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World Mental Health Day: Support Conflict Survivors

Ensure Psychosocial Services Are Based on Rights, Autonomy, Dignity

Farhan*, a 29-year-old man from Kapisa province, said he could not sleep during the night: “I’m in bed [in France], but my mind is in Afghanistan.” © 2022 John Holmes for Human Rights Watch

(Brussels) – Governments, UN agencies, and humanitarian organizations should take concrete steps to develop and invest in psychosocial support for people affected by armed conflicts, Human Rights Watch said today. In line with the theme of World Mental Health Day 2022 on October 10, to “make mental health and well-being for all a global priority,” the focus should be on community-based, rights-respecting services both in conflict countries and in countries where people are fleeing to.

Conflict-related violence can lead to psychological distress, depression, anxiety, and post-traumatic stress. Human Rights Watch research in countries including Afghanistan, Cameroon, Central African Republic, Ethiopia, Gaza, Iraq, South Sudan, and Syria has shown that people, particularly women and people with disabilities, often face barriers in accessing mental health services.

“Millions of people around the world are experiencing the devastating impacts of war on their mental health, but few receive the support they need,” said Shantha Rau Barriga, disability rights director at Human Rights Watch. “The war in Ukraine is the latest reminder that governments and humanitarian agencies need to recognize mental health as a priority and expand psychosocial support services to all those affected by conflicts.”

The Global Mental Health Summit, on October 13-14, 2022, in Rome, is an opportunity for leaders to affirm the mental health impact of armed conflicts and to commit to providing appropriate psychosocial support to all those affected, including women and people with disabilities. Governments, donors, and humanitarian aid organizations should prioritize community-based, rights-respecting services that uphold people’s autonomy and dignity.

An estimated 22 percent of people living in areas affected by armed conflict have a mental health condition, compared with about 13 percent in the general population. Yet, the services available are often insufficient.

In Syria, where about 7.5 million children and adolescents are currently in need of mental health support, parents interviewed by Human Rights Watch described the devastating impact of the conflict on their children’s mental health. All but one person said they and their children have not had access to mental health and psychosocial support services.

The father of a 13-year-old boy with a developmental disability, said: “This situation made him more withdrawn. He sits alone, doesn’t want to interact with any other kids.” The father of a 10-year-old boy with an intellectual disability said that the multiple military offensives in the region particularly affected his son: “He changed a lot. He is always afraid, including when it’s something he shouldn’t be afraid of.”

In Afghanistan, which has been devastated by 40 years of armed conflict, it is estimated that more than half the population, including many survivors of conflict-related violence, experience depression, anxiety, and post-traumatic stress, but fewer than 10 percent receive adequate psychosocial support from the state, according to the previous government’s documents.

A man who was 23 when Human Rights Watch interviewed him in 2019 was offered no psychological counseling after a suicide bombing attack that killed at least 20 people. He was treated for injuries at the military hospital, but “Nobody came to ask about my mind,” he said. “They only treated my body.” Two years later, he sought help but the trauma remains: “I still have flashbacks, all night I can’t sleep. I get angry easily, [especially] when people make noise. But I was keeping that anger inside, and I was very sad. I don’t know what kind of treatment should be provided but there should be people asking about our needs.”

The ongoing war in Ukraine has already had profound consequences for the mental health of those affected, including people who managed to flee to safety. The needs in Ukraine remain high, and in other crisis situations that have received less attention psychosocial support is often overlooked.

Globally, more than 100 million people are forcibly displaced, including refugees, asylum seekers, and those internally displaced. In addition to experiencing psychological harm from the traumatic events that drive people from their homes, research shows that forcibly displaced people often experience additional distress both during the escape and after, while they adjust to an unfamiliar place.

Receiving countries also have an obligation to provide psychosocial support, as part of their international commitment to the right to health. This is recognized in international human rights treaties, including the International Covenant on Economic, Social and Cultural Rights (ICESCR) and the Convention on the Rights of Persons with Disabilities (CRPD).

Roya*, a 19-year-old woman who was evacuated to France together with her mother, said that sessions with a psychologist, and group and art therapy sessions helped her talk about her emotions and recover from trauma. © 2022 John Holmes for Human Rights Watch

In August 2021, when Taliban forces took control over Afghanistan, many Afghans fled the country at short notice, in some cases leaving their families behind. Human Rights Watch research in France showed that despite important efforts to welcome, promptly accommodate, and support Afghan evacuees, many still faced significant hurdles in getting psychosocial support. One woman told Human Rights Watch: “I was in shock mode, and now I am still in shock mode. I keep forgetting things, I even forget my name.”

Human Rights Watch research in countries including Ethiopia and Iraq documented the impact of conflict-related sexual violence on women’s mental health. A Tigrayan woman said that a soldier and civilians gang raped her three months before she spoke with Human Rights Watch, and said she still felt anxiety, guilt, and shame: “I feel stress, I am affected mentally…. That moment comes to my mind every day…. I always remember that day.”

“It’s fundamental to increase the availability of mental health services to survivors of conflict-related violence,” Barriga said. “It’s essential to prevent further suffering, as well as long-term consequences for individuals, their families, and entire communities.”

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