Dr. Ruwan M Jayatunge M.D. – firstname.lastname@example.org
The mental health of children is severely compromised by war and
consequent displacement. Nations have a duty under various UN
agreements to alleviate the effects of war on children’s mental health.
Professor William Yule
UNICEF recently estimated that over 80% of the victims of todays Warfare is women and children. Children who are a vulnerable group have suffered severe traumatic events during the Eelam War. Children of the North as well as of the South have experienced many anxiety related conditions as a result of the 25 year armed conflict in Sr Lanka. They are traumatized children and have various behavioral problems. They are at a high risk of developing numerous psychological ailments. As Ana Freud & Burlingham stated in 1943 Children are always the most vulnerable and generally more exposed citizens in countries where declared and undeclared wars rage.
There has been many research world wide that indicate children of the war zones undergo severe psychological trauma. The research in Gaza, Rwanda, Mozambique and Cambodia reveal children who were exposed to war and atrocities are at a high risk of developing PTSD. Abdel Aziz Mousa Thabet of Gaza Community Mental Health Programme and a Senior Lecturer in Child and Adolescent Psychiatry, University of Birmingham did a study to estimate the rate of Posttraumatic stress reactions in Palestinian children who experienced war traumas, and to investigate the relationship between trauma-related factors and PTSD reactions. The sample consisted of 239 children of 6 to 11 years of age. 174 children (72.8%) reported PTSD reactions of at least mild intensity, while 98 (41%) reported moderate/severe PTSD reactions.
Organized and institutionalized violence like war can affect children in many ways. The effects of traumatic events on children are even greater when that trauma is due to modern warfare. In Sri Lanka a large number of children have been exposed to war trauma. There are numerous case examples which show the occurrence of anxiety reactions among the affected children.
Little K was nine years old when she became a victim of a cross fire between the armed forces and Tamil militants in the North. She sustained a gun shot injury to her left arm. She underwent a traumatic amputation of the left hand. The doctors were compelled to perform this operation in order to save her life. After the operation she was taken to an orphanage in Mulangavil in Killinochi district. She has fear feelings, night terror, bed wetting, hyperarousal and alienation. Traumatized war- zone children like little K carry the psychological scars throughout their lives.
Children who have experienced or been exposed to war trauma may have numerous symptoms including trauma based behavior. They often have anxieties and insecurities that can cause them to perceive every aspect of the world as being unsafe and frightening. The grow up with a generalized fear and hostility which affects their future lives. Trauma is often associated with intense feelings of humiliation, self-blame, shame and guilt, which result from the sense of powerlessness and may lead to a sense of alienation and avoidance. Therefore the initial trauma could become a vicious cycle.
Following case study gives a crude assumption of the longitudinal effects of psychological trauma on children which can affect their later lives.
Master S was 12 years old when 1983 communal riots erupted. His family was hiding in a nebhouring house to evade the mob attack. The attackers burnt their house while Master S and his kid sister hiding under a bed in their Sinhalese nebhour s house. He could hear the shoutings of the mob and the schreemings of the victims. Master S had fear feelings and he thought that the mob would kill him. These fears lasted for many years as he grew older.
Following day their kind nebhour with the help of the Police took them to the refugee camp at Bambalapitiya Kadirashan Kovil . Before going to the camp Master S had a quick glance at their house which was completely destroyed by the fire. He felt sorry for loosing his books and toys.
After spending several months in the refugee camp his father was managed to get asylum in West Germany. For many years S had a nostalgic feelings of his lost books and toys also fear that a group of people would come and attack him unexpectedly.
After coming to West Germany S underwent a prolonged cultural shock and frequently felt a misfit in the Western society. He became more isolated and neglected his studies. As a teenager he became more and more hostile and frequently had conflicts with the parents. After spending 12 years in West Germany S moved to Canada and got married. But he always felt the empty space and became emotionally numbed. On some occasions he could not control his temper and engaged in domestic violence. His violent outburst resulted an injury to his wife and S was charged by the Canadian Authorities. Today he is serving a prison term.
Children who had witnessed the war trauma and atrocities can have diminished cognitive abilities. They frequently have learning difficulties at school. Some have behavioral disorders. Most of them do not receive proper psychological therapies and rehabilitation. Jensen and Shaw (Jensen PS, Shaw J: Children as victims of war) indicated that there is conflicting and controversial literature on children’s reactions to war-related stress. They suggested that children’s cognitive immaturity and adaptive flexibility may mitigate the anticipated stressful effects.
As the researcher Osofsky, 1995 indicates the differential response to trauma depends, in part, on the child’s age and level of psychological maturity. Children vary in their reactions to traumatic events. Some suffer from fears and memories immediately after the event, which dissolve with time and emotional support. Other children are more severely affected by trauma and experience long-term problems.
Children of the war zone may exhibit regressive behaviors such as bed-wetting, thumb-sucking or fear of the dark. They may have increased difficulties separating from their parents. Also they can have attention problems and learning difficulties at school. Many of these affected children can have somatic complaints, irrational fears, sleep problems, nightmares, irritability and angry outbursts. They may appear to be depressed and more withdrawn.
Adolescent (ages 12 to 18) responses are more similar to adults and they are at increased risk for problems with substance abuse, peer problems and depression.
Child soldiers have been exposed to events beyond the normal boundaries of human experiences. This is a story of a child solder whose pseudonym is SE .
SE was 11 years old when he was forcefully recruited as a child soldier by the LTTE. During the training period he was beaten and threatened to be killed if he did not obey the orders. Once he saw a killing of a rival member by the LTTE. Along with other children he had to take part in a number of attacks against the Sri Lankan Army. They were called the members of the Baby Brigade. The Baby Brigade was a support team for the adult fighters. They never had the opportunity of going to school after they became child soldiers. Instead of books they carried AK 47 and grenades. Their childhood had been stolen.
