South Sudan | Mental health specialist: ‘Not all wounds are visible’
Dorothy Namara is a Mental Health and Psychosocial Support (MHPSS) Specialist for Humanity & Inclusion’s South Sudan program.
With a master’s degree in clinical psychology, Dorothy has held a variety of MHPSS roles within the organization since 2018, when she first began working in her home country of Uganda. Always eager to take on a new challenge, Dorothy shares the needs, highlights, and challenges of taking on such an important role. Below, Dorothy shares her experience as a mental health specialist for Humanity & Inclusion in South Sudan.
Q: What are your daily responsibilities?
I engage in a variety of activities depending on what is planned for a given month. I provide technical support for the mental health projects in the program, provide capacity building trainings, and ensure quality assurance to make sure the mission’s MHPSS programs are in line with Humanity & Inclusion’s global standards. I also represent the organization externally and provide an MHPSS lens for stakeholder activities.
I also have to take into account the different mental health emergencies that arise from the project sites. They may not come up every day, but when they do, I give them priority.
Q: What do you like most about your job?
Positive change! Seeing the smile on a person’s face is very rewarding. I wake up every day looking forward to it. I love seeing the transition from their first meeting to their last meeting, and watching them develop positive coping strategies about life amidst adversity. It gives me courage, especially when I see persons with disability. I’m a person with disability myself, so I take a lot of pride in seeing these changes.
Q: What is unique about the context of the South Sudan program?
South Sudan is a very unique context. It has diverse cultures and languages that spread across 10 states. Each of the cultures has its own practices and dynamics that you have to understand before introducing an intervention or project. Community acceptance is key to a project’s success, and not everything that has worked elsewhere works in South Sudan.
You may wake up in the morning ready to go to work, then you encounter a security situation and cannot do what you had planned. You may also have to organize counseling sessions around other projects that participants are involved in, such as cash for work. So, you really have to be flexible and take things one day at a time. Every day has its own unique context.
Personally, I embrace it positively. It gives me the opportunity to think outside of the box and ask myself: How can I best empower the team to accommodate changes positively and move on without being frustrated? It gives me a learning point to embrace the context, embrace the culture and appreciate the people, so for me, it’s very positive.
Q: What are the greatest needs?
We have traumatized populations that are constantly in conflict. Today there may be conflict in one place, another day you will find it somewhere else. We see a lot of trauma cases. Depression, PTSD, anxiety, domestic violence and suicide are all common. Alcohol and substance abuse are particularly common. We also see a lot of protection cases, such as early child marriages and gender-based violence.
Mental health needs to be addressed as part of the bigger pictures of health and protection—especially when it comes to the most at-risk populations, including persons with disability. This population really needs support because most of the time they are left behind. This is why I’m really happy with Humanity & Inclusion’s advocacy efforts. We’re able to create awareness among our partners about mainstreaming disability in their programs, but more support is needed.
Q: What do you wish more people knew about your work?
People should know that the diversification of mental health projects, by including skill development, livelihood initiatives and income-generating activity has a greater impact and results on the psychological wellbeing of the population. For example, coupling mental health with livelihood projects works wonders. Whenever someone is able to get their mind settled, and then you give them a skill to make a living, it empowers them to maintain their coping strategies. They cope better. If they come to the sessions and talk about their stressors, and then they go back home and sleep hungry, this will bring them back to the same situation they were talking about in-session.
There are not many MHPSS actors in South Sudan. South Sudan is a huge country, and mental health coverage is just a drop in the ocean. We can only do as much as our funding can cover. Because mental health is not a tangible thing that entices donor funds, there are very few that really invest in mental health. When you build 10 schools, they are physically there and are visible. But, when you have group counseling sessions with 500 mothers or 200 children, it’s hard to see the evidence until donors can hear participants share the benefits. It’s really a challenge.
Q: Is there anything else you would like to share?
