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ELIZABETH MARIE COKER

TRAVELING PAINS: EMBODIED METAPHORS OF SUFFERING


AMONG SOUTHERN SUDANESE REFUGEES IN CAIRO
ABSTRACT. This paper presents the results of a larger study conducted among Southern
Sudanese refugees in Cairo, Egypt. Illness talk and body metaphors are the focus of
the present work, which is based mainly on an analysis of the illness narratives of people
attending a church-run medical clinic. The findings suggest that refugees use certain narrative styles in discussing their illnesses that highlight the interconnection of bodily ills
and refugee-related trauma. The refugees narrated the histories of their illnesses in terms
consistent and coterminous with their refugee histories, and articulated illness causes in
terms of threatening assaults on their sense of self as human beings and as part of a distinct community and culture. The use of embodied metaphors to understand and cope with
their current and past traumatic experiences was echoed in narratives that were nonillness
related. Metaphors such as the heart, blood, and body constriction were consistently
used to discuss social and cultural losses. Understanding the role that the body plays in
experience and communication within a given cultural context is crucial for physicians and
others assisting refugees.
KEY WORDS: embodiment, illness metaphors, social change, Sudanese refugees

The term social suffering offers a short-hand way of referring to this relationship of a medical biography whose existence and direction are overdetermined by political and historical
forces over which the individual has no control. Such illness narratives provide an opportunity for critical auto/biography. The life history engages with and sheds fresh light on the
anomalies in the core structures of the society.
Vieda Skultans (2000: 11)

INTRODUCTION

The longest-running civil war in Africa to date is one that receives relatively little
media attention in the West. With no immediate resolution at hand, the war between
the North and South of Sudan has claimed an estimated two million lives, with many
millions more homeless and displaced. The roots of this war lie in long-standing
ethnic and religious hostilities between the lighter-skinned Arab-Muslim rulers
of the North and the mostly Christian ethnic groups in the South, fueled by the
discovery of oil in the southern provinces in the 1970s, and increasing dramatically
in recent years (Johnson 2003; Lesch 1998). While a complete analysis of the
myriad causes and complications of this 18-year conflict are beyond the scope of
the present paper, the immediate result is that in recent years an estimated 500,000
southern Sudanese refugees have fled to nearby countries. A lucky few have been
resettled in Australia or North America, the rest are forced to survive in crowded
Culture, Medicine and Psychiatry 28: 1539, 2004.

C 2004 Kluwer Academic Publishers.

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camps (e.g., in Uganda), or make their own way in already overburdened urban
centers such as Cairo.
Cairo is now the home to an estimated 20,00030,000 southern Sudanese
refugees, the majority not yet officially recognized as refugees by the United
Nations. As the war in their country drags on, making the chances of a return to
their homeland unlikely at best, their only hope is to eventually join the ranks of
those who have been resettled to the West, most notably the United States, Canada,
or Australia. Like any developing country, Egypt struggles to provide sufficient
social services for its own people, and the recent influx of refugees has proven to
be more than the economy can comfortably handle. Southern Sudanese refugees
in Cairo are truly outsiders in this environment; their different religion, skin color,
customs, and language all serve to cement their outsider status. They are unable
to work legally, find affordable housing, or obtain a decent education for their children, regardless of their official refugee status. When Egypt ratified the 1951 UN
convention, it included many reservations to the rights of the refugees it hosted, including placing limits on the right to work and the right to access public education.1
As a result, Egypt has, de facto, become a country of transit with most refugees
living in hope of eventually being relocated to a third country. Such opportunities
are limited, very slow to materialize, and depend on being granted mandate status
by the United Nations High Commisioner for Refugees (UNHCR). Nevertheless,
Cairo has developed a reputation, deserved or not, as a gateway to relocation
to the West, possibly due to the difficulty of obtaining legal, long-term residence,
and the active presence of the UNHCR. Consequently, thousands of individuals
and families struggle to survive on little or no formal assistance, employed in the
informal sector, with literally thousands more arriving every month. In short, these
individuals and families exist in limbo socially, economically, and culturally.
The social, physical, and mental challenges of adapting to forced migration have
been well-documented elsewhere, and include the collapse of systems of social
support, socioeconomic marginalization, poor physical health, malnutrition and/or
starvation, and psychological symptoms and disorders (Jablensky et al. 1992).
Cultural coping systems, mediated through a shared language, history, dress, and
ritual practices, must either be adapted to handle the exigencies of a completely new
and unknown situation, or be stripped away entirely (Muecke 1995). Refugees are,
as Victor Turner put it, transitional beings, caught in between the classificatory
systems that define societies and create the link between self, place, history, and
future (Turner 1967). The body, as the existential ground of culture (Csordas
1994), is the terrain on which liminality is worked through and new classifications
are created, as cultural practices, and even language itself, become insufficient to
define self and community.
The present paper focuses on the ways in which refugee trauma and dislocation
are experienced and expressed through descriptions, narratives, and metaphors of

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illness. The focus is on illness talk as represented in the ways in which refugees
describe their illnesses, and also on body talk, or the metaphorical role that
body and illness play in the stories Sudanese refugees tell in order to articulate
their sense of loss and disruption in the social and economic as well as physical
and psychological domains. Specifically, following Bourdieu (1977, 1984), rather
than viewing the body as a mere source of symbols and metaphor, body awareness,
in the narratives presented here, can be viewed as the locus of social practice,
pertaining to the individuals experience of the social world.
The southern Sudanese refugees who participated in the study told stories of
physical and social suffering that simultaneously expressed mourning for a lost
cultural and physical normalcy, moral rage at their present circumstances, and
left at least a window for some unknown, reconstituted future (Becker 1997). The
unique contribution of refugee stories to the literature on embodied narratives of
illness is just this: Having no ready-made cultural script for their experiences,
they must remake their stories as they go, telling of illnesses and social breakdowns
for which ordinary metaphors are profoundly unsuited. In illness, the body becomes
a cultural terrain that must be relearned (Becker 1997). In the refugee experience,
the future, present, and even the past become the unknown terrain that must be
relearned. Cultural narratives and scripts must be recreated from chaos, a chaos
that is first and foremost experienced on the bodies of individual actors. The way
in which the body is experienced, the body talk that is evoked in narrative,
naturally reflects the culture of origin; refugees are not, as Lisa Malkki reminds
us, a cultural tabula rasa on which anything can be inscribed (Malkki 1995).
However, the reordering of culture and community after complete disruption must
begin with the reordering of the body, a process that begins with a recognition of
the disruption-as-illness.
Sickness, argue Scheper-Hughes and Lock, is not just an isolated event or
unfortunate brush with nature (1987: 31). Rather, it is a way of speaking as an
individual, a culture, and a society all in one. Social and cultural attitudes and
struggles are played out in the terrain of the individual body. The individual body
and its sicknesses are not so much representations of the larger environment as a
vital and inseparable part of it. Likewise, in the present study, the extreme cultural,
social, and geographical fragmentation experienced by southern Sudanese refugees
in Cairo were experienced as part and parcel of bodily ills and physical pains. When
the self is broken apart, it hurts, and pain is the ultimate embodied metaphor. It is
everywhere, and nowhere at the same time. It is found in the heart, the stomach, the
head, the legs, but particularly, in these narratives, in the self, or nafs in Arabic (a
term which refers loosely to ones self or psyche). The self, identity, and body are
truly one, and pain was expressed by the participating informants at all of these
levels literally simultaneously. What follows is an attempt to give certain examples
of how this played out in the discourse of my informants, but in the space provided

