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TOWARDS PEACE OF MIND


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CONTENTS 04

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PSYCHOSOCIAL SUPPORT ON THE AGENDA

“I BELIEVE KNOWLEDGE MUST BE ACCESSIBLE”

PSYCHOSOCIAL SUPPORT FOR HAPPIER FAMILIES

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2018 IN NUMBERS

TAKING CARE OF ROHINGYA REFUGEES IN COX’S BAZAR, BANGLADESH

2018 IN BRIEF

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NOBEL PEACE PRIZE FOR SUPPORTING SURVIVORS OF SEXUAL VIOLENCE

WORKING FOR BETTER MENTAL HEALTH CARE IN REFUGEE CAMPS

FINANCE AND ORGANISATION

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25

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CONNECTING ACADEMIA WITH HUMANITARIAN AID WORKERS

SUPPORTING MENTAL HEALTH CARE STRUCTURE IN BURUNDI

THANKS TO OUR DONORS


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12 14 30

25 27

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PSYCHOSOCIAL SUPPORT ON THE AGENDA

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he need for mental health and psychosocial support in humanitarian settings is increasingly recognised. There is a rise in political pressure on governments and humanitarian aid agencies to give more serious attention to mental health care. Celebrities - like Lady Gaga and Prince Harry of the United Kingdom - are speaking out in support of the issue. Mental health in humanitarian settings is a priority in the policy paper of the Netherlands’ Minister of Foreign Trade and Development Cooperation, Sigrid Kaag. Development agencies have started to appoint mental health advisors, but what remains lacking is the financial commitment and support to address the issue on a larger scale. War Trauma Foundation is proud of what has been achieved in 2018 to improve people’s lives and to add value to the mental health and psychosocial support provided by health care and community workers. During the past year we kickstarted a national programme to increase psychosocial support in Burundi, a country which until recently counted only one psychiatrist. We were also able to support community workers and health personnel in Ethiopia, Kurdistan, Sudan, among many other places. Memorable was the training at the Panzi hospital in Bukavu, the Democratic Republic of Congo. Here we helped local staff better understand and support young adolescents confronted by sexual violence. When we arrived in Bukavu for our second week of training, the news broke that the hospital’s founder, gynaecologist

Dr Denis Mukwege, would receive the Nobel Peace Prize. It is an important recognition of the incredibly hard and valuable work of Dr Mukwege as well as the staff in the hospital. In 2018 we made the transition of our Intervention Journal to an open access internet platform. In the new platform we have been able to attract more readers and also receive more submissions. As a result there is more study being done on the effectiveness and impact of mental health and psychosocial support in humanitarian settings. In this annual magazine you will read stories on these and other efforts to improve the psychosocial well-being of people around the world. We hope you will appreciate our report and can find enough reasons in these stories to continue your support for War Trauma Foundation. Thank you for your trust,

Ate Osinga Director a.i.


FIGHTING DEPRESSION IS VITAL FOR THOSE TRAPPED BY CONFLICT. “We need to engage the youth, to discuss their problems,” says Gatluak Stephen, an internally displaced South Sudanese man. War Trauma supports him and others, to help young people address the loss of hope in the community.

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2018 IN NUMBERS

Sweden

Germany

213

People trained Together these support over 1.000.000 refugees and internally displaced people

Netherlands Turkey Switzerland

Iraq

37

Lebanon

30 West Bank Egypt

Jordan

28 Sudan

75

Health professionals

14 Ethiopia

138

Community workers

Sierra Leone Total number of people trained Research and policy advice

42

Democratic Republic of the Congo

Burundi

62


INTERVENTION Our scientific journal is accessible online free of charge

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Issues

61

Articles submitted

47

Articles published

8880

Downloads

Bangladesh

RICH OR POOR?

50% 50% Middle Income Countries Low Income Countries

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NOBEL PEACE PRIZE FOR SUPPORTING SURVIVORS OF SEXUAL VIOLENCE Imagine arriving at a hospital for victims of sexual violence, just as the news breaks that its founder will be receiving the Nobel Peace Prize. This is what happened to our trainers when they arrived at the Panzi Hospital in Bukavu, East Congo.

