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Treating The Mental Impact of War

Doctors Without Borders, also known as “Medecins Sans Frontieres,” or MSF, has been responding to people in crisis for over 30 years. It’s provided emergency medical care in natural disasters, epidemics, famines, and war. But the organization says during the war in Bosnia in the 1990s, MSF realized it needed to address psychological concerns as well, noting emotional scars from trauma can continue long after physical damage has healed. Clinical psychologist Kaz de Jong is MSF’s mental health adviser.

“What do you do if there’s enough food, but no one wants to eat?” That’s the question Mr. de Jong poses in the most recent issue of MSF’s quarterly magazine, ”Alert.” Mr. de Jong says there are a number of reasons for this reaction.

"People who return from their villages because their villages have been burned, they’ve seen their children being killed, and we try to address some of the problems these people have. We try to help them deal with the loss of their material roots, but it can also be of persons in their lives. It can also be that we help them to adapt to the new environment, because living in a refugee camp is very hard, most people are not used to it," he says.

As another example, Mr. de Jong mentions children who’ve lost their parents. The clinical psychologist says MSF tries to find those children, bring them to safe places for protection, then watch over them.

Mr. de Jong says MSF recruits and trains local volunteers as counselers who, themselves, have experienced the given traumatic event.

"Of course they work under clinical, technical supervision of us, but we provide them with training, with tools to help their own people, and basically that’s the process that we try to facilitate as much as possible," he says.

Mr. de Jong says this approach taps the interests and talents of local people who’ve survived the trauma and are interested in helping others, which makes the program more effective.

"Survivors are very good, able to help their own people, and we find very often that the survivors of traumatic experiences are even better supporters than … those people who have not lived through those circumstances," he says.

Mr. de Jong says locally trained counselers helping other victims overcome loss is also part of the adaptive process for both of them. For example, if people don’t eat because they’ve lost the will to live, it helps both to address that problem directly.

He says, "If somebody has lost meaning, it’s not my job to give the meaning back, but together with this person, discover why this person’s still alive, why this person is not dead. And in that way, together we can find, maybe in the beginning, a small meaning of life, which grows. And then people will start to eat again."

The clinical psychologist says in a mass trauma situation, such as the Rwandan genocide in ’94, or the on-going crisis in Darfur, not everyone needs individual attention. He estimates that between 20 and 30 percent of those needing counseling need it one on one. Others, he says, are helped through group therapy, constructive activities, bringing back structure to their lives, and reconnecting them with their environment.

People who suffer physical and mental damage from trauma obviously need medical care, but Mr. de Jong says attention to mental and psychological needs is just as important. He says, at times, showing concern for a person’s welfare is a powerful remedy.