Maternal Deprivation and the "Middle East Syndrome" among Sri Lankan Children

Dr. Ruwan M Jayatunge, M.D. PhD 

The phenomenon known as Middle East Syndrome in Sri Lanka refers to the psychological and emotional challenges faced by children whose mothers have migrated to Middle Eastern countries for work, leaving them in the care of their fathers, grandparents, relatives, or other caregivers.  In recent peak years, more than 200,000 women from Sri Lanka sought employment abroad, as evidenced by the Sri Lanka Bureau of Foreign Employment (SLBFE), which documented approximately 122,358 female departures in 2024 and an additional 82,050 women who left between January and August of 2025. It is reasonable to infer that a significant number of these women had families, including children of school age.

This separation can last for extended periods, often years, during which the children experience significant maternal deprivation, particularly during critical developmental phases. The absence of their mothers can lead to profound emotional disturbances, including depression and anxiety, as these children grapple with the loss of maternal presence. 

Initially, upon the mother's departure, children typically undergo a series of emotional responses as outlined by John Bowlby’s stages of separation distress. They may first exhibit protest, characterized by active distress, crying, and tantrums, followed by a phase of despair where they become withdrawn and lose interest in activities they once enjoyed. Eventually, to cope with the emotional pain, they may reach a stage of detachment, where they emotionally disconnect from their mothers, displaying indifference or coldness upon her return. 

Furthermore, the emotional trauma often manifests in behavioral issues, such as regression to earlier developmental behaviors, increased aggression, and a notable decline in academic performance, which can lead to school refusal. Internally, these children may develop severe attachment anxiety, fearing further abandonment by their remaining caregivers, resulting in extreme clinginess or panic when separated from them.

Young children tend to engage in egocentric reasoning, which leads them to interpret events through a self-centered lens; for instance, they may conclude that a parent’s departure is a direct result of their own perceived misbehavior or inadequacy. This perspective can significantly impact their emotional well-being, as they often internalize guilt and shame. 

Furthermore, it is not uncommon for these children to express their emotional distress through somatic complaints, presenting physical symptoms such as persistent headaches, stomachaches, chronic fatigue, or sleep disturbances, including nightmares. As they mature, these children frequently grapple with deeper identity and emptiness issues, reporting a pervasive sense of emotional void, loneliness, and resentment. They may feel that their emotional needs have been overshadowed by a focus on material wealth, such as financial remittances, which they perceive as being prioritized over their psychological and emotional support. This complex interplay of emotions and perceptions can have lasting effects on their development and overall mental health.

The following case studies illustrate the impact of the Middle East syndrome on children's psychosocial health. 

THX, a nine-year-old girl, experienced significant distress when her mother took a job in the Middle East due to the family's financial struggles. This decision forced THX to remain with her father, a soldier who was only home every two to three months, while her maternal grandmother assumed caregiving responsibilities. Following her mother's departure, THX exhibited emotional challenges, including sadness and feelings of isolation, which manifested in bedwetting and frequent crying for her mother. Despite being a bright student, her academic performance declined as she faced maternal deprivation. Her behavior became increasingly defiant, complicating her grandmother's attempts at discipline. Over nearly three years without seeing her mother, THX's emotional response to her mother's infrequent letters and promises of gifts upon her return became one of indifference, highlighting the profound effects of separation on her psychological well-being.

LKX, an 11-year-old boy, experienced significant emotional distress following his mother's departure to a Middle Eastern country for family support. Left in the care of his father and two younger siblings, he exhibited signs of anxiety, including nightmares and a regression to thumb-sucking. His irritability increased, leading to excessive punishment of his siblings and a noticeable decline in his academic performance, as observed by his teacher. Additionally, LKX displayed physical symptoms such as headaches and stomachaches without any medical explanation, and on several occasions, he refused to attend school, further indicating his emotional turmoil.

Maternal deprivation can have profound and lasting effects on an individual's life, particularly as they transition into adulthood. According to John Bowlby’s Maternal Deprivation Hypothesis, as well as insights from contemporary developmental psychology, the absence of consistent maternal care during the formative years can fundamentally reshape a child's Internal Working Model, which serves as their cognitive framework for understanding relationships. When a child experiences maternal deprivation without the presence of a stable surrogate caregiver, it can significantly influence four critical dimensions of their adult existence. 

Adults who experienced maternal deprivation may struggle with insecure relationships, often manifesting as excessive clinginess and fear of abandonment, or conversely, emotional detachment and a reluctance to form close bonds. This early disruption can also lead to chronic mental health challenges, including a heightened susceptibility to lifelong depression and anxiety, often accompanied by a persistent sense of emotional emptiness. 

In addition, individuals may find their capacity for empathy and social interaction impaired, which can result in difficulties forming meaningful connections and may even lead to antisocial behavior or tumultuous relationships. Additionally, the stress stemming from these experiences may drive some to adopt unhealthy coping mechanisms, such as substance abuse or impulsive actions, as a means of self-soothing. Ultimately, these patterns can perpetuate an intergenerational cycle of emotional unavailability, making it challenging for individuals to establish secure attachments with their own children.

Mental health professionals in Sri Lanka should focus on addressing the "Middle East Syndrome," particularly among children who have been left behind. It is crucial for clinicians to identify these affected children and provide them with appropriate psychological support.

Targeted interventions, such as trauma-informed and attachment-focused therapies like Cognitive Behavioral Therapy (CBT), can aid older children in reframing feelings of abandonment and guilt stemming from their mother's departure. For younger children, expressive arts and play therapy can serve as effective means for expressing complex emotions. Additionally, clinicians should provide caregiver coaching to promote surrogate attachment, enabling remaining family members to create a stable emotional environment. In cases where children exhibit symptoms of depression or severe anxiety, medical evaluation and potential medication may be necessary.

Teachers play a crucial role in identifying students affected by maternal deprivation, offering them extra support, particularly when they encounter learning difficulties and behavioral challenges. School counsellors should also provide tailored assistance to meet the specific needs of these vulnerable children effectively.

Addressing home instability through conflict resolution strategies is vital for fostering a supportive environment. Moreover, maintaining transnational maternal bonds through structured communication can help mitigate separation anxiety, while preparing children for their mother's eventual return can facilitate a smoother transition. Collaboration with school counsellors is essential to monitor academic and behavioral changes, ensuring a comprehensive support network for these children.