Saturday, March 14, 2015

Psychosocial Problems of Child Soldiers


Professor Daya Somasundaram / Dr Ruwan M Jayatunge 
Using children in armed conflicts has been reported in many countries around the world.  Various rebel groups, and occasionally states, in Africa, Asia and Latin America exploit children in their armed conflicts. It is estimated that some 300,000 children – boys and girls under the age of 18 – are today involved in more than 30 conflicts worldwide (Global Report on Child Soldiers 2001). Often these children are kidnaped from their parents and indoctrinated, given brief training and along with the adult rebel carders, sent to fight with the fully trained, fully equipped government forces.  

Many child solders get killed in the war. Those who survive suffer deep physical and psychological traumas. These traumas affect their social and cognitive development.  When the war ends, they are released or they escape, the children often try to reunite with their families when possible. Some go through a process of demobilization and rehabilitation. Despite re-education, rehabilitation and social integration processes, a large number of child solders continue to suffer from the adverse effects of war. 
Despite the adoption of the Convention on the Rights of the Child (CRC) by the General Assembly of the United Nations in 1989, war is an adult male preoccupation that exploits children.  The phenomena of child soldiers can be found manifesting in situations of horizontal inequalities between groups with clearly defined cultural or ethnic identities. Social instability that can lead to violent conflict grows out of severe inequalities in political, economic and social dimensions between groups.  Ethnic and cultural deprivations can then become powerful mobilizing agents. 

The weaker and less resourced rebel forces, but at times, even states, can resort to using children as soldiers. Often in situations of manpower shortage, where adult fighters have been killed, or not willing or available, leaders in the weaker party may turn to women andchildren in asymmetrical warfare .  The proliferation of modern weaponry which allows even children to handle them with ease (The AK 47or T 56  assault rifles or small landmines are so light and easy to handle that children can be easily trained in their use), and of the arm traders in ensuring their supply is also crucial in this complex equation. A huge economic profit from the arms trade, the manufacture and route of supply often involves the international community. Further, the level of the conflict has reached considerable sophistication. Training and arms are from various developed countries. Children on the frontlines become the pawns in adult male games. 

The conscription of children is a form of physical, emotional and moral abuse, more so in the case of “suicide by proxy” (De Silva, 1998). However, it may not be enough to just merely condemn or prohibit the recruitment of children, but to ask the deeper question, “Why dochildren join”? It is as important to understand the context, particularly the systemic factors under which children become soldiers and work to improve these conditions if we are to effectively prevent it.  At the same time, better understanding of these causal factors and the condition of the child soldiers, would lead to designing a more comprehensive and effective demobilization, rehabilitation and reintegration (back with their families and community)  programme for them. The underlying socio-political, economical and psychological factors that compel childrento fight can be quite complex. They can be divided into push and pull factors. The use of push-pull categorization has been used in relation tochild labour by the International Labour Organization’s International Programme on the Elimination of Child Labour  and more specificallychild soldiers .

In war and violent conflict, children are  traumatized by such common experiences as frequent shelling, bombing, helicopter strafing, round-ups, cordon-off and search operations, deaths, injury, destruction, mass arrests, detention, shootings, grenade explosions and landmines.   Studies focusing on children in war situations for example in Mozambique (Richman et al, 1988) and Philippines (CRC, 1986)  report considerable psychological sequelae.   

The impact of the war on their growing minds, and the resulting traumatization and brutalization will be decisive in making them more likely to become child soldiers. In addition to the direct effects on children, war also results in collective trauma at the family and community levels. There is a breakdown of family and community processes, support structures and networks, ethical and moral values, cohesion and purpose. In this uncertain, insecure and hopeless environment, children are more likely to look for alternate opportunities, follow alluring possibilities and be compelled to make unwholesome choices. Brutalization resulting from growing up with violence, impunity and injustice with vulnerability, fear for their safety and real threats would motivate them to protect themselves (and in their imagination, their families and community) with arms and training.  

Many families that are displaced, without incomes, jobs and food may encourage one of their children to join so that at least they have something to eat. There is a higher incidence of malnutrition and ill health in the war torn areas. Allocation and distribution of health care facilities (staff, drugs, equipment) to some areas may be markedly disproportional. Education and schools  become disorganized. There are often real or perceived inequalities in opportunities for and access to further education, sports, foreign scholarships or jobs for some groups compared to other more privileged groups. For the more conscious and concerned children, seeing or experiencing these deprivations for their family and community would push them into joining an armed resistance group. 

