The global population of forcibly displaced people has doubled over a decade to 65 million,
As a result of an upsurge of intense and prolonged societal conflicts. Internal displacements, refugees and asylum seekers constitute the current forcibly displaced populations. The top ten hosts of conflict refugees are predominantly low- or middle-income countries, and when adjusted for Gross Domestic Product (GDP) per Capita, Sub-Saharan Africa shoulders the main burden with 7 countries among the top ten hosts. Uganda is host to over 1 million refugees from Conflict affected countries, positioning the country as the 4th largest host of refugees globally, when adjusted for GDP per Capita. The Ugandan Government, in collaboration the United Nations High Commission for Refugees (UNHCR) has made enormous contributions in the area of emergency relief and resettlement of the refugees. In fact, the Ugandan model of resettlement which includes provision of land to refugees for subsistence farming among others has been globally appraised.
The notable successes in refugee reception and resettlement notwithstanding, conflicts carry severe health and social ramifications for affected individuals that may not be immediately appreciated and thus addressed. These are manifest in a myriad of mental illnesses, particularly Post Traumatic Stress Disorder (PTSD), Depression and other mood disorders. These complications are often of epidemic proportion (i.e. affecting many people), comorbid in nature (i.e. with many people baring several of these conditions concurrently), and are triggered or maintained by increased exposure to substance/alcohol abuse and inter-personal violence. In refugee populations, problems related with acculturation (i.e. absorption into a new culture) further influence the initiation, maintenance of and prognosis for mental illnesses.
Management of mental disorders in refugee settings in LICs: challenges and innovations
The epidemic, chronic and comorbid nature of mental illness in post-conflict populations is a
challenge warranting a paradigm shift in mental illness management. Particularly in
Low-Income Countries (LICs), challenges related to severe human- and financial-resource
constraints have rendered the management of mental illness at societal level difficult. In
Uganda for instance, the psychiatrist-inhabitant ratio is at most 2 per 1 million and public expenditure on mental health is only 4% of the meager total health budget. Under such premises, refugees in LICs exert additional strain on the weak mental health infrastructure and risk structural exclusion from the national mental health agenda. A shift in the provision of basic mental health care from local providers to refugee peers is envisaged to overcome these challenges. Such a shift is also congruent with the cultural adaptation of therapies, proven to enhance accessibility, acceptability and compliance to care,
Role of Academic Institutions
Academic institutions have a moral obligation to contribute to community development including emergency aid, but such contribution should be geared to areas where they are strongest. They can play key roles in generating an evidence base, through research, for the design, implementation and evaluation of new interventions to manage mental illnesses in complex emergencies. In addition the shortage of fully trained psychiatrist in LICs in general necessitates task shifting of mental illness management to other categories of healthcare professionals (e.g. nurses and public health specialist). Such strategy would however require rigorous training of these professionals in specific treatment methods, which initially could be delivered under supervision of senior psychiatrist. Academic institutions could tailor short courses to that effect. Complex emergencies require rapid response, which however requires an evidence base! A continuation of this discussion will follow in a coming article!
About the Author
The Author, Associate Professor Stephen Lawoko, is The Dean of Health Sciences, at Victoria University Uganda, with a track record of research in Social Medicine.