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    CommentaryThe often-ignored mental health consequences of war in Ethiopia

    The often-ignored mental health consequences of war in Ethiopia

    Date:

    Fighting between the Ethiopian government and the Tigray People’s Liberation Front (TPLF) has been taking place in the northern part of Ethiopia since early November 2020. Although itstarted in Tigray during November 2020, it has also spread to neighboring regions such as Amhara and Afar after seven months of fighting, adding to the atrocities and human suffering. The conflict, which has been going on for more than a year, has claimed thousands of lives in the Tigray, Amhara and Afar regions and led to the displacement of millions of people.

    War has disastrous effects on the health and well-being of nations. Studies have shown that conflict situations cause higher mortality and disability rates than any other major disease. War destroys communities and families and often disrupts the development of the social and economic fabric of nations. The effects of war include long-term physical and psychological damage to children and adults, and a reduction in material and human capital.

    Death as a result of war is only the “tip of the iceberg”. In addition to death, there are other consequences that are not well documented. These include widespread poverty, malnutrition, disability and psychosocial illness, to name a few.

    In armed conflicts, civilians, especially children and women, are exposed to both direct and indirect effects of violence. These include illegal recruitment into the armed forces, killings, gender-based violence, human trafficking, loss of loved ones, illegal detention and family separation.

    The combined effects of war, torture and oppression often extend to non-combatant civilians, especially those trapped in war zones or forced against their will to participate in war-related acts such as murder or rape, as we have seen frequently and widely in the current conflict. Moreover, the emotional suffering associated with war can arise not only from direct exposure to life-threatening situations and violence, but also from indirect stressors such as the injury or death of relatives or caregivers, economic hardship, geographical displacement and constant disruption to daily life.

    The WHO estimates that in armed conflicts around the world, 10 percent of people who experience traumatic events, have serious mental health problems and another 10 percent develop behaviors that impair their ability to function effectively. The most common conditions are depression, anxiety and psychosomatic problems such as insomnia.

     The direct correlation between the extent of trauma and the extent of mental health problems has also been demonstrated in several studies. The more severe the trauma – both physical and psychological – the more pronounced the symptoms. From the large number of studies in various war-affected countries around the world, some general risk factors and correlations can be drawn. Women and children are particularly vulnerable to the psychological consequences of war.

    There is evidence of a high correlation between maternal and child suffering in a war situation. Women who have been exposed to conflict have higher rates of post-traumatic stress disorder, depression and anxiety than women who have not been exposed to conflict.

    Subsequent life events and their association with the occurrence of mental and psychological problems have important implications for rapid and full rehabilitation to minimize the negative impacts of conflict situations. Studies consistently show the importance of both physical and psychological support to minimize the effects of war-related trauma. There is no doubt that populations in war and conflict situations should receive mental healthcare as part of the overall relief, rehabilitation and reconstruction process.

    In Ethiopia, however, there are few mental health interventions for conflict-affected civilians or victims. In particular, psychological and emotional support seems to have been ignored in the national relief process since the war began in November 2020.

    We have seen that many Ethiopians, irrespective of their ethnicity, religion and profession, have contributed to the reconstruction of the affected areas by providing vital relief items such as food, hygiene supplies, emergency medicines and other essentials.Some aid agencies and government departments are making efforts to provide psychological support, but when we look at the scale of the problem and the availability of services in terms of mental health support, we still have a long way to go.

    Providing for all these displaced children and women at risk of exploitation, violence, psychosocial problems, abuse and gender-based violence is a difficult process that requires the comprehensive efforts of all stakeholders.How can social workers, psychologists and other aid workers support the emotional recovery and resilience of civilian’s affected by war, who are often vulnerable populations such as children, women and older adults?Only through a better understanding of the conflict and the many mental health problems that arise from it, can coherent and effective strategies for dealing with such problems emerge.

    Therefore, social work, psychology and psychiatry professionals in Ethiopia should fill the gap in mental health support with a focus on volunteering. Given the scale of destruction and the economic capacity of the country, it is difficult for the government or non-governmental organizations to recruit mental health professionals. It is the responsibility of social workers and other helping professions to organize and contribute to the relief process. This can be done through professional associations such as the Ethiopian Society of Sociologists, Social Workers and Anthropologists (ESSSWA) in collaboration with aid agencies and government institutions.

    According to its official website, ESSSWA has more than 900 active members working in various organizations, including colleges and universities, civil society organizations, government agencies, UN organizations, bilateral donor agencies, and grass-root institutions and communities. This is a great asset that the country can use in times of crisis. Universities with departments of social work, psychology and psychiatry could also be part of the relief process by organizing their staff and students to provide voluntary mental healthcare to victims.

    Finally, the media should also play a constructive role in protecting and rehabilitating victims. We see that some media outlets and people on social media are unethically using the platform to conduct interviews and gather information about the war and victims’ experiences. People, especially children and women with traumatic experiences such as rape, should be protected and if possible, placed in a safe house. Media representatives (whether from mainstream or social media) should be sensitive and protect the dignity, identity and story of the individual victims they interview.

    Social workers should also advocate and raise awareness about the ethical and professional use of media in mental healthcare. Disclosing the identity of victims without necessity and without proper confidentiality protocols causes additional stress to victims and may further affect their social and family relationships in the post-conflict period.

    In conclusion, to address the immense psychological and emotional impact of the conflict on the victims, all stakeholders such as social workers, other helping professionals like psychologists, the government, civil society institutions, international and local aid agencies, universities and the media should work tirelessly.

    Reconstruction, economic recovery and investment policies alone will not be enough to fully address the psychological consequences of the war. With the help of voluntary programs such as those proposed in this article, targeted health programs for victims are necessary to overcome the psychological stress caused by the conflict, especially for children, women and the elderly.

    Eden Begna Gobena is a social worker and PhD fellow at the University of Stavanger, Norway

    Contributed by Eden Begna

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