First Person

Why reporting on refugee crises requires empathy for mental health issues

July 6, 2016
Atoo Qerani comforts his wife

Zozan Qerani, 23, a Yazidi Kurd from Iraq’s Sinjar region, had just shared with me her medical records, in which a Greek doctor diagnosed her with depression, anxiety, and episodes of “conscious psychosis,” when she fainted and then started convulsing. This was three weeks ago at a Greek refugee camp. I was talking with Qerani about psychological services for residents when the seizure hit. Later, doctors confirmed that the stress of the interview had likely provoked it.

As the ongoing refugee crisis in the Middle East and Europe stretches into its second year, it is nearly impossible to cover the story without talking to sources who are under enormous stress. That often means diagnosing someone’s fitness to speak safely, a role for which most reporters aren’t trained.

But if we don’t ask people like Qerani to talk frankly, and on the record, then the story of more than 600,000 people estimated to be suffering serious mental trauma, including suicide risk, and the strain they’ve placed on medical systems across the continent, quickly becomes impossible to cover. Lacking the kind of eyewitness evidence refugee testimonies provide, there’s nothing to report, and editors and readers will tire of the story.

The scope of the mental health problems among refugees is staggering: at least half of the more than 1.2 million new refugees to Europe needed treatment for depression, anxiety or post-traumatic stress disorder, according to a September study by Germany’s Federal Chamber of Psychotherapists.

Faced with a 50 percent chance that a source may be grappling with a stress disorder, reporters covering the refugee crisis face a number of ethical quandaries, foremost the need to consider a source’s health, the meaning of “consent” given by someone grappling with mental anguish, and the accuracy of firsthand accounts from people still traumatized by the events they are describing.

“What we’ve learned about people experiencing trauma is you can’t take what they say at face value,” Mike Jempson, director of MediaWise, a UK media watchdog that often works with reporters and sources on covering trauma, told me by phone after I’d returned from Greece.

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“It happens every day,” her husband Atoo said matter-of-factly amid her seizure, and Zozan confirmed this later.


In Zozan Qerani’s case, I was asking a person diagnosed with a profound stress disorder to talk about the emotional, violent events that caused that stress. I found myself wondering if a reporter’s standards were enough, or whether my lack of psychological training would cause me to miss something important in the conversation. “You can’t be sure that what you’re hearing is strictly, factually accurate,” Jempson says.

Then I had to verify those events, or at least verify that she believed them enough to cause herself harm. Even more than most people, trauma sufferers’ painful connection to an event can cause them to leave important details out, often without realizing it, even if the subject is not intentionally lying, Jempson says. “You either have to not do the interview, or you have to circumscribe what they say.”

Consent to share information, and communicating what consent means, is also a common problem for those covering the vast refugee story. In a recent summary of its coverage of the migration story, “Covering a Crisis,” Magnum Photo devoted a section of the project website to “Theory and Practice,” discussing the particular challenges of telling these stories. The package quotes the director of Amnesty International’s program on refugees and migrants, Steve Symonds: “We’re very cautious at Amnesty to avoid the use of images where we think people–dead or alive–are robbed of their agency and presented merely as victims. It becomes extremely difficult to engage with someone about what the consequences of giving their image or story might be before they have got to a destination, before they have resolved the circumstance that has driven them to be on the move.”

In Lesbos, the terms of my interview had been established before beginning. I told them I was writing for TakePart, a website published in Los Angeles. Qerani and her husband Atoo, 28, who translated his wife’s Kurdish, are unofficial leaders of a small Yazidi community in a camp of about 900 people. Both had experience speaking to international press, and they knew I intended to ask personal questions, publish their answers, and that a photographer would take pictures of them. They said okay.


Qerani rests as she recovers from her seizure on June 16. (Photo: Maro Kouri)

But I soon had second thoughts. A few minutes into the discussion, I’d noticed a four-inch scar on Qerani’s wrist, which she had not advertised but also not hidden. She confirmed that it was from a recent suicide attempt. (A doctor familiar with her case, speaking on background, would later confirm the attempt was life-threatening, and not her first.)

Do you stop the interview right there? I felt my questions grow vaguer. But Qerani stuck with it, speaking in detail of her anxiety attacks, and claiming they’d begun after she’d witnessed war crimes in northern Iraq, where her Kurdish town fell to ISIS militias in 2014.

Then, about a half hour into the discussion, she fainted, broke into convulsions, wailed wrenchingly, and tried to strangle herself with her own hands, which her husband pried back one finger at a time.

Who decides who is fit to speak to the press? Even after the seizure, which lasted about 15 minutes, she once more confirmed she wanted to be on the record, agreed I could describe the seizure in the story, and let the photographer shoot pictures of the aftermath of the attack.

