DEMOCRACY AT RISK

LIFE AFTER WAR

FORCED MIGRATION AND MENTAL HEALTH

A billion people are forcibly on the move today: men, women, and children flung far from their centers of gravity, from places their communities have known for generations. These are survivors, remnants of conflict zones who somehow escaped the worst of humanity. Embarking on geographic journeys beyond the terror, most find that trauma travels, too. While they cut across many categories—the ‘internally displaced’ who fled their homes but not their countries, refugees and asylum seekers unable to return to their home countries, impoverished economic migrants, families hoping to reunite, and the untold numbers of stateless people—they share one very important trait. They are desperate.

By the close of 2024, the United Nations High Commission of Refugees projects record numbers will cross into low- and middle- income nations with scarce resources to meet these non-citizens’ needs. They flee to fledgling or established democracies, yet their emotional turmoil is made worse by unwelcome responses from unwilling hosts. The World Health Organization (WHO) tracks forced migrants worldwide to document how this stress of displacement aggravate or ignite mental illness, and found the combination afflicted one in five people, globally. Since it issued this warning, Russia has ravaged Ukraine,Israel has wrought heavy revenge on Gaza for Hamas’ gruesome attack, and Sudanese are wracked by civil war, devastating storms and cholera. WHO must now track the many millions more ejected from their homes.

‘Traumatized’ has become a major demographic. Victims live with their perpetrators and among silent eyewitnesses to unspeakable atrocities. They are crammed together behind high fences of refugee camps, stuffed into detention centers, restricted to the most blighted, overcrowded parts of town and thrust into rural, remote oblivion. Theirs is a dual existence of density and isolation. They have close, if not cramped physical contact, yet their communication is blocked by anxiety, depression, extreme agitation, and psychosis. Most cultural norms fear or punish such mental health challenges, leaving individuals and families to suppress and hide troubles at home, in transit, and in their new host country. 

The mismatch between survivors’ mental health needs and their hosts’ refusal to help portends long term problems for democracy. With intra-and extra-regional conflicts, the number of people damaged and disturbed by war ever increases. If we fail to reverse this trend, we will be a world where the majority of us are emotionally destabilized, vulnerable to manipulative leaders who favor control over freedom, autocracy over democracy. The Kennedy School, the National Institutes of Health, and Freedom House all point to today’s surge of autocracies and the severe impact on mental health, their brutal consequences for the mentally disabled unable to push back on government control or to conquer its neglect.

Life After War: Disturbed transports you to over a dozen countries, some decades into their post-war years; others still in daily conflict. Images and storyboards spotlight here and now conditions, and horizon concerns for growing populations. They are real and representative of places where development demands are vast, human engagement is critical, and the investment dollar can go far. Individually and collectively all of us define the capacity to change the equation – we are the world’s students, its civic leaders, its religiously affiliated, its political organizers, its entrepreneurs, its investors, its young professionals, its wise and skilled retirees. We are all equipped to help change this equation.

Amy Kaslow   Washington, D.C.   August, 2024

S Y R I A N S I N J O R D A N

This is Rana Ersar, boldly confronting sexual violence in the burgeoning Muslim refugee communities of Amman. This is what Arab leadership looks like, rising from families, from entire countries ravaged by war. One of five and a half million Syrians who managed to escape the decade-long horror, Ersar landed nextdoor in Jordan’s capital, an ever hot and dusty place where she shares four rooms with sixteen family members. Their neighborhood is filled with a bevy of other nationalities living the same way: Sudanese who survived massacres in Darfur, Somalis who fled al-Shabab’s terror, Iraqis who dodged death from the many wars on their soil. Syrians are the largest group by far. Countrywide, UNHCR says they number 670,000, though Jordan contends they’re double that, while aid groups and diplomats put their total near two million.

After scrambling for safety, food, and shelter, the refugees have more to fight for: medical care, schools, jobs, family unification. The list of everyday needs is often blurred by the massive cloud of trauma that’s both deeply individual and community wide. Jordan’s Association of Psychiatrists claims one in four people have mental health challenges, while the lament among Jordan’s social workers is absurdly true: there is just one psychologist for every 50,000 people, including millions of refugees badly damaged by what drove them here.

The list of everyday needs is often blurred by the massive cloud of trauma that's both deeply individual and community wide.

The ratio is obvious in daily life. The director of a decrepit public school in East Amman manages the swell of refugees by educating in two shifts each day (1,100 students in the morning; 1,300 students in the afternoon and doubling the class sizes. She’s too short-staffed to prevent the “many children who grow up in poor, violent families” from disrupting, bullying, and fighting teachers and classmates alike. Hers is an all-girls school, where she sees families embroiled in gender violence that is so broad based, the World Bank and Harvard University teamed up and surveyed 1,000 East Amman youth to innovate solutions.

Jordan is a poor country. An aid recipient before its first influx of Palestinians in 1947, it’s been one ever since. Bereft of natural resources, the Hashemite Kingdom has something else highly valuable to donors: peace, and multibillion-dollar foreign assistance is critical to maintaining it. Long stable in a region of utter volatility, Jordan houses the world’s second highest number of refugees, per capita, in city-sized refugee camps with residents whose needs far outsize and outpace Jordan’s capacity to adequately respond. Here, average monthly salaries don’t exceed $1,000 and government belt tightening leaves even the kingdom’s most loyal tribes financially strapped. Stressors are many. Natives, including millions of Palestinian refugees granted citizenship over the years, resent newer migrants for pushing down wages and taking paychecks from locals. Syrian, Iraqi, and Palestinian child labor is the norm; and young girls are at highest risk for indentured servitude, sex trafficking, and most commonly, forced marriage.

Mental illness, barely beyond the official and cultural recognition stage here, has one very determined booster: The Center for Victims of Torture trains local Jordanians and refugees to treat traumatized and abused survivors. Among them is Ersar, whose husband abandoned her a decade ago. CARE works deep in communities developing self-help for females. Now it is Ersar who extends support through a CARE’s Women’s Leadership Council, moving from neighborhood to neighborhood building networks to expose and stop gender-based violence. “We are a link between the community and the decision makers,” she says, acutely aware of sexual violence as an everyday threat. Along with cohorts from Somalia, Yemen, Iraq, Syria and Sudan, she came out of a conflict zone where rape is the most common weapon of war. And they all landed in male-dominated Jordan, where men often conflate aggression with masculinity.

N I G E R I A

Poverty in Sub-Saharan Africa is persistent, profound, and its most populated country is mired in it. Consider these residents of Toge, a village along NIgeria’s major airport road leading to the nearby capital, Abuja. Generations have lived here with no running water, their floors packed dirt in the dry season and muddy during the rains. Misery increases by the minute as demographers predict yet another decade of mismanagement and unchecked violence will thrust 120 million more Nigerians into extreme deprivation.

