Paper presented to: ZIMA parallel mental health session [ZIMA Annual Congress.2009]
Complex Emergencies and the Tree of Life: A community-based approach to
dealing with trauma.
A P Reeler [Director, Research & Advocacy Unit]
Background
Whilst there is continual reference to the suffering of those affected by the Zimbabwe crisis, particularly in
reference to Operation Murambatsvina and the burgeoning food crisis, insufficient attention has been given
to the mental health consequences, both psychological and social, of the massive social upheaval and
organized violence and torture that has accompanied the crisis.
A strong argument can be made that Zimbabwe now conforms to the kind of situation currently termed a
―complex emergency‖. In the context of economic collapse, the collapse of all supportive services [health
and social welfare], severe food shortages, and mass violence, Zimbabwe resembles a country at war, but in
the absence of the more obvious features of war.
A complex emergency requires a strong and sustained humanitarian response and here the mental health
needs of those affected in the current crisis should be addressed, and any programme should adopt as a
framework the following principles (Mollica et al. 2004; Mollica, Guerra, et al.2004):
The co-ordination of mental health care;
Good basic assessment of the problems and the establishment of a monitoring
process;
Implementation of an early intervention phase;
Utilising of the de-facto mental health system;
Emphasis on training and education;
Implementing, managing, and monitoring a culturally competent system of care;
Stress on ethics and community participation;
Care to prevent negative mental health consequences in mental health providers;
Commitment to outcome assessment and research.
These principles are commonly recognised by various expert groups as the basic framework for providing
effective mental health care in complex emergencies (IASC.2007), and should be applied in Zimbabwe in the
development of a national programme for addressing the mental health needs of the Zimbabwe population
affected by both the current crisis as well as the earlier periods of trauma.
There are now a number of excellent reports on the crisis facing Zimbabwe, so it is of great concern that
virtually a none have concerned themselves with the mental health dimension of the crisis. Whilst it must be
acknowledged that food, shelter, and medical care are always priorities in emergencies, it is also the case
that the mental health needs in emergencies are often overlooked. It is for this reason exactly that the UN
and other expert groups have made a decided effort to keep the mental health agenda firmly in the