear, 2005). Research resultssuggest that PTSD is a direct response to traumatic war experiences. If the war-related trauma is prolonged and severe, it can lead to an initial grief reaction or the indi-vidual may develop co-morbid depression (Goenjian et al., 1995; Najarian, Goenjan,Pelcovitz, Mandel, & Najarian, 1996; Terr et al., 1999). Some researchers claim that

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the overlap between PTSD and co-morbid psychological symptoms, such asdepression, may be due to the fact that these symptoms are either direct responses totrauma or that depression is a reaction to PTSD through mediating life events(Eisenbrauch, 1991; Thabet, Abed, & Vostanis, 2004; Weems, Saltzman, Reiss, &Carrion, 2003; Weine et al., 1995). Other researchers believe that co-morbidity is theresult of a complex interaction of many factors (Macksoud & Aber, 1996).

Observations and clinical interviews with children in Uganda and Mozambiquecontradicted the simple conclusion that violent years caused a generation of violentchildren (Raboteg-šaric, Žužul, & Keresteš, 1994). Many of the children neither ident-ified with the aggressors nor adapted their moral standards. Most of the children wantedpeace (Raundalenand & Dyregrov, 1991). The experiences of war could increase thepro-social behaviour of violence victims as a result of increased empathy for thevictims of violence. The pro-social and aggressive behaviours of victimised childrenin Uganda and Mozambique were investigated using the Pro-social Behavior RatingScale designed by Zuzul, Kerestes, and Vlahovic-Stetic (1990).

In Iraq, as a consequence of the 2003 American invasion the UN IntegratedRegional Information Network (IRIN) was informed that almost 50% of children didnot go to school because their parents were too scared to send them ‘school attendancefalling due to fear of abduction’ (IRIN, 2007). In the late 2004, a UNICEF spokes-woman told IRIN that because of poverty more than one million children were outin the streets trying to work to support their families and, in the process, becoming vul-nerable to exploitation and sexual abuse. And according to a May 2006 UNICEF report,25% of Iraqi children between six months and fiveyears suffered from either acute orchronic malnutrition.

In February 2003, an armed conflict erupted in Darfur, between two Sudanese rebelgroups on the one hand and the Sudanese Government aided by a militia on the other(Morgos, Worder, & Gupta, 2008). The armed conflict was long standing and highly inten-sive. Among other results, it displaced a great number of adults and children, many ofwhom ended up in refugee camps. A group of 331 internally displaced persons children,ages 6–17 years from Southern Darfur were the subject of a research to identify the impactof the armed conflict there. The researchers used the Child Post-Traumatic Stress ReactionIndex (Pynoos, Frederick, & Nader, 1987), the Children’s Depression Inventory (CDI;Kovacs, 1992) and the Extended Grief Inventory (Layne, Savjak, Saltzman, & Pynoos,2001). The results indicated that the most frequently mentioned war exposures were:forced to abandon homes, home invasions and witnessing homes burned. There were nosignificant gender differences in total exposure to war experiences. On the other hand,older children were more aware of war experiences than younger children. Girls werefound to have higher depression levels than boys. However, age did not have a significanteffect on the depression level. On the other hand, gender had no significant effect on thegrief level, whereas age had a significant effect: older children showed higher grief levelsthan younger children. Regarding trauma levels, gender showed no differences, but agedid, whereby older children showed higher clinical levels than younger children. Theresults also indicated that the strongest relationship between war exposure and depressionas well as grief is mediated through trauma.

The Republic of Croatia, which was part of former Yugoslavia, was recognised as anindependent state by the United Nations in January 1992. The Croatian designation forindependence was announced in 1991 and was followed by an armed attack on it bythe Yugoslav army. Among the many consequences of the war, there were largenumbers of displaced children who faced a whole range of losses: loss of home, loss

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of parental support and protection, loss of traditional way of living, living with distressedadults, loss of educational structure, poor physical environment, malnutrition and changesin the community (Ajdukovic & Ajdukovic, 1998). The most extensive screeningslooking at the psychological impact of war upon Croatian children (9–14 years old)were made through the UNICEF project ‘Psychological and Educational Assistance toWar Affected Children’ (Kuterovac, Dyregrov, & Stuvland, 1994; Spoljaric, 1993).The children’s distress was measured by the Impact of Events Scale (Horowitz,Wilner, & Alvarez, 1979). Three indicators were used: mothers’ assessment of children’sstress reactions; the post-traumatic stress reactions of children and the level of depressionof children during displacement. The psychological assessment by means of interviewswas done at three successive dates. The instruments used during interviews with childrenwere the Post-Traumatic Stress Reaction Scale (Child Version, PTSR-D: Ajdukovic,1993), CDI (Kovacs, 1992) and Parental Acceptance–Rejection Questionnaire(Rohner, 1984). The assessment of stress symptoms among Croatian children indicatedthat war-related stress had a negative impact on the psychological well-being of childrenfrom babies to adolescents, and displaced and refugee children were especially affected.This result agrees with the contention of (Mccallin & Fozzard, 1990), namely thatexposure to living in displacement is likely to result in a number of stress-related symp-toms in children. Children who experienced traumatic situations immediately before dis-placement were potentially at risk. So were children who lived without or with parentswho coped poorly in displacement, or who lived with families that encountered manystressful experiences or those who were housed in large collective refugee centres.

Intervention measures are normally implemented to help traumatised refugees copewith their problems. One study investigated the effect of adding physical activity to bio-feedback-based cognitive behavioural therapy (CBT-BF) intervention for refugees suf-fering from chronic pain (Liedl et al., 2011). The findings indicated that physicalactivity helped those refugees in coping with pain. It reduced their muscle tensionand heart rate in stressful situations. Instead of being overwhelmed by pain, the refu-gees learned to respond with coping strategies, including self-competence andcounter activities. Other effects of physical activity were also observed, namelyimprovements in anxiety symptoms, development of controllability and self-efficacy.It seems that physical activity acts as mood elevator whereby the biochemicalchanges which result from it contribute to positive mood and help people to dealwith pain in the same manner as antidepressant medications. In essence, physicalactivity can be a promising additional treatment component within a CBT-BF approachto chronic pain management in survivors of war and torture.

