Tuesday 24 April 2018

The Effects of Natural Disasters on Mental Health


The effects of climate change globally are well-researched and well-known. Increases in the frequency and severity of natural disasters in recent years bear out the evidence that the global climate is becoming more unpredictable. 2017 proved to be the costliest Atlantic hurricane season on record, described as “catastrophic” by NASA, and predictions for 2018 suggest it will also be more active than the average. Of the top 10 costliest Atlantic hurricanes, 9 occurred between 2004 and today (only Hurricane Andrew, 1992, makes the list as the 6th costliest storm on record). Pacific Cyclone season has similarly been more active in recent years, with 2014, 2015, and 2016 all appearing in the list for most active tropical cyclone seasons. These are just some of the most immediately obvious consequences of climate change, but lower-level flooding, unpredictable monsoon seasons, droughts resulting in wildfires (such as the particularly damaging 2017 California wildfires, the deadliest on record) and other climatic disturbances are affecting and displacing millions of people globally year-on-year. According to the Internal Displacement Monitoring Centre, 24.2 million people were displaced by natural disasters in 2016 alone. This is compared to 6.9 million people displaced by conflict in the same year.

As Professor Helen Berry of the University of Sydney explains, it is now widely accepted that climate change is one of the leading global health risks today, but the effect that it has specifically on mental health has until recently been largely unexamined. This, she argues, does not make much sense, because those who have lost everything in a natural disaster are vulnerable to many of the same mental health issues as those who lost everything to conflict.

Because of the way that we view conflict and warfare, the issue of mental health in refugees is one that has been discussed at length and researched in-depth by academics and humanitarian professionals alike. The International Committee for the Red Cross and Red Crescent Societies (ICRC), the arm of the Red Cross best-suited to responding to conflict, has published guidance on mental health and psychosocial support for those affected by violence and conflict. A 2016 IFRC report examined Syrian refugees living in Sweden and found that one in three of those sampled suffered with depression, anxiety, and some symptoms of post-traumatic stress disorder (PTSD). A paper published in World Psychiatry by Silove, Ventevogel, and Rees (2017) acknowledges that the admission of PTSD into the DSM-III laid the groundwork for studies on refugees, starting with the victims of the Khmer Rouge’s bloody genocide. In this early study, half of respondents met the criteria for depression and 15% for PTSD.  Since then, humanitarians responding in conflict zones have been aware of the threat that violence poses not just to life, but to mental health.

Following the news that suicide rates in Puerto Rico have risen by a third in the aftermath of Hurricane Maria, which decimated the island in September 2017, more and more people have begun to consider what more extreme weather patterns might mean for the mental health of those affected. If the rising suicide rate in Puerto Rico is a result of the devastating hurricane, it is not difficult to see why. Over six months after the disaster much of Puerto Rico is still in blackout, with no access to electricity at all for most of the island. Despite the official death toll of 64, a recent NY Times report suggests the real number is likely over 1,000. It is estimated that Maria caused over $90 billion worth of damage in Puerto Rico alone, and coming at the end of a decade-long recession from which many were already struggling, this was likely the final nail in the coffin for many residents who were already in dire straits financially.

In examining this problem further, Professor Helen Berry reviewed reports from Public Health England concerning heightened levels of “psychological distress” following extreme flooding, that was still present in respondents up to four years after the event. Rates of PTSD were elevated in flooded areas, even amongst those who were not directly affected by the flooding. The reasoning behind this is interesting to consider.

PTSD has so-long been associated with violence and conflict that the thought that flooding could elicit PTSD symptoms may at first seem surprising. However, an understanding of how PTSD works in fact demonstrates that those affected by natural disasters may in fact be even more susceptible to it than those fleeing violence. Some evidence suggests that the heightened arousal caused by PTSD is a survival mechanism designed to better prepare the individual to deal with similar trauma should the causal event occur again. This is best demonstrated by the stereotypical PTSD sufferer, a combat veteran who has an intense reaction to the sound of a car backfiring once they have returned from war. The perceived similarity of the car backfiring and a gunshot triggers an automatic response. Why though, might this make those who flee natural disasters more prone to PTSD than those who are fleeing conflict?

It could be argued that those fleeing a natural disaster, for which there is often no discernible immediate cause that could predict when the next disaster might happen, would find themselves much more likely to be in a position where they could be re-exposed to the traumatic event than somebody fleeing violence. Consider the current Rohingya crisis. Rohingya refugees, fleeing violence and persecution by their own government in Myanmar, have retreated to the relative safety of Bangladesh. Here, their lives are not immediately threatened by violence. However, the same season of monsoons and cyclones that cause damage in Myanmar also affect Bangladesh, and so the refugee camps there are just as exposed as the homes of the Rohingya back in Myanmar. Syrian refugees fleeing conflict and arriving in Turkey or Iraq no longer need to fear Assad’s guns, but are still faced by the same droughts that plague the entire region. The victims of Hurricanes Maria and Irma, still in the process of desperately trying to rebuild, are now staring down the barrel of the 2018 Hurricane season which is set to begin in May. In essence, the soldier who returned from a war zone is less likely to find himself of the receiving end of gunshots again than the climate migrant fleeing from one town to another to avoid a storm.