We appreciate those that have been able to fund the cause of Humanity & Inclusion in South Sudan. We call upon them to continue, because mental health is not a one-day change. It is a process. For a mental health project to be effective, we need years of implementation to document tangible, more permanent changes and see more of the community benefit.
Everyone is a candidate for mental illness. Anyone can be affected at any time. No one chooses these illnesses. We cannot predict that one day there will be no mental health issues. There are very many stressors in the environment that can cause them, just like any other health-related illness.
Lastly, it is important that we not forget the link to people facing specific hardships, including people with disability who are disproportionately affected. At Humanity & Inclusion, we believe that every life matters, and there is no health without mental health. It is important to invest in mental health and psychosocial support, because not all wounds are visible.
World Refugee Day | More and more people are forcibly displaced from home
More than 80 million people in the world are living forcibly displaced from their homes, according to the latest data from the UNHCR, the United Nations refugee agency. That number has doubled over the last decade, skyrocketing in the last few years.
Violent conflicts, human rights violations, weather-related disasters and food insecurity are among key factors forcing people to flee their homes.
Among the 80 million people currently displaced, 45.7 million are displaced inside their home country. Humanitarian law differentiates between these individuals, who are referred to as internally displaced people, and refugees, who flee their home and cross a border to seek refuge in another country.
More than two-thirds of all refugees come from just five countries:
- Syria: 6.6 million
- Venezuela: 3.7 million
- Afghanistan: 2.7 million
- South Sudan: 2.3 million
- Myanmar: 1 million
39% of all refugees are hosted in Turkey, Colombia, Pakistan, Uganda or Germany.
More and more people are displaced for years. For example, the Kakuma Refugee Camp in Kenya was established in 1992 and has grown akin to a small city. With more an 180,000 people living there, it is one of the world’s largest refugee camps. The camp is home to refugees from Sudan, Uganda, Eritrea, Rwanda, Uganda, Ethiopia, Somalia and the Democratic Republic of the Congo.
Humanity & Inclusion works alongside people living in the camp and nearby host communities to provide physical rehabilitation services and assistive devices such as wheelchairs and crutches, and improve the living conditions of for refugees, in particular those with disabilities, by ensuring equal access to services, raising awareness of discrimination and building the capacity of staff working with refugees to assess needs.
Displacement of people with disabilities
Approximately 15% of the 80 million people displaced worldwide are living with a disability. Globally, an estimated 12 million people with disabilities have been forcibly displaced from their homes by conflict and persecution.
Forced displacement disproportionately affects people with disabilities, who are often at higher risk of violence, exploitation and abuse, and face barriers to basic services, education and employment.
Having left behind their homes and belongings, many displaced people—including those with disabilities—depend on humanitarian organizations like Humanity & Inclusion to access health care, food, water, shelter and other necessities.
Header image: A man carries his daughter, who is wearing leg braces, through a refugee settlement in Lebanon. They are Syrian refugees. Copyright: Kate Holt/HI, 2021
Inline image: An occupational therapist helps a boy with prosthetic legs use a walker during a rehabilitation session at the Kakuma Refugee Camp in Kenya. Copyright: Patrick Meinhardt/HI, 2019
Nepal | Meet Reiza Dejito: Mother and Humanitarian Worker
To mark International Women's Day on March 8, we talked to Reiza Dejito, a strong woman who is deeply committed to both her family and her role at Humanity & Inclusion. Currently serving as the Program Director for Nepal, India and Sri Lanka, Reiza has worked in numerous countries affected by humanitarian crises for two decades.
Why did you decide to join Humanity & Inclusion?
I graduated in science and physical therapy, and I earned diplomas in teaching and then management. I also completed several volunteer missions in the Philippines (my home country) and Ethiopia. And then, three months after leaving Ethiopia, I joined Humanity & Inclusion as a victim assistance project manager in Bor, South Sudan. Since then, I have worked in Kenya, Bangladesh, the Philippines and now Nepal.
Is there one experience that really stands out?
