Intended for healthcare professionals

Education And Debate Conflict and health

War and mental health: a brief overview

BMJ 2000; 321 doi: (Published 22 July 2000) Cite this as: BMJ 2000;321:232
  1. Derek Summerfield, honorary senior lecturer
  1. Department of Psychiatry, St George's Hospital Medical School, London SW17 0RE

    This is the third of four articles

    Series editor: Anthony B Zwi (

    About 40 violent conflicts are currently active and nearly 1% of the people in the world are refugees or displaced persons. Over 80% of all refugees are in developing countries, although 4 million have claimed asylum in western Europe in the past decade. Many wars are being played out on the terrain of subsistence economies; most conflict involves regimes at war with sectors of their own society—generally the poor and particular ethnic groups, such as the ethnic Albanians in Kosovo. Atrocity—extrajudicial execution, torture, disappearances, and sexual violation—generates terror, which maximises control over whole populations, as does the intentional destruction of the fabric of social, economic, and cultural life. Community leaders, health workers and facilities, schools, academics, places of worship, and anyone who speaks out for human rights and justice are often targets. In many regions such war is a factor in the daily lives and decision making of a whole society.

    Summary points

    The reframing of normal distress as psychological disturbance is a serious distortion

    Personal recovery is grounded in social recovery

    Rights and social justice shape collective healing

    Researchers must attend to resilience factors and beware of extrapolating from clinic based samples

    Individual effects

    There is no such thing as a universal response to highly stressful events. However, somatic presentations such as headaches, non-specific pains or discomfort in torso and limbs, dizziness, weakness, and fatigue are central to the subjective experience and communication of distress wrought by war and its upheavals worldwide. This does not mean that these people do not have psychological insights but that somatic complaints reflect traditional modes of help seeking and also their view of what is relevant to bring to a medical setting.1 Some researchers see somatic symptoms as physiological responses driven by …

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