Rehabilitation for Victims Suffering from Trauma and Stigma is Significant in Northern Uganda

With the trial of former LRA commander Dominic Ongwen underway at the International Criminal Court (ICC), community members are pondering the question of how victims suffering from psychosocial conditions such as trauma and stigma will be rehabilitated. Ongwen is charged with 70 counts of war crimes and crimes against humanity allegedly committed in the former internally displaced persons (IDP) camps of Lukodi, Pajule, Odek, and Abok in northern Uganda. His trial, which is currently on recess until September 18, started in December 2016.

During the attacks on these IDP camps and in general during the conflict in northern Uganda, many civilians were the victims of brutal acts such as mutilation, torture, and sexual and gender based violence (SGBV). These acts gave rise to medical complications, including trauma and stigma, which many victims in northern Uganda continue to experience today.

The Importance of Psychological and Trauma Counselling

While many medical rehabilitation programs have been implemented in northern Uganda to aid victims in their recovery, there still appears to be a gap in how to handle victims suffering from psychosocial conditions. This is because many of these programs focused heavily on physical rehabilitation, involving medical treatment for health complications and injuries inflicted upon victims.

For example, the Trust Fund for Victims (TFV) at the ICC has been assisting victims in northern Uganda since 2008. The TFV has provided assistance in the form of medical rehabilitation, psychological rehabilitation, and livelihood support across 18 districts of northern Uganda. More than 45,000 people have directly benefitted from the program, and a further 200,000 people, who are either family or community members, have benefitted indirectly. The TFV’s program has been implemented by local and international organizations including healthcare providers.

Scott Bartell, the Program Manager of the TFV in Uganda, underscores the importance of psychological rehabilitation and trauma counselling.

“We at the Trust Fund in Uganda take psychological rehabilitation and trauma counselling very seriously. Such programs are very important and have proven to be very helpful to the people of northern Uganda. We have been implementing those projects since the very beginning of our program in northern Uganda in 2008. We have reached thousands of people. Many of them have received trauma counselling and medical services but we try to provide integrated services to our beneficiaries in the program meaning they receive counselling and livelihood support at the same time as medical rehabilitation. We have heard from local authorities and other community leaders and the requests for counselling and medical services have increased over the years. At the very beginning people’s appreciation for these programs was not very high but over the years they have a more refined understanding of what their needs are.”

Important Cultural Considerations

As the case of northern Uganda will indicate, rehabilitating victims of trauma can be complicated by the cultural connotation of trauma and other psychosocial conditions to cen, or spiritual haunting. Many people in northern Uganda believe that trauma and other psychosocial conditions occur when the spirit of a dead person haunts a living person as a results of acts committed by the latter. It is referred to as cen in Acholi, and can only be remedied through cultural rituals.

Ocaya, a community member from Pageya asked,“During the trial, expert witnesses testified that some victims are traumatized and suffer stigma. Who is going to take responsibility for rehabilitating them? I believe the condition of such victims requires them to go through cultural procedures in order to become normal. We have our traditional leaders who have the potential of carrying out cultural cleansing for the victims. Will the government or any willing organization facilitate them through the process?”

According to Acholi culture, victims suffering from cen or spiritual haunting need to undergo complex and elaborate traditional cleansing rituals to restore them to a proper mental state. According to medical practitioners, it would involve psychosocial and mental treatment. However, many of these victims, as pointed out by Ocaya, continue to remain untreated in both respects.

Differing Views on Treating Trauma and Stigma

The question of how to rehabilitate victims suffering from trauma and stigma has also been pondered by experts appearing before the ICC to testify in Ongwen’s trial. All these experts have offered varying opinions regarding the effectiveness of Acholi traditional cultural mechanisms in rehabilitating victims of trauma, stigma, and SGBV.

Another community member called Alice from Lukodi raised the complex issue of rehabilitating victims of SGBV.Many girls were who were abducted during the conflict in northern Uganda were forcibly married off to LRA commanders and made to bear children against their will. Many of these girls later returned to the community with their children, only to face rejection from their families and communities. Those who tried to remarry suffered additional abuse from their partners, and many were later abandoned. Many have resorted to raising their children single-handedly.

“Women who were forced into early marriage are now discriminated against and stigmatized by the community. What will be done so that they also feel part of the community?” Alice asked.

Former child soldiers present another complicated issue. On May 15, Michael Gibbs Wessells, a psychologist specialized in treating former child soldiers, testified that tackling stigma was one of the most important issues to rehabilitating former child soldiers. “Young people often tell me that stigma is a bigger problem than presumed or actual mental illness,” said Wessells.

Wessells further noted that one aspect of Acholi culture that could be useful in rehabilitation of victims are the rituals used when someone shows cen, or having a spirit or spirits in them. “Local people will not accept a former child soldier back if that former child soldier exhibits cen. They will be fearful. They will be concerned about that discord. So, these rituals will be useful” to their reintegration into society, said Wessells.

Other expert witnesses have different perspectives. Seggane Musisi, a psychiatrist in Uganda, noted in his testimony that Acholi culture may not have all the answers for addressing the effects of trauma and stigma because this type of violence has never happened before on such a scale. Daryn Scott Reicherter, a psychiatrist, told the court that stabilizing a survivor of sexual violence is a crucial first step in dealing with the trauma the survivor has suffered, a factor that may be more important than helping a survivor of sexual violence get medical care.

Ongwen himself has been the subject of discussion about whether he suffers from trauma and mental health problems. During a hearing on March 19, Ongwen disrupted proceedings and had to be removed from the courtroom. One of his defense lawyers linked the incident to his mental status. However on Wednesday, April 11, and Thursday, April 12, Roland Weierstall, a psychologist, testified that while there was no doubt that Ongwen suffered trauma between 2002 and 2005, it did not mean he had a mental disorder.

A Need for Victim Rehabilitation

All the above indicates a need for rehabilitation of victims suffering from such conditions. Accord to Scott, “Counselling is very much needed by people in the community who have experienced traumatic events, abductions, or attacks on their person or other members of the family or the things that they witnessed during the conflict. Different people need different services and different sorts of treatment for their problems. A course of counselling over a few months may be sufficient for some people depending on their level trauma. Other people may have a more acute form of trauma that requires longer and more rigorous individualized counselling services. Some people may recover with group counselling or other psychosocial types of services. And others may need to see a psychiatrist or a psychologist individually. And some people may require pharmacological assistance as part of their trauma recovery.”

All the above opinions serve to re-enforce the fact that victims of trauma and stigma require attention as a specific category of victims suffering from unique conditions. Otherwise these victims may continue to suffer long after Ongwen’s trial is complete.

Lino Owor Ogora is a peace-building practitioner who has worked with victims of conflict in northern Uganda and South Sudan since 2006. He is also the Co-Founder of the Foundation for Justice and Development Initiatives (FJDI), a local Non-Government Organization based in Gulu District that works with children, youth, women and communities to promote justice, development and economic recovery in northern Uganda.