Natural disasters often arrive with less warning than conflict, which usually develops from tensions over many years, or at least shows signs of occurring prior to becoming extremely deadly. Even when they are somewhat predictable, such as in hurricane season, the ferocity of an individual storm is often not known until just days before, and even then the extent of the damage it will do is unquantifiable. For other events such as earthquakes, there may be even less warning. A sudden destructive event that fundamentally changes your life, sometimes permanently, is undoubtedly going to leave some form of mental scar.

Thanks to years of research and humanitarian trial-and-error, we know a little bit about the mental health toll that violence and conflict can have on its victims. Whilst lacking in many aspects, our understanding of this relationship is still light years ahead of what we know about the consequences of natural disasters on the mental health of those who survive them. Refugees and climate migrants each face similar challenges when they are forced to leave their homes. It is time to start considering how best we can support those who have no choice but to rebuild their lives from scratch, in a place that is not their home.

You can read more here:
Berry, H. L. et al. (2018) The case for systems thinking about climate change and mental health, Nature Climate Change, doi:10.1038/s41558-018-0102-4

Thursday 12 April 2018

The Looming Crisis in Bangladesh


Since the outbreak of violence in Myanmar’s Rakhine State in August last year over 1 million Rohingya refugees have crossed the border into Bangladesh, fleeing what the UN has called “textbook ethnic cleansing” by the Myanmar military. Bangladesh, already one of the most densely populated countries in the world and suffering with widespread poverty, is largely ill-equipped to deal with such a massive influx of people in such a short space of time. To give a sense of the scale of the crisis, the Rohingya settlement in Cox’s Bazar has rapidly become the world’s largest refugee camp, double the size of Dadaab camp in Kenya, which previously held the record. In July 2017, the two government-run refugee camps in Cox’s Bazar had a combined population of 34,000 people. Today, Kutupalong camp alone has an estimated 550,000 (compared to Dadaab’s 250,000), with another 25,000 in the neighbouring Nayapara camp.  

The sprawling camps have expanded exponentially in the past few months to accommodate as many of the fleeing Rohingya as possible, but even that has not been enough. Many more thousands of refugees have been forced to set up their own makeshift camps in the surrounding mountains and hills, and to spread deeper into Bangladesh in search of a safe space to survive. For those in the tent cities conditions are poor, with a severe deficit of resources, poor sanitation, and an almost complete lack of medical equipment for the majority of people. But for those who did not fit into Kutupalong or Nayapara, conditions are even worse.

A lot of these makeshift villages have been constructed on hills and mountainsides, completely exposed to the elements. The aid agencies working across Bangladesh are painfully aware of the approaching monsoon season, set to start in May and run through to September. On average, 80% of Bangladesh’s annual rainfall usually occurs between June and October (20 – 30 inches a month at the peak of the monsoon). This brings widespread devastation after the cold, dry winter that leaves the ground more vulnerable to flooding. Such flooding is rampant and, for the Rohingya camps that find themselves on or around the hillsides near Cox’s Bazar, landslides become a very real threat. UNHCR workers in the area have said that widespread flooding and unstable ground make landslides an inevitability. It is not if, but when.

The myriad camps that continue to appear across Bangladesh are not just in the wrong positions to deal with landslides, but they are also structurally unprepared to cope with the monsoon conditions. Camps with hastily-built latrines and sewage systems risk contamination of their water supply, and many of the tent structures are likely to be washed away with the mud beneath them. With no respite to the repression in Myanmar, and nowhere else for the Rohingya to go, these shelters are likely to become permanent housing for the people living there. It is not uncommon for refugees to live in camps like these for 20 – 30 years before they can go home or move on, and so it is vital that food and water supplies are secured for the long-term. Unfortunately, that is easier said than done.

And the threat to the camps does not end there. Bangladesh’s monsoon season coincides with tropical cyclone season. Cox’s Bazar, located on the coast, is regularly in the path of cyclones. In May 2017, Cyclone Mora forced 500,000 people to flee their homes and damaged 20,000 houses of Rohingya refugees who had previously fled Myanmar. This was before the current crisis, at a time when the two main camps in Cox’s Bazar held only 35,000 people between them. Needless to say, a cyclone of that size this year would cause havoc on an unprecedented scale. The International Federation of the Red Cross and Red Crescent Societies (IFRC) successfully provided aid to the 500,000 people who left their homes before Mora hit, setting up emergency shelter stations in advance of the cyclone making ground and deploying volunteers to help with the clean-up in the immediate aftermath. The scale of the campaign was massive, with around 3.3 million people affected. However, since then the population of the cyclone-vulnerable region around Cox’s Bazar has risen by up to a third, with many of the 1 million Rohingya refugees in Bangladesh settling in and around the area.

