War & Mental Health Series

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M E N T A L H E A L T H W H A T T H E

C O N F L I C T I N U K R A I N E M E A N S F O R A L L O F U S

PART ONE

by Leon de Beer, Deputy Director, SA Federation for Mental Health

“These masks we wear and the stuff we spray on our hands to kill the germs… Do you think they’re going to protect us when they start dropping those big bombs on us? We’re all worried about this little virus, but there’s a much bigger problem coming!”

David*, an attendant at a petrol station, looked at me that Sunday morning in early March with a mixture of frustration and fear in his eyes, just barely visible above his mask. I realised that COVID 19 was no longer the thing that David, and possibly his friends, family and colleagues, were worried about. The news of the situation in the Ukraine had made its way into David’s world, and his concerns that the conflict might escalate and spread across the globe had instantaneously rendered COVID-19 virtually irrelevant to him, especially as the potential use of nuclear weapons had also just started creeping into media reports. David kept looking up at the sky and waving his arms around while talking to me. Eventually he stopped and looked at me with fearful resignation completely dominating his demeanour. “What are we supposed to do, hey?”

This brief but powerful encounter touched me deeply because it made me realise that, regardless of whether anything David said was factually correct or not, we urgently needed to start talking about how people’s mental health was being affected by events such as the Ukrainian conflict, which may be causing increased levels of stress, anxiety and other mental health problems. Even if they’re on the other side of the world. The other thing that struck me was that – for people like David – COVID-19 was apparently no longer the greatest threat because of the bigger threat of war.

I wondered to myself whether this type of mindset, if it spread and grew, could in itself have a domino effect, leading to people dropping their guard [for example not wearing masks and disregarding other COVID 19 preventative measures] because they were potentially resigning themselves to larger threats over which they had little to no control over. This was in itself another potential threat as we were heading into winter in South Africa, meaning that COVID 19 infection rates may start to rise again.

C O N F L I C T I N U K R A I N E M E A N S F O R A L L O F U S

PART ONE by Leon de Beer, Deputy Director, SA Federation for Mental Health

That morning, David felt hopeless, helpless and defenseless, and this was undeniably impacting on his mental health. The work we do as SAFMH should be for people like David and his family, colleagues and friends; to raise awareness about the very real links between war and/or violence and mental health, and to spread the message that it is understandable that people are fearful, and importantly, that they are not alone in these troublesome times.

But what do the experts and the literature say about war and mental health? I reached out to a number of experts and did some research of my own. It seems that the concern I felt for David that morning was justified as you don’t need to be on the frontlines of war, in the firing line, to suffer the mental health consequences of conflict. But for those who are directly affected, the impacts are even worse.

Mental health problems have been shown to be major secondary consequences of armed conflicts, potentially leading to short and long term negative effects on the well being of those living in areas affected by war. In 2019, three years prior to the Ukrainian crisis, the World Health Organisation already stated that, according to estimates by the United Nations, there were approximately 132 million people in 42 countries from across the globe who were in need of humanitarian aid, directly resulting from conflict or disaster. At the time, nearly 69 million people had been forcibly displaced globally by conflict and violence; the highest number since World War II.

A 2006 review of research findings related to the mental health consequences of war found that amidst all the consequences of war, the impact thereof on the mental health of the general population was one of the most significant, with studies showing a definite increase in the rates and prevalence of mental health disorders. Women were generally more affected than men, along with other vulnerable groups such as the elderly, persons with disabilities and children. The prevalence rates of mental health disorders were linked to the degree to which trauma had been experienced, coupled with the availability of emotional and physical support.

W A R A N D M E N T A L H E A L T H W H A T T H E

C O N F L I C T I N U K R A I N E M E A N S F O R A L L O F U S

PART ONE

by Leon de Beer, Deputy Director, SA Federation for Mental Health

In 2019, estimations from the World Health Organisation [WHO] stated that there were significantly more persons living with mental health disorders in areas affected by conflict than had previously been thought, with one in five persons being affected by some type of mental health disorder, [ranging from mild depression or anxiety to psychosis] to one in ten being affected by a moderate or severe mental health disorder. Additionally, because of exposure to traumatic events, there is also an increased risk of persons developing Post Traumatic Stress Disorder and poorer life outcomes as adults during war. The WHO stated that access to care and treatment for these individuals was not only a matter of improving their mental health, but that it was also a matter of survival in many cases.

