Introduction

This report is based on a mental health survey of persons in Freetown, Sierra Leone in May 1999. Several months earlier the city saw fierce fighting that left more than 6000 people dead, an untold number injured and mutilated, and tens of thousands homeless. Many of those affected had gone through similar experiences before, and had fled to Freetown for its relative safety.

The findings only touch on the sufferings of the country’s population. The civil war in Sierra Leone began in 1991 and no region has been spared. The residents of Freetown were not alone in their trauma: the country’s town and village dwellers too, have often been repeated victims of war, displaced time and again from their homes and subjected to terrible and long-lasting hardships.

Although fighting in the country has largely ceased since the Lome Peace Accord of July 1999, the effects of that war will be with the population for a long time. As this survey makes clear, few escaped the mental trauma of the war zone that Freetown became for more than three weeks in January 1999.

MSF found, among other things, that 99% of those surveyed suffered some degree of starvation, 90% witnessed people being wounded or killed, and at least 50% lost someone close to them. The intensity of the fighting is indicated by the numbers: 65% endured shelling, 62% the burning of their property, and 73% the destruction of their homes. Physical harm was also great: 7% had been amputated (typically a limb, hand, foot or ear), 16% were tortured by a warring faction, 33% had been held hostage, 39% had been maltreated in some way or another.

The psychological impact of actually witnessing horrific events imposes a serious psychological stress. Deliberately or not, witnessing at least once events such as torture (54%), execution (41%), (attempted) amputations (32%), people being burnt in their houses (28%) and public rape (14%) often results in traumatic stress or even PTSD. Almost all respondents reported to have seen wounded people at least once (90%).

MSF also found, through a technique called the Impact of Event Scale, that the population showed very high levels of traumatic stress. Traumatic stress associated with physical complaints like headaches (38%) and body pains (12%) are reported most frequently.

The psycho-social and mental health consequences of war on civilians are all too often neglected. Even after hostilities cease, the war may continue in people’s minds for years, decades, perhaps even generations. To address only the material restoration and physical needs of the population denies the shattered emotional worlds; ignores the broken basic assumptions of trust and benevolence of human beings and leaves unaddressed the shattered moral and spiritual consequences of war.

After severe conflicts, people seek to forget or deny what happened to avoid painful memories of the past and to escape the sense of hopelessness, humiliation and anger. But for the direct survivors of violence, acknowledgement of the suffering is a crucial element for making sense of and addressing traumatic experiences. To help a traumatised person there is a need to restore the bonds between the individual and their surrounding system of family, friends, community and society. Overcoming the extreme stress and sometimes even severe mental health problems associated with mass traumatisation such as occurred in Sierra Leone, tests the healing capacity of family and community.