Thirty-year-old Sumaya Ahmed (a pseudonym) is grappling with anxiety and phobias following an emotional crisis triggered by her husband's decision to marry another woman. Initially, she managed to keep herself composed for the sake of her children and family, showing no signs of breakdown or noticeable impact at all.
However, after a period of time, she began experiencing neck and back pains along with difficulty sleeping. Sumaya expresses to "Khuyut," "I underwent challenging circumstances that resulted in my suffering with thanatophobia, where the concept of 'death' became unsettling for me, triggering my anxieties about any potential cause that could lead to death, or receiving news of a family member's death."
Since the outbreak of war in Yemen more than eight years ago, Yemeni citizens continue to suffer from the security, economic, and psychological impacts of these wars. Each day, life becomes increasingly challenging, as years of conflict have drained the patience of citizens, who console themselves with the hope that relief may come soon.
The harsh consequences of war have impacted every aspect of human life, especially the psychological aspect. This has led to an increase in the number of individuals suffering from mild, moderate, and severe mental disorders, along with the deterioration of psychiatric medicine and specialized healthcare facilities in Yemen. These factors have exacerbated the problem, making it difficult to contain this crisis.
“Anxiety has become a common and widespread phenomenon, especially in light of the current circumstances in Yemen, as stated by clinical specialist Jihan. She confirms that approximately 70% of those visiting her clinic are diagnosed with anxiety disorders.”
A report by the World Health Organization states that out of 3,507 health facilities, “mental health services remain inaccessible, and mental health conditions are only available in 21% of the health facilities.” It also noted a shortage of psychiatrists in Yemen since the beginning of the conflict.
Iman Abdulrahman, in an interview with "Khuyut," expresses, "We find ourselves in a perpetual state of apprehension, awaiting the onslaught of successive calamities, leading to a profound sense of insecurity." She further underscores, "If there's one aspect that warfare has completely destroyed, it's our psychological resilience; we are no longer capable of bearing additional burdens."
Iman continues, "The sounds of warplanes are still stuck in my memory, causing me panic. The terrifying news, economic crises, etc.—all of these have led to a loss of security," indicating that this condition started for her in the second year of the war, and subsequently, the problem has since worsened and become progressively increasing. She says, "It even reached a point where I couldn't sleep for consecutive days, causing complete paralysis in my daily life routine, with fears overpowering me more and more."
This is how Iman describes her condition before visiting a mental healthcare clinic, continuing, "I have noticed a significant improvement after undergoing around a year and a half of psychopharmacological therapy and psychotherapy sessions. Throughout this period, I faced challenges and setbacks from time to time."
Inflated Issue and Lack of Specialists
Doctors are talking about a continuous stream of patients entering the clinics seeking treatment and support, as many of them suffer from anxiety, depression, chronic insomnia, post-traumatic stress disorder (PTSD), or obsessive-compulsive disorder (OCD).
According to estimates by the World Health Organization, in global armed conflicts, around 10% of those exposed to trauma are at risk of developing severe mental health issues. While another 10% may experience disorders such as depression, anxiety, insomnia, and back pain, significantly impeding their daily functioning.
One of the key elements of the organization's work in Yemen is to provide mental health and psychosocial support to patients and healthcare workers. Currently, there are only 40 mental health specialists in Yemen, mostly located in the capital, Sana'a. To help address this issue, the World Health Organization (WHO) affirms that it is conducting training programs for healthcare and community workers outside the capital. These programs focus on equipping them with the skills to implement therapeutic interventions using the organization's guidelines for bridging the gap in mental health services, aiming to enhance mental health care across the country.
In contrast, health data issued before the war shows the presence of four mental health hospitals in Yemen, with a rate of 0.21 psychiatrists and 0.17 psychologists per 100,000 Yemeni citizens.
Likewise, the clinical specialist at the Psychological Guidance Foundation, Jehan Dalal, emphasized in her conversation with "Khuyut" the diversity of types, names, and severity levels of mental illnesses. Some of these include psychotic disorders, which are difficult to treat or have prolonged treatment periods, such as schizophrenia, compared to neurological disorders that may affect a wide range of society, such as depression, anxiety, stress, fears, and obsessions.
Anxiety-Inducing Environment
Anxiety has become a prevalent and widespread issue, especially in light of the circumstances in Yemen," said clinical specialist Jehan, confirming that nearly 70% of those who visit her clinic are diagnosed with anxiety disorders.
Besides, anxiety disorder has become increasingly common lately, occurring due to increased secretion of adrenaline hormone. Recent research has shown significant activity in the amygdala region of the brain in individuals with anxiety disorders.
