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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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Twenty-five ethnic Pamiris killed by security forces in Tajikistan protests | Global development

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At least 25 people were killed on Wednesday by security forces in Tajikistan during a protest in the autonomous region of Gorno-Badakhshan (GBAO), where the Tajik regime has targeted the Pamiri ethnic minority.

The deaths mark an escalation of violence in the region. Conflict between the central government and the Pamiri has continued for decades, with the cultural and linguistic minority ethnic group suffering human rights abuses, as well as discrimination over jobs and housing.

The Pamir region has been the only place in Tajikstan where anti-government protesters still take to the streets, despite the authoritarian pro-Kremlin regime.

According to witnesses, several hundred residents of Khorog, the capital of GBAO, gathered at the weekend to call for the dismissal of the governor and the release of demonstrators arrested for participation in a protest in November, when three men were killed and 17 wounded by security forces.

Protests continued until Wednesday when, as people marched to the main square in Khorog, security forces blocked the road and allegedly started firing rubber bullets, stun grenades and teargas at the protesters, killing at least 25 people.

Map of Tajikistan showing region

The Tajik government claimed “members of an organised criminal group” had blocked the highway “in order to destabilise the social and political situation”.

In a statement on the state news agency, Khovar, the interior ministry said: “Law enforcement agencies have begun an anti-terror operation … in a restive region that borders Afghanistan and China and has long been a flashpoint of tensions.”

The Tajik authorities claimed that arms and support from foreign “terrorist organisations” were coming in to the Pamiri region.

“The organised criminal groups did not comply with the lawful demands of law-enforcement officers to hand over their weapons and ammunition, and put up armed resistance,” the interior ministry said.

But activists said their protests had been peaceful. “The government is branding and naming the peaceful protesters as ‘terrorists’, which is a complete fake, and then using that as an excuse to shoot at them,” said one Pamiri activist who cannot be named for security reasons.

During the Tajikistan civil war from 1992 to 1997, thousands of Pamiris were killed in what some human rights activists have described as “ethnic cleansing”.

In 2012, during clashes seen by many in GBAO as an attempt by the Tajik government to bring the autonomous region under its full control, at least 40 civilians were killed.

In February, parents of men killed by Tajik forces during a protest in November called on the international community to step in and protect ethnic minority groups.

Families have demanded that the soldiers responsible for killing their sons be brought to justice and urged the United Nations to intervene.

Guards in old-fashioned shako hats salute two men as they walk through huge golden doors
Tajikistan’s president, Emomali Rahmon, right, at Monday’s meeting with Vladimir Putin in the Kremlin. Photograph: Mikhael Klimentyev/Sputnik/Kremlin/EPA

Tajikistan’s president of 28 years, Emomali Rahmon, who met the Russian president, Vladimir Putin, on Monday, is seen by the Pamiri as wanting to take control of Gorno-Badakhshan.

Neil Clarke, head of the legal programme at Minority Rights Group International, told the Guardian: “The deteriorating human rights situation in the region is leaving the population, who are mainly Indigenous peoples and ethnic and linguistic minorities, at serious risk of harm.

“We now believe that without urgent measures, the situation could escalate towards increasing conflict,” he said. “The widespread harassment of the population of GBAO by authorities including the police, security and military personnel appears increasingly systematic. These include wide-ranging forms of surveillance and invasions of privacy, arbitrary detention and the use of coercion to obtain signatures and/or public statements against the will of the individual.”

Since November security checkpoints have been reinforced, and hundreds of people who took part in the demonstrations have been arrested or banned from leaving the region. Clarke said the latest deaths marked renewed efforts to suppress the Pamiri.

“Authorities have reinstated a blockade on internet connection in the region and have again begun to arrest and detain prominent civil society leaders and independent individuals under the alleged pretext of an ‘anti-terror operation’,” he said.

“Pamiri people are not the terrorists. We are calling for urgent measures by Tajikistan authorities to de-escalate the developing conflict, by restoring and ensuring the respect for human rights in GBAO and most urgently call on authorities to release the activist Ulfatkhonim Mamadshoeva and others who have been detained and interrogated by security forces, without due process, as part of efforts to silence the voice of Pamiri activists.”

Since crackdowns on opposition groups in 2014 in Tajikistan, it is thought that 15 activists who left the country have disappeared in Russia or Turkey.

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Anne Frank: who gave her up to the Nazis? | International

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A book published in the Netherlands in January has caused a stir with it’s claim that a local Jewish notary was the one who revealed the annex in which Anne Frank and her family were hiding to the Nazis, whosubsequently deported the young girl, her sister, and their parents, to a concentration camp.

The Betrayal of Anne Frank: A Cold Case Investigation, is authored by Canadian biographer and poet Rosemary Sullivan. The Betrayal recounts the work of a team made led by Dutch journalist Pieter van Twisk and including American Vince Pankoke, a former FBI agent It has been released throughout the world and encountered no problems, except for in the Netherlands where the publisher Ambo Anthos, withdrew it in February, apologizing “to anyone who was offended.”

The group set out to address the fate of Anne Frank as a cold case — an unsolved crime — and have used artificial intelligence and data processing as well as consulting a behavioral psychologist. They considered why a respected Jewish notary might have informed the Nazis of the Frank family’s hideout at 263 Prinsengracht in the Dutch capital. Over six years the team has ruled out about 30 suspects and scores of possibilities, attempting to fill gaps in information as time has elapsed.

Of the Frank family that had been hidden in the annex, only the father, Otto Frank, returned from the death camps. His daughter is a global icon, with her diary and her fate a symbol of innocence in tragedy.

Sullivan’s book says it is “almost certain” that the Dutch Jewish Council had a list of locations where people were in hiding, on which the Frank family’s may have been included.

