MONROVIA, 30 September 2008 (IRIN) - Only five years out of a brutal 14-year-civil war that killed an estimated 150,000, according to the UN, and displaced and wounded tens of thousands more, Liberia only has one mental health specialist to treat trauma and depression. Health officials are preparing to meet on 2 October to find a way to treat the country's growing mental health needs, despite the lack of trained doctors.

Bernice Dahn, the Ministry of Health director in charge of the Liberia's health system and its employees told IRIN the country is ill-equipped to treat trauma, "To the best of my knowledge, there is one licensed doctor in the country to deal with post-traumatic stress disorder (PTSD). We actually do not have [enough] doctors to deal with this. There is one recognised health centre in [a community located on the outskirts of Monrovia] to deal with this problem."

Mental health care 'urgently needed'

Liberian fighters who were victims of sexual violence are more likely to report higher rates of depression, PTSD- a severe, ongoing emotional reaction to extreme trauma- and suicidal thoughts than non-combatants or former combatants who did not report experiencing sexual violence, according to a study published August 2008 in the Journal of American Medicine.

While this study focused on sexual violence against fighters, the UN has said civilians, especially women and girls, were subjected to multiple forms of sexual violence during Liberia's civil war, including gang rape, sexual slavery, 'survival' sex in exchange for food, and unwanted pregnancies due to rape.

The Ministry of Health's Dahn says health officials are drafting a national policy plan that will address mental health disorders among Liberians.

"We have now reached a decision to hold a national stakeholder meeting on 2 and 3 October 2008, at which time we will discuss with our local and international partners possible ways to deal with the issue [mental health needs] and put into place a policy working document," Dahn told IRIN.

The health director told IRIN she expects to begin specialised training for doctors by December 2008, recognising the need to act as quickly as possible because of the increase of PTSD, especially among youths.

Jesse Plange with the non-profit, Liberia Emissary Anxious for Development (LEAD), which provides employment training to ex-combatants, told IRIN health officials need to pay more attention to youths' mental health needs, especially those who took up arms.

In 2003, the UN estimated one out of every 10 children had been recruited to fight, or a total of about 21,000 child soldiers.

"Although our organisation has hired a counsellor to work with the ex-combatants, in most cases, we observe that they [still] behave abnormally. But we think the more they are kept in training and have a job to do, the more they will try to refrain from violence," says Plange.

He said, unfortunately, his organisation's programs are too short to keep ex-combatants in training for long while they undergo behaviour-change counselling.

"We have been finding [it] difficult to work with most of them [ex-combatants] in most instances because they behave abnormally, and sometime come out with unnecessary demands, such as demands for cash, that the organisation does not have the capacity to handle. And so, we are always careful when it comes to making promises because if promises are not kept, they get upset and may even go amok demanding their concerns be addressed."

Ex-combatant Edward K. Teah, LEAD's executive director, says the pressure of not being able to find work is too much for some former fighters to bear, "This has been the problem for most of us and in most cases, it adds to our frustration. Some think about [resorting] to violence again to make end meet."

By August 2007, the UN reported about 90,000 former fighters, of which about 10 percent were children, registered into programs to help them find work and get used to civilian life once again. But the World Bank has estimated that more than three quarters of the population lives in US$1-a-day poverty, and more than 80 percent do not work in the fomal sector, if at all, rendering most reintegration efforts on the job front tough.

But there are ex-fighters who do not show any signs of trauma, says Francis Kollie, owner of an auto mechanic shop on the outskirts of Monrovia in the community Bushrod. He said his three former fighter employees trained at a vocational school founded by ex-combatants, Monrovia Vocational Training School (MVTC), and have adjusted well.

"We recruited the three ex-fighters after their graduation from the school [MVTC], but if you are not told that these boys are ex-fighters, you would not know because they have adjusted to the working conditions and feel that they are once again part of the society."

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