Conflict in the Middle East and in North Africa has consistently made headlines over the past 2 years for one reason or another. Yet despite the extensive coverage of slaughter and mayhem, little has been said about the destruction of the infrastructure supporting medical services, and even less about the psychiatric consequences of conflict. There is growing evidence of deteriorating mental health of the general population in affected countries, among both those who stay and the burgeoning refugee diaspora. Even worse, in some ways, is the abandonment (or even the targeting) of psychiatric patients, whose hospitals have been destroyed and whose carers have long since fled. In this issue we review the crisis in three countries affected by civil war: Libya, Syria and the Sudan.
Libya went through a convulsive, although relatively brief, civil war that began in February 2011 and ended in October of that year. As Dr Abuazza writes, decades of neglect had left the mental health system in that country in bad shape. There are now just two functioning psychiatric hospitals. The impact of the civil war was to drive many doctors out of the country and few mental health professionals remained to cope with patients. Although matters are beginning to turn around for the better, those seeking help have not only overwhelmed services in those hospitals but they have spilled over into neighbouring countries too, such as Egypt.
Drs Abou-Saleh and Mobayed report on the conflict in Syria, a situation that has persisted now since March 2011 and shows no sign of abating. General medical care has suffered terribly. The authors report that children in particular are affected, because armed groups (especially government forces) have specifically targeted them. Post-traumatic stress disorder (PTSD) could be a problem for up to 60% of adults and an even higher proportion of children. Active destruction of psychiatric facilities has been witnessed.
Finally, Drs Ali, Saeed and Sultan give us an account of the outcome of 22 years or more of conflict in Sudan, where the effects of civil war have been compounded by famine. The proportion of the population affected by PTSD is similar to that in Syria, studies suggest, but in other respects the situation differs from that in Middle Eastern states, perhaps especially in the south. There is a cultural reluctance to acknowledge the extent of mental health problems, because of the stigma. Spiritual healers still play a major role. Yet, as in Libya and Syria, there is a growing call for help from the international community to provide mental health management, both to those within the country and to the refugee populations across borders.