Sri Lanka’s war-traumatised at risk as aid group leaves?

By Nita Bhalla

It was with a heavy heart I read the press release this morning.

A desperately needed aid programme run by the charity Medecins Sans Frontiers (MSF) – in English, Doctors without Borders – in Sri Lanka’s war-torn North has shut down after only 18 months of operation.

I had visited the project last September and I must say that what MSF was giving was no ordinary aid.

It was not distributing food to survivors of the Indian Ocean island’s almost three-decade long conflict. Nor was it reconstructing the shelled and bullet-ridden homes, schools and hospitals of Kilinochchi district.

It was not even helping war-hit populations with new skills to help them get jobs after their businesses were destroyed and their farms filled with landmines during fighting between separatist Tamil Tiger fighters and Government forces.

MSF’s aid could not be seen. Yet it was equally, if not more, essential to the tens of thousands of Sri Lankans who witnessed the deaths of their loved ones in the bloody final phases of the war which ended in May 2009.

MSF was simply there to listen.

War trauma

Their counsellors, survivors themselves who had overcome their trauma, fanned out daily across the ravaged district, going from village to village, listening to stories of what happened during the aerial bombardments.

Mothers recounted stories of how they witnessed their children bleed to death as shells fell over their homes. Guilt-ridden teenagers spoke of fleeing to save themselves – leaving their dead parents’ mangled bodies, without performing culturally important last rites.

The MSF counsellors listened, comforted and also helped them gain closure and safety from their trauma. For those who needed medication, they referred patients to the one government doctor trained to deal with trauma in an area populated by 120,000 people. The need for counselling and mental health care in post-war Sri Lanka is desperate.

In a feature I wrote during my trip to Kilinochchi last year, I wrote:

“Many of the war-affected have failed to gain closure, and are haunted by flashbacks, hallucinations, nightmares, suicidal thoughts and anti-social behavior.

“Experts suggest the poor mental health of men in particular has driven many to alcoholism and led to numerous reports of domestic violence, child abuse and family separation amongst war-hit communities…

“Now mothers, who did not have time to mourn their dead children, show apathy toward their living ones, while children show signs of anti-social behavior at school, unwilling to participate.

“Teachers talk of having to calm screaming students – some as young as six – who fall to the ground with their hands over their heads at the sound of thunder or from the loud bang that comes from a tyre burst, believing the shelling has begun again.”

‘Invisible’ aid

Despite such stories, mental health is not considered a priority by donors and governments in many post-conflict or post-disaster situations. Mental health support is ‘invisible’ aid – aid that cannot be seen and cannot be photographed for the sexy PR picture to show the world, nor is it easy to measure in terms of its impact.

In an era of austerity, every single dollar counts and it is a hard sell for aid agencies like MSF to get donors interested in this kind of ‘soft’ aid. In many countries, like Sri Lanka, governments prefer to firmly focus on development, rather than post-war recovery.

The attitude, say some aid workers, is that of “the war is over, so we don’t need to talk about it any more” – people are possibly uncomfortable with others talking about alleged atrocities committed by both sides in those final months of war.

In MSF’s case, their press release suggests their Kilinochchi mental health project was closed down as the Government and aid groups are now investing in mental health support in the area more.

“We hope that these promises will be realised and that tangible projects will follow, as mental trauma due to conflict, and on-going stress related to resettlement, will need long-term structural support,” Michel Plouffe, MSF’s country manager in Kilinochchi, is quoted as saying in the statement. I also hope so.

Based in New Delhi, Nita Bhalla is correspondent for humanitarian affairs for the South Asia region for the Thomson Reuters Foundation. She primarily focuses on the impact of disasters and conflicts on local populations as well as good governance and women’s rights issues. Prior to that, Bhalla worked as political and general news correspondent in India and before that, in Mauritius as correspondent for the Indian Ocean region. She started her career in journalism in 1999 with the BBC World Service in Ethiopia and has spent much of her time in Africa and Asia.