Navigating a world in conflict: The mental health implications of contemporary geopolitical crises

Abstract

Throughout history, armed conflicts have profoundly affected individuals and societies, with recent events in Ukraine, the Middle East, and beyond bringing into sharp focus the severe mental health and humanitarian consequences of geopolitical crises. Such situations often result in mass fatalities, destruction, displacement, forced migration, and other critical life events. Amid these scenarios, the adverse outcomes for mental health and well-being in both the short and long term must be emphasized. As a conceivable example of the latter, the proposed concept of intergenerational trauma could have far-reaching implications. In particular, in certain regions, civilians have repeatedly experienced instances of violence and may have continually been exposed to critical life events and traumatic stress. In this context, the consequences of these events for individual well-being and global mental health will likely be registered for years to come. Accordingly, urgent help and actions to address the mental health burdens within contemporary conflicts should be accentuated in humanitarian, political, and diplomatic interventions. Equally, health policies must adopt a long-term approach to support initiatives under the purview of global and public mental health objectives.

Following the end of the Cold War, the years 2022 and 2023 have witnessed the highest proportion of global conflicts, with numerous regions around the world impacted by rising geopolitical tensions and significant aggression.[1] Notably, the Hamas terror attacks that began on October 7, 2023, have thus far led to the deaths of 1,200 Israelis and over 230 hostages. Subsequently, these events marked the beginning of an escalation of violence in Israel and the occupied Palestinian territories. In Gaza, approximately 1.4 million residents have left their homes and are considered to be internally displaced.[2] Elsewhere, the Russo-Ukrainian war has caused hundreds of thousands of casualties within the armed forces and among the general population, affecting vulnerable groups like people living in detention.[3] Equally, hostilities remain ongoing in different parts of the world, including in other areas in the Middle East, like Syria and Yemen, and parts of Africa, such as Ethiopia and Sudan, raising profound humanitarian concerns.[1] For the latter, millions of civilians were already internally displaced in Sudan before the current conflict intensified in 2023.[4]

From a psychiatric perspective, established evidence from academic literature indicates that all cohorts exposed to critical life events and war-related trauma present with a higher risk of trauma-related mental health disorders, such as posttraumatic stress disorder (PTSD) and other psychiatric symptomatology.[5] Significantly, children and adolescents can be particularly vulnerable to these issues. This is a prominent consideration to emphasize in contemporary contexts; for example, in the Gaza region, children currently account for the majority of the general population.[6]

It is of note that many individuals currently caught up in ongoing conflicts have repeatedly suffered from the effects of war. Since 2006, Hamas and Israel have been engaged in five wars, with the 2023 conflict being the most recent.[6] Analogously, hostilities in the Russo-Ukrainian War began in Eastern Ukraine in 2014 and escalated following the Russian invasion in 2023.[1] Other regions in Africa have been marked by similar patterns of enduring violence.[1,4]

PSYCHIATRIC IMPLICATIONS

Any conflict can entail critical psychiatric risk factors, which can have short- and long-term consequences. In particular, across the Gaza Strip, certain civilians may have been exposed to continuous traumatic stress (CTS), wherein war-related trauma has been recurrently experienced for more than three generations. This has led some academics to classify the Palestinian people as a “traumatized population.”[7] Notably, the construct of CTS has been introduced as a supplement to the traumatic stress model. This aims to describe the experiences and health-related consequences associated with persistent threats, such as prolonged political conflicts or wars involving pervasive community violence.[8]

According to this model, studies have noted high levels of mental health symptoms among children and adolescents, women, refugees, and prisoners in Palestine and underlined the lack of sufficient psychological support for these populations over time.[7] In other conflict-related contexts like Syria, PTSD has been identified in about one-half of adult refugees, and separation anxiety has been detected in 70% of child refugees.[9] The longer term impact of prolonged stress and repeated exposure to critical life events for populations in conflict zones, such as sudden evacuations, family divisions, and bereavement, may be difficult to estimate and quantify. That said, it is likely that veterans and survivors may require continuous mental health support for years after the end of the war and could exhibit the late emergence of dysfunctions in individual functioning and maladaptive coping strategies; if not sufficiently addressed, these can lead to the onset of psychiatric symptomatology and concurrent functional impairments.[10]

