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For Nelly Shukuru, there was no way out. The fighting that forced her from her home, the squalid conditions in the displacement camp in eastern Congo, the hunger, all felt inescapable. The 51-year-old planned to hang herself.
She said a neighbor stopped her just in time. “In my mind, the suffering was permanent," said the mother of six, seated in a health clinic. “The people who have died are better off than I am.”
Years of conflict in eastern Congo have created a dire mental health crisis. Aid groups say the number of people seeking care has spiked as fighting intensifies. Some of the worst affected struggle to survive in cramped, violent displacement sites that aren't conducive to recovery.
The number of people who received psychosocial support in camps around the main city of Goma increased more than 200% between January and June compared to the same period last year — from 6,600 to more than 20,000 — according to aid group Action Against Hunger.
The number of people reporting suicidal thoughts has jumped from about five a month at the beginning of the year to more than 120, it said.
More than 100 armed groups have been vying for a foothold in mineral-rich eastern Congo near the border with Rwanda. The violence has escalated as the M23 rebel group, backed by Rwanda, has reemerged. The fighting has displaced millions. Over 600,000 shelter in camps near Goma.
More people are experiencing anxiety, depression and post-traumatic stress disorder as well as insomnia and excessive alcohol and drug consumption, psychologists say.
“All around us there is war, and the number of people facing difficulty is increasing daily,” said Innocent Ntamuheza, a psychologist with Action Against Hunger.
But little mental health support is available. Less than 30% of the requested $180 million for protection — which includes mental health services — in the humanitarian response plan has been funded this year, said the United Nations, which calls Congo one of the world’s most neglected crises.
Shukuru said she considered killing herself in August after her drunk 21-year-old son struck her head with a rock because of a fight over a radio. Her children’s drinking had worsened since arriving in the camp because they were idle, she said. The family used to farm and attend church in their hometown of Sake but fled in February when it was bombed.
Her husband, a construction worker, struggles to find jobs. The aid they receive isn't enough.
Some of the camps for displaced families are less than a day's walk from the front lines. The camp where Shukuru lives was struck by shells in May that killed some 40 people and injured others, locals and aid groups said.
Some armed men live among the camps' population. During a visit in August, The Associated Press saw men carrying guns and a truck of people in military fatigues drive through, chanting war songs. It wasn't clear if the people were with the military or self-defense groups.
In the government's attempt to push back M23, it's been supporting militia groups under a coalition called the Wazalendo. But the groups, who previously fought government forces and each other, are accused of committing human rights abuses, locals and aid groups said.
Some fighters and members of Congo's army, often stationed nearby, are also accused of sexual assault.
A 38-year-old said she was raped by three armed men in a field while she was looking for food in May. The AP does not name people who have been sexually assaulted. The mother of eight has been seeking help at a clinic run by Doctors Without Borders, also known by its acronym MSF, but said she often can’t sleep at night and sees the men in her dreams.
The constant presence of armed men in the camp makes it worse.
“It reminds me of the men who raped me,” she said.
People relive traumatic incidents especially when it comes to rape, said Clementine Sifa, the mental health supervisor for MSF.
In September, MSF said it treated an unprecedented number of survivors of sexual violence in Congo last year — more than 25,000 — with the trend continuing this year. The majority of people were treated in displacement camps in Goma.
Lt. Col. Guillaume Ndjike, spokesman for Congo's army in the east, said the army is trying to protect people in the camps by conducting night patrols and setting up mobile police stations. He said armed men aren't allowed in the sites, and people accused of sexual assault or murder are apprehended and held accountable.
Locals and aid workers say there is little accountability.
Some aid groups are training community leaders to spot signs of people who might need mental health support and refer them to a clinic. They watch for people who are isolated, look stressed or have lost their jobs. Stigma surrounding mental health sometimes keeps people from proactively seeking it, they said.
Those who have sought treatment say it's been helpful to learn ways to cope with anxiety and negative thoughts, including breathing techniques.
Wrapping her arms around her chest and tapping her shoulders, Josephine Mulonda said the technique called “butterfly hug” has helped reduce heart palpitations triggered by her husband's killing in January. The 52-year-old had depressive thoughts and worried how she would support their eight children.
War Child, an organization focused on helping children in conflict, uses movement, song and play to help troubled youth express themselves. Dancing in a circle at a displacement site, children chant “Let me cry, I’m crying.” The group also gives parents advice on listening to their children, said Isaac Rwamakuba, War Child's coordinator in Goma for emergency responses.
But he said some of the most affected children lost families through death or separation.
Last November, a 14-year-old was separated from her family when her town was attacked. The AP is not using her name due to the sensitivity of her situation. She is cared for by another family but fears being attacked when she walks for hours into the bush to find firewood to sell.
She's considered ending her life to stop the suffering, she said. The psychological support from War Child helps at least momentarily, she said.
She has no idea if her mother is alive.
