Graduate School of Development Studies
THE REHABILITATION OF FORMER CHILD SOLDIERS:
CONFLICTING CHOICES
A Research Paper presented by:
John McNamara Kielty
(Canada)
in partial fulfillment of the requirements for obtaining the degree of
MASTERS OF ARTS IN DEVELOPMENT STUDIES
Specialisation:
Children and Youth Studies
(CYS)
Members of the examining committee:
Prof. Linda Herrera (supervisor)
Prof. Dr. Jan Pronk (reader)
The Hague, The Netherlands
November, 2009
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Disclaimer:
This document represents part of the author’s study programme while at the
Institute of Social Studies. The views stated therein are those of the author and
not necessarily those of the Institute.
Research papers are not made available for circulation outside of the Institute.
Inquiries:
Postal address:
Institute of Social Studies
P.O. Box 29776
2502 LT The Hague
The Netherlands
Location:
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2518 AX The Hague
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Telephone:
+31 70 426 0460
Fax:
+31 70 426 0799
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Acknowledgements
First, a very big Apoyo Matek to Tabu Simon for his extraordinary
invitation for me to come live with him and his family in Gulu this past
summer. It was a joy getting to know Susan, Carol, Clifford, Giovana and
Robert and the Gulu Gang, Uganda and barbequed pork. TIG! Memories
for a life time. Thank you.
To my parents and brothers who have always been supportive of
everything I do, thank you for everything.
To the A-team, you three made my year. Sweat, blood and tears baby. We
did it! Look forward to many more diners, drinks and wherever and
whenever.
What a year it has been. Thanks to all ISS students and faculty for making
my time in The Hague a learning experience in so many ways. Catch you
all on the road ...
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Abstract
International experts and organisations have struggled to come to a consensus
on how to implement Western psychologically based rehabilitation programs
for former child soldiers in non-Western settings. Scholarship recognises the
inherent claim and value of indigenous healing practices in the rehabilitation of
former child soldiers. Nevertheless, Western interventions continue to
predominate. The contrasting approaches represent conflicting choices in how
to design and implement rehabilitation programs. This dynamic is a reality on
the ground in the district of Gulu, northern Uganda where the conflict
between the government and Joseph Kony’s Lord’s Resistance Army has
abated in recent years.
Former child soldiers in northern Uganda have been abducted and, for
many, experienced extreme traumatic events. Those worst affected require
support to be successfully rehabilitated and to function on par with those in
the community. Local Acholi culture has been severely affected by the conflict
which in turn has profoundly weakened the ability of Acholi traditional healing
practices to support psychosocial rehabilitation. Local and international NGOs
implement Western psychologically based rehabilitation programs as well as
alternative approaches such as creative activities and sport.
Based on two months fieldwork in Gulu, interviews with formerly
abducted children who have and are going through the process of psychosocial
rehabilitation, provide a participant’s perspective on how different program
approaches are received locally. Coupled with interviews from relevant
development actors, this research provides useful insight for rehabilitation
program designers and implementers to understand the effects of conflict on
traditional healing practices, the role of individual skill development
throughout the rehabilitation process and the consequences of Western
dominated rehabilitation programming.
Relevance to Development Studies
Peace building in post conflict settings has a variety of challenges. As a group
vulnerable to rejection by the community, successful rehabilitation reduces the
chances of returnees becoming obstacles to development in the community.
The methods use to support former child soldiers to have normal social has
important implications for the nature of development. Scholarship calls for a
balance between indigenous healing practices and Western psychology based
rehabilitation methods. In reality this is not the case. Those involved in
rehabilitation and in international development in general can benefit from
understanding the consequences of Western dominated interventions.
Keywords
[Child Soldiers, Psychosocial Rehabilitation, Rehabilitation, Traditional
Healing, Northern Uganda, Acholi, PTSD, Counselling]
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Contents
Abstract
Maps
List of Acronyms
Introduction
1.1 Indication of the Problem
1.2 Child Soldiers
1.3 The International Response: Failed Prevention and the
Development of Rehabilitation Approaches
1.4 Rehabilitation Approaches in Non-Western Settings
1.5 Understanding Rehabilitation in Northern Uganda Within the
Context of the Ongoing Evolution of Program Guidelines
1.6 Research Questions
1.7 Methodology
1.8 Considerations and Limitations
4
6
7
8
9
10
Chapter 2 Analytical Framework
2.1 Culture
2.2 Psychosocial Rehabilitation
23
23
24
Chapter 3 Conflict, Culture and Context: Traditional Healing and
Rehabilitation Approaches in Gulu District
3.1 A Relationship in Conflict: Young People and Traditional Culture
3.2 Development Organisations & Pyschosocial Rehabilitation:
Different Approaches for Different Actors
13
15
18
19
19
21
26
26
30
Chapter 4 Western Intervention Methods: The Agency of the
Individual within the Rehabilitation Process
4.1 Counselling
4.2 Community Pressure and Individual Survival
4.3 Alternatives to Counselling
4.4 Self Dependency
34
34
36
37
40
Chapter 5 Conclusion: Responding to the Realities & the Future of
Traditional Healing
References
Appendices
Annex A: Interviews and Observations
42
45
48
48
5
Maps
Northern Uganda
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List of Acronyms
Acronym
Name
CRC
GUSCO
GWED-G
ICC
IES
IDP
LRA
NGO
OP
PTSD
UN
Convention of the Rights of the Child
Gulu Save the Children Organisation
Girls and Women Economic Development – Gulu
International Criminal Court
Impact Evaluation Scale
Internally Displaced People
Lord’s Resistance Army
Non Governmental Organisation
Optional Protocol (to the CRC)
Post Traumatic Stress Disorder
United Nations
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Introduction
In northern Uganda, after 22 years of civil war, the rehabilitation of
former child soldiers continues amidst a society’s strive to rebuild. This
research explores conflicting choices to the rehabilitation of approximately
20,000 formerly abducted children who were forced into service for the Lord’s
Resistance Army (LRA) and as a result committed atrocities and subject to
extreme abuse. Experts agree that rehabilitation programs for former child
soldiers should be culturally sensitive, but there is no consensus on a single
approach as to how this can be best achieved. To explore how current debates
about rehabilitation approaches are applied in the field, I sought out to
understand the perspectives of formerly abducted children in these programs,
NGO workers that implement the programs, and members of the community
in Gulu district of northern Uganda.
For program designers and implementers, determining what approaches
should be used in rehabilitation programs for former child soldiers is
significant for several reasons. Unless programs are culturally sensitive, they
risk imposing the world views implicit in these approaches which are products
of a particular culture. The importation of foreign people, approaches and
ideas that dominate over their local equivalents is particularly sensitive in
countries that have been colonised, such as Uganda which gained
independence from Britain in 1962. In addition to respecting local world views
and cultural practices, culturally sensitive programs are more likely to support
the successful rehabilitation of former child soldiers because they make sense
of how the participant experiences and understands the world. Managing this
process correctly is important because successful rehabilitation and social
reintegration of returnees contributes to the lasting peace of communities.
Depending on how programs are designed, rehabilitation attempts can support
individuals to live productive lives or possibly experience frustration and
rejection that can drive former child soldiers to anti-social behaviour and
undermine peace building.
Initially, my entry point to research on conflict affected children, which
then came to be former child soldiers, was through sport. Development
through sport is used by many grassroots organisations, international NGOs
and UN agencies to address a wide range of issues including psychosocial
support for young people who have experienced traumatic events in their lives.
Understanding, however, that sport is one development tool among many
approaches to rehabilitation spurred my interest to understand the larger
rehabilitation context.
The literature on how interventions can support the psychosocial
rehabilitation of young people affected by conflict focuses on ensuring that
programs do not impose foreign methods that are products of another culture
in non-Western settings. In the 1980s, targeted interventions for the perceived
trauma of children affected by war failed due to their exclusive use of
psychological approaches of Western medicine (Honwana 2006). As a response
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to this trend, Kostelny explains that “to construct culturally relevant
approaches, it is essential to use and to learn from local approaches, placing
culture at the center of psychosocial work” (Kostelny 2006: 29).
Understanding culture as fundamental to rehabilitation guided my research
to explore participant, practitioner and community perspectives on the use of
traditional healing practices, Western trauma based tools such as counselling
and alternative approaches such as creative activities and sport. Basing my
research in the town of Gulu in northern Uganda was useful because of the use
of traditional practices for the formerly abducted as well as the substantial
international NGO and UN presence that have imported their own programs.
Through the examination of programs on the ground and learning from
those involved, this study provides insight into: the effects of conflict on
formerly abducted children and their acceptance of traditional healing
practices, local attitudes towards counselling and other Western rehabilitation
approaches such as creative activities and sport, income generating activities
and the role of individual skill development throughout one’s rehabilitation.
Findings in these areas contributes to understanding the complex dynamics
between a post conflict context, the individual and culture which can inform
programs to implement programs best suited for a particular environment.
And depending on the actual balance of programs, the long term viability of
traditional healing practices can be jeopardised.
This paper consists of five chapters. In Chapter 1, I briefly review why
child soldiering is an issue today and what their experiences are. A review is
also given of the international response to child soldiering through
international treaties dealing with the rehabilitation of child soldiers. A
discussion of the evolution of rehabilitation approaches. Also included in this
section is a presentation of my methodology which explains how and why the
study was carried out as it was with the attendant considerations and
limitations. Chapter 2 is a discussion of how culture influences notions of
rehabilitation and trauma and ‘psychosocial’ rehabilitation as accounting for the
considerations of non-Western settings. Chapter 3 is focused on Gulu district
and explores the effects of conflict on young people and the relationship
between traditional rehabilitation and formerly abducted children. Also
included is the response of various development actors in psychosocial
programming. Chapter 4 seeks to understand the perspective of participants,
community members, NGO practitioners and actors in Gulu district towards
rehabilitation approaches including counselling, creative activities and sport as
well the importance of self sufficiency. Chapter 5 provides some conclusions
that will be useful to rehabilitation program designers and implementers as well
as those involved in cross cultural interventions generally.
1.1 Indication of the Problem
Psychosocial rehabilitation programs for former child soldiers presents a
challenge in implementing two seemingly different approaches. In accordance
with expert consensus, rehabilitation programs for former child soldiers are to
balance local cultural resources such as traditional healing practices with
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Western approaches such as those based on Western psychology and
alternative methods such as creative activities and sport. While the prescription
about how programs should be implemented calls for balance, there is an
assumption that traditional healing practices can function in post conflict
settings and that local participants will accept traditional practices.
All efforts should be made to acknowledge the importance of cultural
resources and to make good use of them. However, it is worthwhile to explore
whether the reality reflects the rhetoric in regards to the ability to use
traditional healing practices in rehabilitation programs as well as the
participant’s perception of indigenous and Western approaches.
1.2 Child Soldiers
Currently it is estimated by the UN that there are 250,000 “exploited”
child soldiers in armed forces today (UN 2009a). The pain that child soldiers
have caused and endured around the world is well documented. According to
Alcinda Honwana, “the scale of the contemporary problem is unprecedented,
both in the numbers of the young people involved and in the degree of their
participation (Honwana 2006: 27). Graca Machel’s seminal report
commissioned by the UN to explore the impact of armed conflict on children
is credited with bringing the plight of child soldiers to global attention(Rosen
2007: 298). The report argues that the nature of modern conflict has changed
and makes children more vulnerable. For example, civilian deaths now make
up 90 percent of casualties as compared to 5 percent in previous decades
which results in more death and injury among children (Machel 1996: 9). In the
decade leading up to the 1995 report, it is estimated that 2 million children
died, 4 million were mutilated and disabled (Machel 1996: 33-34), and 1 were
million orphaned (UNICEF 1995).
The extent of the rise of child soldiers, according to Honwana, “is a
defining feature of our times (Honwana 2006: 27). Within this category, there
is a distinction made between children who are forcibly abducted and those
who volunteer. However, the notion of voluntarily joining an armed force as a
young person is a false choice, since young people face social and economic
pressures to join an armed group as a means of survival and advancement
(Machel 1996: 12).
