In-depth: Aid in an urbanizing world

MIGRATION: Trauma travels too

Many forced migrants suffer from post-traumatic stress disorders
JOHANNESBURG, 22 May 2012 (IRIN) - Georgette* is jumpy and on the verge of tears even before she starts recounting her long and harrowing story of loss and violence in the Democratic Republic of Congo (DRC), her desperate flight to South Africa, and the struggles and setbacks she has endured since arriving in Johannesburg a year ago.

When rebel soldiers surrounded her village in South Kivu Province in eastern DRC, the men, including her husband, were rounded up and locked in a room that was then set alight. Georgette and the other women were taken to the rebel stronghold in the mountains, where they were raped and enslaved for a month before some of them escaped into the forest and ran for their lives.

With the help of a priest and some nuns, the women made it to Lubumbashi, a town near the Zambian border. Truck drivers took Georgette the rest of the way to South Africa, where she believed she would have the best chance of starting a new life.

She does not know what happened to her four children, who were being cared for by their grandmother in a neighbouring village when she was abducted. “I’m not well when I’m thinking of them,” she told IRIN. “I’m always crying.”

Psychosocial needs forgotten

Migration, especially when it is forced, is always stressful and very often traumatic. Reaching a place of relative safety does not mean the trauma of having survived rape, torture or the loss of loved ones is over. Studies have found that migrants are far more likely to suffer from chronic anxiety, depression and post-traumatic stress disorders (PTSD) than non-migrants.

Yet the psychosocial needs of migrants and refugees are usually overlooked as governments and NGOs focus on meeting their more obvious need for food, shelter and documentation.

Dr Manuel Carballo, director of the Geneva-based International Centre for Migration Health and Development (ICMHD), argues that neglecting migrants’ mental and emotional wellbeing is a serious oversight that can not only hamper their chances of surviving and thriving in a new country, but is also likely to make them more dependent on host governments for longer.

''There can only be so many people suffering in camps and shelters before it starts to become contagious to the larger society...there needs to be a sharing of collective pain''
Carballo’s organization works with local authorities to assess the psychosocial needs of refugees in their communities and trains staff to be more sensitive to those needs. “We need to professionalize the whole process of trauma counselling, because [refugees] can very quickly fall through the cracks and be forgotten, and you see this all the time,” he told IRIN.

Convincing governments and donors to fund such programmes was “a difficult one to sell” he admitted, especially in the current economic climate. “But there can only be so many people suffering in camps and shelters before it starts to become contagious to the larger society. Ultimately, there needs to be a sharing of collective pain.”

Setbacks to recovery

Georgette is able to share some of her pain during weekly counselling sessions at the Centre for the Study of Violence and Reconciliation’s (CSVR) Trauma Clinic in Johannesburg.

The Clinic will treat about 150 torture survivors in 2012 through its Refugee Project, but funding is uncertain from one year to the next and the need is great, said Marivic Garcia, a senior trauma professional at CSVR. Besides dealing with past events, many of the refugees suffer new traumas in South Africa that can set back their recovery.

Although they are spared the indignity and psychological consequences of confinement in refugee camps, their existence in urban areas is often extremely precarious. Obtaining asylum seeker documents can be a major source of stress, while many struggle to find work and live in abject poverty. They are also targets for crime and xenophobia.

“Since I left Kinshasa, I never had peace of mind,” said Celeste*, a refugee who was driven from her flat in Cape Town in 2008 during a wave of attacks on foreigners that swept the country. “There’s no war here, but the way people talk to you and look at you, you don’t feel like a human being.”

Celeste and her family decided to move to Johannesburg after the attacks, but the stress of starting over strained her marriage to breaking point. Nine months ago her husband walked out and never returned, and without his small income as a security guard she could not afford to pay the rent. She and her son ended up on the streets, while her daughter stayed with a neighbour.

Celeste and Georgette have both found temporary refuge at the Bienvenu Shelter in Johannesburg, which accommodates about 20 refugee women and 20 children, and provides food and crèche facilities for up to three months while newly arrived or needy refugee women get on their feet and look for work. Many of the women stay longer, admitted Adilia de Sousa, the Shelter’s director.

“They feel they’re drowning in a pool where no one reaches a hand to pull them out,” she said. “Quite a few can’t hold down a job with their mental health issues, but the bigger problem is employers not wanting to hire asylum seekers.”

Georgette initially stayed 10 months at the shelter before obtaining a small loan from Jesuit Refugee Services to start a business selling shoes in the city centre and moving into a rented room. But the high cost of rent forced her to share the room with several other people and one night one of her room-mates tried to rape her.

Her screams summoned neighbours and the man was arrested, but he was soon released and started harassing her, forcing her to return to the shelter and abandon her business. “I was feeling better until this happened. Now I feel it’s better to die, because I don’t feel safe to go out,” she said. “If the shelter wasn’t here, maybe I would have already died.”

Sources of support

Georgette is receiving treatment for PTSD at the Trauma Clinic but also draws strength from a prayer group run by fellow Congolese. For many traumatised refugees who never access the limited mental health services available from NGOs and the public health sector, churches and prayer groups may provide their only source of support.

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“When their identity is gone, a common thing is for people to turn to their religion,” said Garcia. “It helps them find meaning in what has happened to them. It often evolves from, ‘Why did God allow this?’ to ‘God wanted me to live for a reason’.”

Carballo of ICMHD believes that giving refugees more assistance to find work or start businesses would go a long way towards not only restoring their sense of purpose and self-esteem, but relieving the burden on host communities.

He cautioned however that recovery from trauma can be fragile. “The fact they’re smiling or working does not mean they’re fine. There’s a whole background just under the surface that’s very easily brought out again.”

Just watching news reports from the DRC is enough to trigger painful memories for Celeste. Prayer and counselling help, she said, “but there’s still pain”.

*Names have been changed

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