Psychologist Anjila Sultan returned to the city where she grew up, after witnessing the effects of war and cultural pressures on mothers and children

Tracking women’s mental health amid trauma in Yemen

Psychologist Anjila Sultan returned to the city where she grew up, after witnessing the effects of war and cultural pressures on mothers and children

Science in conflict zones

Field researchers in conflict zones often face significant challenges, particularly female researchers conducting fieldwork. The lack of security and strong legal protections for women, along with the proliferation of extremist groups, makes them even more vulnerable to harassment, violence and restrictions on movement. Their work amid conflict also exposes them to trauma, leaving emotional and psychological scars. However, they feel compelled to go where the crucial and most precise data must be collected, while fully understanding the challenges that entails.

Anjila Sultan is the acting head of the mental-health department at Taiz University and a director of the Center for Strategic Studies to Support Women and Children in Taiz, Yemen — a country that consistently ranked at or near the bottom of the World Economic Forum’s Global Gender Gap Index in the years for which it was included. In this second article of a three-part series, Sultan describes how she deals with difficulties and limitations in her fieldwork while the conflict in Yemen continues — and why it is worth the risk.

I spent my adolescence in Taiz, Yemen’s third-largest city, where long exposure to a series of conflicts has led to increasingly serious violations against vulnerable groups. I was affected emotionally by the violence towards women and children there. I could see torture marks all over girls’ bodies, including bruises, wounds and burns — resulting from physical assault by family members, under the pretext of correcting the girls’ behaviour and morality. They needed psychological support for this trauma, but it wasn’t available, which motivated me to study psychology at Taiz University. As a part of my study, I visited correctional facilities and provided mental support for female inmates affected by domestic and gender-based violence.

In 2009, after obtaining a master’s degree in mental health at the University of Aden in Yemen, I worked as a teaching assistant at Taiz University. In 2011, I moved to Egypt to study for a PhD in mental health at Assiut University. My parents then followed me, because an uprising broke out across Yemen as soon as I left, and there was an outbreak of street warfare in Taiz between forces loyal to Ali Abdullah Saleh, who was president at the time, and armed opposition forces. When the Yemeni civil war started in 2014, I saw how vulnerable groups weren’t able to meet their basic mental-health and social needs amid this unbearable and endless series of bloody conflicts.

Statistics suggest that these conflicts have further damaged women’s mental health, and I see this as related to extra social and cultural pressures that have placed new restrictions on women. I have found in my work that widespread unemployment among men leads to an increase in domestic violence, and poverty has led to a rise in child marriage rates among people displaced by the war. I could have been one of those child brides, had it not been for a little luck.

Solidarity and support

Driven by a deep bond of solidarity, I travelled back to Yemen in 2018, one year after obtaining my PhD. I returned to a teaching post at Taiz University and co-founded the Center for Strategic Studies to Support Women and Children, where my colleagues and I conduct studies and provide free mental support. We collect mental-health data for women and children living in the wider Taiz region. These people, some of whom live in refugee camps, are affected by the burdens of conflict, as well as by social and cultural pressures. We examine their mental state to understand how displacement and trauma exacerbate mental-health disorders.

Nowadays, although some calm has prevailed in Taiz itself, the surrounding countryside is still turbulent. Sometimes, armed clashes break out unexpectedly, making me unsure when trying to come up with safety plans. I lead a team of five female psychologists. Lack of security still limits our commutes at night, so I make sure that my team and I are home before then. For safety’s sake, we usually split into two teams of two or three when covering study areas. We make sure we all know the nearest place where communication networks are available, and we communicate with local officials to coordinate our movements. This requires us to be flexible and patient when discussing where to go, and for what purpose.

Since around 2016 or 2017, the continuing violence has given space to various extremist groups across the country to force residents to follow certain traditions that mainly target women and restrict their movement. Unaccompanied women aren’t allowed to travel between cities now. Female fieldworkers, who shuttle between cities and villages without a male relative, have been accused of ‘moral distortion’. This makes getting to the study areas a challenge. I am often bullied, harassed and insulted, and I put up my car window so as not to hear the abuse. Once, when I was away in Egypt, my team was denied access to our study area. I called a local official, who helped me by ordering people in the community not to hinder our work.

Safety precautions

A big concern is when local leaders forbid us to have contact with women and children, after we’ve made great efforts to reach the area. But my biggest fear is that fighting will break out unexpectedly while we are in the countryside, putting our lives in real danger. We take precautions for our personal safety. We don’t take cameras with us, because walking around with a camera can arouse suspicion. Instead, we use our phones to record interviews.

It is important to be aware of cultural problems: to know what behaviours are unacceptable and what topics of conversation might be off-limits. During one of our fieldwork sessions, a fierce fight broke out between refugees and the host-village community. We decided to drive to a safer place and wait for few hours in our cars until the tension subsided. Working in such conditions requires neutrality during quarrels between different parts of the population, and the ability to deal quietly with questions from people who might be suspicious of our motives. For example, I spend a lot of time telling people that we don’t belong to any political party or faction.

It is thought that there is only one psychiatrist for every half a million people in Yemen1. It is my duty not to leave behind those who are suffering as a result of painful experiences and severe psychological crises. From our years working in the region, I know that our psychological support sessions have helped many women to regain their confidence and mental well-being. These results make me feel that we can make a difference, which motivates me to keep working despite the risks.

doi: https://doi.org/10.1038/d41586-023-03099-y

This interview has been edited for length and clarity.

This story originally appeared on: Nature - Author:Shihab Jamal