Handbook of Chandi Fernando Michel Ferrari Editors

Chandi Fernando Michel Ferrari Editors

Handbook of Resilience in Children of War Handbook of Resilience in Children of War

Chandi Fernando • Michel Ferrari Editors

Handbook of Resilience in Children of War Editors Chandi Fernando Michel Ferrari Applied Psychology and Human Development Applied Psychology and Human Development Ontario Institute for Studies in Education Ontario Institute for Studies in Education University of Toronto University of Toronto Toronto, ON, Canada Toronto, ON, Canada

ISBN 978-1-4614-6374-0 ISBN 978-1-4614-6375-7 (eBook) DOI 10.1007/978-1-4614-6375-7 Springer New York Heidelberg Dordrecht London

Library of Congress Control Number: 2013935226

© Springer Science+Business Media New York 2013 This work is subject to copyright. All rights are reserved by the Publisher, whether the whole or part of the material is concerned, speci fi cally the rights of translation, reprinting, reuse of illustrations, recitation, broadcasting, reproduction on micro films or in any other physical way, and transmission or information storage and retrieval, electronic adaptation, computer software, or by similar or dissimilar methodology now known or hereafter developed. Exempted from this legal reservation are brief excerpts in connection with reviews or scholarly analysis or material supplied specifi cally for the purpose of being entered and executed on a computer system, for exclusive use by the purchaser of the work. Duplication of this publication or parts thereof is permitted only under the provisions of the Copyright Law of the Publisher’s location, in its current version, and permission for use must always be obtained from Springer. Permissions for use may be obtained through RightsLink at the Copyright Clearance Center. Violations are liable to prosecution under the respective Copyright Law. The use of general descriptive names, registered names, trademarks, service marks, etc. in this publication does not imply, even in the absence of a speci fi c statement, that such names are exempt from the relevant protective laws and regulations and therefore free for general use. While the advice and information in this book are believed to be true and accurate at the date of publication, neither the authors nor the editors nor the publisher can accept any legal responsibility for any errors or omissions that may be made. The publisher makes no warranty, express or implied, with respect to the material contained herein.

Printed on acid-free paper

Springer is part of Springer Science+Business Media (www.springer.com) Endorsements

My friend Emmanuel Jal says he believes he has survived for a reason—to tell his story, to touch lives. It is remarkable how children, the most vulnerable in con ﬂ ict, are able to transcend the worst evils this world has to offer. The authors of this book recount positive stories of struggles for survival and the remarkable journeys of young people who refused to let their adverse circumstances dictate their future possibilities. This handbook stresses the importance of learning from the past, avoiding cookie-cutter solutions, and, above all, a multidisciplinary approach to caring for our young. It truly takes a village….

LGen Roméo Dallaire (Ret), Founder of the Roméo Dallaire Child Soldiers Initiative

Reading Chandi Fernando and Michel Ferrari’s inspiring collection of papers from around the world, it’s clear that there are specifi c protective processes that help children who are exposed to political violence build and sustain resilience. This is a timely work that sits on the crest of emerging thinking in the fi eld of resilience research. No longer can we explain resilience as something inside a child. It is, as shown in the many studies that are discussed with some of the most disadvantaged children in the world, something we create by making children’s social ecologies safer and more nurturing. This book will be of interest not just to those working with children affected by war, but anyone who works with traumatised young people, whether because of gangs or domestic violence. This volume is one of the fi rst of its kind to show through research and its application to practice that we can help children be more resilient with the right commitments from their families, communities, and most importantly, the policy makers who fund the programs children need.

Michael Ungar, Ph.D., Co-Director, Resilience Research Centre Editor, The Social Ecology of Resilience : A Handbook of Theory and Practice

Contents

1 Overview of the Volume ...... 1 Chandi Fernando and Michel Ferrari

Part I Social-Ecological Approaches to Promoting Resilience in Children of War

2 Promoting Mental Health and Psychosocial Well-Being in Children Affected by Political Violence: Part I–Current Evidence for an Ecological Resilience Approach ...... 11 Weiste A. Tol, Mark J.D. Jordans, Brandon A. Kohrt, Theresa S. Betancourt, and Ivan H. Komproe 3 Promoting Mental Health and Psychosocial Well-Being in Children Affected by Political Violence: Part II—Expanding the Evidence Base ...... 29 Weiste A. Tol, Mark J.D. Jordans, Brandon A. Kohrt, Theresa S. Betancourt, and Ivan H. Komproe 4 Promoting Resilience in Children of War ...... 39 Barbara Magid and Neil Boothby 5 Child Mental Health, Psychosocial Well-Being and Resilience in Afghanistan: A Review and Future Directions ...... 51 Peter Ventevogel, Mark J.D. Jordans, Mark Eggerman, Bibiane van Mierlo, and Catherine Panter-Brick

Part II Child Soldiers

6 When Children Become Killers: Child Soldiers in the Civil War in Sierra Leone ...... 83 Tunde Zack-Williams 7 The Fallacy of the Ticking Time Bomb: Resilience of Children Formerly Recruited into Armed Forces and Groups ...... 95 Lindsay Stark and Mike Wessells

vii viii Contents

8 Children of War in Colombia and Iraq...... 107 Marla J. Buchanan, Kasim Al-Mashat, Liliana Cortes, Branka Djukic, Beheshta Jaghori, and Alanna Thompson

Part III Institutional Support for Children Affected by War

9 Child Friendly Spaces: Promoting Children’s Resiliency Amidst War...... 119 Kathleen Kostelny and Michael Wessells 10 Resilience in Orphans of War in Sri Lanka ...... 131 Chandi Fernando and Michel Ferrari

Part IV Resilience Among Refugees

11 Relational Resilience ...... 147 Colette Daiute 12 Coping and Adaptation: A Narrative Analysis of Children and Youth from Zones of Conﬂict in Africa ...... 163 Jacqueline McAdam 13 Pathways of Success Experiences Among the “Lost Boys” of Sudan: A Case Study Approach ...... 179 Laura Bates, Deborah J. Johnson, and Meenal Rana 14 No Place Like Home: Resilience Among Adolescent Refugees Resettled in Australia ...... 193 Julie Ann Robinson 15 Pathways to Resilience: The Role of Education in War-Zone Immigrant and Refugee Student Success ...... 211 Lana Stermac, Allyson K. Clarke, and Lindsay Brown

Part V Extending our Understanding of the Effects of War on Children: Theory and Practice

16 Political Violence, Identity and Psychological Adjustment in Children ...... 223 Orla T. Muldoon 17 How Can a Majority Be Resilient? Critiquing the Utility of the Construct of Resilience Through a Focus on Youth in Contexts of Political Conﬂict ...... 233 Brian K. Barber and Samuel Benjamin Doty 18 Resilience in the Lives of Children of War ...... 253 James Garbarino and Edmund Bruyere Contents ix

19 Evidence-Based Resilience-Enhancing Intervention Methods for Children Affected by Armed Conﬂict ...... 267 Kirsi Peltonen and Esa Palosaari

Part VI Conclusion

20 Resilience in Children of War ...... 287 Michel Ferrari and Chandi Fernando

About the Editors ...... 303

Index ...... 305

Contributors

Kasim Al-Mashat Department of Educational And Counselling Psychology, and Special Education , The University of British Columbia , Vancouver , BC , Canada Brian K. Barber Founding Director of the Center for the Study of Youth and Political Violence, Professor of Child and Family Studies, University of Tennessee, Knoxville, TN, USA Laura Bates University Outreach and Engagement, Michigan State University, East Lansing, MI, USA Theresa S. Betancourt Department of Global Health and Population, Harvard School of Public Health , Boston , MA , USA FXB Center for Health & Human Rights , Harvard University , Boston , MA , USA Neil Boothby Director of the Program on Forced Migration and Health, Columbia University, Mailman School of Public Health, New York, NY USA Lindsay Brown Department of Applied Psychology & Human Development, Counselling Psychology Program, Ontario Institute for Studies in Education, University of Toronto, Toronto, ON, Canada Edmund Bruyere Center for the Human Rights of Children, Developmental Psychology, Loyola University, Chicago, IL, USA Marla J. Buchanan Department of Educational And Counselling Psychology, and Special Education , The University of British Columbia , Vancouver , BC , Canada Allyson K. Clarke Department of Applied Psychology & Human Development, Counselling Psychology Program, Ontario Institute for Studies in Education, University of Toronto, Toronto, ON, Canada Liliana Cortes Department of Educational And Counselling Psychology, and Special Education , The University of British Columbia , Vancouver , BC , Canada Colette Daiute The Graduate Center, City University of New York , New York , NY , USA Samuel Benjamin Doty Duke University , Durham , NC , USA

xi xii Contributors

Branka Djukic Department of Educational And Counselling Psychology, and Special Education , The University of British Columbia , Vancouver , BC , Canada Mark Eggerman MacMillan Center for International and Area Studies, Yale University, New Haven, CT, USA Chandi Fernando Applied Psychology and Human Development, Ontario Institute for Studies in Education, University of Toronto , Toronto , ON , Canada Michel Ferrari Applied Psychology and Human Development, Developmental Psychology and Education, Ontario Institute for Studies in Education, University of Toronto , Toronto , ON , Canada James Garbarino Director of the Center for the Human Rights of Children, Loyola University, Chicago, IL, USA Beheshta Jaghori Department of Educational And Counselling Psychology, and Special Education, The University of British Columbia, Vancouver, BC, Canada Deborah J. Johnson University Outreach and Engagement, Michigan State University, East Lansing, MI, USA Mark J. D. Jordans Department of Research & Development, HealthNet TPO , Amsterdam , the Netherlands Center for Global Mental Health , London School of Hygiene & Tropical Medicine , London , UK Brandon A. Kohrt Department of Psychiatry and Behavioral Sciences, The George Washington University , Washington , DC , USA Ivan H. Komproe Department of Research & Development , HealthNet TPO, Amsterdam , the Netherlands Utrecht University , Utrecht , the Netherlands Kathleen Kostelny Columbia Group for Children in Adversity, Columbia University , New York , NY , USA Barbara Magid Columbia University, Mailman School of Public Health, New York, NY, USA Jacqueline McAdam Department of Child & Youth Care, University of Victoria, Victoria, BC, Canada Bibiane van Mierlo Research and Development Department, HealthNet TPO, Amsterdam, The Netherlands Orla T. Muldoon Department of Psychology, University of Limerick, Limerick, Ireland Esa Palosaari School of Social Sciences and Humanities/Psychology, University of Tampere, Tampere, Finland Catherine Panter-Brick Department of Anthropology & The Jackson Institute for Global Affairs, Yale University, New Haven, CT, USA Contributors xiii

Kirsi Peltonen Department of Psychology, University of Tampere, Tampere 33014, Finland Meenal Rana University Outreach and Engagement, Michigan State University, East Lansing, MI, USA Julie Ann Robinson School of Psychology, Flinders University, Adelaide, SA, Australia Lindsay Stark Columbia University, Mailman School of Public Health, Program on Forced Migration and Health, New York, NY USA Lana Stermac Department of Applied Psychology & Human Development, Counselling Psychology Program, Ontario Institute for Studies in Education, University of Toronto, Toronto, ON, Canada Alanna Thompson Department of Educational And Counselling Psychology, and Special Education , The University of British Columbia , Vancouver , BC , Canada Weiste A. Tol Department of Mental Health , Johns Hopkins Bloomberg School of Public Health , Baltimore , MD , USA Department of Research and Development , HealthNet TPO , Amsterdam , The Netherlands Peter Ventevogel Department of Research and Development, HealthNet TPO, Amsterdam, The Netherlands War Trauma Foundation, Diemen, The Netherlands Michael Wessells Randolph-Macon College, Columbia University, Mailman School of Public Health, Program on Forced Migration and Health, New York, NY USA Tunde Zack-Williams Department of Sociology , University of Central Lancashire , Lancashire , UK Overview of the Volume 1 Chandi Fernando and Michel Ferrari

Tragically, civilians are increasingly affected by risks war presents for children and their families. war, with many of them being children and youth. We consider these issues in four sections. Although experiences of war and other severe political confl ict often produce long-lasting trauma, it is important to ask what can be done to Section 1: Social-Ecological minimize the effects of war exposure. Research Approaches to Promoting Resilience typically focuses on mental health and on how in Children of War exposure to war generates symptoms of posttraumatic stress or other pathological outcomes of Section 1 of the book explores social-ecological exposure to war; however, the chapters in this vol- models of resilience and their application to promote ume all concern children and youth who demon- resilience and psychosocial well-being. The fi rst strate remarkable resilience in the face of war two chapters present a model of social-ecological experiences. According to Masten ( 2011 ) , several resilience, along with evidence in support of this kinds of phenomena have been studied under the approach. The third chapter discusses social-eco- umbrella term of resilience: (1) beating the odds logical guidelines developed by the Inter-Agency in situations of high cumulative risk for develop- Standing Committee (IASC) to help maximize the mental problems, (2) coping well under dif fi cult effectiveness of interventions to help children and circumstances, (3) bouncing back after some communities affected by war. The fi nal chapter in catastrophe or severe deprivation and (4) posttrau- this section provides a richly detailed application of matic growth following adversity, through trans- these IASC guidelines in Afghanistan. formational reorganization of developing systems. In their chapter, Promoting Mental Health and All contributors to this volume endorse one or Psychosocial Well- Being in Children Affected by more of these views of resilience, with a special Political Violence; Current Evidence for an focus on the unique physical and psychosocial Ecological Resilience Approach , Tol, Jordans, Kohrt, Betancourt and Komproe review fi ndings on resilience in children affected by political violence from a social-ecological perspective and develop a model of social-ecological resilience. C. Fernando (*) • M. Ferrari They present evidence suggesting that it may Applied Psychology and Human Development , be bene fi cial to strengthen protective processes Ontario Institute for Studies in Education, within families. Furthermore, they cite research University of Toronto, Bloor Street West 252 , demonstrating that sociocultural processes such Toronto , ON , Canada M5S 1V6 e-mail: [email protected] ; as ideological commitment and religious beliefs [email protected] can promote better mental health. However,

C. Fernando and M. Ferrari (eds.), Handbook of Resilience in Children of War, 1 DOI 10.1007/978-1-4614-6375-7_1, © Springer Science+Business Media New York 2013 2 C. Fernando and M. Ferrari

Tol et al. recommend that those interested in Mental Health and Psychosocial Support in building on resilience processes develop pro- Emergency Settings ( 2007) use a social-ecological grammes through context-sensitive participative model to promote resilience. Because most psy- assessments and closely monitor preventive inter- chosocial support is provided from within a com- ventions, since this prevention may exact a large munity and not by outside interveners, the IASC societal cost, for example, when promoting tradi- guidelines propose programmes that form a four- tional practices that inadvertently reinforce stigma level pyramid. From the base of the pyramid to or marginalization. the top, these four levels are (1) basic services In their second chapter, Promoting Mental and security; (2) community and family supports; Health and Psychosocial Well -Being in Children (3) focused, non-specialized supports; and (4) Affected by Political Violence ; Part II : Expanding specialized services. Each layer of the pyramid the Evidence Base , Tol et al. examine several lim- is essential and must be implemented simultane- itations in the literature on resilience of children ously; however, the supports near the base of affected by armed confl ict, namely, (a) a lack of the pyramid tend to bene fi t the most people; and longitudinal research, (b) limited knowledge of the mental health style interventions at the top transactional processes, (c) few fi ndings that span tend to be needed for only a few individuals different sociocultural settings and (d) the need experiencing emergency situations. for greater theoretical development. They describe In their chapter, Mental Health and Psycho- four recent research projects that were aimed at social Well -Being of Children in Afghanistan , overcoming some of these limitations. First, the Ventevogel, Jordans, Eggerman, van Mierlo and authors report on a longitudinal study of the risk Panter-Brick provide a detailed case study of efforts and protective processes that help promote the to promote resilience in Afghanistan. They begin psychosocial adjustment and social reintegration by reviewing previous literature on child-focused of former child soldiers in Sierra Leone. Next, research and interventions designed to promote they describe how variables at different ecologi- mental health and psychosocial well-being in cal levels (developed in collaboration with former Afghanistan. The authors adopt a broad perspective child soldiers in Nepal) contributed to outcomes that not only looks at children’s mental health on a measure of positive psychosocial well-being. (including epidemiological and clinical data on dis- Third, in a study with children affected by armed orders and psychological distress) but also situates con fl ict in Burundi and Sudan, they show the it contextually in terms of the economic, cultural value of single-case studies in developing theory and social structures that affect children’s daily suf- about effective treatment processes. Finally, their fering, vulnerability or resilience. Although this fourth study of a school-based intervention with review shows the importance of promoting com- children in Indonesia examined mediators and munity-based, culturally grounded and carefully moderators of intervention effects within a cluster evaluated approaches to resilience, the authors note randomized trial. These examples show how that studies reviewed often fail to adhere to such advances in longitudinal and multi-level statis- principles explicitly or are lacking in depth. The tics—along with theory development and a par- authors then present a number of recommendations, ticipatory context-sensitive approach—can help set within the framework outlined in the IASC us better understand the complexity of resilience guidelines on mental health and psychosocial sup- of children in areas of armed con fl ict. port in emergency situations. Furthermore, they In Promoting Resilience in Children of War , stress the importance of ongoing non-war-related Magid and Boothby also endorse a social-ecological adversity (e.g. poverty) as generating moderate to approach to promoting resilience in children severe levels of psychosocial distress suggests the affected by war. Protective factors available to need for broader-based psychosocial interventions. children immediately before, during and after an Indeed, the authors note that structural injustices event, along with risk reduction, can be crucial in (e.g. gender and ethnic discrimination, lack of sta- improving developmental outcomes. In particu- ble employment opportunities and exposure to vio- lar, they explain how the IASC Guidelines on lence) deserve speci fi c attention in Afghanistan. 1 Overview of the Volume 3

