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Hidden scars: mentally ill patients lost in Yemen’s war | Global development

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Radhwan Ali Hassan lives with his mother in a small house perched at the top of a sleepy Yemeni village called Aqeeqah, on the outskirts of Taiz city. From inside his bare-walled room, the 35-year-old hears the distant sound of an ice-cream van. He sees children running past his window and can smell goats, but he cannot remember the last time he walked outside.

Thick metal shackles around his ankles are attached to a heavy chain fastened to the far wall. They clatter as Hassan paces his room, rocks from side to side and smiles vacantly. His pupils are wide, his movements slow.

Radhwan and his mother.
Radhwan and his mother, Hos Ansayeed. He is shackled to the wall. Photograph: Isobel Yeung

“We forced him to wear clothes today. Usually he’s naked, just lying here,” says his mother, Hos Ansayeed. “Sometimes he gets very angry with me. He doesn’t want to see my face when he’s in a bad way. So I just leave his food at the door without coming in.”

The family do not know what triggered his condition, or what illness he struggles with – he has never been diagnosed. The cost of transport and the consultation fee to visit the nearest psychiatrist are not affordable options. Yemen’s six-year war has driven up prices of fuel and basic goods, leaving families such as Radhwan’s in desperate poverty. They spend everything they have fending off hunger or paying for Radhwan’s tranquillisers, which control his most violent outbursts.

Months after President Joe Biden promised to end US support for Yemen’s war, the world’s worst humanitarian crisis continues to deteriorate. Fuelled by a bitter Saudi-Iranian rivalry, the conflict has rendered two-thirds of the country dependent on aid to survive. More than 2 million children are expected to go hungry or starve this year. With the rebel Houthis stepping up their attack on the city of Marib, tens of thousands of people have been uprooted from their homes in the past few months alone.

With no end in sight, an entire population is struggling to cope. According to the World Health Organization, a fifth of those living in war zones are likely to be suffering from some form of mental disorder, including depression, post-traumatic stress disorder (PTSD), or psychosis. In Yemen, where soaring poverty rates have added to trauma and the healthcare system has been targeted, depleted and neglected, that figure is likely to be higher.

Data is limited, but from 2014 to 2015 there was a reported 40% increase in suicides recorded in Yemen’s capital, Sana’a. And in one of the few scientific studies on mental health carried out, nearly 80% of children surveyed in 2018 showed symptoms of PTSD.

At the Taiz mental health hospital, one of four public psychiatric facilities in the country, patients fare little better than at home. Just two nurses are responsible for 143 severely ill inpatients. Many are shackled to stop them escaping and almost all are heavily sedated, roaming through the corridors in a haze of consciousness.

Several male patients seemed confused at the sight of a visitor coming through the double-bolted metal gates and into the hospital’s main courtyard. Their grey tracksuits smell of urine. One thin man in his 30s saw his father shot dead in front of him. He has barely uttered a word since then.

Another patient in his mid-20s shuffled over to ask for a cigarette. His hand jutted out at a 90-degree angle as he took one, before he crumpled back down on the dusty ground, a grin on his face. Dr Adel Mulhi, who has been here since 2003 and is now the hospital’s director, says his patient was shot in the arm five years ago but when his parents could not afford the treatment he needed then he had gradually slipped into a deep depression. He had been brought to the hospital a year ago and had not seen his family since.

“For lots of people, the stigma controls their outcome,” says Mulhi. “If you are mentally not well, people will feel you are weak, or you’re not good at religion, or it’s from the devil. Our society doesn’t believe in [being] mentally ill.”

This cultural factor combined with the extreme stresses of war is why, Mulhi believes, so many family members end up locking away their loved ones or bringing them to the centre. “They just want to get rid of them. It’s very sad.”

Mulhi knows each of his patients by name and pats them on their heads affectionately, handing out words of encouragement as he strolls past their rooms.

Psychiatric specialists such as Mulhi have become rarer, many leaving for less stressful, safer environments. About 40 remain in Yemen today to serve a population of 30 million. Women often go untreated, their psychological suffering ignored entirely. Many seek out unqualified opinions or try whatever unproven treatment they can find. Several villagers in Aqeeqah said they had paid thousands of Yemeni rials to treat mentally ill family members with electric shock therapy, only to discover that it worsened their condition.

A ward at Taiz psychiatric hospital.
Some of the patients at Taiz psychiatric hospital. Photograph: Isobel Yeung

For professionals who continue to offer their services, resources are scarce. Mulhi’s centre is entirely dependent on government funding, which is barely enough for a quarter of the medication necessary to manage his patients. Until December 2019, the hospital had received financial aid from the UN Population Fund (UNFPA), one of the few international agencies to prioritise mental healthcare in Yemen. But a reduction in its own funding forced it to withdraw support.

In recent years, international donations to Yemen have been in freefall. In March, the UN reported a “disappointing outcome” to its annual pledging conference of aid donors. The UK was among more than 100 governments and donors to slash their contributions, leaving the Yemen fund with about half its target of $3.85bn (£2.7bn), more than $1bn short of what was pledged in 2019. Covid is providing donors with a plausible excuse to cut their contributions, along with allegations of corruption in the aid industry itself.