Oil rich, the country should be an economic powerhouse, schooled and self-sufficient. Instead, it leads the world in the number of children shut out of an education, the majority girls. HIV-AIDS has been the top killer here since the 1980s; Nigeria still claims the second highest HIV infection penetration, globally. Life expectancy? It’s 61 years, one of the world’s lowest. The country soars in corruption, indeed not much transpires without a payoff, from greasing teachers’ palms so registered students can access public schools to prepaying doctors to show up at hospital, where more payola is required inside. WIth Nigeria leaders intent on raising their own prospects, not the nation's living standards, the result is widespread hopelessness, a breeding ground for radical groups whose savage attacks have forced millions of Nigerians from their homes. The best known is Boko Haram, the 22 year-old insurgency kidnapping and sexually enslaves girls as young as those cradled in this mother’s arms. Invoking Islamic Jihad, it deploys toddlers as human bombs.

Criminal justice is corroded at the most basic level: local police demand bribes from parents brave enough to report the abduction of their child

Thugs steal people with little fear of retribution. Kidnap for ransom is brisk business, but only a small part of the robust trade in human beings that goes unchecked in Nigeria, where tens of thousands of citizens are trafficked every year as sex workers, in the construction trades, as farm hands—the entire list of categories is unknown. There is little redress.

Corroded at the most basic level, criminal justice is Nigeria’s oxymoron: local police demand bribes from parents brave enough to report the abduction of their child. Traffickers lure mothers and daughters into sex work, promising them more than the hunger and squalor they leave behind. Tens of thousands are exported to Europe each year, where they are the most trafficked nationality and large numbers go missing. Forced to work off extortionate debts to their traffickers, women and girls are indentured servants, suffering starvation, rape, forced abortions. Those who manage to escape and return home are stigmatized as impure and HIV-infected. Seeking psycho-social support risks injury or death.

Nigeria has a long tradition of punishing those with anxiety, depression and greater mental health issues, all still commonly seen as the work of witchcraft and bad spirits. 

Nigeria has a long tradition of punishing those with anxiety, depression, and greater mental health issues—all still commonly seen as the work of witchcraft and bad spirits. Its routine community response to acute mental health cases: chaining the person to a tree. Key to providing localized care, a properly trained and funded community can fill the gap between treatment needs and available services, which in Nigeria’s case, is substantial. A twenty-year-retrospective of global financing for mental health contends the efforts and the dollars have been grossly outsized by needs.

While Nigeria recently moved the country away from its original “Lunacy Act” ordering deviant citizens to be expunged from society through various means toward a new mental wellness approach that addresses depression, psychosis, trauma and other afflictions, the outlook is grim. Demonstrations and riots fill the streets as Nigeria’s uneasy democracy teeters, and with it, any progressive mental health policies.

K O S O V O

The last of the Balkan wars that shocked with each savage swipe at humanity, Kosovo had its own version of “ethnic cleansing,” a term coined when Yugoslavia’s 1990s breakup released an unrelenting surge of atrocities againt humankind. For more than a decade, these were the grounds for Croat, Musilin and Serb abusers who raped, tortured, and pointedly forced victims to witness brutality. Cities teemed with traumatized people seeking refuge from the madness. Frantic and acting fast, adults placed children in homes, hiding places, even abroad. War-weary parents too damaged to care for their young, cast them aside. Documentation was poor if it existed, and most survivors were warehoused in hastily constructed United Nations camps.

Substance abuse and suicide rates climb in tandem as economic prospects sink.

They have long since returned to their hamlets, villages, towns, and cities, but they remain deeply scarred. Fighting among a population under 2 million was often hand to hand and house to house. Attackers’ identities and their brutality are indelible in a place where mental health specialists assert depression and anxiety impact, if not personally afflict, society as a whole. Unemployment is epic in Europe’s youngest and poorest country; its jobless rate under twenty-five years old is among the highest in the world, illustrated countrywide with groups of idle young men languishing in public squares, smoking, drinking, brooding. Substance abuse and suicide rates climb in tandem as economic prospects sink. Now schools are a flashpoint; this year as Kosovar teachers nationwide call on government to help educators and counselors address widespread psychological disturbances among their students. This is striking, given the Balkan post war bravado.

Boundaries within and between new nation states, post-Yugoslavia, are largely drawn along linguistic, religious, and cultural lines, but inter-ethnic tensions know no borders. Today, the entire region is consumed with endless questions about who did what to whom and when there will be justice. Each year, more mass graves are unearthed and the list of proper burials grows. Anguish mixes with anxiety in a place where cultures cum nations cling to their own historical narratives, and where the threat of renewed vioence casts a constant pall.

Attackers’ identities and their brutality are indelible in a place where mental health specialists contend that depression and anxiety impact society as a whole.

The turbulence here is cover for a major human trafficking hub that taps into local demand and pivots as a leading re-export platform, and it starts at the top with military personnel, international aid workers and peacekeepers, such as the UN Kosovo Force (KFOR), important sources of clients and it turns out, big escalators of human trafficking. Corrupt and unimpeded by a toothless legal system, Kosovo’s organized crime and less formal networks enslave men, but mostly women and children, and sell them and their services in the Balkans, throughout Europe, and the Middle East. The youngest children are forced to beg until they are old enough to be marketed for sex. In an ironic response, Kosovo’s government has set up homes for battered and abused women and girls.

V I E T N A M

The streets of Hanoi are an anthropological study in migration, an urban sprawl created by millions of rural transplants in search of work. Vietnam’s capital city bulges with nearly 10 million people on the ground while enormous construction cranes crowd its skyline, beckoning more to come. This metropolis is at capacity, every square inch is occupied, and the density continues.

Lining roads and avenues, women stir cauldrons of piping hot soup while men stoop over tiny grills of meat. Tea time is all day, and Hanoi’s pavement is studded with people crouched over tiny cups at knee-high plastic tables. Everyone rinses dishes in buckets of murky water. and random open faucets provide curbside bathing as suds slide down gutters filled with refuse. Motorbikes become sleeping beds accommodating grown men draped over their saddles, but at rush hour, they rise and zoom up and over the curbs, choking the air with gas fumes thrown off by two-stroke engines. Trees piercing from sidewalks are pressed into service: their gnarled roots and thick trunks are fit for Buddhist shrines, outdoor closets, barbershops, mini-produce stands, super-rigged electrical outlets, and of course, dog urinals. This peddler sells the fruit, roots, and seeds popular among a clientele missing rural life. Carefully folding fragrant leaves for one customer, she looks up and nods to the next in line. Clearly, her patrons know where to find her each day.

Reckless industrial contamination and climate change threaten to wipe out vast portions of the country's agriculture and displace millions more Vietnamese.

Rural poverty like hers, including the massive loss of farming and fishing livelihoods are direct results of Vietnam’s severe environmental degradation that has forced migration to the cities. Reckless development and industrial dumping turned this resource rich region into one of the globe’s most environmentally vulnerable, contaminating vast portions of Vietnam’s agriculture and threatening to displace many millions more Alarmed scientists, students and scholars detail the impact of climate change on the treasured Mekong Delta.

Consummate market capitalists, under strict Communist Party control, the government plans a decades-long push to grow through exports, investment and entrepreneurship, no matter the ecological or the human cost. Unlike 1975, when Party dogma crackled nonstop through loudspeakers in every village, town, and city, the demagoguery is greatly throttled back now. Vietnam today is Communist Practical. There is one basic rule: don’t criticize the government, and that includes its poisoning of the nation’s natural resources The effect on civic society is chilling, of course, a constant reminder about who’s in control.