Another study highlighted the importance of psychological needs for the PTSD anddisplaced children in schools (Uguak, 2001). The study focused on children (8–14years old) in especially difficult circumstances. It describes a therapeutic programmedesigned to recognise and reduce the ill-effects and adverse consequences of traumaamong affected children and to integrate them into social institutions to lead normallives. The programme was developed by specialised psychologists and implementedby a team consisting of applied psychologists, social workers, animators or pedagogicalpersonnel, community leaders, medical assistants and nurses. The programme consistsof the following activities: music, drawing, computer games, collective sport activities,story-telling, constructive plays and puzzles. Those activities constitute psychologicaltreatments which bring about a change in behaviour of children, give them moralsupport and develop a sense of boldness, credibility and democratic atmosphereamong them (Cohen, Mannarino, & Rogal, 2001).The programme was flexible

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enough to allow children to select activities of their choice and move to other activitieslater on. Music is a therapeutic activity, which reduces tension of PSDT among the trau-matised (EMDH, 2001; Mayers, 1995). It consists of songs, dances and drama andenhances self-confidence, self-expression and creativity in a child. Drawing is anactivity that relates mainly to psychosocial needs. Children may be organised inpairs and asked to do certain tasks such as colouring. In this context, they are forcedto talk to each other and become more sociable. Psychologists can identify the problemsaffecting the children and any improvement they make by examining their drawings atdifferent time intervals. Computer games that employ more language, rather than fungames, were used in this programme. Collective sports are important activities, particu-larly football, running, volleyball and other competitive games. They provide entertain-ment for the children and enhance their self-confidence and social behaviour. Childrenwere free to select the sport of their choice. This provided good feedback on their be-haviour to the administrators of the programme. Tales (talk) Theatre allows children tore-enact their experiences. The activity of storytelling promotes good behaviour. Con-structive play encourages children to do tasks with the help of one another (Rigby,2002; Smith, 1995). It helps children become sociable and gain good interpersonalskills as they grow up. Puzzles enhance the children’s word recognition ability andlogical thinking in the process of solving a puzzle. If done in pairs, it can additionallyencourage partner children to talk to one another and become more sociable.

Turning to the situation in Syria, it seems that the provision of support for thepsychological and social well-being and recovery of children (psychosocial support)has been inadequate. According to a report by the Global Child Protection Group,98% of Syrian children surveyed reported deterioration in their psychosocial well-being. Out of the 2 million Syrian refugees,1 only 20% received some form of psycho-social support. In Jordan as of October 2013, about 113,000 children were able tocontinue their education at KG and other levels, whereas about 87,000 children wereout of school. Thus, the enrolment rate stood at about 45% in the camps and 58%outside the camps with an overall rate of about 55%. In addition, about 10,000 childrenwith specific needs had access to specialised education and psychological services incamps and host communities, and about 32,000 school-aged children benefited frominformal and non-formal education services in camps and in host communities(Syrian Refugees Education Country Profile, 2013).

Syrian children experience problems both in their home in Syria and as refugees inother countries, as attested by War Child Holland in Lebanon.2 Those problems include:(1) Fear of direct violence in their home communities in Syria (fear of attack, fear of build-ings on fire and fear at check points). (2) Displacement (lack of sense of belonging, resent-ment in the host countries against refugees, limited privacy and fear of physical and sexualabuse). (3). Lack of access to education. This does not allow them to socialise, developskills and get away from the stress of their daily lives. 4. Lack of recreation and play.This deprives them of a means of distraction from their unhappy lives. It does not allowthem to let out their energies and share feelings with their playmates. Children in thecamps were unable to play because the camps lacked safe places and because theyneeded to work. The International Labor Organization (ILO) estimated earlier in 2013that 30,000 Syrian children in Jordan were working rather than attending school.UNICEF has launched an initial conditional cash transfer programme to promote schoolattendance (Syrian Refugees Education, 2013, p. 2).

The psychosocial impact on the Syrian refugee children may be profound and longlasting. The mental health of children may be evidenced through feelings of social

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isolation, poor self-image, self-harm, aggression and depression. According to theChild Protection Working Group’s Syria Child Protection Assessment published inSeptember 2013, the main behaviour changes experienced by Syrian children include:

Unusual crying/screaming, disruption in sleep patterns, sadness, bedwetting and unwill-ingness to go to school.Boys are more likely to display aggressive behaviour, including the desire to join armedforces and armed groups. Girls are reported to show more self-harm and fear. Carers tendto limit children’s mobility outside of home and are not always able to provide attention tochildren’s needs. Their main sources of stress are the deteriorated security and also accessto basic needs (food, electricity, water and livelihoods), children’s safety and access tohealth care. Main factors contributing to deterioration are change in behaviour ofcarers, lack of access to education and recreation. (War Child Holland, 2013, p. 8)

The purpose of this study is to investigate some aspects of the impact of the war inSyria on displaced children living in Zaatari refugee camp in Jordan. In particular, thestudy aims:

To identify types and levels of anxiety and depression symptoms experienced by theSyrian refugee childrenwith reference to similar-age children in non-conflict areas close by.

MethodIn the absence of pre-conflict data about the status of Syrian refugees, it was not poss-ible to adopt the longitudinal method (comparison of post- to pre-conflict status of refu-gees). Therefore, a reference group is used in which a sample of refugee children iscompared to a similar group of non-refugee children. And since it was not possibleto travel to Syria to collect data about children who had not been exposed to violence,the control group, it was decided to do the following:

(1) To select a sample of 120 Syrian refugee children from Zaatari refugee campbetween 7 and 12 years of age that would include male and female children.All the children must have lived in the Syrian Daraa district, on the otherside of the Jordanian–Syrian border, before the Syrian conflict erupted.

