For the children who are struggling to survive the Middle East’s ongoing wars, the impacts could be life-changing. According to a new study, the trauma will likely continue to affect them decades from now, haunting the bodies, minds, and families of what scientists call a “lost generation.”

In a wide-ranging analysis of the public-health impacts of turmoil in the Middle East, researchers at the University of Washington’s Institute for Health Metrics and Evaluation (IMHE) see a mass epidemic unfolding through years of systemic social deprivation, displacement, and cycles of violence and illness.

The study, covering the period from 1990 to 2015, shows that the populations of the Middle East and North Africa have suffered drastic increases in chronic illness and death from preventable diseases, along with psychological instability. Rates of diabetes and lung cancer have more than doubled. Amid conflict and poverty, once-stable communities have sunk into undernourishment and long-term food insecurity, along with severe mental distress, producing a generation of neglected children. Three countries in the region—Sudan, Afghanistan, and Pakistan—“are among the 10 countries with the highest child mortality in the world,” which is fueled by preventable health problems such as lower-respiratory infections and diarrhea-related illness.

The findings seem even more dire against the backdrop of a general trend of major public-health improvements seen across the Global South in recent decades, especially in child mortality and infectious diseases. “Compared with other parts of the world, we see that all the gains that have been achieved have been lost right now,” said Ali Mokdad, professor of global health at the University of Washington and co-author of the IMHE study.

Throughout the last quarter-century, regional social volatility has made everyday life more dangerous. Violent incidents and law-enforcement interventions have soared by 850 percent. Extreme rates of anxiety, depression, and schizophrenia have “contributed to nearly 11 million years lived in less than ideal health.” Young people often experience the most devastating long-term impacts, Mokdad warns: “Imagine a generation in Syria, Yemen, Libya, or Iraq that has been broken up during the war, and they see this [impact] from age of 2 or 3 until they are now in their early 20s.”

Spending much of their lives “seeing people being killed… You can imagine how much trauma this is putting on the population.” Compared with other parts of the world, rates of social violence have exploded overall, including collective warfare and interpersonal assault and sexual assault. By 2015, suicides doubled to nearly 30,000 annually, and another 35,000 people in the region were killed by interpersonal violence. Regionally, the past quarter-century has seen a doubling in suicides, while homicide rose by 150 percent.
The care systems of the region
have broken down on multiple levels, and preventive care, including screening for mental illness or managing chronic conditions, has been shattered. Outside of conflict zones, too, waves of refugees have engulfed regional neighbors, so humanitarian and medical facilities of even peaceful parts of Jordan and Lebanon are overstressed. Meanwhile, people become so overwhelmed they neglect their own health and become more prone to self-harming behaviors.

“They’re trying to stay alive, they’re trying to make sure they have food on the table, they’re trying to make sure that their kids are protected,” Mokdad says. “When you are living in an environment [of] war or unrest, people tend to take more risks. So people who smoke, start smoking even more, people who drink, drink more.” Even transportation-related injuries and obesity rates are spiking. The medical system abandons children’s basic health needs amid these cross-cutting risks. “Many kids are not immunized, are falling through the cracks, and this is a recipe for disaster in the long term.”

Official statistics on violent incidents could be vastly undercounted due to barriers to care and social stigma, including “legal punishments that discourage victims, families, and governments from disclosing” psychological illness. Meanwhile, the region has only about seven mental health practitioners per 100,000 people, while there are more than five times as many in some wealthy European countries.

Silencing of mental-health issues is especially acute for the families struggling just to stay housed and fed. In a typical refugee settlement, Mokdad explained, a mother might be expected to put her family duties first and to suppress her emotions: “All the other women will say, ‘Hey, you’re doing this because you don’t want to take care of your chores, you should act normally and take care of yourself and your family.’ So there is a lot of stigma on people not to say they have a mental-health problem.”

War-scarred younger generations suffer high rates of tobacco use, “adolescent pregnancy, and unmet need for contraception.” In addition, since 1990, HIV/AIDS death rates have seen a tenfold increase, concentrated in Djibouti, Somalia, and Sudan. Soaring mortality trends—despite major advancements in life-saving medicine for HIV/AIDS—foreshadow the challenges ahead for overburdened medical infrastructures, which must struggle to monitor infections to provide critical long-term treatment.

The study also cites the obscene maldistribution of wealth as a barrier to restoring health-care systems (per capita gross national product is more than 60 times higher in Qatar than in Afghanistan).

Air pollution, water crises, and rising temperatures fuel additional regional public-health risks. Climate-related disaster and environmental distress have emerged as an underlying factor in social instability and conflict in recent years in the region.

Paradoxically, the vestiges of the last conflict may pave the way for the next one. “Right now this is the tip of the iceberg,” Mokdad says. “And once we have peace in the Middle East, many of these problems will surface.”

The lost generation could be saved through comprehensive long-term investment in social and medical infrastructure—perhaps akin to the rebuilding of Western Europe after World War II. But in an age of austerity, the prospects for massive foreign aid on the scale of the Marshall Plan are narrowing as many donor nations, chiefly the United States, tighten humanitarian aid budgets. By contrast, Mokdad notes, regional stakeholders could play a leading role in restoring public health. For example, relatively stable oil-rich Gulf nations have the resources to redistribute wealth across the region. But with conflict still roiling through the continent, governments must first find the collective moral will to begin clearing the ruins of the crises they ignited decades ago.

“There is a lot of wealth in the Middle East. Investing it wisely would be a good idea…. Internally [regional governments] have enough resources to take care of the problems,” Mokdad says. “But first we need to stop the violence.”