South Sudan civil war taking a devastating toll on mental health

According to MSF, there were 31 attempted and seven successful suicides in 2017 at the camp.

Lack of mental health care, neglect and forced confinement are turning lives into hell for many mentally ill patients in South Sudan's refugee camps.
After fleeing from the country's ongoing violent conflict, many are fighting another battle - against their own minds trapped in trauma, suicidal tendencies, bipolar disorder and psychosis.
On the World Mental Health Day observed on October 10, a psychiatrist with Medicins Sans Frontiers, who recently returned after serving in South Sudan, has spoken about the mounting mental health problems in the conflict zone.
"Many of the displaced people who have encountered extreme violence, torture, rape and abductions have severe mental health issues. Unfortunately, it is not a priority among many other priorities for organisations working in the conflict zone. And patients who otherwise could have had a chance to lead a normal life, are left neglected," Dr Jairam Ramakrishnan, told Khaleej Times.
He said he was the only psychiatrist available for a population of around 50,000 in and around Malakal, the capital city of Upper Nile State, which houses the UN's Protection of Civilians (PoC) site. And he was the first psychiatrist too to serve at the only emergency medical facility run by MSF in the PoC site. 
The site was set up in 2014 to help displaced people find temporary shelter, and currently houses around 25,000 people.
High suicidal tendencies
The ongoing civil war in South Sudan has led to wide-spread ethnic violence that has seen thousands displaced, and more than two million people fleeing to neighbouring countries.
Those whose lives were spared endured deep psychological scars and even serious mental illness as witnessed by Dr Ramakirshnan.

Worldwide figures > Depression:  300 million people are affected. > Bipolar disorder: 60 million > Schizophrenia: 23 million are affected.

He said living in chronically depressing situation in the cramped camps with no electricity and leaking roofs for a long period, had left many people "hopeless."
"Sleep problems, anxieties, psychosis, bipolar disorder, suicidal tendencies and non-epileptic seizures are prevalent among the people I have seen. Many children have issues like mental retardation, behavioural disturbances and nightmares, and need psychological support."
Dr Ramakrishnan said during the ten months he worked in the camp, there was a spate of increased suicide attempts. "That gave me sleepless nights. It was challenging trying to help those who had attempted to hang themselves and survived by sheer chance and remained extremely suicidal."
According to MSF, there were 31 attempted and seven successful suicides in 2017 at the camp. At the end of the year there was a spike of 10 attempted suicides in one month.
Trauma and mental scars
Working in a conflict zone meant the medic had to deal with patients who were held as hostages, those who have witnessed killings and torture, and also victims of sexual abuse. "I recall a patient who was taken as hostage, and he saw people being shot at every day.
He lived through each day expecting it to be his last. Though he eventually escaped and reached the camp, he was afflicted with paranoia and hallucinations which resulted in his being unable to sleep, running away from his shelter and so on."
Being the only psychiatrist available for 50,000 people also came with its own challenges like long working hours and being on duty round the clock.
"It is inevitably challenging to be the only specialist catering to the population. Sometimes it can be exhausting to not be able to completely relax, knowing that you could be called out any time," said the doctor.
Dr Ramakrishnan said he usually had about 250 consultations with 30 new patients a month. "I saw patients as outpatient and inpatient but also did a few home visits to see patients confined in their shelters, disabled by severe mental illnesses."
Recovery gives hope
But the lack of stigma attached to mental illness is one positive side that helps many patients. "Their society does not isolate mentally ill people. There is no exclusion or  ostracisation. They stick together. They treat them as their own, and that really helps."
Despite all the challenges of working in difficult conditions with limited facilities, Dr Ramakrishnan said, it was satisfying and humbling to be able to make a difference in other people's lives.  His presence and what little he could change, the medic said, helped in raising awareness about mental healthcare.
"The best way to raise awareness is by changing the situation. When friends see a man, who was earlier confined to chains, go out and chat with them like any other normal person, there is no other more impactful message about the need to treat mental illness. Recovery and hope go hand in hand."
anjana@kahleejtimes.com

Anjana Sankar

• anjana@khaleejtimes.com