About the Liberian Civil War
Mental Health: Filling a Gap in Peace Building Services
Taboos of Psychiatric Research in Africa

Mental Health for War Survivors in Africa

Many non-profit programs in Africa directed to victims of war and genocide have constantly lacked the inclusion of mental health services in their programs. For instance, we have seen attempts in various post-war countries to rehabilitate war-affected youth (former child soldiers) through disarmament and vocational training without providing comprehensive drug addiction or trauma treatment.

Particularly in Liberia, in disarmament and rehabilitation efforts for this population in the 90’s and in 2003, guns were traded for money, which was used by the participants to maintain their drug addiction. Drugs not only medicate trauma but also impair one’s ability to attend vocational programs. Additionally, crime and violence rapidly rises among individuals under the influence of narcotics, and it is not a surprise that the money that comes from criminal acts is used to buy more drugs, which brings individuals into a vicious cycle that is hard to break without professional help.

Sadly, the aftermath of neglecting psychological services in emergency settings is at most times unseen. Conditions such as Post-Traumatic Stress Disorder (PTSD) and Major Depressive Disorder (MDD) quietly corrupt one’s self-esteem, dignity, and hope for the future. Most survivors, even after many decades after an incident, continue to severely struggle with symptoms such as constant nightmares, flashbacks, avoidance and physiological distress. These symptoms, when combined with environmental factors such as poverty and conflict, often lead to suicide, violence and despair.

We call it the silent war. Refugees can cross borders and receive blankets but have no one to talk to about horrible atrocities witnessed; women victims of sexual assault may receive free surgery thanks to outstanding NGO programs, but hardly any support to deal with constant flashbacks and nightmares that followed the traumatic event(s). Thousands of refugees are at risk for committing suicide in camps in order to contain traumatic symptoms, and sexually abused women becomes more vulnerable to future attacks. Men have also been frequent victims of sexual and domestic violence, but unlike programs for women, this has rarely been addressed.

Liberiaʼs Deprived Mental Health System

As of 2009, the first Mental Health Committee was formed in Liberia, which is a great step for the future of psychological services in the country; however, the committee faces three major problems: 1) The committee is the lowest priority on the agenda in the country’s Ministry of Health, 2) the committee has a very small annual budget to offer psychological rehabilitation to a post-war population of 3.6 million, and 3) There is a lack of professionals in the field. As an example of the urgent need for professionals, there is only one psychiatrist in the country, less than five bachelor level Liberian psychologists, and no masters level clinicians.

The most severe gaps in rehabilitation programs for the war-affected individuals in post-war Liberia are drug detoxification (still to this day non- existent in the country), and psychological services for trauma, depression and abuse.

Fighting Crime and Poverty

Most efforts to fight crime and poverty in Liberia are based on disarmament, education and skills/ vocational training. As fundamental as they are for any nation, we must recognize that the scenario is quite different in a post-war country. You cannot simply trade guns for money if the armed teen is struggling with a drug addiction because he will use that money to sustain that addiction. Providing skills training to former inmates or war rebels will not work if they do not learn basic skills to live in a community and behave accordingly with societal expectations. Sending a former child soldier to school without addressing his traumatic experience is like paying for the tuition for someone you know will fail or quit school.

How Mental Health Can Make a Difference?

Disarm and detox. Detraumatize the children you send to school. Use psychological strategies to enhance self-esteem when teaching an unskilled person a new job. Take the opportunity to teach inmates who are still in jail the basic social skills to relate to society before you try to offer them an opportunity for vocational training. We are not advocating for mental health services because we believe they are more important than other programs and strategies. We advocate for mental health as an essential part of the process of rebuilding lives after a war.