April 2024

We live in an almost unprecedented era of conflict. However, another silent war is being waged in the minds of civilians around the world. The growing mental health crisis in warzones threatens a chance of enduring stability and peace, once the bombs stop.  It is a silent war that is ignored at our peril.

Targeting civilians has become the norm, said the UN, from Gaza to Ukraine, as well as long-running conflicts such as Kashmir.  In 2023, global civilian fatalities in war rose by 122% on the previous year, according to Action on Armed Violence.

This has triggered a surge in civilians with mental health illness as a result of the attrition of war, losing loved ones, homes, community, and, in some cases, their country.

 

The Geneva Graduate Institute’s International Global Health Platform and Beyond Conflict have thrown a spotlight on this urgent and growing problem in our panel discussion on 27 March 2024, “No Peace of Mind”, which heard from experts in the field: Médecins Sans Frontières  (MSF), Ukraine, the Palestinian territories and Kashmir. Our experts delivered a sobering and necessary assessment of the mental health impact of conflict upon ordinary people living with war and displacement.

182 people from 17 countries registered for the online event globally, provoking a lively and wide ranging discussion.

 

THE 1 IN 5

One in five people living in places afflicted by war and conflict have severe mental health conditions, according to the World Health Organisation (WHO), quoting a Lancet study. 

That is an average figure. In some places, it is much higher as people suffer a collective war trauma. Also, the figures for children are most disturbing of all.

UNICEF said children in Gaza face “generational trauma”. If untreated, this trauma can pass down to the next generation.

In Ukraine, UNICEF says 1.5 million children are reported to be at risk of mental health problems.

In Kashmir, many children face generational trauma from decades of terrorism, counter-insurgency, military occupation and human rights violations.

Today wars are routinely targeting children. This means a loss of childhood. An attack on children is an attack on the world’s future.

A generation of kids growing up in war zones today have only ever known war – leading to mental health issues and trauma. What will happen to this generation when they grow up, if they don’t get the help they need?

Mental health issues for all victims of war include suicidal thoughts, self-harm, depression, schizophrenia, bipolar disorder, anxiety and flashbacks.

Yet despite growing evidence of the scale of the problem in these conflict zones and others, there are insufficient resources.

Geneva Graduate Institute and Beyond Conflict “No Peace of Mind” event explored some of these important issues.

 

MSF

“One in five people are likely to develop mental health disorders,”

said Mariana Duarte, MSF MHPSS advisor, as she introduced the event.

“Children, women and the elderly and those with predisposed conditions are the most vulnerable groups. Mental health is an essential component of well being yet it is being relegated to the background in a conflict situation.”

Duarte said there had to be a change in attitude to mental health aid and resources.

“It is a fundamental human right. It is imperative to ensure mental health services are accessible…and integrated into healthcare services.”

 

PALESTINIANS

Mohammad Marie, mental health consultant and Assistant Professor at the College of Medicine and Health Sciences, Annajah National University, Nablus, West Bank, said the challenges facing Palestinian mental health patients was catastrophic and their broader needs vastly unmet:

“Hospitals have been destroyed and there is no healthcare in Gaza. There is no psychiatric support available. No food, no water.  People are living without their basic needs,”

he said.

“Psychiatric patients in Gaza have no medication. Children are operated upon without anaesthetic. It is a catastrophic situation that leads to death and people living with mental health scars for the rest of their lives.”

The UN has called the war in Gaza a war on childhood, with children as young as 5 years old self-harming and contemplating suicide.

 

KASHMIR

Saiba Varma, Associate Professor of Psychological/Medical Anthropology, at the University of California, San Diego, said the world’s focus is always on the war itself, rather than the aftermath. That needed to change.

“It’s what happens after the bombs stop falling. That’s when the real struggle of people starts. Global warfare is a war on the psyche, not just soldiers but ordinary citizens as well.”

Varma said in the absence of sufficient mental health support on the ground, people often turn to their own coping mechanisms to deal with their issues. But a healthy society required more resources to be placed upon mental healthcare. It was an urgent priority, she said.

 

UKRAINE

Dmytro Martsenkovskyi, Assistant Professor, Department of Psychiatry, Bohomolets National Medical University, Kyiv, Ukraine, said:

“At the start of the conflict, more than 10 million civilians were displaced, families, children…Many people have been tortured, lost relatives, homes, due to bombardment.”

In addition there is scarcity of food and medicine, plus living with the daily fear of attack. Yet despite the Ukrainian government trying to put a focus on mental health nationally, ordinary people sometimes do not take up the help.

“Many do not seek out help despite needing it because of the priority of physical safety over mental health needs.”

He also spoke of the on-going stigma attached to mental health problems in Ukraine. If people admitted they had a problem it was often seen as a sign of weakness. This has prompted the government to try to change people’s attitude towards mental health in order to persuade them to seek help.

Breaking down stigma is a challenge in Ukraine, as it is in many other parts of the world. One theme that emerged from the group discussion was how to overcome the stigma challenge and how best to address the severe capacity constraints on the ground with limited resources, as the need for mental health provision grows.

 

MENTAL HEALTH AND A FUTURE PEACE

With our experts speaking as bombs continued to fall, it was inevitable that politics and the societal challenges of their respective countries came into stark relief during the discussion. The pain and suffering of the people in each of these places loomed large for everyone. Individual stories from the frontlines punctuated debate and acted as a visceral reminder of why this issue must no longer be relegated to the sidelines of humanitarian aid.

If peace is to have a fighting chance one day, dealing with the mental scars of war must become a priority for governments and humanitarian agencies alike.

(We would like to share with you an article published by Health Policy Watch about the event which you can access here .)

 

The Beyond Conflict Team