"If I don't feel happy, I can't paint."
In the past four years, Hasan Abdalla has painted less and less. Instead, he keeps his canvases rolled up and stacked in a closet in his apartment in London.
Abdalla, a Syrian Kurdish painter, applied for asylum in the U.K. four years ago.
He's one of tens of thousands of refugees recently arrived in Europe, and now arriving in growing numbers. He's also one of the many struggling to cope with what he has lived through.
It took almost a year for his claim to be accepted, but he was granted five years of humanitarian protection that allows him to live and work in the U.K. He's settling into a new apartment with his wife and youngest son after a string of temporary housing.
Three days after the family moved in, there are still boxes on the floor. Abdalla's wife has unpacked two patterned cups and a small bag of Syrian coffee from home. A soccer match broadcast by Al-Jazeera plays quietly in Arabic on the TV.
In Syria, Abdalla sold his abstract and expressionist work for as much as $5,000, but in London he says he's lucky to get a quarter of that price at outdoor markets. "I used to be productive and I thought that nothing is difficult for me to paint – whatever I want, I could paint," Abdalla said.
But then he hears about another friend or family member killed in Syria. "I live that anxiety – that worry. If you are worried and anxious, you can't paint."
Abdalla's anxieties are not unusual among the refugees now flooding into Europe, a 2015 study suggests.
The German Chamber of Psychotherapists has released numbers suggesting half of the refugees in Germany are traumatized by their experiences. Most commonly, they suffer from post-traumatic-stress disorder or depression – often both.
Of those diagnosed with PTSD, 40 per cent have made plans to take their own lives. Only four per cent get psychotherapy. There are no statistics about the number of refugees who have committed suicide.
Psychotherapy is vital
Doctors who conducted the study say psychotherapy is a crucially important treatment. They warn medication isn't enough to overcome PTSD and its symptoms, which include panic attacks, heart palpitations, difficulty breathing, dizziness, and flashbacks.
For most, the flashbacks are scenes of what made them flee. More than half of the adult refugees surveyed for the German study witnessed or experienced violence. A quarter of the children surveyed have seen dead bodies.
Abdalla knows all of those things. Syrian police arrested him at an airport in 2010 as he returned from an art exhibition in Sweden. They confiscated his passport, then imprisoned and tortured him for days. Abdalla can't remember exactly how many.
After his release, Abdalla joined the Syrian uprising against President Bashar al-Assad. He recalls meeting with friends to protest with hundreds of people in the streets of Damascus.
"They wanted no more than this – just democracy." Then he remembers seeing two of his friends shot down.
"When my friends were shot dead, I knew it was my turn," he said. "So I decided to flee."
Abdalla travelled alone through Lebanon to Turkey, and then for seven days by truck to England in 2011. Along the way, he sold paintings to pay smugglers for a Danish passport and travel.
When Abdalla arrived in England, he unrolled his remaining paintings. He says what he saw on the canvas didn't match his memories of home. When he picked up a paint brush, he noticed his style had changed.
"In my last paintings there is a lot of melancholy – a lot of depression, as I believe, because everything is destroyed," he says. "No longer perfect figures; no longer known elements; no longer traditional colours; no longer that happy background of happy experiences."
Separated from his family and surrounded by strangers at a temporary refugee home, Abdalla says he began to feel depressed.
The stigma of mental illness
Authorities seldom talk to refugees about the mental health services available to them, says Alex Storer, who works for a U.K. mental health charity called Mind. Depending on a refugee's cultural background, they also might not know to ask for this kind of support because of the stigma around mental illness in their native country.
"If [refugees] haven't been supported in terms of their mental health, they're much more likely to become isolated," Storer says. "It's about making sure that integration can happen, and people are supported to be active citizens."
People who seek asylum in the U.K. can access public health services, but Storer says it's difficult to get help for mental illness. Injuries and other physical ailments are prioritized while depression, anxiety, and PTSD can go undetected and untreated. Often, asylum-seekers aren't referred to a mental health specialist until they attempt suicide or self harm.
"As far as they are not reaching the crisis point, their mental health may be deteriorating but they don't get any support around that," Storer said.
In Canada, Prime Minister Justin Trudeau has said he wants to accept 25,000 refugees by the end of 2015. Some refugees already in the country hope Canada is prepared to unpack the mental health baggage new asylum-seekers bring with them.
One of them, Ahmadou Gitteh, became a refugee while studying at Carleton University in Ottawa in 2011.
Death threats by email
He received death threats by email after rejecting a government intelligence job in his native Gambia, a narrow strip of land in Africa surrounded by Senegal. He knew it wouldn't be safe to return home, so he applied for asylum.
When he saw images of the current refugee crisis in a newscast this summer, Gitteh says he had to look away. He doesn't watch the news anymore because it makes him cry. "More and more people become me every day," he said.
Gitteh doesn't know when or if he'll see his home again. He says the thought made him want to commit suicide.
That's why he started seeing Berak Hussain, a counsellor for international students at Carleton. She has worked with refugees from different countries, but with similar struggles – trauma, grief, disbelief, anxiety and depression.
"There's a lot pain from the losses," she said. "They're people like you and I who were at the wrong end of the world when politics and violence and greed and hatred came into their lives."
Hussain says there is an extremely high chance of recovery for refugees with mental illness if they get help. Awareness is a critical first step.
Gitteh, who says Hussain saved his life, didn't know about Carleton's counselling service until the university's international student centre referred him.
Unlike Gitteh, Abdalla hasn't seen a counsellor or therapist and still struggles with feelings of isolation, vulnerability and anxiety.
He says nobody in the refugee-assistance system ever asked about his mental state.