COVID-19 pandemic: New challenge to securing mental well-being in conflict settings.

In December 2019, coronavirus disease (COVID-19) was reported in Wuhan, China and began spreading rapidly through several countries (Xiang et al., 2020). By mid-April 2020, total confirmed cased surpassed two million globally. In Iraq, 1602 cases were confirmed, and 83 persons had died (WHO, 2020a,b).

This pandemic has caused challenges globally in related to the nature and determinants of mental health promotion at a population and an institutional level (Yao et al., 2020; Zandifar and Badrfam, 2020). These challenges are even more concerning in communities like Iraq. COVID-19 pandemic is adding stress among Iraqis already afflicted by the ongoing conflict and political upheavals. It is very challenging to tackle a serious public health emergency in conflict zones where communities are already afflicted with mental health conditions (Hopman et al., 2020).

Healthcare-related knowledge in Iraqi society is notably low and there isn't always a well-established relationship between healthcare professionals and the communities. In addition, the number of health care providers who are trained to address mental health crises is very limited. At the same time, those with mental illnesses are stigmatized by the public and many needing cares chose not to access mental health services (Sadik et al., 2010).

Therefore, frontline practitioners think that the COVID-19 pandemic in Iraq is adding more distress to the population, significantly exacerbating current mental health problems and challenging the capacity of the health care system. The uncertainty associated with the presence and effects of COVID-19, inaccurate news reports, the population's misunderstanding of health messages, travel bans and isolation, and lack of trustworthy sources of information have added considerable mental stress (Wang et al., 2020). The rapid increase in reported cases and mortality associated with the pandemic is triggering common mental disorders, including anxiety and depressive disorders, and posttraumatic stress disorder (PTSD) in people including youth and older adults, people with underlying health conditions, and people in quarantine or isolation; all can lead to serious negative outcomes that exceed the clinical consequences of the COVID-19 pandemic itself.

During disease outbreaks the impacts of other traumatic events such as disasters or public health emergencies can be neglected. Therefore, to respond to multiple traumatic events, research findings and effective programs used in previous public health emergencies and traumatic events should be considered (Shia and Hall, 2020). In this regard, recently an online dissemination session for the public was carried out by first author to increase awareness about how to maintain psychological wellbeing during the COVID-19 lockdown in Iraq. More than a thousand people from various backgrounds participated, and almost half of them reported psychological distresses related to the pandemic. During the session, the World Health Organization’s (WHO) recommendations to support mental and psychosocial well-being disseminated as well (WHO, 2020a,b). One of the participants stated “We have experienced war and displacement many times, we cannot stand stress anymore.” Another participant shared “My whole family and friends are terrified; this pandemic has frightened us even more".

To our knowledge, there is no comprehensive and detailed mental health care protocol to support affected population by restrictive measures, confirmed/suspected COVID-19 cases and healthcare providers in Iraq. Along with other health professionals (Xiang et al., 2020), we strongly believe that there is a critical need to implement mental health services in affected countries and to include mental health care in the national public health COVID-19 emergency program of Iraq. Therefore, we call on medical and mental health professionals to develop a comprehensive program via media outlets, e.g., news channels, and social media platforms, e.g., Facebook, Instagram, to address communities in distress since the use of these outlets increases when people are isolated.

Forming multi-disciplinary coalitions on Facebook could be one strategy to counter mis-information, reduce stigma and to address public panic and the mental stress of COVID-19 in Iraq due to existing challenges in this society. Previous experience has shown that if social media is used skillfully, it can be an effective communication tools and contribute to encouraging people to seek mental health services in the region (Qudrat and Jaff, 2018). It is time to build online networks of psychologists, psychiatrists, public health practitioners and social workers to provide support and disseminate reliable information across the country.

Financial disclosure

This paper did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors

Authors contributions

PS, MDA and DJ conceptualized this correspondence. MDA conducted the literature review. PS wrote the first manuscript and DI critically edited the manuscript. All the authors contributed in revising and finalizing the manuscript. All authors authorized the submitted version of the manuscript.

Declaration of Competing Interest

The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this correspondence.