Mental health in Middle East conflict zones: How are people dealing with psychological fallout?

Zedan, a patient suffering from post-traumatic stress disorder (PTSD), is in medical consultation at the mental health centre of the Bajet Kandala camp for displaced Yazidis near Dohuk, northwest of the Iraqi capital. (File/AFP)
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Updated 15 July 2021
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Mental health in Middle East conflict zones: How are people dealing with psychological fallout?

  • Studies show high incidences of depression in Tunisia, Palestine, Jordan, Lebanon and Iraq
  • Almost 1 billion people worldwide live with a mental illness

ABU DHABI: Almost all 10 to 19-year-olds in the Gaza Strip are exhibiting symptoms of post-traumatic stress disorder (PTSD) due to their exposure to security threats and violence, according to clinical psychologist Dr. Thoraiya Kanafani.

And a 2020 Arab youth survey found that nearly a third of all young people living in 15 countries in the region know at least one person suffering some form of mental illness.




Palestinian children carry household items they recovered from the rubble of a building, destroyed by Israeli strikes, in Beit Hanun in the northern Gaza Strip on May 21, 2021. (File/AFP)

Kanafani told Arab News that studies show high incidences of depression in Tunisia, Palestine, Jordan, Lebanon and Iraq.

In the Gaza Strip, 97.5 percent of 10 to 19-year-olds have PTSD, a mental health condition that results from experiencing or witnessing a traumatic event.

The Palestinian crisis and other major events in the Middle East have caused an increase in mental illness.

Almost 1 billion people worldwide live with a mental illness, but more than 75 percent of those with psychological disorders fail to receive treatment, according to a 2021 World Bank report.




A Syrian man suffering from mental issues looks outside a window at al-Waalan special needs centre in northern town of Aldana near Syria's second largest city of Aleppo on February 14, 2019. (File/AFP)

“Every year, close to 3 million people die due to substance abuse. Every 40 seconds, a person dies by suicide. About 50 percent of mental health disorders start by the age of 14,” the organization said.

The World Health Organization (WHO) said in a 2019 report that one person in five (20 percent) living in a conflict zone is estimated to have depression, anxiety, PTSD, bipolar disorder or schizophrenia.

“Among people who have experienced war or other conflicts in the previous 10 years, one in 11 (9 percent) will have a moderate or severe mental disorder,” the WHO added.

In May, 11 Palestinian children, who were receiving trauma therapy, were killed in their homes by Israeli airstrikes.

Asked if seeking treatment while experiencing continued attacks in a conflict zone is still effective, Kanafani said: “Studies suggest that some type of intervention and treatment for children in war is effective to an extent, especially those that help children build coping skills.”




Palestinian children take part in a four-week summer activities programme organised by the United Nations Relief and Works Agency for Palestine Refugees (UNRWA) which include sports, games, music and crafts, in Rafah in the southern Gaza Strip, on July 08, 2021. (File/AFP)

She added that children living under continued attacks develop a constant fear of violence and suffer from long-lasting anxieties as well as physiological responses to stress. It is beneficial to support their existing coping strategies and educate them on other tools that may help, she said.

In Yemen, about one in five people suffers from mental illness due to the long-running conflict in the country, according to a 2017 study by the Family Counselling and Development Foundation.

“Mental health care remains scarce in Yemen. Mental illness is stigmatized, and the proportion of psychiatrists per population is insufficient. Some of the few existing mental health services have even closed as a result of the pandemic,” ReliefWeb, a humanitarian information service provided by the United Nations Office for the Coordination of Humanitarian Affairs, said in a statement.




People displaced by conflict receive food aid in the Khokha district of Yemen's war-ravaged western province of Hodeida, on April 20, 2021. (File/AFP)

Yemen has the added difficulties of damaged infrastructure as a result of the civil war, Dr. Kirin Hilliar, assistant professor of psychology at Heriot-Watt University Dubai, told Arab News.