(2) To select a sample of 120 Jordanian children with the same age and gendercomposition from the Jordanian Ramtha district, which is across the borderfrom the Daraa district and has similar socio-economic characteristics, i.e.people are mainly engaged in farming or small-scale businesses, and the com-munities are mostly tribal. This sample would serve as the reference group.

(3) As the fieldwork was begun, i.e. interviews conducted with Syrian refugee chil-dren in Zaatari as well as with the comparison group (Jordanian children inRamtha), the violence in Syria became more intense and closer to the border.And although the children in Ramtha did not directly experience violence,they sometimes were able to hear gun and artillery explosions nearby. Thus,it was decided to select a second comparison group of children, with similarage and gender characteristics, but who lived far away from the border. Wechose 120 children from Amman, the capital of Jordan.

Sampling

A snowball sampling technique was used to select the Zaatari Syrian refugee campsample, with randomly chosen starting point in the camp. The sample included 120

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Syrian refugee children (43 boys and 77 girls) aged between 7 and 12 years. All ofthose children used to live in the Syrian Daraa district. The samples of the twocontrol or comparison groups, from Ramtha and Amman, were selected using aquota sampling technique. The children were randomly selected from schools andwere all between 7 and 12 years old. The Ramtha sample included 120 children (64boys and 56 girls) and the Amman sample included 120 children (69 boys and 51girls). We designated children from 7 to 9 years of age as ‘younger’ while thosefrom 10 to 12 years of age as ‘older’.

Instruments

The instruments used in the study were selected for their ability to be used in the popu-lation of children making it possible to obtain information directly from the children(Appendix 1 refers)

This information is divided into two parts:

(1) Part one solicits demographic information regarding the children’s gender,place of birth and age.

(2) Part two consists of Arabic translation of the Hopkins Symptom Checklist-25(HSCL-25), which assesses symptoms of anxiety and depression for 7–12 yearsof age. It was originally designed by Parloff, Kelman, and Frank (1954) atJohns Hopkins University. It consists of 24 questions after one question(No.14: Loss of sexual interest or pleasure) was omitted because it is not appro-priate in the Arabian cultural context. Questions 1–10 relate to anxiety symp-toms, whereas questions 11–24 relate to depression symptoms, which thechildren may have experienced during the week preceding the interviews.The responses measure the symptoms on a 4-point Likert scale, which includes1 = Not at all, 2 = A little, 3 = Quite a bit and 4 = Extremely. The checklist wasaddressed to the children individually and directly during the interviewswithout the presence of their parents. A score was computed for each scaleby averaging the scale value for responses to all the items in the scale, allowingresponses to be ordered from no symptoms to extreme symptoms based on theaverage score.

Characteristics of samples (n = 360).

Sample N Age group – years Gender N

Zaatari (120) Younger (7–9) Boys 11Younger (7–9) Girls 20Older (10–12) Boys 32Older (10–12) Girls 57

Ramtha (120) Younger (7–9) Boys 10Younger (7–9) Girls 23Older (10–12) Boys 54Older (10–12) Girls 33

Amman (120) Younger (7–9) Boys 28Younger (7–9) Girls 12Older (10–12) Boys 41Older (10–12) Girls 39

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The Checklist (HSCL-25) is well documented in terms of reliability and validity. It hasbeen validated against several instruments such as: the mini international neuro-psy-chiatric interview (Mahfoud et al., 2013), Harvard Trauma Questionnaire (Orucaet al., 2008), Present State Examination (Nettelbladt, Hansson, Stefansson, Borgquist,& Nordström, 1993; Lee, Kaaya, Mbwambo, Smith-Fawzi, & Leshabari, 2008).

Data analysis

Independent t-tests were used to compare the total and subtotal scores between boysand girls and between older and younger children. For the comparison of anxietyand depression symptoms between boys and girls and between older and younger chil-dren, the Pearson chi-squared statistic χ2 was used.

Results

(1) The Zaatari sample, as given in Tables 1 and 2, shows results of the HSCL-25,including total scores as well as gender and age subscales. There were no sig-nificant differences in the total score or in the anxiety and depression subscalesbetween boys and girls. At the symptoms level, the symptom ‘poor appetite’ranked first while the symptom ‘blaming yourself for things’ ranked last.There were no differences between boys and girls except in two depressionsymptoms: (1) ‘feeling everything is an effort’, (2) ‘feeling low in energy,slowed down’. In both of these depression symptoms, boys were more inclinedto indicate than girls. There were significant differences in total score as well asin the anxiety subscale between younger and older children. Older children(10–12 yrs) evidenced more symptomology than younger children (7–9 yrs).At the symptom level, the symptom ‘poor appetite’ ranked first while‘blaming yourself for things’ ranked last. There were differences betweenyounger and older children in three symptoms: (1) ‘nervousness or shakinessinside’. (2) ‘heart pounding or racing’ and (3) ‘thoughts of ending your life’.In all those anxiety and depression symptoms, older children were more indi-cated for than younger children.

(2) The Ramtha sample is presented in Tables 3 and 4. There were no statisticallysignificant differences in the total score or in the anxiety and depression sub-scales which can be attributed to gender. The symptom ‘suddenly scared forno reason’ ranked first, while the symptom ‘thoughts of ending your life’ranked last. There was one anxiety symptom ‘nervousness or shakinessinside’ in which there was a statistically significant difference between boysand girls. Girls reported more distress than boys. There were no significantdifferences in total score or in anxiety and depression subscales betweenyounger and older children. At the symptom level, ‘suddenly scared for noreason’ ranked first, while ‘thoughts of ending your life’ ranked last. Therewere statistically significant differences between younger and older childrenin two anxiety and depression symptoms: (1). ‘nervousness or shakinessinside’, (2). ‘crying easily’. Older children were more distressed thanyounger children.

