Post-war trauma endangers growth

LONDON – Traumatised by his experiences as a child soldier in South Sudan, 14-year-old Peter decided to settle an argument with two other children by taking an AK 47 from the local military barracks to shoot them.

Peter, whose name has been changed to protect his identity, was one of nearly 1 800 children being reintegrated into their communities after their release earlier this year from the South Sudan Democratic Army Cobra Faction in eastern Jonglei state.

Some were withdrawn and unable to trust people around them. Some, like Peter – who was disarmed before he could open fire – were prone to aggressive outbursts.

Counsellor Shaun Collins, who has recently returned to Britain after six months as a leader on the UN children’s agency (Unicef) which helped release and reintegrate the children, decided to not to offer Peter formal therapy.

Short of time and resources, Collins thought it better to teach the boy techniques to help him calm down, and draw in community elders, family, social workers and his teacher to help him change his behaviour.

“We had no formal post traumatic stress disorder(PTSD)-type services to work with this boy, so we worked with what we had,” Collins said, referring to a condition that can affect people like Peter who have had traumatic experiences.

Eventually the boy calmed enough to reveal that while fighting his way out of an ambush, he killed several people and saw close friends die. He became both victim and perpetrator.

South Sudan has just a handful of mental health professionals to serve a population who have experienced decades of war.

In countries recovering from conflict, experts like Collins want to see mental health services prioritised alongside housing, health care and education.

“You can see the problem somewhere like Sierra Leone where you didn’t address trauma,” said Collins, who worked in what was Sierra Leone’s only psychiatric hospital.

“The problem doesn’t just go away with the passage of time, it just becomes chronic,” he added.

Many say trauma can affect not only families and communities, but also a country’s prospects of long-term peace, and economic and political development.

The World Bank views trauma as an obstacle to economic development in West Africa, and this year launched a programme to try to address it in Liberia, which has been deeply affected by the Ebola crisis and civil war.

“Research shows trauma is cumulative. So the more terrible things happen to people, the higher the risk of developing mental health problems,” said Inka Weissbecker, global mental health and psychosocial adviser at International Medical Corps.

In places suffering long-term conflict like Gaza or Afghanistan, people are much more on edge, there is more family violence, people have difficulty trusting each other, she said.

“People only talk about the loss of life, but never about the loss of a future,” said Inge Missmahl who is working with the Afghan government to introduce a trained psychosocial counsellor in every public health clinic in the country.

If people do not have too many traumatic experiences, and can find a safe environment in which to live, symptoms of trauma can ease with time.

But if the experiences are repeated or if war continues for a long time, then the symptoms can become chronic.

“If whole generations grow up with violence at home and conflict in their communities, they learn to solve problems in a violent way,” said Missmahl, who founded the International Psychosocial Organisation, Ipso, whose team has so far trained about 300 psychosocial counsellors in Afghanistan.

More than 60% of people who attend public health clinics in Afghanistan are reported to show symptoms of depression, fear and anxiety, Missmahl said.

If unaddressed, trauma becomes a potential cause of the next round of violence and conflict, said Vesna Matovic who, as head of training for London-based NGO International Alert, trains UN agencies, the World Bank and governments in peacebuilding.

For example, Serbia and Croatia have developed trade and cultural relationships with each other, but in other ways the former enemies have not moved since the war ended 20 years ago.

Germany after World War Two as a nation faced its past and its actions, she said. “I think that acknowledging what happened was healing for them as a society.”

“They did quite a good job in not covering up issues, or putting it under the carpet. I think they were facing their past, and that’s always the first step. And without that I don’t think any society can progress so much.”

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