Overview on Psychological and Social Consequences of War

_____________________________________________________________________________________________________ The current data for this review about war association with mental health and social issues have been collected by using the web of science, The National Center for Biotechnology Information (PubMed) and Google Scholar. War leads to physical, social, economical and mental health losses all the times. Among them, mental illness and social issue are the major causes facing the people in the war-affected zone. The review describes about the group majorly exposed to post-war traumatic problems and the destruction of social values. The study is helpful to provide a roadmap for the future research especially to overcome on the post consequences of war in order to avoid any further complications in human and society.

www.msocialsciences.com conflicts, the many people displaced either across or within the country. These people expose to various psychological and social problems.
According to the 2016 survey of Department of Peace and Conflict Research at the University of Uppsala, the 51 ongoing conflicts were documented worldwide, and more than 100,000 people have been killed during these clashes . The conflicts between countries and within the state against non-state actors have hugely influenced recent numbers of global displacement (Hall and Olff, 2016). According to 2017 report of United Nations High Commissioner for Refugees (UNHCR) 10.3 million people in Syria, while 65.6 million displaced people were documented worldwide due to war crises (UNHCR, 2016). Additionally, more than 65 % internally displaced people (IDP) were reported in UNHCR refugee statistics in the past ten years (IDCP, 2017). Furthermore, a report in 2016 alone, noticed 6.9 million IDPs due to conflicts and violence in low and middle-income countries (Owoaje et al., 2016). According to a 2017 UNHCR report (Doocy et al., 2013), countries such as Turkey, Pakistan, Lebanon, and Iran hosted more than 28% of the world's refugees affected in the Syrian Arab Republic or Afghanistan war.
During wars not only the issue of displaced people occurs, but also the mental health problem is the major issue facing the children, me, and women during warfare. Moreover, it leads to extreme violence, aggression, destruction, and mortality of many innocents. Among them, mental health is dominant concerned throughout the globe. War is one of the major causes which have serious consequences of physical, economic and mental losses (Zadeh and Sirati, 2004). Exposure to violence caused by the war has a potentially negative impact on mental health (de Jong et al., 2001). Symptoms include strong and unwanted memories of the event, bad dreams, emotional numbness, intense guilt or worry, angry outbursts, feeling "on edge," and avoiding thoughts and situations that are reminders of the trauma. According to the 2005 National Co-morbidity Survey-Replication study, PTSD affects about 7.7 million American adults in a given year, though the disorder can develop at any age, including childhood. The 30 percent of cases of PTSD were reported in Vietnam veterans in USA . The terrorists attack on the World Trade Centre has shaken the mental health of children, and higher cases of PTSD were reported after post-event. However, the studies reported in children, women, and men with a different intensity.
The use of a weapon in modern warfare with new technology has changed the nature of wars. By taking the example of Syria, Afghanistan, Iraq, Japan, Palestine, some parts of Pakistan due to American drones and Pakistan army operation against non-state actors and Indian army in Kashmir showed that not only targeted the concern groups but millions of innocent children, men and women were killed or exposed to life-long disabilities or mental health issues. Among them, the mental health issue is a primary concern. According to published literature, the mental health issues were more common in Children followed by women. The reason might be due to the high degree of perception and sensitivity in children and women. Secondly, both women and children are always dependent on their father, husband or elders of the family, so they feel a kind of insecurity which exposes them to a mental health issue. Besides health issues, social problems like security, proper services, quality food supplementation, and adequate education are also the major problems raised drastically during and after the war.

Gender-wise Psychological Consequences of War
According to Owoaje et al. (2016), more than 40 million people displaced due to war; among them the majority are facing the problem of mental health (Owoaje et al. 2016). Generall, it is believed that women are involved more in psychological disorders compared to men during the war. Although, men more exposed to war, however, the consequences of war are more severe in women compared to men. There are many reasons which cannot be ignored like insecurity, rape, dependency on their men, more sensitive about losses and cannot do physical work to survive in harsh condition created by war. Although in general situation the association of mental health with gender varies, however during the war it has been noticed that women easily exposed to psychological issues. Sexual abuse is the most common factor which increases the susceptibility of women to mental health compared to men.