Later, the photographer and I talked about how to balance Qerani’s diagnosis of frequent psychotic breaks with her ability to consent, her own agency and right to make decisions for herself, and the incident’s role in the story. Could we leave her out and still report the story?

The value of her story was clear to me. Other than the now nine-month-old German study, which predated the peak of last fall’s refugee flows through Greece, few health statistics exist for Europe’s massive refugee community. Swedish research this past March reached conclusions similar to those of the German investigation, and with nothing new to say, generated less press. The lack of data has made firsthand testimonials by sufferers like Zozan Qerani essential to reporting the ongoing story. We decided to use it.


Even with consent, focusing the story on Zozan–the “bridge figure” approach, in which a single person’s dramatic experience is used to capture a broader problem–gave me pause.


Even so, it was important to know whether Qerani had really thought through her “yes,” when I asked permission to publish private details of her medical condition on a website with a monthly readership of about 10 million, in a language she doesn’t understand. I was also concerned about the fact that her husband, surely not a disinterested party, had acted as her translator and might have downplayed the potential significance of the interview when asking for her consent.

Concerned that she’d regret her decision, I got in touch with the husband Atoo, who speaks English, by instant message. I explained to him once more that I was going to write about Zozan’s illness and detail the attack we’d witnessed.

Atoo said he’d check with her again, and later replied that she’d said she understood and was fine with it. I had to trust him, and I did. I wrote the story, leading with Qerani’s depression after her flight from Iraq.

Even with consent, focusing the story on Zozan–the “bridge figure” approach, in which a single person’s dramatic experience is used to capture a broader problem–gave me pause. Explaining the vast PTSD crisis through one person’s life has become a trope in coverage of refugees and mental health. It’s the only clear way to address a story too serious to ignore, but one that hasn’t changed much in the nine months since the landmark German study, and is a tough sell to editors without a dramatic hook.

The risk of relying on the oft-repeated narrative trick of a sympathetic individual is that it can, paradoxically, dehumanize the problem. A fill-in-the-blank “anonymous refugee facing depression” becomes, rather than a person, a bleak cliché:

“Like many other refugees, Mustafa experienced traumatic events before fleeing his homeland of Syria,” begins a January Al Jazeera America item datelined Berlin, focusing on an anonymous case. The previous October, Vice focused on an unnamed Kurdish man in a Milan resettlement camp, leading with images of a gruesome hanging archived on his cell phone. A June 8 Guardian story on PTSD diagnosis for refugees led with a generalized list of traumatizing refugee experiences–drownings off Greece, torture at home, limbo in Europe– introducing an anonymous man who speaks in horrible detail of his two children drowning off Turkey.

Those anecdotes, while powerful, are weakened by the vagueness of their sourcing, and all go on to say essentially the same thing: the crisis continues. But to the best of my knowledge, the sources in those stories were also more protected than Zozan Qerani, who went on the record but collapsed.

Is it up to the reporter to decide who is really fit to tell their own story? “It happens every day,” her husband Atoo said matter-of-factly amid her seizure, and Zozan confirmed this later. But in hindsight, if you’d told me what would happen, I’d have skipped the interview. That’s not because of guilt. I don’t feel guilty. I feel unsure whether I’m qualified to judge if the experience of the interview harmed her health.

The migration story continues. Reporters are going to keep encountering people like Zozan Qerani. A one-in-two chance exists that tapping a shoulder in a refugee camp means a reporter blundering untrained into a therapist’s role. But I’m sure my editor would not have liked how hard I tried to dissuade Qerani–who’d offered precisely the story I’d flown a long way to get, and felt was important, and already largely written–from letting me use her as a character.

Qerani’s collapse became the focus of a 5,000 word feature about a crisis in mental health services for refugees, which included three photographs of her in distress. After writing the story, I contacted the Qeranis again to confirm their participation a third time. I’d heard from a photographer still in the camp that Zozan had been involved in a security incident the day after I’d left. She’d had another seizure.

Atoo replied quickly: “When you write about my wife, think that she represents two or three thousand Yazidi woman,” he said, repeating something he’d said to me a week earlier at the camp. That wasn’t a winning argument, I thought; I wasn’t there to advance his cause. I asked him to think it over with Zozan once more, and asked how she was doing.

The husband again asked his wife again for her consent, which she again gave, he IM’d back. I trusted their answer, and we published the story. I sent it to him. He wrote back effusively that Zozan liked it.

Marc Herman is a reporter based in Barcelona. He is the author of The Wizard and the Volcano, The Shores of Tripoli, and Searching for El Dorado, and a co-founder of Deca.