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Psychosocial support

“You are not crazy, your situation was”

After war is over, people just want to go on with their lives, rebuild their houses and their country. But simply enjoying peace is often impossible: soldiers as well as civilians are traumatised by war. Without treating trauma, the violence continues, making peacebuilding and reconstruction difficult. Trauma therapist Esther Mujawayo survived the genocide in Rwanda and now treats traumatised refugees in Germany. She told Sheila Mysorekar why it is essential to pay attention to the psychological state of survivors.
Rape victim, South Africa. Pascal Deloche/GODONG/Lineair Rape victim, South Africa.

Why is trauma therapy important in post-crisis situations?
Tackling trauma is vital. If the issue is not addressed, everything else will collapse. Traumatised people don’t function well, they sleep badly, they are forgetful – to the point that simple tasks like cooking become a big issue, like they put salt three times, until the food is inedible. Or they burn down their homes because they forget the fire. Moreover, they cannot control their emotions and have anger issues. To give an example: I know of women in Rwanda who were given credit to open small businesses. But they were not able to operate their new shops. For instance, a woman in a market started to scream at a man who came to her stall, because he reminded her of the man who tortured or even killed family members of hers. This is no way to treat a client – you cannot run a business like that. Reconstructing a country becomes impossible, because people need to function well, but terrible memories are triggered by any small thing.

Is this true for children as well?
In many countries, children lost their parents and grow up with relatives or even strangers. These kids may have witnessed extreme acts of violence and are, of course, traumatised. That leads them to have fits of anger, or wet their beds at night, or scream because of nightmares. Often, their relatives think these children are misbehaving and punish them for wetting their beds or letting out their anger. It is important that people understand that after experiencing terrible things, this kind of behaviour is nothing unusual: Living through abnormal violence causes reactions which seem abnormal, but they are quite normal in this situation.

Former child soldiers may shut up about their past, but then beat up people, including their own children. They may want to hit the one who hurt them, instead they hit their children. Many adults think they are crazy when they notice their own behaviour, and consequently keep quiet about it. For them to heal psychologically, they must understand that the situations they experienced were crazy, not they themselves. So we work with trauma patients in order to enable them to build a new life.

Is your work part of peacebuilding?
Yes, definitely. People need to find peace inside themselves before they can build a peaceful society.

Is the issue getting adequate attention in post-crisis countries?
The relevance of trauma is underestimated greatly. It can cause severe damage in a person and change him or her completely. We only pay attention to the wounds on the body, we don’t notice the invisible wounds. But internal turmoil directs people’s actions and behaviour. It can keep them from functioning and may lead to more violence. In many crisis situations, local people as well as international helpers focus on basic needs such as food and shelter. While these vital issues need to be fulfilled first, trauma should be addressed at the same time. When we bring food, we should also start talking.

If people cannot talk, what will happen?
In post-conflict societies, the levels of violence are extremely high, including, for instance, domestic violence. I know of a case in Rwanda, where a father refused to give a small piece of land to his son, and the son attacked the father and cut his head off. During the genocide, the father had killed people, and the son had witnessed this. This is the kind of violent reaction that may happen, caused by a deep trauma. In their minds, the persons are living in war. They are suffering from post-traumatic stress disorder (PTSD). If a war still goes on in your head, it is not over for you. Anything may trigger bad memories. In therapy, we try to bring the people to the ‘here and now’, so that they understand that the war is indeed over. Finally.

Do traumatised women need special attention?
Yes, they do. In many conflicts, women are raped. They are damaged twice – once, because something terrible has happened to them, but on top of that, they are stigmatised because of it. In the Democratic Republic of the Congo, for example, many women cannot go back to their villages, because they have been raped in violent conflict. They must face everything alone – unwanted pregnancy, HIV/AIDS and other sexually transmitted diseases. They need support, and they need a platform and safe space to talk about their experience.

Who does trauma therapy address?
We need to address society as a whole society, those who committed crimes and those who became victims. Both sides have experienced levels of violence which are not normal. Perpetrators suffer from trauma too. I’ve had cases from Sudan, where militias were forced to put a village on fire and later had flashbacks of flames and people screaming. Those are exactly the kind of flashbacks victims have.

So it is necessary to work with perpetrators?
Yes, that is a necessity of peacebuilding. We tend to have compassion only with the victims, but many people ignore that perpetrators suffer too. Child soldiers, for instance, are at the same time innocent children and killers. As a therapist, you have to address the child and the killer, both in the same person.

What kind of treatment is effective for traumatised people who still live in fragile, violence-prone settings?
It is very difficult to heal if you are still in an unsafe and volatile situation. In South Sudan, for example, people are still fleeing from violence. Nonetheless, it makes sense to address the issue of psychological suffering even then. Human beings have an enormous capacity of coping, but if a mother in South Sudan sees her children dying, how can she cope? She may feel she is losing her mind. It is important to tell her: you are not crazy, the events around you are crazy.

So what can be done for traumatised people in war-torn countries like Syria, Iraq or South Sudan?
While people are still on the run, they may not suffer from trauma symptoms – in a way, the mind makes sure that the body functions in order to survive. But later, in safety, the symptoms occur. I know this from my own experience: In Rwanda during the genocide, while I was running away with my children, trying to save our lives, at night I was able to sleep. Only afterwards, when everything was over, I started to suffer from sleeplessness. In Iraq or the DR Congo at present, healing is difficult, because violence is on-going. If it continues to rain, you cannot dry. In Rwanda, in contrast, it was easier to deal with trauma, because the genocide with its extreme violence lasted three months, then it was over, and there was peace. So it was easier to work on trauma. In any case, people need a secure environment in order to start thinking about what happened to them. We cannot help people who have no solid ground under their feet.

Are there best-practice examples in post-crisis countries?
There are some civil-society organisations, for instance HAUKARI, who do good work with women in Northern Iraq. Doctors without Borders and UNICEF also work on psychological distress and psychosocial support. But there is so much to do worldwide. In Rwanda, for instance, trauma work is by no means over. It is still going on, even 20 years after the genocide. In AVEGA, our widows’ association, we offer women to bring their trauma to the group and share their experience. Sometimes we have older women attend our meetings, women who also lived through the pogroms in Rwanda in 1959, 1963 and 1973. They tell us, that, back then, they never had the chance to talk about what happened, and they realise that they were traumatised. Still, many people in Rwanda, especially men, say that they don’t need psychological attention. But if you talk to them, it turns out that they drink too much, or they are workaholics, or have sexual problems. All of this results from their trauma. And even now, perpetrators in Rwanda cannot talk about what they experienced. Society in general simply sees them as murderers. They are not seen as traumatised people, which they are. So it matters that not only psychologists, but everybody – the whole society – understand trauma and how to deal with it. This may mean simple things, like holding a screaming, angry child instead of punishing him.

What can be done at the international level?
In any country battered by strife and civil war, like South Sudan at present, it is very important that the local people see that others from outside are coming to help. To see that international organisations are on the ground, offering assistance, gives them the feeling of not having been forgotten. Psychologically it matters a lot not to feel alone.  


Esther Mujawayo is a sociologist, trauma therapist and author from Rwanda. Having survived the genocide in her country in 1994, she now works in Düsseldorf, coaching refugees who arrive in Europe traumatised. She is co-founder of AVEGA (Association des Veuves du Genocide d’Avril), an association of Rwandean widows.

Related links:
AVEGA, Association des Veuves du Genocide d’Avril:
Doctors without borders (MSF):
Psychosoziales Zentrum für Flüchtlinge Düsseldorf (PSZ):


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