The collective narrative of trauma and healing among internally displaced individuals in ethiopia: a community-based participatory action research inquiry

Abstract

Background

Ethiopia is ranked among the top five countries with the highest number of internally displaced individuals. Several centers in Gondar City, Ethiopia, provide temporary accommodations for those forcibly displaced from their homes during the 2020–2023 period. Research shows that internally displaced people (IDPs) face stressors such as trauma, poverty, and the collapse of social support networks, resulting in mental distress, impaired relationships, and diminished coping abilities.

Methods

This Community-Based Participatory Action Research (CBPAR) and interpretative phenomenological research study engaged 42 stakeholders (including IDPs, service providers, community leaders, and governmental/non-governmental representatives) residing in Gondar, Ethiopia, who were selected using purposive sampling to explore narratives of trauma and healing shaped by lived experiences. Data were collected through six focus group discussions and nine in-depth interviews, then analyzed using template analysis.

Results

Findings reveal visceral and culturally embedded experiences of trauma, described as ‘wounds to the soul,’ ‘relational wounds,’ and idioms of distress that convey the profound impact of displacement. Collective healing emerged through cultural and spiritual practices, connection to ancestral traditions, and music. Barriers such as low trauma awareness and limited mental health access were also highlighted.

Conclusion and implications

This study underscores the interconnectedness in collectivist cultures and offers insights to develop culturally responsive trauma-informed programs. It calls for further research on healing processes that integrate individual and collective resilience.

Introduction

Internally displaced persons (IDPs) are individuals compelled to leave their residences due to conflicts, violence, human rights violations, or natural catastrophes and have not crossed an internationally recognized state border (UNHCR,2001). The global number of internally displaced persons (IDPs) has surged by 20% in 2022, amounting to 71.1 million. It is estimated that approximately 28.3 million instances of internal displacement were caused by conflict and violence. Among the top ten countries that shelter the majority of IDPs, five are in Africa, with the majority in East Africa (Global Report on Internal Displacement, 2023; IOM, 2023).

Ethiopia, ranked among the top five countries with the highest number of IDPs, faces interconnected crises, including armed conflict, ethnically motivated violence, and recurrent draught (IDMC, May 11, 2023). Over 4.38 million people were internally displaced across 11 regions in Ethiopia because of internal and ethnic conflict (66%), draught (18%), and social tension (7%) (IOM, 2023; IDMC, 2021; UNHCR, May 24, 2023).

Forced internal displacement generates both individual and collective trauma, resulting in diminished well-being, impaired relationships and multigenerational psychological distress (Panter-Brick and Eggerman 2017). Complex trauma is defined as exposure to multiple severe and pervasive traumatic events, often of an invasive, interpersonal nature (NCTSN, 2024).

While research has enhanced our understanding of the impact of trauma on learning, development, and growth, it remains unclear how communities that have experienced trauma can effectively restore their collective well-being (Koshe et al. 2023; Jansen et al. 2015; Makango et al. 2023; White et al. 2017). Recent focus on trauma-informed interventions has promoted a breadth of knowledge of evidence-based treatments; however such intervention often overlook cultural context, which can limit their efficacy in collective societies like Ethiopia.The “treatment gap” (Jansen et al. 2015) reflects the concern that globally validated mental health interventions may not address collective trauma effectively.

Collective traumas, which refers societal and community traumas caused by armed conflict and natural disasters, intertwines with societal disruptions (White et al. 2017). Collective trauma hinders the development of mental health, well-being, social cohesion, and resilience (Miller and Rasmussen 2010; Ommeren 2019; Siriwardhan and Stewart, 2012). Studies have demonstrated that mass trauma, such as forced displacement, has a profound effect on an individual’s mental well-being, leading to issues such as anger, depression, denial, internalized oppression, survivor guilt, and physiological changes in the brain and body. Moreover, it hinders the development of health, wellness, and collective strength (Miller and Rasmussen 2010; Ommeren 2019).

Trauma and trauma-related issues are perceived and interpreted at both the individual and collective levels and vary significantly across different cultural contexts. The Western perspective of trauma and subsequent interventions tends to focus on individual psychological distress, thereby identifying individuals with mental health disorders or challenges and addressing the symptomology of individuals (Jansen et al. 2015). However, this is too narrow a scope to adequately address the collective traumas and idioms of distress, i.e. social and culturally mediated way of expressing distress, in a community context experienced by IDPs, as intervention need to focus on “restoring a disrupted social fabric and reshaping communities in a way that previous social divisions that contributed to the past violence and its related suffering are transcended” ’(Jansen et al. 2015, p.4). For example, Panter-Brick and Eggerman (2017) report that for IDPs in Afghanistan, “education, employment, the timing of marriage, and home ownership—these were key to realizing the societal blueprint of social prominence, respectability, and honor” (p. 397) when such critical aspects of social hope were depleted because of violence and displacement, profound grief and trauma were experienced.

