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Death, destruction, homelessness and displacement are not the only things left by the which has been raging for over sevenÌýyears. It has also engendered another, a more insidious enemy, which has quietly ripped through the lives of Yemenis: .

Deemed among the most destructive impacts the war has had on the , it has especially affected the Ìýand as the war continues to rage, an ever-darkening shadow is being cast over the psyche of the Yemeni people.

An unseen enemy

Mohammed Abdullah Uthman (23) is from a village in province. When he was ten, he was physically assaulted by one of his relatives. The attack left him traumatised and deeply withdrawn, says his mother, Mariam: "He would sit in the corner of his room alone for hours, not responding to questions. He was also constantly nervous and would panic easily."

Mohammed started receiving counselling and treatment which stabilised his condition, but this ended abruptly when the war broke out in the autumn of 2015. War swept the country, and Taiz soon fell under a crushing blockade imposed by the Houthis, which would have dire ramifications for every aspect of life in the city.

"Mental illness is deemed among the most destructive impacts the war has had on the Yemeni population, especially the youth. As the war continues to rage, an ever-darkening shadow is being cast over the collective psyche of the Yemeni people"

Mariam continues: "The war imposed huge pressures, we had to keep moving from village to village, and we are poor – we were unable to take Mohammed again to see a psychiatrist. This caused his mental health to deteriorate. He developed schizophrenia and severe depression, as well as now suffering from diabetes and high blood pressure. All of this when he should be in the prime of his life."

Psychiatrist Reem Abbasi says the psychological disorders resulting from the war show that many are suffering from poor mental health. The youth are especially affected, alongside those most impacted by the war, such as those who have been forcibly displaced.

Displacement can cause a sense of fragmentation, both physical, as families are torn apart, and psychological –Ìýmental health issues can develop alongside the loss of physical safety and wellbeing. Ìý

Dr Abbasi stresses that ignoring the psychological impact of the war and neglecting its victims has severe and long-term consequences for sufferers and their families. It also has an adverse effect on their ability to achieve academically and spurs a loss of self-confidence. Sufferers become frustrated and hopeless as they perceive themselves to have failed with regard to the futures they had envisioned and dreams they had hoped to achieve.

Worrying indicators

A study by The Family Development and Guidance Foundation (a Yemeni non-governmental organisation founded in 2011) found that by the end of 2020, 5,455,348 individuals were suffering from psychological disorders, likely due to the war. The study stated that 80.5 percent of the cases were among the youth category (ages 16-30).

According to a new study published by the Yemeni Psychiatric Association, published in March 2022, there were only 40 specialised mental health clinics in Yemen, for the treatment of an estimated seven million people annually, at least.

The study further stated that mental health centres only existed in five of Yemen's 21 governorates: Aden, Hadhramaut, Taiz, Hodeida and Sanaa. Moreover, the study claimed that there are only 44 psychiatrists in Yemen altogether, making the ratio one doctor to every half a million patients.

"The psychological impact of the war and neglecting its victims has severe and long-term consequences for sufferers and their families"

It outlined a severe lack of equipment, medicines, resources and facilities for the provision of mental health services in all of the governorates, even those with specialized health centres, and stated that the victims of diagnosed mental health disorders due to the war in Yemen surpasses the number of deaths and injuries.

Lack of health services

Taiz is the second most populous of Yemen’s governorates. Its residents suffered uniquely due to the siege imposed early on in the war, which left civilians forced to take alternative and risky routes through mountainous terrain in order to travel across the district; even when it came to transporting food and medical supplies.

As a result, the entry of humanitarian and medical aid into the city became difficult, and many psychiatrists fled. Meanwhile, armed clashes caused significant damage to the only hospital for psychiatric illness, which is located in one of the city’s flashpoints, in the Al-Hasab area, in the west of the city.

Dr Adel Mulhi, director of the Taiz mental health hospital, says that the situation of the mentally ill is much worse today than it was before the war, in part due to the dwindling of humanitarian aid. Previously, patients from five other governorates had also been able to receive treatment at the public hospital, which was the second-largest psychiatric facility in Yemen after the Al-Salaam Specialised Clinic in Aden.

He says there are over 100 inpatients in the hospital, but only one doctor in the inpatient department, and only ten nurses in the entire hospital. He also had to close the department for female patients recently due to the lack of capacity and damage to the hospital building. The government's monthly support for the hospital barely covers 20 percent of its patients'Ìýneeds.

Mulhi stresses that the war is the biggest factor impacting the mental health of the youth. This is exacerbated by the difficulty in accessing care, the lack of comprehensive health services and the small number of mental health specialists. This is all against a backdrop of a collapsed health sector in Taiz and the fact that many psychiatrists have left.

"Many fear their community finding out their child is ill, afraid this will have negative consequences for their marriage prospects and social position within their community"

Social stigma

"At first, I didn't tell anyone about Mohammad's illness, even his father, scared of what people would say, and the looks of the villagers. I feared they would say he was 'insane'Ìýor 'mentally retarded', and would ostracise and bully him," says Mariam.

These attitudes are widespread across Yemen. Dr Marwan Amiri, a psychiatric consultant, says there is very little mental health awareness in Yemeni society, and psychological illness is predominantly viewed as shameful for the family, especially if the sufferer is a woman. He says most Yemenis don’t understand what mental health drugs are and what mental illness is. They just assume these drugs are bad and can lead to addiction.

Dr Mahmoud al-Bakari, a professor of political sociology in Yemen, and deputy manager of the Office of Social Affairs and Labour in Taiz believes that Yemeni society needs to realise that mental illness is like any other disease, and anyone can be vulnerable. He explains that many fear their community finding out their child is ill, afraid this will have negative consequences for their marriage prospects and social position within their community.

Young Iraqis are being driven to despair as dire economic conditions exacerbate a growing mental health crisis

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Thus, any treatment should be offered with appropriate support to the family. Equally, society needs to be educated to increase understanding and compassion for mental health sufferers and awareness needs to be raised among patients themselves on the importance of mental health treatment and the dangers of neglecting it.

The need for treatment

Youth is a time of increased energy and vitality. But when young people are unable to live a normal life, in the midst of a brutal war, high unemployment, widening poverty and vicious political divisions, the impossibility of overcoming these difficulties can easily see their mental health to suffer as a result.

Dr Abbasi believes that, if the psychological effects of war are not addressed early, mental health disorders like depression, PTSD and anxiety can drastically curb the agency and drive of young people and their ability to play an active role in society.

She urges everyone subjected to trauma to seek specialist help, pointing out that right now there is a surge in initiatives around mental health support and services, which is an area of focus for a number of social organisations. Specialist centres do exist, she says, and are an essential component for improving mental health, offering counselling, support sessions and rehabilitation.

The Sanaa Centre for Strategic Studies published a report on January 12, 2022, which warned that if this issue remained undealt, it could jeopardise the potential for healing even after the violent conflict had come to an end, and could have ongoing ramifications for the coming generations.

Haifa Almadhgy is aÌýfreelance journalist from Yemen.

Article translated from Arabic by Rose Chacko