While the Machel report brought the issue of children in conflict and child
soldiers to greater attention, the phenomenon itself has a long history. The
etymology of the word ‘infantry’, for instance, indicates the presence of
children in conflict since the middle ages. Infantry derives from the Italian
word Infante which referred to the children who followed knights into battle
during the middle ages (Honwana 2006: 26). While there may be historical
precedence for the use of children in conflict, the nature and magnitude of the
problem has changed. War itself has changed. “The massive
instrumentalization of children in combat” (Honwana 2006: 28) occurs for
several reasons. New technology has made lighter and smaller weapons which
are now easier for children to use and are readily available due to the expansion
of the global arms trade (Honwana 2006: 26,Machel 1996: 10). As well there is
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a popular perception that children are targeted for soldiering because they are
easily influenced which is considered incomplete by Honwana considering the
concerted global strategy to use children in conflict (Honwana 2006: 44). Most
wars today are intrastate conflicts in which child soldiers are most likely to be
used by non-state actors such as local militia, liberation and rebel groups that
have few resources and little inclination to follow international convention
barring the use of child soldiers (Rosen 2007: 298).
The term child soldier is not exclusive to being involved in combat, but
instead encompasses the wide range of activities that a young person can
perform after being recruited or forcibly abducted. The Coalition to Stop the
Use of Child Soldiers provides the following description of child soldiers:
The Coalition considers a child soldier any person under the age of 18 who is a
member of or attached to government armed forces or any other regular or
irregular armed force or armed group, whether or not an armed conflict exists.
Child soldiers perform a range of tasks including: participation in combat, laying
mines and explosives, scouting, spying, acting as decoys, couriers or guards;
training, drill or other preparations; logistics and support functions, portering,
cooking and domestic labour; and sexual slavery or other recruitment for sexual
purposes (2004: 15).
According to Machel, considering the tens of thousands of child soldiers
in recent decades, “most are adolescents, though many child soldiers are 10
years of age or younger. While the majority are boys, girls also are also
recruited” (Machel 1996: 11). Child soldiers exist in every region of the world
and between 2004-2007 in 19 countries they were involved in government
forces or non-state armed groups (Coalition 2008), yet it is in Africa where
child soldiering has taken place in 13 countries with approximately 100,000
child soldiers (Coalition 2004: 31). In Uganda, the number of children
abducted is staggering. Most accounts of the number of children and women
who have been abducted by the LRA during the 22 year conflict are similar to
UNICEF’s figure of over 25,000 (UNICEF, 2008). However, according to
Annan et al, this number increases to 66,000 when “abductions of any length,
accounting for those who died, have not yet returned, and who did not pass
through a reception centre” are all taken into consideration(Annan et al. 2007:
5).
Many are inspired to come ‘out of the bush’ after listening to radio
broadcasts from other formerly abducted children who verify that once out of
the LRA they are treated well and are able to take advantage of the Amnesty
Act of 2000 which pardons all but the top LRA leadership from prosecution
(UNHCR 2007: 27). These children are returning home to communities that
have themselves suffered greatly from attacks by the LRA. The recent absence
of rebel attacks in northern Uganda in the past several years has facilitated the
return home of most of the 1.8 million internally displaced people (UNICEF
January - March 2008). The sheer number of displaced people, most of whom
were of the Acholi tribe, is an indication of the large scale effects the conflict
has had on the local population. One of the country’s many tribes, the Acholi
populations is approximately two million are indigenous to Paler, Kitgum and
Gulu districts in the north of the country; an area that is referred to as
Acholiland.
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The tragedy of the conflict for the Acholi people is filled with bitter irony.
The LRA, led by Joseph Kony, commits massacres against the Acholi people
who are the very people the LRA claims to be fighting for against the
government in Kampala. The government, against which many Acholi have
strong historical animosity towards (Kroes 2008: 24-25), forcibly moved the
population into internally displaced people’s (IDP) camps in 1996. As
Atkinson explains, moving to the camps was supposedly for the protection of
civilians from the LRA which proved to be the opposite since civilians were
not protected against LRA abductions, killing and rape in addition to attacks by
even the military that was charged to protect them (Atkinson et al. 2006: 3).
Regarding young people, the years spent in the camps is commonly referred to
as the cause for antisocial behaviour and the loss of traditional values among
the youth (Interview 21). As describe by Baines et al, “children in northern
Uganda and especially those living in IDP camps – have suffered terribly over
the past two decades of war and can be seen as the main victims of this
conflict” (Baines et al. 2006: 17)
Tindifa claims that the portrayal of Kony as a lunatic killer fits a pattern of
Western media racism and the government’s attempt to nullify the idea of a
political motive for the conflict (Tindifa 2006: 27). Nevertheless, the LRA has
forced children to commit and endure torture and abuse of every sadistic
possibility. Such experiences can have severe consequences for children:
A brutal system of severe punishments for disobedience as well as rewards for
carrying out the orders of commanders most likely has a brainwashing effect on
the young people, who often internalize the attitudes of their torturers over time
and become “willing” actors and perpetrators of atrocities. ... It can be argued
that, for physical and psychological survival, abductees often have no other
choice but to become part of the terror system, at least for a certain time and to a
certain extent (Atkinson et al. 2006: 4).
Children who emerge from the ‘bush’ by escaping or being captured by
government forces are victims and perpetrators of violence at the same time.
Those in most need of rehabilitation and treatment at receptions centres by
social workers include:
children that have participated in atrocities, who have severe physical or
psychological health problems, including disability; whose behaviour is
potentially dangerous to others; whose families have ceased to exist or reject
them; girls who have been severely abused, and girls who have become mothers
while in armed forces (Jareg 2005: 3).
And while the victims of LRA attacks are deserving of reparations
(Amnesty 2008), to achieve long term peace and stability for the whole
community, it is important to that the formerly abducted receive proper
rehabilitation for the lasting effects of traumatic experiences the abuse that was
inflicted on them in order to support their reintegration back into the their
local communities and support long term peace building.
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1.3 The International Response: Failed Prevention and the
Development of Rehabilitation Approaches
In the wake of greater international awareness of child soldiering around
the world, international treaties have been adopted in an attempt to prevent
recruitment and support the reintegration of former child soldiers. The
Convention of the Rights of the Child (CRC) was a watershed moment in
establishing child specific rights. Coming into effect in 1989, it is the most
widely ratified convention with 193 parties to the convention (UN 2009c).
However, as described by Rosen, the CRC came as a “bitter disappointment to
anti-child soldier advocates” because of its weak language on the obligations of
state parties and making the cut off of recruitment into armed forces at 15
years instead of 18 (Rosen 2007: 301). To address the shortcomings of the
CRC, two Optional Protocols (OP) to the CRC entered into force in 2002
including the OP on the involvement of children in armed conflict (UN 2000)
which has 125 signatories to date (UN 2009d). The OP protocol’s major
achievement was to increase the age of recruitment for state parties, in which it
states that state actors shall “ensure that persons who have not attained the age
of 18 years are not compulsorily recruited into their armed forces” (UN 2000:
Article 2).
Despite the adoption of the CRC and various other international
agreements intended to protect against not just child soldiering but children’s
vulnerability in conflict, “grave violations against children in conflict situations
continue” (UN 2009b: 2). The government of Uganda ratified the CRC in 1990
and the OP in 2002 (UN 2008: 6). In compliance with the OP the government
enacted national legislation UPDF Act, Cap 307 that forbids recruitment of
those under 18 into the military (UN 2008: 9). As for the LRA, the idea that an
international agreement could end their reign of terror is inconceivable given
their wanton disregard for human life which now continues in Central African
Republic.
Referring specifically to rehabilitation, the CRC indicates that state actors
should promote physical rehabilitation and social reintegration of child victims
including those from armed conflict (UN 1990: Article 37). The OP adds more
specific language to rehabilitation and reintegration by referring to the need for
state parties to support technical cooperation and financial assistance in
consultation with relevant international organisations (UN 2000: Article 7).
Outlining rehabilitation within these international treaties has facilitated the
rehabilitation of over 100, 000 former child soldiers since 1998 (UN 2009b).
While this is a great achievement, the underlying question is to understand on
what basis are programs designed?
UNICEF, closely involved in the development of the CRC, has been
instrumental in developing common guidelines for the challenges surrounding
child soldiers. In 1997, UNICEF led the effort to organise the Cape Town
Principles for relevant UN agencies and NGOs working in Africa to “develop
strategies for preventing recruitment of children, demobilising child soldiers
and helping them to reintegrate into society” (UNICEF 2007: 4). As a follow
up, UNICEF again worked with relevant organisations to update the
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rehabilitation approach for former child soldiers based on lessons learned. The
Paris Commitments were the result and include a second Paris Principles and
Guidelines document that provides greater detail useful for program
implementation. Within international rehabilitation work, initial vague
descriptions of physical rehabilitation and social reintegration came to be
articulated as ‘psychosocial’. This inclusive term attempts to address Western
and non-Western conceptions of individual and health by including “social,
cultural and psychological” in rehabilitation (Ager et al. 2009: 526) The
guidelines dedicate little space to psychosocial support explicitly but states that
[it] should be incorporated into the release process at the earliest stages and into
all stages of reintegration programming to assist children, families and
communities in developing and building their strengths and resilience and
involving them actively in their own recovery(UNICEF 2007: 39).
As a central element to rehabilitation and reintegration, the approach on
which psychosocial programs are based is significant because they have a
fundamental impact on the participants. For Akena Charles, a team leader with
Gulu Save the Children Organisation (GUSCO), rehabilitation is supporting
the formerly abducted child to achieve a level of functioning similar to that of
her peers (Interview 22).
Within the larger project of reintegration, Jareg explains psychosocial
support facilitates the participant to address the psychological challenges on an
individual basis as well as the social challenges stemming from experiencing
traumatic events:
Six programmatic areas should be addressed when planning for the recovery and
social integration of children associated with armed forces: restoring family
relationships; relationships with the community; children’s, health –physical and
psychological; organised learning opportunities; vocational training and income
generation; recreation and play. These aspects of rehabilitation and reintegration
need to be integrated within an holistic approach based on a ‘child rights and
child development framework’ (Jareg 2005: 4-5).
The psychological and social aspects of rehabilitation intersect with every
part of a person’s life and is therefore the crucial starting point from which to
understand rehabilitation.
The Paris Principles Guidelines document takes on counselling within
Jareg’s balanced approach. Section 7.75.5 elaborates specifically on counselling
as useful but that it can only work when not forced on a child and
implemented alongside traditional approaches (UNICEF 2007: 39-40). Yet to
suggest that traditional counselling and traditional healing practices can simply
be implemented alongside each other belies the complexity of the relationship
between rehabilitation approaches, as well as former child soldiers and their
cultural values in a post conflict context. Each context must be studied in and
of itself in order to devise the most appropriate program given the particular
circumstances.
Machel’s report itself recognised the need for cultural sensitivity (Machel
1996: 11), but the process to develop appropriate tools for the various contexts
in which psychosocial rehabilitation programs are implemented has occurred
slowly and is ongoing. Now, the Paris Principles address rehabilitation best
14
practices specifically by articulating the need for a balance between local
culture and Western approaches to rehabilitation. This is part of the effort to
reverse the previous trends which imposed Western rehabilitation practices in
non-Western settings. The reason for the focus on traditional healing is
because “healing practices ... are grounded in local beliefs” (Kostelny 2006: 24)
and are thus a product of culture. For, as Kostelny describes, “all children are
part of a culture that shapes their development, provides meaning, transmits
beliefs and values, and structures roles and responsibilities” (Kostelny 2006:
24). However, this assumes that because returnees live within a particular
culture that traditional healings practices can automatically apply to
rehabilitation. The total exclusion of one of the approaches may not be the
answer, but balancing indigenous and Western approaches is not that straight
forward either.
