The Upsala Armed Conflict database lists 33 countries with ongoing armed conflicts in 2011. Some countries, such as Afghanistan, have been in the midst of low-intensity warfare for most of the last several decades. Individuals living in these areas are subjected to intense, and unpredictable violence and unexpected losses: massacres with ethnic overtones and terrorist bombings in addition to all-out firefights between insurgent groups. Those who flee do not always find themselves arriving into safe hands, but instead imprisoned in crime-ridden refugee camps where those charged with their protection further abuse them.
And war is only one type of traumatic event. Repressive regimes routinely use torture to subjugate and terrorize their citizens, including rape and other forms of sexualized violence. The International Council on the Rehabilitation of Torture Victims claims that as much as 35 percent of refugees have experienced torture.
In 1999, WHO estimated that there were approximately 50 million displaced person and refugees around the world. About 50 percent “present mental health problems ranging from chronic mental disorders to trauma, distress and great deal of suffering.” Of these, about 5 million have ongoing mental illness or have been highly traumatized and require professional treatment. An additional 5 million experience significant impairments to their social or psychological functioning.
We now know with some degree of certainty that the sooner traumatic events are addressed and attended to, the less likely they are to lead to pathological symptoms in those who experienced them. We also know that individuals who have had multiple traumas over their lifetimes are more at risk, especially if those traumas remain unresolved. Addressing the needs of repeatedly traumatized individuals quickly is important to their overall recovery and for the recovery of their communities.
The Red Cross/Red Crescent recommends a tiered approach to mental health interventions: community-based psychosocial support that strengthens social and emotional supports and enhances resilience for a wide span of the community, psychotherapy for those with pre-existing mental illnesses or who have been highly traumatized, and psychological first aid. WHO recommends a similar approach.
Professionals providing psychotherapy within these populations usually adopt whatever methods of working they have been trained in and a wide variety of strategies have been used in the field. Given time and economic limitations, most interventions are short-term–the priority is to restore the client to normal and effective functioning. But some organizations provide therapy for as much as a year or more.
According to Mary Fabri’s review of the literature, Trauma-Focused Cognitive Behavioral Treatment (TF-CBT) has been identified as an effective intervention for highly traumatized individuals and CBT-guided treatments constitute a “best practice” approach. Group therapy has a mixed record of effectiveness, but family interventions and psychosocial support seem to enhance the work of individual psychotherapy. Of the greatest priority is adapting the therapy to the culture and needs of the client.
Dwary, M. (2006). Counseling and Psychotherapy with Arabs and Muslims: A Culturally Sensitive Approach (Book Review). Retrieved from: http://www.arabpsynet.com/Books/Dwairy.B1.pdf
Fabri, M. (2011). Torture. Best, Promising, and Emerging Practices in the Treatment of Trauma.
Hardi, L. and Adrienn Kroo. (2011). Torture. Psychotherapy and Psychosocial Care of Torture Survivors in Hungary: A Never-ending Journey.
Human Rights Watch. (2002). Hidden in Plain View: Refugees Living without Protection in Nairobi and Kampala. Retrieved from: http://www.unhcr.org/refworld/docid/3e314172e.html
International Federation of Red Cross and Red Crescent Societies. (2009). Community-Based Psycho-social Support: Trainer’s Book. Retrieved from: http://reliefweb.int/sites/reliefweb.int/files/resources/130F79651B1E9A68C12575C90043CC48-IFRC_june09.pdf
International Rehabilitation Council for Torture Victims. (2011, 20 June). Up to 35% of Refugees are Torture Victims. Retrieved from: http://www.irct.org/Default.aspx?ID=3843&PID=13717&M=NewsV2&Action=1&NewsId=3221
Kakuma Refugee Reflector: A Kakuma Free Press. http://kanere.org/about-kakuma-refugee-camp/
Levine, P. “Trauma is Treated in the Body, Not the Mind.” Somatic Experiencing. Retrieved from http://traumahealing.com/somatic-experiencing/
Levine, P. (1996). Trauma Healing Articles. Retrieved from: http://www.traumahealing.com/somatic-experiencing/reference-healing-trauma-lessons-from-nature.pdf
Upsala Conflict Data Program. (2012, 17 February). CDP Conflict Encyclopedia: http://www.ucdp.uu.se/database, Uppsala University. Department of Peace and Conflict Research. Retrieved from: http://www.ucdp.uu.se/gpdatabase/search.php
World Health Organization. (2013) Mental Health of Refugees, Internally Displaced Persons, and Other Populations Affected by Conflict. Retrieved from: http://www.who.int/hac/techguidance/pht/mental_health_refugees/en/