Photo: Andrew Green/IRIN. A local outpatient clinic in Minkaman, Awerial County, South Sudan
Source: IRIN
Juba, 17 March 2014 (IRIN) - Aid workers warn that while psychosocial
support needs will mount for the tens of thousands of displaced people
in South Sudan, the resources and skills needed to treat them are in
short supply, and there is particular concern for men, who feel targeted
in the ongoing fighting.
South Sudan has been no stranger to conflict in its short two-and-a-half
year history. Emerging from a civil war with Sudan, the country,
especially restive Jonglei State, has seen regular cattle raids,
inter-communal clashes and battles between rebel groups and the national
army.
What is unusual this time, according to Miranda Gaanderse, a protection
officer with the UN Refugee Agency (UNHCR), is the number of men who
fled to UN bases and other relatively safe areas, or left the country
entirely. There are still no exact numbers and the majority of displaced
are women and children, but Gaanderse said the fact that hundreds of
thousands of men have left their home indicates just how violent and
traumatic the fighting has been.
The International Crisis Group estimates at least 10,000 people have
been killed. An interim UN report on human rights violations found
evidence of the targeted killing of civilians, gender-based violence,
including gang rape, and torture by combatants on both sides of the
conflict.
At least some of the violence seemed psychologically targeted, with
agencies reporting bodies were mutilated and left in the middle of
settlements to warn people to leave. In places like Bor, capital of
Jonglei State, weeks after the fighting stopped, bodies still littered
the streets because people were too scared or too scarce to remove them.
“Men were the main targets for violence,” Gaanderse said, and as
fighting continues, fear remains. In the displacement camps, she said,
it is the women who leave to buy things or collect firewood. “Some men
have been sitting there for almost three months. It has a huge impact
along WITH psychological impacts.”
In the absence of psychosocial services, she warned that people could turn to alcoholism or violence.
It looks as though they will have no choice but to sit for several more
months. A late January cessation of hostilities agreement has been
broken multiple times and ongoing peace talks in Addis Ababa have made
little progress.
Martin Ojok Karial, a civil servant in Malakal, has been living at the
UN base there for more than two months. He said he is “just really
angry, because there is no reason… Now nothing happens. No food. No
everything. No future.”
Karial has only a few friends to help him process his anger. He said he cannot talk to his family about it.
The sheer immensity of the crisis has left nearly half of the country’s
population in need of basic assistance and the clock is ticking: With
seasonal rains already started and threating to cut off access to vast
swathes of the country soon, humanitarian groups say providing food,
clean water and basic medical care has to take precedence over
psychosocial support for the time being.
Little donor support
International Medical Corps (IMC) did a rapid assessment of mental
health needs in Awerial County and Malakal, the capital of Upper Nile
State. They contain populations that have seen some of the worst
violence since fighting broke out in South Sudan in mid-December. IMC
researchers found a “fragile health system” that was almost completely
dependent on international organizations, which do not have the capacity
to stage a mental health response.
The aid community’s emergency response to South Sudan’s crisis is broken
down into different categories, called clusters. Psychosocial services
fall under the Protection Cluster, which has received only $3.8 million
of the requested $63.4 million.
Jorge Castro, who carried out the IMC assessment, could not even attempt
to quantify the country’s mental health needs because the current
health workers do not have the time or expertise to catalogue them.
During his visits, Castro found “people having adjustment disorders and
all the spectrum of stresses, anxieties - not just related to this
particular event, but to trauma coming from the past. These are huge
needs. Everybody is vulnerable. It’s not just about children, women and
elders.”
Even before the crisis started, the South Sudan government had no mental
health professionals on staff, leaving any psychosocial response to the
already overstretched aid agencies.
Fatuma Ibrahim, UNICEF’s chief of child protection, said while they do
not have the resources to bring in teams of psychiatrists, there are
other interventions they are introducing, though nearly all, given the
agency’s mandate, are geared towards children.
These include safe spaces where children can play games or draw under
the protection of a trained community member. She said this is a basic
way to draw children out and encourage them to talk about what they have
experienced.
The problem comes, she said, when a child refuses to participate. “That
level of expertise” to engage the child “is still really lacking, to
build that capacity. Because now it goes to one-to-one counselling.
There are very, very few people with that expertise, that competence.”
But she said they hope to be able to reach as many as 90 percent of
children at displacement sites with basic psychosocial interventions.
They are also reaching women at markets or other regular, social
occasions, to encourage them to talk about their experiences. But the
interventions still do not include everyone. “Fathers are usually left
out,” she said.
Threat of psychological scars
Rebecca Athou is sitting in the waiting area of a small hospital in
Minkaman, cuddling her three-year-old son. The boy developed a small
skin infection around his eye, so Athou has brought him for treatment at
the outpatient clinic, run by UNICEF. She believes the boy will recover
quickly. It is his five-year-old brother she is worried about.
In the midst of heavy fighting in Bor in mid-December, Athou, her
husband and three children fled. They crossed the White Nile river and
joined the sprawling, temporary settlement that has grown up in Awerial
County around Minkaman.
More than two months later, every time Athou’s five-year-old sees
“someone holding guns he will call me and tell me, ‘There is someone
coming with a gun to kill us,’” Athou said. He rarely sleeps through the
night. But there is no place she can take him to get help.
Failing to address trauma can cause a host of problems, said UNICEF’s
Ibrahim, including slowed development in children and adolescents and
violent outbursts for both children and adults. Ultimately, she said, it
can help perpetuate the country’s cycle of violence. The lack of
services threatens to leave permanent psychological scars in a new
generation, in a country that was barely starting to recover from
decades of fighting.