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