“T

he psychological staff of Panzi Hospital were very excited about the Nobel price,” says Linda Verhaak, Clinical Psychologist and leader of the Expertise Team on Sexual Violence and Exploitation. “It is considered a great international recognition for all the very difficult work they and their colleagues have been doing for many years.” Bukavu, East Congo, close to the green hills of Rwanda and on the south coast of Lake Kivu. A city in breath-taking scenery whose people are still coping with the violence of its recent history. While newspapers describe the city as the rape capital of the world, Bukavu is also a place where people are building a better and brighter future for themselves and their fellow Congolese. During the aftermath of the genocide in Rwanda, cities just inside the Democratic Republic of Congo such as Goma and Bukavu were overwhelmed with refugees. For many years the area became a base of operations for ethnic militias and on occasions was part of the frontline. Rebel leader Kabila started his armed

movement here. He later became president and his son only recently resigned in contested elections. Bukavu also suffered violence from other armed groups, such as that of General Nkunda who let his troops terrorise citizens of Bukavu by raping 16,000 women in the city in one weekend. Gynaecologist Dr Denis Mukwege is one of two doctors in the region who is able to perform reconstructive surgery, helping women with genital wounds – 60 percent of them are the result of sexual violence. Part of the philosophy of his Panzi Foundation is to support these women not only to heal physically, but also psychologically. Around the Panzi Hospital a structure has been set up to help victims of sexual violence – survivors as they prefer to be called – to heal both their physical and their mental wounds. A group of psychologists and psychosocial workers who are called Maman Cherie - “Sweet Mothers” - help them to pick up their lives again.


“Rape isolates women from their community and families and entire societies get disorganized.�

Democratic Republic of the Congo

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“Panzi Hospital operates to help victims of sexual violence to heal both their physical and their mental wounds.�


“It’s tough work, emotionally, and complicated as many cultural factors are in play like shame and taboo,” says Linda Verhaak, “Raped women get isolated from their community and families and entire societies get disorganized. On a larger scale impunity is a very big problem.” In recent years there has been a growing number of children and adolescents who have been coming to the Panzi Foundation. The children and adolescents have been confronted by sexual violence in different ways: some are survivors of sexual violence, others have been forced to rape others or to witness sexual violence. There is also a group of children who have been born out of rape and have been abandoned by their mothers. This has been very challenging for the psychologists and the Maman Cherie. When working with the youngsters they have been unsure what behaviour is caused by normal puberty and adolescence, and what has been influenced by their traumatic experiences. WarTrauma trainers helps them better understand and support the young people in their development, as well as with attachment issues. The day our trainers arrived in Bukavu for the second week of training - which was mainly focused on additional techniques to support the children – the news broke that Dr Denis Mukwege – still the medical director at Panzi Hospital – would be receiving the Nobel Peace Prize. The recognition of their work is extra motivation for the staff to support the thousands of victims of sexual violence in the Democratic Republic of Congo. Verhaak: “We noticed a big eagerness to get more knowledge about how to help the survivors best, so the participants made it clear that the prize didn’t change the necessity of their work, but actually only underlined the urgency of it.”

THE STORY OF DR. MUKWEGE Dr Denis Mukwege was born in 1955 in Bukavu. He studied medicine at the University of Burundi in Bujumbura. After some years as paediatrician in rural Congo he specialized in Gynaecology to help women suffering genital leisure and fistula following childbirth. He returned to his rural hospital, but during the First Congo War moved to Bukavu where he founded the Panzi hospital in 1999. Also in its early years the hospital was supported by War Trauma Foundation. Panzi Hospital has treated over 80,000 patients with complex gynaecological damage and trauma. Around sixty percent of the injuries have been caused by sexual violence and Dr Mukwege has since specialised in reconstructive surgery to aid victims of sexual violence. In 2012 Dr Mukwege gave a speech at the UN General Assembly condemning mass rape as weapon of war and the failure of the Congolese government to stop it. The speech lead to an assassination attempt at his home in Bukavu only a few weeks later. After a few months exile, he returned to the hospital where he is still medical director. Belgian director Thierry Michel made a documentary about his life and works titled: “The Man Who Mends Women: The Wrath of Hippocrates.” Dr Mukwege received the Nobel Peace Prize 2018 together with Ms Nadia Murad. Ms Murad is an Iraqi Yezidi human rights activist who was kidnapped and abused by Islamic State before escaping.

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CONNECTING ACADEMIA WITH HUMANITARIAN AID WORKERS WarTrauma has been advocating for better mental health and psychosocial support in humanitarian settings for over two decades. Stimulating mental health professionals working in emergency settings to share their experiences and knowledge has been a central objective of Intervention Journal since it was published first sixteen years ago.

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arTrauma brings mental health care knowledge to countries and cities in crisis. In the training and during our assessments we are working with community workers and other humanitarian workers who often have a lot of experience and important stories to tell. The stories and knowledge inspire our trainers and researchers as they develop and adapt methodologies and new theories. WarTrauma quickly realised that our own experts can learn a lot from the real research and stories from the field. Making this knowledge available to professionals working in conflict-aected areas, and to those working with refugees from areas of armed conflict around the world is an important motive for War Trauma to publish Intervention Journal. Early in 2018 the Journal became available through an open access platform, meaning people without access to academic libraries and institutions are now able to download and read articles for free. Audience and readership quickly rose and so did submissions.