Sociocultural factors
Another potent push factor is oppressive social practices where the lower classes and castes are suppressed by the higher, who hold power and authority. For many from the lower classes, joining then becomes a way out of this oppressive system. Similarly, for younger females who experience the patriarchal oppression against their sex, it is a means of escape and `liberation'.

Pull factors
Children because of their age, immaturity, curiosity and love for adventure are susceptible to 'Pied Piper" enticement through a variety of psychological methods. Public displays of war paraphernalia, funerals and posters of fallen heroes; speeches and videos, particularly in schools; heroic, melodious songs and stories, drawing out feelings of patriotism and creating a martyr cult  create a compelling milieu. Severe restrictions on leaving areas create a feeling of entrapment as well as ensure that there is a continuing source of recruits. Military type training instill a military thinking. 

In war and violent circumstances, sociocultural  and religious leaders and institutions  do not protect or protest against child recruitment. The actions of the State in using indiscriminate violence such as heavy firepower, shooting,  bombing, shelling, detention and torture against a community is a powerful motivating factor. 

Psychological Consequences
Apart from death and  injury, the recruitment of children becomes even more abhorrent when one sees the psychological consequences. In those that came for treatment, we found a whole spectrum of conditions from neurotic conditions like somatization, depression, PTSD to more severe reactive psychosis and Malignant PTSD, which leaves them as complete psychological and social wrecks.

 Numerous studies have shown that child soldiers are at high risk of developing PTSD. Okello, Onen, and  Musisiv (2007) found that 27% - 34.9 % of Ugandan child soldiers suffered PTSD.   Kohrt et el. ( 2011) found that 75 of the Nepali child soldiers (52.3%) met the symptom cutoff score for depression, 65 (46.1%) met the score for anxiety 78 (55.3%) met the criteria for PTSD, 55 (39%) met the criteria for general psychological difficulties, and 88 (62.4%) were functionally impaired. A study conducted in Sri Lanka found higher rates of PTSD in childrenthan adults who are conscripted. The emotional consequences for the majority of the children interviewed included sad moods, preoccupations, suicidal thoughts and fears. Most of them experienced loss in relation to the death of members of their family and social status as a result of their actions. This study also found that while all children in Sri Lanka grew up as a generation knowing nothing but war, and being subjected to indoctrination so they would feel hatred against their enemy, the children who were conscripted were from families living in poverty. Children from privileged families either migrated out of the area or would have been released if they were conscripted (de Silva, Hobbs, & Hanks, 2001). 

Garbarino & Kostelny, (1993) suggest that experiences related to political violence and war might constitute a serious risk for the well-functioning family. Most of the child soldiers were separated from their parents for a long period and many have lost the sense of family belongingness. Their family ties are wrecked. These children are separated from their cultural, social and moral identity, and it makes them vulnerable to psychological and social ill effects. Those with PTSD have intrusive memories of the war, flashbacks, emotional arousal, emotional numbing and various other anxiety related symptoms. Many avoid places and conversations related to their past experiences. Somechildren are reluctant to go back to their native villages may be due to shame or guilt.   

Avoidance, as described by the former child soldiers, included actively identifying social situations, physical locations or activities that had triggered an emergence of post-traumatic stress symptoms in the past, and making efforts to avoid them in the future. One of the strongest traumatic re-experience triggers was physical location: some former child soldiers are now avoiding places where they witnessed or participated in violent and inhumane atrocities.
War affects children in all the ways it affects adults, but also in different ways   Combat trauma could affect children in all aspects of their lives causing long term effects that are now termed complex PTSD .  Common symptoms would include affect dysregulation characterized by persistent dysphoria, chronic suicidal preoccupation,  self-injury and explosive anger; dissociative episodes (which in African countries can be in the form of trance or possession states); somatization, memory disturbances, sense of helplessness and hopelessness; isolation and withdrawal, poor relationships, distrust and loss of faith. 

