Mental Health Day: war and Covid-19 strain leave many in Middle East suffering in silence

Charities face a daily challenge of rising demand

A Syrian refugee man walks on the main market street in Al Zaatari refugee camp in the Jordanian city of Mafraq, near the border with Syria on July 30, 2018. Muhammad Hamed / Reuters

Syrian refugees prepare to return to their homelands of Jarablus, Damascus, Aleppo, A'zaz, Al Bab and Afrin in Syria. Here they are seen loading their belongings onto buses and waiting to depart from Esenyurt Municipality garden in Istanbul, Turkey, on November 9, 2019. Emrah Gurel for The National

Syrian refugee students take part in a washing hands activity during an awareness campaign about coronavirus on March 11, 2020. Reuters

The Zaatari camp in Marfaq, south of the Syrian border, became Jordan’s first official camp for Syrian refugees fleeing violence in their country. In the photo: Aya stands with her neighbours in Zaatari camp in Jordan. She is one of 60,000 children in Zaatari camp. WFP

Millions of Syrians have been forced to flee their country since the war began in 2011. AFP

Refugee children at a refugee camp in Lebanon watch a magic show in Syria. Courtesy Magic for Smiles

A boy roller skates at Seven Hills Skate Park in Downtown Amman, Jordan, on September 22, 2020. The Seven Hills is a Jordanian non-profit organisation that uses skateboarding as a tool to encourage social cohesion, youth leadership and gender equality. Andre Pain / EPA

Girls enjoy skateboarding at Seven Hills Skate Park in Downtown Amman, Jordan, on September 22, 2020. The Seven Hills is a Jordanian non-profit organisation that uses skateboarding as a tool to encourage social cohesion, youth leadership and gender equality.

The family of Ali Kinno pose for a photograph at a temporary apartment in the coastal town of Jiyeh, south of Beirut, Lebanon, on September 15, 2020. The Kinno family from Syria's Aleppo region was devastated in the wake of the August 4 explosion at the Beirut port, their tragic story reflects the particular pain of Syrian refugee families in Lebanon, which is now home to about a million Syrians. Hassan Ammar / AP

Prolonged conflicts and the coronavirus pandemic have left mental-health services in the Middle East in crisis, with Lebanon and Syria worst hit.

Doctors Without Borders said twothirds of people seeking mental health support had symptoms of anxiety and depression.

Two months after a massive explosion ripped through Beirut port, demand has significantly increased.

“Although by now many people have had their physical wounds treated and have secured their basic needs for housing, electricity and water, many still cry at night or are startled by the slightest sound,” said MSF psychologist Sara Tannoury.

More than half those asking for help said the blast on August 4 was responsible for their condition.

What people are going through today is a normal reaction to abnormal events

Of those with existing mental illness, 82 per cent said their symptoms worsened after the blast and resulting political and social unrest.

Symptoms cited by MSF’s patients included panic attacks, insomnia, loss of appetite, forgetfulness, lack of focus, loss of interest and negative thoughts.

Data was taken from 98 patients, of which 17 were children, who required medical attention between August 14 and September 30.

As hospitals that escaped serious damage were rapidly overwhelmed, the wounded were forced to take long journeys to seek medical help, often passing devastating scenes of the blast’s aftermath.

That experience scarred many who are now struggling to come to terms with the aftermath.

A 70-year-old woman who lost sight in both eyes after she was hit by debris from the explosion told medics she wished she had not survived.

“She keeps saying that it should have been her dying in the blast, instead of the young men and women who lost their lives,” Ms Tannoury said.

Damaged cars are pictured in front of billowing smoke behind the grain silos at the port of Beirut. AFP

A drone picture shows smoke from the scene of an explosion at the seaport of Beirut. AP Photo

Lebanon's President Michel Aoun wears a protective face mask as he visits the scene of Tuesday's explosion in Beirut. AFP

An emergency command vehicle of the Lebanese Red Cross is pictured in the aftermath of yesterday's blast. AFP

A man inspects the damage of yesterday's blast. AFP

A survivor is taken out of the rubble after a massive explosion in Beirut. AP Photo

A damaged hospital is seen after a massive explosion in Beirut. AP Photo

Lebanese soldiers search for survivors after a massive explosion in Beirut.AP Photo

An ambulance drives near the site of Tuesday's blast in Beirut's port area. Reuters

Lebanese national flags fly at half-mast outside the presidential palace in Baabda, following Tuesday's blast in Beirut's port area. Reuters

A woman is evacuated from the partially destroyed Beirut neighbourhood of Mar Mikhael. AFP

An injured man sits next to a restaurant in the trendy partially destroyed Beirut neighbourhood of Mar Mikhael. AFP

A man walks past damaged building and vehicles near the site of Tuesday's blast in Beirut's port area. Reuters

A man wearing a protective face mask walks past damaged buildings and vehicles near the site of Tuesday's blast in Beirut's port area. Reuters

A woman sweeps at a damaged hospital following Tuesday's blast, in Beirut. Reuters

A man wearing a face mask moves a gurney at a damaged hospital following Tuesday's blast in Beirut. Reuters

The wreckage of a ship is seen following yesterday's blast at the port of Lebanon's capital Beirut. AFP

A view shows the aftermath at the site of Tuesday's blast in Beirut's port area. Reuters

Lebanese soldiers and people gather outside American University of Beirut medical centre following the explosion in Beirut. Reuters

An injured man sits outside American University of Beirut medical centre following an explosion in Beirut. Reuters

The explosion caused damage to Lebanon's PM Hassan Diab's office

The damage at Lebanon's PM Hassan Diab's office following the blast.

