Refugees in Mauritania in lonely fight for mental health care

MBERA REFUGEE CAMP, Mauritania – As tens of thousands of refugees from Mali remain displaced in this expansive camp, families are growing increasingly concerned by a lack of support for their mental health and well-being.

Humanitarian groups working in Mbera refugee camp say a lack of funds and expertise makes providing care for survivors of trauma and violence difficult, especially for individuals who suffer from psychological problems.

Right now, Doctors without Borders (MSF) employs one psychologist full-time in the camp. Once every three months, Italian humanitarian agency Intersos brings a psychologist to Mbera for a brief period of no more than two weeks.

But these specialists are tasked with providing care to the nearly 52,000 refugees at the site – located on the southeast edge of Mauritania, in West Africa – who have fled violence in Mali, and whose displacement continues without a clear end in sight.

Dr David Kidinda, MSF’s medical coordinator in Mauritania, said the organisation’s psychologist began working full-time in March.

We don’t have enough funds. This is the issue. We are stuck.

- Nabil Othman, UNHCR

About 200 patients with mental illnesses who require medication, such as schizophrenia, have been treated so far.

Depression and anxiety are also prevalent and they are more closely tied to the refugees’ experiences in Mali, along the road to Mauritania, or in the camp itself.

“People have lived through traumatising experiences,” Kidinda said.

“They changed their environment. They left everything behind in Mali; their living conditions have become totally difficult; they don’t have resources; they need to rely on aid.”

Many refugees come from nomadic, herding communities in Mali, but in Mbera, they suddenly find themselves without cattle and out of work.

Kidinda acknowledged that this startling, new reality could easily put added stress on the refugees’ mental health.

“It’s true that there are many people in the camp that don’t have work, that do nothing, that spend all day twiddling their thumbs,” he said.

Trauma-fuelled delusions

Draped in a black scarf with one hand on her temple, Kini Walet Mohamedoune rocked back and forth in the shade of a tent in the camp this August.

The elderly woman sporadically shouted every few seconds, her words muffled as the wind kicked up and blanketed the area and everyone in it in a thick layer of sand.

“It’s getting worse,” said her younger sister, Dada Walet Mohamedoune, from under the shade of another tent within view.

Dada and her sister fled their homes in the small town of Léré, in the region of Timbuktu in Mali, when clashes broke out there between rebel fighters and government forces in 2012.

As shots were fired into the air, and the military entered people’s homes, Dada grabbed her daughter’s hand and fled into the bush.

They stayed there overnight, before heading south towards an internally displaced persons camp.

Meanwhile, Kini briefly fled to northern Mali, only to be reunited with her sister about a week later in Mbera.

“It traumatised her,” Dada said about the impact the violence on her sister.

The sound of oncoming cars and bright lights easily agitate her sister, Dada said.

She refuses to eat with her family and becomes verbally aggressive when people speak loudly near her.

“She thinks people are coming to kill her,” Dada said. “When she hears a vehicle, she thinks that people are coming to assassinate us.”

Funding is ‘the issue,’ UN says

The United Nations refugee agency (UNHCR) manages the day-to-day running of Mbera camp, and works with NGOs to provide health, education and other services to the refugees.

In 2017, UNHCR said it needed $19.5m to fund its programmes for the year. But by 7 August, the agency had only met 20 percent of its budget, leaving a funding shortfall of 15.7m.

Nabil Othman, UNHCR’s representative in Mauritania, said the UN is prioritising food distribution, health, and education, while other services are offered subject to funding availability.

Mental health falls among those other services. “We don’t have enough funds. This is the issue. We are stuck,” Othman said. “We don’t have specialists.”

In general, mental health services are limited in Mauritania, so refugees cannot be referred to specialists in the capital, Nouakchott.

Bringing physicians specialised in mental health and mental illness in from abroad is also challenging due to the volatile security situation in south-eastern Mauritania, he said.

Shattering myths, raising awareness

Globally, the prevalence of mental health issues among the world’s refugee population, which numbers 22.5 million, half of whom are under the age of 18, has long been a major concern.

Mental health disorders have been dubbed an “invisible” or “hidden” problem by the World Bank. Refugees, asylum seekers and migrants are at higher risk of developing mental health disorders such as post-traumatic stress, depression and psychosis, according to the World Health Organization.

“Rates of depression and anxiety disorders tend to increase with time, and poor mental health is associated with deprived socioeconomic conditions – in particular social isolation and unemployment,” the WHO found.

Aliou Amadou Ba, the supervisor of community-based protection at Intersos, the Italian humanitarian group that works in Mbera, said at least 200 individuals have severe mental illnesses in the camp.

Many of the cases go untreated, and the camp lacks many types of medication to treat more severe conditions.

But the stigma that many families feel when a loved-one exhibits signs of mental illness is even more difficult to deal with.

Ba said that for refugees from some ethnic groups in the camp, “saying they have a person with mental illness [in the family] is something that brings shame on their family”.

The camp is home to Arabs, Tamasheks, Peulhs and others.

“The community is conservative. It’s very difficult. Changing people’s mentalities is a process that takes a lot of time,” Ba said.

Some adults experience delusions or severe depression, and young children lash out aggressively. Often, the symptoms surface a few weeks after the refugees arrive in the camp, and can be tied to the war in Mali.

Intersos previously operated a weekly programme to support traumatised children in Mbera. About two dozen children drew and played in a safe environment once a week until the initiative was suspended due to a lack of funds.

Without programmes to support them, some families have resorted to physically restraining loved ones with mental illness, a practice that Ba said humanitarian agencies are seeking to end through education.

Long-term specialised care is “where there really is a need,” he said. “It’s the priority of priorities.”

'We want someone to help us'

Meanwhile, other families pin their hopes on maraboutage, a mystical, religious practice which can cost large sums of money, in the hopes that it will cure their problems.

Ba said some have travelled long distances in the Mauritanian desert so that their family members could drink from a well with supposed magical properties.

“They are convinced that the maraboutage option yields more than the medical option,” Ba said.

Back under her family’s tent in Mbera camp, Dada Walet Mohamedoune said her sister, Kini, is currently under maraboutage. “It was a last resort,” Dada said.

She said her sister refuses to take the medication prescribed by doctors to help with her delusions.

“She hides the medicine in her mouth and spits it out. We find pills on the ground,” Dada said, exasperated. “We want someone to help us.”

- Jillian Kestler-D’Amours reported from Mauritania on a fellowship from the International Reporting Project (IRP)