Prioritizing psychological first aid

Published: 12 March 2002 0:00 CET

Sébastien Carliez in Amman, Jordan

Violence claims innocent victims every day in countries across the Middle East and North Africa. Deadly events triggered by natural disasters are also a sad feature of life in the region. Psychological suffering is an increasing challenge for Red Crescent and Red Cross Societies.

In Algeria, violence continues to kill innocent civilians every day. Algerian Red Crescent psychologist Latefa Belarouci, is piloting a support programme for women and children traumatized by the killing of relatives, sometimes in their presence.

"Psychological aid is a rather new concept in Algeria, brought up by a decade of violence", she explained. "The main characteristics of the psychological trauma we face in Algeria is that these traumatic events are intentional acts perpetrated by male adults from within the community - those who would be expected to protect the victims."

These were among the harsh realities discussed by the working group on psychological support programmes (PSP) in the Middle East and North Africa, which met in Amman this month, comprising representatives from the Algerian, Jordanian, Lebanese and Palestinian Red Rescent and Red Cross Societies as well as counterparts from the Danish and French Red Cross.

The participants exchanged the experiences of their field practitioners, and studied available training material taking into account the cultural values of the region. "Although psychological wounds are universal, the manner in which they are expressed and addressed vary from one culture to another", explained Jari Vainio, Federation regional health delegate.

In the region, the Algerian Red Crescent is providing psychosocial support first to affected women. The programme includes vocational training workshops whose objectives are professional and social reintegration. "These are places where women are listened to, where they can talk about their suffering and fears, share their experiences," added Latefa Belarouci.

Such psychological assistance is vital to raped women in particular. Otherwise they tend to keep silent. Sometimes they are socially excluded and often rejected by their own families - in extreme cases, some are even killed. For traumatized and destitute children, the Algerian Red Crescent runs social activities such as summer camps, in order to fight the stigmatisation of children by their peers and reconstruct destroyed social links.

With the support of the International Committee of the Red Cross, the Algerian Red Crescent also provides counseling booths and day centres equipped with psycho-educational materials. It also organizes regular seminars for psychologists, which combine technical sessions on treatment and care with an introduction to community-based intervention. These sessions also offer professionals a space for debate, which is badly needed in Algeria, as "working in emergency situations tends to push time for reflection away", according to Belarouci.

Psychological wounds resulting from the conflict between Israelis and Palestinians are another issue of major concern. "A significant part of the population was born and has lived with the conflict", explained Elia Awwad, director of the mental health department of the Palestine Red Crescent Society (PRCS). People have accumulated stress for years, he noted.

Given the magnitude of the phenomenon, the Red Crescent has long led public awareness campaigns to help people understand why and how stress is impacting their lives, thus fighting the still vivid cultural stigma attached to psychosocial needs and intervention.

Since last October, as the death toll among civilians continues to rise, the Palestine Red Crescent has been providing direct psychological first aid to Palestinian families. With the support of the German Red Cross and the European Commission Humanitarian Office (ECHO), Elia Awwad and his teams

of social workers conduct daily visits to cities and villages of the West Bank. They organise group and individual sessions with mothers, and talk to schoolteachers about child trauma.

Recently, they have extended both their counseling and training activities to Red Crescent emergency medical personnel, who are daily exposed to violence. Two have been killed and more than 120 injured since the current cycle of violence erupted, in late September 2000. "It is essential to teach stress management to caregivers who are on the front line", Dr. Awwad explained.

It is crucial to acknowledge that helpers and lifesavers need psychological support too and that the needs of professionals vary from those of a volunteer. "We have to think of different levels of support, adapted to each category and appropriate training must be provided to field workers," noted Jari Vainio.

In Algeria for instance, professionals feel very isolated, specially those operating in remote areas. "And they are sometimes victims themselves, thus experiencing the same trauma as their patients are", Latefa Belarouci explained.

To address these needs, by improving and expanding their psychosocial support programmes, Red Cross and Red Crescent Societies in the region are looking for more external resources and know-how, including from their sister Societies within the Movement.

The Danish Red Cross has recently committed itself to extending its support to the Palestine Red Crescent, based on their extensive experience in the war-stricken Balkans over the past six years. The Reference Centre for Psychological Support, based in Copenhagen and established in cooperation with the International Federation, helps National Societies to develop their psychological support activities.

"Our programme for children affected by armed conflicts (CABAC) helps children who lost parents and friends to regain hope and confidence for the future", explained Inge Jochumsen of the Danish Red Cross. Methods include many artistic activities, like drama and drawing. "They are based on and driven by the community, relying on respected local figures, like schoolteachers, to heal the wounds," she said. Parents are also invited to meet once a month to discuss activities and comment on preliminary results. Designed for children, CABAC programmes could be adapted to other vulnerable groups, such as women, the elderly, and disabled people.

The Red Crescent and Red Cross Societies of the region and their partners are planning to meet again in May or June to agree on a common plan of action. Two Societies in particular are expected to join the group: Iran, whose proven record of psychological first aid to victims of natural disasters could be of benefit to all; and Iraq, where the morale of the population and the youth in particular has reached an all-time low as a result of eleven years of devastating sanctions and violence.