Sunday, March 08, 2009

The Hidden Battlefield

The destruction brought about by war and armed confl icts transcends the structure of cities and communities and encompasses the mortality and overall well-being of those who engage in it and those who are dragged into it. The victims, the perpetrators, and defenders may not share the same goals in war but they all share the trauma and suffering surfacing from such violent events.

The effects of war, according to a study by R. Srinivasa Murthy and Rashmi Lakshminarayana of the Regional Offi ce for the Eastern Mediterranean of the World
Health Organization (WHO), are varied and some are not even included in most available literature.

The known effects, the study said, included endemic poverty, malnutrition, disability, economic/social decline and psychosocial illness, among others. The
authors said that only when confl icts and mental health problems are fully understood can effective strategies be developed to deal with the effects of war.
"The effects of war include long-term physical and psychological harm to children and adults, as well as reduction in material and human capital. Death as a result of wars is simply the 'tip of the iceberg,'" the authors said.

War trauma and mental health
Perhaps apart from death, injuries, and diseases that war brings to the world, lifelong trauma and mental illnesses would also be among the worst irreversible damages that can happen to civilians and combatants. Family members and relatives who perished and comrades who have fallen during armed conflicts can sometimes bring families and friends to a mental breaking point.

Post-traumatic stress disorder (PTSD) is a common mental health problem among soldiers. It can result from war-related trauma such as wounds or witnessing others being killed or hurt. Quoting a RAND report, Reuters stated that about 300,000 troops returning from Iraq and Afghanistan suffered from PTSD or depression, or one in five of the more than 1.5 million who have been deployed.

Studies conducted among military personnel also showed that soldiers on repeat deployments are more prone to PTSD. Many of these studies also made the world realize that alcohol abuse among soldiers returning from combat is a symptom of PTSD.

But PTSD is not unique to soldiers. Citing two local studies in Afghanistan, the two WHO experts noted that the disabled and women had poorer mental health status during armed conflicts. The studies further showed that there was a signifi cant relationship between the mental health status of the people and the traumatic events.

The fi rst study showed that around 62 percent of respondents reported experiencing at least four trauma events during the past ten years. Symptoms of depression were found in 67.7 percent of respondents, symptoms of anxiety in 72.2 percent, and PTSD in 42 percent.

The second study, the WHO study stated, aimed to estimate the prevalence of psychiatric symptoms, identify resources used for emotional support and risk
factors, and assess the present coverage of basic needs.

There were about 1011 respondents aged 15 years old and above. Nearly half of those surveyed had experienced traumatic events. Symptoms of depression were observed in 38.5 percent of respondents, symptoms of anxiety in 51.8 percent and PTSD in 20.4 percent. The main sources of emotional support were religion and family. The study said that people were able to cope only through their religious and spiritual practices.

"High rates of symptoms were associated with higher numbers of traumatic events experienced. Women had higher rates than men," the WHO study stated.

Malnutrition and other social problems
The first basic need of people that is greatly threatened in areas affected by conflict is food. Without food, people, most especially children, will suffer from
malnutrition and starvation. This will make them susceptible to various illnesses and diseases since their bodies will not have enough nourishment to fight off such infections.

The desperation for food may also push people to do things that could be otherwise deemed as acts of mad men. Recently, IRIN Asia revealed that there have been unconfirmed reports in Afghanistan that a family was forced to sell their children in exchange for food. It said that the local media in Afghanistan reported that a father of four who was suffering from a mental illness offered his two children for sale but there were no takers. Another father, Jan Gul, explained in the article that because of hunger and cold, parents could not do anything and find it reasonable to sell their children just to make the other children, and themselves, survive.

This situation is just one of many acts of desperation in the outskirts of Kabul where 4,500 internally displaced persons (IDPs) now live. The war in Afghanistan has forced them to live in makeshift tents where food is scarce and disease is abundant.

Saving lives
The United Nations (UN) said that while there has been signifi cant progress in obtaining international standards and commitments to protect people's rights affected by armed conflicts, these developments are insufficient, particularly in protecting the rights of children.

Among the international commitments formulated to protect the rights of children include the UN Convention on the Rights of the Child, Optional Protocol to the Convention on the Rights of the Child, and the International Labor Organization Convention No. 182 on the elimination of the worst forms of child labor. In terms of answering the needs of those affected by PTSD among soldiers, reports showed that even the US has not been able to fully implement programs to deal with soldiers affected by PTSD. A report from Reuters even said that there were insufficient
counselors, psychologists and psychiatrists available for returning soldiers.

Further, PTSD-affected soldiers still relied on group therapy over individual care and there was a lack of continuity in care among these soldiers. Ultimately, the effects of wars and various armed conflicts lie not on how effi cient governments and
the UN are in creating international protocols and increasing facilities to answer the needs of affected civilians and military personnel in confl ict areas but on
their capacities to resolve conflicts.

It is imperative for governments and international organizations to work towards achieving and sustaining peace worldwide.

This article was written by Cai Ordinario for Health Alert Asia Pacific Issue 14, 2009 published by HAIN. For free copy of the newsletter, contact