Supporting people in a forgotten country

This autumn WarTrauma provided a training far away in the desert of Algeria. The purpose of the training was to improve the psychological support for the Sahrawi. A special training, because the Sahrawi are the focal point of a forgotten conflict, in a divided country and with a government in exile. Isolated in large refugee camps the situation of hopelessness is difficult to imagine.

After Spain renounced their colony Western Sahara in 1975, neighbouring countries Mauritania and Morocco decided to divide the country. The independence movement Polisario resisted and a war was waged from 1976 until a truce was closed in 1991. Mauritania retreated, but Morocco has divided the country in isolated patches by creating a barrier of 2400 kilometers of large earthen walls and minefields. While the annexation by Morocco has been denounced by many countries, the independent Sahrawi Arabic Democratic Republic proclaimed by Polisario has not been universally recognized.

The training took place in Tindouf, in the Southern dessert of Algeria. Here a semi-autonomous region was set up supported by Algeria and the large refugee camps are where the government in exile is seated. The training was attended by doctors, psychologists and other health staff, mostly educated in Cuba, Spain or Russia. The training brought forward many gaps in knowledge and skills around mental health care.

For example, the psychologists are strong communicators, but they do not use standard methodologies of therapy. Doctors and nurses are familiar with diagnostics and most medications, but often do not realise side effects and contra indications. With regards to depression and post traumatic stress syndrome none of the participants were familiar with standard therapies such as EMDR or Cognitive Behaviorial Therapy.

The training was hosted by the UN Refugee organisation UNHCR in collaboration with the Ministry of Health of the Sahrawi government in exile. War Trauma is looking to do a follow up training to address the many issues we were unable to address. Additional funds to realise this are welcome.

Mental Health Training in Nigeria

Over 2.2 million people have fled the violence of Boko Haram in North East Nigeria. Suicide bombings and armed violence are regular occurrences. Psychiatrist Marjolein van Duijl supported us to train international aid workers who are working with Internally Displaced Persons in the area. Currently Clinical Director at the Centre for Transcultural Psychiatry Veldzicht in the Netherlands she reflects on her experiences.

‘The training was intense and impressive. People here work in dangerous circumstances and encounter a lot of suffering,’ says Marjolein. The training which happened in close collaboration with the UNHCR took place in the city Maiduguri in North East Nigeria which was the epicentre of religious violence in 2009. Over 700 people in the city were killed and almost half of the population in the region was displaced due to the violence of Boko Haram.

The displaced stay in camps where they live in dangerous circumstances. The camps are cramped and overpopulated and there is a shortage of basic provisions such as healthcare, clean water and toilets. Diseases such as cholera and malaria are never far away. The refugees, often farmers, want to go home but cannot till their land due to landmines and general insecurity.

Groupwork during the training

Vulnerable children

‘In this chaotic and busy city it is remarkable you don’t see any motors like elsewhere in Nigeria,’ says Marjolein. ‘Motors were prohibited after they were used for terrorist attacks all the time. Now you see a lot of yellow tri-cycles as taxi.’ Still, bombings continue. In the past year 83 attacks were committed by children. Marjolein continues: ‘This doesn’t get any news coverage in the Netherlands, even though the conflict with Boko Haram has already costs the live of over 100.000 people.’

Almost half of the 2.2 million displaced are children and they are a very vulnerable group. ‘Children in North East Nigeria are faced with the risk of kidnappings, poverty, bomb explosions and hunger. They live in continuous uncertainty in unsafe circumstances. Add to this that when people first fled Boko Haram, schools were used as a refugee camp. The children did not get an education anymore and this has had enormous impact on their future and their dreams. Without perspective on a better future the children have become susceptible for abuse.’

Roleplay domestic violence to provide psychological support and rebuild a social structure.

Humanitarian aid

(Foreign) aid organisations focus mainly on emergency aid. Water, food, safety and shelter. Marjolein: ‘Mental health care is often forgotten. Many refugees have had potentially traumatising experiences, but most people working in refugee camps has no experience with any form of psychosocial support.’ War Trauma Foundation trains health professionals and community workers in low resource settings in areas hit by war and disaster. Key elements of the trainings are how to signal psychological need, how to provide psychosocial support and refer where necessary to psychiatrists and psychologists.

Exceptional experience

Providing the training was an eye opener for Marjolein. ‘In the north of Nigeria there is still a lot of prejudice and superstition around psychological illnesses. People quickly think there is witchcraft in play, which is a common believe in western Africa and was a special point for attention in the training.’

Local aid workers of 7 aid organisations took part in the training. ‘The staff is continuously exposed to external stressors and often have difficulty themselves to cope with the suffering of their patients. Care for oneself is important to provide quality care, and people have to look after each other.’ Aside from sharing practical experiences the training includes modules on cultural outings of stress and psychological problems, how to deal with vulnerable people, how to deal with aggression and how to support self-help of the person in need.

During the training specialists from local health networks were present to tell about their work and to stimulate appropriate referral. ‘Aid workers in refugee camps are now much better in tune with the mental health care provisions present.’

(Interview by Mirjam Kwint, senior communications Centrum voor Transculturele Psychiatrie Veldzicht,


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