Post-conflict Timor-Leste Research Articles

Violence and hegemonic masculinities in Timor-Leste – on the challenges of using theoretical frameworks in conflict-affected societies

ABSTRACT Research on men, masculinities, and of men’s violences has multiplied recently, as have violence-prevention initiatives, especially in conflict-affected societies. Drawing on my experiences of working on violence prevention as well as of conducting research with men in violence-prone groups in post-conflict Timor-Leste, I reflect on the practical and conceptual challenges of this work. Key concepts from Critical Studies of Men and Masculinities (CSMM) were helpful in part but were challenged by the lived realities and narratives of the men I interviewed. Common conflations of violence and hegemonic masculinity proved less-than straightforward. Perhaps inevitably, this work carried with it an element of epistemic violence, of outside concepts being imposed by a privileged me upon my research subjects through my interpretation of their lives. Given how central engaging with ‘violent masculinities’ should be to gender-transformative peacebuilding, these challenges speak to broader questions of the possibilities of social change and ethical questions involved.

Guns, gender and petroleum: a critical analysis of the underlying dynamics of Timor-Leste’s development trajectory

This article examines the underlying political economy context of the uneven development outcomes in post-conflict Timor-Leste. We use a modified version of a structural political economy approach that is situated in a Gramscian understanding of the state-society relationship. This approach conceptualises development as a process of historically specific class-based and gender-based contestations over the distribution of resources that result in particular forms of socio-political orders maintained through a combination of institutional and ideological mechanisms of wealth generation. Our analysis of whose interests have been prioritised and marginalised in post-independence Timor-Leste is based on a systematic examination of three major factors: regulation of class relations, organisation of gender relations, and the governance of the petroleum industry. We conclude that despite some important improvements in the formation of formal democratic institutions in Timor-Leste, the processes of the distribution of power and access to resources remain far from being inclusive prioritising a class-based group of male-dominant elites that manipulates institutions to advance their interests and use a hegemonic gender ideology to justify and maintain these existing unequal arrangements in the prevailing socio-political order. Thus, the development outcomes in Timor-Leste are strongly connected to the political-economic processes from a larger historical perspective.

Measuring and improving the image of a post-conflict nation: The impact of destination branding

Abstract It is essential for destinations to understand and manage the perceptions that affect their image. There is, however, no widely accepted theoretical framework for measuring destination image. The approach proposed in this paper uses the same group of respondents to measure organic and induced destination image. It is tested using the case study of post-conflict Timor-Leste. A qualitative survey of a sample of Australian ‘non-visitors’ is used to measure Timor-Leste's ‘organic’ image. After exposure to a mock destination brand, the survey respondents are reassessed to ascertain ‘induced’ image. Findings suggest that it is possible to significantly improve a destination's image through branding, even in the case of a nation suffering from a long-term negative perception. This paper advances theory on destination image measurement by proposing a methodology for testing the organic and induced images of a destination and by analysing the impact of branding in improving the image of a destination.

Frontier finance: the role of microfinance in debt and violence in post-conflict Timor-Leste

Microfinance programs targeting poor women are considered a ‘prudent’ first step for international financial institutions seeking to rebuild post conflict economies. IFIs continue to visibly support microfinance despite evidence and growing consensus that microfinance neither reduces poverty nor breaks the cycle of domestic violence. In the case of Timor-Leste, a feminist political economy approach reveals how microfinance engendered debt allows for the control, extraction, and accumulation of profits and resources by an elite class and exacerbates gender-based violence. Timorese elite classes have benefitted from microfinance during the Indonesian occupation and in today’s post-conflict regime. Extractive debt relations between elite classes and ordinary citizens are enabled by a gender order that is regulated by brideprice and characterized by gendered circuits of violence. Brideprice weds the exchange of women to the class system in which the (violent) control of women is paramount to retaining political power. Microfinance adds liquidity and high interest rates to the debt relations of brideprice helping to create the very conditions for poor women’s disempowerment in a fragile state. Thus, the success of microfinance is predicated on systems of gender inequality and gendered circuits of violence, debt, and the exchange of women.

