Depression causes persistent sadness, a loss of interest in activities that you normally enjoy and an inability to carry out daily activities. Credit: WHO

By Baher Kamal
ROME, Apr 3 2017 (IPS)

Just three weeks after celebrating the International Day of Happiness, the United Nations now asks you the following questions: do you feel like life is not worth living? Are you living with somebody with depression? Do you know someone who may be considering suicide?

Not that the world body all of a sudden wants to spoil your happiness—it is just that depression affects people of all ages, from all walks of life, in all countries, and as many as over 300 million people worldwide, according to the latest estimates from the World Health Organization (WHO).

“These new figures are a wake-up call for all countries to re-think their approaches to mental health and to treat it with the urgency that it deserves,” WHO Director-General Margaret Chan said in a news release.

Depression causes mental anguish and impacts on people’s ability to carry out even the simplest everyday tasks, with sometimes devastating consequences for relationships with family and friends and the ability to earn a living. At worst, WHO adds, depression can lead to suicide, now the second leading cause of death among 15- to 29-year-olds.

Credit: WHO

No wonder then that the World Health Day on 7 April provides everybody –depressed or not– with a special opportunity to mobilise action around a specific health topic of concern to people all over the world.

Understandably then, the theme of 2017 World Health Day campaign is Depression: Let’s Talk.

In spite of these warnings, not all news is bad news. A better understanding of what depression is, and how it can be prevented and treated, will help reduce the stigma associated with the condition, and lead to more people seeking help.

What Is Depression All About?

To start with, the world health body explains what depression is all about: it is an illness characterised by persistent sadness and a loss of interest in activities that you normally enjoy, accompanied by an inability to carry out daily activities, for at least two weeks.

In addition, people with depression normally have several of the following: a loss of energy; a change in appetite; sleeping more or less; anxiety; reduced concentration; indecisiveness; restlessness; feelings of worthlessness, guilt, or hopelessness; and thoughts of self-harm or suicide.

Credit: WHO

But do not panic–depression is something that can happen to anybody, it is not a sign of weakness, and more importantly: it is treatable, with talking therapies or antidepressant medication or a combination of these.

Fine then. Now that the world leading body specialised in health issues assures once and again that much can be done to prevent and treat depression, you may ask what to do to overcome this bad feeling?

Stop Prejudice, Discrimination, Stigma

One of the first steps is to address issues around prejudice and discrimination. “The continuing stigma associated with mental illness was the reason why we decided to name our campaign Depression: let’s talk,” said Dr Shekhar Saxena, Director of the Department of Mental Health and Substance Abuse at WHO.

“For someone living with depression, talking to a person they trust is often the first step towards treatment and recovery.”

There is also the need to increase investment–in many countries, there is no, or very little, support available for people with mental health disorders. Even in high-income countries, nearly 50 per cent of people with depression do not get treatment.

On average, just 3 per cent of government health budgets is invested in mental health, varying from less than 1% in low-income countries to 5 per cent in high-income countries.

Credit: WHO

On top of this, WHO reminds that investment in mental health makes economic sense–every 1 dollar invested in scaling up treatment for depression and anxiety leads to a return of 4 dollars in better health and ability to work.

What to Do to Prevent Depression

To begin with, WHO recommends to talk to someone you trust about your feelings. Most people feel better after talking to someone who cares about them.

Should this not be enough, then seek professional help–your local health-care worker or doctor is a good place to start.

Meantime, keep up with activities that you used to enjoy when you were well; stay connected, keep in contact with family and friends; exercise regularly, even if it’s just a short walk, and stick to regular eating and sleeping habits.

As importantly, don’t by shy—just accept that you might have depression and adjust your expectations. You may not be able to accomplish as much as you do usually.

And, of course, void or restrict alcohol intake and refrain from using illicit drugs–they can worsen depression.

As you see, depression can be treated. And it goes without saying that if you think you have depression, all you need is to just seek help.

It goes without saying that the best recommendation would be not to feel depressed! But!

