Friday, May 28, 2021

Combat Trauma And Post War Sri Lanka


Ruwan M Jayatunge M.D. 

The Sri Lankan society experienced a 30-year prolonged armed conflict that changed the psychological landscape of the Islanders. A large number of combatants, civilians, and members of the LTTE underwent the detrimental repercussions of combat trauma. Following the armed conflict in Sri Lanka over 90,000 people lost their lives and thousands of families are still grieving. A large number became physical and psychological casualties of the war.  The war trauma still echoes in Sri Lankan society.

War has serious consequences for both short-term survival and longer-term recovery and development (Sørensen, 1998). War trauma represents a horrendous experience for the Sri Lankans. The Sri Lankan society is still struggling with the negative aftermath of the 30-year armed conflict.  If not addressed effectively the psychological scars following combat can stay behind for many years. It can change the psychological markup of people making them more dysfunctional. 

Londoño and colleagues (2012) indicate that exposure to violence in general and to armed conflict, in particular, has been consistently associated with an increased prevalence of mental illness.  Although mental disorders are a major public health problem, the development of mental health services has been a low priority everywhere, particularly in low- and middle-income countries (Minas, 2012).

 War trauma has impacted Sri Lankan society at every level. The social fabric has been severely damaged. It has become a part of social experience and memory.  As the Salvadorian psychologist Martin-Baro wrote of his own country, what was left traumatized were not just Salvadorian individuals, but Salvadorian society. This expression is totally applicable to Sri Lanka.

During the post-war period interpersonal violence, child abuse, rape, alcohol and drug abuse, social violence have been increased in significant numbers. Many of these social maladies have direct or indirect connections with war trauma.  Deplorably Psychological wounds of the Eelam war were not adequately addressed and the deleterious effect of combat trauma impacts the post-war Sri Lankan society.

Nature of the Sri Lankan Conflict

The Sri Lankan Conflict was the longest-running armed conflict in Asia.  It was a conflict between the Government Forces and a rebel separatist group better known as the LTTE (The Liberation Tigers of Tamil Eelam).  The LTTE was regarded as the most lethal terrorist group in the world. In the subsequent years, the LTTE was banned in the UK, the US, and Canada. The LTTE   attacked the Sri Lankan armed forces with modern high-tech weapons. In addition, the LTTE used numerous unconventional methods to fight the Sri Lankan Forces using child soldiers and suicide bombers. The Northern conflict consumed many lives and caused damage to the property worth billions of dollars.

Sri Lankan Combatants and War Trauma

Sri Lankan military forces deployed their entire bayonet strength for nearly 30 years.  During this critical period, the Sri Lankan military launched nearly 20 major military operations against the LTTE. Over 200,000 members of the Sri Lanka armed forces and Police had been directly or indirectly exposed to combat events during these years.  They were exposed to hostile battle conditions and many soldiers underwent traumatic battle events outside the range of usual human experience. In 2009 May the Sri Lankan government declared that the country won the war against the LTTE. Although the armed forces were able to gain a decisive victory it came with a huge social cost. The Eelam war affected the psychosocial health of the combatants. Significant numbers are still impacted by combat trauma. During the post-war era, high numbers of desertions and suicides have been reported among the combatants.  According to the Military Spokesperson of the Sri Lanka Army from 2009 to 2012 postwar period nearly 400 soldiers had committed suicide (Sriyananda, 2012).

The Social Impact of Combat-Related PTSD

The experts believe that the circumstance of war can produce a range of emotional, psychological, and behavioral stress reactions among soldiers and officers that can lead to a condition known as PTSD (Post Traumatic Stress Disorder). Posttraumatic stress disorder (PTSD) is a condition that engenders both symptomatic distress and severe disruption in interpersonal and social functioning (robertson et al. 2004).

During the Eelam War, many soldiers experienced combat-related psychologically distressing traumatic reactions. Most of these acute traumatic reactions were not appropriately diagnosed or treated. Some soldiers were emotionally overwhelmed as a result of war trauma. There was no apparatus to identify these distressing reactions and offer psychological first aid without delay. Some soldiers lived with the traumatic ruminations for years while serving in the operational areas. These victims were later diagnosed with combat-related PTSD.

For a number of years, the Sri Lankan authorities were reluctant to believe that combat-related PTSD   was emerging in the military. PTSD was regarded as an American illness and there was an unofficial taboo to use the term PTSD. The tension of combat trauma was mounting in the military over the years and there had been suicides and self-harms reported from the battlefields. The soldiers affected by war trauma had behavioral problems and their productivity was plummeting. Many soldiers who had positive features of combat-related PTSD without any physical wounds were compelled to serve in the operational areas and engage in active combat. In the early days of the war, soldiers were sometimes charged with malingering when they tried to seek medical attention. Many traumatized veterans deserted the army or joined underworld criminal gangs. Until 2005 the Sri Lanka Army did not medically discharge any combatant on psychological grounds especially PTSD.