Children Formerly Recruited into Armed Forces Section 2: Child Soldiers and Groups , cite increasing evidence that most children formerly recruited into armed forces or The second section of this volume considers the groups can be rehabilitated to become functional particularly troubling issue of child soldiers. The members of their families and communities. In fi rst two chapters in this section explore reasons other words, despite claims to the contrary, these why children become soldiers, while the third children are not a “ticking time bomb of angry, considers ways to reintegrate child soldiers into alienated and traumatized youth whose only communities after con fl icts have ended. skills … are those they learned at war” (Child soldiers, 2008 ). Indeed, Stark and Wessells pro- In When Children Become Killers: Child Soldiers pose a paradigm shift from a de fi cits- to a in the Civil War in Sierra Leone, Zack-Williams strength-based approach that strives to under- explores the growing phenomenon of child soldier stand and support these children as they attempt as a growing feature of modern warfare. In par- to shed their wartime identities and rejoin civil- ticular, his chapter is a case study of the civil war ian life. The authors explore the resilience of for- in Sierra Leone, which saw the use of child com- merly recruited children and analyse how their batants by both sides: the government and its allies reintegration into civilian life is supported by fi ve (the Civil Defense Force) versus the rebel and key elements: (1) psychosocial interventions, their allies (the Armed Forces Revolutionary (2) cultural and spiritual practices, (3) education, Council). Zack-Williams considers the role chil- (4) livelihoods and (5) family and community dren played in the civil war, which children were mobilization and reconciliation. Recognizing the targeted, and how they were recruited to become enormity of the ethical challenges associated child soldiers. He notes that many children who with any attempt to reintegrate formerly recruited joined the national army seized the chance for children into their communities, the chapter employment in the army to escape from their life concludes with a refl ection on the humanitarian as “street children,” which was often precarious principle “Do No Harm.” and dangerous. A signi fi cant number of the young Buchanan, Al-Mashat, Cortes, Djukic, Jaghori fi ghters who joined the Revolutionary United and Thompson present two studies in their chap- Front (RUF) were drawn to its ideological appeal ter, Children of War in Columbia and Iraq . Using of the RUF and its charismatic leader. Zack- narrative methods, the authors examine the effects Williams points to another factor that drew chil- of war on children and processes that promote dren in Sierra Leone into armed groups challenging resilience, along with recommendations to help existing political authorities: loss of the bond of children who have experienced war. The fi rst trust and reciprocity between generations. Within study considers factors that promote resilience in this context, he presents four key aspects of resil- former child soldiers in Colombia in one of the ience: (1) critical-mindedness that shields children government’s rehabilitation and reintegration from discrimination and forms the basis of a cri- programmes. The other study examined the tique of existing social conditions; (2) agency or impacts of war experiences on Iraqi children who active engagement at home, in school and among survived the US military’s so-called Operation peers that results in a positive impact on their Iraqi Freedom. Protective factors for these two environment; (3) fl exibility that promotes adapta- studies are shown to vary due to signi fi cant con- tion to cognitive, social, emotional and physical textual differences between countries, communi- demands, in a bicultural setting; and (4) commu- ties, families and individual children. The authors nalism, or the celebration of social bonds, social conclude their chapter with a review of protective duties and collective well-being. These issues factors that aim to ameliorate the condition important to promoting the resilience of child sol- of children suffering from the trauma of diers are further considered in the next chapter. war. Important among these protective factors Stark and Wessells in their chapter, The are effective coping strategies, belief systems Fallacy of the Ticking Time Bomb : Resilience of (such as religious beliefs and ideologies) and 4 C. Fernando and M. Ferrari social relations—especially family relationships. children’s psychosocial well-being and institu- Finally, it is important to assess and address tions like family and orphanage. They also locally salient daily stressors like poverty, family consider how cultural contexts incorporate local violence, unsafe housing and social isolation that idioms of risk and resilience and culturally often accompany acute war trauma. appropriate meaning-making as part of a dynamic system that promotes well-being even in the face of terrible tragedies children in war orphanages Section 3: Institutional Support have experienced. Particular attention is paid to for Children Affected by War Buddhism as a critical ideology in the lives of people in Sri Lanka, including for children living The two chapters in this section explore institu- in these orphanages. tional supports for children who have been affected by war. The fi rst examines efforts to create Child Friendly Spaces in areas of con fl ict; the Section 4: Resilience Among Refugees second considers orphanages as important sites for promoting resilience using culturally impor- Much of our knowledge about the effects of war tant beliefs and practices such as Buddhism. on children and adolescents comes from research Kostelny and Wessells in their chapter, Child on refugees. The fourth section concerns resil- Friendly Spaces : Promoting Children ’ s Resiliency ience among refugees and contains fi ve chapters. Amidst War , note that although exposure to war The fi rst three chapters in this section use narra- threatens children’s development and well-being, tive methods to document the experience of protective practices present in families and com- immigration to North America. The fi rst chapter munities can help buffer negative developmental involves refugees from the former Yugoslavia, outcomes. In this regard, it is critical to minimize while the next two chapters involve immigrants risk and enhance protective support for children’s from Africa. The fi nal two chapters discuss suc- well-being at multiple levels of their sociocul- cessful programmes to help immigrants become tural ecology. They focus their chapter on efforts more resilient. While the fourth chapter of the to establish Child Friendly Spaces after armed section describes a programme designed to help confl ict—a widely used intervention that inte- immigrants just arriving in Australia, the last grates protection, psychosocial support and edu- chapter explores how public school education cational opportunities for children. The authors can be adapted to help young immigrants become discuss the purpose and function of Child Friendly more resilient. Spaces, and their intended bene fi ts for children In her chapter, Relational Resilience , Daiute who participate in them. Using case studies from argues that, like human development itself, resil- Afghanistan and Uganda, they illustrate some of ience is a social-relational process. The chapter these benefi ts as well as some of the challenges focuses on how children’s cognitive and emo- of this intervention method. Kostelny and tional responses emerge in language and other Wessells conclude by suggesting ways to more symbolic interactions with family, community systematically manage these challenges so as to and nation. This development occurs as they strengthen this approach. make sense of the world around them and their In their chapter, Promoting Resilience Through place within it. Daiute illustrates this process Faith Development in Orphans of War in Sri through examples from her studies of youth Lanka, Fernando and Ferrari assess the role of growing up during and after the wars in the orphanages in promoting resilience in war-orphan former Yugoslavia that occurred in the1990s and non-war-orphan children in Sri Lanka. The (Daiute, 2010 ). She discusses issues of study authors use a social-ecological model of resil- design and analyses needed to advance theory, iency that explores the relationships between research and practice that address con fl ict-related 1 Overview of the Volume 5 displacement. Daiute concludes by noting that Robinson, fi rst summarizes past research on the research from many theoretical perspectives many ways in which war infl uences the mental encourages the examination of resilience as a health of child and adolescent refugees, both in relational process, situated in speci fi c circum- their homelands, in countries of asylum and after stances and not simply an essential aspect of repatriation or resettlement. She then considers individual character. the methodological issues inherent in research In her chapter, Coping and Adaptation : that examines the effects of war through the study A Narrative Analysis of Children and Youth from of refugees. Robinson also presents an empirical Zones of Con fl ict in Africa , McAdam uses narra- study that compares the adaptation of two groups tive inquiry to research the coping and adaptation of mid-adolescent refugees who were new arriv- of nine youth who survived situations of political als to Australia: The fi rst group were exposed to confl ict in Africa as children. Her research high- effects of war, while the second were voluntary lights the role of culture in framing individual migrants, not exposed to war. Robinson found coping and adaptation under conditions of both resilience and vulnerability among the ado- extreme adversity. She also proposes the need to lescent war refugees. In terms of resilience, most design culturally appropriate policies and prac- adolescent refugees had average or above aver- tices for refugee children of war, in which under- age academic progress and peer acceptance, and standing resilience involves understanding not emotional and behavioural problems that were only universal human characteristics but cultur- within the normal range for Western samples. ally speci fi c behaviours important to people’s Nevertheless, adolescent refugees showed lower personal experience of psychosocial well-being. academic progress and peer acceptance, and more The chapter by Bates, Johnson and Rana, emotional and behavioural problems, than did Pathways of Success Experiences Among the their voluntary migrant peers. “ Lost Boys ” of Sudan , continues the exploration In their chapter, Pathways to Resilience : The of resilience among African refugees. It reviews Role of Education in War - Zone Immigrant and fi ndings from 8 years of research on the adapta- Refugee Student Success, Stermac, Clarke and tion of Sudanese refugee youth who resettled in Brown note that, despite decades of migration the United States, and explores the developmen- from global con fl ict zones, it is dif fi cult to tal pathways of four successful young men 10 develop guidelines and “best practices” to help years after resettlement. Although separated from immigrant and refugee students learn in educa- parents as children and exposed to trauma and tional settings. The main challenge is due to our chronic adversity related to civil war, these youth limited knowledge of how traumatic stress has were found to demonstrate notable resilience. affected these students. Accumulating interna- Moreover, the authors found common pathways tional research suggests, however, that multiple to successful adaptation in Africa and the United contextual factors play a critical role in academic States. Personal characteristics such as sociabil- achievement among students from war zones, ity, fl exibility and a strong sense of purpose were including language acquisition opportunities, common to successful youth, as were supportive institutional supports, instructional practices and relationships with adult mentors and peers. strategies of teacher–student engagement. Cultural beliefs and values were also important in Stermac’s previous research suggests that these helping youth to adapt while maintaining a sense contextual factors likely enhance student of “where they came from.” In general, these key con fi dence and resiliency, and provide an optimal personal characteristics, supportive relationships path to educational and academic achievement and the availability of community resources were and success. Thus, the authors propose that essential in coping with adversity. engaging these factors may establish “best prac- No Place Like Home : Resilience Among tices” for supporting academic success among Adolescent Refugees Resettled in Australia , by students with histories of war-trauma exposure. 6 C. Fernando and M. Ferrari

Muldoon notes that boys, in particular, are more Section 5: Extending Our likely to adapt by acting out, especially when Understanding of the Effects of War they grow up in poverty, in violence-prone areas. on Children Political, national or gender identities are also an important factor in political confl ict. Social iden- Theory and Practice tities in groups that condone violence increase the likelihood of youth participating in political In section fi ve, we consider efforts to extend and violence, because such identities normalize and challenge the very notion of resilience. The fi rst rationalize the use of violence to resolve confl ict. chapter of this section considers youth who have Such identities can also buffer the mental health grown up in communities in which political vio- impact of any stressors. More generally, any lence is an accepted response to historical griev- efforts to reduce violence must target the social, ances, and therefore integral to the psychosocial economic and political causes of confl ict, creat- identity of some youth. The second chapter cites ing a society that promotes general well-being similar cases to show that we cannot consider while supporting individual efforts to become wartime experiences to have a similar meaning resilient. for all participants: How youth experience war In their chapter, How Can a Majority Be will depend on how they interpret the meaning of Resilient ? Critiquing the Utility of the Construct of those experiences. This may help explain why Resilience Through a Focus on Youth in Contexts most youth interviewed seem remarkably resil- of Political Con fl ict , Barber and Doty challenge ient, a fi nding that challenges the very notion of these presumptions even further. They begin by resilience. The following chapter takes a lifespan synthesizing paradoxical fi ndings from the litera- perspective, demonstrating that the effects of war ture on political con fl ict, showing that most chil- on children differ according to an individual’s dren are not adversely affected by war because degree of developmental maturity as well as to their understanding of their war experiences the speci fi c contexts of war experience; sadly, in depends on their speci fi c experiences and how some cases, the effects of war trauma emerge they are interpreted. For example, the authors only years later. The fi nal chapter for this section claim that Palestinian youth see political con fl ict presents an integrative summary of effective as a continuation of a historical struggle for basic resilience-enhancing interventions to help chil- rights and self-determination. Barber and Doty dren of war at different social-ecological levels, then discuss reasons why the expectation of wide- offering a toolkit of possible interventions to pro- spread dysfunction in youth experiencing political mote resilience among war-affected youth. confl ict is misguided. More generally, they pro- According to Muldoon in her chapter, Political pose that research should examine (1) speci fi c Violence , Identity , and Psychological Adjustment types of con fl ict exposure experienced, (2) the in Children, concern for youth growing up in sit- effect of con fl ict on speci fi c domains of youth uations of political violence has led to two dis- functioning and (3) the long-term effects of differ- tinct strands of research: (1) studies of the mental ent types of exposure to situations of war. Their health consequences of political violence and (2) overall conclusion is that resilience—as com- how attitudes are shaped by the social divisions monly construed in the research literature—is not that accompany political violence. While these a useful way to identify a set of individuals who two literatures are often considered separately, are uniquely adaptive in contexts of severe politi- Muldoon considers them together: More cal con fl ict. The authors propose that their approach specifi cally, she considers how the social allows for a more focused effort to determine who identi fi cation processes that underlie political is not resilient, and under what circumstances. attitudes affect both children’s experiences and In Resilience in the Lives of Children of War , how they interpret and adapt to those experiences. Garbarino and Bruyere extend the previous 1 Overview of the Volume 7

discussion of resilience, and bring it full circle by a whole as well as among children living in adopting a lifespan developmental and ecological institutions are recommended. perspective advocated in the fi rst section of the book. In their chapter, they note that a core insight of an ecological perspective is that child develop- Conclusion ment takes place in the very specifi c contexts of a child’s life: it is not universal. In this regard, child The concluding chapter by Ferrari and Fernando development does not work exactly the same way explores themes that integrate the various chap- for everyone in every situation; rather, it involves ters in the volume, while pointing out important a complex interaction between a child’s biology differences in how resilience is conceptualized. and psychology and the in fl uences of family, Contributors to this volume all agree that a multi- community, culture and society. All of these ele- pronged strategy is needed to help children caught ments combine to produce an “ecological niche” up in political violence, one that both reduces for individual development. As a result, the risk factors and strengthens protective factors authors note that when one asks the developmen- that support children’s psychosocial well-being. tal question “Does X cause resilience?” the best While it is diffi cult to study the effects of war scienti fi c answer is “it depends”: It depends upon on children and youth, and even the success who the child is and where they develop. However, of interventions, in a rigorous scientifi c way, Garbarino and Bruyere argue that to understand important efforts have been made to do so as and promote children’s well-being requires seen in the chapters in this handbook. A more adopting the developmental and philosophical comprehensive developmental theory and itera- insights of the UN Convention on the Rights of tive methodological approaches such as design the Child within each particular context, as a way experiments—as well as case studies and more of asserting universal values. rigorously controlled trials and more develop- In their chapter, Evidence -Based Resilience - mentally and context-sensitive interventions— Enhancing Intervention Methods for Children can improve the psychosocial well-being of Affected by Armed Con fl ict , Peltonen and children and their families affected by war. Palosaari provide a literature review of factors protecting the mental health of children in war zones and related resilience-enhancing interven- References tion methods. In their chapter, their aim is to provide a “toolbox” for intervention planners. Child Soldiers “A ticking timebomb”. (2008). Retrieved Among the resilience-based methods identifi ed from http://www.planusa.org/contentmgr/showdetails. as techniques are those related to children’s php/id/353396. cognitive, emotional and social skills; their Daiute, C. (2010). Human development and political violence . New York: Cambridge University Press. social support systems; and community attitudes. IASC. (2007). IASC guidelines on mental health and The methodological quality of the intervention psychosocial support in emergency settings . Geneva: studies reviewed ranged from poor (pre- to Inter-Agency Standing Committee. post-evaluations with no comparison group) Masten, A. S. (2011). Resilience in children threatened by extreme adversity: Frameworks for research, to good (randomized controlled trials). Further practice, and translational synergy. Development and studies among younger children and families as Psychopathology, 23 , 493–506. P a r t I Social-Ecological Approaches to Promoting Resilience in Children of War Promoting Mental Health and Psychosocial Well-Being in Children 2 Affected by Political Violence: Part I–Current Evidence for an Ecological Resilience Approach

