Forced from home
In Yumbe, northern Uganda, a town that hosts the largest refugee settlement in Africa, MSF community health educators like Emmanuel Rambo travel across a massive camp to encourage residents to take advantage of mental health support services. Rambo is South Sudanese, twice displaced from his hometown in Yei by conflict, and he can easily relate with the predominantly South Sudanese refugee population in the camp. “There is a stigma within the community—people do not understand what mental health is. Some associate [mental illness] with witchcraft,” he says. “And yet there is a huge need for mental health [care] among this population.”
MSF teams in Yumbe conduct around 900 consultations per month. “But I suspect we are seeing only a fraction of those who need our support,” Rambo says. He and his colleague Vastine Tayebwa, a clinical psychologist, believe that the high numbers of patients can be attributed to one main factor: displacement.
“It’s the sense of loss, past traumatic experiences, and future uncertainty that these refugees are facing,” Tayebwa says. “So far this morning I have seen six patients and already four more are waiting.” While a September 2018 peace agreement signed by the South Sudanese government and several rebel factions has reduced the level of violence, conditions remain volatile. Many refugees are not able to return home and still struggle with their experiences during the young country’s years of civil war.
MSF’s medical research arm, Epicentre, conducted a survey among nearly 10,000 South Sudanese refugees entering Uganda’s Yumbe camp in 2017 and found that nearly all—99.9 percent—cited attacks on their village of origin or neighboring communities as the reason for leaving their country. Mild or moderate mental health disorders can increase up to 20 percent during emergency situations such as conflict-related displacement, according to a 2012World Health Organization (WHO) report.