Integration – Too Bad That it Starts in the Head

A sense of belonging cannot be found in 13.3 square meters. Rana knows that too well, but the young woman from Syria is a searcher. Every single day, trying to find the essence of what it means to be German through vapours of body odour, scraps of chats in Arab and a certain ponderousness that seems to have paralysed most of her fellows in misery. Only a flimsy curtain is left to separate her quantum of privacy in her container from the outside world, where everything is different. Where she is not allowed to be different. The culture, the language, the people – this place is not a home. Not yet. But will it ever be?

On paper, Rana should be able to integrate into any society. With 22 years, she is young, firmly educated, a student in her best years with a fervent wish to see her dreams come true. Rana is ready to re-integrate. Yet she struggles to fit in. The stumbling blocks that she encounters have many faces. Clearly there are bureaucratic barriers that hit her and all the others almost to an equal extent. But there is also something else – a stumbling block, not visible - not at first glance. One that cannot be eradicated by signing form sheets or attending language classes. And it threatens to quash not just Rana’s integration plans, but also those of hundreds of thousands of refugees. Possibly without them even realising.

Between 2015 and 2016, more than two million refugees left their home behind to make their way to Europe. Seeking shelter from their war-torn and crisis-ridden countries, they willingly accepted the danger of the Balkan route or similar dangerous routes to make their way to Europe. Thousands drowned during the journey, but most of them actually arrived in Germany, which had the highest number of people seeking asylum comparing to any other European state. Interior minister Thomas de Maiziére saw the country facing “significant challenges” at the attempt to cope with around 1.2 million refugees. The wheels of the Federal Office of Migration and Refugees were spinning incessantly. At the same time, the difficulties of integrating the masses appeared to be blatant. The majority of the asylum seekers did not know a word of German upon arrival. And even though around 70% of them were technically “fit for employment”, spokesman of the Federal Office precluded that the biggest part of them would first fall into a basic security net, long before real employment could ever be realised. All these aspects easily faded into the background when Islamic terrorism was suddenly spreading in Europe, causing people to wonder if there was room for Islam in their liberal society. Paris, Nizza – first resonating from a distance, until the wave finally swamped over Germany with bigger hits in Würzburg or Berlin by the end of 2016. But Rana does not really fit into this grid of precaution. The German language might give her a hard time, but she is a quick learner – and improved steadily after initial language classes. Back in Syria, she had just been enrolled at University. An aspiring academic – one of estimated 10% in the group of refugees, according to government surveys. And regular prayers remain her only concession to her religion, which in her eyes, has no space for radicalism. Still, Rana simply cannot let go. She cannot focus on becoming German.

And that is not surprising, says Prof. Dr. Helmut Kury, one of Germany’s leading criminologists. He interviewed Rana back in 2016, together with 824 other refugees in four big German cities. She told him her story. About how foreign men came into her house in Aleppo and deported her father. He, a high school teacher and erudite academic, had put his head above the parapet by criticising the government – and lost it while doing so. Shortly after that, she lost her home, as its former safe pillars had started cracking under the surface long age. When her mother was informed that her husband, actually a healthy man, had died of “illness” during his imprisonment, the women in her late fifties knew that their safe days in Syria were finally numbered. The children, Rana and her brother Tarek, had to flee the country. Now Rana’s predicament can be summarized with a simple code - “F 43.1” in the ICD, the “International Classification of Diseases”. The young woman suffers from PTSD, “posttraumatic stress disorder”. And it is not just her. Prof. Dr. Kury’s examination revealed that approximately on third of the refugees in Germany suffer from this disorder; roughly the same amount has clinical depression. In many of the cases, both mental diseases come through at the same time. Similar figures range from 30% up to more than 40% of PTSD-affected refugees currently living in Germany. First symptoms usually occur about half a year after a traumatic event – often referred to as “man-made-disasters”, as the event is usually is often caused by human hands. Atrocities, too hard for the human soul to process, until it bursts under the pressure. And the worst part is that these horrible images do not stay in the past. They come back, hunting in flashbacks, forcing the persons affected to experience the trauma, or pieces of it, again and again.

Rana feels the sorrow; she is constantly worried. Worried about her mother, who stayed behind in Syria, as the money was not enough to pay the traffickers for the whole family. Worried about her brother, who made friends with young Arabs in the camp, who shared an equal glimpse of forlornness and brought him in touch with alcohol and drugs. She could have been worried when her language classes got cancelled. Around 4 billion Euros will need to be invested, to pay for language courses, additional teaching staff and job preparation courses. The plan is elaborated, but until then, resources are limited. Instead, Rana was sent to a family who lived in a suburb of Munich, with no connection to an academic life or any social agglomeration. And the vision of her nearly drowning, not knowing how to swim, with her life solely depending on a life vest – it weighed heavier. Like a screaming voice in her head, obfuscating her thoughts and her will. Rene B. could not make the voices in his head go silent either. And when they became too loud, he decided to lie down on rail tracks to put his life to an end. Some policemen spotted him strolling alongside the tracks and detained him before he could succeed with his plan. Rene had seen things in Afghanistan that neither his body nor his soul could cope with. But in opposition to Rana, he is a not a refugee. He is a soldier, who had been serving as a medical orderly in Afghanistan for more than eight years, as he describes it in an interview for the magazine “Die Zeit”.