Working with Rohingya refugees in Bangladesh. They’ve suffered so much. One woman told me how she watched helpless as her husband was murdered and her house was burned down. A 9-year-old child, who was injured in the arm by a bullet after being caught in the crossfire, told me he’d forgiven the attacker for hitting the wrong target. Men, women and children walked for days and days to cross the border with little food and water. Awful.
As a director in the Philippines, I joined the emergency team to help the victims of Super Typhoon Goni. I was extremely impressed by the resilience and generosity of Filipinos. And the commitment of my team and partner organizations to provide assistance to those who needed it most.
What’s the hardest part of your job?
As Program Director, I’m responsible for the security and protection of my teams and ensuring they are safe and sound, and in good health, especially during emergencies, crises and conflicts. In 2016, I had to manage the evacuation of Humanity & Inclusion’s teams in South Sudan following a series of deadly clashes between armed groups. It was the most trying experience of my career.
What's really important when it comes to working with your team?
Trust. Transparency. Empathy. And being able to laugh together.
Humanitarian and mother: how do you strike the right balance?
For many women, achieving this balance is a huge challenge and often prevents them from taking on more responsible positions. I’m extremely fortunate to have a supportive family and a husband who takes care of our child when I’m working. Thanks to their support, I can do the job I do. My family is my biggest incentive. They really inspire me to do better every day.
Is gender equity a challenge in the humanitarian sector?
I’ve been personally fortunate to work with male colleagues and team leaders who are advocates for women's leadership. But while many women work in the humanitarian sector, there are still too few in senior positions. Many organizations have made a lot of progress, but not enough. There is a great deal of work to do before we achieve greater equity. It’s not an easy task, because these inequalities run deep. They’ve been entrenched in cultural, social, financial and political life for generations. It’s not simply a question of empowering women and advancing their rights, but of changing corporate cultures. Men also have a role to play here. I want to see women access positions of responsibility just like men. I think we'll get there...slowly but surely.
Header image: A Filipino woman named Reiza (wearing the blue visor) and another woman carry a tub of supplies after Typhoon Goni in the Philippines. Copyright: HI
Inline image: Reiza squats down to talk with a girl who has an artificial leg at a refugee camp in Kakuma, Kenya, in 2015. Copyright: Xavier Bourgois/HI
South Sudan | Humanity & Inclusion’s emergency mobile teams assist vulnerable displaced people
Since 2013, the crisis in South Sudan has forced millions of people to flee their homes. Several thousand South Sudanese caught between fighting and famine have fled the country, while 1.9 million internally displaced people have taken refuge in camps around Juba, the capital, and in more isolated regions of the country. Most are women, children, and older people, including people with disabilities.
Humanity & Inclusion has deployed emergency mobile teams to assist the most vulnerable individuals. They provide rehabilitation and psychosocial support to people in conflict-affected areas. The teams consist of specialists who provide technical and material support to rehabilitation centers in remote and isolated areas and directly care for people with disabilities by providing them with rehabilitation and orthopedic-fitting sessions.
Steven Lavour, a rehabilitation health worker with Humanity & Inclusion, is a member of the Juba mobile team. He is providing support to Isaac Ramadan, a physical therapist from the rehabilitation center in the city of Yei. He is also responsible for supplying the center with mobility aids.
Growing mobility needs
“A lot of people in Yei need wheelchairs, crutches, and prostheses,” explains Steven. “Unfortunately, we cannot keep up with the rapidly growing demand. Many people are currently waiting to be fit with an orthopedic device or to receive a mobility aid. People who have fled the Yei region during the crisis are now returning. The challenge for Humanity & Inclusion will be to respond to this rise in demand. It will be several months before we receive and distribute the orthopedic devices, which are being made in Kenya.”
Conflict in South Sudan
In fact, for several months, hope has returned to the South Sudanese as the peace agreement signed in September 2018 begins to take effect, with a de-escalation in tensions and a reduction in conflicts. Displaced people and refugees in the camps are planning to return to their villages or have already begun to do so.
Humanity & Inclusion’s mobile teams have also set up discussion groups for members of the community in order to assess their needs, along with information sessions on disability prevention measures and community-based rehabilitation.
