What is happening now in Yemen?
The crisis in Yemen has been going on for more than six years, and it’s no longer a top story in the headlines. Fortunately, in Hajjah governorate we see fewer casualties as a result of fighting compared to the early days of the conflict.
However, the war is not over.
There are of course still conflict-related deaths in the country. What doesn’t usually receive attention, though, is the impact that this conflict has had on people’s wellbeing, and their mental health in particular.
"Mental health disorders aren’t a choice"
Hamdan Saleh had worked happily in the administration department of the Yemeni security forces for years.
But at the start of the civil war in Yemen, he became one of the hundreds of government employees who had their salaries stopped.
Psychosis and paranoia
His pay was the only source of income for his family.Their sudden financial difficulties, alongside the worsening conflict, led Hamdan to develop mental health issues.
Hamdan began to suffer from psychosis and feelings of paranoia.
“I started believing that everyone was conspiring against me, trying to harm me. I had hallucinations too, hearing and seeing mystical creatures telling me to do things. Telling me to die."
"One day I poured gasoline on myself to set myself on fire. I changed my mind at the last moment by thinking of my children.”
With no knowledge or understanding of mental health care, Hamdan’s family turned to spiritual treatment. However, it did not work.
Social and economic impact
“Hamdan was referred to the MSF mental health clinic at Al-Gamhouri Hospital in 2019 after he had already suffered from the disorder for years,” says MSF psychologist Rasmia Mohammed Ali.
“He is another example of how the conflict has affected people’s lives economically and socially, leading to severe mental health issues.”
“While the lack of services for mental health care is a problem, people’s limited understanding of such conditions is also a challenge.
Lack of services
There are patients who feel better once they start taking the right medication and so leave the treatment considering themselves fine. This could lead to relapse.
Hamdan was one who struggled to consistently take his treatment, but he is now fully treated and discharged from the clinic.”
Back to normal life
Hamdan is now a farmer back in his village. He grows corn and wheat. He feels better, and his family and social life are back to normal.
It has been a month since Hamdan last came to the mental health clinic with his son. As he walked out of the clinic, Hamdan said he hoped he would never come back here again.
“I experienced some side effects of the treatment. But I had to take medicines to make myself better. "
"If I had a choice, I would have never taken the medicines, but mental health disorders aren’t a choice "
"I still fear something could happen to my children"
The memories of her hometown of Harad still haunt Hafsa.
At around nine o’clock one evening in 2016, an airstrike hit her neighbourhood. Her children were at their mosque praying and only Hafsa and her husband were at home.
Now, living over 150 kilometres away, Hafsa remembers how her house trembled and the heavy sound as a bomb struck a nearby gas station.
Many of the houses nearby collapsed and more than 250 people were either injured or killed.
The external part of Hafsa’s house was badly damaged, but this was nothing compared to the loss the family suffered that night.
Shock of explosion
Hafsa’s husband already had a heart condition and, while he was not physically harmed during the airstrike, the shock of the explosion caused his heart to stop.
Hufsa took him immediately to hospital, but the doctors told her that he had died some hours earlier.
“We moved from Harad to Hajjah. It’s been more than five years since I visited my hometown, where I lived the first 50 years of my life. "
"Harad is very close to the frontline and nobody lives there now. We are not allowed to travel there. I was told the only things one can find there are landmines.”
Flashbacks and trauma
Hafsa developed psychosis following this traumatic incident. She began to have flashbacks of the airstrike and could not stop thinking about how it had taken everything from her.
She also developed a sense of paranoia, fearing all the time that something terrible could happen again.
“I do not want to have all my children together in one room. If something happens, everyone together would become victims of bombs or airstrikes. "
"I do not like letting my children go out. When they do, I ask them to stay in contact with me regularly. I fear something could happen to them,” adds Hafsa.
Following the death of her husband and their move to Hajjah, life has not been easy for Hafsa and her family.
Entirely dependent on humanitarian aid
There is no income for her family, and they are entirely dependent on humanitarian aid.
Hafsa came to know about mental health services from her granddaughter, who attended a routine mental health awareness session at a hospital.
When she learned about the symptoms that might point towards a mental health disorder, she realised her grandmother could be a patient.
Hafsa was not the only one in her family who developed mental health issues. Her daughter developed psychosis and attempted suicide by setting herself on fire.
She was severely burned and needed weeks of treatment for her injuries. Alongside this, she was also treated for psychosis at the Al-Gamhouri Hospital mental health clinic in Hajjah, which is supported by Médecins Sans Frontières/Doctors Without Borders (MSF).
“We treated both Hafsa and her daughter for psychosis developed following their experiences during and after the airstrike. We see a number of such patients."
"The conflict and its consequences on people’s lives are one of the leading causes of mental health disorders,”
*The name of the patient is changed
"Mental health services are not only for ‘crazy’ people"
Alima* was in hospital for a routine reproductive healthcare appointment when she overheard a couple of women talking about mental health care.
Her idea of mental health has always been something that only “crazy” people needed.
Alima was surprised to hear that these two women regularly used these services and yet they did not seem to have mental health issues.
She asked them about it, and this was the moment she realised a person does not have to “be a crazy person” to get these services.
After her divorce, Alima went through a rough period. The family of her ex-husband did not permit her to see her three children.
Fell into depression
Alima, who was already dealing with anxiety, fell into depression. She suffered from a sleep disorder and isolated herself. Alima went on to take an extreme step and attempted suicide.
“One day I saw my son from afar, but I could not go to meet him. I felt very distressed that day and cried for hours."
."That day I decided to consult a psychologist. I went to the Al-Gamhouri Hospital mental health clinic in Hajjah city and spoke with a psychologist for four hours.
How services can help
It was the first time I understood the idea of mental health and how these services can help.”
Alima continued weekly counselling sessions for almost a year at the mental health clinic, which is supported by Médecins Sans Frontières/Doctors Without Borders (MSF), alongside unplanned sessions whenever she felt stressed.
Alima describes the relaxation techniques and role-play exercises as magical. From someone who knew nothing about mental health, Alima is now an advocate of mental health services in her social circles.
“I knew a man in my neighbourhood who was very aggressive to others, but he could not remember anything about his behaviour the next day."
"I thought this might be a symptom of a mental health condition and I advised his family to get help through local mental health services.
Lack of services
However, there is a lack of such services in the rural area where we live. I myself have to travel for around 45 minutes to reach the mental health clinic, and I consider it close by.”
Alima’s life has positively changed from what it was a year ago. She has started a small business making homemade sweets.
More importantly, she is socialising with her friends again and has resumed her university education.
“She smiles now – something she had forgotten how to do."
"We cannot change a person’s circumstances, but we can help them cope better with the situations they face."
Healthcare often not available
"There are many who require such mental health care, but it is often not available. When available at private clinics, it is beyond their affordability."
"Most of these people are poor, and they can’t pay up to 3000 Yemeni Riyals for a one-hour consultation,” said MSF psychologist Rasmia.
*The patient’s name is changed
What’s the way forward from here?
In our daily work at the MSF clinic in Hajjah, we try to normalize mental health issues and help change the social understandings and associations that link mental health conditions with things like “craziness” and “danger”. These associations create stigma and suffering for mental health patients and their families.
Norms do not change as fast as we would like, but it is our hope that if we keep committing to our work, the changes in our practices will have a direct impact on the way these notions are articulated within society, leading to a slow but hopefully sustainable change