“As mental health advocates, we join with the voices of people around the world to condemn the Russian invasion of Ukraine. Acts of war and violence are not only morally abhorrent. They destroy the mental health and wellbeing of victims and perpetrators alike. Epidemiological evidence from diverse cultures around the globe has shown the negative impact of war and violence on the mental health of populations. These adverse mental health consequences can last for years, and often have inter generational sequelae. We therefore call for a speedy resolution of the conflict and support all peaceful means to facilitating a resolution to the current situation in Ukraine. We also call on all countries of the world to provide mental health care and support to the victims of violence and war and give greater priority to mental health.”

The impacts of war on mental health are thus far-reaching and severe, and it is important that we, here and now, in 2022, ensure that awareness is raised about this at all levels of society.

Prof Crick Lund, a renowned mental health academic from the University of Cape Town, shared the following perspective when I asked him about his views on the Ukrainian situation:

U R P A R T N E R S W O R K I N G W I T H C O M M U N

PART TWO by Leon de Beer, Deputy Director, SA Federation for Mental Health

When reflecting on a topic as far reaching and deeply emotive as war and mental health, it is important that we make sure we also hear the voices and capture contributions from our partners working at community level. Our colleagues from Cape Mental Health provided the following insights on the mental health consequences of war after we asked them to contribute to this series -

The war in Ukraine highlights the impact of trauma induced by mass violence, displacement and persecution on the mental state of people living in these conditions. Living with intense and constant fear of violence, injury or death; experiencing the sudden loss of your loved ones; witnessing the destruction of your home and property; losing your civil identity; having your entire world displaced and being forced to search for refuge in foreign countries have serious negative consequences for mental health. The horrors of war are endless and can create a lifetime of trauma that may be impossible to recover from.

In the heat of battle and the immediate aftermath, health and disaster-aid workers are focused on attending to the injured; thereafter dealing with urgent needs such as medical services and supplies, clean water and sanitation, emergency shelters, electricity and telecommunications that are vital to prevent further suffering and loss of life.

According to studies published on the Long Term Impact of War, Civil War, and Persecution in Civilian Populations Frontiers in Psychiatry (2022), based in Africa, Palestine, Myanmar and Syria, war survivors often suffer from feelings of displacement, anxiety, depression, and post traumatic stress. Human rights violations during conflict such as physical and psychological torture, rape, and imprisonment without trial, can compound mental health misery and long-term psychological harm.

Living in a constant state of fear is not helpful to one ’ s mental health. “War has various effects on the mental health of affected individuals; it can trigger signs of depression, anxiety, or any other signs of mental health conditions” explains the staff from Cape Mental Health’s Psychosocial Rehabilitation (PSR) services.

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PART TWO by Leon de Beer, Deputy Director, SA Federation for Mental Health

There is a good chance that survivors in affected nations will develop post traumatic stress disorder (PTSD) with long term, intergenerational consequences.

According to the online publication Mind the Gap: Why Mental Health Care Matters for Rebuilding Syria (2022) – child survivors, and children born into war, can often struggle with emotional, developmental, and intellectual challenges. This can result in school drops out, substance abuse and thoughts of suicide. The study further states that children who are raised in conflict are more likely to exhibit delinquent behaviour.

Members of Fountain House SA, a psychosocial rehabilitation service provided by Cape Mental Health, felt that people with pre existing mental health conditions could relapse due to the strain on their mental health caused by the war. In their opinion, persons fleeing from war zones and refugees could feel a sense of abandonment and displacement and this could also trigger mental health issues for people who do not have pre-existing mental health conditions.

The staff and trainees at Training Workshops Unlimited for persons with intellectual disability expressed concern for the people in Ukraine. “It makes me very sad to see how elderly people and small children have to flee from their homes and all the damages and the buildings being destroyed. Watching the images of people looking afraid while having to run away from their homes is not nice” says trainees. They hoped the war would stop. Some were afraid that the war would come to South Africa as well.

“People are being traumatised by the war ” say members of the PSR programme. “Support is needed, and mental health facilities need to be accessible now more than ever, so that the long term effects of war can begin to heal.”

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PART TWO

by Leon de Beer, Deputy Director, SA Federation for Mental Health

We wish to reiterate the Athens Anti War Declaration which states:

"War is the worst of human-made disasters and has tragic and unacceptable consequences on the mental health of its victims. The catastrophic impact of war on mental health is longitudinal, transgenerational, and amplified by refugee crises both in countries of origin and elsewhere."

As CMH, our plea is for the wars and conflicts to stop in Ukraine, Afghanistan, Yemen, Syria and elsewhere in the world. We must support and promote the dignity of all displaced people, provide food, housing, medical attention and mental health services and ensure that they know they belong to a common humanity one world one people.