Humanity & Inclusion in South Sudan
Our teams have been operating in South Sudan since 2006, working to improve protection, quality of life, and the promotion of rights of vulnerable populations. Since December 2013, South Sudan has been undergoing a political crisis, which has resulted in fighting and massive population movements. The number of internally displaced people has reached 4.3 million and some 1.6 million South Sudanese—63% of which are children—have fled to other countries in desperate need of aid. Our team is on the ground, contributing to the urgent humanitarian response. Learn more about Humanity & Inclusion's work in South Sudan.
South Sudan | Going the extra mile to bring rehabilitation to isolated populations
New Fangak is a remote area of South Sudan surrounded by rivers and wetlands. Many villages are only accessible by boat or plane and the majority of the population of 26,000 are agro-pastoralists.
Reaching the most isolated populations
Humanity & Inclusion’s team of rehabilitation specialists, known as the ‘Flying Team’ travels to some of the most remote areas of South Sudan, like New Fangak, to better understand the needs of the community and how HI may be able to provide relevant services.
The Flying Team conducts focus groups with members of the community to hear about their concerns and issues linked to health, disability, and rehabilitation. In New Fangak, many people mentioned that polio-like symptoms were prevalent within the population as, historically, the area was cut off from access to vaccinations. The first polio vaccination began just three years ago.
In Tonga, our team found that people with disabilities lacked access to services due to social stigmas and a lack of mobility aids such as crutches, wheelchairs, and walkers.
Prevention of disabilities
The Flying Team conducts a range of training sessions on measures to prevent disabilities and how to include basic rehabilitation procedures. In New Fangak, they worked with 19 health workers from six different organizations and health facilities. This was the first training on the subject of disability and rehabilitation that participants had ever received.
Training is an important step in building awareness and capacity throughout the more remote locations of South Sudan. Humanity & Inclusion’s Flying Team will continue to visit these locations and offer specialized support and services through awareness raising campaigns, capacity building workshops, and training sessions. Our goal is to ensure no one is left behind, no matter where they may live.
Many thanks to the European Civil Protection and Humanitarian Aid Operations (ECHO) for supporting this important work.
Uganda | South Sudanese refugees tell their stories
Renowned photographer Giles Duley visited a refugee camp in Omugo, Uganda, where he met refugees with disabilities fleeing violence in South Sudan. Many of these individuals who were affected by the conflict, shared their personal stories and the significant challenges they face in the refugee camp.
Beatrice, who sits next to her mom, Reida, are a part of the 1 million South Sudanese who have taken refuge in Uganda.
Beatrice, who became paralyzed at age six due to the polio virus, wishes she could play with the other kids in the camp. Soon after this photo was taken, Beatrice received a wheelchair from HI’s team. As a result, she will be able to attend school and play with others.
Reida, Beatrice’s mother, sorts through beans that she will soon cook over wood for her three children. Beatrice likes to cook the sauce for the beans and often helps her mother.
John had his leg amputated in 2012 as a result of cancer. When shootings started during the night in his village in South Sudan, he had to leave in a hurry with his wife. John took his crutches but had to leave his prosthesis behind.
In the camp, John became a community volunteer with Humanity & Inclusion. He travels around the refugee camp to identify vulnerable people and people with disabilities, so that our teams can ensure they receive the support they need.
Catarina fled violence in South Sudan with her family. She feels very lonely in the refugee camp. It is very rocky which makes it difficult for Catarina to get around. She wishes she could go and have a chat with her neighbors and visit others in the camp.
Mary fled the violence in South Sudan and took refuge with her family in Omugo refugee camp.
“I wonder if I will see my friends again?” she said. She cannot reach her friends that she used to visit in South Sudan. They are all separated in other camps. It makes her feel stressed.
Mary has a disability due to the polio virus and also has scoliosis. She had to leave her wheelchair behind when she fled and now struggles to move throughout the camp.
