Considering all the consequences of an armed conflict, the mental health of the civilian population has one of the most significant implications. As a consequence of war and violence, trauma and emotional instability are common among people. For example, the war situation in Iraq, the Vietnam War, and even at the end of the First/Second World Wars, mental health casualties were significantly high. This occurs due to a number of reasons, including exposure to violence, trauma related to combat for military personnel, displacement, economic hardships, and the non-availability of services. In such a situation, it is essential to provide and integrate psychosocial support to those vulnerable people who are affected due to an armed conflict or a war-like situation, creating violence and loss of life. To be more specific, when mediating a situation, it is more important to have a supportive environment that encourages positivity and trauma-specific assistance so that the mental health victims can recover from the trauma, depression, and anxiety. This paper analyses how mental health is a hidden casualty of armed conflict and how integrating psychosocial support into the mediation process is relevant in supporting the mental health of victims of armed conflict.
INTRODUCTION
Armed conflict not only affects physical health but also mental health. This is because of the violence experienced by the general population and combatants. It not only causes destruction of houses and properties but also causes displacement. The non-availability of essential public services also makes it difficult for people to find support during and after an armed conflict. According to research published by the World Bank Group, 2 billion people worldwide are affected by some form of conflict, which leads people to seek refuge in other countries, displacement of habitation, food insecurity, and lack of access to healthcare. Research also showed that more than 190 million people lost their lives because of armed conflict in the 20th century. This is why health facilities are required to integrate psychosocial support for the mental health victims due to armed conflict, so that better care and support can be provided. In a post-war mediation process, mental health support is necessary so that the affected parties can go back feeling normal and have access to essential services like education and healthcare. In this regard, a study concluded that anxiety levels are high among combatants and violence increases among civilians during armed conflict, which causes more than 90 per cent of the population to face some form of mental trauma and distress. Neglect, displacement, lack of education, food, and other essentials put people into an adverse situation without any alternative, which directly or indirectly affects their confidence, ability to perceive things, and have a positive outlook overall. For example, armed conflict in several African countries has shown high post-traumatic stress disorder (43%), insomnia (63%), depression (41%), and anxiety (45%), which is why health facilities must have integrated mental health support in African countries. This is why community-level mental and psychosocial support during and after armed conflict has been frequently suggested for countries in Africa. Also, in a post-war situation, it is important to help people transition to normal life, which is often known as transitional justice, which can be done through mediation and reconciliation. A very recent study in this regard took the example of Sri Lanka, which was in a huge civil and political turmoil affecting thousands of people, and this made the government build Mental Health and Psychosocial Support as a part of humanitarian assistance so that people can reintegrate themselves into a normal society. Therefore, mental health support is necessary considering the nature and extent of the mental health impact of armed conflict on people and combatants.
HOW IS MENTAL HEALTH AFFECTED BY ARMED CONFLICT?
The phrase “mental health as a hidden casualty” underscores how psychological wounds remain invisible compared to physical destruction, yet they are equally debilitating. In conflict zones, this manifests in three dimensions:
1. Direct impacts – trauma from exposure to violence, torture, or sexual assault.
2. Indirect impacts – anxiety and depression resulting from displacement, poverty, and insecurity.
3. Long-term impacts – intergenerational trauma transmitted through families, perpetuating mistrust and hostility.
“Psychosocial support” in mediation should be understood not merely as clinical therapy but as a broader ecosystem of care. This may include community-based counselling, peer-support groups, storytelling, rituals of remembrance, truth commissions, and cultural or religious healing practices. Recognizing psychosocial needs, therefore, requires mediators to move beyond legal texts toward fostering safe spaces where emotions and identities are acknowledged.
a) Violence, Destruction and Displacement
An armed conflict is expected to cause not only violence but also the displacement of people from their homes. Maybe because their home has been destroyed due to war, or they lived in a region that is struck by destructive military conflict. In this process, people lose their homes and are led to seek refuge elsewhere. A study noted that the breakdown of communities led to the displacement of people, which made it less safe to travel and seek refuge. Increased violence and disruption of law enforcement increased homicides in countries like Cambodia, Sri Lanka and Iraq. Therefore, it is reasonable to argue that people losing their homes will definitely have a substantial impact on their mental health when they are not able to meet their every necessity. This can also be said to have an impact on the health outcomes of people since displacement also leads to a lack of access to essential services.
