“Young people are more emotionally vulnerable”

May 26th, 2009

Carmen Martinez is a psychologist with MSF. Over the past few months she has worked in North Kivu in the Democratic Republic of Congo (DRC). Today she is flying to Haut-Uélé district, in the northeast of the country, where MSF has increased its activities in response to the deteriorating humanitarian situation. In this interview, Carmen speaks about the psychological impact of the war on the population and in particular on young people.

What are the consequences of war on the population?

War can have psychological and emotional consequences but it can also have social consequences that affect the way people live. There is fear, something everyone is familiar with. In war, fear is everywhere. And there is anxiety: people might have problems dealing with stress, perhaps because of a traumatic experience. Some of the patients I meet tell me about flash-backs - repetitive images of what they have been through. Others are afraid at night, have nightmares and become emotional at the slightest noise… They are scared to leave their homes. They avoid any situation that could remind them of what they have experienced. They also get headaches or physical symptoms without being able to explain why. We also see sadness and depression. This is what happens when someone loses all hope.

Teenagers were born in the war. They know nothing else. Are they more vulnerable ?

War affects everyone. But it is true that childhood and adolescence are times when your personality is being defined. Young people can experience more difficulties growing up in the midst of war. They might have problems interacting with others, show antisocial tendencies or behave badly. Some become more introverted. All these reactions are what we call behaviour of ‘protection’… Young people generally have more social problems and are more emotionally vulnerable On the other hand, they can also recover more quickly. As psychologists, we can do a lot for young people.

What is MSF doing to provide psychological support ?

I’ll give you an example. I worked in a camp for displaced people in North Kivu, where we adopted a community approach. Our target groups included former child soldiers – - young people aged between 14 and 20 who have handed in their weapons. We set up a group that met once a week. First of all we had to build an atmosphere of trust. Next, we identified group activities. The group members decided to form a football team and then suggested running sports activities with younger children. They also came up with the idea of income generation activities. The overall aim is to find ways in which they can develop their own skillsto support one another. For those who want it, we also ran individual psychological support sessions.

“War affects everyone. But it is true that childhood and adolescence are times when your personality is being defined. Young people can experience more difficulties growing up in the midst of war,” Carmen Martinez, psychologist with MSF

As a psychologist, you come face to face with the horror of war …

Of course, we hear a lot of “war stories”. Young people tell you that they were forced to kill. They feel powerless because they were enlisted in armed groups against their will. That is always very hard to hear. What’s more, you see a lot of young girls who have been sexually abused. In North Kivu I remember two young girls, five and eight years old, who were taken by an armed man and forced to spend the night with him. Everybody in the community knew about it, but they were all too afraid to say anything. We even had a hard time convincing their mother to come to the hospital with her two girls. This story really affected me, but unfortunately it is far from being the unique.

What are the psychological consequences for victims of rape ?

In addition to the physical effects, the psychological impact of sexual violence is very, very difficult to deal with in the long term. Sexual violence directly affects the dignity of the victim. The individual loses any sense of being a person, she (or he) sees herself (himself) as an object. Rape also has serious social consequences: victims are stigmatized, rejected by their relatives and the whole community. I have seen a lot of victims of sexual violence, mainly young women but also men.

In Masisi, in North Kivu, MSF works with a network of “women counsellors” who work with communities and get them to understand the issues surrounding sexual violence. They identify victims of sexual violence, hold an initial confidential meeting and then send the patient to the hospital or the outreach clinics for medical and psychological care. An MSF psychologist interviews the victims, organizes training and technical supervision for the counsellors, and provides psychological support to the counsellors as well. I worked in Masisi where I developed the mental health strategy which encourages MSF to assist victims of sexual violence but also people who have undergone traumatic experiences during the war.

Is it this kind of assistance that you will offer in Haut-Uéle district?

The humanitarian situation in Haut-Uéle is extremely worrying due to the presence of Ugandans rebels of the Lord’s Resistance Army (LRA) and of the Ugandan and Congolese armies which are conducting joint military operations in the region. I will go to Faradje, where MSF has begun to provide medical support at the local hospital. We will define what we need to do in terms of mental health but also give psychological support to the hospital staff. They are living through war and recently experienced a direct attack on the hospital during which several people were killed. The medical personnel here often find themselves on the front line, coming face-to-face with the violence of the war.