Since the 30th of January, 2020, COVID-19 has been designated as a Public Health Emergency of International Concern (PHEIC) by the World Health Organization (WHO) due to its unprecedented threat to global health. The lockdown measures and quarantines have altered peoples’ lives, resulting in reported mental health problems with severity anticipated to have a long-term impact. The pandemic is affecting economies at their core, generating an economic crisis with job losses resulting in increased poverty and inequalities at a global scale. Informal economy workers are particularly vulnerable because the majority lack social protection, access to quality health care, and protection against loss of income.
In Zimbabwe, a state of emergency was declared on 20 March, 2020, resulting in a nationwide lockdown that started on 30 March. Various measures were put in place to restrict population movement and to prevent the spread of the virus. According to the Zimbabwe Peace Project (ZPP) Monthly Monitoring Report: July 2020, there has been an increased and ongoing presence of uniformed forces using unacceptable force in low-socioeconomic-status communities. Widespread beatings with batons and excessive use of physical force to ensure social distancing and the observance of lockdown measures have generated fear and contempt. Cases of brutality during lockdowns continue to rise, confirming yet another window for human rights abuse (Zimbabwe Human Rights NGO Forum: June 2020). The exact numbers of victims are not known in most cases due to fear of reporting perpetrators in positions of power and influence (Cyril Zenda, FairPlanet: April 2020).
When COVID-19 started, Zimbabwe was already facing a collapsing public health system that had been deteriorating over the years (Zimbabwe Peace Project (ZPP) Monthly Monitoring Report July 2020). In general, Zimbabwe suffers from a shortage of health workers and poor working conditions including poor remuneration. Health care workers (HCWs) faced serious challenges including the unavailability of personal protective equipment (PPE). According to the Zimbabwe Association of Doctors for Human Rights (ZADHR) 2021 report, unavailability of PPE and uncertainty over quality and supply of PPE had a negative impact on the preparedness of health care workers to handle cases of COVID-19. The HCWs took industrial action over the shortage of PPE and poor working conditions during this critical period. There has been an increase in cases of COVID-19 among HCWs, resulting in an increase in deaths. Media reports on COVID-19 deaths have instilled fear in other HCWs and have likely amplified the negative effects of the pandemic.
While many people could see the overt effects of COVID-19, like physical illness and death, the other side of the coin is mental health which is not prioritised in Zimbabwe. There are very few mental health facilities; there are only 11 mental health facilities across the entire country. Several facilities are no longer functional due to inadequate resources or various other reasons such as inability to maintain existing infrastructure (ZADHR: 2021).
As of April 2020, an estimated seven million Zimbabweans required urgent humanitarian assistance due to chronic food insecurity and limited or no income-generating activities (Office for the Coordination of Humanitarian Affairs OCHA, April 2020). It is estimated that 90% of the Zimbabwean population is working in the informal economy, and many live from hand to mouth (Institute of Development Studies: 2020). The lockdown measures imposed were, to a large extent, injurious and disempowering—especially to women, who form 64% of this group (ZimRights: April 2020). Marketplaces were demolished, and livelihood activities and peoples’ houses were destroyed—all under the guise of enforced lockdown, which left people in poverty while they were observing stay-at-home orders (reuters.com/article: June 16, 2020). People have been faced with the new realities of working from home, temporary unemployment, home-schooling of children, and lack of physical contact with other family members, friends, and colleagues. In addition, a lack of adequate information created unofficial channels that led to the rise of fake news and misleading conspiracy theories, causing a lot of fear, confusion, and mistrust. The community social fabric has been disrupted due to the measures and stigma associated with COVID-19. Adhering to the new norm has been a huge challenge in communities. Families have been negatively affected especially in terms of the inability to fully mourn due to restrictions on funeral rites. Communities are struggling psychologically because of the inability to carry out traditional rituals and get closure.
The combination of the above-mentioned economic and social pressures increased the strain on individuals and community groups, with an increase in gender-based violence and child abuse. There were reports of increases in risky behaviour among young people through substance misuse, risky sexual activity, and a disregard for lockdown measures (Tree of Life reports).
In order to offer ongoing support to communities during lockdown, the Tree Of Life Trust in Zimbabwe designed community-based, participatory, and culturally appropriate virtual training for communities with pre-existing vulnerabilities. The Tree of Life Trust is a survivor-driven Zimbabwean non-governmental organisation. It provides innovative group-based trauma healing interventions to individuals and communities affected by collective and ongoing trauma. It uses culturally appropriate approaches to enable the poorest and most disempowered to participate, providing long-term support and follow-up. Our Vision is “A healed and empowered society that puts its efforts into peace, recovery and reconciliation.”
The initial training focused on health sensitisation and the provision of basic psychosocial support relating to lockdown or social-distancing measures. It also provided access to contact details of relevant networks and of reporting hotlines for gender-based violence, child abuse, and other needs. Follow-up capacity building was provided in response to participatory feedback from communities. It focused on healthy relationships and risky behaviour among young people, exploitation, healthy relationships, substance abuse, and coping skills. 153 Community-based Facilitators were trained to provide one-on-one and virtual support, including bereavement and loss support to families affected by the pandemic. The intervention enabled identification, early access, and referral pathways for further holistic psychosocial support as required. In addition, Tree of Life collaborated with other local NGOs to render services to individuals living in informal settlements whose marketplaces and/or houses had been demolished under the lockdown. Narrative therapy and problem solving were found to be the most effective for this particular cohort of clients in view of their ongoing hardships and need for empowerment and resilience-building. Inter-agency identification and community mapping were also found to be essential in responding effectively to these clients.