b) Depression, Anxiety and Trauma
The impact of armed conflict on mental health is not something uncommon, and several studies have confirmed the widespread suffering that humans face because of war and armed conflict between countries. For example, a study found that in Afghanistan, armed conflict has caused 67 per cent of the people to have suffered from depression and 52 per cent suffer from post-traumatic stress disorder (PTSD). Another study found that symptoms of anxiety, PTSD, and depression were common in Afghanistan, which increased the risk factor of both adults and children. Similarly, research on the war in Iraq showed that more than 23 per cent of the combatants had depression and PTSD. Even the World Health Organisation affirmed that mental health as a casualty of armed conflict is more widespread than previously perceived, and it is difficult to describe the kinds of mental health issues caused by war until a person actually meets a victim or people affected by armed conflict. Additionally, another study discovered that war veterans with PTSD were more likely to experience metabolic abnormalities, sexual dysfunction, sleep disorders, psychoactive substance use disorders, and suicidal thoughts. Studies on the effects of armed conflict on combatants’ memory and other cognitive abilities have revealed that war veterans experience more attention, executive function, learning, memory, and visuospatial issues, and that these issues are mostly linked to military deployment. Therefore, it is imperative that these individuals have access to care and therapy for the support they need for psychosocial development and normality. Access to care is not only about enhancing mental health; it can also be a matter of survival because their diseases frequently affect their capacity to operate. Ignorance of mental health and mental disease is still pervasive in many nations.
c) Fear, loss of confidence and support
People who are restrained, imprisoned, and concealed from society may be identified as a result of the uptake of mental health care during emergencies and conflicts in nations where such assistance has been scarce. This very support frequently helps debunk misconceptions about mental illness, pave the way for care and treatment, and pave the way for a more respectable existence. For instance, before the war, countries like Syria and Lebanon had very little access to mental health services outside of the mental hospitals. However, due to a growing awareness of the need for support, mental health and psychosocial support have now been incorporated into school-based programming, community and women’s centres, and primary and secondary health facilities. Every nation has a duty to make investments in mental health. However, investing in mental health is especially crucial among populations affected by conflict, where the prevalence of mental health issues is more than twice as high as in the overall population. However, in populations affected by conflict, where the prevalence of mental health disorders is more than twice as high as in the general population, it is especially crucial. As mentioned earlier, armed conflict creates violence, and violence negatively affects the human brain and emotions, which leads people to have emotional and mental instability, making it difficult for them to feel normal. Recent research found that the psychological effects of conflict are more likely to affect women. There is proof that the anguish of mothers and children during a war is strongly correlated. In areas impacted by war, social support and traditional birth attendants play a significant role in fostering the psychosocial well-being of mothers. Women are vulnerable, but their ability to bounce back from adversity and support their families has been acknowledged. Numerous studies consistently show a clear relationship between the severity of psychiatric issues and the degree of trauma. The severity of the symptoms increases with the amount of physical and psychological trauma experienced. In order to minimise the negative impacts of conflict situations, subsequent life events and their correlation with the onset of psychiatric illnesses have significant significance for prompt and thorough rehabilitation.
d) Mental Disorder Among Children
Children are extremely vulnerable to armed conflict. Since children are going through their developmental stages, a violent and disrupted society is detrimental to their growth and mental development. In this regard, the United Nations Children’s Fund (UNICEF) initiated a psychosocial support programme for children depending on the nature of exposure to armed conflict and traumatic situations. Results showed that girls experienced more distress than boys among children. Similarly, women experienced more distress and trauma as compared to men among adults. Also, it has been found that children are dependent on social support, without which they are vulnerable to poor mental health and experience poor psychosocial development. Cultural experience and identity also play an important role when it comes to a child’s psychosocial development. A significant source of cultural identity and a basis for understanding trauma and recovery may be found in religion. According to a study conducted among resilient orphans among war-affected children in Sri Lanka, coping with challenges and fostering well-being can be achieved through Buddhist religious practices such as meditation, reciting the five precepts of Buddhism, reading stories about the Buddha, and developing an understanding of life’s circumstances. These exercises, in particular, were thought to provide structure and aid the kids in understanding and, eventually, coming to terms with the horrific past they had lived. This is where Bronfenbrenner’s classic ecological model of child development can be used to explain the social setting and relationships that provide the micro and macro systems required for the psychosocial development of children. These are the keys to a child’s development, based on the educational curriculum drafted in most schools and educational institutions. A lack of such support in a war-stricken region means the children in those regions are vulnerable to a lack of psychosocial development and would thus require mental health support integrated into the education system.
While all civilians suffer psychological consequences of war, women, children, and other vulnerable groups experience disproportionate harm. Sexual violence in conflict, often used systematically as a weapon of war, leaves lasting trauma, including stigma, shame, and social exclusion. Women are frequently caregivers, tasked with holding fractured families together while managing their own trauma. When women’s experiences are excluded from mediation, agreements risk ignoring critical needs such as access to reproductive health, justice for survivors of gender-based violence, and safe community spaces.
