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Date: Thu, 22 Jul 1999 22:15:36 -0500
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Subject: Africa: War-Affected Children
Africa: War-Affected Children
Date distributed (ymd): 990722
Document reposted by APIC
+++++++++++++++++++++Document Profile+++++++++++++++++++++
Region: Continent-Wide
Issue Areas: +economy/development+ +security/peace+
Summary Contents:
This posting contains a briefing paper on "Indigenous Healing
of War-Affected Children in Africa" by Edward Green and
Alcinda Honwana, based on research in Mozambique and Angola.
The paper reports on the effective involvement of traditional
healers and customs in coping with the trauma of child
soldiers and other children subjected to violence. The paper
was published in the Indigenous Knowledge series of the World
Bank (see contact information below).
+++++++++++++++++end profile++++++++++++++++++++++++++++++
IK Notes reports periodically on Indigenous Knowledge (IK)
initiatives in Sub-Saharan Africa. It is published by the
Africa Region's Knowledge and Learning Center as part of an
evolving IK partnership between the World Bank, communities,
NGOs, development institutions and multilateral organizations.
The views expressed in this article are those of the authors
and should not be attributed to the World Bank Group or its
partners in this initiative. A webpage on IK is available at
http://www.worldbank.org/aftdr/ik/default.htm
Letters, comments, and requests for publications should be
addressed to: Editor: IK Notes, Knowledge and Learning Center
Africa Region, World Bank 1818 H Street, N.W., Room J5-171
Washington, D.C. 20433 E-mail: [log in to unmask]
IK Notes
World Bank
No. 10, July 1999
Indigenous Healing of War Affected Children in Africa
Edward C. Green, Ph.D. and Alcinda Honwana, Ph. D.
Children in war-torn countries of Africa and elsewhere are
often direct or indirect victims of violence, and/or witnesses
to various horrors associated with war. Children as young as
seven or eight are forcibly conscripted and indoctrinated as
child soldiers or porters in several African countries. Girls
as well as boys often suffer, some being forced into sexual or
other service at early ages. In conflicts where terrorizing
civilians has become a routine means to political and military
ends, women and children are deliberately targeted for torture
and death.
Globally, there are at least one million children separated
from their parents be cause of war, and there are many
thousands who have been traumatized even more directly by war.
Child victims of this sort often exhibit symptoms of post
traumatic stress disorder (PTSD), to use the Western
psychiatric label.
Symptoms of PTSD and related stress reactions common in
children include: avoidance/numbing, as in cutting off of
feelings and avoidance of situations that provide reminders of
traumatic events; insomnia, inability to concentrate,
"intrusive re-experiencing," such as nightmares and
flashbacks; lethargy, confusion, fear, aggressive behavior,
social isolation, and hopelessness in relation to the future,
and hyper arousal as evidenced in hyper vigilance and
exaggerated startle responses.
In recent years, UNICEF, USAID, and various private, voluntary
organizations such as Save the Children and the Christian
Children's Fund have developed various types of so-called
psycho-social programs to assist war-affected children. Yet
therapeutic techniques for war-affected children remain at a
very preliminary stage of development. It is not known to what
extent western psychotherapeutic techniques for PTSD which
were originally developed to treat American veterans of the
Vietnam war would be appropriate and effective for children in
Africa and other less-developed areas.
One of the concerns with the PTSD is the very notion of
post-traumatic stress disorder. In these contexts, it is
problematic to talk about trauma as the past (post), if one
understands the notion of violence to be broader than direct
exposure to war situations (military attacks, landmines,
etc.), and to encompass spheres like poverty, hunger,
displacement and the like. Another concern with the PTSD lies
in its therapeutic techniques which are centered on the
individual patient. Such focus ignores local beliefs in the
role that ancestral and malevolent spiritual forces play in
the causation and healing of the affliction. It also
undermines family and community involvement and active
participation in the healing process.
During early psychosocial programs for war-affected children
in Mozambique and Angola, community leaders, traditional
healers and families showed tremendous knowledge of how to
heal the social wounds of war in war affected children and
adults. Such disorders are in fact quite treatable by
traditional healers, based on indigenous understandings of how
war affects the minds and behavior of individuals, and on
shared beliefs of how spiritual forces intervene in such
processes.
During the implementation of these programs, people expressed
no need for help in addressing children's' specific mental or
behavioral manifestations. What they needed, they said, was
help in finding missing family members and in establishing
schools, pre-schools, creating jobs opportunities for the
youth, and promoting a stable social environment in which to
function.
