SAKE, DEMOCRATIC REPUBLIC OF CONGO — She mutters under her breath, her eyes vacant. From time to time, she jumps with a high-pitched cry as if something has just stung her. For more than a decade, Matilde Kunda has not been the same.
“At the beginning, she could go a whole day without talking,” says Kunda’s sister, Faida Mwasi, who shares her three-bedroom house with Kunda, 51. “Often, she would call out the names of her children.”
In 2008, Kunda witnessed the massacre of her six children and her husband, all stabbed to death by an armed group that attacked her village in North Kivu province in eastern DRC. Afterward, her mental health crumbled.
“When we noticed she was not herself anymore, we thought she had been bewitched or possessed by evil spirits, so we took her to a healer,” says Mwasi, who lives in a village near the city of Sake, also in North Kivu. “The healers asked us for goats and chickens, but nothing has changed so far.”
Kunda’s story is a familiar one in DRC, where 25 years of armed conflicts have ravaged the mental health of its people, as hundreds of thousands have been separated from their families, displaced from their homes, or exposed to scenes of violence or torture.
The challenge is especially acute in rural areas, where cultural stigma, religious beliefs, lack of transport and a dearth of mental health professionals all conspire against Congolese seeking to address their psychological issues — the hidden toll of DRC’s conflicts.
“Unfortunately, many people think that the aftereffects of the war are only physical, and ignore the consequences of the war from a psychological point of view,” says Eugène Bashombe, a psychologist at the Neuropsychiatric Hospital Center of Goma, a city of about 670,000 residents located 24 kilometers (15 miles) southeast of Sake.
North Kivu and neighboring South Kivu are among the most violent regions in the world, according to the Kivu Security Tracker, a joint project by Human Rights Watch and the Congo Research Group at New York University.
More than 100 armed groups, including some from Rwanda and Uganda, battle each other for political power, land, diamonds, gold, copper and other natural resources. Fighting has displaced about 4.5 million Congolese within DRC and killed untold millions. Rampant kidnapping and sexual assault terrorize civilians.
Several armed groups remain headquartered in and around Goma, and the ongoing fighting has profoundly affected the local population, Bashombe says. At least 80% of his hospital’s patients have suffered war-related trauma.
Yet in a nation of almost 73.8 million people in 2014, only 638 worked in the field of mental health services, according to the most recent comprehensive report from the World Health Organization.
“Not only are there very few qualified personnel, but most of the specialists work in towns,” says Anicet Mulwani, administrator of the neuropsychology unit at the Neuropsychiatric Hospital Center of Goma. “The rural environment remains at the mercy of healers and so-called pastors.”
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He says village healers and practitioners of witchcraft often give patients potions. And people sometimes tie up mentally ill relatives and keep them at home.
“Sometimes when they come to us it is too late,” he says. “People don’t think it’s a disease that can be cured with the help of doctors.”
Add to war the effects of the new coronavirus pandemic, and Mulwani says many of his patients live in fear and hopelessness. Some people, he says, turn to illicit drugs.
Last year, he says he saw between 650 and 850 patients a month, a 30% increase over 2019.
Those patients were unusual, in that they sought — and found — help. Asiya Kashindi’s story is more typical.
In 2005, when she was 15, Kashindi lived in her native village, Tongo, in Rutshuru territory in North Kivu province. One night, attackers invaded the family’s home and raped her in front of her parents and siblings. Then the assailants sexually assaulted her mother and hacked her father to death with a machete. Kashindi never recovered.
Today, she suffers from extreme depression and chronic migraines. She isolates herself, often crying for no apparent reason. Five years ago, she started spending entire days holed up in a church.
“It will be all right, God will heal me one day,” she murmurs.
After the attack in Tongo, Kashindi never went to a hospital for psychological care. Instead, she sought a healer who concocted a potion to relieve her migraines, says her younger brother, Anaclet Akili.
“We have nowhere to take her but to the healer who lives in our village,” Akili says.
Akili says he never took his sister to receive care in Goma, 72 kilometers (about 45 miles) away, because he wasn’t aware of such treatment and didn’t have the money for transport anyway.
Back at Mwasi’s home, her sister, Kunda, remains mostly quiet. Before her family was attacked, Kunda farmed potatoes and beans, and her husband kept more than 30 goats. She was known for her smile and energy, but over the years she has lost weight and has grown listless, Mwasi says.
Mwasi can’t recall the last time Kunda smiled or left her room.
“She is still breathing,” Mwasi says, “but her soul is in heaven with her family.”