Come on, it is not the end of the world!

Excerpt:

About 10 percent of the Indian population of 1.2 billion people experiences a form of mental illness - that is about 200 million people. Credit: IPS

By Minto Felix
NEW DELHI, Mar 4 2015 (IPS)

India is not only poised for greatness, some say it is already on its way. The events that have shaped the nation’s dialogue over the past month showcase an India with a bold vision – to transform industry, to close the gap on inequality and ultimately, to redefine its place as a leader among the world.

Yet, it is a baffling reality that political leaders from across the spectrum have failed to adequately respond to one of the most pressing human challenges facing India today. A challenge that not only comes attached with significant consequences to the most important asset of the country – it’s people – but also, if not taken seriously, is likely to impede upon the continued progress achieved by the nation.

India has only one psychiatrist for every 343,000 people, and one of the highest suicide rates in the world.
The challenge of mental illness is an urgent priority for the country, one that requires collective action and constructive reforms.

Imagine this: by the year 2020, depression and anxiety is set to be the biggest illness facing humanity, costing the world about 13 trillion dollars to treat.

In India, conservative measures from the Bangalore-based National Institute of Mental Health and Neurosciences (NIMHANS) estimate that about 10 percent of the population experiences a form of mental illness – that is about 200 million people.

Whether they’re Bollywood celebrities like Deepika Padukone, who recently and poignantly blogged about her struggle with anxiety, or the painful stories of suicide that have emerged in recent years from farmers grappling with the pressures of prolonged drought, mental illness impacts individuals from every walk of life and throughout the lifespan.

It is also well established that mental illness particularly impacts those most vulnerable in our communities, especially those that experience poverty and discrimination.

With the exception of India’s first Mental Health Policy, which was launched to positive public reception in October last year, we have seen little to no action follow suit in driving through core reforms identified.

Further, with mental health expenditure occupying only 0.83 percent of the total health budget, which, in turn, also continues to be a tiny fraction of overall government expenditure, the plausibility of important change occurring in this arena remains grim. So what’s needed to shift the status quo?

1. Start an informed conversation

The essential first step in driving positive change on mental ill-health is to learn about it. Whilst there certainly have been improvements over the past decade, the mental health literacy amongst Indians remains low.

This is problematic for several reasons, as it allows for misinformation to propagate at the community level, and as a natural consequence, stigmatising attitudes that prevent individuals from seeking the appropriate help they require.

Improved understanding of mental illness not only removes stigma, it also builds compassion – of how to adequately care for oneself, as well as for others, when experiencing mental health difficulties.

A population that is mental health literate is also armed with the tool kit to be powerful agents of change, and can confidently hold medical professionals, governments and policy makers to account in improving the status of mental health in India. To have individuals experiencing mental illness labeled as inadequate and deprived of their humanity is simply not acceptable in 2015.

2. Build world-class infrastructure

It is altogether unacceptable that India has only one psychiatrist for every 343,000 people, and it is worrying that India has among the highest suicide rates in the world, particularly within its youth population.

This reflects poorly resourced infrastructure, and also inadequate services to match the deep needs experienced by the population.

In some senses, the answer is simple – increase the amount of funds directed towards tackling mental illness, and in other senses, the solutions are more complex – of determining quality care coordination across states, of making investments in priority areas such as youth mental health, and working to increasing the number of trained mental health professionals.

As is the case with technology and infrastructure, India should aspire to have a word-class mental health system that is efficient, effective, and accessible by its entire population.

3. Age of innovation

One of the genuine achievements of the past year with regards to mental health is the decriminalisation of attempted suicide. The repeal of this legislation is an important step in working towards reducing the number of suicides, but also reflects the broader societal factors that need to be addressed in strengthening the mental health of Indians.

Economic, social and political factors all play a vital role in strengthening or damaging a person’s level of health, and this is no different with mental illness.

Countless NGOs and government agencies around the country are implementing exciting projects that seek to alleviate mental illness, as well as surrounding factors of gender based violence, homelessness, and drug abuse. However, in order for these projects to make a lasting difference, they need be implemented on a larger scale.