Aid agencies are already stretched to their limits coping with the world’s fastest growing refugee crisis. The Rohingya have fled their homeland to escape the violence perpetrated against them by their own military, and, with nowhere else to go, have ended up in overcrowded and increasingly precarious camps set to be battered by extreme weather in the upcoming months. Though actual figures are not available, conservative estimates suggest that at least 50,000 Rohingya have been killed in the military ‘clearing operations’ in Myanmar and over 1 million have been displaced to Bangladesh alone, with many more fleeing for Pakistan, India and Indonesia. The nightmare that began in August 2017 is far from over. And, as several aid agencies have cautioned, the real crisis is still to come.


For more information on the current crisis and to see how you can help, visit the IFRC website https://media.ifrc.org/.  

Sunday 1 April 2018

Budapest’s House of Terror: Examining the Dangers of Ideology and the Importance of Self-Determination


The winter of 1944-1945 saw 3,500 murders on the bank of the Danube, executions carried out by fascist Arrow Cross Party militiamen. This would be one of the final terrors the Nazis would inflict upon the people of Hungary, who were to be ‘liberated’ by the Soviets just two months later following the Siege of Budapest. The Soviet chokehold around the city would result in the starvation of 38,000 civilians, but would also force the desperate Nazi occupation to its knees. The unconditional surrender of the city on 13th February 1945 was a major victory for the Allied powers, and for the Red Army on its long march to Berlin.

What followed was 44 years of Soviet occupation, coming to an end in 1989. For the war-weary civilian population of Hungary, the years of terror were only just beginning. Today, Budapest’s House of Terror tells the story of a nation held hostage by rival ideologies for half a century. For Hungary, the intricacies of the Nazi and Soviet occupations were lost to the overwhelming similarities of their methods. The Hungarian national socialist party, the Arrow Cross, boasted 300,000 members in 1939. Emboldened by the expansion of Germany and subordinate to the Nazi Party, the Arrow Cross recruited thousands from working-class districts around Budapest to march in its rank-and-file. By 1945, these young men and women were rounded up by the Hungarian Communist Party and the Soviet occupiers and forced to renounce their allegiances to the national socialists. An entire society was forced to turn coat overnight. For many members of the Arrow Cross Party, this was as simple as switching out their uniforms. Nazi terrorisers became Communist terrorisers over night through a costume change.

An ordinary Hungarian peasant at the time could be forgiven for not even noticing the dramatic shift of power in Budapest. Widespread land reform that was supposed to secure the livelihoods of peasant farmers made little real difference to their predicament due to the continuation of war time restrictions and compulsory food quotas to supply Soviet troops and their Hungarian lackeys. Those who refused to hand over their quota no longer had to fear the concentration camps of Germany and Poland, however; their fate lay eastwards in the Siberian gulags. Before being sentenced, many in Budapest would be processed at the “House of Horrors” by the State Protection Authority (AVH). Many locals knew of this building as the “House of Loyalty”, once used by the Arrow Cross secret police to ensure allegiance to the fascist regime and now repurposed by the AVH to ensure allegiance to the communists. The methods of physical and psychological torture utilised by the Arrow Cross and AVH at the House looked remarkably similar.    

As the House of Terror Museum demonstrates, these two rival ideologies each created a reality that was largely indistinguishable from the other. Ideology itself is not necessarily a bad thing, but any idea taken to its extremes necessitates imposition of that idea onto others. Often that means against their will. The 400,000 Jews forcibly moved to concentration camps throughout Hungary by the Arrow Cross in the 1940s and the 20,000 wounded and killed by Soviet tanks on November 4th 1956, following the October revolution, were all victims of ideologies that painted anyone with differing opinions as enemies. Nothing mobilises men and women to kill their neighbours like ideology. But as the speed with which Nazi ideas were dropped and Communist ones adopted by so many complicit Hungarians demonstrates, ideology is usually just an excuse to exert power over others. For every genuine believer in the cause there are a hundred more willing to adopt it for their own personal gain. This includes the people who turn a blind eye to the violence committed in order to protect themselves.

Budapest is a testimony to the power of individuals and their capacity to overcome a uniform ideology. Today you can buy t-shirts depicting communist party members wearing party hats, drink at Communist-themed bars and visit memorials both commemorating the victims and denouncing the actions of those that embraced both Nazi and Communist ideals at the cost of their own sense of humanity. The actions of the parties of terror have become something to mock, and that is a good thing. It is by promoting individuality and encouraging us to see the fallacies in such simplistic thinking that we prevent something like this from happening again. It prevents these excuses for violence from gaining any traction in society. Today we have more information at our fingertips than at any other time in history, and yet many people still choose to listen to only one source, and to accept what they are told as fact because it is what they want to hear. At its most extreme, this kind of behaviour becomes dangerous.

The crushing of the 1956 revolution in Hungary by superior Soviet firepower at first appeared to be a defeat for the first student protestors and their many supporters, but it revealed some of the cracks in what otherwise appeared to be an iron-clad system of rule. Change did not come immediately after these brave actions and sacrifices, but the seeds were sowed. As best said by the House of Terror exhibition itself, “no people can be subjugated forever; one can and must take up the fight even against a power thought to be invincible”. History is awash with examples of dictators failing and regimes built on terror collapsing. The common denominator in those victories is the unwavering humanity of the individuals who fight against those systems of oppression. That is the only ideology worth fully embracing.