Scarred souls – the emotional toll of Sierra Leone’s civil war

Patient chained to his bed at the Kissy Mental Hospital, Sierra Leone’s only psychiatric institution
Patient chained to his bed at Sierra Leone’s only psychiatric institution

The war that raged in the West African nation of Sierra Leone for nearly a decade knew no bounds. Speak to any Sierra Leonean and you’ll hear stories of unimaginable pain and horror. As Médecins sans Frontières noted in a report in early 2000, “even after hostilities cease, the war may continue in people’s minds for years, decades, perhaps even generations. To address only the material restoration and physical needs of the population denies their shattered emotional worlds. It ignores the broken basic assumptions of trust and benevolence of human beings and leaves unaddressed the shattered moral and spiritual consequences of the war.

Original broadcast: March 8, 2000

Photos: Eric Beauchemin


Transcript

We would like to advise listeners that they may find the graphic nature of some of the descriptions in this programme disturbing.

Radio Netherlands, the Dutch International Service, presents, “Scarred Souls”. The programme is produced and presented by Eric Beauchemin.

There is one psychiatrist for the whole of Sierra Leone. There is one doctor who has had psychiatric experience. Basically they are the only two people who can deal with the psychiatric conditions for the whole of Sierra Leone, so a population of what, 4 or 5 million?

Anybody who was in Sierra Leone during all these armed conflicts should have suffered some form of trauma in one form or another.

The war that raged in the West African nation of Sierra Leone for nearly a decade knew no bounds. Speak to any Sierra Leonean and you’ll hear stories of unimaginable pain and horror. What started as a revolution in the early 1990s to overthrow a corrupt regime and create greater equality quickly degenerated. The rebels of the Revolutionary United Front began to maim and kill in their war to gain control of Sierra Leone’s vast diamond and mineral resources. The atrocities committed first by the rebels and then, to a lesser degree, by the other forces, were quite simply horrific, says Sierra Leone’s only psychiatrist, Dr. Edward Nahim.

Dr. Edward Nahim, Sierra Leone’s only psychiatrist
Dr. Edward Nahim

The war has been described as one of the most brutal wars ever fought in modern warfare. The atrocities were actually tremendous: amputation of limbs, raping, gang raping of women, chopping off of heads, splitting the stomachs of pregnant women and using the intestines as a checkpoint rope, burning people alive, setting houses on fire with all the occupants inside, or just gunning them down at point blank range. So the rebels had a field day in killing, maiming, raping and doing whatever they want to.

The thousands of people who had their limbs and other body parts chopped off bear some of the most gruesome physical and psychological scars of the war. Abdul Sankoh is a 28-year-old teacher. In April 1999, the rebels entered his village. The rebel leader was Abdul’s former schoolmate. He ordered his bodyguards to kill Abdul. When they refused, Abdul’s former schoolmate beat them with a gun.

Abdul Sankoh, 28-year-old teacher
Abdul Sankoh

Then he told me that he is going to amputate my arms. He told me that we the teachers used to write about them, criticising their government or their mission. I told him that before ever he amputate my arms, let him burn down our houses. Then he said, no. He won’t burn the houses, but he will amputate my arms. Then he tied me, beating me up with guns. Then they brought the axe from our house. Then he amputated this of my right hand. Then I apologise for my lifetime. He said no. So he amputate both of my hands. Then I told them to kill me. He said, no, he won’t kill me. He said because of I having a mouth, that is why I am causing noise to him. Then he cut off my mouth, then it hangs. He cut off my ears so at that time, he left me lying on the ground. So I was there shouting, crying.

They just basically perpetrated some of the most horrific war crimes, for no apparent reason. You know, you hear that again, and again, and again in the testimonies, of “we had never done anything to these people. We didn’t know who they were. We don’t know why they were targeting us. And yet, they burnt us alive in our houses”. They amputated, they killed, without any real logic as to why they were picking one person and not the next.

In July 1999, the government of Sierra Leone and the rebels signed a peace agreement that included a blanket amnesty for all the atrocities committed during the 9-year war. Even though the rebels are continuing to terrorise the north of the country, a fragile peace reigns in most of the rest of Sierra Leone. A relatively small-scale international relief operation is now underway to help rebuild the country’s shattered infrastructure and assist some of the victims.

