George Hunter
MSF psychologist

There are people who, maybe 6 months ago, were living at home in a city – their kids were going to school, they were getting up in the morning and going to work. Now they live in a tent – most of them have nothing. They’ve been forced to flee. In many cases they’ve lost family members, lost friends. So everyone here is really traumatized to some extent. It’s just a matter of how it shows up – whether you don’t sleep, you don’t eat, you have stomach pains – but everybody has some effect from this.
We have a lot of people here who have other family members in other camps. Or in some cases, they have no idea where their families are, they have no idea where their children are. In some cases, the children have lost parents. We have people who have been refugees two or three times in the recent past. They fled, they left everything behind, they lost everything. Things appeared to settle down, they went back, rebuilt their lives as best they could to some extent – and then had to flee again. So they’ve been re-traumatized now and this cycle repeats itself several times and each time it’s just that much worse. There’s just that much less stability – there’s that much less hope in a sense.
The children are especially vulnerable because this is really very much a small city. And children alone are easy to take advantage of in any number of ways. They also don’t have the maturity or the knowledge of how to operate the system. How to go to the officials, get food, get tents, those kinds of things which are difficult for everyone here. It’s a complex system. But for the children, it’s really almost unmanageable.
These camps were assembled very quickly and they’re trying to work things out. Between the camps, there are several hundred thousand people now, and they’re issued dry food, it’s the rainy season, there’s no wood, it’s difficult to cook, it’s difficult to prepare food, so they have to go out into the forest and forage for wood. A woman foraging for wood by herself in the forest is inherently vulnerable. The latrines aren’t lit, and women have to go out by themselves in the middle of the night.
We have fairly large teams of mental health workers here in the camps. Just because you are a refugee doesn’t mean that you’ve left your profession behind. So in these large camps, we are typically able to find Burundians who are mental health workers, people who are formerly social workers or psychologists.
In terms of mental health, one of the things that’s really important to do here is to normalise the experience. For one particular patient, for instance, it’s important to convey the message that the fact that she has nightmares and doesn’t sleep at night isn’t because she is going crazy or because there is any sort of mental illness there, it’s because of what she’s experienced. The message that, “it’s really the situation that’s crazy, it’s not you” – is a very powerful message. Often the trauma and the anxiety manifest itself physically. So we see things like stomach aches and chronic headaches. Sometimes it’s just a matter of talking about it and normalising it and listening to people. And we find that has a huge positive effect.
What I find stunning is the scale of this situation, and the fact that it doesn’t seem to be really on anybody’s radar. We do the best we can, and they do the best they can to take care of each other. I think the thing that I find most remarkable is that after everything people have been through, there is just incredible caring among the communities here. (January 2016)

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