Chad: The fear that follows them. Providing mental healthcare for refugees

Attacks perpetrated by Boko Haram in the Lake Chad region have increased over recent weeks, and military presence in the area has also expanded in response. The number of people who have been forced to flee their homes has more than doubled, bringing the total number of displaced in the area to 75,000. The fear that has been instilled in the population – consisting of refugees from Niger and Nigeria, and Chadians themselves – has only been exacerbated by the continuing violence which shows no sign of abating. Mental health needs are high, and with this latest rise in violence, will only continue to grow.

From the beginning of its response to this crisis in Chad in March this year, Médecins Sans Frontières (MSF) saw an immediate need to incorporate psychological care into its medical activities. Today, working in the Dar Es Salam refugee camp in the Lake Chad region, MSF’s psychologists listen to stories of horror and the ongoing fear that plagues the daily lives of survivors. Among the patients seeking psychological support in MSF’s refugee camp clinic, one in four show signs of depression. Sleeping disorders, severe emotional reactions and trauma-related anxiety reactions are also commonplace.

“I saw Abeni*, a 16 year old girl who had fled from Baga in Nigeria,” recounts Forline Madjibeye, MSF psychologist. “Both of her parents were killed, as well as her neighbours. She took the hand of her little brother and her nephew, as well as the four children who belonged to her neighbours, and eventually she made it here. I spoke with her yesterday and she said she still does not have a refugee card, and is not receiving any food. The children are crying because they are hungry.”

Escaping from this situation and arriving to extremely difficult living conditions only compounds the psychological effects of such trauma. According to Forline, the responsibility of taking care of six children in a refugee camp, combined with what she has experienced in Nigeria, has taken an enormous toll on Abeni. She continues to re-experience the fear, she is unable to sleep, is extremely stressed, and is suffering depression because her future is completely uncertain.

“We want to be able to give back some sense of control to Adeni, so that she can better handle the fear and sadness she is experiencing and take care of herself and the children,” continues Forline. “This is not an easy situation, and others have sadly been through it too. So I encourage her to share her experiences with other refugees, and not to stay at home alone.”

With an increase in violence in the region, insecurity has followed the refugees since the moment of their departure. Although they may have believed they were fleeing to safety, they are instead still haunted by the events, they do not feel secure, and thus continue to relive the trauma. ‘Home’ is now a gathering of exposed tents in the middle of a desert, where they may be vulnerable to further attacks.

Aurelia Morabito, a psychologist who has been working for MSF in Lake Chad for the last two months, explains that the symptoms patients display are intrinsically linked to the traumatic events that refugees have experienced, but also the living conditions and feelings of fear they face on arrival.

“The process of recovery is long. People have witnessed horrible things, they become refugees, and then they arrive to a camp where life is grim and very tough. Initially, they have post-traumatic stress, they cannot sleep. But then there is no option but to stay.  You are not only a victim of Boko Haram, you now have to go through the process of accepting life as a refugee, of having to take care of life in a different place, and of having to live with the reality that you have no idea what tomorrow holds.”

Since starting the program in March, MSF psychologists have seen some 524 patients. Teams provide individual and family or couple consultations, and children can also partake in a weekly drawing workshop to express what they are feeling.

“It is easier for children to express their fears through drawing,” says Aurelia. “Afterwards, we talk about the pictures with them and their parents with the aim to help them control their fears. In every session, the children recount horrible stories through their drawings. We see pictures of guns and helicopters, and decapitated people. We hear stories of children who left Nigeria, only to experience another attack in Niger, to come back to Nigeria to see the violence again. Many have run alone through the night, or stayed the night hiding in the water, hoping nobody will find them.”

The aim of the MSF mental health team is to provide support to the refugees to lessen the burden of the trauma, and to ensure that they have a professional to talk to for as long as they need. Psychologists listen to patients in a safe and confidential space, and through acknowledgement of their suffering, help them find the best coping strategies.

“Through our sessions, MSF psychologists listen and try to normalise the reactions of the refugees,” explains Aurelia. “This helps to stabilise and secure the patient while they connect with others and share experiences. We know that we cannot make the suffering go away, but we can help people to deal better with their unbearable reactions.”

MSF has been working in the Lake Chad region of Chad since March 2015, soon after the first waves of refugees fleeing Boko Haram violence in Nigeria began. In addition to its mental health program in the Dar Es Salam refugee camp, MSF is also carrying out mobile clinics providing basic healthcare to the resident and displaced population. The organisation will also soon incorporate a mental health component to these mobile clinics.

In the capital, N'djamena, MSF supported Ministry of Health hospitals following two Boko Haram attacks that took place on 15 June and 11 July. Since April, MSF has been training Ministry of Health staff in N'djamena on management of mass casualties and made donations to three hospitals of the capital, in order to help increase the national capacity to respond to emergency scenarios.

MSF has been working in Chad for over 30 years. The organization runs regular programs in Abéché, Am Timan, Massakory and Moissala. In July this year, MSF also started working in Bokoro in Hadjer Lamis province in response to acute malnutrition.

*name has been changed to protect identity