Tree of Life’s experiences both via its massive presence in communities and via the feedback from Community Facilitators showed that the majority of the people had been severely affected. The effects were not only from the loss of lives or COVID-19 itself, but also from a wide range of the socio-economic impacts of the pandemic. In 2020, the Tree of Life Community-based Facilitators reached 66,569 people. Of these, 18,327 people were directly mobilized by Tree of Life (8,877 men and 9,450 women), whilst 48,242 people were mobilized through existing groups such as church meetings and community gatherings (Tree of Life Annual Report:2020).
The following recurring themes were noted as causes of distress. These include:
- Unemployment and loss of livelihoods.
- Increased hunger and poverty.
- High rise in prices of basic foodstuff which are being charged in United States Dollars.
- Increased substance abuse, particularly among young people.
- Increased domestic violence and sexual gender-based violence.
- Increased hopelessness and suicidal thoughts, particularly amongst young people.
- Increased transactional sex by young girls as a means of getting money.
- Unfair distribution of food handouts based on political affiliations.
- Fear of catching COVID-19 and general lack of awareness.
- Fear of getting a COVID-19 vaccine due to harmful misinformation in the media and lack of awareness.
- Lack of access to medication and defaulting on HIV medication due to movement restrictions.
Adapting to lifestyle changes that were introduced to control the spread of COVID-19 has been associated with an increase in mental health problems among the general population. Zimbabwe’s protracted economic and social pressures have meant that the COVID-19 pandemic has exacerbated vulnerabilities affecting the whole population severely. The crisis provides opportunities to build on positive innovations focusing on the identification of mental health challenges, prevention, and response. These should be adaptable and flexible for community-based care. The experiences of Tree of Life in community-based Mental Health and Psycho-social Support (MHPSS) can be used by the government, partners, and mental health practitioners to develop effective and responsive policies.
About the Author
A dedicated, highly competent, dynamic, and experienced transcultural mental health and psychosocial (MHPSS) professional counsellor, Eugenia Mpande has devoted much of her 20-year career to extensive work with individuals, families, community groups, and members from civil society organisations who have lived both traumatic and traumagenic experiences. Eugenia is highly experienced in communicating psychological concepts in localized contexts for easy and practical implementation by communities. She holds a Master of Social Sciences in child and family studies (systemic psychotherapy) - (Africa University 2012). She is the Training and Supervision Manager at Tree of Life Trust, Zimbabwe.
References
- Chimbwanda T. “Bulawayo and Harare Health Care Workers Gain New Skills on Management of Stress, Anxiety and Depression During The COVID-19 Pandemic”. World Health Organisation 28 October 2020. Web.
- https://www.fairplanet.org/story/army-and-police-brutality-keeps-starving-zimbabweans-indoors/: April 2020
- Institute of Development Studies: https://www.ids.ac.uk/opinions/the-impact-of-the-covid-19-lockdown-on-zimbabwes-informal-economy/
- Office for the Coordination of Humanitarian Affairs (OCHA) (2020), ‘Zimbabwe situation report’, 21 April 2020, https://reports.unocha. org/en/country/zimbabwe/
- https://www.reuters.com/article/us-health-coronavirus-zimbabwe-idUSKBN23N0LJDying of hunger': Zimbabwe street vendors hit by coronavirus clampdown: June 16 2020.
- Tree of Life: Annual Report: 2020
- World Health Organisation (WHO): Https://Www.Who.Int/Docs/Default-Source/Mental Health/Special-Initiative/Who-Special-Initiative-Country-Report---Zimbabwe---
- Zimbabwe Association of Doctors for Human Rights (ZADHR). Report on a Qualitative Research Study to Explore the Experiences of Medical Practitioners Responding to Covid-19 in Zimbabwe: December 2021.
- Zimbabwe Peace Project (ZPP), Monthly Monitoring Report, WHO SHALL PROTECT THE PEOPLE? When the State unleashes violence on people it is supposed to protect, who shall protect the people: July 2020
- Zimbabwe Lawyers for Human Rights. Fighting Coronavirus; High Court Orders Govt to Protect Frontline Health Practitioners and Equip Public Hospitals with Medication to Stem Epidemic. Https://Www.Zlhr.Org.Zw/?P=2004).
- Zimbabwe Lawyers for Human Rights (2020), ‘ZIM court censures soldiers and police conduct during #Covid National Lockdown violations’ (media release), 14 April 2020, https://www.zlhr.org. zw/?p=2001
- Zimbabwe Human Rights NGO Forum. Set the women free: The torture of women in Zimbabwe during COVID-19
- ZimRights: 21 Days lockdown: Their voices matter. Response to covid 19 measures week 3 report: April 2020.