Handicap International for example has set up a workshop to manufacture artificial limbs for the amputees, like Abdul Sankoh. But the emphasis has been mainly on dealing with the physical wounds, despite the very deep psychological scars, says Dr. Nahim.

Well, as a result of the war, quite a good number of people have been psychologically traumatised. And what I normally say is anybody who was in Sierra Leone during all these armed conflicts should have suffered some form of trauma in one form or another. There is nobody who can hardly say well, it did not affect me in any way. The victims suffered and those who were witnesses also suffered. A very common problem now is post traumatic stress disorder, panic anxiety, psychotic depression, schizophrenia, and sometimes physical illnesses and deaths directly related to the stresses all these people have suffered.

It’s not only adults who bear the scars of the war. Children too have been deeply traumatised, says Davidson Jonah, the director of the Christian Children’s Fund in Sierra Leone. CCF has been working with several thousand children, including a group living in a camp for displaced people in Freetown.

Davidson Jonah, the director of the Christian Children’s Fund in Sierra Leone
Davidson Jonah

When those children arrived at the camp, they couldn’t even eat, let alone sing. Most of them have gone through a lot of traumatic events. And so they are stressed up to a point that their psycho-motor sensory organs were not functioning well, so they couldn’t dance, they couldn’t play, some of them couldn’t talk. But the dancing is an activity that involves their body. It involves their physical self. So they dance away and sing away a lot of what they’ve seen and that brings them back to where they were before. Because before maybe an attack on their village or the burning of their house, they were children who were playing. They would go to school. They would sing and dance with their friends around the village or in the compound. So what we do is we bring back those activities that would jog back their memories to where they were before. So it’s like moving them from that block. So they just continue from where they last left before the atrocities.

We enter a camp or a community. Our psychosocial trainers work with children for 10 days. During the period that they are working with these children, the camp dwellers assist them to identify people who they trust who would work very well with their children. These selected parents are trained for a period of 10 days and after the training, we provide them with materials and they begin working with the kids themselves. They do dance, drama. They do songs. They do story-telling, they do cultural dancing and they do arts & crafts. It’s all in an effort to de-traumatise them, relieve them of the stress as a result of the violence they have seen or may have participated in and prepare them to go back into normal life.

The Christian Children’s Fund also organises outings at the beach for some of the girls who were raped by the rebels. The girls, some as young as 9, not only bear the psychological scars of having been raped for months on end, but many, like Miriam, also bear the physical evidence of their months of forced captivity in the bush.

Miriam was raped during the war
Miriam was raped during the war

At Kambia, I became pregnant, you know. EB: When did you have the baby? At June, June 2nd. EB: Is it a boy or a girl? A girl. EB: And what’s her name? Maudelin, the name of my counsellor. EB: Is she a pretty girl? Yes. EB: Do you like her or when you see her, do you think of the rebel? I don’t think of the rebel. Just like that because I think that’s the way God wants me to live. It’s the wish of God so there is no way out for me to abandon her. EB: Nowadays, do you still think a lot about the time that you were held captive by the rebels? I just feel sad and think about what has been happening to me, you know. Because I was suffering, a lot of suffering. I sit lonely with myself thinking, you know. That was the time I started to give up everything. When I am explaining to my counsellor, she counsel me and she speaks to me about certain things. That this is not the end of my life. Let me don’t think again about the bush. EB: So the counselling has made you feel better? Yes.

Despite the stigma of being a single mother, Miriam is now back in school and wants to become a nurse. Maud Peacock is Miriam’s counsellor. She’s worked with many of the rape victims.

We’ve done group counselling as well as individual counselling. The counselling processes have played a very important role in the development of their self-esteem. You know, they’ve been devalued. They had the feeling that they are no longer wanted in society. You know, that stigma as a result of what happened to them sexually. But now, through the counselling, we had tried indeed to make them realise that life is worth living. Originally they lacked that confidence. And we’ve been successful, Christian Children’s Fund, to sort of reunify them to their former schools. You know, we have three here who were attending the old established schools in Sierra Leone. And when they returned, we tried to reconnect them to the schools and they accepted them. And they are doing beautifully well, Eric.

The idea is to first of all get the girls to find a listening ear, to be able to come back to reality, to be able to cope with everyday living situations, to be able to face society again, and to know that there is somebody who can help them do this. And there is somebody who can walk through life with them because this is what we want.

