Research shows that many regard acts of retaliation as a way to overcome their experiences.

By Samuel Okiror Egadu in Kampala (AR No. 125, 08-Aug-07)

More attention is needed for the treatment of severe trauma suffered by many former child soldiers recruited to militias in northern Uganda and the Democratic Republic of the Congo, DRC, according to a new study.

The report, published last week in the prestigious Journal of the American Medical Association, JAMA, said reconciliation efforts in countries where children have been recruited as fighters “need more help in order to break the cycle of violence in war-torn regions”.

The study by German researchers found that post-traumatic stress made former child soldiers less willing to reject revenge and consider reconciliation. Their mental distress could "impose barriers to sustainable and long-term peace building", said the study.

JAMA, the most widely circulated medical journal in the world, said the researchers interviewed 169 children aged between 11 and 18 who had been forced to fight in northern Uganda and the DRC. They live in two rehabilitation centres which have been home to some 20,000 former child soldiers over the past ten years.

The United Nations estimates some 250,000 children worldwide are currently fighting in wars, mostly in Africa, but very little research has gone into the effects of such violence on the mental health of young combatants, said the report. Recent research suggests that 38,000 children have been kidnapped in northern Uganda in the course of the last 21 years to fight with the rebel Lord's Resistance Army, LRA.

Figures for the DRC have been difficult to compile, but Thomas Lubanga, leader of a militia in Ituri, a mineral-rich northeastern province of the DRC, is currently imprisoned in The Hague facing trial by the International Criminal Court, ICC, on charges of forcibly recruiting children under the age of fifteen to fight in the complex Ituri conflict.

"Post-traumatic stress might be an important factor influencing post-conflict situations and may contribute to cycles of violence found in war-torn regions," said Christophe Pierre Bayer of the University of Hamburg, who conducted the study with colleagues.

"Our findings indicate that mental distress and mental illness, namely symptoms of PTSD (post-traumatic stress disorder), are associated with war-affected children's attitudes toward reconciliation and could therefore impose barriers to sustainable and long-term peace building."

Bayer said PTSD symptoms include irritability or outbursts of anger, sleep difficulties, trouble concentrating, extreme vigilance and an exaggerated startle response. A person may initially respond to the trauma with horror or helplessness, and then may persistently relive the event.

The children surveyed by the German team reported that they had been violently recruited, served an average of 38 months and witnessed beatings, shootings and rape. More than half said they had killed somebody. Often the children in the study had been compelled to help beat or hack to death fellow child captives who were attempting to escape.

With these traumatic experiences leaving about a third of these children with post-traumatic stress symptoms, the researchers wanted to see how what they had experienced might impact on their willingness to forgive.

The study has importance for Uganda because here is strong local pressure to use traditional reconciliation and forgiveness ceremonies of different ethnic groups to reintegrate the LRA into society rather than have recourse to ICC-style retributive systems.

Ugandan president Yoweri Museveni referred his country's northern civil war to the ICC, following which the ICC's chief prosecutor Luis Moreno-Ocampo issued arrest warrants in July 2005 for the LRA's top five men - its leader Joseph Kony, Vincent Otti, Raska Lukwiya, Okot Odhiambo and Dominic Ongwen. Lukwiya died in combat last year.

The LRA leaders have been indicted on 33 counts of war crimes and crimes against humanity, including abduction, sexual enslavement, mutilation, the killing of civilians and forcibly using children as guerrilla fighters. The LRA rebellion drove more than 1.7 million people into internal refugee camps throughout northern Uganda. Some 100,000 people have died in the conflict.

The German researchers asked the children to give yes/no answers to such statements as "I am going to pay back the persons who harmed me for what they did" or "I am ready to forgive the persons who harmed me".

The former child soldiers with more severe symptoms of post-traumatic stress were significantly less willing to consider reconciliation, and they regarded acts of retaliation as a way to overcome their experiences.

The results indicating a link between post-traumatic stress and attitudes toward reconciliation support the need to promote both physical and psychological care for children affected by war, said Bayer and the other report authors.

Another report in the same edition of JAMA, by Judith Bass of Johns Hopkins University in Baltimore, said a controlled trial showed that group psychotherapy among 300 former child soldiers was effective in reducing depression among displaced adolescent girls who were survivors of the northern Uganda war - but the intervention was not effective for adolescent boys.

Bass and her researchers compared group therapy sessions to creative play techniques, which included role playing and artistic expression.

Of the different effects on boys and girls, Bass said, "I'm not sure that's all that inconsistent with what we see when psychotherapies have been used in other places, where the impact is greater among girls who potentially have more ability to sit and talk about their problems and things like that. But in terms of the boys, maybe we need to start looking at what else can be done for the boys. Maybe boys need an added component, and not just talk therapy."

Commenting on the JAMA reports, a northern Uganda childcare support group, Gulu Save the Children Organisations, Gusco, conformed the trend.

Gusco has received since 1994 some 8,000 formerly abducted children who escaped or were rescued from LRA captivity. "We usually do not re-unite these children with their families until we are sure they are ready," said Gusco spokesman Francis Shanty. "But we have been shocked by some cases where children get late reaction of post-traumatic stress disorder which continues the cycle of violence.

"When we identify such children we readmit them at the centre."

Samuel Okiror Egadu is an IWPR reporter in Uganda.