Additionally, my colleagues from Indlela Mental Health [formally Port Elizabeth Mental Health] shared the following after they held a staff discussion on the issue:

The war on Ukraine is absolutely devastating to the world at large. More than 2 million Ukrainian people have been displaced, mostly women and children. It is shocking that this is happening despite the fact that both countries (Russia and Ukraine) are signatories to the Convention on the Elimination of all forms of Violence and Discrimination against Women (CEDAW).

There seems to be no accountability and we need to see a push in humanitarian law, human rights laws, criminal laws etc. Where is the United Nations here? Who has the power to put a stop to this madness?

We can only imagine the overwhelming sense of emotions experienced by the Ukrainian people fear, anxiety, disconnection from friends, family. This will all have lingering effects on psychological health and well being and survival.

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U R P A R T N E R S W O R K I N G W I T H C O M M U N I T I E

PART TWO by Leon de Beer, Deputy Director, SA Federation for Mental Health

They also shared some ideas on what they think needs to happen:

1. 2. 3. Ms Shona Sturgeon, a social work lecturer, lifelong mental health advocate and Honorary board member of SAFMH shared the following when asked about the importance of SAFMH tackling this topic:

Access to life saving services in times of crisis – humanitarian agencies to provide relief and support Enforce adherence to regulations to protect the people of Ukraine

Safe passage ways for people to flee to safety and provision of aid (food, shelter, transport etc.)

"I would like our contribution to highlight the fact that this invasion has impacted on mental health in so many ways. It has meant that those service users in the affected areas are probably without their medication, causing untold problems for them. They are also without their support systems. Countries into which they are moving must be aware of these two issues, and not only address their physical needs.

Regarding the mental health impact on all people in those areas, indeed in the whole country, whether civilians or in the military, much has been written about the impact of war on people’s mental health. For those impacted on by this invasion, they are probably also feeling anger etc. that the “world” is not coming directly to their aid even if “intellectually” they may understand the complexities of the current situation. I sincerely hope that some effort is being made to address the conflicting emotions that these people must have. Practical issues need to be addressed, but emotional issues well need attention too – even if later. Many people will also need to mourn their dead, and, again, we know the difficulties that arise if this is not possible. On the world-wide stage, this invasion has had an impact on people’s feeling of security, and I wonder if the anxieties of children are being recognized world-wide as they hear their parents/adults talk of the possibility of a 3rd world war. "

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PART TWO

by Leon de Beer, Deputy Director, SA Federation for Mental Health

General William Sherman, leader of the Union army in the American civil war, famously said that “ war is hell”. Short as it might be, this statement seems to capture the true reality and horror of war. War effects the world in countless ways.

In the short-term, war leads to the destruction of infrastructure, the weakening of political and economic institutions, and a loss of human life and disability worldwide. Apart from the direct results of war, such as leading to people dying or being injured, large numbers of people are also affected negatively due to the wider effects of war on global health. War often re directs essential and oft scare resources away from those who need it towards war efforts, along with doing damage to healthcare infrastructures. War leads to people fleeing their homes to find safety elsewhere, with recent estimations of the UN showing that approximately 70 million people are currently displaced because of war [more on displacement in part 3]. Apart from its other effects, displacement can be extremely detrimental to people’s health, due to a lack of safe and regular places to sleep, to wash and clean, and due to exposure to the elements. It also removes the ability to have access to regular sources of proper food and nutrition. But it does not only affect physical health. As has already been shown in this series, war also impacts very negatively on the mental health of those actively involved in conflict and on ordinary civilians.

In the longer term, war has the unavoidable consequence of drastically altering social cohesion and development, leading some researchers to define war as “development in reverse ” . War leaves a legacy of persistent underdevelopment through weakening local and national political institutions, through the destruction of social fabric, and through creating divisions between populations by removing the foundations of values, norms and communal group and interpersonal trust, which facilitates interpersonal cooperation At a micro-level, researchers have found that armed conflict affects both tangible things like individual investment, consumption and income adversely, along with less tangible things like social trust and psychological wellbeing.

Taking all this into consideration, it would seem that war is in fact hell. A hell that is sadly an avoidable, man made one.

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PART THREE

As someone who has migrated to another country, I am all too familiar with the sadness and anxieties of leaving the home you know and the loneliness that greets you in the place you will now call ‘home’. It was an experience unlike any other and yet, I was not forced to leave my home or my country, and I was certainly not facing the violence and hostilities of war. I therefore chose to focus on the issue of forced displacement, war and mental health for this, the 3rd part of our 4 part series on “War and mental health”.

