By Dr Selam Kidane
The Tigray war has been marked by some of the most brutal, widespread sexual abuse witnessed in recent years. Women and girls (and some men) have been attacked, sometimes repeatedly. It has left them terribly damaged and this must be addressed.
So too must be the impact this trauma has had on their communities. If this is not addressed the hurt they have endured could spill out and cascade down the generations – threatening the future of communities across the Horn of Africa.
This programme draws on the PhD thesis that I was awarded in November 2021 that developed this programme. It will help us answer the urgent question: how to stop the trauma of sexual abuse being passed from one incident to another; from one community to another.
My study investigated the relationship between Post Traumatic Stress and social economic resilience amongst refugee populations. It also relates to how high levels of traumatic stress impair decision-making. The study was carried out among Eritrean refugees in Ethiopia and in Northern Uganda.
The work measured whether resilience could be increased by introducing a self-help and low-cost programme, which I designed, called the Trauma Recovery Understanding Self-help Therapy (TRUST).
The TRUST-programme was piloted in Northern Uganda among women returnees after the civil war, where many had been grotesquely abused by the notorious Lord Resistance Army.
How it works
Using the simple, self-help programme which was delivered on a basic smart phone (phones widely available in the area) TRUST showed real promise. In Ethiopia the TRUST programme was administered through phones since the phone is a trusted communication technology for refugee youths in the camps.
TRUST has three elements to it a psycho-educational, trauma processing skills and social re-integration. This is provided in the form of video based instructions and accompanied by opportunities for people to access text based support if needed. In all there are seven sessions including (where possible), one community wide event to celebrate the progress people have made in processing traumatic stress.
The videos are password locked and will only be released when a participant has accessed the preceding video. The essence is that people access videos at their own pace but it is recommended that they at least leave a 2-3 days between sessions so they can practice the skills or process the information provided.
The findings suggest that the TRUST-programme is versatile and renders a significant effect on social and economic resilience, on individual trauma and collective trauma. TRUST provides a viable option to assist in addressing trauma and enhance social and economic resilience of refugees and their communities.
A real-life use of TRUST
My ‘eureka’ moment came in a dusty café in the middle of the refugee camp in Ethiopia that I was using as a makeshift office.
I worked through the day fuelled by endless cups of sweet tea and with no time to reflect on the data I was collecting to see if any pattern was emerging, despite the fact that people were telling me encouraging things about how much the intervention had helped.
And, then, in came Merhawit. I remembered her instantly as she was one of the most severely traumatised people I had met in the camp. I remember thinking (during the baseline data collection); if it works for her, it will work for real.
Nearly two months later, she was telling me how tough it was going through the programme.
She particularly found processing all the old memories difficult. She told me how many times she stopped, as well as how she somehow managed to force herself to restart, because she was desperate for something that would help. And, finally, she told me how it all came together for her at last (but painfully slowly).
She told me exactly what made TRUST work for her. She emphasised that it does indeed work, but needs a significant level of support, even remotely via the internet.
Apologetically, Merhawit told me that there were times when she resented hearing my voice on the video, as it meant having to face things that she had been avoiding for so long. She explained how it would have been good to be able to ask me if this was normal.
With a properly connected system Merhawit would have been able to ask me such questions in a text message. As it transpired, she only had access to my voice on the video and limited access to text support; she made do, however, and was able to go through the programme – and it worked for her. She has been able to resume her life.
I realised that if TRUST had worked for the most complicated trauma case, then it did indeed work. And it would work even better if we could improve the level of support and encouragement available and overcome connectivity issues.