Furthermore, the definition of communities varies greatly across different societies, settings, and cultures, as does the level of cohesiveness within them. Therefore, it is crucial to develop mental health interventions that are specifically tailored to individual cultural contexts(White et al. 2017). The ramifications of collective trauma extend across various dimensions, encompassing cultural trauma, racial trauma, generational trauma, family trauma, and individual trauma (Hirschberger,2018; Weisner 2021). Decades of research have demonstrated that unaddressed trauma can result in trauma-related mental health conditions, including posttraumatic stress disorder, acute stress disorder, and reactive attachment disorders. The healing process from trauma involves addressing both physiological and dissociative symptoms and rebuilding a functional belief system that encompasses aspects of vulnerability, meaning, and self-esteem (Hirschberger 2018). Cultural norms and values have shaped this belief system. In predominantly individualistic Western societies, therapists tend to encounter clients who express feelings of vulnerability or inadequacy. On the other hand, in collectivist cultures, such as Ethiopia, individuals’ primary concerns often relate to social functioning and the evaluations they receive from others. Thus, the approach to healing processes for individuals from individualistic cultures may differ significantly from that of individuals from collectivist cultures, even though the distinction between these cultural paradigms is not always clear-cut (Hirschberger,2018).

In general, addressing trauma and fostering healing and resilience begins with understanding idioms of distress through the community’s narrative shaped by lived experiences. Interventions and research need to focus on the community as a source of healing and resilience, promote community-based and collaborative efforts, and address psychological factors at the individual and community levels (Jansen et al. 2015). Supportive interventions must clearly understand what the community finds significant in effectively addressing pain and promoting healing (Jansen et al. 2015; Nguyen et al. 2023; White et al. 2017).

Drawing on the conceptualization of a culturally responsive constructive processing approach for addressing trauma (Sewell and Cruise 2011), this study explored the individual and collective lived experiences of internally displaced people in Ethiopia, guided by the following research questions:

1. How do internally displaced individuals convey their perspectives on persistent loss and trauma stemming from forced displacement?

2. What are the collective traumas experienced by the internally displaced people in Ethiopia?

3. Which cultural and contextual factors are associated with healing trauma among internally displaced people in Ethiopia?

Methods

Research paradigm

This study employed a mixed methods approach combining Community-Based Participatory Action Research (CBPAR) and interpretative phenomenological research design to obtain in-depth and rich responses to our inquiry. Although these approaches originate from different paradigms, merging them provides a more comprehensive understanding of the experiences of a specific community. CBPAR emphasizes community empowerment, social change, and stakeholder involvement, while the phenomenological paradigm focuses on understanding lived experiences and their subjective meanings (Bush et al. 2019). Several studies have employed a combination of focus group data collection and interpretive phenomenology to enhance client-centered care (Jones et al. 2013). CBPAR entails gathering data from focus groups to understand the concerns of a specific group that shares traits or experiences, and community members participate in the project at various stages (Cyr 2019; Kieffer et al. 2013; Israel et al. 2013). An interpretive phenomenological approach enables researchers to acquire deeper experiential insights and reflections that are impossible in focus-group discussions. The combination of Phenomenology and CBPAR was a suitable approach for this study as it facilitated the emergence of collective knowledge from the group, leading to the discovery of a community perspective and collective understanding.

Setting

This study was conducted at one of the Internal Displaced People (IDP) Centers in Gondar City, Ethiopia. The center was established in 2020 to provide temporary shelter to individuals who were forced to leave their homes because of the War in Northern Ethiopia and those displaced by ethnic violence from the Oromia region. At the time of the study, the IDP center was inhabited by 2,850 individuals, including 1,138 adults, 450 children aged 0–5, and 1,237 youth aged 6–17, who were expected to reside there for at least two years.

The IDP Center is an appropriate location for obtaining information regarding contextual and cultural adaptation to trauma-informed mental health interventions from experts, the IDP community, IDP leaders, and governmental and non-governmental organizations, as it has been in operation for two years.

Recruitment and sample size

Trust is an essential component of CBPAR. Four research team members had volunteer experience in IDP centers and a good reputation in the IDP community. These research team members facilitated the relationship between the research team and the community. To present the research and its aims, the research team organized a town hall meeting, which comprised five university professors (one from the United States and four from the University of Gondar) and one clinician from a local university hospital. Attendees of the town hall meeting included representatives of the IDP center, community leaders, service providers, and other volunteers. Based on the discussion from the town hall meeting, forty-two individuals were selected purposefully, using lived experience and extensive knowledge of the culture and context of the IDP center as criteria.

The participants received a written information and informed consent agreements, which were also verbally explained to them prior to the commencement of the individual interviews and focus group discussions. Among the forty-two participants, 16 (7 men, 9 women) were internally displaced individuals, while the remaining were service providers (i.e., counselors, psychologists, sociologists, and psychiatrists), community leaders, and representatives from government and non-governmental organizations.

FGD and interview participation were determine using purposive sampling to ensure diverse representation of stakeholders, including IDP, community leaders, local government officials, and service providers. FGDs included 6–8 participants per group, selected to capture varied perspectives, while individual interviews focused on individuals with significant lived experiences or leadership roles. Two experienced research team members approached individuals who met the specified criteria and obtained their consent for participation in either a Focus Group Discussion (FGD) or an individual interview. Table 1 shows the comprehensive demographic characteristics of the selected informants.

