Mental Health Afflictions of Children in the Middle East
Amidst the COVID-19 pandemic and protests worldwide against racial injustice, one thing has not changed: the fact that armed conflict and instability continues to hang like an unrelenting cloud over the Middle East. This has had an impact not only on infrastructure, physical health, and survival, but also on the mental health of those who are fortunate enough to survive (or unfortunate to have to live through) the unending war and conflict, and resulting devastation.
Armed conflicts have a devastating impact on the mental health of affected populations. Post‐traumatic stress disorder (PTSD) and depression are the most common mental disorders in the aftermath of war for both adults and children, occurring in at least one third of people directly exposed to traumatic war experiences.
PTSD among Syrian refugee children has been so severe and unprecedented in magnitude, that it has escalated to the point where some mental health professionals have coined a new term for these particular cases of trauma: “human devastation syndrome”. Dr. M.K. Hamza, a Syrian neuropsychologist, uses this term as it aptly reflects the fact that the children’s devastation “is above and beyond what even soldiers are able to see in the war”, including “seeing dismantled human beings that used to be their parents, or their siblings”.
In the Gaza Strip, 7 out of every 10 of evaluated adolescents have been found to meet the criteria for post-traumatic stress disorder (PTSD), with nearly 97.5% of these same adolescents displaying severe anxiety levels. A 2007 survey of Palestinian schoolchildren found that 80% of children witnessed shootings firsthand, with 10% exhibiting a depressive-like state, and 14.1% exhibiting emotional difficulties. Psychiatric patient admittances in Gaza have increased by 69% within the last two years, with increases in reported anxiety, depression, and suicidal thoughts and behaviors. A 2018 Save the Children survey in Iraq found that “43 per cent of children in the city of Mosul reported feeling grief always or a lot of the time” (Save the Children, 2018).
Despite the widespread nature of anxiety, depression, and PTSD, much of the responsibility for remedying these emotional and psychological impacts has fallen to non-governmental organisations such as Medecins Sans Frontieres (MSF- Doctors without Borders), which has provided welfare and support to many Iraqis with mental health ailments. MSF advises that there are currently only four psychiatrists for every 1 million residents in Iraq, and even fewer professionals are trained in related mental health professions such as psychological counseling. As things stand, there are only four professionals currently looking after Syrian refugees in Iraq who must grapple with carrying out 70-100 counseling sessions per week with these individuals. Similarly, in Jordan, a country now hosting nearly 700,000 refugees, there are a total of 31 psychiatrists for the whole country, which is largely composed of refugees from Palestine, Iraq, and Syria. Lebanon and Turkey also have inordinate numbers of Syrian refugees who have fled the devastation within their own country. Unfortunately, most psychiatric professionals are strictly hospital-based and provide mainly biological care leaving no mental health professionals to address PTSD in these populations. Add to that the situation in Yemen, home to the worst humanitarian crisis on earth, where hundreds of thousands have been killed, with millions suffering from malnutrition and preventable diseases such as cholera. It has been difficult to quantify and evaluate mental health there, but it is clear that the situation is especially dire. When you have children witnessing the deaths of their family members, or witnessing their loved ones withering away from starvation in front of their own eyes, it takes a massive psychological toll. Moreover, there has been a shortage of psychiatric specialists in Yemen since the start of the Saudi intervention. In January 2016, the WHO estimated that there were 40 psychiatric specialists in Yemen, most of whom were based in the capital, Sana’a. In December 2016, the director of the mental health program at the Ministry of Health suggested there were just 36 psychiatric specialists. Mental health is not integrated into the primary health care system, and many Yemenis are unable to access treatment when they first make contact with the healthcare system.
Mental health in the COVID-19 Era
On top of the devastation and mental health crisis, these populations have had to contend with the COVID-19 pandemic as well. In their dire state, to have to grapple with this condition only adds to the mental health catastrophe that they face.
Since the pandemic and national lockdowns, the United Nations High Commissioner for Refugees (UNHCR) has documented alarming reports of increasing mental health issues among the many refugees in the Middle East and Northern Africa. In Lebanon, Libya, Yemen, and other countries in the Middle East, there have been spikes in suicide, domestic violence, insomnia, and depression. To the credit of the UNHCR, they have been implementing a number of approaches to address these mental health issues. They are utilizing and training personnel in Psychological First Aid (PFA), an evidence-based approach to intervene for individuals in the immediate aftermath of disaster and terrorism to prevent the development of PTSD. For instance, in Iraqi refugee camps, trained community workers have provided PFA to primary healthcare staff, NGO workers, and community outreach volunteers. Furthermore, the UNHCR has created hotlines to receive and respond to psychological issues. This is helping the situation, but more needs to be done to address the dearth of mental health professionals, as well as the root cause of the dire circumstances that have led to the resultant mental health catastrophe in the first place. The cruel fact of the matter is that U.S. and Western foreign policy and intervention have played a big part in why the situation is what it is today. To quote award-winning Beirut-based journalist Robert Fisk of The Independent, “We always arrive with our tanks and our helicopters and our [armored] personnel carriers, and our soldiers, instead of arriving with our teachers, our educators, our doctors and our social carers.” From my position, I would like to emphasize doctors, and add on professionals from all spheres of health care, including mental health. We must acknowledge the role of our country in perpetuating the catastrophe in that part of the world today. I can think of no better way than those in health care and mental health can get involved than through joining human rights organizations and offering their services to this part of the world. Moreover, we need to put pressure on our elected leaders to change their stance and approach on the Middle East of endless military intervention. We need our leaders to take a non-interventionist policy, ending our military occupation and interference with the affairs of other sovereign nations. All this has done is create a never-ending cycle of destruction and failed states. Among other things, the current U.S. administration is openly supporting the Saudi-led intervention in Yemen which is creating the worst humanitarian catastrophe and resultant mental health crisis in the world. The U.S. has cut all funding to the United Nations Relief and Works Agency (UNRWA), the main organization sustaining the lives of Palestinian refugees in Gaza. These decisions are only going to make the situation and ensuing mental health catastrophe even worse.
We need to make our voices heard, and to show not only solidarity, but also directly intervene and offer our services to address the needs of these people. It is the very least we, as Americans and Westerners, can do. Millions of lives depend on it.
Racheed Mani is a third-year medical student at the Renaissance School of Medicine at Stony Brook University. He is also the founder of the PHR student chapter at his medical school.