The purpose of our study was to conduct a preliminary investigation into the experiences and mental health of Senegalese refugees. Although research has established that refugees are more prone to psychiatric illnesses than the general population, little has been written about West African refugees. Our focus was on adult refugees (18 years of age and older) from the Casamance region of Senegal. A total of 80 participants (39 women, 41 men) were randomly selected from refugee camps in The Gambia. The Harvard Trauma Questionnaire and the Hopkins Symptom Checklist-25 were used to assess levels of traumatization and mental health status. Typical of refugees of war, participants reported suffering a large number of various traumas. High prevalence rates of anxiety, depression, and posttraumatic stress disorder were also found in this group. A substantial mental health problem exists within the Senegalese refugee population that may signify a potential human crisis.
The responsibilities of health care professionals are broadening in range such that they now embrace humanitarian crises, war, and violence. Recently, the long arm of health care has extended to touch even the realm of genocide (Willis and Levy, 2000). The evolving responsibilities of health professionals include documentation of human rights violations occurring in these contexts. Such documentation may provide early warning of impending human disasters as well as crucial evidence in establishing responsibility for criminal acts and the need for and direction in which to point reforms (Iacopino and Waldman, 1999). This represents critical information for policy makers, prosecutors of war crimes, and the public. Health care professionals can offer a unique contribution to the investigation and documentation of human rights issues in the context of health effects on vulnerable populations and individual victims. Health-related information may produce evidence of human rights abuses that is more credible than standard methods of case reporting (Geiger and Cook-Deegan, 1993).
In the spirit of the expanding role of health care professionals in documenting human rights abuses, we present a study of the trauma events and psychiatric sequelae of a sample of West African refugees from the Casamance region of Senegal. The findings presented may well serve as early warning of an impending crisis within a civilian population.
For nearly two decades, fighting in the Casamance region of Senegal between the separatist movement, Mouvement des forces democratiques de Casamance (MFDC), and government troops have terrorized civilians. Hundreds of cases of torture, extrajudicial executions, kidnappings, and detention of political prisoners by the Senegalese government have been documented by Amnesty International (1998), even though the constitution offers full guarantees for the protection of human rights. Evidence of the murder and torture of civilians by the MFDC was also apparent. However, the strength of Amnesty International's evidence is limited by their exclusive reliance on qualitative case reporting.
As a result of this obscure, underreported, and sparsely documented conflict, thousands of Senegalese have fled the southern region, crossing the nearby Gambian border to find sanctuary. The majority are estimated to be staying with relatives in the urban area of Banjul (United Nations High Commissioner for Refugees [UNHCR], 1998). However, those without such recourse must live in the refugee camps managed by the UNHCR (1998). The current study focuses upon this camp population.
Research has found refugees to be at greater risk for suffering from psychopathology than nonrefugee populations (Boehnlein and Kinzie, 1995a; Ekblad and Roth, 1997; Williams and Westermeyer, 1986). Major depressive disorder is one of the most common diagnoses, with studies reporting its occurrence in 29% of Afghan refugees (Mghir et al., 1995) and as many as 96% of Cambodian refugees (Carlson and Rosser-Hogan, 1991). Kinzie (1989) found that approximately 20% of the 600 patients seen at the Indochinese refugee clinic in Oregon had been hospitalized as a result of depression with suicidal risk. A refugee camp survey of 993 Cambodians by Mollica et al. (1993) reported 55% were symptomatic of depression and 15% of posttraumatic stress disorder (PTSD), another common diagnosis among refugees.
Despite the growing body of mental health research concerning refugees of various ethnic back-grounds, little is known about the experiences and symptom presentation patterns of African refugees, who constitute about one third of the world's refugee population (UNHCR, 1998). Indeed, a study of Sierra Leonean refugees reported by us represents the only work addressing trauma events and mental health among West African refugees (Fox and Tang, 2000). Already, other cultures have been found to differ from each other in experience and symptom presentation. For example, in a clinical sample, Kinzie et al. (1990) found the prevalence rate of PTSD to vary widely among Indochinese ethnic groups with the Mien having the highest rate at 95%, Laotians at 65%, and Vietnamese at 53%. Such variation may reflect differing educational and socioeconomic backgrounds, as well as traumatic experiences among the groups. In addition, although avoidance behavior has been observed to be common among Southeast Asian refugees and may even be a therapeutic means of alleviating distress for them (Kinzie, 1989), research with a group of Salvadoran women refugees disclosed the absence of avoidance (Jenkins, 1996).
Similar research is necessary among African refugees to determine similarities and differences with Western definitions of PTSD, anxiety, and depression. Such knowledge would be of direct benefit to mental health workers in refugee camps in assessing and treating these illnesses. The purpose of our study was to conduct a preliminary investigation into the experiences and mental health of Senegalese refugees.
1 New Mexico Highlands University, Department of Behavioral Sciences, Las Vegas, New Mexico 87701. Send reprint requests to Dr. Fox.
The authors would like to thank Mr. Alade Joiner, UNHCR National Officer in The Gambia, for his foresight in requesting this study.