The politics of ownership in policymaking: lessons from healthcare delivery in post-conflict Timor-Leste

This article examines the political economy of national ownership, focusing on the reconstruction of the healthcare system in post-conflict Timor-Leste in relation to the shift from aid dependence to oil dependence. Considering three main approaches to development policymaking, it argues that, from 2002, the government generally used patronage-based strategies that benefitted elite political networks, increasing corruption. Based on empirical research, the study demonstrates that, in several areas, the government of the Revolutionary Front for an Independent East Timor (2002–2007) could exercise some autonomous decision-making despite being heavily aid dependent. Later, under the National Congress for Timorese Reconstruction government (2007–2017), empowered by oil resources, elites had greater control over development. However, the creation of a ‘modern’ healthcare system was central to the elites’ political ideology, involving populist rather than patronage-based politics. Analysis of this research indicates that ownership regarding healthcare has become concentrated among powerful groups, while health professionals, who advocate a neoliberal approach, lack a political voice. Thus, the paper problematises the Paris Declaration’s focus on country ownership to ensure better aid delivery as unrealistic because ‘ownership’ becomes subject to contestation.

Longitudinal path analysis of depressive symptoms and functioning among women of child-rearing age in postconflict Timor-Leste

This longitudinal study indicates that exposure to the traumas of mass conflict and subsequent depressive symptoms play an important role in pathways leading to functional impairment in the postconflict period...

Spirit Ecologies and Customary Governance in Post-conflict Timor-Leste

Abstract In post-conflict Timor-Leste, the concepts of spirit ecologies and intergenerational wellbeing direct our attention to the ways in which Timorese people derive strength from house-based family networks as well as protective and productive spiritual relations with living nature. These practices of exchange resonate with a comparative body of research that has described similar ‘spiritscapes’ elsewhere in Southeast Asia and their relevance for social and environmental governance. Exploring the diverse ontologies of particular Timorese ‘spirit ecologies’ and their embedding in a concept of more-than-human ‘intergenerational wellbeing’, in this article we investigate the renewed significance of these ‘house-based’ practices for social and environmental governance in Timor-Leste. We argue that despite the challenges, multiple engagements of mutually appropriated, transgenerational debt obligations and ritually regulated forms of resource governance are emerging as cultural, and increasingly state-sanctioned, strategies aimed at rebuilding the social and environmental commons.

Building a national eye-care service in post-conflict Timor-Leste.

ProblemViolent conflict left Timor-Leste with a dismantled health-care workforce and infrastructure after 2001. The absence of existing health and tertiary education sectors compounded the challenges of instituting a national eye-care system.ApproachFrom 2001, the East Timor Eye Program coordinated donations and initially provided eye care through visiting teams. From 2005, the programme reoriented to undertake concerted workforce and infrastructure development. In 2008 full-time surgical services started in a purpose-built facility in the capital city. In 2014 we developed a clinical training pipeline for local medical graduates to become ophthalmic surgeons, comprising a local postgraduate diploma, with donor funding supporting master’s degree studies abroad.Local settingIn the population of 1.26 million, an estimated 35 300 Timorese are blind and an additional 123 500 have moderate to severe visual impairment, overwhelmingly due to cataract and uncorrected refractive error.Relevant changesBy April 2018, six Timorese doctors had completed the domestic postgraduate diploma, three of whom had enrolled in master’s degree programmes. Currently, one consultant ophthalmologist, seven ophthalmic registrars, two optometrists, three refractionists and four nursing staff form a tertiary resident ophthalmic workforce, supported by an international advisor ophthalmologist and secondary eye-care workers. A recorded 12 282 ophthalmic operations and 117 590 consultations have been completed since 2001.Lessons learntInternational organizations played a pivotal role in supporting the Timorese eye health system, in an initially vulnerable setting. We highlight how transition to domestic funding can be achieved through the creation of a domestic training pipeline and integration with national institutions.

