Life and Death Bringing Child Soldiers Whole Again
[ Autumn 2011 ]
Today, among the 87 war-torn countries in which data have been gathered, 300,000–500,000 children are involved with fighting forces as child soldiers.
Some, as immature as seven, commit unspeakable atrocities: killing parents and siblings, assaulting neighbors, torching the villages they in one case called abode. Some are forced to serve as sex slaves. Many are injected with drugs to curb their inhibitions against committing violence.
Once the killing ends, peace treaties are signed and emergency humanitarian missions pull out. Simply these children's sorrows persist.
Theresa Betancourt has made it her mission to understand how to promote their resilience—and ultimately, their healing.
From Child Soldier to Productive Citizen
Betancourt, ScD '03, directs the Research Plan on Children and Global Adversity at the François-Xavier Bagnoud Heart for Health and Human Rights at Harvard School of Public Wellness. For nine years, she has tracked the emotional fate of old child soldiers and explored how—and if—this war-scarred cohort can keep to pb meaningful and productive lives.
Using both surveys and one-on-one interviews, Betancourt has painted a psychic portrait of young people—coolly referred to in the academic literature as "children formerly associated with armed forces and armed groups"—who struggle to detect a place in tattered postwar societies. She is now adapting and testing group interventions for troubled youth in Sierra Leone that take proven successful in other places riven by violence.
Dust Cloud—or Lasting Care
"We need to devise lasting systems of intendance, instead of leaving backside a dust cloud that disappears when the humanitarian actors leave," says Betancourt, who is also an assistant professor in the Department of Global Health and Population.
In Sierra Leone, help quickly evaporated after the African country's crisis was no longer in the news. Today, Sierra Leone ranks 11th from the bottom on the United nations Human Development Index of 169 nations. Its district wellness officers are justifiably preoccupied with loftier rates of maternal and baby mortality. The country has one psychiatrist—who practices in the upper-case letter, Freetown, and is soon to retire.
Betancourt's research seeks to bear witness how former child soldiers and other state of war-afflicted youth may be helped, despite such express resources, to become contributing members of society as adults. She has disseminated her findings to hundreds of professionals from local and international NGOs and UN agencies working with Sierra Leone'south former child soldiers.
She hopes that one 24-hour interval these accomplishments tin can be bolstered by a broader continuum of intendance—one that extends from everyday citizens who requite troubled kids encouragement and guidance to frontline community health workers to psychologists and psychiatrists, who can manage cases needing a higher level of services. In an platonic globe, grassroots mental wellness services would offering a place for sufferers to tell their stories, talk almost their dreams and ambitions, and develop trusting relationships.
"The postconflict environment is where things break downwards, but also where nosotros can assistance," she says. "We don't have time to waste."
From Alaska to Africa
Tragedy told by the numbers
Child recruits in the Sierra Leone civil state of war interviewed by Theresa Betancourt's enquiry team had been severely traumatized by their experiences:
70% had witnessed beatings or torture.
63% had witnessed fierce death.
77% saw stabbings, chopping, and shooting close-up.
62% had been beaten past armed forces.
52% witnessed large-scale massacres.
39% had been regularly forced to have drugs such as marijuana and cocaine.
45% of girls and five pct of boys had been raped past their captors.
27% had killed or injured others during the state of war.
Betancourt'south path to Sierra Leone began in the Alaskan permafrost. She was born in a Native hospital in Bethel, a town almost the state's west coast that then numbered almost three,000. Her parents, both Caucasian, imbued the family unit with a passion for other cultures. Her begetter was a math and scientific discipline teacher who had joined the Peace Corps in the early 1960s, stationed in Ethiopia. Her mother worked in remote villages for the federal baby learning program.
In Bethel, where the majority of residents were Yup'ik, Betancourt acquired both an insider and outsider perspective. "My friends were Yup'ik. I had Yup'ik baby sitters. I spoke Yup'ik. We were outside the dominant culture—merely we needed to understand that civilization in order to alive well."
Her father's passion for Federal democratic republic of ethiopia never waned. When friends came over for dinner, he would haul out his slide projector and display pictures from his Peace Corps days. "We were in small-boondocks Alaska permafrost," Betancourt says, "but we always knew what Africa looked like."
Initially trained every bit a advisor using expressive arts in therapy with children, Betancourt started focusing in 1995 on children afflicted by war. First with the United nations Office of the Loftier Commissioner for Human Rights, then with the International Rescue Commission (IRC), a New York-based humanitarian organisation, she worked with young refugees in Republic of albania, Chechnya, and the Eritrea-Ethiopia border, organizing emergency teaching programs and eventually research initiatives.
