Healing the wounds

    As professionals, we routinely work with victims of trauma
    -Êwhether it be a child who has endured physical, emotional
    and sexual abuse, or an unaccompanied teenager fleeing from
    persecution and conflict in a war-torn nation. This can present us
    with emotional, ethical and system challenges and frustrations.

    The response to humanitarian disasters, whether they are a
    result of natural causes such as the tsunami or because of war as
    in Africa, tends to focus on the physical health of the survivors.
    This is out of necessity – during my work in Sierra Leone’s
    national psychiatric institution, juvenile secure facilities,
    prisons and community outreach in the capital Freetown, the
    grinding poverty, poor sanitation, lack of clean water and
    affordable food and medical care all had profound, sometimes fatal
    consequences for the individuals.

    Sierra Leone is still recovering from a decade-long, brutal
    rebel war, characterised by the forced use of child soldiers, the
    carrying out of massacres, rapes and mutilations.(1) There is a
    similar conflict in neighbouring Liberia and Ivory Coast, as well
    as much economic, social and political instability throughout

    While aid flows to South East Asia, thought needs to be given to
    the long-term needs of survivors. Once the emergency relief is
    completed, the long-term social, economic and psychological
    recovery of survivors needs to be considered – recovery in terms of
    education, employment and livelihood, and addressing the needs of
    orphaned children.

    Trauma can have an impact for many years. Some Holocaust
    survivors have reported trauma-related symptoms decades after the
    event, in part because they have not been given comprehensive
    support such as psychosocial and psychological interventions,
    education, employment and access to a friendly social structure for
    those who have lost their families.(2)

    People living in the UK who are from countries affected by the
    tsunami or relatives of tourists caught up in the disaster may come
    to social services for help. The media has highlighted several
    individuals from countries such as Sri Lanka and Thailand who have
    lost large numbers of family in their country of origin.

    In Sierra Leone, I work with many young people who are isolated
    from their family or any kind of supportive social structure, are
    unemployed, uneducated and homeless. Many witnessed, and some
    participated in, atrocities and horrific events during the war.
    Feelings of alienation and a sense of hopelessness for the future
    prevail among these young people. Crime rates are very high, as is
    drug abuse – crack cocaine and heroin are particularly prevalent.
    This is further compounded by young refugees from the conflict in
    Liberia, and internally displaced Sierra Leoneians from the rural

    For recovery to be meaningful, there needs to be consistent
    recognition that the training, resourcing and retention of local
    people and services is central to the recovery process.(3)

    My experience in Sierra Leone shows that non-governmental
    organisations and aid agencies bring in expertise from abroad in
    the areas of mental health, child welfare and protection. While
    there are local services, resourced by very committed and
    experienced individuals, they are grossly under-funded; salaries
    are often below subsistence levels, and the economy is very poor
    with each person having to get by on the equivalent of about
    £260 a year. Sierra Leone is ranked as one of the poorest
    countries in the world, with a life expectancy half that of
    “developed” nations – 39 years of age – and nearly half the
    population is under the age of 15.

    But if local people are enlisted as central to the recovery
    process, this increases the potential for healing. It helps make
    sense of the trauma within the cultural context and aids the future
    growth of areas or countries or communities affected by large-scale
    disasters or conflict. Professionals from the UK enlisted in the
    recovery process should bear this in mind at all times.

    Kidnapped girl became a rebel

    Binta is a 14-year-old refugee from Liberia living in Freetown
    the capital of Sierra Leone. She has been in Sierra Leone for about
    six months.

    Binta had been living with her family in a village near Salala
    in southern Liberia. When rebels attacked the village her pregnant
    mother was murdered in front of her. Binta recalled how the rebels
    cut open her mother’s stomach, and removed the foetus, before
    decapitating her. Binta was then kidnapped by the rebels and held
    as a sex slave where she was repeatedly raped over a six-month

    She escaped and became involved in armed conflict. She
    eventually fled over the border to Sierra Leone and found herself
    in Freetown.

    Binta works as a street prostitute. She has a dependency on
    crack cocaine and heroin, and has major psychological problems. She
    feels there is no hope for the future and will remain uneducated,
    unemployed and homeless, and isolated from family and society. She
    is a child who has suffered extreme, unimaginable trauma, but
    because she became a “rebel” as a way of surviving she is condemned
    by the wider community.


    The recent catastrophic tsunami in South East Asia brings into
    focus once again the issue of working with victims of trauma. This
    article, based on the author’s personal experiences of working with
    young people and their families in post conflict Sierra Leone,
    begins to explore some of the longer-term psychological needs of
    victims of large scale trauma.


    1. Children Affected by War Programme, Government of Sierra Leone,
      Ministry for Health/Unicef, 1997
    2. Judith Herman, Trauma and Recovery: From Domestic Abuse to
      Political Terror, Basic Books, 1997
    3. Natalie Losi, “Assumptions on Psychological Trauma
      Interventions in Post-Conflict Communities”, in Renos K.
      Papadopoulos ed, Therapeutic Care for Refugees – No Place Like
      Home, Tavistock Clinic 2002

    Further Information

    • Cairo Arafat, “Psychosocial Assessment of Palestinian
      Children”, United States Agency for International Development,

    Contact the Author

    Email: shaun.collins@beh-mht.nhs.uk
    or call 020 8442 6467

    Shaun Collins is head of service for child and adolescent
    mental health services in Haringey, north London, and is employed
    by Barnet, Enfield and Haringey Mental Health NHS Trust. He is
    undertaking a PhD with the Tavistock Clinic, London, exploring the
    psychosocial needs of juvenile offenders in Sierra

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