Our observation has been that children are particularly vulnerable during their impressionable formative period, causing permanent scarring of their developing personality. Rebels  have expressed their preference for younger recruits as “they are less likely to question orders from adults and are more likely to be fearless, as they do not appreciate the dangers they face.  Their size and agility makes them ideal for hazardous and clandestine assignments. 
Some of the child soldiers have managed to escape from their country but are still living with past memories of war. A study conducted by Kanagaratnam et. al. (2005) focuses on ideological commitment and posttraumatic stress in a sample of former child soldiers from Sri Lanka living in exile in Norway. Using a sample of 20 former child soldiers the researchers tried to find a correlation between ideological commitment and developing mental health problems. 

Usually female child soldiers face hardships in the war front. Female child soldiers in Uganda, Sierra Leone and in Congo were frequently used as sex slaves and they were repetitively raped by the adult fighters. The LTTE used female child soldiers to commit murders when they attacked endangered villagers. There were groups of female LTTE carders which mainly consisted of underage girls called “Clearance Party”. The Clearance Party advances after the assault group; their main task was to kill the wounded civilians or soldiers by using machetes. As the researcher Hamblen (1999) pointed out Gender appears to be a risk factor for PTSD; several studies suggest girls are more likely than boys to develop PTSD.
Attachment Problems
When the children were forcibly removed from their parents many children experienced separation anxiety. Some developed into full blown symptoms of Separation Anxiety Disorder. These children repeatedly cry, attempt to run away from the captors, they have fear of being alone, and sometimes troubled by nightmares. The senior carders use physical violence and intimidation to train the newly recruited child soldiers. The British Psychologist John Bowlby believed that attachment behaviors are instinctive and will be activated by any conditions that seem to threaten the achievement of proximity, such as separation, insecurity and fear.    

Many ex-child combatants have apathy and poor attachment with their parents. The parents often feel that their child has changed dramatically and he is unable to express love and warmth in return. Some express that there is an invisible wall between parents and thechild.  The child seems to have lost the sense of trust in adults and feels that he has lost his identity as a valuable member of the society. The child becomes oppositional, defiant, and impulsive and parents feel that the child acts as if adults don’t exist in their world and does not look to adults for positive interactions. Some children had created bonds with their abductors during their stay with them and feel that they had better time with the militants than with the parents.    

Moral Development
Children’s moral development can be disrupted by their participation in armed conflicts. Normally children learn to conform to a number of social rules and expectations as they become participants in the culture. Children and adolescents who had been displaced by civil war in Colombia reported expecting that they and others would steal and hurt people despite acknowledging that it would be morally wrong to do so, and many of them, especially adolescents, judged that taking revenge against some groups was justifiable. 

Social learning theorists like Albert Bandura claim that children initially learn how to behave morally through modeling. Many child soldiershad learned their social behavior through adult militants and for a number of years these senior figures were their role models. They had learned that aggression and violence were acceptable behaviors and killing the enemy was a correct. They were constantly taught that kindness, compassion and forgiveness were  signs of weakness.  The senior members of the rebel forces did killings and torture in front of thechildren for them to observe and learn. According to Bandura’s postulation, individuals acquire aggressive responses using the same mechanism that they do for other complex forms of social behavior: direct experience or the observation-modeling of others.  For a number of years violence had become a way of life for these children. For years they believed that violence was a legitimate means of achieving one's aims and it was an accepted form of behavior. They find it difficult to disengage from violent thoughts and have a transition to a non-violent lifestyle. 

Participation in war and indoctrination into the ideologies of hatred and violence leaves children’s moral sensibilities distorted. Children may hand over their guns, but they cannot so easily abandon the violent ways of thinking in which they have been trained. Part of demobilization is enabling the child to move away from violence and into a more inclusive and constructive way of life. The inclusion of peace education in curricula facilitates this process.

Cognitive Development 
Recruiting children for military purposes and exposing them to combat lead to problems in their cognitive development. When children are indoctrinated and forced to perform acts like killings, destructions and torture their cognitive schemas take a pathological shift. Their problem solving skills are diminished and logical thinking is suppressed by the ideology. They are taught to react instead of thinking. They just obey orders from the senior militants and act like perfect killing machines. The time they spend in training and hiding in jungles, doing bunker duty and participating in various attacks, seriously limit them for fruitful learning opportunities. 

