Generation of children in need of mental health support in Yemen

• 12-year-old Yemeni boy in severe distress following deadly school bus attack in Saada
• A generation of children in need of mental health support to avert lifelong psychological damage, warns Save the Children

12-year-old *Khaled was on his way to a picnic when a deadly airstrike hit his school bus, killing 40 children in northern Saada province, Yemen, on August 9. Not only was he badly injured in the attack, putting him in a wheelchair since, the horrifying experience has also left him feeling anguished and numb.

*Khaled told Save the Children: “We were happy, we were going to [play]. When we reached the market there were people there, and everything [was as usual]. Then there was firing. I couldn’t find my friends. I feel my friend’s pain and my pain. I don’t feel anything else.”

Following the airstrike, *Khaled told Save the Children staff that he has trouble sleeping at night and becomes scared when he hears the sound of airplanes soaring overhead.

*Khaled: “I wish that the war stops so I can continue to learn and build my life and achieve my dreams. I want the war to stop so they stop killing children, women and men. What is their sin?”

*Khaled’s mother told Save the Children: “Suddenly I saw people hurry to the bus. What is wrong? What happened? They said the bus was hit, that no kids survived. Everyone was looking for their kids… Then they admitted [my son] to the intensive care unit... We spent 22 days [in hospital]. There was pus coming out of his eyes, his ears bleeding, his nose was stitched, they have operated everywhere on him, behind his ears, fragments in his head. They said his leg is damaged; they [took] 16 x-rays [of him].”

Yemen is one of the most dangerous places in the world to be a child today. A child in Yemen has already lived through more than 18,000 airstrikes in his or her lifetime. The ongoing brutality means children are being consistently exposed to extreme violence, further heightening the risk of psychological damage.

The children of Yemen have watched their friends and family members die before their eyes or be buried under the rubble of their collapsing homes. They have watched their schools and hospitals be targeted and destroyed, been denied access to life-saving food and medicine, and have been torn apart from the life they once knew. The prolonged exposure to war, stress and uncertainty can be extremely upsetting for children and create issues and challenges that last a lifetime.

Yet Yemen has barely any mental health services or sufficient support for children suffering from distress. More than half of all health facilities have closed or are only partially functioning. According to the World Health Organization (WHO), in 2017 only 40 psychiatrists were working in the country–that’s about one psychiatrist for approximately every 700,920 people. To make matters worse, the problems for children suffering mental health issues and the support they need are not well recognized or understood in Yemeni society.

Save the Children is warning that there could be long-term psychological damage to a generation of children as a result of this conflict unless more mental health and psychosocial support is provided. With the right help, many of the harms can be mitigated and healed.

A survey published in 2018 that spoke to nearly 1,000 children in Sana’a, found that 79 per cent showed signs of serious psychological consequences as a result of the conflict. The study reveals that in the first year of the conflict family members began noticing children bedwetting, refusing to be alone or not wanting to leave the house.

Research in other parts of the Middle East by Save the Children last year found exposure to prolonged conflicts has a devastating effect on children’s mental health and wellbeing. We found evidence of what experts call ‘toxic stress’–the most dangerous form of stress a child can experience, which is caused by strong, frequent or prolonged adversity without adequate caregiver support. If left untreated, ‘toxic stress’ can have a lifelong impact on children’s mental and physical health.

Kelly McBride, Save the Children’s Regional Mental Health and Psychosocial Support Technical Advisor, said:

“Children in Yemen, who make up nearly half of the population, are exposed to a myriad of stress factors. Given the developmental stage that children are in, they are extremely vulnerable in times of crisis. Without security in their lives, they are unable to learn the very basic skills that are needed to thrive. This can severely impact their immediate and long-term mental health and psychosocial wellbeing.

“Children in conflict zones often experience bedwetting, nightmares, hypervigilance, grief, depression, anxiety, aggression, feeling withdrawn, and numerous other challenges. This can impair their ability to engage in daily life, including an inability to focus or perform well in school, learn new information, form relationships and attachments, or find a sense of safety.

“There is little community awareness in Yemen of how to support children and families whose mental health and wellbeing are suffering. Also, many of those who suffer from severe distress do not have access to the services they need due to general lack of trained staff and stigma. This is a gap the international community is trying to fill during this critical time.”

Save the Children specialists on the ground are supporting *Khaled and other children affected by the bus attack through intensive psychosocial support and covering their families’ transportation costs to and from hospital. Save the Children has reached more than 12,500 children like *Khaled through its mental health and psychosocial support programmes in Yemen this year, but we need to reach many more.

Tamer Kirolos, Save the Children’s Yemen Country Director, said:

“Brutal violence, including explosive weapons and bullets, continues to take an unacceptable toll on children. We call on all parties to the conflict to take immediate measures to prevent grave violations against children and find a peaceful political solution to end this conflict. The consequences of this conflict will have a lasting impact on the country for years to come. It is paramount that the international community comes together to ensure these children get the support they need to rebuild their lives.” 

With the right help, most children in Yemen will eventually be able to recover and have a normal life. But without an urgent boost to the provision of mental health and psychosocial support, Yemen’s children could be left with lifelong suffering and diminished long-term prospects.

Notes to editors:

• According to the World Health Organization (WHO) in 2016, out of 3,507 health facilities surveyed in 16 out of 22 governorates in Yemen, 55% (1,847) are either partially functioning or non-functional. See more here.
• In 2017, there were only 40 psychiatrists in Yemen for a population of more than 28,036,829–that’s about one psychiatrist for every 700,920 people. Learn more here.
• According to the Yemen National Health Strategy from 2010, there were only 44 psychiatrists out of 8,534 specialist doctors in Yemen.
• According to the Yemen Data Project, total air raids from 26 March 2015 to 31 August 2018 is 18,326. Source: https://mailchi.mp/f47262abc07d/september2018-yemen-data-project-update-389115
• Research in Yemen on specific causes and effects of mental health is minimal.
• There is widespread social stigma around mental health in Yemen, with reports of people suffering from mental health issues being detained in family homes or abandoned and left homeless.
• According to a study published in 2018, of 902 students surveyed in Sana’a, nearly three quarters were unable to have strong feelings such as being able to cry or feel happy. Source: https://carpo-bonn.org/wp-content/uploads/2018/03/10_carpo_brief_final.pdf
• Save the Children has over 50 years of experience working in Yemen. Operational in the country since 1963, the charity was the first international aid group in Yemen. We work nationally and locally to promote and protect children’s rights, with programmes in education, protection, health, nutrition, water, livelihoods, and food security. For more see here.  
• Save the Children stands side by side with children in the toughest places to be a child. We do whatever it takes to make sure they survive, get protection when they’re in danger, and have the chance to learn. Together, we fight for children every single day.