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I can only begin to do justice to the incredible depth and multilayered texture of
the refugee self as experienced by those involved.
BACKGROUND AND METHODOLOGY

All of the subjects in the present study were refugees from the southern Sudan,
an area consisting of up to 100 culturally and linguistically diverse ethnic groups,
(Deng 1972; Seligman and Seligman 1965). I intentionally chose not to focus on
one particular ethnic group because the goal was to understand the commonalities
in experience for those identifying as southern Sudanese. This said, it must be emphasized that there was no natural southern Sudanese collective identity prior
to the NorthSouth civil wars that have ravaged the region on and off since 1955
(Johnson 2003). Although ethnic loyalities and mutual hostilities between southern Sudanese groups still exist to some extent (Deng 1972), the shared threat of
northern cultural and religious domination has brought a new level of cohesiveness
and identification as southern Sudanese in recent years. This is particularly true
among refugees in Cairo, all of whom face common external threats based on their
skin color, religion, and precarious political status. In fact, despite differences in
cultures of origin, much of the discourse focused on we the southern Sudanese,
suggesting that the refugees themselves had learned to experience their identity
as members of a common regional group facing very similar refugee histories and
current problems.
The results presented here are part of a larger study examining the experiences of
southern Sudanese refugees in Cairo, their interactions with health-care providers,
and their illness presentations. The data were collected over a period of one year
with southern Sudanese refugees from various ethnic groups in the Cairo area.
The data consisted of the following: 61 open-ended, semistructured interviews
with refugees presenting to a church-run health clinic specifically for individuals
who had not yet been granted official refugee status by the UNHCR, and as
such had no recourse to UN-sponsored health care; 16 in-depth interviews with
Sudanese men and women from the community at large, who may or may not have
been granted refugee status; interviews with midwives and administrators at the
church clinic mentioned above; a question-and-answer session with 45 pregnant
Sudanese refugees attending a health education class at the churchs antenatal
clinic; home visits with Sudanese families; visits and staff interviews at Caritas
(a UNHCR-supported health clinic for officially-recognized refugees in the Cairo
area) and interviews with staff members at a Cairo-based center for victims of
torture and domestic violence. All data were recorded through written notes. In
addition, six focus groups were conducted with between six and eight participants,
two at the home of a research assistant working on this project and four at the
previously mentioned church clinic. These focus groups were tape-recorded and

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the data were translated and transcribed. Most of the interviews with the southern
Sudanese were carried out in Juba Arabic (an Arabic dialect spoken in southern
Sudan), by a trained native research assistant, with the author in attendance. As the
present focus is on illness experiences, most of the data used in this study came
from the individual interviews with clinic attendees, as well as the focus groups,
most of whom, it turned out, had had direct experience with illness and healthcare
seeking in Cairo.
ILLNESS EXPERIENCE AND ILLNESS TALK

The idea for the present paper stemmed from a series of conversations with the
British medical director of the Anglican church-run clinic where the majority
of the data presented here were collected. He was concerned with the preponderance of what he termed somatization among the many recently arrived Sudanese refugees presenting to the health clinic. In other words, he and his staff
perceived that there were many physical complaints in the absence of readily observable organic dysfunction. Of course, many refugees did suffer from serious
illnesses such as tuberculosis, and the clinic was well equipped to treat these ailments and/or refer patients to outside hospitals and clinics. Malnutrition was also
a commonly recognized problem, and food programs were in place to supplement the nutritional needs of pregnant/nursing mothers and children, in particular.
However, there were many more who complained of inexplicable pains and sicknesses that created frustration on the part of the medical staff and refugee clients
alike. This medical directors dissatisfaction with the limits of medical terms such
as somatization to explain the phenomenon that he was seeing was obvious;
these labels did little to help him understand the realities and meaning of what
he was observing, nor did they provide satisfactory clues to how the refugees
could best be helped. The conceptual paucity of the term somatization illustrates the dualistic nature of western medical reasoning, as well as the western
cultural tendency to intellectualize distress (Becker 1997). Research on the meaning of somatization in this particular context and for these particular refugees
was thus part of an initiative to improve the ability of the clinic to meet their
needs.
Therefore, the present analysis will begin with illness stories as recounted by
people attending the clinic for treatment. Whether or not their objective symptoms
constituted a disease for a given individual was not confirmed for reasons of
privacy. These stories, whether they reflect a measurable disease or not, provide
a glimpse into the ways in which illness becomes an avenue for discourse about
the refugee trajectory. As will be shown, the refugees in the present study remembered their illness stories with direct reference to their flight experience, and vice
versa.

