For women refugees, the violence doesn’t end once they flee a homeland that has become a war zone.

An in-depth study by Islamic Relief UK on Syrian refugee women who have fled to neighboring countries shows that even when no longer endangered by bombs and bullets, they face fatal despair under the weight of poverty and alienation. Military violence has been replaced by long-term psychological trauma, community violence, and, over time, a generation of social regression.

Focusing on refugee communities in Lebanon (with 1.5 million Syrian migrants) and Iraq (with about a quarter-million refugees in Kurdistan alone), the report shows how barriers to work and education silence refugee women inside and outside their embattled communities.

About 70 percent of Syrian refugees in Lebanon, just over half of them women and girls, are living in poverty, up from 48 percent in 2014. Their families often lack basic social resources and women are formally or informally excluded from job markets. Women refugees suffer an estimated two-thirds unemployment rate, and those who do work pull in less than half the legal minimum wage on average, and are highly exposed to labor and sexual exploitation at work.

Previously refugees in Lebanon had been legally barred from working, but the policy was recently amended to allow limited work authorization. But discrimination pushes many toward the underground economy, so “the vast majority of Syrians work with no legal rights.”

Women refugees in Iraqi Kurdistan have considerably more job opportunities in various restaurants and retail stores, but joblessness and poverty wages are endemic, especially in isolated refugee camps where women suffer extreme discrimination inside and outside the home.

The limited research available on refugee populations shows intense risks of sexual harassment and sexual assault, along with more hidden problems such as domestic violence and sexual exploitation. In one survey in Lebanon, nearly three-quarters of reported incidents of gender-based violence took place inside the household, with young mothers and girls facing especially high risks. Many women without other options are drawn into sex work or survival sex to earn income.

The material hardships shade into psychological distress: family life is rife with depression and marital conflict. Reported rates of suicidal tendencies run as high as 41 percent among young Syrians in Lebanon, according to a 2014 UN study.

When they venture out they face verbal abuse: locals “would shout at them to go home or accuse them of ‘stealing jobs,’”

But before they can even contemplate going out to find a job, women are often held back by childcare needs. With families torn apart, extended kinship caregiving networks are gone, and many fear leaving their children alone in an insecure environment. About half of the child refugee population, roughly 250,000 children, are out of school in Lebanon. While they lose years of critical educational development, they are dragged into the child labor market—and plunged into a whole other realm of insecurity and exploitation. Back in Syria child labor is not common, but since women are the linchpin of the household economy, denying them work shifts the burden of income earning onto kids.

One woman interviewed in the study, 33-year-old Noor Hassan of Qushtapa refugee camp in Erbil, Iraq, compared her life in Syria with the isolation her family experienced after displacement:

In Syria I was working till 9 or 10pm…. Back there, we were living as you do in Europe. We were free, with no one noticing what you are doing, but in the three years I’m living here I didn’t go out of the camp even once for anything other than my medicine.

Women could work in local restaurants, but since it involved late hours and was seen as disreputable (associated with sex work), her brother warned her, “If you go, I will kill you.’”

A mother in Kurdistan, who ran a small shop with her husband, described having to work 18-hour days while keeping watch over her children:

Here there’s no freedom. We can’t easily go out or come back in so we just spend our days in the camp. The children haven’t been outside the camp…. Here, I’m working for long hours just to make my children not need any help from others.

But the factors keeping women indoors are complex: According to co-author Helen Stawski, while there are security issues surrounding refugee areas, internal cultural pressures can be a stronger constraint:

refugee communities…are also limiting women’s freedom to move freely and work based on perceptions of what women might be doing to earn money in such desperate times (i.e. working in prostitution). This is…responding to both real and perceived threats.

Staw notes that immediate safety issues could be addressed through community-based measures like fostering grassroots institutions, boosting women’s leadership at the camps, and enhancing their access to legal aid, Stawski points out that although basic security measures, like expanding women’s community participation and access to legal aid, could help to “mitigate the real threats [of violence]—the perceived ones must be addressed through community dialogue and training.” Political and social empowerment is the only way to restore women’s stake in helping their communities recover—but in refugee communities, a generation of girls is growing up amid oppression and deprivation that their mothers never experienced.

Syrian refugees in Lebanon and Iraq receive less Western media attention than those who have fled to Europe, but regional displacement is a larger and more brutal crisis. Currently international aid is, understandably, primarily spent on meeting immediate needs, but the failure to rebuild basic institutions, and to integrate women into the social fabric, will keep violence burning across the Syrian diaspora long after the gunfire stops. Women and children are perhaps the first to be rescued from front lines of the war, but in the fight to survive, they’re always left behind.