In June 2022 it was announced that there are more than 100 million people now forcibly displaced around the world, mostly through armed conflict and war. The ongoing war in Ukraine is what tipped the scales and now we have more people than ever before who have been forced to flee their homes.

Whilst the Russia-Ukraine war is at the forefront right now, the Council on Foreign Relations Global Conflict Tracker reports that there are currently 27 ongoing conflicts worldwide. The tracker also categorises these conflicts into three groups: unchanging, worsening and improving. Worryingly, none of the conflicts are described as “improving”.

Forced displacement is one of the world’s most challenging and pressing issues. Increasingly, nations have responded with an emphasis on the securitisation of migration and tightening of immigration policies over the rights and well being of those who have been forced to flee their homes. This ABC News report sharing Mohammad Harb’s story is an example of the complex traumas those forcibly displaced face on their journey to find refuge.

“The global refugee crisis is a mental health catastrophe.”

– Ellie Khan

In Part One of our War and Mental Health series, we reported that there were significantly more persons living with mental health disorders in areas affected by conflict than had previously been thought, with one in five persons being affected by some type of mental health disorder.

by Michel'le Donnelly, Project Leader: Advocacy & Awareness, SA Federation for Mental Health

W A R A N D M E N T A L H E A L T H – F O R C E D

D I S P L A C E M E N T A N D M E N T A L H E A L T H

PART THREE

Community studies done with recently resettled refugees confirms this estimate, listing depression, PTSD and other anxiety disorders as more common amongst refugee populations than that of non war affected populations. The increased risk to mental health problems is linked to both experiences before fleeing (i.e. exposure to war trauma) and afterwards (i.e. stress of being in a new country, dealing with refugee processing, the treat of deportation).

The below video explains the many complexities that come with immigrant and refugee mental health very well.

PREVALENCE OF MENTAL ILLNESS AMONGST PERSONS FORCIBLY DISPLACED

Despite the gaps in research and difficulties in gathering data, there have been a number of studies showing the prevalence of mental illness amongst refugee populations when compared to the host county. For example, refugees who have lived in a host country for more than five years tend to show higher rates of depressive and anxiety disorders than the host population.

by Michel'le Donnelly, Project Leader: Advocacy & Awareness, SA Federation for Mental Health

W A R A N D M E N T A L H E A L T H – F O R C E D

D I S P L A C E M E N T A N D M E N T A L H E A L T H

PART THREE

Some studies also indicate that the risk for forced migrants having a serious mental illness is higher in those fleeing from war than the general population of the host country This is true even for those who have been resettled for several years, which suggests a significant and lasting impact of the war experience.

Whilst people might assume that refugees and asylum seekers would mostly be diagnosed with post traumatic syndrome (PTSD), the WHO Regional Office for Europe reports that mood disorders such as depression are in fact more prevalent. Refugees and other forcibly displaced people may also be disproportionately affected by suicide risk.

The recently released WHO report on refugees and migrant health, describes the causes of developing mental illness after leaving one ’ s country as discrimination, missing family, and a lack of community support. Prevalence rates of mental illness are also dependent on how long refugees have spent in their host country, with the most recent estimates from the WHO finding that the burden of mental illness is up to 22.1% in “conflict affected populations”.

"Their lives have been abruptly taken from them, they have lost control of their world and their security has been abruptly wrenched from them. Often they feel guilt and shame, as if they could have done something to prevent it, when they could not. The consequences for an entire population may take many years to resolve, if in some cases that is even possible." – Cheryl Johnson (Counsellor)

CHILDREN ARE MOST AT RISK

In a study by Burgin et. al (2022), the authors argue that younger migrants and adolescents who have experienced war and violence are more affected by poor mental health, which can mean long term consequences for their development.

by Michel'le Donnelly, Project Leader: Advocacy & Awareness, SA Federation for Mental Health

W A R A N D M E N T A L H E A L T H – F O R C E D

D I S P L A C E M E N T A N D M E N T A L H E A L T H

PART THREE

An article published in the European Journal of Public Health found that refugee children are facing severe psychological health issues. These include depression, sleep disorders, anxiety and PTSD. The threat of protracted conflict sees many parents making the difficult decision of sending their children on the perilous journey to find a better life, many of them alone. Studies have found that the impact of war on adolescents and children is “tremendous and pervasive” and can mean that children are at an increased risk for developing specific mental illnesses. Indeed, mental health professionals in host countries are struggling to deal with the issues related to refugee and asylum seeking children, especially because of the number of child refugees coming through their borders.