The promise and peril of paralegal aid

Strengthening the rule of law and promoting access to justice in developing countries have been longstanding international policy objectives. However, the standard policy tools, such as technical assistance and material aid, are routinely criticized for failing to achieve their objectives. The rare exception is paralegal aid, which is almost universally lauded by policymakers and scholars as effective in promoting the rule of law and access to justice. This belief, however, rests on a very limited empirical foundation regarding what paralegal programs accomplish and under what theory they operate. This paper critically examines the conventional wisdom surrounding paralegal initiatives through case studies of two successful paralegal programs in post-conflict Timor-Leste that are broadly representative of the type of initiatives commonly implemented in developing countries. These programs did improve access to justice services, bolster choice between dispute resolution forums, and increase local knowledge of progressive norms on human rights and women’s rights. Yet, as this article shows, even successful programs can expect to achieve only incremental gains in promoting the rule of law because advances largely depend on alignment with the priorities of powerful state and non-state actors, donors, program implementers, and paralegals themselves. To date, the literature has not acknowledged these limitations. This article addresses this gap by demonstrating that paralegal aid faces multiple challenges that mean paralegals cannot necessarily transcend or modify deep seated norms and power structures. These issues include principal agent-problems due to the extensive delegation required, internal limitations resulting from paralegals’ limited authority and independence, and external constraints from state and non-state justice actors. Paralegal programs also face program design, implementation, and sustainability challenges. Consequently, scholars, practitioners, and policymakers need to adopt a more balanced view of paralegal aid.

A wait-list controlled study of a trauma-focused cognitive behavioral treatment for intermittent explosive disorder in Timor-Leste.

We tested a trauma-focused, cognitive-behavior therapy treatment (TF-CBT-anger) for intermittent explosive disorder (IED) and related dimensions of anger adapted to the local culture in postconflict Timor-Leste. The intention-to-treat sample (n = 78) comprised Timorese nationals (women = 49; men = 29), ages 18 years and older, meeting Diagnostic and Statistical Manual of Mental Disorders (4th ed.) criteria for IED, with equal numbers (n = 39 each) being randomized to the treatment group (TG) and wait-list (WL). Assessments were made at 1 week prior to therapy, immediately at posttreatment, and at 1 month follow-up. Primary measures included an IED diagnosis made according to the East Timor explosive anger measure and the directionality of expression and control of anger assessed by 4 dimensions of the State-Trait Anger Expression Inventory (STAXI-2). Secondary measures included psychological distress assessed using the Kessler scale and an index of posttraumatic stress disorder (PTSD) assessed using the Harvard Trauma Questionnaire. In the TG, there was a decline in IED from 100% to zero at follow-up. In the WL, more than 70% (of the 100% at baseline) showed persisting IED at second and third assessments. The TG alone showed significant (p < .05) improvements on all STAXI-2 scales, the effect sizes for the intervention being uniformly large (>0.80). Psychological distress and PTSD showed substantial reductions in the TG but not the WL group. Although based on a modest-sized sample, our findings provide the first evidence in support of the efficacy of TF-CBT-anger for IED in a culturally diverse, postconflict setting. (PsycINFO Database Record

The Role of Trauma-Related Injustice in Pathways to Posttraumatic Stress Symptoms Among Conjugal Couples: A Multilevel, Dyadic Analysis in Postconflict Timor-Leste

