Mental health and psychosocial support in South Sudan
For days, Nyamech’s small boat drifted down the arduous Nile, with no engine, powered only by the wind. If the boat got too close to the riverbank, they risked being caught by armed soldiers stationed along the route. They used their hands and sometimes sticks to push the boat away from the shore.
Nyamech was traveling with her four young children, having taken them from their village in Jonglei to save their lives. After days on the Nile, she had given up hope of finding safety. She thought that they would never make it to Bor town, the capital of Jonglei.
When they finally did, the single mother quickly found the United Nations peacekeeping base. At six protection of civilian (PoC) sites at UN bases across the country, hundreds of thousands seek protection from the brutal war that has engulfed South Sudan since December 2013. The conflict has had a devastating toll on the civilian population.
While Nyamech had reached relative safety, for months, she could not sleep. She faced intrusive thoughts, stress, nightmares and constant worries about her husband. She had not seen him since the start of the war.
“I was living unconsciously, with no hope,” Nyamech said.
Nyamech is not alone. She is just one of 1.9 million people displaced in South Sudan – forced to flee their homes due to conflict and hunger. Thousands like Nyamech have been displaced for nearly four years, many rarely leaving the confines of the crowded UN PoC sites.
These communities often feel imprisoned by a war that has forced them to live in congested, unfamiliar places. Unable to go home for fear of their lives, many have not heard from family members since the crisis began.
Even as the effects of violence, displacement and confinement contribute to community-wide distress, mental and psychosocial well-being are often overlooked. Humanitarian organizations are overwhelmed responding to ever growing needs in South Sudan, where an estimated 7.5 million people are in need of lifesaving assistance.
In response to this gap in assistance, the International Organization for Migration (IOM) initiated a mental health and psychosocial support programme in the Bor PoC site in 2014. The Organization later expanded these services to displacement sites in Bentiu, Malakal and Wau. Combined, the programmes directly reach as many as 10,000 individuals each week. The pilot programme in Bor was developed from an assessment in 2014 that revealed that 80 per cent of respondents had experienced psychosocial suffering since the crisis began.
Top: An IOM MHPSS support officer visits families newly displaced in Wau in July 2016. IOM/Mohammed 2016
Bottom: An adult support group offers women the chance to learn reading and math. IOM/McLaughlin 2017
When IOM rolled out mental health and psychosocial support services in the Bor PoC site, trained counselors would visit Nyamech at home to help her find a way to heal. She then began attending group sessions, finding that discussing her issues with other women, while doing embroidery, slowly enabled her to regain her internal strength and let go of negative thoughts.
The counsellors and facilitators of the groups are trained by IOM and selected from within the displaced community. Through continuous training in basic counselling, psychosocial first aid and other capacity building courses, they gain expertise in providing mental health and psychosocial support in an emergency setting, stress management and peer-support systems. The counsellors often go house-to-house to ensure the most vulnerable do not feel lost and alone in the billowing camps.
The psychosocial support groups, such as Nyamech’s widows’ support group, allow people to exchange experiences and advice with others who have had similar experiences, providing a sense of control and reducing feelings of helplessness and distress related to displacement.
Since 2014, IOM has developed 85 peer support groups across the Bor, Bentiu, Malakal and Wau displacement sites, with nearly nearly 2,000 participants, including youth, adults, widows, people with disabilities and the elderly.
For Tien, a 24-year-old living in the Bentiu PoC site, the support groups have helped to set him on a path to healing, guiding a troubled youth to a musician and artist who now serves as a leader in his community.
“My name means ‘prisoned.’ The year I was born my father, an ex-soldier, was imprisoned. I lost him in 2010 in armed conflict. In 2013, when the crisis erupted, my three older brothers left to join the army and have been killed, too. If you are born in a soldier’s family, that’s the only path you see yourself following,” Tien explained.
When it was no longer safe in his home village, Tien came to the PoC site in Bentiu town on three separate occasions. The first two times, he tried to flee from the camp. The third time, he realized he was the only son to his widowed mother and he chose to stay as he and his family were in need of protection.
“I was not comfortable living here while my siblings and my dad died as soldiers. Moving around in the camp aimlessly, I would get involved in fights with others.”
“One day, I decided to give it [mental health and psychosocial support activities] a try. I joined the musicians and dancers’ groups, and I forgot myself there – I came back to my normal self. We not only danced and played music, but we also had discussions and shared our experiences and concerns. This calmed me down. I quit smoking in three months after joining the group in November 2015.”
Photo: Tien has become an invaluable member of the mental health and psychosocial support team at the Bentiu PoC site. IOM/Myrzabekova 2017
Creative, recreational, cultural and educational groups, such as Tien’s music group, provide a much-needed break from the isolation many face in the camps. They increase confidence and re-establish a sense of normalcy and routine, disrupted by conflict and displacement.
In the music group, Tien had a chance to expand his musical skills. He eventually composed and performed an original piece for a film produced by the youth support group in the Bentiu PoC site in 2016. The film, “Jal Tekädä, The Journey of my Life,” went on to win an award at the Juba film festival in July 2016. Watch Jal Tekädä here: http://weblog.iom.int/using-film-heal-wounds-war-south-sudan.
IOM selected Tien to participate in psychosocial first aid training, after which he was selected to become a facilitator of peer support groups and eventually as a supervisor of facilitators, coordinating five mental health and psychosocial support groups in the PoC site.
“While doing my job, I participate in the performances myself. It helps me as well a lot. When people share their stories, I see myself in them and can relate. We all share our experiences and get better, overcome hard times and come back to normal ourselves.”
“My two sisters who were constantly worrying for me and crying are also happy now. I want to convince my half-brothers to leave the conflict.”
The stress of displacement not only causes pain for individuals but it also strains inter-and intra-communal relationships. IOM’s mental health and psychosocial support programming emphasizes the importance of strengthening local capacities to manage and prevent eminent conflicts on day-to-day basis, as well as long-term peacebuilding and confidence building efforts in the PoC sites and host communities.
In an effort to bridge the communities in the PoC site and the community in Bor town, IOM conducted conflict transformation and mediation trainings to support both intra-communal conflict resolution and help rebuild trust between the Nuer and Dinka communities.
In Bor town, one such participant is Peter, the chairperson of the Bor town traditional community court and a member of the Dinka community.
“When in life, a person harms you, you want to avenge. The training made us look at the issues differently and realize the importance of listening to the opinion of all sides involved in a conflict.”
Following the training, Peter has used his experience to mediate issues and conflicts in his community in Bor town, including addressing inter-ethnic conflicts between Dinka and Nuer communities, at odds due to the ongoing crisis. In one case, he helped families of a Dinka man and Nuer woman discuss peacefully the prospect of the couple getting married and eventually led to a marriage that respected the traditions of both communities.
Photo: Peter walks in Bor town. IOM/Myrzabekova 2017
As the crisis in South Sudan edges towards its fifth year, millions across the country remain displaced, far from their loved-ones, homes and livelihoods. As displaced communities continue to rebuild the social fabric of their disrupted lives, IOM remains committed to improving mental health and emotional well-being of those affected by the conflict.
The IOM MHPSS programme in Bor was supported by the Italian Development Cooperation. Programmes in Bentiu, Malakal and Wau are supported by the Italian Development Cooperation, the US Agency for International Development Office of Foreign Disaster Assistance, the Department for International Development, Global Fund and Government of Korea. IOM handed over MHPSS activities in the Bor PoC site to partner African Leadership and Reconciliation Ministries (ALARM) in August 2017.