As South Sudan this month marks its fifth anniversary as an independent nation, peace and stability remain elusive. Recent violence threatens the ceasefire agreement signed last year. Peace of mind is infinitely more fleeting. A report released by Amnesty International on July 6, Our hearts have gone dark, contains harrowing testimony of the mental health impacts of the mass killings, rape, torture, and abductions characterising South Sudan’s ongoing civil war.
With fighting between rebel groups and violence toward civilians intensifying, particularly since December, 2013, virtually no one in South Sudan has escaped the horror of this war. More than 10 000 people have been killed. 2 million citizens are displaced due to armed conflict, says the report. It documents the accounts of survivors and witnesses of violence as well as of health and government officials, and says that depression and symptoms of post-traumatic stress disorder are widespread. Many people interviewed knew of others who had attempted or committed suicide. The deaths and physical destruction of war are readily apparent but the psychological trauma is less visible, emphasises the report, and must be addressed.
The mental health effects of war and torture produce long-term psychological scars. These will threaten South Sudan’s ability to recover and rebuild its communities. Despite mental health being critical to the country’s future, agencies including WHO and donor governments have not prioritised mental health services. Traditional family support networks and community non-governmental organisations cannot possibly meet the needs. Mentally ill people are said to be routinely held in prisons without access to health care or medicines. The South Sudan health system, already in tatters, is ill equipped to cope. Just two psychiatrists are present in the country of 11 million people, and they work in one centre, Juba Teaching Hospital, with 12 psychiatric beds.
A letter in The Lancet in 2014 by two doctors who had trained 50 interns at Juba Hospital sounded an alarm for more attention to people with mental illnesses in South Sudan. The new report amplifies this appeal. International agencies and donors must support all efforts to end the war and its atrocities, but also must recognise and help repair the damage already inflicted on the hearts and minds of South Sudan’s population.