strategies developed for internally and externally displaced populations. This be no less the case for
Zimbabwe in its complex emergency.
Trauma and complex emergencies
The term ―complex emergency‖ is increasingly being used to describe situations of disaster, frequently
political in origin and process, which result in the massive destabilization of a state’s capacity to care for its
citizens (WHO.2003). As Richard Mollica and his associates have put this, A complex emergency is a social
catastrophe marked by the destruction of the affected population ’s political, economic, socio-cultural, and
health care infrastructures (Mollica et al. 2004): no better description could characterize Zimbabwe today.
Now complex emergencies can quite clearly occur as a consequence of natural events, as in the recent Asian
tsunami or the effects of Hurricane Katrina on New Orleans, but they can also occur as a consequence of
human intervention, as in periods of civil war or low intensity conflict, or what may be termed ―organized
violence and torture‖. In this latter case, there may well be destruction of political and economic structures,
but here are also frequently the effects of the direct actions of humans on other humans, and no countries
in Africa have made this more evident than the Democratic Republic of the Congo, Rwanda, or Sudan. A
distinction should therefore be made between accidental harm causing trauma, as in natural disasters, and
deliberate infliction of harm as is seen in wars, civil wars, low intensity conflict, genocide, and widespread
political repression.
This report is not concerned with describing the many ways in which trauma may be inflicted during complex
emergencies, but rather to very briefly describe their effects. The most obvious effects are physical, seen in
illnesses and injuries, which may be short-lived, but also may lead to long-term disability. However, the most
persistent consequences will be psychological, and especially if the trauma was deliberately inflicted (Mollica
et al. 2004). Here four points should be emphasized:
Firstly, the most probable long-term consequence of experiencing a traumatic
event is the development of a psychological disorder;
Secondly, the probability of psychological disorder following a traumatic event increases
with the frequency of experiencing physical harm, such as torture;
Thirdly, the probability of psychological disorder increases with the number of
exposures to trauma such as organised violence or torture [OVT];
Fourthly, whilst men are probably the most common primary victims of OVT,
women and children are disproportionately the most common secondary victims,
and certainly secondary victims are much more common than primary victims.
The comment should also be made that it is well-established that psychological disorder due to violence can
be caused by physical injury or torture, but equally that mere psychological exposure, as in witnessing
violence, or even living in situations of very common physical violence, such as a war or low intensity
conflict, can also cause psychological disorder.
Whilst there are very few good epidemiological studies of the incidence or prevalence of disorders due to
trauma in Zimbabwe, there are a number of studies that are helpful in understanding the likely picture.