The Banyan, a Chennai based mental health NGO, is leading the way in this space, with both its innovative service delivery in working with vulnerable women experiencing mental illness but equally, in its commitment to scale through establishing partnerships with universities in other parts of India and government agencies to increase the organisation’s reach.

By the very same token, it is indeed the role of the government to evaluate, to encourage, and extend the full potential of these initiatives. There is a pressing need to build a bank of evidence-based solutions for tackling this health issue.

There is no health without mental health, and the call for reform is crystal clear. If we are able to promote the full mental health of each and every person living in this country, India can only be stronger, richer, and indeed a more fulfilled nation.

Edited by Kanya D’Almeida

Excerpt:

Students at Columbia University carry mattresses on the Carry That Weight National Day of Action to show their support for survivors of sexual assault. Credit: Warren Heller

By Lyndal Rowlands
UNITED NATIONS, Nov 25 2014 (IPS)

“A recurring nightmare for me is I’m trying to tell someone something and they are not listening. I’m yelling at the top of my lungs and it feels like there is a glass wall between us.”

Jasmin Enriquez is a two-time survivor of rape. Like two-thirds of rape survivors, Enriquez knew her rapists. The first was her boyfriend when she was a high school senior, the second a fellow student she had been seeing at college."What I hear from women is that they are told to shut up: they are told to shut up during it, they are told to shut up after it, and they are told by some institutions to continue keeping their mouths shut." -- Dr. Dana Sinopoli

“[The nightmare] shows how I’ve always felt that even as someone coming forward as a survivor, as soon as I start giving details to some people, they instantly start to shut it down. As in, you’re being crazy or hyperemotional, instead of taking it as one whole piece and looking at it holistically,” Enriquez told IPS.

Women who have experienced gender-based violence are at a significantly increased risk of developing a mental disorder, such as post-traumatic stress disorder, anxiety or depression, within one to three years after the assault.

Enriquez explains, “People don’t seem to understand that after being sexually assaulted, it’s something that you have to live with the rest of your life.

“Most of the time there is an incredible amount of anxiety or depression or other mental health issues that people just don’t understand,” she says. “It’s been five years since I was sexually assaulted and I still live through the trauma.”

A special Lancet series published Friday says that one in three women have experienced physical or sexual violence from their partner.

Researcher Dr. Susan Rees from the University of New South Wales told IPS that there is strong evidence that if you are exposed to gender-based violence, you are at a much higher risk for the onset of post-traumatic stress disorder (PTSD), anxiety and depression as well as attempted suicide.

Rees’ research into the connection between gender-based violence and mental disorders has shown that women who have been assaulted are significantly more likely to experience a mental disorder in their lifetime.

Women who have experienced one form of gender-based violence have a 57 percent chance of developing a mental disorder compared with only 28 percent of women who have not experienced gender-based violence. Significantly, 89 percent of women who have experienced gender-based violence three to four times will develop a mental disorder.

It is important for survivors of assault to get early support to help prevent the onset of an associated mental disorder, Rees said.

However, experiencing sexual assault can be confusing, especially for young women and girls, and this may prevent them from getting early intervention.

Enriquez explains that she didn’t initially realise the connection between her response to the trauma of sexual violence and the symptoms she was experiencing.

“I’ve recently been very jumpy, kind of always tense and I get startled easy, I didn’t understand why that was happening and it was very frustrating.”

Enriquez’ fiancé, who is not the person who assaulted her, used to jump out at her or play games to surprise her, and she found this really upsetting,

“I didn’t understand that it was related to me being sexually assaulted until probably my senior year of college. I feel like if I had been educated about what normal symptoms are of PTSD, I would have known that there was more to it and that it was a normal piece of it.”

Community attitudes affect prevalence

Community attitudes towards women, including strong patriarchal attitudes, power imbalance and gender inequality contribute to the prevalence of violence against women, said Rees.