Who’s bristling? Vietnamese youth and young adults aged fifteen to twenty-nine, a collective quarter of the population well-aware that the best schools and jobs are reserved for party loyalists, that education costs far outstrip what’s affordable, that joblessness or low-quality employment await many who manage to graduate. For government planners, it’s simply about production, and soaking up as many youths as possible in low-wage, low-skill assembly line work while the factory investments pour in from South Korea, Singapore, Japan, and Taiwan. As trade wars rage and China’s costs rise, Vietnam is building factories for 20,000 to 30,000 workers devoted to the efficiency of the production line, be it electrical parts, shoes, or computer chips. These industrial zones house workers in complexes behind security fencing, where conditions are often harsh and abuses many. Human trafficking, forced labor, and sex slaves complete the equation. Vietnam brazenly ignores international standards, and dropped to a low point on the leading index of countries engaged in the purchase, sale, or enslavement of human beings. Given its porous borders and focus on luring workers to industrial areas, the trend will worsen if left unchecked.

It will take serious studies to determine the impact of intensive manufacturing on mental health, as well as the impact of racing urbanization on the psyche.

Communist Party leaders point to the millions it employs and the many more it prevented from sinking into poverty. It will take serious studies to determine the ongoing impact of intensive manufacturing on mental health, as well as the ongoing impact of racing urbanization on the psyche. Data is slim, but early assessments spotlight high incidences of depression, anxiety and other conditions related to stressful work environments. NGOs and mental health specialists accuse the government of underreporting numbers of Vietnamese confronting mental health issues. Outlying villages and towns have no access to treatment other than what’s considered the norm: banishment, caging, chaining, or worse. By sheer numbers, though, it’s in the cities where mental disorders are greatest, and as urbanization accelerates, the percentages will climb. Both Hanoi and Ho Chi Minh City’s urban sprawl seem as certain as the government’s determination to ignore the psycho-social toll on its citizens.

R W A N D A

In the 30 years since Rwanda redefined intra-national conflict by committing and somehow surviving the fastest genocide in history, it’s made striking progress in realms that long vex most post-war societies: security and living standards. The nation managed to quell the terror only after a savage, sustained, and orchestrated Hutu campaign wiped out nearly 800,000 Tutsis and moderate Hutus in just 100 days. Armed with machetes, hatchets, clubs, and spears, Hutu genocidaires moved through their own neighborhoods looking for “cockroaches” to exterminate; they killed men, women and children and left over 100,000 orphans, hundreds of thousands of rape victims, and a population traumatized for generations. It took decades, but the government aknowledged a third of the survivors suffer mental illness. Despite obvious needs, most suffering the wide range of mental disorders have spurned offers for treatment, fearing societal shaming will turn them into outcasts.

Rwanda is the third most imprisoned country in the world, housing tens of thousands of men and women convicted of massacring their neighbors, their friends, even their own families.

Paul Kagame, the first and only president since the genocide, reversed the exodus of Rwandans by outlawing ethnic division. Emphatically. His immediate command for “One Rwanda” has held this nation together for the last thirty years while he remarkably converts this east African nation’s devastation into economic opportunity. For years, he he disallowed Rwandans from talking publicly, much less teaching about the genocide, but no citizen escapes the genocide’s psychological legacy. The continent’s second most densely populated country is landlocked in a volatile region, making Rwanda’s villages important, often insular communities where locals took justice into their own hands and where they tried some 1.2 million accused in 12,000 local courts. The vast majority of assailants are back in their communities, having admitted crimes, apologized for their actions, and completed community service. Others went to the country’s dark prisons, where the inmates dress in fluorescent-colored solid pink, orange, and yellow, coded according to the severity of their crimes and sentences. Nothing can cover their deep emotional scars. They are in Rwanda, the third most imprisoned country in the world, housing tens of thousands of men and women convicted of massacring their neighbors, their friends, even their own families.

Kagame, who reworked the constitution so he could serve a third seven-year term, contends he is the answer to Rwanda’s continued stability. And he may be right. But Rwandans are so internal about coming to terms with their recent past, that closure is elusive and tensions fester. Here, everyone is a survivor. 

Rwandans are so internal about coming to terms with their recent past, that closure is elusive and tensions fester. Here, everyone is a survivor.

Chantal Murekatete stands next to the Ntarama Memorial Church, an orange brick structure pock-marked by gunfire and grenade explosions. A congregant here, her world was torn apart as Hutus raped and slaughtered their way through nearby Kigali and areas surrounding the church. Panicked by violent surges pitting neighbors against neighbors, and friends against friends, Murekatete joined five thousand other Tutsis from the region’s villages during the wild scramble for refuge. They filled the church, and those who could not fit inside, swelled just outside, hoping that huddling next to or near this place of worship would afford them some protection, some place closer to God.

Once a critical mass of Tutsis assembled, Church leaders called in Hutus who ignited the building with explosives, then butchered nearly everyone in and around the environs. The Church elders’ collusion with the attackers was a scene repeated across Rwanda's lush green landscape, known as “Land of a Thousand Hills.”

Hacked in the face and left for dead, Murekatete was piled on top of slaughtered bodies and underneath others. Victims endured unspeakable violations, including the disembodiment of pregnant women. Murekatete crawled out of the massacre, and quickly learned she lost her entire family. Twenty years later, she returned to the church to commemorate the anniversary of the genocide. It is now a memorial of blood-soaked clothing, dried and weathered, stuffed into the blasted-out windows and strewn across the crude wooden pews. Cracked skulls line shelves along the back walls. Murekatete's gaze seems focused on something very far away. She is silent.

E L S A L V A D O R

Daily inter- and intra- gang battles, just five years ago, thrust El Salvador among the most murderous places on earth. The government of Nayib Bukele was ushered in by voters demanding a public response, and he made demonstrable change, fast. In the most abject area of San Salvador, Bukele cleaned up gang occupied houses, restored them to locals, and stationed both the police and the military there to protect. For hopeful Salvadorans, what the new president accomplished in the bleakest part of the capital city, they began to see throughout the rest of El Salvador. Beating back the hyper violence requires force and follow through, fortitude no government has ever shown until now.

Throughout the country, terrified bus commuters long-avoided eye contact, lest they attract the attention of gang members preying on riders for cell phones, watches, and wallets. Thugs divided up territory to shakedown businesses, from modest papusa street carts to upscale professional offices, and they delivered on their promise to harm those who refused. Every school, every neighborhood, and every commercial establishment able to afford it, had installed high walls, barbed wire, and security guards with submachine guns. Pick-up trucks moved through the streets, with armed men perched in the back.

In a corrugated metal labyrinth of houses slapped together along a busy San Salvador highway in 2015, young Enri hung onto the front door. His mother left for her nearly five-hour round trip commute to clean houses, and the six-year-old was not allowed to go outside. Gang leaders lived next door and across the street. Like most Salvadorans, his family would not venture beyond the house after dark. More than 60,000 Salvadoran youth had already joined gangs. Today, nearly half of Salvadorans are under age twenty-four and have known years of risk and violence. Many languish in rural areas, so unaccompanied youth move to urban areas where they are vulnerable as victims and often became perpetrators themselves. The government’s bold pushback on terror may change the future for Enri’s generation, but years of unchecked extortion, rape and murder impact the psyche and mental health in a country where machismo crushes weakness and where mental health care is poor and out of reach for the vast majority.