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In his interviews with chronic pain patients, Kugelmann (1997) determined that
pain, far from being an isolated phenomenon in the lives of his respondents, was
woven into narratives reflecting, among other things, how people make sense of
their suffering and their worlds. In his subjects stories, straightforward explanations of physical (i.e., objective) pain inevitably gave way to narratives of social
roles, identity, economics, etc., that contradicted the imposed dualism suggested
by the dominant discourse of the medical clinic. The stories told by the health
clinic clients in the present study showed a very similar pattern. The respondents
began by stating their actual symptoms, but the physical aspect of the symptoms
was very quickly immersed in a web of significance that addressed the realities of
their traumatic and ongoing experiences as refugees.
There were no clear-cut illness or symptom patterns for the clinic respondents.
In other words, there seemed to be no typical refugee syndrome other than diverse somatic complaints. The most common symptoms were stomach aches or
digestive complaints, chest pain, cough, general body pain, or muscle aches, heart
complaints (heart pain), and complaints of burning sensations at various points
on the body, as well as unspecified itching (a very common complaint, involving
virtually any part of the body). Other complaints mentioned included lafa rasi (a
sort of dizziness or tendency to fall down), painful legs, malaria, insomnia/poor
sleep, stiff body, toothaches, and blisters or ulcers anywhere on the body. Although
a few respondents appeared to have clear-cut, acute symptoms suggestive of anything from a common cold to tuberculosis, in most cases the complaints were
multiple and diverse, interspersed with possible causes and contributing factors.
Traveling pain
What was remarkable about the illness stories told by clinic attendees and others
in the study was the way in which the stories were contextualized, symbolizing
movement, flight, and restlessness, at once immediate and part of the refugee
history. If illness and disease are inseparable from the structure of society (Good
1977), then so are they inseparable from the disruptions of society. Illnesses reflect
networks of social meaning and interaction as they have become changed and even
warped by trauma and flight (Good 1977).
One of the most consistent aspects of the respondents narratives was their tendency to voice their complaints in time frames related to the refugees experience
(sometimes spanning more than a decade). Their pain was historicized, moving
through the body and stopping at various locations, only to move on to another
spot later on, sometimes years later. Respondents would describe pain as literally
traveling through them, stopping from place to place and then continuing on
elsewhere. To understand this traveling pain, I prefer to avoid simplistic analogies or oneone symbolic relationships between, for example, moving pain and
moving people. Rather, to quote Byron Good (1977: 48), The meaning of an

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illness term is rather constituted by its linking together in a potent image a complex
of symbols, feelings, and stresses, thus being deeply integrated into the structure
of a community and culture.
It was very common for the presenting complaints to be narrated in terms of
a long, complex history of symptoms and remission, with causal explanations
woven into the narratives. Very few of the presenting complaints were actually
acute and noncontextual. No matter what the illness, the clients talked of histories
with that or similar disorders, and readily articulated the conditions under which
the symptoms usually appear. In other words, the notion of the traveling pain
mirrors the experience of moving from place to place, but it also carries with it a
statement of the strength or ability of the individual body to withstand the onslaught
of external disruptions. These disruptions come from all sides, from all directions.
If it is not one thing, its something else was the unspoken message in the
refugees illness stories, reminiscent of Arthur Franks (1995) chaos narrative, in
which stories or narratives are devoid of the solace of restitution or a foreseeable
happy ending. The pain doesnt end because there is no end in sight for these
refugees. As Frank puts it, the body telling chaos stories defines itself as being
swept along, without control, by lifes fundamental contingency (Frank 1995:
102). The traveling pain articulated in concert with the onslaught and immediacy
of irresolveable life problems suggests an embodiment of just the sort of chaos
narrative that Frank described. Consider the following excerpt by a 45-year-old
Dinka woman who had been in Cairo for two months:
Im suffering from rapid heart beat (darabat fil gelib). I also have a cough. The heart
problem started in Tonj [a town in southern Sudan]. I think it is caused by the cold weather
here. When it was cold in Tonj, my illness worsened and when it was warm I felt better.
When it started in Tonj, I was given some tablets and capsules. I think the illness started
in Tonj because after the death of my husband and two children I mourned for three years.
I could not eat or drink well. It started by a mere cold and or flu and then a sore throat.
It continued down my heart and up to date Im suffering of it. We separated with my
only child during the war in Tonj. I ran to Khartoum and he remained in Tonj. I think
too much about my family and my fate. The first time I came here I got referred to ***
hospital to take an ultra-sound. Today I brought the results of the medical ultra-sound. I
do not know what the doctors will do to me but I believe that I will be given the right
treatment. My refugee situation affects me because Im lonely and in a foreign land. I think
too much about the loss of my family and about my only son with whom we got separated
during the war. When I was in Khartoum I wrote to the pastor about the situation and he
gave me money to come here for further treatment and for a change. Nobody helps me
and life is hard here. I do not have anyone who helps, no husband, no children, no job
yet. Life is hard. In fact, since my husband and two children were killed I have remained
unhealthy until now. I do not have friends to talk to about my problems. I do not want to
talk about my misfortune because the more I talk about my problems the more I suffer.
I have been badly offended, I have no child now, no husband, not anyone responsible for
me. In God I only entrust my life, and the best place for me would be a convent, where I
would stay quietly with the sisters. In fact, my heart does not allow me to talk too much.
Also, I believe that talking to people about my problems gives me more psychological
discomfort.

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This woman articulated the ultimate chaos narrative. Nothing is helping, nothing
has helped, and nothing will help, and the only solution is withdrawal. Her sick
body and moving pain are simply another aspect of the chaotic conditions of her
life, ultimately inseparable from her other life experiences. As she says, she has
been badly offended, and this offense is far from over. As her story suggests,
current illness episodes were experienced as part of an ongoing process of health
or ill-health that waxes and wanes according to existential factors ranging from
torture to the death of relatives to poor food to hard living conditions.
The way in which illness was contextualized and historicized as part and parcel
of an ongoing process directly or indirectly tied in with experiences of forced
migration was one of most consistent aspects of the narratives. As the woman
quoted above testified, illnesses often had their origin in Sudan, however they
were reawakened and even modified with the transition to Cairo. In the sections
that follow, the theme of traveling pain will come up again and again, as causes
and symptoms are cast in a discourse of disruption and relocation. In sum, the
picture painted by the respondents was that of physical illness as an integral part
of a disrupted and ill life experience, not as an isolated variable entering and
temporarily inhabiting the body.
What makes it worse
Rather than speak of causal explanations of symptoms or illnesses, I prefer to
borrow from Kleinmans (1980) notion of explanatory models (EMs), which
emphasize not only etiological explanations of illness but also the personal and
social meanings of the illness experience. In the refugees narratives, explanatory
models for illness doubled as explanatory models and/or metaphorical examples of
extreme social and personal disruption and pain. In fact, there were rarely single,
isolated origins for any illness event. Illnesses were not, as mentioned, even spoken
of as events but as processes, as an embodied thread in a story of pain (Kleinman
1989). Therefore, explanations were multiple, as life problems and worries were
multiple.
The trauma of physical relocation is an integral part of any refugees story.
The very definition of refugee is of one who has been forcibly uprooted, and
the ensuing disruption of cultural identity reflects the territorialized nature of the
culture of origin (Malkki 1995). In the present stories, the pain of physical dislocation came out in detailed accounts of the pathological nature of the Egyptian
environment, and the contrasting idealization of the health-giving qualities of
southern Sudan. The cold winters in Cairo (compared to Sudan), dust, pollution,
and the physical confinement of a such a large, crowded city were all frequently
given as reasons for illnesses. In addition, the impure food was a very common
complaint, not only among the clinic attendees but among the focus group respondents as well. Highlighting the dramatic contrast between there and here, the

