P.H.A.S.E presentation held by Dr. Heba Habib at the monthly conference, May 6th, 2015, on the subject of the psychological impact of the Jan 25th, 2011 revolution on Egyptians and on the increase in violence suffered and/or perceived. P.H.A.S.E (Psychological Health Awareness Society in Egypt,) is a registered Non Profit Organisation (Registration number 6692/2006), with more than 70 active members. PHASE was founded to offer psychological treatment to help abused and traumatized women/children and men who would otherwise be unable to pay for their much needed treatment.

1. PSYCHOLOGICAL HEALTH & AWARENESS SOCIETY IN EGYPT
‫وعي‬‫وعي‬
p.h.a.s.e
‫الجمعية‬‫المصرية‬‫للتوعية‬‫والصحة‬‫النفسية‬

2. MISSION & PROGRAMS

3. POST-REVOLUTION
EGYPT’S PSYCHOLOGICAL WELL-BEING
Photo: Reuters

4. Egyptian Society
First Major Example of Mental Healthcare as a Major
Priority
for a Society
in History

5.  First Known Psychiatric Text -2000 Years BC-
 First Known Mental Hospital -Saqqara-
 Temple of Imhotep at Memphis -2900 Years BC- popular center for mental
illness treatment
 Methods of Treatment:
• opium
• rituals or prayers
• "sleep therapy“ as dream interpretations

6. Sleep Therapy

7. About P.H.A.S.E…
• Egyptian Non-Profit Civil Society Organization
• 2006
• Maadi Cairo, Egypt
• Professionals
• 70 Active Members

8. P.H.A.S.E… The Mission
TO IMPROVE PSYCHOLOGICAL WELLNESS IN THE COMMUNITY
• Increase Awareness
• Improve Healthcare Services
• Address Social Component
for Psychological & Psychiatric conditions

9. INTER-RELATEDNESS OF P.H.A.S.E PSYCHOSOCIAL AREAS OF INTEREST
Substance Abuse, Violence, Coping with
chronic illnesses : Psychosocial Illnesses…

10. Improving Psychological WELLNESS iN the commu
nity
Through
1. Improving quality of psychological health care : by
Improving efficiency of experts in specific areas
 Addiction
 Violence
 Exposure to traumatic events (life threatening or chronic diseases)
P.H.A.S.E….Objectives:
2. Increasing public awareness:
 Complications of addiction: (HIV, STD, Psychiatric conditions,
Psychosocial & Economic drawbacks etc.) & means of prevention
 Psychosocial impact of violence & EXPOSURE to traumatic
events : on individuals, families, surroundings & society

11. Funding Agencies:
 Italian Cooperation in Egypt
 Drosos Foundation & Family Health International
 Al Fanar Foundation
National & International Organizations:
 National Council for Childhood & Motherhoood
 European Union (Child Trauma Network)
Educational Institutions:
 Kasr El Aini Medical School Egypt
 Faculty of Medicine Temple University-USA
 Faculte de Medecine Universite Pierre et Marie Curie -Paris- France
 Universitad Complutense de Madrid-Spain
 Laval University, Canada
P.H.A.S.E… The Partners

12. P.H.A.S.E… The Partners…
• Public Services: Giza Primary & Preparatory Schools
South Cairo Primary & Preparatory Schools
• Public and Private Business Companies
Te data Masreyyoun Dedd El 3ounf
National Awareness Campaign Against Violence
Ministry of Solidarity
• Association of Diplomats spouses in Egypt
 Arabs
 Asians
• UNITED NATIONS AGENCIES
UN-Women; UNICEF; UNODC

13. P.H.A.S.E… The Networks…
Professional Associations:
 World Association for Social Psychiatry
 World Psychiatric Association
 Egyptian Psychiatric Association
 Arab Psychiatric Association
Civil society institutions:
 Egyptian NGOs working with vulnerable population
 refugees (Catholic Relief Services, Médecins Sans Frontières)
 women & children victims of domestic violence ( around 15 NGOs)
 street children (SAMU Social, Banaty Foundation, Establ Antar)
 patients with chronic illness (HIV/AIDS; Hepatitis C; Cancer; Diabetes)
 Women’s Associations

14. P.H.A.S.E… The Networks
• Child Trauma Network: European Union Project

15. P.H.A.S.E THE INITIATIVE…
 Psychological Health: important component of Social Wellbeing
Total number of human resources working in mental health facilities in Egypt
4.98 per 100,000 population:
Psychiatrists: 1.44 /100,000
nurses : 2.6 /100,000,
psychologists : 0.11 /100,000
social workers : 0.27/ 100,000
62 outpatient mental health facilities (only 2 for children & adolescent)
•Users of these facilities (2004) 254/100000
•34% females
•12% children or adolescents.( Children under 15 years are 34% of Egypt
population)
2% of health care expenditures by government health department for mental health
• 59% for mental hospitals
•Lack of Community Mental Health Structure
Creation of PHASE
WHO report on mental health system in Egypt 2006

