Years of war in Congo have created a dire mental health crisis. But little support is available

GOMA, Congo (AP) — 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.

EDITOR’S NOTE — This story includes discussion of suicide. If you or someone you know needs help, the national suicide and crisis lifeline in the U.S. is available by calling or texting 988. There is also an online chat at 988lifeline.org. Internationally, many governments and other organizations offer help and information on how to contact them is available online.

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.

The Associated Press receives financial support for global health and development coverage in Africa from the Gates Foundation. The AP is solely responsible for all content. Find AP’s standards for working with philanthropies, a list of supporters and funded coverage areas at AP.org.

Children who suffered from war induced trauma receive counselling in Goma, Democratic Republic of the Congo, Thursday, Aug. 29, 2024. (AP Photo/Moses Sawasawa)

Nelly Shukuru, 51, and others receive counseling in Goma, Democratic Republic of the Congo, Tuesday, Aug. 27, 2024. (AP Photo/Moses Sawasawa)

Children, some suffering from traumatic stress caused by the ongoing fighting between government troops and M23 rebels, play in Goma, Democratic Republic of the Congo, Thursday, Aug. 29, 2024. (AP Photo/Moses Sawasawa)

Eveline, 22 , walks to a health center seeking mental counselling in Goma, Democratic republic of the Congo, Monday, Aug. 26, 2024. (AP Photo/Moses Sawasawa)

Nelly Shukuru, 51, who had planned hanging herself, walks in the Lushagala camp in Goma, Democratic Republic of the Congo, Tuesday, Aug. 27, 2024. (AP Photo/Moses Sawasawa)

Nelly Shukuru, 51, hold the scarf she had planned on using to hang herself after spending three years displaced in the Lushagala camp in Goma, Democratic Republic of the Congo, Tuesday, Aug. 27, 2024. (AP Photo/Moses Sawasawa)

SRINAGAR, India (AP) — Leaders of Kashmir’s biggest political party were sworn into office Wednesday to run a largely powerless government after the first local election since India stripped the disputed region of its special status five years ago.

National Conference leader Omar Abdullah will be the region’s chief minister after his party won the most seats in the three-phased election. It has support from India's main opposition Congress party, although Congress decided not to be a part of the new government for now.

The vote was Kashmir's first in a decade and the first since Prime Minister Narendra Modi’s Hindu nationalist government scrapped the Muslim-majority region’s long-held semi-autonomy in 2019. The National Conference staunchly opposed the move, and its victory is seen as a referendum against the Modi government's changes.

Lt. Gov. Manoj Sinha, New Delhi’s top administrator in Kashmir, administered the oaths of office to Abdullah and the five members of his council of ministers in a ceremony under tight security at a lakeside venue in the region’s main city of Srinagar. Some of India’s top opposition leaders, including Rahul Gandhi of the Congress party, attended.

However, there will be a limited transfer of power from New Delhi to the local government as Kashmir will remain a “union territory” — directly controlled by the federal government — with India’s Parliament as its main legislator. Kashmir’s statehood would have to be restored for the new government to have powers similar to other states of India.

India and Pakistan each administer a part of Kashmir, but both claim the territory in its entirety. The nuclear-armed rivals have fought two of their three wars over the territory since they gained independence from British colonial rule in 1947.

Kashmir’s last assembly election in 2014 brought to power Modi’s Bharatiya Janata Party, or BJP, the first time ruled in a coalition with the local Peoples Democratic Party. T he government collapsed in 2018, after the BJP withdrew from the coalition and New Delhi took the region under its direct control.

A year later, the federal government downgraded and divided the former state into two centrally governed union territories, Ladakh and Jammu-Kashmir. The move — which largely resonated in India and among Modi supporters — was mostly opposed in Kashmir as an assault on its identity and autonomy amid fears that it would pave the way for demographic changes in the region.

The region has since been on edge with civil liberties curbed and media freedoms restricted.

Like on election day, authorities on Wednesday limited access of foreign media to the oath ceremony and denied press credentials to most journalists working with international media, including The Associated Press, without citing any reason.

In the recently concluded election, the National Conference won 42 seats, mainly from the Kashmir Valley, the heartland of the anti-India rebellion, while the BJP secured 29 seats, all from the Hindu-dominated areas of Jammu. The Congress succeeded in six constituencies.

Militants in the Indian-controlled portion of Kashmir have been fighting New Delhi’s rule since 1989. Many Muslim Kashmiris support the rebels’ goal of uniting the territory, either under Pakistani rule or as an independent country.

India insists the Kashmir militancy is Pakistan-sponsored terrorism. Pakistan denies the charge, and many Kashmiris consider it a legitimate freedom struggle. Tens of thousands of civilians, rebels and government forces have been killed in the conflict.

Experts say the new government, stripped of all the essential powers, would face a daunting task to fulfil its election promises against huge public expectations to resist the 2019 changes and the federal government’s tight control.

Praveen Donthi, senior analyst with the International Crisis Group, said the region’s political vacuum of the last few years will not vanish with the polls alone.

“The Modi government should build on it by restoring full statehood and empowering the government,” said Donthi. “Otherwise, it will intensify disaffection and is a set up for failure.”

Modi and his powerful home minister, Amit Shah, have repeatedly stated that the region’s statehood will be restored after the election, without specifying a timeline. However, they vowed to block any move aimed at undoing the 2019 changes but promised to help in the region’s economic development.

For the new chief minister, meanwhile, it's going to be a tightrope walk.

“As a pro-India politician at the helm of this powerless administration, Omar Abdullah knows his limitations,” Donthi said. “He would be looking at his job as a buffer to moderate the worst instincts of New Delhi, but he would be clutching at straws."

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Paramilitary soldiers stand guard outside the venue of swearing in ceremony of ministers of Kashmir's local government on the outskirts of Srinagar, Indian controlled Kashmir, Wednesday, Oct. 16, 2024. (AP Photo/Dar Yasin)

Paramilitary soldiers stand guard outside the venue of swearing in ceremony of ministers of Kashmir's local government on the outskirts of Srinagar, Indian controlled Kashmir, Wednesday, Oct. 16, 2024. (AP Photo/Dar Yasin)

Paramilitary soldiers stand guard outside the venue of swearing in ceremony of ministers of Kashmir's local government on the outskirts of Srinagar, Indian controlled Kashmir, Wednesday, Oct. 16, 2024. (AP Photo/Dar Yasin)

Supporters of Indian National Congress and National Conference party celebrate early leads in election outside a counting center on the outskirts of Srinagar, Indian controlled Kashmir, Tuesday, Oct. 8, 2024. (AP Photo/Mukhtar Khan)

Jammu and Kashmir National Conference (JKNC) party leader Omar Abdullah, standing in car shakes hands with supporters as he celebrates his victory in the election for a local government in Indian controlled Kashmir, Budgam, Tuesday, Oct. 8, 2024. (AP Photo/Dar Yasin)