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‘No sense of safety’: how the Beirut blast created a mental health crisis | Global development

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Rayan Khatoun has been dreading 4 August. She has been constantly on edge as the anniversary of the port explosion in Beirut approached.

The blast threw Khatoun into a wall as she came home from work and left her with a head injury, a fractured cheekbone and torn tendons. Since then, she has suffered from recurring nightmares, insomnia and anxiety attacks.

“For months after, I was too scared to be anywhere near glass,” she says. “Sometimes, I experienced a sudden fear of open spaces as if I had nowhere to hide if something happened.”

Khatoun’s children are in constant fear of something happening to her, after seeing how badly she was hurt. “We have lost our sense of safety completely,” she says.

With the country in meltdown, failed by the political class, its people are in the grip of a mental health crisis without adequate resources to deal with it.

Lifeline, Lebanon’s emotional support and suicide prevention helpline, says the number of calls it’s receiving each month has almost doubled since May 2021 to 1,050.

The port explosion “ripped apart people’s homes, as they were in them”, says Dr Olivia Shabb, a clinical psychologist at the American University of Beirut. “It destroyed the ability for many people to have the most basic form of trust required to live with peace of mind.”

A stopped clock
A stopped clock in a damaged building marks the moment when the port explosion tore through Beirut in August 2020. Photograph: Marwan Tahtah/Getty

Widespread power cuts caused by fuel shortages are also now lasting up to 22 hours a day. Without electricity at night to power air conditioning, many people are struggling to get enough sleep during the hot and humid Lebanese summer.

“Sleep is an essential component of mental health,” says Dr Joseph el-Khoury, the incoming president of the Lebanese Psychiatric Society. “We are getting reports of babies not getting their essential sleep, with added stress on parents.”

The power cuts have also forced businesses, already dealing with a volatile economy and currency fluctuations, to close early or for several hours each day, reducing much-needed income.

“The situation is unbearable,” says Jean Antoun, who runs a coffee shop that was damaged in the explosion. “We have now no fuel, no electricity, and the prices of raw material and ingredients are changing by the hour.”

Rayan Khatoun, Beirut, Lebanon
Rayan Khatoun has suffered from anxiety and insomnia since the blast

Khatoun is torn about whether to attend the protests being held on Wednesday to mark the anniversary of the blast. She fears that being so close to the port could have an impact on her mental health.

It’s common for symptoms to get worse around anniversaries, particularly if avoidance has been a coping mechanism, says Shabb. People can avoid discussing the blast or going near the port “but they can’t avoid the occurrence of a date and the sensations that will come with a muggy, sunny afternoon on 4 August”.

Khoury adds that recirculating videos of the explosion itself are likely to distress those suffering from post-traumatic stress disorder (PTSD).

“I do not think we can stop people from sharing, especially in the context of social media,” he says. “But I encourage those who feel the need to share, to share instead their personal story, or pictures that carry a symbolism for them. Even pictures of the damage and destruction are likely to trigger people significantly.”

Mental health has been a low priority in the Lebanese health system, which is skewed towards high-cost interventions for the wealthy, rather than accessible care for the the general population. According to the Global Challenges Research Fund, two million Lebanese people could not realistically afford to go to a doctor in 2020.

In the 12 months since the blast, demand for mental healthcare has increased, says Khoury. He has been prescribing psychotherapy, counselling and medication to treat survivors of the port explosion experiencing depression, anxiety and PTSD.

There has, however, been an exodus of psychiatrists and psychologists from Lebanon, as the value of salaries dropped by about 90% due to the devaluation of the Lebanese currency. Khoury is now based mostly in Dubai.

“Many who were comfortable financially for decades are now barely making ends meet,” he says. “Families are being broken, with one breadwinner having to move abroad.”

A pinboard with notes of comments and thanks to the Embrace team
Messages of thanks for the Embrace team, which operates Lifeline in Lebanon, a helpline for emotional support and suicide prevention. Photograph: Nabil Mounzer/EPA

While Lifeline currently has enough power to operate 21 hours a day, it has negotiated with the health ministry for solar panels to be installed to reduce its dependency on increasingly scarce fuel. This will enable it to provide a 24-hour service by the end of August, according to Hiba Dandachli, the communications director for Embrace Lebanon, the NGO which operates Lifeline.

Callers to Lifeline are likely to continue to face power cuts and poor connectivity however, and these disruptions affect the ability of counsellors to establish a rapport with people in sensitive emotional states, says Dandachli.

Dr Joseph el-Khoury, the incoming president of the Lebanese Psychiatric Society
Dr Joseph el-Khoury: ‘Families are being broken’

“The one positive aspect is that talking about mental health is no longer a taboo, especially for the younger generation,” says Khoury, “so this is leading to them seeking proper treatment.” However, even those who seek treatment may struggle to access medication.

“A lot of critical medication is out of stock and agencies are not able to import new stock due to the devaluation of the Lebanese lira,” says Remi el-Haji, a clinical pharmacist at a hospital in Beirut.