In 2002, at the end of a bloody 11-year civil state of war, Betancourt made her initial trip to Sierra Leone to work with the boys and girls at that place. "The beginning time I met with former child soldiers, what struck me was that they looked actually little, really immature. They told me they were 13 and fourteen, only they looked viii. They were malnourished and wearing tattered clothes.
I couldn't fathom what they had seen."
Betancourt has now been tracking more than than 500 erstwhile child soldiers, many of whom are growing into adulthood and starting their ain families. Her master questions: What helps young people suffer this feel and still thrive? What qualities of the private, the family, and the environment shape resilience? How tin effective interventions, resonant with the local culture, be delivered by community members who receive special training and routine supervision?
Groundbreaking Research Tells the Story
Betancourt believes both numbers and words are needed to take the measure of a child soldier's trauma. As a issue, she relies on both quantitative and qualitative methods in her research efforts. In her longitudinal study, she uses a detailed questionnaire to elicit the boys' and girls' war and postconflict experiences. Her local staff conduct in-depth qualitative interviews of the children and their caregivers, forth with focus groups in the customs.
Much of the existing scholarship on intergenerational relationships in state of war-exposed populations is based on the experiences of Holocaust survivors. Betancourt'due south piece of work is, therefore, groundbreaking. Her 9-year project following male and female child soldiers in Sierra Leone is Africa's first such prospective study.
And a 2007 study that Betancourt co-authored was ane of the first randomized controlled trials of mental health interventions among African adolescents afflicted by war—and one of only a handful of trials of psychological treatments for low conducted in a developing country. Among other things, she has shown that effective treatments—and clinical trials of these treatments—are viable in poor, rural, illiterate, war-torn communities.
A Vicious Circle
In Sierra Leone and elsewhere, one-time child soldiers suffer nightmares, intense sadness, intrusive thoughts, and recurring vehement images. Not surprisingly, those who committed extreme acts of violence, or were its victims, tend to suffer the most persistent mental health bug and demand the virtually intensive care.
Often, these children take difficulty with community relationships after their release. They struggle with guilt and shame. They are labeled as different or untrustworthy, which, in a vicious circle, deepens their sense of isolation. In their habitation communities, they are blamed for having destroyed lives, homes, holding, and lodge itself. Those who are socially isolated are especially vulnerable to addictions and abusive relationships.
Girls face a compound brunt. They are more than probable to suffer depression, feet, and post-traumatic stress disorder, compared with boys. Some have returned to their communities having had unwanted pregnancies during their times with insubordinate groups. At dwelling, they face the double stigma of having participated in violence and being seen as "impure," regardless of their war experiences.
Hundreds Taught to Work with Old Child Soldiers
HSPH Fellowships
En route to earning her doctorate in 2003 at HSPH, Theresa Betancourt received crucial financial help. In 1998 and 1999, she was awarded a Taplin Fellowship, which paid her expenses. In 1998, she held a Saltonstall Fellowship at the Harvard Centre for Population and Development Studies, which helped launch her field inquiry on the Chechnya conflict. In 2008 and 2009, she received the Julie Henry Junior Faculty Development Accolade, which supported Betancourt'south Family Strengthening Intervention projection in Rwanda, a airplane pilot study to bolster resilience and preclude mental health bug among children in postgenocide Rwanda whose families are affected by HIV/AIDS; the research led to a National Establish of Mental Health grant.
To grapple with these problems, Betancourt and her colleagues have looked to existing bear witness-based mental wellness interventions that aid violence-affected youth manage their emotions and build interpersonal skills. The goal is to forge connections to families and communities, and give children the
wherewithal to negotiate the adversities they oft encounter. Ideally, such approaches are linked to educational and job programs that restore civilian roles—since returning to school or securing a livelihood are prime sources of confidence and motivation in the children.
Betancourt emphasizes that direct, sustained treatment of state of war-affected children is the task of local partners. "I like to stay put in a place, develop relationships, and keep working at things over time," she says. Despite the oppressive content of her work, she is neither dour nor drawn to philosophical discussions about the nature of practiced and evil. Equally she puts it, "I'yard very pragmatic." Married to a md specializing in health inequities, and the female parent of two immature children, she has a noticeable lightness of spirit.
Distress Has a Local Significant
Betancourt is planning pilot studies that use components of cognitive behavioral therapy and an approach known as group interpersonal psychotherapy that has proved successful in relieving depression among children—some old soldiers, some not—crowded in refugee camps in embattled northern Uganda. Grouping interpersonal therapy is based on the idea that the roots of depression, and the mechanisms for healing it, lie in people's relationships with others. Immature people who have all experienced the same ordeal tin can share support, wisdom, and agreement.