Almost half of Salvadorans are under twenty-four years old, and had only known risk and violence in a country where machismo crushed weakness and where mental health care is out of reach for the vast majority. 

Gangs were gravitational pulls for idle Salvadorian teens and twenty-somethings drawn to purpose and protection, and the youth gave organized crime a wide and efficient stranglehold over society. The present government’s powerful and public marginalization of the gangs has restored local pride and planeloads of Salvadorans are returning home.

W E S T B A N K

For women and girls, mobility in this traditional male-dominated society is about agency, and those seeking it must brave a traditional Islamic culture thick with thorns. Economic life for West Bank Palestinian women has always been marginal, even as young females enrolled in higher education. Their participation in the labor force limps here; it’s one of the lowest in the world. Cultural acceptance of women at work and the jobs to match could change their course, despite and perhaps especially given the severe limitations Israel’s occupation imposes. This entrepreneur breeds songbirds to sell in remote villages of the Nablus Hills. She started her business with UNRWA’s micro financing, built enclosures in her backyard, and soon became a wholesaler to area pet stores. Her earnings have been critical for the family budget, and she has gained hard-won respect at home and in the community. As she gives a tour of her cages, her husband and children beam with pride. 

The mechanics of it look simple, but a complex layer of impediments stand in the way of similar successes. External inhibitors: closed borders with Israel, limitations on travel within the occupied territories, along with daily restrictions, humiliations and public fears of occupation. The internal restraint: pervasive male resistance. in this conservative Muslim society, the vast majority of men forbid their family’s females to attend school, to take public transportation, to use community childcare, or to work outside the home. Women and girls follow their father’s, son’s and brother’s commands. Emotionally destabilizing and physically degrading, gender marginalization compounds poverty, poor health and isolation for females across a broad swath of the Palestinian population.

The World Health Organization and the Palestinian Authority mapped mental health resources for West Bankers, and noted the powerful taboos against seeking help. Médecins Sans Frontières, decades deep into treating escalating mental health needs on the West Bank, calls emotional anguish and disability so stigmatized, it’s a silent crisis. But the Palestinian Authority’s top mental health professional, Sawah Jabr, cautions against WHO’s broad diagnostic strokes, and balks at the notion that post-traumatic stress disorder (PTSD) plagues Palestinians. For West Bankers and Gazans who face uncertainty and violence on a daily basis, there is nothing “post” about their disturbing experiences and fears, she says, making a distinction between what she calls “justified misery and clinical depression.”

Deteriorating economic conditions portend more challenges for Palestinian women and children where the largely conservative Muslim society eschews public discussion of sexual abuse and the repression of females is a cultural norm.

Deteriorating economic and security conditions portend worse challenges for Palestinian women and children. Sexual abuse is never addressed publicly, making repression of females a dangerous cultural norm that somehow gives family abusers quiet permission to sell females as commodiites in the sex slave market. It worsens during conflict, and the Jerusalem-based Palestinian women’s organization SAWA is here to fight sex trafficking’s enslavement of women and early teens, detailing prostitution rings, identifying perpetrators and fighting a crude Palestinian law allowing contrite rapists to avoid punishment if they marry their victims. Sawa chips away at deeply entrenched traditions of Arab households: psychological and physical blocks males erect to prevent their toddlers, their mothers, their sisters and grandmothers from going out in public. Even if it’s just to visit the nearby community center.

M O Z A M B I Q U E 

Global warming, a war humans have waged on the earth, wreaks havoc on Africa’s southeast coast. This is Kongolote Refugee Camp, a few miles from Mozambique’s capital of Maputo, and a few months after a cyclone struck with its savage rains. Nature’s wrath is familiar to the lowlands along this southeastern coast, unleashing here every couple of years. When the water reaches impossibly high levels, desperate locals cling to trees, climb to rooftops, and hope that boats and recovery helicopters spot them in time. After washing away lives, tropical storms leave people languishing in camps for months, usually years, where endless lines of canvas tents are caked in dried mud and the hot air is thick with dust. These restless children are among many millions forced from flooded areas to dry patches of land. This is circa 2000; today they’re probably parents, even grandparents. Once again, they’re under water as Mozambique staggers from the most deadly, most costly cyclone that’s ever swept across this part of the Indian Ocean’s coastline.

 A leading indicator of economic development—the education of girls—barely registers in Mozambique. 

Aid groups know this country as the epicenter for the region’s storms and geo hazards that level enormous swaths of land, stripping survivors of homes they’ll never replace. Wracked by a sixteen-year civil war that left a million dead and the people divided, 70 percent of Mozambicans today live in poverty, most of it extreme. Storm after storm breaks up families, leaving women and children vulnerable to raw street life where the police do little to thwart roaming gangs, violent crime, sexual abuse and human trafficking.

Migrant physical health is a vexing problem in Southeastern Africa, where HIV and TB infection rates are the world’s worst. The natural disasters quickly spread communicable diseases that command immediate responses. The storms also wreak havoc on mental health: migrants and internally displaced are more prone to mental illness. What makes the situation dire for young migrants here is the exploitation of children, escalating alarmingly fast, and in the dark. Labor and human rights groups detail widespread abuses in an economy that’s more than 80 percent informal, which means no oversight and no accountability. They estimate some 30 percent of the country’s children, as young as these boys here, are forced into labor. Unchecked, this trend could overtake the percentage of boys and girls attending school. A leading indicator of economic development—the education of girls—barely registers in Mozambique. Nearly half the country’s females aged fifteen years and older are illiterate. Clearly, the country’s problems extend far beyond the short term.

Some 30 percent of the country’s youth, aged five to fifteen are forced into labor. Unchecked, this trend could overtake the percentage of boys and girls attending school. 

2019’s back-to-back cyclones obliterated the nation’s harvests and farms, and the human toll is still unknown. The torrential rains collapsed infrastructure and intensified challenges to meet emergency needs. Major health groups like UNICEF, WHO, and Médecins Sans Frontières scrambled to beat back deadly cholera outbreaks.

Mozambique’s responses to these urgencies never address the population’s attending emotional trauma. Indeed, the latest onsite look and literature review contends that mental health care in Mozambique is as deficient as it is needed: massively. The nation needs homegrown capabilities, a strong medical community with schools, doctors, clinics, and hospitals that not only treat post-disaster trauma but also engage the public in ways to blunt its impact. The repeated and untreated shock, or PTSD, compounds physical and mental illness. Yet broader society further marginalizes the afflicted; Mozambicans view mental disorders with fear and suspicion.

Unable to stop climate change in its tracks, the government expects income from its vast gas fields will pull the people out of devastation and poverty. The deposits are along the northeastern coast, where Islamic radicals tap into local frustrations. The main grievance against the government: its brutal land grabs that upended the entire landscape and emptied out longtime residents. Economic prospects are so bad, humiliated men cannot afford to pay the “marriage fee” for prospective brides. The conditions are ripe for Islamic radicals to pluck young men from the streets.

