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The need for protection and assistance of more than 40 million of the world's refugees and internally displaced persons -- the victims of armed conflicts -- constitutes a major challenge to the international community. In many situations, these needs have not been met effectively, and serious gaps in provisions have been evident. Most disturbing from the point of view of ISTSS is that the international community often ignores that the psycho-social harm inflicted on traumatized persons can be as damaging as physical pain and insults, and must receive equal attention.

U.N. Secretary-General Kofi Annan noted in June 1998:

"In the past year, there has been more evidence of ... disturbing trends. ... There has been further erosion in the respect for humanitarian principles, both in terms of denial of access to people in need and through deliberate violence against civilians and aid workers. ... Increasingly, such attacks have become the objective of armed conflict, rather than an unfortunate byproduct. Warring parties seek to terrorize populations into leaving specific areas. Hatred and suspicion between members of different ethnic or religious groups are incited by ... faction leaders." (Document A/53/139-E/1998/67,p.3)

Strengthening Coordination of U.N. Emergency Humanitarian Assistance

During the ECOSOC Substantive Session in July 1998, the first humanitarian segment was held to identify challenges facing the international community in the field of emergency humanitarian assistance. This segment was part of the implementation of the U.N. program of reform endorsed by the General Assembly. Reflecting these changes, the Department of Humanitarian Affairs became the Office for the Coordination of Humanitarian Affairs, with a focus on three core functions: policy development and coordination, coordination of humanitarian emergency responses, and advocacy of humanitarian issues.

In January 1998, Sergio Vieira de Mello of Brazil was appointed to head the new office, as undersecretary-general. ISTSS would like to express its full support to the creation of OCHA and the nomination of de Mello. For the society, this has proven to be a fortunate choice. His previous experience in humanitarian and peacekeeping operations, as well as his many field visits, make him fully aware of the traumatic impact of armed conflict on refugees and internally displaced persons.

On July 15, during the ECOSOC Humanitarian Segment, de Mello stated: "Since my appointment ... I have visited four of the regions in which humanitarian programs are facing the most severe challenges. In Afghanistan, we are confronted by a country brought to its knees by a conflict, which has now lasted over 20 years. Inhumane policies of discrimination against women in large parts of the country pose particular difficulties for humanitarian agencies. In Sierra Leone, I saw with my own eyes the victims of unspeakable atrocities committed by supporters of the former junta. ... In Angola, I saw how new waves of displacement are resulting from a contested peace process and how new land mines have been planted in several areas."

As a result of the special segment, the way the U.N. system can move forward has become clearer. Complex emergencies require an integrated response by a widerange of national and international governmental and nongovernmental actors. The role of OCHA is to facilitate the development of a concerted response in which each actor is able to fulfill its mandate within a jointly agreed framework. Progress has been made in defining ways of doing this in different sets of circumstances, recognizing that each situation is sui generis and requires its own model.

New forms for joint programming and partnerships among OCHA, the High Commissioners for Refugees and Human Rights, UNICEF, UNDP, U.N. Peace-keeping Operations, the World Food Program, and a widerange of committed and skilled NGOs are being developed. The status of ISTSS at -- and within involvement with -- all relevant aspects of the work of the United Nations has become more important than ever.

ISTSS Participation in ECOSOC Deliberations

As an ISTSS representative, I presented two written and oral statements during the ECOSOC session. On July 14, in a special workshop on refugees and internally displaced persons chaired by Undersecretary-
General de Mello, I pointed out that millions of refugees and internally displaced persons run a risk of depression, anxiety disorders, PTSD, and other forms of mental distress caused by traumatic experiences including the violent death or torturing of a parent, husband, or close relative; family separation and displacement from home and community; participation in or witnessing of atrocities; exposure to combat; and other life threatening situations. They are often the victims of abuse and are arrested and held in detention camps. Scholarly literature, especially a range of studies presented in the Journal for Traumatic Stress Studies, indicates that without a support system, refugees and internally displaced persons are vulnerable to various stress reactions. The nature of the reaction depends on the type of trauma, the number of traumatic stressors, the frequency and length of exposure and the person's individual characteristics. Response to trauma can be immediate or delayed for weeks, months, or years.

Strategies for coping with and reacting to stress and trauma differ markedly between cultures, communities, and individuals. An understanding of cultural differences and local traditions for dealing with stress must be the starting point of any intervention effort, and community participation must be ensured.

In the speech, I indicated that ISTSS members would be interested in participating in the identification of appropriate psychotherapeutic methods. ISTSS is aware that while many forms of external interventions can promote psycho-social recovery, psychotherapeutic approaches based on western models may not be feasible in all contexts.

On July 28, in regard to social and human rights questions, I made four specific recommendations covering better training of U.N. and NGO personnel, with specific emphasis on:

  • Expertise in trauma treatment;
  • Improved cooperation, especially in the field between relevant governmental and NGO agencies;
  • Strengthening of emergency preparedness and monitoring and evaluation efforts; and
  • Greater attention to the provision of services for traumatized U.N. and NGO help givers.

I observed that ISTSS encourages contracts between NGOs, including ISTSS, and U.N. agencies. Existing contractual arrangements such as the UNICEF/University of London program in Mostar and Zenica, the UCLA and UNICEF project in Bosnia, and others were used as examples.

ISTSS Status and Involvement at the United Nations

Except for two additional speakers, no other representatives during a four-week conference addressed the traumatic stress dimensions of armed conflict and other man-made and natural disasters. The ISTSS must remember that some influential members of the U.N.'s international community argue that few people are traumatized in war and natural disasters, and the concept of PTSD is a Euro-American concept that has little, if any, place in international thinking.

Yet, one may conclude that the current climate at the United Nations is ready for the wide involvement of members of ISTSS in U.N. activities on all levels. The ISTSS is not alone in its dedication to the discovery of knowledge and advancement of policy and service initiatives that seek to reduce traumatic stressors and their immediate and long-term consequences. By invitation of the U.N. Division for Social Policy and Development and OCHA, I am developing several ISTSS/U.N. joint activities along with ISTSS members Matthew Friedman and Terence Keane.

Finally, ISTSS must pay tribute to the courage and dedication of U.N. and NGO aid workers throughout the world who face daily the traumatic realities of refugees and internally displaced persons.

In response to one child refugee's fate, James Kunder, a special advisor to UNICEF, stated: "Esmeralda does not know the word for artillery, but she remembers clearly the night her hamlet exploded. In drawings, she pictures the ground littered with pieces of bodies. She remembers running through dense forest for days, where it was always cold and wet, and where horrible insects crawled at night. Her younger brother, she recalls, coughed constantly until he died. Now she lives in a place called a 'camp.' The adults who guide her through her eight years cry a lot now, and strange men come in the evening to issue orders."

In January 1997, I visited a refugee camp for Rwandan children in Goma. I came away numb with disbelief that human beings could suffer so much mental and physical pain. We, the members of ISTSS, serve as witnesses and must do everything possible to ease the trauma of refugees and internally displaced persons. We must commit ourselves to soften their miseries.