Pictures of the damage at Lebanon's PM Hassan Diab's office

People gather outside American University of Beirut medical centre following the explosion in Beirut. Reuters

Lebanese soldiers stand outside American University of Beirut medical centre following the explosion in Beirut. Reuters

Damaged vehicle and buildings near the scene of Tuesday's blast in Beirut's port area. Reuters

A man walks by an overturned car and destroyed buildings. Getty Images

A view shows the damaged facade of a building following Tuesday's blast in Beirut's port area. Reuters

A view shows the aftermath of yesterday's blast at the port of Beirut. AFP

A man pushes a buggy with a child on Wednesday past a damaged vehicle near the scene of overnight blast in Beirut's port area. Reuters

In this drone picture, the destroyed silo sits in rubble and debris. AP Photo

People inspect the damage near the scene of Tuesday's blast in Beirut's port area. Reuters

People inspect the scene of Tuesday's blast in Beirut's port area. Reuters

Shattered glass lies in front of a building following a blast in the Lebanese capital Beirut. AFP

Lebanese army troops carry a wounded man evacuated from a ship at Beirut's port. AFP

This picture shows damage at Beirut-Rafic Hariri International Airport. Courtesy Lebanese Plane Spotters / Facebook

“Some children are now bearing responsibilities beyond their age.

“One young boy had to call his father to come and rescue his mother who was trapped under a fallen wall.

“In the past in Beirut, society and communal networks – family, friends, neighbours – would have normally been the first point of informal support for a troubled person.

“Today, these networks are all equally impacted and people are turning to mental-health specialists.

“What people are going through today is a normal reaction to abnormal events.”

To help cover the gaps in mental-health services in Lebanon, MSF is in discussions with the Lebanon National Mental Health Programme – which is part of the Ministry of Public Health – with the aim of integrating its support within their national plan.

It aims to ensure a long-term strategy that meets the increase in needs.

“The blast in itself is a traumatic incident that generates its own short-term acute psychological consequences,” Ms Tannoury said.

Jordan, Zaatari Refugee Camp, June 2013 On 29 July, the Zaatari camp in Marfaq, south of the Syrian border, became Jordan’s first official camp for Syrian refugees fleeing violence in their country. As Jordan continues to receive tens of thousands of Syrians, opening this camp had become necessary to accommodate terrified families. On World Refugee Day, WFP PI Officer Dina El-Kassaby walked around the camp and spoke with refugees about their expectations and hopes for the future. In the photo: Aya stands with her neighbours in Zaatari camp in Jordan. She is one of 60,000 children in Zaatari camp who miss something from home. Aya tells a WFP staffer that her mother promised her she could return home to Syria as soon as possible to collect her teddy bears and bring them back to Jordan where they can sleep with her in her tent in Zaatari camp. Photo: WFP/Dina El-Kassaby

“But if these are left untreated, these could erode people’s psychological well-being in the long term.

“We need to look at mental health as an integral part of a person’s well-being."

Meanwhile in Syria, years of conflict have severely weakened the health sector to the point of collapse in some regions.

Vital services are either completely unavailable or functioning at only 50 per cent.

A shortage of qualified mental-health professionals, impaired access because of safety and security reasons and the loss of many health services left the most vulnerable with nowhere to turn for support.

Before the civil war broke out in 2011, access to psychological and psychiatric help was already rare.

It is estimated there are only 50 psychiatrists in Syria to service the whole population, after 50 fled the country because of the conflict.

As a result, a significant number of Syrians suffering from mental health conditions remain undiagnosed and untreated, said the International Committee of the Red Cross.

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Since 2018, the ICRC has tried to rebuild capacity in the country to treat a problem only worsening as a result of the Covid-19 pandemic.

Until August, 120 patients benefited from a psychological and mental services programme for patients with physical disabilities in the ICRC Physical Rehabilitation Centre in Aleppo.

Isolation and travel restrictions brought on by the pandemic revived terrifying memories of war for some.

Nazha El Hallaq, a Syrian refugee who works in a hairdressing salon in Aarsal in Lebanon, is among those who suffer flashbacks of conflict.

"When self-isolation started, we found ourselves in the house not being able to move around," she told a Red Cross researcher before World Mental Health Day.

“It reminded me of a time when we were in Syria and we had to stay home because of the shelling and bombing.”

Last year, the ICRC provided specialised mental-health care and psychological and psychosocial support to 23,829 people, including 2,840 children.

It also supported 6,964 professionals or community members through training.

In the ICRC's latest survey, more than half (51 per cent) of respondents said the Covid-19 pandemic had harmed their mental well-being.

Nearly three in four (73 per cent) said front-line health workers and first responders have more need for mental-health support than the average person.

"The Covid-19 health crisis has exacerbated the psychological distress of millions of people already living through conflicts and disasters,” said Robert Mardini, the ICRC's director general.

“Lockdown restrictions, a loss of social interaction, and economic pressures are all impacting people's mental health and access to care.”