Providing a peer-reviewed platform to publish articles helps scholars and practitioners working in humanitarian settings to sharpen their academic and research skills. Writing an article entails analysing your methods, describing your experiences clearly and creating an evidence base for psychosocial interventions. This experience often improves the quality of the research itself. Focusing on empirical research, practical experience, case studies and literature reviews, last year Intervention was able to publish two special thematic issues. The first focuses on Psychosocial Support and Conflict Transformation, exploring the role of mental health care in peacebuilding and a post conflict society. The second special issue on mental health and psychosocial support in Afghanistan is designed to provide a platform for young Afghan scholars and practitioners and to create a base of articles on mental health care to be used as reference and learning material for students at the University of Kabul.


“Intervention’s Afghanistan issue creates reference and learning material for students at the University of Kabul.”

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“ I BELIEVE

KNOWLEDGE MUST BE ACCESSIBLE

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E

nd of 2018 Marian Tankink ended her five-year tenure as Editor in Chief of Intervention Journal. Marian has been involved with Intervention for many years and supported its development from a paper-based journal to an open access online publication. As a medical anthropologist and former community psychiatric nurse, she works as a researcher, trainer and developer of practices and approaches for (inter)national organisations and institutes, mainly in the Great Lakes Region in Africa. Her work focuses on interpersonal interaction in relation to gender, (sexual) violence, psychosocial well-being, and mental health in (post) conflict areas and among refugees. Currently she is involved in research into how linking organisations that work in mental health and peacebuilding will increase the psychosocial well-being of individuals and communities and create a better basis for achieving sustainable peace. You have seen the Journal Intervention change during your time as an Editor in Chief, what do you feel are some of the most significant changes in the Journal? It is difficult to pinpoint such changes. Many of the changes were small and slow. The objective of Intervention is still to share research and make a connection between the academic world and people who work in the field. Also, content wise it is difficult to pinpoint large changes, though it seems there is a move towards more evidence-focused articles and on articles focused on refugees and on children.


The transcripts submitted have always been very diverse. The privilege of being an editor in chief is that one can provide some direction through special sections or issues. We must have been one of the first looking at the longterm psychosocial development of former child soldiers: what is the state of mental health of former child soldiers after they have been demobilised, deprogrammed and returned home? What happens to them? As editor I also appreciated how we can react quickly to events. During the Ebola crisis within half a year we had a special issue on the mental health impact of the crisis, for example what happens to the mind of a mother when her child is sick with Ebola? My last issue, the special edition on Afghanistan, was also a great issue, because we hear and learn so little about the state of mental health care in Afghanistan. We understand and know nothing because of the difference in culture and language. Having an issue for Afghanis, by Afghanis is fantastic. How was the change from print journal to open access publication? To be honest, the work and the process was hard and difficult, but I am very proud we made it as a team. I believe that knowledge must be accessible, especially in our field where many of our potential readers do not have access to academic libraries. So having open access really contributes to our mission in that sense. With open access even the number of submissions

seems to have increased. Last year there were 25% more articles submitted. This year we will find out if this is structural. In the past few years some crises ended and new disasters happened. Did you see these changes reflected in the articles submitted? With a journal one generally works ahead one year, so with a delay we have seen the warzones move from Iraq and Afghanistan to Syria and Yemen. But it is true we have seen the articles move to increased attention to children, to the Yezidi and to the refugees in Turkey. The mental health impact of sexual violence remains an important topic. New for me was the attention to the relationship between parents and children, how does a parent deal with a stressed child? Also interesting is that one can sometimes be a little political, discussing the mental health effects of the Trump policy of separating refugee parents and children, or how Europe deals with refugees. As editor you have also been a coach to many new authors. Can you tell us how this went? The coaching has been interesting and rewarding. We try to connect the academic world with the people in the humanitarian field. This means that some of our authors working in warzones have never learned how to write an article. They have important and interesting experiences and insights to share, but they do not know how to guide a reader. As an editor you need to find the pearls and stimulate the author to give the article an introduction, body

“Some articles just need a few tweaks, others need a lot of work.”

and conclusion. Some articles just need a few tweaks, others need a lot of work. Can you recall an author that went through significant development? Most authors only publish once or twice in Intervention so this is difficult to see. There are some authors that did submit multiple stories, and you do see there is a development in the quality of their writing over the years. They learn what the focus of Intervention is. The fact that people are submitting multiple times is also quite special given the relatively low impact the Journal has. Coaching an author is also something you need to do with respect. Sometimes you do need to warn them when you send your reviews because it looks so full of track changes. I really liked the relationship with the authors. In the email exchanges people become very human and personal. Now some still contact me outside my role at Intervention, just to get tips on research. I had not expected this and it gives me a lot of energy to have been able to mean something in peoples’ lives and academic development. I am going to miss this.

