We Call it the Silent War: the Lonely Mind-Body Battle that Begins When Conflict Ends.
Post-traumatic stress disorder (PTSD) is a common outcome of war: it is a debilitating mental health condition that shatters one's ability to function in society. It is often associated with psychiatric comorbidity and chronic cognitive, behavioral, and physiological impairment.
The United Nations High Commission of Refugees (UNHCR) reported a staggering estimate of over 65.3 million refugees and internally displaced persons (IDPs) fleeing from war worldwide - the highest number documented in history. The number of people of concern that remains in the West, East and Horn of Africa regions is reported at over 16 million.
While refugees that are settled in developing countries may have greater likelihood of receiving mental health services at some stage in their lives, access to psychological treatment in Africa remains precarious. Our ultimate focus is to incorporate innovative solutions to make sure that the safe, evidence-based treatment we are validating becomes available free of charge to as many people as possible.
Surveys in Africa Testified to Alarming Rates of Over 40%
of Populations Impacted by War Displaying Symptoms of PTSD. Experts suggest the numbers could be higher.
➤ Trauma is a Silent Epidemic
A genetics study of traumatised refugees from the Rwanda genocide reported rates of PTSD diagnoses to approach 100% based on the nature and severity of a traumatic event. Alongside genocide, other common war crimes across Africa can be categorised among some of the most severe worldwide:
- The use of children in armed forces and groups
- Pervasive sexual violence as a weapon of war
- Physical mutilation
- Systematic torture
A national survey in Liberia also indicated that 44% of the total population reported PTSD symptoms 5 years after the end of the second war, but experts suggested the numbers were likely higher. Other post-conflict zones in Africa and worldwide have testified to similar statistics [1, 2].
➤ Time Doesn't Always Make it Better
PTSD typically follows a chronic, often lifelong, course. While we are still trying to understand the biological make-up that helps some people to heal naturally and other not, it's been well documented that trauma symptoms remain pervasive in refugee groups decades after traumatic exposure [3, 4]. PTSD has also been noted particularly predominant in individuals from specific geographical locations where violent conflicts took place, such as Nimba County in Liberia, even twenty years after the war.
➤ The Ebola Outbreak Worsened Existing War-Related PTSD
- While West Africa has been declared Ebola-free, the long-lasting impact of the endemic on mental health is concerning among communities that had already suffered so much.
➤ PTSD May Heighten the Risk for Poverty Further Aggravating the Consequences of War and Conflict.
A recent study of traumatised Congolese refugees in Uganda confirmed previous studies indicating that trauma survivors present significant impairment in cognitive and psychosocial functions. Such impairments make it challenging for traumatized populations to attend school programs, keep jobs, and contribute to playing a role in emerging economies.
➤ Trauma Relief is Not a Humanitarian Priority
Humanitarian assistance is stretched thin, with few if any resources for psychosocial support and mental health. Under-resourced health systems have other priorities and there is still little appropriate support for people living with trauma, PTSD and extreme stress.
➤ Current Efforts are Expensive
The World Bank, Liberia and Japan have a psychological support project reaching approx. 18,000 beneficiaries with mental health and psychosocial support to alleviate the consequences of the Ebola epidemic in West Africa. While necessary, this and other trauma interventions rely on individual, one-on-one approaches that are costly and cannot be taken to adequate scale.
➤ No Evidence-Base is Available to Guide Treatment Choice
There aren't enough trauma treatment studies with African groups. Systematic reviews [5, 6, 7, 8, 9] identified experiments that investigated the efficacy of trauma treatment models for refugees worldwide. Even with a handful of studies, researchers were unable to draw a firm conclusion of what treatment works and should be recommended for refugees, considering all studies were methodologically diverse, and involved different refugee populations. Among all studies identified, only two [10, 11] were conducted with Africans (Sudanese, Rwandan and Somali groups).
We urgently need more scientific research to develop best practices around trauma relief interventions in war-impacted communities.