A ceasefire between Hezbollah and Israel in late November 2024 brought an official end to more than a year of conflict, but six months later people across Lebanon are still grappling with the psychological impact of heavy bombing and mass forced displacement.
In a country that has been through constant cycles of violence and economic collapse for nearly 50 years, trauma is nothing new. But that doesn’t make it any easier to deal with, or mean there are more resources available for everyone who needs help.
The recent conflict between Israel and Hezbollah ramped up in intensity in September 2024, when Israel remotely detonated pagers and other devices that it said belonged to Hezbollah members. It followed up with heavy bombing and an invasion in south Lebanon that – at its worst – forced around one million people to flee their homes.
The 27 November truce should have brought an end to the violence, but after half a year, Israel still bombs in Lebanon. Around 90,000 people are still unable to go back to their homes, and even those who have returned are dealing with trauma, destruction, and the loss of friends, family, and a sense of security.
Some are quick to label what many in Lebanon are feeling as Post-Traumatic Stress Disorder (PTSD) – and it is common for Lebanese to use the term to explain why they feel a physical reaction when thunder rolls across the sky, fireworks are set off, or celebratory gunfire rings out.
But Myra Saad, a mental health counsellor and art therapist based in Beirut, says the concept of PTSD doesn’t necessarily apply to a place like Lebanon.
That’s in part because the “post” in PTSD implies a return to safety after trauma – a rupture in an otherwise secure life. This is something that has not truly been the case for Lebanon in decades.
“In a case of PTSD where someone has an accident or a one-time event in a country which is relatively safe, we work with the patient to help them understand that their environment is safe, and this won’t happen again,” explains Saad, who has counselled first responders who dealt with the aftermath of Israel’s bombings. “This is simply not applicable in Lebanon.”
An ongoing trauma
Since the start of the 1975-1990 civil war, Lebanon has seen multiple wars and crises. This has escalated since anti-government protests in late 2019, a severe ongoing financial collapse, the deadly 2020 Beirut port explosion, the ongoing conflict in neighbouring Syria, and more recently the war with Israel.
While researching the concept of "ambiguous loss”, which occurs when relatives go missing or are forcibly disappeared (as many as 17,400 people are still missing from Lebanon’s civil war), Saad came across a condition called Continuous Traumatic Stress Disorder (CTSD).
It was first uncovered in apartheid South Africa and defined by researchers as “one possible way of describing the psychological impact of living in conditions in which there is a realistic threat of present and future danger, rather than only experiences of past traumatic events.”
While CTSD is not in the Diagnostic and Statistical Manual (DSM) – a widely used guide for mental health professionals – it is increasingly recognised as an important way of understanding trauma in places like Lebanon.
“The past five years we lived through some of the biggest events [anyone can go through] in life,” Saad says of why people in Lebanon are dealing with something closer to continuous trauma, rather than PTSD. “Since 2019, people in Lebanon have lived more than what some people live in 90 years of life. And this is in addition to what people have lived since the civil war.”
War isn’t the only crisis that can kick off mental health concerns in Lebanon, or anywhere for that matter. In 2023, Hisham Assaad was busy writing his second cookbook whilst working as both humanitarian clown and a photographer, when Lebanon’s frequent water shortages began to get to him.
“I had to economise on water or be stinky for a couple of days, and not go out,” he says of 2023, when the shortages were particularly bad. “Just the thought of having no running water, it drained everything from me.”
“Running after the water truck was another issue,” he explains of the vehicles that have become increasingly necessary to fill taps – as fuel and electricity crises depleted the state’s ability to do so. “It triggered this part of me where I wanted the day to stop. I would only function when the water was functioning.”
Assaad tells this story with a sad laugh. In another country, he notes, this would sound absurd. In Lebanon, it’s part of a routine.
That’s because various wars, crises, and rampant corruption have created chaotic living conditions in Lebanon, including little if any access to public electricity or water.
“The traffic, the lack of electricity while driving at night – everything you do is affected by the state of the country,” Assaad says. “Sometimes I have the luxury of living a daily life, but 80% of it is affected by the state of the country.”
For Haya Saleh, a 22-year-old Lebanese university student who moved to Canada in 2021, the realisation that many parts of her life were not actually “normal” only came when she talked about her past with new friends.
“I remember having to talk about the Beirut port explosion to non-Lebanese people I met in Canada. I couldn’t tell them more than the headlines,” she says, even though her home’s windows shattered on the outskirts of Beirut on that August 2020, and over the years she had lost relatives and lived through the ups and downs of the protests and economic downfall.
“It feels like we are comfortable sharing these details with each other [in Lebanon] because we go through these things together and know the threshold of what you tolerate is much higher,” Saleh explains. It wasn’t, she adds, until she had geographical, emotional, and social separation from her country that she realised just how much she had normalised the unthinkable.
Compounding trauma
Many in their 50s and 60s have had to deal with even more, living through more war, multiple major political assassinations, militia rule, and mass emigration. It may not be clear to them what stability feels like.
