"Imagine a safe place": Working as a psychologist with refugee children

In Jordan Médecins sans Frontières / Doctors Without Borders (MSF) are working with families who are trying to rebuild their lives

MSF psychologist Kateřina Šrahůlková and a girl draw pictures together

In Jordan people usually work from Sunday to Thursday. Friday and Saturday are weekend days. We have many patients every day; I would like to tell you about some of them. I won´t mention any names and have changed some details in order to protect their privacy.


A 15-year old girl comes to see us, together with her mother. The girl’s face and a part of her body were severely burnt during the war. After she was injured she was confined to a house, before someone reached her to help her. The family hasn´t got enough money for plastic surgery. They tell me that a burnt face means that this girl will probably never get married and have children. 

The girl is extremely shy, coy and tense. She almost doesn´t react, using minimal facial expressions. She has massive anxiety at the beginning of our sessions. 

At the end of the session she even smiles a little

Here in Jordan I work with an interpreter, but this would be difficult even in Czech. 

According to the notes the girl herself doesn´t feel any problem, she doesn´t want to talk about anything, yet her state seems to be very dramatic. Her mother says that she cries all the time. 

In the first fifteen minutes I sweat as if I was running a marathon. I hopelessly cling to the minimal information I have, but the girl starts to respond. At the end of the session she begins to answer my gentle questions using some words, not just nodding.

She even smiles a little. 


This is the first time the father of this family has come to a session with his wife and their son. The boy is 13 years old, his mother says. The boy himself doesn´t know his age. He is smiling at me. 

The father speaks about two years of hiding from conflict in his country, about constant changing of home, about fear and hopelessness and about an effort to protect his children. 

I can see in his eyes the terror he endured. It makes me shiver. 

It´s obvious that that the father is immensely exhausted, I can see in his eyes the terror he endured. It makes me shiver. 

They have been in Jordan for four years. The boy says that he is afraid sometimes. The parents say he is frightened all the time. 

For a long time the boy was afraid to go to school, even  to leave the house. 

He is still afraid of lights. 

He is still afraid to sleep in darkness. He has nightmares. He describes a working hard in the fields to help his family to earn some money. He has worked in the fields since the age of 12. His mum says that somebody tried to rape him there. He managed to escape. 

The parents are also seeking psychological help for themselves. 


Kateřina Šrahůlková and some of the MSF team in Jordan
Kateřina and her MSF colleagues in Jordan



I start to feel tired. Tired of everything. I wonder if this is worse than usual because of the additional vaccinations I got after arriving to Jordan. 

I have my first Jordanian patient. 

The patient is a girl. According to the notes she likely has autism spectrum disorder. She’s smart but her behavior is often unusual, especially in relation to touch and smell. 

Her behavior is why she is bullied at school. Children make fun of her, her mother is worrying that the girl is different, that people look at her in the streets, that she cannot control herself. She is ashamed. She feels it´s inappropriate behavior for a girl. 

She is ashamed. She feels it´s inappropriate behavior for a girl. 

It´s difficult to explain to the mother that some of the girl´s behaviors probably cannot be cured, that they are related to stress, and that if she is put under pressure, one unusual behavior is likely to morph into another. 

The girl herself says that her behavior is “insane”, but she can´t help herself. It´s difficult to live with autism, but to be an autistic girl in this setting is something I can´t imagine. 


Some more fathers come to the consultations. One entered my office smoking a cigarette. Even though it´s prohibited. He is suspected of tormenting his former wife and his older son. After a very long time, his current wife managed to convince him to visit our clinic. They came with two children. 

The boys are eight and five years old. The younger boy clearly has developmental delays, but neither child communicates verbally, not even with monosyllables. 

Neither child communicates verbally

The older son used to communicate, but after going to live with his father for several years, he stopped. 

The younger one is exploring the office without any control, the older one is sitting anxiously, he is afraid of being spoken to even with the gentlest tone, his movements are fitful, his eyes are full of fear. 

The father will allow us to work with the older child only if we will work with the younger boy as well. All this was explained by his wife later, on the phone, not in the workroom. 


I´m thinking about a boy from yesterday. 

He came here two weeks ago after an urgent phone call. We managed to squeeze him into the schedule between two other patients. 

At home he cried day and night for a week. His mother came with obvious despair in her face, although I could only see her eyes, which were full of sorrow. 

I talked with the boy about his fears. He was afraid of death, the vision of him dying kept coming to his mind as a lively image and he couldn´t think of anything else. His father had died and now he couldn´t get rid of the idea that the same destiny was waiting for him in the following days. 

We talk about fear generally, about life and death, about what death might look like

We talk about fear generally, about life and death, about what death might look like, about his imagination. 

We practised the mental technique of a safe place: imagining a safe place in his mind, which he can evoke himself. The boy grasped the idea quickly and imaginatively, he promised to practise it. He got a pencil and a notebook (he doesn´t have any at home) and we talked about the possibility of drawing his fears. 

Another Sunday…

I´m used to working with children and whole families in difficult situations in my home country, the Czech Republic. I have experience with the fact that some life stories strike me more than the others. I have developed mechanisms to protect myself.

But today´s consultation has struck me as much as any other in a long time. 

Yes, I know and I still repeat to myself that I expected that life stories of these children and their parents would be difficult. 

Today came a woman with a toddler. She said she'd had a miscarriage ten days ago. She was several months pregnant. She lost the baby because her husband beats her. Very violently. She is worried about her children. As well as the toddler she has a baby under the age of one. She refused any help we can offer in such cases (calling the authorities, who can intervene). She only wanted consultations for her and her child. 

I had another session that day, so didn´t have time to process the session with the woman, but it came back on my way to Irbid. 

I wanted to discuss it with my colleague, to ask what we can do, but I almost wasn´t able to tell her about the case. 

Hopelessness is something that always hits me hard. 

To be continued…