The Russian Psychologist Lev Vagotsky’s sociocultural theory emphasizes the role in development of cooperative dialogues between childrenand more knowledgeable members of the society. The recruitment and military usage of children limit their associating with knowledgeable members of society like teachers, clergy and other community leaders. There were no educational or intellectual stimulations for the childsoldiers. Vagotsky  expressed that children learn the culture of their community through these interactions. For child soldiers these interactions became restricted and their universe is limited to combat and violence. These children were deprived of cultural tools with limited time to read or write. Their vocabulary mostly consisted of war and violence based terms. Demobilized children have limited vocabulary and language skills. Children who enter with limited vocabulary knowledge develop more slowly over time than their peers who have rich vocabulary knowledge. It has been reported that many young child soldiers were unable to perform cognitive tasks like reading comprehension or to solve mathematical word problems during their stay with the rebels. Although many child soldiers wore wristwatches pompously, they were unable to read time.

Learning Difficulties 
When rehabilitated, child soldiers go back to school once again. They have been away from the school environment for many years.  Their cognitive and leaning skills were adversely affected by the war at a significant level.  Despite all these odds the children struggle to study and learn new social skills. The memories of war have not left them completely. Children proved most susceptible to anxiety and emotional problems. Teachers have observed a wide range of learning problems in former child soldiers. They had missed a vast amount of teachable moments by the mentors and unfortunately had spent crucial time with rebels. Instead of reading, writing and doing math they were taught how to shoot and kill.     

Some children have attention problems. Memory difficulties may be due to psychological distress that they experience. They continue to struggle with learning in the classrooms. In some schools peer rejection was recorded following their past history of war experience. The communities have not fully accepted the former child combatants.  When facing social rejection former child soldiers experience embarrassment, confusion, and humiliation and it could go hand in hand with falling behind their peers in school. Some are poorly motivated and show anger and frustration at school. The affected children are becoming withdrawn, shy, anxious, and helpless with a devalued sense of personal worth and lower personal expectations. 

Experts believe that education is a form of powerful social integration and rehabilitative apparatus. Therefore education is the way out for most of these war victims. However, further research has found that although the majority of children greatly benefit from access to education, some former child soldiers are not interested in continuing their education.

Appropriate help, including coaching in learning strategies or treatment should be offered to the   ex-child combatants with learning difficulties. Educational bridging  programs work well in these settings, as they enable returning children to achieve some basic literacy and primary level competencies in a relatively short time. Bridge programs effectively create a base from which the child can move to other learning options. In most cases, children proceed to vocational education. Vocational training exists to help children gain skills in agriculture, animal husbandry, baking, carpentry, crafting, masonry, mechanics, tailoring and a variety of other trades.

Behavioral Problems
Former child soldiers exposed to brutal episodes of war-related violence face a range of behavioral problems. In addition, post-conflict factors may contribute to varying degrees of vulnerability to adverse behavioral outcomes. According to Lev Vygotsky   the child’s culture and community that he lives in largely affects his development. Vygotsky believed that important learning by the child occurs through social interaction.  

For a number of years child soldiers spend time with adult militants under strict rules and regulations. The children were constantly exposed to hostile situations that had negative impact on their psychosocial wellbeing. The children’s thinking pattern and cognitive schemas changed in to more aggressive and violent direction. The children were indoctrinated to perform atrocities without asking questions. They witnessed the gloomy realties of war that made drastic changes in their behavior.  The children who had committed atrocities in the past have high risk of developing conduct disorders or anti-social personality disorder and addiction problems if their mental health issues are not appropriately addressed.  

In Nepal, Kohrt and his team in 2008 concluded that post-conflict factors such as stigma might contribute to adverse mental health outcomes. Former child soldiers in his sample showed significantly higher symptoms of depression and PTSD compared to matched controls even after adjusting for exposure to traumatic events. In 2010 the researcher Betancourt  did a prospective study to investigate psychosocial adjustment in male and female former child soldiers in Sierra Leone using 156 male and female child soldiers. Over the 2-year period of follow-up, youth who had wounded or killed others during the war demonstrated increases in hostility.   It has been reported that former child soldiers in Uganda had various behavioral problems and some of them were charged with anti-social activity after their demobilization. Over 70% of prisoners in the juvenile crime unit in the Gulu District, Uganda are former child soldiers, incarcerated on charges of rape, assault and theft.