The laborious work of Dr. Neil J Fernando- the former Consultant Psychiatrist of the Sri Lanka Army gave an insight to the authorities to think about war trauma and PTSD seriously. The first soldier who was able to get a medical discharge with PTSD (in 2005) was a Lance Corporal with malignant PTSD. He was a POW who was held by the LTTE for nearly 5 years.

Combat-related PTSD has impacted combatants hugely.  The wounds that they received from the war were not confined to the battlefield. It was not an individual trauma anymore.  The war trauma frequently transformed their domestic environments. Domestic and community violence, child abuse addiction issues, self-harm, etc. became massive social problems. War trauma has turned into a vicious cycle affecting individuals as well as the entire society.

The Residual Effect of Combat Trauma

It is important to know that in the post-war era late reactions of combat-related PTSD can emerge. Combat stress has a residual effect on some veterans. For some soldiers combat related traumatic reactions can emerge at a later date. Posttraumatic stress disorder (PTSD) may develop as a serious long-term consequence of traumatic experiences, even many years after trauma exposure (Lecic-Tosevski et al. 2013). There is a risk of emergence of late reactions of combat-related PTSD in the post-war Sri Lankan society.

According to Dr. Michael Robertson of the Mayo Wesley clinic, ex-servicemen can experience delayed reactions to combat stress. A large number of WW2 Veterans who never had any anxiety-related symptoms later complained of Delayed PTSD. Some reactions were manifested 40-50 years after the original trauma. Therefore the health authorities in Sri Lanka should be aware of the late reactions of combat-related PTSD.  Studies are needed to systematically assess the mental health of the members of armed services who fought a prolonged war.

Combat Trauma among the ex LTTE Carders

Combat Trauma among the ex LTTE Carders is least discussed. Very few studies are available on the mental health factors relating to ex-militants. Many surviving members of the former LTTE either now live in Sri Lanka or live abroad. Most of these ex-militants joined the movement as children and throughout the war, they underwent the harsh realities of war trauma.

As children, these members witnessed and engaged in violence. While spending time on the battlefield they turned into adults. As adults, they continuously lived through battle stress until the end of the conflict in 2009.

Mental health experts believe that psychological trauma experienced by people during their childhood has a higher tendency to manifest mental health problems in later life.   According to several mental health experts, some of the ex LTTE members suffer from malignant PTSD (Disorders of Extreme Stress Not Otherwise Specified or DESNOS). These victims live with rage, guilt, alienation and suicidal ideation. They lack social skills and unable to form families due to a lack of parental skills and intimacy. Although a number of rehabilitation projects were launched by the Sri Lankan government to rehabilitate the former militants some of them still live with scarred minds. Those who managed to flee and live as refugees in the Western countries do not receive culturally fitting psychological rehabilitation therapy. These individuals need psychosocial rehabilitation in order to reintegrate into society.

The Child soldiers in the Sri Lankan Conflict 

Over 7000 children were forcibly recruited and sent to war by the LTTE during 1983 – 2009 (Human Rights Watch). Children were abducted and forced into weapon training and they were subjected to torture, indoctrination, sleep deprivation, and often forced to commit atrocities.   During the Eelam War, these children witnessed absolute carnage that would impact their future adult lives.

Former child soldiers have numerous mental health issues. Children who survive traumatic events exhibit a diverse set of symptoms and physical signs often meet with diagnostic criteria for attention-deficit hyperactivity disorder, anxiety disorder, etc (Perry, 2003).

In 2009 the Sri Lankan Government liberated all the child soldiers that were held by the Tamil Tigers. These child soldiers were reunited with their families and they were offered rehabilitation.  Among the conflict-ridden countries, Sri Lanka became the first state to free all the child soldiers that were held by the rebel group.  Today Sri Lanka is free of child soldier menace.  This is a major victory to the civilized world that sternly condemns the military use of children.

Today these ex-child soldiers undergo rehabilitation. Most of them go to schools and receive vocational training.  But still many are trapped with their dreaded combat memories. According to the local clinicians, a considerable number of Sri Lankan child soldiers are suffering from depression, PTSD, somatization, and adjustment disorders. They need effective long-term rehabilitation and acceptance by society.

The Civilians Affected by the War   

In armed conflicts, civilians have little protection from collateral or incidental damage and often they become vulnerable. Among the consequences of war, the impact on the mental health of the civilian population is one of the most significant (Srinivasa Murthi & Laksminarayana , 2006). The recent military conflicts in Afghanistan and Iraq had a large number of civilian casualties.  The Eelam War in Sri Lanka was no exception. A large number of civilians from the North and South became innocent victims of the war in Sri Lanka. Many became casualties due to the colorectal damage following military offensives against the rebels (in the North) and suicide bombing by the LTTE (in the South).

According to the International Institute for Strategic Studies (2003) between 1980 and 2000, the LTTE carried out 168 suicide attacks causing heavy damage to civilian, economic, and military targets. Suicide bombings and other forms of explosions can cause long-term repercussions on survivors. Bashir and colleagues (2013) highlight that civilian victims of suicidal and improvised bombings present with a wide range of neurological symptoms and injury patterns, which often differ from the neurological injuries incurred by military personnel in similar situations, and thereby often require individualized care.