1.4 Rehabilitation Approaches in Non-Western Settings
The failure and rejection of Western only approaches to rehabilitation
programs for former child soldiers in non-Western settings was the impetus
towards accepting traditional healing practices in psychosocial rehabilitation
programs. Despite this fundamental shift in the debate, Summerfield maintains
that, unfortunately, “Western approaches to mental health are seen as an
automatic part of the humanitarian response, even for victims of war in
non­Western countries” (Derek Summerfield 2002: 1106). Examining the root
of Western interventions, Honwana points to Boothby’s research on an early
rehabilitation program at the Lhanguene Rehabilitation Centre in Mozambique
in 1987 for the children who had fought as part of the RENAMO rebel group,
which was administered by an American psychologist. Honwana states,
“neither their social isolation nor the process of verbally reliving their most
horrible experiences was helpful in enabling them to make the transition into
peacetime society (Honwana 2006: 138-139). According to Summerfield, “the
very idea of Western talk therapy or counselling, with its focus on detached
introspection, is alien in most non-Western cultures” (Summerfield D. 2004:
43). And according to Kostelny counselling practices that encourage emotional
expression through talking-may be inappropriate, or even harmful” (Kostelny
2006: 25).
A 1999 study in Freetown Sierra Leone was carried out to examine
traumatic stress of randomly selected adults who had endured the
consequences of 9 years of conflict and the accompanying gruesome human
rights abuses. Using an Impact of Event Scale (IES) to measure the effects of
traumatic events including post traumatic stress disorder (PTSD), the
researchers concluded, “the IES showed that 99% of respondents had scores
that indicated very high levels of disturbances, indicative of severe PTSD in
western Europe” (Jong et al. 2000: 267). Considered against the definition of
PTSD that, as Wessells notes, “includes dysfunctionality, by which is meant an
inability to perform expected daily tasks such as going to school or working”,
(Wessells 2006: 136) the results showing 99% PTSD begs credulity.
According to American Psychiatric Association’s authoritative Diagnostic
and Statistic Manual (DSM-IV), cited in Vivo, there are 6 criteria to diagnose
15
PTSD, including “severe problems in social or occupational every day
functioning” (Vivo 2007: 7). The severity of trauma is key because the lack of
adherence to this criteria allows for an over diagnosis, regardless of whether
the nature of PTSD reflects local beliefs on health. Alternative diagnosis could
include Acute Stress Response and Acute Stress Disorder which are less severe
on the grounds of shorter duration and intensity of symptoms (Henley 2005:
7). According Liesbeth Speelamn, a child psychologist working with former
child soldiers in Uganda since 2001, it is the notion of functionality that has
been lost in common usage and which allows for the PTSD label to be applied
recklessly. Speelman goes on to add that in northern Uganda “most child
soldiers experience trauma, are they traumatised? It’s questionable. And as for
PTSD, it’s not a large number” (Interview 24).
If the study in Freetown were accurate, this would mean that that vast
majority of the population would be incapacitated and unable to lead their daily
lives. Commenting on the same study in Sierra Leone, Summerfield argues that
to suggest that virtually all of the population is dysfunctional, “risks [PTSD]
being clinically meaningless and a ‘pseudocondition’ ” (D. Summerfield 2001:
97). The case in Sierra Leone epitomises the imposition of Western ideas of the
self and mental health in a non-Western setting. According to Jong such
practices are widespread (Jong et al. 2000: 267).
Assuming the applicability of Western approaches in non-Western
settings has been a fundamental mistake of rehabilitation programs. Referring
to “indigenous worldviews and systems of meaning”, Honwana contends that
“in order to be effective, the healing strategies to deal with the problems faced
by children affected by war in Africa need to take into account, and be
inscribed within, these healing systems and world views” (Honwana 2006:
156). In the article, Religion and Politics: Taking African Epistemologies
Seriously, Ellis and ter Haar describe how African religious views are widely
perceived to be superstitious. Distinctive features of African religion include a
belief in the spiritual world in which “spirit idioms” have specific identities and
can exercise their power over events and phenomena in the world (Ellis and ter
Haar 2007: 389).
As a product of African religion, Honwana explains the basis of traditional
healing practices that typifies African approaches to rehabilitating former child
soldiers:
The Cartesian dichotomy that separates body and mind in Western epistemology
is not recognized in these cases ... Because their wrongdoings can affect their
families and villages as well, the family members – including both the living and
the dead – are directly involved in the cleansing and healing process. The
ancestors are believed to have a powerful role in protecting their relatives against
evil and misfortune (Honwana 2006: 117).
This description aptly applies to Acholi culture in which the attitudes
about the relationship of the individual to the community and spirituality are
and shape particular practices such as healing. This definitional of culture is
fundamental to understanding the rehabilitation of former child soldiers and is
elaborated upon here. Acholi religion and traditional healing practices is an
example of African spirituality. Atkinson et al.’s thorough study of Acholi
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traditional healing fills a gap in the literature to understand not only the
mechanics of the many different ceremonies for different circumstances, but
the rich layers of meaning behind actions and symbols that are particular to the
context of Acholi culture. As mentioned in Atkinson et al.’s study, ‘traditional’
refers to “the living traditions of the people” as they are practiced today and
not those from an idealised past (Atkinson et al. 2006: 9). Though, that does
not mean that the practices are any more relevant. Based on Atkinson’s et al.’s
study, the following provides a basic introduction to traditional healing in
Acholi culture.
Depending on the ailment, spirits can be attributed as the cause of illness
or misfortune. For example, ancestors or chiefdom joggi are associated with
minor illnesses or misfortune. Whereas Free joggi, including Cen, are attributed
with causing more serious disturbances. Cen is the vengeful spirit of a dead
person that can haunt its killer, their family and clan as well as any person that
comes upon the dead body. The type of ceremony used to cleanse the person
afflicted with Cen depends on what the nature of involvement with the person
who was killed. For a killer, symptoms of Cen can include nightmares,
trembling, shouting, aggressive and random behaviour (Atkinson et al. 2006:
52-71).
Citing Okot p’ Bitek (1971), Atkinson writes that a central aspect of
Acholi culture has been focused on understanding why bad things happen and
how to respond to it (Atkinson et al. 2006: 42). One common example of a
traditional ceremony to cleanse one of haunting spirits is Mato Oput which
seeks to reconcile two clans after a murder has been committed. While
traditional culture has suffered through the conflict, the ritual has been
performed for returning child soldiers who have killed and is well known as an
example of Acholi traditional healing (Atkinson et al. 2006: 78-91). Rituals such
as Mato Oput can support psychosocial effects in several ways such as through
a “reduction of unspecific stress in the community (for example, feeling
haunted by spirits), the reaffirmation of positive cultural values, an increase in
community cohesion, the improvement of interpersonal relationships”
(Atkinson et al. 2006: 126).
The applicability of traditional Acholi rituals depends on the degree to
which they are accepted by the people themselves. As Atkinson acknowledges,
and what is most significant for traditional healing and formerly abducted, that
the relevance of traditional approaches for young people is decreasing because
those “who have grown up during a time of war with restricted possibilities to
experience or participate in such practices” (Atkinson et al. 2006: 114). This is
primarily due to the government, in 1996, forcibly moving two million people,
of which one million were Acholi and 90% of its population, into IDP camps.
There “the population languishes in squalid, disease-ridden camps, mostly
unable to cultivate and dependent on food aid for survival”(Atkinson et al.
2006: 1). The role of the community is implicit in traditional. In Gulu district
its relevance has suffered because of the conflict but also because of the
dominance of Western NGOs that import their own methods. Since the
benefits for the returnee and the community are known (Ager et al. 2009), and
17
in lieu of weakened traditional rituals, it is useful to focus on a re-examination
of the individual within communal psychosocial rehabilitation.
1.5 Understanding Rehabilitation in Northern Uganda
Within the Context of the Ongoing Evolution of Program
Guidelines
Conflict may disrupt cultural resources such as healing practices, but “the
role of outsiders should be to help restore traditions by assisting in community
empowerment and building local capacity through facilitation, training, and
technical assistance(Kostelny 2006: 29). Kostelny’s position carries the basic
assumption that culture and its tradition, though damaged, can carry on after
conflict. And according to the Inter-Agency Standing Committee (IASC), a
body created by the UN General Assembly to enhance humanitarian
assistance, psychosocial support programs should “not assume that methods
from abroad are necessarily better or impose them on local people in ways that
marginalise local supportive practices and beliefs” (IASC 2008: 11).
However there are risks in simplistic classifications of Western and nonWestern. Every non-Western setting is not the same nor are the effects of each
conflict on a society the same. Assuming the applicability of traditional healing
ignores the potential for cultural rupture due to the effects of conflict.
Therefore, in each context, it is important to understand how the
consequences of conflict affect the relationship between former child soldiers
and the beliefs that underpin traditional rituals and subsequently, what are the
consequences for returnees accepting traditional healing practices.
Despite the ongoing refinement of implementation guidelines, using
culturally grounded programs as a reference is a useful prism through which to
examine the practices of rehabilitation programs in the field and the
perspectives of those involved. If traditional practices are fractured, how does
the community perceive the use of Western rehabilitation methods? How is the
individualism of Western approaches reconciled within the community?
The balance, such as it is, between traditional and Western approaches is
not a blanket formula that can be imposed in non-Western settings.
Determining how to design rehabilitation practices that respect local culture
are very relevant for practitioners in the field. In northern Uganda, the variety
of rehabilitation approaches seemingly mirror the multitude of organisations.
Therefore, with an established practice of traditional healing rituals for
formerly abducted children, and a mass of international organisations with that
have imported their own rehabilitation approaches, exploring the experience
and perspectives of those involved in rehabilitation programs for former child
soldiers in Gulu district of Northern Uganda will provide insight into questions
of the significance of the relationship between the effects of conflict on culture
in different contexts, local perspectives on Western counselling and alternative
approaches, as well as the role of the individual in one’s own rehabilitation that
will be useful for program designers and implementers who are faced with the
seemingly conflicting choices of rehabilitation approaches.
18
1.6 Research Questions
Main Research Questions
What are the conditions for practicing traditional rituals?
How are Western rehabilitation approaches perceived locally?
Sub-Questions
What effects does conflict have on the relationship between traditional
cultural values and the acceptance of traditional rituals by former child
soldiers?
What is the role of the individual in international approaches to
rehabilitation?
1.7 Methodology
Given the conflict in northern Uganda, the use of traditional practices for
returning child soldiers and the plethora NGOs implementing rehabilitation
programs, Northern Uganda was an ideal location to learn from the
participants themselves about how they feel about their rehabilitation
experience and the various approaches. Prior to arriving in Uganda, my
colleague Robert Okeny arranged for my introduction to GUSCO, which
works exclusively with formerly abducted children. With this first contact, I
travelled and lived in Gulu town for two months. GUSCO was my first point
of contact and I was able to attend their community dialogues in the villages
which provided access to interviewees. However I became immersed in the
community and travelled from town to various locations in Gulu district
including Lamogi, Palaro, Odek and Atiak sub-counties to hear the stories of
formerly abducted children directly and the perspectives of NGO practitioners
and members of the community.
Data was collected primarily through semi structured one on one
interviews and focus groups. This gave me the flexibility to respond to new
information while covering the range of issues I had identified through an
accessible conversational approach. This approach was preferable to
questionnaires because it allowed me to adjust my interviews based on the
person and context. Given the over 30 interviews I conducted this was the
most useful and practical tool. Conversely, life study interviews would have
been too narrow due to its in depth approach with a small number of subjects.
This would not have allowed me to gain insight into the diversity of opinions
needed to understand how various approaches are perceived locally. While
semi structured interviews provided the flexibility to access a wide range of
actors it also allowed me to understand the reasons behind their perspectives.
Interviews with NGO staff and white collar workers were conducted in
English due to a generally a high level of proficiency. In the villages,
proficiency levels were inconsistent. Therefore, especially for focus groups, I
was able to make use of interpreters. Interviews notes were hand written and
coded usually after every interview.
19
Applying the principle of doing no harm was forefront in my mind. At all
times I abided by NGO guidelines given to me by GUSCO and War Child.
