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ADF Health October 2005 - Volume 6 Number 2

Personal view

Fighting for a childhood in Africa

• Louise Newman and Mike O’Connor

It might be late at night, the rebel forces will come into their camps. They will surround . . . the village, they will pull everybody out from the family hut and home. They will beat and kill the parents, then they will forcefully bind the children in rows of ten or twelve and they will march them off at gunpoint while their parents lie bleeding and dying before them. The children are then taken, often over the border into Sudan, where they are trained militarily. You often find that training . . . goes on for about two weeks maximum. They are taught to carry guns, they’re taught to use weapons . . . I’ve met kids who can arm and dismantle an AK47 in 10 minutes but they can’t even read or write. - Melanie Gow, Policy Officer, World Vision 1

War in Africa during the 1980s to mid 1990s resulted in five million excess deaths and an annual economic loss of US$13 billion. 2 By 1995, 35 African countries were at war, involving 550 million people. These countries are all poor, with limited health services and education resources. Every nation in sub-Saharan Africa has either been the victim of war or borders another nation which has been so devastated. 3 Human Rights Watch estimates there are 300 000 children under the age of 18 years participating in armed conflicts in Asia, Europe, South America, the former Soviet Union and Africa. 4 In Cambodia in the 1980s, 20% of wounded soldiers were between the ages of 10 and 14 years, and in the Liberian civil war between 1989 and 1997, children as young as 7 years of age took part in combat. 3

One hundred and twenty thousand child soldiers are located in sub-Saharan Africa. 5 "Commanders see children as cheap, compliant and effective fighters." 6

The scope of the problem

Ten African countries have been identified as most affected by recruitment of children into military forces: Angola, Burundi, Congo-Brazzaville, the Democratic Republic of the Congo, Ethiopia, Liberia, Rwanda, Sierra Leone, Uganda and the Sudan. 7 The Lord’s Resistance Army in northern Uganda is a Sudanese-backed guerrilla force, and 90% of its members are aged between 13 and 16 years. 8 The Box summarises the numbers of children involved in African countries.

Where conflicts have been in progress for many years (for example, more than 30 years in Angola), the supply of adult soldiers may dwindle. This can lead to increased pressure to conscript ever more youthful cohorts of children. 12

Children join government or rebel groups for reasons of economic hardship, loss of family, revenge, or through deliberate coercion. This can involve kidnap from schools, such as in Uganda. 13 In that country’s northern region, children are also snatched from villages, as described by Melanie Gow in the opening quote. A study by the Henri Dunant Institute in 1998 found that the most popular method used by military forces to prevent child soldiers deserting was to force them to kill a relative, thus ostracising the child from home and family. 9,14

Up to a third of child soldiers in Africa are female. 7,15 Girls are often volunteers rather than kidnapped victims, responding to propaganda or attracted by prospects of better living conditions or gender equality. 16 However, their fate is often to become domestic servants or sex slaves to their superiors. 7,11

Roles of child soldiers

Very young recruits (6-year-olds) may commence as porters of ammunition and food, cooks, spies and concubines, 3 but then move on to roles such as manning checkpoints, and acting as bodyguards or informants. Later, when they are able to handle a weapon, they will be assigned tasks such as ambush, executioners of enemies and fighting on the front lines. 17 Some are sold into slavery in exchange for weapons, money or other commodities that are in short supply. 7

Their training for aggressive roles may involve desensitisation to violence: this may include being forced to fight each other, punishment for any child offering help to those who were abused, forcing innocent children to punish wrongdoers, and forcing children to commit atrocities in their own villages. 3 Some children recruited into the Lord’s Resistance Army in Uganda have been forced to form gangs to kill other children with clubs, rocks and pieces of firewood. 7 In Liberia, armed factions deliberately targeted family relationships, destroying all sense of normality. Child soldiers would be forced to witness the execution of family members and then applaud these acts. 17 At checkpoints, children would be forced to have sex with women as a means of humiliating the women and breaking down the children’s respect for elders. Older soldiers would also sexually abuse the children. 17

Child soldier in Liberia. Photograph by Chris Hondros.