The Sri Lankan conflict caused mass displacements. At the end of 2006, at least 520,000 people in Sri Lanka were victims of conflict-induced displacement in a country of 20 million, making up one of the largest displacement crises in Asia in absolute terms and particularly in terms of the proportion of the population displaced (Civilians in the way of conflict: Displaced people in Sri Lanka September 2007).  Many civilians who became displaced lived in shelters for long years and fled the country. Adverse mental health consequences have been reported among the displaced people.

The war trauma in Sri Lanka destroyed the social fabric and a large number of civilians underwent hardships of war. People lost their loved ones. They lost their property and livelihoods.  It affected the individual as well as on a collective level.  For most of the Sri Lankans, the war became a collective trauma. Tens of thousands of Sri Lankans still face the bitter consequences of the war. They live with their traumas suffering silently.

Civil society has been degraded by war trauma. Hostility, suspicion, alienation, emotional numbing, indifference, scapegoating became the common components in the war-ridden Sri Lankan society. Empathy, tolerance, and compassion gradually disappeared as the war progressed. There is a noticeable lack of quality in civil society, partly due to the crippling brain drain, but also due to the devastating effect of the war. There is also a widely reported perception in northern Sri Lanka that there has been a marked deterioration in social values evidenced by changing sexual and social behaviors. (Somasundaram 2007)

The researches indicate that armed conflict can have long-term consequences. Nandi (2013) investigated to what extent the soldiers and young women of World War II were affected by PTSD symptoms over the course of their lives and in this study, the researchers recruited 52 male and 20 female Germans aged 81-95 years and interviewed regarding war experiences and PTSD symptoms. Of the men, 2 % and 7 % met the criteria for current and lifetime PTSD diagnoses, respectively, as compared to 10 % and 30 % of the women, respectively. These researches show that the impact of war trauma can affect Sri Lankan society for long years.


The Eelam War and the War Widows

One harsh reality of the war is that every soldier killed in war leaves behind grieving family and relatives. It has been a reality since the Trojan War. The women who have left widows as a result of the Sri Lankan conflict are facing radically altered circumstances. There are estimated thousands of war widows who still experience grief reactions. Many widows young and with the death of their husbands these women have become a psychologically and socially vulnerable group. Most of the women who underwent severe emotional pain still have not completely recovered. Many have become the victims of pathological grief and were clinically diagnosed with Prolonged Grief Disorder or PGD.

They are unable to work through their grief despite the passage of time. With widowhood, they experience identity change, role adjustment, and change in social status.

Many researchers concur that the mental trauma of the war widows can last for long years. Depressive reactions are common among the Sri Lanka war widows. Many LTTE carders who died in action left their wives in grief-stricken situations. The war widows of the Northern part of Sri Lanka experienced a similar plight.

In conservative Asian societies, widows face social, economic, and legal handicaps. Widow as its name denotes is associated with some form of socio-cultural stigma and humiliation. They are considered a bad omen in many Sri Lankan rural areas. They are marginalized by their own communities. These factors affect their self-esteem. In some events, the accusations were made by the in-laws stating that the husband’s death occurred because of the unluckiness of the wife and they are partially answerable for the husband’s death. They experience a lack of social support and loss of their social possession in their own family circles.

The war widows face a number of mental health problems. They have suffered bereavement as a result of the violent deaths of their husbands and these traumatic memories hound them for long years. They are often subjected to extreme forms of discrimination and physical, sexual, and mental abuse. Therefore, widowhood represents a form of “social death” for these women.

Healing the Post War Sri Lankan Society

Post-war societies are highly vulnerable. Therefore the combat trauma in the post-war era has to be managed effectively. There are numerous examples from other countries that reveal the susceptibility of the social networks and communities in the post-war period.  For example, soon after the American Civil War, some of the traumatized soldiers formed an extremist movement called KKK which engaged in racial violence. Many American volunteers who participated in the Spanish Civil War engaged in social violence and some Lincoln Brigade soldiers became top criminals. Post-Vietnam War caused vast social chaos in the USA. Similarly, many Afghanistan veterans of the Red Army engaged in organized crimes in the former USSR.

Soon after a mass conflict like war, there is a tendency to political extremism and sometimes religious fundamentalism to emerge. In a post-conflict, society the social fabric is fragile, people are traumatized and they become easy targets to these extreme and damaging forces. Soon after WW 1, Germany faced such a situation, and NAZIS could exploit the collective trauma experienced by the German people. The Taliban fundamentalists grabbed power at the end of the Afghan-Soviet conflict. Hence, there is an impending risk that Sri Lankans face today and the Democratic forces have an absolute responsibility to restore the peace and justice system in the Country

The major impacts of war include the disintegration of communities and damaging the psychological well-being of the people. Therefore, major psychosocial interventions are required to restore the damages caused by the war. The promotion of human rights and justice are the key way to reinstate the social equilibrium. The victims of war trauma need appropriate treatment psychosocial support and culturally sensitive rehabilitation. Apart from these measures infrastructure reconstruction and reconciliation should be focused in the post-war Sri Lankan society.


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