Impact of war trauma on South Sudanese
By Nhial T. Tutlam*
War is a very nasty affair. Of course, this is not news to anyone who has experienced it. Most people who have experienced war have either witnessed or directly experienced some of the most traumatic events. For context, the Harvard Trauma Questionnaire (HTQ), an instrument developed to assess traumatic events and effects of trauma among war refugees, provides a list of about forty war-related traumatic events. These include events such as lack of food and shelter; ill health without access to medical care; combat situation (e.g. shelling and grenade attacks); forced evacuation under dangerous conditions; witnessing or experiencing rape or other types of sexual abuse or sexual humiliation; torture; murder, or death due to violence of a close family member or friend; serious physical injury from combat situation or landmines; kidnaping; forced labor; forced separation from family members; disappearance or kidnapping of a family member or friend; serious physical injury of a family member or friend due to combat situation; witnessing or experiencing beating to body or head; witnessing killing or murder; seeing dead bodies; and many other traumatic events.
Most people from war-ravaged countries have experienced many of these events. I have personally experienced at least 10 such events. For example, I have heard bullets zip by when we were attacked and we had no idea how we would make it to the other side unscathed. I have spent long tense minutes in a bunker while a government bomber circled overhead, worrying about how our entire family might perish if the plane dropped one of its deadly bombs and it fell directly on top of our bunker. I have walked hundreds of miles running away from one danger to another. I have walked hundreds of miles in search of food because there was none where we were. I have spent countless hours in the bush hiding from forces that attacked our village. I have lost many relatives, including my own father, to the war. And even with what I have seen and experienced, I consider myself one of the few lucky ones who did not experience some of the worst events that many South Sudanese experienced. Unfortunately, South Sudanese continue to be exposed to unimaginable trauma. In the current conflict, children have been burned alive, boys castrated, women and girls raped in front of their husbands or brothers, all these done by people who should be protecting them.
The undeniable reality is that most people who have experienced such high level of trauma, as the South Sudanese have, get affected and the effects can linger for a long time, even a lifetime. For example, one study of Cambodia refugees found the prevalence of 61% for the current of PTSD and 51% for depression, twenty years after resettlement in the US. Other studies have found similarly high prevalence of trauma associated disorders among the holocaust survivors more than 50 years after they experienced their trauma. Even more frightening, studies have found that the effects of trauma can be passed from one generation to another.
South Sudanese are no exception. There are not many studies looking at the effects of war trauma of South Sudanese out there. But the few that have been conducted among South Sudanese refugees have found high levels of trauma and trauma associated mental disorders. Specifically, the prevalence of PTSD, depression, and anxiety have been found to be as high as, 48%, 59%, and 26%, respectively. My own study among South Sudanese women resettled in the U.S. found a similarly high level of disease burden. Even their children who have not directly experienced any war trauma themselves have a relatively higher prevalence of emotional and behavioural problems. Simply put, the overwhelming majority of South Sudanese have been affected.
I count myself among the multitudes that have been affected. In my case, about two years after the death of my father in a plane crash in South Sudan during the war, I started to have nightmares. The nightmares always started the same way: I would see a plane full of people falling out of the sky, most of the time into a river, and I would desperately swim toward the wreckage to rescue the survivors. Most of the time I would actually get there and help people. Occasionally, the story would start with me in the plane as it crashed, and even there, I would be trying to help any survivors.
Over time, the nightmares became more frequent. They also became more intense and I would often wake up from the bad dreams drenched in sweat. Even seeing planes in the sky or hearing about plane crashes in the news often brought great anxiety. I remember one particular day in 2006 when my wife and I went to the movies, and the one that happened to be showing when we got there was the movie, “We are Marshall,” which is a movie about Marshall University’s football team that perished in a plane crash in 1970. The first scene of the movie, of course, was the plane crash; I instantly almost lost control of myself in the theatre upon seeing that scene.