Those children that do have a mental illness often have limited access to psychiatric healthcare services. A study in Denmark found that “only 3.5% of refugee children access psychiatric facilities compared to 7.7% of their Danish born peers.” The barriers experienced by refugee children in accessing services are many including fears of discrimination, no awareness of services, and language barriers.

The below poem by 12-year old Abdullah reminds us that the effects of war go far beyond the physical destruction that we see. There are millions of Abdullah’s navigating the world today and it is imperative that we prioritise understanding the long term mental health of refugee children to guide policies and promote long term wellbeing.

by Michel'le Donnelly, Project Leader: Advocacy & Awareness, SA Federation for Mental Health

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PART THREE

WHAT CAN BE DONE

A major issue that is furthering displacement has been the inability to find an answer for lasting peace around the world. The fact that wars have been allowed to ravage nations, devastating civilian populations for centuries, is the ugly reality facing the international protection regime right now.

Whilst there are three traditional durable solutions when it comes to forced displacement voluntary return, local integration and third country resettlement a majority of displaced persons are living in enduring displacement with no answers as to when they can return to their normal lives. This is why instead of focusing all resources on ending wars, we should instead focus on meaningful investment into safeguarding the mental health of a generation of people who have been robbed of their right to attain good mental wellbeing.

The WHO’s Global Action Plan (2019 2023) is a resource for Member States to use when trying to understand how they should meet the health needs of refugees and migrants. It also outlines the number of barriers that refugees and asylum seekers experience in accessing health care services.

According to the experts, a comprehensive, multi disciplinary and inclusive approach is what is needed to tackle the mental health needs of refugees and asylum seekers. These include:

Making mental health care available and easily accessible through general health care, taking into account language and cultural considerations. International protocols ensuring continuity of care for refugees and asylum seekers as they move through different countries. Migration laws that include detention, or the separation of families should be avoided. Host countries should ensure there are meaningful social integration policies that will allow forced migrants to feel part of the community.

by Michel'le Donnelly, Project Leader: Advocacy & Awareness, SA Federation for Mental Health

W A R A N D M E N T A L H E A L T H – F O R C E D

D I S P L A C E M E N T A N D M E N T A L H E A L T H

PART THREE

Essam Daod is one of the only child psychiatrists working on the shorelines in Greece and the Mediterranean. He is also a co-founder of Humanity Crew, one of the only organisations offering psychosocial support to people fleeing by sea. Whilst the work Essam and the Humanity Crew is doing is commendable, one can’t help but wonder why there aren’t more Essam’s in the world? Why are people who are fleeing the clutches of danger not being offered the emergency services, including mental health care, that they need? Why are they being treated like prisoners by the countries in which they arrive? These are the questions we must ask of our officials and of ourselves.

Often the debate around refugees and asylum seekers is framed as a security or economic issue; however, it is a human rights issue and we all need to do better to ensure the mental wellbeing of persons forcibly displaced is adequately supported and that they feel that their needs and fears are being heard. After all, in the words of Benjamin Zephaniah, “ we can all be refugees”.

by Michel'le Donnelly, Project Leader: Advocacy & Awareness, SA Federation for Mental Health

N D M E N T A

E A P O N O F W A R

PART FOUR

E A L T H F O O D A S A

by Leon de Beer, Deputy Director, SA Federation for Mental Health

Towards the end of February 2022, the world saw the outbreak of yet another violent conflict when Russia invaded the Ukraine, leading to a full scale war. Fueled by strategies and false propaganda [echoing those used by Nazi Germany], Russia has killed unarmed civilians, including children, women and families It has bombed maternity and children’s hospitals, churches, and homes, and has unashamedly violated laws and human rights. Russia has even denied humanitarian bridges meant to provide civilians access to water, food and medicine, or as an escape route to safety. Now, as we write this, the Ukrainian war has already passed the six month mark, with no signs whatsoever of the intensity of the conflict lessening not on the battlefield, nor in terms of the war rhetoric coming out of Kyiv and Moscow.

However, for many people who have been spared the direct horrors of war, the Ukrainian conflict might seem distant enough that, while being something they’re aware of or even fear from a safe distance, they may not yet see it as something that impacts on them directly. So in this, the fourth part of our “ war and mental health series”, we look at one issue that we all – by virtue of simply being human – have in common, and that is the need for food. We also look at how purposeful starvation and the disruption of food supply chains caused by the Ukrainian war is affecting all our lives, and inevitably also our mental health.