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refugees lamented the loss of the clean and pure foods that they could just
pick off the tree in southern Sudan. This abundance was spoken of in concert
with the purity of Sudan and the food there, and associated contamination (by
chemicals and whatnot) of food in Egypt. For example, a man who had gone to
the clinic because of severe skin itching only to be told that he had no disease
went on to say, What I came to discover was that the foods [in Egypt] are full of
chemicals. In the Sudan we live on natural foods that contain no chemicals. All
these chemicals have an effect on our bodies.
The association between being a refugee and taking in impure food went
beyond explanations of physical quality or the simple association of chemicals
with sickness. To understand the respondents emphasis on the illness-causing
nature of food, one must consider the meanings of food as linked to culture and
place. Complaints of chemically-tainted food and water were underscored by the
loss of place, of home, that respondents experienced when leaving Sudan, and
the subsequent loss of relatives and social stability. Said one of the focus group
participants, in response to a discussion about what had been lost in the move from
Sudan to Cairo:
I have come here to this [Egypt] from a very far place. Now, with the absence of my relatives,
how can I be happy? How can ones mood be okay? Now, even if I eat the food, I can eat
until I am satisfied but at the end I will begin to think: where is this brother/sister of mine
living now? And where are the rest? In this way, the food that you have eaten will not work
in your body.

This excerpt suggests the complex role that time and place play in narratives
and experiences of illness, as well as a hypothetical mediating factor between the
traveling pain and the trauma of dislocation. This excerpt also refutes the notion
that these refugees were somatizing their distress in the sense of being unable or
unwilling to acknowledge the hidden psychological factors behind it. In fact,
the refugees did verbalize their existential and social traumas, and their bodily
pains were an integral part of this discourse. When one is a refugee in a strange
land and separated from relatives, the body will not work properly. Even food
will not work in the body if ones social environment and nafs (psychology) are
not healthy. In fact the vast majority of the respondents, whether clinic attendees
or not, spent more time discussing their illnesses in social or existential terms
than in physical terms. Of the 61 clinic attendees interviewed, only 11 did not
spontaneously mention emotional or social factors in their elaboration of their
illness symptoms. These explanations were woven seamlessly in with other causal
explanations, and were usually one of several possible causes.
Thinking too much was a very common exacerbating factor in illness, even
if it was not seen to have directly caused the illness. Typically, the refugees stated
that they thought too much about their very hard conditions in exile, or their past
security problems in Sudan, which fueled their illnesses in one way or another.

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Many others spoke about their financial situations and lack of job opportunities,
again, causing them to think a lot about what was happening to them. The
following excerpt illustrates the way in which thinking allows the past to affect
the body in the present:
I sometimes suffer from headache to the extent that I cannot raise my eyes like this [raises
eyes to ceiling]. My eyes seem as if they want to drop down. But the only thing is that I
know that it is only nafsiyat [psychological problems] due to too much thinking. The proof
is that if you sometimes sit like this, something will just cross in your eyes and then you
will begin to think of the way that you were leading your life before, in the Sudan.

As the preceding excerpts suggest, the respondents had definite notions of how
their nafs interacted with their bodies to produce illness. Some version of this
theme was elaborated by virtually all the respondents in the focus groups and the
individual interviews when the subjects came up. Anger, guilt, too much thinking, and loneliness or separation from relatives were seen as integral aspects of
illness, or indeed, as sicknesses unto themselves. This underlines the difference
between biomedical models of illness, which see disease as impersonal, and
many indigenous models that incorporate moral dimensions of power, weakness,
and resistance (Harkin 1994; Swartz 1997). Thinking too much was a direct
result of current financial, social, and political insecurity, and an integral part of a
larger process of loss and movement. This implicated the body-self as a part of a
larger whole that was disrupted or diseased, a factor that invariably caused illness
and distress through the persons loss of social and cultural mooring (Comaroff
1983).
Psychological distress was seen as leading to physical symptoms, but it was
also seen as a problem in and of itself. My major problem is psychological illness
because of worry and anxiety for my future said one man who came in complaining
of back, neck, and ear pain. I keep wondering for how long I will remain in such
a situation of poor nutrition, shelter, and care. There is nothing that comforts ones
psychological upset. Another man named anger as a direct cause of his high
blood pressure and constant headache. When asked how and why it began, he said,
I think it began because of anger. Im often angry. The economic and political problems
in Sudan and particularly in my region, Darfur, made me nervous. Worst of all I was
surrounded by many social problems at home with my wife. When I talk too much I have
severe headaches, so when it starts, I abstain from talking. I cannot establish the usual course
of the illness but at one time I have a severe headache and sometimes it is not there. I think
it depends on my emotions.

Here, the body remembers the ongoing trauma and pain having roots in the
flight experience. According to Casey (1987), body memory risks the fragmentation of the lived body. In this mans narrative, we see not only the fragmentation
of the lived body but articulation of the fragmentation of the social and political
body through embodied experience. He is literally cut off from social contact