“It makes sense that if you change attitudes then you can change prevalence, you can reduce the risk for women,” she said.

This is what Enriquez aims to do with her organisation Only With Consent. Together with her fiancé, Enriquez speaks with students to raise awareness and change young people’s attitudes towards sexual assault.

“I definitely think that there’s a gender piece that goes with both the mental health and the sexual assault and that it ties back to any time a woman expresses an emotion of being angry or upset we immediately call her out for being irrational or emotional.” Enriquez told IPS.

“If the majority of survivors who are speaking out are women, and they are expressing these feelings of being upset or being angry, or being really hurt, or any of those feelings, we discredit what they are saying, because we see them as irrational creatures,” Enriquez said.

Psychologist Dr. Dana Sinopoli told IPS that it is also important to consider how gender-based violence affects men, especially men who experience childhood sexual assault. She said that this should involve addressing gender stereotypes such as that men are aggressive or impulsive.

As Carry That Weight explains on its website:

“People of all gender identities can experience and be affected by sexual and domestic violence—women are not the only survivors just as men are not the only perpetrators. We strive to challenge narrow and inaccurate representations of what assault looks like and also acknowledge that these forms of violence disproportionately affect women, transgender, gender nonconforming, and disabled people.”

Sinopoli added however that changing community attitudes towards women was an important part of addressing gender-based violence.

“Consistently what I hear from women is that they are told to shut up, they are told to shut up during it, they are told to shut up after it, and they are told by some institutions to continue keeping their mouths shut.

“That is what we can link to the depression and the anxiety and a lot of the re-experiencing and retriggering that is so central to PTSD,” Sinopoli said.

Sinopoli added that “the way that society reacts, to someone who discloses or is struggling, is so important.

“The more that people speak up the more that we will actually see a decline in such significant psychological symptoms.”

Early intervention can help

When helping someone who has experienced violence, Rees said that it is important that friends and family reassure the victim that it “it is never acceptable to be hit, or to be treated violently or to be raped.”

Unfortunately, population studies show that women who have experienced gender-based violence are also at increased risk of experiencing it again in their lifetime.

“This might be the case because often men target women who are vulnerable, so if she has a mental disorder or trauma as a result of an early childhood adversity, she may be more likely to be targeted by men who in a sense benefit from powerlessness, inequality and fear.”

She said that warning bells that a relationship is unhealthy include controlling, jealous behaviour such as telling you who you should socialise with, or getting jealous because you are doing better than he is at university.

“Often women think that’s because he cares about me, he’s worried about me and that why he wants to know where I am all the time,”

But this type of behaviour should actually be seen as a warning of future emotional and perhaps physical abuse, Rees said.

Rees said that the reasons women don’t leave violent relationships are complex,

“She may be suffering depression. She may not have the economic resources to leave. She may worry about the children, and rightly so, because often people end up homeless, and she also may know that she’s at high risk of retaliation from the perpetrator if she leaves.”

Rees also explained that it is important for health practitioners to receive training so they can be confident to ask about domestic violence and respond appropriately.

She added that primary health care responses need to be integrated with community-based services to ensure that survivors have access to help that is sensitive to the complex impact of sexual violence.

Edited by Kitty Stapp

Of the 100 patients seen at Kashmir’s psychiatric facilities each day, roughly 75 are women. Credit: Shazia Yousuf/IPS

By Shazia Yousuf
SRINAGAR, India, Nov 19 2014 (IPS)

It was almost midnight when Mushtaq Margoob woke up to the incessant ringing of his phone. It was his patient, a young woman whom Margoob, a renowned Kashmiri psychiatrist and head of the department of psychiatry at the only psychiatric hospital in Kashmir, had been treating for depression for many years.

“See me now. I don’t have time till tomorrow,” the patient screamed down the phone. “I might have killed myself by then.”

The woman was educated, had a PhD in Bioscience and came from a rich family. After her marriage last year, the symptoms of her depression had begun to fade away, and she had started crawling back to a normal life.

