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Somalia, in the Horn of Africa, suffers violence, political instability and high mortality rates. The recent major drought in Somalia led to what was termed the worst humanitarian disaster in the world. In July 2011 it was reported that nearly 60 000 people had entered into Kenya from Somalia already that year, including 1300 new arrivals every day to the Dadaab refugee camp, described as ‘the largest, most congested and one of the most remote refugee camps in the world’ (see http://www.unhcr.org/4e204b1e9.html). The drought along with mass migration into such poor conditions are likely to have significant short- and long-term mental health consequences for the populations involved.
The delivery of mental healthcare in the Democratic Republic of Congo (DRC), formerly Zaire, is influenced by geography, politics, legislation and the structure of the health system, as well as traditional beliefs and culture.
The Dominican Republic is located in the Caribbean Sea and comprises three-quarters of the island Hispaniola, which it shares with Haiti. According to the 2002 census, approximately 8.5 million people live in the Republic, with 64% residing in urban areas (Oficina Nacional Estadística, n.d.). During 1990 and 2000, the Dominican Republic was a leader in economic development for Latin America and the Caribbean; however, this was not reflected in the areas of human and social development (Pan American Health Organization & World Health Organization, 2007). Less than 1 % of the health budget administered by the Ministry of Public Health and Social Assistance (MISPAS) is allocated to mental health and the public system is generally underfunded (Pan American Health Organization & World Health Organization, 2008). However, there is an array of mental health services within the country when privately funded facilities are taken into account.
The Netherlands borders the North Sea and is located between Belgium and Germany. Its total area is about 41 500 km2, nearly 34 000 km2 of which is land area. The country consists mostly of coastal lowland and land reclaimed from the sea (polders). An extensive system of dykes and dams protects nearly one-half of the total area from being flooded.
Bolivia is a multicultural country located in the heart of South America. Neighbouring countries include Brazil, Peru, Argentina, Paraguay and Chile. It is a large nation, with an area of nearly 1100000 km2, although most of its territory was lost in wars. A particularly damaging loss was the sea coast, which was lost to Chile in the late 1800s. According to the constitution, Sucre is the capital city but La Paz is the seat of government and is often referred to as the capital.
The Republic of The Gambia, on the west coast of Africa, is a narrow enclave into Senegal (which surrounds the nation on three sides), with a coastline on the Atlantic Ocean, enclosing the mouth of the River Gambia. The smallest country on mainland Africa, The Gambia covers 11 295 km2 and has a population of 1705 000. There are five major ethnic groups: Mandinka, Fula, Wolof, Jola and Sarahuleh. Muslims represent 95% of the population. English is the official language but a miscellany of minor languages are also spoken (Serere, Aku, Mandjago, etc.). The Gambia has a history steeped in trade, with records of Arab traders dating back to the ninth century, its river serving as an artery into the continent, reaching as far as Mauritania. Indeed, as many as 3 million slaves were sold from the region during the trans-Atlantic slave trade. The Gambia gained independence from the UK in 1965 and joined the Commonwealth of Nations.
The following view was espoused in a 1903 Lancet editorial describing psychiatric services in the East: ‘The treatment of lunatics in the East has not yet fully emerged from the clouds of ignorance and barbarism which have surrounded it for ages.’ One of the first reformers was ‘Mr. Theophilus Waldmeier, a gentleman resident in Syria, who commenced in the spring of 1896 the work of helping and providing for the numerous sufferers from mental disease in Syria and Palestine.’ He attempted to introduce the methods of humanity and science in this field. In 1939 Bernstein described his visit to the Maristan Arghoum, a psychiatric hospital, in the city of Aleppo. He observed the complete lack of medical supervision, ‘bad’ patients being chained and the despotic rule of the ‘keeper’ of the hospital.
Uzbekistan is a landlocked central Asian country with an area of 447 400 km2. It borders Kazakhstan in the north, Kyrgyzstan and Tajikistan in the east, Turkmenistan in the west and Afghanistan in the south. Uzbekistan has 14 regions (provinces). In 1991 it emerged as a sovereign country after more than a century of Russian rule — first as part of the Russian empire and then as a component of the Soviet Union.
The Republic of Yemen, on the south-western coast of the Arabian Peninsula, was formed in 1990 when North and South Yemen united. Yemen covers 527 970 km2. The capital is Sana'a. The country is divided into 20 governorates and one municipality. It has an elected president, an elected House of Representatives, and an appointed Shura Council. The president is head of state, and the prime minister is head of government. Suffrage is universal for people aged 18 and older. The population of Yemen according to the 2004 census is about 20 million, but recent years have seen the arrival of many refugees.
Zambia, previously called Northern Rhodesia, was a colony of Great Britain until 1964, when it gained independence and changed its name. It is a landlocked country located in southern Africa and shares its borders with Zimbabwe, Namibia, Botswana, Mozambique, Malawi, Tanzania, Congo and Angola. It has an area of 752 612 km2, about three times the size of Britain, but a population of only 12 million.