Weiste A. Tol, Mark J. D. Jordans, Brandon A. Kohrt, Theresa S. Betancourt, and Ivan H. Komproe

nature, and increasingly involves a multitude of An Ecological Resilience Theoretical rebel groups (Themner & Wallensteen, 2011 ) . Framework Current political violence occurs at the places where people live and work and thereby increas- In 2010, 30 confl icts were recorded in 25 loca- ingly puts children and adolescents at risk of tions. Most political violence, including armed death, systematic human rights violations (includ- confl icts and war, takes place in low- and middle- ing recruitment by armed forces, torture, disap- income countries, is dominantly intra-state in pearances, and sexual violence), and destruction of community structures (Pedersen, 2002 ; Wexler, Branski, & Kerem, 2006 ) . W. A. Tol , Ph.D. (*) From the First and Second World Wars, Department of Mental Health , Johns Hopkins Bloomberg researchers and service providers have systemati- School of Public Health , 624 N Broadway, Hampton House/Room 863 , Baltimore , cally documented the negative psychological con- MD 21205-1996 , USA sequences of political violence on children and Department of Research and Development , adolescents. A recent meta-review of 17 studies HealthNet TPO , Amsterdam , The Netherlands involving 7,920 children, for instance, found e-mail: [email protected] pooled prevalence estimates of 47 % (95 % CI: M.J.D. Jordans , Ph.D. 35–60 %) for posttraumatic stress disorder (PTSD) Department of Research and Development , and 43 % (95 % CI: 31–55 %) for major depres- HealthNet TPO , Amsterdam , The Netherlands sive disorder (Attanayake et al., 2009 ) . Although Center for Global Mental Health , London School such epidemiological work presents a crucial step of Hygiene and Tropical Medicine , London , UK in documenting the impact of armed con fl icts and B. A. Kohrt , M.D., Ph.D. war, service providers are confronted by questions Department of Psychiatry and Behavioral Sciences , that go beyond establishing that exposure to politi- George Washington University , Washington , DC , USA cal violence increases chances for developing psychological symptoms. Such questions include T. S. Betancourt , Sc. D. Department of Global Health and Population, “What are the main in fl uences on child and ado- Harvard School of Public Health , Boston , MA , USA lescent mental health in political violence-affected FXB Center for Health and Human Rights, areas?” “Why do some children and adolescents Harvard University, Boston, MA, USA develop psychological symptoms and others do I. H. Komproe , Ph.D. not?” “What services are most effective to prevent Department of Research and Development , mental health problems in children and adoles- HealthNet TPO , Amsterdam , The Netherlands cents growing up in political violence?” and “What Utrecht University , Utrecht , The Netherlands type of protective resources may children and

C. Fernando and M. Ferrari (eds.), Handbook of Resilience in Children of War, 11 DOI 10.1007/978-1-4614-6375-7_2, © Springer Science+Business Media New York 2013 12 W.A. Tol et al.

Person Micro-system Meso/ exo-system Macro-system

Coping Family connectedness Interactions between family and school Religious institutions Ideological commitment Caregiver mental health supports Cultural practices Religious beliefs Intelligence/ Creativity Peer relations Neighborhood connectedness

School environment

Social Support

Fig. 2.1 Ecological resilience framework for children affected by war

adolescents build on to retain mental health when of Bronfenbrenner, more specifi cally his 1979 confronted with political violence?” Despite grow- monograph (Bronfenbrenner, 1979 ) . Bronfen- ing attention for mental health and psychosocial brenner originally posited his theoretical frame- support in humanitarian settings (Inter-Agency work as a solution to the perceived dilemma Standing Committee [IASC], 2007 ) , however, between “hard” scienti fi c psychometric practices Cairns and Dawes ( 1996 ) words regarding the aca- in academic laboratories on the one hand and the demic fi eld more than 15 years ago still ring true: relevance of fi ndings for policy and practice on … the fi eld can still be said to be in its infancy. Part the other hand. His early, most cited, work of the problem is that, for many years, investiga- emphasizes the importance of the environment in tors have been content to explore whether political which children grow up and conceptualizes envi- violence has negative psychological consequences ronmental infl uences at different nested levels for children, but have neglected to move much beyond this broad premise (Cairns & Dawes, (see Fig. 2.1 ). The individual (ontogenic system ) 1996 , p. 129). is fi rstly situated in a microsystem , consisting of the direct activities, roles, and interpersonal rela- Two bodies of work present promising ave- tionships in a certain setting (e.g., the home, nues to move beyond this premise. In their call school). The mesosystem is comprised of the for a paradigm shift, a number of authors have interrelations among two or more of these emphasized (a) an ecological -transactional settings (e.g., relations between home, school, approach (Cummings, Goeke-Morey, Schermer- and peer group). Subsequently, these systems horn, Merrilees, & Cairns, 2009 ; Elbedour, ten are nested within the exosystem, in which the Bensel, & Bastien, 1993 ; Garbarino, 2001 ; Kohrt child does not actively participate, but which et al., 2010 ; Triplehorn & Chen, 2006 ) and (b) in fl uences—and is in fl uenced by—the develop- the importance of examining resilience processes ing person (e.g., the parents’ workplaces). Finally, (Betancourt & Khan, 2008 ; Layne et al., 2009 ; the macrosystem represents consistencies in the Punamaki, Qouta, & El Sarraj, 2001 ; Tol, Jordans, form of culture or subculture that permeate the Reis, & De Jong, 2009 ) . micro-, meso-, and exosystems (Bronfenbrenner, Researchers advocating an ecological 1979 ) . Current applications of this theoretical approach have often referred to the early work framework with children in adversity have 2 Promoting Ecological Resilience–Part I 13 focused on transactions taking place between phases, with contemporary writing emphasizing risk and protective factors at different socio- the need for a focus on the multilevel (i.e., inte- ecological levels, i.e., the family, peer, school, grating biological and social fi ndings) and and wider community levels (Betancourt & Khan, dynamic (i.e., resilience as a process rather than 2008 ; Earls & Carlson, 2001 ; Lynch & Cicchetti, a static outcome) nature of resilience (Masten, 1998 ; Zielinski & Bradshaw, 2005 ) . 2007 ) . Despite signi fi cant strides in elucidating In later work, Bronfenbrenner reevaluated and resilience processes, a major gap in the literature revised his theoretical approach. He critiqued the remains the lack of fi ndings from non-industrial- contemporary shift of focus to environmental ized low- and middle-income countries (Ungar, factors in developmental studies as a “failure 2008) . Research from industrialized high-income of success.” In his own words, “In place of too countries may not be generalizable to these much research on development ‘out of context,’ settings, because of differences in the conceptu- we now have a surfeit of studies on ‘context with- alization of childhood across cultures, in symp- out development’” (p. 108). Bronfenbrenner’s tom expression, help-seeking behaviors, and later bioecological model reemphasized the available support systems (Boyden, 2003a ; signi fi cance of studying development as a joint Howard, Dryden, & Johnson, 1999 ) . function of person and environment, by positing Inspired by both of these bodies of work, the research designs that simultaneously took into term “ecological resilience” has been used to account aspects of the developing person focus attention on resilience processes operating (e.g., temperament, cognition), the context of at diverse contextual levels, rather than a domi- development, and the longitudinal processes nant focus on individual variables. In the context through which development takes place (i.e., the of children and war, an earlier defi nition referred chronosystem model) (Bronfenbrenner, 2005a ) . to ecological resilience as “those assets and pro- In addition to a renewed interest in contextual cesses on all socio-ecological levels that have infl uences on mental health through an ecologi- been shown to be associated with good develop- cal-transactional lens, those working with chil- mental outcomes after exposure to situations of dren in adversity have emphasized the importance armed con fl ict” (Tol et al., 2009 , p. 167). In our of studying aspects of resilience. Since the 1970s, opinion, the main rationale for broadening of researchers have noted that, despite growing up attention to contextual aspects of resilience con- in very diffi cult circumstances, a large group of cerns the possibility to aid the development of children function well. Initially it was thought mental health and psychosocial programs for that resilience concerned a group of “invulnera- children affected by armed confl ict. By identify- ble” children, but more current fi ndings have ing how protective processes at wider social lev- shown that resilience may be achieved through els in fl uence biological and psychological relatively ordinary means including intelligence, functioning, the development of especially uni- self-esteem, and the availability of committed versal and selective public health prevention caregivers or other attachment fi gures (Masten, efforts may be informed. Such prevention efforts 2001 ) . Although exact de fi nition remains contro- that aim to reach larger population groups before versial, common reported defi nitions of resilience they develop mental health problems are more include (a) exposure to adversity (e.g., poverty, feasible and likely more cost-effective in settings chronic maltreatment, violence) and (b) positive deprived of mental health infrastructure, espe- psychosocial well-being, as illustrated in cially specialized mental health professionals de fi nitions by Masten (2001 ) , “good outcomes in (de Jong, 2002 ) . Accordingly, international con- spite of serious threats to adaptation or develop- sensus guidelines and psychosocial practitioners ment,” and Luthar, Cicchetti and Becker ( 2000 ) , advocate the importance of building on strengths “a dynamic process encompassing positive adap- available in families and communities in a cultur- tation within the context of signi fi cant adversity.” ally sensitive manner (Inter-Agency Standing Research on resilience has moved through several Committee [IASC], 2007 ) . Despite this consensus, 14 W.A. Tol et al. however, practitioners currently report to have generally been associated with the use of more little rigorous research fi ndings to inform their diverse coping methods (Bat-Zion & Levy-Shiff, programming (Cardozo, 2008 ) . 1993; Paardekooper, de Jong, & Hermanns, 1999 ) . In this respect, Punamaki, Muhammed, and Abdulrahman ( 2004 ) found that among Kurdish children dramatic military violent events Ecological Resilience Findings (e.g., shootings, risk of death) were not associated with coping behavior, whereas adverse fam- Below, we provide an overview of research ily and economic circumstances were. In addition, fi ndings regarding resilience in children and ado- individual factors such as age and gender have lescents living in areas of political violence been shown to in fl uence coping responses. For according to the different socio-ecological levels. instance, Punamaki and Puhakka found that with We present fi ndings regarding the person (i.e., age (and maturing abstraction and metacognitive ontogenic system), and micro-, meso-, exo-, and skills), Palestinian children used more emotional macrosystems (see Fig. 2.1 ) (Bronfenbrenner, and cognitive coping (i.e., adjusting the way one 1979 ) . Although we mostly refer to research with feels and thinks in relation to a stressful situation, children and adolescents in settings where politi- as opposed to attempting to change the situation cal violence occurs, occasionally we refer to the itself) and demonstrated a wider repertoire of relevant literature on children and adolescents in coping strategies. Older Israeli children also used adversity in high-income settings (e.g., popula- more emotion-focused coping than younger tions affected by communal violence, refugee children while sheltering against chemical and populations). biological weapons in the Persian Gulf War (Weisenberg, Schwarzwald, Waysman, Solomon, & Klingman, 1993 ) . Bat-Zion and Levy-Shiff Person (or Ontogenic System) ( 1993) observed that children’s coping responses increased when parents displayed positive emo- Coping tional responses during these attacks. Researchers have built on the stress paradigm of Second, research attention has focused on Lazarus and Folkman ( 1984 ) in an attempt to which coping styles may be protective for mental explain individual variation in psychological out- health. Consistent with Lazarus and Folkman’s comes after exposure to political violence. Coping ( 1984) theoretical framework, it has been posited is often de fi ned as “constantly changing cogni- that effectiveness of coping depends on the situa- tive and behavioral efforts to manage speci fi c tion in which coping is employed. In controllable external and/or internal demands that are situations, active-approach coping behavior may appraised as taxing or exceeding the resources of protect against psychological problems, whereas the person” (Lazarus & Folkman, 1984 , p. 141). in uncontrollable situations passive-avoidance Efforts have been made to distinguish between strategies may be more appropriate (Punamaki, different styles of coping strategies, e.g., emo- 2006 ) . This statement is only supported by mixed tion-focused vs. problem-focused, approach vs. evidence. Aforementioned studies with Israeli avoidance, and cognitive vs. behavioral (Skinner, children in sealed rooms during Iraqi Scud Edge, Altman, & Sherwood, 2003 ) . The literature attacks—an uncontrollable stressor—evidenced on coping in children affected by political vio- an association between avoidance strategies lence has focused on two main questions. First, and fewer postwar psychological symptoms researchers have aimed to identify which factors (Solomon, 1995; Weisenberg et al., 1993 ) . in fl uence the use of coping behavior. A number Seemingly in contrast, effectiveness of coping of studies suggest that coping partly depends on methods of Palestinian children was found to dif- the type of exposure to political violence. For fer between a group of children before and during example, more sustained or proximal exposure the First Intifada; active fi ghting and behavioral to political violence and related stressors has coping were effective during but not before the 2 Promoting Ecological Resilience–Part I 15 more high-intensity violence period of the and insecurity, depression, and feelings of failure Intifada (Punamaki & Puhakka, 1997 ) . In a study after exposure to political hardships. (Punamaki, on coping among Kurdish children, in which both 1996) . In Northern Ireland, strong national active and passive coping methods were associ- identifi cation was associated with lower levels of ated with positive mental health outcomes, the PTSD among a random sample of 3,000 adults only longitudinal study failed to fi nd a relation- living in confl ict-affected regions of Northern ship between active coping and mental health Ireland and more distally affected bordering outcomes among Palestinian adolescents who counties (Muldoon & Downes, 2007 ) . A media- grew up during periods of political violence tion effect was con fi rmed in later analyses (Qouta, Punamaki, Montgomery, & El Sarraj, (i.e., experience of violence strengthens national 2007 ) . Punamaki (Punamaki 2006 , Punamaki identi fi cation which in turn predicts smaller et al., 2004 ) concludes that the key factor deter- symptomatology) particularly for those with a mining effectiveness of coping may be the ability minority Irish identity in Northern Ireland to fl exibly fi t a diverse repertoire of coping meth- (Muldoon et al., 2009 ) . Also in Nepal, continued ods to speci fi c situational demands. affi liation to the Maoists rebel forces after signing of the peace accords was associated with Ideological Commitment better mental health (Kohrt et al., 2008 ) . Ideological commitment and active participation In an excellent review of their work in the occu- in struggle have been repeatedly put forward as pied Palestinian territories, Qouta et al. ( 2008 ) fur- protective factors for children and adolescents in ther nuance these fi ndings. They point to research situations of political violence (Barenbaum, showing political activism being associated with Ruchkin, & Schwab-Stone, 2004 ) . In times of better outcomes only after the First Intifada chaos and threats to one’s way of life, ideological (among adolescents 17–18 years old), whereas it commitment may provide a sense of purpose, was associated with higher levels of symptomatol- meaning and coherence—turning “victims” into ogy (mother-reported PTSD and emotional disor- “survivors.” The little empirical support—due to ders) in children during the First Intifada, when a lack of studies addressing this issue—mainly the same adolescents were 14–15-year olds originates within the context of the Israel– (Punamaki et al., 2001 ) . Also, they did not fi nd an Palestine confl ict where the active involvement association between political activism and mental of youth was pronounced, especially during the health outcomes in a longitudinal study with First Intifada (Barber, 2001 ; Qouta, Punamaki, & Palestinian youth (Qouta et al., 2007 ) , although El Sarraj, 2008 ) , as well as Northern Ireland these fi ndings may suffer from too small a sample (Muldoon & Downes, 2007; Muldoon, Schmid, size to detect statistically signi fi cant relations. & Downes, 2009 ) . Barber (2008 ) describes how Qouta and colleagues also warn that violence may Palestinian youth, both male and female, were beget violence (Qouta et al., 2008 ) . This warning actively involved through demonstrations, throw- is echoed by research with Israeli adolescents. ing stones, distracting soldiers away from dem- Laor and colleagues report different patterns onstrations, and delivering supplies to fi ghters. explaining ideological commitment among boys This involvement was associated with higher and girls. Among girls, ideological commitment social competence and civic involvement, higher was explained by high exposure to traumatic empathy and lower antisocial behavior for males, stressors, low resilience, and high symptomatol- and higher public religiosity for females (Barber, ogy. Among boys, ideological commitment was 2008 ) . Similarly, Baker (1990 ) points to the pro- explained by high resilience (operationalized as tective effects of involvement in the First Intifada self-reported con fi dence, optimism, and ability to given the high level of self-esteem in his sample cope) and high symptomatology. They conclude of Palestinian youth. Earlier fi ndings among that the role of ideology may be described as a Israeli-Jewish youth (10–13 years old) likewise double-edged sword, protecting against adverse showed that children with high ideological com- mental health outcomes as well as possibly mitment did not develop symptoms of anxiety contributing to the toxic cycle of violence. 16 W.A. Tol et al.