Christiana Thorpe is the director of the Forum of African Women Educationalists, FAWE, a group that’s providing counselling, training and education to over 2000 rape victims. Many more girls and young women are still believed to be held by the rebels or are in areas that are inaccessible. Because of the sheer number of traumatised girls, FAWE soon approached the Dutch branch of Doctors without Borders, says Maureen Mulhern.

They saw the events, particularly the raping of so many women and the abductions as a major concern that would interrupt the potential for women for their future. And they wanted to make sure that some of these young girls still had the opportunity to continue with their education and that this trauma should not be there for the rest of their lives, that somehow we should do something to help them over it. They also wanted to give them some kind of moral support in terms of counselling. The problem is that in Freetown there is really nothing in the type of services that would give any real therapy or treatment to people who have been through a traumatic event. So the counsellors they have are people who have a great deal of compassion, who have been through very similar experiences themselves, who had a lot of good will, and who tried to support these young women and girls as best they could.

As the depth of the psychological scars became clear, FAWE and other local groups realised that the rape victims were not the only ones who had been severely traumatised by the war.

Christiana Thorpe of FAWA
Christiana Thorpe of FAWA

They were seeing parents who were traumatised by the fact that their children had been abducted, that they had come back and were different people. They didn’t know how to handle them. There were behavioural difficulties and so on. Families who had children who had been child soldiers and had returned and didn’t know how they would deal with them and so on. So they were starting to see a wide variety of trauma cases. That’s part of the realisation of people, the need to do something about the traumatisation because they realise what the social issues are as a result of this. There are children who are going to school who are completely traumatised and can’t concentrate. There are children who are going to school who maybe supported one side or the other and they’re in the same classroom. So how to do you teach history to these kids? And how do you get them to pay attention in the first place? Some of these children have been bearing arms and they have been involved in a war. So how can you expect them to go back into a classroom situation and take the authority of a teacher who has no gun and who is not threatening to kill them if they don’t do what they’re told? So they see that if they don’t deal with these issues, their young people in the next generation will also just go back and join the fight.

The true level of trauma suffered by Sierra Leoneans became evident during a survey carried out by MSF-Holland in the capital Freetown. It showed 90% of Freetown’s inhabitants had witnessed people being wounded or killed, and at least half had lost someone close to them. Despite the profound psychological wounds Sierra Leoneans have suffered, there’s virtually no one to help treat them: only Dr. Edward Nahim and another doctor with some psychiatric experience. It’s an overwhelming task in a country already overwhelmed by the brutality of the war. But there are traditional mechanisms to help cope with trauma, says Dr. Nahim.

In the extended family system, nobody is alone. You have your mother, father, brothers and sisters, cousins, neighbours. Everybody in the neighbourhood or the community is a member of the family, and if you have a problem, they all come around to give you some form of counselling. We have various methods of traditional counselling, like religious counselling. Counselling is done in the Moslem way and in the churches. All what they are doing there mostly is group psycho-social counselling. And also you have the juju men. They do a lot of counselling. You have the traditional healers, the village headmen, the chiefs. So as you can see, it is not only left to health professionals. Even those who are not professionals do some counselling in one way or another.

The war was so vicious that even community leaders themselves have been traumatised. But they, like most everyone in Sierra Leone, says Maureen Mulhern, think that they’re suffering from a physical problem.

They come with physical ailments that are really not…they don’t have a physical base. It’s a psychological base very often, so aches and pains, hypertension. And the amount of hypertension in Freetown just after the war was really…is incredible. Just about everybody had high blood pressure. For the most part it was stress-related, so after a period of time, we saw the incidence of that decreasing and people come with headaches and aches and pains and in a way, it seems like people are looking for attention. They want somebody to acknowledge that they have a problem, but they don’t know how to express a psychological problem. That’s not part of their culture or whatever. They just express it as a physical symptom.

Even when people acknowledge that they have been traumatised, says Dr. Nahim, the manifestations are different than in the developed world.

For example, a European would say, I cannot sleep. I have nightmares. I have bad dreams, whereas here now they would say I see devils. And these devils are tormenting me. So you have to perform certain ceremonies so that these devils will disappear. Or I say snakes or very dangerous objects. You know, it’s the same type of treatment only that the language being used is different. The symptoms are the same for the European and the African.