Social relationships play a key role in child’s behavior as explained by the Psychologist Urie Bronfenbrenner. Nested interacting spheres of social relationships that determine individual behavior and well-being are the fundamental components of analysis in social ecology. When these children were abducted and kept in camps, they had no way of having healthy social relationships.  

Child Soldiers and Problems of Reintegration in to Society 
Reintegration of the ex-child soldiers could be challenging. Child soldiers often face psychological and social problems. It has been reported that sometimes their community members ostracize these children fearing their war time activities. Some of these children had killed or tortured their relatives. These factors hinder the child soldiers reintegrating back into society and living meaningful and productive lives.   

A number of studies done in Asian, African and Latin American countries show that reintegration of ex-child soldiers face similar challenges. In some countries the conflicts still prevail and liberated child solders still have impending threats such as recapture by the rebels, persecution by the authorities and attempts to harm them by the members of their community for past atrocities.  

The Coordinators of Save the Children, Gulu Uganda, found that three months after the rescue of 300 ex-child soldiers in 2004-2005, none were found residing in the community in which they were supposed to have been reintegrated.  It should be stressed that it is those responsible for the recruitment, training and deployment of child soldiers who should be charged as war criminals, not the child soldiers themselves who surrender or are captured. They should not be treated as criminals or juvenile delinquents, but offered appropriate psychological, socio-economic and educational opportunities for rehabilitation. Successful reintegration of child soldiers into society had been reported in many countries around the world.

Angola’s demobilization exercise, which lasted from 1995 to 1997, was one of the most extensive in the history of the United Nations. It was perhaps the first time that children were specifically included in a peace process. While not explicit in the 1994 Lusaka Protocol, their demobilization and reintegration was declared a priority in the first resolution adopted by the commission set up to implement the peace agreement. Partnerships among local civil society networks made it possible for many children to return to their homes. 

One longitudinal study documented that post-conflict experiences such as family support and economic opportunity played a role in the mental health of 39 Mozambican males re-interviewed 16 years after reintegration. Post conflict rehabilitation is crucial to the ex- child combatants. The society should be empathetic and create a healthy environment to these traumatized children to recuperate and reintegrate into society as productive members. The researcher   Betancourt is of the view that former child soldiers’ acute war experiences have long-term consequences, but the nature and extent of these consequences are influenced by post-conflict risk and protective factors.  

Many experts have highlighted that reintegration of child soldiers should emphasize three components: family reunification, psychosocialsupport and education, and economic opportunity.

Professor Daya Somasundaram 

Daya Somasundaram is a senior professor of psychiatry at the Faculty of Medicine, University of Jaffna, and a consultant psychiatrist working in northern Sri Lanka for over two decades. He has also worked in Cambodia for two years in a community mental health programme with the Transcultural Psychosocial Organisation. Apart from teaching and training a variety of health staff and community-level workers, his research and publications have mainly concentrated on the psychological effects of disasters, both man-made wars and natural tsunami, and the treatment of such effects. His book Scarred Minds: The Psychological Impact of War on Sri Lankan Tamils describes the psychological effects of war on individuals. He has co-authored The Broken Palmyra: The Tamil Crisis in Sri Lanka: An Inside Account.

Somasundaram received the Commonwealth Scholarship in 1988 and the fellowship of the Institute of International Education’s Scholars Rescue Fund in 2006–07. He is a fellow of the Royal College of Psychiatrists, Royal Australian and New Zealand College of Psychiatrists and Sri Lanka College of Psychiatrists. He has functioned as co-chair of the subcommittee on PTSD formed under the WHO working group on stress-related disorders during the ICD-11 revision process. Currently on an extended sabbatical in Australia, he is working as a consultant psychiatrist at Glenside Hospital, supporting Survivors of Torture and Trauma Assistance and Rehabilitation Service (STTARS), and is a clinical associate professor at the University of Adelaide.

1 comment:

  1. The concept of child soldering in our country has been invariably associated with the LTTE probably because there is enough evidence in the forms of photographs, videos etc.But people should remember that many and enough children had participated in the violent acts launched by the JVP during 88/88 period.Interestingly some of them are even celebrated as martyrs even today, but are conveniently excluded from the category of child soldiers which sound derogatory-as least it does not paint a positive picture of the movement who involved them.Typical Sri Lankan Hypocrisy?.Thanks Doc.Ruwan for writing this bold & eye opening article..


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