By Judith Twala, MA, former psychotherapist/trainer with the Center for Victims of Torture in Dadaab, Kenya. Dadaab is the world’s largest refugee camp in the northeast region of Kenya, close to the Somali border. Most refugees in this complex of camps are from Somalia with others from South Sudan, Eritrea, Ethiopia, the Democratic Republic of Congo and other countries.

As a psychotherapist /trainer with the CVT Dadaab project, I have been interacting with war and torture survivors from the Democratic Republic of Congo, Burundi, Ethiopia, Southern Sudan and Somalia for more than two years. Though from different mother countries, these survivors share one thing in common and that is ambiguous loss.

Ambiguous loss is defined as an unclear loss that defies closure; a situation or problem that has no answer and thus no resolution. The ambiguity can be where there is a physical absence with psychological presence, or a psychological absence with physical presence. Thus, ambiguous loss can traumatize and immobilize grief and coping processes and prevent individuals and families from moving forward with their lives.

Thus, ambiguous loss can traumatize and immobilize grief and coping processes and prevent individuals and families from moving forward with their lives.”

Our counseling groups run for ten weeks. In sessions six and seven we handle loss and grief. The main objective of these sessions is to provide a supportive environment for participants to talk about their war-related losses and express their grief regarding these losses. The other objective is to help group members begin to reconnect with positive memories of their loved ones who died.

Our clients have suffered massive losses from the war. Most have suffered multiple losses, and many have lost their entire families. Many also have relatives who are still missing, and they do not know whether they are still alive or dead. They are suffering from ambiguous loss.

Let us think of a woman separated from her husband and the father to her children. The loss is so complicated and she is more affected. She has no answers when the kids ask about their father whom they know or whom they cannot understand because the war broke out when they were small. The other dilemma for such a woman is whether to move on and remarry, or just keep waiting for the husband. She does not know whether he is to come back to her or is dead a long time ago. A woman in this situation may feel guilt at betraying her husband’s trust. And in most cases, her children might treat the new “man” as her husband and not their father which then means more frustrations in the relationships.

The United Nations High Commissioner for Refugees and the International Organization for Migration have been trying to offer durable solutions like resettlement and repatriation. CVT clients have shared during this session of how sometimes resettlement separates relatives. In the African context, families live in close knit communities. It is not just about the nuclear family, but the entire extended family. A grandmother, for example, may be resettled in Canada or Australia and leave the grandchildren behind. Like many people, she probably thinks resettlement should bring joy and peace, but emotionally and psychologically, the old woman mourns the separation from her grandchildren until they reunite or until death. The remaining relatives also are in a dilemma whether they will see the resettled relatives again!

Funeral rituals in many cultures are very significant to the bereaved because they help to bring closure to the loss. But what happens to the families with the missing relatives? They are sometimes preoccupied with anger for the missing persons for not getting in touch and also guilt for judging the missing persons.

The responsibility of the clinical team is to provide empathy, validation, and support – not to give advice. It is also during this session that we help clients to understand that when we have not had the chance to thoroughly express our grief or acknowledge the depth of our loss, we may feel unresolved pain. This session gives dual help: that is to educate clients on how to bear the pain, but also still validate their losses and pain.  During this session, clients are helped to begin reconnecting with the positive memories of their loved ones who died or are missing. This does not take away the fact that some of the clients might never know what happened to their loved ones.  After a long wait and hoping to see their missing relatives for some years, they may come to hear that their loved one died in war. It takes them back to a mourning process. What about those who do not hear a thing about the missing relatives? The denial, the pain, the uncertainty of what exactly happened to them can be heavy and that is why follow up sessions are held up to one year after the start of group therapy. Through the follow-ups, the clinical team continues supporting the survivors so they can heal and rebuild their lives as fully as possible.