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According to the WHO report, the depression percentage is 41.9 and 29.3 in women and men respectively. Depression, anxiety, psychological distress, and sexual violence rates are higher in women than men throughout the globe. Many factors such as poverty, hunger, violence, and physical weakness are the factors that expose the women more to a mental health issue.
According to the 2005 survey of Médecins Sans Frontières in Kashmir, the majority of the people were found to be mentally ill because of direct crossfire of the Indian army, or sexual abuse, etc (Jong et al., 2008a). The ratio of health illness was more common in females and children compared to male adults (Jong et al., 2008a). Additionally, the high percentage of insecurity, psychological distress and suicidal tendency in Kashmiri women compared to men were noticed (Jong et al., 2008a). Similarly, according to FATA research centre report, the people of FATA faced severe consequences due to the war on terror and women were reported to be the second-highest ratio experienced psychological illness. According to Jong et al., the tendency of suicide was found more common in females compared to males in Afghan refugees in Pakistan. The similar trends were noticed in Kashmiri women as well because of violence of the Indian army in Kashmir (Jong et al., 2008b). Tolin and Foa noticed a higher ration of anxiety in women compared to males due to violence . The National Center for PTSD (US Department of Veterans Affairs) documented the high prevalence of PTSD in US women (10%) compared to men (5%) . Till the mid-to-late 1990s, the occurrence rate of PTSD among Vietnam veterans were reported to be higher in women (20%) compared to men (8%). While working with local Trust named Dost foundation, we found a higher ratio of depression, anxiety, PTSD and sleep disorder cases in Pakistani and Afghani women compared to men affected due to war.
Although many studies showed a higher ratio of psychological disorders in women compared to men. However still very limited data is available which demarcated the exact causes and factors which increase the susceptibility of women compared to men. During war-time generally ratio of mental health tendency is elevated in women compared to men. First, we suggest to find the exact causes of mental health throughout the globe in both men and women. Secondly, during or after the war, special attention should be given to women in order to avoid chronic illness.

Mental Health Problems Children Affected Due to War
Modern war targets not only the armed persons but also the civilian populations. According to Ahlstrom, during the war, 90% of the civilians' death has been reported (Ahlstrom, 2006). Although the War causes serious damages to human mental health, however the women and Children or more vulnerable to mental health issues during warfare (Murthy and Lakshminarayana, 2006). According to the 2006 UNICEF reports, approximately 2 million children were killed, 6 million disabled, 20 million homeless, and over 1 million disconnects from their parents in various conflicts. Besides the above, lethal consequences, the children in the war zone experienced severe mental health issues (Catherine et al., 2009). According to the Save, the Children 2017 documented data 70% children in Syria experiencing the PTSD (Save the Children, 2017).
Children mental health is a global issue (Patel et al., 2007). There are many regions in the world that have been at conflicts fora long time where children know only about war (Jensen and Jon, 1993). Additionally, it was documented by many studies that the children of war region developed aggressive behaviors, abusing habit, grief reaction, loss of hope and self-respect 1990, Pynoos et aI. 1987Jensen and Jon, 1993;Theresa and Kashif, 2008). The children developed a sense of hate from the country involved in war, for example, the Russians for the US child, Palestinian for the Israelis child (Jensen and Jon, 1993). The age from 9-20 is considered the most critical age during which any event left their influence for a long time on children an entire life. A study documented mental health issues across all children ages (9-16) in the war zone of Afghanistan (Catherine et al., 2009). According to 1997 UNICEF survey showed that out of 300 children interviewed in Kabul, 90% were thinking that they would die in the conflict, while 80% shown sadness, frightened, and unable to face the challenges in life ( Van, 2002). Similarly, it was reported that the majority of children were found to have PTSD in Afghanistan (Cardozo et al., 2004;Scholte et al., 2004). The advent of the US 'War on Terror' not www.msocialsciences.com only restricted to Afghanistan but also affected the people of Pakistan's Federally Administered Tribal Areas (FATA).
According to the FATA research centre reports the American Drone attacks, military operations and terrorists attacks caused serious psychological and social issues among the people in the area. Many children were disabled and killed in the last 18 years. Similarly, a study also revealed a severe mental illness in Syrian Children because of crises started in last eight years (Jon et al., 2018). Moreover, Jon and his co-workers selected the children age ranges 8-15 years. It was noticed that the majority of the children faced a high degree of depression, anxiety and PTSD (Jon et al., 2018). Additionally, the children don't know anything except war in Syria. These psychological problems lead to immunity depression, which exposed the children to various kinds of diseases. Poverty reached to its peak, and behavior of revenge has been grown with a great extent in these effected children (Ben Taleb et al., 2015). Even the fetus inside mother started perception after six months. So exposure to expulsion or war affects their health even during their developmental stage. Violence breeds violence easily in children which in later stages more dangerous for the society. Similarly, we also noticed a special kind of fear among Afghanis refugees from Russians and USA. Many Afghanis Children experienced severe sleep disorder. The children affected war or violence particularly at the age of 9-16 exposed to life-long PTSD. So, psychological counselors are especially encourage to target children as first add after and during war-time.

