Good mental healthcare should be part of peacebuilding

First published by ISS Today

The negative impact of armed conflict on the mental health of combatants is well documented. But it wasn’t until about two decades ago that literature on the effect of conflict on civilians began emerging.

The United Nations Refugee Agency Statistical Yearbook of 2016 revealed that globally, about 57% of refugees came from three conflict-torn countries – Sudan (2.4-million), Afghanistan (2.6-million) and Syria (6.3-million). Also, 85% of displaced people worldwide were in developing countries – contrary to the perception that rich countries host the majority of refugees.

According to the Armed Conflict Location and Event Data project, in 2017 alone there were over 16 500 events of conflict and violence reported in Africa, and about 23 000 fatalities (Figure 1). Mental health conditions like PTSD, anxiety and depression are triggered by traumatic events and can persist for many years after the event.

Figure 1: Violent events in Africa, 1997-2017. Source: Armed Conflict Location and Event Data project

Although recorded incidents of violence against civilians have declined over the years, other conflict events (for example remote violence like bombings and IED attacks) have increased, and trauma manifests, even years later, if effective treatment is not sought.

In response to the World Health Organisation’s need to integrate mental health as part of health and social welfare programmes, 177 country states have strengthened governance on mental health and social care. However, low-income countries don’t have the human and financial resources, health professionals or basic infrastructure to sufficiently address the problem.

Creating a distinction between the effects of conflict and other coexisting social pressures can also be problematic. For instance, in a region like the Sahel, how do we quantify the extent of trauma caused by armed conflict and, say, the suffering caused by chronic poverty? Many experts concede that there’s no single panacea for societies affected by multiple socio-political emergencies, but that a psychosocial framework is needed.

In terms of healthcare, western countries have provided support structures for refugees. But the deeper turmoil of disrupted lives, alienation in a strange culture and loss of status are potentially dilemmas beyond quick once-off medical remedies.

So how should Africa deal with mental health? More inclusive health and educational systems to address mental illness caused by conflict, and eliminate the stigma around mental illness in general, is needed.

Local or culture-specific psychological norms and beliefs could be weaved into the mental health framework. This could provide an alternative to western psychiatry methods that frame suffering as a scientific problem that needs solving without acknowledging traditional, cultural and religious aspects that may be pertinent to refugees’ cultures.

For example, ancient systems such as Ayurveda or Chinese medicine view the body and mind as one in their approach to health and illness, and attempt to examine issues within their social, economic and cultural environments.

Local identity and understanding can be important in alleviating the suffering of people who have lost much, if not all, of their worlds. This can help deal with the stigma surrounding mental health discussions and with seeking professional help.

Social and political reform should strive to deliver justice and public recognition for victims of war and conflict. Further research is required on this issue, but evidence shows that mental distress is prevalent in conflict-affected regions.

Stellah Kwasi is a Researcher, African Futures and Innovation, ISS Pretoria