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Expert Voices

Caring for People Coming Home after Trauma in Yemen

Published February 6, 2019

Photo: Tesfanesh Kasseye, counselor, and Medhanye Alem, associate psychotherapist/trainer, both with CVT Ethiopia

When organizations reach out for help, CVT Ethiopia is there. Since 2013, the team has extended care to Eritreans who fled their country after surviving torture and atrocities back home. In Ethiopia, the CVT Ethiopia team has earned a reputation for the quality of its trainings on working with trauma, as well as for its staff support strategies. As a result, the staff has increasingly been invited to train national and international organizations across Ethiopia, including the International Organization for Migration (IOM), UNHCR, Norwegian Refugee Council, ZOA and the International Labor Organization, among others.

But in the last months of 2018, the CVT Ethiopia team took on a different kind of care, helping IOM as they were working with Ethiopians in Djibouti who are returning home after surviving traumatic experiences in Yemen. In recent years, large numbers of Ethiopians have migrated to Yemen to find work. In 2017, the UN estimated that 99,000 people went to Yemen, most of them Ethiopian.

Many migrants travel from Ethiopia through Djibouti, which is located across the sea from Yemen, at the point where the Red Sea meets the Gulf of Aden. Many hire smugglers to help them cross Djibouti and reach Yemen, sometimes with disastrous results when reaching Yemen, as the UN has reported beatings, extortion, torture, rape and many more abuses.

And migrants find that the ongoing war in Yemen does not spare them, with many Ethiopians to be found in the middle of violent conflict and subject to attacks, explosions, gunfire and all the atrocities of war.

As a result, large numbers of Ethiopians make the decision to return home. The IOM works globally with migrants, including people returning home, helping them make the transition and reestablish their lives. When IOM staff at the Migration Reception Center (MRC) in Djibouti began working with returning Ethiopians, they saw the serious effects of the highly traumatizing experiences the migrants had survived.

IOM Djibouti reached out to CVT for help. They wanted to work effectively with people who had been traumatized, and they also wanted help with the stress their staff were feeling as they worked with these challenging and often complex cases.

Two clinicians from CVT Ethiopia developed a training plan and traveled to Djibouti, where they conducted sessions with IOM staff for nine weeks at the end of 2018. Medhanye Alem, associate psychotherapist/trainer, and Tesfanesh Kassaye, counselor, focused their work in several areas: training IOM staff on mental health and psychosocial support for people who are highly traumatized; training on the basics of crisis intervention; providing understanding of the psychological, social, emotional and physical effects of grief and loss; doing direct counseling for individuals in need of immediate care; and training on self-care techniques to help with stress and burn-out, and ways to assess the extent to which staff are impacted by secondary trauma. They also closely mentored and provided supervision for IOM’s appointed focal point person for mental health and psychosocial support (MHPSS), preparing her to take over the direct counseling once CVT staff left.

Trainings were conducted with IOM staff, and sensitization sessions, which provide an overview of mental health, as well as psychoeducation trainings, were done for the wider community. CVT Ethiopia staff also introduced the concept of psychological first aid (known as PFA), to help the IOM staff focus on establishing safety and stability for migrants, many of whom arrived directly to the MRC after their harrowing experiences and needed support to get stabilized and have their basic needs met.

Tesfanesh said there were thousands of migrants in the area, many returning from Yemen, but some were people planning yet to go to Yemen. For those in the reception center, Tesfanesh saw that needs for things like food, clothing and medication were being met, but mental health care needed to be improved. “I saw that they needed a professional who could assist them in staying at ease until they could go back home,” she said.

As training began, Medhanye and Tesfanesh began speaking with returning migrants, learning about their experiences. “Most reported they were mainly traumatized by smugglers,” Medhanye said. “Smugglers did things like taking them into a desert area, holding them for ransom. They raped the women. They imprisoned people, even Yemeni migrants, for ransom. They told us of beatings, witnessing others being beaten in the prisons, and being deprived of food and necessities.”

Medhanye also said the journey itself was not easy, with people having to cope with starvation and even facing the death of friends along the way. The impacts of the war in Yemen were felt by many, including children. “We worked with three children who had been shot, all in different parts of their bodies,” Medhanye said. “They had to be admitted to the hospital for medical care before they were brought for psychological care.”

The training, particularly its specialized techniques for children like these, was very well received as the IOM staff had been struggling to cope with many difficult cases. The MRC does not have the supervision structure that is part of CVT’s clinical model, so CVT discussed care for the migrants and also for the staff themselves. “We chose techniques which will give results without requiring close supervision,” Medhanye said. The training focused on support and five categories of self-care: physical, social, spiritual, psychological and professional. Each of these has effective practices that can be used at any time.

In addition, the CVT counselors could see that it made a difference for the returning Ethiopians when they met Ethiopian counselors. “When they first met us, when they saw Ethiopians there, they knew someone could help, someone could speak their language,” Medhanye said. “We could see the relief on their faces; we could see them smile. It meant a lot to them.”

And even severe cases showed progress. Tesfanesh said, “I had one client who came from Yemen with symptoms of auditory and visual hallucinations, delusions. We found her in front of the MRC compound where she had fallen on the ground and lost consciousness.”

The young woman was admitted to the hospital for psychiatric care. The woman regained consciousness and was able to speak to Tesfanesh, who spoke the woman’s native language. “That’s when the effects of treatment really started for her,” Medhanye said. The woman was able to move to the MRC and followed up with a doctor and Tesfanesh.

The woman made improvements quickly. Tesfanesh said, “After we did four or five sessions, she started to reorient to reality and reduced her hallucinations, delusions and other symptoms. She started to wash her clothes without request; she started to clean her dorm together with her dorm mates.”

The woman said she felt she was in a safe place now. She began to make progress and heal until, as Medhanye said, “She was ready to go home.”

The IOM staff reported learning a great deal from the training and said they were encouraged by the positive changes they saw in the migrants. According to Medhanye, the IOM staff increased their awareness and knowledge about trauma and particularly how to care for traumatized children which differs from care for adults. “They now know how to comfort migrants in crisis and how take care of themselves,” he said. “As we were leaving, they were asking for more.”

IOM staff requested CVT’s continued support, as did the migrants. “I could see how much we were able to help,” Medhanye said. “I wish I had stayed longer and helped more migrants. Leaving wasn’t easy for me.” However, with their increased capacity, Medhanye and Tesfanesh know that the staff at the IOM MRC will be able to carry on providing quality support to migrants in need.

Funding for CVT’s programs in Ethiopia is provided by the United States Government and the United Nations Voluntary Fund for Victims of Torture. Funding for CVT’s work in Djibouti was provided by International Organization for Migration and private sources.

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