Jehan further emphasizes that the interruption of salaries, successive economic crises, the depreciation of the Yemeni riyal against foreign currencies, the exchange rate disparity between governorates, along with the unemployment and the unavailability of jobs, and the petroleum derivatives crisis; all these factors have led everyone to experience a state of natural anxiety to secure the minimum necessities of life. According to reports from UN organizations, around 17 million Yemenis are in need of food assistance, including 6.8 million people in a state of food emergency, amid the loss of income sources for millions of Yemenis.
In addition to housing instability, large waves of displacement have also played a significant role in individual and societal psychological instability. The number of internally displaced persons moving from one province to another has reached approximately three million people, accounting for 11% of the total population. Moreover, many families have also lost their breadwinners, leaving many women and children to face their fate alone under harsh conditions.
Fear of Treatment
In this context, the fear of medications is a complex issue for many people regarding their safety and effectiveness, as well as the fear of falling into the trap of addiction, based on their beliefs. One of the primary reasons many people refrain from seeking mental health care and avoid psychiatric facilities is the long-standing societal perception and stigma surrounding these facilities. There is a common belief that these facilities deteriorate patients' health and worsen their condition; due to extreme fear and the belief that the medications have negative effects on the body, leading to a fear of becoming addicted and unable to live without them.
“The crisis and these disorders have even impacted the age group that everyone is pinning their hopes on to emerge from this grim reality. Moreover, subjecting children at an early age to several psychological traumas can make their treatment solutions in the future more complicated if this issue is ignored during childhood and if parents and family members do not take it seriously.”
Pharmacist Dr. Ahmed Al-Husami, speaking to "Khuyut," affirms that there is absolutely no problem with using psychiatric medications when needed, as long as it is done under the supervision and follow-up of the treating physician. He explains that the human body naturally maintains a state of balance, producing substances that cause anxiety and others that calm it down. Medications are resorted to when there is a disruption in this balance, causing an increase in the secretion of anxiety-inducing substances. These medications work to restore this balance, compensate for the body's deficiencies, and return the individual's body to its natural state.
Dr. Al-Husami emphasizes the importance of adhering to the treatment plan prescribed by the treating physician, including gradually starting and stopping the medication. This approach prevents the body from experiencing a shock because medications substitute for natural body secretions, leading the body to rely on them instead of its natural secretions.
Therefore, according to Al-Husami, medications should be gradually tapered off after recovery to allow the body to regain attention and stimulate its secretions after being dormant. He explains that the issue with medications is not their use but rather their misuse without medical supervision, which poses a real problem.
Children Are a Ticking Time Bomb
The crisis and these disorders have even impacted the age group that everyone is pinning their hopes on to emerge from this grim reality. Moreover, exposing children at an early age to several psychological traumas can make their treatment solutions in the future more complicated if this issue is ignored during childhood and if parents and family members do not take it seriously.
In fact, one of the child's primary needs in the early years of his life is stability— feeling safe— as it constitutes his greatest need. His first fears often start with "weaning anxiety," as termed by some specialists, progressing through crises he may encounter, such as the loss of one or both parents and the difficulty of adapting to life without them
A study conducted by Yemen's children relief organization revealed that children in areas that have witnessed intense conflict recently have suffered from increased levels of fear, insecurity, anxiety, and anger. Parents reported that 5% of children are experiencing involuntary urination (bedwetting), 2% have regressed to stuttering, while 47% are suffering from sleep disorders, and 24% have difficulty concentration.
Samaah Ya'eesh, a pediatric specialist, tells "Khuyut" that the main reason children develop anxiety after experiencing crises in Yemen is attributed to their parents, who have a significant influencing on their children without realizing that this behavior is wrong and detrimental to them. Excessive concern for their children and extreme fear for them from anything, and depriving them of leaving the house out of fear for their safety, make the child grow up with significant fear stimuli. They acquire anxiety and fear from their parents through observing their excessively anxious and unnatural behaviors in daily life.
Ya'ish explains that fear and anxiety are inseparable; it's natural for humans to experience anxiety, but exaggerating it can be considered pathological anxiety.
Samaah specifically calls on parents to dedicate a specific time to sit with their children, engage in conversations with them, and foster closeness. Their needs go beyond material things and providing the essentials of life; the psychological and emotional aspects are also crucial at all stages of a child's life. She advises adopting modern parenting methods and not projecting their own painful past experiences onto their children, avoiding making those experiences a template for parenting. Instead, parents should learn from past mistakes and prevent them from being repeated with their children.
