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Violence and trauma: the mental health needs of South Sudanese refugees

Emergency Health
South Sudan

More than 1 million people have fled from South Sudan to neighbouring Uganda since the outbreak of civil war in 2013. Many have witnessed or experienced violence, including forced displacement, rape and indiscriminate killing. Handicap International (HI) is providing psychosocial support to respond to the complex and urgent mental health needs of refugees. 

Janina Poni from South Sudan walked to Uganda on her own

Janina Poni from South Sudan walked to Uganda on her own. | © Philippa Russell/Handicap International

The Frontline

There is nothing to indicate that you have reached Omugo settlement in northern Uganda. No check-point or security; no particular landmark. The first sign that this area differs from the thatch-roof villages traditional to the region is the occasional glimpse of white tarpaulins amongst the trees.

Despite appearances, this is in fact the frontline of Uganda’s refugee crisis. More than 800,000 people from South Sudan have fled to the Ugandan border since the civil war escalated in July, 2016; adding to 200,000 refugees already present. One-by-one, the settlements created to host them have reached capacity. One settlement alone, Bidi Bidi, hosts 275,000 people and is the largest single refugee camp in the world.

Omugo is now the destination for all refugees arriving in Uganda.

“In the space of a few weeks, Omugo has transformed from a vast expanse of East African bush to home for 15,000 people” explains HI country director, Ryan Duly, “The Ugandan government, UNHCR, and NGOs are rapidly putting in place the basic infrastructure and services needed: water tanks, latrines, roads, food distributions … in the meantime, people continue to arrive in their hundreds.”  

Distressing stories

On the 16th of October, a group of 240 refugees arrived at Omugo and waited in patient lines to be allocated a plot of land on which to build a shelter.

Amongst them, 71 year old Joel Roba. His vision is blurred by thick cataracts and he walks slowly, using a wooden stick. Joel describes returning to his village after the fighters came. Amongst the dead were several of his sons, daughters and grandchildren. He found one son with both legs mutilated and struggled to get him to hospital.  

Beside Joel are two adolescent girls, 12 year old Viola and her 16 year old sister, Annet. They travelled alone for 3 days to reach the border, despite the very real risk of sexual assault. The girls left their village after their mother died. They don’t know exactly what happened to her, only that she had surgery and the stitches burst.   

Viola and Annet are being looked after by Ate Charles, a 48 year old man with polio who they met just a week ago. Ate’s wife was killed by fighters in May 2017. He sold his home and all his belongings to prepare to make the journey to Uganda alone. After 2 weeks, and just 20km from the border, he was attacked, beaten and robbed of all his money. The attackers even took his shoes.

Depression, anxiety, PTSD

Harrowingly, these stories are not exceptions. The majority of refugees in Omugo have experienced violence, trauma and fear in South Sudan. As a result, rates of depression, anxiety, post-traumatic stress disorder and other severe psychological conditions are alarmingly high.

HI is providing psychological ‘first aid’ training to frontline aid workers, the first people to meet and take care of refugees. This is critical in order to identify and look after somebody who arrives in a state of crisis. Cases requiring psychiatric intervention are referred to HI’s medical partners at the local hospital.

For less severe cases, HI’s team of psychologists and social workers will work with the individual to develop a personalised and long-term plan to reduce their distress. This may involve one-to-one support sessions or group therapy.

Simon Bakamuto, a HI psychologist and trainer, explains, “Sharing experiences often helps to reduce feelings of isolation and can begin to rebuild social ties. For somebody who has lost their family, friends or village, this can be instrumental to their recovery.”

HI is also working to raise awareness amongst refugees, for whom mental health can be a hidden topic. Many are not aware that the symptoms they experience, such as insomnia, anxiety, aggression and ‘overthinking’ can be managed through treatment. HI’s presence in Omugo will mean that refugees no longer suffer in silence.

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