The Impact of War and Atrocity on Civilian Populations: Basic Principles for NGO Interventions and a Critique of Psychosocial Trauma Projects

Current patterns of violent conflict worldwide mean that over 90% of all casualties are civilian and the terrorisation of whole populations is used as a means of social control. Victims must also endure the deliberate demolition of their economic, social and cultural worlds. How such events are understood is crucial in determining the ways war-affected populations experience and describe them, and the forms of coping and help-seeking brought into play. These are complex and dynamic processes, with outcomes shaped by social, cultural and political forces.

Psychosocial projects drawing on western trauma models have had a sharply increased profile in recent years and this paper offers a critique of this work, using Bosnia and Rwanda as particular examples. The ordinary distress and suffering of war is liable to redefinition as a psychological condition – traumatisation – requiring professional attention or treatment in its own right. For the vast majority, traumatisation is a pseudo-condition. This rather narrow approach risks creating inappropriate sick roles and sidelines a proper incorporation of people s own choices, traditions and skills into strategies for their creative survival. It also aggrandizes the role of western experts and their mental health technology, which is assumed to be universally applicable.

As well as solid background knowledge about the characteristics of modern conflict, international relief workers need to be as informed as possible about the social, cultural and historical dimensions of its impact in the particular locality to be served by a project. A basic premise for effective interventions is the quality of the relationship forged with those we want to assist. From this may flow projects which are based on the priorities of users, do not challenge their own cultural frameworks and interpretations, and hopefully, are able to respond to evolving circumstances and choices.

The core issue is the role of a social world, invariably targeted in conflict and yet embodying the capacity of survivor populations to manage their suffering, adapt and recover: this means a collective, not individualised, focus. The psycho- prefix of psychosocial work is misleading and should be dropped. Emphasis should be placed on social development/rehabilitation principles, to which can be grafted those additional issues thrown up by crises which are man-made rather than natural. In particular, this means an overall approach which locates the quest of victims for rights and justice as a central and not peripheral issue.