South Sudan | Displaced and disabled: humanitarian services fall short
Conditions are extremely harsh for everyone living in South Sudan’s Bentiu camp, but people with disabilities are particularly vulnerable. A new report by Humanity & Inclusion and the International Organization for Migration (IOM) assesses the situation in the Bentiu Protection of Civilians Site in South Sudan, where humanitarian services struggle to meet the needs of people with disabilities.
The civil war raging in South Sudan has forced many Southern Sudanese to flee to camps like Bentiu. Several humanitarian organizations are helping, but improvements must be made to ensure humanitarian response takes into account the needs and rights of people with disabilities.
Present in the field, HI and IOM have identified discriminating factors affecting people with disabilities and recommended ways to promote more inclusive humanitarian response.
Inaccessible water and food
People with disabilities say they’re unable to fully benefit from the site’s humanitarian infrastructure and services. Major barriers identified include long distances, inaccessible infrastructure and roads, information formats poorly adapted to their disability, and discrimination. In fact, some 49% of surveyed people with disabilities reported particular difficulty accessing clean drinking water due to the distance to water pumps and unsuitable road surfaces. Many people reported difficulty moving around their shelter. Children with disabilities cannot access child-friendly spaces.
Although there are priority queues at food distribution sites, people with disabilities are finding it difficult to get their rations home safely, because containers are unsuitable and often stolen by others along the routes to their shelters.
These are just some of the discriminating factors that make daily life more difficult for people with disabilities in the camp.
Inclusive humanitarian services needed
The report suggests ways for humanitarian services to become more inclusive. These include prioritizing funding for inclusive programs, adapting infrastructure and information sources, improving mechanisms to protect against abusive behaviour, and requesting technical support from local and international disability representatives.
Funding bodies, camp coordinators and humanitarian organizations can ensure that people with disabilities feel protected and involved in sites like Bentiu. By adapting their activities to meet the needs of people with disabilities, humanitarian actors can optimize services for people living in camps and help ensure inclusive and accessible humanitarian assistance for all.
The HI and IOM report: Access to humanitarian services for persons with disabilities in Bentiu Protection of Civilians Site
Uganda Field Update | Aiding the most vulnerable South Sudanese refugees
Since the outbreak of civil war in South Sudan in 2013, Uganda has offered a place of safety to more than 1 million people fleeing the conflict since July 2017. More than 85% of the refugees are women and children. Meryll Patois, HI’s rehabilitation technical advisor in Uganda outlines the needs of South Sudanese refugees and the services that our teams are providing.
Caring for the most vulnerable
The needs are acute among South Sudanese refugees due to the type of conflict they're fleeing. HI is the first organization to provide this type of service—there are no other rehabilitation services in the camp. We can see the violence of the conflict on the bodies of our beneficiaries. Some people have suffered extreme violence and did not have access to any healthcare for a long time. They had to flee with their injuries, worsening the damage to their bodies.
Many of the people our teams are helping have fractures and injuries caused from shotguns. Many were attacked during the night and had to run away. Most of them have walked in very difficult conditions for days, without having access to any health services. We see a lot of beneficiaries who have unnecessary complications from simple injuries—these could have healed better if they were dealt with at an early stage. If a fracture is not treated right away, for example, it can lead to complications and long-term impairment.
HI has an integrated approach, which sets our services apart. We take a holistic view of every beneficiary we meet. For example, a mother with a broken leg cannot walk. So she cannot go and buy food in the market, work, or take care of her children. She may also have psychological trauma. In this case, our team would provide her with rehabilitation support but also psychological and protection support, and refer her to other organizations so that she can have access to all of the services she needs.
Our team would also try to find out if there is a caretaker who could help a person with an injury or disability. If so, we would train each caretaker, so they know what to do to support their friend, neighbor, family member, etc. We find a lot of solidarity in the camps. Neighbors are supporting each other even if they only just met. We rely on these human links to make sure beneficiaries can get all the care they need.