Village children in Mozambique. Photograph by David Hume Kennerly.

An important study by a Belgian educationist from Ghent University examined 301 child soldiers in Uganda. 18 Almost all these children had experienced multiple episodes of trauma: 77% had witnessed a killing, 39% had killed another, 6% had seen a first-degree relative killed, and 2% had been forced to kill a close relative. More than 30% of girl soldiers had been sexually abused, and 20% had given birth to a child while in captivity. All the children had been abducted at a young age (mean, 12.9 years) and had remained in captivity for a mean of more than 2 years. Ten per cent of interviewed children were orphans.

Psychological sequelae in child soldiers

Children who are recruited as soldiers experience a range of traumatic and adverse events, which contribute to both short- and long-term psychosocial difficulties. These children are already vulnerable as the result of preexisting social disadvantage and deprivation. Children of particular groups who are seen as a threat may be directly targeted for recruitment, and disadvantaged children may volunteer as a way of ensuring food and shelter. Children living in conflict zones and those separated from family are also more likely to be recruited. 19

The psychological impact of being a combatant is determined by the child’s separation from his or her family social network and, often, cultural group. Very young children will be more dependent on their captors and more likely to adopt the group norms and values. Older children and adolescents may initially resist their captors, but some will have been enticed by particular ideologies, political goals or promises of security. In all these situations, the aim of attaining compliance is assisted by separation of children from their previous existence and breaking down old connections and loyalties. Sleep deprivation, punishment, prolonged repetition of instructions and psychoactive drugs all contribute to the state of relative amnesia. Pre-combat "training" also breaks down previous values of behaviour and may involve "initiation rituals" of maiming or killing, which desensitise the child to violence. This may cause longer term difficulties with aggression, shame and guilt.

The psychological state of child soldiers in the aftermath of war will also be influenced by its duration. Children involved for less than 6 months are more likely to be able to see themselves as victims and separate from their captors, but those involved for longer than 12 months will change their self-concepts and embrace the values of their captors. Long-term child combatants are more likely to remain involved in violent or criminal behaviour following demobilisation, and should be a focus of rehabilitation programs. 20

The persistent exposure to war entrenches violence in the minds of child soldiers as the sole means of resolving conflict. 13 In one study, 18 97% suffered from posttraumatic stress disorder (PTSD), characterised by nightmares, flashbacks and insomnia. PTSD is linked to drug and alcohol use, memory difficulties, family discord and social dysfunction. 7 In children, it may take the form of recurrent intrusive, distressing recollections of thoughts and images. Children may experience the distressing events again through dreams, stories or play. 12 Depression and anxiety states are also experienced by most children who are active or passive participants in conflicts. 8 The typical profile of a child soldier is "a boy between 8 and 18 . . . drug or alcohol addicted, amoral, merciless, illiterate and dangerous". 21

Children’s greatest fears may be their fear of attack by members of their own community when they return. Girl soldiers who have borne children are often stigmatised and neglected. Their greatest stresses following repatriation are not necessarily the aftermath of violence, but economic hardship. 15

Physical trauma to child soldiers

It is estimated that, in Africa over the past 60 years, two million children have been killed in battle, with six million left disabled and one million orphaned. 8 Children have a disproportionately high casualty rate compared with their adult comrades because of a lack of experience and maturity. This leads child soldiers to take unnecessary risks. 3 Their smaller bodies render them more vulnerable to complications of injury. The rough conditions of military camps include a poor dietary intake and lack of hygiene and health care, combined with harsh physical punishments. Commanders view these children as more expendable - they receive less training and are assigned more dangerous tasks such as checking for minefields or spying on the enemy. 3 Landmines alone are credited with death or injury to 12 000 Africans per year. Angola has the highest rate of amputees in the world; there are an estimated 5.5 mines for every Angolan child. 8

