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.
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
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