Children represent another vulnerable group. Exposure to violence disrupts education, fosters anxiety, and normalizes aggression. Without psychosocial interventions, children may carry these scars into adulthood, perpetuating cycles of violence. Refugees and internally displaced persons also require special attention, as forced migration compounds trauma with uncertainty and identity loss. The elderly, often forgotten, experience grief from loss of family networks and declining health in exile. A gender-sensitive and age-sensitive mediation model must integrate targeted psychosocial services for these groups.
EXPLORING THE HISTORICAL PERSPECTIVE: MENTAL IMPLICATIONS FROM WAR-STRICKEN COUNTRIES
Afghanistan: Afghanistan has experienced more than two decades of armed conflict and to date, it experiences territorial disputes among militants. A study done in 2004 showed that mental health symptoms were very common and prevalent among people in Afghanistan, specifically in the eastern province, which led to the Taliban movement, which has caused significant disruption to the mental health of the people living in that region. The cause of mental issues was noted as trauma due to increased terrorist movements and gunfire which led to loss of life, causing emotional distress among those who witnessed such horrific incidents.
In Afghanistan, decades of conflict produced widespread trauma, particularly among women who endured both Taliban repression and war-related sexual violence. Mediation efforts, including the 2020 Doha negotiations, largely overlooked psychosocial rehabilitation. International agencies attempted to establish women’s shelters and trauma counselling, yet cultural taboos and stigma constrained their reach. The exclusion of women’s voices from negotiation tables compounded mistrust, demonstrating how neglecting mental health perpetuates gendered marginalization in peace processes.
Iraq: Iraq has officially been at war several times since the 1960s, including the Iraq-Iran war, the Gulf War and the anti-Kurdish Al-Anfal campaign, causing civil but kinetic conflicts. This has been frequently connected to human rights violations because of the mental and physical condition of the people living in Iraq and Iran for more than four decades. Women and children were frequently under threat of being killed and raped due to cross-cultural differences and religious turmoil. For example, a study done on women’s mental health in Iraq found that more than half of the people suffered from curtailment of movement, the right to refuse sex and other developmental decisions. Similarly, another study found that five years of military operations in Iraq led to significantly poor mental health of children, where children experienced PTSD along with their caregivers and parents. Therefore, an integrated psychosocial support program is necessary for such a situation so that the adverse conditions can be addressed.
In Iraq, sectarian conflict and ISIS atrocities left entire minority groups—such as the Yazidis—traumatized. Mediation and reconstruction efforts initially emphasized political power-sharing but underestimated the depth of psychological scars. Programs initiated by UNHCR and WHO to provide trauma counselling to Yazidi women survivors of sexual slavery highlighted that without addressing their psychological recovery, reintegration into Iraqi society would remain incomplete.
Israel: Similar to Iraq, Israel has also been through several kinetic conflicts that involved military interventions and loss of life. In this regard, a study noted that more than three decades of armed conflict, more than 75 per cent of people showed stress-related traumatic symptoms. In this regard, it has been noted that one of the most common coping mechanisms is love from own people and social support.
Palestine: Since the 1990s, Palestine has been experiencing a new-age war, and many studies have reported on the poor mental health condition of Palestinians. For example, as reported by the Gaza Community Mental Health Programme, more than 32 per cent of people experienced severe PTSD and 49 per cent experienced moderate PTSD, where men had a higher rate than women. In addition to poor academic performance, 27 per cent of parents reported bedwetting, and 39% said their kids experienced nightmares. Additionally, the study found that children who were refugees had more violent behavior than children who were not. According to 38% of the respondents, the primary influence was a shooting, 34 per cent said it was violence on television, 7% mentioned being confined at home, and 11 per cent said it was the arrest and beating of family members and neighbors.
The Israeli–Palestinian conflict demonstrates the danger of prolonged trauma. Generations of children raised under occupation or displacement internalize fear and hostility, fueling cycles of mistrust. Mediation attempts focusing narrowly on borders and settlements have repeatedly faltered. Psychologists warn that collective trauma feeds zero-sum thinking, undermining compromise. Some grassroots initiatives, such as “Parents Circle” (a forum of bereaved Israeli and Palestinian families), reveal that acknowledging grief together can open pathways for empathy that traditional mediation fails to access.
Colombia: Colombia, like another country to has experienced armed conflict, is considered to have made its people experience the invisible wounds of war for decades. A recent study noted that mental health victims in Colombia were desperately in need of improved social and mental health outcomes for people. It has been found that mental health treatment is necessary to improve the inequalities between people with mental health issues in Colombia.
Sri Lanka: Sri Lanka has been experiencing civil disputes for more than 25 years between the minority Tamil and certain Sri Lankan groups, who are alleged to have violated the human rights of minority groups. Studies have shown that the civilian population is highly affected by mental health issues, which led to anxiety disorder, depression and drug use. Stress on women and children is something that has also been noted in the past. This is reason why scholars, through public consultation, have suggested that there has to be mediation and reconciliation mechanism so that post-war trauma can be addressed. This reasonably means that apart from resolving the civil dispute, the mental health of the civilians is something that the Sri Lankan government must take care of through post-conflict mediation and psychosocial support to the victims of poor mental health.
