Monday, July 06, 2020

The Stress of being South Sudanese

Rebecca uprooted from South Sudan to a north Ugandan refugee settlement, tried to take her own life. “By then I didn’t care about anything – not myself, not even my kids. The pain was too extreme.” 

Her experiences fit into a wider trend of a mental health crisis across these vast displacement sites, where people from South Sudan who fled the trauma and violence of civil war now live in a drawn-out exile of frustration and diminishing support.

“People face a lot of structural adversities,” says Dr Wietse Tol, formerly of the John Hopkins Bloomberg School of Public Health, who last year led a psychological study of South Sudanese refugee women in Uganda. “If the situation continues to wear you down, at some point it just breaks you.”

Overwhelming hardships inevitably push the most vulnerable to the edge. Rebecca arrived in Bidibidi in 2017 after fleeing rebel assaults and famine. Abandoned by her husband along the way, she arrived in this crowded, chaotic and unfamiliar settlement with her children.
“I was happy for the first time in a long while,” says Rebecca, “There was no shooting and no soldiers.” But the initial sense of relief faded as the war back home dragged on. She struggled for money and endured stigma for being a single mother. “I felt completely alone,” she says. 
Nationwide, around a fifth of refugee households have at least one relative suffering psychological distress, while fewer than half have access to therapy, according to UNHCR
Since conflict erupted in 2013, hundreds of thousands have crossed into north-east Uganda to escape. The largest refugee settlement, Bidibidi, houses more than 232,000 people across arid scrubland, which the rainy season churns into thick mud. Globally, it is second only in size to the Kutupalong camp for Rohingya refugees in Bangladesh.  These makeshift camps have transformed into semi-permanent refugee towns. Many doubt that South Sudan’s new power-sharing government will end a conflict that has killed around 400,000 people.
As poverty and protracted violence have prevented their return, data from the UN’s refugee agency indicates that the rates of attempted and actual suicide have increased significantly here over the past three years. This is an indication of a wider mental health emergency that also manifests itself in addiction, depression and trauma-related disorders. The psychological toll of war can provoke a downward spiral of anxiety and trauma, compounded by social dislocation as cultural and family networks fragment. Some face domestic violence; others fear for relatives left behind.
“They have lost the past and don’t have hope for the future,” says Geoffrey Dramani, a protection associate with the UNHCR. “They find themselves in a state of desperation.”
In northern Uganda, dwindling funds have slashed basic services and job opportunities. In April, a shortfall of £109m meant the World Food Programme cut refugees’ rations by 30%.  Just 40% of the almost $927 million (£751 million) needed to help refugees in Uganda was reached last year. The funding prospects for 2020 are dire, with only 21% of the total requirements received so far. Coronavirus brings added pressures. Restrictions impede the refugees’ ability to earn money and put children at risk of abuse as schools shut.
For refugees, despair often comes years after the most turbulent periods of displacement. “We find that people commit more suicides after things have stabilised,” says Keneth Shaka, Bidibidi’s assistant settlement commandant. “It’s in this time that we need more psychosocial support for refugees than during the emergency time.”
During exile, weddings and other festivities that bind communities together “are put on hold”, says Joyce Wahome, a protection officer with UNHCR. “These avenues of happiness are not there.”

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