Mental health crisis in Yemen

Dear Editor,

The COVID-19 pandemic in Yemen has been described as ‘a crisis within crises’ (Mousavi and Anjomshoa, 2020). Yemen is a low-income economy country in the Middle East with a population of around 28 million challenged by poverty, famine, and an ongoing civil war that followed the Arab Spring. This is further compounded by an ongoing flow of migrants and refugees that regularly cross into the country. Plus, the health system has been heavily affected by the ongoing conflict, with only half of its health care facilities remaining fully functional (Mousavi and Anjomshoa, 2020; Zawiah et al., 2020). According to the United Nations, the situation in Yemen continues to represent the world’s worst humanitarian crisis.

As it could be expected, the conditions in Yemen have been further worsened by the COVID-19 pandemic. In a survey conducted between March and April 2020, healthcare workers in the country reported that the healthcare system in Yemen did not have the necessary resources or capabilities to face the COVID-19 pandemic (Zawiah et al., 2020). The country has very limited resources, which are almost entirely dependent on the support of the World Health Organization, which makes it imperative to prioritize only highly suspected cases (Dhabaan et al., 2020). A fragile healthcare system, lack of protective equipment in the hospitals, difficulties for aid agencies to provide assistance, and the overlap of other infectious diseases such as cholera add to the struggles faced by the country. As a result, by July 2020, Yemen had recorded one of the highest mortality rates in the world related to COVID-19 (Looi, 2020).

Mental health is also an area in desperate need of attention in Yemen. It is estimated that more than one in five people suffers from a mental health disorder, including depression, post-traumatic stress disorder, and schizophrenia (Charlson et al., 2019). Both the government and non-governmental organizations have implemented some services for the provision of psychosocial support in the country (World Health Organization, 2021). Still, in a country where mental health care resources are scarce, including mental health professionals, there is a need for further investment in mental health. The integration of mental health services into primary care and further training of primary healthcare providers in mental health care could assist in reducing the burden of mental health problems in the country. The mhGAP Humanitarian Intervention Guide, a guide with recommendations for mental health assistance developed for non-specialist healthcare providers in humanitarian emergencies, could provide further assistance (World Health Organization and United Nations High Commissioner for Refugees, 2015). The destruction of healthcare facilities represents an apparent obstacle, but the provision of psychosocial support at a distance, i.e., via telemental health care or telepsychiatry, could also ease some of the country’s need for mental health care (Junaid Tahir et al., 2021).

In Yemen, the global mental health emergency imposed by the COVID-19 pandemic met and exacerbated complex humanitarian crisis, adding to the growing mental health burden in the country. Presently, there are no clear strategies to control or slow down the rate of infection (Maher et al., 2020). There are, however, ongoing preparations to support Yemen with facing a second wave of COVID-19, including the promotion of COVID-19 vaccination (ReliefWeb, 2021). Still, the global health community and international organizations need to pay attention to Yemen and support the implementation of evidence-based interventions, as much as can be done during the present situation. It is imperative to include in these efforts the provision of mental health care to the people of Yemen, paying particular attention to the depth of trauma this population has experienced. It is both an issue of human health and human rights, and an essential need for the people in Yemen.

Financial disclosure

No funding source to disclose.

Declaration of Competing Interest

The authors report no declarations of interest.