Shell-shocked children in CAR need psychological support
CAPE TOWN - Many children deeply affected by violent clashes between armed groups and government forces in the Central African Republic (CAR) are in real need of psychological support, according to the International Committee of the Red Cross (ICRC).
The Switzerland-based humanitarian organisation said some of these victims are living in camps for displaced persons near the town of Kaga-Bandoro. But whether they have just arrived or been here for months, or even years, everybody in these camps shares the same painful experiences.
The stories of pillaging, rape and summary execution are endless, and they are all similar. Men, women and children tell these stories.
In addition to losing their familiar surroundings, many of these children have been deeply affected by what they have experienced or witnessed. Many have lost family or friends.
Fabrice, 13, had to watch as his brother was murdered in 2019. "They shot at my brother. He fell. He lay dying on the ground. It hurts when I think of him. I sleep very badly. I have lots of nightmares."
In a country like the CAR, where psychiatric services are virtually non-existent and the health system suffers from chronic under-funding, traditional healers, marabouts and shamans are the usual option when it comes to treating psychological trauma.
Parents turn to these practitioners when their child suffers from nightmares or from images they cannot shake off, when deep depression makes them avoid their friends, or when they faint for reasons their families cannot understand.
There is only one psychiatrist practising in the whole of the CAR, according to the ICRC.
"The most common emotions are fear, sadness and anger. Some children are really sad, and some even refuse to speak,” said Romaric Debas, a Central African Red Cross volunteer.
Since 2014, ICRC mental health specialists in the Kaga-Bandoro region have been in dialogue with traditional healers and parents, to convince them that the traditional approach and "modern" treatment can be complementary.
Healers are now sending children to the ICRC, either immediately, without taking action themselves, or when a child's condition fails to improve despite their rituals.
In all cases, the aim is to make the child better while respecting everyone's beliefs, the organisation said. When the parents give their consent, the ICRC's therapists can get to work.
By replying to a questionnaire, parents provide the information needed to assess the psychological state of their child. Psychological support is provided once a week in the camps for displaced persons, with the aid of Central African Red Cross volunteers, either in groups or with individual children.
Therapists use stories, drawing, breathing exercises or simply the spoken word during individual sessions at Kaga-Bandoro Hospital.
Karine, 10, has been deeply affected by her family's forced displacement and the recent death of her mother. She says that talking to the therapy team has helped.
"I went to see the people from the Red Cross and they comforted me. I don't have nightmares any more. I can have fun with the other children."
Parents are always involved in the therapy. The ICRC sets up an oral contract with them, enabling its therapists to monitor the child's progress. On average, therapy lasts three months. Over 550 children in the three camps for displaced persons at Kaga-Bandoro underwent therapy in 2020.
The needs remain enormous, with the result that none of the children affected by the most recent displacements have been able to receive psychological support so far. But the results are encouraging. Parents living in the town are starting to contact the ICRC, asking the organisation to treat their children.
ICRC president Peter Maurer was in Kaga-Bandoro last week to see the results of the mental health programme for himself.
"When we started thinking about a more holistic approach to health problems, we began talking about psychological problems, the kinds of mental health problems that people are exposed to during war,” he said.
“I'm very encouraged to see that the first programmes are now under way. Because it's true that in the past, we perhaps paid too much attention to the physical aspect. We saw the physical wounds and we treated them. But we didn't see the invisible.”
The ICRC hopes that the Central African government will be able to start providing adequate mental health services soon, if stability and development replace violence, so that Central African society, children and adults alike can finally overcome its deep psychological traumas.