For example, one of our beneficiaries, Beatrice, is a 10-year-old, little girl whose legs are paralyzed due to complications from the Polio virus. She cannot walk. We will provide her with a wheelchair to go to school and we will also teach her mother how to support her daughter with physical therapy exercises.
Reaching and empowering the invisible
There is a huge injustice for people who cannot move around and don’t have access to the services they need because they cannot leave their shelter. HI is reaching these people who are often unintentionally excluded from humanitarian aid. Our role is to make sure that they receive the support they need. Sadly, there are still many in need of that support today.
HI has a fixed point in the camp for rehabilitation services, it's here that people can find us. We also have mobile teams of physical therapists, who reach individuals who are unable to leave their shelters. During a rehabilitation session, HI’s physical therapists work on movements to help the beneficiaries recover. If movement is not possible, HI’s team provides the beneficiaries with assistive devices such as crutches or wheelchairs to help improve their daily life.
We have a protection team that travels around the camp and identifies the most vulnerable people and their needs. We also rely on HI's community based volunteers, who are also refugees and know the community very well. Similarly, some beneficiaries are referred to us by other NGO partners such as Save the Children and the International Rescue Committee.
More about our work in Uganda
Present in the country since 2009, our teams helps victims of landmines and other explosive remnants of war to recover through physical rehabilitation, psychological support, and job training. Staff members also educate other Ugandans about the risks posed by these weapons. We are also conducting a census of people with disabilities, referring them to relevant services. Learn more about our work in Uganda.
Photo: Tabitha, 8, is from South Sudan and now lives in Omugo refugee camp in Uganda with her family. Tabitha has difficulty walking due to Polio. HI provided her with new crutches, adjusted to her height, so she can go to school with ease.
South Sudan Update | Emmanuel can now travel to school by himself on his tricycle
Twelve-year-old Emmanuel is a student at Illuhum school in Torit, a region to the east of the capital Juba, in South Sudan. Because of his disability, his mother used to carry him to school on her back, before going to work as a coal seller. A heavy burden on her, it also made life difficult for Emmanuel, who was often late for school.
That is, until he met Humanity & Inclusion (which operates under the name “Handicap International” in South Sudan). Since receiving a tricycle from our team, Emmanuel now travels to and from school on his own. “I still can’t believe I can go so far, so fast!” he says.
“Including people with disabilities in their communities and ensuring they enjoy the same chance of success is vital,” explains Paul Crichley, the Director of HI in South Sudan. “It’s also important that people with disabilities have equal access to healthcare and education. Thanks to his new tricycle, Emmanuel is more independent and can now take part in a complete range of school activities, just like his friends.”
Emmanuel’s school is one of several supported by HI, which helps to make the facility more accessible to children with disabilities. According to Crinchley, it’s been three years since the project was launched and it continues to have a positive impact on people’s lives. “It’s easier to physically access the schools now,” he continues. “And we’ve trained teachers to include children with disabilities in the classroom.” These teachers will continue HI’s work even after the project has ended.
In the Torit region alone, HI has handed out 40 mobility aids, such as wheelchairs and tricycles, to give independence and dignity to people like Emmanuel, who can now move around more easily.
Emmanuel is no longer the last to arrive at school. In fact, he’s always the first! And because he can move around by himself, he plays an active role in school life, and has even been voted class representative. What does he want to be when he grows up? “I want to study and help people who can’t walk, especially children like myself,” he says. “I want to play an equal role in their community.”
HI in South Sudan
HI first deployed an emergency response team to South Sudan in 2006. Since then, our teams have continued to adapt its activities to respond to the immediate needs of the internally displaced population, and promote the equal rights and equal access to services for people with disabilities or injuries. Learn more about our work in South Sudan.
1 million South Sudanese refugees in Uganda
Since the outbreak of civil war in South Sudan in 2013, Uganda has offered a place of safety to people fleeing from the conflict. On August 17, the Government of Uganda and the UN Refugee Agency announced that the staggering threshold of 1 million South Sudanese refugees has now been reached.Read more