Mental health: Living with anxiety, uncertainty and fear - Colombia's cycle of violence

When analyzing the problems families face, it often becomes apparent to the psychologist that the client is still suffering from the consequence of a violent experience.

MSF experience indicates that the incidence of mental health disorders amongst people living in communities of return is likely to be higher than amongst people living in rural areas who have not been displaced, and even higher than amongst those displaced people living in urban slums.

Among the psychosocial consultations conducted by MSF in communities of return, the most common reasons given for seeking professional attention include family problems (30%), anxiety (18%), depression (15%) and other psychological disorders (3%).

Family problems are often mentioned first as the reason for seeking a consultation. However, when analyzing the problems families face, it often becomes apparent to the psychologist that the client is still suffering from the consequence of a violent experience. While one individual may be able to live with painful memories, others find the memories unbearable. MSF's experience shows that when people cannot deal with these experiences directly, they focus instead on other aspects and pressures in their daily lives. Many feel it is easier to deal with practical problems rather than with the underlying, unresolved pain.

MSF consultations suggest that once returnees have been home for some time they tend to experience extremely high anxiety. People feel particularly vulnerable because they believe they are not in control of their own destiny.

"We're renting out here, we're still paying because, why are we going to build a house if those people (armed groups) come back and pick us out again? We're still displaced here. We're not doing well. We're here in transition and we don't think about making a stable life. We know that if those people come back, they'll kill us. We don't deal with anyone, we wish there were no armed groups, but because we're peasants they say we're guerrillas. We're alone here; the state never worries about us. And what can you do when it's guns that rule?"
&#— A mother living in a community of return

Insomnia provoked by the anxiety caused by living in a permanent state of worry is something heard in all three phases of the cycle of violence described in this report.

However, it is in communities of return where insomnia appears with the greatest intensity. Those MSF patients who returned after fleeing from violent events constantly mention sleeping disorders and their struggle to overcome them.

"We've been here for a year and still we're not well. When the dogs bark my husband gets up and sits out on the patio to see if someone is coming. There are more nights that we don't sleep than we do. How are you going to forget the things you saw, the people they killed? I only sleep when I go somewhere else. It's a nightmare here. People say that those people will come back."
&#— A woman living in a community of return

The cycle repeats

I'm afraid to stay alone in the house at night. When my husband goes to town for two or three days, I don't sleep, I stay up all night. I turn on all the lights and I think that it's going to happen all over again... my husband says. "You're not alone, you're with God and the Virgin." And I say, "Yes, but still." He says that it won't happen again, but, yeah, who knows?


Uncertainty and anxiety surround people's journey of return. However, MSF has seen that in time, communities of return begin to recover. Businesses start to open and one can begin to perceive a tenuous prosperity amid the abandonment.

MSF's teams working in returnee communities have witnessed how, with the passage of time, people begin to think about economic and social reconstruction.

MSF's own mobile teams seem to have contributed to generating a sense of "normality" in some places. Continued presence and assistance can help people feel less alone and gradually development of the community encourages more people to return.

In Colombia, however, there is a bitter irony to this progress: As communities slowly rebuild they become objects of strategic interest to armed actors on all sides of the conflict. Over time, communities of return regain infrastructure and a marketplace. As they recover their economic footing, they become attractive crossroads for parties in the conflict. This generates greater anxiety among the population, and greater interest to control these areas.

"They (the armed groups) have come here, they come to buy things, they chat with you, they ask you things... until now, nothing. Until now they've offered us the opportunity to work. We don't know if later they'll come back and step all over us. What happens is that when they come and see that we're badly off, they leave us alone, but when they see that people are getting it together they come and hit you up again. God forbid. We hope that if they come back they only ask you to give them a little bit of groceries, and what are you going to do?"
&#— A merchant living in a community of return

This mounting tension forces rural community members to face again the realities of living under constant threat.

People are once again forced to decide how much risk they are willing to accept for the life and livelihood they have begun to regain. A mother who recently returned to her village with her five children described the experience of return as the beginning of a new cycle of violence. Talking to MSF, she said, >>