Adapting to mass violence and displacement at an individual,

family and social level: Experiences in South Sudan

Prof. M. Sebit

College of Medicine, University of Juba, South Sudan

Presentation

1. Introduction: highlights of mass violence & Displacement from other countries

2. Overview of mass violence & Displacement in South Sudan

3. Adapting/Adjusting to mass violence & displacement

4. The way forward Mass Violence & Displacement

INTRODUCTION: MASS VIOLENCE & DISPLACEMENT: EXPERIENCES FROM OTHER COUNTRIES

Example-1: Kenya• Following presidential

election, 2007

• 1000 people were killed

• 500000 people displaced

• 11% male and 9% femalewere victims of violence

Example-2: Rwanda genocide civil war

• Tutsi and Hutu: 1994

• Estimated 500,000-1,000000 Rwandans were killed(1)

• Many more displaced/refugees

INTRODUCTION: MASS VIOLENCE & DISPLACEMENT: EXPERIENCES FROM

OTHER COUNTRIES 2#

Example -3: The Central African Republic Bush

War

• Around 10,000 people were displaced because of the civil unrest.[1

• Many people were killed

Over 5,000 people seeking refuge in Ntrama church were killed by grenade, machete, rifle, or burnt in Rwanda.

OVERVIEW OF MASS VIOLENCE & DISPLACEMENT IN SOUTH SUDAN

Juba in December 17, 2013

• Early estimates stated that at least:

a) 1,000 people were reported to have been killed[30-31 and

b) Over 800 other people were injured [32]

c) Eyewitness accounts also cite SPLM Dinka troops assisted by guides in house to house searches to Nuer homes and killing civilians in Juba.[33]

OVERVIEW OF MASS VIOLENCE & DISPLACEMENT IN SOUTH SUDAN

Juba in December 17, 2013

• Multiple sources confirm door-to-door searches for ethnic Nuer,

• Human Rights Watch and Amnesty International at least 200-300 Nuer men were shot by security forces at a police station in Juba.

• 1000s of Nuer civilians sought refuge in peacekeepers’ base. Nine months later, many still remain there.

• The Guardian and BBC reported that 240 Massacres of civilians Nuer men were rounded up and killed at a police station in Juba in mid-December 2013.[154][155]

A South Sudanese man holding a HK G3

OVERVIEW OF MASS VIOLENCE & DISPLACEMENT IN SOUTH SUDAN

Bentiu

• The conditions in Bentiu, the capital of oil-rich Unity state, represent a particularly appalling situation. Families are living knee-deep in water and fighting continues to threaten their safety. Women and girls are at risk of sexual violence, given cramped conditions and the breakdown in social and cultural norms as a result of the violence.

• The United Nations documents crimes against humanity, including arbitrary killings and attacks on churches, hospitals and international aid facilities.

• “Civilians were not only caught up in the violence, they were directly targeted, often along ethnic lines,” the report states

The Dead and Those Left in South SudanCreditLynsey Addario for The New York Times

Humanitarian ConcernsSouth Sudan

• Estimated 1.8 million people who remain displaced from their homes

• IDP: 1.35 million are within South Sudan and

• Refugees: 453,600 have fled to neighbouring countries

• Nearly 100,000 civilians are currently sheltering on U.N. bases around the country as South Sudan.

.

IDP

THE ORIGIN OF MASS VIOLENCE & DISPLACEMENT

a) Tribal mass violence & displacement e.g. RSS, Rwanda

b) Religious mass violence & displacement e.g. Iraq, between Sunni & Shiite

c) Greed for power & control e.g. Yemen, Western countries

d) Post election violence or Manipulation of the constitution e.g. Kenya & Burundi

Displacement

a) Internally displacement e.g. IDP’s Camps

b) Externally displacement e.g. refugee camps

c) UN Peace Keeping Force Compound e.g. RSS

Generally Five Factors that May Impact Negatively to adapting to mass violence & displacement

1. Safety/Security: The traumas and stresses associated with mass conflict are multiple, convey complex meanings to the survivor and community.

