Mental health gaps as conflict's horror lingers

Amid the still-visible damage from election unrest in Côte d’Ivoire’s main city Abidjan is another less tangible but very real form of destruction - psychological trauma.

It is difficult to say how many people need mental health care after the recent unrest, according to health experts in Côte d’Ivoire; the Health Ministry says it has no such figures. But health workers and residents told IRIN people seeking help with conflict-related trauma have few places to turn.

“My youngest cries herself to sleep every night,” said 28-year-old Bakary, who saw his wife dragged into the street and shot dead. “We would like help but what options are available to us?”

The government-funded National Programme for Mental Health (PNSM) estimates that thousands of people who need mental health services have no access to such care. “There are not enough qualified people for the population’s psychiatric needs,” PNSM coordinator Roger Delafosse told IRIN. PNSM was set up in 2007 to train people in psychological care. But this was five years after the 2002-2003 crisis; Delafosse said even after the earlier conflict mental health care was not considered a priority.

Researchers say that worldwide, while awareness of mental health issues has improved somewhat in recent years, a continued low awareness and a lack of political commitment still stand in the way of proper care.

The Ivoirian Health Ministry did not give a figure for the ratio of mental health professionals among the population, but for 21 million people there are three mental healthcare facilities: a psychiatric hospital in Bingerville just outside Abidjan, an outpatient unit in the political capital Yamoussoukro, and a facility in the north-central city of Bouaké. The only clinical psychological services currently available in the west are run by the medical humanitarian orgranization Médecins Sans Frontières (MSF), according to the NGO; hospitals in the western towns of Daloa and Guiglo are supposed to provide psychological services but such posts are vacant.

Photo: Monica Mark/IRIN
Thousands of Ivoirians like Bakary who saw family members gunned down, have no recourse to psychological help

After fighting triggered by Côte d’Ivoire’s 2002 rebellion the government set up a unit known as the Cellule de Solidarité, which offered psychological support to victims of fighting. But it was closed in 2005. Noel Faiteh, a psychiatrist at Bingerville Hospital, said something similar needs to be set up again.

Many of the people coming to the Bingerville facility these days are acting on sheer desperation, Faiteh told IRIN. “Even as I speak there are new patients arriving.”

Witness to violence

“The most vulnerable people are the ones who directly witnessed violence - be it participants or victims,” he added. “If it's not treated, this kind of trauma can develop so that over time, instead of just psychological support the patient then needs psychiatric help as well."

Assessing mental health needs is complicated by the fact that a given event will trigger varying reactions, MSF clinical psychologist Nathalie Lion told IRIN. “There are no rules. Two people in the same family can experience the same situation differently. We can’t make up a list saying this or that group will need help - so many factors are involved.”

She added that one important factor in how children cope is whether they felt safe in their environment. “Very simple things like if a child was held in his mother’s arms during [an incident] or if a child was told it’s OK to cry and another was not - all these things can have an impact on how a situation is processed.”

Many people, still burdened by what they lived through, have a tough time just trying to make a living, Ivoirians told IRIN. François Massoné, 46, said he is tormented daily as he walks into his bakery where he saw two employees - one his brother-in-law - shot dead. “We can say we’re fine but we’re not really,” he said. “It’s hard coming to work now, but I’ve got a family to feed.”

Massoné said he would like to see the government provide people with more help for mental distress. “[This kind of care] is more important than bags of rice and sugar to bereaved families,” he said, referring to recent government donations of food and equipment to people affected by the conflict.