The book notes that Arnold van den Bergh, a member of the Council, had contacts in high Nazi circles. So, “he could have given that list up at any time.”

To approach a cold case, one begins by reviewing all previous investigations for new clues. Speaking to EL PAÍS by phone, Vince Pankoke says that in this process one might speculate on what happened, and analyze the personality and biography of the suspects.

Pankoke says that, “we are not 100% sure,” the team found that van den Bergh was the most likely person to have triggered the raid in which Nazi police found the Franks.

“Although we cannot prove it beyond a reasonable doubt,” continues Pankoke, the team felt compelled to share their conclusions, because “it could have been a time bomb if discovered by anti-Semitic or neo-Nazi groups,” adding that the notary would have done so to save himself and his own family.

The speculation in the book has troubled several Dutch historians who specialize in the Holocaust and in the Dutch Jewish Council itself.

Bart van der Boom, a professor at the University of Leiden, says there is no evidence that the Council had the addresses of people in hiding.

Council members were respected people in the Jewish community, who “believed that opposing the Nazis would be much worse” than accepting the creation of the Council, a Nazi initiative.

“The idea that they would give a list to the Nazis is ridiculous,” says van der Boom.

“Jewish leaders did not decide who would be deported and they did not take charge of gathering people for it.” That suggestion, adds the professor, “is one of the numerous errors of the book.”

Van der Boom goes on to say that the Dutch Jewish Council “was criticized by everyone after the war for collaborating with the occupier, and there were Nazis who tried to blame it to save themselves.”

In the book, van der Boom says that the cold case team points to a German translator’s statement that they had heard the Council had the lists, and “that information is not credible.”

Indeed, in the historian’s expert opinion, the book is “an amateur work; all smoke and mirrors.”

Van der Boom has written to Rosemary Sullivan, in an appeal, he says, to her academic conscience. He tells EL PAÍS that Sullivan responded “that she trusts the research.”

Both van der Boom and his colleague, Bart Wallet, Professor of Jewish History at the University of Amsterdam, are particularly appalled at a sentence by the author in the English version.

After stating that van den Berg, who died in 1950, “saved his family by giving the Nazis addresses, including 263 Prinsengracht,” Sullivan writes: “Perhaps he also paid a price. He died of throat cancer. In a strange way, it was appropriate: he lost the ability to speak.”

Wallet states firmly that an academic peer review process would not have permitted the book to be published in its current form.

Pieter van Twisk, the Dutch journalist, admits that the team expected criticism, especially in the Netherlands.

“I was not prepared, however, for the toxic atmosphere [that has been] created,” says van Twisk.

“We were not [deliberately] looking for a Jewish traitor, as has been suggested, and we believe that Otto Frank knew or suspected who ratted them out, because he said he did not want his children to suffer for it.”

“There are specialists who agree with us and do not dare to speak in order to preserve their reputation. It’s ridiculous.”

It also seems to van Twisk that the Dutch publisher Ambo Anthos has dropped the book for fear of a lawsuit by members of the van den Bergh family: “I didn’t want to go to court with victims of the Holocaust.”

Pankoke, for his part, indicates that the book “is Rosemary Sullivan’s interpretation of the interviews she did with us and the reports of our work. There is a difference between what she interprets and the investigation itself.”

At any rate, Pankoke notes, “collaboration with the Nazis and the fate of Anne Frank” is a highly sensitive topic in the Netherlands.

The other main piece of evidence presented in the work is an anonymous note about the betrayal, sent after the war to Otto Frank. The original has not been found, but a copy of the writing, known to academics, was among the documents of a Dutch police investigator, Arend van Helden, who investigated the matter between 1963 and 1964. The note says that Van den Bergh revealed the Franks’ hideout to the Nazis, and that the department that received the tip-off “had a list of addresses (of Jewish people in hiding) also provided by him.”

Forensic examination by Pankoke’s team confirmed that the copy “had come off Otto Frank’s typewriter a couple of years before 1959.”

The team explored whether “the note was taken seriously in its day and if the lead was good.”

After discovering “that due diligence, an adequate review, had not been applied to confirm the allegations,” Pankoke’s team deemed it a legitimate piece of evidence.

For Bart Wallet, the person who wrote it “misquotes the Nazi institutions, showing a lack of inside knowledge to make such a statement about the notary.”

Such notes, Wallet continues, were frequently sent between people after the war “as gossip, or to settle scores.”

In Wallet’s opinion, if the list of hidden Jews had existed, “we would be facing one of the greatest traitors of the war and it would have been known, preventing his return to civilian life.”

To all of the above, there are added doubts about the whereabouts of the notary after the beginning of 1944. Anne Frank and her family were found by the Nazis in August of that year. Pankoke points out that van den Bergh “was trying to go unnoticed or else he hid, because details are missing here.”

However, another Dutch historian has just found a wartime diary with an entry that places the notary in the town of Laren, near Amsterdam. Van den Bergh obtained the necessary documentation to pass himself off as only partly Jewish, and thus had freedom of movement. But a Nazi colleague who wanted his office had gotten that declaration annulled.

Due to this, and with his three daughters hidden since the end of 1943, the two historians consulted believe that van den Bergh and his wife went into hiding at the beginning of 1944, according to reports from his descendants in the 1970s, as the family had survived.

Regarding the response of historians in the Netherlands to the book, Pankoke suspects a case of “academic arrogance.”

“When historians don’t like our findings, they reject them. That the notary went into hiding does not prove that he did not give the lists to the Nazis before, or later.”

“In addition, academics state that he was a good person,” but, “I know from experience that decent people can do terrible things,” the former FBI agent concludes.

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Under the volcano: a year after Mount Nyiragongo’s eruption, people of Goma start to rebuild their lives | Global development

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