There is evidence from throughout Africa that mental or
psychiatric disorders are among the conditions for which
modern or western medical help is least likely to be sought.
African people generally turn to indigenous forms of therapy
in case of mental health. Empirical studies of the relative
effectiveness of different forms of western psychotherapy in
fact show that virtually all psychotherapies do the patient
some good and all are potentially effective when embedded
within social and cultural specificities. This may suggest
that as psychotherapists, indigenous African healers may be at
least as effective as modern medical specialists, especially
among those who share a common African culture.
Anthropological research done in Mozambique and Angola shows
that war related psychological trauma is directly linked to
the power and anger of the spirits of the dead. The
impossibility of performing proper burials in times of war
does not allow for these spirits to be placed in their proper
positions in the world of the ancestors, so they are
considered to be bitter and potentially harmful to their
killers and passers-by. Social pollution may arise for being
in contact with death and bloodshed. Individuals who have been
in a war, who killed or were around killings are believed to
be potential contaminators of the social body. Thus, cleansing
and purification rituals are essential for their reintegration
in the communities.
In 1994, during the first project in Angola specifically to
help war-traumatized children, it was found that children were
already being helped by indigenous psychotherapy, provided by
indigenous healers in the form of ritual purification
ceremonies. This was provided for both ex-combatants and
children who had either participated in or witnessed blood-
shed. The earlier Children and War project in Mozambique found
similar treatments for children. In both countries, these
therapies appeared to be effective, at least in the
short-term.
Traditional healing for war-affected children in Angola and
Mozambique seems to consist principally of purification or
cleansing rituals, attended by family members and the broader
community, during which a child is purged and purified of the
"contamination" of war and death, as well as of sin, guilt,
and avenging spirits of those killed by a child soldier. These
ceremonies are replete with ritual and symbolism whose details
are distinctive to the particular ethnolinguistic group, but
whose general themes are common to all groups.
"In the day of his arrival his relatives took him to the
ndumba (the house of the spirits). There he was presented to
the ancestral spirits of the family. The boy's grandfather
addressed the spirits informing them that his grandchild had
returned and thanked the spirits for their protection as his
grandson was able to return alive (...) A few days later a
spirit medium was invited by the family to help them perform
the cleansing rituals for the boy. The practitioner took the
boy to the bush, and there a small hut covered with dry grass
was build.
The boy, dressed with the dirty clothes he brought from the
RENAMO camp, entered the hut and undressed himself. Then fire
was set to the hut, and an adult relative helped out the boy.
The hut, the clothes and everything else that the boy brought
from the camp had to be burned. A chicken was sacrificed for
the spirits of the dead and the blood spread around the ritual
place After that the boy had to inhale the smoke of some
herbal remedies, and bath himself with water treated with
medicine" (Fieldnotes, Mozambique).
This healing ritual brings together a series of symbolic
meanings aimed at cutting the child's link with the past (the
war). While modern psychotherapeutic practices emphasize
verbal exteriorization of the affliction, here through
symbolic meanings the past is locked away. This is seen in the
burning of the hut and the clothes and the cleansing of the
body. To talk and recall the past is not necessarily seen as
a prelude to healing or diminishing pain. Indeed, it is often
believed to open the space for the malevolent forces to
intervene.
This is also apparent in the following case from Uige
(Angola).
"When the child or young man returns home, he is made to wait
on the outskirts of the village. The oldest woman from the
village throws maize flour at the boy and anoints his entire
body with a chicken. He is only able to enter the village
after this ritual is complete. After the ritual, he is allowed
to greet his family in the village. Once the greeting is over,
he must kill a chicken, which is subsequently cooked and
served to the family. For the first eight days after the
homecoming, he is not allowed to sleep in his own bed, only on
a rush mat on the floor. During this time, he is taken to the
river and water is poured on his head and he is given manioc
to eat. As he leaves the site of the ritual, he must not look
behind him."
This case emphasizes the non-interaction with family and
friends before ritual cleansing. The child is kept out of the
village until the ritual is performed, and cannot greet people
and sleep in his bed until the ritual proceedings are over. As
mentioned above, although children may be asked about war
experiences as part of treatment, this is not a fundamental
condition for healing.
The ceremony aims at symbolically cleansing the polluted child
and putting the war experience behind him, to "forget" (note
the symbolism of being forbidden to look back, in the example
from Uige). Food taboos and other kinds of ritual restrictions
are applied. In the Uige, for example, fish and fowl must be
avoided by the cleansed person for 1-2 months, after which the
person must be reintroduced to the food by the traditional
healer who officiated at the ceremony.