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through his bodys inability to articulate; to express is to suffer bodily pain. Interestingly, this mans interpretation of the link between his emotions and his bodily
symptoms, so frequently expressed by the respondents, posits a mind/body connection opposite to that expressed by the American respondents in Kugelmanns
(1997) study of chronic pain patients. While these Americans saw physical pain
as causing emotional problems, the Sudanese almost invariably saw social and
emotional pain as leading to physical pain, an interpretation that would be threatening to many North American chronic pain patients, imbued as they are with strict
mind/body dichotomies. The man quoted in the preceding paragraph is literally
living his anguish through his body, and what is more, he recognizes this clearly.
Anger is pain, pain is embodied. Social interaction, when disrupted, is embodied
through physical pain.
In addition to overwrought emotions, loneliness and lack of social support were
commonly mentioned as contributing factors to illness. One of the primary losses
for the refugees was the loss of the extended family as a means of support, a situation that is common to refugees throughout the world (see Gold 1989; McSpadden
and Moussa 1993; Williams 1993). The family, for the southern Sudanese, consists
of an elaborate network of kin who are always ready and virtually obligated to offer
their help to family members. In the Cairo context, not only are family members
often not present, but if they are, they may be unable to offer help. This places
enormous stress on individuals on both sides. Respondents frequently lamented
the fact that they were unable to support additional family members continually
arriving from Sudan. Not only were they penniless, but their landlords frowned on
too many people living in one flat, and this was often a cause for eviction. This
was an enormous source of shame to those unable to provide the requisite support
to their relatives, and a source of pain to those who had come to Cairo expecting
support from relatives and were rejected. For those who were virtually alone, with
no extended family members nearby, this alone was enough to cause or exacerbate sickness. In fact, several respondents assured me that this family breakdown
was a sickness in and of itself, and was bound to show itself in the body of the
individual.
The narratives wove concerns about lack of social support with multiple other
causative factors. The sense of loneliness as contributing to illness was common in
the narratives, suggesting that the sense of family and community breakdown was
very strong. As one man put it, My situation as a refugee has affected my illness
in that I have no needed support from my close relatives, they are all in Sudan.
To sum up notions of etiology for the respondents in this study, physical, social, and psychological themes were woven together in the explanatory aspects
of these narratives. Disruptions, deprivations, and overload (sensory, physical,
food-related) all contribute to general ill-health. However, causation cannot be
understood without reference to the specific ontological world of the Sudanese

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refugees. The self is not contained within the boundaries of the physical body, but
extends to the social world and its important relationships. Thus, social sicknesses
are spoken of as if they are physical sicknesses, and in fact, are often experienced
as such. The physical body is sick if the social self is not intact. Likewise, the
refugees had quite elaborate notions of the relationship between the mind (emotions) and the body. Basically, the two conceptual entities of nafs and the physical
body were not spoken of as separate. It was taken for granted that emotional pain
could cause physical pain; it was for this reason that the doctors pills sometimes
did not work.
In this sense, illness talk revealed the ways in which being a refugee impacted the
self and rendered it sick on various levels. At the same time, illness talk revealed
important areas of resistance to the total annihilation of the self-as-refugee in
Egypt. The simple fact of being in someone elses land, losing the social support
and the identity grounding and the food, air, and space of southern Sudan was, as
so many said, a sickness in itself. By identifying it as such, the refugees were
able to articulate their embodied pains, and identify what, exactly, was ailing them.
This was more than the medical profession was able to do. The following excerpt
by a female focus group respondent poignantly expresses the futility of medical
treatment when the social and geographical basis of identity has been lost:
There in the Sudan if you are sick, you will tell your mother this. Your brothers and sisters
will come. You will see your relatives beside you and as a result you will be a bit better.
When it comes to a situation where you dont have money, whether for medicines or for
anything [i.e., food] you will find a number of people ready to help you. Your brother, your
cousin, or your niece or any other relative of your father or mother will be there to help
you. But when we compare with the situation in this country, who is there to help you?
Nobody. Even if you get a medicine to swallow in order to make you feel better, you cannot
[feel better] because of nafsiyat (psychological problems). You will find that your sickness
cannot be treated because of the percentage of thoughts. Now, if I was in the Sudan, when
I am sick like this, Ah, my sister would come to see me. Oh? Who is that? My mother,
she has come to see me. And who is that? A relative of mine. And so forth. There is a
great difference here.

As this suggests, the relationship (if, indeed, one can talk about a relationship between things that are not separate to begin with) between the political, social, and physical body is also about control, and resistance. If the self
is bounded by social and community ties rather than individual skins, then the
connection between political powerlessness, social disintegration, and physical illness becomes clear (Douglas 1966, 1973). The powerlessness of modern
medicine to cure illnesses rooted in social distintegration and politically-based
trauma suggests resistance to modern medicines hegemonic claims to the bodyself (Foucault 1975). Medicine as a concept is neither complete nor effective unless it addresses the social as well as physical transformations of bodies (see Green
1996).

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EMBODIED METAPHORS

As demonstrated in the previous sections, illnesses were historicized and given


meaning through the constant juxtaposition of time, place, and movement in narrative. At the same time, experiences of suffering, exile, and marginalization were
articulated through the consistent use of common themes and metaphors. Much
recent anthropological theorizing has centered on the use of metaphoric language
to express embodied experiences of everything from embarrassment and anxiety
to identity loss and political resistance (Good 1977; Holland and Kipnis 1994;
Jenkins 1991; Kirmayer 1988; Lock 1990; Low 1994; Ots 1990). The metaphors
used by the subjects in the present study reflected important themes in the construction of identity in southern Sudan, however, they also served to reestablish
order out of chaos and bridge the gap between the idealized past and the disrupted
present (Becker 1997).
Low (1994) describes metaphoric language as strategic, allowing for the expression of otherwise inexpressible suffering, but also as creative and generative,
supposing the possibility of change. Thought results from embodied experience
and is creative, using metaphor, metonymy and mental imagery based on bodily
experience. Thus, metaphor is grounded in the body and emerges from it, producing categories of thought and experience (Low 1994: 143). For example, the
metaphor of nervios commonly used by Central American refugees has been put
forth as an example of an embodied metaphor of the self and its relation to social
systems, in particular the breakdown of these systems (Jenkins 1991; Low 1994).
Nervios, in other words, represents the loss of the self as it is socially and culturally
defined.
Jenkins and Valiente (1994) concluded that, among El Salvadoran women presenting at a psychiatric clinic in the Los Angeles area, the metaphoric use of el
calor (heat) served as a narrative vehicle through which terror and political flight
were expressed. El calor was an embodied form of emotional engagement with
the reality of the refugee situation; a somatic mode of attention (Csordas 1993).
In other words, the metaphors used by the southern Sudanese refugees to describe
their situations and their pain were not stand-ins for things (i.e., gender or
race or loss), but rather ways to describe the ongoing, dynamic embodiment
of process and experience, self and other (Goslinga-Roy 2000).
United hearts
An analysis of the symptom presentations of the refugees attending the health
clinic did not reveal any syndrome or common metaphor as clear-cut as nervios
or el calor. However, a comparison of some of the more typical loci of illness
with the body talk revealed in the focus groups and in-depth interviews suggests
ways of talking through and about the body that have much in common with the

