Issue No. 892

Mental Health in Conflict: The Crisis No One is Funding

Armed conflict exacts a heavy and often invisible toll on both combatant and civilian minds as well as on bodies. Those affected by humanitarian emergencies often experience psychological distress, with the World Health Organisation (WHO) reporting that an estimated one in five individuals develop mental health conditions such as depression, anxiety, or post-traumatic stress disorder. In conflict-affected settings specifically, 13% have mild forms of these conditions, while moderate or severe mental conditions affect 9% of populations. Yet despite this overwhelming evidence of need, mental health support remains systematically marginalised in humanitarian programming.  

Somalia offers a grim illustration of how global patterns of crisis intersect when protracted violence, state fragility, and recurrent climatic shocks converge. After decades of conflict and displacement, the country’s mental-health system has been left threadbare, with its capacity crushed by the scale of human need. In 2021, a preliminary study by the United Nations and Somalia’s Health Ministry found that an estimated 76% of Somalis have experienced psychological disorders. Yet for most, good-quality, affordable care remains far out of reach. Reviews and national assessments suggest that the vast majority of people with mental-health conditions never receive formal treatment; many first turn to religious or traditional healers before seeking medical help. Humanitarian agencies report growing caseloads in the field, but the gap between need and provision remains cavernous – reflecting both chronic underinvestment and the immense difficulty of sustaining services in a landscape defined by contested authority and shifting donor priorities.

This fragility has material and devastating consequences. In early 2025, the World Health Organisation reported a near-total collapse in country requests for essential psychotropic medicines in conflict-affected settings – a drop of roughly 96% was attributed to the abrupt withdrawal of international funds. For people living with severe mental illnesses, this disruption leads to treatment discontinuation, relapse, heightened risk of self-harm, and an unmanageable strain on families and health systems already at breaking point. In Somalia, where the safety net is perilously thin, these supply shocks magnify the human toll of conflict and challenge any illusion that mental-health care can wait until “basic needs” are met.

Grievance, loss, and social fragmentation often characterise the recruitment pathways into armed groups and formal/informal security forces in Somalia. Many recruits are young, have experienced pre-existing abuse or displacement, or joined expressly seeking revenge. When psychological screening, routine clinical care, and rehabilitation services are absent, those pre-existing traumas are left to fester. The result is not merely an accumulation of individual disorders but a systemic risk, in which untreated trauma and substance abuse erode discipline, normalise violence within units, and increase the likelihood of abuses against civilians. In short, the psychological state of armed actors is not peripheral to civilian protection; it is central to it. 

An important, and often neglected, dimension of the violence in Somalia is the role of substance abuse among combatants and security personnel - notably with the widespread consumption of khat and the use of other psychoactive substances, and the way this interacts with trauma and the broader psychological toll of prolonged conflict. When these substances are combined with variables such as high exposure to trauma, the absence of effective mental-health support, and the recruitment of individuals already shaped by clan conflict or personal vendetta, it fuels a vicious cycle in which the traumatised themselves become agents of further harm.

Two linked assumptions have long shaped – and constrained – the place of mental health in humanitarian programming. The first rests on a rigid reading of Maslow’s hierarchy of needs, which ranks material survival – food, shelter, clean water – unquestionably above psychosocial well-being. The second assumes that general humanitarian aid will automatically “co-address” psychological suffering: that rebuilding houses, restoring livelihoods, or reuniting families will in themselves alleviate  trauma. Both ideas hold intuitive appeal because they seem to simplify the hard choices of resource allocation, yet both are deeply flawed. Evidence and guidance from the Inter-Agency Standing Committee (IASC) make clear that Mental Health and Psychosocial Support (MHPSS) must operate across distinct tiers – from community-based initiatives and basic psychological care to specialised clinical services for severe conditions. Material assistance may create the conditions for recovery, but it is no substitute for targeted mental-health care.

Compounding this neglect is the problem of measurement. Physical destruction is visible and countable: bodies, collapsed homes, malnutrition rates, and displacement figures translate easily into reports, appeals, and performance metrics. Psychological harm, by contrast – shaped by culture, stigma, and silence – is far harder to quantify in ways that command attention or funding. This invisibility feeds a self-perpetuating cycle: what is not measured is not prioritised; what is not prioritised receives no funding; and what is unfunded remains unmeasured. Acknowledging the true scale of psychological harm would also demand a reckoning that many actors would rather avoid. It is easier to claim that civilian suffering is limited to the visible scars of war than to face the reality that trauma seeps through entire communities, long after the guns fall silent. 

Against this backdrop, practical change of humanitarian programming in Somalia should begin with the basics –  restoring and safeguarding supply chains for essential medicines so that treatment is not interrupted when funding falters or insecurity disrupts transport. It also means investing in community-based psychosocial programmes that build on local coping mechanisms and forms of resilience, rather than importing models that ignore social context. Primary-care staff require training to recognise common mental-health conditions and to prescribe psychotropic medicines safely, bridging the vast gap between specialist care and community need. And within the security sector, screening and rehabilitation programmes are critical to ensure that untreated trauma and substance use do not translate into further civilian harm.

International guidelines already outline these steps, but turning them into practice requires predictable funding, political commitment, and protection for those who document and speak out about abuses. Plans for reprioritisation of funding by OCHA in 2025 have seen a 74 percent reduction in funding, now targeting a mere 1.3 million people in Somalia. This has left an even smaller budget for treating the wounds of war. If humanitarian actors are willing to treat psychological health – not only of civilians but of combatants – as a core protection concern rather than a secondary need, then priorities, programming, and financing must shift accordingly.

In short, the humanitarian community should no longer classify mental health as a secondary issue. When left untreated, psychological distress undermines the very foundations of recovery – social cohesion, civic participation, and the safe delivery of aid – and perpetuates cycles of harm. Breaking the cycle requires investment in routine MHPSS surveillance, integration of basic mental-health indicators into humanitarian needs assessments, and donor willingness to fund psychotropic supplies and trained personnel as core, not ancillary, components of emergency response. Recognising mental-health care as life-sustaining, mainstreaming it within emergency response, and prioritising the mental health of combatants alongside that of civilians are not optional reforms: they are central elements of any credible strategy to protect lives and rebuild societies after conflict.

The Somali Wire