Providing Psychological Care to People Displaced by Xenophobic Violence in South Africa

One month into its medical humanitarian intervention following a series of violent xenophobic attacks in South Africa’s KwaZulu Natal (KZN) province, Doctors Without Borders/Médecins Sans Frontiéres (MSF) is reorienting its work to meet the psychological needs of traumatized foreign nationals taking shelter in the single remaining displacement camp, in addition to offering medical support in Malawi and Zimbabwe.

The Chatsworth camp, south of the coastal city of Durban, is currently home to 520 foreign nationals, mostly refugees and asylum-seekers from Burundi and the Democratic Republic of Congo (DRC). They were left behind after more than 3,000 Malawians, as well as several hundred Mozambicans and Zimbabweans, were repatriated to their home countries.  

Just after the attacks, about 7,000 people sought refuge in three different displacement camps in Durban. The Burundians and Congolese are now stuck in limbo: they cannot be repatriated to the conflict zones they originally fled, but they don’t feel safe re-integrating into South African communities that they were driven out of just weeks earlier.

Shifting Focus to Psychological Needs

MSF psychologists found significant levels of post-traumatic stress among the majority of camp residents assessed, as gauged by the internationally recognized Harvard Trauma Questionnaire, which rates the frequency with which patients experience nightmares, flashbacks, or a sense of hopelessness and helplessness.

“The kind of trauma I saw in the Chatsworth camp is similar to what I’ve seen in displacement camps in Central African Republic and South Sudan where people have exposed to active conflicts,” said MSF psychologist Gail Womersley. “From our interviews with these camp residents it’s clear that some have suffered cumulative traumas. They have experienced violence in their country of origin, again during the 2008 xenophobic violence, and yet again in 2015. However, they also tell us about the daily level of discrimination and alienation they experience—at hospitals, in minibus taxis, and from police elsewhere.”

Since early May an 11-person MSF team—which includes medical doctors and nurses—has been providing psychological counseling sessions for groups and individuals, including children. Working in close collaboration with the KZN department of health, the team has provided more than 1,400 consultations to displaced people since April 14 through a regular mobile clinic at the camp. Prior to this, the team’s objective was to provide support services where there were gaps in the response: for daily medical care, water and sanitation services, help for survivors of sexual and gender-based violence, and improved camp management. The team is now handing over full responsibility for health care provision to the health department in order to focus on psychological needs.

"People Remain Fearful"

“The community integration efforts by the government have started, supported by the United Nations High Commissioner for Refugees,” explains Ainslie McClarty, MSF nurse and deputy project coordinator. “However, the displaced people are telling us that they don’t feel like they are safe and secure enough to re-integrate now. News of foreigners being swept up in police operations and reports of violence fuel their insecurity. People remain fearful, and they have not had time to adjust to a process that will determine their future. They need to build trust in the authorities and progress is slow. This is easily undermined when people are not directly involved in consultations and decisions affecting their future.”

MSF has expressed concern about the clear contradiction between local authorities’ conciliatory approach taken in favor of community reintegration efforts and the aggressive national crime-fighting operations by police, the military, and the home affairs department. These raids have seen more than 700 foreign nationals arrested and detained because they were without documents, and they are now subject to deportation.

During the mass repatriations from Durban to Malawi and Zimbabwe, MSF teams working in regular HIV programs in these countries mounted short-term responses to assist the repatriated nationals in Blantyre and Beitbridge, respectively.

The MSF teams provided medical screenings and referred injured or at-risk patients for further care after stabilizing them. Psychologists in both Malawi and Zimbabwe counseled people traumatized by the violence and upheaval. In Malawi, where 3,831 people were repatriated, follow-up work will be done based on the needs of some people who have now re-settled in Mangochi as they begin to pick up the pieces of their lives.