Zimbabwe is a landlocked country which has recently emerged from some marked political and socio-economic challenges. Against this background, mental health has fallen down the priority list, as matters such as food shortages and the AIDS scourge have taken prece dence. Zimbabwe is in southern Africa; Zambia and Botswana lie to the north, Namibia to the west, South Africa to the south and Mozambique to the east. Its population is 11.4 million. The capital city is Harare, which has a population of 1.6 million.
The Republic of Trinidad and Tobago is the most southerly of the Caribbean island states. Trinidad is just 14 km from the coast of Venezuela. Trinidad covers an area of 4828 km2 while Tobago, the sister isle, has an area of 300 km2. The total population is approximately 1.3 million; 40.3% of the population is of East Indian descent, 39.6% of African descent, 18.4% mixed and 1.7% belong to other ethnic groups (Central Statistical Office, 2001). St Ann's Hospital in Port of Spain, the capital, was established in 1900 and is the country's only psychiatric hospital. There are two general hospitals, one in the north, at Port of Spain, and the other in the south, at San Fernando.
Following a 10-year war of liberation (fought by the Mau Mau against the British), Kenya attained full independence from colonial rule in 1963. For 10 years the country enjoyed rapid economic growth (6–7% per annum) but this slowed steadily to near stagnation in the 1990s. Poor governance, abuse of human rights, internal displacements of citizens, large numbers of refugees from neighbouring countries and the AIDS pandemic conspired to reduce Kenyans’ life expectancy to 47 years (in the UK it is presently 77 years). Some 42% of the population now live below the poverty line, and 26% of Kenyans exist on less than US$1 per day. The annual per capita income in Kenya is US$360 (in the UK it is $24 000) (World Bank, 2002). AIDS currently has an estimated prevalence rate of 12%. In large parts of rural Kenya many sexually active adults are unable to work, and elderly grandparents are left to look after orphaned children (some already infected with HIV), as they struggle to deal with their own grief for the loss of many of their own children. In December 2002 a new government was elected, which gives some grounds for optimism in an otherwise bleak situation.
Ghana is a West African state that attained independence from Great Britain in 1957 and became a republican state in 1960. Its population is about 22 million (2004 estimate), distributed in ten regions. The World Health Organization (WHO) has estimated that 650000 of the population are suffering from severe mental disorder and 2166000 are suffering from moderate to mild mental disorder (see www.who.int/mental_health/policy/country/ghana/en).
Since the mid-1980s, a profound reform in the organisation of mental health provision has been taking place in Greece (Madianos & Christodoulou, 2007; Christodoulou, 2009). The aim has been to modernise the outdated system of care (Christodoulou, 1970), which was based on in-patient asylum-like treatment, the beginning of which can be roughly dated to the second half of the 19th century (Christodoulou et al, 2010).
Albania, situated in the western Balkans, has an area of 28 748 km2 and a population of 3 069 275 (year 2001), almost one-third of whom are aged 0–14 years. Life expectancy is estimated to be 70.4 years for both sexes (World Health Organization, 2003a). According to the World Health Organization's classification, Albania is a country with low child and low adult mortality rates. The nation's total expenditure on health in 2001 amounted to 3.7% of gross domestic product.
Azerbaijan is a nation with a Turkic population which regained its independence after the collapse of the Soviet Union in 1991. It has an area of approximately 86 000 km2. Georgia and Armenia, the other countries comprising the Transcaucasian region, border Azerbaijan to the north and west, respectively. Russia also borders the north, Iran and Turkey the south, and the Caspian Sea borders the east. The total population is about 8 million. The largest ethnic group is Azeri, comprising 90% of the population; Dagestanis comprise 3.2%, Russians 2.5%, Armenians 2% and others 2.3%.
Bermuda comprises a group of small islands in the Atlantic Ocean, situated approximately 1000 km east of the USA. It is a self-governing crown dependency of the UK. It is the third richest country in the world, with average wages per head of US$41 495 in 2000. Its economy is based on a flourishing offshore insurance industry and tourism.
The Republic of Croatia is in central Europe, on the Mediterranean. A large majority of its 4 440 000 inhabitants are Croats (89.6%). The main religion is Roman Catholicism (88%). Sixteen per cent of the population is aged over 65 years. Croatia was a part of Yugoslavia after the Second World War until 1991, when Croatia declared independence. Following the declaration, Croatia was attacked by the Yugoslav army and by Serbia and suffered a devastating war (1991–95). The transition had consequences for mental health, for example a dramatic rise in the prevalence of post-traumatic stress disorder, especially among soldiers. The majority of soldiers received appropriate psychiatric treatment; there has, however, been an increase in claims motivated by secondary gain, as a result of government policy.
Iraq is known to be the cradle of civilisation — a country with a rich history. Present-day Iraq occupies the greater part of the ancient land of Mesopotamia, the plain between the Euphrates and Tigris rivers. Some of the world's greatest ancient civilisations arose in this area, and Iraq possesses a huge number of historical monuments and archaeological sites.