Among the NGOs with the staying power on the ground, CARE is a standout given its ability to help troubleshoot immediate shortages like clean water, nutrition, sanitation, shelter and cultivate longer term solutions to send girls to school, train and employ women, and mitigate the impact of successive natural disasters.

G U A T E M A L A

Drugs, violence, and profiteering governments have crushed Guatemala’s society. The UN-backed corruption monitor crystalizes the impact on average citizens caught in a world where criminals run with impunity while elected leaders collude, mafia-style, with ruthless gangs and the burgeoning narcotics trade. The toxicity is stark wit a quarter of the population suffering neuropsychiatric disorders in their lifetime. 

Mothers stunted in their own growth struggle to feed themselves and their children. Generations are borne of sexual violence.

Made destitute by government land grabs and fearing farming in fertile areas where terror reigns, Guatemalans go hungry. Famine hits indigenous tribes hard as does the legacy of the nation’s thirty-six-year civil war, when militias gang-raped and murdered entire native communities in the highlands. Generations are borne of the militias’ and guerillas’ top weaon of war: sexual violence. Indigenous number nearly half of Guaemala’s population, and two thirds suffer malnourishment. Stunted in their own growth, mothers struggle to feed themselves and their children.

In and outside of families, a culture of impunity normalizes sexual assaults. Femicide is among the highest in the world here. It’s all in the dark: a staggering 90 percent of domestic violence cases go unreported, while only 2 percent of murder cases prosecuted result in a conviction. Progress is one step forward and two steps back, because de jure and de facto are two separate realities. Although the legal age for marriage was increased from fourteen to eighteen in 2015, in practice, nearly a quarter of female minors married. Misogyny’s grip on Guatemala means males control whether girls can attend school and if women can leave the house. A staggering 82 percent of Guatemalan men surveyed nearly a decade ago denied the women in their lives had any authority. Laws may have changed since then, but practices haven’t, especially among native populations. Fathers still force daughters to marry before puberty. Female illiteracy is high, strikingly so among the indigenous.

The country has seen a surge in incest and births among ten to fourteen-year-olds. Bearing children at high risk to their own bodies and to those of the newborns, young teens care for large families well before they have learned to care for themselves. This, while Guatemala moves to further criminalize abortion and restrict access to sexual and reproductive services. The country is savagely making its way up to the number one spot as the most sexually violent and murderous place for women on earth.

Where in the chaos can ailing child mothers find and safely access psycho-social support? What are the prospects for escaping aggression, so firmly rooted in the nation’s culture? The tens of thousands of Guatemalans who leave their homes each month, desperate for a better life beyond their borders, already know the answers to those questions. Emigration is a highly gendered phenomenon as degradation and survival push women out of the country. For those who remain, psycho-social services are minimal and out of reach.

Here, on the cobblestone streets of Antigua, mothers and their young arrive each morning from far outside the city to peddle vibrant woven goods, leather products, assorted fruit, and vegetables. They come from the rural areas and highlands where new mothers are pre-adolescent.

Guatemalan women are pushing back on commonplace public sexual assault in libraries, at schools, inside parks, bathrooms, near national monuments… and on virtually every bus. 

With international intervention, Guatemalan women try to push back on what 44 percent of UN surveyed respondents reported commonplace public sexual assault in libraries, at schools, inside parks, bathrooms, near national monuments, and of course, buses. Local NGO Multicolores reaches for remote, high risk women who suffer seemingly inescapable violence at home. Tapping into designs and explosive color of their Maya world, the women learn rug hooking, a profitable and physically liberating replacement to the painful backstrap loom they long used for cotton weaving. Tearing second-hand t-shirts into piles of color, the women share struggles and successes, while their artful, high-priced floor and wall coverings are exhibited in fine art galleries and win international textile prizes. They have gained the respect of local men, the community at large, and even the US government; the State Department Arts in Embassies purchased three oversized Multicolores rugs and installed them in the permanent collection of the US Embassy in Guatemala City.

I R A Q

Once the bastion of secularism in the Arab world, where women advanced in their careers and highly educated youth were the nation’s great promise, Iraq’s elevation has been leveled, war after war. Conflict has eroded families, along with a society protecting childhood as sacred and recognizing women as essential. After an eight-year battle with Iran, much of it hand-to-hand combat, soldiers returning from the front were edged out by a replacement workforce: educated and trained Iraqi females combined with foreign manual labor. Gender violence escalated, poverty quickly spread, and anguished parents began to deploy their young sons and daughters as income earners. 

An alarming number of children have been dispatched to stave off family hunger: they peddle cigarettes, petrol, pornography and themselves.

Along the banks of the Tigris River, a moonlit beggar boy tries to hustle a passerby with card tricks. He was a rare sight in 1989. But during the thirty-five years of invasions and many insurgencies since, an alarming number of children have been dispatched to stave off family hunger. They peddle cigarettes, petrol, pornography, and themselves.

Today, millions of Iraqis are displaced across the country, and refugee camps are exploding. Instability is the best breeding ground for human traffickers, and in Iraq, there have been many competitors in the market: ISIS-trained, Iran-backed militias, and tribal forces. They abduct women and children to deploy them in combat, as ordnance makers, human shields, suicide bombers, and indentured servants. They pluck eight-year-olds from their homes, force youth from refugee camps, and have targeted entire ethnic populations like Yazidi women for sexual slavery. As Iraq attempts to restore some semblance of order to the land and the occupied people ISIS left in its wake, the survivors’ mental disorders command attention and resources. 

Iraq’s psychological fallout from a continuum of crises simply overwhelms any local professional capacity. 

Iraq’s psychological fallout from a continuum of crises simply overwhelms any local professional capacity. Mental disorders are the fourth leading cause of ill health in Iraqis over the age of five, asserts Médecins Sans Frontières, the global NGO that has fanned out across the country to offer and train others in pyscho-social support. Hospital beds are at capacity, and international attention is waning. The International Organization of Migration visits refugee and displaced persons camps to de-stigmatize discussion about mental health and major stressors, including domestic violence, joblessness, and marginalization. Hundreds of NGOs are on the ground in Iraq to treat trauma, depression, and psychosis.

The land where Arab women had unparalleled agency and where parents once pampered, even insulated their young, is gratuitously violent. Iraq is now a global destination point for sex tourists seeking children and a leading marketplace for human slavery.

R U S S I A

Outside the Chamah soup kitchen in Moscow, elderly and indigent Jewish patrons line up in the falling snow. Some ride two hours each way on the city’s crime infested metro for nutrition that’s become critical to their survival. Once they arrive, they find a whirl of activity where cooks and volunteers turn out piping hot pots of stew, plates piled with meat, and buttered rolls straight from the oven. The lunchroom is filled with diners who peel off layers of clothing before they tuck into their serving.

Russia’s aging citizens struggle on minimal resources. Since the fall of the Soviet Union in 1991, pensions shriveled, government assistance vanished, and the aged found food and fuel prices far out of reach. For the group at Chamah, deprivation was just the latest in a succession of horrors they survived over many decades: anti-Jewish pogroms, the Holocaust, Stalin's forced labor camps, refused emigration, banishment to Siberia, vicious anti-Semitic attacks, the wrath of skinheads, and ever-increasing Russian xenophobia. And now? Insecurity is the norm. President Vladimir Putin’s xenophobic nationalism often cites Jews and other minorities as suspicious groups, further marginalizing them. 

