In July 2013, actress Angelina Jolie spoke out against rape as a weapon of war, urging a Japanese audience to join her fight to stop sexual violence in war zones. “Our aim must be to shatter impunity, so that rape can no longer be used as a weapon of war anywhere in the world as it was in Bosnia, and as it is today from Congo to Syria,” she said. Jolie serves as special envoy for the U.N. High Commissioner for Refugees. Her statement about rape as a weapon of war is an issue close to SalusWorld’s heart as we see and understand the psychological damage such assaults can have on an individual, their family, and society.
The 20th century represents the most war-ridden century in recorded history and the most lethal for civilian deaths from war. The Red Cross (1999) estimates a total that about 40 million people killed in war and conflicts since WWII. While the number of civilian casualties is great, the numbers do not begin to capture the masses of civilians who suffer the psychological, and often invisible, scars of war. The effect of war on civilians involves multiple traumas over time and includes events such as rape, torture, forced labor, conscription as a child solider, assault, and displacement. Like Jolie pointed out, civilians, specifically women and children, are victims of extreme violence and witness extreme acts of violence directed toward self and others and the impact of such experiences can result in deep psychological scars (Hanson & Vogel, 2012). Psychological and emotional injuries may be the most enduring effects of war, yet historically, they may be the least addressed in terms of rebuilding a society and preventing future violence.
While communicable diseases continue to represent the leading cause of disease burden in resource-poor areas, non-communicable diseases are becoming increasingly more significant as causes of disability and premature death. In particular, unipolar depression is the third leading cause of disease burden worldwide – representing 4.3% of total disability-adjusted life years; and, the WHO predicts mental illness collectively will become the second leading cause of disease burden by the year 2020 (WHO, 2001) compromising 15% of the disease burden.
Perhaps there is a relationship between war and global mental health statistics. To date, large-scale recovery efforts commonly have focused on more visible needs such as food, shelter, clothing, and physical health, as well as economic aid. Psychological trauma and disease have been overlooked or minimized, leading to their becoming part of the psyche of a society that extends into future generations.
Mental illness is one of the great invisible burdens on developing societies, accounting for four of the 10 leading causes of disability worldwide. In emergencies and oppressive regimens, the problem is even greater, as the number of people suffering from severe mental disorders increases and those with pre-existing mental illnesses are exposed to new levels of stress and human rights violations. SalusWorld understands the devastating effect that mental illness has on the world’s poorest nations and nation’s touched by war. As part of its holistic approach to health, SalusWorld incorporates mental health and well-being into its programs to address the psychosocial needs of disaster survivors and help those with pre-existing mental disorders.
As one of the very few international relief organizations to make mental health care a priority, SalusWorld has the capacity to identify and treat those with pre-existing mental health disorders as well as train and build the capacity of local providers in the service of creating a sustainable model.
In Myanmar and Northern Thailand extreme human rights abuses are targeted at civilians in an effort to silence communities through fear. Healing must also occur on both a societal and individual level. In populations recovering from extreme civil oppression and neglect or civil conflicts (as in Shan relocated to Thailand), reconciliation requires attention to the psychosocial needs of the survivors. The failure to address mental health problems can lead to emotional and behavioral problems and functional impairment. It can also prevent the solidification of social justice and functional civil societies.
Four years ago SalusWorld began to train paraprofessionals in the areas of mental health services and emotional healing. Starting in 2008, SalusWorld’s Community Mental Health Initiative (CMHI) has worked to strengthen CBO’s capacity in the realm of psycho-social programming and trauma rehabilitation initiatives.
As we approach our fifth year of operation, it has become evident (through pre and post training and the receipt of support services assessments) that this project enhances the capacities of first line responders, health care workers, educators and activists by helping: to restore the basic personal functioning clients had prior to their trauma experiences (for example, improving parenting capacity, the ability to perform in school/at work or other productive endeavors); to identify “triggers” more readily and helping those in need develop strategies to address them; to rebuild trusting relationships with friends, family and peers; and to restore feelings of self worth. The local counseling, outreach and training staff are a diverse group, and include men and women, Shan, Burmese, Karin and Rakhin, Buddhists, minority faiths and identify card holders of Burma and Thailand. They serve as vital interpreters and ambassadors for SalusWorld as its program grows and continues to learn the most effective means to reach, treat, and heal individuals in need of psychosocial services. Clients are inherently involved in, and in fact, in charge of their own healing and rehabilitation. Client interventions and training programs are monitored by expert consultants throughout the service and educational provision period and are modified accordingly to best suit client and audience needs. The trainings provided enhance local capacity in mental health service provision as well as enhance local capacity to provide services overall to survivors of extreme trauma.
Read more: Hanson, E., & Vogel, G. (2012). The Impact of War on Civilians, in L. Lopez Levers (Ed.) Trauma Counseling: Theories and Interventions. New York: Springer Publishing Company.