When we consider the global impact of illness and disease, we might picture children in beds under mosquito nets to protect from malaria or the tightening of travel restrictions during the Ebola crisis. Most people would likely agree that disease is a pressing global issue, but few would think about mental health as a portion of this problem. However, according to the Center for Disease Control and Prevention (CDC) mental illness makes up 14% of the issue of disease worldwide, and this percentage is heightened amongst populations afflicted with violent conflict.
American soldiers in Southern Iraq in 2003 during Operation Iraqi Freedom
The treatment of mental health presents a problem in most areas, due to residual stigma and lack of resources, but this problem is exacerbated in areas where violent conflict is a part of everyday life. Because mental illness is far more difficult to track and study, it often receives less attention than physical illness, especially in the context of humanitarian crises, where physical ailments are often clearly visible and require urgent attention. Understandably, prioritized attention is given to the physical safety of afflicted persons. Nevertheless, the CDC estimates that between 30% and 70% of individuals who have lived in combat zones will suffer from mental illnesses such as post traumatic stress disorder (PTSD) and depression.
In response to heightened awareness about the issue of mental health in combat zones, the CDC has conducted several surveys of psychological damage in affected areas since 1999. The first of these surveys focused on the population of Kosovo after the war between Serbians and the Kosovo Liberation Army that took place in 1998 and 1999. The survey aimed to assess the prevalence of psychiatric illness and its correlation to specifically war-related traumatic events. Participants in the survey were randomly selected from 558 Kosovar households. The results of the survey demonstrated that almost 20% of Kosovar Albanians over the age of 15 exhibited symptoms related to PTSD, and even more suffered with decreased social functioning and other mental health issues. The conductors of the survey concluded that the war had a significant impact on the mental health of the general population, and risk factors such as age, employment, and pre-existing conditions contributed to the emergence of psychiatric problems in some people. The survey also predicted in its conclusion that the treatment of mental health would be a crucial step in returning Kosovo to a functioning society. Further surveys have found that adolescents in Kosovo are still highly vulnerable to psychiatric disorder; one survey estimated that 25-40% of adolescents in Kosovo deviated from psychiatric normalcy in one way or another. This clearly demonstrates the lasting effects of violent conflict on the mental health of populations in affected combat zones.
Palestinian children in the town of Beit Jala
In a more recent context, the mental health of children and adolescents in conflict areas in the Middle East has been studied extensively. A variety of prolonged and intense conflicts have afflicted the Middle East for a number of years, and, as seen in the case of Kosovo, the mental health of the general population has been substantially affected. In comparing a number of psychiatric surveys in countries across the Middle East region, a similar connection between trauma and psychiatric disorder was found. This study found that rates of PTSD amongst children and adolescents ranged from 5-8% in Israel to 23-70% in Palestine and 10-30% in Iraq. The study concluded that risk factors of level of exposure to traumatic experiences, age, gender, religion, and socio-economic factors played a role in the severity of the mental health crisis in a given region.
While it can be easily demonstrated that mental health is a serious issue in combat zones, the next major hurdle is access to care. Regions in crisis are unlikely to have adequate health care of any kind, and as previously stated, mental health is often seen as of less importance than physical health. Even where care is available, those who struggle with mental health conditions brought on by experiencing violent conflict are often unlikely to seek treatment. A survey of American soldiers deployed to Iraq and Afghanistan found that of those who displayed symptoms of mental disorders, only 23-40% ended up seeking treatment. The surveyors concluded that stigma created a sizeable barrier for those wishing to seek treatment, even where available.
Although it is easy to feel disconnected from catastrophes occurring halfway across the world, the acknowledgement of mental health as a global issue reminds us of our shared humanity. Health care is a human right, no matter how one believe this should translate into policy-making. After reviewing a series of psychiatric surveys in conflict zones, it becomes clear that mental health care must be considered when dealing with the aftermath of a humanitarian disaster. Outward injuries are easier to see, but they are not always the only scars left by war and violent conflict. If we start by recognising the severity of war’s impact on mental health, we can then take the necessary steps to improve access to mental health care, particularly as an included aspect of humanitarian aid. Finally, the stigmas which worldwide prevent afflicted individuals from receiving the care they need must be broken down by awareness and conversation. The power of speaking up can do wonders, and as long as we do not stop there, we can improve the circumstances of those living with mental illness everywhere. Even if suffering in conflict zones is some degree of inevitable, we can do what we can ameliorate this suffering by advocating for access to mental health care for all people.