Background
Brief history of the Bougainville Crisis
Methods
Year | Activities |
---|---|
2009a
| Meetings with workers from the Nazareth Centre and Leitana Nehan Women’s Development Agency, two non-government agencies attempting to address MHPS issues |
2011a
| Forty people volunteered to meet with DT following an announcement made at a church service about his interest in understanding people’s experiences during and since the war. With the participant’s permission, DT documented thematic information to validate the events likely to have caused MHPS problems (Table 2). No personally identifying information was collected Multiple meetings with workers (n = 7) from three agencies to clarify: data obtained from the literature review (Table 2); the MHPS issues identified in meetings; and the capacity in Bougainville to address MHPS issues |
2013a
| 80 people were consulted in a series of meetings and/or at a public forum. Those consulted were President Momis, Ministers and Members of Parliament (n = 4), Senior Parliament/Ministry Officials (n = 3), senior public servants (n = 9), public servants representing departments (n = 8), representatives of women’s groups (n = 7), representatives of church groups (n = 9), village representatives (n = 33), senior staff of three aid agencies (n = 4) and volunteers (n = 2) A public forum was held at Buka Hospital, during which data regarding the events that occurred during the war thought likely to have had a MHPS impact was presented (Table 2). Participants (n = 28) provided feedback and clarification about the direct and indirect MHPS impacts of the war and the capacity in Bougainville to address these issues. An outcome of the public forum was the establishment of the Bougainville Mental Health Steering Committee |
2014b
| DT, DS and PB together with the Bougainville Mental Health Steering Committee (including BM, LG, EB) developed a strategic framework for addressing MHPS issues in Bougainville. This process clarified the current MHPS issues, explored the existing capacity and the potential within Bougainville to address the MHPS challenges arising from the war, and involved 22 meetings, including with President Momis, senior public servants, representatives of women’s groups, workers from agencies attempting to address MHPS issues and aid agencies. A strategic framework to address MHPS issues was submitted to the Autonomous Bougainville Government for review [12] |
Results
Findings: literature review
Event(s) | Evidence/comment |
---|---|
Total deaths attributed to the war | Estimates of the total number of deaths vary from 12,000 [13] to 20,000 [2] from a pre-war population of 160,000 [4] In 1993, half way through the war, the Minister of Health had compiled the names of 10,000 people who had died [14] |
Deaths due to deprivation of medical supplies | Incomplete data from 18 of 23 Health Centres reported 2023 deaths from normally preventable diseases in the period January 1990–July 1991 [15]a
|
Combat related deaths | |
Extra-judicial killings murders and disappearances | Investigators confirmed 158 extra-judicial killings and 13 disappearances [10, 18] b, but concluded that the number of extra judicial killings was “undoubtedly higher” ([18], p. 1)b
The alleged extra judicial killings of 374 people and the murder of 166 people was reported [15, 19]a. Additionally, there are reports of extra-judicial killings where the number killed is unknown (e.g. “a group” [15], p. 12a). It is unclear if these numbers are additional to or inclusive of those in other reports [10, 18]b
|
Displacement of population | More than half of the population was displaced: 15,000–20,000 fled Bougainville [4]; 67,300 were internally displaced into care centres (internal refugee camps) [18] and nearly half of those in these centres were under 15 years of age [1]; and unknown numbers moved to BRA bush camps and hid independently [1]. About 50,000 people were living in care centres at the time of the cease-fire [13] |
Sexual assault | Reports range from the alleged sexual assault of individuals through to the sexual assault of “many” in care centres, pack rapes, individuals being murdered after being raped, women committing suicide after being raped and people being detained and sexually assaulted over weeks [10
b, 14, 15
a, 18
b, 19
a, 20]. While the numbers who were sexually assaulted is unknown, thousands of files of rape victims were destroyed by combatants who feared the implications of these records in relation to possible action regarding war crimes [4]. Reports of sexual assaults contrast with the view of there being a low pre-war incidence of sexual assault due to unique cultural factors in a largely matrilineal society [21, 22] |
Deliberate and indiscriminate gunfire | |
Harassment, beatings and torture | |
Undermining of traditional authority | The traditional authority of elders and women was undermined by military command [23] |
Damage to important values and relationships | |
Property damage | 118 alleged incidents resulting in the destruction or damage of residential and commercial property, food gardens and crops, theft and the killing of animals [15, 19]a. Events documented range from the burning of one home to the destruction of clusters of villages resulting in the displacement of 10,000 people. It is estimated that the homes of one-third of the population were destroyed [4, 14]; 14 million cocoa trees were destroyed [1]; and that only 20 % of cocoa trees remained in Southern Bougainville [1] |
The collapse of the education system | |
Economic | The pre-war economy was “dominated” by the Panguna mine ([1], p. 50). It has been estimated that in 1989 the mine would have contributed 4000 direct and 8000 indirect jobs [25]. The mine has not reopened. Cocoa and copra are Bougainville’s largest export crops [26] and historically have been the major source of income for the majority of the population [25]. In 1988/98, 18,000 tons of cocoa and 27,000 tons copra were produced and this fell to negligible levels during the war [1]. By 2006, cocoa and copra production had increased to 15,000 and 12,800 tons respectively [26] |
Findings: community perceptions of ongoing MHPS issues and the need to address these issues