Religious Beliefs Alvarado, 2006 ) . In con fl ict-affected child popu- In addition to ideological commitment, religious lations, evidence for the protective nature of beliefs have been discussed in the literature as a intelligence comes from El Salvador and the protective factor for mental health. In their review Middle East. Walton, Nuttall, and Nuttall (1997 ) , of the literature on adversarial growth, Linley and in an ecologically inspired cross-sectional study Joseph (2004 ) found that religious activities and with fi fty-four 12-year olds in El Salvador, found intrinsic religiousness were associated with posi- that intelligence was highly related to better men- tive changes following adversity. Likewise, tal health. Similarly, high intellectual and sophis- Fernando and Ferrari ( 2011 ) report that Sri ticated problem solving were associated with less Lankan orphans found Buddhist and Christian symptomatology in Lebanese children (Saigh, religious practices useful to cope by providing a 1991 ) . The aforementioned review from Qouta sense of meaning, offering structure, and promot- et al. (2008 ) cites two studies in which fl exible ing acceptance of diffi culties. In one of the few information processing and high cognitive capac- more thorough empirical evaluations of an eco- ity were associated with good psychological logical theoretical perspective, Cummings et al. adjustment and appeared to protect against the (2009 ) report that mother’s church attendance negative impacts of political violence. A further predicted more adaptive family functioning. In follow-up study among Palestinian youth ( n = 86) addition, mother’s evaluation of the importance points to the complexity of intelligence and cre- of religion and her Christian attitudes predicted ativity as resources. During the First Intifada, the better child mental health, warmer relations authors did not fi nd a direct relationship between between mothers and children, and greater gen- creativity and intelligence on the one hand and eral security in the family. Mother’s religiosity psychological outcomes on the other. A study also buffered the effects of maternal mental health with the same children after violence subsided problems on children’s well-being. Religion was showed (a) a relationship between creativity and not a cure for all, however. Mother’s religiosity good adaptation, and (b) discrepancy between the was also found to magnify family problems, e.g., two (i.e., high IQ but low creativity) being associ- it intensi fi ed the relation between father’s drink- ated with worse outcomes. Moreover, intellectual ing problems and child and family outcomes. Tol, and creative potential was better realized in Reis, Susanty, and de Jong ( 2010 ) describe how loving and accepting families (Punamaki et al., religious coping was often used among Protestant 2001 ) . The authors conclude that interventions and Muslim families in Poso (Indonesia), where should “focus on integrating and balancing cog- political violence played out along religious lines. nitive and emotional responses, and that children One of the few positive consequences of the should be encouraged to make comprehensive confl ict, according to religious leaders, was use of their potential in both areas” (Punamaki an increased religiosity in both communities et al., 2001 , p. 265). (Tol et al., 2010 ) . However, increased religious segregation after the con fl ict and dif fi culties in reconciliation between groups could indicate this The Microsystem increased religiosity may increase chances for successful mobilization for violence in the name Family of religion in the future. The crucial role of the family in predicting chil- Intelligence and Creativity dren’s reactions to community violence is well The resilience literature has often pointed to cog- established, with research demonstrating the nitive capacity as a useful resource in dealing association between adaptive family functioning with adversity (Masten, 2001 ) , and studies with and children’s psychological outcomes violence-exposed populations in high-income (Betancourt et al., 2012 ; Betancourt & Khan, countries seem to confi rm this (Breslau, Lucia, & 2008; Garbarino & Kostelny, 1996 ; Wallen & 2 Promoting Ecological Resilience–Part I 17

Rubin, 1997 ) . Similarly for children affected by Results demonstrate associations between higher war, the family is centrally positioned in under- levels of family social support and healthy family standing the impact of violence on children and adaptation as well as between higher levels of explaining occurrence, maintenance, or preven- family education and decreased negative role of tion of mental health problems (Cummings et al., perceived war stress. In a study with a representa- 2009 ; Qouta et al., 2008) . In a qualitative study tive sample of 5,775 adolescents aged 12–18 with Indonesian children affected by political years in Colombia, Kliewer, Murrelle, Mejia, de violence, participants mentioned that any mental Torres, and Angold (2001 ) found that family sup- health and psychosocial problems were fi rst and port buffered the relation between exposure to foremost handled within the family (Tol et al., violence and anxiety and melancholia. This rela- 2010 ) . Further evidence for the importance of the tion was strongest for girls and younger adoles- family environment concerns the importance of cents. The fact that support from family is more maternal health, which showed to be a strong pre- bene fi cial than from peers is explained by the dictor of children’s mental health in a variety of higher levels of emotional “attunement” of fam- studies (Bryce, Walker, Ghorayeb, & Kanj, 1989 ; ily members and the family’s increased ability to Qouta, Punamaki, & El Sarraj,, 2005 ) . match the type of support to the type of stress. The above results provide promising evidence for Family Cohesion the protective role of the family system, wherein Since early attachment studies, scholars have the interconnectedness of its members and the argued that a connection to a caregiver during and resources of the family unit promote healthy after aversive events, may be a better predictor of adjustment, serving as a buffer for youth’s mental adjustment than the aversive events itself. For health status. example, the availability of close and reliable attachment fi gures to provide adult-led processing Parenting Practices and Parental Support of the young child’s experience has been empha- Parental functions are vulnerable in situations of sized based on fi eld work with children in fi ve war and violence (most notably to provide safety war-affected countries (Garbarino, Kostelny, & and security), yet varying parenting practices and Dubrow, 1991 ) . Moreover, the protective effect of parenting styles have been associated with family connectedness is demonstrated by a study increased resilience in these situations (Punamaki, among former child soldiers in Uganda, linking it Qouta, & El Sarraj, 1997 ; Qouta et al., 2008 ) . to improved psychosocial well-being of youth Several studies have investigated how family (Annan, Blattman, & Horton, 2006 ) . Jovanovic, practices regulate symptom development among Aleksandric, Dunkic, and Todorovic (2004 ) pres- children and adolescents affected by political ent evidence for the reverse effect, albeit among violence. Having over-involved parents and fam- adults, with low family hardiness (i.e., weak family discussions about issues related to terrorism is ily adaptive resources) predicting increased PTSD associated with more posttraumatic stress symp- symptoms among children in former Yugoslavia. toms, and adolescents who claimed that their par- Yet, not all research comes to the same conclu- ents decreased their levels of anxiety reported sion. A study among 54 Salvadoran children failed higher personal resilience (Laor et al., 2006 ) . The to demonstrate a correlation between family likelihood of both positive and negative effects of intactness and mental health outcomes (Walton parenting styles is also demonstrated in a study et al., 1997 ) , instead demonstrating the impor- among Israeli school children under threat of tance of the personal impact of the war on the SCUD attacks. Positive parental emotional mani- child. However, the authors explain this, in part, festation is associated with different types of by a relatively low sample size. child coping, while both positive and negative A study among families after the Lebanese parental emotional manifestation is associated war provides further insight into what types of with increased stress reactions (Bat-Zion & Levy- family resources are protective (Farhood, 1999 ) . Shiff, 1993) . These results appear to point to the 18 W.A. Tol et al. premise that parents serve as fi lters through which nonrejecting, and nonpunitive parenting has been children process the meaning of threatening shown to protect against mental health problems events. High parental emotional arousal and agi- (Qouta et al., 2008 ) . Likewise, children exposure tation, whether positive or negative, signals to violence combined with low levels of maternal increased levels of threat to the child resulting in support had higher levels of intrusive thoughts heightened distress. At the same time, positive and internalizing symptoms (Kliewer, Lepore, parenting styles also increase a child’s resilience Oskin, & Johnson, 1998 ) . to cope with the distress. The importance of positive parenting practices and a sense of parental support for children to Peers, School buffer the negative impact of violence has often been put forward. The ability of the parents to Although peer networks and the school context reassure the child and help them make meaning have been advanced as important sources of resil- of stressful events is considered essential in the ience for violence-affected children, as evidenced child’s process of adjustment (Betancourt & by for example the popularity of school-based Khan, 2008 ) . The parent–child relationship is interventions and youth groups (Persson & central in such processes, as is demonstrated by Rousseau, 2009) , empirical evidence of their pro- the consistent associations between relationship tective nature is still weak. Limited fi ndings are variables (i.e., parental support, behavioral and available regarding children in adversity in psychological control) and youth functioning in a Western settings, which generally confi rm study among Palestinian youth (Barber, 1999 ) . expected associations between peer and school Interestingly, the study also demonstrates the sta- variables and mental health outcomes. For exam- bility and harmony of the parent–child relation- ple, peer support buffered the effects of commu- ship in the wake of the Intifada, pointing toward nity violence on anxiety for children in the the institutional resilience of the family in the United States (Hill & Madhere, 1996 ) , and was face of political violence, contrasting in part associated with more competent classroom fi ndings by Punamaki et al. (1997 ) . In a later behavior (Hill, Levermore, Twaite, & Jones, study, Barber ( 2001 ) fi nds that perceived parental 1996 ) . Similarly, children who were exposed to acceptance protected boys and girls from the family adversity (disadvantage, violent marital stresses of violence, in that those who were active confl ict, harsh discipline) did not show external- in the confl ict but with high levels of perceived izing problems if they reported high levels of parental acceptance demonstrated no increase in positive peer relationships. Peer acceptance mod- antisocial behavior, compared to those with low erated the relationship between family adversity perceived parental acceptance. Similarly, paren- and externalizing problems (Criss, Pettit, Bates, tal acceptance buffered the association between Dodge, & Lapp, 2002 ) . Not only positive fi ndings Intifada experience and youth depression. have been reported, however. In one of the few Punamaki et al. (1997 ) fi nd that reduced quality longitudinal studies with community violence- in parenting explained high levels of neuroticism affected children in the United States, O’Donnell and low self-esteem after experiencing traumatic and colleagues found that peer support was events and conclude that good perceived parent- associated with better future expectations, self- ing is protective for adjustment problems of chil- reliance, and interpersonal relations, whereas it dren. These authors also found that consistent was also associated with worse substance abuse parenting (both parents with a similar style) and delinquency. The authors point to the risks of predicted better child functioning (Punamaki unstructured peer groups leading to deviant et al., 2001 ) . While being a potent safeguard, behavior in at-risk youth (O’Donnell, Schwab- the authors warn that in itself good parenting Stone, & Muyeed, 2002 ) . Similar to peer-related is insuffi cient in protecting children. In terms fi ndings, a dearth of information exists regarding of speci fi c parenting practices, supportive, the protective role of schooling for children in 2 Promoting Ecological Resilience–Part I 19 situations of political violence; we only identifi ed Ellis ( 2010 ) examined the role that postcon fl ict studies addressing children exposed to commu- stigma played in shaping long-term psychosocial nity violence. In South African children exposed adjustment. The researchers used two waves of to violence, involvement in conventional after- data (2002, 2004) from a longitudinal study of school activities was associated with less anxiety. male and female former child soldiers in Sierra In addition, support received at school was asso- Leone. They examined the role of stigma (mani- ciated with less depression and fewer conduct fest in discrimination as well as lower levels of problems (Ward, Martin, Theron, & Distiller, community and family acceptance) in the rela- 2007 ) . Similarly in children exposed to violence tionship between war-related experiences and in the United States, school support was associ- psychosocial adjustment (depression, anxiety, ated with fewer psychological symptoms (sub- hostility, and adaptive behaviors). They observed stance abuse and conduct problems), and this that postcon fl ict stigma had important associa- effect increased over time. With regard to indications with psychosocial adjustment. Additionally, tors of resilience (i.e., future expectations, self- higher levels of family acceptance were associ- reliance, and interpersonal relations), peer support ated with decreased hostility, while improve- seemed more important than school support ments in community acceptance over time were (O’Donnell et al., 2002 ) . associated with adaptive attitudes and behaviors. They found that postconfl ict experiences of discrimination largely explained the relationship The Meso- and Exosystems between past involvement in wounding/killing others and subsequent increases in hostility. According to Bronfenbrenner’s theory (Bron- Stigma similarly mediated the relationship fenbrenner, 1979, 1989, 1999, 2001, 2005b ; between surviving rape and depression. However, Bronfenbrenner & Ceci, 1994 ) , the mesosystem surviving rape continued to demonstrate inde- refers to the interaction between one or more pendent effects on increases in anxiety, hostility, microsystems (the interactions between two or and adaptive/prosocial behaviors after adjusting more settings where a child may spend a great for other variables. deal of time). Examples may include interactions In a small exploratory study of the reintegra- between peer groups and family systems or tion of formerly abducted children from northern between family systems and school systems. Uganda, Corbin ( 2008 ) examined the overlap Studies examining these interactions are very between reunifi cation with family, reinsertion rare. Some examples may be found in studies of into the community, and experiences outside of community processes such as social capital or the home related to education and income-gener- stigma and their infl uence on other settings of ating skills. Additionally, Corbin explored the development, such as family or school function- particular experience of young women who ing. Studies of social capital as related to child reported feeling shamed and stigmatized as a adversity include variables such as social sup- result of past experiences of sexual violation. The port, residential instability, parental involvement, study’s qualitative fi ndings underscored how and social cohesion. For instance, in a study of families help to mediate the reinsertion of female social integration and mental health in Croatia, former child soldiers into community networks Kunovich and Hodson ( 1999a, 1999b ) found lit- through traditional puri fi cation rituals and forms tle support for a buffering hypothesis whereby at of welcome. In addition, Corbin reports that these higher levels of war-related exposure the avail- young women experienced increased community ability of social capital served to mitigate the acceptance when engaged in productive activi- in fl uence of war experiences on mental health. ties, such as farming or going to school, and Examining stigma and its relationship to longitu- decreased acceptance after sharing their re fl ections dinal outcomes in former child soldiers, on trauma experiences with community members Betancourt, Agnew-Blais, Gilman, Williams, and (c.f., Stark & Wessells, this volume). 20 W.A. Tol et al.

