Prioritizing Mental Health is a Vital Step Towards Refugees’ Wellbeing in Uganda

While escaping conflict, navigating uncertainty, and coping with the absence of familiar social networks during emergencies, the mental well-being of refugees is frequently overlooked.

In a world fraught with conflicts, persecution, and environmental crises, Uganda stands as a beacon of hope for over 1.5 million displaced individuals, including South Sudanese, Congolese, and Somali refugees according to the 2022 report from the Office of the Prime Minister (OPM).

No one wants to leave their home, but people are forced to seek refuge after enduring alarming and frightful experiences and long periods of uncertainty. For some refugees, this uncertainty continues even once they get to the settlements. They are confronted with formidable challenges as they try to rebuild their lives. When social safety nets have unraveled the psychological toll on the refugees can be severe.

This harsh reality is discussed in the Lutheran World Federation (LWF) 2023 Mental Health and Psychosocial Services (MHPSS) needs assessment report made possible with funding from the United States Government (Bureau of Population, Refugees, and Migration, PRM). The research was conducted across the settlements of Palorinya, Adjumani, Palabek, Rwamwanja, and Kyangwali which are home to more than 40% of the total refugee population in Uganda. The assessment found that refugees who have spent more time in settlements are more prone to depression, due to disruptions in social, economic, cultural, and spiritual lives.

Prioritizing mental health for refugees in Uganda 

“My friends call me a doctor,” says Joan (name changed). The 22-year-old South Sudan refugee is a peer educator in the Palabek refugee settlement in Uganda. She helps other young adults in the settlement deal with trauma and mental health issues and advises on family issues and sexual reproductive health rights. She is part of a program by LWF to improve the mental health of young refugees, who find it difficult to confide in older members of the community

Traumatic experiences after fleeing conflict 

Refugees often end up spending years, if not decades, in host countries Their successful integration into the host society is dependent on their mental wellbeing.  Many refugees come from conflict areas, Franco Chitanana says. “Traumatized individuals are prone to perpetuate violence, unaddressed mental health needs can hinder their ability to adapt, find employment, and contribute positively to their new communities,” the LWF Country Representative cites the report. “Cases of child neglect, alcoholism, and domestic abuse emerge.”

“Imagine seeing your children crying yet you don’t have money to buy food for them, I usually cry when I see my children cry because I cannot provide for their food, my husband is overdrinking alcohol and even when I talk to him to stop, he cannot listen…” said one of the FGD participants in Morobi, Palorinya settlement.

Joan, the young peer educator, has experienced terrible things herself. “Five years ago, I was married and pregnant when the rebels broke into our house at night, “she says. The armed men assaulted the young woman and killed her husband and brother. Later in the refugee settlement, Joan’s trauma manifested as depression.   

The report revealed that suicide is a major concern with heightened stress levels due to food insecurity and lack of livelihood opportunities. The fear of societal judgment, particularly among men, is an unspoken, yet deeply significant concern.

Stigma and discrimination

According to the MHPSS needs assessment report, the community responses indicate negative perceptions of mentally ill people; they are considered restless, aggressive, sinners, unproductive and useless; “once mentally sick, always mentally sick with no or limited hopes of recovery”. Stigma and discrimination against persons with mental illness prevent people from seeking help. Among the health care providers, feedback demonstrated that majority agreed with notions that people with mental illness should be prevented from having children, they cannot make decisions for themselves, and are dangerous to others. Furthermore, majority said they would be ashamed if people knew that someone in their family had been diagnosed with a mental illness.

Caretakers of persons with mental illnesses generally seek help from traditional healers before taking their patients to hospitals; this often worsens mental disorders. “In South Sudan, we don’t grieve when we lose our loved ones; all you have to do is drink, and everything will be okay. You will forget,” says Lima Albino, a refugee from South Sudan. “Before the LWF therapy sessions, I used to hear women in the neighborhood crying at night due to their husbands’ alcohol-induced violence.”

Refugees are not helpless; they have agency and capacities to cope with adversities. – Adriana FRANCO CHITANANA, LWF Country Representative in Uganda 

Inherent resources 

LWF integrates mental health and psychosocial support across different sectors, including health, education, livelihoods, and GBV prevention and response. Various projects aim to improve access to resources and safety for vulnerable individuals and communities. With funding from PRM, LWF provides multi-sectoral support to host communities and refugees experiencing distress to help them cope with trauma and its effects. Much of this work builds on inherent community resources. To ensure that MHPSS services are community-led, LWF has trained and supported 1,914 CBPSS ambassadors to help reduce the high levels of suicide and distress.  

“Refugees are not helpless; they have agency and capacities to cope with adversities,” Franco Chitanana finds. In the wake of an emergency, community members themselves are always the first to respond. LWF addresses the complex psychosocial consequences of displacement and war trauma by harnessing their knowledge and aptitudes.   

For Joan, a young woman from South Sudan, the peer education program was an essential step in her recovery. She could talk about what had happened to her and her family for the first time among her peers. Today, she says that being able to help others and sharing her experience made her feel stronger.    

“Supporting refugees’ mental well-being can contribute to social cohesion and conflict resolution. As we celebrate World Mental Health Day, let’s prioritize mental health services for refugees in Uganda as part of a fundamental humanitarian obligation and to uphold their basic human rights”, Franco Chitanana concludes.