Behind migration: trauma and psychosocial intervention in Central Africa

According to UNHCR in 2016 there were 67.75 million people displaced worldwide: about 17 million are refugees, 2.826.508 are asylum seekers and 36.627.127 are internally displaced. The reasons for these massive displacements vary from natural to man-made disasters and, even if extremely different, both these two situations are characterized by the involvement of entire populations. For this reason, literature on mental health labels these two degrees of events “collective traumas”, indicating in a such way “shared injuries to a population’s social, cultural, and physical ecologies” (Saul, 2014) “or “social suffering” described as “interconnected adversities on the level of individual, family, community and society” (Kleinmann, 1997). Nevertheless, the disasters that motivated migration are not the only adversities that refugees face: the processes of migration and resettlement, whether in another village of the same country or in a hosting country, are two other challenging situations that may threaten their physical safety and worse their psychological condition. Different considerations are instead to be made for those people who decide not to leave their context since the occurrence of a disaster, especially if man-made, may change the society into a “Complex humanitarian emergency” (CHE) or rather in a situation characterized by: “...a protracted emergency situation with massive population displacement and destruction of social networks and ecosystems; insecurity, often based on armed conflict, affecting civilians and others not engaged in fighting; and the emergence of ‘predatory social formations’ with high levels of social insecurity threatening the ability of the population to sustain livelihood and life” (Ventevogel, 2017 pp. 21). Generally speaking, the intervention on mental health, whether in a hosting country or in a Complex Humanitarian Emergency, should encompass three domains (Ventevogel, 2015): the first one is related to a psychosocial level, while the second and the third concern respectively the common and severe psychological disorders related to the different adversities faced. In hosting countries, the psychosocial level of intervention may be declined in the sense of social integration of refugees (e.g. professional and school achievement, civic engagement, participation to social networks). Differently, in CHE it may concern the development of community resilience, defined by Norris et al. (2008) as a process made of four adaptive capacities: economic development, communication and information, community competence, social capital. The second and third level of intervention require instead a specific focus on mental health. In hosting countries this consideration suppose the construction of services able to take in consideration the cultural background of immigrants, their way to express psychological suffering and also the meaning that they attribute to their psychological conditions; for these reasons it is fundamental, in this field, to create multidisciplinary equipes that involve the presence of specialized cultural mediators (Beneduce, 2001). In CHE situations the management of common and severe mental health disorders may face instead the paucity of mental health services (often placed exclusively in big cities difficult to be reach) and qualified professionals; therefore, literature suggests that in these contexts efforts should be made in order to train mental health professionals and to decentralize the related services (Ventevogel, 2011). Whatever the level of intervention, in CHE contexts the construction of local services often rely on external aid, nevertheless the involvement of local communities is fundamental in order to provide effective cultural-grounded interventions (Ventevogel, 2011; 2012; Murray, Dorsey, Bolton, Jordans, Rahman, Bass and Verdeli, 2011; Ager, Strang, Abebe, 2005). Training project in Central Africa Republic In line with this, the proposed project is aimed at developing a training program for the creation of a Community of Practice (Wenger, 1998) of professionals with psychosocial competences, in order to foster resilience within communities of Central Africa Republic (CAR), a country where a political and military crisis is occurring since 1996. The training program is carried out by Sapienza University in partnership with Université de Bangui and University of Rwanda. Since the project is intended as a training for trainers, in order to obtain a multiplier effect it involves people who will be able to become in turn trainers on these issues. For this reason, the group of participants is made of: psychology students belonging to Université de Bangui; members of local NGOs; proponents of civil and religious communities in CAR. The training program is currently provided through some short-term in loco training. In addition to some specific contents about trauma evaluation and psychosocial intervention, the training is about the development of mutual interdependence within participants in order to give them the chance to directly experience how to create human capital. The project started in July 2017 and to date three on-site trainings have been arranged with the aim to create the bases for the construction of a Community of Practice and to transmit some of the aforementioned contents. In particular concerning the trauma management, participants have been trained in the identification of psychological trauma and in the administration of instruments of trauma evaluation for children and adults. Concerning the psychosocial intervention, it has been provided a training session about the creation of “groupes de parole”, a psychosocial methodology for psychological support previously applied in Ruanda after the genocide in 1994. Participants have been also encouraged to put in practice what they have learnt in these preliminary sessions. In order to achieve the aforementioned multiplier effect, the project aspire to develop a blended learning methodology through the use and creation of online and remote resources that participants could use in future to train other learners. Bibliography Ager, A., Strang, A., Abebe, B. (2005). Conceptualizing community development in war-affected populations: illustrations from Tigray. Community Development Journal, Vol 40 No 2, pp. 158-168 Beneduce, R (2001). Migrazione e disagio psichico: le sfide dell’ambivalenza. Psychiatry online Italia Kleinman, A., Das, V., Lock, M. (1997). Introduction, in Somasundaram, D. (2014), Addressing collective trauma: conceptualisations and interventions. Intervention, 43: 60 Volume 12, Supplement 1. Norris, F.H., Stevens, S.P., Pfefferbaum, B., Wyche, K.F., Pfefferbaum, R.L. (2008). Community Resilience as a Metaphor, Theory, Set of Capacities, and Strategy for Disaster Readiness. Community Psychology, 41:127– 150 DOI 10.1007/s10464-007-9156-6 Saul, J. (2014). Collective Trauma, Collective Healing: Promoting Community Resilience in the Aftermath of Disaster in Somasundaram, D. (2014), Addressing collective trauma: conceptualisations and interventions. Intervention, 43: 60 Volume 12, Supplement 1. Ventevogel, P., Ndayisaba, H., van de Put W. (2011). Psychosocial assistance and decentralized mental health care in post-conflict Burundi 2000 – 2008. Intervention 9, 315-331 Ventevogel, P., van de Put, W., Faiz, H., van Mierlo, B.Siddiqi, M. Komproe, I.H. (2012). Improving access to mental health care and psychosocial support within a fragile context: a case study from Afghanistan. PLoS Medicine 9, e1001225 Ventevogel, P. (2017). Borderlands of mental health: Explorations in medical anthropology, psychiatric epidemiology and health systems research in Afghanistan and Burundi Geneva: Peter Ventevogel Wenger, E.C. (1998). Communities of Practice: Learning, Meaning, and Identity. Cambridge University Press