“Reports suggest that only 51 percent of all healthcare facilities in the country are fully functional,” she added. Hilliar further said there are limited mental health services — a stigma that is also evident in many countries in the region. 

The Syrian crisis has led to about 207,000 civilian casualties since the beginning of the conflict in 2011. About 25,000 of these were children, according to a 2021 report by Statista.




Syrian patients sit in a yard at a mental health clinic -- the sole such facility in the rebel-held north of Syria -- in the town of Azaz, near the border with Turkey, on July 6, 2017. (File/AFP)

Another 2017 report by the International Review of the Red Cross said over 2.4 million homes have been damaged, 67 percent of the industrial capacity has been destroyed, 45 percent of health centers are no longer functioning, and 30 percent of educational institutions have been demolished.

This has plunged 89 percent of Syrians into extreme poverty. This critical situation in the country has left those living through the crisis at high risk of psychological damage.

“In 2018, it was reported that only 80 psychiatrists were working in Syrian territories, and psychologists were not trained or licensed in the country. However, the WHO and other NGOs have helped in providing training to health professionals, so they feel more capable to provide psychiatric and psychological services to those in their communities,” Hilliar said.

Wars and extremist attacks in the region have affected not only those witnessing them, but also social media users who are being exposed to negative news every day.




 In this file illustration photo taken on April 7, 2021, a smart phone screen displays the logo of Facebook on a Facebook website background, in Arlington, Virginia. (File/AFP)

Reports of killings, torture and bombings are taking over social media. Users might not even notice how much negative information they consume daily and the effects of that on their mental health.

Referring to Palestine, Kanafani said social media has been an important tool for spreading awareness about the truth of what is happening there.

“The negative consequence for many individuals who are viewing all the content is survivor’s guilt as well as emotional fatigue. Viewers who do not live in Palestine are experiencing strong feelings of helplessness, injustice and frustration. The consistent nature of these feelings may lead to emotional burnout,” she added.

Hilliar said that it can be hard for many people to read and watch details of negative events happening around the world. This type of content can make people feel helpless after witnessing the suffering of others, she added.




A woman uses her mobile phone to check Facebook and other mobile apps in Yangon on February 4,2021. (File/AFP)

A 2020 report by Cleveland Clinic, a US academic medical center, said that social media “doom scrolling” can cause negative thoughts and mindset which can affect a person’s mental health.

“Consuming negative news has been linked in research with greater fear, stress, anxiety and sadness,” the report said.

Kanafani said that the Middle East lacks mental health funding, resources and workforce, while stigmatization and lack of proper awareness also leaves people reluctant to seek treatment.

The highest number of psychiatrists in the region, according to Kanafani, are found in Qatar, Bahrain, Kuwait and Lebanon, with Saudi Arabia and the UAE following with less than five psychiatrists per 100,000 population.

“Positively, we are certainly seeing an increase in the provision of mental health facilities in the Middle East, though the rate of growth varies widely across different countries,” Hilliard said.

She added that the UAE, for example, is seeing an increase in mental health services.


Aoun slams ‘systematic policy of aggression’ as Israeli strikes kill 2, wound journalists in south Lebanon escalation

Updated 59 min 29 sec ago
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Aoun slams ‘systematic policy of aggression’ as Israeli strikes kill 2, wound journalists in south Lebanon escalation

  • Lebanese Army: Attacks terrorize civilians and hinder weapons control plan
  • Israeli army spokesperson said military eliminated Abu Ali Salameh, who served as a Hezbollah liaison officer in the area
  • Israeli drones targeted sites with heavy airstrikes, wounding journalists in Qanarit and destroying their equipment, cameras and vehicles

BEIRUT: Two people were killed and several journalists wounded in a series of Israeli attacks on Wednesday targeting southern areas, most of which lie north of the Litani River.

The Lebanese Army Command described the escalation as “impeding the army’s efforts and hindering the completion of its plan to confine weapons to Lebanese territory.” It said that the strikes terrorized civilians, caused deaths and injuries, displaced dozens of families and undermined regional stability.

