Fifteen years after the end of Sri Lanka’s internal conflict, the Northern Province still grapples with an unresolved mental-health crisis. Despite years of post-conflict development, the psychological toll of the three-decade-long internal conflict continues to affect the lives of thousands. The conflict left behind more than physical damage. It disrupted families, displaced communities, and created emotional wounds that remain largely untreated. Grief, trauma, fear, and stress continue to affect many, long after the fighting stopped.
The situation reflects how the effects of war extend far beyond the battlefield. Forced displacement, the loss of livelihoods, high unemployment, and the breakdown of traditional community structures have deepened the psychological burden. A 2019 study found that nearly 60% of the residents in the said province live with mental-health issues including depression, anxiety, post-traumatic stress disorder, psychosis, and trauma-linked physical symptoms. This rate is considerably higher than global averages for populations affected by conflict, indicating the scale of the issue in the region.
In response, the Ministry of Health has introduced a number of services to restore mental healthcare in the province. Psychiatrists, mental-health officers, and diploma-level professionals were placed in all five districts (Jaffna, Kilinochchi, Mannar, Mullaithivu, and Vavuniya). More than 50 mental-health clinics were set up, supported by in-patient units and rehabilitation centres for people dealing with substance abuse. Mental health was gradually included in primary healthcare, with community mental-health workers teaming up with Medical Officers of Health to offer treatment at the community level.
Community support centres were established to serve as local hubs for mental health awareness and counselling. Training sessions were also held for primary healthcare staff to help identify early symptoms and reduce stigma around mental illness. At the district level, psychosocial forums brought together Government agencies and non-governmental organisations to support a more organised approach to care. These forums also gave local professionals and volunteers an opportunity to share experiences, raise challenges, and coordinate action on the ground.
Although such initiatives were introduced, several gaps remain. One of the biggest challenges is the lack of qualified professionals. The region does not have enough psychiatrists, clinical psychologists, social workers, or trained counsellors to meet the growing demand for care. Multidisciplinary teams are rarely available, which limits access to specialised services, particularly for those dealing with severe trauma. Ex-combatants, torture survivors, and the families of the disappeared have no formal rehabilitation programmes tailored to their needs. As a result, many of the most affected groups remain without proper psychological support.
The effects of war have also become embedded in the social fabric. High rates of domestic violence, substance abuse, suicide, and child abuse are reported across the province. These patterns are particularly visible in Kilinochchi and Mullaitivu – areas that saw the most intense fighting during the final stages of the conflict. Families of the disappeared live in ongoing grief, unable to conduct proper funeral rituals or find closure due to the absence of truth or justice.
Trauma is being passed down through generations. Many parents, themselves struggling with the psychological aftermath of war, face difficulty in raising emotionally secure children. As a result, children are growing up with feelings of neglect, aggression, withdrawal, or learning difficulties. Teachers in the region report behavioural issues, a lack of concentration, and absenteeism among students. Without proper intervention, this cycle of emotional instability could continue into the future and impact the region’s long-term development.
Language barriers, limited transport options, and long distances to clinics further restrict access to care. Many patients cannot afford regular visits or medications. Mental-health services are also heavily concentrated in district capitals, leaving rural and isolated communities under-served. People in these areas either go without care or depend on traditional healers, which may delay appropriate treatment.
To address these problems, there is a need for a broader approach to mental health. A national mental-health policy tailored to post-conflict recovery would help. Such a policy should link mental healthcare to larger community development and social welfare efforts. Training more mental health workers and improving their access to resources and ongoing support would improve the reach of services. Local universities could be supported to introduce specialised training in psychosocial care, trauma counselling, and conflict-sensitive mental health delivery.
Rehabilitation programmes are also needed for those who endured extreme trauma. Ex-combatants, survivors of torture, and the families of missing persons require care that goes beyond medication and clinic visits. Community-based healing initiatives can be a powerful addition. Encouraging group therapy sessions, peer support activities, and training volunteers can help create safe, culturally familiar spaces for healing. Lessons can also be drawn from global models, such as trauma recovery programmes used in Rwanda and Bosnia, where community-based storytelling and psychosocial workshops helped promote healing and reconciliation.
Tying mental health with economic recovery can also build resilience. Helping people find a steady income, engage in livelihoods, and regain structure in their lives has a direct impact on wellbeing. Vocational training, small enterprise support, and job-placement programmes can indirectly improve mental health outcomes. Certain finance-based programmes targeted at widows or war-affected youth have shown promising results in reducing stress and anxiety. Mental health should also be considered in development planning, so that housing, education, and infrastructure projects integrate emotional and psychological wellbeing into their frameworks.
Efforts to tackle stigma must continue as well. Public awareness campaigns, storytelling through community media, and training of religious and community leaders can help shift public attitudes. The fear of being labelled mentally ill still prevents many from seeking help. Civil society groups have an important role to play in keeping mental health on the public agenda. Government policy must protect the rights of those with mental illness, ensuring non-discrimination in workplaces, schools, and healthcare.
The road to recovery is long, but some progress has been made. Mental health services now exist where there once were none. But, the emotional wounds caused by decades of violence and loss will take much more time and care to heal. The people of northern Sri Lanka deserve more than access to clinics. They deserve real, lasting support for rebuilding their lives. Recognising mental health as a basic right is essential for reconciliation and lasting peace.
(The writer is a Temporary Demonstrator at the Jaffna University)
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The views and opinions expressed in this article are those of the author, and do not necessarily reflect those of this publication