Innovations for Poverty Action Sierra Leone field coordinator Anthony Mansaray is speaking on October 30, 2011 with a group in Sierra Leone about the community reconciliation ceremonies run by Fambul Tok to help bring communities back together decades after the civil war. Photo: Jeffrey Steinberg)

Twenty-five years ago, Sierra Leone plunged into a decade-long brutal civil war, made famous by the chilling practice of mass amputations of hands, arms and legs and the film “Blood Diamond.” How does a country recover from a war in which neighbor turned on neighbor, 50,000 people were killed and more than half the population had to flee their homes?

Sierra Leone is not unique. Roughly a quarter of the world’s nations were in a civil war when the Sierra Leone conflict started. The question of how to rebuild — not just buildings but also communities and individuals — affects millions of people worldwide.

What’s the best way to help communities recover from civil war?

New research by Jacobus Cilliers, Oeindrila Dube and Bilal Siddiqi, released today in Science, evaluates community-based reconciliation efforts in Sierra Leone. Using a randomized controlled trial, the authors found that a relatively cheap and short reconciliation program, which brings communities together to discuss the war and enable perpetrators to ask forgiveness, can help rebuild community ties and social capital.

That’s the good news. The bad news is that individuals feel more anxious and depressed, presumably from recalling and reliving that trauma. Both results hold up two years after the program.

Here’s why this matters. Recovery efforts in Sierra Leone, as elsewhere, have focused on rebuilding physically. Sierra Leoneans rebuilt schools and clinics, repaired roads and relaunched large-scale mining operations. The economy’s output doubled in the 10 years following the war. Multiparty democracy was successfully restored both at the national and local level. And in 2007, the incumbent peacefully transferred power to the main opposition party.

But much less has been done to help repair the trust that helps a community function, or to relieve the psychological burden of those who suffered and those who committed atrocities. And that’s important.

Local communities urgently need to work together – but national truth and reconciliation efforts don’t reach them

Sierra Leone’s war was not ethnic but an uprising of the powerless against the powerful. Young men in particular turned against their own traditional tribal leaders who locally allocate land, dispense justice, collect taxes and organize the community to provide amenities from bridge repair to payment of teachers.

In a poor country like Sierra Leone, the national government doesn’t deliver many services – so communities have to work together. Where there are no banks, community members provide each other with credit and insurance. When government teachers rarely show up, communities join together to pay an educated member of the village to teach their children. When resentments continue, however, cooperating can be hard.

Countries from South Africa to Chile have tried to put conflict behind them with truth and reconciliation commissions. The commission convenes public proceedings, where victims tell their stories, attrocities are documented and fighters ask one another for forgiveness. These are hard to evaluate for efficacy: We will never know whether or how a particular country would have prospered without such a commission. What’s more, many work only at the national level, not community by community.

That was the problem with Sierra Leone’s commission: Only a fraction of those involved in the war could give evidence or attend sessions. People in rural areas had a hard time following the proceedings, since they didn’t have televisions or newspapers: Many households could not even afford a radio.

A group in Sierra Leone tried out local reconciliation ceremonies

Starting in 2008, a Sierra Leonean organization (Fambul Tok, or “family talk” in Krio) started to bring local truth and reconciliation efforts to communities throughout Sierra Leone. For three days, trained facilitators would work with members of a cluster of roughly 10 villages (called a section) to document war experiences. This included a two-day ceremonial bonfire, where victims would tell their stories and perpetrators would ask for forgiveness. On average, about 350 people attended each bonfire ceremony.

One such bonfire story is that of Sahr and Nyumah, childhood friends separated by war. During the war, Nyumah says, he was taken by the rebels. After he repeatedly refused to kill his own father, rebels forced him to choose between being killed or beating his friend Sahr so savagely that Sahr’s body is permanently misshapen. Nyumah was then forced to kill Sahr’s father. Now grown, Sahr and Nyumah live only one mile apart but have not spoken of that day since. At the bonfire, Nyumah recounted his story and bowed low to Sahr, asking for forgiveness, which Sahr gave. Fambul Tok reports that the two have rekindled their friendship. Nyumah often visits Sahr and helps him with farm work.

Community cooperation improved measurably

Fambul Tok could not afford to go to every community. From a list of 100 suitable sections, it randomly selected 50 in which to work. Researchers Cilliers, Dube and Siddiqi, working with the research NGO Innovations for Poverty Action, then compared outcomes in communities that took part in reconciliation ceremonies and those that did not.

The researchers looked for practical and locally relevant measures of how well the community was working together, such as how much people voluntarily contributed to such local amenities as road repair, community teachers and women’s groups. They also asked individuals questions about their mental health. These questions were asked nine months after the reconciliation ceremonies were completed and (in a random subset of communities) again 31 months afterwards.

The results are striking. In communities that hosted the reconciliation ceremonies, 30 percent more respondents report forgiveness for the combatants.

That is borne out in everyday actions. For instance, respondents reported a small but significantly larger number of people they could turn to for help and advice. They contributed more time and effort to their community: 11.9 percent attended parent teacher association (PTA) meetings (compared to 8.2 percent in the control group) and more contributed money to the PTA (8.8 percent vs 6.6 percent).

These results sharply contrast with results from other popular postwar efforts, like Community Driven Reconstruction (CDR). CDR efforts attempt to rebuild physical infrastructure and repair community relations at the same time. Donor agencies or national governments offer communities flexible rebuilding grants, on the condition that they make decisions about how to use it in a way that brings the community together and takes into account the views of women, youth, and minorities.

Rigorous randomized evaluations of these programs, including one I conducted in Sierra Leone, find that the CDR approach improves physical infrastructure — but doesn’t measurably improve community cooperation, trust, or involvement.

But there’s some bad news about the reconciliation ceremonies — and about war trauma

Telling stories from the war and thereby reliving the trauma seems to have hurt participants’ mental health. Individuals in communities that participated in the reconciliation process report higher levels of depression and anxiety. More of them have symptoms of post-traumatic stress both nine months and two years later.

So what is the right way to respond to the enormous mental health consequences of civil war? Can retelling traumatic experiences, meant to ease the psychological burden, actually reinforce the trauma? In communities where there will be no intensive, high-quality mental health support, is it better to let people forget?

Unfortunately, social scientists know very little about how to address war trauma at large scale in poor countries. Few programs have been tried and even fewer evaluated. In an accompanying article in Science, Katherine Casey and I note that in 2009, out of Sierra Leone’s population of 5.5 million, only 2,000 people were treated for mental disorders.

As Sierra Leone’s civil war ended, the entire country held only one psychiatrist and two trained psychiatric nurses.

What is to be done?

Rebuilding nations after war must attend to the repair not just of physical infrastructure but also of communities and individuals. We need innovative ways to help when thousands of people have experienced extraordinary levels of trauma.

Rachel Glennerster is executive director of the Abdul Latif Jameel Poverty Action Lab at the Massachusetts Institute of Technology and academic lead for Sierra Leone for the International Growth Center. She has been conducting research in Sierra Leone since 2004 and tweets @RunningREs.