news focus: Sectarian violence in Northern Ireland has left health services with further strain on increasingly tight budgets. Jonathan Traynor reports on the legacy of confrontation

Published: 06/12/2001, Volume III, No. 5784 Page 16 17

Images of schoolchildren attacked by blast bombs and verbally abused in north Belfast on their way to school flashed across television screens for months, as a territorial dispute engulfed the youngsters of Holy Cross Primary School.

With last week's announcement of an end to the Loyalist protest, the images have faded from our screens. But in their wake, local health and social services are piecing together the physical and mental health of a community torn by strife at a time when the service is facing another cash crisis.

In the heart of the nationalist Ardoyne area, one GP reports that young children are being prescribed anti-depressants.

The scars of 30 years of violence remain fresh despite ceasefires and tentative IRA decommissioning.

The 'Troubles' were largely concentrated in Belfast, with over 40 per cent of deaths resulting from political violence. Of that 40 per cent, just over 75 per cent of deaths of local residents were in the north and west of the city. North and West Belfast health and social services trust, which has a day centre just yards from the scenes of the Holy Cross dispute, now needs additional money to cope with the aftermath of the protest.

Last week, the trust published a needs assessment, Caring through the Troubles: health and social services in North and West Belfast, which examines the impact of the Troubles on delivering health and social services in the area, and potential extra costs.

Trust chair Pat McCartan says there is an urgent need for increased funding to 'begin the social reconstruction of those communities most affected by the Troubles'.

The study looks at the difficulties and pressures trust staff experience working in the area. It shows how staff deal with clients traumatised by the conflict, while also living in an environment dominated by sectarian division.

Dr Mike Tan, a GP working in the Ardoyne area, says his practice had changed from a family-oriented service to delivering an acute medical service. His workload has doubled since the Holy Cross dispute broke out.

Dr Tan reports that his surgery has seen children suffering from bed-wetting, nightmares, flashbacks, loss of appetite and increasing behavioural problems.

Children aged four and five have been prescribed anti-depressants or sedatives.

'Some of the children were given limited courses of medication to help them sleep, but then stopped because we do not want them becoming dependent. We tell the parents that they must go to counselling. There is a counselling service here in Ardoyne, but it is fully booked. So they come back to us for more medication. '

The fallout from the Troubles is not confined to Belfastl. In the north east of the province, one of the advisory panels working to cope in the post-ceasefire environment is struggling to meet the needs of victims, particularly those suffering as a result of sectarian intimidation.

The northern area trauma advisory panel, chaired by Northern health and social services board director of social services Mary Wilmont is pleading for more cash. It is developing ways to address the needs of victims by developing training programmes for staff, improving the availability of information and by undertaking needs assessment research.

Among the findings, which looked at the needs of families made homeless as a result of sectarian intimidation, was that families were affected in several ways.

These included cross-community intimidation, intimidation within their own community and intimidation against security forces' families as a result of the Drumcree dispute over Orange Order march routes.

While media attention has been focused in Belfast, more families were made homeless in the Northern board area in the preceding two years with incidents of petrol and pipe bombing and other forms of serious intimidation occurring on a weekly, and sometimes nightly, basis.

The psychological impact was described in the report as very serious and with potential longterm adverse effects, particularly for children. Many adults affected by these events abuse alcohol or prescribed drugs as a result, and others reported the use of psychiatric medication or sought the assistance of mental health services, according to the report.

Mrs Wilmont says: 'We need to be alert to the unmet needs of the victims of the Troubles over the last 30 years and also aware that despite the paramilitary ceasefires, there are new victims being created as a result of ongoing community conflict in towns and villages across the board's area.

'I urgently need resources which will enable us to provide a better response in the future. '

The recommendations from this report and the North and West Belfast study are now under discussion with their respective health boards.

But as Northern Ireland health minister Bairbre de Brun recently admitted that she asked for a£128m increase for the 2002- 03 budgets and got less than a£40m increase, reports and recommendations may end up gathering dust while the victims piece together their lives.