The fragile state of children's mental health in Lebanon

Over the last two years, children’s lives around the world have been upended by the coronavirus pandemic. But for Lebanon’s children, in particular, the pandemic, and its related anxieties, has been only one hardship in an overflowing basket of woe facing the country.

Doctors and psychologists have been reporting an alarming increase clinically in the number of children and teenagers requiring mental health services, in parallel to the country’s deteriorating living conditions.

Since the end of 2019, when a popular revolution ground the country to a halt, Lebanon has been undergoing economic, political and social demise. It has been regarded as the gravest threat to stability since the country’s 15-year civil war, while three-quarters of the population have fallen into poverty.

"Any respite from the economy’s downturn, now entering its third year, is yet to emerge. As the cost-of-living surges amid sky high inflation, many households have been forced to reprioritise needs, laying aside mental health treatment"

For the often-overlooked youngest generation, the fragile state of living has been derailing childhoods up and down the country, to the detriment of their psychological welfare.

“This year has been definitely one of the busiest... we have more than 100 children on the waiting list at this point, waiting to be seen,” Dr Fadi Maalouf, an associate professor of child and adolescent psychiatry at the American University of Beirut, told The New Arab.

“This may be due to several factors. There has been an increase in mental health problems in children and adolescents, but this may also be due to the fact that we don’t have professionals, some of them have emigrated.”

Globally, one out of seven children aged between 10 and 19 are estimated to live with a diagnosed mental disorder, according to UNICEF. However, in Lebanon, the ratio is higher, with around one in five aged between 15-24 reporting feeling depressed.

Last autumn, children returned to school 24 months after they were sent home in October 2019, following nationwide anti-government protests that brought disorder to the streets for months.

The disruption brought on by the revolution movement morphed into the pandemic and meant children were taught remotely for two years – and this has had a lasting impact, according to Maalouf.

“We're seeing mainly in preteens, and teenagers, a lot of what we call ‘school refusal’; which is refusing to go to school, also known as maybe school phobia,” he explained.

Maalouf said the issue stems from anxiety-related symptoms, like not wanting to leave home or leave parents, or safety concerns.

But in a particular case in Lebanon, Maalouf noticed incidences of school phobia cropping up among children in families who have recently emigrated.

Over 77,000 people are estimated to have left Lebanon over the last 12 months in search of a more stable existence, according to a report from Information International, a Beirut-based consultancy firm.

Despite moving to a hoped-for safer environment, children have actually struggled to acclimatise, Maalouf said. “We are seeing families who have left the country, moved to the Gulf [for example], and whose kids were not able to adjust to the schools there, [so] they brought them back.”

But the problem remains on return to school in Lebanon, trapping children in a cycle of difficulty. “They've already developed the school phobia,” Maalouf added.

"Pandemic-induced lockdowns and related stresses, like domestic violence, have harmed children’s wellbeing and caused cases among the paediatric population to rise"

The mass migration of citizens, the third in Lebanon’s modern history, has not only drained the country of talent, but has left emotional voids too.

In another unique-to-Lebanon case, Maalouf has met youngsters who are mourning departed friends. “Because of the exodus that has taken place, the kids who stayed here lost many friends who left the country, so now they're having to manage...they’re dealing with the physical loss of a social network for them.”

One breaking point for residents' mental health in Lebanon was the Beirut port explosion of August 2020, when hundreds of tonnes of poorly stored ammonium nitrate detonated, killing 218 people, wounding thousands, and ripping apart the capital city.

In just seconds, tens of thousands of homes and their inhabitants were ransacked. As windows, walls, and doors were destroyed, so too was the sense of safety that a home embodies.

“After the Beirut explosion I had several children [come in] for different disabilities; like they cannot talk, they become violent – these [problems] were during the pandemic also,” Dr Anita Toutikian, a psychotherapist, said to The New Arab.

“Some children or adolescents start to develop self-harm, [or] start to be aggressive.” She explained that once a child feels their assurance of safety is lost – triggered by a single incident or multiple factors – they can behave out of character, and interactions can become negative.

Toutikian specialises in art therapy to treat children in her private rooms in Beirut, which she opened over a decade ago. “Play is the language for children,” she said, sitting in her therapy room that resembles a nursery; boxes of toys line the table and cupboards are filled with paints and crayons.

For Toutikian’s patients, the return to school was positive. “The children that I saw, it accelerated the therapy,” she said, referring to younger children while conceding that among teenagers it can be more complicated.

But Toutikian’s practice has not been totally immune to the crumbling state around her. “To tell you the truth, many people stopped coming to therapy,” she admitted. “Many children, the parents could not afford the therapy, so I didn’t see them again.”

Any respite from the economy’s downturn, now entering its third year, is yet to emerge. As the cost-of-living surges amid sky-high inflation, many households have been forced to reprioritise needs, laying aside mental health treatment.

“And those who [still] come to therapy, are more or less, well off,” Toutikian said.

Yet, the emptying of one therapy room has only caused another to fill up. Primary health care centres, which offer low fee consultations, have witnessed an uptick in patients, among them children, seeking psychological support.

St Antione Community Center based near Jdeideh, in the northern suburbs of Beirut, is one. Before the crisis, the centre would refer two or three people a month for mental health services, Dr Nancy Abi Assaf, a general practitioner, told The New Arab. But today, it has swelled dramatically to two or three cases a day.

“People could afford private care services, so they were not visible to us,” she explained. Pandemic-induced lockdowns and related stresses, like domestic violence, have harmed children’s wellbeing and caused cases among the paediatric population to rise, she said.

“Oh my god," Assaf exclaims, holding her head in her hands, visibly troubled by the impact of Lebanon’s crisis-ridden state on the country’s children, "it’s really sad."

Rosabel Crean is a freelance journalist based in Beirut, Lebanon.

Follow her on Twitter: @CreanRosabel