The effects of war on mental health
Source: في عین الله / Unsplash
While my focus has been more on the latest research in neuroscience, after my harrowing conversations with colleagues providing medical assistance in the Middle East, I recently felt it was necessary to write an article on mental health in the region.
In the midst of the COVID-19 pandemic and ongoing reckoning with racial injustice, one thing has not changed: the fact that armed conflict and instability continue to hang over the Middle East like an inexorable cloud. This has implications not only for infrastructure, physical health, and survival, but also the mental health of those fortunate enough to survive (or have to go through) the endless war and conflict and the devastation that ensues.
Armed conflict has devastating effects on the mental health of the affected population. Post-traumatic stress disorder (PTSD) and depression are the most common post-war mental disorders in both adults and children, and occur in at least a third of people who are directly exposed to traumatic war experiences (Ibrahim & Hassan, 2017).
The PTSD in Syrian refugee children was so severe and unprecedented in scale that it escalated to the point where some psychiatrists coined a new term for these particular cases of trauma: “Human Devasation Syndrome.” MK Hamza, a Syrian neuropsychologist uses this term because it aptly reflects the fact that the devastation of children “goes beyond what even soldiers can see in war,” including “looking at disassembled people who used to be their parents or her siblings were ”. (Ahmed, Mahood & Waheed, 2018).
A 2018 Save the Children survey in Iraq found that “43 percent of children in the city of Mosul said they always or often experience grief” (Save the Children, 2018).
In the Gaza Strip, 91% of children now suffer from PTSD (EuroMedMonitor, 2021). In addition, almost 97.5% of similar adolescents who experienced a war showed high levels of anxiety (Elbedour et al., 2007). A 2007 survey of Palestinian school children found that 80% of children had witnessed shootings firsthand, with 10% having a depressive-like state and 14.1% having emotional difficulties (Giacaman et al., 2007). The admission of psychiatric patients in Gaza has increased by 69% in recent years, with reported anxiety, depression, and suicidal thoughts and behaviors increasing (Al Mezan, 2018). Independent journalist Harry Fear explores the situation after visiting the enclave in a recent documentary.
Despite the widespread nature of anxiety, depression, and PTSD, much of the responsibility for addressing these emotional and psychological effects rests on non-governmental organizations such as Medecins Sans Frontieres (MSF – Doctors Without Borders), social welfare and support for many Iraqis with mental illness. MSF points out that there are currently only 4 psychiatrists for every million Iraqi residents and even fewer professionals are being trained in related psychiatric professions such as counseling. There are currently only four specialists looking after Syrian refugees in Iraq, who have to conduct 70 to 100 counseling sessions with them per week (Lundquist, 2015).
Also in Jordan, a country that is now hosting almost 700,000 refugees, there are a total of 31 psychiatrists for the whole country, which consists mostly of refugees from Palestine, Iraq and Syria. There are also excessive numbers of Syrian refugees in Lebanon and Turkey who have fled the devastation within their own country (Lundquist, 2015). Unfortunately, most mental health professionals are hospital-based and primarily providing biological care, so no mental health professionals in these populations can treat PTSD.
Add to this the situation in Yemen, home to the world’s worst humanitarian crisis, in which hundreds of thousands have been killed and millions suffer from malnutrition and preventable diseases such as cholera. It was difficult to quantify and assess mental health there, but it is clear that the situation is particularly dire. When you have children who witness the death of their family members or witness their loved ones wither away from starvation before their very eyes, it takes a tremendous psychological toll.
In addition, there has been a lack of psychiatric specialists in Yemen since the Saudi-led intervention began. In January 2016, the WHO estimated that there are 40 psychiatric specialists in Yemen, most of whom are based in the capital, Sanaa. In December 2016, the director of the Department of Health’s Mental Health Program suggested that there were only 36 psychiatric specialists. Mental health is not integrated into the primary health system and many Yemenis do not have access to treatment the first time they come into contact with the health system (Sana’a Center, 2017).
Mental health in times of COVID-19
In addition to the devastation and mental health crisis, these populations also faced the COVID-19 pandemic. In their dire state, having to deal with this condition only adds to the mental disaster they face.
Since the pandemic and national lockdowns, the United Nations High Commissioner for Refugees (UNHCR) has documented alarming reports of increasing mental health problems among the many refugees in the Middle East and North Africa. There has been an increase in suicide, domestic violence, insomnia and depression in Lebanon, Libya, Yemen and other Middle Eastern countries (UNHCR, 2020).
It is thanks to the UNHCR that they have implemented a number of approaches to address these mental health issues. They use and train personnel in Psychological First Aid (PFA), an evidence-based approach, to intervene in the immediate aftermath of disasters and terrorism to prevent the development of PTSD. In Iraqi refugee camps, for example, trained community workers have provided PFA for basic medical staff, NGO workers and public relations volunteers. In addition, the UNHCR has set up hotlines to receive and answer psychological problems (UNHCR, 2020). This is helping the situation, but more needs to be done to address the shortage of mental health professionals and the root cause of the dire circumstances that led to the resulting mental disaster.
Another endeavor that has made great strides in tackling the mental health of migrants and refugees from this region is The Humanity Crew. This by the Arab-Israeli psychiatrist Dr. Essam Daod and his partner Maria Jammal founded the organization in November 2015 and campaigns for the psychological problems of a traumatized population that is fleeing destruction and persecution. Dr. Daod delivered a brilliant TED talk that really shows how crucial and beneficial psychological interventions can be, especially for a youthful population plagued by psychological trauma.
Why it matters and what we can do
The cruel fact is that US and Western foreign policy and military intervention, while not the only culprits, have played a large part in why the situation in this region of the world is what it is today. To quote the late, award-winning, former Beirut journalist, Robert Fisk of The independent one, “We always come with our tanks and our helicopters and our” [armored] Personnel trucks and our soldiers, instead of arriving with our teachers, our educators, our doctors and our social workers. ”From my position I would like to highlight doctors and bring in professionals from all areas of health care, including mental health.
As a doctor in training, a contributor to this website, and as an everyday citizen in touch with close friends in this region who also work in the healthcare sector, my role here is to really present the numbers, some (but by no means all of the details) and tell how this region of the world is doing from a mental health perspective. Numbers don’t tell the full story, but neither do they lie. It is easy to neglect the human impact of war if it does not affect you immediately. Before you finish reading this, ask yourself: Of all the hundreds of thousands to millions of dead and injured in this region, can you name one? What I’ve mentioned here barely scratches the surface of how dire the situation really is.
While advocating harmful and often unnecessary military intervention is always an option, especially from a mental health perspective, we can do the following: at least donate to these organizations, or better yet, donate their time and effort to volunteer and to help those who need them.
There are certainly other humanitarian organizations helping with such efforts that I have not mentioned. You are out there; it is only up to us to seek them out. It may be a little more difficult in times of COVID-19, but please, any form of contribution to organizations like MSF, Humanity Crew or the UNHCR will make a big contribution. It won’t necessarily cover all mental health issues in all locations, but it will certainly make a significant difference to many. Millions of lives can benefit from it now and in the future.