(3) The Amman sample is given in Tables 5 and 6. There were statistically signifi-cant differences in the total score and in the anxiety and depression subscales.Girls were more distressed than boys. The symptom ‘difficulty falling asleep,

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Table 1. Anxiety and depression symptoms among Zaatari children and differences on screening instruments HSCL-25 by gender (n = 120).

Symptoms! M SD

Not at all (%) A little (%)Quite a bit

(%) Extremely (%)

χ2 tBoys Girls Boys Girls Boys Girls Boys girls

Poor appetite 2.53 .978 36.8 63.2 35.7 64.3 33.3 66.7 39.1 60.9 0.215Feeling everything is an effort 2.38 1.021 29.6 70.4 21.4 78.6 50.0 50.0 52.4 47.6 9.362*Feeling low in energy, slowed down 2.31 .906 26.9 73.1 22.0 78.0 44.2 55.8 80.0 20.0 14.123*Nervousness or shakiness inside 2.24 1.061 23.7 76.3 33.3 66.7 35.5 64.5 66.7 33.3 9.973Heart pounding or racing 2.18 1.012 25.6 74.4 45.5 54.5 40.0 60.0 30.8 69.2 3.5Feeling fearful 2.11 .994 41.0 59.0 37.2 62.8 33.3 66.7 21.4 78.6 1.821Headaches 2.10 .947 42.1 57.9 40.5 59.5 26.7 73.3 20.0 80.0 3.231Difficulty falling asleep, staying asleep 2.07 .981 35.7 64.3 28.9 71.1 39.3 60.7 45.5 54.5 1.366Suddenly scared for no reason 2.03 1.100 37.0 63.0 45.8 54.2 23.1 76.9 37.5 62.5 2.937Feeling blue 1.94 .863 41.5 58.5 28.8 71.2 40.0 60.0 42.9 57.1 1.971Worrying too much about things 1.94 .955 40.8 59.2 23.7 76.3 37.5 62.5 55.6 44.4 4.52Feeling no interest in things 1.94 .866 31.8 68.2 42.9 57.1 34.5 65.5 25.0 75.0 1.427Feeling of being trapped or caught 1.94 .876 26.7 73.3 32.5 67.5 56.7 43.3 25.0 75.0 7.672Feeling lonely 1.93 1.014 33.3 66.7 50.0 50.0 30.0 70.0 33.3 66.7 2.718Feeling tense or keyed up 1.90 .920 33.3 66.7 36.1 63.9 40.7 59.3 33.3 66.7 0.439Crying easily 1.88 1.014 38.6 61.4 37.5 62.5 36.8 63.2 16.7 83.3 2.154Feelings of worthlessness 1.86 .929 31.4 68.6 31.1 68.9 42.9 57.1 70.0 30.0 6.255Felling restless, cannot sit still 1.84 .917 34.5 65.5 42.9 57.1 29.2 70.8 33.3 66.7 1.271Trembling 1.84 .698 28.9 71.1 38.5 61.5 40.0 60.0 50.0 50.0 1.267Faintness, dizziness or weakness 1.83 1.007 35.5 64.5 26.9 73.1 45.5 54.5 40.0 60.0 1.862Thoughts of ending your life 1.79 .934 33.9 66.1 28.6 71.4 44.4 55.6 62.5 37.5 3.953Spells of terror or panic 1.78 .835 36.4 63.6 35.0 65.0 40.9 59.1 0 100.0 1.941Feeling hopeless about the future 1.75 .981 31.8 68.2 42.9 57.1 31.3 68.8 50.0 50.0 2.083Blaming yourself for things 1.43 .785 36.8 63.2 21.1 78.9 40.0 60.0 75.0 25.0 4.584HSCL general anxiety Boys M = 2.00 SD = .53 .295

Girls M = 1.97 SD = .51HSCL general depression Boys M = 2.07 SD = .47 1.942

Girls M = 1.91 SD = .93HSCL total Boys M = 2.04 SD = .43 1.345

Girls M = 1.94 SD = .39

!: in descending order by average.*p < .05

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Table 2. Anxiety and depression symptoms among Zaatari children and differences on screening instruments HSCL-25 by age (n = 120).

Symptoms M SD

Not at all (%) A little (%) Quite a bit (%) Extremely (%)