Cortes and Buchanan ( 2007 ) report similar experiences in a sample of former child soldiers The Macrosystem from Colombia (c.f., Buchanan & Cortes, this volume). Participants indicated that educational Cultural Practices and vocational activities contributed to a sense of empowerment, agency, and improved incorpora- Bronfenbrenner provides an inclusive explanation within social networks. Among this sample, tion of macrosystem in his 1994 chapter on eco- reintegration was facilitated by governmental and logical models of human development: NGO programs that provided resources and The macrosystem consists of the overarching pat- counseling. The authors underscore how, as one tern of the micro-, meso-, and exosystems charac- of the initial points of contact outside of the teristic of a given culture or subculture, with armed group, these programs acted as surrogate particular reference to the belief systems, bodies of knowledge, material resources, customs, life- communities that help children transition back styles, opportunity structures, hazards, and life into social networks. They provide a safe setting course options that are embedded in each of the for the reconnection between families, children, broader systems. The macrosystem may be thought and peers, and establish a task-oriented environ- of as societal blueprint for a particular culture or subculture (Bronfenbrenner, 1994 , p. 40). ment that can help children to navigate more formal resources within the community. While Bronfenbrenner focuses on the societal Further studies of the multidimensional inter- blueprint as central to the macrosystem, social actions between family, school, and peer domains scientists commonly interpret this as the cultural can inform the development of interventions to component of studying child vulnerability, or enhance resilience. One such study of 377 South resilience. For example, it is notable that others African youth exposed to community violence have reinterpreted this as the cultural blueprint (Ward et al., 2007 ) showed that negative out- that shapes the other systems (Eamon, 2001 ; comes were further compounded by peer delin- Hong, 2010 ) . There is a growing literature on quency but mitigated by school support and how practices termed “cultural” may contribute involvement in conventional after-school activi- to improved psychosocial outcomes of children ties. While parent support was not signifi cantly affected by war. Psychosocial practitioners, as related to any outcome variable, the authors spec- well as anthropologists and other social scientists, ulated that an overlap between violence in the have questioned the appropriateness of Western home and parental support may account for this psychological and psychiatric therapies for survi- surprising result. vors of mass violence, especially for children Overall the fi ndings on the in fl uence of social (Bracken & Petty, 1998 ) . They argue that these capital, stigma, community acceptance and other approaches have the potential of doing more harm aspects of social relations point to the complexity than good, in part because they putatively do not of mesosystem infl uences on mental health. In incorporate a social and contextual framework, as particular, much more research is needed on how would be central in an ecological systems different settings of child development infl uence approach such as Bronfenbrenner’s work. one another, for example, studies of how social In the IASC Guidelines ( 2007 ) , as well as in capital or community connectedness infl uence psychosocial work that preceded the IASC the functioning of families and peer groups Guidelines, there is a strong emphasis on cultur- over time. In order to deepen our understanding ally appropriate social interventions and their of the relevance of Bronfenbrenner’s bioecologi- advantages over solely importing Western clinical theory on the mental health of war-affected cal approaches (Dawes & Cairns, 1998 ; Wessells, youth, researchers must adopt a more multidi- 2006 ; Wessells & Monteiro, 2006 ) . These guide- mensional approach to the examination of these lines and this work emphasized using traditional different domains. approaches to con fl ict resolution and healing, 2 Promoting Ecological Resilience–Part I 21 i.e., locally originating resiliency promoting preventing contamination of impurity to the social factors. Moreover, psychosocial interventions group. Broader institutions of macrosystem regu- categorized as targeting “culture and values” pro- late social relations through a focus on harmony vide opportunities for normal religious practice in spiritual relations and maintaining spiritual and work with traditional, religious healing purity, for which war experiences are one form of sources (Psychosocial Working Group, 2003 ) . pollution. This pollution can arise from war expo- Similarly, the IASC Guidelines advise interven- sures such as death and partaking in bloodshed. tionists to “learn about and, where appropriate, Living within this macrosystem, reintegration collaborate with local, indigenous and traditional becomes framed in terms of pollution and con- healing systems” (IASC, 2007 , p. 136). tamination that needs to be addressed before one One of the key examples of interventions can be accepted back: “traditional institutions are touted as culturally appropriate—in keeping with essential in bringing back balance, harmony, and cultural macrosystems—is traditional cleansing social stability” (Honwana, 1997 , p. 293). Ultimately, rituals to reintegrate children affected by armed purifi cation is crucial for mental health and psycho- con fl ict back into society. Donor and implement- social well-being because if the spiritual pollution ing humanitarian agencies have promoted tradi- caused by blood is not washed off, it is “dangerous tional rituals for reintegration of child soldiers. In because it can contaminate the com munity and cause Sierra Leone, communities and families employed insanity” (Honwana, p. 300). “rituals of welcome” to incorporate returned girl Similar to some descriptions from Angola, soldiers into acceptable social positions (McKay cleansing practices were determined to be very & Mazurana, 2004 ) . In Mozambique, traditional successful in facilitating reintegration of war- healers facilitated reintegrating ex-combatants by affected girls back into their communities in Sierra “taking the war out of the people” (Nordstrom, Leone. “Cleansing ceremonies represented a sym- 1997 , p.146). Rituals have tremendous potential bolic gesture of community reconciliation in to aid children and communities in a manner that which both the girls and the community had pre- is culturally congruent with locally available scribed roles and demonstrated a willingness and resources and practitioners. These reintegration desire to be reconciled” (Stark, 2006 , p. 206). rituals are crucial for interventions consistent Explicit, bounded rituals are obviously not the with the local macrosystem. In many of the only manifestation of the macrosystem at work. world’s con fl ict-affected regions, people regard The macrosystem in fl uences the overall world- “spiritual stresses as primary” whereas concepts view including expectations of what is possible of psychological trauma may lack salience; and what is needed to obtain well-being. In purifi cation rituals by local healers to get rid of Afghanistan, children’s resilience is grounded in bad spirits are often better suited to handle Muslim cultural framing of “faith, family unity, sources of distress rather than trauma programs service, effort, morals, and honour” (Eggerman (Wessells & Monteiro, 2006 , p. 216). & Panter-Brick, 2010 ) . The criteria for self- In Angola, traditional healers conduct commu- respect and dignity—possibly especially amidst nal cleansing rituals for child soldiers to purify chronic violence—grow from this worldview. them of their exposure to killing (Honwana, 2006 ) . On an even broader level, one of the cores of Honwana ( 1997 ) examines specifi c rituals such as children’s resilience in settings of armed con fl ict ancestor worship and puri fi cation for use with is the cultural belief that children are resilient . reintegration of former soldiers and others affected Summer fi eld ( 1998, 2000 ) and Bracken and by war. She illustrates how traditional institutions Petty, 1998 have been two outspoken critics on maintain social relations. Trauma healing does this issue. Their argument implies that the not come from outside processes but from elders Western macrosystem comprising medical and and traditional practitioners. This focuses on the humanitarian institutions as well as cultural communal nature of problems, and on the issue beliefs regarding psychological trauma threatens 22 W.A. Tol et al. the resilience of children. These authors and Traditional rituals often reinforce gender dis- others have pointed out that children in many cul- crimination by promoting the status of “(older) tural settings are seen as being able to withstand males” and “threaten the human security and the experience of war still develop in functioning well-being of women and girls” (Denov, 2007 ) . productive adults rather than being “stigmatized Furthermore, Denov adds, “when assessing as permanently damaged” (Summer fi eld, 1998 ) , whether ‘culture is always right,’ one cannot dis- which may be the portrayal from some relief or count … the reality and implications of gendered medical organizations. exclusionary practices.” Honwana also observes While their point is absolutely crucial to keep that cleansing rituals and puri fi cation of girls are in mind and avoiding stigma should be centerfold “more common in rural areas where family soli- to any intervention, particularly those focused of darity and age hierarchies prevail” (Honwana, promoting resilience, with children affected by 1997 , p. 300). Girl soldiers are particularly threat- war, it is important not to romanticize non-West- ening for patriarchal societies. Therefore, adults ern worldviews without strong ethnographic data. may use ritual to disempower girls and return The need for rituals as described in Angola and them to socially acceptable subjugated roles. This Sierra Leone demonstrate that families and com- raises the question of whether rituals are univer- munity members can profoundly stigmatize war- sally the best practice for reintegration of child affected children, even before the introduction of soldiers, particularly for girl soldiers. Western medicalization. However, both stigma- Psychosocial interventionists thus fi nd them- tizers and the stigmatized interpret that discrimi- selves at the intersection of potentially competing nation in frames of spiritual pollution rather than frameworks. On the one hand, psychosocial pro- psychological trauma. But, as Stark explains, that grams operate from a desire to follow rights-based pollution can lead to insanity. Moreover, in Nepal, frameworks that advocate for gender equity and one third of adults felt that children who witness inclusion of children in communal and social pro- violence can have permanent damage to their cesses. On the other hand, psychosocial practitio- “brain-mind” leading to permanent impairment ners advocate following community-initiated in morality, rational behavior, and subscription to approaches and traditional practices consistent caste hierarchy (Kohrt & Maharjan, 2009 ) . This with the beliefs and institutions of the macrosys- raises our next issue of how to address macrosystem. Unfortunately, these may be rooted in tem institutions, beliefs, and policies that may be processes of exclusion such as patriarchy and potentially harmful for children’s resilience in ethnic discrimination. The advocacy of traditional con fl ict settings. practices can have the inadvertent outcome of reinforcing stigma and marginalization rather than fostering psychosocial well-being for war-affected Challenges to Cultural Practices children, especially girls. In contrast to reports from Sierra Leone and Angola, the majority of While the potential positive benefi t of rituals is former girl soldiers in Nepal rejected participation apparent from a social cohesion and integration in traditional cleansing rituals for reintegration perspective, there are also threats to well-being because they viewed it as making them submis- possible in rituals. Rituals of re-socialization may sive and countering their struggles working toward come at a cost to participants. For example, child gender equality (Kohrt, in press ) . soldiers are threatening to adults because they do Dawes and Cairns (1998 ) provide the example not fall into socially expected roles of submission of a cultural practice where daughters are traded to adult authority (Boyden, 2003b ) . Rituals may to another family in marriage or some form of restore the expected socially submissive role of servitude to compensate for other wrongs com- children, but this may represent a lost opportu- mitted between families. For example, Punjabi nity for children to gain a greater voice in social families in rural India that regard female children processes. The issue of girl soldiers exemplifi es as “an unproductive burden” direct more violence this challenge. toward daughters than sons (Pettigrew, 1986 ) . 2 Promoting Ecological Resilience–Part I 23

Conversely, cultural beliefs may buffer microsystem levels (e.g., ideological commit- against child maltreatment. Among indigenous ment and religion seem to serve protective func- Hawaiians, hitting a child is thought to anger tions only under some conditions). We feel this ancestral spirits and cause illness in the abuser; in research would benefi t from a multidisciplinary Papua New Guinea violence toward children vio- and multilevel research agenda, involving the lates a woman’s status within the community and social and medical sciences. Given the large acute is not likely to be tolerated by community mem- needs and the delay in fi ndings from longitudinal bers (Korbin, 2002 ) . Ultimately, in program studies, we believe that randomized controlled implementation, “gender privileging requires trials that take into account mediators and mod- understanding of local beliefs, practices, and erators of treatment should be prioritized in such norms” (Wessells & Monteiro, 2006 ) . an agenda. We can surmise that cultural practices can not We end this chapter with three re fl ections only contribute to resiliency within the ecological regarding practice. First, there is relatively robust framework but also increase vulnerability. While data regarding the importance of family-level there are differing camps in the psychosocial (microsystem) variables for the importance of community, especially with regard to the speci fi cs promoting mental health in children and adoles- of implementation, most practitioners typically cents affected by political violence. Given this fall somewhere in the “blended approach” advo- data, it is surprising that a recent systematic cating for pluralistic endeavors incorporating review (Tol et al., 2011 ) identi fi ed only one rigor- local and imported psychosocial frames and tools ous study that addressed an intervention that for intervention, with careful critical consider- worked directly with mothers (Dybdahl, 2001 ) . ation of both the local practices and imported We would highly recommend interventionists to techniques (Dowdney, 2007 ) . work directly with families or closely involve caregivers in their work with children and adolescents, e.g., in school-based programs. Closing Thoughts Second, it will remain important to closely monitor intervention programs with program par- From our review above, it may be surmised that ticipants, building on local insights regarding eco- developers of preventive interventions have only logical resilience, given the complexities of social a small body of knowledge on protective pro- processes and the possibility to do harm. For cesses to build on, despite the apparent consensus instance, a double-edged sword effect may accom- that strengthening contextual resources for chil- pany efforts to strengthen ideological commit- dren and adolescents affected by political vio- ment and agency of adolescents when this agency lence is essential. On the ontogenic and is subsequently taken up in the cause of violence, microsystem levels, there is a growing body of contributing to a toxic cycle of violence. Similarly, promising fi ndings that may inform the develop- religion may serve a multitude of functions in ment of interventions (see above). This literature times of political violence and cannot simply be could be greatly strengthened by more longitudi- promoted without examining possible negative nal work, examination of transaction processes, consequences. Our discussion of cultural prac- and stronger theory development especially in tices should warn against simple “cultural” solu- nonindustrialized low-income countries. More tions to complex processes, which is often what specifi cally, we advocate research into the possi- time-bound external agents and their funders are ble protective role of a fl exible coping repertoire hoping for. Interventions should build on detailed and the importance of peer and school supports in context-sensitive assessments that address per- strengthening resilience. ceived local needs and resources, a detailed Very little research has addressed meso-, knowledge of the history of armed confl ict, and an exo-, and macrosystem processes. More work is analysis of local leadership and power relations. clearly needed in this area, given the lack of clear Third, especially with relation to child sol- unidirectional fi ndings on the ontogenic and diers, meso- and exosystem fi ndings point to the 24 W.A. Tol et al. importance of stigma for children affected by Betancourt, T. S., Salhi, C., Buka, S., Leaning, J., Dunn, G., armed con fl icts. These fi ndings indicate the need & Earls, F. (2012). Connectedness, social support and internalising emotional and behavioural problems in to address stigma in order to promote the well- adolescents displaced by the Chechen confl ict. Disasters, being of children and adolescents at the commu- 36(4), 635–655. doi: 10.1111/j.1467-7717.2012.01280.x . nity level, e.g., through mass media campaigns, Boyden, J. (2003a). Children under fi re: challenging preparation of community leadership (e.g., teach- assumptions about children’s resilience. Children, Youth and Environment, 13 (1). ers, religious leaders, and older women) and dur- Boyden, J. (2003b). The moral development of child sol- ing reintegration processes. Further study of the diers: What do adults have to fear? Peace and Con fl ict: effectiveness of such approaches would then also Journal of Peace Psychology, 9 (4), 343–362. be indicated. Bracken, P., & Petty, C. (1998). Rethinking the trauma of war . New York, NY: Free Association Books. Breslau, N., Lucia, V. C., & Alvarado, G. F. (2006). Intelligence and other predisposing factors in expo- References sure to trauma and posttraumatic stress disorder: A follow-up study at age 17 years. Archives of General Annan, J., Blattman, C., & Horton, R. (2006). The State of Psychiatry, 63 (11), 1238–1245. Youth and Youth Protection in Northern Uganda: Bronfenbrenner, U. (1979). The ecology of human devel- Findings from the survey of war affected youth . New opment: experiments by nature and design . Cambridge: York, NY: UNICEF. Harvard University Press. Attanayake, V., McKay, R., Joffres, M., Singh, S., Burkle, Bronfenbrenner, U. (1989). The developing ecology of F. M., Jr., & Mills, E. (2009). Prevalence of mental human development: Paradigm lost or paradigm disorders among children exposed to war: A system- regained. Paper presented at the Biennial Meeting of atic review of 7,920 children. Medicine, Con fl ict & the Society for Research in Child Development, Survival, 25 (1), 4–19. Kansas City, MO. Baker, A. (1990). The psychological impact of the Intifada Bronfenbrenner, U. (1994). Ecological models of human on Palestinian children in the Occupied West Bank development. In T. Husen & T. N. Postlethwaite (Eds.), and Gaza: An exploratory study. The American Journal International encyclopedia of education (2nd ed., Vol. of Orthopsychiatry, 60 (4), 496–505. 3, pp. 37–43). Oxford: Elsevier. Barber, B. K. (1999). Political violence, family relations, Bronfenbrenner, U. (1999). Environments in develop- and Palestinian youth functioning. Journal of mental perspective: Theoretical and operational mod- Adolescent Research, 14 (2), 206–230. els. In S. L. Friedman & T. D. Wachs (Eds.), Measuring Barber, B. K. (2001). Political violence, social integration, environment across the life span: Emerging methods and youth functioning: Palestinian youth from the Intifada. and concepts (pp. 3–28). Washington, DC: American Journal of Community Psychology, 29 (3), 259–280. Psychological Association Press. Barber, B. K. (2008). Contrasting portraits of war: Youth’s Bronfenbrenner, U. (2001). The bioecological theory of varied experiences with political violence in Bosnia human development. In N. Smelser & P. Baltes (Eds.), and Palestine. International Journal of Behavioral International encyclopedia of social and behavioral Development, 32 (4), 298–309. sciences (Vol. 10, pp. 6963–6970). New York, NY: Barenbaum, J., Ruchkin, V., & Schwab-Stone, M. (2004). Elsevier. The psychosocial aspects of children exposed to war: Bronfenbrenner, U. (2005a). Ecological systems Practice and policy initiatives. Journal of Child theory. In U. Bronfenbrenner (Ed.), Making human Psychology and Psychiatry, 45 (1), 41–62. beings human: Bioecological perspectives on human Bat-Zion, N., & Levy-Shiff, R. (1993). Children in war: development (pp. 106–173). Thousand Oaks, CA: Stress and coping reactions under the threat of Scud Sage. missile attacks and the effect of proximity. In L. A. Bronfenbrenner, U. (Ed.). (2005b). Making human beings Leavitt & N. A. Fox (Eds.), The psychological effects human: biological perspectives on human develop- of war and violence on children . Hillsdale, NJ: ment . Thousand Oaks, CA: Sage. Lawrence Erlbaum. Bronfenbrenner, U., & Ceci, S. J. (1994). Nature-nurture Betancourt, T. S., Agnew-Blais, J., Gilman, S. E., reconceptualized in developmental perspective: A bio- Williams, D. R., & Ellis, B. H. (2010). Past horrors, ecological model. Psychological Review, 101 (4), present struggles: The role of stigma in the association 568–586. between war experiences and psychosocial adjustment Bryce, J. W., Walker, N., Ghorayeb, F., & Kanj, M. (1989). among former child soldiers in Sierra Leone. Social Life experiences, response styles and mental health Science & Medicine, 70 (1), 17–26. among mothers and children in Beirut. Lebanon Social Betancourt, T. S., & Khan, K. T. (2008). The mental health Science and Medicine, 28 (7), 685–695. of children affected by armed confl ict: Protective pro- Cairns, E., & Dawes, A. (1996). Children: Ethnic and cesses and pathways to resilience. International political violence—A commentary. Child Development, Review of Psychiatry, 20 (3), 317–328. 76 (1), 129–139. 2 Promoting Ecological Resilience–Part I 25

