Strategic Planning (Mental Health)

A survivor receiving mental health support
A survivor receiving mental health support

In the lead up to the publication of the new Strategic Plan of Survivors Fund (SURF) for 2021 to 2023, we will be publishing several posts to provide more context of our work – and implications for the the survivors of the genocide against the Tutsi in Rwanda which we support.

Mental Health

In the aftermath of 1994, genocide survivors showed high rates of mental health and psychosocial problems due to the brutality that the majority of them had been exposed or witness to. Entire family systems as well as the general social fabric that formerly provided support were destroyed due to losses of family members and growing mistrust and fear following the genocide. Studies analysing the mental health situation in Rwanda following the genocide have mainly focused on groups of widows and orphans or children living in child-headed households. An elevated level of depressive and anxious symptoms as well as post-traumatic stress disorder (PTSD) was found in each of these groups.

The recent Rwanda Mental Health Survey (RMHS 2018) conducted by the Rwanda Biomedical Centre (RBC) revealed the increased prevalence of various mental disorders within the general Rwandan population and within genocide survivors. Results from this survey indicated that:

  • Major depressive episodes (MDD) occurred in 12% of the general population and 35% of Genocide Survivors
  • Post-Traumatic Stress Disorder (PTSD) occurred in 3.6% of the general population and 27% of Genocide survivors

Survivors and their families continue to present with considerable rates of posttraumatic stress disorder (PTSD) and substantial depressive and anxiety symptoms. Studies evidence a strong association between health problems and psychosocial factors such as social integration. Posttraumatic stress reactions were especially elevated in adult survivors who had experienced a high number of traumatic events, had poor physical health and were lacking in social integration.

Descendants of genocide survivors show a higher risk for mental health problems than descendants of former prisoners. A high trauma load as well as missing family integration and support characterizes their specific vulnerable situation. The capacity of Rwanda’s Social Care system to prevent and respond to an increasingly complex range of social vulnerabilities remains limited due to a lack of trained mental health professionals (with only 10 psychiatrists in the country) and a small budget for mental health services. There remains two centres (Le Centre Psychothérapeutique Icyizere and CARAES Ndera neuropsychiatric Hospital) in the Rwanda health care system which provide specialist treatment for PTSD.

Implication for survivors and related vulnerable groups: Access to mental health support continues to be a critical need for survivors, and with specialist services so limited in Rwanda the burden to provide such treatment falls to local survivor’s organisations. With so many other competing needs, it is unlikely in the years ahead that this situation will change, which particularly disadvantages survivors due to the crippling effects resulting from PTSD. That there is increasing evidence for the intergenerational inheritance of trauma, makes the need to not only sustain but extend mental health support to survivors and second-generation survivors even more vital. 

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