χ2 tYounger Older Younger Older Younger Older Younger Older

Poor appetite 2.53 0.98 42.1 57.9 28.6 71.4 25.0 75.0 8.7 91.3 6.329Feeling everything is an effort 2.38 1.02 22.2 77.8 19.0 81.0 33.3 66.7 33.3 66.7 2.690Feeling low in energy, slowed down 2.31 0.91 23.1 76.9 31.7 68.3 25.6 74.4 10.0 90.0 2.151Nervousness or shakiness inside 2.24 1.06 44.7 55.3 21.2 78.8 12.9 87.1 16.7 83.3 10.950*Heart pounding or racing 2.18 1.01 48.7 51.3 15.2 84.8 11.4 88.6 23.1 76.9 16.467*Feeling fearful 2.11 0.99 25.6 74.4 30.2 69.8 25.0 75.0 14.3 85.7 1.418Headaches 2.10 0.95 31.6 68.4 19.0 81.0 33.3 66.7 10.0 90.0 3.853Difficulty falling asleep, staying asleep 2.07 0.98 38.1 61.9 18.4 81.6 25.0 75.0 9.1 90.9 5.970Suddenly scared for no reason 2.03 1.10 25.9 74.1 29.2 70.8 19.2 80.8 31.3 68.8 .976Feeling blue 1.94 0.86 31.7 68.3 30.8 69.2 10.0 90.0 0.00 100.0 6.455Worrying too much about things 1.94 0.96 34.7 65.3 13.2 86.8 33.3 66.7 11.1 88.9 6.917Feeling no interest in things 1.94 0.87 25.0 75.0 33.3 66.7 13.8 86.2 50.0 50.0 4.634Feeling of being trapped or caught 1.94 0.88 31.1 68.9 22.5 77.5 13.3 86.7 100.0 0.00 14.733*Feeling lonely 1.93 1.01 31.6 68.4 29.2 70.8 16.7 83.3 11.1 88.9 3.455Feeling tense or keyed up 1.90 0.92 37.3 62.7 19.4 80.6 14.8 85.2 16.7 83.3 6.213Crying easily 1.88 1.01 26.3 73.7 28.1 71.9 31.6 68.4 8.3 91.7 2.340Feelings of worthlessness 1.86 0.93 27.5 72.5 20.0 80.0 42.9 57.1 20.0 80.0 3.164Felling restless, cannot sit still 1.84 0.92 36.4 63.6 20.0 80.0 12.5 87.5 16.7 83.3 6.295Trembling 1.84 0.70 28.9 71.1 24.6 75.4 26.7 73.3 0.00 100.0 .945Faintness, dizziness or weakness 1.83 1.01 25.8 74.2 26.9 73.1 27.3 72.7 20.0 80.0 .218Thoughts of ending your life 1.79 0.93 22.0 78.0 42.9 57.1 16.7 83.3 0.00 100.0 9.315*Spells of terror or panic 1.78 0.83 34.5 65.5 20.0 80.0 18.2 81.8 0.00 100.0 4.606Feeling hopeless about the future 1.75 0.98 24.2 75.8 28.6 71.4 31.3 68.8 20.0 80.0 .619Blaming yourself for things 1.43 0.78 23.0 77.0 42.1 57.9 30.0 70.0 0.00 100.0 4.477HSCL general anxiety Younger M = 1.77 SD = .44 −2.74*

Older M = 2.06 SD = .52HSCL general depression Younger M = 1.87 SD = .36 −1.56

Older M = 2.00 SD = .44HSCL total Younger M = 1.83 SD = .33 −2.43*

older M = 2.03 SD = .414

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Table 3. Anxiety and depression symptoms among Ramtha children and differences on screening instruments HSCL-25 by age (n = 120).

Symptoms M SD

Not at all (%) A little (%) Quite a bit (%) Extremely (%)

χ2 tYounger Older Younger Older Younger Older Younger Older

Suddenly scared for no reason 2.35 1.05 31.3 68.8 17.6 82.4 38.2 61.8 20.0 80.0 4.411Heart pounding or racing 2.27 0.99 22.6 77.4 40.0 60.0 21.2 78.8 20.0 80.0 4.562Feeling fearful 2.23 1.04 40.0 60.0 28.6 71.4 16.7 83.3 15.8 84.2 5.487Felling restless, cannot sit still 2.23 0.92 29.0 71.0 30.0 70.0 22.5 77.5 33.3 66.7 .817Nervousness or shakiness inside 2.16 1.04 42.5 57.5 21.6 78.4 25.9 74.1 6.3 93.8 8.813*Feeling everything is an effort 1.92 0.77 25.6 74.4 31.5 68.5 20.0 80.0 50.0 50.0 1.710Crying easily 1.9 0.97 39.6 60.4 22.9 77.1 17.4 82.6 0.00 100.0 8.878*Headaches 1.88 0.87 19.6 80.4 36.7 63.3 27.8 72.2 14.3 85.7 4.162Difficulty Falling asleep, staying asleep 1.88 0.99 29.8 70.2 29.0 71.0 18.2 81.8 30.0 70.0 1.180Feeling tense or keyed up 1.8 0.76 36.2 63.8 21.2 78.8 26.3 73.7 0.00 100.0 3.594Worrying too much about things 1.75 0.76 32.7 67.3 28.9 71.1 10.0 90.0 100.0 0.00 6.376Faintness, dizziness or weakness 1.67 0.93 23.6 76.4 40.9 59.1 30.0 70.0 16.7 83.3 2.946Poor appetite 1.64 0.72 23.7 76.3 30.4 69.6 35.7 64.3 0.00 100.0 1.473Feeling low in energy, slowed down 1.64 0.84 30.9 69.1 23.3 76.7 21.1 78.9 33.3 66.7 1.099Spells of terror or panic 1.62 0.79 27.7 72.3 27.5 72.5 27.3 72.7 25.0 75.0 .014Feeling blue 1.61 0.75 28.6 71.4 31.8 68.2 10.0 90.0 0.00 100.0 3.122Feeling no interest in things 1.61 0.76 32.3 67.7 23.7 76.3 21.4 78.6 0.00 100.0 2.035Trembling 1.58 0.71 33.8 66.2 20.0 80.0 20.0 80.0 0.00 0.00 2.865Feeling lonely 1.48 0.78 26.3 73.8 24.0 76.0 50.0 50.0 0.00 100.0 4.401feeling hopeless about the future 1.47 0.70 27.6 72.4 31.3 68.8 18.2 81.8 0.00 100.0 1.085Feelings of worthlessness 1.44 0.74 24.7 75.3 27.6 72.4 33.3 66.7 75.0 25.0 4.950Feeling of being trapped or caught 1.35 0.56 24.1 75.9 31.3 68.8 60.0 40.0 0.00 0.00 3.357Blaming yourself for things 1.29 0.67 24.7 75.3 46.2 53.8 37.5 62.5 0.00 100.0 3.799Thoughts of ending your life 1.27 0.51 23.9 76.1 41.7 58.3 25.0 75.0 0.00 0.00 3.022HSCL general anxiety Younger M = 1.86 SD = .46 −1.171

Older M = 2.01 SD = .51HSCL general depression Younger M = 1.55 SD = .33 −1.48

Older M = 1.59 SD = .44HSCL total Younger M = 1.68 SD = .32 −.559

Older M = 1.77 SD = .36

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Table 4. Anxiety and depression symptoms among Ramtha children and differences on screening instruments HSCL-25 by gender (n = 120).

