Content note: this post includes mention of suicidal thoughts. Please take care while reading.
I’m going to tell you the stories of two women: Asifa and Samira. Both are patients at the mobile clinics Médecins Sans Frontières / Doctors Without Borders (MSF) runs in eight sites across Marib, in the west of Yemen.
Asifa* is 29. She lives with her husband and five children in a camp for people who have had to flee during Yemen’s civil war.
At our first meeting she cried a lot. She was deeply sad and frustrated. Things had got to the point that she wasn't able to take care of her children.
Many of the patients who are seen by our mental health team are in a constant state of hyper-vigilance, anticipating a disaster...
Asifa said she had first started feeling this way after the family had to leave their home and move to the camp. They now live in a crowded tent without the most basic necessities, like regular food, warm clothes and decent shelter.
Displacement also puts pressure on relationships and family systems. Over half of women who come for individual consultations with our team say that family issues are making their mental health worse, and Asifa is no exception.
“After the displacement, he became very angry, always displacing his anger on me and the children. He also became very suspicious of everything. He lost control over the family; he doesn’t provide for us. He thinks we don’t listen to him anymore,” she said.
With no place to live, no hope for the future, no food for her children and with a husband who beats her, Asifa told us she feels she would be better dead.
The impact of war
Asifa and her husband are not the only story like this in Marib. It was once thought one of the safest places in Yemen, and people from all over the country are now living in around 150 formal and informal camps. Thousands of vulnerable people do not have food to eat, sources of livelihood, or safe places to live with their children. Cut off from traditional community support, their physical and mental health are both hit hard.
Yemenis have been living through this civil war since 2014. Many have lost family members and loved ones during the conflict and live with the fear that the violence may erupt again at any time. Many of the patients who are seen by our mental health team are in a constant state of hyper-vigilance, anticipating a disaster.
Post-traumatic stress symptoms are not uncommon. Many come to us with excruciating images about what happened in the conflict, nightmares and racing hearts when someone mentions the frontline. These symptoms are exaggerated in women who have their loved ones still in the battlefield.
Because the war is not over. Our patients tell us that working on the frontline is the only way to gain money and survive these days. Many of the women who come to us have loved ones there, and live with constant worry that they might lose them at any time. This uncertainty and fear contribute to issues including depression, sleeping disorders, and anxiety disorders.
Yemenis are not the only people living in extremely difficult conditions in Marib. Samira*, 17, is a migrant from Ethiopia living in a camp. Six months ago, she left her family in Ethiopia and started her journey, mostly overland, to find work in Saudi Arabia. Like many other female migrants transiting through Yemen, she experienced both sexual and physical violence.
Now Samira is stuck in Marib, staying in a small tent with more than 20 women. She has no money to buy food or warm clothes and no way to communicate with her family.
Supporting our women migrant patients is always challenging as their smugglers often accompany them everywhere. They are not allowed to talk to people if there is no medical emergency...
Samira says she feels “worthless now and sees no hope” in her life. She is sad and anxious most of the time, isolating herself from other people.
Between November 2020 and November 2021, MSF mental health counsellors provided 265 individual consultations for migrants. 76% had anxiety symptoms including sleeping problems, nightmares and flashbacks. 32% suffered from depressive symptoms along with suicidal thoughts.
However, supporting our women migrant patients is always challenging as their smugglers, who manage the journey from Africa to Saudi Arabia, often live with them and accompany them everywhere. They are not allowed to talk to people if there is no medical emergency.
As for male migrants, they come only for physical health concerns, the rest of the time, they work in inhumane conditions for long hours to survive.
A neglected issue
There are over two million people in Marib, residents, displaced people and migrants combined.
Our staff provide general medical care and help people to access basic services for their survival and safety. Our teams work with the community to share information and raise awareness about symptoms of mental health issues, stress management and where people can seek help.
People’s need for mental healthcare is visibly high.
But MSF is the only organisation providing counselling and psychiatric care. Mental health is one of the most neglected areas of healthcare in general in Yemen. Lack of awareness, cultural and societal norms and stigma surrounding mental health issues often prevent people from seeking support.
MSF alone cannot meet the overwhelming mental health needs of people in Marib. There are many others like Asifa and Samira who need support.
* Names and identifying details have been changed