Devils are pursuing not only the victims, but also the fighters. Dr. Nahim, Sierra Leone’s only psychiatrist, is also the head of the Sierra Leone Drug Addiction Council, the only local charity working with the rebels who’ve reported to demobilisation centres. They spend four weeks there before being sent back to their communities. Dr. Nahim and his team of volunteers are trying to provide some type of therapy during the former combatants’ stay at the demobilisation centres.

Well at first you have to allow them to talk what they want to say because you know them, they don’t know you. So it’s something like a free association. What you do is you ask them individually to give their experiences in the war, how they’ve suffered and how it affects them. Some of them will say their parents were killed. They’ve lost their loved ones. They’ve lost all their properties. And they themselves have killed and because of that, they cannot sleep. You know, all the atrocities they’ve seen keeps recurring into their minds. At night, they have nightmares, they have bad dreams, they are hyper aroused. You know, they just can’t sleep. Another common thing among all these people, most is drug abuse. And because of drug abuse, they get delirious, and as a result of the delirium, they start hallucinating. So you have to see whether it’s just a traumatic event or drug induced psychosis or both.

Dr. Nahim’s team is overwhelmed by the sheer numbers of combatants reporting for demobilisation. Over 11,000 of the estimated 45-thousand fighters have already been demobilised. Up to a third of the rebels are children. 16-year-old Desmond was abducted at the age of 10, drugged and trained to fight and kill. The first time he killed, he became so sick that he thought he was going to die. Eventually, killing became normal, says Desmond, but now he’s haunted by his days with the rebels.

Desmond
Desmond

I have many dreams about that, even the time I escape from them. When I sleep, I dream that somebody is coming towards me, holding a knife. By that time, I shout in my sleep. When my auntie came in and ask. She asked me what is wrong. I say somebody is going to kill me. That had happened with me many times. Sometimes, my mouth stiff. Somebody was standing on the top of my head saying words. By that time I wouldn’t understand what this person is saying.

As peace takes root in the country, it’s likely that more and more combatants will struggle with the memories of their deeds, particularly the child soldiers who were among the cruelest fighers. Ibrahim, who’s 16, headed a small boys unit during the war. He killed at least 5 people a day and drank human blood every morning. During his 8 years as a rebel, he earned the nickname General Bloodshed.

I have a problem. My problem is with my head. EB: Ibrahim, tell me what the problem is with your head. Because sometimes I just sit and start shouting. I don’t know what is happening. EB: Why were you shouting? I don’t know. I think because I’m not taking it, that’s why. EB: You’re not what? I’m not drinking human blood, that’s why. EB: So when you didn’t drink blood you didn’t feel well. Yeah. EB: Do you hit some of the other boys here also? Yeah, even this morning, I fight. EB: And what were you fighting about? I don’t know. I don’t know what I was fighting about.

Patients at Kissy Mental Hospital
Patients at Kissy Mental Hospital

Dr. Nahim and the Sierra Leone Drug Addiction Council would like to provide follow-up treatment for the combatants once they return to their villages. Ideally, if they get funding, they’d like to have a counsellor in every single community. The counsellors could then refer former combatants or others who become mentally ill to the Kissy Mental Hospital, Sierra Leone’s only psychiatric institution.

Quite a good number are brought for psychiatric treatment because at home, there is peace. They keep the whole house awake at night because of their disturbed behaviour: breaking down objects, screaming, shouting, threatening to kill, or threatening to burn the house. Because of all that, definitely, they would like to get rid of him and get him into a place of safety. That’s why they bring the patients. If the patient is quiet, they can cope. When he is violent and they cannot cope, they come for help.

The Kissy Mental Hospital is located in the eastern suburbs of the capital Freetown, where the rebels wreaked the greatest destruction. As part of its mental health programme, says Maureen Mulhern, MSF-Holland decided to help repair it.

Renovating Kissy Mental Hospital
Renovating Kissy Mental Hospital

We understood in the beginning that the place was totally destroyed and that all the patients had been killed. But in fact that wasn’t the case in the end. So we had another look. The situation was appalling for the patients here. There were no drugs, there were no doors on the rooms, there were no windows. There was really nothing, no food for them to eat. We don’t have the capacity for psychiatric care, but we thought we could do something to try to raise the level of care for the patients who are here. So we actually have a mobile team that comes in to do generalised health care for the patients once a week. And then we decided that we should rehabilitate some of the buildings, put doors and windows on, paint the structure.

