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Concept of Mental Health among the Somali Community in Dadaab Refugee Camp.

The 8th’ Annual Pan-African PCAF Psychotrauma Conference

PRESENTATION BY;JOHN KIVELENGE, MHO – IRC. 15th, July 2015

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INTRODUCTION:- The IRC is one of the largest humanitarian agencies in the world, providing relief, rehabilitation and post-conflict reconstruction support to victims of oppression and violent conflict since 1933. - The IRC has been operating in Kenya since 1992, and set base in Dadaab refugee camp in 2009 providing comprehensive health care services, Nutrition services to children under 5 years, reproductive health care, women empowerment, response to SGBV and refugee protection programming to thousands of refugees escaping conflict and natural disaster in Somalia, Sudan, Ethiopia and other neighboring countries . In Dadaab, the IRC operates 2 camps- Hagadera & Kambioos.

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- Dadaab, world’s largest refugee complex is situated in Garissa County approx. 80 Kilometers from the Somalia border, comprises of five refugee camps - Ifo 1, Ifo 2, Dagahaley, Hagadera and Kambioos. We still continue to receive a significant number of new arrivals per month mostly from Somalia.

As of end of April 2015, the overall population in Hagadera(106,863) & Kambioos(20,784) persons (Source; UNHCR Statistics April 30th’ 2015).

- In Hagadera/Kambioos refugee camps there are over 2000 persons registered in the mental health program with various mental disorders.

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Cont….- IRC Community mental health care services are integrated within other health program services to offer holistic care to all our patients in the two camps (PHC approach).

- Through linkage with the community health promoters who carry out home visits in the camp, we are able to get clients identified with mental/neurological disorders who are referred to our various mental health satellite clinics located at the various H/Posts in the camp.

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Cont…..

- Prolonged conflict and instability in Somalia has affected the mental health and psychological well-being of its people.

- Trauma experienced by many Somalis in Somalia brought a profound impact on mental health functioning and available accounts of trauma reported by Somalis suggest many suffered repeated psychological trauma.

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Cont…

WHO defines mental health as "a state of well-being in which the individual realizes his or her own abilities, can cope with the normal stresses of life, can work productively and fruitfully, and is able to make a contribution to his or her community"

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The sociological relativistic concept;

- Any person is mentally healthy who is well adapted to society, who functions well in terms of the social order he is living in. In this definition society (or the state) is the measure, not man. This concept believes that there is a kind of pre-established harmony between man and the state, or man and society.

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Causes of mental illness (Somali concept) Are predominantly spiritual or metaphysical: - Mental illness comes from God or Evil spirits ( jinni ) or - Caused by another person through (witchcraft) or - Curses from parents or bad behavior. Somalis traditionally explain behavioral problems as an expected result of spiritual causes or possession by an evil spirit.

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Causes of mental illness (Somali Concept) cont…-Alternative healing is highly practised e.g. Psychotic symptoms mostly may be treated by a Spiritual healer by reciting some verses from the Holy Koran or by preparing an amulet to protect the person from evil spirits or ”jinni ”.

- The “evil eye” is a concept believed in by many Somalis. The evil eye is a misfortune or illness caused by a person wishing harm on another.

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Western concept (Modern Medicine)- In contrast, the scientific view of mental illness is based on a combination of biological and environmental factors i.e.

- biochemical imbalance, - brain problem, - genetic or birth defect) or

- response to trauma or learned behaviors.

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Treatment of mental illness (Somali Traditional way) - Traditionally, Somalis believed that mental illness is caused by possession of evil spirits or as a punishment from God, thus the reason why Spiritual healing is required for mental illness.

- Spiritual healers use religious rituals for healing, other times traditional healers like the “Borana” are used where witchcraft is suspected to be the cause of the illness.

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Community support.- Somali culture is traditionally communal and family oriented, hence they have good support.-There is almost always an extended family to rely upon, and even severely ill persons usually live with their family members, although a minority of mentally ill persons may move away from their families, often ending up in market places or wander aimlessly in the camp.- Only in rare extreme cases of violence or extremely deviant behaviour, or when the family’s resources are over stretched to breaking point, will mentally ill persons be excluded from their families, although sometimes they may be chained up on a tree or caged in a room.

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Cultural Beliefs; - Seeking for treatment or assistance from a resource outside the community for mental illness sometimes is considered shameful to the family therefore, Spiritual treatment is tried first and formal mental health treatment is considered as the last resort.

