South Sudan: Devastating impact of war on mental health must be addressed

People forced to eat human flesh and to disembowel dead bodies during South Sudan’s civil war that began in 2013 are among thousands suffering from trauma and psychological distress amid a chronic shortage of mental healthcare services in the country, Amnesty International said today as the country marks its fifth anniversary.

In a new report, “Our hearts have gone dark”: The mental health impact of South Sudan’s conflict^[1], the organisation documents the psychological impact of mass killings, rape, torture, abductions and even a case of forced cannibalism, on the survivors and witnesses of these crimes.

“While the death and physical destruction caused by the conflict and preceding decades of war are immediately apparent, the psychological scars are less visible and neglected,” said Muthoni Wanyeki, Amnesty International’s Regional Director for East Africa, the Horn and the Great Lakes.

“Whilst an end to atrocities including torture, rape and murder would be an obvious urgent first step to preventing additional mental health consequences, action also must be taken to heal the damage already done, by providing victims with treatment and other appropriate reparations.”

Based on interviews with 161 victims of and witnesses to human rights violations, as well as mental health professionals, government and UN officials, and representatives of non-governmental organisations, the report reveals a dire lack of mental health services across the country for people in need of support and care.

This almost total absence of services is resulting in mental health conditions such as Depression and Post-Traumatic Stress Disorder (PTSD) going untreated. There are currently only two practicing psychiatrists in the entire country of 11 million people and mental health patients are routinely housed in prisons instead of receiving the care and treatment they desperately need.

While the death and physical destruction caused by the conflict and preceding decades of war are immediately apparent, the psychological scars are less visible and neglected

Many of the people interviewed described a range of symptoms consistent with PTSD and Depression, including nightmares, irritability and the inability to concentrate.

Malith, a survivor of one of the war’s worst incidents in December 2013 when government security agents shot dead about 300 men in Gudele, a neighbourhood of the capital city Juba, told Amnesty International: “Sometimes I dream that I died with those who were killed. I wake up sweating and trembling … I think about how I survived. Why did these others die? It makes me feel bad.”

Another survivor of the Gudele massacre, Phillip, described how he hid under a pile of bodies during the massacre. When he was discovered by soldiers, they forced him to drink the blood and eat the flesh of the dead or be killed.

He said: “At night when I sleep, those who were killed come back in my nightmares.” He added, “I can’t eat, I don’t want anything I am offered. I don’t think the way I am feeling will ever change.”

The government has consistently detained its perceived opponents since the conflict began. Detainees have spoken of killings, beatings, insufficient food and water among other horrors, leading to prolonged psychological distress.

Lual told Amnesty International he was forced by National Security Service (NSS) officers to disembowel the bodies of his murdered fellow detainees at a facility in Juba, so that they would not float when dumped in the river.

He told Amnesty International: “I feel hopeless … I feel depressed, I am never happy … I think about committing suicide … All of this makes me feel bad, and I hate myself.”

Doing more to address mental health needs is not only essential for individuals’ wellbeing, it is also critical for South Sudanese to effectively rebuild their communities and country

In Bentiu, the capital of Unity state, which has the largest Protection of Civilians (PoC) sites in the country, women venturing out of the site for food, fuel or medicine have experienced sexual violence leading to significant psychological distress.

Nyawal said she and her friend were raped twice in one day by two sets of government soldiers in Bentiu when venturing off-site in 2015.

She said: “I am very angry about what happened … It has changed my life. I am nothing. I have nothing good … I am ashamed.”

The vast majority of those interviewed said they had not received any psychological support or mental care.

“The government, supported by the international community, must honour its international legal commitments to respect, protect and fulfil the right to health, including mental health. It must also prevent and impartially investigate and prosecute acts such as torture that continue to cause psychological harm to many,” said Muthoni Wanyeki.

“Doing more to address mental health needs is not only essential for individuals’ wellbeing, it is also critical for South Sudanese to effectively rebuild their communities and country.”

Names have been changed to protect interviewees’ identities.

References

1. ^{^} “Our hearts have gone dark”: The mental health impact of South Sudan’s conflict (www.amnesty.org)