Lingering psychological trauma three years after Libya’s uprising

TRIPOLI - In Hay El-Islami, a poor neighbourhood in western Tripoli, two groups of children are facing off. The first is led by a 10-year-old whipping a strip of plastic. About 30 metres down the dusty, unpaved street, their rivals wait with wooden sticks. 

Nearly three years after an armed popular revolution in Libya toppled former strongman Muammar Gaddafi, this is how children here play. Women leaving nearby shops do not even take notice. It has become a regular sight. It even features in a public service announcement by the Ministry of Culture and Civil Society warning parents of the risks of a culture of violence among their children. 
The 2011 civil conflict between Gaddafi’s supporters and rebels trying to oust him from power killed up to 25,000 people and injured 50,000 more, according to estimates by the National Transitional Council, the former interim government body. In the process, the conflict - and decades of repression before it - has left psychosocial scars from which the population is only just starting to heal. 
While some Libyans suffer from serious medical conditions like post-traumatic stress disorder (PTSD) and suicidal depression, more diffused and subtle psychological and social problems have become much more pervasive in this fractured society. 
Evolving symptoms

There are few statistics about the prevalence of PTSD in Libya; discussing psychological problems remains taboo here. 
But one indication is the rising number of admissions at the psychiatric hospital in Tripoli. 
“Before the war, we used to see 7-10 new patients a day,” said Abdulrauf Idres, a psychiatrist at the hospital. “Now it is more - between 20 and 30,” he told IRIN. 
Symptoms have calmed somewhat from the initial period following the war, when suicidal thoughts were common, especially among former fighters, according to psychologist Tatiana Nasser, who works at the Libya Youth Center (LYC). Instead, a larger number of people are now showing less violent symptoms of PTSD: Children suffer from a lack of self-confidence, shyness or hyperactivity and trichotillomania (the compulsion to pull out one's own hair), she said. 
Other signs are increased crime and drug use. 
This month, Tripoli Chief of Police Mohammed Swaisi said crime rates had increased - reaching 3,597 crimes - in the first half of 2013 (he didn’t specify how big the increase was). 
Abdullah Fannar, deputy director of the hospital, says he has noticed many more drug-addicted people since the end of the revolution. They are former revolutionaries suffering from PTSD, he says. 
“The family, which is the nuclear base of Libyan society, was destroyed after the war,” Idres said. “Young men who earned money have been killed or are now unable to work anymore because of PTSD or drug abuse. They destroy themselves but also their whole family. It is a vicious circle.” 
The age of drug-addicted patients has lowered from the 20s to 14-15 years old, Idres said. “These young patients tell me the same story: ‘After the war, Libya was free. So I quit school and I tried alcohol, then hashish, then pills [especially Tramadol]’. I can predict that after 10 years, this generation will have severe psychiatric problems like delusional or maniac behaviours,” he said.
Nasser is worried not only for this generation, but about the one to follow. 
“PTSD impacts fighters in the first step, then the following generations,” she said. “The aggressiveness of the teenagers and children is linked to the post-war chaotic situation.” 
Return to normality? 
Without strong central authority, Libya continues to be hostage to unchecked rival armed militias. They have shut down oil production facilities, taken over government ministries and even temporarily detained the prime minister. Attacks by gunmen and shootouts at checkpoints are common. The civil war and ensuing disruption of oil exports - Libya’s sole source of revenue - by rebels has also caused a “total collapse” of the economy.
In addition to being unable to return to normality, Libyans also have had to adapt to a new, more open society, after 42 years of dictatorship in which the population had limited access to the outside world.
Ali Elakermi was arrested at age 22 for being a member of an Islamic political party. He spent 29 years and 5 months in Abu Salim prison, making him the second longest political detainee in Libya’s history.  

Upon leaving prison, “it was difficult to understand the new world with all these new technologies, like mobile [phones] and Internet,” he told IRIN. “But the [hardest part] was for the single males around 50 years old. How can they find their place in Libyan society with no children or wife?” Now 63, Elakermi was lucky to marry after his release in 2002. He found his way by creating the Libyan Association for the Prisoners of Opinion. “Not only do I want to explain to children what happened during Gaddafi’s time, but I also want to explain that revenge and exclusion are not the solutions.” 