After his return from the battlefield, he started drinking alcohol excessively. At work, people noticed quickly that he appeared nerveless and inattentive. Rene locked himself up at home, abstaining from social interactions with friends and even family members. He also stopped playing football in his local club. The world kept turning, but Rene had decided to hop out. Blending in – integrating – it was no longer an option. His supervising doctor Zimmermann knows too well about the consequences of PTSD-affected soldiers. In a trauma-clinic in Berlin, he has been supervising many soldiers who suffered from comparable conditions. In fact, the number of traumatized soldiers has been on the rise, even though the last mission of the Federal forces in Afghanistan officially ended in 2014. In 2015, 235 got diagnosed with PTSD, 15% more that in the year before, even though the estimated number of unknown cases is likely to be higher. “These people have seen disastrous things that cause deep exasperation. Death and destruction, violence against women and children. The list is long.”, explains Dr. Zimmermann. The victims tend to retire from the world, in order to stay away from social interaction. Isolation is the logical consequence.

But the soldiers who acknowledge their mental health problem find help in the army. They can draw on several therapy offers, ranging from relaxation therapy, group sessions to “Tai-Chi”. Thanks to clinical investigation and thorough preparation, the therapy helps up to 80% of the patients to recover. At the centre, the people know that there is always a small amount slipping through the cracks. Nevertheless, the system is one of the best in the world, an “effective harness”, providing sufficient psychological and physical help, says Dr. Zimmermann. A new law passed in 2011 ensures that soldiers diagnosed with PTSD stay in the service of the army, in a position that is suitable for their mental condition. Without help, their integration back into society would not be possible, but the army makes sure that they are taken care of. It is pointless to say that this comprehensive safety net for soldiers does not reach out to refugees. Budget cuts would never allow such an investment. Rana herself has never seen a therapist in Germany – and if there had been an opportunity, the queue certainly would have been miles long. According to the Federal Chamber of psychotherapists, only 4% of the refugees affected by PTSD in Germany receive treatment. As most of Rana’s fellow refugees, she has been dealing with her thoughts all by herself. And most of them have been exposed to horrifying conditions – people being shot in front of their eyes, abducted, houses being bombed away. As the Danish existentialist Søren Kierkegaard stated: “It is true that life needs to be understood retrospectively, but do not forget that it also needs to be lived progressively.” But what happens when the pictures of the past are so gruesome, that their grip makes it impossible for a person to avert his gaze? It is of no surprise that, as in most of the cases, the quandary of integration is being reduced to a game of numbers. As far as the government is concerned, successful integration is rather measured by more palpable parameters, as for example the employment rate. In 2016 for example, the director of the Nuremberg Institute for Labour Market and Occupational Research (IAB) Joachim Möller stated that it would be a major success if within five years, at least 50% of the refugees could be allocated a job. There is no such a prediction for the mental health status of refugees.

Meanwhile, as Dr. Kury’s survey concluded, about 50% of the refugees actually consider to return home once the war is over. One can only hope that these fifty per cent are the ones that in Möller’s calculation would end up without a job after five years anyway, so that the placement strategy would not be in vain. Until then, the refugees keep living in the tightest of spaces, with primitive sanitary installations, next-door to foreign people from different strata of society. With the sword of Damocles in the form of denied asylum and the fear of deportation constantly swinging above their heads. But what looms inside their heads is most likely to be worse. Just like the soldier Rene B. after this return from the battlefield, many of the refugees in Germany are suicidal. The federal chamber of psychotherapists warns that around 40% of them have either toyed with the idea of taking their own live or actually tried to do so. And these are primarily young man and women – as for the data of Dr. Kury’s survey, around 60% are under 30 years old. And while the world behind the curtain is debating about how language courses can be financed and how corporations can be motivated to hire refugees, regardless of cultural and language barriers, the temper inside the camps is boiling over every once in a while. Measured by the frequency of police actions in the camps, the level of irritability and aggressiveness is very high, as indicated by repeated physical fights and assaults. This level of stress can easily be attributed to symptoms of PTSD. Dr. Zimmermann describes it as “Hyper-Arousal-Symptom” – his patients are generally strung up, nervous, easily irritated. It often comes to cases of domestic abuse. As he explains it, this is also the reason why there were many cases in Berlin where corporations refused to hire ex-soldiers. They were too scared of possible outbursts and did not want their clients and customers to “put up with the risks” of a possibly instable soldier. That is what makes it extraordinarily difficult to reintegrate them into the “normal labour market”. Meanwhile, no one seems to worry about finding jobs for refugees, who are usually traumatized to a same extend. No matter how progressive the government has been working to pave the way for a smooth integration process –amelioration measures usually take too long to realise. Months and even years of waiting have become the standard. And that even though in cases of mental illnesses, quick therapy is actually indispensable. The longer the wait, the deeper the wound. And while the time is passing by, refugee camps have long ago turned into “anti-integration”-nucleuses - even though approximately 72% actually feel welcome in Germany, regardless of the blatant occasional right-wing assaults or precaution by landlords or employers.

Especially the younger people show open rebellion. “Most of the people who came to Germany were between 15 to 30 years old and male. In criminology, that is statistically the social group mostly associated with crimes”, says Prof. Dr. Kury. He also knows how the crime rate strongly depends on the living conditions. “I have never met an imprisoned offender with no record of socialization issues”, he adds. Alone, without prospect, traumatized – the basis for integration is what is cracked down the core, not just the follow-up actions. Unsurprisingly, that is also the group most prone to radicalization influences by Salafist groups. In the meantime, Rana has returned to Munich. She is back in her old refugee camp, where she can be close to her brother. She knows that it might not be too late for her to bring him back straight and narrows. After all, he might manage to turn the corner. Integrating the masses – Rana remembers how chancellor Merkel was on the news, making history when she said “We can do it.” Germany might be able to do it. But are the refugees? Rana does not have an answer to this question. But she knows that she will keep searching.