Assessing Trauma in Sri Lanka Psycho-Social Questionnaire

This short overview contains excerpts from the complete report that can be downloaded in Word format here Summary This report is based on a mental health survey among the population of the Welfare Centres (WFCs) in Vavuniya (Sri Lanka). The Welfare Centres were established 10 years ago as temporary facilities to house those that were to be resettled in other parts of Sri Lanka. Due to the ongoing insecurity the mostly Tamil inhabitants have settled permanently in the Centres. A pass system limits the movements of this group of 23,000 people considerably. The appraisal of traumatic experiences shows that substantial numbers of the WFC inhabitants have been exposed to direct war fare (attack on village 65%, aerial bombing 77%, mortar fire 54%). People witnessed wounded persons (60%), torture (51%) and people being burnt in their houses (38%). The personal experiences highlight more the indirect consequences of war (arrests/kidnap 18%, hostage/detention 17%, maltreatment 18%). Rape experiences are low (2%) and are also witnessed by a few (2%). However, 60% has heard of raped cases. Since rape is a taboo and very difficult to reveal in an interview survey, it is possible that rape is under reported. Personal losses are high: at least 37% lost someone close and 30% witnessed their actual death. Other reported consequences of the conflict are loss of all properties/ houses (both 97%), suffering from starvation (94%) and missing/separation from family members (48%). In addition to these past experiences a majority of the respondents indicate a constant feeling of un-safety (87%). It can be concluded that the population does not only carry a heavy burden of past traumatic experiences. They are chronically under pressure because they do not feel safe. Suicide rates in Sri Lanka are reported as among the highest in the world. The number of successful (62) and attempted suicides (691) in Vavuniya is equally high. The prevalence of suicide was three times higher among the population of the WFCs! In our survey 24% of the people reported to have someone in the family that attempted suicide. It is concluded that there is a clear need for a psychosocial intervention in the WFCs. This program should not only address the events of the past. The majority of the respondents (87%) are presently feeling unsafe. The lack of security, the poor living conditions and the ability to move freely must be addressed through an ongoing dialogue with those responsible. The dialogue has resulted in a relocation of 400 families and the intention to resettle another 3,600 before the end of 2001. MSF Recommendations To focus humanitarian aid only to material restoration and physical needs denies the shattered emotional worlds, ignores the ruined basic assumptions of trust and the benevolence of the human beings. It leaves un-addressed the broken morale and the spiritual consequences of war. There is a clear need for a psychosocial intervention that addresses the needs of the inhabitants of the Welfare Centres. This program should not only address the events of the past. The majority of the respondents are presently feeling unsafe. The lack of security, the poor living conditions and the ability to move freely must be addressed through an ongoing dialogue with those responsible. At the date of this final version the government has started the resettlement process. The balance between clinical services and social components is crucial for the success of the program. The respondents indicate that when stressed 'talking' is useful (72%). The majority (82%) is not familiar with the services a counselor can offer. The relevance of using mass (psycho) education tools is supported by the survey indicating (39%) unfamiliar with the concept of stress and unable to identify it (58%). In addition to psycho-education the social component should further focus on strengthening of the existing coping mechanisms (meditation, talking to friends/neighbours). To counteract 'learned helplessness' the community should be mobilised. The facilitation (instead of taking over!!) of local organisations, camp residents to organise community activities (recreational, skills training, education) should be an integrated part of the program. A population that is psychologically healthy can prosper and overcome the burdens of the past. Psychologically healthy people can also solve their disagreements in less violent ways. Helping traumatised people is a matter of restoring the bond between the individual and the surrounding system of family, friends, community and society. To overcome mass traumatisation as in the case of the Sri Lankan Welfare Centres in Vavuniya the healing capacity of family and community systems supports people in their coping with extreme stress and more severe mental health problems. Psychosocial and mental health programs are evident tools in this process of adaptation and restoration. The involvement of local people in these programs is of crucial importance. Acknowledgements This report is produced in close co-operation with a multinational team motivated to bear witness to the anguish suffered by the people living in the Welfare Centres (WFC) in Vavuniya, Sri Lanka.