It has been more than a year since government soldiers attacked Mary Poni’s house in the South Sudanese town of Yei. They raped her elder sister and beheaded her father – part of a harrowing string of events that would eventually push her to attempt suicide, twice.
“I don’t sleep,” 25-year-old Poni said in the capital, Juba, where she now lives. “Whenever I try closing my eyes, I see my dad’s head falling before me.”
Since December Poni has received some psychological support, not as part of an organised programme but because she showed up – along with several other traumatised people – at the offices of Humanity & Inclusion, an NGO formerly known as Handicap International.
Five years of civil war in South Sudan have not only killed almost 400,000 people, they’ve also left a nation of traumatised survivors in their wake – millions of them displaced and living in camps or squalid conditions that add to the mental and emotional strain.
The government, reeling from the day-to-day fallout of the war and political dysfunction, offers little to no support. The entire mental health programme for a country of more than 10 million people relies on one hospital ward equipped with eight beds and served by one psychologist.
Less than two percent of nationwide funding is put towards the health sector, and no money is specifically allocated for mental health services, according to Dr. Felix Lado Johnson, the state minister of health in Juba.
Informal support also exists, like the sessions Poni attends. Humanity & Inclusion psychologist Melodie Safieddine explained that she usually treats NGO workers, but when people arrive at her clinic in Juba in search of care, she tries to help the ones she can.
The country has no official mental health data, but a 2015 study by the South Sudan Law Society and the United Nations Development Programme reported that more than 40 percent of people surveyed across six states showed symptoms consistent with post-traumatic stress disorder, or PTSD. Aid group Médecins Sans Frontières documented more than 51,500 people seeking psychosocial support in 2017, a 35 percent increase from 2016.
Psychologists warn that years of conflict have normalised violence and death to an extreme degree, threatening people’s moral framework and mental health for the foreseeable future.
Anthony Feinstein, professor for the department of psychiatry at the University of Toronto and Sunnybrook Health Sciences Centre, believes stunted developmental growth as a result of persistent trauma could even have far-reaching effects on South Sudan’s future leaders.
“There will be those whose development has been scarred by war and conflict and their political decisions may well be influenced by this,” he said. “Decisions that are emotion-based may lack rationality, which… can generate further discord and conflict.”
‘I cried for death’
For Poni, the past year has been one devastation after the next. After her father was murdered, she escaped with her four sisters, leading them out of town towards the village where she thought it would be safer, rather than joining the thousands fleeing across the border to neighbouring Uganda. But on the way, the girls were brutally attacked by five government soldiers who tied them down and systematically gang raped each one until they bled, Poni said.
“I cried for death,” she said, recounting how several hours later their five bloodied and beaten bodies were rescued from the bush by the driver of a passing truck, who took them to a nearby church. But Poni’s three younger sisters were too badly injured and all died in the chapel. The youngest was 13 years old.
Since their deaths Poni has blamed herself for leading the family into the village instead of going straight to Uganda. “That’s why they were raped and killed,” she said.
Safieddine, who has been treating Poni, said this “blame effect” is common in South Sudan because of the nature of the attacks. “People are seeing their perpetrators directly; they’re facing it,” she said.
“The level of disaster is enormous. The consequences of what’s happening will be felt for the whole generation of kids growing up.”
After Poni’s three sisters were killed, she and her surviving sister sheltered in the church for two weeks, until they decided to flee for Uganda. They walked for seven days through the bush; but then, right before crossing into safety, they were attacked and gang raped again by government soldiers, she said.
During the attack Poni said she witnessed an elderly woman being shot and killed in front of her, and watched as soldiers ripped an unborn baby out of a pregnant woman’s womb and chopped it to pieces as the mother also died.
“This is not humanity. It’s insanity,” she said.
In December 2017, Poni said, , made it across the border to Uganda. Once inside Bidi Bidi refugee camp in northern Uganda, something inside Poni snapped.
Traumatised, bitter, and distrustful of everyone, especially men, she retreated into herself.
She said she began to label any man who crossed her path as a rapist. She was also guilt-ridden for being unable to save her sisters. During her 12 months in the camp, she tried to commit suicide twice – the first time on malaria pills, the second by drowning in a lake.
After seeing their villages and families destroyed, tens of thousands of South Sudanese, including Mary Poni, fled to camps in northern Uganda for safety.
Last January, MSF reported a spike in the number of attempted suicides in the Malakal site, which is home to almost 30,000 civilians. Eight to 10 people tried to kill themselves each month, 80 percent of whom were under the age of 35. While the number has now stabilised at approximately three to four attempted suicides monthly, MSF says things will only change if the underlying factors are addressed.
“The lack of employment, the lack of prospect, the living conditions: these are the triggers for the mental health problems,” said MSF medical coordinator Endashaw Mengistu Aderie. “Dealing with those requires more than what we are doing. It requires stepping up efforts to provide services for the population.”
“You can’t rebuild the country without rebuilding the mind and the hope.”
However, issues like mental health are way down the priority list in South Sudan. Against the backdrop of collapsed markets in a devastated, war-torn economy, combating hunger and beating back famine takes precedence.More than five million people already face severe food insecurity, 36,000 of whom are on the brink of starvation, according to the latest analysis by the government and the UN.
Together with other trauma experts Safieddine is concerned for the country’s future if more isn’t done to help this generation of traumatised survivors of war and violence. “You can’t rebuild the country without rebuilding the mind and the hope,” she said.
‘We all really need help’
After almost a year in the refugee camp in Uganda without assistance, Poni heard from a friend about Humanity & Inclusion in Juba and made the risky journey back to South Sudan to try to get psychological help. Since December she has been working with Safieddine to try to overcome her guilt and stop the disturbing cycle of thoughts in her head.
“The one thing that’s changed my life entirely is (when Safieddine told me) ‘don’t blame yourself because it was not your fault’,” said Poni. Shifting the narrative has helped liberate her mind and for the first time in a year she began socialising again and attending church. She is also experimenting with art therapy and trying to help others.
Last week, while walking to her counselling session, Poni encountered a troubled government soldier, bought him a bottle of water, and gave him some money to feed his starving family. She said he told her that “if he finds a quiet place, he’s going to shoot himself so he can rest”.
“The whole country is traumatised,” she said. “We all really need help”
Read full story here: South Sudan: “The whole country is traumatised”