Healing minds as well as bodies
More than 60 per cent of the Rwandan children interviewed said they did not care whether they ever grew up.
Governments, United Nations agencies and non-governmental organizations (NGOs) must integrate the psychological and social needs of war-traumatized children into all aspects of their relief work, says a new United Nations report. Relief workers are increasingly aware that children's psychological and physical well-being are interlinked. The report urges that current psychotherapy approaches to the psychological well-being and development of children affected by armed conflict be integrated with culturally-appropriate concepts and traditions, to promote the long-term recovery of children.
It is essential to re-establish familiar routines of home and community life, "a sense of normalcy says the report written by Graça Machel, the UN Secretary-General's Expert on the Impact of Armed Conflict on Children. In the report she urges the creation of programmes that reflect the cultural values and traditions of the people they are intended to serve, and calls for more participation by local people in the design, implementation and monitoring of aid programmes.
"It is vital that all forms of external help be given in such a way that they enhance people's ability to help themselves," the report says.
For increasing numbers of children living in war-torn nations, childhood has become a waking nightmare. In the last decade, more than 2 million children have been killed during wars, while more than 4 million have survived physical mutilation, and more than 1 million have been orphaned or separated from their families as a result of war.
According to surveys by UNICEF:
A nine-year-old Liberian girl recounted this story to one of Ms. Machel's advisers during a field visit to Sierra Leone: "I saw 10 to 20 people shot, mostly old people who couldn't walk fast. They shot my uncle in the head and killed him. Then they made my father take his brains out and throw them into some water nearby. Then they made my father undress and have an affair with a decaying body. Then they raped my cousin who was a little girl of nine years old."
Such experiences leave emotional, psychological and spiritual scars that may last a lifetime. Even after the conflict is over or they have reached safety, many children remain filled with rage, aggression and guilt. Many Filipino children in the area of Marag, for instance, were convinced that they must have done something bad to make the military drop bombs on their homes. A 13-year-old former Khmer Rouge soldier saw recurrent visions in which the intestines of one of his victims turned into snakes that then began to strangle him.
When civilian populations and infrastructure are targeted during conflict, traditional family and community networks which would normally give comfort and emotional support to children in crisis are also fragmented or destroyed. Parents in the tide of refugees pushed into camps are stripped of their capacity to shelter and protect their children. In crisis situations, young women and mothers without protection are frequently raped or forced to trade sex for food, while fathers accustomed to farming and supporting their families stand in line for hand-outs, humiliated and powerless to help themselves or their children. The impact of traumatic events on children is inseparable from the impact on their families and communities: adults must also be healed if there is to be much hope of dealing with the emotional pain of their children.
The sheer magnitude of psychosocial distress among children from different language and cultural backgrounds rules out the possibility of uniform textbook approaches. The report questions the value of costly, individualized trauma therapy in residential treatment centres, which in some cases may damage children. The report warns against in-depth clinical interviews conducted without ongoing support for follow-up: the "most important factor contributing to a child's resilience is the opportunity for expression, attachment and trust that comes from a stable, caring and nurturing relationship with adults". It is crucial, the report adds, to assist parents and teachers to communicate with children on difficult issues.
In cultures which make few distinctions between body, mind and self, and in which spirits and ancestors are perceived to play an active role, those who wish to help with healing in such societies must understand the local culture, including ceremonies related to growing up, death and mourning.
In one African country, a girl who at the age of 10 was forced to witness her mother's gang-rape and murder, and who was herself forced to serve for two years as a concubine for rebel soldiers, underwent a traditional ritual to cleanse her of all that had befallen her. The ceremony also made her potentially marriageable.
The report warns that journalists or researchers should not encourage children to relate "horror stories" for media purposes. Children's traumatic experiences must be treated ethically and confidentially.
Despite the daunting level of damage done to children, much can be accomplished even with limited resources. In Rwanda, 70,000 people have participated in singing, dancing, drama and writing projects organized by international NGOs to express and ease the pain of their memories. And in the Philippines, some traumatized young people have been trained to help care for younger children as junior facilitators" who are able to establish rapport more quickly than adults, and who can also therapeutically share their own experiences of war.
Even the re-establishment of daily routines such as food preparation, laundry, gardening and going to school foster a sense of purpose, self-esteem and identity, the report says. It is not impossible to rebuild a sense of community: in Angola, for example, traditional chiefs provided orphaned teenagers with land and supplies while experienced builders helped them to construct their own homes. Aid workers must include women in decision-making about the design, delivery and evaluation of initiatives. Without women's participation, children are at greater risk.