Symptoms M SD

Not at all (%) A little (%) Quite a bit (%) Extremely%

χ2 tBoys Girls Boys Girls Boys Girls Boys Girls

Suddenly scared for no reason 2.35 1.05 56.3 43.8 61.8 38.2 52.9 47.1 35.0 65.0 3.783Heart pounding or racing 2.27 0.989 64.5 35.5 45.0 55.0 60.6 39.4 40.0 60.0 4.442Feeling fearful 2.23 1.041 51.4 48.6 57.1 42.9 62.5 37.5 36.8 63.2 3.182Felling restless, cannot sit still 2.23 0.921 61.3 38.7 55.0 45.0 50.0 50.0 33.3 66.7 2.458Nervousness or shakiness inside 2.16 1.037 42.5 57.5 64.9 35.1 70.4 29.6 25.0 75.0 12.173*Feeling everything is an effort 1.92 0.773 59.0 41.0 53.7 46.3 48.0 52.0 0.00 100.0 3.073Crying easily 1.9 0.965 50.9 49.1 60.0 40.0 52.2 47.8 44.4 55.6 1.045Headaches 1.88 0.871 60.9 39.1 51.0 49.0 44.4 55.6 42.9 57.1 2.035Difficulty falling asleep, staying asleep 1.88 0.992 50.9 49.1 58.1 41.9 54.5 45.5 50.0 50.0 .475Feeling tense or keyed up 1.8 0.763 46.8 53.2 57.7 42.3 57.9 42.1 50.0 50.0 1.369Worrying too much about things 1.75 0.764 61.5 38.5 42.2 57.8 60.0 40.0 0.00 100.0 5.139Faintness, dizziness or weakness 1.67 0.929 51.4 48.6 59.1 40.9 60.0 40.0 33.3 66.7 1.724Poor appetite 1.64 0.719 55.9 44.1 47.8 52.2 64.3 35.7 0.00 100.0 2.538Feeling low in energy, slowed down 1.64 0.838 47.1 52.9 53.3 46.7 73.7 26.3 66.7 33.3 4.452Spells of terror or panic 1.62 0.791 53.8 46.2 47.5 52.5 72.7 27.3 50.0 50.0 2.234Feeling blue 1.61 0.748 47.6 52.4 59.1 40.9 70.0 30.0 33.3 66.7 3.011Feeling no interest in things 1.61 0.762 50.8 49.2 60.5 39.5 50.0 50.0 0.00 100.0 3.299Trembling 1.58 0.705 47.7 52.3 57.5 42.5 66.7 33.3 0.00 0.00 2.181Feeling lonely 1.48 0.778 53.8 46.3 44.0 58.3 41.7 100.0 0.00 3.626Feeling hopeless about the future 1.47 0.698 48.7 51.3 62.5 37.5 54.5 45.5 100.0 0.00 2.622Feelings of worthlessness 1.44 0.742 50.6 49.4 65.5 34.5 50.0 50.0 25.0 75.0 3.287Feeling of being trapped or caught 1.35 0.56 51.8 48.2 56.3 43.8 60.0 40.0 0.00 0.00 .276Blaming yourself for things 1.29 0.666 49.5 50.5 69.2 30.8 62.5 37.5 100.0 0.00 3.917Thoughts of ending your life 1.27 0.514 50.0 50.0 62.5 37.5 75.0 25.0 0.00 0.00 1.975HSCL general anxiety Boys M = 1.95 SD = .52 .295

Girls M = 2.01 SD = .49HSCL general depression Boys M = 1.61 SD = .36 1.942

Girls M = 1.56 SD = .29HSCL total Boys M = 1.75 SD = .39 0.036

girls M = 1.75 SD = .31

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Table 5. Anxiety and depression symptoms among Amman children and differences on screening instruments HSCL-25 by gender (n= 120).

Symptoms M SD

Not at all (%) A little (%)Quite a bit

(%) Extremely (%)

χ2 tBoys Girls Boys Girls Boys Girls Boys Girls

Difficulty falling asleep, staying asleep 1.71 0.974 58.2 41.8 60.6 39.4 62.5 37.5 41.7 58.3 1.457Feeling fearful 1.58 0.729 63.5 36.5 58.3 41.7 00.0 100.0 25.0 75.0 9.433*Trembling 1.58 0.849 64.3 35.7 54.1 45.9 25.0 75.0 25.0 75.0 6.665Feeling tense or keyed up 1.56 0.824 60.0 40.0 64.7 35.3 28.6 71.4 16.7 83.3 7.379Heart pounding or racing 1.55 0.765 64.3 35.7 60.5 39.5 12.5 87.5 00.0 100.0 13.502*Crying easily 1.53 0.864 64.9 35.1 53.6 46.4 60.0 40.0 00.0 100.0 12.764*Worrying too much about things 1.5 0.842 58.2 41.8 72.4 27.6 00.0 100.0 25.0 75.0 10.193*Felling restless, cannot sit still 1.49 0.82 64.6 35.4 56.7 43.3 00.0 100.0 14.3 85.7 12.380*poor appetite 1.49 0.84 57.3 42.7 69.6 30.4 44.4 55.6 33.3 66.7 3.433Nervousness or shakiness inside 1.48 0.788 58.8 41.3 73.1 26.9 30.0 70.0 00.0 100.0 11.139*Feeling hopeless about the future 1.48 0.907 62.1 37.9 64.7 35.3 28.6 71.4 22.2 77.8 8.085*Feeling blue 1.46 0.819 61.4 38.6 65.4 34.6 00.0 100.0 14.3 85.7 11.951*Suddenly scared for no reason 1.46 0.721 58.4 41.6 60.0 40.0 25.0 75.0 50.0 50.0 1.938Feeling everything is an effort 1.39 0.749 59.8 40.2 65.2 34.8 50.0 50.0 00.0 100.0 7.613Headaches 1.37 0.662 54.8 45.2 75.9 24.1 33.3 66.7 00.0 100.0 9.051*Feeling lonely 1.36 0.754 62.0 38.0 55.6 44.4 20.0 80.0 20.0 80.0 6.530Feeling of being trapped or caught 1.33 0.781 59.4 40.6 66.7 33.3 50.0 50.0 14.3 85.7 6.049Spells of terror or panic 1.33 0.7 62.4 37.6 47.4 52.6 25.0 75.0 25.0 75.0 5.157Blaming yourself for things 1.32 0.815 59.2 40.8 70.0 30.0 00.0 100.0 50.0 50.0 3.620Feeling low in energy, slowed down 1.29 0.6 60.9 39.1 47.8 52.2 00.0 100.0 100.0 00.0 6.845Feeling no interest in things 1.27 0.59 57.9 42.1 65.0 35.0 00.0 100.0 50.0 50.0 4.571Feelings of worthlessness 1.27 0.695 57.0 43.0 92.3 7.7 00.0 100.0 00.0 100.0 15.926*Faintness, dizziness or weakness 1.27 0.67 59.6 40.4 57.1 42.9 33.3 66.7 25.0 75.0 2.625Thoughts of ending your life 1.23 0.658 59.6 40.4 85.7 14.3 16.7 83.3 00.0 100.0 10.623*HSCL general anxiety Boys M = 1.35 SD = .34 3.058*

