The Intersection of Women, Dementia, and Conflict Zones: A Perspective Piece for International Women’s Week
The Intersection of Women,
Dementia, and Conflict Zones: A Perspective Piece for International Women’s
Week
Esra Hassan
Amidst
the ongoing conflicts worldwide, the repercussions such as displacement,
violence, disruption of education and healthcare, loss of livelihoods, and
fractured community and social networks loom large, both during and after the
conflicts. While research on the intersection of dementia and conflict remains
scarce, there are needs among individuals living with dementia in
conflict-ridden regions. Notably, women caregivers emerge as central figures in
providing care and support within these contexts. This perspective aims to
provide an overview of the interplay between women, dementia, and conflict
zones to highlight the barriers and challenges women in conflict and war-torn
environments face, particularly concerning dementia care and caregiving.
Around the world, one out of every 70 people faces crises that
demand urgent humanitarian help and protection [1]. This number is growing due
to increasing conflicts displacing more individuals. On a global scale, about
50 million people are living with dementia. 60% of them reside in low and
middle-income countries where access to healthcare and social support is limited.
While there are guidelines advocating for inclusive assistance to those at
risk, they're often overlooked for people living with dementia, leaving them
without the aid they need. There is a lack of accurate data on how many people
with dementia are affected by conflicts due to insufficient national records or
data collection during emergencies. However, broader research shows that
disasters disproportionately endanger people with disabilities and their
families. During humanitarian crises, the disturbance in home, community, and
environment puts individuals with disabilities, particularly those with
dementia, at heightened risk [1].
“She’s going through the daily trauma
of rediscovering that war has begun, and keeps trying to evacuate” - Dr Boichak (quoted in the New York
Times, 2022) [2].
There is a growing acknowledgment of the need to address the
challenges faced by individuals with dementia and their caregivers in conflict
settings. Although research specifically focusing on dementia in
conflict-affected areas has been relatively limited in the past decade, there
have been some studies and initiatives addressing this intersection [3].
When
conflict strikes, families caring for someone with dementia often face tough
decisions. The physical and psychological challenges, or even just the
perception of these challenges, can push caregivers to make choices they
wouldn't normally make. For example, in
Syria, sending elderly family members to retirement homes was uncommon due to
cultural norms. However, after years of war and displacement, many families
felt compelled to do so. By 2016, as conflict claimed lives or forced
relocations, older relatives increasingly found themselves in oversubscribed
care homes in safer regions. The conflict's impact on Syria's health workforce
has led to over half of its doctors, around 27,000, fleeing since 2011 [1]. Some of the biggest challenge’s families face include:
“the evacuation of
people with dementia from the most dangerous territories and finding a new
place for them to live; the lack of medication and medical supplies; the
difficulty for people living with dementia and their relatives to flee from
their country” – quote on the Dementia Services in Ukraine (2024) [4]
Over the past decade, there has also been a growing
recognition of the importance of addressing mental health and psychosocial
support in humanitarian responses, including in conflict-affected areas. While
dementia may not always be explicitly addressed in these initiatives, efforts
to improve mental health and psychosocial support in emergencies may indirectly
benefit individuals affected by dementia and their caregivers. Research on the
long-term cognitive health effects of conflict-related trauma has also gained
attention in recent years. Studies have explored the impact of post-traumatic
stress disorder (PTSD) and other forms of trauma on cognitive function and the
risk of dementia, particularly among veterans and survivors of conflict-related
violence. This is supported by India’s largest dementia study where the highest
prevalence of dementia was found in conflict-affected Kashmir (11% of the
population over 60 in Kashmir has dementia). A 2019 survey by Médecins Sans
Frontières found that 70% of Kashmiri adults had witnessed sudden or violent
deaths of people they knew, with each adult experiencing an average of 7.7
traumatic events during their lifetime [5]. While the link between trauma and
dementia is a growing area of research, it is important to highlight this
association is not casual. However, there is a moderate association observed
among American war veterans with PTSD and an increased risk of dementia later
in life. Loneliness and social isolation are also thought to be important risk
factors for developing dementia in the Kashmiri population. Further studies are
needed in other conflict zones to assess the link between trauma exposure and
dementia [6].
Women:
Studies on gender dynamics and caregiving in conflict zones
have highlighted the disproportionate responsibility of caregiving for
individuals with dementia that falls on women. In the humanitarian
context, dementia affects more women than men globally, with the majority of dementia
caregivers being female. Women in crisis situations face heightened risks due
to displacement and the breakdown of support structures, with over 70%
experiencing gender-based violence. Women often take on additional caregiving
tasks, sacrificing their own needs for their families' well-being. Women
provide 71% of informal care globally, with the highest proportion in
low-income countries. In 2015, they contributed around 82 billion hours of care
for people with dementia at home [7].
Double
Vulnerability – Impact of trauma on dementia risk and caregiver responsibility:
Women
in war and conflict zones face a double vulnerability to dementia. They not
only experience the trauma of conflict, potentially increasing their risk of
developing dementia, but also shoulder the responsibility of caring for family
members with the condition. Studies show a higher prevalence of dementia among
women in conflict-affected areas compared to global averages. The psychological
stress of conflict and traumatic events can contribute to cognitive decline and
conditions like PTSD, further exacerbating the risk of dementia [8]. Women caregivers in conflict zones bear a disproportionate
responsibility in caring for family members with dementia [9]. In Afghanistan,
decades of conflict have resulted in displacement and instability, making it
hard for women caregivers to access the necessary resources and support for
dementia care [10]. Despite these obstacles, women in war-torn areas persist in
their caregiving roles for family members with dementia. Often, they shoulder
this responsibility alone as traditional support systems are disrupted by
conflict. These women sacrifice their own well-being to provide constant care,
balancing caregiving duties with the demands of daily life in conflict zones.
