Uganda: Post-traumatic stress rife in the north

GULU, 23 October 2008 (IRIN) - Sleepless nights, flashbacks and hallucinations have become normal for Michael Ocira, a former soldier in the rebel Ugandan Lord's Resistance Army (LRA), which has waged a civil war in the north for more than two decades.

"When I imagine the days in the bush, I lose my senses and thoughts, only to be told later that I acted violently, grabbing hold of anything to [use to] beat anyone near me," Ocira told IRIN on 22 October in Gulu town, one of the areas most affected by the LRA war.

Ocira said he often has terrible headaches and feels extremely tired whenever he has a flashback into his LRA days.

"The only way out is to drink alcohol heavily so that I can have a break in my mind," he said.

Ocira's is one of hundreds of cases of trauma-related ailments experienced by residents and returnees in many parts of northern Uganda and health officials say mental illness is widespread in the north because of the war.

This case is part of a growing body of evidence that alcohol and drug abuse is rising among former LRA abductees and internally displaced persons (IDPs), many of them trying to fight the trauma caused by the war and the subsequent displacement.

Health experts say the problem is especially prevalent among those suffering from post-traumatic stress disorder (PTSD) and that illegal drug use and heavy drinking are very common in the region.

Worrying trend

A two-year lull in hostilities saw many IDPs in squalid camps returning to their villages or transit sites. As they begin to rebuild their lives, and development agencies embark on rehabilitation work, psychiatrists and studies reveal that mental illness as result of the war has adversely affected reintegration and community relations.

Benjamin Alipanga, a clinical psychologist at Gulu University's psycho-traumatology division, told IRIN that the level of trauma and mental illness in the region was worrying, with many of the population suffering from PTSD, depression and other conditions.

"The magnitude of the problem is so high inorthern Uganda but we do not have enough psychiatrists to help people suffering from trauma," Alipanga said. "We have only three psychiatrists serving the entire war-affected northern Uganda, some two million people."

According to Alipanga, other traumatic events common during the conflict include rape, abduction, brutal killing, physical torture, as well as living in IDP camps under life-threatening conditions.

"Even those who were not affected directly by the war are suffering from secondary trauma since they interact with people who are suffering from severe trauma," Alipanga said.

Psychiatrists and humanitarian agencies providing psycho-social support in the region have expressed concern over the rising cases of people suffering from mental illness in the region.

Study

According to data obtained from VIVO, a Germany-based agency providing treatment to traumatised IDPs and ex-LRA rebels in Gulu, Kitgum and Amuru areas, the rate of post-traumatic stress disorder among IDPs in the three district is 48 percent, depression 24 percent and suicidal tendencies 24.8 percent.

Elisabeth Schauer, the director of VIVO, said the agency had conducted a survey involving 1,140 respondents between the ages of 12-25 years and found that mental illness like PTSD and depression were high in the community.

Schauer said people suffer more from trauma as they return to their villages their old homes trigger off memories of the war.

"The villages where these IDPs are returning are the places where a number of people witnessed brutal killings, saw their relatives being abducted or were abducted [themselves], others forced to kill or tortured," she said. "This explains why there has been a slow return of IDPs to their villages because they fear getting into places they experienced some of the bad occurrences."

She said PTSD and depression could contribute to a cycle of violence and hinder the recovery of the region.

Rise in crime

Increasingly, the troubled ex-abductees and a number of war-affected persons are turning to crime, local officials said, with some ending up in prison for homicide and other criminal offences.

"We are receiving a number of cases of attempted suicide and drug abuse in villages and towns in the region," the police spokesman for northern Uganda, Johnson Kilama, told IRIN, adding that domestic violence, arson and assault were also on the rise.

He said some IDPs had been found growing marijuana and sniffing substances such as petrol and glue as a way of relieving mental stress.

Rising awareness of the problem has highlighted the need for access to treatment and an evaluation on whether people with mental illnesses have been receiving adequate help in northern Uganda.

Dr James Okello of Gulu Hospital's psychiatry unit said mental disorders were a major factor for non-adherence to health programmes.

"We need scientific, beneficial, traditional and religious means of addressing mental problems in the region," he said.

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