Cardozo, B. L. (2008). Guidelines need a more evidence Fernando, C., & Ferrari, M. (2011). Spirituality and resil- based approach: A commentary on the IASC ience in children of war in Sri Lanka. Journal of Guidelines on Mental Health and Psychosocial Support Spirituality in Mental Health, 13 , 52–77. in Emergency Settings. Intervention, 6 (3), 252–254. Garbarino, J. (2001). An ecological perspective on the Corbin, J. N. (2008). Returning home: Resettlement of effects of violence on children. Journal of Community formerly abducted children in northern Uganda. Psychology, 29 (3), 361–378. Disasters, 32 (2), 316–335. Garbarino, J., & Kostelny, K. (1996). What do we need to Cortes, L., & Buchanan, M. J. (2007). The experience of know to understand children in war and community Columbian child soldiers from a resilience perspec- violence. In R. J. Apfel & B. Simon (Eds.), Mine fi elds tive. International Journal for the Advancement of in Their Hearts: The Mental Health of Children in War Counselling, 29 , 43–55. and Communal Violence . Chelsea: Yale University. Criss, M. M., Pettit, G. S., Bates, J. E., Dodge, K. A., & Garbarino, J., Kostelny, K., & Dubrow, N. (1991). No Lapp, A. L. (2002). Family adversity, positive peer place to be a child: Growing up in a war zone . relationships, and children’s externalizing behavior: A Lexington, MA: Lexington Books. longitudinal perspective on risk and resilience. Child Hill, H. M., Levermore, M., Twaite, J., & Jones, L. P. Development, 73 (4), 1220–1237. (1996). Exposure to community violence and social Cummings, E. M., Goeke-Morey, M. C., Schermerhorn, support as predictors of anxiety and social emotional A. C., Merrilees, C. E., & Cairns, E. (2009). Children behavior among African American children. Journal and political violence from a social ecological per- of Child and Family Studies, 5 (4), 399–414. spective: Implications from research on children and Hill, H. M., & Madhere, S. (1996). Exposure to commu- families in Northern Ireland. Clinical Child and Family nity violence and African American children: A multi- Psychology Review, 12 , 16–38. dimensional model of risk and resources. Journal of Dawes, A., & Cairns, E. (1998). The Machel study: Community Psychology, 24 , 26–43. Dilemmas of cultural sensitivity and universal rights Hong, J. S. (2010). Understanding Vietnamese youth of children. Peace and Con fl ict: Journal of Peace gangs in America: An ecological systems analysis. Psychology, 4 (4), 335–348. Aggression and Violent Behavior . de Jong, J. T. V. M. (Ed.). (2002). Trauma, war, and vio- Honwana, A. M. (1997). Healing for peace: Traditional lence: Public mental health in socio-cultural context . healers and post-war reconstruction in Southern New York, NY: Kluwer. Mozambique. Peace and Confl ict: Journal of Peace Denov, M. (2007). Is the culture always right? The dan- Psychology, 3 (3), 293–305. gers of reproducing gender stereotypes and inequali- Honwana, A. M. (2006). Child soldiers in Africa . ties in psychosocial interventions for war-affected Baltimore, MD: University of Pennsylvania Press. children. Retrieved 06 June 2010, 2010, from http:// Howard, S., Dryden, J., & Johnson, B. (1999). Childhood www.child-soldiers.org/psycho-social/Gender_stereo- resilience: Review and critique of literature. Oxford types_and_inequalities_2007.pdf. Review of Education, 25 , 307–323. Dowdney, L. (2007). Trauma, resilience and cultural heal- IASC. (2007). Guidelines on mental health and psychoso- ing: How do we move forward? Coalition to Stop the cial support in emergency settings . Geneva: Inter- Use of Child Soldiers Psychosocial Web Page. Agency Standing Committee. Retrieved August 1, 2007, from www.child-soldiers. Inter-Agency Standing Committee [IASC]. (2007). IASC org/resources/psychosocial . Guidelines on Mental Health and Psychosocial Dybdahl, R. (2001). Children and mothers in war: An out- Support in Emergency Settings . Geneva: IASC. come study of a psychosocial intervention program. Jovanovic, N., Aleksandric, B. V., Dunkic, D., & Child Development, 72 (4), 1214–1230. Todorovic, V. S. (2004). Family hardiness and social Eamon, M. K. (2001). The effects of poverty on children’s support as predictors of post-traumatic stress disorder. socioemotional development: An ecological systems Psychiatry, Psychology, and Law, 11 (2), 263–268. analysis. Social Work, 46 (3), 256–266. Kliewer, W., Lepore, S. J., Oskin, D., & Johnson, P. D. Earls, F., & Carlson, M. (2001). The social-ecology of (1998). The role of social and cognitive processes in child health and wellbeing. Annual Review of Public children’s adjustment to community violence. Journal Health, 22 , 143–166. of Consulting and Clinical Psychology, 66 (1), Eggerman, M., & Panter-Brick, C. (2010). Suffering, 199–209. hope, and entrapment: Resilience and cultural values Kliewer, W., Murrelle, L., Mejia, R., de Torres, Y., & in Afghanistan. Social Science & Medicine., 71 (1–2), Angold, A. (2001). Exposure to violence against a 71–83. family member and internalizing symptoms in Elbedour, S., ten Bensel, R., & Bastien, D. T. (1993). Colombian adolescents. Journal of Consulting and Ecological integrated model of children of war: Clinical Psychology, 69 (6), 971–982. Individual and social psychology. Child Abuse & Kohrt, B. A. (in press). The role of traditional rituals for Neglect, 17 (6), 805–819. reintegration and psychosocial wellbeing of child sol- Farhood, L. (1999). Testing a model of family stress and diers in Nepal. In A. L. Hinton & D. E. Hinton (Eds.), coping based on war and non-war stressors, family Legacies of Violence: Symptom, Memory, and resources and coping among Lebanese families. Intervention in the Aftermath of Mass Trauma . Archives of Psychiatric Nursing, 13 (4), 192–203. Durham, NC: Duke University Press. 26 W.A. Tol et al.

Kohrt, B. A., Jordans, M. J. D., Tol, W. A., Perera, E., McKay, S., & Mazurana, D. (2004). Where are the girls? Karki, R., Koirala, S., & Upadhaya, N. (2010). Social Girls in fi ghting forces in northern Uganda, Sierra ecology of child soldiers: Child, family, and commu- Leone, and Mozambique . Montreal: Rights and nity determinants of mental health, psychosocial well- Democracy. being, and reintegration in Nepal. Transcultural Muldoon, O. T., & Downes, C. (2007). Social identi fi cation Psychiatry, 45 (5), 727–753. and post-traumatic stress symptoms in post-confl ict Kohrt, B. A., Jordans, M. J. D., Tol, W. A., Speckman, R. Northern Irelans. The British Journal of Psychiatry, A., Maharjan, S. M., Worthman, C. M., & Komproe, I. 191 , 146–149. H. (2008). Comparison of mental health between for- Muldoon, O. T., Schmid, K., & Downes, C. (2009). mer child soldiers and children never conscripted by Political violence and psychological wellbeing: The armed groups in Nepal. Journal of the American role of social identity. Applied Psychology: An Medical Association, 300 (6), 691–702. International Review, 58 (1), 129–145. Kohrt, B. A., & Maharjan, S. M. (2009). When a child is Nordstrom, C. (1997). A different kind of war no longer a child: Nepali ethnopsychology of child story. Philadelphia, PA: University of Pennsylvania development and violence. Studies in Nepali History Press. and Society, 14 (1), 107–142. O’Donnell, D. A., Schwab-Stone, M., & Muyeed, A. Z. Korbin, J. E. (2002). Culture and child maltreatment: (2002). Multidimensional resilience in urban children Cultural competence and beyond. Child Abuse & exposed to community violence. Child Development, Neglect, 26 (6–7), 637–644. 73 (4), 1265–1282. Kunovich, R. M., & Hodson, R. (1999a). Civil war, social Paardekooper, B., de Jong, J. T., & Hermanns, J. M. integration and mental health in Croatia. Journal of (1999). The psychological impact of war and the refu- Health and Social Behavior, 40 (4), 323–343. gee situation on South Sudanese children in refugee Kunovich, R. M., & Hodson, R. (1999b). Confl ict, reli- camps in Northern Uganda: An exploratory study. gious identity, and ethnic intolerance in Croatia. Social Journal of Child Psychology and Psychiatry, 40 (4), Forces, 78 (2), 643–668. 529–536. Laor, N., Wolmer, L., Alon, M., Siev, J., Samuel, E., & Pedersen, D. (2002). Political violence, ethnic confl ict, Toren, P. (2006). Risk and protective factors mediating and contemporary wars: Broad implications for health psychological symptoms and ideological commitment and social well-being. Social Science & Medicine, of adolescents facing continuous terrorism. The 55 (2), 175–190. Journal of Nervous and Mental Disease, 194 (4), Persson, T. J., & Rousseau, C. (2009). School-based 279–286. interventions for minors in war-exposed countries: Layne, C. M., Beck, C. J., Rimmasch, H., Southwick, J. A review of targeted and general programmes. Torture, S., Moreno, M. A., & Hobfoll, S. E. (2009). Promoting 19 (2), 88–101. “resilient” posttraumatic adjustment in childhood and Pettigrew, J. (1986). Child neglect in rural Punjabi fami- beyond: “unpacking” life events, adjustment trajecto- lies. Journal of Comparative Family Studies, 17 (1), ries, resources, and interventions. In D. Brom, R. Pat- 63–85. Horenczyk, & J. Ford (Eds.), Treating traumatized Group, P. W. (2003). Psychosocial intervention in com- children: risk, resilience, and recovery. East Sussex: plex emergencies: A framework for practice. In T. P. Routlegde. W. Group (Ed.), Working paper (p. 2). Edinburgh: Lazarus, R. S., & Folkman, S. (1984). Stress, appraisal, Queen Margaret University College. and coping . New York, NY: Springer Pub. Co. Punamaki, R. L. (1996). Can ideological commitment Linley, P., & Joseph, S. (2004). Positive change following protect children’s psychological well-being in situa- trauma and adversity: A review. Journal of Traumatic tions of political violence? Child Development, 67 (1), Stress, 17 (1), 11–21. 55–69. Luthar, S. S., Cicchetti, D., & Becker, B. (2000). The con- Punamaki, R. L. (2006). Resiliency in conditions of war struct of resilience: A critical evaluation and guide- and military violence: Preconditions and developmen- lines for future work. Child Development, 71 (3), tal processes. In M. E. Garalda & M. Flament (Eds.), 543–562. Working with children and adolescents: An evidence- Lynch, M., & Cicchetti, D. (1998). An ecological-transac- based approach to risk and resilience. Lanham, MD: tional analysis of children and contexts: The longitudi- Jason Aronson. nal interplay among child maltreatment, community Punamaki, R. L., Muhammed, A. H., & Abdulrahman, H. violence, and children’s symptomatology. Development A. (2004). Impact of traumatic events on coping strate- and Psychopathology, 10 , 235–257. gies and their effectiveness among Kurdish children. Masten, A. S. (2001). Ordinary magic: Resilience pro- International Journal of Behavioral Development, cesses in development. American Psychologist, 56 (3), 28 (1), 59–70. 227–238. Punamaki, R. L., & Puhakka, T. (1997). Determinants and Masten, A. S. (2007). Resilience in developing systems: effectiveness of children’s coping with political vio- Progress and promise as the fourth wave rises. lence. International Journal of Behavioral Development and Psychopathology, 19 , 921–930. Development, 21 (2), 349–370. 2 Promoting Ecological Resilience–Part I 27

Punamaki, R. L., Qouta, S., & El Sarraj, E. (1997). Models (2011). Mental health and psychosocial support in of traumatic experience and children’s psychological humanitarian settings: Linking practice and research. adjustment: The roles of perceived parenting and the Lancet, 378(9802), 1581–1591. doi: 10.1016/s0140- children’s own resources and activity. Child 6736(11)61094-5 . Development, 64 (4), 718–728. Tol, W. A., Jordans, M. J. D., Reis, R., & De Jong, J. T. V. Punamaki, R. L., Qouta, S., & El Sarraj, E. (2001). M. (2009). Ecological resilience: Working with child- Resiliency factors predicting psychological adjust- related psychosocial resources in war-affected comment after political violence among Palestinian chil- munities. In D. Brom, R. Pat-Horenczyk, & J. Ford dren. International Journal of Behavioral Development, (Eds.), Treating Traumatized Children: Risk, 25 (3), 256–276. Resilience, and Recovery . London: Routledge. Qouta, S., Punamaki, R. L., & El Sarraj, E. (2005). Tol, W. A., Reis, R., Susanty, D., & de Jong, J. T. V. M. Mother-child expression of psychological distress in (2010). Communal violence and child psychosocial war trauma. Clinical Child Psychology and Psychiatry, wellbeing: Qualitative fi ndings from Poso, Indonesia. 10 (2), 135–156. Transcultural Psychiatry, 47 (1), 112–135. Qouta, S., Punamaki, R. L., & El Sarraj, E. (2008). Child Triplehorn, C., & Chen, C. (2006). Layers of support: The development and family mental health in war and mili- social ecology of protecting children in war. In N. tary violence: The Palestinian experience. International Boothby, A. Strang, & M. Wessells (Eds.), A world Journal of Behavioral Development, 32 (4), 310–321. turned upside down: Social ecological approaches to Qouta, S., Punamaki, R. L., Montgomery, E., & El Sarraj, children in war . Bloom fi eld, CT: Kumarian. E. (2007). Predictors of psychological distress and Ungar, M. (2008). Resilience across cultures. British positive resources among Palestinian adolescents: Journal of Social Work, 38 (2), 218–235. Trauma, child, and mothering characteristics. Child Wallen, J., & Rubin, R. H. (1997). The role of the family Abuse & Neglect, 31 , 699–717. in mediating the effects of community violence on Saigh, P. A. (1991). The development of posttraumatic children. Aggression and Violent Behavior, 2 (1), stress disorder following four types of traumatization. 33–41. Behavior Research & Therapy, 29 (3), 213–216. Walton, J. R., Nuttall, R. L., & Nuttall, E. V. (1997). Skinner, E. A., Edge, K., Altman, J., & Sherwood, H. The impact of war on the mental health of children: (2003). Searching for the structure of coping: A review A Salvadoran study. Child Abuse & Neglect, 21 (8), and critique of category systems for classifying ways 737–749. of coping. Psychological Bulletin, 129 (2), 216–269. Ward, C. L., Martin, E., Theron, C., & Distiller, G. B. Solomon, Z. (1995). Children in the line of fi re. In Z. (2007). Factors affecting resilience in children exposed Solomon (Ed.), Coping with war-induced stress . New to violence. South African Journal of Psychology, York, NY: Plenum. 37 (1), 165–187. Stark, L. J. (2006). Cleansing the wounds of war: An Weisenberg, M., Schwarzwald, J., Waysman, M., examination of traditional healing, psychosocial health Solomon, Z., & Klingman, A. (1993). Coping of and reintegration in Sierra Leone. Intervention: school-age children in the sealed room during Scud International Journal of Mental Health, Psychosocial missile bombardment and postwar stress reactions. Work & Counselling in Areas of Armed Confl ict, 4 (3), Journal of Consulting and Clinical Psychology, 61 (3), 206–218. 462–467. Summer fi eld, D. (1998). Protecting children from armed Wessells, M. (2006). Child soldiers: From violence to pro- confl ict Children affected by war must not be stigma- tection. Cambridge, MA: Harvard University Press. tised as permanently damaged. British Medical Wessells, M., & Monteiro, C. (2006). Psychosocial assis- Journal, 317 (7167), 1249. tance for youth: Toward reconstruction for peace in Summer fi eld, D. (2000). Childhood, war, refugeedom and Angola. Journal of Social Issues, 62 (1), 121–139. “trauma”: Three core questions for mental health pro- Wexler, I. D., Branski, D., & Kerem, E. (2006). War and fessionals. Transcultural Psychiatry, 37 (3), 417–433. children. Journal of the American Medical Association, Themner, L., & Wallensteen, P. (2011). Armed con fl icts, 296 (5), 579–581. 1946–2010. Journal of Peace Research, 48 (4), Zielinski, D. S., & Bradshaw, C. P. (2005). Ecological 525–536. in fl uences on the sequelae of child maltreatment: Tol, W. A., Barbui, C., Galappatti, A., Silove, D., A review of the literature. Child Maltreatment, 11 (1), Betancourt, T. S., Souza, R., & van Ommeren, M. 49–62. Promoting Mental Health and Psychosocial Well-Being 3 in Children Affected by Political Violence: Part II—Expanding the Evidence Base

Weiste A. Tol, Mark J. D. Jordans, Brandon A. Kohrt, Theresa S. Betancourt, and Ivan H. Komproe

in progress in Northern Ireland (Cummings, Limitations in Current Knowledge Goeke-Morey, Schermerhorn, Merrilees & Cairns, 2009 ) , and in Sierra Leone (see below). In our opinion, current research and knowledge Without longitudinal data, conclusions regarding regarding ecological resilience is hampered by causality (e.g., it may be possible that creativity four main interrelated limitations. does not protect against mental health problems, First, knowledge regarding ecological resil- but mental health problems affect creativity) can- ience is dominantly cross-sectional in nature. not be drawn, and it remains possible that other Notable exceptions include work in the Middle variables are responsible for observed resilience. East (Punamaki, Qouta & El Sarraj, 2001 ) , work Second, very few studies address processes involving transaction, i.e., resilience processes in which variables at different social-ecological W. A. Tol , PhD (*) Department of Mental Health , Johns Hopkins Bloomberg level interact over time. For instance, it is possi- School of Public Health , 624 N Broadway, Hampton ble that consistent and supportive parenting leads House/Room 863 , Baltimore , MD 21205-1996 , USA to better coping skills in children, which in turn Department of Research & Development , strengthens positive parenting in a reenforcing HealthNet TPO , Amsterdam , the Netherlands cycle. Such hypotheses require sophisticated e-mail: [email protected] multilevel longitudinal designs, which are hard M. J. D. Jordans , PhD to implement in politically unstable resource- Department of Research & Development , poor settings. However, naturalistic designs may HealthNet TPO , Amsterdam , the Netherlands also shed light on these hypotheses as discussed Center for Global Mental Health, London School by Sameroff and Mackenzie (2003 ) . of Hygiene & Tropical Medicine , London , UK Third, most political violence takes place in B. A. Kohrt , MD, PhD low-income countries in settings with varying Department of Psychiatry and Behavioral Sciences , George Washington University , Washington , DC , USA sociocultural settings (Ungar, 2008 ) . Concepts and measurements from high-income countries T. S. Betancourt , ScD Department of Global Health and Population, may not be appropriate in these settings because Harvard School of Public Health, Boston, MA, USA of differences in conceptualizations of distress FXB Center for Health & Human Rights, and optimal child development, help-seeking Harvard University , Boston , MA , USA strategies, and what type of support is available I. H. Komproe , PhD and needed among others. Mixed methods Department of Research & Development , research that employs participatory qualitative HealthNet TPO , Amsterdam , the Netherlands techniques to elicit contextually sensitive indica- Utrecht University , Utrecht , The Netherlands tors of well-being is crucial in this regard.

