Last summer, as I was hiking near a tourist site in northeastern Jordan, a boy of twelve or so struck up conversation in a manner distinct from that of traditional peddlers. My broken Arabic bridged the gaps in his broken English. He eventually asked if I would like to see some pictures of his family from Syria, passing me a cracked smartphone. I had to bring it up close in the afternoon sun, one hand shielding the space between the screen and my eyes. I had expected posed family photos, and so it took a moment for me to absorb the video of a chaotic street scene. Dismembered bodies littered the ground. I realized the discombobulated tin from the speakers was screaming.

As this violent month has blurred the boundary between strategy and insanity, I’ve returned to this scene many times. After an entire downtown coffee shop was taken hostage by a self-styled cleric in Sydney, and after the massacre of nearly 150 students and teachers in Peshawar, attempts by media and the public to interpret these narratives as one or the other have varied across geopolitical space. Both attacks aligned with the anniversary of our own tragedy at Sandy Hook, which was marked by a revived rhetorical focus on mental health programs. Overseas, however, similar initiatives are rarely proposed as preventative options against terror and brutality. To properly combat these demons, victims and potential perpetrators of terrorism alike need increased access to mental health services — and the inability of humanitarian agencies to provide this care may be contributing to a cycle of violence.

In the most comprehensive study to date, criminologists note that most social scientists “have discounted a causal relationship between mental illness and terrorism. This is not the case within terrorism studies, the media, or political circles…where theories of patholigization continue to exist.” In academia, studies with funding from security actors tend to draw connections between the two, while those with non-state support tend to show no relationship. This leaves us drawn to extremes: all terrorists are crazy, or none are. As often presented in the media, this divide persists along borders: all lone actors in the United States are insane or vulnerable or externally radicalized, while all abroad are rational actors in politically-motivated groups conducting extreme violence in service of a grand strategy. Given single instances, it’s difficult to differentiate between the two.

Making diagnoses after death, as many have attempted in the Sydney hostage crisis, is complicated and easily biased. Strong religious expressions are common psychotic themes, and evidence suggests that both are associated with heightened activity in the same portion of the brain. In 2011, for example, a man on incorrect medication, with no history of extremism or terrorist affiliations, forced the landing of a Southwest Airlines flight after standing on his seat to shout threats and religious proclamations. Existing research on terrorism and mental illness also ignores the ways illnesses may manifest in different cultures: in societies where the role of religion is more prominent than in the United States, related symptoms may be less detectable using Western-based diagnostic criteria.

Last year, 82% of deaths from terrorism occurred in Pakistan, Iraq, Syria, Afghanistan, and Nigeria. What often goes unmentioned is that these five countries are all home to inadequate basic health systems, with high mortality rates from infectious disease and other preventable causes. It follows that they are also home to significant gaps in mental health diagnosis and treatment. These countries encompass regions where it is difficult to give birth in a clinic, or to procure mosquito nets under which to sleep — much less to discuss suicidal thoughts with a therapist, or to cope with grief through counseling, or to obtain diagnosis and treatment for schizophrenia. They are home to extended conflicts, including prolonged civil wars, external invasions, and insurgencies. Globally, 10–20% of children are estimated to have mental health problems; it’s safe to assume that children in these countries shoulder a disproportionate burden. And adaptations that help children survive in violent settings could potentially lead to mental health disorders in adulthood, some of which may be associated with tendencies to perpetuate the ferocious cycle.

During the height of last summer’s war in the Gaza Strip, I was conducting research in the health department of the U.N.’s Palestinian refugee agency. The dramatic need for psychological support — especially for children, kept awake for weeks by night bombing — arose in our meetings, but lack of trained providers made any actual treatments impossible. Children crowded into school shelters were provided 30-minute art therapy sessions, 50 at a time. A clown showed up. That was it.

On the outskirts of limestone ruins, in a country hosting more refugees than its existing services could ever dream of handling, I was started by the casual recollection of extreme violence from a boy half my age and twice as hardened. Six months later — in the wake of two attacks that shook the globe — what do I want for him?

Barring the ability to undo the fighting that left him orphaned, I would like a more comprehensive approach to prevention: one that treats instances of extreme mass violence abroad as unnatural, avoidable, and ambiguous in origin as we treat it at home. Effective interventions require funding for truly rigorous studies on terrorism, trauma, and mental illness. These must be collaborative efforts from researchers in both counterterrorism and the social sciences, balancing issues of public safety with fair treatment of vulnerable and oppressed populations. And they should be adapted culturally: what works in Northern Nigeria won’t necessarily match the needs of children in the Gaza Strip.

Most importantly, relief agencies and host countries need to allocate funding and training to provide stronger mental health services and accessible treatment for trauma for those victimized by terrorists. Certainly, mental health services face serious competition for funding: waning international attention and growing refugee populations have made even food procurement for refugees a struggle. But so long as humanitarian aid is tethered solely to physical well-being, global efforts to combat terrorism and to help heal its victims will remain incomplete.