Table 1.

Demographic characteristics of informants

	Frequency (%)	M(SD)[Range]
Participants age		44.7 (11.7) [25,71]
Gender
Female	25 (59.5)
Male	17 (40.5)
Higher Education
No Formal Education	4 (9.5)
Primary Education	6 (14)
Highschool and above	32 (76)
Marital Status
Single	19 (45)
Married	23 (55)
Type of Participants
• Helping professionals (Psychiatry nurses, social workers, psychologists, and counselors)	17 (40.5)
• Internal Displaced Individuals	16 (38)
• Community Leaders and aid workers	6 (14)
• Government officials	3 (7)
Length of stay in living the IDP Centers (N = 16)		2.5 (0.34 [ 2, 3]
Years of experience in working/volunteering in the IDP Center (N = 26)		1.6 (0.6) [1,3]

Data collection

Data were collected through in-depth interviews, semi-structured Focus Group Discussions (FGDs), and field observations in a local language (Amharic).

Focus group discussions

The FGDs were designed to gather community perspectives on loss, trauma, idioms, distress, and collective healing using the following guiding questions: Can you elucidate your thoughts on how the experience of forced displacement has affected your daily life? In what manner do you believe your life has changed most significantly since your displacement? How do you manage or address your feelings of trauma and distress over time? What common challenges have you and others encountered in your community as a result of displacement? What are the most significant sources of collective distress among displaced individuals in the area? Which events would you identify as having had the most profound impact on your community as a whole? What cultural practices, if any, have facilitated coping with the trauma of displacement? Are specific traditions, rituals, or communal practices essential to the healing process? How do you perceive the local context (e.g., social, economic, or political factors) influencing the way individuals heal from displacement-related trauma? What forms of support have been the most efficacious in assisting you or others in coping with trauma? The FGDs were moderated by posing follow-up context-dependent questions during group discussions.

Individual interview

The individual interviews posed questions regarding the participants’ lived experiences as internally displaced persons (IDPs) or individuals working with IDPs (for example, what have been the most challenging aspects of displacement for you personally? What is the most persistent source of distress after displacement? Can you identify any events that you believe have affected the IDP community more significantly than the others? What do you perceive as a lasting impact on your community due to displacement? Can you discuss any cultural practices that have assisted you personally in coping with the trauma of displacement?).

Furthermore, both focus group discussions (FGDs) and individual interviews included inquiries about the demographic factors associated with the current state of the IDP center, such as safety, basic needs, and background histories encompassing health, education, family situation, religion, spiritual practice, and resources. To ensure ethical and cultural appropriateness, individual interviews were conducted with a fluent Amharic-speaking interviewer with extensive experience conducting qualitative and clinical interviews. Four research team members facilitated the FGDs. Continuous monitoring of participants’ emotional states was performed during the interviews and focus group discussions, followed by debriefing sessions. The FGDs and interviews were translated into English by the researchers with the assistance of two language experts who aided in maintaining the meaning and quality of the translation and back-translation process.

In community-based participatory action research, the data collection process evolves into an intertwined spiral phase (Fig. 1). The data-collection process involved four distinct phases. In the initial stage, we engaged with stakeholders, held town hall meetings, introduced the research agenda, and designed focus group questions collaboratively with stakeholders, which took one week to complete. We conducted six focus group discussions with diverse stakeholders over four weeks during the second phase. In the third stage, we conducted nine individual interviews with IDP community leaders, IDPs, and professionals working with IDPs, which took two weeks. The final data collection phase involved identifying key themes from the data collected during the three phases. The research team reviewed and analyzed the transcription and field notes, first through immersion in data and hand coding. Then, the data were further organized using Excel. The identified themes were shared with the research participants for further discussion to verify, clarify, and share opinions about emerging issues. These were conducted over the final three weeks of the data collection period.

Fig. 1.

Data collection process

Data analysis

Thematic analysis, particularly template analysis, was used to identify key themes (Brooks et al. 2015). This approach is particularly well-suited to our study because of its flexibility and applicability to many types of worldviews and philosophical lenses. Template analysis emphasizes the creation of hierarchical coding while maintaining a balance between a high degree of structure in the process of analyzing textual data (Brooks et al. 2015; King and Brooks 2017). This hierarchical coding “template” distinguished template analysis from other forms of thematic analysis. Hierarchical coding allows researchers to build themes based on the most relevant data on a research question at different levels of specificity. This approach enables analysts to focus on crucial data, leading to more insightful and comprehensive research analysis. In this study, the aspect of a broader view of this analytical approach was specifically applicable, as we gained a community perspective and did not adopt a case-by-case approach.

We adhered to the procedural steps outlined in King’s (2012) template analysis. Codes were generated from the bottom up and refined through several revisions that reflected the significant changes ensuring cultural relevance and analytical rigor (see Table 2). We integrated interpretive phenomenological principles throughout the process rather than in one discrete step. This entailed multiple discussions between researchers, ongoing self-reflection, reciprocal movements between the data (i.e., the community’s experiences), and researchers’ perceptions and interpretive lenses based on their educational, cultural, and philosophical perspectives (interpretations) of the hermeneutic circle. Grondin (2015) describes this process as a circular and questioning movement that involves continuous examination and reexamination of the data and the researchers’ interpretation of the data. This process serves as a complementary approach to the Template Analysis. The hermeneutic circle is an ongoing process that aims to unlock the authentic meaning behind any experience and to gain a profound understanding of the experience of inquiry.