The Okupiolissa ritual from Huila in Angola clearly shows the
active participation of the community in these rituals, and
stresses the idea of cleansing from impurities.
"The community and family members are usually excited and
pleased at the homecoming. Women prepare themselves for a
greeting ceremony (...) Some of the flour used to paint the
women's foreheads is thrown at the child and a respected older
woman of the village throws a gourd filled with ashes at the
child's feet. At the same time, clean water is thrown over him
as a means of purification (...) the women of the village
dance around the child, gesturing with hands and arms to ward
away undesirable spirits or influences. (...) they each touch
him with both hands from head to foot to cleanse him of
impurities. The dance is known as: Ululando-w-w-w. When the
ritual is complete, the child is taken to his village and the
villagers celebrate his return. A party is held in his home
where only traditional beverages (...) The child must be
formally presented to the chiefs by his parents (...) the
child sits beside the chiefs, drinking and talking to them,
and this act marks his change of status in the village."
These cleansing and purification rituals involving child
soldiers have the appearance of what anthropologists call
rites of transition. That is, the child undergoes a symbolic
change of status from someone who has existed in a realm of
sanctioned norm-violation or norm-suspension (i.e., killing,
war) to someone who must now live in a realm of peaceful
behavioral and social norms, and conform to these. In the case
presented above from Huila, the purified child acquires a new
status which allows him to sit besides the chiefs and interact
with them. Until the transition is complete (through ritual
performance), the child is considered to be in a dangerous
state, a marginal, "betwixt and between," liminal, ambiguous
state. For this reason, a child cannot return to his family or
hut, or sleep in his bed, or perhaps even enter his village,
until the rituals have been completed.
Manifest symptoms associated with PTSD and related stress
disorders reportedly disappear shortly after these ceremonies,
after which the family, indigenous healers and local chiefs
direct attention toward helping to establish an enduring,
trusting relationship between the traumatized child and family
members, and with adults of good character. These ritual
interventions are also intended to re-establish spiritual
harmony, notably that between the child and its ancestor
spirits.
The re-establishment of normal relationships and activities
with other children may not be part or a major part of these
indigenous healing rituals. But, healers, village elders,
teachers and other child caregivers readily understand this
when presented with the idea during project-supported training
seminars, in both Angola and Mozambique. Play therapy,
drawing, drama, dance and story-telling are some of the
techniques introduced in these seminars.
There is no doubt that these rituals are instrumental in
building family cohesion and solidarity, and in dealing with
the psychosocial and emotional side of these children's
problems. The fact is, however, that they return to an
impoverished countryside struggling with basic survival needs,
and many with no schools, hospitals, no vocational training or
job opportunities which would allow them to envisage the
prospects of a better future. Thus, while these rituals are
important they need to be complemented by community
development programs to sustain the gains achieved in the
psychosocial and emotional sphere, and which cannot be
dissociated from the rest.
Therefore, the approach of donor organizations, NGO and other
organizations involved in humanitarian aid for war-affected
children should take into account local understandings of war
trauma and indigenous strategies for dealing with it. They
should work towards promoting stable, secure,
culturally-familiar environments in which children can gain a
sense of competence and security in a more predictable world
by encouraging self-reliance through reliable community
development projects. their families, or with appropriate
foster families if necessary.
The project of the Christian Children's Fund in Angola tries
to build upon existing indigenous healing practices and
strengths, and complementing these with its psychosocial
interventions such as those just described. Evaluations of
this project and the earlier "Children and War" project in
Mozambique have shown that such an informal partnership
between indigenous healers, with their ritualistic therapies,
and donor-assisted programs, with emphasis on the family and
social adjustment of the child, may provide a model of how
indigenous and Western-scientific approaches can be pursued
together to provide maximum benefit to children in need.
Furthermore, such a model of cooperation and sharing of
responsibility serves to validate indigenous healing and
beliefs, which tends to energize and mobilize local people
who, ultimately, need to develop sustainable, culturally
acceptable solutions to help themselves.
The authors would like to thank the Christian Childrens Fund,
Save the Children (USA), the Children and War Project and the
Displaced Children and Orphans Fund, USAID, for use of
information from their programs. We would also like to thank
Mike Wessells for useful comments and suggestions.
Edward C. Green can be contacted at: [log in to unmask]
Alcinda Honwana can be contacted at [log in to unmask]
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