Eastern Congo grapples with mental health catastrophe after years of war
Study finds that after decades of brutality half of eastern DRC’s adults suffer post-traumatic disorder and a fifth thought of suicide
The psychiatrist demonstrates how to treat a new patient. “First, we tie them up using these,” he says, speaking in Beni at one of two mental healthcare facilities in the Great North, eastern Congo.
He pulls out a bundle of rope and chains. Most of the patients in his clinic bear the scars of their treatment. John, 19, sits with raw, red rings at his elbows and ankles where his family bound him before bringing him here. He recalls not sleeping for days owing to the discomfort of having his elbows tied behind his back. John, who is suffering trauma following a spate of kidnappings, is not a rare case. “Most arrive bound,” the psychiatrist says.
Nzenze is a different case. He sits on a lump of volcanic rock outside a church in Goma and beats himself repeatedly. After his father was killed in the first Congo war, Nzenze spent one night talking nonsense and has spoken only once since. He was good at school, his mother says. He spoke last year, when she wanted to use his old exam papers to light a fire. “He cried out and stopped me.”
Displaced this year for the fourth time, he camps on the edge of a slum, taking prescription sedatives every night and sleeping on lumps of volcanic rock. “He’s getting worse,” his mother says, as Nzenze rhythmically punches his arm.
Twenty years after conflict broke out in eastern Congo, the unspeakable acts of brutality – mostly indiscriminate slaughter and widespread rape – have been regularly documented. Less well known is the mental health catastrophe that a generation of violence has visited on these people. Ddisplacement, forced recruitment, poverty and sexual violence have contributed to a mental health crisis.
“Nobody really knows what to do,” says Lynn Lawry, a Harvard academic behind one of the few qualitative surveys of human rights abuses in the east.
Lawry’s 2010 study found that half of adults meet the criteria for post-traumatic stress disorder, while one in five had considered killing themselves within the preceding year. “When you extrapolate out the numbers you’re looking at millions,” Lawry says.
National healthcare structures are weak. Goma is the capital of North Kivu province and one of the country’s largest cities. At Goma’s sole mental health facility, staff cut new arrivals from their shackles with a hacksaw. Brother William, the administrator at the Catholic-run centre, said every patient, no matter what his or her state, is relatively lucky. Les fous, meaning the mad ones, are often left chained in their homes when their families flee, leaving the rebels to shoot them dead, or worse. More than 60% of patients in the Goma centre are there because of the war. William said they had the physical capacity for more, but not the financing.
Here in Congo, a country with the land mass of western Europe and a population of 68 million, there is one mental health outpatient facility and six mental hospitals, according to the World Health Organisation. There is no national prevalence data and only 40 or so psychiatric doctors, nearly all of whom are in the capital.
In the Munzenze central prison in Goma, an elderly man introduces himself as Colonel Alphonso. He was once a police colonel, he says, but today is spearheading a political movement. The colonel wears a wedding dress. In the chaotic prison enclosure, he holds up a black bomber jacket. Written in white paint on the back is M29. “The movement for defending the rights of minorities,” he says, a tragic pastiche of the guerrilla group M23, which emerged over the past two years as the latest challenge to the Congolese government and is only now close to defeat.
Alphonso and three other mentally ill inmates sleep four to a single mattress alongside rebels, petty criminals and sexual offenders because there is nowhere else for them to go, a prison official says.
Mental health initiatives by non-governmental organisations such as the International Rescue Committee target survivors of sexual violence. “[The problem] is too big. You can’t address it, but you can address specific areas,” explains a senior humanitarian adviser.
Asked what provision of care there is for young men traumatised by violence or displacement, he shrugs. “Even if you had places to refer these guys, personally I’d prefer that they stay in their family.” Psychiatric disorders require trained staff and medicines. “There is no capacity to deal with it,” he says.
In the Goma mental health clinic, a tall woman greets visitors. Eyes half closed, she emits a low, wavering cry. The skin on her neck and chest is marked with scars where traditional medical practitioners have scored it to insert plant extracts. Many Congolese people consider mental illness as a spiritual problem; belief in witchcraft is widespread. A former rebel who uses a pseudonym, Colonel Mama, said ex-combatants emerge scarred from the invasive treatments of witch doctors. She recalls smoking marijuana every day to ward off the cold. “Many women lost their minds.”
Lawry said there was no need for more research into the prevalence of mental illness. “We know it’s really prevalent. We need to come up with more programmes that work,” she said.
The senior humanitarian adviser in Goma raises his palms to the sky: “What can we do?” The challenge is to stop people dying, he says.
“The first problem is security and protection. If you solve this, you’ll have a direct impact on mental health.”