While lackluster about using psychiatry to treat the mentally ill, the government regularly deploys it as a political punishment, and it’s notorious for its “forensic tests” of its opponents. 

Today, the Chamah soup kitchen serves hundreds of destitute Jews. Most are isolated, living in decrepit apartments and houses, some with no running water or adequate heat. After they push back from their noontime meal here, the men and women often linger at cloth-covered lunch tables, telling stories and gossiping while others settle quietly in the library. They come from different parts of the vast city, and this is their sense of community, much of it funded by overseas aid organizations. Russia ranks the seventh lowest in the world in psychological and mental wellbeing, with no specialized care for geriatrics, a glaring omission for this aging society.

The Russian government controls the country’s entire mental health landscape, administering service characterized by Russian psychiatric professionals as once poor, now abysmal. The Kremlin slashes funds, drastically reduces hospital beds, and ignores acutely needed outpatient services. It’s made few gains in this arena since it crudely warehoused patients in former barracks, remote monasteries, even old slave labor and concentration camps. Russian xenophobic culture is suspicious of difference, and dismissive of weakness. While lackluster about using psychiatry to treat the mentally ill, the government regularly deploys it as a political punishment. A noted Dutch-based NGO released a damning assessment of Russia’s abuse of psychiatry for political purposes, case studies of government critics, members of the opposition, and more. Victims are seized, tortured, tested, diagnosed and incarcerated in asylums, labeled with the wide array of fabricated mental illnesses.

Integrating mental health into mainstream medicine, much less as a form of geriatric care, is far from Russia’s reality. 

Integrating mental health into mainstream medicine, much less as a form of geriatric care, is far from Russia’s reality. NGOs do what they can to fill the gaping holes in coverage. Chamah dispatches doctors for home visits and casts a wide net with its meals and ways to attend to elderly who would otherwise die from neglect.

The soup kitchen is a destination for those who are isolated, and the sustenance is beyond food. Patrons here wear their very best clothing for their lunch together. Men arrive in old suits and neckties, and women in brightly colored scarves. Social workers here say the conversation and camaraderie over daily meals is as much about dignity as it is survival.

T H E D O M

This young Dom girl was found playing in one of Amman’s many rambling and decrepit areas where have-not Jordanians share space with millions of other poverty-stricken immigrants. There are the Palestinians who fled Israel, the Iraqis and Syrians who poured in from wars next door, the Africans drawn by Jordan’s open door to refugees. And there are increasing numbers of Dom. Largely unknown, the minority lives on society’s edge in almost every country of the region. Called Gypsies, the Dom, like the Roma, trace their roots back to the Punjab’s castes of migrating artisans and entertainers who left the subcontinent some 1000 years ago. Once they reached Persia or thereabouts, the Roma went on to Europe, and the lower status Dom continued deep into the Middle East. All have been stuck at the intersection of social isolation, poverty, and political instability, ever since. Stigmatized and severely ostracized, Dom have poor access to public facilities. Safe water, adequate nourishment, education, employment and medical attention all elude them. Virtually non-existent for this group: mental health care for afflictions caused or exacerbated by their rough conditions. 

Stigmatized and severely ostracized, Dom have little to no access to public facilities.

Dom families have been here since Jordan was founded, their encampments the only sign of life along an otherwise barren desert-scape. The caravans are all but gone, those tending livestock are increasingly rare. Regional wars, violence, and destitution forced many clans to break up. Most have gone urban: their largely nomadic lifestyle has given way to life in small, substandard structures on the blighted outskirts of cities and towns. Some cling to tent life, scraping to pay rent for a small area, wedged in between buildings, or in an open, abandoned lot.

Their lives are hardly stable, or secure. It is a rare national host that affords them what the general citizenry enjoys: energy, water, schooling, sanitation, healthcare, and police protection. In Jordan, as elsewhere, Dom are marginalized, stateless, left to fend for their own communities. As wars displace them across the region, even United Nations Camps turn Dom away for inadequate personal documentation. Here, in Jordan’s capital city, school teachers claim that Dom are class bullies, unruly, and dishonest. They start fights in the hallways, complains one overworked administrator. She contends Dom children are more aggressive because of family violence.

Public disdain for the minority is so profound, Dom must hide their identity and “pass” for another ethnicity.

Public disdain for the minority is so profound, Dom who do become professionals must hide their identity and “pass” for another ethnicity. This, while Dom youth do what they do: they try to fit in. They want to lose what they call the Gypsy dress, the Domari speech, the markers of belonging to the group at the bottom.

Children drop out of school early. Boys train for carpentry and textile jobs that will go to Jordanians and other refugees, first. And this child, found playing on the steps, will likely marry in a couple of years. Dom girls become brides by age fifteen, caring for their own babies before growing up themselves. They will try to stay with their clan, for support. But societal pressures and urbanization mean Dom are detached from their own customs, minimizing their traditions and their language.

While refugee demands continue to surge here, the competition for resources leaves Jordan’s Dom at the end of the list. There is one group after them: the Syrian Dom, refugees who fled next door in search of a better life. The outlook for the Dom as an ethnic group looks grim, perhaps imperiled. Prejudice against them is so powerful, it even puts humanitarian assistance out of reach. Stateless, they’re not even on the radar of mainstream aid groups.

L E B A N O N

Down a short hill from Lebanon’s storied American University of Beirut, an old broom seller hawks his wares, street side. He’s perched on an overturned bucket right at the hairpin turn where drivers are forced to slow down long enough to glance at his collection of mops and brushes. He waits. Business is slow for this octogenarian, a Palestinian refugee from Jerusalem. His family escaped the violence of “the Nakba,” what Palestinians call 1948 when Arabs both fled and were expelled from the new state of Israel. He’s anxious to talk about why he’s still sitting with so many items near the end of the day. It’s a string of common complaints: there are no jobs for Lebanese he says, and Palestinian work permits are even harder to come by, the government has no money, people are getting more desperate, and there is growing anger toward refugees. 

It’s a string of common complaints: there are no jobs for Lebanese and Palestinian work permits are even harder to come by, the government has no money, people are getting more desperate, and there is growing anger toward refugees.

Still staggering from its own protracted civil war that ended in 1990, Lebanon has long been the go-to for survivors and fighters from neighboring conflicts. The trend started a century ago with an influx of Armenians fleeing their homeland. A destination point for Palestinians from their earliest fights with Israel and a landing pad for their leaders after Jordan expelled them, the country is now under Shia-Islamicist Hezbollah control. Add onto that millions of Syrians who have crossed into Lebanon since Assad turned on his people in 2011, and the country earns the dubious distinction as host to the largest refugee population, per capita, worldwide. All this in a territory the size of the state of Connecticut.