It is widely acknowledged that the survivor’s psychological response to the traumas of mass conflict can affect adversely other family members. Yet, the focus of past epidemiological studies in the field has been confined to the individual survivor’s posttraumatic stress symptom (PTSS) response. We report the first study of its kind in a postconflict country, in which we examine the effects of trauma exposure in one member of conjugal couples on the PTSS of the other. The study involved 677 conjugal couples drawn from a community survey ( n = 1,354) in postconflict Timor-Leste. We used culturally adapted and psychometrically tested measures of traumatic events (TEs), preoccupations with injustice, explosive anger, family conflict, and PTSS. A multilevel actor–partner interdependence model (ML-APIM) demonstrated individual pathways involving exposure to murder and atrocities, preoccupations with injustice, explosive anger, and family conflict, leading to PTSS in both men and women when examined separately, with minor variations in paths by gender. Preoccupations with injustice in male survivors contributed to PTSS in the female partner, but not vice versa. Women may have a gender-specific propensity to identify with the male partner’s preoccupations with injustice following exposure to murder and atrocities. Our findings offer novel clues to the possible factors contributing to the higher rates of PTSS among women.

The factor structures and correlates of PTSD in post-conflict Timor-Leste: an analysis of the Harvard Trauma Questionnaire

BackgroundPost-traumatic stress disorder (PTSD) is the most widely assessed form of mental distress in cross-cultural studies conducted amongst populations exposed to mass conflict and displacement. Nevertheless, there have been longstanding concerns about the universality of PTSD as a diagnostic category when applied across cultures. One approach to examining this question is to assess whether the same factor structure can be identified in culturally diverse populations as has been described in populations of western societies. We examine this issue based on an analysis of the Harvard Trauma Questionnaire (HTQ) completed by a large community sample in conflict-affected Timor-Leste.MethodCulturally adapted measures were applied to assess exposure to conflict-related traumatic events (TEs), ongoing adversities, symptoms of PTSD and psychological distress, and functional impairment amongst a large population sample (n = 2964, response rate: 82.4%) in post-conflict Timor-Leste.ResultsConfirmatory factor analyses of the ICD-10, ICD-11, DSM-IV, four-factor Emotional Numbing and five-factor Dysphoric-Arousal PTSD structures, found considerable support for all these models. Based on these classifications, concurrent validity was indicated by logistic regression analyses which showed that being a woman, trauma exposure, ongoing adversity, severe distress, and functional impairment were all associated with PTSD.ConclusionsAlthough symptom prevalence estimates varied widely based on different classifications, our study found a general agreement in PTSD assignments across contemporary diagnostic systems in a large conflict-affected population in Timor-Leste. Further studies are needed, however, to establish the construct and concurrent validity of PTSD in other cultures.

Symptoms of post-traumatic stress disorder, severe psychological distress, explosive anger and grief amongst partners of survivors of high levels of trauma in post-conflict Timor-Leste.

Little is known about the mental health of partners of survivors of high levels of trauma in post-conflict countries. We studied 677 spouse dyads (n = 1354) drawn from a community survey (response 82.4%) in post-conflict Timor-Leste. We used culturally adapted measures of post-traumatic stress disorder (PTSD), psychological distress, explosive anger and grief. Latent class analysis identified three classes of couples: class 1, comprising women with higher trauma events (TEs), men with intermediate TEs (19%); class 2, including men with higher TEs, women with lower TEs (23%); and class 3, comprising couples in which men and women had lower TE exposure (58%) (the reference group). Men and women partners of survivors of higher TE exposure (classes 1 and 2) had increased symptoms of explosive anger and grief compared with the reference class (class 3). Women partners of survivors of higher TE exposure (class 2) had a 20-fold increased rate of PTSD symptoms compared with the reference class, a pattern that was not evident for men living with women exposed to higher levels of trauma (class 1). Men and women living with survivors of higher levels of trauma showed an increase in symptoms of grief and explosive anger. The manifold higher rate of PTSD symptoms amongst women living with men exposed to high levels of trauma requires replication. It is important to assess the mental health of partners when treating survivors of high levels of trauma in post-conflict settings.

The role of grief symptoms and a sense of injustice in the pathways to post-traumatic stress symptoms in post-conflict Timor-Leste.