Table 2.

Template data analysis steps, process, and product

Steps	Process	Product
1. Immersion in the data
2. Organization of emerging theme	Initial template developed for coding /broad concept	Initial Template  • IDP Community  • Contextual factors  • Cultural factors
3. Define an initial coding template	Revised template	Revised Template  • Adversity in the IDP Community  • Demographic nature of the community  • Present moment situations  • Rituals
4. Re-analyzing transcripts for template/concept fit	Revised template with the combined concept	Combined and Revised Template  1. IDP Community   a. Adversity   b. Demographic characteristics  2. Contextual factors   a. System   b. Community   c. Individual   d. Risk factors  3. Cultural factors   a. Everyday rituals
5. Refine terms and definitions, finalize the template, and apply it to the complete data set	Revised templates with the elimination of the extraneous concept Re-naming of concepts to more reflective THEMES Final Themes developed	Revised Template Final form  1. IDP Community   a. Adversity/trauma narrative  2. Contextual factors   a. Current situation   b. Risk factors  3. Cultural factors  a. Everyday rituals  Themes and Subthemes  • The construct of Trauma  • Lived collective experience of Trauma   o The Loss of being   o The Loss of becoming   o The loss of belonging  • The culture and legacies of individual and collective healing   o Connection to ancestors, land, and history   o Connection to religious and spiritual practices   o Connection to Music, art, and everyday ceremonial practice

During the analysis process, we consistently centered our examination on our participants’ genuine experiences, aiming to comprehend the individual and collective implications of trauma and healing within internally displaced communities. To this end, we scrutinized the data and developed themes that correlated with the stakeholders. Subsequently, we revisited the transcripts to delve deeper into the themes and their connotations. We utilized our interpretive lens to guide our understanding of the overall essence and to interpret the significance of internally displaced persons’ trauma and healing experiences. To fortify the credibility of our analysis procedures, we cross-checked emergent themes among the researchers involved in the study. We conducted member checking by organizing a sense-making workshop with stakeholders, during which we presented our findings and invited their feedback and suggestions for any necessary modifications (see Table 2).

In qualitative research, understanding the background of researchers is critical as they serve as primary analytical instruments. The first and fifth authors were identified as mental health counselors with doctoral-level training and were immersed in the counseling profession in the United States. The first author was also recognized as a qualitative researcher with over a decade of experience in conducting and teaching qualitative research. The second author obtained his Ph.D. in Clinical Psychology in Europe and holds the position of Professor of Psychology in Ethiopia. The third, fourth, sixth, seventh and eighth authors specialize in the fields of clinical psychology, social work, and psychiatry, respectively. Six of the eight research team members were Ethiopians. The two of the eight authors are U.S. citizens, with one possessing extensive travel and work experience in Africa. Each of the authors demonstrated a strong commitment to culturally relevant approaches to mental health intervention and a dedication to providing quality mental health services to populations in need. The first and second authors served as methodological experts. Both research teams actively participated in the data collection, interpretation, and analysis. Five members of the research team, who are also residents of the city where the Internally Displaced Persons (IDP) camps are situated, possess prior knowledge of IDP transition. This expertise enabled them to collaborate closely with IDPs and other stakeholders to comprehend the nature and characteristics of idioms of distress and collective trauma from the participants’ subjective reality.

Ethics statement

Ethics approval for this study was obtained from the Ethical Review Board of College of Social Science and the Humanities, University of Gondar with Reference no. C/S/S/HRP 10,078/09/2015. This study was conducted in accordance with the National Research Ethics Review Guideline (5th ed.) of the Federal Democratic Republic of the Ethiopian Ministry of Science and Technology. Information pertaining to participant confidentiality, informed consent, and data access was included in the Participant Information and Consent Form. To ensure confidentiality, personal identifiers such as names were not recorded in the data collection tool; subsequently, the collected data were securely stored after the completion of data entry. No incentives were provided to participate in this study.

Results

A summary of the themes that emerged from the template analysis that depicted the construct of trauma, barriers to understanding trauma, collective narrative of loss, and the practice of collective healing are presented in Fig. 2.

Fig. 2.

Thematic connection of individual and collective trauma, barriers to awareness, and collective healing

The construct of trauma

The local community in IDP centers did not have a single equivalent word to describe trauma. However, trauma was described through somatic, emotional, and spiritual idioms, reflecting profound cultural significance. A 54-year-old internally displaced woman, for example, stated, “when your gut is twisted to its core,” and similarly, another 42-year-old internally displaced women say, “having a sense of doom in your belly.” The IDP who participated in the FGDs also used spiritual experiences, such as “wound to your soul,” “being cursed by Kefuken (evil days),” “losing your hope in God,” and emotional experiences, such as “emotional scar,” “living in a state of scarcity,” when they report their view of trauma. The IDP participants also used sentences that show the effect of trauma on their mental state and cognitive functioning, such as “never being back to yourself,” “when your innocence is taken away… you will never be the same,” and “living without seeing your future.“, and social and relational effect, such as “ beleb west lezelalm yemkemet mekera (the suffering that is stored in your heart forever),” “ the wound that separates you from your social world,” and “relational wound and community madness.”

