For Philadelphia’s SWANA Communities, Mental Healthcare Access Is Slowly Improving But Barriers Remain

Razan Idris

In 2022, Faleeha Hassan, a Philadelphia-area writer, released her memoir, War and Me, recounting her experiences coming-of-age during Iraq’s wars. Within it, Hassan described how she felt after fleeing from violent militias and an abusive ex-husband, writing, "I had lost the ability to sleep at night. If I did fall asleep, I would wake a couple of hours later after having nightmares and terrifying dreams about men chasing me and trying to slay me or blow up where I was." Although harrowing, Hassan’s experiences with trauma are unfortunately not unusual for many of Philadelphia’s first-generation immigrants and refugees from the Southwest Asian and North African region. 

For many recent immigrants, access to either psychiatric services for mental illnesses or to therapeutic services for social wellness is a new phenomenon. For example, one 2009 study of Lebanese mental health after a devastating war and widespread poverty showed that despite high levels of exposure to traumatic events, “only 3.7% of subjects and only 14.6% of those with severe mental disorders received treatment”.

According to Sarah Moussa, a Syrian-American therapist raised in Pennsylvania, many immigrants are harmed by living through warfare, dictatorship, or other types of persecution and harm. “They’re not processing anything,” Moussa tells Al-Bustan, “Because they’re just always surviving and on edge, and don’t have the time and space to feel or work through what they’ve experienced. They accept that this is just how life is.” 

Rather than the persecution immigrants fled being a distinct moment in time, the ripple effects continue to follow them to the United States.

The psychological trauma that SWANA immigrants have experienced does not end because of immigration. “The 2000s after 9/11 was an extremely alienating time for SWANA immigrants,” recalls Yusra Aziz, an Iraqi-Moroccan therapist whose own father had fled Saddam Hussein’s Iraq via a student visa to Philadelphia in the 1980s.

Rather than the persecution immigrants fled being a distinct moment in time, the ripple effects continue to follow them to the United States. For example, Hassan’s memoir recounts that when she moved to New Jersey as a hijab-wearing woman, she was forced out of her first home by an Islamophobic neighbor whose husband had served in the 2003 American invasion of Iraq.

Even when approaching health professionals, SWANA immigrants often find that their trauma is poorly understood. In 2019, Samah Jabr, chair of the mental health unit at the Palestinian Ministry of Health, described for The Middle East Eye how the individualist language used by many mental health professionals does not capture social trauma which many SWANA immigrants have experienced.

“‘A lot has changed in terms of people’s willingness to talk about mental health…It’s partly because people… increasingly can say, ‘Oh my cousin’s cousin’s cousin is a therapist.’”

“The individualised model of PTSD ignores the collective aspects of the psychological experience of Palestinians,” Jabor wrote. “How can we measure the psychological impact of events not aimed at individuals, such as Israel’s new nation-state law, the Judaisation of Jerusalem or the siege of Gaza?” This is corroborated by Hassan, who wrote of her first visit to a psychiatrist in Turkey: “She simply advised me to mix with other people, read the Qur’an, and wear a blue headscarf. What could I do but thank her and leave?" 

Additionally, class is also an overwhelming barrier preventing access to mental healthcare for many SWANA communities. According to the Migration Policy Institute, “22 percent of MENA immigrants in 2019 lived in poverty, compared to 14 percent of all immigrants,” with numbers fluctuating highly between different ethnic groups.

In Pennsylvania, Moussa has struggled to overcome healthcare insurance inequality with her clients, who are often low income and cannot afford therapy sessions. “They seek me out because I’m a fluent Arabic speaker,” says Moussa, “So I do my best to accommodate them.” In addition, Aziz has seen older women’s fears that social workers will take away their children if they go to therapy. “Laws are made to be a trap you don’t understand as an immigrant,” explains Aziz, “so I was happy to have an opportunity to help them and clarify.” 

But Aziz has hope for the future. “A lot has changed in terms of people’s willingness to talk about mental health”, Aziz tells Al-Bustan. “And it’s partly because people in our communities increasingly can say, ‘Oh my cousin’s cousin’s cousin is a therapist,’ and that makes them more willing to talk.”

Moussa shares a similar sentiment, saying “It was my cousins abroad who told me I was lucky to be training to be a therapist because our communities really need it.” As time goes on, the rise in culturally-sensitive and trauma-informed mental health projects in the Philadelphia area — like Al-Bustan’s Tabadul pilot program — bode well for the future of mental health for first generation immigrants in the city.

Razan Idris is a Sudanese-American PhD candidate in History at the University of Pennsylvania and the curator of the #SudanSyllabus, working on a project tentatively titled The Colors of the Earth: Blackness in 1930s Egypt.