The day’s security situation was dominated by hours of Israeli escalation, including airstrikes and evacuation warnings targeting villages and populated areas ahead of further bombardment.

The Israeli army said that warplanes carried out precision strikes on civilian vehicles in Bazouriyeh, killing a Hezbollah member. A separate drone strike hit a civilian vehicle on the Zahrani-Mseileh road, killing one person, with Israel claiming the target was another Hezbollah operative.

Israeli army spokesman Avichai Adraee said that the military “eliminated Abu Ali Salameh, who served as a Hezbollah liaison officer” in the village of Yanouh, in southern Lebanon. He accused Salameh of managing Hezbollah activities to “enable the group to operate within civilian areas and on private property, and to establish terrorist infrastructure in the heart of populated civilian areas, through the deliberate and cynical exploitation of the residents to serve Hezbollah’s objectives.”

Adraee claimed that on Dec. 13, Israel alerted Lebanon’s enforcement mechanism about a Hezbollah weapons depot in Yanouh. Salameh allegedly relayed the notification to other Hezbollah members, who then blocked Lebanese army access by staging a gathering while removing weapons from the site.

He said that Salameh also coordinated with the Lebanese army to falsely document the property as weapons-free, even as “suspicious boxes” were removed via a back entrance. Adraee called these actions a violation of Israel-Lebanon understandings, adding that “the Israeli army will continue to take measures to eliminate all threats.”

Israeli artillery also shelled the Harmoun area in the Bint Jbeil district, south of the Litani River, prompting Israeli army warnings — complete with maps — for residents of Qanarit, Kfour in Nabatieh and Jarjouh to evacuate immediately.

Israeli drones then hammered the sites with heavy airstrikes, wounding journalists in Qanarit and destroying their equipment, cameras and vehicles.

The Press Photographers Syndicate said: “Israeli claims of maintaining safe distances offer no protection, just as the warnings issued by the enemy to civilians offer no protection. It seems that cameras are not a red line.”

The statement urged photojournalists “to exercise caution and avoid turning their professional commitment into a reckless gamble.” 

Civilians in the targeted areas reported receiving phone calls from Israel ordering them to clear squares, residential neighborhoods and a mosque.

The Lebanese Army Command confirmed that “Israeli attacks and violations targeted civilian buildings and homes in several areas, most recently in villages in the south, in a blatant violation of Lebanon’s sovereignty and security, the cessation of hostilities agreement, and UN Security Council Resolution 1701.”

Lebanese President Joseph Aoun issued a statement on Wednesday evening condemning the strikes and accused Tel Aviv of “pursuing a systematic policy of aggression” that targeted civilians and violated international humanitarian law, and constituted “a dangerous escalation.”

“This repeated aggressive behavior proves Israel’s refusal to abide by its commitments under the cessation of hostilities agreement and reflects a deliberate disregard for the efforts exerted by the Lebanese state to control the situation on the ground, maintain stability, and prevent the escalation of the confrontation,” he said.

He called on the international community — particularly the agreement’s sponsors — “to assume their legal and political responsibilities and take clear and effective measures to stop these violations and put an end to the policy of impunity.”

The escalation also came as Aoun reaffirmed his commitment to “monopolizing weapons in the hands of the state throughout all Lebanese territory.”

At a meeting of the Higher Supervisory Committee for Lebanon’s border protection program — attended by the US and Canadian ambassadors — Army Commander Gen. Rudolph Haykal stressed the army’s “absolute commitment” to securing borders but called for “qualitative military support” to tackle challenges on the northern and eastern fronts.

The army said that the ambassadors praised “its professionalism and success,” stressing the need to bolster the military institution to enhance its ability to maintain security nationwide. Lebanese military units are currently securing the northern and eastern borders with Syria to combat smuggling, weapons transfers and illegal infiltration.