Social bond 
While 2-3 percent of the population have psychological problems as a result of the conflict, many more suffer from a lack of “social bond”, according to Marco Gagliato, a psychosocial programme manager at a psychosocial centre run by the International Organization for Migration (IOM).
The centre provides a space for Libya’s various ethnic communities to share their cultures with each other, which was mostly forbidden before. 
In February, for example, an Amazigh community from the Tamzin area in Jebel Nefusa District was invited to the centre. 

“It is really important for us,” Mohamed Massaud, an Amazigh from Tamzin, told IRIN. “Gaddafi prevented us to come to Tripoli. It is the first time for the elders to see the capital of their country.”Others are trying to help heal the wounds through theatre, sport, music, capoeira and other activities. That’s how LYC helps 750 people aged 6-25 deal with socio-economic and psychological problems. Its Who am I and What Do I Want? project is run by Hilfswerk Austria International and funded by the oil company OMV. 

Still others look to more practical ways to help people move on. Unlike Elakermi, Khaled Hamidi, a former rebel still traumatized by the war, has a hard time letting go of his anger. “If I meet a Gaddafi loyalist who I know killed or tortured [people], I will not be able to shake his hand,” he told IRIN. In an attempt to help him get past such feelings and reintegrate into society, IOM offered him a job as a project manager at its psychosocial centre. “To give Khaled responsibilities is a step on the road towards reconciliation in Libya,” Gagliato said. But addressing psychosocial wounds remains a sensitive subject in Libya. For one psychiatrist, who requested anonymity, addressing the lingering effects of psychosocial trauma is not a priority for the government, which is struggling to provide security and regain control of its revenue-generating oil facilities from militia groups. 

“Psychological issues are taboo. Nobody wants to launch public campaigns,” the psychiatrist told IRIN. “So, it is easier for officials from the Ministry of Health to steal money from our budget because nobody will complain. As a result, sometimes our programmes have facilities but not doctors, sometimes it is the opposite.” 

Continued taboo 

From its unmarked office in Tripoli, the International Rehabilitation Council for Torture Victims (IRCT) helps further the recovery of about 10 patients, ranging from prisoners who were severely tortured to people who jump each time they hear a big blast, reminding them of shelling during the war. 
Using words such as psychology, mental health or PTSD is often counter-productive, says Sana Bousbih, a project manager at IRCT. 

“In Libyan society, it is difficult to admit publicly that we need psychological support, for fear of being socially stigmatized,” she said. 

IOM refers to its centre as a recreational and social centre, rather than a psychosocial centre (it goes by the name Moltakana, or “Our space”). Meanwhile, the IRCT building has no sign at the entrance; the address is given by word of mouth to maintain a low-profile. 
Strengthening local capacity to respond to psychosocial needs is another challenge. To that end, IRCT employs general practitioners, a physiotherapist, a gynaecologist and a psychologist: all are Libyan. 
Signs of success
Despite the challenges, some projects are beginning to show signs of success. 
For example, in collaboration with the Ministry of Education, Danish Church Aid has been running a psychosocial project for children and youth in Misrata, a city heavily affected by the conflict, since November 2011. 
In the artwork produced recently by the children, Shaada Sewee, a project field operator, noticed a transition “away from images of violence and fighting which dominated art found in schools immediately following the revolution, to images of hope, collaboration and a new future.” 
In partnership with the Ministry of Local Government and local communities, the UN Children’s Fund (UNICEF) is installing 13 playgrounds in symbolic areas across Libya. The first, inaugurated in February, is near the now defunct Abu Salim prison, notorious for alleged mistreatment of political prisoners under Gaddafi’s rule, including a prison massacre in 1996 in which more than 1,000 were killed. 
“In Libya, playgrounds are missing for children to enjoy themselves and to recover from psychosocial issues,” Maria Calivis, regional director of UNICEF for the Middle East and North Africa, said at the opening. 
“The playgrounds are a vital contribution for the healthy development of our children in Libya,” Mohamad ElHaji, deputy minister of local government, said in a press release.
At the new park, young boys have given up the war games to play on swings and toboggan down hills, while their mothers socialize. 
“It is a really good idea for the children and the mothers,” one of them told IRIN. “We just need chairs and a coffee shop!”