Prior to every interview, I introduced myself, the institution and the purpose of
this study in exploring how to best implement rehabilitation programs. For
formerly abducted children I assured them of their anonymity. Prior to taking
any pictures, permission was always requested. All of this was done verbally.
Since my research was focused on rehabilitation practices and their lives after
captivity in general, my questions did not probe into their experiences with the
LRA lest discussing these topics cause discomfort or even hardship.
Additionally, the experience of former child soldiers in captivity are well
documented and the specifics of their experiences would not have aided my
analysis aside from possibly finding correlations to time spent with the LRA
and difficulty in rehabilitation which I was not equipped to assess.
Semi Structured Interviews:
33 Interviews were conducted, one on one and focus group, with formerly
abducted children, mix of abducted and non-abducted, parents of abducted
and non-abducted, community counsellor, academics and NGO practitioners
from GUSCO, WCH, St. Monica’s Girls Tailoring School, GWED-G, Save the
Children in Uganda. For a detailed list of interviews see Annex A.
With formerly abducted children, I introduced the purpose of my research
in broad terms; to understand their rehabilitation programs and experiences.
This guided their answers in the general area of my interest without being too
vague so that they did not know what they were answering or too particular so
as to tell them what I wanted to hear. Within in the interview, I sought to
cover areas including, how they felt about the rehabilitation practices, how they
felt after participating in it, how are their conditions and attitudes today, how
have/do others support or hinder your reintegration. Questions about their
attitudes towards particular rehabilitation methods such as counselling and
traditional healing, were open ended with phrasing such as “did you find it
useful or not useful?”
From the focus groups, it was difficult to get a sense of the discussion
because of my lack of Acholi language abilities which would aid me in
understanding the group dynamic when people converse among themselves
over a given question. For the most part though, when an individual spoke,
others listened attentively and each spoke in turn. To spur debate, I would ask
the group if they agreed with the previous respondent’s answer. Also, I have
included the replies of multiple respondents to a given question in order to
better present the views of the group.
Research participants were reached in different ways. Over time, I was
able to make more contacts and through each meeting I was introduced to
other individuals who could possibly be interviewed. As an outsider, this tactic
worked exceptionally well as the recommendations from colleagues and friends
gave me access to people and organisations that I would have not otherwise
had. As a result, the research sampling is random.
20
Observation
Over the course of 8 weeks, as a participatory observer, I lived with a local
family and sought to immerse myself with as much information about local
rehabilitation programs and NGO work taking place in Gulu district. I had
countless conversations with NGO workers and took every chance possible to
visit the field.
Secondary Data
Through secondary research, using database for academic journals, I have
been able to provide the contextual background and analysis to child soldiers,
the conflict in Acholiland, and Western and traditional rehabilitation
approaches to the rehabilitation of former child soldiers in order to provide a
foundation to understand the current situation of rehabilitation approaches
and local perspectives of on Western approaches.
1.8 Considerations and Limitations
Children who grew up in IDP camps are also prone to experiencing
trauma and being traumatised just as young people who were forced to serve
for the LRA (Wessells 2006: 133). And while there is overlap in rehabilitation
programs between the two groups, widening this paper’s scope to include all
young people affected by the conflict was not feasible. However, the findings
relating to the nature of rehabilitation can be useful in considering the design
of programs for young people in non-Western settings more generally.
Respondents were generally positive towards each of the programs and
endorsed the means of implementation. There was generally an uncritical
attitude towards notions of Western psychology such as trauma and
counselling practices. Widespread positive support of an imported idea does
not necessarily imply some sort of deception or inaccuracy, and instead may
actually reflect a high degree of indigenisation.
For local government workers, however, there is a material interest in
maintaining the status quo. For their role in coordinating the local community
and other efforts to support the NGO’s work in the community, local leaders
receive bicycles to perform the requested activities and credit for their mobile
phones. Some communities have several NGOs working in it which means
that some leaders could benefit several times over.
Since I was a visitor, I did not have access to a secure meeting location
and meetings would be outside under the mango tree where meetings often
take place. This was a challenge to keep numbers manageable since sometimes
other potential participants for the focus group would join the interview in
mid-session. Participants were not concerned by the location of our meetings
and returnees readily spoke about their experience as one in front of others
indicating that concerns about concealing their past was not an issue.
21
Difficulty in coordinating with local leaders via NGO contacts made it
challenging to secure one on one interviews with formerly abducted children.
Also, participants walked far distances to the meetings, which created pressure
to conduct group interviews as opposed to making individuals wait hours
before their turn.
For the various meetings, I lacked a private interpreter to conduct each
interview with me, which meant that with each NGO there was a different
person who interpreted the questions and replies. This makes the variable in
translating terms more likely and possibly creates inconsistencies in translating
words and ideas. Additionally, questions originated in English using English
terms to describe phenomena such as rehabilitation. Using Western vocabulary
in non-Western setting can limit the ability for individuals to provide responses
outside a Western framework.
22
Chapter 2
Analytical Framework
2.1 Culture
To address the conflicting rehabilitation choices of Western and
traditional healing involves reconciling the underlying difference in world views
of each. Kostelny explains the difference as it relates to childhood:
While Western ideas of childhood view the child as an autonomous entity or as
developing into one, other countries (including most war zones) children’s
identities are defined mainly in terms of their social relations and social roles;
people have collectivist identities that honour the good of the group over any
individual good (Kostelny 2006: 21).
The distinctions Kostelny draws between Western and collectivist
identities mirror the contrast of cultures in Gulu and the context in which
young people are examined.
Experts call for a balance between two fundamentally different
perspectives for programs in non-Western settings, but the massive influence
of international NGOs and UN agencies betrays another reality. With over 220
NGOs in the town of Gulu (Interview 9), the city is a major development hub.
The application of traditional practices alongside NGO programs as a general
rule is not clear. Traditional rituals are common for returnees, though mostly
taken on by community elders, the implementation of imported practices is
widespread. Terms such as trauma, PTSD and psychosocial rehabilitation are
common language among local NGO workers and lay people.
It is within the Acholi context of collectivist values and severely affected
children that Western psychological approaches attempt to address a child’s
trauma. An interesting counterpoint to accusations of imposing individualistic
methods is to refer to Ellis and ter Haar’s argument that Christianity in Africa
should not be seen as an imposition. Its presence should not be seen as a break
with the Africa’s spiritual past but as representative of the changing nature of
world views and their ability to incorporate new ideas (Ellis and Ter Haar 2007:
388). Accordingly, widespread acceptance of PTSD oriented counselling would
also indicate indigenisation.
The question of indigenisation strikes at the core of the issue because of
the perceived incompatibility between the collectivist identities of non-Western
settings and the individualism of the West. Yet, the ‘core symptoms’ of trauma
are similar across cultures and include:
Problems re-experiencing traumatic events, having nightmares and intrusive
thoughts. [Those who have experienced a traumatic event] are suffering from
hyper arousal, including poor sleep, poor concentration, and irritability.
Avoidance symptoms are also common, especially those involving reminders
that trigger memories of the past and violence. Numbing and social
withdrawal, however, can vary depending on individual or situational
differences (B. Drozdek 2007: 9).
While the symptoms of trauma are the same across cultures, the context in
which they are interpreted and acted upon are different (B. Drozdek, J.P.
23
Wilson 2007: 373). The primacy of context is recognised, but yet to be
adequately accounted for in rehabilitation programs. In the West, the focus on
the individual excludes other aspects of a person’s life which is fundamental to
understanding life experience in other cultures. Therefore, the universal
existence of symptoms does not mean they have the same meaning in each
context, which renders the use of terms such as PTSD invalid (D. Summerfield
2004: 233-239) or as Kleinman cited in Wessells describes it, a categorical
fallacy (Wessells 2006: 137).
The predominance of Western culture and science globally supports an
assumption of the superiority of the products of Western society. Drozdek
looks at Western society to understand how Western medicine, including
PTSD and counselling, is a product of its own culture:
The Western industrial culture overemphasizes the self-assertive and neglects
the integrative tendencies. This culture prefers rational over intuitive thinking,
analysis over synthesis, reductionism over holistic approach and linear over
non-linear thinking (B. Drozdek 2007: 3).
The products of Western medicine are symptomatic of Drozdek’s
description of Western culture. Instead of representing a universal
phenomenon, PTSD was developed by American psychologists to treat
soldiers returning from the Vietnam War. As Summerfield argues, various
antisocial behaviours became subsumed under one rubric. The creation of
PTSD is in fact a product of social and political forces that worked to develop
a new disorder (D. Summerfield 2001: 95). Simple questions raised by
Summerfield raise important questions as to the fundamental validity of PTSD.
With each new addition of the Diagnostic and Statistical Manual of Mental
Disorders, new disorders appear and others disappear. Questioning the
seemingly flighty existence of disorders, Summerfield asks “where were they
before?” And “where did they go?” (D. Summerfield 2001: 97). This transience
of disorders begs the ability of Western science to claim that its diagnosis
objectively and exclusively reflects reality.
The rise of individualism and the medicalisation of the human condition
are distinct cultural aspects of modern Western society. Presenting Western
medicine as “universal knowledge” betrays its true nature as an “ethnomedical
system” peculiar to a particular culture (D. Summerfield 2004: 233-239).
2.2 Psychosocial Rehabilitation
In light of the inherent cultural bias that sees rehabilitation as mental
health and divorced from spirituality and the social world, reconciling the
different approaches therefore means that international rehabilitation
implementers have to change according to the context. Reflecting this attempt
to change rehabilitation practices, the term ‘psychosocial’ rehabilitation is used
by international organisations and is intended to “indicate commitment to non
medical approaches” (Ommeren et al. 2005: 71).
According to Ager et al “the term ‘psychosocial’ encompasses social,
cultural and psychological” spheres as elements in a child’s recovery (Ager et al.
2009: 526). The process of rehabilitation is to support the recovery of the
24
former child soldier and according to Akena Charles of GUSCO, this is
achieved “when the functioning of the returning children is on par with those
in the community. Children can relate freely and get involved with community.
Child rights are protected” (Interview 22).
While rehabilitation is a long term process, its success for formerly
abducted children can be thought of as the ability to deal with the past in a way
that minimises the symptoms of trauma, puts one in a position to socialise with
others and support oneself. These criteria for successful rehabilitation, in this
context, are used to indicate a positive outcome generally. Part of the long
process of rehabilitation is simultaneous with reintegration of returnees to their
home communities. This is part of a formal disarmament demobilisation and
reintegration process which is “the formal and controlled discharge of active
combatants from armed forces or other armed groups”(UNICEF 2007: 8).
For those children most affected, the process of rehabilitation starts in the
centre and will continue long after a returnee leaves the reception centre. Jareg
describes the process:
The process of re-uniting a child with his/her family and facilitating their
community membership is, of course, also a complex process, which is partly
dependent on the success of the ‘rehabilitation’ process. ‘Reintegration’
eventually becomes indistinguishable from ‘rehabilitation’ as the child’s
psychosocial progress is inextricably linked with their once again becoming
members of the community(Jareg 2005: 3).
Rehabilitation, then, is a lengthy process that makes use of both
indigenous and Western approaches addressing the individual, communal and
spiritual aspects of the returnee’s trauma.
Appreciating the complexities of cultural identities and the purpose of
psychosocial rehabilitation, it is possible to best understand the perspectives of
those involved in rehabilitation programs in order to understand the effects of
conflict on traditional healing. As well as to know how the role of the
individual plays out given the opposing views of the self in relation to health.
More broadly, the role of local and international development actors and the
degree to which the rhetoric of balanced programs reflects reality will not only
be instructive for program design and implementation, but indicate to what
extent international development is living up to its commitment to respect and
partner with traditional healing practices.
25
Chapter 3
Conflict, Culture and Context:
Traditional
Healing
and
Rehabilitation
Approaches in Gulu District
Local development professional describe how the forced relocation of the
majority of Acholi people into IDP camps became a threat in itself to the
people and to Acholi culture due to the prolonged wretched social conditions
that had to be endured. The effect has been a rupture in the relationship
between traditional cultural values and youth which has reduced the acceptance
of traditional healing practices among formerly abducted children. Today, in
lieu of government services, Gulu district is abound with development
organisations implementing a variety of rehabilitation programs. Among the
organisations are local and international NGOs such as GUSCO and War
Child Holland that are the primary organisations studied for their different
approaches to psychosocial rehabilitation.