- While grieving, some may desire quick solutions to their personal pain, as others question why they are crying continuously. - Culturally, this emotionality is seen as a sign of weakness by the community so many will mostly try to suppress their grief reaction.

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Stigma & Discrimination- Mental illness has a social stigma and usually some families attempt to care for the mentally ill person within their family, while some seek for psychiatric treatment and others chain the patient under a tree at home giving various reasons e.g. some say are protecting the sick from harm etc. - Those having mental illness in the society are mostly considered less worthy and command less respect than those who are considered mentally stable or sane. - Mental illness is a mark of shame, disgrace, Fear and mistrust in the community. Family members and friends turn their backs at times when they are tired of those having mental illness.

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The plight of patients with mental illness in Dadaab refugee camp

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Protection concern: Patient with mental disorder chained at home

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Cultural Concepts of Mental Illness;

In Somali culture, concept of mental health only include 2 perspectives on

mental illness i.e.- one is either mad (waali ) or

Normal.

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Known Mental Disorders. “MURUGO” is generally defined as sadness, It also means severe sadness, stress, or disappointment, but it can also mean a very serious depression that is associated with physical manifestations.

- These physical manifestations may include headache, loss of appetite, crying, troubled sleep, social isolation, feeling hot, and irritable etc.

- The main causes of “murugo” are thought to be war related trauma , stressful life in the refugee camps and financial problems as many refugees are mostly unemployed, marital problems.

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Known Mental Illnesses Cont .

- “Waali” is defined as crazy, mad, and generally mentally unfit. - A person described as having “waali” has behaviors that are abnormal include talking to self or not talking at all, wandering in the streets aimlessly, may remove clothes in public, dressing inappropriately, confused and in other words he/she maybe having - Psychosis.

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Known Mental Illnesses Cont…

-“Jinni” is believed to be a very serious and extreme form of mental illness, and it presents with a very sudden onset - (Acute Psychosis).

- This is particularly a very stigmatizing form of mental illness that is thought to be caused by supernatural beings or spirits created by God.

- The “Jinni” is thought to be very powerful and can exert control over actions and behaviors of those afflicted.- It is characterized by intense fear, bad dreams, disorientation, and sometimes violent behavior towards others. Because spirits cause this form of mental illness, treatment from a psychiatrist is deemed useless. Instead, the service of a spiritual healer or sheikh and clan elders is highly needed.-

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New Illness among the Somali refugees; “Buufis” is a Somali word commonly used in the Dadaab refugee camps in Kenya to describe a person's dream of or longing for resettlement mostly to USA (land of fortunes), Buufis conveys the idea of comparison between one's life in the camp and others' lives elsewhere who have been resettled. 

- Other, closely related meanings of the word have come to be used for , "resettlement itself, the people who long to go overseas, and the madness that at times occurs when the dream of going overseas is shattered”. It commonly triggers mental illness to those who get their resettlement process cancelled.

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Other unfamiliar mental Disorders;

- Post Traumatic Stress Disorder(PTSD)- Mood Disorder- Puerperal psychosis- Personality Disorders - Sexual Disorders- Alcohol & substance use disorders- Impulse Control Disorder Symptoms (gambling)- Anxiety Disorders (Phobias)- Anorexia nervosa- Somatoform or Psychosomatic disorder

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Prevention of mental illness (Somali context)

- Prevention of mental illness in the traditional Somali worldview, is primarily through the use of prayer and living a life according to the Islam religion.

- A common view among Somalis is that an individual cannot prevent future illness, as the ultimate decision on illness is always in God’s hands.

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CONCLUSION:1. Integration and decentralization.- IRC Community mental health program in Hagadera/Kambioos due to its integration with the community health program, has been well accepted by the community because the MH services have been decentralized from the main hospital to the H/Posts next to the refugee homes to reduce the long walking distance for services. - The patients are now able to receive their psychiatric treatments near their community and go back home to stay with their family members, an idea well embraced by the camp.

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Conclusion cont……

2. Reduced stigma and discrimination.- Through community awareness campaigns and trainings in the camp regarding mental illness, stigma & discrimination has significantly reduced. Trainings have been conducted for the various stake holders including the religious leaders, also use of mass media- Gargaar radio, this has enhanced acceptance of patients with mental/neurological disorders in the camps as some patients after treatment have now been unchained and can relate well with other people.- Mental illness has been demystified within the refugee camps and mental health seeking behaviour has improved significantly.

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ASANTE SANA !