Refugees Lack Vital Mental Health Care

YUMBE, UGANDA — When Nafisha Jackson and her family fled to Uganda in 2017, she hoped to escape the civil war in South Sudan. Yet the trauma of the conflict has followed them to the Bidibidi refugee settlement here in Yumbe, in northern Uganda, near the South Sudanese border. Over the past four years, Jackson’s husband has attempted suicide four times, most recently in July, and Jackson has attempted suicide herself.

Her husband abused her, she says, and the psychological toll of the civil war and the financial hardship of living in the settlement have at times felt overwhelming. Government food stipends have also been reduced, due to the coronavirus pandemic, putting added strain on Jackson’s ability to care for herself and her four children, three girls and one boy aged between 3 and 10 years old.

Jackson says she sought help for her husband, but mental health counseling and other support services for refugees have been severely lacking.

“We went to the health center, because our pastor advised that he could get medicine,” Jackson says. “But no one helped. There was no doctor for his condition.”

Uganda hosts about 1.5 million refugees, mostly from South Sudan and Democratic Republic of Congo, according to data from the Office of the Prime Minister and the United Nations High Commissioner for Refugees. The Bidibidi settlement is the largest in the country, with about 240,000 refugees.

There is an immense need for mental health and psychosocial support among the refugee population. Refugees suffer from a range of mental health and behavioral disorders, including anxiety, depression, post-traumatic stress disorder, and alcohol and substance abuse.

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They have endured traumatic experiences, including displacement and the loss of loved ones, and they face the daunting challenge of starting their lives over in Uganda with limited resources. Among refugee households in Uganda, 40% said family members couldn’t obtain psychosocial care, according to a November 2019 report from the refugee agency.

As a result, more and more refugees are attempting suicide. There were 346 suicides or attempted suicides in refugee settlements across Uganda in 2020, more than twice as many as in 2019, according to the agency. As of June 2021, there were 208 suicides or attempted suicides in the settlements, says Rocco Nuri, senior external relations officer at UNHCR, in Uganda. Most of those cases occurred in the Bidibidi settlement.

“Suicides increased in the settlement because people got frustrated to wait for peace to come by,” says Solomon Osakan, refugees desk officer for the West Nile region in the Office of the Prime Minister. “There are cases of refugees who developed mental illness and suicidal attempts because family members who returned into South Sudan were all murdered.”

The pandemic has exacerbated the situation, as mental health services have taken a back seat to combating COVID-19. Officials needed to turn the mental health ward at Arua Regional Referral Hospital, the major referral hospital near the Bidibidi settlement, into a ward for treating COVID-19 patients, according to the Office of the Prime Minister.

This has some experts worried. “The effects of war and conflicts still linger, yet there are few interventions and organizations focusing on mental health,” says Dr. Alex Adaku, a psychiatrist who has studied mental health and psychosocial support for South Sudan refugees in northern Uganda. “The pandemic has left many stressed and isolated.”

The Ugandan government has made mental health care a part of its Health Sector Integrated Refugee Response Plan. But the coronavirus forced officials to redirect their focus, Osakan says. Much of the care that’s currently available in the settlements comes from local and international aid groups.

One of those groups is TPO Uganda, a local nongovernmental organization that provides psychosocial support to refugees. From January to August, the group provided assistance, including cognitive behavioral therapy, to nearly 33,000 refugees in the Bidibidi settlement, says Racheal Tukahiirwa, one of the group’s mental health supervisors.

UNHCR is also working to provide more mental health care to refugees. “In coordination with other partners, we are working to build community centers to facilitate counseling sessions,” says Nuri. But it’s an uphill battle. “Providing psychosocial support service is labor-intensive, and funding is insufficient to meet the psychosocial needs of refugees.”

Patricia Lindrio, GPJ Uganda

Nafisha Jackson has been living in the refugee settlement since 2017, when she and her family fled the civil war in South Sudan.

Nuri says the refugee agency has been advocating for increased attention and resources for mental health and psychosocial support from the international community. But there’s still a large funding gap.

“In 2021, UNHCR alone needs approximately $2 million to provide psychosocial support services to refugees,” Nuri says. “To date, we have received only 35% of funding to deliver these services.”

In July, Jackson’s husband was arrested following his most recent suicide attempt — an effort to protect him, Jackson says, given the lack of mental health care available to them. His detention has saved her from his continued abuse, but his absence also means she must provide for her family all on her own.

“He beat me when I dared to speak up about not providing for the family,” she says. “But at least he contributed something.”

She tries to remain hopeful for herself and her children. At the end of the day, she finishes tending to her vegetable garden, where she grows potatoes and cowpeas, then prepares a meal for her children. The youngest can’t stop crying, but she carries on.