Coping with trauma in North Kivu Torture, forced labour, harassment, rape, armed attacks, killings and lootings happen weekly, if not daily in the province of North Kivu in Democratic Republic of Congo. In this part of the world, almost no one has escaped the damage caused by the conflict that has festered in this region for the last 16 years. Most, if not all, have lost loved ones, had to flee fighting, or have witnessed others get killed and tortured. Among the amazingly green and lush hills, resources are abundant and diverse – gold, cassiterite, coltan, and rich fertile soil. Crops grow in abundance when the fields are accessible. But tension is palpable in the air, more gunshot victims are in the hospital, aid workers are attacked on the road, rumours of killings and attacks abound, there is gunfire in the villages. One incident after another... The population is living in fear. Whole families are suffering, displaced by the conflict into areas that are barely more secure than their villages, struggling to find food and clean water sources, struggling to maintain their dignity, doing all they can to keep on living although their world is falling apart.
As part of its project in Mweso, Médecins Sans Frontières (MSF) runs a psychosocial program to care for those who are suffering intense psychological distress as a result of the war. Many have severe post-traumatic stress symptoms that include constant fear, flashbacks, insomnia, suicidal thoughts, feelings of despair, heart palpitations and breathing difficulties. They come to MSF hoping that we can give relief, and support, and maybe medication. A 12–year-old boy has just seen his mother and siblings killed by armed men. His father was severely wounded but somehow the boy managed to flee, despite the gunmen’s attempt to kidnap him, "I am scared. I am scared all the time,” he says. A 60-year-old woman suffering from crippling headaches and stomach pains spends her days wondering: “When will it be my turn to be killed?” One man has nightmares so bad that he nearly falls out of his hospital bed. Another tells of daily flashbacks and crying spells for the past 10 years, after he was tortured during detention. Many talk about “feeling dead.” Most of the people MSF assists have been displaced from their villages and now live in makeshift shelters in camps throughout the province. Shelters crowd up against each other on a soil depleted of vegetation. The materials used to construct the shelters are now old and barely able to withstand seasonal changes. Families of four or more share a space less than three square metres in size. Most of the displaced people have been in camps for years. They have no news of the family and loved ones they have left behind and it is too dangerous to go back to check on them. Living conditions and stressors in the camps are simply unbelievable, with regular lootings and harassment. In Kashuga, a village 15 kilometres from Mweso, there are five camps housing approximately 15,000 displaced persons. People in the camps are startled easily. At any loud noise, all living souls vanish from the camp in an attempt to save their lives, running off naked if necessary. They are regularly harassed and their belongings looted. They have no access to their own fields and they occupy the fields of the locals, making food production a serious problem. When it rains, their straw roofs do not keep them dry and they cannot make fires in their huts because of the stagnating rainwater. Men hide from armed groups, scared of being grabbed for forced labour. Women have to stand naked in their huts while they wait for their one set of clothes to dry. Children fend for themselves like little adults, carrying jugs of water or bundles of wood heavier than they are. Girls become pregnant as a result of rape. Left orphaned by the war or illnesses, male children enrol in the armed forces with no other alternative for survival. It is unsurprising that in these dire circumstances, so many suffer from serious mental health problems, problems so debilitating they are no longer able to care for themselves or their loved ones.
Some spend the days alone, sitting in front of their shacks; others never leave their beds. For many people in the camps, social events such as weddings and celebrations have stopped. Some have even stopped seeking healthcare for themselves and their loved ones. A woman with severe burns is left alone in her shack by her family – “she will die anyway” they say. It is of no surprise if angry outbursts and acts of revenge towards innocent bystanders have become an accepted part of daily life. The poorest of the poor and the most pained of the pained are those that the MSF psychosocial teams deal with on a daily basis. Those with the grimmest health problems, the worst living conditions, the least food of all, and the most traumatic life experiences constitute the caseloads of the psychosocial teams. And the counsellors are up for it. Congolese counsellors are trained by MSF to provide psychosocial support to their own communities. They help those in psychological distress regain control over their lives so they are able for example to cultivate crops, care for their children, trade goods and participate in community activities. Reducing the severity of their symptoms so they are able to function again is essential for their health, their nutritional status, their living conditions, their sense of belonging to a community and their capacity to live life despite the difficulties they face every day. Through a series of individual or group sessions, the counsellors work to address psychosomatic symptoms, practical problems, family disputes, grief, loss and overwhelming emotions such as sadness or anger. Helping their clients understand that their symptoms are normal considering what they have lived through is often the first step towards managing or resolving their problem. Often it is by reading their client’s body language and observing their facial expressions that the counsellors can see the horrendous experiences their clients have lived through. The clients may not share their terrifying stories; it is not necessarily helpful. But their stories remain present and palpable in the room and in the work. Like the rest of the medical care that MSF provides in North Kivu, the mental health service preserves lives. It helps the most traumatized and desperate patients accept their challenges and decide against suicide. It helps those wanting revenge, such as attacks and killings, choose a less aggressive way of dealing with their anger. Psychosocial care also restores dignity by helping patients deal with their traumatic experiences in order to avoid chronic health problems and to heal. Some clients walk more than 15 kilometres to attend their follow-up sessions. The majority of the people who seek help do get better – those who were crying daily start smiling again, those who had fear all the time can experience anxiety-free moments, those who have abandoned life start working again. The counsellors start hearing reports of changes – displaced people state that the level of violence has gone down in some camps, the counsellors notice it is harder and harder to find clients during the day because they are off working, doctors report improvements in patients' compliance to medical treatment and in levels of cooperation. Sometimes just a few consultations can create astounding changes. A 15-year-old girl, who was suicidal, unable to stop crying, unable to speak or make eye contact, started to tell us parts of her experience of kidnapping and sexual slavery. After a few sessions, her story of torture and suffering had not changed, but her crying had ceased, she began to smile, and she also started working the fields again. The world around her had not changed but she is committed to moving forward.