16. Social Violence & Mental Health
Structural Violence (one of the 3 aspects of social violence with cultural & symbolic
violence)
is accused of being directly responsible for psychological human suffering (Farmer, 1996)
Present Sociopolitical Factors
 Overpopulation: Cairo 20 millions people(Central Agency
for Public Mobilization and Statistics, 2010)
 Massive unstructured urbanization (United Nations Development Program (Egypt), 2003 )
 + 50 % of houses economically supported by women
(Radwan et Reiffers, 2006)
Photo: www.sawtalniswa.com
Aspects of psychological suffering

17. P.H.A.S.E activities & Programs

18. 5 MAIN
ACTIVITIES

19. P.H.A.S.E… The Activities
1. COUNSELING & TREATMENT OF PSYCHOLOGICAL DISORDERS
 Addiction
 Psychological traumas (abuse, domestic violence, natural disasters, life-
threatening diseases…)
 General Psychiatric conditions
2. PREVENTION & COMMUNITY AWARENESS PROGRAMS
3. TRAINING for psychosocial teams, for education schooling personnel
4. SCIENTIFIC RESEARCH (e.g., instruments adapted to Egyptian
population, international conference ICSPE..)
5. REHABILITATION from addiction & trauma (yoga, meditation,
empowerment)

20. SUBSTANCE ABUSE & VIOLENCE: PSYCHOSOCIAL ILLNESSES…
• 1,119,373 drug abusers in Egypt: Extrapolated Prevalence Rate of
Drug abuse in Egypt, i.e., population of people who are managing Drug
abuse at any given time (US Census Bureau, International Data Base,
2004)
• Addicts spend more than 16 billion Egyptian pounds a year on drugs
• Multi-country Study in 2004 (Chile, Egypt, Philippines & India)
identified regular alcohol consumption by husband or partner as a
risk factor for any lifetime physical intimate partner violence across
all four study countries
• 80 percent of child abuse associated with alcohol and other drugs
use

21. PROGRAMS...
1. Prevention Program Against Substance Abuse in Schools 2007
(National Council for Childhood & Motherhood, UNODC & Italian
Embassy
2. HIV/AIDS Prevention for Drug Addicts 2008-2012 (FHI & Drosos
foundations)
3. Smoking Prevention Program 2010 (PHASE resources)
A) Substance Abuse

22. B) Coping with chronic illness: HIV/AIDS
HIV/AIDS Prevention for Drug Addicts 2008-2012 (FHI & Drosos foundations)
• Number of people living with HIV in Egypt is estimated to be 11,000 in
2009 according to UNAIDS, among which are 2,400 women.
• HIV infection is a chronic life threatening condition.
• To be diagnosed with HIV is a traumatic experience which induces
psychological distress that can develop into serious psychological and
psychiatric condition jeopardizing the HIV carrier quality of life and
productivity.
• Psychological distress due to being HIV carriers has particular
characteristics linked to social stigma associated to “shameful” HIV
transmission (sexual and intravenous drug-related transmission)
(Gore-Felton et al., 2006; Leserman, 2008; Vaughan & Kinnier, 1996).

23. C) Violence: Psychosocial Illness…
Examples
Observatoire National des Droits de l’Enfant (Maroc(
Photo: Women of the Egyptian Revolution www.sawtalniswa.com

24. Examples of Social Violence: Violence Against
Women
 47 % of ever-married women experienced physical violence since
the age of 15 (Egypt Demographic and Health Survey (EDHS) 2005)
 36 % of sample of 5,613 experienced marital violence (emotional,
physical, and/or sexual) (Egypt Demographic and Health Survey (EDHS) 2005; US
AID , 2009)
 Some statistics show that domestic violence is due to
o Husbands (72%)
o Fathers (43%)
o Brothers (37%) (Egypt Demographic and Health Survey, 2005 )
 Violence against women
• Widespread and commonly accepted phenomenon in Egypt
• No accurate & up-to-date statistics on the levels of violence
against women ( 98 percent of rape and sexual assault cases are
not reported to authorities)
• Difficult to assess nature and degree of such violence in Egypt

25. Violence: Psychosocial Illness…In Egypt: 63.4% of married women victims
of violence (Us AID Violence Against Women Report in Egypt 2009)
Most of sources of
violence were combined
but here are the statistics
for the most prevalent
type according to the
victim