This caregiving responsibility can further strain their physical and mental
health, perpetuating a cycle of vulnerability and deprivation. Living in a war
or conflict zone can intensify dementia symptoms for affected women. The
constant threat of violence, displacement, and loss can heighten feelings of
confusion, anxiety, and depression among caregivers. Additionally, the stigma
surrounding dementia in many communities can further isolate and marginalize
these women, exacerbating their mental health challenges.
Access to Healthcare:
In
conflict-affected settings, women caregivers may face heightened mental health
challenges. For example, in Yemen, ongoing civil war has resulted in widespread
humanitarian crises, including limited access to healthcare and mental health
support services [8]. Furthermore, conflict disrupts healthcare systems and
infrastructure, hindering access to diagnosis, treatment, and support services
for individuals affected by dementia [9,10]. Many
women caregivers also report a struggle to navigate bureaucratic barriers and
transportation issues to access the care they need.
Since 2011, the
civil war in Syria has caused widespread displacement and destruction of
infrastructure, making it difficult for individuals affected by dementia to
access healthcare services [11]. Similarly, the Iraq war, which began in 2003,
has had lasting effects on the population, including displacement and violence,
posing challenges for women caregivers in accessing dementia care resources [10].
In Afghanistan, decades of conflict have had a significant impact, particularly
on women and children, making it challenging for women caregivers to access
healthcare services and support for dementia care amidst ongoing violence and
instability. Similarly, Yemen's civil war has led to humanitarian crises,
including food insecurity and lack of healthcare access. Finally, since gaining
independence in 2011, South Sudan has experienced cycles of violence and
displacement, posing obstacles to accessing essential services and support for
dementia care. These examples illustrate the challenges women caregivers face
in conflict-affected regions, where existing vulnerabilities are exacerbated,
creating barriers to accessing vital services and support.
Conclusion:
In conclusion, while
research on dementia in conflict settings remains limited. Targeted
interventions and support services are vital to address the distinct needs of
individuals affected by dementia in conflict-affected areas. The intersection
of conflict and cognitive health poses complex challenges that demand
comprehensive solutions. Although further research is needed to fully
understand this intersection, particularly in low-resource settings, these
examples emphasize the increasing acknowledgment of the importance of
addressing dementia care in humanitarian and conflict contexts, as well as the
disproportionate barriers faced by women caregivers.
Author: Esra Hassan, GMBPsS, PhD candidate
Brighton and Sussex Medical School
Centre for Dementia Studies, Department of Clinical Neuroscience
Founder of the CFHSR - public humanitarian pilot
References
[1] Alzheimer's Disease International. (2019). Forgotten in a Crisis
Addressing Dementia in Humanitarian Response. Global Alzheimer’s & Dementia Action Alliance,
Alzheimer’s Disease International, and Alzheimer’s Pakistan
Published: May, 2019.
[2] Victoria Kim is a correspondent. A version of this article appears in print on April 21, 2022, Section A, Page 11 of the New York edition with the headline: For Grandmother With Dementia, War Starts Anew Day After Day. https://www.nytimes.com/2022/04/20/world/dementia-grandparent.html
[3] Global Observatory on Ageing and Dementia Care (2012). https://1066.alzint.org/global_observatory.php
[4] UK parliament. (2024). Dementia Services in Ukraine, Volume 743: debated on Wednesday 10 January 2024. https://hansard.parliament.uk/commons/2024-01-10/debates/5FF4ACBF-833E-482C-A6D2-397E84844A9E/DementiaServicesInUkraine
[5] Médecins Sans Frontières (2019). https://msfsouthasia.org/msf-scientific-survey-45-kashmiri-population-experiencing-mental-distress/
[6] Rauf I, Hussain A, Roub F. Loneliness, social isolation, traumatic life events, and risk of alzheimer's dementia: A case–Control study. Indian Journal of Social Psychiatry. 2022 Jul 1;38(3):276-81.
[7]
[8] Smith SM, Goldstein RB, Grant BF. The association between post-traumatic stress disorder and lifetime DSM-5 psychiatric disorders among veterans: Data from the National Epidemiologic Survey on Alcohol and Related Conditions-III (NESARC-III). Journal of psychiatric research. 2016 Nov 1;82:16-22.
[9] Wu Y, Chen S. Resilience modeling of traffic network in post-earthquake emergency medical response considering interactions between infrastructures, people, and hazard. Sustainable and Resilient Infrastructure. 2019 Apr 3;4(2):82-97.
[10] Gomez P. Refugees living with dementia: assessing the barriers to healthcare access in crisis-affected populations in Lebanon and Switzerland, and the role humanitarian actors have on addressing them.
[11] Peralta García L, Ouariachi T. Syrian journalists covering the war: Assessing perceptions of fear and security. Media, War & Conflict. 2023 Mar;16(1):44-62.
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