“I have gifted lifelong sadness to my daughter.” -- Shahzada Akhtar, a Kashmiri woman living with PTSD
But the day she made the hasty phone call to the doctor, she had learned something that shattered her life into fragments all over again.

“I have been diagnosed with Premature Ovarian Failure [POF],” she said to Margoob at his home. “If I cannot have any children, what should I live my life for?”

Although Margoob was able to pacify her with timely counseling and medication, the diagnosis and the constant reminder of being infertile have taken his patient back into deep depression.

“The mental stress due to ongoing conflict has taken a toll on the physical health of young women, especially their maternal health,” explains Margoob.

Downward spiral of mental and maternal health

The conflict here, which dates back to the 1947 partition of India and Pakistan, has claimed some 60,000 lives as Indian armed forces, Pakistani troops and ordinary Kashmir citizens struggle to assert control over the bitterly contested region.

The “pro-freedom” uprising of 1989, launched by Kashmiris who resented the presence of Indian and Pakistani troops, morphed into a long-standing resistance movement that has left deep scars on Kashmiri society.

As a result, the area known as the Kashmir Valley, tucked in between towering mountain ranges in the northern Indian state of Jammu and Kashmir, is witnessing an alarming increase in childlessness and infertility among local women.

Infertility is becoming increasingly common among young Kashmiri women, who are suffering from stress and trauma due to the long-standing conflict in the region. Credit: Shazia Yousuf/IPS

Physical and mental health experts cite conflict-related stress as the main cause of the health crisis among women, which has robbed thousands of their fertility.

The most recent Indian National Family Health Survey (NFHS) indicates that 61 percent of currently married Kashmiri women report one or more reproductive health problems.

This is significantly higher in comparison to the national average of 39 percent. The percentage of POF among infertile women below 40 years of age is also abnormally high – 20 to 50 percent – when compared to the nationwide rate of one to five percent.

“Stress causes structural changes in the brain and disturbs the secretion of various neurotransmitters. These changes lead to various physical ailments including thyroid malfunction, which in turn can cause infertility among women of childbearing age,” Margoob explains to IPS.

According to statistics available with the Government Psychiatric Diseases Hospital, 800,000 Kashmiris are suffering from Post Traumatic Stress Disorder (PTSD) and most of them are women. PTSD, like many other mental health disorders, directly affects women’s childbearing capacity.

Stress and stigma

In Kashmir, psychiatry OPDs are run at two hospitals – the Shri Maharaja Hari Singh (S.M.H.S) facility in Srinagar, and the Government Psychiatric Diseases hospital – six days a week. Of almost 100 patients seen at each OPD every day, 75 are females.

One of the many women who frequents these facilities is 20-year-old Mir Afreen, who grew up watching her mother battling mental illness. In 1996, when Afreen was only two, her mother, Shahzada Akhtar, received a message about the death of her cousin brother in cross-fire.

“I had met him only a day before. I couldn’t believe he had died. I tried to cry out his name but had lost my voice,” recalls Akhtar.

Akhtar never recovered from the sudden, devastating news, and soon developed PTSD.

In consequence, her daughter’s childhood quickly slipped into darkness. Afreen often saw her mother sedated, sleeping for days at a time, going without food, and crying for no apparent reason.

She was always taken along to psychiatric clinics, hospitals and faith healers where her mother searched for a cure for her condition. Happiness was far, far away from their home.

“I have gifted lifelong sadness to my daughter,” Akhtar tells IPS tearfully.

Her statement is not too far from the truth. For the last several years, Afreen has been complaining about chest pains and breathlessness. Akhtar first thought it was due to stress, or her daughter’s recent obesity.

But when Afreen developed facial hair and her monthly cycles became irregular, Akhtar took her to a gynecologist.

“The doctor uttered a long name which I couldn’t understand, so I asked her to explain the [condition] to me,” Akhtar says. “She told me if this is not treated, Afreen will never have children.”

Afreen was diagnosed with Polycystic Ovarian Syndrome (PCOS). Unknown and almost non-existent before the conflict, the syndrome now affects 10 percent of Kashmiri females including teenagers.