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TAKING CARE OF ROHINGYA REFUGEES IN COX’S BAZAR, BANGLADESH The Rohingya crisis in South East Asia has led to the creation of the world’s largest refugee settlement around Cox’s Bazar in Bangladesh. WarTrauma supported the Royal Tropical Institute KIT with their assessment of available mental health and psychosocial support services in the area.

O

ur expert research and assessments can provide an important added value to governments, NGOs and agencies aiming to improve mental health care services in humanitarian emergencies. For example, in 2016-2017 WarTrauma contributed to a regional MHPSS plan in the tense North West Region of Pakistan, which is now being implemented by the regional government. In Bangladesh we provided KIT with an expert review of their assessment of mental health care provision in the world’s largest refugee settlement. Myanmar – or Burma as it used to be called – was under the rule of a very closed military regime for decades but has been opening up over the last few years. The main opposition leader Aung San Suu Kyi - 1991 Nobel Peace Prize laureate - was under house arrest for 15 years before being released in 2010. Following elections she became president, but is now being criticised for her handling of the unrest with the Rohingyas. Due to guerrilla fighting and army reprisals, around one million Rohingyas fled to neighbouring countries.

Bangladesh

Most of the refugees came to Bangladesh and made their homes in formal and informal

settlements around Cox’s Bazar, a fishing port and important tourist destination in Bangladesh. According to humanitarian agencies, the Cox’s Bazar district is the largest refugee settlement in the world, housing around 900,000 people. Parts of the district used to be forested areas but have been cleared by refugees building huts and shelters. An important recommendation coming out of the assessment of the Royal Tropical Institute is for all partners working in the humanitarian assistance and (future) development programmes in Cox’s Bazar to provide integrated, effective and culturally appropriate services to the Rohingya. Examples could be to encourage peer support groups and employ refugee community workers to give mental health training and psycho education to other health care providers and counsellors around sexual and reproductive health and genderbased violence. It also is important to develop referral pathways around mental health for all organisations, learn from best practices and scale up the most effective interventions. Seventy-year-old Rohingya grandmother Hanibi - traumatised after seeing two family members shot - receives counselling from 18-year-old community health volunteer Formin.


“People are still carrying strong memories of the violence they faced back in Myanmar.�

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WORKING FOR BETTER MENTAL HEALTH CARE IN REFUGEE CAMPS UNHCR The world currently houses around 68.5 million forcibly displaced people. Of these, around 40 million are internally displaced. Over 25.4 million people are refugees and some 3.1 million have requested asylum. The UN High Commission for Refugees, UNHCR, is one of the agencies safeguarding their rights and well-being. UNHCR helps refugees with protection, shelter, education and health programmes to heal their pasts and build brighter futures. War Trauma Foundation works closely with the UNHCR to improve the mental health and psychosocial situation of refugees. We train people working in refugee camps to identify and manage mental health problems. While many people need only a limited amount of psychosocial support to experience better mental health, it is important for community workers to know when to refer people to specialised psychological or psychiatric care. In 2018 we conducted training to support people in Sudan and Ethiopia.

SUDAN AND SOUTH SUDAN

W

arTrauma has provided training to dierent groups in Sudan and South Sudan over the years. The Sudanese conflict has been one of the longest lasting in African history. After a first civil war there came a second civil war lasting from 1983 to 2005. South Sudan became an independent state in 2011 but in 2013 ethnic and tribal tension led to a new war. Refugees streamed to both sides of the border between South Sudan and Sudan. The refugee camps formed themselves along ethnic lines, with one or sometimes two ethnic groups living together per camp. Supporting the health units of UNHCR and other NGOs in the refugee camps, we trained 26 medical doctors in the Sudanese capital Khartoum. The doctors came from camps in three states along the border of South Sudan and Eritrea. To

help them provide mental health care and diagnosis, we provided training to recognise the most frequently appearing mental health conditions such as psychosis, acute stress, depression, grief and post-traumatic stress disorder, but also gave more information about epilepsy. Working in refugee camps themselves, they discussed how the dierent services in their camps were organised, how the camps could become safer places and how a psychosocial support structure could be integrated with other services.

Sudan

South Sudan


“ War Trauma Foundation works closely with the UNHCR to improve the mental health and psychosocial situation of refugees.�

Children at the Khor Al-Waral camp play in front of their school.