Girls M = 1.63 SD = .66HSCL general depression Boys M = 1.29 SD = .34 2.539*

Girls M = 1.54 SD = .68HSCL total Boys M = 1.31 SD = .32 −2.848*

Girls M = 1.57 SD = .66

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Table 6. Anxiety and depression symptoms among Amman children and differences on screening instruments HSCL-25 by age (n = 120).

Symptoms M SD

Not at all (%) A little (%) Quite a bit (%) Extremely (%)

χ2 tYounger Older Younger Older Younger Older Younger Older

Difficulty falling asleep, staying asleep 1.71 0.97 32.8 67.2 33.3 66.7 37.5 62.5 33.3 66.7 .070Feeling fearful 1.58 0.73 31.7 68.3 39.6 60.4 20.0 80.0 100.0 3.315Trembling 1.58 0.85 34.3 65.7 37.8 62.2 25.0 75.0 12.5 87.5 2.041Feeling tense or keyed up 1.56 0.82 35.7 64.3 35.3 64.7 28.6 71.4 16.7 83.3 1.008Heart pounding or racing 1.55 0.77 30.0 70.0 50.0 50.0 100.0 100.0 11.100*Crying easily 1.53 0.86 37.7 62.3 25.0 75.0 60.0 40.0 100.0 7.151Worrying too much about things 1.5 0.84 36.7 63.3 31.0 69.0 100.0 25.0 75.0 2.211Felling restless, cannot sit still 1.49 0.82 36.7 63.3 30.0 70.0 25.0 75.0 14.3 85.7 1.823Poor appetite 1.49 0.84 29.3 70.7 43.5 56.5 33.3 66.7 50.0 50.0 2.425Nervousness or shakiness inside 1.48 0.79 33.8 66.3 34.6 65.4 40.0 60.0 100.0 2.225Feeling hopeless about the future 1.48 0.91 39.1 60.9 11.8 88.2 28.6 71.4 22.2 77.8 5.423Feeling blue 1.46 0.82 41.0 59.0 19.2 80.8 100.0 14.3 85.7 7.644Suddenly scared for no reason 1.46 0.72 23.4 76.6 54.3 45.7 25.0 75.0 50.0 50.0 10.974*Feeling everything is an effort 1.39 0.75 37.9 62.1 21.7 78.3 50.0 50.0 100.0 5.193Headaches 1.37 0.66 32.1 67.9 41.4 58.6 33.3 66.7 100.0 2.384Feeling lonely 1.36 0.75 34.8 65.2 33.3 66.7 20.0 80.0 20.0 80.0 .887Feeling of being trapped or caught 1.33 0.78 36.5 63.5 20.0 80.0 50.0 50.0 14.3 85.7 3.015Spells of terror or panic 1.33 0.70 31.2 68.8 42.1 57.9 50.0 50.0 25.0 75.0 1.476Blaming yourself for things 1.32 0.82 34.7 65.3 30.0 70.0 100.0 25.0 75.0 1.383Feeling low in energy, slowed down 1.29 0.60 29.3 70.7 47.8 52.2 100.0 100.0 8.332Feeling no interest in things 1.27 0.59 33.7 66.3 35.0 65.0 100.0 50.0 50.0 1.780Feelings of worthlessness 1.27 0.70 35.0 65.0 38.5 61.5 100.0 100.0 3.779Faintness, dizziness or weakness 1.27 0.67 32.3 67.7 42.9 57.1 33.3 66.7 25.0 75.0 .742Thoughts of ending your life 1.23 0.66 36.5 63.5 28.6 71.4 100.0 100.0 5.052HSCL general anxiety Younger M = 1.44 SD = .37 −.414

Older M = 1.48 SD = .57HSCL general depression Younger M = 1.30 SD = .40 −1.34

Older M = 1.48 SD = .57HSCL total Younger M = 1.36 SD = .36 −.946

Older M = 1.45 SD = .56

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staying asleep’ ranked first, while the symptom ‘thoughts of ending your life’ranked last. There were differences between boys and girls in 11 symptoms,namely: feeling fearful, heart pounding or racing, crying easily, worrying toomuch about things, feeling restless and cannot sit still, nervousness or shakinessinside, feeling hopeless about the future, feeling blue, headaches, feeling ofworthlessness and thoughts of ending your life. In all these symptoms, girlswere more distressed than boys.

There were no statistically significant differences in total score or in anxietyand depression subscales attributable to age. The symptom ‘difficulty fallingasleep, staying asleep’ ranked first while the symptom ‘thoughts of endingyour life’ ranked last. There were statistically significant differences betweenyounger and older children in two symptoms: (1) ‘heart pounding or racing’,(2) ‘suddenly scared for no reason’. In both these anxiety symptoms, older chil-dren were more distressed than younger children.