Mia Atoui, a licensed psychologist and co-founder of Embrace Lebanon, an NGO that offers mental health counselling and operates the country’s only suicide hotline, says that, “from a mental health perspective, the situation is dire, with many people struggling with anxiety, depression, trauma, and loss.”
She says studies suggest PTSD is widespread in Lebanon, although agrees with Saad that the CTSD term “may resonate more in the Lebanese context”.
Beyond the personal impact of these traumas, the psychological scars of war and other traumatic events can – on a macro level – be even more profound as they feed into a sense of national uncertainty and instability.
While it isn’t formally recognised as a clinical diagnosis, Atoui explains that CTSD’s attempt to include the continuous, unresolved stress over a long period time makes sense in places like Lebanon, Gaza, and other countries “where conflict is protracted and crises are not isolated events, but rather long-lasting”.
She says CTSD can manifest in other symptoms and diagnoses that are common in Lebanon “such as generalised anxiety disorder and depression”, adding that, “patients presenting with these symptoms often report the impact of continuous exposure to unstable and threatening environments as a strong risk factor for these symptoms.”
Beyond the personal impact of these traumas, the psychological scars of war and other traumatic events can – on a macro level – be even more profound as they feed into a sense of national uncertainty and instability.
“It also hampers the capacity to trust institutions and hope for a better future,” Atoui says. “People living with compounded trauma often struggle to find emotional stability, affecting their relationships, work, and overall well-being.”
The problem with resilience
Because of the daily challenges people in Lebanon have to deal with – whether it’s getting water and electricity, or medication and petrol in the face of shortages and rising prices – Lebanon is often labelled a “resilient” country.
But the cliché of Lebanese resilience, oft-repeated in media and political discourse, has become a harmful expectation. It implies that suffering through daily indignities or worse is manageable, or even normal. That people will bounce back, no matter what.
That’s simply not the case. In 2023, Lebanon saw a 21% increase from the previous year in deaths by suicide, with 168 reported deaths reported by Embrace.
The need for psychosocial support is real and urgent, but there are still blockages to getting help. “It’s okay to feel,” emphasises Saad, whose words challenge a cultural resistance to acknowledging emotional challenges, especially in times of crisis.
Dealing with compounding traumas in addition to the everyday struggles of life in Lebanon – not to mention more typical personal challenges such as the loss of a job, or an unhealthy relationship – can become a Herculean task.
But that does not keep the country from being operative, even if it is dysfunctional.
“When we go through a crisis, if we’re going to stop on every single little thing, we won’t be able to work,” Saad says. “So, automatically, our bodies do our daily functioning by design, and they might stop feeling. But if this stays, and we use it in work, in personal relationships, this is dangerous.”
“During the peak of the crisis, it’s okay to be numb as long as we’re aware that this is now, in the moment, at the peak,” she adds. “But when the crisis subsides, it’s important to take time to understand what one went through.”
Similarly to many Lebanese, to be able to keep on working and living, Assaad says there have been times when he tried to keep his emotions at bay, not processing the reality he was going through. “Deflection was my coping mechanism,” he says of 2021-2022, when Lebanon’s financial, water, and electricity crisis was at its worst.
“Sometimes, I would get frustrated at home. I would just get myself busy tidying up, cooking, listening to music, or a podcast, in order not to spiral. Otherwise, I would just crash, stay on the sofa, and doomscroll.”
It’s hard to be far from Lebanon during tough times, too.
“The phone was always in my hand,” says Saleh of the recent war. “You know that your close friends and family are living through this. There is a kind of dissonance in your life…. [You are safe], but you don’t know what is going to happen to your home.”
In 2016, the World Bank published a report showing how mental health directly impacts economic productivity: People suffering from anxiety, depression, or trauma are more likely to miss work, require long-term care, and contribute less to GDP.
In Lebanon, the reverse is also true: The failing economy and soaring unemployment have fuelled the mental health crisis. The Lebanese pound has lost over 95% of its value since 2019, with the median salary plummeting from around $630 to just $63.
That leaves the cost of therapy out of reach for most. Mental health services exist – there’s a growing network of NGOs and online platforms trying to fill the gaps in the healthcare system – but access remains inconsistent, especially outside major cities. And in a society that has only recently begun to talk openly about emotional well-being, there can be stigma attached and many still view therapy as a luxury.
And so Lebanon continues to spin in a vicious cycle: A population in pain, with little access to healing; an economy in freefall, driven in part by the collective toll of burnout; a place where life-altering events happen too fast to feel, too often to fully understand.
“As Lebanese, we think we thrive in chaos,” says Saad. “We have the analogy of rising from the ashes, like the Phoenix… But we are not thriving.
“We have so much potential. We have so much history. We have nature, a great educational level, medicine, creativity. When Lebanese travel abroad, they shine, but here, it just seems like we plateau.”
In Lebanon, dial 1564 for the the Emotional Support and Suicide Prevention Hotline. For other locations, click here to find a helpline near you (via the International Association for Suicide Prevention).
Edited by Annie Slemrod.
