Since achieving independence from Britain in 1948, Sri Lanka has experienced two major armed conflicts: the JVP (Janatha Vimukthi Peramuna) insurgency and the North-East conflict. And then there was the devastating effect of the 2004 tsunami. Due to these events, Sri Lankan populations have experienced internal and external displacement and had to undergo highly traumatic migration episodes. Some people have been displaced for several decades. At the peak of the conflict in 2001, around 800,000 people were internally displaced in the country. The conflict ended in 2009, and since then around 480,000 internally displaced people (IDP) have returned to their areas of origin in the Northern and Eastern provinces.
Some people have been displaced for several decades. At the peak of the conflict in 2001, around 800,000 people were internally displaced in Sri Lanka.
Not surprisingly, children and adults from every ethnicity, religion and socio-economic background have been affected by conflict-related mental health issues. But we know little about this: epidemiological studies into the wider prevalence of mental disorders linked to conflict in Sri Lanka have been limited. None of these studies had been focused exclusively on forced migrants nor explored populations affected by prolonged internal displacement during the three decade-long Sri Lankan conflict.
I therefore felt it would be very worthwhile to investigate the mental health and resilience of internally displaced people (IDP) affected by prolonged (over 20 years) forced displacement in Sri Lanka. My two-phase study was a collaboration between the Institute of Psychiatry, Psychology and Neuroscience, King’s College London and the Institute for Research & Development, Sri Lanka. It is the first comprehensive study to explore prolonged forced displacement in Sri Lanka and its impact on mental health.
We first studied a group of ethnic minority Muslims, displaced from the Northern Province 20 years ago. At the end of the conflict in 2009, the government encouraged them to return to their areas of origin, and for the most part they did. However, many opted to stay back as they were uncertain about what resources, land or support would be available to them – or how safe they would be – if they returned.
Others had not yet been drafted in to the process of return migration by the government. In the second part of our study we followed the same people as they were returning, and compared the mental health statuses of these people during displacement and return migration. We found that displaced people had higher mental health problems, while returnee groups had lower prevalence. We also found that widowhood/divorced status, lack of security, and lack of food were linked to mental health problems.
Our studies suggest significant policy implications about how to provide post-conflict mental health care to IDPs in Sri Lanka. Our findings from the two-phase study have already led to the development of an intervention that aims to integrate mental health into primary care.
This involves us training primary care practitioners who cater to IDP populations to better identify, treat and refer those with mental health disorders. This will take place in all districts of the Northern province, and is funded by a five-year research grant from the Centres for Disease Control and Prevention (CDC), in the USA. It is oriented around the World Health Organization’s mental health Gap Action Programme: it promotes a broadening out of treatment from the current narrow focus on trauma and post traumatic stress disorder, to a strategy that focuses on a wider spectrum of mental disorders. It will also lead to development of teaching resources and locally relevant material.
I sincerely hope that the broad lessons we have learnt during the study will be helpful in planning similar interventions with other people who are forced, by conflict, to migrate.
What inspired you?
I was inspired by my personal experiences of growing up in a country affected by 30 years of conflict and an urge to understand the mental health consequences for those affected. I am interested in developing useful, low-cost interventions at primary care level.
Why does this research matter?
This study is a global first exploring the mental health of returnees. It matters because it can make a tangible impact on improving the health of post-conflict populations. This work has led to the development of a global initiative around ethical challenges in humanitarian research and the post-research ethics audit process. I am collaborating with an international team on this, with seed funding from Research for Humanitarian Crises (R2HC) programme. The Global Public Health, Migration and Ethics Research Group at the Faculty of Medical Science was recently established to further develop these research activities under one umbrella.
Dr Chesmal Siriwardhana’s research interests are in migration and mental health, resilience, bioethics and humanitarian research ethics. He is a Senior Lecturer in Public Health and is Lead in the Global Public Health, Migration and Ethics Research Group at Anglia Ruskin’s Faculty of Medical Science. He is also a visiting lecturer at the Centre for Global Mental Health, Institute of Psychiatry at King’s College London. He completed his MSc and PhD at the Institute of Psychiatry, King’s College London. He is also an accredited science journalist and is affiliated with the Institute for Research and Development (IRD), Sri Lanka.
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