A one-way ANOVA was used to test for differences in anxiety anddepression subscales as well as the total score among the three groups(samples) of children, (Table 7). The Scheffe post hoc comparisons of thethree groups indicated that both the Zaatari and Ramtha children displayed sig-nificantly greater anxiety than the Amman children. However, there was no sig-nificant difference between the Zaatari and Ramtha children in terms of anxietysymptoms.

In terms of depression, the Zaatari children displayed significantly greaterdepression symptoms than the Ramtha or Amman children. The Ramtha chil-dren, on the other hand, displayed significantly greater depression than theAmman children.

Discussion and conclusionsWith respect to depression symptoms, the Zaatari children were more implicated thanthe Ramtha children, who in turn were more implicated than the Amman children. Thesymptom ‘thoughts of ending your life’ was expressed only by Zaatari children. Thisresult is perhaps not unexpected since the Zaatari children are the refugees who experi-enced the consequences of violence first hand. With respect to anxiety symptoms, therewere no significant differences between the Zaatari and Ramtha children. Perhaps thereis an inference here to the effect that although the Ramtha children were not exposeddirectly to violence, they nevertheless felt the consequences of violence in Syria:they lived nearby on the other side of the border with hostilities approaching. This

Table 7. Differences in screening instruments HSCL-25 by group (n = 360).

Subscale SS df MS F Sig.

Anxiety Between 21.123 2 10.562 39.830* .000Within 94.664 357 0.265

Depression Between 20.747 2 10.373 55.026* .000Within 67.301 357 0.189

Total score Between 18.675 2 9.338 51.446* .000Within 64.796 357 0.182

*p < .05.

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observation should help to draw attention to the dire circumstances of children insideSyria who are trapped between fighting groups. The Zaatari children did not showany differences with respect to anxiety or depression symptoms attributed to gender.However, there were differences due to age. Older children were more likely to evi-dence symptoms than younger children. This is in line with the findings of Werner(2012) who noted that ‘The more recent the exposure to war, and the older the child,the higher was the likelihood of reported posttraumatic stress disorder symptoms.’(p. 664)

Further research at the Zaatari camp is planned. The results of this preliminary studyare not entirely unexpected. The further the children live away from the conflict andhostilities the more secure they appear to feel and the fewer are the symptoms ofanxiety and depression evidenced It is interesting that the older children – thosebeyond the middle years of childhood – are evidently more susceptible to the impli-cations of violence and strife than the younger children. Unsurprisingly perhaps, theextreme depressive and anxiety symptoms were evidenced mainly in the group of chil-dren living in the Zaatari refugee camp – they were the ones who had been at the heartof the conflict and many had experienced quite horrific acts towards members of theirown families and others. Here, there were no gender differences – boys and girls beingequally influenced and the older more than the younger. With these children, there isclearly a need for positive intervention towards rehabilitation and counselling. Theproblem however is that resources for habilitation are scarce and the need is great.Syria is not unique in this respect – the need for restoration of positive images ofself is immense in all war-torn countries where children are the collateral damage ofsavagery. Of course, the fear of war is but one aspect of a complex refugee problem– for many children the right to grow in safety, the right to nutrition, water, the rightto play and develop as healthy allround individuals are all rights that are dailydenied to the refugees in camps.

Educational activities during emergencies provide children with a safe space tobegin the trauma-healing process and to learn skills and values needed for a morepeaceful future. There is general consensus that child protection and education inter-ventions support and promote the well-being of children in emergencies; however,those measures are invariably inadequate in practice. This can be attributed to theusual shortage of funding and to the fact that child protection is neither understoodnor prioritised within emergency responses. Funding for education is usually limited.According to the inter-agency network for education in emergencies, only 2% of huma-nitarian aid goes to education.

Too little is known of the social and psychological impact of these deprivations asthe children reach maturity – and equally little is known of interventions that could – ifdeployed – help such children become happy, autonomous and self-actuating adults –committed to peaceful co-existence in complex world of political and sectariandivisions. Future research is being planned that will provide longitudinal data aimedat elucidating the longer term impact of the experience of violence and abusethrough internal conflict.

Notes1. UN Camps in Iraq, Turkey, Lebanon and Jordan by 2013.2. An independent and impartial, international non-governmental organisation investing in a

peaceful future for children affected by armed conflict.

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Notes on contributorsDr Sinaria Kamil Abdel Jabbar is an Assistant Professor of Education at the Department ofCurriculum and Instruction, The University of Jordan. Dr Jabbar also serves as Assistant tothe Director at the Office of International Relations at the University. She received her BA inEnglish Literature from Petra University in Jordan in 2002 and an M.ED and Ph.D. in EarlyChildhood Education and Adult Education from The University of Missouri-Saint Louis, in2005 and 2008, respectively. Her research interests encompass adult education, internationaleducation, refugee studies, human rights, women studies, and youth and development andhave published over eight papers in world-class journals. Dr Jabbar is an active member invarious committees including parliamentary committees for education reform in Jordan. Inher free time, Dr Jabbar loves to read, travel and participate in humanitarian activities.

Dr Haidar Ibrahim Zaza is an Associate Professor of Educational Psychology/measurement andevaluation. His current research interests include data analytics, Big Data main issues ofresearch, Educational Psychology Issues, scaling and Item Response Theory applications. Hereceived his B.A. degree in Educational Sciences from The University of Jordan (1997), MSand Ph.D. degrees in Educational Psychology from The University of Jordan (2000 and2006, respectively). Dr Zaza runs a number of local and regional projects, published over 15papers in local, regional and world-class journals. Dr Zaza’s experience in measurement andevaluation extends to 10 years in service, research, and development. Dr Zaza served in The Uni-versity of Jordan as a head of Educational Psychology Department. and director of educationalpsychology program.

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Appendix

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