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Arab World Fails in Mental Health Care, Germany Chooses to Pay the Price

Reutknife
A Syrian refugee in Reutlingen, apparently upset about relationship troubles, hacked a 45-year-old woman to death with a 40-cm döner kebab knife. He then ran shrieking through the city, hacking at other people with the knife, until a man in a BMW ran him over and brought the rampage to an end. Although only in Germany for a year, the accused killer had been in trouble with the police before for drug, property, and violent crimes (g). Early reports about the 27-year-old Syrian rejected asylum seeker who blew himself up in Ansbach, injuring a dozen other people, indicate he had a history of mental illness and had twice attempted suicide.

This is not normal behavior, even for people who (may) have withstood trauma. And this sort of behavior doesn't just crop up one day out of nowhere. It's a good bet both of these men displayed behavior problems back home, although given taboos and the language barrier, it will probably be hard to find out precise facts.

As I've argued before on this blog, it seems that among the hugely disproportionate numbers of random young males Germany allowed to wander across the border last year, there's a disproportionate number of violent, mentally ill young men. The reasoning could hardly be simpler: If you have 5 children, 3 of whom are men, and 2 of those men have jobs and/or families, who are you going to send to Germany to try to set down an anchor there and start the chain migration which, your hope, might one day allow your whole family to resettle? Two of your sons are founding families and/or generating income to support you, so losing them would be a problem. But what about your 18-year-old son, who has always seemed a bit 'off', who says odd things or deals drugs or has a nasty temper or sometimes talks to himself?

One of the reasons families might be eager to off-load family members with mental illnesses is because mental health care in the Arab world is totally inadequate

The Arab world is taken to mean the 22 members of the Arab League, accounting for 280 million people. The region has the largest proportion of young people in the world: 38% of Arabs are under 14. Life expectancy has increased by 15 years over the past three decades, and infant mortality has dropped by two-thirds. Around 12 million people, or 15% of the labor force, are unemployed. The quality of education has recently deteriorated, and there is a severe mismatch between the labor market and the education system. Adult illiteracy rates have declined, but are still very high: 65 million adults are illiterate, almost two-thirds of them women. Some 10 million children still have no schooling at all.

The health expenditure estimated as a percentage of gross domestic product is highest in Palestine (13.5%), followed by Lebanon (8.8%), Jordan and Djibouti (8.5%) and Egypt (6.4%) . Health services in all Arab countries are provided by public (government) and private sector facilities and out of pocket (this last category representing 63.4% of the total in Sudan, 58.7% in Egypt, 58% in Yemen, 56.1% in Morocco and 54.9% in Syria). In some countries insurance systems contribute to the provision of the service. Non-governmental organizations (NGOs) have come to be recognized as an important actor in the provision of health services, especially in countries with internal instability (in particular, Lebanon in late 1980s and Palestine now).

The mental health expenditure as a percentage of total health expenditure is not available in most Arab countries and not reported by the officials. Only three Arab countries have provided an estimate: Qatar (1%), Egypt (less than 1%) and Palestine (2.5%)....

Currently, most of the Arab countries are exposed to conflicts, wars, terrorism and fundamentalism, which may be the seeds for many behavioral and mental disorders.

Cultural beliefs of possessions and the impact of sorcery or the evil eye affect interpretation of mental symptoms. In this context, the first resort for the families of mental patients is not even the general practitioner, but the traditional healers, who acquire a special importance because of their claim of dealing with the “mystical” and the “unknown”. In the majority of Arab countries there is no interaction between the medical profession and the traditional healers. In Jordan, there is some kind of a relationship, which remains informal and unorganized. In Saudi Arabia, however, they constitute part of the staff, using religious text and recitation in management.

In conclusion, our data show that, in the Arab world, health and education budget assignment is below the recommended requirements far better quality of life. The budget allowed for mental health as a percentage from the total health budget, in the few countries where information is available, is far below the range to promote mental health services. The mental health human resources and the inefficient data collection by the official agencies are incompatible with the gross domestic product of Arab countries. An appeal for implementing mental health in primary care as stipulated as a policy in many Arab countries and to prioritize mental health in the agenda of politicians is urgently needed.

In the close kin-network and community you live in, your son already notorious as a problem child and/or petty criminal and/or target of a curse or evil eye, so he cannot find a job and isn't a suitable match for an arranged marriage. At home, he can do nothing but cause problems for your family. Abroad, nobody knows about his past, and he'll have a chance for a fresh start. 

As long as there's a country there offering a welcome and housing and education and money to any random young male who makes it across their borders, what's there to lose? Even the $5,000 for a smuggler isn't that much of a sacrifice, since you will no longer have that mouth to feed, and will no longer have to stay up at night worrying about what your unstable, unpredictable family black sheep might do tomorrow. And if he lands in prison or a mental hospital in Germany, everyone knows those are quite comfortable in comparison with similar institutions anywhere else in the world.  And maybe the change will do him good, he'll establish himself, and bring you to join him! What is $5,000 against the priceless prospect of being able to relocate most of your family to a nation which is infinitely more stable and secure than where you live?

More stable and secure for now, that is...

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