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types of metaphors presented by Jenkins and others. To begin with, the heart has
an important place in the embodied experience of illness for the Sudanese. For the
clinic respondents, the heart was often an end place in the traveling of the illness
through the body. In all, ten clinic attendees specifically mentioned pain in the
heart in addition to other ailments. In most of the clinic narratives, the heart was
a point in which pain rested, often originating in another area of the body; a locus
of illness but not a cause or a focal point. This was reflected in the way the heart
was used to discuss the refugee experience for the respondents in general.
The heart is the locus of social and emotional pain, wounds, and sicknesses
for the southern Sudanese. When people discussed loneliness, fear, or the poor
treatment they received at the hands the Egyptians, the heart was where this was
felt, first and foremost. We have wounds in our hearts said one woman, referring
to the loss of her country. Said another woman: We have no freedom, we are
insulted on the streets, we could be arrested at any time and deported back to our
country. All this adds to the pain that is already in our hearts. As Byron Good
found in his study of illness semantics in Iran (Good 1977), the heart is an important
embodied symbol of emotional distress, and, at the same time, its use is reflective
of certain types of emotional distress and not others. Generally, heart pain was
mentioned specifically in relation to loss of identity and culture. When people
discussed the loss of their children, for example, through lack of education and
antisocial habits, they did so through the metaphor of the wounded heart. When
discussing their inability to move freely and mingle with other members of their
society, the fear was placed in the heart. When wives were too busy to attend to
their husbands needs, this too, was due to an unclean heart.
Having a bad or an unclean heart had repercussions beyond the simple
experience of loss and heartache. The southern Sudanese accused themselves of
having bad hearts due to, for example, interethnic discord which caused tensions
within the refugee community. Said one respondent,
Our people have bad hearts towards one another and if you today go to the UN and your
heart is not clean, God will not grant you refugee status. If truly you have love in your heart,
God will grant you acceptance from the UN. If you have in your heart bad things, such as
this person is like this and this person is like that; this is something that we Sudanese
have as a habit. What is this?

In other words, the heart was clearly the place where unity of community and
identity were located. Tensions, breakages, fragmentation in unity between group
members or families literally dirtied the heart and made it unclean. On the
other hand, strength, stability, and devotion to the family and community were
located in the heart. At this particular moment, said one woman, we should
all be with one heart, because we are in exile. The phrase At this particular
moment underlines the role of the heart in symbolizing community and unity,
and the meaning of the common placement of heart pain at the end of the pain

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trajectory in the narratives. Consider the following excerpt by a 39-year-old Bari


woman.
I dont know what my illness is. It is an illness that affected me some years ago. I dont
remember what year it started but I think it began around five years ago. It started in my
legs. I have a burning pain in my legs and after the burning pain, they become cold like cold
water. My legs developed itching and I scratched them. But recently it has moved to affect
my hands and heart too. I feel as if there is a fire burning in my hands and heart. The pain
has now moved to my stomach as well.

This woman had been in Cairo only a short while at the time of this interview,
having arrived from Khartoum a couple of months prior. Her narrative clearly
illustrates the theme of traveling pain, and also the association of the heart
with her recent move to Cairo. It is in Cairo, the latest stop in their journey, that
community and cultural unity are most under threat. As urban refugees, these
refugees must assimilate multiple, shifting, and sometimes conflicting identities
just to survive, a very different experience from that of camp refugees (Malkki
1995). Hence, the heart, an important symbol of community, relation, and unity,
was transformed into a potent symbol of distress and a frequent focus of illness
complaints in an environment where unity and identity were breaking down.
Human blood
If the heart was the locus of unity and community (and the breakdown thereof), the
blood was the metaphor used to express the idea of humanness. The refugees
often described being treated as nonhuman by the people they were forced to deal
with in Egypt, whether the institutions designated to help them or the Egyptians
themselves. Not being human was how they described their sense of not being
recognized as functioning, intelligent people. A sense of humanity was what they
had had in abundance in the southern Sudan, and what they had lost during their
refugee trajectories. Being human was described in many ways, but it was often
expressed through the metaphor of blood. Blood relationships were the strongest,
and these were breaking down. Blood (or the recognition of one as having blood)
was the recognition of one as a fellow person. We the southern Sudanese said one
man, God gave us good blood and the foods we eat. However, their blood was
not recognized by those who would not recognize them as humans. One woman
complained of the arbitrary way in which she was treated by the UNHCR office
responsible for granting the coveted refugee status to asylum seekers:
If they [UNHCR] want to accept you they will look at your personality, or your face. If your
blood goes with them, then they will pass you and resettle you. But if your blood does not
go with them completely they will reject you or even close your file.

Recognizing blood, in other words, is the act of recognizing one as human,


or, in this case, recognizing one as a legitimate refugee and therefore worthy of

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official recognition and its accompanying benefits. Not recognizing one as human
means not acknowledging ones human blood, which is akin to being nonhuman,
or an animal. Said one man, Here, you are overworked like a donkey, as if your
body has no blood.
While generally not used as a symptom of illness per se, blood nevertheless
is a common symbol for the collective sense of existential loss that the southern
Sudanese experience as urban refugees in Cairo. As a metaphor, blood has
powerful cultural and symbolic connotations. In many different cultures, across
time and place (including Egypt and many parts of Sub-Saharan Africa), the notion
of blood is a potent symbol of the self, the soul, and the relationship between
related people or close associates (Du Boulay 1984; Frazer 1890). Arguably, it
is the very essence of symbolic humanity, as evidenced by the huge number of
metaphors relating to blood in many different languages. In English, a coldblooded person is one with no conscience or thought for others; in Egypt, a
light-blooded person (damma khafiif ) is one with a carefree spirit, etc. Like the
heart, blood can symbolize personal human characteristics, but unlike the heart
it is also the symbolic locus of actual kinship or relatedness (there is no a priori
reason why one could be related by blood but not by heart, liver, etc.). In the
southern Sudan, as in Egypt, the importance of blood ties is paramount, and
indeed, recognition of one as a person implies recognition of ones bloodline.
Given this, the significance of the above excerpt becomes clear. The perceived
treatment that the southern Sudanese receive at the hands of their Egyptian hosts
is that of complete nonrecognition of their personhood or humanity. They are truly
liminal (Turner 1967) in the sense that they have no place as people or as humans
among other humans as long as they are outsiders by blood. As refugees and nonMuslims, they are denied a place in the social fabric of Egyptian society, in the
network of blood ties so important in this context. It is truly as if they have no
blood, as long as it goes unrecognized by the society in which they are living.
The silenced body
You all know there is a proverb like this: If a person is living in kutura (danger), you are
actually on fire inside the grass, the whole grass is burning. What you are supposed to do is
to get another fire and burn the grass around you so that you are left in a clear place. But for
us, we ran from fire there in the Sudan and then we enter another fire here in Egypt. Now
there is no freedom.