FOOD AS A WEAPON OF WAR

An extremely concerning problem arising from the Ukrainian war is the weaponisation of food as a war tactic. At present, a dreadful contradiction is manifesting in the Ukraine, where thousands of people, stuck in cities besieged by Russian forces, are facing starvation, while the country’s grain stores are bursting with food. This has left the Ukrainian government begging for international assistance to help export their grains to global markets, which will help address the world’s food crisis, which is in itself an urgent global priority. However, this won’t stop warmongers using starvation as one of their favoured weapons.

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PART FOUR

by Leon de Beer, Deputy Director, SA Federation for Mental Health

In the world today, Russia is not the only perpetrators of this; most people who face famine in the world today are afflicted by war, and many are being starved deliberately through what amounts to a form of ‘societal torture’. Globally, at the end of 2021, approximately 200 million people were already struggling with acute food insecurity. These numbers escalated severely after the Russian invasion and the blocking of the Ukraine, which is highly problematic as the country is a major exporter of oil seeds and grains. This in turn disrupted global food markets, leading to escalating food prices across the world.

FROM GLOBAL TO LOCAL

And so it is here where the Ukrainian war albeit almost 15 000km away from us here in South Africa starts becoming an everyday, real life problem, as it does for so many other countries who might not be feeling the direct, full force of the war, but who are feeling its knock on effects. While Africa as a whole is still trying to recover from the socio economic consequences of the COVID 19 pandemic, the Russia Ukraine war is posing a major food related threat to the global economy, affecting many African countries directly. Within a few weeks of the war starting, global crude oil, sunflower and wheat prices soared to extraordinary levels, which is very problematic as Africa, who immediately started feeling the effects of massively increased food prices, is heavily dependent on food imported from both countries.

Here at home in South Africa, the United Nations have stated that the Ukrainian war has created various new, multi dimensional risks to our economy by worsening supply chain blockages and inflation pressures because of, amongst other things, higher food prices. This could in turn lead to adverse effects on things like employment, poverty and food security, all of which in turn impacts on our mental health.

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PART FOUR

E A L T H F O O D A S A

by Leon de Beer, Deputy Director, SA Federation for Mental Health

THE LINK BETWEEN FOOD, MENTAL HEALTH AND POVERTY

While the relationship between what we eat and our mental health is complex, we know that eating well has a positive effect on how we feel. But what if we are deprived of food to the extent that we experience food insecurity, defined as a lack of consistent access to sufficient amounts of food to enable an active, healthy lifestyle? While food insecurity is a nutritional issue that affects a person ’ s diet and weight, it also impacts on psychological wellbeing, for example through an individual feeling deprived of choices pertaining to food or experiencing anxiety related to the supply of food. Food insecurity may thus lead to negative consequences for mental health.

A study assessing the mental health outcomes of famine and food insufficiency in West Africa showed that exposure to food insecurity is associated with “increased psychological distress including anxiety, sleeplessness, intellectual disability, general mental, and emotional instability”.

In South Africa, as in other countries across the world, food is one of the key needs for a person ’ s daily survival. In our country, food is recognised as a fundamental human right according to our constitution. However, approximately 6.5million people in South Africa are food insecure and hungry, which continues to be a significant challenge for our country.

This food insecurity is driven by several factors, including conflict (such as the Ukrainian war), poverty and population growth. Households that are food insecure do not have enough money to buy food and cannot produce their own food. These households also frequently face, among other challenges, unemployment, which make them especially vulnerable to what is termed “economic shocks".

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PART FOUR

by Leon de Beer, Deputy Director, SA Federation for Mental Health

Considering this against the stark background that, in 2015, 55.5% of South African were already living below the poverty line, a concerning picture starts to emerge when we think about the dramatically rising prices of food due to the Ukrainian war, and the fact that millions of people are increasingly being affected by food insecurity and the prospect of poverty.

Poverty and mental health have a precarious relationship in that persons who experience poverty [especially early in life or for extended periods] are at risk of various health and developmental problems throughout their lives. Childhood poverty is linked to impaired cognitive, behavioural and attention related outcomes, along with poorer achievement in school, increased rates of delinquency, anxiety and depressive disorders, and higher levels of virtually all types of mental health conditions in adulthood. At the same time, adult poverty is linked to psychological distress, depressive and anxiety disorders, and suicide.