A major endocrine disorder in women of reproductive age and one of the leading causes of infertility across the world, PCOS has emerged as another major cause of infertility among Kashmiri women in recent years.

Medical experts have identified stress as one of the main reasons for the emergence of PCOS in Kashmir. A study conducted by Sher-i-Kashmir Institute of Medical Sciences (SKIMS), the major tertiary healthcare facility in Kashmir, on 112 women with PCOS, found that 65 to 70 percent of them had psychiatric illnesses including PTSD, depression and Obsessive Compulsive Disorder (OCD).

Akhtar feels helpless. Unlike other ailments, Afreen’s particular health issue is not up for discussion, not even with her own siblings. If the word spreads, she thinks, it will ruin her daughter’s marriage prospects and thus destroy her life.

“Even when I take her to the doctor, I make sure that no one sees us,” reveals Akhtar. “I first check the place and then let my daughter in.”

Afreen does the same. She has not revealed anything about her condition to her friends. When the girls talk about their grooms and life after marriage, she keeps mum. When it is the time for her medication, she secretly swallows the pills without water.

Current trends predict a bleak future

Nazir Ahmad Pala, an endocrinologist at SKIMS, says that more and more young females visit the endocrinology department for various disorders. A good number of disorders, he says, are born from depression.

Anxiety over the possibly loss of male breadwinners is prompting many women to choose education and employment over marriage. Credit: Shazia Yousuf/IPS

“In the past, the department received mostly older patients but now around 20 percent of our patients are school and college going girls with endocrine abnormalities. This trend is disturbing,” Pala tells IPS.

The young girls mostly complain of obesity and ovulatory disturbances that bring a temporary halt in their menstrual cycles.

The condition is called Central Hypogonadism and is common in depressed women, explains the doctor. Another equally frequent ailment is galactorrhea, a spontaneous secretion of milk from the mammary glands due to an abnormal increase of prolactin levels in the body caused by antidepressant intake.

“Unfortunately most of the [conditions], in one way or the other, lead to infertility. And the root cause of all these [conditions] is the stressful life that women have been living in the post-conflict era,” Pala asserts.

Experts here are sounding warnings about the catastrophic shape that women’s health in the Valley is taking. A study conducted at SKIMS on maternal health indicates that 15.7 percent of Kashmiri women of childbearing age will never have an offspring without clinical intervention.

Another conflict-related cause of infertility among Kashmiri women is late marriages. Over the war years, the marital age has risen from an average of 18-21 to 27-35 years. Because of economic insecurity and anxiety over the prospect of losing male breadwinners, women are choosing education and employment over marriage.

“Economic instability and insecurity is eating our society like termites,” says Margoob.

The doctor reveals that cut-throat competition in schools and colleges to earn a secure future has hugely disturbed the mental health of young girls as well.

Dissociative Disorders (DD), marked by disruptions or breakdowns in identity, memory or perception, are rapidly increasing in young school- and college-going girls, along with conditions like Panic Disorder, all of which interrupt the “smooth journey to motherhood”, Margoob says.

*Patients’ names have been changed on request.

Edited by Kanya D’Almeida

Soundus, a young girl being treated in hospital for injuries from Israeli shelling of Gaza (August 2014). Credit: Khaled Alashqar/IPS

By Khaled Alashqar
GAZA CITY, Aug 16 2014 (IPS)

“My child became blind and lost the ability to speak, his dad died and his three brothers are seriously wounded. He still has not been told about the loss of his dad,” says the mother of 7-year-old Mohamad Badran. 

Mohamad is in hospital for treatment after being seriously injured in Israel shelling of Gaza. “My only way to communicate with him is by hugging him,” his mother adds.

Israeli air attacks and shelling in Gaza have left more than 1,870 dead and thousands injured. They have caused damage to infrastructure and hundreds of homes, forcing a large number of families to seek shelter in schools run by the U.N. agency for Palestine refugees (UNRWA).Some of the children have suffered serious injuries which cannot be treated in Gaza due to the limited medical infrastructure and capacities caused by the Israeli blockade.