Patient chained to his bed at the Kissy Mental Hospital
Patient chained to his bed at the Kissy Mental Hospital

I am Annu Ibrahima. I am the trained and qualified psychiatric nurse attached to this mental hospital. Now we are coming to the male section of the hospital. What we did is we concentrated the whole patients in this hall because MSF and the other NGOs are helping us rehabilitate the other wards, so for that matter, we concentrated the whole patients in one. So you observe that it is more or less a jam packed ward.

We’ve come up to the female ward. Can you tell me what the difference is between…first of all there are far fewer patients here in the female ward than in the male ward, but aside from that? The other difference is that whilst the illnesses of the males can be attributed to drug abuse and other substance abuse, the females on the other hand, there must be some element of depression and other mental entities. That is why they are here. Some of them must have had some marital problem, disappointment and all the rest. Some of the female patients as well as many of the male patients have chains, and some of them are actually chained to their bed. EB: What is the reason for that? We reflect it back to the culture of violence that has engulfed our society. The males because they are very, very violent and even when they are admitted in the hospital, if care is not taken, they may injure the hospital workers or the nurses or even the doctors. So what we do is we chain them to the bed and then with the we give them this injection to quiet them. With time we release the chain and then we see how best…but initially for the first 1, 2, 3 weeks, they are being chained. EB: But you told me that many of these patients have been here for several years and many of the patients are still chained. Why is that? Most of these patients they go and come. Even if they are discharged, it will not even be one or two months, and they come back. So most of them are not new cases as we may be expecting because of the advent of the war.

In other societies that have experienced war, it’s only months or years later that the psychological scars create problems for people. Maureen Mulhern expects the same thing to happen in Sierra Leone.

They need the basics first: they need the food, they need the shelter, they need to have some kind of income so that they can continue just those basic survival. And it is when things become more stable and they can start to think about building a new life for themselves that these things can come back. There’s no prescription to how people respond to these problems, but it will be after a period of time, when all those basic needs are actually starting to be met again that they then have to start and come to terms with some of the horrors that they’ve seen and been through.

In the Balkans, trauma and counselling became essential elements of the relief operation, as international groups realised the extent of the psychological suffering people had gone through. The United Nations Human Rights Commissioner Mary Robinson has described the atrocities committed in Sierra Leone as even worse than those in Kosovo. Still, there are far fewer aid organisations active in Sierra Leone than in the Balkans, and MSF Holland is one of the few international groups trying to deal with a traumatised nation of 5 million people. In its report on trauma in Sierra Leone, Doctors without Borders points out that even after hostilities cease, the war may continue in people’s minds for years, decades or even generations. Dr. Nahim agrees.

Destroyed building in downtown Freetown
Destroyed building in downtown Freetown

That is definitely going to happen here. You see, sometimes trauma can be transmitted from generation to generation. I’m pretty sure some of the children unborn, not born yet, might suffer the same traumatic events people have experienced now by just listening to the horrible stories being told. And most of those who are psychologically traumatised for now might live with their psychological trauma till the end of their lives. That is quite correct.

Many of these scarred souls will also have to live with the physical scars for the rest of their lives. 28-year-old Abdul Sankoh, the teacher who had both his hands cut off, and whose lips had to be sown back on will never be able to forget the war. Nor will his family.

At the first time my wife saw me, she was unconscious. When she regained consciousness, she encouraged me. She said this is they way the Almighty God wants you to be. EB: And your children when they saw you? They were afraid of my stumps. EB: Are they still afraid of you? No. They’ve become used to the stumps now. EB: It must be difficult not to be hold your children. It’s difficult but not very difficult to hold my children. EB: You can still hold them. I can still hold them. I can still play and laugh, do everything in common. But I am always going with this philosophy that the way the Almighty God wants you to be in the world, so you have to be. I should have died the day they cut off my hands and they cut off my mouth. I should have died because the bleeding. But God said I am only going to suffer the pain but I will not die. So everything is with God.

“Scarred Souls” was produced and presented by Eric Beauchemin. Technical production: Rick Kingma. This has been a Radio Netherlands’ presentation.