South Sudan: Devastating impact of war on mental health must be addressed
People forced to eat human flesh and to disembowel dead bodies during South Sudan’s civil war that began in 2013 are among thousands suffering from trauma and psychological distress amid a chronic shortage of mental healthcare services in the country, Amnesty International said today as the country marks its fifth anniversary.
In a new report, “Our hearts have gone dark”: The mental health impact of South Sudan’s conflict, the organisation documents the psychological impact of mass killings, rape, torture, abductions and even a case of forced cannibalism, on the survivors and witnesses of these crimes.
“While the death and physical destruction caused by the conflict and preceding decades of war are immediately apparent, the psychological scars are less visible and neglected,” said Muthoni Wanyeki, Amnesty International’s Regional Director for East Africa, the Horn and the Great Lakes.
“Whilst an end to atrocities including torture, rape and murder would be an obvious urgent first step to preventing additional mental health consequences, action also must be taken to heal the damage already done, by providing victims with treatment and other appropriate reparations.”
Based on interviews with 161 victims of and witnesses to human rights violations, as well as mental health professionals, government and UN officials, and representatives of non-governmental organisations, the report reveals a dire lack of mental health services across the country for people in need of support and care.
This almost total absence of services is resulting in mental health conditions such as Depression and Post-Traumatic Stress Disorder (PTSD) going untreated. There are currently only two practicing psychiatrists in the entire country of 11 million people and mental health patients are routinely housed in prisons instead of receiving the care and treatment they desperately need.
Many of the people interviewed described a range of symptoms consistent with PTSD and Depression, including nightmares, irritability and the inability to concentrate.
Malith, a survivor of one of the war’s worst incidents in December 2013 when government security agents shot dead about 300 men in Gudele, a neighbourhood of the capital city Juba, told Amnesty International: “Sometimes I dream that I died with those who were killed. I wake up sweating and trembling … I think about how I survived. Why did these others die? It makes me feel bad.”
Another survivor of the Gudele massacre, Phillip, described how he hid under a pile of bodies during the massacre. When he was discovered by soldiers, they forced him to drink the blood and eat the flesh of the dead or be killed.
He said: “At night when I sleep, those who were killed come back in my nightmares.” He added, “I can’t eat, I don’t want anything I am offered. I don’t think the way I am feeling will ever change.”
The government has consistently detained its perceived opponents since the conflict began. Detainees have spoken of killings, beatings, insufficient food and water among other horrors, leading to prolonged psychological distress.
Lual told Amnesty International he was forced by National Security Service (NSS) officers to disembowel the bodies of his murdered fellow detainees at a facility in Juba, so that they would not float when dumped in the river.
He told Amnesty International: “I feel hopeless … I feel depressed, I am never happy … I think about committing suicide … All of this makes me feel bad, and I hate myself.”
In Bentiu, the capital of Unity state, which has the largest Protection of Civilians (PoC) sites in the country, women venturing out of the site for food, fuel or medicine have experienced sexual violence leading to significant psychological distress.
Nyawal said she and her friend were raped twice in one day by two sets of government soldiers in Bentiu when venturing off-site in 2015.
She said: “I am very angry about what happened … It has changed my life. I am nothing. I have nothing good … I am ashamed.”
The vast majority of those interviewed said they had not received any psychological support or mental care.
“The government, supported by the international community, must honour its international legal commitments to respect, protect and fulfil the right to health, including mental health. It must also prevent and impartially investigate and prosecute acts such as torture that continue to cause psychological harm to many,” said Muthoni Wanyeki.
“Doing more to address mental health needs is not only essential for individuals’ wellbeing, it is also critical for South Sudanese to effectively rebuild their communities and country.”
Names have been changed to protect interviewees’ identities.
For more information or to arrange an interview, please call Seif Magango in Nairobi on +254 788 343897 or +254 20 428 3020, or email firstname.lastname@example.org
South Sudan became an independent country on 9 July 2011 after decades of war, lengthy negotiations and a resounding “Yes” vote in a referendum to secede from Sudan.
It plunged into a brutal civil war two years later after President Salva Kiir accused his influential Vice-President Riek Machar of plotting to overthrow him in a coup.
Government and opposition forces have deliberately attacked and killed civilians, abducted and raped women, committed acts of torture, destroyed and looted civilian property and attacked humanitarian personnel and assets.
Thousands of people have been killed, including women and children, entire towns and villages destroyed and approximately 1.7 million people internally displaced.
After two years of on-and-off peace talks, the two leaders agreed to a permanent ceasefire and later formed a unity government with President Kiir at the helm and Machar as his first deputy. Although the agreement ended the conflict on paper, the country continues to be wracked with violence.
The report is primarily based on research conducted by Amnesty International in April and May 2015, and in May 2016 in the cities of Juba, Malakal and Bentiu, which have all been affected by the conflict.
In May 2016, in Juba Central Prison alone, there were 82 inmates categorised as mentally ill, including 16 women. More than half of these inmates had not committed any crime.
The African Union (AU) Commission of Inquiry on South Sudan led by former Nigerian President Olusegun Obasanjo noted in its final report that trauma appeared to be a key consequence of the conflict.
A survey of 1,525 South Sudanese people in conflict-affected areas carried out by the South Sudan Law Society (SSLS) and the UN Development Programme (UNDP) between October 2014 and April 2015 found that 41% of respondents exhibited “symptoms consistent with a diagnosis of PTSD”.
According to the Ministry of Health, there are only the equivalent of one and a half physicians and two nurses/midwives for every 100,000 citizens, all of whom are disproportionately based in urban areas.
The health sector is allocated only 3% of the 2015-16 national budget, far short of the 15% target pledged by African governments under the Abuja declaration in 2001.
Mental health is defined as the state of emotional and psychological wellbeing in which individuals can cope with the normal stresses of life, work productively, and be active members of the community.
The World Health Organisation (WHO) estimates that in situations of armed conflict and other emergencies, the proportion of the population suffering from mild or moderate mental disorders rises from about 10% to 15-20%.
In recognition of the importance of mental wellbeing to development, in September 2015, the UN included mental health as an element of the new global Sustainable Development Goal (SDG) on health.