Sana'a. Yemen

Their dignity has been deeply wounded

Àngels Mairal, a Médecins Sans Frontières (MSF) psychologist, arrived in Yemen this past March. After a few weeks, the Yemeni authorities started releasing migrants who had been detained on illegal farms, some of them victims of torture. At the same time, deportations of foreigners from Saudi Arabia into Yemen increased, as did the number of migrants who voluntarily wanted to return home. Mairal has been assisting this population.

What problems did you encounter when you arrived in Yemen?

When I arrived in Yemen, I started working with my colleagues assisting migrants in Haradh town, in the north of the country, close to the border with Saudi Arabia. There, the International Organisation for Migration (IOM) runs a camp sheltering some of the migrants from other nations who want to be repatriated to their country of origin –people needing special protection such as women, children, elderly people and sick people. Additionally, there are hundreds of migrants in the town gather waiting to make yet another attempt to enter Saudi Arabia or to return home.

MSF runs two clinics outside the camp where we conduct individual and group sessions providing mental health support to those in need. My work during the first weeks consisted of supporting our clinical work in the area and also building the capacity in psychological care of other organisations working with migrants.

What happened in April?

By early April, Yemeni authorities started releasing migrants who had been detained by traffickers on illegal farms. In just a few days, groups of about 200 people were referred to a detention centre on the outskirts of Haradh. From there, they started being transferred in groups to another detention centre in Sana’a, the capital. Since the number of people was too high in Sana’a, a group of about 480 people had to remain in a prison in Amran for a few days.

While this was taking place, Saudi Arabia deported groups of illegal migrants to Yemen, who also ended up in these detention centres or went there of their own will to be repatriated. The detention centre in Sana’a has a capacity to shelter 200 people but sometimes there have been as many as 1,200.

What is the situation like right now?

Repatriations from Sana’a to Ethiopia, where most migrants come from, have already begun. All the migrants in prison in Amran have been transferred to Sana’a; the centre there is still beyond its initial capacity.

Deportations are expected to go on throughout the coming days, and we don’t know whether more migrants will be released from the illegal farms or whether this has been a one-shot event.

What is the situation endured by these migrants like?

Yemen is located along one of the main migration routes. Many people leave the Horn of Africa in search of a better life in the Gulf countries. On the way, many migrants fall prey to smugglers. The migrants released by Yemen officials told us that they have been victims of torture and ill-treatment. Traffickers resort to extortion to get money from the migrants’ families. Many of them have gone through terrible experiences where they were subjected to or witnessed extreme violence, including the murder of other migrants. The migrants we were seeing in Haradh used to recount these experiences.

We clearly just witness a fraction of the problem. There seem to be scores of migrants crossing Yemen every year and the number reaching Saudi Arabia or falling prey to traffickers is uncertain.

What are the mental health needs of this population?

Even if all the people we see have endured similar situations, the impact ill-treatment may have on each person and their recovery varies depending on the individual, the duration of the traumatic experience, their personality, and their own capacity for resilience.

We see posttraumatic stress symptoms (PTSD) manifested by flashbacks, recurrent thoughts, insomnia, isolation, and deep sorrow. We also see psychosomatic symptoms such as headaches, tachycardia, difficulty breathing. Many people also find it difficult to concentrate or to follow a conversation.

We also see something that even goes beyond these symptoms and that many of them voice as “I have no rights” and “I do not exist as a human being”. Their dignity has been deeply wounded. Many of them do not feel safe and their most basic needs are not being met. They feel uncertain; they don’t know when they will be able to go back to Ethiopia, what their life will be like when they go back or how they will be able to return to their place of origin from the capital.

Life for sexual violence survivors is especially difficult. Women who’ve already endured the trauma of having been humiliated or raped must also contend with unwanted pregnancies, shame, stigma and possibly rejection by their families when they return home.

We have also seen some people suffering from psychotic disorders or severe depression that we have referred to the psychiatric hospital in Sana’a.

How does MSF assist these people?

We focus our intervention on group activities. The group, the entire community, is traditionally an important resilience factor. The aim is to reinstate a feeling of being in control, as much as possible, over the environment, and also over their own body and emotions. We try to rebuild their sense of dignity, their capacity for building reliable relationships. As soon as they feel sufficiently confident, they can start talking about the consequences of the experiences they have endured and start a grieving process for their loss of time, money, health, friends, hope for the future, and more.

One facet of the group activities are psychoeducational sessions during which we can talk about the symptoms they may suffer from following the experiences they’ve endured and inform them that the severity of those symptoms is likely to diminish over time. There are also discussion groups where people are able to voice their concerns and share them with others.

After these sessions, we organise others with smaller groups where we are able to offer psychological counselling and deal with their symptoms more in depth. We also invite them to individual sessions where we are able to focus much more on each person’s circumstances.

As the moment they are to be repatriated is uncertain, these interventions are very short; many involve just one or two sessions. Still, we try to alleviate the most acute suffering and mobilise their resources to cope, and we’ve been able to confirm the positive impact of our intervention when it comes to enabling people to freely voice their suffering without fear of being judged.