Civil War Pushes Stress Levels to Record High in Uganda

Uganda has among the highest rates of post-traumatic stress and depression ever recorded among refugees, according to the results of a study published this week.

More than 20 years of civil war in the north of the country has left many people highly traumatized and in poor health due to a lack of medical care and access to food and water.

The study, conducted by the London School of Hygiene and Tropical Medicine (LSHTM) and Gulu University in Uganda, found that the rates of symptoms of post-traumatic stress disorder (PTSD) and depression among refugees in Uganda were higher than those recorded for displaced groups in other conflict areas, such as Afghanistan, Croatia and along the Thai-Burma border.

Researchers interviewed 1,210 adults displaced by fighting between the Lords Resistance Army and government troops to assess their exposure to traumatic events and measure their levels of PTSD and depression.

They found that more than half (54%) displayed symptoms of PTSD and more than two thirds (67%) showed signs of depression.

Up to 2 million people have been displaced because of civil war, which began in 1987. Over the last two decades, LRA insurgents have terrorized the northern regions, attacking towns, killing and raping men and women and abducting thousands of children, who have been forced to fight, work or become sex slaves.

Residents of Katine sub-county are among those who have suffered under the rebel group, reporting the kidnapping of children, some of whom have not returned home, violent attacks and stolen goods and livestock.

Peace negotiations between the LRA and the government have been ongoing since 2006, but a deal has proved elusive. The most contentious issue appears to be the arrest warrants issued by the International Criminal Court for the LRA leader, Joseph Kony, and some of his generals. Kony says he will not sign a peace deal until the warrants are withdrawn. The ICC says the warrants will stand.

Over the past two years, Kony and his army have gradually moved their bases to the Democratic Republic of Congo and more recently to the Central African Republic and northern Uganda is now experiencing a semblance of peace. But while some people are making their way back to their home towns and villages, up to 80% of the population of Gulu, Amuru, Kitgum and Pader districts are still considered displaced, and an estimated 85% still live in government camps.

The study, published in BMC Psychiatry magazine, questioned people in two of the districts, Gulu and Amuru – 60% of whom were women - in 2006. More than two thirds had been displaced for more than five years and just over 40% had lived in two or more camps.

Three quarters of those questioned said they had witnessed or experienced the murder of a family member or friend and more than half reported having been beaten or tortured. More than 40% said they had been kidnapped and 14% had been raped or sexually abused (of these around 8% were men).

The vast majority (90%) said they had experienced lack of food or water and two thirds had been ill without medical care because of the fighting.

Women were found to be twice as likely as men to show symptoms of PTSD and more than four times as likely to exhibit signs of depression.

"This study provides evidence of extremely high exposure to traumatic events suffered by civilians in Gulu and Amuru districts of northern Uganda and indicates widespread human rights abuses," said the report.

"The levels or PTSD and depression recorded in this study are amongst the highest recorded globally using similar methodologies amongst displaced and conflict-affected populations."

Bayard Roberts, research fellow on the conflict and health program at LSHTM, said many of the traumatic events experienced by the interviewees had occurred while they lived in government refugee camps. Some 93% told researchers they did not feel safe in the camps, due to fears of further attack, outbreaks of disease and worries about limited access to food and medical care.

"This suggests that although the camps have been specifically set up to protect civilians, that is not the case," said Roberts.

He added that the huge impact of the fighting on civilians in a relatively small, densely populated area meant it was plausible for symptoms of mental trauma to be higher in Uganda than in countries such as Afghanistan.

The study called on the Ugandan government and the international community to "strengthen" support for people in camps to help reduce mental health problems and further exposure to trauma.

While better security in the area in the two years since the study was carried out has meant living conditions have not got worse, not much has improved, says Roberts. "Hundreds of thousands of people are still living in limbo."

The report concluded: "A meaningful resolution to the conflict in northern Uganda would facilitate a return by IDPs [internally displaced persons] back to their homes, support a healing process, and help IDPs rebuild their lives."