Post-civil war Sri Lanka offers another critical example. While the 2009 end of hostilities formally concluded decades of violence, Tamil communities carried deep trauma from displacement and disappearances. Truth and reconciliation initiatives were proposed but often politicized. NGOs that introduced community therapy and storytelling circles found that such interventions restored inter-ethnic trust more effectively than state-led commissions. This suggests that psychosocial support rooted in local culture can complement formal mediation structures.
RECOMMENDATIONS: INTEGRATING PSYCHOSOCIAL SUPPORT INTO MEDIATION PROCESSES
Sustainable Peace
For positive mental health, peacebuilding can be considered one of the most important factors. Since mental health after armed conflict is a serious public health issue, it is important to focus on peacebuilding mechanisms and provide the required mental health support to the victims. This is simply because trauma threatens the inner peace of a human being, which has a direct nexus with mental health. A fairly recent opinion noted that PTSD is extremely common in a post-war setting, and the conventional, more strict PTSD diagnosis cannot be applied to communities without taking into account the fact that trauma manifests itself differently in different cultures. If these cultural factors are disregarded, victims may not be acknowledged, and their problems may go unnoticed. Due to peacebuilders’ emphasis on more traditional symptoms like hyperarousal, this symptom inhibition may cause trauma in adults and children to go unnoticed. Peacebuilders need to develop their ability to grasp PTSD in a variety of ways and adjust it to the cultural setting.
Social and Cultural Support
There is a pressing need to focus on how specific psychosocial support mechanisms can be adopted for children that might be different from those required for adults. It is important for social work practitioners, psychiatrists and mental health counsellors to work at a community level so that specific intervention policies can be implemented. Transitional justice has been frequently quoted by scholars for the purpose of psychosocial support in African countries. Post-conflict mediation, reconstruction and restoration processes are often integrated with mental health support so that peacebuilding approaches can be promoted. Even during the Ukraine-Russia war, addressing the mental health of the civilians and those who are impacted by the war was considered by studies which suggested that the creation of the Inter-agency Coordination Council on Mental Health Protection and Psychological Assistance to Persons Affected by the Armed Aggression within a short span of time shows the importance of social support to those directly and indirectly affected by kinetic conflict.
International institutions increasingly recognize the role of mental health in peacebuilding, yet implementation gaps persist. The United Nations acknowledges mental health in its Sustainable Development Goals, while WHO’s Mental Health Action Plan emphasizes services for crisis settings. However, mediation mandates—such as those of UN Special Envoys—rarely incorporate psychosocial programs as integral components of peace talks.
NGOs often bridge this gap. Organizations such as Médecins Sans Frontières (MSF) and the International Rescue Committee have provided trauma counselling alongside humanitarian aid. Yet these efforts are often short-term and lack integration with mediation frameworks. Local civil society groups sometimes offer more culturally resonant interventions, such as storytelling circles in Africa or community rituals in South Asia, but funding and legitimacy challenges persist. Institutionalizing psychosocial support within mediation therefore requires stronger coordination between international bodies, national governments, and grassroots actors.
CONCLUSION
From all the discussions above, it can be concluded by saying that the effects of armed conflict on mental health are not very hidden nowadays and rather are well documented through research. Be it as a result of direct warfare on combatants or indirect impact on civilians, armed conflict is always a barrier to promoting justice and equitable needs. Mental health is an important factor when it comes to animals and human beings are vulnerable to poor mental health. Availability of resources, affordability, and economic stability are all affected by an armed conflict. Another important finding and implication is in relation to the condition of the countries that are war-stricken. Most countries that have experienced armed conflicts for decades are economically poorer, politically unstable and backward in several aspects. It shows a similar pattern in relation to the degradation of public health and government capabilities. This is the reason why a conflict setting also requires an integrated psychosocial support that is capable of actually assisting the victims of poor mental health. Existing research has extensively established the prevalence of a wide range of psychological disorders and syndromes among communities in conflict settings. Nonetheless, studies also show that over half of the population is resilient when faced with the most severe trauma during times of conflict. Without question, mental health care should be provided to people affected by war and conflict as part of the overall relief, rehabilitation, and reconstruction efforts. The post-war mediation process can be explored to integrate the psychosocial support required to provide the necessary social assistance to the victims of poor mental health due to war and kinetic conflict. Similar to the first half of the 20th century, when conflict significantly influenced the development of mental health concepts, research into the psychological effects of the wars of the present century may provide fresh insights and answers for issues pertaining to the mental health of broader populations.
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