Khoury has seen patients reducing or stopping their treatment and using expired medication. There is concern about the impact this could have on those suffering from serious psychiatric illnesses and conditions such as Alzheimer’s.

“Trauma treatment assumes a return to safety and that the danger has passed,” notes Shabb, “but there hasn’t really been a return to safety. People feel that there is no guarantee that if they heal here [in Lebanon], that they are not going to have to go through something similar next year or in a few years.”

No one in authority has yet been held accountable for the port blast and politicians have shown little appetite for a robust investigation. Shabb believes that many of the mental conditions that people have developed over the past year are an understandable reaction to a “twisted context”.

“We need to normalise the problem as a structural problem,” she says. “We can’t keep putting the responsibility on people to heal themselves when the conditions that govern them are so harmful.”

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[Ticker] US to lift Covid travel-ban on EU tourists

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Fully vaccinated travellers from the EU and the UK will be let back into the US from “early November” onward, the White House said on Monday, ending an 18-month ban and prompting airline firms’ shares to climb. “This new international travel system follows the science to keep Americans … safe,” a US spokesman said. The EU recently recommended increased restrictions on US visitors, amid anger at lack of US reciprocity.

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Ten women and girls killed every day in Mexico, Amnesty report says | Global development

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At least 10 women and girls are murdered every day in Mexico, according to a new report that says victims’ families are often left to carry out their own homicide investigations.

The scathing report, released on Monday by Amnesty International, documents both the scale of the violence and the disturbing lack of interest on the part of Mexican authorities to prevent or solve the murders.

“Mexico is continuing to fail to fulfil its duty to investigate and, therefore, its duty to guarantee the rights to life and personal integrity of the victims as well as to prevent violence against women,” says the report, Justice on Trial.

“Feminicidal violence and the failings in investigation and prevention in northern Mexico are not anecdotal, but rather form part of a broader reality in the country,” the report adds.

Femicide has been rife in Mexico for decades – most notoriously in an epidemic of murders which claimed the life of some 400 women in the border city Ciudad Juárez during the 1990s. In recent years, a growing feminist movement has held massive street protests against the violence, but authorities have proved unwilling to take action to stop the killing.

“It’s always a question of political will,” said Maricruz Ocampo, a women’s activist in the state of Querétaro.

Ocampo has been part of teams lobbying state governors to issue an alert when femicides reach scandalously high levels – a move to raise awareness and mobilise resources. But officials often resist such moves, she said, as governors worry about their states’ images and investment.

“They refuse to recognise there is a problem,” she said.

The president, Andrés Manuel López Obrador, has also downplayed the problem. He branded the women protesting on 8 March, International Women’s Day, as “conservatives” and alleged a dark hand manipulating the demonstrations.

When asked last year about rising violence against women, he responded, “Tell all the women of Mexico that they are protected and represented, that we’re doing everything possible to guarantee peace and quiet and that I understand that our adversaries are looking for ways to confront us.”

Mexico recorded the murders of 3,723 women in 2020. Some 940 of those murders were investigated as femicides.

The Amnesty report focused on Mexico state, a vast collection of gritty suburbs surrounding Mexico City on three sides. It has become notorious for femicides over the past decade – and for the way the former president, Enrique Peña Nieto, a former Mexico state governor, ignored the problem.

The report found cases of families carrying out their own detective work, which were ignored by investigators. In many cases, authorities contaminated crime scenes or mishandled evidence. They often did not even pursue leads such as geolocation information from victims’ mobile phones.

In the case of Julia Sosa, whose children believe she was killed by her partner, two daughters found her body buried on the suspect’s property – but had to wait hours for police to arrive and process the crime scene. One of her daughters recalled the subsequent interview process, in which “the police officer was falling asleep”.

Sosa’s partner hanged himself, prompting police to close the case, even though family members said there were more leads to pursue.

In states rife with drug cartel violence, activists say cases of femicides go uninvestigated as impunity is commonplace.

“The authorities say it’s organised crime and that’s it,” said Yolotzin Jaimes, a women’s rights campaigner in the southern state of Guerrero. “Many of these aggressors find protection under the excuse of organised crime.”

The persistence of femicides is a stark contrast to recent gains by the women’s movement in Mexico. The country’s supreme court decriminalised abortion earlier this month. A new congress recently sworn in has gender parity and seven female governors will be installed by the end of year – up from just two before last June’s election’s

The decriminalisation of abortion “let off some steam” from the pressure driving the protests “because part of the demands was over the right to choose,” Ocampo said. “But when it comes to violence, we still see it everywhere.”

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US official urges EU to speed up enlargement

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Gabriel Escobar, the US’ newly-appointed acting deputy secretary of state for South Central Europe, has urged Europe to speed up Western Balkans enlargement. “To return 20 years later and see that there hasn’t been much progress on that front was a little disappointing,” he told the RFE/RL news agency Friday, referring to his last post in Europe in 2001. “We would like to see a more rapid integration,” he said.

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