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Base de datos de evaluación

Evaluation report

RWA 1998/800: Follow-up Survey of Rwandan Children’s Reactions to War Related Violence from the 1994 Genocide



Author: Gupta, L.

Executive summary

Background

The recent genocide and massacres that occurred in Rwanda between April-July 1994 resulted in unprecedented levels of exposure to violent events, personally witnessed by survivors, as indicated in the findings from the baseline trauma survey of 3,030 children conducted by UNICEF and the Ministry of Rehabilitation and Social Reintegration in 1995. In response to the suffering of Rwandan children in the aftermath of the genocide, UNICEF developed and began implementing the Psychosocial Trauma Recovery Programme in October 1994 in close collaboration with the Ministry of Rehabilitation and the Ministry of Health.

Purpose / Objective

UNICEF undertook this follow-up study of a subset of 327 children who were interviewed in the 1995 baseline trauma survey for the following purposes: first, to assess the severity of psychological distress and grief, reactions two years after children's exposure to the violence in 1994; and second, to identify potential high-risk subgroups of children who may still be suffering from severe symptoms of trauma and/or grief, and may benefit from more intensive therapeutic intervention.

Methodology

This follow-up study focused on children's reactions to the violent events they witnessed during the Rwandan genocide that occurred from April to July 1994, where an estimated 500,000 adults and 300,000 children were brutally massacred using primitive weapons such as machetes and nail studded clubs. The questionnaire that was used for this follow-up study had been piloted and revised in 1995 for the initial baseline trauma survey. The follow-up survey was administered in August 1996-January 1997, approximately two years after the genocide occurred and one year after the baseline survey in 1995. Approximately 670 potential respondents comprised the 1996 follow-up sample list. The final study sample included 327 (49%) participants representing all eleven prefectures in Rwanda.

Key Findings and Conclusions

The findings from this follow-up survey indicate that the majority of children continue to experience high levels of distress related to the violence they witnessed more than two years ago. In fact, many of the children and adolescents interviewed are still experiencing the same levels of avoidance, and higher levels of intrusion and arousal symptoms at 24-29 months after the fighting, as compared to the 1995 baseline data. 81% of the sample reported that they think about the event sometimes or often even when they don't want to, and 63% of the children have waves of strong feelings about the event.

As the data shows, a significant percentage of the children who participated in this study continue to experience intrusive images, sleep disturbances, nightmares, arousal symptoms such as anxiety, fear, nervousness, and irritability as well avoidance behaviors. More than two thirds of the children reported that they sometimes or often feel so sad that they can hardly cope with life and 64% think that life is not worth living. The results of the present study support an accumulating body of evidence that distress levels continue among children and adolescents more than 1 year after war.

The multivariate analysis clearly indicates that sensory exposure, loss of family members, and personal threat are related to the degree of intrusion and arousal symptoms. Living in centers was also associated with higher intrusion and arousal scores, and girls continue to experience higher levels of intrusive memories and thoughts as well as arousal symptoms than the boys more than two years after the violence. In addition to the post-traumatic stress symptoms evidenced in this sample, the majority of children whose family members were killed are also experiencing prolonged grief reactions despite the passage of time.

However, it is important to keep in mind that there are many other mediating variables and potential stressors (i.e. poverty, lack of housing or food) beyond the three exposure variables that may have contributed equally or more to the variance in children's psychological reactions as measured by the IES scores in this follow-up study. Therefore, a more inclusive analysis of additional stressors and mediating variables would provide a clearer understading of children's psychosocial status over time, especially for the vulnerable subgroups (i.e. adolescents, girls, and children living in centers) who may benefit from more intensive emotional support.

Recommendations

Provide operational support in 1998-2,000 to maintain the National Trauma center in Kigali, so it can continue to strengthen national capacity in Rwanda through the training of trainers program and expand the outpatient treatment facilities (there is only 1 clinic room and NTC needs 2 more rooms) to accommodate the steadily increasing numbers of outpatient referrals from the community for severely traumatized children/families who may benefit from more intensive intervention.

Provide support for longitudinal research in 1998, to assess psychosocial functioning at 4 years post-genocide on a random sample of 200 children to increase our understanding of the long-term effects of war-related violence on survivors. Qualitative case studies could be used with survey research methods to learn more about the mediating factors (i.e. poverty, malnutrition and family support) that affect their coping capacities and overall recovery.

Disseminate the findings from this follow-up study to the Rwandan government authorities, the social Ministries, the National Trauma Center, all UN agencies, and local and international implementing non-governmental partners to raise awareness about the psychological status of child survivors.



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Report information

Date:
1998

Region:
ESARO

Country:
Rwanda

Type:
Survey

Theme:
Health - Mental Health

Partners:

PIDB:

Follow Up:

Language:
English

Sequence Number:
1998/800

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