Fieldset
Mental health in Yemen: “The number of severe cases is astonishingly high”

Not all war-wounds are visible. Mental health specialist Antonella Pozzi shares the work of the team in Hajjah, Yemen, a country that has lived through years of civil war...

The crisis in Yemen has been going on for more than six years, and it’s no longer a top story in the headlines. Fortunately, in Hajjah governorate we see fewer casualties as a result of fighting compared to the early days of the conflict. However, the war is not over.

There are of course still conflict-related deaths in the country. What doesn’t usually receive attention, though, is the impact that this conflict has had on people’s wellbeing, and their mental health in particular.

The issue

I’m the mental health activity manager for Médecins Sans Frontières / Doctors Without Borders (MSF) in the city of Hajjah, about 120 kilometres northwest of Yemen’s capital, Sana’a.

Authorities have identified more than 9,000 patients in the Hajjah area who are in need of mental health services. The actual number is probably even higher, since mental health needs tend to be underestimated.

Even if the conflict were to end tomorrow, what it has done to people’s psychological health will be seen and felt for many years to come

MSF is supporting Al-Gamhouri hospital to provide specialised mental health services. We treat a wide range of conditions, from anxiety and insomnia to psychosis, depression, bipolar disorder and post-traumatic stress disorder (PTSD).

The impact of conflict

One of the important things to understand about mental wellbeing is that it is very much affected by external factors. The more intense someone’s circumstances are, the more their wellbeing will be impacted.

Living in a context of war means being exposed to constant stress for a long period of time. Armed conflict in Yemen has not only affected people’s physical health: it has reduced their access to healthcare, education, and food, it restricts their freedom of movement and denies them the freedom to express themselves. This has a profound effect on people’s mental health.

People often travel distances of more than 100 km to access our services...

We regularly see patients after they have attempted to take their own lives; the number of patients we see with severe symptoms is astonishingly high. Around 45% of the patients we see are severe cases and some months (for example March, June, and July of this year), more than half of new patients at the MSF clinic presented with severe mental health disorders.

Extreme measures

One of the things that may account for these high numbers is the lack of other mental health services in this area. People often travel distances of more than 100 km to access our services, showing the high needs across the country.

However communities also need help to understand more about mental health conditions and how to recognise them. This would give patients and their families at least some of the tools they need when experiencing severe symptoms, including where to turn to for professional help.

Stigma and lack of awareness are two sides of the same coin, leading to discrimination and segregation

Without this, in the case of patients experiencing psychosis, families often resort to chaining them, sometimes for days or weeks.

When asked about these methods, the families clearly explain that they do not know how to handle moments of severe aggressiveness and agitation, when the patient poses a danger to those around them. Even if we empathise with the families, measures like chaining are extreme and in violation of basic human rights.

We also see that the first option for families is often spiritual treatment. This can make it harder to treat patients, especially those with severe symptoms. Frequently patients arrive at our clinic only if a mental health issue has become very acute, and after they have already been exposed to ineffective and sometimes harmful practices that exacerbate their symptoms.

Stigma

Another important factor impacting our patients is stigma. Stigma and lack of awareness are two sides of the same coin, leading to discrimination and segregation, which can mean people hide their conditions, increasing their suffering and isolation.

We find that women in particular are discouraged from sharing their feelings and from speaking up about their psychological struggles. In many cases this leads to severe states of depression.

In our daily work at the MSF clinic in Hajjah, we try to normalise mental health issues and help change the social understandings that link mental health conditions with things like “craziness” and “danger”.

Norms do not change as fast as we would like, but it is our hope that if we continue to commit to this work, the changes in our practices will have a direct impact on the way these ideas are articulated within society, leading to a slow, but hopefully sustainable change.

Our hope

Even if the conflict were to end tomorrow, what it has done to people’s psychological health will be seen and felt for many years to come.

Yemen needs a long-term comprehensive approach including more services to address the looming mental health crisis.  

It is our hope that through our collaborative work we can contribute to improving the mental health conditions of people who have already had to face and overcome adversity at profoundly deep and devastating levels.

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