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20 “In the past five years of war I have seen many people who I now realise may also have mental health problems. The mhGAP training will help me to find those missing cases. It will also help us to take better care of ourselves. We usually ignore self-care.” Diang Puch, 34 years old, medical doctor in Alagaya in White Nile State, a camp with 19,000 refugees

The doctors are working in camps housing between 9,000 and 45,000 refugees of different tribes and will be training their team in the UNHCR health units. In all camps combined there are over 500,000 refugees. The training also helped the doctors to deal with their own stress levels. They were able to share some of the terrible things they hear but also experience themselves. One of the doctors told the story of operating on a patient who came in wounded after a fight between refugees and the host community, when one of the parties came to mete out their revenge and killed his patient on the operating table. Other stories also told about frustration and high work pressure, but the participants completed the training feeling positive and motivated to provide better mental health support and go back to people they think they might have misdiagnosed.

“We mainly focus on the medical and physical problems and not on the mental issues. I have seen many suicide attempts. One family that I need to start working with when I get back is where one girl tried to kill herself, but we managed to save her. Her mother has been very upset, because the sister of the girl had already committed suicide. The camp where I work is very busy. Every day people start lining up before 5 am. People are waiting before you’ve had breakfast. Most aid organisations just come to our camp, do a project and leave no structure behind. The mhGAP training will actually help us to help ourselves.” Nyawela, 32 years old, medical doctor in Al Redias 2, a camp in White Nile State with 24,000 refugees


“The self-care session was very good; sharing the stress was nice. Sometimes after a session I feel sad or angry. Then I lock the door when the client has gone and cry or kick against the wall. Luckily, when there is a patient who tells me how he or she is getting better, I am very happy. It is very rewarding work.� Rania, 35 years old, a mental health supervisor working in two refugee camps, El Keshafa (13,000 people) and Khor Al-Waral (45,000 people)

ETHIOPIA

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n Ethiopia we supported health and community workers from five camps near the border with South Sudan. In these camps there are refugees from the Sudanese conflict who sometimes have been living there since the 1983-2005 civil war. The area remains tense: security issues in the area prevented some of the intended participants from travelling to attend the training. Most of these community workers had been trained by WarTrauma a few years earlier. This was our first opportunity to return to them to provide additional support and supervision and discuss peer consultation methods. Experts agree that feedback and supervision moments such as these are essential in the skills development of psychosocial workers. However, they do not happen very often. In the four years we have been supporting UNHCR with mhGAP training sessions, this is the first time we were able to do such a refresher and supervision. We hope it will inspire other agencies to do the same.

Ethiopia

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22 “Psychiatry was part of my education but we studied it only briefly. The way of discussion and the way of training we received now just blew me away. Normal training sessions are just endless powerpoint presentations. Here we were really challenged. With the role plays and the discussions you can really check if you learned.� Khaltoum, 29 years old, a medical doctor in El Nimr camp in East Darfur where there are about 9,000 refugees from the Firteet tribe


“In the refugee camp we work on many different medical interventions, including mental health. There is active work done around sexual and reproductive health and rights and HIV, but we realize we can improve in mental health care. This training will bring us knowledge so we have more confidence working on mental health. It will also help me and my colleagues to take care of ourselves and cope with the stress our everyday work brings us.” Basheir, 26 year old, a Medical Activity Manager for Medicines Sans Frontier until December 2018. He worked at the Khor Al-Waral refugee camp where there are 45,000 refugees

“As a veteran trainer, the experiences remain valuable to myself as well. I have learned a lot from other trainers and from working in different cultures. In my experience the engagement differs from group to group. Health professionals are usually less interactive, while community health workers in contrast are often very much engaged. The challenge with the trainings is that there is a lack of continuity and supervision for people to really master certain skills.” WarTrauma trainer Benyam Worku is a psychiatrist who teaches at the University of Addis Ababa, Ethiopia.

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24 “Many Burundians are suffering from traumatic stress due to civil war, genocide and instability, often in combination with extreme poverty.�


SUPPORTING MENTAL HEALTH CARE STRUCTURE IN BURUNDI “Burundi needs your support,” wrote Amy Besamuca in her first email to WarTrauma. Dr Besamuca has been working in the small country in the Great Lakes region in the heart of Africa for around ten years, dividing her time between her own practice as a psychiatrist in the Netherlands and supporting the sole mental health facility in Burundi. However, since political tensions in 2015 development assistance to the country has been limited and at the same time she saw the need for psychosocial support increase.

