The country faces a complex task of helping citizens deal with trauma, after new cases of cross-generational trauma keep coming up, with some increasingly committing suicide, 25 years after the 1994 Genocide against the Tutsi.

The number of trauma patients in the country according to experts, far outweighs the available trained professionals, which has left many patients unattended to, while others lack access to treatment due to high costs involved especially with private practices.

Currently, the country only has 124 professionally trained trauma counsellors, 11 psychiatrists and 2,000 psychologists, which is one psychologist for every 1,000 patients.

“We need more professionals because most of the few psychologists we have are not employed because there is no budget yet the need is massive,” said Emmanuel Musoni Rwililiza, a psychiatrist and psychotherapist attached to Rwinkwavu hospital.

“It is time to organise and come up with a strategic plan even in the private practise before it’s too late,” said Dr Rwililiza.

The high cost of mental health treatment especially in private practice, which stands at Rwf35,000 per visit has been a major impediment to many accessing treatment.

Stigma associated with mental health in the society is also another issue that has discouraged many from accessing treatment.

“The number of people committing suicide in the country is increasing and it is likely to rise even more in the coming years,” Dr Rwililiza added.

He said that last year up to 70 people committed suicide in the country and in Rwinkwavu district hospital in Kirehe District alone, they record a minimum of six suicide cases and they all suffer trauma from the 1994 Genocide against the Tutsi.

Many of those suffering from this trauma have been unable to work, which affects their economic potential and that of the country as a whole.

Hidden trauma

Experts say that in the near future even those who are functioning well right now, will recall the past, which then turns into trauma. They say that from a psychological point of view, during the current time of peace survivors will seek justice and offer forgiveness, and many could be in shock and numb with pain and fear, so there is a need for professional help for survivors during this phase.

About 223,500 people sought mental health consultation in public hospitals in 2018, according to the 2018 Rwanda Mental Health Survey.

The prevalence rate for depression stood at 11.9 per cent and 35.6 per cent of them were genocide survivors, meaning that one in three genocide survivors faces trauma.

At least 18 per cent of HIV positive people get mental health disorders while some mental conditions are related to poverty.

The prevalence of Post-Traumatic Stress Disorder stands at 3.6 per cent.

“We never used not to get male patients coming for help for depression and other mental health support, mainly because of the Rwandan adage that men’s tears flow from the inside, but these days we are getting an increasing number of men seeking help,” said Mwiririza Jeanne, who works with Tubahumurize, an organisation that offers trauma counselling services.

Over the past few years, thousands of genocide perpetrators have been completing their prison sentences and reintegrating back in society, however many suffer acute trauma that has never been treated.

Dr Rwililiza said the best model would be helping the perpetrators deal with the trauma while still in prison, then preparing them for life outside and how to deal with survivor’s reactions to avoid hurting those still trying to heal.

He said that although trauma might be different between genocide survivors and perpetrators, the reactions are similar, because the same way a survivor will avoid a place where she/he was hunted is the same way a perpetrator will avoid a place where he/she killed.