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
Africa.

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
provinces.

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
period.

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.

Abstract

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.

References

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,
  2003

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
Leone.