According to the World Health Organization, more people in Sub-Saharan Africa suffer from depression and PTSD than from HIV/AIDS and TB combined. Every country south of the Sahara has either been affected or borders on a nation that has been devastated by armed conflict that threatens to expand into regional civil war. Depression and PTSD can destroy an individual’s well-being and productivity and prevent their participation in society. A victim may have survived the unspeakable horrors of war, but she can be left unable to work, care for herself or tend to her family. In the words of Elizabeth Alderman, “If people don’t care whether they live or die, they won’t put down their bed nets or walk to get potable water. They can’t follow complicated anti-retroviral therapy regimens. And they can’t work or take care of their children.”
A Generation of War-Affected Youth
Long after conflict has ended, a generation of war-affected youth, many of them former child soldiers and orphans, continue to suffer anger, hostility and social isolation, putting them at high risk for poor health and life outcomes, such as low rates of school completion, joblessness and poor economic self-sufficiency. Young men with PTSD can turn to alcohol and substance abuse and sexual violence. All survivors are at increased risk for suicide. Beyond the toll on human lives, post-conflict economic recovery, public health initiatives and peace building are also severely compromised against this background.
The Treatment Gap
Treatment options for depression are scarce in post-conflict countries, where fewer than 10% of victims have access to mental health care. According to the WHO, in low- and middle-income countries there is on average one psychiatrist to serve 200,000 or more people, and few mid-level mental health professionals.; in low- and middle-income countries that even have a mental health budget, it accounts for less than 1% of the total health care budget. In the countries where the Peter C. Alderman Global Mental Health Program works, there is on average less than one psychiatrist to treat one million people.