Physical and Mental Health Impacts
Numerous physical health impacts have been noted as a result of armed conflict. Death and dismemberment as a direct result of combat are obvious ones, especially as civilians have been increasingly targeted in recent conflicts, such as through roadside bombs or suicide bombers in public places. However, other physical health impacts occur, including a greater number of chronic medical conditions. An increase in high-risk behaviors has also been found, such as substance use, including tobacco, alcohol, and other drugs (Medecins Sans Frontieres, 2011).
However, the mental health impacts of conflict can last long past the physical impacts if intervention is not provided. Common psychological difficulties include depression, anxiety disorders, and PTSD (Attanayake et al., 2009; Medecins Sans Frontieres, 2011; Murthy & Lakshminarayana,
2006). These impacts are even more pronounced among those who have been displaced from their homes (Husain et al., 2011). Prolonged conflicts typically erode traditional community coping mechanisms and supports, leaving them even less able to cope. While many people are able to recover from psychological distress once the trauma ends, others will need assistance in doing so. For others, they lack the ability to leave the traumatic situation.
While Doctors Without Borders/Medecins Sans Frontieres (MSF) is better known for its physical health interventions, they also offer psychosocial services. As one staff member stated, “What do you do if there is enough food, but no one wants to eat?” (Doctors Without Borders, 2005a, ^2). Social workers are among the mental health professionals who volunteer to work with Doctors Without Borders. These volunteers are experienced in working with trauma issues and PTSD (Doctors Without Borders, 2013).
The core of their psychosocial approach is for their mental health workers to work with local residents to build the community’s capacity to resolve the trauma in a culturally appropriate manner. The staff adapts cognitive-behavioral therapy and brief therapy techniques to the cultural context in which they are working. Recognizing the context of a crisis situation, the goal is not to cure people but to “support and improve the coping mechanisms of beneficiaries” (De Jong & Kleber, 2007, p. 490). MSF also coordinates with local staff and traditional healers to work together with the person’s cultural context, particularly to address spiritual concerns. Readers are referred to the handbook developed by Medecins Sans Frontieres (2011) for further detail.
Local social workers also offer services to help people recover from conflict. These services may look different from those offered by the international community. Doucet and Denov (2012) found that Sierra Leonean social workers were likely to offer direct advice and incorporate their personal stories to help their clients. While this would run counter to social work practice in a number of Western nations, their clients reported it was helpful.
Traditional healers may also be sought out to help individuals who are having a difficult time returning to community life. In countries such as Mozambique and Angola, those who have engaged in conflict must be cleansed before they are accepted back into society. They are carriers of the spirits of the dead; if the former soldiers are not cleansed, they will carry the anger of the spirits back into the community. These vengeful spirits cause the psychosocial issues from which the person is suffering (Green & Honwana, 1999; Honwana, 2006). Rituals and healings will be conducted to help the individual, the nature of which will depend on the primary religious identification of the individual and how rural his or her village is (Honwana, 2006).