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Five years of raging conflict in Yemen have had a devastating impact on the mental health of an entire generation of children, pushing some to the brink of depression, according to a new survey by Save the Children. More than half of the children surveyed said they feel sad and depressed, more than one in ten said they feel that way constantly.

The organisation launched its findings while the country fears an outbreak of Covid-19, which would put an even bigger strain on the already hampered health services and the work of aid workers.

Accoring to the survey, around one in five of the children interviewed said they are always afraid. Overall, 52 per cent of the children reported never feeling safe when they are apart from their parents, 56 per cent said they do not feel safe when walking alone.

In the largest survey of its kind since the escalation of the conflict in Yemen, which reaches five years this week, Save the Children interviewed more than 1,250 children (age 13-17), parents and adult caregivers about their mental wellbeing. The survey also shows that:

• 38 per cent of caregivers reported an increase in children’s nightmares.
• 18 per cent of children reported they always feel grief, 51 per cent that they sometimes feel this way
• 8 percent of caregivers reported an increase in bedwetting of their child
• 16 per cent of children say they are never or rarely able to relax
• 36 per cent of children reported never feeling like they could talk to someone in the community if they are sad or upset

Many of the interviewed children reported possible signs of anxiety such as increased heart rate, stomach pains, sweaty palms and feeling shaky when fearful or afraid.

Eyad*, 14, from Saada, lost an eye after he was hit by shrapnel during an air raid. He likes to play basketball with the hoop he made from metal wire and rope – it helps him cope with his anxiety.

“[When the air raid happened] We went out running, the entire family – everyone was running for their life from the bombing, to the point we forgot one of my nieces.”

“[After this] I became lazy, not wanting to study, and I would always be tired, feeling dead. You can say that I lost hope. When we were younger, before the airstrikes started, every time we saw an airplane all of us children would gather and sing, ‘Airplane fly, flying airplane,’ but now after the airstrikes we are very scared of it.”

Children are paying a high price for the Yemen conflict. Since December 2017, at least were killed or maimed in the violence.

Across the country, some 10.3 million children are food insecure, including 2.1 million who are acutely malnourished, and two million children are displaced. According to numbers of the Health Cluster, which is formed of several international organisations and UN agencies, almost 1.2 million children fell sick with cholera, diphtheria or dengue fever over the last three years.

Should COVID-19 be confirmed, it would add another layer to burden of the Yemini people. Save the Children fears it might push many over the edge as the possibility to contain the virus is limited, the health system is already overstretched and it would deeply impact aid workers abilities in reaching the most vulnerable children with medical and other supllies.

The survey by Save the Children indicates that in addition, children and youth in Yemen are facing a mental health crisis and living in constant fear of coming under attack by explosive weapons or sniper fire.

Abed*, 10, also from Saada, lost his two brothers when the pharmacy where his father worked was hit by an airstrike.

“My life has changed since my brothers died. When I remember them, I feel sad. Then to distract myself, I go to play or do anything else. Children in the whole of Yemen are grieving their brothers, fathers, mothers due to airstrikes.”

If this crisis is not addressed, an entire generation will suffer long-term consequences, Save the Children warns. Children in conflict need places where they feel safe and can relax, or their stress response systems will remain activated, leaving them at serious risk of stress-related mental health conditions – but also impact their health in the long term, making them vulnerable to chronic diseases, like heart conditions.

Inger Ashing, CEO of Save the Children International, urged all parties in the conflict to work towards a political and peaceful solution.

“The children we spoke to are terrified. They are too scared to play outside. They are bedwetting when they hear airplanes flying overhead or bombs falling. This is what 5 years of war does to the mental wellbeing of children, and we cannot allow this war on children to continue.”

“With COVID-19 now a worldwide epidemic, the potentially devastating threat of a coronavirus outbreak in Yemen makes urgent action to pressure parties to end the war more important than ever. A political solution is the only sustainable way to end this terrible war, and stop the suffering of children. Governments with influence over the warring parties must use their power to get all parties to the negotiation table. Those who continue to sell arms to the fighting parties must know they are fuelling this war, and history will judge them. Nobody can claim ‘we did not know’. The world knows, and yet the world continues to let it happen.”

According to the most recent data, only two child psychiatrists are available in the whole of Yemen and only one mental health nurse is available for every . Children have the right to feel safe and to mental wellbeing; to avert the looming mental health crisis in Yemen, more funding for mental health and psychosocial support, including specialist support, is needed, Save the Children warned.