C. Fernando and M. Ferrari (eds.), Handbook of Resilience in Children of War, 29 DOI 10.1007/978-1-4614-6375-7_3, © Springer Science+Business Media New York 2013 30 W.A. Tol et al.

Fourth, we believe that research on ecological soldiers in Nepal. Third, we present a study resilience with children affected by political vio- consisting of a series of 11 single-case studies lence can be strengthened by stronger develop- that was aimed at theory formation regarding ment of theory. A sign of poor theoretical treatment processes of individual psychological development concerns the popular citation of treatment with children affected by political Bronfenbrenner’s, 1979 work without acknowl- violence in Burundi. Finally, we review the results edgement of his later bioecological work, in of a cluster randomized trial of a school-based which he more strongly focused on the impor- intervention with violence-affected children in tance of development as situated in the person Indonesia that included study of moderators and and advocated a person-process-context-time mediators of intervention bene fi ts. (i.e., chronosystem) model (Bronfenbrenner, 2005 ) . Here, Bronfenbrenner’s writing foreshad- owed current interests and advances in develop- A Longitudinal Study of War-Affected mental research that have illuminated how Youth in Sierra Leone environmental and biological processes interact, for instance, by showing how brain architecture In 2002, collaboration between the Harvard is shaped by adversity in early childhood School of Public Health and the International (Shonkoff, 2010; Shonkoff & Phillips, 2000 ) . Rescue Committee (IRC) led to the launch of a Similarly, while the international resilience liter- longitudinal study of war-affected youth in Sierra ature is moving beyond a “wish-list” approach to Leone. The study was designed to examine risk examine processes—including biological pro- and protective processes in psychosocial adjust- cesses (Masten, 2007 ) —most research with chil- ment and social reintegration. It was informed by dren in this fi eld still concerns testing associations an ecological approach to child health and well- of family-level and individual-level variables being which examines the interaction of in fl uences with good developmental outcomes. As stated in at the individual, familial, peer, community, and the previous chapter, very little data exists on cultural/collective level (Betancourt & Khan, meso-system interactions. We feel that two 2008 ; Bronfenbrenner, 1979 ) . The study was also research approaches may be promising to shaped by contemporary theory and research strengthen theory in this regard. First, hypothesis related to resilience in the mental health and devel- generating n = 1 research may help to uncover opment of children and families in adversity. resilience processes in action. Second, following Survey interviews were conducted at three Bronfenbrenner’s mentors’ advice “if you want time points, in 2002, 2004, and 2008. The core to understand something, try to change it” sample comprised children who had been (Bronfenbrenner, 1979 , p. 37), randomized con- involved with the Revolutionary United Front trolled trials that take into account moderators (RUF) who were referred to the IRC’s and mediators of intervention may be helpful Disarmament, Demobilization, and Reintegration to provide insight into how resilience processes (DDR) program in Sierra Leone’s Kono District take place. (a sample of N = 260 drawn from a master list of Below, we describe four research projects 309 youth that were served by the IRC’s Interim aimed at overcoming some of these limitations. Care Center (ICC) during the most active period First, we describe a longitudinal study with for- of demobilization, June 2001 to February 2002). mer child soldiers in Sierra Leone, aimed at The study design also included a comparison examining risk and protective factors in this pop- group of community children ( N = 137) identi fi ed ulation over time. Second, we summarize a par- by random door-to-door sampling and, in 2004, ticipatory approach to the development of a an additional cohort of former child soldiers measure of positive psychosocial well-being, ( N = 138) who were not served by ICCs. which was subsequently used to assess environ- All participants were interviewed by trained mental infl uences on well-being of former child Sierra Leonean research assistants, in Krio, the 3 Promoting Ecological Resilience–Part II 31 most dominant local language. The surveys con- forces and to social and economic hardships in tained a mix of standard measures and locally the post-confl ict environment (Betancourt, derived measures, developed in close consulta- Brennan, et al., 2010 ) . We also looked at the role tion with local staff and community members. of stigma (including discrimination and lower Main measures of interest included standard levels of community and family acceptance) as a information about age and length of involvement potential mediator between war-related experi- with armed groups, war-related violence expo- ences and problems with post-confl ict psychoso- sures, and a scale of psychosocial adjustment cial adjustment and adaptive behaviors. We found developed and validated for use among former that societal stigma due to being a child soldier child soldiers in Sierra Leone by researchers at also explained a signifi cant proportion of the the Oxford Refugee Studies Program (MacMullin variance in levels of hostility that the cohort of & Loughry, 2004 ) , which contained subscales for youth reported over time (Betancourt, Agnew- anxiety, depression, hostility, con fi dence, and Blais, et al., 2010 ) ; greater stigma was also asso- prosocial behaviors. Taking more of an ecological ciated with less prosocial behavior. perspective, the survey instruments also included Poor outcomes were partly mitigated by some questions about family con fi guration and rela- post-con fl ict factors, including social support, tionships upon return, community acceptance, being in school, and increases in community social support, access to educational and skills- acceptance over time. Higher levels of family training opportunities, and family socioeconomic acceptance were associated with lower hostility. status. The 2004 and 2008 follow-up surveys Improvement in community acceptance was repeated these baseline measures and added other associated with positive adaptive attitudes and items to examine community collective ef fi cacy behaviors (Betancourt, Brennan, et al., 2010 ) . (nonformal social control and social cohesion), Overall, community acceptance—both initially stigma/discrimination, high-risk behavior, civic and over time—had a bene fi cial effect on all out- participation, and post-con fl ict hardships. comes studied (Betancourt, Brennan, et al., 2010 ). This research has led to several publications Qualitative data from a series of in-depth key about how war-related and post-confl ict experi- informant interviews indicated that even young ences affect the long-term mental health and psy- people who experienced extreme trauma could chosocial adjustment of former child soldiers reintegrate well if they had strong family and (Betancourt, Agnew-Blais, Gilman, Williams & community support (Betancourt & Ettien, in Ellis, 2010 ; Betancourt et al., 2008, 2010 ; press ) . We also found that youth who lacked Betancourt, Brennan, Rubin-Smith, Fitzmaurice strong, effective support were on a much riskier & Gilman, 2010 ; Betancourt & Ettien, 2010 ; path characterized by social isolation and high- Betancourt, Zaeh, Ettien & Khan, 2012 . The risk behavior such as substance abuse and, in research indicates that the long-term mental some cases, engaging in high-risk or abusive health of former child soldiers is affected both by relationships in order to secure basic needs war experiences and by post-con fl ict factors. For (Betancourt & Ettien). instance, lower levels of prosocial behavior (such The fi ndings of this fi rst longitudinal study of as helpfulness towards others) were associated male and female former child soldiers indicate with having killed or injured others during war- that psychosocial adjustment and community time, and with the presence of social stigma reintegration of war-affected youth are complex towards that child, after the war (Betancourt, processes involving a range of factors across time Agnew-Blais, et al., 2010 ) . Young people who and ecological levels. However, post-confl ict fac- reported having been raped exhibited heightened tors that play a role in determining long-term out- anxiety and hostility after the war (Betancourt, comes are of particular interest to researchers, Borisova et al., 2010 ) . Worsening anxiety and practitioners, and policy-makers, since many depression over time were also closely related post-con fl ict factors can be modi fi ed while war both to younger age of being involved in fi ghting experiences cannot. 32 W.A. Tol et al.

helping others, and broad social ideals included Child-Led Indicators in Nepal: not engaging in caste discrimination and desire to A Participatory Approach with improve the nation. The measure was inversely Former Child Soldiers correlated with depression (r = −0.36, p < 0.001) and PTSD ( r = −0.18, p < 0.05). The measure pos- Based on a participatory approach, former child itively correlated with reintegration support from soldiers in Nepal developed a measure of positive the family and community after returning from psychosocial well-being (Karki, Kohrt & Jordans, the armed group (r = 0.46, p < 0.001). 2009 ) . The process comprised working with small We assessed the contribution of different eco- groups of 8–10 former child soldiers in which the logical levels to the resilience and psychosocial children engaged in an extended participatory well-being measure using hierarchical regression activity. Over a 3-day period, a group of children models (see Table 3.1 below). Individual-level would complete seven activities: First they variables contributed 27% of the total variance. described feelings in the heart-mind, which is the Micro-system family-level variables contributed organ of emotion and memory in Nepali ethnopsy- 12% of the total variance. Finally, exo-system chology (Kohrt & Harper, 2008 ; Kohrt & Hruschka, community-level variables contributed 13% of 2010 ) . Second, they ranked feelings according to the total variance. This demonstrates the impor- those most impairing in their lives and selected the tance of considering social-ecological levels in most impairing feelings as the focus for subse- addition to individual characteristics when iden- quent steps. Third, they highlighted the causes of tifying risk and protective factors for childhood these target feelings and the effect these feelings resilience. Of note, the type of community (exo- have on their lives and the lives of others. Fourth, system) contributed signifi cantly to psychosocial they identi fi ed the ideal psychosocial well-being well-being among former child soldiers. Children for children their age (i.e., resiliency-promoting returning to communities with high levels of factors). Fifth, they mapped resources in their female literacy had greater well-being, whereas communities that could be mobilized to help solve children returning to communities dominated by psychosocial problems and promote psychosocial upper caste elites had poorer well-being. These well-being. Sixth, they selected interventions and factors, in turn, are in fl uenced by macro-system activities needed to achieve ideal well-being and level factors such as cultural beliefs and policies promote resilience. In the fi nal step, they selected related to gender and caste equality. child-led indicators for children to evaluate inter- This Nepal example has important interven- ventions, for example, monitoring school attention implications, speci fi cally around the area of dance and grades, doing focus groups, having policy at the macro-system level. Policy advances street discussions, and conducting radio call-in to promote greater inclusion of children in the shows to discuss changes in the community. educational system would engender resilience, as The nine items on the child-led indicator scale educational level was one of the strongest predic- developed by the children included (1) being tors of psychosocial well-being. Moreover, poli- hopeful about the future, (2) desire to help others, cies are needed to assure greater representation of (3) feeling safe, (4) con fi dence in speaking with girls in the educational system because female others, (5) treating everyone equally and not literacy strongly predicts positive psychosocial engaging in caste or ethnic discrimination, (6) well-being. Through his research and advocacy, concentration on studies, (7) feeling free of Bronfenbrenner was instrumental in establishing unnecessary fear, and (8) desire to improve one’s the Head Start program in the United States as an country. This measure encompassed well-being approach to reduce socioeconomic barriers to across ecological levels: individual intrapsychic education, which often occurred along racial and objectives were to control one’s fear and improve ethnic lines. Similar policies and programs are concentration, goals for interpersonal behavior needed to foster resilience among not only girls included con fi dence in speaking with others and but among entire communities in Nepal. 3 Promoting Ecological Resilience–Part II 33

Table 3.1 Multivariate regression models by ecological level for locally developed measure of child soldiers in Nepal ( n = 142) Positive psychosocial well-being b (95% CI) p -value Variance (R 2 ) Child variables (individual ontogenetic) 0.27 Age 0.14 (−0.13–0.39) 0.31 Female −0.21 (−1.19–0.79) 0.68 Education (none = ref.) Primary 1.76 (−0.67–4.20) 0.002 Lower secondary 2.88 (0.39–5.36) Secondary + 2.99 (1.06–4.92) Married −0.27 (−1.62–1.08) 0.69 Recruitment (>14 years) −0.95 (−1.81–0.08) 0.03 Time as soldier (>1 year) −0.81 (−1.72–0.09) 0.08 Time since returned (>1 year) −0.15 (−1.05–0.74) 0.74 Beating −0.02 (−1.02–0.98) 0.96 Bombing −0.95 (−1.70–0.21) 0.01 Abduction 0.76 (−0.33–1.86) 0.17 Torture −0.64 (−1.63–0.34) 0.20 Still associated 1.51 (0.20–2.81) 0.02 Family variables (micro-system) 0.12 Joint family −0.33 (−1.08–0.42) 0.39 Family size (#members) −0.28 (−0.47–0.10) 0.002 Hindu religion −0.34 (−1.54–0.87) 0.58 Caste (high caste = ref.) Dalit −0.21 (−0.82–0.41) 0.77 Janajati −0.19 (−093–0.54) Wealth 0.06 (−0.32–0.43) 0.77 Wealth worse after con ﬂ ict −0.05 (−0.99–0.90) 0.99 Female decision maker −0.21 (−1.03–0.62) 0.62 Family member killed −1.72 (−2.77–0.67) 0.001 Physical abuse −2.13 (−3.18–1.08) <0.001 Community variables (exo-system) 0.13 Con ﬂ ict mortality (>200) 0.42 (−0.39–1.23) 0.31 Female literacy (>45%) 1.95 (1.22–2.68) <0.001 High caste proportion (>40%) −2.06 (−3.01–1.10) <0.001 Total variance 0.51 Note : Generalized estimating equations used to control for village clusters

Policy changes are also needed to reduce child repercussions for caste- and ethnic-based crimes abuse, which is a major risk factor for poor out- and discrimination (Kohrt, 2009 ) . To date, much comes. Nepal lacks any comprehensive legal of the international work with children and policy or enforcement mechanism to protect chil- con fl ict has involved speci fi c targeted individ- dren from abuse (Baker & Hinton, 2001 ; His ual-, family-, and often school-based program- Majesty’s Government, 1992 ) . Lastly, policies ming. This research in Nepal suggests that policy are needed to eliminate caste- and ethnic-based change is crucial as well. Future interventions discrimination related to high caste hegemony. should fi nd avenues to promote local advocacy Policies in this area have been very slow to mechanisms to change national policies that develop in Nepal and have consistently lacked enhance ecological resilience for children. 34 W.A. Tol et al.

