When reflecting on a topic as far-reaching and deeply-emotive as war and mental health, it is important that we make sure we also hear the voices and capture contributions from our partners working at community level. Our colleagues from Cape Mental Health provided the following insights on the mental health consequences of war after we asked them to contribute to this series:
The war in Ukraine highlights the impact of trauma induced by mass violence, displacement and persecution on the mental state of people living in these conditions.
Living with intense and constant fear of violence, injury or death; experiencing the sudden loss of your loved ones; witnessing the destruction of your home and property; losing your civil identity; having your entire world displaced and being forced to search for refuge in foreign countries have serious negative consequences for mental health. The horrors of war are endless and can create a lifetime of trauma that may be impossible to recover from.
In the heat of battle and the immediate aftermath, health and disaster-aid workers are focused on attending to the injured; thereafter dealing with urgent needs such as medical services and supplies, clean water and sanitation, emergency shelters, electricity and telecommunications that are vital to prevent further suffering and loss of life.
According to studies published on the Long-Term Impact of War, Civil War, and Persecution in Civilian Populations Frontiers in Psychiatry (2022), based in Africa, Palestine, Myanmar and Syria, war survivors often suffer from feelings of displacement, anxiety, depression, and post-traumatic stress. Human rights violations during conflict such as physical and psychological torture, rape, and imprisonment without trial, can compound mental health misery and long-term psychological harm.
Living in a constant state of fear is not helpful to one’s mental health. “War has various effects on the mental health of affected individuals; it can trigger signs of depression, anxiety, or any other signs of mental health conditions” explains the staff from Cape Mental Health’s Psychosocial Rehabilitation (PSR) services.
There is a good chance that survivors in affected nations will develop post-traumatic stress disorder (PTSD) with long-term, intergenerational consequences. According to the online publication Mind the Gap: Why Mental Health Care Matters for Rebuilding Syria (2022) – child survivors, and children born into war, can often struggle with emotional, developmental, and intellectual challenges. This can result in school drops out, substance abuse and thoughts of suicide. The study further states that children who are raised in conflict are more likely to exhibit delinquent behaviour.
Members of Fountain House SA, a psychosocial rehabilitation service provided by Cape Mental Health, felt that people with pre-existing mental health conditions could relapse due to the strain on their mental health caused by the war. In their opinion, persons fleeing from war zones and refugees could feel a sense of abandonment and displacement and this could also trigger mental health issues for people who do not have pre-existing mental health conditions.
The staff and trainees at Training Workshops Unlimited for persons with intellectual disability expressed concern for the people in Ukraine. “It makes me very sad to see how elderly people and small children have to flee from their homes and all the damages and the buildings being destroyed. Watching the images of people looking afraid while having to run away from their homes is not nice” says trainees. They hoped the war would stop. Some were afraid that the war would come to South Africa as well.
“People are being traumatised by the war” say members of the PSR programme. “Support is needed, and mental health facilities need to be accessible now more than ever, so that the long-term effects of war can begin to heal.”
We wish to reiterate the Athens Anti-War Declaration which states:
War is the worst of human-made disasters and has tragic and unacceptable consequences on the mental health of its victims. The catastrophic impact of war on mental health is longitudinal, transgenerational, and amplified by refugee crises both in countries of origin and elsewhere.
Our plea is for the wars and conflicts to stop in Ukraine, Afghanistan, Yemen, Syria and elsewhere in the world. We must support and promote the dignity of all displaced people, provide food, housing, medical attention and mental health services and ensure that they know they belong to a common humanity – one world one people.
Our colleagues from Indlela Mental Health [formally Port Elizabeth Mental Health] shared the following after they held a staff discussion on the issue:
The war on Ukraine is absolutely devastating to the world at large. More than 2 million Ukrainian people have been displaced, mostly women and children. It is shocking that this is happening despite the fact that both countries (Russia and Ukraine) are signatories to the Convention on the Elimination of all forms of Violence and Discrimination against Women (CEDAW). There seems to be no accountability and we need to see a push in humanitarian law, human rights laws, criminal laws etc. Where is the United Nations here? Who has the power to put a stop to this madness?
We can only imagine the overwhelming sense of emotions experienced by the Ukrainian people – fear, anxiety, disconnection from friends, family. This will all have lingering effects on psychological health and well-being and survival. They also shared some ideas on what they think needs to happen:
- Access to life saving services in times of crisis – humanitarian agencies to provide relief and support
- Enforce adherence to regulations to protect the people of Ukraine
- Safe passage ways for people to flee to safety and provision of aid (food, shelter, transport etc.)
Ms Shona Sturgeon, a social work lecturer, lifelong mental health advocate and Honorary board member of SAFMH shared the following when asked about the importance of SAFMH tackling this topic:
I would like our contribution to highlight the fact that this invasion has impacted on mental health in so many ways. It has meant that those service users in the affected areas are probably without their medication, causing untold problems for them. They are also without their support systems. Countries into which they are moving must be aware of these two issues, and not only address their physical needs. Regarding the mental health impact on all people in those areas, indeed in the whole country, whether civilians or in the military, much has been written about the impact of war on people’s mental health. For those impacted on by this invasion, they are probably also feeling anger etc. that the “world” is not coming directly to their aid -even if “intellectually” they may understand the complexities of the current situation. I sincerely hope that some effort is being made to address the conflicting emotions that these people must have. Practical issues need to be addressed, but emotional issues well need attention too – even if later. Many people will also need to mourn their dead, and, again, we know the difficulties that arise if this is not possible. On the world-wide stage, this invasion has had an impact on people’s feeling of security, and I wonder if the anxieties of children are being recognized world-wide as they hear their parents/adults talk of the possibility of a 3rd world war.
General William Sherman, leader of the Union army in the American civil war, famously said that “war is hell”. Short as it might be, this statement seems to capture the true reality and horror of war. War effects the world in countless ways.
In the short-term, war leads to the destruction of infrastructure, the weakening of political and economic institutions, and a loss of human life and disability worldwide. Apart from the direct results of war, such as leading to people dying or being injured, large numbers of people are also affected negatively due to the wider effects of war on global health. War often re-directs essential and oft-scare resources away from those who need it towards war efforts, along with doing damage to healthcare infrastructures. War leads to people fleeing their homes to find safety elsewhere, with recent estimations of the UN showing that approximately 70 million people are currently displaced because of war [more on displacement in part 3]. Apart from its other effects, displacement can be extremely detrimental to people’s health, due to a lack of safe and regular places to sleep, to wash and clean, and due to exposure to the elements. It also removes the ability to have access to regular sources of proper food and nutrition. But it does not only affect physical health. As has already been shown in this series, war also impacts very negatively on the mental health of those actively involved in conflict and on ordinary civilians.
In the longer term, war has the unavoidable consequence of drastically altering social cohesion and development, leading some researchers to define war as “development in reverse”. War leaves a legacy of persistent underdevelopment through weakening local and national political institutions, through the destruction of social fabric, and through creating divisions between populations by removing the foundations of values, norms and communal group and interpersonal trust, which facilitates interpersonal cooperation. At a micro-level, researchers have found that armed conflict affects both tangible things like individual investment, consumption and income adversely, along with less tangible things like social trust and psychological wellbeing.
Taking all this into consideration, it would seem that war is in fact hell. A hell that is sadly an avoidable, man-made one.
By Leon de Beer – Deputy Director, SA Federation for Mental Health