Overview on the Displacement of People Due to War
Organized violence and conflicts have deep and horrible effects on already frail developing countries, where 84% of the world's refugees live (IDCP, 2017); political and economic structures are damaged, laws are disregarded, the basic rights of people are often badly treated, and healthcare facilities are crushed (Salama et al., 2004). These studies showed that the displacement of people due to wars increasing significantly. In addition, it has been shown in previously published studies that armed various for different reasons severely affect the mental health (Roberts et al., 2009;IDCP, 2017). More than 60 % IDPs throughout the globe has no proper international protection which exposed them to mental illness and other fatal diseases (IDCP, 2015). If proper attention was not given these mental issues lead to a chronic form of mental illness (Turner, 2015). Moreover, these mental health issues also related to many environmental features that directly impact of mental health such as forcefully departure from homes or separation from family members and loss of jobs (Tol et al., 2011).
Besides the above facts and figures, we also argued that the ratio of psychological and social issues of IDPs and refugees in Pakistan and Iran might be higher than the above calculated ratio. According to Sumerana working as a clinical psychologist with various local health services unit, reported many cases of PTSD, war phobia, sleep disorder, anxiety, hopeless, and social were in war affected IDPs. The above-published studies revealed that the war effected IDPs experienced depression, PTSD, alcohol abuse, and anxiety disorder with a higher ratio.

Social Issues Created Due to Displaced People
The huge numbers of refugees due to war have a negative impact on the economy, local ecology, and infrastructure of a country where they migrated. The refugees become permanent competitors of local citizens in water, housing, food, and medical services. With the passage of time their existence leads to an increase in the demands of natural resources, social services, health, education, energy, transportation, and employment. The refugees cause the imbalance of prices, which further remarkably change the flow of goods and facilities within the society. Rent for accommodation becomes the highest, rates of basic goods and food, etc increase in the market which adversely affecting the poor community of the country. The huge refugee population engaged the main authorities of a country by providing basic needs shelters to these people who also affect the development process of a state. Many of these refugees were found to be involved in terrorists and kidnapping activities directly or as facilitators, which is again a serious threat to the peace of the region. The massive existence of refugees also destroyed the natural resources and infrastructure of a residing country. In and around refugee camps, many trees and other plants are destroyed. Their waste disposal is also big threat to the environment. Roads and soil undergo massive deterioration. Pakistan and Iran are the countries hosting the biggest population of Afghani refugees. In Pakistan, approximately more than over two million refugees contributed to the destruction of roads and canals, and a significant increase in the consumption of fuel and fodder resources. Many families brought livestock which caused overgrazing and created feed deficiency for the local livestock.

