* Any views expressed in this opinion piece are those of the author and not of Thomson Reuters Foundation.
It’s a major problem that raises the risk of disease and domestic violence, so why aren’t we doing more to address it?
There are currently more than 50 million people worldwide who have been forced from their homes as refugees and internally displaced persons due to armed conflict – the highest number since the Second World War. The vast majority of these are in low- and middle-income countries.
There are important reasons why harmful alcohol use may be a risk in conflict-affected populations. They have often experienced violent and traumatic events which can lead to post-traumatic stress disorder and other mental health problems which then increase the likelihood of harmful alcohol use. Alcohol may also be used as a form of coping strategy, to deal with the loss of family and friends, homes, livelihoods, income and social support – all of which can be consequences of conflict.
Research has shown that harmful alcohol use is a problem particularly among conflict-affected men, and is present in a wide variety of settings, such as among refugees in Thailand and Nepal, and internally displaced people in Uganda and Georgia. It is also likely to be an issue in current conflicts. For example, Ukraine has high levels of alcohol consumption generally, and this may increase among people affected by the conflict there. Even among Syrian refugees there are reports of heavy drinking despite alcohol consumption being forbidden from a religious perspective. The problem can just become even more hidden.
But why should we care – surely there are many other urgent challenges that humanitarian agencies need to contend with? I believe this is a problem that is too important to keep ignoring. Harmful alcohol use increases the risk of non-communicable diseases such as diabetes, cancers and cardiovascular disease, and can contribute to mental disorders such as depression or post-traumatic stress disorder. The burden from these diseases is growing among conflict-affected populations.
It can also increase the risk of infection from communicable diseases such as HIV/AIDS, as well as interrupting regular treatment for conditions like tuberculosis, HIV, diabetes and hypertension. Importantly, harmful alcohol use can be a factor in violence against women which is a major problem in many conflict-affected populations.
Clearly, in the acute phase of a conflict humanitarian agencies need to prioritise more immediate life-saving care such as providing food, water, vaccines, and treating, controlling, and preventing communicable diseases. However, refugees and internally displaced people are forced from a permanent home for years, and often decades, and as the security situation stabilises, their broader health needs must also be addressed through expanding the range of health services available, including services to tackle harmful alcohol use.
The benefits of reducing harmful alcohol use include improved physical and mental health, reduced harm and violence to others, improved family and social relations, and greater productivity. There are programmes to tackle the problem that have proven simple, cheap and effective in stable settings and these could be adapted, implemented and evaluated with conflict-affected populations. The problem is no one has attempted to do this.
Harmful alcohol use appears to be off the radar for humanitarian agencies and their funders. Humanitarian guidelines provide virtually no information on how agencies should address the problem, and there seems to be very little capacity (or appetite) within the humanitarian agencies to tackle the issue. There also seems to have been no attempts to develop, implement and evaluate harmful alcohol prevention and treatment programmes with refugees and internally displaced people in low- and middle-income countries.
I have conducted research in a number of refugee and internally displaced people camps, and residents and health workers have often remarked on the need to address the problem of alcohol in the camps. Yet their words do not seem to be heeded by humanitarian agencies and governments.
The delays in recognising and responding to the problem of harmful alcohol use among conflict-affected civilians reflect similar delays in addressing the issue among soldiers. However, governments have belatedly started to take the problem of harmful alcohol use among their soldiers and veterans more seriously. It is time that humanitarian agencies did likewise for the civilians they are mandated to help and protect.
This article is based on an editorial in Addiction.
Dr Bayard Roberts is Director of ECOHOST – The Centre for Health and Social Change at the London School of Hygiene & Tropical Medicine.