Grief symptoms and a sense of injustice may be interrelated responses amongst persons exposed to mass conflict and both reactions may contribute to post-traumatic stress disorder (PTSD) symptoms. As yet, however, there is a dearth of data examining these relationships. Our study examined the contributions of grief and a sense of injustice to a model of PTSD symptoms that included the established determinants of trauma events, ongoing adversity and severe psychological distress. The study involved a large population sample (n = 2964, response rate: 82.4%) surveyed in post-conflict Timor-Leste. The survey sites included an urban administrative area (suco) in Dili, the capital of Timor-Leste and a rural village located an hour's drive away. Culturally adapted measures were applied to assess conflict related traumatic events (TEs), ongoing adversity, persisting preoccupations with injustice, symptoms of grief, psychological distress (including depressive symptoms) and PTSD symptoms. We tested a series of structural equation models, the final comprehensive model, which included indices of grief symptoms and injustice, producing a good fit. Locating grief symptoms as the endpoint of the model produced a non-converging model. In the final model, strong associations were evident between grief and injustice (β = 0.34, s.e. = 0.02, p < 0.01) and grief and PTSD symptoms (β = 0.14, s.e. = 0.02, p < 0.01). The sense of injustice exerted a considerable effect on PTSD symptoms (β = 0.13, s.e. = 0.03, p < 0.01). In addition, multiple indirect paths were evident, most involving grief and a sense of injustice, attesting to the complex inter-relationship of these factors in contributing to PTSD symptoms. Our findings support an expanded model of PTSD symptoms relevant to post-conflict populations, in which grief symptoms and a sense of injustice play pivotal roles. The model supports the importance of a focus on loss, grief and a sense of injustice in conducting trauma-focused psychotherapies for PTSD amongst populations exposed to mass conflict and violence. Further research is needed to identify the precise mechanisms whereby grief symptoms and the sense of injustice impact on PTSD symptoms.

A high-risk group of pregnant women with elevated levels of conflict-related trauma, intimate partner violence, symptoms of depression and other forms of mental distress in post-conflict Timor-Leste.

Women in post-conflict, low-income, post-conflict (LI-PC) countries are at risk of exposure to the traumatic events (TEs) of war and intimate partner violence (IPV), forms of stress that are known to lead to depression and other adverse mental health outcomes. We aimed to assess an index of exposure to these two forms of trauma to identify pregnant women attending antenatal clinics in conflict-affected Timor-Leste at high risk of depression and other forms of stress. A large, cross-sectional study of women in the second trimester of pregnancy was conducted in the four main government antenatal clinics in Dili district of Timor-Leste, between May 2014, and January 2015. The sample consisted of 1672 consecutive women, 3 to 6 months pregnant, with a response rate of 96%. We applied the Edinburgh Postnatal Depression Scale, the Kessler-10 psychological distress scale and the Harvard Trauma Questionnaire. IPV was assessed by the World Health Organisation measure. Composite categories of conflict-related TEs and severity of IPV showed a dose–response relationship with depressive symptoms: for exposure to four or more conflict-related TEs and severe psychological IPV, the adjusted odds ratio (AOR) was 3.95 (95% confidence interval (CI) 2.10–7.40); for four or more TEs and physical abuse, AOR 8.16 (95% CI 3.53–18.85); and for four or more TEs and severe psychological and physical abuse, AOR 9.78 (95% CI 5.31–18.02). For any mental distress, the AOR for four or more TEs and severe psychological abuse was 3.60 (95% CI 2.08–6.23); for four or more TEs and physical abuse 7.03 (95% CI 3.23–15.29); and for four or more TEs and severe psychological and physical abuse the AOR was 10.45 (95% CI 6.06–18.01). Of 184 women (11% of the sample) who reported ⩾4 TEs and either physical abuse alone or in combination with severe psychological abuse, 78 (42%) reached threshold for depressive symptoms and 93 (51%) for any mental distress, a 10-fold increase in depressive and other mental health symptoms. Priority should be directed to providing urgent mental health and social interventions for this group of women. Our findings offer a framework for a tiered approach to detection, guiding prevention and intervention strategies for IPV and associated mental health problems in low-income post-conflict countries.

