Refugees can flee their countries, but they can’t escape the trauma of war.
Emmanuel Muamba* is a softly spoken man and the corners of his eyes wrinkle every time he smiles. The autumn sun flows in through a large window at one end of the room he rents for himself, his wife and three children. The old three-roomed house is in a quiet street in Troyeville in downtown Johannesburg. Against the wall of the room, next to the window, is a dark wooden chest of drawers, with blankets piled on top. On an adjacent wall, boxes and plastic bags clutter the fireplace. Bottles of medicine and pills are lined up on the mantel.
Emmanuel’s wife, Antoinette*, looks up from where she is sitting on the single-bed sponge mattress on the floor in front of the disused fireplace. She cradles a child who barely
fits on her lap.
Taking a seat next to his wife and son, Emmanuel wipes the child’s mouth dry with a piece of cloth. He takes the boy’s small, bony hand and stretches out his fingers, one by one.
Nine-year-old Fabrice* has severe intellectual and physical disabilities brought on by hydrocephalus. The condition is a build-up of fluid in the cavities or ventricles deep in the brain, which can be caused by a head injury, according to the United States-based medical research organisation, the Mayo Clinic.
WATCH: No healthcare for refugees in SA
The race away from war
Antoinette takes a deep, shaky breath. She remembers the day her son was hurt. One night in 2007, when Fabrice was only two months old, they were awoken by the sound of gunshots and their neighbours screaming: “Let us go! Let us go! The war is starting!”
She looks at her son solemnly. “No one ever plans that a war will start in their area.”
Antoinette grabbed her baby, strapped him on to her back and, with her neighbours, ran for the hills surrounding Goma, a city in the eastern part of the Democratic Republic of Congo (DRC).
After what felt like hours of running, a frantic Antoinette noticed something was amiss. The infant she had tied to her back was no longer there.
“The material tore and the baby fell down but in the commotion I did not notice. I just kept running. I went back and found my baby lying on the ground — crying.”
The DRC, especially the eastern part of the country, has been embroiled in intermittent violence dating back to the aftermath of the Rwandan genocide of 1994, according to the United Nations.
“We decided to leave our homeland. The priests there helped us to run away. They facilitated us to move from Goma via the sea [Lake Kivu] to Tanzania. From Tanzania, we went to Zambia. We entered through Zimbabwe and we found ourselves in South Africa.”
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Refugees reliant on relief services
The Muamba family arrived in South Africa in September 2010 with nothing but the clothes on their backs and a sick toddler.
Shortly after their arrival in Johannesburg, they were introduced to the Jesuit Refugee Services (JRS), an international charity organisation that helps refugees and asylum seekers to access healthcare, education and other services. The organisation provides transport for the family to get to Fabrice’s medical appointments and, when necessary, to pay for his medication. Fabrice is on chronic epilepsy medication to prevent seizures; he needs physiotherapy every week and sees a paediatric specialist every three months.
No one in the family speaks a local language, so one of the JRS’s home-based careworkers has to accompany them to all the appointments to translate. But Fabrice is not the only member of this family in need of care. His father has severe high blood pressure and an ailing memory as a result. The couple recently took on the care of their two grandchildren, one of whom has epilepsy and the other is HIV positive.
“Antoinette does not have any physical medical condition, but she has depression,” says Marceline Sangara, a JRS home-based careworker. “We try by all means to counsel her so that she is able to take care of her family.” Sangara says they provide mental healthcare to their patients when they need it.
But the JRS has only two homebased careworkers, who have to make weekly home visits, collect medication for and travel to doctor’s appointments with about 70 patients.
“Some hospitals do provide counselling but it’s not enough. They only see the patients in the facilities; they don’t know the reality of everyday life these patients are facing,” she says.
Refugees and mental health
According to a 2016 study in the European Journal of Psychotraumatology, refugees have a higher prevalence of trauma-related mental health disorders than the general population.
The chief director of noncommunicable diseases in South Africa’s health department, Melvyn Freeman, says refugees are entitled to the same health services as the rest of the population, but the department does not have a special mental health programme for refugees.
The World Health Organisation (WHO) estimates that humanitarian emergencies double the prevalence of mild to moderate mental disorders — such as mild forms of depression, anxiety or post-traumatic stress disorders — from 10% to up to 20%. Freeman says the mental health needs of refugees put additional pressure on the country’s health services.
“We’re not very well equipped in terms of resources to deal with all the mental health problems in the country. We are trying to expand our services, but we have a paucity of mental health practitioners, especially in the state sector,” he says.
Often it is up to nongovernmental organisations such as the JRS and the Cape Town-based Trauma Centre to fill the gap. The adversity refugees face once they have arrived in South Africa, such as the lack of basic necessities such as food, shelter and clothing, aggravates the mental health issues they already face, according to Valdi van Reenen-le Roux, the director of the Trauma Centre.
“We ran away from our homeland due to the problem of insecurity. Now we are here in this country living a very bad life,” says Antoinette, as she lays her son down on the mattress next to her.
According to the WHO, people like the Muambas who survive war are more likely to recover psychologically if they feel “safe, connected, calm and hopeful, and have access to social, physical and emotional support, and find ways to help themselves”. But the family feels helpless and defeated.
Keeping them off the street
“We can’t even think about the future because we are going through too much suffering,” says Antoinette. She used to sell second-hand clothing in the Johannesburg city centre but her stock was often confiscated by the metro police. Without the help of the JRS, the family would have little choice but to go back on to the streets they used frequent with their son and beg for money.
The organisation provides the family with food and clothing and even pays the rent for the single room they now call home. “We have no one. We depend 100% on JRS for assistance,” Antoinette says. Many people can recover from mental illness if their basic needs are taken care of, and they have physical and psychosocial support. But currently this task falls squarely at the feet of organisations such as the JRS and the Trauma Centre, which are often understaffed and strapped for cash.
“We can have a big heart and desire to assist many people. But we have a limited budget that does not allow us to meet the needs of all the people who are destitute,” Sangara says.
*Not their real names
This is the second of a three-part series on the lack of access to healthcare for refugees in South Africa. Read the first part here. The third part will be published on May 13.
Ina Skosana is a 2015 Pfizer Mental Health Journalism Fellow