Conclusions

Assessing Trauma in Sierra Leone
The survey among respondents from all suburbs of Freetown indicates high levels of traumatic stress among the population surveyed. Every indicator (experienced events, Impact of Event Scale and Physical Health) points in the same direction. The indicators are discussed below. The responses on the second section appraise the traumatic experiences of the respondents. The high percentages of certain events (starvation (99%), witnessing wounded people (90%), having lost someone close (at least 50%)) result in a clear conclusion that most respondents living in all parts of Freetown have experienced at least one traumatic experience. It is likely they have been subjected to many more. The Impact of Event Scale (Horowitz, Wilner & Alvarez, 1979) indicates high levels of traumatic stress and PTSD in the survey population (99%). The final score on the I.E.S. is constructed around two clusters of reactions: intrusions (e.g. flashbacks, reliving of events) and avoidance (e.g. evasion of situations, amnesia). Neither of them contributed significantly more to the overall PTSD score. The outcome of the Impact of Event Scale (I.E.S.) is not conclusive and should be considered with care since the I.E.S. questionnaire is not validated for Sierra Leone and the cut-off scores applied in this report are based on Western European data. The outcomes on the I.E.S. should not lead to the conclusion that almost everybody in Sierra Leone is traumatized and suffers from PTSD or other mental health problems. However, the high scores on the I.E.S. are supported by the outcomes on the appraisal of traumatic experiences (second section). The results of the last section (physical health) confirm the tendencies reported earlier. Traumatic stress associated with physical complaints (like headache (39%) and body pains (12%)) is reported most frequently. The visits to health facilities are relatively high (42%). The high levels of traumatic stress or even PTSD indicate a clear need for psychosocial or mental health interventions to address the needs of the survivors of violence in Freetown. To focus humanitarian aid only on material restoration and physical needs denies the shattered emotional worlds of the population, and ignores the ruined basic assumptions of trust and the benevolence of human beings. It leaves unaddressed the broken morale of the survivors and the spiritual consequences of war. A population that is in general psychologically healthy can prosper and overcome the burdens of the past. Psychologically healthy people can also solve their disagreements in less violent ways. Helping traumatized people is a matter of restoring the bond between the individual and the surrounding system of family, friends, community and society. To overcome mass traumatization as in the case of Sierra Leone, the healing capacity of family and community systems must support people in their coping with extreme stress and more severe mental health problems. Psychosocial and mental health programs are evident tools in this process and should not be overlooked. The involvement of Sierra Leoneans in these programs is of crucial importance. LITERATURE [To follow]
SECTIONS ESTIMATED TOTAL POPULATION CUMULATIVE POPULATION ATTRIBUTED NUMBERS NO. OF CLUSTERS PER SECTION
EAST 1 106458 106458 1 - 106458 5
EAST 2 112910 219368 106459 - 219368 5
CENTRAL 1 35748 255116 219369 - 255116 2
CENTRAL 2 27542 282658 255117 - 282658 2
WEST 1 52870 335528 282659 - 335528 2
WEST 2 73258 408786 335529 - 408786 4
EAST 3 112972 521758 408787 - 521758 5
WEST 3 80800 602558 521759 - 602558 5
Total No. 602558      
Table 1: Key areas and cluster distribution.    
  TEAM 1 TEAM 2 TEAM 3 TEAM 4
DAY 1 CALABA TOWN OLD WHARF MURRAY TOWN ABERDEEN/FERRY RD
DAY 2 APPROVED SCHOOL/ KUNTOLOH BAILO BARRY/DOCKYARD LUMLEY ABERDEEN VILLAGE
DAY 3 NATIONALWORKSHOP MAYIBA/KISSY BROOK WILBERFORCE VILLAGE TENGBETH TOWN
DAY 4 FOURAH BAY KANNIKAY KINGTOM NATIONAL STADIUM
DAY 5 BOMBAY STREET GUARD STREET KROO TOWN ROAD KROO BAY
DAY 6 GINGER HALL HAISHOBI CORNER SUSAN&##146;S BAY GOVERNMENT WHARF
DAY 7 MOUNTAIN CUT MAGASINE COURT BROOKFIELDS SACKVILLE ST/LUMLEY ST
DAY 8 DAN STREET SORIE TOWN    
Table 2: The survey schedule.