The Beirut port explosions that ravaged through Beirut two weeks ago, killing at least 200 people, injuring thousands, and leaving hundreds of thousands of homes damaged or destroyed, has taken an unprecedented toll on the mental health and wellbeing of the population. The blasts come at a time when people were already living under stress, suffocated by the devaluation of the Lebanese lira, fuel and electricity shortages, intermittent lockdowns and covid-19 containment measures, and widespread anger and protests at government corruption and mismanagement. Almost half of the Lebanese population, and at least two thirds of the refugee population, are now living under the poverty line. The port disaster has re-ignited anger at the ruling elite, who ignored warnings about the lethal capacity of the explosive materials stored improperly in the port. The pre-existing daily experiences of chronic stress, the trauma caused by the explosions, and the continuing exposure to uncertainty and fear, are a perfect storm for the emergence of significant and persistent mental health difficulties.
After the port disaster, affected parents reported concerns about their children’s trouble sleeping, silence and unresponsiveness, clinginess and anxiety, fear of another explosion, repetitive play and a preoccupation with explosions and loud sounds. Parents struggled to cope with these reactions in the midst of their own traumas, which for many opened old wounds from the civil war and subsequent wars and violence. Parents asked heartbreaking questions: ‘How can I get my child to forget? Can I cry in front of them? What should I tell them happened? Will they be normal again?’ In one psychosocial group with adolescents and parents, run through the NGO Embrace, parents were surprised to hear the depth of their children’s understanding of the situation. Young people reported worrying about whether they can afford their home anymore, what will happen if the government doesn’t resign, if the explosions will trigger a civil war, if the hospitals – many of which were damaged in the blasts - will be able to treat them if they contract the coronavirus. The complex and layered worries are clear to see in the minds of the city’s young people.
Research has shown consistently that war, armed, conflict, and natural disasters are significantly associated with an increased risk of mental disorders in children (Attanayake et al., 2009). What is particularly concerning about the potential impact of the port explosions on mental health, is that this appears not to have been a deliberate act of war, nor a natural or man-made accident. This was the consequence of a political elite so paralyzed by sectarianism and corruption, that they shamelessly risked the lives of their own people. These innocent people are not martyrs who died for a clear cause, but are rather victims of senseless negligence. The fallout of anger and despair from this reality is likely to fuel post-traumatic reactions to the explosions, where a meaningful narrative of the grief and loss cannot easily be constructed. Socio-political injustices of this scale in other country contexts have been linked to poorer mental health, increasing the risk of depression and anxiety (Giacaman et al., 2011). In Lebanon, collective experiences of war, regardless of personal exposure, was associated with elevated anxiety (Nuwayid et al., 2011), indicating the importance of the shared and social nature of the distress. The port explosions shook the whole country, literally and figuratively; the fear, pain, and anger are also experienced collectively. Children are not immune to this collective pain, and are impacted by their parents, families, and communities experiences and reactions (Diab et al., 2018).
In the same way in which the pain of the port disaster is experienced collectively, coping and resilience can also be cultivated at the collective level. While long-term residents of Lebanon are tired of having to be resilient, the strong social and community support networks that exist all over the country are massively protective for children’s mental health. Following the port explosions, despite reeling from the disaster, people descended to affected areas in their hundreds, cleaning away debris, covering blow-in doors and windows, offering food, water, and shelter, and providing a compassionate listening ear. People were flooded with support from their friends, relatives, colleagues, and local businesses and organizations. These forms of community level, naturally occurring, intervention can be strongly protective for child mental health (Betancourt et al., 2013). Such protective mechanisms can be nurtured through capacity building and support for parents, families, and communities. For example, in one of the most affected low-income areas, Karantina, a public park that had been closed by the municipality was re-opened and is being used by NGOs (UNICEF, War Child Holland and CatalyticAction) as a safe space for children and parents away from the chaos around them. The playground space was a community initiative, designed in 2016 using a participatory approach, and is being re-imagined post-disaster, by CatalyticAction and the AUB’s Neighborhood initiative, in collaboration with the community and children themselves. International guidelines on mental health and psychosocial care after humanitarian emergencies strongly recommend a community-based approach, which draws on community resources, and is available for the whole affected population (IASC, 2007). Whilst specialized mental health care and focused psychosocial support will be needed on a large scale in the weeks and months to come, community-level initiatives like the Karantina playground can help to foster the capacity of the collective to encourage and support natural recovery and coping. Given the scale of destruction and the collective nature of distress following the port disaster, such strengthening of communities will be vital to protect the mental health and wellbeing of children.
References
Attanayake, V., McKay, R., Joffres, M., Singh, S., Burkle Jr, F. & Mills, E. (2009). Prevalence of mental disorders among children exposed to war: A systematic review of 7,920 children. Medicine Conflict and Survival, 25(1); 4-19.
Betancourt, T. S. Meyers-Ohki, S., Charrow, A. P. & Tol, W. A. (2013). Interventions for children affected by war: an ecological perspective on psychological support and mental health. Harvard Review of Psychiatry, 21, 70–91.
Diab, S. Y., Palosaari, E. & Punamaki, R-L. (2018). Society, individual, family, and school factors contributing to child mental health in war: The ecological-theory perspective. Child Abuse & Neglect, 84; 205–216.
Giacaman, R., Rabaia, Y., Nguyen-Gillham, V., Batniji, R., Punamäki, R-L. & Summerfield, D. (2011). Mental health, social distress and political oppression: The case of the occupied Palestinian territory. Global Public Health, 6(5); 547-559.
IASC (2007). IASC guidelines on mental health and psychosocial support in emergency settings. Geneva: World Health Organization Inter-agency Standing Committee.
Nuwayid, I., Zurayk, H., Yamout, R. & Cortas, C. S. (2011). Summer 2006 war on Lebanon: A lesson in community resilience. Global Public Health, 6(5); 505-519.