In Rwanda in 1994, the Australian Defence Force Contingent of Health Service Support undertook a disproportionate percentage of paediatric surgery (38.5%), of which 36% was for war-related injuries. 22

There is concern about the effect of sexual abuse of child soldiers on the prevalence of HIV infections. 23,24 In Uganda, nearly all girl soldiers who have escaped have a sexually transmitted disease. 7

Rehabilitation of child soldiers

Following demobilisation, child soldiers face significant problems reintegrating into their communities. Difficulties may include no remaining family, educational shortfalls, and a major burden of guilt for previous acts of violence. 14 Exposure to violence during the formative years of personality development means that child soldiers carry violent solutions into their adult lives. 25

The long-term outcome for child soldiers is related to the ability to rebuild attachment and social networks, to recreate a sense of purpose and meaning in life, and to rebuild connections to tradition and cultural beliefs. Children who have been involved in violence and atrocities towards their own villages and groups may be shunned and remain in poverty. Girl soldiers are less likely to reintegrate and may resort to prostitution. A major challenge for rehabilitation programs is providing educational and vocational alternatives to criminal activity, and remediating the effects of brutalisation.

Many Western charities are now actively involved in rehabilitating African child soldiers. In Liberia, the United Nations International Children’s Fund, Save the Children Fund, International Rescue Mission and Don Bosco Homes place such children in safe havens. 11 World Vision Uganda and Gulu Support the Children Organisation are involved in residential care and psychosocial counselling for children who have escaped from the Lord’s Resistance Army. 9 Some agencies, such as the Christian Children’s Fund, have blended Western psychological techniques with local beliefs and healing rituals to help child soldiers reintegrate into their Angolan communities. 26

Concern has been expressed about current Western initiatives in rehabilitation, which focus on counselling rather than addressing communal wounds, supporting children’s coping and functioning and providing positive roles for children. 15 Doubt has also been expressed about the mixed effects of institutional care of demobilised child soldiers: reliance on the provision of food and clothing without the need to work, and creation of an elite group of privileged children to the detriment of other war-affected children. 17 For example, in Mozambique, only 5000 of an estimated 250 000 war-traumatised children were child soldiers. 8 Finally, the participation by former child soldiers in excellent education programs offered by some foreign aid organisations has been poor. 27

While not irreversible, loss of family, schooling and adult mentors can result in former child soldiers leading lives of crime for many years afterwards. The sheer barbarity of their experiences in war complicates their return to a normal childhood.

Competing interests

None identified.

References

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Dr Louise Newman is the Director of the New South Wales Institute of Psychiatry and a Child and Adolescent Psychiatrist with expertise in the area of infancy and early childhood development. She is undertaking research into the prevention of child maltreatment and interventions for parents who have experienced early abuse. She is involved in advocacy for the human rights of asylum seekers and particularly for children affected by the Australian Government’s policy of mandatory detention.

Commander Mike O’Connor is Vice President of the Royal Australian College of Obstetricians and Gynaecologists and chairs the Chapter of Military Obstetrics and Gynaecology. He has been a consultant obstetrician and gynaecologist to the RAN since 1982. He has appointments at St George public and private hospitals in Sydney and is chairman of the Division of Obstetrics and Gynaecology at St George Private Hospital. He has served on HMAS Stalwart, HMAS Tobruk and HMAS Manoora, the last being as support for pregnant refugees during the Tampa crisis in 2001. He has also served in Bougainville and East Timor.

New South Wales Institute of Psychiatry, North Parramatta, NSW.

Louise Newman, FRANZCP, Director

Department of Obstetrics and Gynaecology, St George Hospital, Kogarah, NSW.

Mike O’Connor, MD, FRANZCOG, RANR, Consultant obstetrician and gynaecologist

Correspondence: Commander Mike O’Connor, Department of Obstetrics and Gynaecology, St George Hospital, PO Box 185, Kogarah, NSW 2217.