3.1 A Relationship in Conflict: Young People and Traditional
Culture
Traditional values and social relations have been damaged through a whole
generation of Acholi youth growing up IDP camps. Ajok Margaret, of UN
Human Rights, advocates on behalf of women and children to the government
for more programs and reparations because the only current psychosocial
programs are for formerly abducted children. Having seen the paltry social
services provided for young people before they are detained by police, Ajok
states that because of camp life, “[youth] have no respect, the cultural values
have eroded. In the camps, toys are the only guns, young people only know
violence (Interview 23).
Several interviewees stressed the profound impact living in the camps had
on young people. Adokorach Christine of CRR explained that the camps were
lawless, had rampant alcoholism, and prostitution due to the vulnerable state of
women. Girls were affected by rape and increased sexual activity. Boys are
susceptible to becoming drunkards, no hope for the future, no work ethic.
They expect relief, such as WFP food handouts, and when it is no longer there
they become thieves (Interview 10).
Victor Ochen, whose brother and several classmates were abducted, and
who started the African Youth Initiative Network (AYINET) adds another
account. Today’s youth have been born and raised in camps where they ate one
meal a day, and even slept in the bush when the situation in the camps was too
dangerous. Youth made decisions based on desperation. They witnessed abuse
and participated in it as well. Victor goes on to say that in addition to the threat
of LRA attacks and negative social pressures, the government also committed
attacks including rape which is why in 2005 they army starting testing for HIV
within in its own ranks (Interview 20).
26
As people have begun moving from the IDP camps back to the villages, a
community counsellor near Gulu town in Unyama attributes many of the
major current social problems to the experiences in the camps. There is a high
risk of “rape and defilement” for women. Generally, men have no interest to
cultivate land. They see no purpose in returning to the villages. Children and
youth see what their parents are doing and refuse to go to school, they have
bad manners and some start drinking at 9 years old, become thieves, join gangs
and smoke marijuana (Interview 26). Director of the NGO Girls and Women
Economic Development in Gulu (GWED-G), Angwech Pamela Judith adds
that the conflict has brought AIDS among children, child headed households,
orphans, school drop outs. Children are influenced by the violence. When they
draw, they draw fighting. When they play games, they are shooting games
(Interview 31).
Fabius Okumu – Alya, Director of the Institute of Peace and Strategic
Studies at Gulu University, argues that the camp system led to a total
degeneration of the social fabric in Acholi culture. Most damaging however for
the continuity of culture between generations was the loss of the evening
fireside gathering called the Wong-oo (Interview 21, 28). Wang-oo was the
focal point where the continuity of traditional values and customs took place
(Atkinson et al. 2006: 37). According to Fabius Okumu – Alya, the Wang-oo
was held every evening, the household ate and listened to the elders’ stories
which served as both entertainment and moral education and conflict
resolution (Interview 21).
There was simply no space made to recreate the Wang-oo in the same way
as it had existed. Consequently, for over 20 years, the lack of a formal space to
bind the community in the midst of serious social problems severely
undermined the status of elders and the continuity of traditional values from
one generation to the next. Several older respondents decry the loss of Acholi
cultural traits such as such respect for the patriarch, child work, but not labour,
and increasing individualistic attitudes of young people (Interview 28, 29). l, the
role of elders as described by Sister Okello was central to the lives of young
people. They would spend a lot of time together and be moulded according to
the values of the older generation in order to prepare them for their future. So
many things have happened and young people go to movies and discos. When
there were disputes, elders used to mediate, but now “young are learning from
the young. Now, it is rare for young people to sit with elders”(Interview 18).
Traditional chiefs used to be a fountain of power, but this was lost in the
camps since they had no status. Power rested with those that who coordinated
food distribution (Interview 21).
The experience of children and youth in the camps affected the
acceptance of traditional practices in the rehabilitation of the formerly
abducted. The benefits of the rituals can only be maximised for all if the
participants subscribe to the ideas on which the ceremonies are based. Young
people are not only participants in rehabilitation programs but also community
members whose acceptance of the returnee supports their psychosocial
recovery by not stigmatising through calling the returnee a killer for example.
Therefore the incongruity between the beliefs of formerly abducted children
27
and other young people in the community with those of their elders who lead
the rituals has consequences. If the effectiveness of traditional practices is
compromised due to cultural detachment, then this can pose difficulties for
rehabilitation and possibly the peace and reconciliation for the entire
community.
The attitudes of formerly abducted children who participated in traditional
Acholi healing ceremonies vary. One of the activities that GUSCO organises
for children who have returned to the reception centre from captivity is to
burn the clothes they had worn when they first arrived as part of a ceremony
to symbolise leaving their past behind. In a focus group discussion with
formerly abducted children, they gave various views on the purpose of burning
clothes: “it doesn’t work. Cen (evil spirit) cannot leave a person by burning
clothes. Burning clothes is just for hygiene.” Another said, “burning clothes
happens because after returning others might recognise the clothes as stolen
from someone they know,” and “clothes are burned because of lice”. For most
in the group, they believe that burning clothes cannot do away with Cen, but
it’s the first step in doing away with memories (Interview 6). Regardless of
whether burning clothes was thought to have had any use, the mixture of
responses provides an indication of the different attitudes towards Cen and the
spiritual world on which traditional healing is based. When asked specifically
about the ceremonies intended to cleanse them of Cen after returning to the
village, such as the ceremony of stick and the egg, responses included, “it
doesn’t help, it’s just tradition” and “nightmares only exist in a person’s
memory” (Interview 6). The variety of explanations and sceptical views
contrasts with those of other returnees who were more positive about their
views and experiences with traditional healing.
A focus group in Palaro sub-county of three formerly abducted children,
two males and one female who have been back in the community for 3, 5 and
8 years, attributed their ability to integrate into the community with the affects
of the traditional rituals and community sensitisation. As one respondent said,
the traditional ceremony she went through changed the community’s attitude
towards her and showed that the community still loves her. The effects were
immediate as her nightmares stopped. The other male respondent indicated
that he strongly believes in the rituals because it is the culture and referred to
vague consequences for the individual if he did not participate. The female
respondent was resigned to the status quo saying that ever since she was born
the traditional practices were already there, if elders believe it then who is she
to deny the them (Interview 27). These participants have strong positive
comments in support of traditional healing, though for different reasons of
which some possibly allude to social pressure.
If some participants do not subscribe to the ideas that underpin the
activities, seen more clearly in the first focus group, then it begs the question,
for whom do the rituals benefit? Liesbeth Speelman, adds to this point when
she points out that “stepping on egg shells doesn’t end stigmatisation”
(Interview 24). A viewpoint reiterated by Okumu who says that “Cultural traits
such as stepping on egg shells doesn’t bind people anymore.” (Interview 21).
Explaining further, Speelman contends that the approach to rehabilitation as it
28
existed previously in Acholiland was not just stepping on egg shells, but a
society that supported each other. According to these two commentators, the
meanings that bind participants to the rituals no longer exist and nor are the
social support systems to facilitate the rehabilitation and reintegration that the
rituals represent.
For some however, there is no question as to the ability of traditional
healing to serve as a primary rehabilitation tool. Accompanying the participants
of the focus group in Palaro was a youth leader. The purpose of him joining
the meeting was not clear, since the meeting had been arranged by the local
government office. He said that for those who did not participate in the rituals,
the nightmares were driving them insane (Interview 27). This absolutist
perspective is echoed by Okidi- Lumedo David M., an author promoting
Acholi cultural values, who contends that if an individual does not accept the
cleansing ceremony, then the community will not accept the individual and that
the person will carry on with criminal behaviour. And all those who have gone
through the ceremony will no longer have nightmares whereas those who have
not had the cleansing do have nightmares (Interview 28). Such perspectives
clearly put the locus of control over the individual’s rehabilitation in the
community. The effect of this is that if a returnee does not conform to
communally defined traditional mechanisms or any other manifestation of
communal expectations, then the individual’s rehabilitation has no chance of
success in the eyes of the community.
While nightmares may end for some, rehabilitation and reintegration are
long term processes that depend on community support. Epitomising
traditional healing through rituals with 100% a success rate not only begs
credulity but also does an injustice to the community cooperation that is
supposed to take place after a ritual. As part of the individual and community’s
rehabilitation, effort needs to made to restore community capacity and
attitudes to support returnees.
A position that presents traditional practices in Acholiland as able to
perform as before ignores several important points. A divorce between the
cultural traditions of the elders and young people including former child
soldiers, weakens the attachment to the cultural values that underpin traditional
healing practices. Therefore it cannot be assumed that the widespread belief in
the efficacy of the rituals is the same as it once was. As Sister Okello states,
“forgiveness is a process that has to begin in each individual’s heart” (Interview
18). If the participants and community do not believe in the rituals, then
merely performing rituals does not necessarily mean that it has the same effect
on the participant as it once would have. At the very least, belief in the rituals
cannot be said to be universal.
Furthermore, there is the question of whether traditional ceremonies are
applicable in the current context at all. Okumu makes an often repeated claim
that the traditional practices are overwhelmed by the scale and nature of the
conflict since they were not intended to address large scale massacres(Interview
21). Prior to the conflict the ritual had been last used for individual murders in
the 1950’s and 60’s (Interview 21, 25). Keller adds that rituals to cleanse those
who have killed were intended for inter-clan incidents up to simple murder”
29
and that “killings during times of war traditionally did not require Mato Oput”
(2008: 231).
The International Criminal Court (ICC) has indicted five of the LRA top
leadership and is well known throughout Uganda though for many in the north
its reputation is poor (Interview 20). In Acholiland, preference for traditional
justice, as opposed to the ICC, is attributed the culture’s emphasis on forgiving
(Kasaija 2006: 6). Lauren Gould, PhD candidate at the Centre for Conflict
Studies at Utrecht University studying Acholi reconciliation, suggests that the
initial attitude of forgiveness to former child soldiers gives way to the reality of
living next door to someone who may have perpetrated violence in the
community. The desire of the average person wanting to leave the camps
enabled them to think that once they returned to life in the village, the social
problems plaguing life in the camps would go away. Now, after many have
made the transition, life has not gotten easier and now people are disappointed.
It is these conditions, according to Gould, that creates animosity towards
former child soldiers. Young people returning from the LRA are now being
denied their land rights by communities because of what they did while in
captivity arguing that they do not deserve land (Interview 25). A sense of
community and reconciliation appear to suffer in conditions of social
breakdown.
Attitudes aside, the ability of traditional practices to satisfy its own criteria
falters on practical grounds. Okumu raises the point that for many acts of
violence committed by the LRA, the identities of the attackers are not known
which is central to identifying the culprit and the clan who all will provide
compensation (Interview 21)(Atkinson et al. 2006: 90). So when rituals are
carried out, what sense of personal justice to the victims is there? (Interview
21) Furthermore, many rituals prescribe compensation to be paid which is
practically impossible for most people and their communities to afford
(Atkinson et al. 2006: 82) (Interview 24).
The relevance of traditional healing practices for former child soldiers has
been undermined by a fundamental detachment in young people’s relationship
with traditional beliefs and relationships. Furthermore, the nature of the
conflict also seriously weakens the application of traditional rituals on its own
terms. Given the predicament of traditional healing, it is valuable to understand
what is the reaction of the government and development actors towards the
psychosocial rehabilitation of returnees.
3.2 Development
Organisations
&
Pyschosocial
Rehabilitation: Different Approaches for Different Actors
In Gulu town the omnipresence of NGOs and UN agencies is clear.
There are 220 NGOs in Gulu (Interview 9) conducting every type of
development project. Even within psychosocial rehabilitation there are
numerous organisations each with their own approach. In conducting
interviews regarding psychosocial rehabilitation, terms such as trauma,
traumatised and counselling are used effortlessly by NGO workers and lay
30
people alike. The language and ideas of psychologically based interventions are
well entrenched.
