Mental Health

Overview of Health Problems

In general, victims of human rights violations suffer many health problems (1-11). They may suffer from one category of conditions—such as Sickle Cell Anemia—that are prevalent in certain geographical areas, but are not related to socioeconomic conditions or to systematic violence. 

Other illnesses affecting these individuals fall into a second type of health issue when illness is related to the geographical area and poor socioeconomic conditions, yet still is unrelated to systematic violence. Malaria, for example, is prevalent in tropical swampy regions and is an even greater problem in poor populations that lack screens in their homes.

Moreover, a third category of conditions, including malnutrition and gastroenteritis, are directly related to poor socioeconomic conditions and are exacerbated by systematic violence—particularly during uprooting of large segments of the population.  For instance, the Somali and the Rwandan populations suffered from malnutrition and gastroenteritis prior to the outbreak of the civil war and the genocide.  As hundreds of thousands of people were uprooted, however, the incidence of these two conditions exponentially increased and further strained the almost non-existent food and potable water supplies (3-7).

Finally, victims of systematic violence may experience health problems directly related to the process of uprooting, mistreatment, or torture.  This fourth type of health issue can be divided into physical and mental health problems. Before discussing specific signs and symptoms of mental health problems resulting directly from systematic violence, let us first review some representative types of torture. 

References:
1. Toole MJ, and Waldman RJ. Refugees and Displaced Persons: War, Hunger, and Public Health. JAMA 1993;270(5):600 – 605.

2. Ackerman LK. Health Problems of Refugees [Clinical Review]. J American Board of Family Practice. 1997;10(5): 337 – 348.

3. Goma Epidemiology Group. Public Health Impact of Rwandan Refugee Crisis: What Happened in Goma, Zaire, in July, 1994? The Lancet. 1995; 345(8946): 339 – 344.

4. Howarth JP, Healing TD, and Banatvala N. Health Care in Disaster and Refugee Settings. The Lancet 1997;349(9068s): 14sIII – 17sIII
.
5. Centers For Disease and Prevention. Health Status of and Intervention for US-Bound Kosovar Refugees – Fort Dix, New Jersey, May – July 1999. MMR 1999;48:729 – 732.

6. Center For Disease and Prevention. Enhanced Medical Assessment Strategy for Barawan Somali Refugees – Kenya, 1997. MMR 1998;46:1250 – 1254.

7. Marfin AA, Moore J, Collins C, Bielllik R, Kattel, U, Toole MJ, and Moore PS. Infectious Disease Surveillance During Emergency Relief to Bhutanese Refugees in Nepal. JAMA 1994;272(5):377 – 381.

8. Somnier F, Vesti P, Kastrup M, and Genefke IK. Psysocial Consequences of Torture: Current Knowledge and Evidence. In: Basoglu, M. Torture and Its Consequences – Current Treatment Approaches. Cambridge University Press. Cambridge, UK, 1992. p.56 – 68.

9. Mollica RF, Donelan K, Svang T, Lavelle J, Elias C, Frankel M, and Blendon RJ. The Effect of Trauma and Confinement on Functional Health and Mental Health Status of Cambodians Living in Thailand-Cambodia Border Camps. JAMA 1993;270(5): 581 – 586.

10. Nice SD, Garland CF, Hilton SM, Baggett JC, and Mitchell RE. Long-Term Health Outcomes and Medical Effects of Torture Among US Navy Prisoners of War in Vietnam. JAMA 1996;276(5): 375 – 381.

11. Skylv G. The Physical Sequelae of Torture. In: Basoglu, M. Torture and Its Consequences – Current Treatment Approaches. Introduction. Cambridge University Press. Cambridge, UK, 1992. p.38 – 53.