Social work practices and enabling the integration of students from war and conflict zones

Until recently, few studies have examined international students’ social issues and well-being from war and conflict zones. A significant proportion of international students in Turkey have arrived from countries actively engaged in conflict; however, it is unclear how social work procedures have effectively addressed students’ needs and ability to cope after migrating. This quantitative study aimed to identify the challenges and well-being issues of 63 Syrian students who have recently integrated into Turkey. The investigation took place at Ankara Yildirim Beyazit University in Turkey, during the 2017–2018 academic year. The research is based on two measurement scales and a questionnaire. Results were analyzed using independent t-test samples and found that social workers faced challenges in integrating the students. A lack of participation in social activities and cultural challenges are common problems faced by these students. Traditional support methods were effective strategies for overcoming new social environments. The effectiveness of social work intervention is reviewed further.


Introduction
W ar and conflict are known to be particularly debilitating and socially damaging to youth. The long-term impact of war on young people requires consistent review and study in order to assess the level of impact of various conflicts on social changes. Major conflicts such as the current Syrian crisis has resulted in death, imprisonment, long-term health and psychological issues, and forced involvement in militias and terrorist organizations. Such adversities prevent the healthy growth of young people and can result in chronic problems, as they are surrounded by an unstable atmosphere and a lack of physical, psychological, and social support (Snoubar and Hawal, 2015). Young people in such war and conflict zones live in oppression, alienation, and fear for years. Such emotional and mental problems require serious clinical interventions (Zastrow, 1991). This is because war has both short-and long-term psychological impacts and is considered particularly traumatizing; therefore, clinical intervention with victims is highly recommended (Klingman, 1992). According to a report by local clinicians working with Bosnian youth, problems such as educational dropout, poor academic performance, and lack of preparation for future professional and family life increased as a result of conflict (Layne et al., 2001). Another investigation conducted by Rhiger et al. (2008) explored the impact of the Israeli-Palestinian conflict on Israeli youth. The results showed that 85% of the subjects had experienced severe and troubling events; students stated that they were directly exposed to at least one traumatic event, while many students indicated that they were exposed to various events.
Furthermore, according to research conducted on An-Najah University students in Palestine, a prominent negative outcomes resulting from the conflict between Palestine and Israel is mental health issues. Students expressed their fear, specifically concerning the danger they and their families may face. The researchers found the students showed signs of anxiety, constant tension and frustration due to conflict. What's more children, adolescents and adults were at higher risk of being exposed to racial discrimination, violence, and persecution by occupying forces in their home country (Assaf, 2005). Results from research conducted on Iraqi youth who witnessed conflict found they expressed significantly high levels of sadness, depression, fear, anxiety, nightmares, memory disorders and severe psychological disorders after trauma (Al-Khubaisy and Al-Atrany, 1997;Assaf, 2005). Young people exposed to traumatic events in the environment of war and conflict require remedial interventions and services that can promote their quality of life and integration within a new society. Fennig and Denoy (2019) stated that social work that assist young people who have migrated due to war requires an expansion and development to accommodate the integration of diverse cultures. The intervention of social work with these young victims of wars and conflicts and the ability of social workers to provide the most appropriate interventions based on mental health care is significant. In contrast, interventions that can reflect the needs of this group may be effective if they are based on a cultural adaptation approach (Fennig, 2021). Also, the importance of a spiritual approach to mental health recovery and well-being while working with young victims of war and conflict should be recognized (Carlisle, 2016). Therefore, the integration of young victims into the new society requires psychological and social assessments that consider the cultural context, spiritual state, adaptations, challenges, and opportunities in their lives (Denov and Blanchet-Cohen, 2016). Also, the network of services provided to young victims of war and conflict, whether health or social or educational, should be developed to be structurally and culturally sensitive and compatible with individual needs, values, beliefs, and experiences (Buccitelli and Denov, 2019).
In general, the events of wars and conflicts have a negative impact on the mental health of young people. Throughout the studies conducted on youth who witnessed traumatic events, it can be argued that many internal and external symptoms related to their ability to adapt, depended on their personal and family relationships. Therefore, it is possible to infer that avoiding conflict and living in a safe environment with a support network, may successfully assist young people who are victims of wars and conflicts to adapt (Borba et al., 2016). Consequently, the practice of social support services with this group is of great importance in helping them adjust to a new way of life and establish positive relationships.