First and foremost, it is the responsibility of the government as the
primary duty barer to provide social services. While the years of conflict may
have provided an excuse for poor service provision, despite the LRA’s
withdrawal from Uganda and the relative peace they left behind, NGO’s
remain the main service providers, which is likely to remain for the foreseeable
future.
Uganda’s country report on the CRC’s OP of children in armed conflict
portrays a flattering role of the government facilitating a rich NGO
environment through which the formerly abducted receive the psychosocial
treatment they need (UN 2008: 31). This is in direct contrast to a report from
Amnesty International that acknowledges the usefulness of the initial
psychosocial support that the formerly abducted receive at reception centres
during the first couple of weeks out of captivity, but that the government is
failing its responsibility to provide long term mental health services (Amnesty
2008: 14).
According to the former highest government officer in neighbouring Lira
district, at the district level, there has been an investment in government
capacity, since “previously, the problems of children were not taken seriously.
Now there is a deliberate effort [by government] to address the challenges of
children” (Interview 19). While the infrastructure and training may be in place,
the ability or willingness of the government to manage NGO implementation,
quality and to guide the transition of service delivery to the government is in
question (Interview 21, 15, 9).
NGOs have rushed to fill the gap left by government. Constantly driving
through the dusty streets of Gulu town are the various 4x4s with decals
proclaiming which UN agency or international NGO to which the vehicle
belongs. For many local NGOs and even local government trucks, donor
names such as UNICEF are prominently displayed alongside the local recipient
organisation. According to Donald Odero of Save the Children in Uganda, the
“government is the nucleus in the development process. NGOs are just
supposed to bridge the gap” (Interview 11). But who fills the gap between the
NGOs?
Uganda’s 2007 report to the CRC states that “World Vision, Gulu Support
the Children Organisation (GUSCO), Concerned Parents’ Association (CPA),
Rachele and Kitgum Concerned Women’s Association (KICWA) show that so
far, over 25,000 formerly abducted children have gone through rehabilitation
centres (UN 2008: 16). This massive effort to support the reintegration of
formerly abducted children is generally conducted independently without
consistent cooperation to develop a common approach and best practices for
psychosocial support. While a guidelines document was produced in 2004 by a
group of relevant NGOs and UNICEF in Gulu, it pertained to creating
minimum standards for reception centres and once handed over to the
government there has been little follow up on monitoring psychosocial best
practices (Interview 11, 24).
31
According to Adolf Gerstl, regional coordinator of the EU’s Northern
Uganda Rehabilitation Program (NUREP), €4.7 million was provided to 6
NGOs to for ‘software’ related programs in the first half of 2009. Such
programs are made up of a mixture of livelihoods, psychosocial, training, peace
building and conflict resolution. Yet, regarding their psychosocial programs, all
the organisations selected use various methods to implement their programs.
Monitoring and evaluation is done to ensure the application was executed
properly, but is not measured against the best practices within a topic
(Interview9). The lack of tools to measure how programs perform underscores
the need for a greater consensus on program implementation methods.
One the most common methods for rehabilitation is trauma counselling
which is used by GUSCO in its reception center for formerly abducted
children. GUSCO is an indigenous organisation started by the parents of
abducted children in 1997 to care for children returning from captivity and
supported the rehabilitation of 7,769 returnees as of 2007 (Gusco 2009). Prior
to its inception, children were held in military barracks and let go into the
street looking for their parents. GUSCO also supports reintegration through
family tracing and vocational training (Interview 11). However, counselling is a
central element of its rehabilitation approach.
When the formerly abducted come to the GUSCO’s reception centre, for
a minimum of three weeks, children become part of an established routine to
instil healthy living habits and to acclimatise returnees to life outside the bush.
Upon arrival, social workers administer a mental health assessment to
determine if a returnee is suffering from PTSD and then provide the
appropriate counselling based on their condition (Interview 30). This process is
based on documents such as the Assessment of war affected adolescents and adults in
Northern Uganda: A Manual for Counsellors and Interviewers that assess health in
terms of ‘psychotraumatisation’ without accommodating for Acholi world
views of spirituality and connection to the community (Vivo 2007: 4-12).
A trained GUSCO social worker, with a degree in social work from
Msamizi Institute of Social Development in Kampala, describes the
counselling process. Over time trust is built and a child can come to speak
about their past experiences go through counselling. For example, a child who
has come to the centre and is not speaking due to trauma and runs out of soap
will come and ask for more soap. Even these simple interactions builds trust.
Over time, a dialogue forms, the purpose of which is to make the child realise
what happened is in the past and to look to the future (Interview 30).
Providing the opportunity but not forcing dialogue is consistent with
rehabilitation guidelines (UNICEF 2007: 40). Nevertheless, according to an
external evaluation on GUSCO, “Children are also invited to share their
‘abduction story,’ including their experiences in captivity ... All children are
interviewed individually to ‘open their file’” (Barnett et al. 2004: 25) or in other
words, speak at length about their experience. And while a traditional healer or
pastor may be requested by the program participant (Interview 3)(Barnett et al.
2004: 30) the schedule of daily counselling at the reception centre prioritises
counselling based on PTSD in order to support recovery through exploring the
traumatic experiences of the former child soldiers.
32
War Child Holland is not the first stop for children coming out of the
bush but its use of creative activities and sport serves as a useful contrast to
GUSCO’s counselling as a means to support the trauma former child soldiers
have faced in order to achieve normal functionability. WCH’s activities are part
of a program that supports formerly abducted children and at the same time
others who were not abducted. This approach avoids stigmatising the formerly
abducted by not singling them out as ‘different’ and providing them with extra
resources while others go without. These programs provide a type of individual
therapy and support the development of life skills while preventing the
worsening of trauma symptoms. And while the program focuses on the group
as a whole, it provides individual therapy for young people within a communal
context. Individuals learn the life skills they need to guide making healthy and
productive choices for their future while simultaneously being integrated
socially (Interview 24)(Interview 35).
Other programs in which participants and personnel were interviewed
include two other local organisations. St.Monica’s Girls Tailoring School
focuses specifically on developing vocational, such as tailoring, catering,
secretarial and computer training, skills that formerly abducted and other
vulnerable girls can use to be self supporting. GWED-G implements
psychosocial programs and is an implementing partner for the WCH
supported girls football team.
GUSCO’s counselling work in the reception centre, WCH’s individual
recovery and social integration through creative and sport activities as well as
St. Monica’s and GWED-G all work towards support the successful
rehabilitation of formerly abducted children. Interviews with participants,
parents, non-abducted children, NGO implementers and other development
actors provide perspectives on whether the different approaches are
acceptance locally and thus the degree to which they are compatible with local
culture.
33
Chapter 4
Western Intervention Methods:
The Agency of the Individual within the
Rehabilitation Process
According to field research conducted for this paper in the northern Ugandan
district of Gulu, participants had positive experiences while engaged in various
types of rehabilitation approaches. To determine local perceptions towards
imported methods, interviews with programs participants were key and
supported by other community and development actors. Participants, mainly
from GUSCO, WCH but also from others such as St. Monica’s Girls Tailoring
Center, GWED-G and Unyama community counselling, have a positive
attitude towards PTSD oriented counselling, supportive community
counselling, and creative activities and sport. The strong desire of former child
soldiers to increase their life chances through education and to support oneself
with an income, crystallise a link between the reception centre, social
reintegration and self dependency in which the role of individual skill
development is key to successful rehabilitation.
4.1 Counselling
Several unexpected insights into the perspective of participants in
rehabilitation programs were learned during a large focus group with formerly
abducted children on the border with Sudan. It was a two hour motor bike trek
from the town of Gulu along the country roads to Bibia parish in Atiak sub
county. My colleague, Tabu Simon, remarked how incredible it was to be in
this area as dusk approached and still be safe. For him, it was a sign that peace
had arrived. But were those who had gone through GUSCO’s program at
peace with themselves and the community?
Lending stark imagery to the serene surroundings of thatched huts, the
focus group participants mentioned that as members of the LRA, they could
move freely, in the area in which we were sitting, just a few years before. In
discussing their experiences at the GUSCO reception centre, prayer and
counselling became two parallel topics that provided an interesting point of
reference to learn more about the role of each in rehabilitation. As one
respondent explained, their rescue from the LRA was because of God, which
is why some had become born again Christians. Another described their
perception of the relationship between the two, “all rehabilitation is prayer and
counselling hand in hand together. They are difficult to separate. Prayers are
included in counselling practice” (Interview 6).
Even though prayer was combined with counselling, there were distinct
perceptions as to the function of each. For one respondent, “counselling
helped because I stopped doing the things of before, it provided moral
guidelines”. And another said that “counselling is more important because it
allows for reform. If there were only prayers, a person would still do
atrocities.” As to a question on what they saw as the difference between
34
counselling and prayer, their answers included: “counselling talks facts, prayer
is general” and “counselling brings a person face to face with what they’ve
done. The person feels it. Prayers are too general to get advice”(Interview 6).
The respondents in this group indicate that counselling, as compared to prayer,
is a useful tool to reform behaviour. The respondents are aware of what
benefits their rehabilitation and express a preference for ones that can aid them
in concrete ways to deal with the challenges of changing their actions.
GUSCO’s counselling practices experienced by focus group participants in
Palaro sub-county also received positive comments. Of the three formerly
abducted children, the first male respondent expressed that counselling allowed
him to share and know that he is not the only one with problems stemming
from the violence they committed and observed while in the LRA. The second
male and female respondent both indicated that counselling was instrumental
to give them hope for the future (Interview 27).
In Unyama, just outside of Gulu town, the only support for the formerly
abducted is a local counselling centre. The little funding they receive through
GWED-G does not even go towards paying the local staff who provide
counselling to the community and among them many formerly abducted girls
and girl mothers. In an interview with a formerly abducted girl who came back
from captivity, forced marriage and a child due to rape, counselling as her
primary source of hope was clear. Even just arriving at the counselling centre,
women seemingly spilled out of the office, which upon entering only had
enough room for one desk. By the time everyone had made way for our
meeting to start in the office, those who were inside now made up a large
group sitting outside. Many of these women are part of a group of 30 formerly
abducted girls from Unyama and the surrounding region. When they have
problems such as flashbacks and are struck with fear or are discriminated
against by the community, they come to the counselling centre to receive
positive feedback and encouragement. As the former girl mother now a young
adult makes clear, the counselling gives them the comfort to persevere through
their daily challenges (Interview 26).
The experience at St. Monica’s Girls Tailoring Center, which has been
taking formerly abducted girls since the beginning of the conflict, contends
that the difference counselling makes in a child is clear. Those who go through
GUSCO are less aggressive and more polite than those who go back to their
village straight from captivity (Interview 8). A student, who was not abducted
herself, describes formerly abducted girls who start at St. Monica’s as
aggressive and suffering from nightmares. When counselling happens, there is
a change, it gives them courage and helps one forget what has taken place
(Interview 13).
For many returnees, systems of support and counsellors to facilitate
personal empowerment may not be available considering that approximately
one third of returnees may pass through reception centres such as GUSCO’s.
However, according to Victor Ochen’s experience with organising programs to
support those affected by the conflict, former child soldiers often do more to
stigmatise themselves due to feelings of worthlessness. As a result, they do not
interact with others or ask for help, since they think that they are an
35
inconvenience to others (Interview 20). Counselling is one tool that enables the
formerly abducted to begin moving forward in their attitude towards oneself
and others and eventually to pursue school or work. Indicative of counselling’s
importance in the community is Adokorach Christine’s, program manager at
CRR, description that even in the context of food shortages and experiencing
the trauma of war that women’s main priorities are schooling and counselling
(Interview 10).
A sense that counselling is thought to be a cure all by respondents is
understandable. In a community such as Unyama where there has been no
government health services police used to be the only recourse for support.
Often assault charges would go away because of bribes and people felt
helpless. Now there is a place to turn to (Interview 26).
Counselling was identified as a very useful tool for returnees to deal with
their traumatic experiences with the LRA as well as a key means of support
once back in the community.
