Ayla[1] loved working as a nurse. More than the work, she loved the people in her community that she treated during house calls and tended through all sorts of illnesses. Most of all, she loved watching the babies she’d helped to deliver grow into the children and young people who brought life to her neighborhood. When Ayla’s husband divorced her, it was her work that helped her endure the heartbreak and kept her sense of self strong. When she was down, her community faithfully returned the love she’d always shown them—grateful for all the care they’d received at her hands over the years. Now, however, it is Ayla’s hands that have forced her to give up her beloved work.
Over the last nine years, Yemen’s war has claimed the lives of two of Ayla’s seven children. Not long after the second funeral, Ayla’s hands began to tremble involuntarily. She could no longer safely administer IVs or give injections, and she was left to grieve the loss of her job on top of the losses of two children and her marriage. This also left her in financial need as she no longer had any way to support her five remaining children nor her grandchildren, who had come to live with her following her son’s death. Still, when a local non-profit brought Ayla’s household donations of clothes and shoes, she was thinking about her neighbors. “They’re really struggling, too,” she told the non-profit’s representative. “I see children in the streets that I cared for when they were still in the womb wearing clothes that they’ve outgrown or that are too threadbare to mend. It will be hard to enjoy our new clothes when we see them going without. Please help them, too, if you can.”
As they work to serve Yemen’s most vulnerable, humanitarian organizations often encounter the spirit of generosity that Ayla models among their beneficiaries. Like Ayla and her family, Noor and her two sisters were unable to afford basic necessities like new clothes and proper meals. They were barefoot and wearing threadbare garments when a local non-profit brought them clothes during an in-kind relief distribution. The non-profit’s representative was surprised when they said, “Do you have clothes for our cousins, too? They really need them more than we do!”
Fortunately, the non-profit was able to assist both Noor and her sisters, as well as their cousins, through the distribution of donated clothing. However, also like Ayla, more and more Yemenis are experiencing the devastating toll delivered by a toxic cocktail of acute and chronic psychological trauma combined with unmet physical needs. Few are being supported with the awareness or resources to cope.[2]
Mental health has historically been a taboo topic in Yemen, associated with myth, superstition, witchcraft, and jinn.[3] Many Yemenis describe those seeking mental health support as not normal, unstable, possessed, crazy, or far from God. Meanwhile, traditional and Quranic healers have long served as the primary carers for Yemenis suffering from mental health conditions, combining religion, hypnotism, suggestion, and native herbal medicine in their treatments. Formal psychiatric treatment is often only sought in the most severe cases of schizophrenia and psychosis.
Even before Yemen’s war, Yemenis suffering from mental health conditions could be seen wandering on city streets. Those whose families did keep them at home were often restrained in whatever way the household could devise to prevent them from harming themselves or others. Now, over nine years of war have exposed Yemenis, on a daily basis, to the psychological pressures of military operations, displacement, lack of food, unemployment, fear of persecution, and lack of basic services. Additionally, they have faced climate-related challenges such as floods, torrential rainstorms, and heat waves over the same period.[4] Meanwhile, the shackling of persons with mental health disorders continues to take place, even in some mental health facilities. In early 2021, a reporter visiting the Taiz mental health hospital found that many of the facility’s patients were heavily sedated and shackled—with just two nurses responsible for caring for the 143 inpatients being treated there. At the time, the hospital had only enough funding to buy a quarter of the medications needed to manage its patients—while 75 percent of Yemen’s health facilities report never having essential psychotropic medications available.[5]
According to a 2021 paper produced via collaboration between The Sana’a Center for Strategic Studies and the Columbia Law School Human Rights Clinic, prolonged exposure to violence and trauma may increase an individual’s threat perception. This, in turn, can trigger negative responses such as pre-emptive violence to defend oneself and an unwillingness to compromise. Furthermore, the exposure may intensify feelings of anxiety, fear, and anger that transform into a general distrust of society at large, authorities, and even neighbors. Such pervasive distrust can undermine reconciliation efforts, while poor mental health may also affect cognitive skills such as perspective-taking and problem-solving. Consequently, left unaddressed, conflict- and atrocity-induced poor mental health has been associated with greater support for violent responses and a lower likelihood of envisioning nonviolent solutions—leading to reduced support for peace and reconciliation. Mental health and psychosocial interventions, however—including the facilitation of community-based social support initiatives and psychological education—can temper these effects and even contribute to more constructive peacebuilding.[6] According to the World Health Organization, the loss of productivity caused by depression and anxiety costs the global economy a trillion US dollars annually. Meanwhile, every US dollar invested in expanding treatment for depression and anxiety yields a return of five US dollars in terms of economic productivity. In Ayla’s case, the untreated psychological impacts of grief and loss have manifested in physical symptoms that have cost not only her—but also a local community in a nation where qualified healthcare workers are in short supply.[7] Thus within Yemen’s complex crisis, the price of failing to address mental health and psychosocial support needs should not be underestimated.
[1] Names changed to protect vulnerable Yemenis.
[2] A 2019 study found that the most prevalent mental health conditions in Yemen were post-traumatic stress disorder, depression, anxiety, schizophrenia, and phobia.
[3] Invisible, shapeshifting creatures who are mentioned in the Qur’an and considered to be neither innately evil nor innately good as well as to be subject to God’s judgment in the afterlife. They are said to be responsible for many diseases and all kinds of accidents.
[4] https://sanaacenter.org/files/THE_IMPACT_OF_WAR_ON_MENTAL_HEALTH_IN_YEMEN.pdf
[5] https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8233030/
[6] https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8233030/
[7] National Mental Health Strategy in Yemen, The World Health Organization
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