The current study The current study focused on international students who have experienced traumatic events and social integration. The main objective of this study is to identify the challenges, environmental issues, and well-being of students coming from war and conflict areas and their integration into the new society. In light of this main objective, the following sub-objectives were identified: (i) to explore if there are significant differences in terms of depression between international students from war and conflicts zones, and those from war-free zones; (ii) to explore whether a residency period in a safer environment is positively associated with students' ability to integrate into a new society through relationship establishment, social activities participation and overcoming cultural problems; (iii) to identify the methods used by students to overcome all the difficulties faced with moving to a new host country; and (iv) the extent the students used psychological and social support services provided at the university they attended. To determine respondents' involvement in war or conflict, the questions included the extent of their exposure to violence and whether they were compelled to seek asylum or otherwise. In addition, questions were asked regarding family members' exposure to war-related harm, such as kidnaping, detention and threats.

Methodology
Sample. This study consisted of international students who came from Syria for higher education in Turkey at Ankara Yildirim Beyazit University (AYBU) during the academic year 2017-2018. There are five public universities in Ankara, and the students enrolled at Ankara Yildirim Beyazit University are primarily from Syria (YÖK, 2017). The following inclusion criteria was required to participate in the study: 1. Syrian national 2. Enrolled at AYBU University for the academic year 2017-2018 3. A baccalaureate student who has studied for at least one year in Turkey (specifically first, second, third and fourthyear students) 4. Provided informed consent.
A total of N = 121 Syrian students were enrolled at AYBU in 2017-2018 (AYBU ÖİD, 2017). The number of students who met the inclusion criteria was N = 98, and N = 63 students agreed to participate in the study. The participants came to Turkey with their families due to the civil war and conflict in Syria. Forty-five of these students were considered refugees, as they had witnessed or been directly exposed to war. The remaining 18 students were considered immigrants, and had traveled to other countries before arriving to Turkey at the beginning of the Syrian conflict, and did not witness or were not exposed to war-related incidents. They then later came to Turkey purposely for higher education.
Study materials. For data collection, the researchers used two measurement scales and a demographic questionnaire. The scales used were: 1. Demographic questionnaire 2. the UCLA Loneliness Scale (Russell et al., 1980), and 3. the Beck Depression Inventory (Beck et al., 1961) This study used the Arabic version of the UCLA Loneliness Scale (El Beheiry, 1985), which has been shown to be a valid and reliable measure of loneliness in the Arabic context. The scale consists of 20-items rated on a four-point Likert scale. In addition, the researchers used the Beck Depression Inventory developed by Beck et al. (1961) in order to evaluate symptoms of depression. There are 21-items in the inventory rated on a fourpoint Likert-type scale (minimum score = 0, maximum score = 3; 0 = no depressive symptoms, 3 = severe depressive symptoms). The scale was adapted for Arab students by Al-Musawi (2001). Previous research has shown the Beck Depression Inventory used successfully in Arab societies (Radwan, 2003;Abdel-Khalek, 1996). In addition to these scales, we prepared a questionnaire to understand the students' demographic details, life during and after the war and schooling information at AYBU for the 2017-2018 academic year.
Procedure. The researchers of this investigation used both email and on campus notices to recruit participants, through opportunity based sampling. Quantitative research methods was used to collect data from Syrian students who had come from conflict areas and non-conflict zones, and were enrolled at AYBU. A questionnaire was to collect demographic data; the UCLA Loneliness Scale and Beck Depression Rating Scale were applied to collect data regarding the psychological condition of the students. Students who did not want to complete the questionnaires in the presence of the researcher were allowed to take the questionnaire home. However, they were asked to return the completed questionnaires to the researcher within 3 days. Only forms that were completed in full and correctly were accepted and further analyzed.
Data analysis. Independent samples t-test were used to compare depression and loneliness between students from war prone areas and those from war-free zones in Syria, while also taking into consideration years spent in Turkey. Frequency data was collected to examine the students' relationship with Turkish student, other international students, and academicians. The analysis will also evaluate the frequency of participation in social and cultural activities, the problems subjects faced due to cultural differences and the methods used to cope with these problems. The analysis was performed using the SPSS 20.0 software program.
Research ethics. Ethical approval was obtained from Ankara Yildirim Beyazit University's Research Ethics Committee and was pre-registered with the number (13/03-02072013-352). In addition, informed consent was gathered from all participating students before testing. Confidentiality was maintained by not requesting names or any other information that would identify the students involved. The subjects were informed of their right to withdraw from the investigation at any time.

Findings
The key findings of this research were discussed under five main themes: depression and loneliness, building relationships, participating in social activities, problems due to cultural differences, and methods for coping with moving to Turkey from Syria. Table 1 summarizes the findings obtained from the independent samples t-test; comparing the depression and loneliness levels of students who were from war and conflict zones to those who were from conflict-free zones.