The participants highlighted that trauma was experienced more than cognitively understood in the Ethiopian culture. The cultural norm of “toughening it and moving on” discouraged open expression of the effects of trauma.

Barriers to trauma awareness

Gaps in trauma awareness and the lack of understanding of its effects as barriers to treatment constitute another theme that emerged from the analysis of the professionals’ perspective, who observed the internally displaced people’s lived experience through their working or volunteering relationship. The level and type of emotional trauma caused by forced displacement appear to be insufficiently discussed openly despite being expressed through the residents’ everyday behavioral, emotional, cognitive, and relational functioning.

Although some professionals who participated in FGDs believe that the community has a good understanding of trauma, others argued that there is a lack of awareness. Focus group discussions showed that many community members were not knowledgeable about the impact of trauma on their mental health, relationships, and interactions. They also tend to downplay signs of posttraumatic stress and are hesitant to seek treatment. This was highlighted during a focus group discussion in which one a female psychologist participant in the professional group expressed this sentiment.

“I frequently visit IDP centers and often encounter individuals who have experienced a severe traumatic event and exhibit symptoms of PTSD. However, many are unaware of their condition and do not seek mental health support. During my visits, I engaged with these individuals and encouraged them to share their experiences and receive counseling support to help them cope with their trauma.”

A man who had been displaced internally and residing in the camp for over two years shared his observations related to a lack of acknowledgment of psychological wounds during an individual interview. He said,

“Spend 24 hours in this camp, and you will witness numerous people losing their grip on reality and battling sleeplessness. You will see many engaging in both verbal and physical alterations over trivial matters. People here are on the edge. Sometimes you do not know what flips their emotions in a split second. As we say, ‘hode yebasew newe yalew’ (everyone is emotionally drained and lacks the strength to endure another day), even though most of us don’t admit it, we have already lost our sanity since we arrived at this camp.”

Understanding collective lived experience of internal displaced individuals

Qualitative analysis revealed that the community in the IDP center is experiencing communal loss, in addition to significant losses (e.g., their homes, social and economic resources, stability, and familiar culture and relationships) they already experienced. The following section provides a comprehensive account of the communal loss stemming from forced displacement.

The loss of being

The IDP center community faces a severe violation of human rights due to chronic crises and systemic issues. The scarcity of vital resources, such as food, shelter, healthcare, and education, has been revealed through FGD with community representatives. The temporary shelters provided in the center failed to meet basic human rights standards, with each five-square-foot tent housing of four families, including children who cramped together. Insufficient aid offered by the government and humanitarian agencies adds to the misery, with each household receiving only 15 kg of flour and one liter of oil every three months. As a result, the community relies heavily on temporary and inconsistent support from local volunteers and non-profit organizations. Due to the absence of stability and sufficient support, numerous residents not only endured hunger, sickness, poor hygiene, overcrowding, and malnutrition but also experienced a loss of their sense of identity.

One of the residents who participated in the in-depth interview stated,’ The feeling of despair and desperation has enveloped me since I arrived here. I have lost my sanity. No suffering is compared with waking up in the morning and seeing your children’s hungry eyes. You have nothing to feed on. It is gut-wrenching; you do not know who will save you today, and you do not have any idea who you will be tomorrow. A year ago, I was a homeowner, a successful businesswoman with a happy marriage and three happy children. Today, I am lost; I do not have the privilege of mourning my husband’s death while having three hungry children who have just lost their father and everything and sleeping in broken tents with no food. The uncertainty of it is maddening, and it is taking a toll on my health.

The statement made by a 56-year-old internally displaced man during the individual interview indicated that losing their sense of identity and self-perception was a prevalent issue faced by IDPs. He said,’ I was a successful contractor who helped many people in my family and sent two of my children to college, but now, as you see me, I am very sick with no medical treatment because I cannot afford it. I am left with nothing. I never thought I would become such a helpless and hopeless person throughout my entire life. I was just a successful self-made contractor, well-respected in my community and well-to-do, but now it all becomes history.”

The loss of becoming

IDPs experience numerous setbacks, such as losing autonomy, job opportunities, and self-employment. Many adults in IDP centers can work, but they face obstacles in getting jobs and supporting their families because they are considered temporary residents and are not recognized by government officials, limiting their freedom to leave the center and seek employment opportunities. Many compounds also do not have identification cards, hindering access to essential community services such as banking and public healthcare. Consequently, residents have been living in uncertainty for the past two years, denied equal rights and privileges as other citizens. A 51-year-old displaced man in a focus group shared, “I do not have a Kebele Identification card. As a result, I could not seek employment or open bank accounts. This has made my situation more complex. I am chronically ill and require medication, which costs approximately 800.00 Birr. I reached out to an old friend in Addis Ababa and explained my situation to him. He was more willing to help me and even offered to transfer some money to me. Unfortunately, I cannot accept his help as I cannot access and utilize different services without proper identification.”

