Psychiatrist Pieter Ventevogel has led UNHCR’s mental health response for the past six years, a time during which the number of people uprooted by conflict and persecution has grown to an unprecedented 79.5 million, including 26 million refugees. He sat down with global website editor Tim Gaynor in Geneva to discuss refugee mental health and how it is being impacted by the COVID-19 pandemic.
What was the state of refugee mental health before the current pandemic?
It varies, but we could use the global estimates from the World Health Organization. One in five – 22.1 per cent – of the adult population in conflict-affected areas have mental health problems. We don’t have data on children, but we can assume it is even a bit higher, because children are more susceptible. That baseline is around two to three times higher than the level in people at large, according to other studies.
Many people assume that Post Traumatic Stress Disorder (PTSD) is the most prevalent condition among refugees, but it is certainly not the only mental health issue they face, and we see it less often than we would expect in the field. There are a lot of people who struggle with events in their countries of origin, or during flight, violent experiences, and even within the country of safety. But PTSD is a specific clinical diagnosis, and when we discuss refugee mental health, we should look beyond one single issue.
The most common problems are in fact depression and anxiety. Depression is often related to loss – a loved one, a home, a job, social standing or social circle. Sufferers see no hope for the future. This can to some extent be mitigated in a setting where you can develop yourself, but in many cases refugees are in limbo, just waiting for something to happen. Solutions do not come easily, and people can lose all perspective that their lives will become better.
As time goes by, we are also seeing that the proportion of people with severe mental health conditions such as schizophrenia or manic depression is on the rise in displacement. We don’t know exactly why – you don’t get schizophrenia through forcible displacement – but there is perhaps an underlying vulnerability, either developmentally or through biology, that can come to expression in certain conditions. When the support system breaks down for these people, they can develop symptoms. In humanitarian settings, people with severe mental health conditions are at high risk of abuse and neglect. That is simply unacceptable.