Notes from the Field

The Psychological Cost of Sri Lanka’s Civil War

September 18, 2013

On September 21, residents of Sri Lanka’s war-torn Northern Province will vote in the first provincial council elections of the region. The event is significant for the former conflict zone – the hardest-hit province in the country, scarred from 26 years of violent fighting and military rule.

Damaged building from Sri Lanka's civil war

Buildings such as this one damaged during Sri Lanka’s decades-long civil war are being rebuilt in the hardest-hit Northern province.

On a recent trip to the North, there was little indication of the violent war that was such a palpable part of the region just a few years back. Save for some ruins in the form of dilapidated houses and singed trees, the occasional war monument, and military personnel, the turbulent past seemed to be fading. In Jaffna, newly built roads link the capital to the rest of the country. For a town that was under curfew during the climax of the civil war (from August 2006 to May 2009), it is remarkable to observe the number of people who come out of their homes after dark, strolling on new sidewalks lit by streetlights. These developments are very positive; at the same time they are relatively skin deep: wars, conflicts, and the violence they wreak form deep scars in the psyche of society which are not as immediately visible. The final stages of the war left many citizens of the North displaced, disabled, and living in refugee camps with a complete loss of their source of livelihood. Sadness, fear, agitation, and inability to sleep or eat well are only some of the ongoing symptoms that these survivors grapple with every day.

In 2005, when the country was in the midst of a ceasefire and still recovering from the 2004 tsunami, The Asia Foundation partnered with local NGOs to begin a program which we then called “Reducing the Effects and Incidences of Trauma (RESIST),” that focused on raising awareness for the needs of survivors of conflict-related violence and trauma and helped to set up clinical service centers. The country context changed drastically in 2006, when open war broke out again between the Liberation Tigers of Tamil Elam (LTTE) and the army, creating a volatile work environment and the need to shift the focus of our program. In 2009, the Sri Lankan Army declared victory, ending the war and enabling access to regions and communities in the North that were previously inaccessible. During this time, we shifted our concentration to improving the quality of psychosocial services, such as counseling, medical support, physiotherapy, relaxation techniques, raising awareness of the consequences of conflict-related violence, and assistance with referrals for our two main NGO partners, the Family Rehabilitation Centre (FRC) and the Association for Health and Counselling (Shanthiham). To address the emerging needs of the large-scale displacement, loss of lives, and livelihoods that took place during the immediate post-conflict period, we established partnerships with the government psychosocial service providers for a more sustainable and wider reach of services.

Now, four years after the war ended, taking into account the socio-political landscape of the post-war climate, we are shifting from a “crisis intervention approach” to a “post-conflict approach” through the Victims of Trauma Treatment Program (VTTP). In a more secure, mobile environment, the space and opportunity to provide better clinical services and expand our reach has increased.

Over the last eight years, the project has assisted 11,387 clients. As a part of the post-conflict approach, we have increased collaboration with government sector service providers such as the National Institute of Mental Health, the College of Psychiatrists, the Ministry of Social Services, and the National Institute of Social Development in a bid to institutionalize psychosocial service provision. A major focus of the entire program and especially VTTP is to build the organizational capacity of FRC and Shanthiham through administrative and clinical support. This has been a slow process, but as VTTP draws to an end, both organizations now possess the capacity to manage organizational and clinical resources independently.

Mihiri Ferdinando is a program manager and Asnah Anver is an intern, both for The Asia Foundation’s Victims of Trauma Treatment Project in Sri Lanka. Ferdinando can be reached at mihiri.ferdinando@asiafoundation.org. The views and opinions expressed here are those of the individual authors and not those of The Asia Foundation.

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