To ensure the lasting well-being and active citizenship of Sudanese survivors of conflict, international, state and civil society actors must integrate mental health and psychosocial support interventions into humanitarian, peacebuilding and transitional justice efforts, writes Amina Mwaikambo.
During war and conflict, civilians directly affected by violence have diverse needs and require tailored interventions. In most cases, humanitarian responses in conflict zones are focused on people’s primary and basic needs. These include food, healthcare, safety, shelter, water and sanitation, alongside other contextually relevant needs related to a specific crisis situation. Humanitarian responses tend to be centred around the rights that victims and survivors have been deprived of, and how people and their basic needs and rights can be protected. These crisis interventions are crucial, particularly during large-scale humanitarian crises.
Yet, when a trauma-informed approach to crisis management is not implemented, these interventions are limited in their capacity to mitigate long-term traumatisation and mental health decline in the context of war and conflict. For long-lasting psychosocial well-being at the individual and collective levels, it is key that mental health and psychosocial support considerations are integrated. These support interventions, when undertaken by international, state and civil society actors, promote well-being and mitigate significant post-traumatic stress conditions that tend to persist as countries transition into peacebuilding, transitional justice, and structural and judicial reform.
Since the eruption of conflict between the Sudanese Armed Forces and the Rapid Support Forces on 15 April 2023 in Sudan, civilians have been targeted by militia groups, which are committing atrocities such as mass killings, sexual violence, human trafficking and recruitment of child soldiers. An estimated 7.4 million people have been forcibly displaced and at least 1.9 million people have fled Sudan to seek asylum in the Central African Republic, Ethiopia, South Sudan and Ethiopia.
Approximately 24 million children have been affected by the conflict in Sudan since April 2023, making it one of the world’s worst humanitarian crises for children. Children have been deprived of their basic needs, resulting in acute malnutrition and inadequate healthcare. Schools have shut down or are unsafe due to violence and shelling, impeding healthy cognitive development. Impacts of conflict and forced migration on children are not limited to physiological health, affecting also their mental health through grief, fear, family breakdown, and discrimination in host countries.
Sudanese children are being born and raised in conditions of significant distress and trauma. Their early childhood development is severely compromised by states of hypervigilance and psychological instability, which are common presentations in high-distress contexts. Conflict is particularly difficult for children because it cements the mental framing of how they understand the world as a place to live in, undermining children’s sense of psychosocial safety.
The impact of the conflict on the mental health and psychosocial well-being of Sudanese children and adults – especially displaced persons – remains under-recognised. Looking beyond basic needs, it is crucial that humanitarian actors and society more broadly recognise the trauma that war and violence inflicts on people. The unwitting side-lining of mental health and psychosocial needs deprives victims and survivors of the experience of having their emotional needs met, which means that their bodies’ shock response remains in survival mode.
Prioritising Mental Health and Psychosocial Needs of Victims of Conflict
When the mental health and psychosocial needs of victims and survivors are not prioritised or acknowledged, their ability to recognise the depth and intensity of the trauma they have experienced is compromised. This predisposes people to remain in survival mode while navigating everyday life, putting strain on their bodies and minds. The devastation to human lives during conflict and forced displacement is often experienced physically; however, trauma impacts can be long-term and tend to remain a psychological burden even after conflict stops or civilians find a sense of physical safety.
Survivors of war and conflict learn how to survive through the trauma, and are often able to function in their daily tasks. However, due to continuous traumatisation, the under-recognised impacts of violence remain and catalyse mental health decline.
Yet, psychosocial support is still very much stigmatised in society. As such, it is imperative that emergency support services prioritise trauma-informed approaches to humanitarian support for victims and forced migrants who are at risk for mental health decline. It is crucial that conceptualising mental health and psychosocial needs is not restricted to a top-down and prescriptive approach, where a service provider is dispatched to support people who have been negatively impacted by conflict. Mental health and psychosocial support interventions should be holistic, community-based and contextually relevant to incorporate the intersections of identity and demographics of the people affected by conflict.