The above statement by a male focus group respondent illustrates the final
major theme that characterized the narratives in the present study, that of physical
constriction and helplessness. Freedom, this man seemed to be saying, means
having the power to fight fire with fire, to effect change in the environment
and clear your own space. However, the ability to resist was lost with the

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move to Egypt. Themes of physical constriction or restriction, being unable to


move, abounded in the narratives of all the refugees, whether clinic attendees
or not. For the clinic clients, restriction was often expressed as feelings of being
passive while the body was controlled by unknown forces. Said a 24-year-old
Pojulu woman, My body stiffens and my head, legs, and hands are forced to
turn backwards. It started suddenly when I was preparing supper. I had a severe
pain after the incident and I found a wound on my hand. Refugees in the present
study present themselves as helpless, inert, literally unable to move. Their literal,
physical, embodied constriction represents their helplessness and hopelessness.
The narratives reflect bodily constriction on many levels: the pains associated
with working in the homes of others, the sicknesses caused directly by physical
constraint and lack of air to breath, the fantasies woven around hopes vested
in dances, traditional ceremonies, escape from Egypt. Physical constriction was
one of the most important contributing factors to illness, and was directly related
to the physical and existential conditions associated with being a refugee in Egypt.
Constriction was the embodied loss of freedom and the ability to practice ones
traditional culture, and this was emphasized over and over again. Said one woman:
I will now concentrate on how my body pains. Truly, in the Sudan it was okay. Sudan is
my own country. I had freedom. I could leave our home and move freely without anyone
insulting me. I was free in my movement. But now, what pains me a lot in my body is that
here you cannot work or move freely.

Refugees almost unanimously complained about the lack of freedom and


physical restrictions imposed on them because of their marginal status as (usually)
illegal residents in a foreign country. As the above excerpt suggests, this was often
narrated in terms of restricted bodily movements. The respondents feared walking
in the streets of Cairo because of the abuse they suffered there. They stayed in their
crowded apartments, often not visiting relatives or friends even if they had any
because everyone was too busy or preoccupied with his or her own troubles. However, the physical constriction was also experienced as an active repression of the
physical expression of their beliefs and culture. In the southern Sudan, each ethnic
group has its own dances and songs. Rituals such as births, weddings, and funerals
are celebrated through large gatherings, of which drumming and traditional dancing
are an integral part. The refugees were acutely aware of their inability to sing, dance
or drum, and stated over and over that this was a crucial locus of their sense of loss of
community and identity. If they tried to practice traditional rituals or dances in their
small, rented apartments, they risked being kicked out by landlords who did not accept either noise or large gatherings. Even the church, which was a gathering place
in which the refugees felt safe, constricted or restricted their physical expressions of
culture.

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Inside the church there in Sudan we could hit the drums, clap our hands and sing in a loud
voice. But here we cannot do these things. If you sing aloud you will be told, bera bera
(lower your voice), we are inside the church. There in the Sudan if you were going on the
road [traveling], you will travel while singing. But here we do not have this. You only walk
like a dog that has reached someones house and bends its tail downwards.

Although physical constriction was linked to psychological distress, it was also


commonly associated with what the refugees referred to as or rotuba (translated
loosely as rheumatism), a disorder that could affect literally any part of the body
(even the heart) and which, they claimed, was not commonly found in the southern
Sudan. Said one respondent,
In the Sudan we dont have rotuba. But here the lack of walking makes us affected by
rotuba. There we move about. If you dont run, you move. You may walk long distances.
But here, supposing you go out, you will find that after a short time you will begin to breathe,
ah ah ah, and you will feel as if your breathing needs to stop until you cannot breathe
anymore. Therefore, the rotuba has its effect on us because of lack of physical exercise in our
bodies.

As this excerpt suggests, breath, or loss thereof, was often spoken of in conjunction with being unable to move about freely. Lack of physical exercise
suggested a physical explanation for rotuba and other illnesses. But metaphors of
restriction and constriction were more about the body being literally silenced
than about any physiological explanation of muscle atrophy. That silencing of the
breath or breathing difficulties were commonly related in stories of loss of freedom
demonstrates the lived nature of cultural and physical constriction, as in the following statement by a male focus group respondent: We were staying in our own
land, we were pushed to come North, where we have no way of breathing. In other
words, breathing is directly related to physical constriction in that freedom of
movement, freedom of cultural expression and physical space that one can call
ones own are crucial to life, to being able to breathe freely, to being human.
Consider the following excerpt by a male focus group respondent:
Our life in Egypt is not easy. It is not an easy life. You can see that my body is silent, aha,
aha, it is because I am not happy. It is because I am in hell. I am in hell. I was in Paradise
and now I am in hell. I have my own country but I was forced to leave my country. I thought
that I was going to be happy but I find myself in hell, not Paradise, and a human being
cannot continue to live in this situation.

DISCUSSION

When the southern Sudanese refugees discussed their illnesses, they told of physical pains brought on by unfamiliar foods, overwork, worry, and stress. Through
their use of language, they revealed the cultural schemas, linguistic patterns, and
expressive metaphors rooted in their cultures of origin. However, in their stories