The loss of belongings

Several community members in the IDP center felt like outsiders in Gondar despite their Amhara ethnicity. Many members were assimilated into Tigray culture, speaking the local language and familiar with Tigray and Oromia customs. Upon relocation to Gondar, the children who spoke Tigrigna faced rejection. One of the counselors working at the IDP center reported his observation of their difficulties in finding a sense of belonging. He stated,’ Both the place where they constructed their residence (Tigray and Oromia), and this birthplace where they temporary shelter fails to accept them for who they are. They were displaced from their homes because of their ethnicity, and the local inhabitants in Gondar resisted and rejected them because they spoke Tigrigna or had married and had children with a Tigrayan background. I witness them expressing sentiments like ‘nowhere to go’ daily.”

One of the residents also shared a story to reflect the struggle they were dealing with belonging to the community. She stated,

“Recently, about six children from the IDP Center played soccer in the field using a homemade ball. Two children of similar age approached from a nearby house and were requested to join the game. Our children (those at the IDP Center) enthusiastically welcomed them. However, an adult woman suddenly ran towards these two children and loudly proclaimed, ‘You cannot play with these Kouralyo” (a name for reused materials). Observe how our children’s spirits were crushed and how they had ceased playing. I refrained from saying anything to this woman, but when I later shared the incident with one of my tent mates, she revealed that she had been called a ‘leftover’ on numerous occasions by the local residents.”

The culture and legacies of healing and resilience

The following three cultural themes were found to be vital to cultivating healing and passing legacies of resilience. These themes were built on the inherent potential and strengths of an individual, family, community, or culture.

Connection to ancestors, land, and history

Participants emphasized the importance of acknowledging and valuing unique culture and history as essential components in conveying legacies of resilience and healing. As one of the elderly individuals interviewed pointed out, “Our forefathers have a rich heritage of bravery, tenacity, and unwavering commitment to their moral principles, which they demonstrate through perseverance in the face of adversity. This is our story. We must simply remember to uphold these values during the challenging times we are currently facing.”

Another individual expressed a similar sentiment, stating,

“While our culture may not be particularly adept at addressing personal traumas such as rape, our ability to overcome significant challenges such as civil wars, feminine issues, and droughts while preserving our independence and avoiding colonization serves as a source of hope and determination for many of us to endure current hardships.”

Participants not only drew on the legacy of their ancestors and historical events to instill hope and promote healing from psychological wounds but also expressed a desire to mend their land. The statement of the oldest participant conveyed this theme: “You know, our land, Ethiopia, is a blessed one with favorable weather and 13 months of sunshine. Even though our land is also wounded like us, I remain hopeful that the land also carries God’s protection over us, keeping us safe.”

Connection to religious and spiritual practices

The people of Northern Ethiopia are deeply committed to their religious and spiritual practices, which played a significant role in shaping their worldviews. Their beliefs and practices inform them of how they perceive and cope with their emotional and physical pain. Additionally, their spiritual values influence their decision to seek help when faced with difficulties in life.

One of the participants who reported experiencing various emotional and mental challenges, such as low energy, nightmares, lack of sleep, and difficulty focusing, explained her view on the cause of her pain and healing as follows: “All of these mental messes that my children and I are dealing with are a punishment from God for the lack of purity in our lives. We are all sinful; only God’s mercy can cure us.” Regarding addressing their mental health issues, another participant stated,

”I traveled for four hours to a church with a holy water site, where I stayed for 14 days and bathed in holy water, drinking it daily, and praying frequently. This improved my health and made me feel better, but as soon as I returned to this IDP center, all my pain, back pain, migraines, and blurred vision came back.”

A substantial number of religious individuals tend to seek support from the church and religious leaders when dealing with mental health issues. This finding emphasizes the crucial role of faith-based institutions in addressing mental health concerns within their communities. Additionally, FGDs suggested that religious individuals may find it simpler to confide in their religious leaders, whom they perceive as empathetic and non-judgmental and who share similar cultural and spiritual beliefs. One participant stated, “Many individuals tend to visit hospitals for physical ailments; however when it comes to psychological issues, they prefer to seek spiritual guidance at churches rather than consulting mental health professionals or institutions. One helping professional expressed,

“I visited the IDP center to provide individual therapy…Listening to her [client] stories, I was struck by the severity of her adversity and wondered how she would heal from all the distortions. Before considering the techniques I could use to help her, she thanked God and said everything was now behind her, with valuable lessons about God’s presence in her life. She is now well and has moved past experiences”.

Connection to music, art, and everyday ceremonial practice

In essence, Ethiopian traditional music, art, rituals, and ceremonies function not only as a form of entertainment or cultural artifacts but also as a means of expression, a way to communicate their experiences and emotions, and a crucial component of their identity as people. One of the community leaders in the FGDs stated,’ We tend to focus more on the present moment and incorporate ceremonial practices into our lives, when we eat, drink, socialize, and even deal with grief. We have music and melody to express our emotions without relying solely on words.” Another participant in the in-depth interview said, “Our culture encourages the use of music and rituals to process both emotional pains, such as grief, and joy.”