26. Lack of national data on child abuse & neglect ,Difficult to measure extent of
problem
High levels of corporal punishment & verbal abuse
Home 81%, 90%
School 91%, 70%
Work 27%
(UNICEF ,2010)
70% of mothers have hit or slapped their children on the body
40% have hit or slapped children on the face
2005 EDHS (Egypt Demographic and Health Survey ) on domestic violence
10,000 STREET CHILDREN In The Four Largest Governorates
National Council of Childhood and Motherhood (NCCM)
Examples of Social Violence: Violence Against
Children

27. C) VIOLENCE
VIOLENCE INTERVENTION PROGRAMS :VIP
1. Domestic Violence: Mawadda offers appropriate Health care &
Support services to victims of Interpersonal Violence
2. Outreach & Prevention in Community: School-based Violence
prevention and early intervention programs
3. Community-based Violence Prevention and Early Intervention
Programs in Cooperation with TEdata Masreyyoun dedd el
3ounf

28. P.H.A.S.E LEVELS
OF
INTERVENTION
IN VIOLENCE
AWARENESS
PROGRAMS

29. DOMESTIC VIOLENCE

30. ‫الواردة‬ ‫الحالت‬ ‫مجموع‬

31. ORPHANAGES PSYCHOLOGICAL
WELL-BEING PROMOTION

32. • Start 8 orphanages in Cairo
• In Cooperation with
 Ministry of Solidarity
 IBM
 Al Binaa Foundation
 Masr El Kheir
 Bank El Shefa
 Ajial Foundation
 Homat El Mostakbal Foundation
• Pilot project to be extended to more orphanages

33. ‫أولدي‬ ‫جمعية‬
‫عدد‬375
‫عليجي‬ ‫تدخل‬ ‫تحتاج‬ ‫التي‬ ‫الحال ت‬ ‫عدد‬11‫بنا ت‬
6(‫ال(ن‬ ‫)إلى‬ ‫بنين‬
‫تعديل‬
‫سلوك‬
‫أخر‬
‫دراسى‬
‫يصعب‬
‫التعامل‬
‫معها‬
‫انطوائية‬ ‫سرقة‬ ‫ل‬ ‫تبول‬
‫ارادى‬
‫السلوك‬
6 4 3 3 3 3 ‫العدد‬

34. WHAT HAPPENED
PSYCHOLOGICALLY TO EGYPTIANS
SINCE
2011 REVOLUTION?

35. Psychological Effects of Violence, Chronic Conflict & Political Unrest
 Increased stress and anxiety
 Stress : hindered ability to meet life’s demands due to real or perceived
challenges beyond the range of available coping resources (Gunnar & Quevedo,
2007).
 Stress disorder:
• Stress response negatively affects a person’s daily functioning (occupational or
social obligations) (Olfson et. al., 1997)
• Stress disorders: debilitating nature
 loss of energy (depression, poorer quality of life) (Liverant, Suvak, Pineles, &
Resick, 2012)
 anxiety (Barlow, 1988)

36.  Stressors: varying degrees
 Trauma: Extreme stressor threatening their physical integrity (Flannery, 1999)
( violence or violence inflicted on others) (Breslau, 2009))
 PTSD:
• re-lives the traumatic event,
• avoids items or settings event,
• heightened sensitivity for stimuli (Flannery, 1999).
 PTSD :
• stress & anxiety
• must follow a traumatic event (Breslau, 2009).
• comorbid disorder: depression or drug abuse to cope with trauma (Breslau,
2009).
• Men: more likely to experience traumatic events
• Women are more frequently diagnosed with PTSD (Breslau, 2009).

37. SIGNIFICANT TRAUMATIC EVENTS
DURING REVOLUTION
• 18-day uprisings between January 25 and February 11, 2011
• Violent clashes:
 Imbaba in May 2011,
 Maspero in October 2011,
 Mohamed Mahmoud in November 2011,
 Port Said in February 2012, and
 Abbaseya Square in May 2012,
 Ettehadeyya December 2012
• Proliferation of guns on the streets
• Rate of armed robberies increased by almost 83% in May 2011 compared to
the rate before January 25 of that year
• Rate of murder was up 75% as well (Hendawi, 2011b). In 2011, 2,774
murders were reported in Egypt (Fleishman & Hassan, 2012)

38. MENTAL HEALTH DATA
AFTER 2011 REVOLUTION
• 313 people interviewed (Cairo and Giza)
• 60% met the criteria of Post-Traumatic Stress Disorder, which was much
higher than they expected
• Females : significantly higher trauma levels compared to males (t = 2.23, p
< .05).
• 60.1% of the participants agreed that services offering help for people facing
violence, injury, or stress after the uprisings was important
• Most of the people were traumatized by violence they saw on the television
(61%)
 seeing someone being injured on the streets (47%)
 knowing someone who got injured (19.8%)
 being personally injured (8%)
(Abdelmonem et al 2013)

39. Photo: El Pais
THANK YOU