Last year the UNFPA closed 80 of 180 healthcare facilities, some of which were providing psychosocial services for Yemen’s population at large. This year, having only reached 13% of its necessary budget, it expects to close more.

“Mental health was not, and is still not, one of our main concerns,” says Yemen’s deputy public health minister, Dr Ishraq al-Subaie, who acknowledges that all programmes and initiatives to tackle mental health problems are on hold.

“Our efforts have been focused on rebuilding hospitals, treating the war-wounded and addressing reproductive healthcare. With the current state of the economy and the outbreak of Covid-19, we’re unable to cope,” she says. “Mental health has been completely neglected.”

For staff at the Taiz centre, the idea of rehabilitating, rather than restraining, their patients is scoffed at. “Of course no one here is getting what they need,” says Mulhi. “But the situation right now is not safe for us, let alone for the mentally ill. All we can do is contain them.

“This is just the spark. The lightning hasn’t yet come. Just like American soldiers went to Vietnam and are still suffering now,” he says, adding: “This war, this mental burden, this tragedy will bring a picture of mental illness in the future that I am afraid we will not be able to face. Hopefully I won’t be in this life at that time, inshallah. Hopefully I’ll be buried by then.”

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Missing child in Germany: German boy found alive after surviving eight days in sewer | International

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German police have found an eight-year-old boy who went missing from his home in Oldenburg, a city of 170,000 people in northwestern Germany. The child, named Joe, was discovered on Saturday in a sewer just 300 meters from his house. He had survived in the sewer for eight days while hundreds of officers and volunteers frantically searched the surface for clues to his whereabouts. “Eight-year-old Joe lives!” police in Oldenburg announced on Twitter.

The boy, who suffers from learning disabilities, disappeared on June 17 from the garden of his house. Police launched a large-scale search with drones, helicopters, sniffer dogs and dozens of officers, who were joined by hundreds of volunteers. As the days passed, a homicide team joined the investigation amid growing fears that Joe – who is only identified by his first name due to Germany’s privacy laws – could have been the victim of a violent crime. A witness claimed to have seen him in the company of an unidentified man and it was feared he may have been kidnapped.

“It was absolute luck,” said Stephan Klatte, the Oldenburg police spokesman, said of Joe’s discovery. A neighbor who was walking in the area raised the alarm when he heard “a whining noise” coming from the ground, just under a drain. When officers lifted the manhole cover, they found the boy, completely naked. He had no serious external injuries, but was dehydrated and suffering from hypothermia, for which he was taken to hospital for treatment. According to German media, he is recovering well. “If he hadn’t made a sound, or if no one had heard him, we might never have found him,” Klatte said.

In a statement, the police reported that they believed that Joe likely entered the rainwater drainage system through a sewer on the same day of his disappearance and “lost his bearings after walking several meters.” Police have ruled out any foul play in the incident.

On Sunday, the day after Joe was discovered, police commissioned a specialized company to inspect the sewage system with a robot equipped with a camera. The robot examined the sewer between the boy’s home and the place where he was found. It recorded several items of clothing, including what he was wearing when he disappeared, in a pipe about 60 centimeters in diameter that runs under one of the streets of the neighborhood where he lives with his parents. The robot found, for example, the child’s vest, 70 meters from the point of entry.

Officers found an entrance to a three-foot-wide drainage channel near the farm where he was last seen on the day of his disappearance. Authorities believe the boy entered the channel while playing. After 23 meters, the tunnel leads to another narrower plastic pipe and police think it is likely the eight-year-old continued down this path. Joe was eventually found about 290 meters from where he entered the sewer system.

Police believe that Joe became more and more disoriented until he could no longer find a way out. “A first statement from the child confirms this assumption,” said the statement, which does not provide more details about what he told officers. Investigators say they have not been able to question the boy in detail, as he remains in hospital. Nothing has been found to suggest that the child came to the surface in the eight days in which he was missing. In the statement, police asked that no questions about his state of health be made out of respect for him and his family.



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Bereaved then evicted by in-laws: Kenya’s widows fight disinheritance | Global development

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Within months of the death of her husband in 2014, Doreen Kajuju Kimathi, from Meru, eastern Kenya, was told that his bank accounts had been frozen, and she had been forced out of her home by her in-laws.

The pregnant 37-year-old was left with no resources to fight back, and returned to her parents’ home. “It was traumatising, and I went into depression for five years,” says Kimathi.

Doreen Kajuju Kimathi
Doreen Kajuju Kimathi, who now volunteers for a widows’ support group. Photograph: Courtesy of Widows Empowerment Initiative for Africa

Her experience is far from unique. While Kenya protects widows’ inheritance in theory, the patriarchal culture and the influence of colonial legislation that restricted married women’s property rights means the law is often not enforced.