Lebanon has long lived as a world-class debtor, and it functions erratically under financial pressure. Divided along sectarian lines, government payroll is all about patriarchy and covers ten percent of the entire population, including rosters of “ghost workers” who collect income but don’t work. Donor fatigue means diminished aid for refugees while Lebanon’s treasury scrambles to pay salaries. Cuts in military pensions, university funding, utilities, and other critical services leave most limping but hit harder for the staggering 44 percent of the population living in poverty. Popular resentment builds over refugees for Lebanese job losses. The government has teamed up with dozens of local humanitarian organizations and many more internationally to critically assess Lebanon’s mental health environment and to develop a strategic plan for the nation’s pressing mental health needs. 

Remarkably, Lebanon’s lack of public confidence is matched by its strong civic engagement. Perhaps the place with the single largest engagement of NGOs, worldwide, Lebanese society has a long history of community and extra-community responsibility, with thousands of groups positioned to help the needy.

And the future? Up-and-coming Lebanese talent worry about underemployment and shrinking wages across the spectrum. Refugees’ desperate acceptance of lower pay and dangerous working conditions has pushed more citizens out of work into poverty. Legions of jobless Lebanese college grads are part of a disturbing brain drain of promising youth who want to work as the engineer or accountant they trained to be, not in the waitress or bus driving job they’ve managed to find. The poor are growing poorer, and many who thought they “made it” are falling from the coveted entrepreneurial middle class. They call it 'the neglected crisis:’ new, steep economic divisions more profound than ethnic, religious, and political differences.

In Beirut, the divide is inescapably visual. Consider the new pristine downtown area, with soaring white buildings affordable to rich Gulf Arabs. Lined with absentee investments, the streets are empty and quiet, save the construction cranes operating nearby. A wooden plank wall shielding a prime seaside building site is sprayed with "You Stink but you don’t do sh*t” in big, black angry letters. Graffiti artists have sprayed the "You Stink" movement's message since 2015’s trash crisis, when garbage piled high on streets, dumps were beyond capacity, and public rage about government incompetence spurred a powerful wave of homegrown advocacy for better living standards.

Across the city at the Burj Barajneh Refugee Camp, Palestinian men return from a day’s work. Wearing soiled white shirts with “window cleaner” in large black letters across their backs, they walk through a dusty haze of heat and diesel emissions, passing waist-high piles of trash and industrial refuse. Their home is just beyond the 40-foot-high metal fencing. It’s a place teeming with men in open-air metal works, repair shops, and fruit stands, groups of them walking to mosques, and others gossiping over tea. Children dart in and out of makeshift houses with corrugated metal roofs. Women peer out of windows and from behind curtains. Lebanon is home to hundreds of thousands of Palestinians like these. Many have integrated into villages and cities over the decades, while others remain in sprawling camps-cum-urban ghettos.

The country won’t allow more recent Syrian arrivals this illusion of stability. Lebanese authorities force them to break down the hard structures they erect to weather the punishing winds and rains. Nothing permanent, the government warns; the Syrians aren’t staying.

R E P U B L I K A S R P S K A

This is the face of grief, one among hundreds of thousands of anguished Muslims who make the mountainous memorial trek to Srebrenica. In this Bosnian town nearly 30 years ago, Serbs unleashed their most savage attack of the Balkan wars. Raiding a “safe enclave” for Muslims, they rounded up men and boys, warehoused them in a battery factory, tortured and slaughtered them. Serbs coined the phrase “ethnic cleansing” as they erased males from virtually every family in Srebrenica and for miles around. The death toll neared 8,000. 

Every year, Bosnians lay more fully assembled relatives to rest. Dozens of graves are closed each summer. A thousand more skeletons are still missing, leaving the entire population waiting for closure.  

Serb killers feared mass graves could lead to war crimes charges, so they drove earthmoving equipment through the carnage to quickly spread the corpses wide and far. For the past three decades, forensic investigators and average citizens have unearthed human bones in this mountaintop town, just miles from the Serbian border. The work continues, and every year, Bosnian Muslims lay more fully assembled relatives to rest. Dozens of graves of completed skeletons are closed each summer. A thousand more victims are still missing, leaving the entire population waiting for closure and still in aftershock. A new repository for bones and personal effects, including clothing, will house these partial remains until their burials can be complete.

Srebrenica remains a Muslim majority in Bosnia’s Serb-dominated Republika Srpska, as remnants of families return to slowly repair their lives. Stone stairways crumble into tall weeds; the houses they once led to are blackened ruble. From a distance, stacked red brick and corrugated roofing sheets appear to be a promising new beginning, but a closer look reveals long-weathered materials crusted with rubbish and the stains of time. There are as many unfinished new houses as there are those destroyed. 

All of Bosnia still wears the conflict that incinerated populated areas, along with the infrastructure and housing stock supporting them. Cites and rural hamlets alike are pockmarked from shelling, their streets still marred by mortar fire. Billboards rise from large swaths of fenced-off land, warning of mines, and unexploded ordnance. 

Survivors here, and throughout Bosnia, resent the US-brokered agreement that pushed combatants into an uneasy peace and offered little more than the template for separateness: Serb governance in the north and northeast (called Republika Srpska) with a Bosnian Muslim and Croat federation covering the rest of the landscape. Bosnians agree on one thing: their self-serving government is a failure. Leaders tap into bitter memories and stereotypes to maximize their support; inter-ethnic hatred is arguably more profound today than it was during the war. 

Srebrenica’s only relief from the inescapable history of conflict is that tragedy has been normalized, perhaps because it’s literally part of the landscape. This is where ten thousand men fled into the thick of the forest while women and children hid among dense shrubs and trees, living on whatever roots and berries they could collect. Like other Balkan combatants, Serbs used rape as a weapon of war, leaving Srebrenica’s Muslim women to suffer enormous shame with babies born from sexual attack. Families transfer trauma from one generation to the next. An essential part of stabilizing the region is addressing surging mental health needs of the survivors; the government seems to recognize this, but the real work is done on the municipal level where the large NGO community tries to reduce the cultural stigma on seeking mental health treatment and sets up local clinics. But practitioners in the field warn that the government’s poor response to the alarming post-traumatic stress disorders among citizens, post COVID, post Russia invasion of Ukraine, puts citizens at great risk. 

Men beat and sexually assault women at an alarming rate, the juvenile delinquency rate is soaring, and youth are leaving in droves.

Anger festers. Thirty years after men put down arms, few have picked up jobs. The legacy of 350,000 restless and unemployed ex-soldiers, their schooling interrupted by war, casts a pall on society. Men beat and sexually assault women at an alarming rate, juvenile delinquency is soaring, and youth are leaving in droves. The IMF says Bosnia’s brain drain of young, educated talent portends a tough future for a country that bears deep scars of war. Among those who remain, antidepressant use, much of it self-dosing, has risen precipitously, spurring greater attention to the efficacy of treatments. 

Easing trauma is not on outside meddlers’ agenda. Ripping open old wounds, Russia’s Vladimir Putin made sure that his favored Serb nationalist Milorad Dodik secured the ethnically allotted seat in Bosnia’s inter-ethnic presidency. Russia’s public endorsements of Dodik emboldened the Serb leader’s calls for Republika Srpska’s right to a land grab and its own statehood. In turn, Dodik pushed Bosnia’s recognition of Russia’s illegal annexation of Crimea. Dodik harbors the same yearning for ethnic purity, for a separate state of Serbs and only Serbs. He has agitated for his own military force, and warns Serbs are under threat.