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urundi has faced many crises in the past half century. Since its independence in 1962, the country has experienced civil war, genocide and instability. Most Burundians have at one point in their lives been refugees or internally displaced. Substance abuse is a significant problem. As a result, many Burundians are suffering from traumatic stress due to their experiences, often in combination with extreme poverty. The country ranks third on the list of the world’s poorest countries. With 12 million people Burundi is quite densely populated, but with a population that is largely rural and bad infrastructure. According to statistics, around half of Burundians have no access to even the most basic healthcare services. Where in some countries 100 km is a few hours driving, in Burundi the same distance may take up to two days to cover.

In spite of all these problems, there has always been great potential. There may be only one psychiatrist working in the public health field, but the one national psychiatric hospital Centre Neuro Psychiatrique de Kamenge - has very committed staff. Amy Besamuca explains: “CNPK collaborates with general hospitals in several provinces and works with a multidisciplinary medical team visiting these hospitals and a prison.” Her request planted a seed with WarTrauma. Over the past few years WarTrauma has been increasing access to mental health services on a local or provincial level by working with partners in NGOs, UN agencies and local and regional governments. With our experience in health systems strengthening and our vision of integrating mental health in other services we recognised we could have a national impact in Burundi.

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26 To increase access to mental health care, there has to be a structure of sustainable first or second-level community-based mental health care, rehabilitation, prevention and more. Thanks to our donors we were able to train twelve of the staff at CNPK to become trainers themselves. These trainers will be teaching staff and community workers in remote provinces how to provide basic psychological care and to recognise when referral to a specialist psychologist or psychiatrist is needed. During the first phase of the project these trainers were supported to teach 50 people working in areas relatively close to the capital how to provide mental health care. The training has opened the eyes of many of the healthcare providers trained. They were helped with basic knowledge around mental health and psychosocial support. Trainees now better recognise the dangers of harmful substance and alcohol abuse,

“Language is important in healing from trauma. Without words people cannot express mental issues, they are unable to explain what they feel. We must invent new words in Kirundi for these mental health problems, because those words don’t exist yet.”

and some realised for the first time that epilepsy was not contagious. Maybe most important is that the training has started to provide language for describing and discussing mental health issues. “Language is important in healing from trauma. Without words people cannot express mental issues, they are unable to explain what they feel,” participants explained. “Words are also important to create awareness and

decrease stigma. We can help people with mental health issues and chaining someone with psychosis to a tree is not a solution. We must invent new words in Kirundi for these mental health problems, because those words don’t exist yet.”

Burundi


PSYCHOSOCIAL SUPPORT FOR HAPPIER FAMILIES The Multi-Family Approach is a psychosocial support methodology developed by War Trauma Foundation. After WarTrauma trained groups in the Occupied Palestinian Territories, these are now ready to train other groups in the region facing similar challenges.

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ased on the Multiple Family Group Therapy, WarTrauma has been developing and adapting the approach with families on the Palestinian Westbank over the past few years. Due to restrictions following the military and political situation the resilience of ordinary citizens in the Territories is under severe pressure. The psychosocial support helps people to be more balanced and makes for happier families, with children who perform better at school, less intimate-partner violence and fewer burned-out mothers.

These added skills will help the supervisors working with the Multi-Family Approach in the Palestinian Territories to be more self-suďŹƒcient.

We are supporting local knowledge and implementation partners such as Birzeit University in Ramallah and the community support groups CBR and ICPH, who are by now almost fully independent in working with the methodology. For example, we organised special supervision sessions with focus on peer consultation to sharpen some of their skills and include a self-evaluation mechanism.

Following a first meeting in Amman, Jordan, the Palestinian trainers were able to travel to Kurdistan to provide training in the cities of Duhok and Erbil, where many people live who have been subjected to the rule of Islamic State, including a large group of Yezidi.

The experienced groups in the Palestinian Territories are a valuable resource for WarTrauma and these new experts have started to support the implementation of the Multi-Family Approach elsewhere. There has been continuous exchange between the West Bank and partners from Kurdistan.

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28 Kurdish governmental and nongovernmental community organisations and a group of specialists who work with vulnerable groups and war victims within their communities attended the training. The trainers gave an history of the Multi-Family Approach and some of its key features, using their own experiences as examples. With Kurdistan being an emerging state in turmoil, this is an opportunity to learn from the Palestinian organisations that have been working for a long time in similar settings. The training also looked at the function of the Multi-Family Approach groups, the objectives of forming the groups, how to

Iraq

form the groups, and practising the MFA skills through different kinds of role play. “The people in the groups were fascinated by the training,” according to trainers Samar Abuomar and Eman Owda, both CBR community workers. “The trainees have experience in community work, and they were able to share and think about their experience and their ways of working with groups. They were also very keen to learn new skills.”

“The Multi Family Approach supports happier families, with children who perform better at school, less intimate-partner violence and fewer burned-out mothers.”