2. Bonds/Networks: Potential for positive adaptations, depending on the availability of resources (intra-personal or interpersonal) that can be mobilised to meet these challenges.

3. Justice: Preoccupation with cumulative injustices of the past can play a central role in maintaining psychological symptoms following exposure to persecution and human rights violation (Silove, 1999; Rees et al., 2013.)

Generally Five Factors that May Impact Negatively to adapting to mass violence & displacement 2#

4. Roles and Identities: Mass violence and displacement invariably impact on established roles within the family and the society, disruptions that demand active accommodation and adaptation.

5. Existential Meaning: Conflict and displacement represent a major disruption to the sense of continuity of life, compelling survivors to re-appraise, and at times, to revise fundamentally their world views and systems of belief.

Adapting/Adjusting to mass violence & displacement

• Refugee camps: children adapt more easily than adults

• IDP’s camps: children adapt more easily than adults

• Big cities/towns: Destitute children may adapt to bad habit e.g. becoming commercial sex workers/ glue sniffing, pick pocketing etc.

• Mass exudes to Europe: drowning, mass death

• Mental illness: PTSD, depression, PTSD + alcoholism etc.

How to Assist Victim of Mass Violence & Displacement

a) Crisis Response

b) Consequence Management

c) Criminal Justice Support

d) Crime Victim Compensation (available any time) to reimburse victims for out-of-pocket expenses

e) Training and Technical Assistance – to identify resources, assess needs, coordinate services to victims, and develop strategies for responding to an event

Examples of Support Needed

• Counselling services

• Compensation for medical & mental health costs, lost wages, and funeral expenses

• Emergency food, clothing, transportation, and travel

• Temporary housing

• Repatriation of remains

• Cleaning and return of personal effects

• Child/dependent care

• Physical and vocational rehabilitation

• Employer and creditor intervention

• Some victim-related ME & law enforcement costs

• Needs assessment and planning

• Support for victim participation in criminal justice proceedings

• Victim outreach and notification systems

Challenges to Peace in South Sudan

• The path to a lasting peace will require addressing not just the immediate challenges presented by the current conflict, but those that existed long-before independence was achieved such as:

a) corruption,

b) political party reform, and to have National army, security & police etc.

c) inter-communal violence

d) tensions over oil-sharing revenues with Sudan.

e) the injustice and the issue of tribal hegemony

• As a result of corruption, the Government of South Sudan failed to invest in public infrastructure, education, or health care etc..

The way forward Mass Violence Lessons & Displacement

• Help communities prepare and respond to mass violence

• Compendium of Resources, operational procedures, best practices, and lessons learned

• Planning through long-term victim support

• Checklists: Planning/Partnership, Response, Recovery

• Emergency planners, law enforcement, prosecutors

• Victim service providers and health care/mental health providers

The way forward to addressing Mass Violence & Displacement 2#

• Step-by-step approach to help develop a comprehensive victim assistance plan for mass violence incidents

• Bring together key partners to review emergency plans and integrate or refine victim issues

• Victim assistance protocols can enhance the effectiveness of response and recovery.

• Response and Recovery checklists can assist communities address immediate and longer-term victim issues.

A CASE STUDY

Home: Malakal Town: Exchange hands several times between SPLA & rebels

Age: An 8yrs old child, milestone: Normal; No PPHx or M Hx

• Education: Primary Two

• Both parents alive & well

• No family history of mental illness

• C/O sudden on of verbal & aggressive behaviours

• Home: Malakal Town: Exchange hands several times between SPLA & rebels

• Age: An 8yrs old child, male,normal milestone: ; No PPHx or M Hx, sibs: 1/2

• Education: Primary Two

• Both parents alive & well

• No family history of mental illness

• C/O sudden on of stoning vehicles, verbal & aggressive behaviours 3wks prior to referral

• HPI: stoning vehicles accusing the owners to have killed his grand mother ( alive), running after soldiers/police & stoning the them. Occasionally he would have night terrors and want to open the door to challenge the killers; visual hall (seeing the killers)

• He was very aggressive to me & refused to be interview or examination.

• .Qs: what would be the provisional diagnosis & treatment.

• What was the prognosis?

THANKS