Dr.
Sarath Panduwawala and Dr Ruwan M Jayatunge
The 'Post-War
Period' can be defined as the years following a major war, characterized by
significant changes in the individuals as well as in the society. The Eelam War
in Sri Lanka erupted in 1983 and ended in 2009. Following these years, Sri
Lankan society experienced a collective trauma. The Sri Lankan conflict caused widespread human suffering and population
displacement. Many individuals were physically and mentally traumatized,
and war trauma still echoes in society.
Mental health is a
state of mental well-being that enables people to cope with the stresses of
life, realize their abilities, learn well and work well, and contribute to
their community (WHO). Optimal mental health is important to personal,
community, and socio-economic development. Prolonged armed conflict can
extinguish the mental well-being of people.
There is a high
prevalence of mental disorders in post-conflict situations. War has a
catastrophic effect on the health and well -being of nations (Murthy &
Lakshminarayana, 2006). War creates acute and long-lasting mental health
problems (Kastrup,2006). Combat trauma has negative social and clinical
outcomes. As a result of war-related collective trauma, people experience lower
levels of mental well-being. The armed conflict in Sri Lanka has caused
negative consequences in the general population (Somasundaram &
Sivayokan,1994). Following war trauma, social equilibrium is shattered and it
affected the mental health continuum.
The Eelam War
impacted both military and civilian lives and destroyed the social fabric.
War-affected regions were left with weakened infrastructure, increased poverty,
and dramatically under-functioning education and healthcare systems
(Dissanayake et al., 2023). Armed conflicts produce a wide series of
distressing consequences, including death, all of which impact negatively on
the lives of survivors (Carpiniello ,2023). The Eelam War drastically and
detrimentally affected the mental health of the people, and many victims still
need treatment and psychosocial support. Although the war in Sri Lanka is over,
the communities are still affected by the postwar consequences.
There is poverty,
wrecked social capital, and mental and psychosocial disorders in conflict
settings. Carpiniello (2023) highlights a series of war-related, migratory and post-migratory stressors
that contribute to short- and long-term mental health issues in the internally
displaced, asylum seekers and refugees. Following war trauma, social violence,
child abuse, high rates of substance misuse, breakdown in relationships, and
mood disorders, grief symptoms follow, and the risk of suicide increases.
Furthermore, unemployment, low productivity and poor coping strategies are
evident. There is a significant association between psychiatric disorders
(depression and PTSD) and disability among war victims. Some of the war
victims have greater engagement in risk-taking behaviors and a tendency towards
re traumatization. The collective trauma in Sri Lanka can lead to a generational trauma, and it can have a ripple effect beyond the immediate
victims.
The burden of mental disorders is high in
conflict-affected populations (Charlson Et al., 2019). The war has disintegrated the existing protective
networks in the communities. The community leaders have lost their
designated positions in society. Due to poor social support, war-affected
people are still struggling to build their lives. They experience high levels
of psychosocial problems. The mental
health consequences caused by armed conflicts are still underestimated in Sri
Lanka. People are still experiencing the consequences of war, and it is essential
to build resilience and establish supportive
environments for mental health in war-affected areas with sustainable
development goals.
Mental health can play an important role in
effective post-conflict reconciliation and reconstruction (Baingana et al., 2005). Murthy and team (2006) indicate that populations in war and conflict situations should receive
mental health care as part of the total relief, rehabilitation and
reconstruction processes. Social support and resilience could be protective
factors against mental health issues prevailing in victims (Dissanayake et al., 2023). Organizing mental health services in conflict and in post-conflict
situations requires many skills and complex work across sectors (Piachaud,
2007) and it is a formidable challenge for mental health professionals.
Culturally sensitive interventions have to be developed to meet the mental
health needs of the population (Ghosh et al., 2004). Strengthening Coping strategies and promoting maternal
psychosocial well-being in war-affected regions. Provide fruitful ways of
coping with the conflict situations.
In post-conflict situations there are six
levels of interventions needed: first, increasing resilience; second, making
the family the focus for effective support; third, encouraging community
solidarity and traditional methods of support: fourth, using the media in
mental health promotion; fifth, the integration of mental health skills of
caring for the population with general services; and sixth, focusing on
long-rather than short-term measures. (Ghoshet al.,2004).
Improving mental health facilities and
providing psychosocial support for war affected communities are important.
Mental health care must be prioritized, and effective community interventions
should be implemented. Psychosocial rehabilitation is important, and these
programs will encourage empowerment, self-management and autonomy in daily
activities. These interventions would mitigate the harms
caused by the armed conflict in Sri Lanka.
(Dr Sarath Panduwawala is a retired Consultant
Psychiatrist who served as a visiting psychiatrist of the Sri Lanka Army)
References
Baingana F. Fannon I. Thomas R. Mental health and conflicts - Conceptual
framework and approaches. Washington: World Bank; 2005.
Carpiniello B. (2023). The Mental Health Costs of
Armed Conflicts-A Review of Systematic Reviews Conducted on Refugees,
Asylum-Seekers and People Living in War Zones. Int J Environ Res Public Health.
6;20(4):2840. doi: 10.3390/ijerph20042840.
Charlson F, van Ommeren M, Flaxman A, Cornett J, Whiteford H, Saxena S.
(2019).New WHO prevalence estimates of mental disorders in conflict settings: a
systematic review and meta-analysis. Lancet. 20;394(10194):240-248. doi:
10.1016/S0140-6736(19)30934-1.
Dissanayake L, Jabir S, Shepherd T, Helliwell T, Selvaratnam L,
Jayaweera K, Abeysinghe N, Mallen C, Sumathipala A. (2023).The aftermath of
war; mental health, substance use and their correlates with social support and
resilience among adolescents in a post-conflict region of Sri Lanka. Child
Adolesc Psychiatry Ment Health. 2023 Aug 31;17(1):101. doi:
10.1186/s13034-023-00648-1. PMID: 37653394; PMCID: PMC10472617.
Ghosh N. Mohit A. Murthy SR. Mental health promotion in post-conflict
countries. J Roy Soc Promot Health. 2004;124:268–270. doi:
10.1177/146642400412400614.
Kastrup MC. Mental health consequences of war: gender specific issues.
World Psychiatry. 2006 Feb;5(1):33-4. PMID: 16757990; PMCID: PMC1472268.
Murthy RS,
Lakshminarayana R. (2006).Mental health consequences of war: a brief review of
research findings. World Psychiatry. ;5(1):25-30. PMID: 16757987; PMCID:
PMC1472271.
Piachaud J. Mass violence and mental health--training implications. Int
Rev Psychiatry. 2007 Jun;19(3):303-11. doi: 10.1080/09540260701349514. PMID:
17566908.
Somasundaram DJ, Sivayokan S. War trauma in a civilian population. Br J
Psychiatry. 1994 Oct;165(4):524-7. doi: 10.1192/bjp.165.4.524. PMID: 7804667.