“There is an entire parallel system operating outside succession laws,” says Roseline Njogu, a Kenyan lawyer. “Years of law reform have led us to formal equality, but equality of law doesn’t mean equality of power, and that’s where we get tripped up.”

Human rights groups report that discriminatory practices in marriage limit women’s capacity to own land. According to the Kenya Land Alliance, only 1% of land titles are registered to women, and another 6% are registered jointly with a man.

While children have equal inheritance rights, land is more often passed on to sons, leaving daughters with fewer assets, and making a future wife vulnerable to eviction if her spouse’s family regard the property as theirs.

For young widows such as Kimathi, it can be even harder to hold on to marital property. “You’re considered less entitled to it because you’re expected to remarry,” she says.

But a fightback is under way. Grassroots organisations are emerging all around the country to build community awareness of women’s legal rights. One group, the Come Together Widows and Orphans Organization (CTWOO), has offered legal advice and support to nearly 500,000 widows since 2013.

The NGO is trying to address disinheritance at its roots. It works with other groups to increase financial and legal literacy across the country, especially among married couples, encouraging them to discuss finances openly, and to write wills.

Dianah Kamande, the founder of the Come Together Widows and Orphans Organization.
Dianah Kamande, the founder of the Come Together Widows and Orphans Organization. Photograph: Courtesy of CTWOO

The founder, Dianah Kamande, says that – contrary to popular belief – most dispossessed widows are middle-class, like Kimathi, not poor. The poor usually have less property, and the rich have access to lawyers.

Kamande says death and estate planning are still taboo topics for many married couples, and that some people obscure their wealth. “Men keep lots of secrets about money from their wives, and trust their mothers and siblings more – who in turn disinherit the wife and children,” she says.

Widows Empowerment Initiative for Africa logo
Grassroots groups are emerging to build awareness of widows’ rights. Photograph: Courtesy of Widows Empowerment Initiative for Africa

The country’s Unclaimed Financial Assets Authority says it has 50bn Kenyan shillings (£347m) in unclaimed assets, and about 40% is money left by people after they die. Concerned by the rising number of unclaimed assets, research by the authority found roughly 43% of Kenyan respondents said they would not disclose their financial assets to anyone – even people they trusted.

“There’s secrecy around financial investments. For many of the people who find out about the assets left by their spouse, it’s a eureka moment,” says Paul Muya, of the UFAA.

Five years after being widowed, Kimathi’s life was still on hold. She had looked into hiring a lawyer but could not afford it. Without access to the family property, it was difficult for her and her son to get by, and she had to rely on help from her parents and sister.

But through the CTWOO, she found out that she did not need a lawyer to access the courts. She filed a claim, and within a year had gained access to almost all of her dead husband’s property. Last year, Kimathi opened a bar and restaurant in Kitui, 110 miles east of Nairobi.

“It was a huge relief to get the money. Being a widow in Kenya is financially and socially isolating, and knowing what that’s like pushed me to help others in the same situation,” says Kimathi, who now volunteers with a widows’ support group.

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WHO concerned about first cases of monkeypox in children | Science & Tech

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Reports of young children infected by monkeypox in Europe – there were at least four in recent days, with a fifth one recorded a few weeks ago – have raised concern about the progress of an outbreak now affecting more than 5,500 people in 51 countries.

The health organization’s Europe chief, Hans Kluge, also warned on Friday that overall cases in the region have tripled in the last two weeks. “Urgent and coordinated action is imperative if we are to turn a corner in the race to reverse the ongoing spread of this disease,” said Kluge.

The WHO has not yet declared the outbreak a global health emergency, however. At a meeting last Saturday, the agency ruled it out but said it could change its views if certain scenarios come to pass, such as a spike in cases among vulnerable groups like children, pregnant women and immunocompromised people. Available data shows that children, especially younger ones, are at higher risk of serious illness if they become infected.

The last known case of a child contracting monkeypox was reported on Tuesday in Spain, where a three-year-old was confirmed to have the disease. Cases in Spain are now in excess of 1,500 according to health reports filed by regional governments.

Also on Tuesday, Dutch authorities reported that a primary school student had become infected and that contact tracing had been initiated to rule out more cases within the child’s close circle of contacts. On Saturday, France reported one confirmed case and one suspected case among elementary school students.

The UK has so far recorded at least two infections in minors. The first case, reported in May, involved a baby who had to be taken to intensive care for treatment with the antiviral Tecovirimat, of which few doses are available but which has already begun to be distributed in several countries. British authorities this week reported a second case of a child with monkeypox. The UK currently has the biggest monkeypox outbreak beyond Africa.

The main vaccine being used against monkeypox was originally developed for smallpox. The European Medicines Agency said earlier this week it was beginning to evaluate whether the shot should be authorized for monkeypox. The WHO has said supplies of the vaccine, made by Bavarian Nordic, are extremely limited.

Until May, monkeypox had never been known to cause large outbreaks beyond Africa, where the disease is endemic in several countries and mostly causes limited outbreaks when it jumps to people from infected wild animals.

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