4.2 Community Pressure and Individual Survival
As the counselling centres demonstrate, the community is at the same
time a challenge and a support for the formerly abducted to achieve
functioning on par with their peers. At the core is the whether the individual
has the opportunity to advance their rehabilitation in order to function in the
community alongside their peers. However stresses from the community
challenge returnees to rely on themselves and support mechanisms that bolster
individual strength.
Sensitisation and other activities that facilitate the community to support
the individual are key to creating an environment that accepts the returnee and
allows them to reintegrate (Interview 4)(Interview 27)(Interview 35).
Depending on how people react to a girl mother, the community itself can be
another source of anxiety thus compounding the challenges involved in an
individual’s psychosocial rehabilitation. In Unyama, the returned girl mother
says that while an individual family may be happy to see their daughter back,
the community discriminates. As she explained, in the eyes of the community,
“the worst thing you can do is return from captivity with a child.” For her, not
having parents and with a child from captivity makes life difficult. There is
never anyone to help take care of the baby, so she works with the baby on her
back. Furthermore, “when children play with each other, if the child of a
formerly abducted mother beats another, then the community says it’s because
there is no father and we should go back to the bush. Indicating that having
the child was not her choice, the girl mother says that it “wasn’t our way”
(Interview 26). Without family and as a girl mother, she is more vulnerable to
discrimination from the community.
Sister Okello’s experience as deputy director at St. Monica’s reiterates that
for girls who come with children back to the village, communities “may not
wish to receive them”. Therefore mothers are more difficult to settle. The
burden for boys less is since family relations and education opportunities do
not suffer as a result of being abducted (Interview 18). But if girls have been
36
with another man then marriage is not possible and as a result move from guy
to guy (Interview 16).
As the focus group participants in Palaro noted, stigmatisation was
rampant when they returned but community sensitisation by GUSCO was a
major support in improving their social relations (Interview 27). Seemingly,
NGOs are revitalizing processes of community support that have suffered as a
result of the conflict.
Community acceptance, just like rehabilitation, can also be a long term
process. In Palaro, the focus group of three formerly abducted children, two
males and one female, acknowledged that years after returning, stigma
persisted in the community. Abuse was most likely to take place after people
have been drinking (Interview 27).
While counselling can take place in a group setting, alternative approaches
such as creative activities and sport are more social in that returnees participate
in these psychosocial programs alongside non-abducted children. This
approach supports a returnee on an individual basis within a group setting thus
facilitating their reintegration into the community.
4.3 Alternatives to Counselling
Contrasting GUSCO’s focus on counselling, WCH’s Ideal program works
in schools in Gulu district conducting creative games and activities with
students in class including abducted and non-abducted children. WCH strives
to be participatory. Children are asked to identify the causes of conflict in their
lives and community and come up with solutions to the problems. By engaging
the students, ages 10-14, they identify the challenges in their lives and are part
of the process to develop the skills needed to deal with those problems. The
program is not conducted solely for the formerly abducted as it is believed that
this adds to stigmatisation. Instead, a dual benefit of supporting the
psychosocial rehabilitation of the formerly abducted along with the nonabducted, who may have also experienced trauma in the IDP camps, can be
addressed simultaneously.
The students themselves endorse the program’s inclusivity when they
noted that “we have many different children, they come to the group to learn”,
“there are children who don’t have parents, so it’s good for them”, and “it
makes children be respectful, so it’s good for children” (Interview 17).
One of the first activities of the program is to ask the children what do
they like and do not like, and what brings conflict. Atingo Jackie, psychosocial
program designer for WCH, explains that this activity allows the program
implementer to understand why the children feel the way they do(Interview
15). After asking the students what they drew, many eager and dutiful
responses followed. One respondent answered that “a picture of child carrying
gun” brings conflict and what does not bring conflict is “a child carrying a
book”. This type of interactive approach actually defines the content of the
weekly program for a particular group (Interview 17).
Through creative exercises such as drawing and games, positive messages
are delivered and practical skills are learned through students’ own suggestions
37
to a given problem. Fighting over a pen was a common example given by
students who also devised the solution. Those who are fighting should be
separated and the pen should then be taken to the teacher in order to find out
who owns it. Those fighting should ask forgiveness and reconcile(Interview
17). In this way, group activities support the formerly abducted and conflict
affected children generally by providing individuals with the ability to make
decisions that lead to greater individual and social harmony.
In a group interview with students participating in WCH’s Ideal program,
all the students indicated that they support the program. They offered several
reasons including that the program: is “nice”, “improves relations with
friends”, “changes your ideas”, “good if you have difficulties mentally”,
“encourages people not to fight”, “see friends”, “unites people”, “good ideas”
(Interview 17). The program is well received by the students of this school.
However, reflecting the limitations of NGOs, not every student in the school
can participate since it is not feasible for WCH to implement a program for
between 1,000 to 2,000 students in each school.
As demand for WCH’s programs grew, the Big Deal program was initiated
in order to reach school drop outs who were recommended by the community
to participate due to antisocial behaviour such as getting involved in gangs,
aggressive behaviour, stealing. The ages of participants from a focus group of
Big Deal participants in Lamogi sub county ranged from 15-20 and had
completed the 18 week program one year prior. The social tools that
participants were trained in supported them to make decisions that facilitated
positive and healthy relationships with others which for many was a
breakthrough (Interview 16).
To shape the weekly modules in order to be most relevant to their lives,
the WCH facilitator asked participants what good things they have done in
their life as well as the bad things. Each weekly module incorporated the
feedback of participants who identified several main challenges including
conflict with themselves, with friends and relationships. Speaking for the
group, one participant said that the things they were taught and the training
they received “changed people’s lives” (Interview 16). The respondents
pointed to an example of a useful tool that facilitated peaceful resolution. It
was explained that “when you have a problem that you can’t resolve on your
own, go to a third party, then go to the person and explain your behaviour and
then forgive” (Interview 16).
One respondent’s answer indicated that she was a formerly abducted girl
who had come back from the LRA with a child from a forced marriage.
Referring to how the program has supported her, she said that now she knows
how to take care of her child. Previously, she used to think of beating the child
because of the absent father, but has now come to think of the child as hers
and treats it well (Interview 16).
When asked what were the most important module themes and how the
activities in the program supported them, many positive answers were
provided. The module on conflict helped one participant realise he was a
trouble maker. The emotion module supported another in “dealing with my
emotions, thinking before acting”. Tools to deal with relationships supported
38
participants on “how to mend relationships, create friends”. Another
participant in the focus group would fight and be left out of social groups
because of aggressive behaviour. Speaking of the affect of WCH’s program,
she the respondent said that “after the training I changed” (Interview 16).
Many mentioned that learning how to resolve conflicts peacefully was a
main benefit of the program, but not the only one. The program also provided
an opportunity to socialise and as one respondent emphasised, the program
“gives the opportunity to get to know people not just to solve problems”.
Others referred to useful skills such are farming skills and how to take care of
her house (Interview 16). Having learned concrete tools that help participants
take better care of themselves, dependents and establish healthy relationships,
all respondents were emphatic that they and others be able to continue to
benefit from programs like these.
Some programs, and organisations, focus on sport as the primary vehicle
to deliver messages that facilitate a change in a young person’s psychosocial
situation. Victor Ekesu, director of Right To Play in Lira, a non-Acholi district
also greatly affected by the conflict, argues that the “failure to live
harmoniously can be ingrained, key is to build a new generation that will
appreciate each other. Games bring people together” (Interview 19).
Director of GWED- G, Angwech Pamela Judith, explains that due to the
conflict, schools stopped sports programs. Now GWED-G implements WCH
football activities for female youth ages 9-17. Teams of 30 girls practice and
play matches. These activities are accompanied by dialogues which are
opportunities to learn about issues important to leading a healthy life including
information on reproductive health, gender based violence, AIDS counselling
and lifestyle. Providing youth with information “helps young people to make
decisions on their own and encourages children to think about the future
(Interview 31).
After watching an impressive practice match, I spoke with the group of 30
girls, aged 9-17, who played on the Pacoh girls football team supported by War
Child and GWED-G. All the girls were eager to tell me why they enjoyed
football and how it had changed them for the better. Punctuating the positive
mood surrounding the team, one player said of the future that, “I want to kick
like Ronaldo!” (Interview 33).
The existence of a girls team at all is a major achievement in itself.
Historically, girls were not supposed to raise their legs above knee level and
girls playing football was unheard of (Interview 32). Solely on their own
initiative, the girls started the team four years prior when they were living in
IDP camps after which War Child began to provide funding and support. In
asking about their experience playing football, responses resounded with
positive replies including that “it helped me socialise”, “respect parents”, “stop
abusing others”, “leave friends with bad influence” (Interview 33).
In answering questions about their experience and perspectives, one player
voluntarily identified herself as a formerly abducted girl. Eager to answer every
question first, she explained that initially she just wanted to be in a quiet place
but participating in “football changed my life completely. It ended the
discrimination directed towards me by other young people. It is so good, now I
39
have respect for others, associate with others”(Ibid.). Group activities offer the
opportunity for an individual to benefit in their own way while at the same
time inculcating the group with behaviour that promotes peace in the
community. Inclusive activities also reduce opportunities for stigmatisation by
not singling out former child soldiers. A focus group of parents in Parlo subcounty noted that community resentment does occur, for example, when
reintegration packages are given to the formerly abducted, while others receive
no other material support (Interview 34).
The communal nature of sport can bring together young people with
different experiences, enabling each to benefit in their own way. For the
formerly abducted girl, she is now socialising in a normal context alongside her
peers. In this sense, she is at the same point of departure to advance or not
further in life, just like anyone else. A logical next step in her successful
rehabilitation is to consider how she will support herself in the future.
4.4 Self Dependency
Initially, my interviews were focused on people’s attitudes towards their
rehabilitation experience relating to traditional rituals, counselling, alternative
rehabilitation approaches and factors influencing their rehabilitation since
returning from the LRA to present day. However, sitting in the villages where
these young people live, the notion of examining rehabilitation in retrospective
terms sidelined the conditions and concerns of the participants today and their
future well being. However, throughout the interviews, the needs and desire
for education and the importance of vocational training to make money was
clear. The overtly individual nature of doing something oneself, in studying and
working, highlighted the ultimate role of agency in improving one’s own
situation.
Having a supportive and financially capable family were indicated as two
important elements needed to prosper (Interview 26, 19). Over the course of
many interviews, it was often mentioned by young people and parents that they
or others could not afford the fees to send their children to school (Interview
8, 17, 16, 33, 34). For some returnees without parents and girl mothers, they
are left to their own devices to overcome the lack of resources in the
community or outright rejection (Interview 26).
The dynamics of community acceptance and survival are evident in the
focus group discussion with formerly abducted in Palaro sub-county. The first
respondent indicated that it took 1 month to feel accepted, the second
respondent 2-3 months and the third, a female, 4-5 months. Now the males are
able to earn a living through petty business such as selling used clothes. For the
female however, after a problem with her sewing machine that has rendered it
inoperable, she has no other source of income and feels the advancements she
made in life are slipping backwards because she cannot support herself
(Interview 27).
In Unyama, the formerly abducted girl mother was determined to create
her own reality. Despite the difficulty of her experiences as part of the LRA
and back in the community, during the interview she spoke with confidence
40
and purpose. The interview ended with a comment on the one thing that could
help her move her life forward, “all I want to do is to find a way to make
money”. Ever the self starter, she then she made a pitch for me to sponsor
soccer equipment for the football team she has started with other formerly
abducted girls (Interview 26).