CONNECTING THE PRECARIOUS DOTS

So whilst we may not all be affected by the violence plaguing countries in conflict, we can all relate to the reality of the threat of food insecurity and it’s potentially devastating and long lasting impacts. What we are therefore facing because of the Ukrainian war is a multi faceted, complex and interconnected vicious circle, where the war has led to skyrocketing food prices, increased levels of food insecurity, hunger and poverty all in turn potentially leading to poorer mental health for large sections of nations across the world.

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M E D I A W A R

PART FIVE

by Leon de Beer, Deputy Director, SA Federation for Mental Health

The Russian invasion of the Ukraine in February 2022 led to millions of people living in the Ukraine fleeing their homes, leaving behind everything they’ve ever known. Thousands of people, including children, have suffered injuries or have lost their lives while daily videos and photos of the brutalities these people have suffered have been portrayed in the media. The atrocities seem unimaginable, and the pictures themselves are also very traumatic in their own right. For the people of the Ukraine, living in constant fear, while simultaneously struggling to find a degree of security and safety, has taken a serious toll on their mental health.

Over the course of the first four parts of our series on “ war and mental health”, we have explored a number of important issues pertaining to the topic, illustrating how far reaching and devastating the impacts of war can be on the lives and mental health of people from across the world. We have looked at the cold, hard facts and figures regarding conflict situations, we have explored, in detail, the various mental health consequences of war, and we have gathered the views of mental health professionals and mental health care users on the topic. We’ve assessed the impacts of war on health systems, infrastructure, economies and political institutions. We’ve seen how war leaves a destructive legacy of “development in reverse ” , and we have taken a detailed look at the harrowing effects of conflict driven displacement and food as a weapon of war.

THE SOCIAL MEDIA WAR...

As we bring this series to its conclusion, we want to reflect on one last, highly unique aspect related to this particular conflict; an aspect that has brought this particular war closer to people from across the world than any other war had previously been done. And that is the role that social media has played. The Ukrainian war has been called “the social media war ” because the events that have transpired there have not only been broadcast live through conventional news platforms, but also extensively via platforms such as TikTok, Instagram and Twitter, at unprecedented rates.

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PART FIVE

by Leon de Beer, Deputy Director, SA Federation for Mental Health

Violent images from the war have been spread widely, with some videos [tagged #UkraineWar] having been viewed 600 million times over the course of just a few days. The reality is that these audio and visual clips can be very triggering for anyone exposed to it, leading to serious psychological consequences.

The sad truth is that our world has always been plagues by conflicts Given the instabilities in Iraq, civil unrests in Syria, various conflicts in other countries, along with the impacts of the COVID 19 pandemic, the Ukrainian war has presented us with yet another traumatic event on an already lengthy list of traumatic events, all of which may impact our mental health adversely.

Yet when we look at trauma, we often assume that this only pertains to people directly affected by violent conflicts. However, Steve Sugden (MD), a colonel in the United States’ Army Reserves and psychiatrist at Huntsman Mental Health Institute in Utah, tells us that while “The long term effects of trauma are significant”, it is important to note that "Civilians, soldiers, and those consuming the war through social media can develop the typical psychological profile of trauma". He also states that “Studies have shown that consumers of a war via television, social media, or other forms of media can be just as impacted as the actual individuals within the conflict”.

And this, dear readers, is why we have felt the need to talk so extensively about war and mental health. In July 2022, there were an estimated 4.7 billion social media users across the globe, which made up around 59% of the total global population. The numbers of social media users have continued to increase over the preceding 12 months, with 227 million new people joining social media platforms since July 2021. This equates to an annual growth in social media use of 5.1%, which in turn equates to approximately 7 new users becoming active every second of every day.

The role of social media in spreading information about the war is however only one of many already known negative effects of social media, with studies showing how social media may have adverse impacts on relationships, productivity at work, educational settings, and specifically also on mental health.

W A R A N D M E N T A L H E A L T H

M E D I A W A R

PART FIVE

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by Leon de Beer, Deputy Director, SA Federation for Mental Health

However, social media has become such a big part of our lives that it has become difficult for people to simply look away. The figures above are staggering, and when one takes into consideration the trauma that social media users may be exposing themselves to because of images of the Ukrainian conflict, a very concerning picture starts to emerge. Children, young people and people of all ages are all potentially being exposed to images and videos that may lead directly to trauma on a daily basis, meaning that problems related to mental health – as a knock-on effect of the war ‘trending’ on social media – may just soar over the coming years

But why and how do people get exposed? It has been found that from a clinical perspective, people turn to electronic media as sources of information during times of crises. This is due to the fact that, for many, social media has become a coping mechanism to assist with stress or merely just as a distraction. When watching images or videos from the Ukrainian war on a screen, people are enabled to empathise with persons who are affected, which may inform, educate and even inspire people to want to help.

