In the first of a three-part series, Dexis explores issues around mental health, stress, and trauma in development. This piece was originally published by Dexis Consulting Group on April 29, 2020. It was shared here with permission.
People in developing countries often contend with a range of ongoing stressors from active conflict, post-conflict transition, fragile governance structures, and economic uncertainty to name a few. Now in the era of COVID-19, existing insecurities are heightened, and local stakeholders must navigate additional fears, disinformation, and other effects of the rapidly evolving global pandemic.
Somalia, for example, already struggles with high levels of displacement, random attacks by al-Shabaab extremists, reoccurring drought, and food insecurity. Recent swarms of locusts have further threatened the country’s agricultural sector and led the government to declare a state of emergency in February.
Somalia’s capacity to manage the COVID-19 public health threat adds additional cause for concern. Local health infrastructure is severely undermined due to years of conflict and the state’s fragility. The Ministry of Health, for instance, suffers from a shortage of personal protective equipment (PPE) and ventilators.
Another challenge is protracted displacement across the country due to conflict. There are around 2.6 million internally displaced persons (IDPs) in Somalia, who often live in overcrowded and under-served camps. IDPs are particularly at risk of contracting COVID-19 because of living in confined environments that are often unhygienic and unsanitary and have limited access to clean water. Many people in IDP camps also have underlying conditions, and child malnourishment is a persistent challenge.
Collectively, this puts enormous pressure on citizens and systems alike. Prior to COVID-19, the World Health Organization estimated that one in three Somalis are affected by mental illness, a rate even higher than similar conflict-affected countries. And Somalia has limited facilities and few psychologists to help people cope, be it with preexisting mental health conditions or emerging tensions around the pandemic.
As Dr. Siddharth Ashvin Shah with Greenleaf Integrative states, “Trauma is another way to say ‘excessive stress’ or ‘overwhelmed coping mechanisms.’” Dr. Shah goes on to note that almost everything from routine tasks to program outcomes can suffer when individual brains and community groupthinks are traumatized.
“Cognition and decision-making are either affected by hypervigilance or numbing (under vigilance),” he says. Hypervigilance related to COVID-19 might manifest as hoarding PPE and hand sanitizer. Numbing might manifest as lapses in situational awareness or caring for others who are ill.
What makes matters even worse is the spread of misinformation on the pandemic. There’s a persistent narrative within Somali society that COVID-19 is a hoax engineered by the political elite to accumulate money from aid donors or that the disease does not kill practicing Muslims.
In addition, al-Shabaab restricts genuine health-related information in the areas it controls, claiming that COVID-19 is “spread by crusader forces who have invaded the country.” And they use this narrative to threaten those who accept any foreign aid. However, the good news is that Muslim clerics in the country have begun working to counter al-Shabaab’s propaganda.
What’s now urgently needed is a behavior change communication (BCC) campaign in Somalia, one that examines the ways people process information, assess personal and collective risk, and make decisions. A BCC campaign is best delivered with complementary publicized government delivery of assistance, in this instance COVID-19 assistance. It must also be grounded in cultural norms—such as understanding Somalia’s traditional practice of communal living—address issues of stigma, and leverage the social capital of local leaders, religious figures, and other key influencers.
Tapping into the country’s rich oral culture and tradition is the optimal method for BCC in Somalia. Radio dramas and Facebook videos are essential vehicles for storytelling as rural populations still rely on radio and most local youth are online via cell phones. Additionally, competitions calling for input into stories or uploads of video public service announcements can tap into a feeling of public inclusivity and diversity.
Recognizing the high prevalence of trauma survivors in Somalia, any information circulated about COVID-19 also needs to employ sensitive approaches to messaging. As Dr. Shah notes, “Your communications can either be traumatizing or trauma-informed.” This includes design elements and messaging that presents information clearly, with empathy, and in ways that empower individuals to make beneficial choices versus simply stoking fears.
And a behavior change communication campaign could offer live-saving information presented in ways that people can more readily absorb and act upon. Factoring mental health into development should be a priority for all implementers. During an active pandemic, it is critical.
Bron Morrison is a Senior Director for the Center for Global Security and Stabilization at Dexis where she is responsible for expanding Dexis’ work in global security and stabilization in complex operating environments. Dexis also thanks Dr. Siddharth Ashvin Shah of Greenleaf Integrative for contributing to this series.
Photo by Eric Lafforgue / Hans Lucas / Hans Lucas via AFP