In a news note, the U.N. Children’s Fund (UNICEF) said that Israeli airstrikes and shelling have taken a “devastating toll … on Gaza’s youngest and most vulnerable.” It said that at least 429 children had been killed and 2,744 severely injured.

Some of the children injured have suffered serious injuries which cannot be treated in Gaza due to the limited medical capacities caused by the Israeli blockade.

According to UNICEF, about 400,000 children – half of Gaza’s 1.8 million people are children under the age of 18 – are showing symptoms of psychological problems, including stress and depression, clinging to parents and nightmares.

Monika Awad, spokesperson for UNICEF in Jerusalem, told IPS that 30 percent of dead as a result of the Israeli military attacks are children, and “UNICEF and its local partners have been implementing psychosocial support programmes in Gaza schools where refugee families are sheltering.”

”We have a moral responsibility to protect the right of children to live in safety and dignity in accordance with U.N. charter for children’s rights,” she added.

However, the acute psychological effects of the Israeli attacks Gaza that have emerged among children, such as loss of speech, are among the biggest challenges that face psychotherapists.

Dr Sami Eweda, a consultant and psychiatrist with the Gaza Community Mental Health Programme (a local civil society organisation working on trauma and healing issues), told IPS: “When the Israeli war against Gaza ends, psychotherapists will grapple with many expected dilemmas such as the cases of the murder of entire families and the murder of the parents who represent the central protection and tenderness for the children. Such terrible cases put children in a state of loss and shock.”

According to Eweda, “we first need to stop the main cause of these traumas and psychological problems, which is the Israeli war against Gaza, and then begin an emergency intervention to support children’s health and treat traumas and severe psychological effects, including the loss of speech, which is considered as one of the self-defence mechanisms for overcoming traumas.”

Throughout the Gaza Strip, where entire neighbourhoods such as Shujaiyeh and Khuza’a have been destroyed by the Israeli invasion and heavy bombardment, access to basic services is practically impossible.

Displaced children in a UN-run school in the Shujaiyeh neighbourhood of Gaza (August 2014). Credit: Khaled Alashqar/IPS

People in these areas have been suffering difficulties in accessing drinking water and have been living in an almost complete blackout since the Israeli shelling of the power station which was the sole source of electricity in besieged Gaza.

Social Watch– a network of civil society organisations from around the world monitoring their governments’ commitments to end poverty and achieve gender justice – Thursday called on the international community to declare the Gaza Strip an “international humanitarian disaster zone”, as requested by Palestinian NGOs.

“The unrestricted violation of international law and humanitarian principles adds to the instability in the region and further fuels the arms race and the marginalisation of the issues of poverty eradication and social justice that should be the main common priority,” said Social Watch.

“The recurrence of these episodes in Gaza is the result of not having acted before on similar war crimes and of not having pursued with good faith negotiations towards a lasting peace,” it added.

In a press release, Save the Children, the world’s leading independent organisation for promoting children’s rights, said: “Children never start wars, yet they are the ones that are killed, maimed, traumatised and left homeless, terrified and permanently scarred.”

“Save the Children will not stop until innocent children are no longer under fire and the root causes of this conflict are addressed. If the international community does not take action now, the violence against children in Gaza will haunt our generation forever.”

In an interview with IPS, Save the Children’s spokesperson in Gaza, Asama Damo, said: ”We call for a permanent ceasefire and for lifting the siege on Gaza to ensure the delivery of humanitarian aid and basic services to children.”

“We also need the international community to intervene to end the catastrophic humanitarian situation and fight the skin diseases that are widely spreading among the refugees at UNRWA schools due to overcrowding and congestion.”

According to UNRWA, 87 of their schools are being used as shelters by the refugees, half of whom are children under the age of 18. Ziad Thabet, Undersecretary of the Ministry of Education in Gaza, told IPS:

“Israel deliberately targeted educational institutions and the education sector in general; large proportion of those killed and wounded are children and school students. Many schools and kindergartens were attacked.”