Separately, the role of media outlets including television, social networks, and newspapers in modern conflicts could engender potential harms. As was illustrated throughout the COVID-19 pandemic, related phenomena, such as so-called infodemics or possible disinformation, can contribute to distress in the general population.[11,12] An infodemic may be defined as the excessive amount of information about a situation, which spreads rapidly in potentially harmful ways.[11,12] Wars have often captured news headlines and filled social media for months or years; at the time of writing, contemporary conflicts are no exception.[13,14] Continuous exposure to war-related news and stories can lead to feelings of being threatened, fear, and a constant state of alert, as has been noted in contemporary crises.[13] Additionally, helplessness and despair can be generated by prolonged exposure to news and images of war; in this regard, it has been highlighted that in the Russo-Ukraine War, mental health symptoms may also be experienced by those subjects who are not directly caught up in the conflict.[14] According to evidence gathered in different scenarios (e.g. during the COVID-19 pandemic), an individual sense of self-efficacy may be threatened when people are repeatedly exposed to scenes of violence and suffering.[11,12]

Thus, war-related trauma can be heightened for those people directly implicated in the conflict, but anyone may conceivably experience vicarious traumas. Exposure to traumatic events can impact physical as well as mental health, even among individuals indirectly exposed to stressors. In relation to this, researchers examined the psychological and physical health impacts of media exposure following the attacks at the Twin Towers in New York on September 11, 2001, and after the beginning of the War in Iraq in 2003. Posttraumatic stress-like symptoms were repetitively assessed for three years and early exposure to the news and the frequency of exposure to conflict-related images predicted the onset of posttraumatic stress symptoms two to three years after the attacks.[15] Other evidence concerning terrorist attacks in North America and Europe found that the brutality and unpredictability of these events contributed to CTS in the general population.[16] The consequences of this may include substantial stress, anxiety, fear, difficulties related to sleep and concentration, or PTSD symptoms in victims and eyewitnesses.[17]

Moreover, war-induced displacement and migration can be sizeable predictors of negative mental health outcomes for refugees and asylum seekers.[14] Importantly, in the current crises, 6,343,000 refugees from Ukraine have been recorded globally and millions of civilians are expected to flee following the conflict in Sudan.[4,18] Equally, the Middle East has seen dramatic refugee movements and forced migration in the last five decades, with approximately 16 million refugees and 60 million displaced people across this region.[19] This refugee status has been described as “living in a state of limbo and uncertainty,” with negative implications for both physical and mental health and possible correlations with symptoms of PTSD and major depression.[20]

Notably, numerous stressors can play a role in determining health outcomes for migrants, including pre- and postresettlement stressors, the asylum-seeking process, and transitions from war-related trauma to new settlements.[20] In the postmigration phase, acculturation challenges, a lack of social support and connectedness, socioeconomic issues and the impact of racism, stigma, and discrimination can have prominent consequences.[21]

MANAGEMENT

In contemporary contexts, ongoing geopolitical conflicts, particularly in the Middle East, have reached devastating proportions and are undermining humanitarian objectives and challenging the peace and safety of the international community. In the authors’ opinion, it is likely that the consequences for global mental health will be registered for years to come. Therefore, there is a pressing need for urgent psychiatric support to be emphasized alongside humanitarian, political, and diplomatic efforts. Internationally, mental health professionals can play a pivotal role in advocating for these schemes through connections with policymakers.

For instance, psychiatric care provisions must be provided in emergency settings, using digital solutions or dedicated phone lines (e.g., suicide and crisis hotlines) where face-to-face service delivery is unfeasible or unavailable. In this respect, as with other crises, nongovernmental organizations (NGOs) alongside national-level agencies can play a vital role in boosting mental well-being through relevant initiatives. From a public mental health perspective, in the longer term, community-based programs could provide accessible care and build resilience. Additionally, there is an urgent need for news agencies to commit to accurate and responsible reporting, as misinformation can exacerbate psychiatric issues, and for social media companies to be more vigilant toward content moderation.[11,12] More broadly, comprehensive plans for the reception of refugees should be developed internationally, which must include psychosocial assistance, social support, and integration schemes.

CONCLUSION

As demonstrated by conflict situations across the world, war-related trauma has been a persistent and challenging issue throughout human history, with deleterious outcomes for mental health. In our view, contemporary events once again provide an impetus for mental professionals to engage in collective humanitarian efforts with the goal of advancing global healing.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.