Land access and livelihoods in post-conflict Timor-Leste: no magic bullets

In Timor-Leste, customary institutions contribute to sustainable and equitable rural development and the establishment of improved access to and management of land, water and other natural resources. Drawing on multi-sited empirical research, we argue that the recognition and valorization of custom and common property management is a prerequisite for sustainable and equitable land tenure reform in Timor-Leste. In a four-community study of the relationship between land access and the practice of rural livelihoods in eastern and western districts of Timor-Leste, where customary management systems are dominant, we found different types of traditional dispute resolution, with deep roots in traditional forms of land management and with varying levels of conflict. The article shows how customary land tenure systems have already managed to create viable moral economies. Interviewees expressed a desire for the government to formalize its recognition and support for customary systems and to provide them with basic livelihood support and services. This was more important than instituting private landholding or state appropriation of community lands, which is perceived to be the focus of national draft land laws and an internationally supported project. We suggest ways in which diverse customary institutions can co-exist and work with state institutions to build collective political legitimacy in the rural hinterlands, within the context of upgrading the quality of rural life, promoting social and ecological harmony, and conflict management.

Land access and livelihoods in post-conflict Timor-Leste: no magic bullets

Land access and livelihoods in post-conflict Timor-Leste: no magic bullets

Prevalence and correlates of explosive anger among pregnant and post-partum women in post-conflict Timor-Leste.

BackgroundLittle is known about explosive anger as a response pattern among pregnant and post-partum women in conflict-affected societies.AimsTo investigate the prevalence and correlates of explosive anger among this population in Timor-Leste.MethodWe assessed traumatic events, intimate partner violence, an index of adversity, explosive anger, psychological distress and post-traumatic stress disorder among 427 women (257 in the second trimester of pregnancy, 170 who were 3–6 months post-partum) residing in two districts of Timor-Leste (response >99%).ResultsTwo-fifths (43.6%) had explosive anger. Levels of functional impairment were related to frequency of explosive anger episodes. Explosive anger was associated with age (>35 years), being married, low levels of education, being employed, traumatic event count, ongoing adversity and intimate partner violence.ConclusionsA combination of social programmes and novel psychological therapies may assist in reducing severe anger among pregnant and post-partum women in conflict-affected countries such as Timor-Leste.Declaration of interestNone.Copyright and usage© The Royal College of Psychiatrists 2015. This is an open access article distributed under the terms of the Creative Commons Non-Commercial, No Derivatives (CC BY-NC-ND) licence.

Clustering of symptoms of mental disorder in the medium-term following conflict: An epidemiological study in Timor-Leste

It is important to define subpopulations with mental health and psychosocial reactions in the medium-term following conflict to ensure that an appropriate array of services are provided to meet the diversity of needs. We conducted a latent class analysis (LCA) on epidemiological data drawn from an urban and rural sample of 1221 adults (581 men and 640 women, response 82%) in post-conflict Timor Leste 4 years after the cessation of violence. The prevalence of PTSD was 4.9%; severe distress 4.8%; anger attacks 38.3%; and paranoid-like symptoms 10.9%. The best fitting LCA yielded three classes comprising those with no or minimal symptoms (86%), a class with anger-paranoia (13%) and a comorbid mental disorder class (1.5%) characterized by PTSD (100%) and severe distress (98%). The comorbid mental disorder class had an over-representation of men, the unemployed, residents in the urban area and persons with the greatest exposure to human rights trauma, murder and health stress. The anger-paranoia class experienced moderate levels of trauma and had an over-representation of urban dwellers, women, and those with higher levels of education. The analysis assists in clarifying the populations with mental disorder and adverse psychosocial reactions in need of intervention in the medium-term following conflict.

Roles of Civil Society in Natural Resource Management: Community Associations in Post-Conflict Timor-Leste

Roles of Civil Society in Natural Resource Management: Community Associations in Post-Conflict Timor-Leste