The Middle East has been in conflict for many decades and wars have become the ‘normative reality’ of children residing in the area. Questions have been raised about children's vulnerability to the stresses that come with living in a war area. Are children more resilient because they are more flexible in their ways of coping? Or are children more vulnerable because their psychological development is influenced by the environment?

The Gaza Strip has been badly affected by war and conflict over the past four decades. Palestinians are exposed to repeated incursions of the border areas, with many resulting casualties. At the end of December 2008, more than 230 Palestinians were killed and at least 770 were injured, including 100 in critical condition, after an Israeli airstrike. This was followed by a military operation that continued for 23 days, in which 1420 Palestinians, including 446 children, were killed. At least 4000 houses were totally destroyed and 16000 partially damaged (Palestinian Red Crescent, 2008).

The children who experienced the genocide against the Tutsi in Rwanda are now in their mid to late 20s. It is almost impossible to comprehend the scale of the terror and destruction of Rwanda's societal infrastructure between 6 April and 16 July 1994. While the world remained inactive, Rwanda, a small impoverished central African state, experienced the murder of about 1 million of its citizens; it also saw the terrorising, humiliation and rape of countless thousands. Although women and children were directly targeted, some actively engaged in atrocities. About 300000 children were murdered, a significant number at the hands of other children. The level of terror differed across the country and escape was frequently by luck alone. A UNICEF (2004) study of 3000 children revealed that 80% had experienced death in the family, 70% had witnessed a killing or injury, 35% saw other children killing or injuring other children, 61% were threatened with being killed and 90% believed they would die (Human Rights Watch, 2003). Of the 250000 women raped, 30% were between 13 and 35 years of age, 67% developed HIV/AIDS and 20 000 births resulted (Donovan, 2002).

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.

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.

Despite the growing importance of mental health in international and national policies, the contribution to the psychiatric evidence base from non-Western countries is sparse. Such a gap in research output between high- and low-income countries constrains improvements in public health and mental health policy and practice in developing countries, where there is perhaps the greatest unmet need. If research is to inform local mental health policy and practice, it must reflect the diverse realities of local health systems and cultural factors.

Article 14 of the General and Specialist Medical Practice Order 2003 for specialties in psychiatry describes the specific conditions that a doctor must meet in order to be eligible as a specialist for the purposes of inclusion on the Specialist Register. The conditions as published by the Royal College of Psychiatrists (2003) include, among other requirements, that the psychiatrist shall demonstrate working knowledge of the epidemiology, aetiology, psychopathology, clinical features and natural history of the major psychiatric disorders in ICD-10 (World Health Organization, 1992), including age, gender and socio-cultural considerations, based upon the scientific literature. Familiarity with ICD-10 diagnostic criteria is therefore an important part of psychiatric training.

This article looks at the advantages and disadvantages of being monolingual or multilingual, with particular reference to dementia patients who belong to ethnic minorities. There has been some progress in understanding the field of cultural diversity and the variations between different ethnic groups in relation to their specific difficulties when suffering from dementia (Hendrie et al, 2001). However, research has largely been targeted towards cultural variations and dementia, while the language aspects have not been properly researched.

Medicines made from substances that are controlled under the international drug control treaties (‘controlled medicines’) are out of reach for the majority of patients around the world. Seya et al (2011) demonstrated that 5.5 billion people (83% of the world's population) live in countries with little or no access to opioid analgesics, 250 million (4%) have moderate access and only 460 million people (7%) have adequate access. Insufficient data are available for 430 million (7%). If the need for treatment of moderate to severe pain were to be satisfied adequately, the global consumption of strong opioid analgesics would go up from 231 tonnes of morphine-equivalents to 1292 tonnes.