Social Consequences of War
War always has a destructive impact on the society. The world war first shook the globe, and even the impact can be felt till to this day. Due to war the death of empires and grown of new nations came into being. It affected the literature and changed the culture. According to John and Timothy, the conflicts between nations cause huge damages to social values in all aspects (John and Timothy, 1991). The war destroyed the school, hospital and other important institutions responsible for character building. After the war, one can see many casualties, injuries, and disability in war affected areas. Unemployment, prevailing of poverty, destruction of infrastructure, severe declining of GDP, food scarcity, limited resources, and the unlimited user creates unbalance in society (World Bank group, 2017). Many people died due to the lack of medical facilities in Syria which have been destroyed due to long term warfare (Sparrow, 2014). According to the Baker report, some 200,000 people have died because they did not have an approach to routine medical care (Baker, 2014). Moreover, it was also reported that the war causes the high degree of socio-economic dysfunction which leads to poverty and other social tribulations (Lopes et al., 2004;Jong et al., 2005).
According to sociologists, poverty is the major cause of many evils. Poverty affects the growth and health of children. Poverty is associated with the development of negative action such as prostitution, begging, abuse, and other criminal victimization. No one is killer or beggar by birth; it is the society which diverts them to do such kind of act. Many children join bad companies because of poverty, and www.msocialsciences.com at a later stage, they become permanent threats for society. From these facts, we strongly argued that war not only causes physical destruction but also destroy the prosperity of a region. Being the engagement with the US as a front line of the war on terror in Afghanistan, Pakistan faced a massive destruction of infrastructure, political and social damage. The economy of Pakistan is severely affected, and many social problems have been reported in FATA and Khyber PukhtunKhwa particularly. So far, the war caused the death of more than 35,000 citizens and 3,500 security personnel, and $67.93 losses to Pakistan (Umbreen, 2011). The military operations against the terrorists displaced a huge population. Lack of food resources exposed children and women to begging and sexual abuse (Tariq,203).
Due to war, many people displaced. The displaced people feel insecurity and as a result, involved in many negative activities. According to a report in 2016, the conflicts created 6.9 million displacements of people throughout the globe. The survey from 21 countries reported the total of 39,518 adult displaced due to war . The displaced people due to war experienced PTSD which usually prevailed for a long time. The displaced people have no excess even to the basic need of life. Although the war in terror was started to diminish the terrorism from the world, however, it increases the poverty and reinforces the terrorist attacks. Many innocent people were killed in Afghanistan. Many of them lost their families. These losses decrease the strength of the bond between human and social values. Furthermore, the war also created a behavior of revenge in affected people. The interaction of social and psychological issues created due to war has been summarized in Figure 1. The figure showed that the many issues are directly proportional to each other. For example, war destroyed the economy of a country which prevailed poverty; while Poverty causes depression and other mental health issues. Poverty also exposed many people to bad evils which are dangerous for the society.

Conclusions
Based on the above cited literature, we concluded that war is always terrible and creates serious issues which take a long time of recovery. Moreover, we addressed the possible psychological and social problems faced by the war-affected people. These issues should be keeping in mind while providing any psychological or financial support to war affected people. Children and Women are more sensitive and easily get mental health issues, so their protection and counseling must be kept on priority. The refugees migrated countries should be provided enough fund so that the hosting country provide possible add to the displaced people. The hosting country must prepare their policies so that the refugees will not influence their stability.

Author Contributions:
WG and SK wrote this review paper. Moreover, WG designed, supervised and revised the manuscript.

Funding source
This work did not receive any specific grant from funding agencies in public, commercial or not-forprofit sectors.