Mental health crisis in war-torn country – Ethiopia

 

The 2019 novel coronavirus shocked the world beyond our wildest imagination. The severe impact of this pandemic hinted at the fragility of our public health policy, disaster preparedness, and global collaboration. This global crisis is not entirely unprecedented; different scientific community members have predicted this and warned us, with a minor or insignificant response. The lack of coordinated response from global public health actors and governments resulted in grave social, economic, and health consequences.

Similarly, the scientific community has warned low-middle-income nations about the possible next pandemic of mental health crisis. According to some systematic reviews, a mental health crisis has already been a significant concern throughout the COVID-19 pandemic. Through the expanded campaign toward universal health coverage, people with mental disorders in low-income countries are at risk of being left behind due to minimal attention to the problem. The burden of this ‘silent’ crisis is a particular concern and significant challenge in war-torn countries like Ethiopia.

Since early 2019, Ethiopia has been wobbling by the edge of a cliff due to an internal ethnic-based civil war. Coupled with the global pandemic, the significant destruction of the health infrastructure, and the high shortage of health workforce in the war and violence-affected areas of the country (Tigray, Afar, Amhara, Metekel, and Wellega), the mental health crisis among young girls and women of sexual victims and orphaned children is alarmingly high. Young children are out of school, facing the problem of the ugly war, and witnessing the death of a family member at the hand of a fellow community member. Despite the continued report mentioning the increasing burden of sexual abuse, teenage pregnancy, and abortion, the need for psychosocial and mental health is not well addressed. But all this is very much normalized and overlooked.

Due to a recent personal experience of loss, my interaction with people from different backgrounds ranging from villagers to the community elders, from local administrators to the federal government higher officials; I noticed that everyone has an experience of personal loss they could share to comfort me. The pain is so visible on almost everyone’s face that despite the deep denial and normalization, the need for mental health care and support is at its highest.  But unfortunately, the effort to increase self-awareness and self-care as a nation for the public is minimal. This taunting experience haunted me this past summer and keeps waking me up; this is also the nightmare of many healthcare providers.

Despite the agenda of mental health getting acknowledgment on international platforms, including the agenda of Universal Coverage for Mental Health (2019) by WHO, the attention given to the problem is very limited in low-middle-income countries. With only one public mental hospital in the capital Addis Ababa and less than 90 psychiatrists for a nation of more than 100 million, the mental health program in Ethiopia is very limited in the countryside, where most of the population resides. Some university hospitals, including Jimma, Haramaya, Gonder, Mekele, Hawassa, and Bahir Dar, have few inpatient psychiatry cares with a minimal number of beds for the catchment they serve. These capacities are very much compromised in the war affected areas like Mekele and Gonder, while the other violence affected areas of the country had no access to care from the outset.

Three pressing challenges stand out when discussing this concern with some policymakers—first, the inadequate local and global political leadership and commitment towards addressing mental health, hence poor funding to the cause. Second, the shortage of health care providers in the field and minimal incentive to motivate future enrollment. Third, society’s significantly low awareness of mental health needs is overshadowed by cultural, religious, and traditional beliefs, misinformation, and stigma about mental health.

Reflecting on this observation, it pains me to see that mental health care has been neglected at this time when it is needed the most. To this end, I call on the health actors, governmental or non-governmental organizations, to act on this grave problem. Without mental health, there is no health.

About the author: Hailu is a physician and health policy researcher, currently studying for his Doctor of Public Health at Harvard T. H. Chan School of Public Health.

Competing interest:  I have read and understood the BMJ Group policy on the declaration of interests, and I have no conflicts of interest to declare.

Handling Editor: Neha Faruqui

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