Refugee from Sierra Leone puts personal struggle with PTSD to work for others

Salifu Mansaray, in Burien where he works with mentally ill seniors at NAVOS Mental Health Solutions. (Photo by Sandi Halimuddin)

Salifu Mansaray has turned his own experience of trauma from Sierra Leone’s bloody civil war into an asset in serving mentally ill seniors in Burien.

“The war was nightmarish; it still haunts people,” said Salifu Mansaray of the Sierra Leone Civil War. “Post-traumatic stress disorder is something inside of you that you need to address. You can’t ignore it.”

Mansaray, a robust man with an outwardly cheerful disposition, straddles two different experiences — that of a mental-health worker and that of a Sierra Leonean refugee living with symptoms of trauma.

The 11-year civil war, which lasted from 1991 to 2002, resulted in about 70,000 casualties.

The war became notorious for gratuitous violence, especially of mass-scale amputations as a means of terror and punishment.

Mansaray, one of an estimated 2.6 million refugees from the war, fled his native country in 1998 amongst escalating violence, leaving his home, family and friends behind.

A school in Koindu damaged by RUF rebel forces during the Sierra Leone Civil War. (Photo from USAID via Wikipedia)
A school in Koindu damaged by RUF rebel forces during the Sierra Leone Civil War. (Photo from USAID via Wikipedia)

A two-year journey via Hong Kong eventually landed him, and later his wife and children, in SeaTac. Soon after, he found a job working as a case manager at NAVOS Mental Health Solutions in Burien.

At first he thought it was just another job. But at this boarding home for seniors with mental-health issues, Mansaray found meaningful parallels in his own life.

“Some patients can go for a long time without any major blowouts, but for others if symptoms are not under proper control—without education, therapeutic activities and a stable environment—from time to time triggers go off,” he says.

By seeing and treating patients with mental-health illnesses, Mansaray is more aware of his need for desensitization. Mansaray has learned about triggers, the objects, words or situations that can set off flashbacks and depression.

He knows what a blowout feels like and what to do to control it. He understands coping mechanisms to post-traumatic stress disorder (PTSD); his way of coping to a traumatic past is strong faith and a busy lifestyle.

PTSD is a physical response to trauma that can be manifested in symptoms like flashbacks, emotional numbing, detachment and outbursts of emotion.

It’s most commonly associated with veterans suffering with flashbacks of the battlefield, but the condition can affect anyone who experiences emotional distress.

The emotional toll of war is far-reaching, affecting civilians and refugees who are often forgotten in the PTSD discourse.

While he doesn’t mind talking about PTSD as a medical condition, Mansaray is hesitant to expand on his experiences as a Sierra Leone refugee. He is startlingly optimistic; he refers to his experiences as reasons for growth in faith, character and perspective.

Children fetching water from Cockle Bay, in Freetown. (Photo from Flickr by Matt Stephenson)
Children fetching water from Cockle Bay, in Freetown. (Photo from Flickr by Matt Stephenson)

“[PTSD] is something of my past now because I am now aware,” said Mansaray. “I don’t dwell on the past because it’s not something I want to dwell on. I’d rather focus on the present and the future.”

But back in Freetown, the capital city of Sierra Leone, reminders of the civil war can be found everywhere; high unemployment rates amongst an unskilled generation, violence amongst disgruntled youth, and in the crumbling, half-constructed buildings abandoned since the civil war.

Despite a peaceful recent history, evidenced by violence-free national elections in November 2012, the memory of gratuitous violence is most clear in the memory of Sierra Leoneans.

Victims of trauma here are not likely to seek treatment due to deep-seated stigma toward mental illness. In many post-war countries like Sierra Leone, cultural barriers preventing address of mental-health issues can impede both healing and development efforts.

In Sierra Leone, there is only one official psychiatric facility, the Sierra Leone Psychiatric Hospital, located in Freetown. Built in 1872, the government facility is located in Kissy, the eastern part of Freetown. Locals refer to the center as “crase yard,” which translated from Krio means “a place for crazy people.”

“At the few mental centers [in Sierra Leone], the people who receive care are perceived as people with serious health conditions, so those suffering with trauma do not even want to go,” said Mansaray.

Freetown, Sierra Leone. (Photo by Magnus Ohman via Wikipedia)
Freetown, Sierra Leone. (Photo by Magnus Ohman via Wikipedia)

It is hard to convince people that mental illness is real. Anything that has to do with the brain that doesn’t physically manifest itself is not recognized as an illness.”

For Mansaray, post-war trauma is painfully real. He has seen fighting, shooting and death.

He’s lived the violent reality portrayed in “Blood Diamond,” the Hollywood blockbuster film. Mansaray watched the beginning of the Leonardo DiCaprio film, but couldn’t finish it.

Commonly referred to as the blood diamond conflict, the civil war was sparked in 1991 by rebel army Revolutionary United Front (RUF)’s territorial domination of diamond-rich land in Eastern and Southern Sierra Leone territory. What followed was a reign of terror—with child abduction, systematic rape, mass-scale amputations and murder—rooted in polarization of regional and ethnic groups.

Sierra Leone militia fighters, such as Mansaray, were especially prominent targets of rebel attacks and reprisals. Some of his fellow Sierra Leone Army comrades were killed during the RUF’s political witch-hunt.

When talking about the civil war, Mansaray doesn’t sensationalize his experience fighting rebels or illegally escaping the country by an open boat because for Mansaray it’s not a proud war tale for the storybooks.

It’s a deeply personal experience of trauma — one that is connected to the devastation of his home country, extended culture of terror, and what he describes as the loss of fellow “nice, loyal officers who were just doing their job.”

It’s a vivid memory embedded in the timeline of a whole nation.

Salifu Mansaray. (Photo by Sandi Halimuddin)
Salifu Mansaray. (Photo by Sandi Halimuddin)

Following the civil war, international relief organizations prompted the Sierra Leone government to give greater attention to mental-health issues.

Yet awareness and treatment of mental health remain low.

Priorities and needs in Sierra Leone are different. Infrastructure is lacking: rocky, unpaved terrain makes travel to-and-from the provinces an inconvenient and often dangerous endeavor. Urban planning is deficient: the long rainy season from May to November is marked by flooding and fatalities in crowded slums.

Government scope and capability is limited: during a deadly cholera outbreak in 2012, the Ministry of Health and Sanitation was dependent on non-governmental organizations to lead cholera mitigation efforts.

More often than not, when foreign aid is provided to Sierra Leone, disease prevention for viruses such as malaria takes priority over other mental-health issues.

Mansaray is adamant that development efforts should not precede mental-health awareness efforts. Rather he remains they should be pursued simultaneously, as both development and mental health are essential and codependent.

“Wellness has to be about emotional, physical, social and spiritual healing. For Sierra Leone, the wellness that the country needs is not just infrastructure — that has to be blended with social responsibility,” said Mansaray. “I feel like we’ve got some ways to go as a country.”


  1. Thank you for bringing the issue of mental health in Sierra Leone, both for those that remain in the country and those that have left, to light. Fabulous article Sandi!

  2. Great piece Sandi! I’m glad there are some thoughtful writers out there like you to bring our attention to issues that don’t make the front page. Keep up the great work Sandi!

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