Awareness of the importance of mental health and psychosocial support can be shown by international, state and civil society actors by acknowledging the human impact that rests in the lives of victims and survivors of conflict. This is enhanced when resources are available to displaced people, refugees and asylum seekers to explore their collective trauma by fostering healthy relationships and strengthening community connections. Another key area is promoting trauma-awareness and mental health rights through advocacy, so that victims and survivors may have access to the language and resources that adequately describe the psychosocial disequilibrium that is caused by political instability.
Service providers who focus on peacebuilding, transitional justice, forced migration and other conflict and post-conflict challenges are positioned to meet the needs of victims and foster long-term resilience and well-being when they integrate a trauma-informed approach into crisis interventions. Human rights law practitioners or agencies who support victims with access to redress and justice can develop trauma-informed services that are aligned with ethical best practices when working with vulnerable people or people in distress.
Addressing the Human Cost of Conflict in Sudan
Sudanese people have endured the human cost of conflict. People have been separated from friends and family. They have witnessed abductions, killings, shelling and other atrocities across Khartoum, Darfur and Kordofan. They have lost friends and family members and been deprived of the ability to bury their loved ones. With the understanding that healing from trauma is accessed from different avenues and dimensions comes acknowledgement of the impact of being unable to participate in religious and cultural practices for passing on and burial.
Transitional justice processes often focus on the judicial and geopolitical implications of war and conflict. The invisible cost of conflict is in the dehumanisation of civilians exposed to atrocities and often left without an avenue for justice and reparation. While civilians battle for survival and face a deep sense of loss and separation, many anticipate the establishment of a transitional government to reform Sudan and reinstate a sense of trust and stability for its people. Sudan has a long history of conflict that challenges the transitional justice principle of non-recurrence, which is something that many practitioners have had to grapple with as conflict continually erupts. This raises the question of what it will take to rebuild Sudan.
The people of Sudan affected by the most recent conflict are people with names, faces and identities. The conflict has not only deprived Sudanese people of peace, predictability and autonomy, it has also caused many of them to feel forgotten, as their names, faces and identities are replaced by their condition of survival or the atrocity they have experienced.
An ongoing integration and acknowledgement of mental health and psychosocial support needs during the active conflict serves to promote the well-being and resilience of the Sudanese people. The people who will likely be participating in the establishment of a transitional government are among the people who survived war trauma. Among the key issues that perpetuate cycles of conflict in contexts like Sudan is the disintegration of the social fabric and the breakdown of relational systems that serve as the bedrock for sustaining healthy human relationships which are appreciative of diversity in culture and ethnicity.
For many humanitarian practitioners, activists and human rights defenders in Sudan, the conflict is a threat to their sense of hope and reform. Sudan had been making strides in peacekeeping and transitional justice endeavours, which were disrupted by the October 2021 and April 2023 eruptions of violence, leaving a sense of ambiguity about the status of these processes.
In order for transitional justice processes to be effective, the people of Sudan need to be prioritised, and their psychosocial well-being recognised as a key component of their lived experience and their ability to continue to advocate for their human rights. Stakeholders within Sudanese governing bodies, political agencies and the international community have a responsibility to protect the rights of millions of Sudanese victims of the conflict between the Sudanese Armed Forces and the Rapid Support Forces.
This includes foregrounding conflict resolution and peacebuilding initiatives that are victim-centred. It also includes supporting the free flow of humanitarian assistance and mitigating the destruction of healthcare and industrial infrastructure that is critical for the survival of Sudanese people now and in the future. Furthermore, state service providers in host countries need to be sensitised to the needs of Sudanese people, particularly in relation to documentation and access to basic services.
The atrocities that have been enacted in Sudan need to be investigated for purposes of justice and accountability, with the understanding that justice is a component of trauma healing. When people’s trauma has been acknowledged and addressed and they are in a healthier state, this can translate into political will and increased capacity to participate in truth commissions, rehabilitation processes and reparations programmes that serve as foundations of transitional justice.
Amina Mwaikambo
Amina Mwaikambo is a Senior Mental Health and Psychosocial Support Practitioner at the Centre for the Study of Violence and Reconciliation.