Many individuals at IDP centers lack formal education and are unable to read or write. Despite this, they can express their political ideology and pain through music and performances. For example, a professional group member who participated in FGDs stated, “Take a look at ‘Mehaber.’ (religious social gatherings). This group has a ritual of singing, praying, chanting when the group gathers, or the coffee ceremony, which serves as a means for people to sit together and invent their problems to each other daily.”

Discussion

This study aimed to explore the lived experiences of trauma and healing among IDPs in Gondar City. Findings emphasize the cultural embeddedness of trauma, as well as the role of communal resilience in recovery.

Perceptions and lived experiences of trauma related to mass displacement are both subjective and collective. An important finding is the rich descriptions of trauma by IDPs, which are intricately connected to somatic, spiritual, and emotional experiences. Statements such as ‘ wound to soul’, “when your gut is twisted to its core” and “having a sense of doom in your belly” show the importance of connecting individuals to their body and spirit for healing. Also, detailed descriptions of trauma focused on social and relational implications within a community context, such as “ the wound that separates you from your social world” and “relational wound and community madness.” These experiences highlight the profound interconnectedness in collectivist cultures, which ultimately impacts the perception of trauma, as well as the necessary components of healing. The findings of this study related to the construct of trauma are in line with prior research conducted by Mate (2012) and Hirschberger (2018), which emphasizes trauma as a subjective experience that ought to be understood as a continuous process rather than as an event/s. None of the participants provided specific details about the incidents that occurred during their experiences of trauma. Instead, they focused on the reactions that arose in response to traumatic events. A theme related to the understanding of trauma that emerged from the analysis was the lack of community awareness regarding the impact of trauma on mental health. The tendency to minimize signs of post-traumatic stress and hesitation to seek treatment within the community was observed by both professional practitioners and some internally displaced individuals. This highlights the need to cultural consideration regarding the applicability of the DSM-V criteria for trauma and PTSD in this community. While the DSM-V provides a standardized framework for trauma diagnosis, its applicability in collectivist culture is limited. This study supports calls for culturally adapted diagnostic criteria (Patel and Hall 2021).

Cultural factors, such as stigma or differing perspectives on mental health, may influence individuals to interpret or respond to trauma in ways that do not align with DSM-V classifications. As indicated by Patel and Hall (2021), it is essential to examine the cultural relevance or limitations of the DSM-V criteria in diagnosing PTSD and explore approaches that complement traditional trauma assessments to capture the lived experiences of this population.

Another central theme is the identification of the ongoing collective trauma experienced by the IDP, including the loss of being, becoming, and belonging. These collective and continual losses illustrate the complex levels of grief and loss related to personal objects and treasures, identity, relationships, safety, and opportunities to build a future. This theme has also been reflected in previous phenomenological studies on similar populations (Wondie et al. 2023).

The findings of this study also indicate that trauma is a substantial factor that influences the experiences of both individuals and communities and that comprehending collective trauma is essential for identifying the appropriate path toward collective healing. These results are consistent with studies that explore the experiences of displaced individuals, refugees, and trauma (Morina et al. 2018; Neace, Thaier, & Nasier, 2020: Zeleke et al. 2015). The solution to a problem is frequently discovered at the site of the problem. It is essential not only to comprehend the nature and extent of the adversity endured by individuals and communities in an IDP center but also to grasp the significance that the community attaches to their experiences, as well as the context and culture that shape their interpretation of these experiences. This finding indicates that the path to health development, restoration, and lifelong well-being is culturally grounded. The pathway to healing both individual and collective trauma for IDPs is long and complex, and the use of community values and practices is essential. In collective cultures such as Ethiopia and mass and community-based experiences such as internally forced displacement, both trauma and healing are experienced collectively. This suggests the need to reconsider the current approach to addressing trauma: a more holistic approach incorporating culture, spirituality, civic action, and collective healing is necessary (Alvarez and Farinde-Wu 2022; Carello and Butler 2015).

Ethiopian culture attaches excellent significance to ceremonial practices, which are performed on various occasions such as weddings, funerals, and religious holidays. These rituals bring people together to celebrate their joy and mourn their sorrows. The music played during them is often deeply emotional, reflecting not only people’s pain and suffering but also their resilience and strength. The lyrics are poetic and moving, conveying a sense of hope and optimism regarding the future. A notable example is found in the lyrics of a song frequently performed in the center, which states, “be makara Tsina be fatana tsina lagizew naw engji hulum yalfalina,” translating to “Every adversity too shall pass; persevere through it.” These musical compositions provide community members with an optimistic perspective of their future. Ethiopian folktales are critical elements of their storytelling customs, which have been passed down through generations. Often accompanied by music and dance, these narratives enable individuals to recount their experiences of subjugating the past (validation of trauma) and their aspirations for the future (installation of hope).