As seen in Table 1, there was no significant difference between depression levels of Syrian students who were from war and conflict zones (X = 18.18) and those who were not (X = 15.39) (t (61) = 1.17, p > 0.05). Similarly, there was no significant difference in the sense of loneliness between Syrian students who were in war and conflict zones (X = 45.02) and those who were not (X = 45.61) (t (131) = -0.21, p > 0.05). This shows there was no statistical difference in depression or sense of loneliness among the Syrian students.
The students' relationships with Turkish students were also evaluated as a determinant of integration into the Turkish community for both student groups from war zones and war-free zones. Summary of these findings can be seen in Table 3.
As can be seen in Table 2, almost all of the students who witnessed war and conflict (97.78%) had good relations with Turkish students. The rate of good relationships (66.11%) was lower among students who had not been in a war and conflict zones in Syria. The fact that students from war and conflict zones had higher number of good relationships with Turkish students, may have contributed towards more positive relationships when compared to Syrian students from non-conflict zones.  The findings of relationships with other international students in Turkey are summarized in Table 3. Regardless of exposure to war, the majority of students appeared to have good relations with other international students.
Results in Table 4 represent findings on the relationships between academicians and Syrian students in Turkey. The majority of the students who witnessed war (91.11%) had good relations with academicians at the university; whereas 77.78% of the students who did not witness war had good relationships with academicians at the university.
Results shown in Table 5 represents findings on the degree to which Syrian students participated in social activities within the university. Approximately half (53.33%) of students who witnessed war participated in social activities. The majority of students who did not witness war (77.78%) did not participate in social activities at the university.
Findings regarding the frequency of participation of international students from Syria in social and cultural activities outside the university are provided in Table 6, and shows that 26.67% of students who witnessed war and conflict and 33.33% of students who did not witness war had never participated in social and cultural activities. The proportion of students who always participated in social and cultural activities was low in both groups. Table 7 shows the cultural differences and problems experienced by Syrian international students in Turkey. Both groups of students had experienced negative attitudes towards them for being foreigners. Around half of the students who witnessed war (46.67%) had problems in their relationships with the opposite sex. The rules in the daily life of Turkish society were also an issue for students who witnessed war, though they stated that they had no problems with the Turkish language. For students who had not witnessed war, food and rules in daily life were among the primary issues they faced. Table 8 presents the findings on Syrian international students' methods of coping with the problems they experienced. Students who had witnessed war were most likely to ask for help from their families and God (through prayer) when they encountered problems. Getting the help of a psychologist or social worker was the least likely method used. Students who had not witnessed war were also most likely to seek help from their families and God (through prayer) to solve their problems. Psychologist and social worker support was requested by only 4.44% of students who witnessed war and conflict, and 0% of non-exposure to war and conflict student had applied for support from psychologists or social workers at the university. Furthermore, there were some students who had not requested any help at all for their problems, and also students who used a combination of methods in coping for their problems.

Discussion
Levels of depression and loneliness. Results of the current study have revealed that there was no difference found between both student groups in terms of depression and loneliness. There is also no difference in the findings associated with students' who    had spent at least two years in Turkey. This is accordance to other recent studies that have indicated that the post-conflict environment has a significant role and an impact on psychological adaptation. This suggests when migrants from war and conflict zones move to a new country where there is political stability and distance from daily pressure and economic and social challenges, this can prevent the development of mental illnesses and promote adaptation to facilitate the process of integration (Newnham et al., 2015b). Living in an environment of war and conflict can influence the emergence of mental health problems associated with trauma, and individuals living with these experiences require special attention and a safe environment (Newnham et al., 2015a). What's more, in the current study it was found that living within a safe environment far away from war and stressful situations has a positive effect on facilitating the process of integration and impeding the development of some social and psychological problems that are experienced by people from war and conflict zones. Similar to other studies, it has been found that support systems provided by social workers has a significant role in the well-being of those who have experienced trauma. An effective means of recovery is by providing victims with emotional support within a safe environment. According to MacGeorge et al. (2007), individuals who have emotional support systems in place are less depressed than those who do not receive support. Furthermore, there is an association between low social support and mental health problems (Duru, 2007). The support that students receive from their peers and their families shows clear benefits (Demaray and Malecki, 2002). Students, who receive social support after witnessing war and conflict, experience a reduction in anxiety and depression (Nazzal et al., 2017). It can be argued that the presence of social relations and social support for students positively reduces loneliness. The lack of social support, together with fewer social relations, is positively associated with feelings of loneliness (Perlman and Peplau, 1984).