An individual’s use of skills to advance can be most widely seen in
vocational skills for income generating activities. Yet, be they economic, social
or mental coping mechanisms, the skills used by returnees at different stages in
their rehabilitation facilitate their advancement. Through counselling, former
child soldiers are given the tools to cope with their past and enhance their
opportunities to move forward. Counselling at GUSCO or supportive
counselling in the community, participants find great value in talking about
their problems with others. The role of the community is a key element is
rehabilitation, and its attitude towards a returnee can change over time being
the source of both positive and negative influences. Even when confronted
with discrimination the returnee can persevere and survive as many do. But it
is especially in these circumstances that it is evident how the mental, social and
vocational skills of the individual are necessary to navigate the various
obstacles involved in rehabilitation. This is does not discount the importance
of the community in any way, since without it an individual’s rehabilitation is
meaningless. As the final arbiter of acceptance, the community may be the
most important factor in an individual’s successful rehabilitation. However, in
the context of the rehabilitation debate in which the individual has been
eschewed due to the excessively individualistic nature of previous Western
programs, the fostering of various types of individual skill can be seen as part
of a continuum of individual skill development necessary for rehabilitation
within concurrent communal processes.
41
Chapter 5
Conclusion: Responding to the
Realities & the Future of Traditional Healing
In addressing the main research questions, this research found the
conditions to practice traditional healing to be fundamentally weakened due to
the effects of the conflict with the LRA. Contrasting the opinions of vocal
critics, it was very interesting to see that Western rehabilitation practices to
have widespread support among participants. These findings are elaborated
upon below and include a reflection on fundamental dynamic of the
international NGO presence in Gulu and its influence on the viability of
traditional healing irrespective of the effects of the conflict.
The profound effects of conflict in Gulu show the importance of
understanding context. In order to ultimately implement rehabilitation
programs for former child soldiers that will be accepted by participants,
understanding how conflict affects the relationship between traditional cultural
practices and youth is of value. In the district of Gulu, the effects of the IDP
camp conditions on young people and their relationship with traditional
cultural values is central for understanding the weakened ability of traditional
healing practices for former child soldiers in Gulu. The effects of the cultural
rupture can be seen in the ambivalent attitude of some interviewees to
traditional healing practices. As a result, the normal assumption of using a
balance of traditional practices and Western approaches is thrown into
question. Traditional practices should not be abandoned due to the disruption
in cultural practices that can be expected with conflict. At the same time it
cannot be assumed that every context is affected by conflict in the same way.
Despite the effort among program implementers and designers to prevent the
imposition of Western approaches, rehabilitation efforts cannot assume that
traditional practices can be used simply because they are indigenous. Each
context must be understood in and of itself in order to determine how to
design programmes that can best meet the psychosocial needs of former child
soldiers.
The relevance of the acceptance of traditional practices by participants
may be relevant but not dire for many in Gulu. Many will face challenges of
stigma from the community, but as can be seen from those interviewed over
time, they have survived and can find work while stigma, at least, decreases
over time. However, for the more vulnerable, such as girl mothers who are
often rejected outright by the community, their daily realities depend on
support mechanisms that bolster their survival as an individual. Therefore, the
use of traditional ceremonies is unlikely to support such vulnerable groups.
Considering the criticisms of Western interventions imposing foreign
world views through the diagnosis of PTSD and the use counselling, it was
surprising that many participants were very positive about their counselling
experience. For returnees, talking about problems with a stranger is widely
accepted by participants and the community. The Formerly abducted who
participated in GUSCO’s counselling sessions at the reception centre describe
42
counselling as an enabler that supported them to change their behaviour and
deal with their past. This is an interesting finding because it contrasts with
critics such as Summerfield who contend that exploring the past is a foreign
imposed approach and harmful. For participants in GUSCO and in the
community, counselling provided individuals with concrete tools to address
their current challenges in order to avoid dysfunctional or anti social behaviour
in order to move past their negative experiences.
Just as counselling provides individuals with the skills to manage their
trauma, WCH’s creative and football activities also foster individual skill
development, but focused within a social setting. Participants in the Ideal and
Big Deal programs emphasised how they have learnt conflict resolution skills
and as a result have positive attitudes and are better able to socialise. For a
formerly abducted girl with a baby from a forced marriage, the program has
supported her to move beyond seeing her child as a product of rape and
instead provide the baby with loving care. Participants in the girls football
team also gave their resounding approval of the positive effects of football, as
one former female child soldier said “football changed my life completely”
(Interview 33). What is surprising here about the testimonies of individuals in
these groups is the individual therapeutic effects that these activities have
within a group setting. They provide a dual purpose of supporting the
individual with the skills for positive interaction while simultaneously
facilitating social reintegration. In the Ideal, Big Deal and football team, there
was a strong sense of attachment to the group beyond just participating in
activities.
In discussing the current realities with formerly abducted, other children
and youth and parents it became evident that education and earning an income
was a priority for so many people. The girl mother who told me, “all I want to
do is to find a way to make money”(Interview 26) impressed upon me the role
of individuals in their own rehabilitation and reintegration process. The
desperate need and desire to support oneself is evident in vulnerable groups.
The individual is the agent that propels her own rehabilitation, but at the same
time the role of the community is indispensable. Community acceptance
provides the conditions for the potential of individual agency.
All these findings apply and are useful to design programs with an
understanding of the effects of conflict and conceptualising the role of the
individual throughout rehabilitation in a way that has been largely ignored.
Nevertheless, the entire paradigm in which rehabilitation programs operate in
Gulu is lopsided and disingenuous. Rehabilitation programs in Gulu could
continue as they are and be accepted as has shown to be the case, but that
would make a mockery of the notion of striving for a balance between
indigenous and Western approaches. That counselling, and even the more
culturally neutral creative and sport activities, is accepted leaves the impression
that nothing is being lost since the participants have no objection to them. This
is analogous to the dying out of indigenous language. When a young person
learn English as her mother tongue instead of the local language, she too feels
no loss. But in fact there is a tremendous loss of knowledge, values and
43
identity associated with the language. The same is true of traditional healing
and other expression of traditional culture.
Conflicting choices between a dichotomy of approaches gives way to one
which obliges Western development agencies to live up to their mantra of
respecting traditional healing by implementing it alongside imported methods.
Whether or not traditional healing practices or other cultural resources are
effective in the way they once were, there remains is an obligation among
visiting organisations that implement locally to support the revival of local
resources as much as possible.
The whole notion of balance is undercut by the reality of psychosocial
rehabilitation programs on the ground. The lack of government activity in this
area has allowed the prodigious growth of NGOs in Gulu to create de facto
guidelines on rehabilitation approaches. Former child soldiers, as judged by
interviews, have benefited from the programs in which they participated in.
However there seems to be little effort to implement programs alongside local
cultural practices, be they traditional healing or otherwise. This situation
allowed imported methods to proliferate and done nothing to support the
recovery of traditional healing practices. While the attitude of participants may
be agreeable to imported programs that does not necessarily mean that there is
not an imposition of some sort. Given the position of NGOs to influence
rehabilitation approaches in Gulu, there needs to be an honest commitment to
honouring the spirit of balance and the utilisation of cultural resources. Being
in a post conflict context with little government action and a dominant culture
of international NGOs, the opportunity exists to face the changes in Acholi
culture represented in the new attitudes and beliefs of children and youth to
create a local solution instead of abdicating that responsibility and relying on
imported methods.
The weakness of traditional healing in Gulu can be attributed to the
effects of conflict, but the perpetuation of this situation is avoidable. Unless
the development sector in Gulu and the local community work together to
devise ways for traditional healing and cultural resources to be relevant for
former child soldiers, and also the general youth population in Gulu, the
knowledge and values of Acholi culture will be lost and the result will be a
future generation heavily influenced by imported beliefs and practices. The
significance rests beyond the mechanics of achieving a balance between two
approaches but to understand what kind of world views are former child
soldiers and young people being moulded into.
"And in the end then, it really comes down to a choice: do we want to live in a
monochromatic world of monotony, or do we want to embrace a polychromatic world of
diversity. Margaret Mead the great anthropologist said before she died, that her greatest fear
was that as we drifted toward this blandly amorphous generic worldview, not only would we
see the entire range of the human imagination reduced to a more narrow modality of thought,
that we would awake as if from a dream one day having forgotten that there were other
possibilities."(Davis 2008)
44
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47
Appendices
Annex A: Interviews and Observations
#1 Observation GUSCO staff meeting, July 13, 2009
2 Observation GUSCO community dialogue, July 15, 2009
3 Interview (one on one) Anthony Paklaki, Social Worker, GUSCO, at
GUSCO Reception Center in Gulu town, July 16, 2009
4 Interview (one on one) Pastor Oyera Martin Leko, Dino Parish, Odek subcounty, Friday July 17
5 Interview (focus group) with 10 community Leaders from Odek sub-county,
included local counsellors 1- 3 and local parish leaders, Friday July 17, 2009
6 Interview (focus group) formerly abducted children, Bibia, Atiak sub-county.
Included 10 males responded ages 15-30, Wednesday July 29, 2009
7 Interview (one on one) Obalo Fred Otim, Parish Chief, Atiak sub-county,
July 30, 2009
8 Interview (one on one) Acire B Bernard, Instructor at St. Monica’s Girls
Tailoring Centre, Gulu town July 31, 2009
9 Interview (one on one) Adolf Gerstl, Regional Coordinator, Northern
Uganda Rehabilitation Program, NUREP office, Gulu town, August 2, 2009
10 Interview (one on one) Adokorach Christine, Program Manager, Center for
Reparation and Rehabilitation, CRR office, Gulu town, August 4, 2009
11 Interview (one on one) Donald Odero Save the Children, August 4, 2009
12 Interview (one on one) Anthony Ajok, Education Field Coordinator,
United Movement To End Child Soldiering, GUSCO office Gulu town August
5, 2009
13 Interview (one on one) student at St. Monica’s Girl Tailoring Center, Gulu
town, August 7, 2009
14 Interview (one on one) Manuela Schweigkofler, Technical Advisor,
Horizont 3000, Austrian Organisation for Development Co-operation, Caritas,
Gulu town August 6, 2009
15 Interview (one on one) Atingo Jacky War Child Holland, Agwayugi Lamogi
sub county, August 7, 2009
16 Interview (focus group) War Child Holland Big Deal group, Agwayugi
Parish, Lamogi sub-county, August 7, 2009
17 Interview (focus group) War Child Holland Ideal group, Agwayugi Parish,
Lamogi sub-county, August 7, 2009
18 Interview (one on one) Sister Assumpta Acein Okello, Deputy Director, St.
Monica’s Girls Tailoring Centre, Gulu town, Wednesday August 12, 2009
19 Interview (one on one) Victor Ekesu, Coordinator, Right To Play Lira,
Former local council 5 for Lira district Friday August 14, 2009
20 Interview (one on one) Victor Ochen, Co-Director African Youth Initiative
48
Network, Friday August 14, 2009
21 Interview (one on one) with Fabius Okumu – Alya, Director, Peace and
Strategic Studies, Gulu University, August 20, 2009
22 Interview (one on one) Akena Charles, team leader, GUSCO, Gulu town,
August 20, 2009
23 Interview (one on one) Ajok Margaret, UN Human Rights, August 20, 2009
25 Interview (one on one) Lauren Gould, Leiden University, Gulu town,
August 20, 2009
26 Interview (one on one) Huma Polline Unyama, director of Unyama
Counselling Center, and formerly abducted who is a girl mother, August 25,
2009
27 Interview (focus group) Formerly Abducted Children, 2 males, 1 females,
ages 17-29, Gulu district, Palaro sub county, August 26, 2009
28 Interview (one on one) with Okidi- Lumedo David M., Acholi author, Gulu
town, August 27, 2009
29 Interview (one on one) Olanya Cons Bernard, headmaster in Amuru,
August 27, 2009-09-09
30 Interview (one on one) Akidi Beatrice, social worker, GUSCO, Gulu town
August 19, 2009
31 Interview (one on one) Angwech Pamela Judith, GWED-G, Gulu town,
August 19, 2009
32 Interview (focus group) 16 parents of girls football team in Pacoh, Tuesday
August 25, 2009
33 Interview (group discussion) 30 Pacho girls football team, August 25, 2009
34 Interview (focus group) 8 Parents of children in Palero, August 26, 2009
35 Interview (one on one) Lakony Joel, Social Worker Trainer, War Child
Holland, Gulu town August 7, 2009
49