Obviously, I knew exactly why I was having these nightmares. This is one of the classic symptoms of Posttraumatic Stress Disorder (PTSD). Experts in the field call this reliving the event or re-experiencing symptom. But despite my knowledge, and the fact that I worked in a healthcare setting at the time, I sought no professional help for a long time. I did not even share any of this with my close family members. That is what most people do: suffer in silence.
I did eventually seek help, though. One day, one of the few people I had shared my story with—a colleague I shared an office with—suggested that I go to an air show hoping this would help me deal with my problem. She was a physician, so her advice was based on her knowledge. Experts in the field call this exposure treatment, where you confront whatever you are dealing with head-on. I listened to my friend’s advice and went to the air show with her and her family. We spent an entire afternoon watching Air Force pilots dazzling crowds with their mesmerizing manoeuvres; literally watching planes doing tricks so dangerous that everyone held their breath every time they came so close, almost crashing into one another.
Not long after that, my nightmares gradually began to dissipate. In addition, the following year, I embarked on a mission to write a book about my dad. Although I had thought about writing the book since the time my father died in 1998, I had hitherto not made any serious plans about the book. That same year, I was also able to finally see my father’s grave, giving me much needed closure. The process of writing the book served as an invaluable therapy for me. In essence, my colleague’s prescription, combined with my book writing project, worked and helped me get to a better state of mind. Although David Morris, author of The Evil Hours: A Biography of PTSD, says: “Despite the quixotic claims of modern neuroscience, there is no cure for trauma. Once it enters the body, it stays there forever, initiating a complex chemical chain of events that changes not only the physiology of the victims but also the physiology of their offspring,” I believe I have beaten the odds.
I am telling my story for two important reasons. First, I hope my story sparks a much-needed conversation about the effects of war trauma in our community. Secondly, I share my story to let people in our community know that any of us can be affected, and indeed all of us are affected in one way or another. I have friends who have seen far worse than I have and have confided in me that they have had many sleepless nights because of nightmares. It is okay to admit these facts and seek help. This is the only way we will get better as individuals and, by extension, that is how we will heal our community. We are all carrying these hidden wounds of war and it is time for us to acknowledge this reality and start the discussion so that we can begin to seek ways to heal these wounds. When one of our brothers recently declared himself president of the Republic of South Sudan and commander-in-chief of the armed forces, while in Nebraska, and posted it on social media, most of us laughed. But this is no laughing matter; the fellow was dead serious about his announcement. People like him need help. There are many like him walking unnoticed in our community.
This issue of mental health is especially important for our community now. At the moment, our community is reeling from increasing suicide rate, especially among young people. The rising rate of substance abuse, particular alcoholism, is destroying many families. Equally troubling, we are now losing young people to the scourge of drug overdose at an alarming rate. Moreover, from Omaha, Nebraska to Nashville, Tennessee, we are losing our young people to the justice system for both minor and serious offences. We got a rude reminder of this last week when we learned that one of our community members brutally murdered his wife in front of their young children in Indiana. All these events are not normal, my people.
Yes, I know stigma about mental health is pervasive the world over. We are guilty of this, too. This makes it difficult to discuss and deal with this major public health problem openly. But as people who have known nothing but war for several decades, we need to talk about trauma and its effects in our community and begin to plan what we can do about it. I am also well aware that coming from a country run by megalomaniacs, who continue to recklessly drive our beloved motherland from one unnecessary conflict to another, we will, unfortunately, have to continue to deal with this problem until the root cause of our trauma is completely uprooted. But we can’t afford to wait until such a time. The time is now for us to take charge of our health and take steps toward healing.
*Nhial T. Tutlam, PhD, MPH, a native of South Sudan, is an epidemiologist with Saint Louis County Department of Public Health and an adjunct faculty at Lindenwood University and Saint Louis University. His doctoral dissertation research focused on the impact of maternal war trauma of South Sudanese women resettled in the U.S. on their U.S. born children. He can be reached by email: [email protected] .