Opinion editorial by Minister Sigrid Kaag: Mental health in crisis situations - a basic necessity and fundamental right

Opinion editorial, written by Sigrid Kaag, the Dutch Minister for Foreign Trade and Development Cooperation. The article was published on 30 June 2019 in The Guardian.

The genocide in Rwanda, now 25 years ago, shocked the world. In only 100 days, many hundreds of thousands of people were killed. Not for anything they might have done, but for who they were. After the genocide, the international community provided food, water and tents. Countries offered help with the reconstruction of Rwanda’s physical infrastructure. The unspeakable traumas that children, women and men had suffered, however, went largely ignored.

Our daily news is still full of the horrors of war and the physical destruction it leaves in its wake. It is only right that this makes the headlines. But we hardly ever read or hear about the mental suffering of individuals, families and entire communities. A serious omission. The war may be over; their trauma is not.

In conflict or post-conflict situations, many people suffer from mental health conditions. Traumatic experiences increase the risk of anxiety, depression, and post-traumatic stress disorder. According to a recent publication by the WHO, at least one in five people in conflict situations suffers mental health conditions. But in these settings, fewer than one in ten have access to professional care. Some 40% of children in conflict have severe emotional issues. As much as 12% of the world’s population lives in an active conflict zone. 

Unfortunately, mental healthcare in such situations is – at best – only a secondary concern. This is a flawed response to deep human suffering, especially at a time when the number of conflicts is increasing and their complexity growing. In 2016, the number of armed conflicts reached an all-time high. Millions of people worldwide have been forcibly displaced by violence and conflict. The consequences are colossal. Children growing up in the midst of war form a wounded generation who have suffered the loss of human dignity. A generation that is itself unstable has trouble passing on stability to their own children. This means that a community can never move on. Trauma and severe mental distress do not just go away. Coordinated assistance is needed. 

To me, it is clear that psychosocial support is not a luxury, but a necessity. It needs to be part of basic service provision. As normal as food, water and tents.

To me, it is clear that psychosocial support is not a luxury, but a necessity. It needs to be part of basic service provision. As normal as food, water and tents. Mental health and psychosocial support should be available to all people in conflict and post-conflict situations. Neglecting people’s mental suffering – staying silent – is not an option. If we truly want to help a country with reconstruction, we shouldn’t just rebuild the bombed bridges. We should also help people repair their broken souls. 

Humanitarian organisations are doing what they can. Survival of the body, not the soul, is their first concern. That’s understandable, but it’s only half of the solution. Access to mental healthcare is a human right. This is already the case in theory. But it should also be happening in practice. 

The good news: there are already many initiatives. But they are too dispersed and isolated to be effective. That is why I am advocating for greater focus on psychosocial support. I will do so in concert with partners such as UNICEF, WHO, UNHCR, NGOs and the International Red Cross. And I will urge my counterparts from other countries to act, too. 

Investing in mental wellbeing is an investment in prevention, in reconstruction and in human dignity.

In October this year, I will also host an international conference on this subject in Amsterdam. I want everyone to understand the devastating long-term effects of mental suffering. Mental healthcare must be recognized as a basic need. And it should be made structurally available. Now is the time to act. 

Clearly, investing in mental wellbeing is an investment in prevention, in reconstruction and in human dignity. It’s an investment in people, in a stable foundation, in the future. We should all work together on this. Mental health was neglected in Rwanda 25 years ago. We must ensure we do everything we can to tackle it in today’s conflicts.

Ministry responsible