Northern Muslim IDPs: the mental health impact of prolonged forced displacement
Sri Lanka, a developing country with a multi-ethnic society, has seen many instances of internal displacement of people presenting major public health issues. Main reason for mass displacement was recent civil war, compounded by 2004 Tsunami and other natural rural poverty, economic difficulties and political upheavals. During thirty years of conflict, thousands of people have been internally and externally displaced from northern, eastern and north central provinces. The longer term impacts of displacement and resettlement are poorly understood.
Puttalam district in western SL has a large number of internally displaced populations (IDPs) due to its geographical closeness to conflict areas. Muslims living in the north were displaced by the civil war over a few weeks in 1990 and settled in Puttalam. A majority (72%) were displaced from Mannar district.
The “Common Mental Disorders and Association with Resilience among internally displaced people in Puttalam District (COMRAID) study” was recently conducted. In brief, it consisted of a cross-sectional survey of migration exposure, mental health and resilience 450 adult residents who, as a Muslim minority, were originally forced to leave their homes (in northern SL) in 1991 and have been temporarily resident in the Puttalam District.
The overall aim was to explore the prevalence of common mental disorders (CMD) among internally displaced people (IDP) due to conflict in Sri Lanka (SL) and the association of CMD prevalence with resilience, social networks/support.
These IDPs were forcefully displaced in 1990 due to conflict from Northern SL and spent 20 years in prolonged displacement. No epidemiological data or evidence was available about mental health of IDPs and the impact of forced, prolonged displacement. Therefore, this work aimed to clarify not only the prevalence of mental disorders among IDPs in SL – a national public health priority – but also to provide internationally relevant data on the interplay between social networks/support and individual resilience as modifying factors.
The prevalence rate of common mental disorders (CMD) such as depression, anxiety, somatoform disorders among the IDPs is being established. The prevalence of PTSD, suicidal ideations and substance abuse among this population affected by forced and prolonged internal displacement is being studied. The socio-demographic information of the IDP population was also gathered on domains of poverty, education, food security, financial stability and others. These may be associated with CMD and are currently being analysed for possible interactions. Individual resilience, adequacy and availability of social support and social networks have also been studied. Association of these findings with CMD prevalence is being analysed. These discoveries are very important both locally (Sri Lanka) and globally for mental health and public health outcomes and policy making.
The implications arising from this work are several. Although Sri Lankan populations have been particularly affected by conflict-associated forced migration over many years, very little research has investigated mental health in IDPs. The epidemiological output from this study will offer clear evidence about the mental disorder burden among this vulnerable population. Furthermore, output from the study will provide important insights in to interplay between potential protective factors such as individual resilience, social support and resilience and mental disorders. In addition, the study findings will provide information and data about prolonged forced displacement, a subject which has been paid very little attention in the world.
This study was conducted in a rapidly mobile population to address questions of particular relevance to Sri Lanka but also of substantial international importance. There are important policy implications regarding IDP management arising from the findings, especially in the back drop of recently concluded conflict. Study findings may provide important insights into interventions to reduce the risk of mental disorders and other adverse consequences of migration and add significant knowledge to the global evidence base on mental health of forced migrants.
Dr. Chesmal Siriwardhana MD MSc
Principal Investigator – COMRAID study
