Few would argue that war and conflict do not affect those involved, either at the time or afterwards. The useful question to consider is: what are their psychological effects and what are the most appropriate paradigms and descriptors to use for these effects that will be both meaningful and useful to survivors wherever they may be living?

People affected by war and conflict often face a whole series of challenges. In addition to dangers to life and limb, there may be loss of family members, loss of financial security and personal safety, loss of property and of livelihood; there may also be existential losses such as hopes and plans for the future. That war can cause psychological distress appears incontrovertible, but whether this is best described within a narrowly individualistic, medicalised psychiatric framework and symbolised by a diagnosis of post-traumatic stress disorder (PTSD), or within a wider framework that accounts for practical and human loss and distress at the individual and community level is contested in the literature (for a full review of this debate see Bracken & Petty, 1998; Summerfield, 1999; Yule, 1999; Rousseau & Measham, 2007).

Concepts of trauma and traumatisation are, of course, broader than just PTSD but this term has been widely and sometimes uncritically used in relation to war and conflict. The word trauma has been used to explain both an event such as war and a reaction to it, perhaps erroneously linking cause and effect in a rather less complicated way than is found in reality. So the language and descriptors have not always been as accurate as they might be, perhaps adding to confusion about ways of working with individuals or communities after the event and sometimes leading to an over-medicalised discourse. Some believe that war and conflict can traumatise entire communities, whereas others believe that very few people actually develop symptoms that would lead to a diagnosis of PTSD (Summerfield, 1999). Bracken (1998) and Summerfield (1999) have noted the difficulties associated with the concept of PTSD, which include the unquestioning use of a Western world view and the imposition of this in what might be viewed as a patronising manner. In addition, ‘PTSD’ may describe what is actually a normal human response to abnormal events, promoting a label of individual pathology.