“I heard more bullets and they said again ‘Let us in or we will burn you.’ I looked into my parents’ faces and saw them sweating, I smelt urine from the employee who was holding my arms down.” (Nine year old genocide survivor.)
For most of us, when we think about conflict we think of armies, bombs and guns. We think of open wounds and broken bones, limbs being blown off and people dying. We rarely hear about children being stolen from their parents or rape being used as a weapon of war to weaken a community. Sadly these are some of the realities.
It may seem obvious that people who have suffered such atrocities will develop mental health problems. Post-traumatic stress disorder is an example of an anxiety disorder experienced by some people who have witnessed violence and military combat. Symptoms include reliving the event in nightmares or flashbacks and difficulties with sleep and concentration. Other more subtle symptoms include feeling alone or feelings of guilt.
It is difficult to imagine why a victim would feel guilty when they may have done nothing wrong. A person can feel guilty that they have survived when the rest of their family and friends did not, that somehow their survival has caused another’s death. This can often be accentuated by the idealisation of the deceased. Survivors can feel that they are unworthy of surviving. There can also be a feeling of shame in being associated with the crime that has been committed.
The medical profession is concerned with developing ways to help people overcome these unwanted symptoms. However, in the aftermath of conflict, where the circumstances are so “abnormal”, how can we be clear about which responses are “normal”? For example in the case of survivors’ guilt, while guilt can be debilitating, stopping a person from moving on with their life, it can also be positive in helping people cope with feelings of helplessness. It can bring meaning to someone’s experiences and allow survivors to feel a continued connection to those who have died. Critics argue that using the labels of “illness” and “therapy” can be unhelpful and even damaging when trying to help a community recover from conflict.
Another difficulty in working out how to best support those who have been involved in conflict is the consideration of important, and often vast, cultural differences. It is possible that while symptoms experienced by someone in one setting may be helpful, in another cultural setting they may be an indication of the need for therapy. Considering these cultural differences and how they affect not only an individual’s behaviour but also how a society functions, is hugely important when working abroad in any context. It is relevant whether you are playing with children as part of a summer volunteering project, providing emergency medical care with Médécins sans Frontières or building bridges with Engineers Without Borders.
Even for those who do not plan to travel to other countries, there are many conflict survivors living here in the UK. While the majority of refugee populations remain on their continent of origin, some travel huge distances in search of safety. In the past 15 years Scotland has seen a large increase in asylum applications since it became a major UK dispersal centre for asylum seekers. With around 20,000 asylum applications made in the UK every year, and 1,000 of those being in Scotland, it is likely that working as a healthcare professional, or in any public service job in Glasgow, you may come across people who have had their world shaken by conflict. Understanding some of what people may have experienced or how they may be suffering now is one step we can take towards better equipping ourselves to meet their needs.
If you are interested in hearing more about conflict and how it can affect the individual, a country’s infrastructure and the international community, Medsin are running a series of four workshops beginning on 28 October at 7pm in room 430 of the St Andrews Building. See https://www.facebook.com/medsin.glasgow for more details.