However, as we ’ ve seen, this increase in screen time and an “over-saturation of traumatic content” can cost the person dearly in terms of their mental health. Sugden draws an interesting parallel between the Ukrainian war and the events of 9/11, as the latter was the first ever televised ‘disaster’. Studies that followed this found that people who had watched the event on TV had been just as likely, or even more, to develop trauma like symptoms that people residing in New York during the event.

SO WHAT CAN WE DO TO PROTECT OURSELVES?

There is clearly a need to protect ourselves from over-exposure to information about the Ukrainian war, which is flooding social media platforms.

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The following are some suggested strategies for helping to minimise the mental health risks related to this, bearing in mind that simply turning off devices or leaving social media platforms to limit the amount of content being viewed related to the war is not always easy or practical for many people:

Avoid looking at content before you go to sleep at night or when you wake up this is important because viewing distressing images or videos may cause unnecessary stress and anxiety, which might either keep you awake during the night or affect you throughout the day

Make sure the content you are viewing and/or sharing is accurate and not misleading or false

Take stock of your feelings for example, if you start feeling anxious, turn of your device and step away from the content

Avoid what is referred to as “doomscrolling” [defined as the act of “mindlessly scrolling through negative news articles, social media posts, or other content sharing platforms”]. Doomscrolling involves a person reading negative story after negative story, with one Canadian study referring to the phenomenon as “social media panic”. People are encouraged to instead focus on content that does not lead to them feeling stressed

Instead of watching events unfold on social media, rather stay engaged through, for example, supporting activities related to the Ukrainian war that could boost your mental health, for example donating to relief efforts or organising local events to assist families who may have ties to the Ukraine

Use this time to assess your mental well being, take a break from social media and seek out assistance you may require

T H E S O C I A

PART FIVE by Leon de Beer, Deputy Director, SA Federation for Mental Health

W A R A N D M E N T A L H E A L T H – T H E S O C I A L

M E D I A W A R

PART FIVE by Leon de Beer, Deputy Director, SA Federation for Mental Health

IN CONCLUSION ...

We know now, beyond a shadow of a doubt, that the realities of war are horrendous soldiers and civilians are all affected negatively, both psychologically and physically. Malnutrition, illness, injury, death, sexual violence and disability are all consequences of war, while Post Traumatic Stress Disorder, anxiety and depression are all some of the emotional effects. The terror associated with war disrupts people’s lives and tears families and relationships apart, leaving individuals and communities in utter distress.

Going back to the opening paragraphs of our war and mental health series, where I recalled a conversation I had with David, a petrol attendant, about how the war in the Ukraine was causing him anxiety, I am left to wonder what role social media may have played in David’s life at that time. Did he, as so many others, view traumatising images or videos on social media? Did he start feeling the gnawing feelings of stress and anxiety related to the Ukrainian war, despite being thousands of kilometres away, simply because of being a social media user? Did he learn about the true horrors of war while lying in bed late at night, perhaps doomscrolling through social media? Did he see people being brutalised, buildings laid to waste and lives torn apart from behind his cell phone’s screen? And how many other people in South Africa were currently grappling with the same fears, anxieties and even trauma because of over-exposure to the events on social media?

Here in South Africa, we remain fortunate enough to be spared some of the direct effects of the Ukrainian war, for example the immense violence associated with it. However, we are feeling some of the indirect effects through, for example, the increased prices of food. But we now also know that we are perhaps even more at risk of suffering the consequences of the war than what we may have initially thought, because of so many of us being highly active users of social media.

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PART FIVE by Leon de Beer, Deputy Director, SA Federation for Mental Health

And while we may not be able to directly address many of the effects of the war, we are able to keep ourselves, our children, family and friends safer through encouraging a more responsible use of social media. Let’s stay informed, let’s help where we can, let’s look after each other, and let’s not immerse ourselves in content to the extent that it damages our mental health. Because war is hell. Whether viewed from the confines of a building left in ruins, or from the comfort of your bed.

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WE WOULD LIKE TO DEDICATE THIS SERIES TO ALL OF THE COURAGEOUS PEOPLE WHO HAVE BEEN AFFECTED BY WAR MAY YOU SOON BE FREE OF THE HORRORS OF CONFLICT, AND MAY YOUR MENTAL HEALTH PROSPER.

& MENTAL