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The woman, now aged 18, came here from Africa and is now in a residential care unit 
A vulnerable young woman who came here from Africa as a teenager and spent about two years in direct provision has been so traumatised she still refuses to sleep in a bed, the president of the High Court has heard. 
Her complex disorder involved intense fasting over three years, apparently for religious reasons, resulting in “alarming” weight loss requiring her to be tube fed at stages, while excessively lengthy periods standing up have resulted in her being treated for leg problems. 
A psychiatrist said the woman, now aged 18, may have suffered trauma as a result of being physically abused by extended family members in her home country and possibly on her journey to Ireland. She came here from Africa in 2015 with her mother and brother, who were not involved in the abuse, and lived with them in direct provision until she was hospitalised and made a ward of court in early 2017 due to serious concerns about her physical and mental health. 
She has been 18 months in a residential care unit where she has received therapies for what a child psychiatrist described on Thursday as a “complex” disorder difficult to categorise but involving trauma, behavioural and emotional issues. 
“Her life has been very difficult, she was treated badly by people close to her and has had trauma, loss and uncertainty,” the doctor said. She developed some unhelpful but understandable behaviours in response, “does not fit neatly into a box” and her care involved “thinking outside the box”. 
Some progress has been made, including she will sleep sitting on a chair, is not fasting to the extent she had previously and has engaged with professionals, including her key worker and the psychiatrist, who was praised by Mr Justice Peter Kelly for the care and attention she has shown. 
The case was before the judge on Thursday to consider future care as the woman is now an adult ward of court, having just turned 18. The judge approved a care plan which involves responsibility for the woman’s psychiatric treatment been transferred to an adult mental health services unit. 
The plan, depending on the woman’s progress, is ultimately aimed at her living independently in her own apartment in the community with supports. 
Care unit 
Her mother remains in direct provision while her brother lives independently. Both are supportive of the woman but she has said she does not wish to live with them. 
The psychiatrist said the woman regards the care unit as a “refuge” and her understandable anxiety about leaving there may have contributed to a recent physical deterioration, including weight loss. It was hoped she would be able within a few weeks to spend occasional nights in her apartment, with staff supports. 
David Leahy BL, representing the woman’s interests, thanked the doctor for providing care based on “thinking outside the box”. 
When Mr Justice Kelly asked whether the view was the woman’s condition would improve, the doctor said the hope was, “down the line”, she will not have to be a ward of court. She is young, her condition is understandable given her experiences and she has skills to function independently but that “will take time”, the doctor said. 
Her life may be limited in some respects but she has some academic ability, enjoys reading and discussing books, could probably take up some type of job and may return to academic education at a later stage. In his ruling, the judge noted the “troubled” and “unusual” background. He also noted tube feeding had had to be re-introduced in recent weeks because the woman had reduced her food intake, although apparently not for religious reasons. 
He made the orders sought, including for the woman’s transfer to her apartment when that is considered appropriate. 
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