By Kate Moran
Google the words “Middle East” or” “refugees,” and you’ll find no shortage of articles bemoaning the current humanitarian crisis that has seemingly engulfed almost every country in the region. Many of these articles focus on important health-related issues: food security, sexual violence, and the civil conflicts that prevent aid from reaching vulnerable populations. Indeed, there are a great many organizations operating in the Middle East, all seeking to mitigate these problems. Yet, rarely are money or attention directed to one of the region’s greatest crises: the unavailability of, and lack of access to, mental health care.
Perhaps the reason for this lacuna is because mental health is one of the more difficult medical concepts to pin down; opinions vary widely on what the very definition of mental health is, much less how to treat it. Moreover, mental health encompasses a huge range of conditions, some of which appear minor and others that are severe enough to cause significant disruptions to daily life.
Perhaps it is because mental health isn’t as “glamorous” an issue as combatting sexual violence against women and girls in refugee and internally displaced populations. Or maybe it is because the global community doesn’t know where to start—how do we improve the mental health of vulnerable populations if the underlying causes are so vast and seemingly beyond our control?
Make no mistake: mental health is the greatest unchecked public health issue in the Middle East today. The rates of depression and anxiety for the region are greater than anywhere else in the world. We know what’s causing these alarmingly high rates of mental illness: years—and in some cases, decades—of political and social unrest; a seemingly never-ending cycle of economic booms and busts, worsened by global markets; and steady and increasing ‘brain drain’ of doctors and other medical professionals to the West.
Currently, for every million Iraqi citizens, there are only four psychiatrists to service them. In Al-Zaatari, Jordan’s largest camp, 32% of all refugees receiving support to prevent and deal with mental health illnesses are children. Yet, in 2013 there were only 34 psychiatrists and 24 psychologists—for the entire camp. It’s clear that the level of need is disproportionately greater than the ability of the Jordanian authorities and NGOs operating in Al-Zaatari to deal with it.
So how do we convince the global community—not just NGOs and governments, but individuals—to invest in mental health care in the Middle East? Simply, we must connect the dots between this care and the broader forces causing mental health conditions in the first place. The soaring rates of depression and anxiety in the region are inextricably tied to the broader social and political milieu in which they exist. These conditions cannot be understood without framing them in the context of civil war, sectarian conflict, political occupation, economic unrest, and rising religious extremism.
These issues, some of which have existed for decades, are the underlying causes of the Middle East’s mental health crisis; many continue to worsen as relations between states, as well as within states, deteriorate even further. Thus, we cannot be advocates for change in the region without understanding the broader forces at play and working to find sustainable social and political solutions. Without recognizing the role of quality mental health care in the overall health of a population and taking steps to ensure access to this care, the underlying issues causing the problems cannot be reconciled. While this might seem like a circular argument, it’s necessary to address the two issues—both the underlying cause (instability) and the symptoms (mental illness) in tandem with one another, so as to maximize long-term impact.
Although there are many other problems in the region that must be addressed, the critical need for mental health care, and a commitment by both local actors and the international community to provide for this care, cannot be overlooked. There must be an investment—rhetorically as well as financially—in both mental health care and creating spaces within existing initiatives to broaden services in this regard.
So when we talk about health in the Middle East, we should talk about food security. We should talk about sexual violence, gender equity, and economic empowerment. Without simultaneously talking about and addressing mental health, however, the region’s vulnerable populations will continue to suffer. They will never move beyond the refugee camps to create new lives for themselves, and the Middle East will never move beyond its endless cycle of instability. Poor mental health unquestionably dampens an individual’s full potential. Without the availability of and access to mental health care, the future generations of the Middle East will not flourish, but languish.