MHPS issuesa
| Community perceptions |
---|---|
Ex-combatants | Ex-combatants were described as displaying behaviours thought to reflect the long-term impact of trauma exposure including substance abuse; weakening of family responsibilities; conflict with spouses concerning the use of money to purchase alcohol; perpetration of violence (including sexual) against women and children; and the use of sex as a coping mechanism. Substance abuse and the perpetration of sexual assault by ex-combatants have been reported elsewhere [13, 14]. While the number of ex-combatants displaying these behaviours across Bougainville is unclear, in personal communication with DT, a local politician and Catholic Nun reported that 232 ex-combatants were identified in one of Bougainville’s 33 political constituencies as manifesting one or more of these problems |
Lost generation | Those who were children/adolescents during the war are referred to as the “lost generation” in Bougainville. This group were described as being marginalized and alienated, having limited to no formal education, lacking engagement with traditional social values and roles and displaying aberrant behaviours Some of this group continue to be impacted by their war experiences which include armed combat, witnessing human rights abuses and being displaced into care centres [14, 24]. While the number within this group who are adversely impacted by these experiences is unknown, a few years after the war an expatriate Marist Brother teacher/counsellor noted that most of 50 male students, who had been involved in combat, were impacted by post-traumatic stress including displaying a range of aberrant behaviours considered to be trauma related [24] |
Substance abuse | Substance abuse (home brewed and commercial alcohol and marijuana) is considered a major problem and was reported to be associated with rape and unwanted pregnancies, fighting, criminal behaviour, the destruction of village values and drug induced psychosis. These detrimental impacts have also been identified in a number of reports [14, 23, 29]. Substance abuse has been linked with unresolved trauma [14, 23] |
Gender violence | Gender-based violence including sexual violence is considered a significant issue in Bougainville. The view is that gender-based violence including sexual assault has continued at a higher rate compared to that prior to the war. Qualitative research has identified a high prevalence of gender-based violence including sexual assault in Bougainville [27, 28]. Gender based violence has been linked with unresolved trauma [14] |
Missing persons | People continue to search for the remains of relatives, who are presumed to have died during the war, to return them to their clan for customary burial. It was reported that the inability to perform customary burial ceremonies complicates the grieving process and has implications for land ownership and use [14], The numbers impacted by their inability to locate the remains of relatives is unknown, but it was estimated that there are “many” ([14], p. 7). The importance of the issue however is reflected by the fact that in 2014 the Autonomous Government of Bougainville acknowledged the suffering of the relatives of the missing and adopted a policy to clarify their fate [33] |
Police force | Senior police reported considerable difficulties for the police force generally coping with working in a post-conflict community impacted by a range of MHPS issues. They also reported that some officers who are ex-combatants continue to be impacted by their war experiences, and this impacts their work performance and families. The various issues contributing to the difficulties policing in Bougainville have been reported elsewhere [14] |
Displacement | People continue to be displaced within and outside Bougainville. Some are living with relatives causing great strain on host families, while others are living insecurely squatting on land belonging to others [14]. Reasons reported for not returning to their villages include unresolved trauma, fear of rejection for past crimes and threats of violence [14]. The burdens of displacement include separation from families and traditional lands [14]. The numbers who continue to be displaced is unknown but in 2003, as many as 9000 who fled to the Solomon Islands had not returned [1] and it has been estimated that thousands of families continue to be displaced within Bougainville [14] |
Trans-generational impact | A trans-generational impact of the war appears to be emerging among those born after the war. Reports indicate that this group have been impacted by their exposure to a range of trauma-related aberrant behaviours in parents and the society at large (e.g. excessive drinking, weakening of family and community structures, absence of customary guidance and role models previously provided by traditional authority structures) |
Findings: current resources to address MHPS issues
Constraints on the capacity in Bougainville to address MHPS issues |
---|
No formal assessment of MHPS needs across Bougainville |
Limited access to evidence based training and professional supervision of workers |
Limited opportunity to build institutional capacity |
Insecure and intermittent funding |
Lack of resources and support to build a strong organizational framework to achieve consistent co-ordination and integration of services |
Inadequate resources to implement and monitor evidence-based practice, lack of capacity and resources to undertake systematic treatment outcome assessments |
The absence of an overarching and integrated plan to advance the mainstreaming of mental health services as an essential component of overall health service development |
Facilitating factors |
---|
Broad recognition of the need to address MHPS issues |
Interest in building the local MHPS capacity |
The presence of key individuals and agencies interested in being actively involved in addressing MHPS issues |
During the 2014 consultancy, President Momis identified the need for the government to take a greater role on caring for those who have mental health problems, including the need for legislation to support this proposal |