Level of establishing relationships. The findings from this investigation showed that almost all participants who had witnessed war, also held a bond or relationship with a Turkish peer, while subjects who had not witnessed war were far less likely to form a relationship with another Turkish student. Further, the majority of students who witnessed war had good relationships with faculty and other international students at the same university. This suggests that students who have come from war and conflict zones seek to form new relationships in order to adjust and adapt to their new environments. These findings are in accordance with other studies conducted on Syrian students coming from war and conflict areas. This includes a study by Kozikoglu and Aslan (2018), which also found Syrian students forming well-established bonds and relationships with other Turkish students, academicians, and employees. Likewise, Sezgin and Yolcu (2016) demonstrated the successfulness of Syrian students in making significant efforts in communicating with Turkish nationals in order to dissociate negative views of Syrian refugees in Turkey. Having an advanced level of language likely has a role in facilitating communication with others and forming relationships. Furthermore, it can be argued that the Turkish students, academicians, and other international students sympathize with students who have witnessed wars and conflicts. In addition, students coming from war and conflict areas may tend to establish good relationships as a strategy in order to achieve success in their new homes in order to prevent nationals from forming a negative view of them.  Level of participation in social activities. Approximately half of the students in the current investigation who witnessed war participated in social activities at the university. However, the majority of students who did not witness war did not participate in social activities at the university. The proportion of students who always participated in social and cultural activities were low in both groups. Perhaps this is due to the fact that most of the students are scholarship beneficiaries, meaning that they would be required to spend more time on studying in order to maintain a certain grade standard in order to keep their scholarships. Students may also choose to place greater emphasis and efforts in order to attain higher grades to receive a monthly stipend, as poor performance means risking sponsorship status. With this in mind, students would rather spend time with their studies than participating in social activities. It is also important to mention that students may have concerns regarding adapting to Turkish culture. This result is consistent with a study by Assaf (2005) on victims of war and conflicts from Palestine, who also attended university, 56.20% of these students expressed an unwillingness to participate in social activities among their peers. The researchers also concluded and attributed that the students may devote more time to studying for academic purposes. Young people try to prove themselves in difficult circumstances and prepare for a career ahead, rather than focusing on participating in social activities. Nevertheless, studies indicate that there is a strong correlation between participation in social activities and academic achievement (Akobirova, 2011). Participation by students in social activities within the university also contributes positively to mental health and personality development (Kaya, 2019).
Level of cultural differences. The subjects' attitudes in this current study, towards foreigners and towards the opposite sex was shown to be a concern among the Syrian students. Furthermore, the daily lifestyle within Turkish society was reported by students (who had been exposed and non-exposed to war) reported that this was an issue for them. The majority of students reported that Turkish people's interactions with foreigners is the most frequent issue they faced. This result corresponds to the conclusion reached by Sezgin and Yolcu (2016) in their study conducted on Syrian students, as it shows a negative attitude towards Syrian students, mainly when they communicate in Arabic. This often exposes Syrian students and leads to discrimination, as well as rejection. Snoubar (2015) conducted a study on international students from 61 countries, who were enrolled in Turkish universities, and revealed that foreign students suffered strained relationships with Turkish nationals of the opposite sex. Another challenge they faced was cultural differences. Turkey is an emerging new academic hub for students and is attracting international students. Yet, Syrian students may not be recognized as international students, but rather refugees by their Turkish hosts. The social work profession in Turkey can exert effort at the community level on issues related to the acceptance of cultural diversity and its importance in enriching society.
Methods of coping with problems associated with integration. The students who witnessed war mostly ask for help from their families and seek comfort through religion when they encounter problems. Receiving help from a psychologist or social worker is the least adopted method used by the subjects. Students who have not witnessed war are also more likely to seek help from their families and religion in solving issues or difficulties. None of the students applied for social worker assistance. There were also students did not seek help from anyone when faced with problems. From the results of this study, it is clear that students from war and conflict areas did not receive adequate attention and support and did not receive psychosocial support services within the university. This indicates an apparent deficiency in the practice of social work within certain groups in university settings. Also, it can be argued that these students often tend to use religious-cultural strategies to deal with problems they encounter. This may be due to the absence of clarity regarding the role and acceptability of social work within societies that encounter war. This conclusion is supported by Murthy and Lakshminarayana (2006) study, which indicates that the use of cultural and religious strategies when facing mental and social disorders and problems is one of the most common in developing countries. Another study conducted by Snoubar (2015) indicates a high tendency of international students coming from the Middle-East, Asia, and Africa using religious and cultural confrontational strategies when dealing with the psychological and social problems they face within a new society.
