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Liberia

Aftermath of Liberian civil war

Study finds one-third of population served as combatants, large numbers experienced sexual violence

Los Angeles, Calif. - In one of the largest population-based surveys of Liberians following nearly 15 years of civil war, a study partly funded by International Medical Corps (IMC) found that one-third of the population were combatants - many abducted into fighting. The study also found that large numbers of combatants, including a significant percentage of men, experienced sexual violence.

According to the findings, which appear in the August 13 issue of the Journal of the American Medical Association, both male and female combatants who had been exposed to sexual violence during the war also exhibited more symptoms of mental health disorders, including far higher rates of major depression, post-traumatic symptoms, substance abuse, and suicidal thoughts.

Given the widespread lack of access to health care, the findings reveal a clear need for increasing access to primary health care services that include integrated community-based mental health care.

International Medical Corps is currently operating primary health care programs in Liberia, where tens of thousands of people died in separate civil wars since 1989 that were marked by massive abuses of the civilian population. IMC's work in Liberia includes education and prevention programs around sexual and gender-based violence. This latest study highlights the massive and continuing need for expanded mental health programs that also address gender-based violence among both men and women.

The survey, funded in part through a donation from the Schooner Foundation, sought to assess the psychosocial impact of the Liberian civil wars, including information on participation in combat, exposure to sexual violence, social functioning, and mental health. Researchers surveyed 1,666 adults aged 18 or older, in Liberia, during a three-week period in May 2008.

Among the Liberian population, 40 percent of adults met symptom criteria for major depressive disorder and 44 percent for post-traumatic stress disorder. Thirty-three percent of those surveyed reported serving time with fighting forces, and 33 percent of the former combatants were women.

Among those women, 42 percent experienced exposure to sexual violence, compared with 9 percent of non-combatants. Among the male former combatants, 33 percent experienced exposure to sexual violence, compared with 7 percent of male non-combatants.

Symptoms of depression, PTSD and thoughts of suicide were higher among former combatants than non-combatants, and higher among those who experienced sexual violence than those who did not.

"Both female and male former combatants who experienced sexual violence had worse mental health outcomes than non-combatants and other former combatants who did not experience exposure to sexual violence," Dr. Lynn Lawry, the article's senior author notes.

Seventy-four percent of female former combatants who experienced sexual violence had symptoms of PTSD, compared with 44 percent who did not experience sexual violence. Among male former combatants, 81 percent who experienced sexual violence had symptoms of PTSD, compared with 46 percent who did not experience sexual violence. Male former combatants who experienced sexual violence also reported higher rates of depression symptoms and thoughts of suicide.

"Like their female counterparts, male former combatants who experienced sexual violence have worse mental health outcomes than both the general population and also other former combatants," the authors write. "This unexpected finding suggests that standard post-conflict rehabilitation programs and gender-based programs will need to adjust current programming to take into account males who have experienced sexual violence, especially former combatants."

International Medical Corps has extensive experience with such post-conflict mental health programs. In neighboring Sierra Leone, IMC set up mental health services at the primary health care level to address the needs of a very similar conflict-affected population with a high number of young ex-combatants.

"Stigma around the issues documented in the study remains high," noted International Medical Corps' Senior Mental Health Advisor Dr Lynne Jones, following her reading of the study and assessment of the situation in Liberia. "So a public mental health approach is essential. Given the continuing problems of this and other sexual and gender-based violence (SGBV) indicators cited in the study, mental health service provision should be combined with SGBV education and prevention campaigns. Integrating livelihoods and literacy programs will also be a critical step in helping these populations recover and rebuild."

Since its inception nearly 25 years ago, International Medical Corps' mission has been consistent: relieve the suffering of those impacted by war, natural disaster and disease, by delivering vital health care services that focus on training. This approach of helping people help themselves is critical to returning devastated populations to self-reliance. For more information visit our website at www.imcworldwide.org.

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