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they went a step further, beyond the confines of the physical body or cultural habits,
to express the chaos of the refugee; a chaos that is beyond words or experience
because it is unprecedented. Refugees must endure the most traumatizing form of
transcultural contact that exists, being thrust, physically and socially defenseless,
into the midst of a hostile and powerful other. This is a reality that does not just
go away or fade into the past, nor is it something that can be easily adjusted to. It
is a reality that cannot be filtered through the comforting lens of historical scripts
and past experience, but must be lived on an immediate level, through the senses
and through the body. The illness stories in the present study told of flight, fear,
pain, and culture-loss writ large in immediate bodily experience. Their movement
was a pain that moved through them, their loss of freedom was their inability to
draw a deep breath, and even their blood was invisible to those around them. These
stories were simultaneously moral commentaries, attempts at resistance and cries
for help. The challenge is to interpret these stories as the ongoing creations that
they are; the reality is that the exigencies of providing care to refugees gives priority to biomedical hegemony in reading the stories that the refugees are telling
with their bodies and words.
From a medical perspective, many of the refugees in the present study were
somatizers; people with multiple physical complaints in the absence of objectively verifiable disease. This, in fact, was the self-identified challenge of those
who wanted to treat them. A biomedical practitioner finds meaning in pain through
the identification of organic dysfunction, the absence of which indicates the alternative label of somatization, a condition notoriously impervious to treatment,
and quite commonly diagnosed among refugees in general (De Girolamo 1994;
Harding et al. 1980; Orley 1994; Peltzer 1999). From their own perspective, on the
other hand, the illnesses experienced by these particular refugees articulated the
social and emotional breakdown they were suffering, experienced through the lens
of their culturally-constituted notions of self. To ignore the meanings they attribute
to their illnesses is to ignore the illness itself, and this meaningless treatment will,
and does, generally fail in the long- or short-term, regardless of its absolute effect
on the organism.
Attending to discourse about illness within a particular cultural and social setting reveals illness as part and parcel of the symbolic structure and social life
of a community (Foucault 1975, 1977; Good 1977). Notions of causation, body
metaphors such as the heart and the blood serve as idioms of distress to
describe losses in various life domains (Nichter 1981). Many of the refugees were
literally immobilized by pain, but not just any paina pain that reflects more
than an illness, but a sense of helplessness in a foreign culture that has stolen
away the social and cultural framework supporting the physical body. When the
clinic attendees were asked to describe their symptoms, they did so by situating
these symptoms within the social context that produced them. Nor did the refugees

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somatize to the extent that they allowed their physical pains to speak for them;
they recognized openly that their physical pains were a result of a cultural and social breakdown that affected the lived body as a matter of course. Their symptoms
were part of being a refugee, part of the pain of losing their country, losing their relatives, and living constantly in fear of deportation, public harrassment, or financial
crisis.
While medical anthropologists have been quick to criticize the medical establishments overreliance on reductionistic labels, few, if any, have explored the concept
of refugee somatization as a phenomenon worthy of an interpretive study in and
of itself. Refugees from different backgrounds are certainly not culturally homogenous; however, the experiences of disruption, loss and fear articulated by those in
the present study would undoubtedly evoke a visceral recognition in anyone who
had been forcibly uprooted from his/her home by war, and forced to lived in a
hostile environment, faced with an uncertain future. Sure, they all somatize, but
in this body talk is there a deeper level of analysis, a common ground in which
the role of the body becomes, for a time, explicit in a way that would never be
seen in a society that remained more securely tied to its institutions, history, and
geography?
By exploring the embodied nature of narrative, and the narratives of the ill body,
the present study attempts to answer this question for at least one refugee population. What made the results so intriguing was not that the refugees considered
themselves to be ill on many levels, and expressed this distress largely through
medium of the body, but the way in which their embodied pain constituted a narrative in its own right. It is no wonder that their physicians became frustrated in trying
to treat pains that shifted and travelled through time and somatic spacemedical
reality has no way to interpret such pain, and so it becomes reified as somatization
or depression. On the other hand, by reading these pains as stories, by paying
attention to the use of metaphors both in speech and in embodied experience, one
becomes privy to history-making in progress (Ferreira 1998). Refugees are living
chaos narratives such as those described by Becker (1997) and Frank (1995).
However, in the case of refugees it is not the ill physical body that must recreate
itself, but society that is thrust into chaos. Refugee illness narratives have much
to tell us about the process of coping with the loss of society that is unique to the
refugee experience. As they emplot their stories with their bodies and their words,
refugees are actively reconstructing their stories and helping to shape an uncertain
present and future (Becker 1997).
Allan Young and others have recently argued for a more nuanced analysis of
pain and suffering (Das 1997; Young 1997). Pain, in this analysis, needs to be
listened to not just for what it communicates about the state of the physical body,
but what it communicates about the social and moral realms as well. Through their
embodied metaphors and illness talk, the southern Sudanese refugees in Cairo are

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communicating a message about the existential crisis in which their community is


embroiled. They have literally lost their country, their society, and their traditions.
They are physically constricted on all sides. Their cultural practices are lost to
them, they fear the total annihilation of their identity as southern Sudanese, an
identity which is partially constructed through the very situation in which they
find themselvesthat is, attacked and marginalized by virtue of their skin color,
religion, and place of originbut which is informed by strong ties to cultural
practices and the place from which they have been violently separated. Sickness,
according to Frankenberg (1986), is a cultural performance, lending itself to an
understanding of illness that is not limited to the individual or biological realms.
This is a sickness, they are saying. You have no sickness, is what they are
hearing from medical practitioners and others who reduce their physical complaints
to organic processes or psychiatric entities like depression or posttraumatic
stress disorder (see Watters 2001 for a complete review of the PTSD debate
within refugee mental health).
Please tell our story to those outside, in America and elsewhere in the West,
said many of my informants when I asked for their cooperation to participate in this
study. In Palestine, one person dies and everybody hears about it, but thousands
of southern Sudanese die and nobody pays attention. The goal of this paper was
to tell this story of sickness, loss, and fear of death (social, cultural, and physical),
using the very metaphors and idioms with which the people involved understand
their pain. By listening to these metaphors and discourses, one comes to understand
that the integrity of the individual, or the individual body, is highly contextual and
dependent upon the integrity of the culture and community that is under assault.
Recovery, or relief, is vested in refugees faint hopes of returning to their place of
origin and putting back together what they have lost.
ACKNOWLEDGMENTS

I thank the staff of the Joint Relief Ministry of All Saints Cathedral, Cairo,
Egypt, for providing access and support throughout this project. I also thank
Ms. Regina Poni Jacob and Mr. James Wani-Kana Lino Lejukole, who collected and translated most of the data for the present project, and were invaluable
in helping me to understand the situation of Sudanese refugees in Cairo. This
project was funded by The Social Research Center of the American University in
Cairo.
NOTES

1. Egypt is also a signatory to the 1969 OAU convention, which would give refugee status
to almost all refugees from the Sudan. However, in Egypt UNHCR takes responsibility

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for asylum determination, and does not (for unknown reasons) apply the criteria of this
convention.
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Department of Sociology, Anthropology, Psychology and Egyptology


The American University in Cairo
113 Sharia Kasr el Aini
P.O. Box 2511
Cairo, Egypt
e-mail: emcoker@aucegypt.edu