AFRICA:The Traumatized

Continent

F. Njenga

• Africa went through a period leading to political independence in the sixties and seventies.

• It went through difficult times in economic, political and security terms in the eighties and early nineties.

• In the next few decades, it is expected to go through a renaissance.

• To date East, West, Central and Southern Africa are still at war over issues that seem unclear even to the combatants.

• Conflicts including wars and civil strife result in an increase in mental problems.

• We as psychiatrists must therefore pay attention to the wars and other conflicts.

• Though newer, the threat of terrorism is most immediate.

Wars in • Somalia• Nigeria• South Sudan• Kenya

Other seemingly peripheral issues to be addressed by Africans include:

• Poor governance• Political instability• High social morbidity due to

natural and manmade calamities.

OTHER CHALLENGES

• the economic crisis • increasing rates of urbanization• Regional political instability• Drought

• Conflict is greater in semi-democracies or governments in transition and democratic institutions must be inclusive at all levels – for example voting systems should ensure that all major groups are represented in governments.

• These are issues that were until recently foreign to psychiatric literature.

• These are the real issues in Africa

Stewart 2002, British Medical Journal

• Poverty and inequitable distribution of resources has recently been identified as a major cause of conflict

• Africa has a few millionaires and millions in abject poverty.

PUBLIC HEALTH

• Public health refers to all organised measures (whether public or private) to prevent disease, promote health and prolong life among the population as a whole.

• Its activities aim to provide conditions in which people can lead a healthy life.

Example of public health activities:• Vaccination• Motor vehicle safety• Safer work places• Safer drinking water

HISTORY

• From antiquity is was known that lack of proper waste disposal spread communicable diseases (miasma theory of rotting organic matter).

ROMAN TIMES

• Diversion of human waste was part of urban public health.

• 1854 London outbreak of cholera due to polluted well.

• Malaria is due to bad air from swamps. • Prevention involves the destruction of

their breeding grounds, as well as the treatment of the disease.

• HIV control involves reducing transmission, and the treatment of patients.

• Diabetes control demand lifestyle changes as well as the treatment of the patients.

• So what causes PTSD (Post Traumatic Stress Disorder) in Africa?

• Why is Africa such a traumatized continent?

• Terrorism is today a topic of vital importance to the lives of millions of people around the world.

• It occurs in both wealthy and poor countries.

• Terrorists operate in democracies and in authoritarian states.

• There is no single root cause of terrorism, or even a common set of causes.

• It is common ground that “no political goal or cause justifies intentionally attacking civilians”.

Terrorism can never be justified or excused.

• At the individual level, terrorists are generally not drawn from the poorest segments of their societies

• Typically, they are at average or above average levels in terms of education and social economic background.

• Symptoms of psychopathology are not common among terrorists. Neither do suicide terrorists, as individuals, possess the typical risk factors of suicide.

• There is no common personality profile that characterizes most terrorists who appear to be relatively normal individuals.

• Alienation breeds terrorists who are isolated.

• The challenge is how to engage them.

• Terrorism takes root in chaos and the absence of good governance.

TRUE OR FALSE

• Democracy and proper governance, including free expression and a vibrant civil society, respect for human rights and a functioning, fair judiciary, allow dissent to be expressed in non-violent and legitimate ways.

WHAT IS THE EVIDENCE

• Some have suggested that the United Nations Department of Public Information could undertake a public relations campaign promoting tolerance and understanding among all cultures and religions.

• Extremist ideologies that promote hatred and terrorism should be confronted on ideological grounds by investing more effort into challenging them politically, and not only by the use of coercive force.

SECURITY

• States that respect human rights and basic democratic principles, however, must not subvert these freedoms in the search for security.

• Without adequate understanding of the nature and effects of terrorist activity we cannot hope to answer adequately any of these questions.

PUBLICATIONS

• Many professions responded overwhelmingly on all levels. Various societies, institutions, and organizations generated feature publications from their unique perspectives.

PSYCHOLOGICAL WARFARE

• Its randomness amplifies the whole community’s fear.

• As such, terrorism is indeed psychological warfare.

• Modern terrorists have also become aware of new opportunities for exerting a mass psychological impact as a result of technological advances in communications.

• No society is immune to the current wave of terrorism or the sense of vulnerability that it engenders.

• First was the imperative to resist the culturally prevalent (American) impulse to do something, to find a quick fix, to focus on outcome rather than process, to look all too swiftly for closure, and to flee “back to normal”.