Russia understands that Bosnians harbor the same hatred, the same suspicions of decades, even centuries ago. Russia knows the entire Balkans were marked by tribal wars, slaughters, and mass graves. Encouraging Greater Serbia is to scramble any effort to move past that ethnic hatred. But Putin intends to keep Bosnia off balance to give Russia an unquestioning ally in the middle of Europe. Again, Bosnia teeters on the treacherous. Here, and throughout the region, almost everyone wrestles with trauma. For anguished mourners like this woman in Srebrenica, reconciliation is beyond reach. The new political landscape all but guarantees it.

P A N A M A

Armed traffickers will move over 750,000 forced migrants through the Darién Gap in 2024, trampling one of earth’s most critically endangered ecosystems. This is Sara Omi, an indigenous Emberá community leader in its Choco region, where sixty percent of her people have fled the human and environmental disaster, intrusions that drive out indigenous communities protecting and sustaining one of the globe’s most important old growth forests. The species-rich tropics has plant life known only to Panama (twenty percent of what grows here only grows here), all under an enormous mature canopy called the “natural lung” of the Americas, where Omi’s Emberá have thrived with Mother Nature for centuries.

The constant crush of humanity through the delicate rainforest hasn’t generated much response from Panama’s government, but scientists worldwide are bracing for fallout. The Smithsonian Institution, the world’s largest museum with its only home outside the US in Panama, has a century drawing world class specialists to study local fauna and flora, the oceans and paleontology. Today, the Smithsonian Tropical Research Institute is frantic to protect the unparalleled biodiversity from human destruction. It puts a premium on the Emberá’s natural restoration of the forest, as intruders trample and recklessly poach logs, illegal mines and clearcut.

This is a 100-mile long, 30-mile wide stretch between Colombia and Panama, an undeveloped, lush green density, interrupting the otherwise paved Pan-American Highway from Alaska to Patagonia. There are no roads in the Darién, just mountainous jungle punctuated by rivers, swamps and wetlands that often become deadly human sinkholes. Impossible to penetrate without skilled guidance, travelers fall victim to cartels of vicious crossers who navigate, but also beat, rob and rape them en route. Eyewitnesses contend the savage behavior is worse on the Panamanian side. Violently controlled, the entire forest has given way to a “transnational criminal economy” that Insight Crime tracks with vigor.

Largely ignored by Panamanian and Colombian authorities, the criminality keeps pace with migration. Roving gangs and paramilitary groups leading refugees run roughshod through this rich ecosystem and poison a once pristine environment for the Emberá, Wounaan and other native communities along the water’s edge. Distinct, isolated peoples who speak different languages, they live in open stilt houses along banks of rivers that flow to the Pacific ocean. In the past two years, indigenous have seen their ancestral grounds overrun by refugees from every corner of the world.

Omi is President of the Emberá Congress in the Darién Gap (last year Forbes Magazine once again named her among the 100 most influential women in Central America). She wants to stop flows of smuggled humans who “make their necessities everywhere'' defecating all over the forest floor. She frowns: “They pollute everything. Dead bodies of drowned migrants float in rivers and contaminate the water for drinking and fishing. Tribal people are getting sick.”

Everyone is at risk. Emberá men who once hunted, toiled the oil and slashed palm leaves have become now drawn to fast money as trafficking guides or worse. Women, overrun by migrant demands for meals, have no time to distill natural color and weave the intricate designs that have set the standard for the region's finest folk art. Indigenous hunger is a new problem and likely to worsen as natives stop growing and collecting food. Forest protection's future looks dim as do the prospects for indigenous youth. Omi is deeply troubled that parents pull children from school to help serve migrants. Losing education she says will wipe out their way of life. Analyrtics from the International Crisis Groups say the cartels and savage treatment of females and children in this jungle threaten to quickly destroy what’s left.

The daughter of the Emberá first female chief, Omi resists, as she was taught to do, but her political rise grates against the ingrained machismo culture that sees female leaders “as menacing” and the entire gender as prey.

She looks out for her people and for those passing through. "It's all local,” explains Omi, the sexual violence “increasing against migrant women and children,” impacts natives, too. Human Rights Watch asserts the government’s stance allows “crimes against migrants and sexual violence against women” to occur with impunity. Indeed, the Panamanian government has yet to step in. It simply lacks the will and the resources to hear from victims: Panama’s National Migration Service’s appointed prosecutor has no staff interpreters to translate for Haitians, Africans, and other non-Spanish speakers who have been attacked.

Deeply disturbed by the sharp increase in brutal sexual assaults and government inaction, the organization with special expertise in treating victims of Darién’s sexual violence, Médicins Sans Frontiers, recently publicly prodded Panama to do more, Government officials did act; they summarily shut MSF down. Now there is no accountability, no security and no careful treatment for those brutalized, while daily, often deadly intrusions through here go unchecked.

W E S T B A N K

This young West Bank sheepherder was born during the 1973 Arab Israeli War in a place that has since defined bitterness between Israel and its Arab neighbors. Framed in the oversized hood of a second-hand Israeli Defense Force jacket, he and his flock appear like a dotted mirage in the barren hills.

Over the decades, thousands of Palestinian children like him have been killed in the crossfire as stone throwers or hoisting molotov cocktails in the streets, sitting with family at home or alongside classmates at school. The Yom Kippur War, named for Egypt and Syria’s surprise High Holy Day attack on Israel, left Palestinians to navigate on their own, and spurred Palestine Liberation Organization (PLO)’s Yasser Arafat’s quest for a Palestinian state within the occupied territories. United Nations Security Council Resolution 242 recognizing Israel drew grudging acceptance from moderate Arabs which only infuriated and ignited more radical Palestinian elements bent on Israel’s destruction. Decades later, the players have changed, and the struggle continues with one constant: no matter how close combatants come to an agreement, orthodoxy simply polarizes positions.

West Bank anger festers over Jewish settlers' illegal seizure of land that Arab families farmed and their livestock grazed for generations. Unchecked by an Israeli government as unpopular domestically as it is around the world, Israeli settler violence is daily now, and this youth would be a target wandering with his herd. He is today a grandfather, perhaps even a great grandfather if he survived the past 40 years of Israeli occupation, and likely worried about his offspring. Militarized, Arab villages and towns are tinder boxes now, certain to have daily skirmishes with Israeli settlers and the Israeli forces.

The International Criminal Court this year issued stern warnings about Israel’s high risk of committing genocide against Gazan civilians while it hunts down Hamas operatives hiding among Palestinian cilvilians.The collateral fatalities of Gazan boys and girls exacts an enormous emotional toll on Palestinians, writ large.The ongoing nightmare casts a pall over West Bank villages and towns where the World Bank reports its most recent survey of thousands of residents reveals half the population suffers mental health challenges.The findings, corroborated by local psychiatric organizations, occurred before Hamas’ October 7, 2023 invasion sparked Israel’s immediate lockdown of the West Bank and its retaliatory invasion of Gaza. West Bankers under 29 years old comprise over 60 percent of the total population and they are restive. Border closures have cost them nearly a half million jobs in 2024, against the searing injustices of occupation and a soaring arrest rate. Mix this up, and it is a potent cocktail for an explosion.