In review of the literature, we find numerous studies suggesting that, in times of stress, international students have resorted to family, friends, or other social support systems to help them overcome problems before seeking professional help (McVay, 2015). In the current study, we found that almost all of the students coming from war and conflict did not seek professional help in overcoming issues they faced, this may be to numerous reasons, including cultural stigmatization and feelings of shame in receiving social or psychological care. This can be considered a common barrier that hinders psychological and social support services in universities (Jones, 2012;McVay, 2015). A recent study conducted in Canada on young victims of war and conflict indicates the impact of some structural measures on their access to mental health and social services. In addition to the effect of public understanding of mental health services and exposure to forms of racism, prejudice, and threats to dignity (Buccitelli and Denov, 2019). Since young people who are victims of war and conflict have a high risk of psychological issues, it is necessary to strengthen the provision of a culturally competent service as this can help and encourage these groups to seek professional help instead of relying on informal support networks (Bartholomew et al., 2021). A recent study conducted on international students from Syria and affected by wars and conflicts indicates the need to consider the cultural context when developing psychological and social support services for youth affected by wars and conflicts (Alotaibi, 2021).
Consequently, one of the priorities for professional intervention in social work with students who have experienced war, is understanding their external world related to their basic needs and focusing on understanding their inner world related to issues of resilience and mental health. Finally, focusing on integrating these students into the new community by promoting communication issues and engaging them in various activities (Roestenburg, 2013). Consequently, designing specific activities directed towards new students to introduce them to the services social work provides and how they can benefit them would be beneficial, especially for those coming from war and conflict zones. In this context, to engage such students, social work units could reach students from war and conflict areas and engage them in social activities to positively impact their mental health, personality development, and academic achievement. Readiness to provide psychological and social support through direct reception or telephone counseling could also be adopted. Social workers could also embark on awareness campaigns regarding the effects of wars and conflicts on individuals, families, and the roles that could be provided by community institutions, including the social work unit within the university.
Limitations of the study A limitation faced in this investigation is that among the participants, some students refused to participate in the qualitative ARTICLE HUMANITIES AND SOCIAL SCIENCES COMMUNICATIONS | https://doi.org/10.1057/s41599-021-01009-z aspects of the study, citing participation as useless, and their experiences with previous researchers consequently affected the current researcher's results, as they viewed no 'real-world' benefits stemming from participating in the study. It is necessary to explore the experiences and problems faced by young people from war and conflict zones through embedded research that targets the experiences they encountered in the early years when coming from conflict zones to a new society.

Implications for social work practice
The study presents some aspects of the potentially beneficial effects of professional intervention with young people who are coming from war-and conflict-effected countries. The results illustrate the importance of a safe environment in improving the psychological and behavioral readiness of young people with experience of war and conflict (Betancourt et al., 2014). In addition, there is an urgent need for post-conflict psychological and social support programs for young people (Zuilkowski et al., 2016). This will ensure that vulnerable groups are introduced to services that can support their well-being (Snoubar and Hawal, 2015). However, young people coming from countries that have witnessed wars in the Middle-East often resort to traditional means, such as seeking counseling from family and friends to resolve their problems. This could be attributed to Eastern culture, a lack of social service units in their home country, and a lack of adequate services provided (Snoubar, 2015). Thus, social work intervention with these students requires excellent knowledge of victims' cultural orientation and the need to involve them in developing programs that can benefit new arrivals from the affected countries. It is important to take into consideration that the students viewed contacting professional service units, is seen to be a last resort or not viewed as an option at all. There is also a distinct deficiency in social work practice, prejudice and racial discrimination issues, and in training victims in how to deal with such situations within new societies. It is supported that social workers identify these young people and communicate with them in order to initiate appropriate targeted intervention. Strategies to be used should include the involvement of friends, family, supplication, and the use of religious contexts as means of establishing students trust.

Conclusion
Investigating the problems experienced by international students who are exposed to wars and conflicts and integrating them into a new society, from the perspective of social work, is of particular importance in today's environment, where conflicts and wars are increasing in many countries, especially in the Middle-East. By exploring the problems this group of students' experience, it was found that there is a great distances between the problems they face and the systematic responses to their care needs. It is also critical to review the social work units in universities, in their care for young people coming from war and conflict areas and providing long-term benefits for these types of students. Practitioners and researchers also should be mindful of culture and the culture that arises from living in a stressful environment. Participating in research and the development of practices aimed at providing care for young people from countries that are experiencing wars and conflicts, contributes to their integration into Turkish society. It is recommended that future studies incorporate cross-cultural methods in order to determine the impact of international students' integration into new societies and the social care provided.

Data availability
The datasets generated during and/or analyzed for the current study is not publicly available due to the consent form stateting that the data generated from this investigation will not be shared publically unless the datasets are requested directly from the author with their permission.