Danieli (2001)

LONG TERM

• Second, knowing that there will be long-term effects not only of the disaster itself but also of the immediate interventions, we must recognize the necessity for the importance of long-term commitment, and systematically examine every short-term decision from a long-term perspective.

RESILIENCE

• Survivors have described an increased appreciation for life, a reorganization of their priorities, and a realization that they are stronger than they had thought.

TYPES OF TERRORISM

• Picco distinguishes between “tactical terrorism” whose political objectives are well-known, precise, and negotiable.

• And “strategic terrorism” based on non-negotiable, perpetual confrontation with the enemy: anyone who is different.

HISTORY

• Many consider the earliest acts of terrorism to have started in ancient Palestine during the first century CE.

• Jewish citizens sought freedom from Roman occupation by engaging in assassination of Romans and suspected Jewish collaborators.

• Another group, led by Simon Ben Koseba, exhibited intense fanaticism by killing mainly Romans and Greeks, often in open displays of violence similar to those seen today.

• What the America is tasting now is something insignificant compared to what we have tasted for scores of years.

• Our nation (the Islamic World) has been tasting this humiliation and this degradation for more than 80 years, its sons are killed, its blood is shed, its sanctuaries are attacked, and no one hears and no one heeds.

Osama Bin Laden

• The intent and purpose of Osama Bin Laden and the Al Qaeda network was clear.

• America was to be punished for its many offenses against the Muslim people and Islam.

• The simple fact of the matter is that military action against terrorism will never be sufficient unto itself.

• It must be combined with diplomatic, political, economic, psychological, and humanitarian efforts.

• As long as military actions remain the primary response to terrorism, then the precipitating, exacerbating, and maintenance causes of terrorism will remain and terrorism will continue.

• Governments must be prepared to negotiate and engage in creative diplomatic dialogues and interactions with terrorist groups.

• Poverty is fertile ground for recruiting terrorists because of the hopelessness and helplessness it breeds.

SUICIDE BOMBERS

• For many counter-terrorist agencies, suicide bombers have been a source of bewilderment.

• While courage in carrying out a terrorist mission might be understood, the willingness of suicide bombers to die for their cause has led to the incorrect assumption that these individuals are deranged or mentally ill.

• Nothing could be more inaccurate.

TRUTH

• The rewards for suicide bombers are numerous and varied, including the promise of:

• Eternal afterlife; • Financial support for families; • A post-death status of prestige

and honour in their community.

TERRORISM AS A STRATEGY OF PSYCHOLOGICAL WARFARE

• The ability of a few individuals to manipulate public opinion, thus influencing the highest policies of the land, makes terrorism a strategic threat to democratic societies.

• Terrorism undermines the sense of security and disrupts everyday life, harming the target country’s ability to functions.

TARGET POPULATION

• Only by understanding how terrorism manipulates the target population can we learn how to avoid falling into the trap of such psychological warfare.

THE STRATEGY OF TERRORISM

• Modern terrorist attacks are perpetrated to achieve a resounding media echo in order to reach public opinion.

MEDIA

• The desired panic could be produced by the continuous broadcast of threats and declarations, on radio, TV, videos, and all the familiar methods of psychological warfare.

CONCLUSIONS

• Decision-makers and security personnel in countries affected by terrorism, often appear to be woefully ignorant of the psychological manipulations used by terrorist organizations.

• The media often grant the terrorists a platform to publicize their views and psychological manipulations, not only through the coverage of the attack itself, but also in airing interviews with terrorist’s and videotapes made by them.

• In their public statements, military and police spokesmen must take into consideration the psychological effect of terrorism.

• When terrorism succeeds in creating such anxiety within a society that daily life becomes impossible, then that society has lost the war against terrorism.

• Action must be based on comprehensive research into how the terrorists use psychological manipulations to achieve their goals.

• On the basis of this information, tools can be developed to neutralize these manipulations.

• The target community must be taught to view media coverage of terrorist attacks with a critical eye, in order to avoid falling for terrorist manipulation.

• The media need not to be a tool in the hands of the terrorist organization.

• On the contrary, they can play a crucial role in neutralizing the psychological damage of terrorism.

• Reporters must be wary of their natural tendency to amplify the horror of a terrorist attack, and thus serve as a platform for the terrorists.

• Those faced with countering terrorism must have as thorough an understanding of the terrorists and their methods as the terrorist has of his target society.

• Africa is a traumatized continent with a bright future.

• Thank you for your attention.