In Betancourt's intervention, war-afflicted young people learn that they are not lone in their experiences and emotions.
"The key is existence able to put a word to their feelings: sadness, worthlessness, hopelessness, loss of free energy, the sense that life is non worth living," she says. "We spend a lot of time trying to learn local terms for emotional suffering. Once intervention and problem solving begins, these young people no longer feel lone. Their symptoms kickoff to elevator."
Betancourt and her team phone call their pilot model the Youth Readiness Intervention, because information technology builds readiness to succeed in disquisitional aspects of life such as personal relationships, taking care of one's self, planning for the time to come, and achieving economic self-sufficiency. Meeting weekly for two months, the participants focus on the present: setting goals, curbing high-take a chance behaviors and substance use, reducing trauma-related distress, and boosting community involvement.
Complementing African Programs and Traditions
A Recipe for resilience
Former child soldiers are not a monolithic population of the emotionally wrecked. "When people recall of child soldiers, they think of people who are terribly damaged in some way," Theresa Betancourt says. "But I've seen very much the opposite: tremendous stories of resilience, of credence, of love in families."
In her view, resilience springs from a complex ecology of individual traits and social forces. "In i sense, any child who fabricated it through the war alive likely adult survival strategies to navigate a harsh and dangerous environs. Some of these young people, especially those who survived abuse, possess a sense of resourcefulness, which shows upwardly in confidence and a sense that they tin can command their fate."
Some other stiff cistron in resilience is family connectedness. When parents openly cover their sons and daughters and bring them back into the fold, it non only sustains the child but too sends a signal to the larger community that the male child or girl is worthy of credence and care. Going to school, doing homework, and graduating besides foster a sense of normalcy and regaining lost time.
How the wider culture draws meaning from the state of war and its aftermath also influences the fate of one-time kid soldiers. During the postwar, regime-led process, which has included sanctioned forgiveness and community sensitization campaigns, many immature people received the explicit message that their involvement in the state'south atrocities was not their error.
"The groups fit well in collectivist cultures such as in Uganda or Sierra Leone," says Betancourt. "In northern Uganda, we saw very strong effects in girls, more than so than in boys. That may be because in these crowded camps—where girls had a lot of responsibilities caring for people, cooking, gathering firewood, fetching water—they didn't take much in the way of supportive social contacts before meeting other girls in the aforementioned situation."
Betancourt's locally adapted models as well complement what has been initiated in Sierra Leone and other nations, including "sensitization" campaigns that encourage communities to discuss the disharmonize and the dangers of excluding whatsoever stigmatized grouping. Traditional healing ceremonies—such as ritual washings and collective feasts—can also mark new beginnings for one-time child soldiers.
Such prove-based interventions are far more effective than the once-popular technique in humanitarian assistance known as "psychological debriefing," in which Western practitioners briefly visit state of war zones, behave therapies in which victims talk about their traumatic experiences, then go out.
Co-ordinate to Betancourt, "Flying in and request someone to share their trauma in one or two sessions, without an ongoing, safe therapeutic relationship, can actually do more harm than proficient."
Not a "Lost Generation"
In the aftermath of cluttered civil wars, investments in psychosocial and mental health bug are typically phased out as the problem shifts to a postconflict so a reconstruction stage. "Unfortunately, these children'southward needs exercise not follow a similar phasing-out procedure, especially when they have been ill-addressed at the outset," says Betancourt. "At that place is real difficulty in getting funding for this work. Sierra Leone, in item, is seen equally a 'has been' disharmonize: no longer sexy."
What nearly worries her is that societies will write off former child soldiers every bit a "lost generation." The reverse could be truthful, she contends: The very qualities that helped these children survive a harrowing experience may as well enable them to catalyze change in their shattered homelands.
And while Betancourt'southward research may seem specialized, many of her findings transcend culture. "When someone's a survivor, it means they are all the same here today, despite what they went through," she says. "It would be terrible if people who had been through events like this saw themselves as hopeless or equally victims. A survivor orientation means existence able to feel the strength of what it takes to go far through such horrendous experiences and nevertheless move forrad in life."
Learn More than
Annals to hear Theresa Betancourt speak during our complimentary HUBweek Panel, "Four Global Health Threats, Four Global Health Opportunities"
Madeline Drexler is editor of theReview.
Source: https://www.hsph.harvard.edu/news/magazine/child-soldiers-betancourt/
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