Implications for Practice: Culturally grounded interventions should integrate community mobilization, ancestral connections, and religious practices to foster resilience. The findings align with the IASC Guidelines on Mental Health and Psychosocial Support in Emergency Settings (IASC, 2007), emphasizing the importance of community-based approaches. Future research should focus on developing resilience-oriented interventions and examining collective healing mechanisms in displaced populations.

The theoretical framework of “Ubuntu,” which posits that humanity is derived from interdependence, cooperative action, and altruistic services to others, may offer a valuable perspective for addressing collective healing from trauma (Alexander et al. 2004). It is possible to facilitate healing and restore one’s sense of identity by understanding and addressing the causes of the trauma. Given that trauma represents a distortion of identity, it is crucial to incorporate culturally grounded healing practices that re-establish a collective sense of self. Drawing on cultural and identity-based resources may provide a viable pathway for promoting community well-being and fostering resilience. It is essential to employ a trauma-informed approach that enables us to pose pertinent questions, such as “What happened to you?” instead of “What is wrong with you?” we must also incorporate an additional step to pose inquiries like “What was right with you?” to reach the healing zone (Abrutyn 2023; Hirschberger 2018).

Contribution, limitation, and implication for future research

To the best of our knowledge, this study is the first to investigate the collective experience of trauma and healing among forced-displaced people using participatory community-based action research and an interpretive phenomenological design. This study relied on data gathered from key participant interviews and focus group discussions (FGDs). However, the validity of the study may be compromised if respondents provide only a biased and one-sided perspective on community issues. To address this risk, the triangulation of data from a diverse group of informants, including internally displaced persons, professionals working with IDPs, government and non-government officials, community leaders, and IDP center officials, was prioritized. This approach was implemented to minimize errors and biases using a single data source. Multiple sources were employed to ensure the validity and reliability of the collected data, including written documents, interviews, focus group discussions, and field observations.

Future research should focus on creating culturally responsive mental health interventions for mental health providers to serve IDPs from collectivist cultures effectively. Furthermore, future investigations should concentrate not only on addressing trauma and treating trauma symptoms, but also on understanding the processes of healing, both individually and collectively. It is crucial to examine how communities that have experienced trauma can restore their well-being through connections and collective resilience. The manner in which a contract between collective trauma and healing is perceived is of utmost importance. Trauma and well-being must be viewed as two sides of a coin, determined by the environment in which the community resides, operates, and engages in leisure activities. Future research should identify the components necessary to restore community well-being and to promote healing.

Conclusion

Because of a disproportionally high number of internally displaced individuals due to conflict, famine, and other reasons, Ethiopia has constructed several centers that temporarily accommodate individuals who have been forcibly displaced from their homes. However, internally displaced people are subjected to many stressors, including poverty, mass and community trauma, individual trauma and the collapse of social support networks, which can result in mental distress, impaired interpersonal relationships, diminished coping abilities, and poor psychosocial well-being. Through in-depth interviews and focus group discussions with various stakeholders, this study illuminates the stories of internally displaced people in Ethiopia by connecting the individual and collective experiences related to trauma and healing. Several themes emerged, including a collective definition of trauma, collective lived experiences, and collective connection to culture and legacies of healing and resilience. Through these themes, the lived experiences of internally displaced people were highlighted to show a profound sense of loss, as well as a connection to the community and culture necessary for healing. The results of this study can be used to adapt or develop a culturally responsive trauma-informed program to address the mental health and healing of internally displaced people to promote the healing and reclamation of well-being.

Abbreviations

CBAR.

Community based action research

FGD

Focus group discussions

IDP

Internally displaced people

PTSD

Post trauma stress disorder

IDMC

Internal displacement monitoring center

UNHCR

United nations higher commissioner for refugees

IOM

International organization of migration

TPLF

Tigray people liberation front

NCTSN

National child traumatic stress network

Author contributions

The overall research process was designed by W.A.Z. and contributed by Y.W., W.A.Z., and T.H., who contributed to the review. T.H., M.D., G.N., B.T.E., and M.M.M. contributed to the implementation of the research; Y.W., M.D., T.H., M.M.M., and W.A.Z. contributed to the data collection and analysis of the results; W.A.Z. and C.H. contributed to the writing of the manuscript. W.A.Z. conceived and supervised the project. All authors have read and agreed to the published version of the manuscript.

Funding

This research received no external funding.

Data availability

The data the support the findings of this study are available on request from the corresponding author. The data are not publicly available due to the privacy or ethical restriction.

Declarations

Human ethical approval

Ethics approval for this study was obtained from the Human Research Ethics Committee of University of Gondar and the Ethical Committee of the College of Social Sciences and Humanities with Reference no. C/S/S/HRP 10078/09/2015 on 12 May 2023. This study was conducted in accordance with the National Research Ethics Review Guidelines (5th Ed.) of the Federal Democratic Republic of the Ethiopian Ministry of Science and Technology.

Informed consent

Information pertaining to participant confidentiality, informed consent, and data access was included in the Participant Information and Consent Form. To ensure confidentiality, personal identifiers, such as names, were not recorded in the data collection tool; subsequently, the collected data were securely stored after the completion of data entry. No incentives were provided to participate in this study.

Competing interests

The authors declare no competing interests.