Following the training, two modules were translated from English to Arabic. At least six multi-family support groups were set up in Erbil and Dohuk. Based on the experiences, WarTrauma wrote a paper to be published in the special issue of Humanitarian Exchange on MHPSS in Humanitarian Crises.

Internally diplaced Yezidis have taken refuge in unfinished buildings in Daben city, Kurdistan, Iraq.


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2018 IN BRIEF WITH AND FOR SYRIAN REFUGEES In the STRENGTHS programme WarTrauma is part of a consortium of organisations in Europe and the Middle East aiming to improve psychological aid for Syrian refugees. When the Syrian war broke out a large group of refugees spread over the Middle East and Europe. Many of them have had traumatizing experiences before or during their flight. However, in the Middle East there are not enough trained specialist to provide mental health interventions, while in Europe there is a shortage of psychologists who speak Arabic. In the programme Syrian volunteers are trained in the Problem Management Plus (PM+) method to provide psychosocial support to other Syrian refugees. Together with our two Dutch partners i-psy and the Vrije Universiteit (VU) the first groups of volunteers were trained and we are now researching the impact of the interventions. The project is funded through the European Union’s Horizon 2020 Research and Innovation programme Societal Challenges.

ALTHEA RESEARCH NETWORK Sharing knowledge is a key objective of War Trauma. For young researchers it is especially useful to open up their research ideas, results and conclusions to the criticism of outsiders. This is why WarTrauma cofounded the Amsterdam Global Mental Health Research Network ALTHEA together with de Vrije Universiteit (VU) Amsterdam and the University of Amsterdam (UVA). The ALTHEA network is meant for researchers working in global mental health, interested to expand their network, seeking partnerships through joint programming/consortia, or simply want to get challenged on their research activities. Three times a year ALTHEA has informal meetings during which three dierent researches are presented.


WAR TRAUMA FOUNDATION BECOMES ARQ INTERNATIONAL War Trauma Foundation continues as ARQ International within ARQ National Psychotrauma Centre. ARQ is a leading institute in the field of psychotrauma and brings together knowledge and expertise. ARQ was set up by Centrum ’45, a mental health care facility operating since 1973 to support survivors of the Holocaust and the Second World War and by now many other groups of clients. ARQ offers preventative support and advice, conducts scientific research into psychotrauma and provides training and courses. In addition ARQ advises organisations and governmental agencies on optimal care for people confronted by traumatizing events. We do this since the Second World War, with a strong focus on innovations: in the Netherlands and worldwide. ARQ International focuses on prevention of psychotrauma in warzones and disaster areas by setting up and improving available psychosocial support locally.

HOLSLAG DONATES PROCEEDS OF BOOK Author Antonie Holslag donated the proceeds of his books to War Trauma Foundation. Holslag went through a traumatizing experience himself being a victim of random street violence, leading him to write about the experience. The funds are meant to support Yezidi women in Kurdistan.

NEW TRAINING ON MATERNAL MENTAL HEALTH “Mental health often appears to be considered an unaffordable “luxury” for women in resource-poor settings”, stated the WHO in 2009. While a lot has been done to improve the physical well-being of mother and child, the care for the mental well-being of (future) mothers is largely absent. WarTrauma’s new training aims to increase the knowledge and skills of maternal and child health workers on how to support and improve the mental and social well-being of women during pregnancy, delivery, and post partum. The training addresses different mental health conditions that may occur during these life changing events. The trainees will have learnt theoretical knowledge and background as well as practical tools on how to provide basic psychosocial support for mothers and their peers. The content of the training programme is based on psychosocial support assessments and is enriched with cases appropriate for the context.

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FINANCE AND ORGANISATION GENERAL War Trauma Foundation is excited that there is increased recognition of the importance of mental health and psychosocial support in conflict and emergency settings. The Dutch Ministry of Foreign Trade and Development has made mental health and psychosocial support a development priority, and the United Kingdom organized a high-level summit on the issue. However, financing is lagging behind the promises and priorities. Worldwide there are 3 billion people without access to mental health services, while WHO has only 12 million euros available annually. It illustrates why also War Trauma Foundation remains dependent on many small and medium-sized philanthropic funds and individual donors.

In 2018 we received less income from fundraising. The number of small and medium-sized funds that supported us increased and their average donation also increased, but the number of assignments from humanitarian organisations dropped dramatically. We recognise we are overly dependent on a small number of larger donors and are working to diversify our donor base. Due to dierent funds refocusing their strategies we hope our eorts will come to fruition in 2019.

GOVERNMENTS In 2018 we continued to receive project funding from the EU, supporting the STRENGTHS programme of a wider consortium of organisations. We submitted proposals to multiple initiatives but have not yet been successful.

