How cognitive behavioural therapy can help with the mental challenges that come with being a refugee.
This piece is by guest writer Louisa de Wet, monitoring and evaluation Officer for UN Women in Uganda.
In December 2017, Harriet and Valerie visited the BidiBidi refugee settlement in the Western Nile region in northern Uganda to see how approaches to water, sanitation and hygiene (WASH) could be improved. Recently named the world’s largest refugee settlement, in Bidibidi there are many practical challenges that need tackling in regards to the daily runnings of things such as sanitation, healthcare, and education, but how is the mental health of refugees being addressed?
In Bidibidi over 85% of the population are women and children, and there are currently over one million South Sudanese that reside in the Uganda. Many refugees have made life changing sacrifices on their journeys to the safety of Uganda’s border, witnessing violence, death, and abuse along the way. This can leave victims with both physical and psychological trauma.
Guest author Louisa de Wet, describes how they are using Cognitive Behavioural Therapy (CBT) techniques to help women and girls overcome the trauma they have faced and look towards the future.
28-year-old Chandia* lives in Ayilo II Refugee Settlement in Adjumani, northern Uganda. She fled from South Sudan in 2014 on foot, accompanied by her 4-year-old son. Her husband remained in South Sudan, and she was left to fend for herself in the long and dangerous crossing to Uganda. On their journey to reach safety, they walked through dense bush. Every so often they would come across dead bodies, and meet unaccompanied children whose parents were killed along the way.
Upon arrival in Adjumani, having walked for days without food or water, they were met and received by UN personnel who assured them of their safety and security. Both Chandia and her son were malnourished, sick and exhausted from their treacherous, and dangerous journey. At the refugee reception centre, she describes feeling both overwhelmed and astounded by the sight of countless South Sudanese countrymen – mostly women, children, the very elderly, and young. They had all fled the insurgency and violence of their home country to seek refuge in neighbouring Uganda. After spending five days at the reception centre, Chandia and her son were relocated to her current plot of land in Ayilo II settlement.
Having already experienced extensive trauma and hardship fleeing her home country, Chandia tells of how she learnt that her husband had abandoned her for another woman. Her voice was almost a whisper as she breaks down for a moment of tears. Her ex-husband now also lives as a refugee in Adjumani, and used to visit her home at night to inflict both physical and sexual abuse on Chandia. After falling pregnant again, she was helpless and initially resented her unborn child, wanting to abort her pregnancy.
Chandia is one of over 250,000 South Sudanese refugees currently living in Adjumani. Uganda has seen an unprecedented growth in refugee population, reaching a total of 1,381,207 in 2017. The South Sudanese refugees comprise the largest population, at 1,021,903 – 86% of whom are women and children. The government of Uganda rolled out the Comprehensive Refugee Response Framework, which guides implementation of a progressive refugee response emphasising the humanitarian-development nexus in Uganda.
July 2016 became a significant turning point in Chandia’s life, when she was met and screened for psychosocial stress disorders by UN Women and its implementing partners. She was enrolled in group Cognitive Behavioural Trauma Therapy (CBTT), along with 12 other women suffering from severe trauma and post-traumatic stress. After successfully completing 10 CBTT sessions, she was elected as secretary to help coordinate and manage the group. These women also received entrepreneurial and leadership training. Chandia, with a small start-up grant, has now built up a small business selling food and vegetable items which she operates within her settlement. With her newly acquired leadership skills and confidence, Chandia also plans to stand as a candidate for the upcoming elections in the Refugee Welfare Council.
Through psychosocial support and training, Chandia and her two sons live a better and more hopeful life in Adjumani. She explains that in her darkest moments she very seriously contemplated suicide as the only way to end her suffering and pain. She thanked both UN Women and partners for the therapy, training, and financial support which provided her the freedom, capacity and confidence to improve her socio-economic status. Her focus now is to be enrolled in adult literacy and numeracy class, meaning that she will be able to communicate and interact with the Ugandan host community and expand her business to the surrounding local markets. Finally, she dreams of one day returning to her home in South Sudan, where she aspires to be a female champion and leader, teaching and empowering other women about their rights.
Since the outbreak of the civil war in 2013, the work that UN Women supports in northern Uganda directly impacts the lives of 100,000 women and girls – through the provision of psychosocial support, legal aid, medical referrals, prevention of sexual exploitation and abuse, leadership skills building, knowledge generation and capacity building on gender in humanitarian action and women’s economic empowerment. As a result of this support, the assisted population have now transitioned to focus more on their socio-economic wellbeing.
*Names have been changed.