Eastern Mediterranean countries are struggling under a burden of mental health problems and Palestine is the worst affected in the region, the first study of its kind has found.
The Burden of Mental Disorders in the Eastern Mediterranean Region 1990-2013, published recently, found that the weight of mental health in most countries in the Eastern Mediterranean region is higher than the global average. The burden of mental disorders in EMR increased by 10.8 per cent from 1990 to 2013 while globally, it increased by 5.5 per cent.
The study estimated that 54.4 per cent of Palestinian boys and 46.5 percent of Palestinian girls aged between 6–12 years were suffering from emotional and behavioural disorders. The 12-month prevalence of mental disorders ranges between 11 and 40.1 percent.
Dr Ali Mokdad, director of Middle Eastern Initiatives at Institute for Health Metrics and Evaluation, University of Washington is the senior author of the study. He explained the purpose of the study: “Historically the region has seen a lot of unrest. We always felt that there are mental health problems in the region. We wanted to know the recent impact of the Arab spring and the unrest on mental health.”
Dr Nadia Dabbagh, consultant child and adolescent psychiatrist at Dubai Health Authority and Co-Founder of Camali Clinic in Dubai, was born in UK to an English mother and Palestinian father. Her father was born in Jaffa, Palestine and left Palestine as a refugee in 1948.
Dr Dabbagh witnessed the impact of the conflict in Palestine in her own life and this inspired her to become a psychiatrist and research on the subject.
She said: “My father was a 10 year old boy at the time and injured by the Zionist groups who were terrorizing the civilian Arab population as part of the ethnic cleansing of the land. This ‘Nekba’ was a catastrophe and trauma for him and his family and the Palestinian people. It has had ripple effects down the generations. There was another exodus of Palestinians from Kuwait in the early 1990s following the Gulf War. We grew up there and left in 1990. Sadly since the devastation of Iraq and Syria to name a few now there are many Arab refugees fleeing instability and war.”
“Personally I know of Palestinians suffering from a fully range of mental health problems from Post Traumatic Stress Disorder, depression and anxiety. These can have a huge impact on the individual and family. For example domestic violence is a serious problem and a parent with mental illness impacts on children’s well being. This has consequences for the next generation. That said, I know of many highly successful and resourceful Palestinians who have learnt the power of perseverance. This resilience is remarkable. The key is to provide opportunities and hope,” said Dr Dabbagh.
Dr Yaseen Aslam medical director at The Psychiatry and Therapy Centre in Dubai Healthcare City explained the impact of mental health disorders on a child aged between 6 and 12.
Dr Aslam said: “It can affect the child’s ability to cope with academic work and their ability to progress intellectually. It can also affect their attendance and their academic and scholastic development. Also, it can have a huge impact on the relationships they form with peers and their ability to develop emotionally and psychologically.”
These abilities can be impaired from having emotional and psychological disorders. Their personality development and relationship with family members can also be affected.
Children of this age group can experience symptoms of anxiety and panic disorder and behavioural disturbances affecting their temper.
“The problem in places like Palestine is that there is a lack of facilities and healthcare facilities and infrastructure which allows to detect and treat these conditions. There is a lack of information and education among school teachers and parents in order to detect and observe changes in the mental health and emotions which may indicate need for assessment. There is a lack of knowledge amongst non-psychiatric doctors about mental health,” added Dr Aslam.
By not detecting and diagnosing early, it increases the risk of problem later in in life which might be more difficult to treat, he said.
Dr Aslam has seen many Palestinians who grew up in conflict and faced problems related to upheaval and displacement or were raised by parents who experienced the effects of war. In many cases this affected their ability to parent which then had an effect on their children.
Dr Khalid Saeed regional advisor for Mental Health and Substance Use at WHO EMRO said that when looking at this data one needs to be cautious because some of these studies might have been carried out in the immediate after math of an emergency. Common mental disorders often double in the aftermath of an emergency.
The study also mentioned that “the burden of mental disorders in Palestine should be interpreted with great caution, as it may be affected by a conflation between mental disorder and mental health, measurement validity issues, data accuracy issues.”
“In Palestine the most common problems are depressive illness and anxiety related disorders. We need to raise awareness in the public and health sector. Quite a few interventions can be done by social sector as well. You also need to raise the level of services available,” said Dr Saeed.
“Teachers, doctors, nurses, all need to be trained in basic psychological first aid. There is a need that medicines also should be available along with intervention. It’s important to not only have awareness and health literacy programmes but at the same time to make sure that services are put into place and they are as widely available as possible,” added Dr Saeed.
The Burden of Mental Disorders in the Eastern Mediterranean Region 1990-2013 uses data from the Global Burden of Disease and international experts have collaborated on this study.