In the current disastrous situation in Gaza, it seems not only that the burnt bodies of Gaza’s children are the heritage of war, but also that their educational and health future is being burned.

(Edited by Phil Harris)

Renato Grbic is a simple Belgrade fisherman, who grew up on the shores of the Danube River in Belgrade, but he performs an additional job that he is not paid for.

In the last 14 years, 50-year-old Grbic has saved the lives of 25 people who were attempting to commit suicide by jumping into the river from Belgrade’s Pancevo Bridge.

“When I ask them why (they wanted to end their lives), they either say they were ‘depressed’ or they ‘could not take it any more’,” he told IPS. “Times are really hard for people today.”

Serbian Health Minister Slavica Djukic Dejanovic echoed Grbic’s words when she said, “By 2020, depression will be the second leading cause of absence from work.

“The current number of psychotherapists and psychiatrists is not enough to deal with the issue and we are making an effort to improve the situation soon,” she added in her opening address at a congress of mental health experts in Belgrade.

According to statistics from the ministry of health, this Eastern European nation of 7.2 million people has only 350 certified psychotherapists and 900 psychiatrists.

The Association of Psychotherapy Societies of Serbia puts the need for psychotherapists at between 6,000 and 8,000. Some 1,500 specialists are currently undergoing training and will be qualified to enter the system soon.

“Roughly a third of the population has experienced mental disorder due to the current economic crisis that has taken its toll in the form of unemployment and growing poverty,” Nadja Maric Bojovic, head of the Belgrade Psychiatry Clinic, told reporters.

Lingering trauma from the wars that ripped through the region in the 1990s, coupled with memories of the NATO bombing of Serbia in 1999, as well as enduring hardships from economic stagnation during a period of international sanctions 1992-2000 have all compounded the issue.

“European statistics put the rate of mental disorders at 27 percent in 27 European Union member countries, with issues such as anxiety, insomnia and depression at the top of the list,” she added.

Concurring with largely accepted data by other experts in the field, she said that one in ten people with mental health issues has sought professional help.

“A large number of people have mental problems, but do not know how to solve them,” Zoran Milivojevic, head of the Association of Psychotherapy Societies of Serbia told IPS. In the absence of adequate professional services, “they take to tranquillisers instead, (leading to) large abuse of these substances.”

Ministry of health statistics suggest that the tranquilliser bromazepam (known in Serbia as ‘Bensedine’) was the most frequently prescribed drug in the country in 2011. Doctors prescribed 4.3 million packs of the product, with three million sold under the counter that same year, despite a prohibition law since 2002.

The tranquilliser lorazepam was the fifth most common prescription drug in 2011, with 1.6 million legally issued packs.

“They think it’s simply easier to take a drug than to try to solve problems with visits to therapists,” psychologist Nebojsa Jovanovic told IPS. “That calls for (increased) personal involvement.”

Serbian institutions have insufficient data on mental health issues, with the exception of precise statistics on suicides. There Serbia ranks 13th in the world, with 14 suicides per 100,000 people, according to statistics from the World Health Organisation (WHO).

Translated into annual statistics, this means that there were 1,400 suicides in Serbia in 2011, almost four per day.

But the only specialised centre for prevention of suicides – an emergency phone line in Belgrade  – ceased to exist in September due to a lack of finances.

“We had more than 2,300 calls from February 2011 until September this year,” Branka Kordic, the psychologist who was in charge of the project told IPS.

“We had no statistics on how many suicides we prevented, but most of the callers were men over 50 who had lost jobs, whom I’d call the biggest casualties of transition, who lost self-esteem, family support and the basic means of existence.”

Since 2000 Serbia has made a painful transition into the market economy, which accompanied by the last global crisis, led to a record unemployment rate of 25.5 percent.

The economic hardships and personal struggles have “been too long and too much for many,” Nebojsa Jovanovic told IPS.