A translated version of this piece is Available in: العربية (Arabic)
The Arabic Twitter account of the United Nations Development Programme posted the following: “Yemenis go to sleep in a wretched state and wake to worse, as the currency continues rapid decline in relation to foreign currencies and the UN issues warnings that famine will become an unmanageable reality.”
The tweet was widely shared and seen, but what the world does not see, what the UN fails to notice, is that behind the hunger, the death, the economic collapse, the agonies of physical wounds and missing limbs are the other, less visible products of war and its woes: mental illnesses comprised of, for example, psychological breakdown, depression and trauma. Men, women and children are living through the very worst and most damaging days of their lives, enduring a daily barrage of psychological injuries and shocks from missile and artillery bombardment, forcible detentions and torture, tearing apart mind, body and emotion, and alongside these, social and family ties.
Women bear the heaviest burden. This is equally true of peacetime as it is of wartime, which destroys both human beings and infrastructure: schools, hospitals, factories, homes. Before the outbreak of this conflict, many women suffered psychologically at the hands of men, whether close relatives such as a husband, brother or father, or members of the extended family and social network: men who exercise control over their lives and their decisions. As a result, these women suffered from a wide spectrum of psychological problems. They were subjected to physical violence when they refused to comply with male directives.
As a mental health counsellor, one of the extraordinary and profoundly human paradoxes I have encountered is that these same women now find themselves suffering from the absence or loss of these men,
and prefer the return of the men who kept them in cages rather than losing them, or having them return as corpses, or skeletons, zombified from torture, or vanished in unknown prisons.
Designed by Waleed alward
Yemeni women find themselves alone in circumstances when they are most in need of companionship. War, famine and disease wreak havoc within their families, even as they must assume responsibility for their households and provide the food and medicine needed to keep them alive. The task of tracing the absent man of the house is also their responsibility. They must visit prisons, apply at human rights organisations or arrange intermediaries. For women unable to leave the house without a male chaperone, the endless quest to locate not only this absent man but also find employment for themselves is all the more difficult, and they are subjected to all forms of abuse, exploitation, harassment, violence, degradation and humiliation.
Then there are those women who carry a different burden: their men have been with them from the outbreak of war in 2015 to the present day. They look not for their men, but for answers, for someone to help change their husbands’ behavior towards them and their children, to help them cure their husband’s addiction to smoking and qat, to address their husbands’ introversion and refusal to leave their room, the bouts of severe agitation and nervous instability they suffer from, and of course to do something about the violence that has become an integral part of their daily lives.
The psychological suffering of Yemeni women cannot be cast aside and ignored, but here I seek to address it as a product of male psychological instability.
One of my patients is Umm Khaled (not her real name), a mother of six. Her husband is a civil engineer, who lost his job after the private firm where he worked closed down. He did all he could to find employment elsewhere, but since 2015 he has been without work and all his savings have been spent. His psychological state deteriorated and he started to suffer from insomnia and nervous tension. He began to beat his children severely and subjected Umm Khaled to his irritability and violence, which led to her eldest son leaving home. She still does not know where he is. “I hope God’s taken him”, she says, “or that he’s been detained, or has gone to the front”. But when that happens, when her wish comes true, she will find herself locked in the endless quest to find her missing son.
The names of these wives and mothers may change, but the stories they tell about their men – their husbands and brothers and fathers – remain the same: they are victims of trauma, and of the country’s economic collapse as a result of war and the blockade of the country by sea, air and land which has reduced imports by 90 per cent. And the situation has been made worse by the government’s inability to pay the salaries of up to a million state employees, each of whom support, on average, a family unit of seven individuals, not to mention the collapse of the riyal’s value relative to the dollar, and the huge rise of prices of foodstuffs and petroleum-based products.
Some 22 million people have no choice, therefore, but to turn to aid. According the UN, US$3 billion are needed to implement the Yemen Humanitarian Response Plan in 2018, which will provide aid to 80 per cent of affected citizens. However, aid organisations face many difficulties around the transfer of money to Yemen, as a result of banks adhering to protocols designed to prevent the funding of terrorism. The greater catastrophe is that Yemenis living abroad, whose families within the country depend on them financially, are unable to transfer funds to them as easily as before, if at all. Thirteen million Yemenis face starvation if the war does not come to an end in the near future.
Yemeni men, traditionally sole providers for their families, now suffer severe frustration and depression, having lost their jobs, and now unable to meet their families’ most basic needs, not even daily meals to stave off malnutrition and death, nor the medicines and treatment required when one of their family members falls ill.
Designed by Waleed Al Ward
What the war has done is to create a disequilibrium: a violent psychological trauma accompanied by feelings of impotence, injustice, frustration and despair when confronted by daily demands that are impossible to fulfill. Things that were easily sourced before the war, he is now unable to provide, all of which is exacerbated by a woman constantly reminding him of his impotence, his weakness and his lack of resourcefulness—constantly prodding him to look for work, to do whatever he can to keep his children from starvation.
Every day, Yemenis witness relatives, friends and neighbors being killed in bombing runs and because of militia artillery fire. They see people humiliated, beaten, murdered, abducted and tortured, and they see their children dying of hunger and disease, with no support from a healthcare system which has almost entirely collapsed, and almost no access to advanced psychological support services. All of this has led to a leap in incidences of severe depression, mental illness personality disorders, and post-traumatic stress disorders
There has been a noticeable and terrifying rise in social and domestic crimes which were previously unknown in the country, most significantly those involving violence, such as the abduction, rape and subsequent murder of women and children, the disfigurement and mutilation of children by their parents and close relatives, and domestic murder-suicides in which parents of both sexes kill themselves after murdering their children.
Yemeni organisations which provide healthcare are not, unfortunately, equipped to offer psychological support, and lack a trained cadre of mental and psychological specialists. In January 2016, the World Health Organization indicated that there were some 40 psychiatrist in the country, most of them based in the capital, Sana’a. There was no figure given for psychiatrists.
Yemenis of both sexes exist in a state of severe psychological disorders . Seventy-five per cent of the population live in rural areas, and are unlikely or unable to access the few mental health services that do exist. Even when they can, psychological disorders still carry a stigma for most Yemenis, meaning that they will only seek the services of psychiatrists or counsellors where there are clear cases of mental illness. They may, however, be more open to approaches from close friends or family, or willing to attend psycho education session which can function as a first step to seeking support.
As a result, approaches such as psycho-education training , psychological first aid ,debriefing session, family and marriage counselling session , spaces in which people can vent, workshops in which people can learn tools to manage stress and deal with trauma have proved the most successful ways to help many people achieve a degree of psychological equilibrium in their lives.
The greater challenge facing Yemenis, their government – or any government that will take charge after the end of the war – is how to help society recover from the psychological trauma left by war and the social, domestic and economic devastation it leaves in its wake. What is urgently required is a long-term plan drawn up by trained specialists in the fields of psychology and mental health, to deal with the psychological disturbances and mental illnesses that stem from the trauma of war. It must include educating society on the issue, making it easier for those in the grip of trauma and post-traumatic stress to seek assistance. This will allow us to work on preventative measures to ensure that war trauma does not escalate into untreatable conditions, which could fill the streets of our country with yet more of the mentally ill, and to protect those who suffer from these illnesses from homelessness, death or de facto imprisonment within their homes or hospitals without access to the most basic forms of proper healthcare and psychological treatment.
Kawkab Al Wadeai, P.HD
Mental Health Consultant