INDIVIDUALS DONATIONS The amount from individual donations received remained stable. While our group of trusted individual donors is slowly getting smaller, on average their donations increased.


INCOME 2018

10%

INCOME 2017

19%

Funds, businesses, private donors

Funds, businesses, private donors

1% 5%

Governments

Governments

Institutional

Institutional

Other income

Other income

33% 71%

62%

EXPENDITURE 2018

26%

EXPENDITURE 2017

12%

29%

Training and capacity building Research and development

Research and development

Administration

Administration

Cost of raising income

Cost of raising income

19%

18% 44%

10%

Training and capacity building

42%

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34 ORGANISATIONAL QUALITY War Trauma Foundation has ANBI status. This means it is recognised as a non-profit by the Dutch Tax Authority. We also have the quality mark of the Central Bureau of Fundraising (CBF) as well as the Framework Partner Agreement (FPA) with the European Community Humanitarian Aid Office (ECHO). The CBF bureau and ECHO check our reports annually to ensure that as an NGO we focus on our mission and objectives and keep ourselves to humanitarian principles. The cost of our own fundraising as a proportion of the funds raised is 10.4 percent (11.9 percent in 2017). To safeguard our processes, WarTrauma has achieved ISO 9001 certification, showing our quality systems are up to the standards of the International Organisation of Standardisation. One of the guidelines we use is Guideline 650 around the costs of Control and Administration. There are standard complaint procedures. In 2018 we received no complaints.

ARQ NATIONAL PSYCHOTRAUMA CENTRE War Trauma Foundation is a partner in the ARQ National Psychotrauma Centre. ARQ connects and supports organisations that work around the theme of psychotrauma. In this way the different partners strengthen each other.

WarTrauma makes use of the expertise of professionals in psychotrauma from ARQ Centrum ’45 to support our work around mental health and psychosocial support.

STAFF AND VOLUNTEERS WarTrauma works with a small team of programme officers running the daily activities. In addition, we work with trainers and associates with ample experience in mental health and psychosocial support in emergency settings, many of them psychologists and psychiatrists treating refugees and veterans themselves. For support services like HR, finances and IT we use the services of ARQ Servicecentre. In 2018 we were supported by a Syrian refugee volunteering with us.


THANKS TO OUR DONORS Anna Muntz stichting Broeders Joannes de Deo Congregatie der Broeders H. Aloysius H. Hartstra Stichting Hubertine Stichting Kanunnikessen van de H. Augustinus Kringloopwinkel Graafstroom Medische Missie Zusters Paters Passionisten Provinciaal Dominicanen (Orde der) Solidair met Medemensen St. Bron van Leven St. N. van Ballegooijen Fonds St. Nelis van Dril St. Van de Brink Houtman Zusters Dominicanessen van Neerbosch and many others...

DO YOU WANT TO CONSULT OUR FULL ANNUAL REPORT? Please check our website at: www.wartrauma.nl/jaarverslagen/jaarverslag2018 DO YOU HAVE ANY QUESTIONS ABOUT THIS MAGAZINE? DID YOU LIKE IT OR NOT? HAVE YOUR CONTACT DETAILS CHANGED? Please let us know at: E-mail: fondsenwerving@wartrauma.nl Phone (+31) 88 3305110 www.wartrauma.nl COLOPHON: All text by Martin Stolk, War Trauma Foundation Photocredits: Front cover: UNHCR/Georgina Goodwin, p. 4: WarTrauma, p. 5: UNHCR/Will Swanson, p. 9: Mukwege Foundation/Torleif Svensson, p. 10: Mukwege Foundation/Benjamin Duer, p. 13: Mukwege Foundation/Wolfgang Schmidt, p. 14: WarTrauma, p. 17: UNHCR/Caroline Gluck, p. 19: UNHCR, p.20, 21, 22, 23: WarTrauma/Martin Stolk, p.24: UNHCR/Georgina Goodwin, p.29: UNHCR/Dominic Nahr, p. 30: WarTrauma/STRENGTHS, p. 36: UNHCR/Will Swanson. Design: Raffaele Teo (arteo71@hotmail.com) This magazine is a publication of War Trauma Foundation © War Trauma Foundation, May 2019 ADDRESS: Nienoord 5-13 1112 XE Diemen The Netherlands CONTACT: T +31 (0)88 – 330 5110 E info@wartrauma.nl WANT TO SUPPORT US? Please donate at bank number NL29 INGB 0000 0010 50. BIC INGBNL2A

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Proud to share our new magazine "Towards Peace of Mind" highlighting our work with Nobel Peace Prize winner Denis Mukwege, around our journa...

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