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This article participates on the following special index pages:
Post-election violence 2008 - Index of articles & images
Dealing with the "Complex Emergency" in Zim: Thoughts
on psychosocial support to the community
A P Reeler
September 18, 2008
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Background
Whilst there
is continual reference to the suffering of those affected by the
Zimbabwe crisis, particularly in reference to Operation
Murambatsvina and the burgeoning food crisis, insufficient attention
has been given to the mental health consequences, both psychological
and social, of the massive social upheaval and organised violence
and torture that has accompanied the crisis.
A strong argument
can be made that Zimbabwe now conforms to the kind of situation
currently termed a "complex emergency". In the context
of economic collapse, the collapse of all supportive services [health
and social welfare], severe food shortages, and mass violence, Zimbabwe
resembles a country at war, but in the absence of the obvious features
of war . The types of trauma reported, especially in the past 5
years, conform in most respects to those seen in obvious times of
war: the profiles for the pre-Independence period and Matabeleland
in the period 1980 to 1987 are markedly similar to that seen nationally
since 2000. Certainly, the mental health consequences seem wholly
similar to what would be seen in other complex emergencies where
there has been obvious war. It is worth noting again that international
commentators are now arguing that there is need to plan for the
kinds of assistance for Zimbabwe that would ordinarily be reserved
for post-conflict situations .
A complex emergency requires a strong and sustained humanitarian
response, and even the invocation of the "Responsibility to
Protect". Whether this will occur or not, the mental health
needs of those affected in the current crisis should to be addressed,
and any programme should adopt as a framework the following principles
:
- The co-ordination
of mental health care;
- Good basic
assessment of the problems and the establishment of a monitoring
process;
- Implementation
of an early intervention phase;
- Utilising
of the de-facto mental health system;
- Emphasis
on training and education;
- Implementing,
managing, and monitoring a culturally competent system of care;
- Stress on
ethics and community participation;
- Care to
prevent negative mental health consequences in mental health providers;
- Commitment
to outcome assessment and research.
These principles
are commonly recognised by various expert groups as the basic framework
for providing effective mental health care in complex emergencies,
and should be applied in Zimbabwe in the development of a national
programme for addressing the mental health needs of the Zimbabwe
population affected by both the current crisis as well as the earlier
periods of trauma.
There are now
a number of excellent reports on the crisis facing the displaced
in Zimbabwe, so it is of great concern that none have concerned
themselves with the mental health dimension of the crisis. Whilst
it must be acknowledged that food, shelter, and medical care are
always priorities in emergencies, it is also the case that the mental
health needs in emergencies are often overlooked. It is for this
reason exactly that the UN and other expert groups have made a decided
effort to keep the mental health agenda firmly in the strategies
developed for internally and externally displaced populations. This
be no less the case for Zimbabwe in its complex emergency.
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