Little SE witnessed a number of horrific events which changed his psychological makeup drastically. He was forced to observe torture, then forced to induce it on victims. Today SE is in a rehabilitation center but his horrendous psychological scars have not left him completely. He has intense rage , suicidal urge and alienation. Once a bright and innocent student now has become a victim of the Eelam War.
Exposure to war traumas can deleteriously affect children’s social, emotional, and cognitive development and pose significant problems into adulthood if left untreated. Exposure to war situations children lose predictability in their lives. They become far a way from daily routine and daily habits which provide security for them. It affects their psychosocial development negatively.
Master P was terrified when air attacks took place in Jaffna. During this attack his neighbor’s house was destroyed and some were critically injured. They were taken to the Jaffna hospital. Master P becomes anxious when he hears aircraft sounds. He has startling reactions, intrusive memories of the air attacks and sometimes nightmares.
Children’s well-being and development depend very much on the security of family relationships and a predictable environment. Miss L was 13 when the LTTE attacked their village in the North Central Province of Sri Lanka. The attackers shot the adults and killed the children and women with knives. She was lucky to be alive. When the village was attacked she managed to escape with her uncle. But her parents and the younger brother got killed. Miss L couldn’t continue her education after the tragedy. She became more depressed and had constant feelings of being threatened, nightmares of the attack, and psycho somatic ailments.
During the Eelam war some of the Sinhalese and Tamil children witnessed the deaths of their parents or other family members. They have experienced loss of loved ones, loss of property etc. These children have undergone severe grief and some have developed pathological grief reactions. These children carry the psychological scars of these past traumatic events. Obviously the majority of them have not received adequate treatment and rehabilitation; they will become adults with the unhealed trauma. Their anger will be sublimated to the society and this is going to be a vicious cycle.
Master D (10 Y) was a bright student who suddenly showed learning difficulties and behavioral problems when his father died in the Rivirasa operation. He became aggressive and started bed wetting. He lost the interest in social activities showed positive features of Paternal Deprivation Syndrome. He was not a happy child after his fathers death.
Living with a father who is affected by the combat trauma is another predicament faced by some children. Little B was an eight year old boy who was beaten by his PTSD father an ex combatant with sudden rage. The boy was hospitalized and received treatment for his physical injuries.
Miss M (15Y) and master L (12Y) are sister and brother of the same family. Many days they had to spend the nights at neighbor’s house when their father became aggressive and went into tantrums. He is a combatant suffering from PTSD. When he experienced combat related flashbacks he became extremely violent. Their mother left the house following continuous physical aggression by the father.
In recent years, since 1990, nearly 49 wars have been waged, and 46 have been fought with small weapons. Over 40 million men, women, and children have been forced into refugee status due to war violence.A situation of war, frequently experienced by refugees, has a disorganizing and traumatizing effect on the entire family. The Eelam war caused displacements of civilians at large. Many are still living in refugee camps. Master M (9Y) and his family had to flee from his village with the other neighbors when the LTTE ordered the Muslim people to leave the North. Their family came to Puttlam and lived in a small hut without basic facilities in Alankuda- Kalpitiya. Master M became more isolated and showed positive features of anxiety and depression. He was nostalgic about his native village in Mannar. His education was disrupted and today M works as Three Wheel driver in Puttalam town. M feels himself as an alien in Kalpitiya .He is addicted to cannabis and has no long term life plans.
During the Eelam War the LTTE launched a number of suicide bombings sometimes targeting civilians. Master N (15Y) was a psychological victim of the dreaded Central Bank Bombing by the LTTE. When the blast occurred they were in a motor car. They sustained minor injuries, but master L was psychologically shattered. He had fear feelings, startling reactions, intrusions, nightmares for nearly a year.
How to heal the wounds occurred due to the armed conflict ? These children need medication, psychotherapy, psycho social rehabilitation and long term monitoring. In Sri Lanka there is a big scarcity of experts in this area. Very often traumatized children grow without psychosocial support. Unhealed traumas affect their cognitive and personality development.
Time does not heal the trauma. Therefore active measures are highly needed. Social support should be given to the children who were exposed to war trauma. Children’s resiliency to traumatic events is influenced by the degree of social support and positive community influences (Garbarino et al., 1992).
To minimize the psychological damage the children need effective care. Parental support is highly essential to heal the emotional scars experienced by the war-zone children. As the experts point out children with adequate family cohesion manifest less stress in reaction to trauma and are better able to recover from the initial impact of the trauma.
Cultural factors and traditional healing systems play a vital role. Community ideology, beliefs and value systems contribute to resiliency by giving meaning to dangerous events, allowing children to identify with cultural values, and enabling children and adults to function under extreme conditions (Melville and Lykes, 1992). In treating war zone children family therapy, group therapy, Cognitive-behavioral therapy (CBT) , art therapy, music therapy, EMDR and school and community interventions have been used. Also they are helped with coping skills.
War trauma in Sri Lanka has created a dilemma situation. A large number of children have been affected by the prolonged armed conflict in Sri Lanka. This has become one of the crucial problems that would affect our future. Consider a significant numbers our next generation are traumatized and unhealed. The vicious cycle of war will deal with them once they become adults. Therefore this fierce cycle has to be dealt with effectively and professinally.
(the author who was the Focal Point — Mental Health in Puttalam District at the Health Ministry now offering his services to a Canadian Community Services Association in Ontario gives a balanced and unbias view of War Trauma and how it affected Sri Lanka Children )