Theory Formation of a Psychosocial Intervention in Burundi

A recent systematic literature review of mental health and psychosocial intervention for children affected by political violence presents a wide range of treatment modalities, with 18% focusing on universal interventions (Jordans, Tol, Komproe & de Jong, 2009 ) . Moreover, while treatment evaluation studies are still scarce, evidence for ef fi cacy of treatment is emerging. Yet, to date there are no studies that assess treatment processes for child-focused interventions in areas of political violence. A better understanding of how treatments work, and speci fi cally how they impact children’s resilience, is much needed to direct treatment re fi nement, setting the stage for Fig. 3.1 Change in sense of hope. Note: The graph pres- future ef fi cacy studies and scaling-up of the inter- ents the change in hope of one client over time. Intervention vention. This calls for research that is geared started at measurement 5. The gap in the line diagram represents a missed interview due to the client’s illness towards theory formation. The use of empirically grounded single-case studies can play an important, practice-relevant The results present a wealth of information on role in this regard (Lundervold & Belwood, the working elements of a paraprofessional psy- 2000 ) . Single-case (n = 1) studies focus on the chosocial intervention in Burundi. When temporal unfolding of variables within subjects speci fi cally looking at the interplay between (monitoring of client progress), thereby evaluat- counseling and resilience, there appear to be two ing the effect of the intervention on an individual trends: fi rst, counseling having the intended effect level allowing for evaluation of processes of of increasing children’s sense of empowerment change (whether, how, and for whom treatment and hope and, second, the role of counseling in works). We conducted 11 n = 1 studies of children mobilizing existing resources within the child’s between 11 and 14 years of age (9 females, 2 context. Both trends are concurrent with reduc- males) that were referred to counselor presenting tion of symptoms in the studied cases. To illus- with moderate to severe psychosocial distress trate this interplay, we present two examples. (Jordans et al., 2012 ) . Children and the counselor were followed weekly before, during, and after treatment (4, 8, and 4 measurements, respec- Case Vignette 1 tively), to assess outcome indicators (i.e., depression, anxiety, posttraumatic stress symptoms, A 13-year-old girl, who witnessed the killing of function impairment, and sense of hope) and her father, reports a combination of fear, night- treatment process variable (i.e., treatment percep- mares, and sleep problems. From the start of the tions, session content, utilized intervention strat- counseling process the client expresses a sense of egies) during the counseling period. Analyses relief and reassurance in being able to express her included visual inspection of change trajectories, feelings, especially as she feels ashamed of her testing the stability of trends of successive mea- thoughts and problems. The emerging trust in the surements, content analyses of treatment process counselor and consequently feeling at ease allows data, and fi nally categorizing and associating for verbalization of painful memories. The client treatment outcome trajectories with treatment reports a sense of encouragement and hope for process data. the future as a result of this process (Fig. 3.1 ). 3 Promoting Ecological Resilience–Part II 35

treatment processes of counseling that may contribute to increased resilience of children and their context. It points towards the role of treatment, and in particular a therapeutic relationship, in reaf fi rming a sense of hope and empowerment (enabling or reinforcing clients to help themselves). At the same time it demonstrates the importance of existing resources and support outside the client-counselor context that have a powerful in fl uence on the healing process of children, most notably the involvement of parents in the treatment process. This con fi rms the fi ndings of the protective role of parenting practices, as sum- marized in the previous chapter. While the above- mentioned results present initial hypotheses, further research should look into the specifi c practice elements that contribute to increased resilience. Fig. 3.2 Change in PTSD symptoms. Note: The graph presents the change in PTSD of one client over time. Intervention started at measurement 5 Moderators and Mediators in a Cluster Randomized Trial in Indonesia

Analyses demonstrate that client change is asso- In a study focused speci fi cally on testing an ciated with the quality of the therapeutic alliance ecological resilience theoretical framework, we in this case. examined moderators and mediators of a classroom-based psychosocial intervention in con fl ict-affected areas of Indonesia (Tol, Komproe Case Vignette 2 et al., 2010 ). Given the experimental nature of a randomized controlled trial and assessment at mul- An 11-year-old girl demonstrated signs of selec- tiple time points (pre- intervention, post-interven- tive mutism, aggressivity, and high levels of tion, and follow-up at 6 months), this design allowed PTSD symptoms. After 6 sessions characterized for testing whether an increase in ecological resil- by reluctance and silence, the parents are included ience through intervention was associated with a in the process. The parents refer to their child’s decrease in symptomatology. In short, we random- problem as “wind fear.” It appears that since a ized schools to either a treatment or waitlist condi- 2003 armed attack of the rebels during a heavy tion and subsequently screened for exposure to storm, winds serve as a traumatic trigger for the political violence events, PTSD symptoms, and child. Subsequently, the counselor works with anxiety in the province of Central Sulawesi on the the parents on their awareness of the child’s prob- island of Sulawesi, Indonesia. This area has suffered lems (i.e., posttraumatic triggers) and strengthen- communal violence played out along religious lines ing their parental roles of guidance and support to since 1998 (Tol et al., 2008 ) . Our choice, adaptation, deal with the child’s dif fi culties. Analyses clearly and development of instruments to assess show a milestone change in PTSD symptoms psychosocial well-being (including psychologi- soon after the involvement of parents at session 7 cal symptoms, function impairment, and resil- (measurement 11) (Fig. 3.2 ). A similar trend is ience variables) were based on previous found in other cases as well. qualitative research which involved focus group The above cases are provided as examples to discussions and key informant interviews (e.g., illustrate the use of n = 1 studies in exploring massage healers) concerning local perspectives 36 W.A. Tol et al. on how political violence compromises psychoso- In addition, we anticipated that individual cial well-being and which initiatives were under- (gender, age, exposure to violence, displacement) taken to address this impact (Tol, Reis, Susanty & and contextual variables (family connectedness, de Jong, 2010 ) . Screening in 14 schools resulted in household size, social support by people outside the inclusion of 182 and 221 children and their par- the households) would moderate the relationship ents in the treatment condition and waitlist condi- between treatment participation and reduced tion, respectively. Treatment consisted of 15 PTSD symptoms and function impairment. We structured sessions of combined cognitive behav- employed a parallel process latent growth curve ioral and creative-expressive techniques, includ- modeling approach to test these hypotheses. ing drama, drawing, structured play, dance, and First, we examined whether treatment was asso- music activities. These activities focused both ciated with better outcomes on the resilience vari- on decreasing symptomatology (e.g., through ables (i.e., hope, coping, social support), a creation of a trauma narrative by the use of precondition for their function as mediators. We drawing) and strengthening children’s resources found that participating in treatment was indeed (e.g., through cooperative play activities, discus- associated with better outcomes on hope, positive sion of coping strategies). Previous analyses coping, and peer- and play-based social support; based on mixed methods regression analyses treatment was not associated with decreased nega- showed that the girls in the intervention condi- tive coping or increased emotional social support. tion improved more with regard to PTSD symp- However, the improved resilience variables gener- toms and function impairment. For both girls ally did not serve as mediators of changes in PTSD and boys in the intervention condition, hope symptoms and function impairment. In contrast, remained stable, whereas it decreased in the we found that play-based social support functioned waitlist condition (Tol et al., 2008 ) . Here, we as a mediator in the opposite direction, in that larger were interested in explaining these changes in increases in play-based social support were associ- PTSD symptoms and function impairment by ated with smaller decreases in PTSD symptoms. examining moderators and mediators. Mediators With regard to moderators, we found that are variables that identify why and how treat- gender (girls), household size (smaller household ments have effects, whereas moderators are size), and reporting more social support from variables that identify on whom and under what adults outside the household were associated circumstances treatments have different effects with larger treatment bene fi ts. We interpreted this (Kraemer, Wilson, Fairburn & Agras, 2002 ) . For fi nding in terms of vulnerability, i.e., those chil- instance, a change in negative cognitions about dren with less social support before the interven- the self may be a mediator of the relation between tion were able to bene fi t more from the social participating in cognitive behavioral therapy and support it offered in order to decrease their psy- decreased depressive symptomatology. Such a chological distress (Tol, Komproe et al., 2010 ) . change in depressive symptomatology may be In conclusion, this rigorous evaluation pro- moderated by social support, in that participants vides only limited support for the proposed eco- with better social support show stronger treat- logical resilience theoretical framework. It will ment bene fi ts. remain important, despite broad consensus on the In accordance with an ecological resilience importance of contextual resources for popula- framework, we hypothesized that increased hope, tions exposed to violence, to systematically check better coping (i.e., the use of more positive cop- our theoretical assumptions in order to provide ing strategies and less negative coping strate- the best possible services. Together with other gies), and social support (specifi cally emotional authors (Kazdin, 2007 ; Kazdin & Nock, 2003 ; and play-based social support, and social support Kraemer et al., 2002) , we feel that randomized provided by peers) would mediate the relation controlled trials are a promising method to do between treatment participation and decreases in this, given their experimental design. However, PTSD symptoms and function impairment. randomized trials would then have to be designed 3 Promoting Ecological Resilience–Part II 37 to take into account mediators and moderators of Betancourt, T. S., Borisova, I. I., Williams, T. P., Brennan, treatment, which is currently rarely done in either R. T., Whitfi eld, T. H., de la Soudiere, M., et al. (2010). Sierra Leone’s former child soldiers: A follow-up high- or low-income settings. study of psychosocial adjustment and community reintegration. Child Development, 81 (4), 1077–1095. Betancourt, T. S., Brennan, R. T., Rubin-Smith, J., Concluding Remark Fitzmaurice, G. M., & Gilman, S. E. (2010). Sierra Leone’s former child soldiers: A longitudinal study of risk, protective factors, and mental health. Journal of The above examples are meant as illustrations of the American Academy of Child and Adolescent possible ways in which some of the current short- Psychiatry, 49 (6), 606–615. coming in our knowledge on ecological resilience Betancourt, T. S., & Ettien, A. (2010). Transitional Justice and Youth Formerly Associated with Armed Forces may be addressed. Obviously, other research and Groups in Sierra Leone : Acceptance , efforts have been published which could have Marginalization and Psychosocial Adjustment . New served a similar function, and the above examples York: UNICEF. have their own limitations. For instance, they do Betancourt, T. S., & Khan, K. T. (2008). The mental health of children affected by armed confl ict: Protective pro- not address recent advances in knowledge regard- cesses and pathways to resilience. International ing biological processes and markers of resil- Review of Psychiatry, 20 (3), 317–328. ience, despite the potential of this emerging body Betancourt, T. S., Simmons, S., Borisova, I. I., Brewer, S. of knowledge to inform prevention practices E., Iweala, U., & de la Soudiere, M. (2008). High hopes, grim reality: Reintegration and the education of (Feder, Nestler & Charney, 2009 ; Haglund, former child soldiers in Sierra Leone. Comparative Nestadt, Cooper, Southwick & Charney, 2007 ) . Education Review, 52 (4), 565–587. Nonetheless, we believe that advances in longitu- Betancourt, T. S., Zaeh, S. E., Ettien, A., & Khan, L. N. dinal and multilevel statistics provide an opportu- (2012). Psychosocial adjustment and mental health services in post-con fl ict Sierra Leone: Experiences of nity to start unraveling the complex transactional CAAFAG and war-affected youth, families and ser- patterns between person and context that are at vice providers. In S. Parmentier (Ed.), New Series on the heart of understanding the mental health and Transitional Justice . Antwerp: Intersentia. psychosocial well-being of children living in Bronfenbrenner, U. (1979). The ecology of human development: Experiments by nature and design . Cambridge: areas of political violence. Combined with con- Harvard University Press. tinued attention to strengthening theory, a partici- Bronfenbrenner, U. (Ed.). (2005). Making human beings patory approach, and sensitivity to sociocultural human: Bioecological perspectives on human devel- context, we feel such advances put researchers in opment . Thousand Oaks, CA: Sage. Cummings, E. M., Goeke-Morey, M. C., Schermerhorn, a position to move beyond establishing that expo- A. C., Merrilees, C. E., & Cairns, E. (2009). Children sure to political violence is associated with psy- and political violence from a social ecological per- chological symptoms, thereby providing crucial spective: Implications from research on children and knowledge to inform prevention and treatment families in Northern Ireland. Clinical Child and Family Psychology Review, 12 , 16–38. practices. Feder, A., Nestler, E. J., & Charney, D. S. (2009). Psychobiology and molecular genetics of resilience. National Reviews in Neuroscience, 10 (6), 446–457. References Haglund, M. E. M., Nestadt, P. S., Cooper, N. S., Southwick, S. M., & Charney, D. S. (2007). Psychobiological mechanisms of resilience: Relevance Baker, R., & Hinton, R. (2001). Approaches to children’s to prevention and treatment of stress-related psycho- work and rights in Nepal. The Annals of the American pathology. Development and Psychopathology, 19 , Academy of Political and Social Science, 575 , 889–920. 176–193. His Majesty’s Government. (1992). Children ’ s Act of Betancourt, T. S., Agnew-Blais, J., Gilman, S. E., 2048 . Williams, D. R., & Ellis, B. H. (2010). Past horrors, Jordans, M. J. D., Komproe, I. H., Tol, W. A., Smallegange, present struggles: The role of stigma in the association E., Ntamutumba, P., & de Jong, J. T. V. M. (2012). between war experiences and psychosocial adjustment Potential treatment mechanisms of counseling for among former child soldiers in Sierra. Social Science children in Burundi: A series of n=1 studies. The & Medicine, 70 (1), 17–26. American Journal of Orthopsychiatry, 82 , 338–348. 38 W.A. Tol et al.

Jordans, M. J. D., Tol, W. A., Komproe, I. H., & de Jong, designs. Journal of Counseling and Development, 78 , J. T. V. M. (2009). Systematic review of evidence and 92–102. treatment approaches: Psychosocial and mental health MacMullin, C., & Loughry, M. (2004). Investigating psy- care for children in war. Child & Adolescent Mental chosocial adjustment of former child soldiers in Sierra Health, 14 (1), 2–14. Leone and Uganda. Journal of Refugee Studies, 17 (4), Karki, R., Kohrt, B. A., & Jordans, M. J. D. (2009). Child 460–472. led indicators: Pilot testing a child participation tool Masten, A. S. (2007). Resilience in developing systems: for psychosocial support programmes for former child Progress and promise as the fourth wave rises. soldiers in Nepal. Intervention: International Journal Development and Psychopathology, 19 , 921–930. of Mental Health, Psychosocial Work & Counselling Punamaki, R. L., Qouta, S., & El Sarraj, E. (2001). in Areas of Armed Con fl ict, 7 (2), 92–109. Resiliency factors predicting psychological adjust- Kazdin, A. E. (2007). Mediators and mechanisms of ment after political violence among Palestinian chil- change in psychotherapy research. Annual Review of dren. International Journal of Behavioral Development, Clinical Psychology, 3 , 1–27. 25 (3), 256–276. Kazdin, A. E., & Nock, M. E. (2003). Delineating mecha- Sameroff, A. J., & Mackenzie, M. J. (2003). Research nisms of change in child and adolescent therapy: strategies for capturing transactional models of devel- Methodological issues and research recommendations. opment: The limits of the possible. Development and Journal of Child Psychology and Psychiatry, 44 (8), Psychopathology, 15 , 613–640. 1116–1129. Shonkoff, J. P. (2010). Building a new biodevelopmental Kohrt, B. A. (2009). Vulnerable social groups in post- framework to guide the future of early childhood pol- confl ict settings: A mixed-methods policy analysis icy. Child Development, 81 (1), 357–367. and epidemiology study of caste and psychological Shonkoff, J. P., & Phillips, D. A. (2000). From neurons to morbidity in Nepal. Intervention: International neighborhoods: The science of early childhood devel- Journal of Mental Health, Psychosocial Work & opment . Washington, DC: National Academy Press. Counselling in Areas of Armed Confl ict, 7 (3), Tol, W. A., Komproe, I. H., Jordans, M. J. D., Gross, A. L., 239–264. Susanty, D., Macy, R. D., et al. (2010). Mediators and Kohrt, B. A., & Harper, I. (2008). Navigating diagnoses: moderators of a psychosocial intervention for children Understanding mind-body relations, mental health, affected by political violence. Journal of Consulting and stigma in Nepal. Culture, Medicine and Psychiatry, and Clinical Psychology, 78 (6), 818–828. 32 (4), 462–491. Tol, W. A., Komproe, I. H., Susanty, D., Jordans, M. J. D., Kohrt, B. A., & Hruschka, D. J. (2010). Nepali concepts Macy, R. D., & De Jong, J. T. V. M. (2008). School- of psychological trauma: The role of idioms of dis- based mental health intervention for children affected tress, ethnopsychology and ethnophysiology in allevi- by political violence in Indonesia: A cluster random- ating suffering and preventing stigma. Culture, ized trial. Journal of the American Medical Association, Medicine and Psychiatry, 34 (2), 322–352. 300 (6), 655–662. Kraemer, H. C., Wilson, T., Fairburn, C. G., & Agras, W. Tol, W. A., Reis, R., Susanty, D., & de Jong, J. T. V. M. S. (2002). Mediators and moderators of treatment (2010). Communal violence and child psychosocial effects in clinical trials. Archives of General Psychiatry, wellbeing: Qualitative fi ndings from Poso, Indonesia. 59 , 877–883. Transcultural Psychiatry, 47 (1), 112–135. Lundervold, D. A., & Belwood, M. F. (2000). The best kept Ungar, M. (2008). Resilience across cultures. British secret in counseling: Single-case (n=1) experimental Journal of Social Work, 38 (2), 218–235. Promoting Resilience in Children of War 4

Barbara Magid and Neil Boothby

neighboring ethnolinguistic or religious groups, War Zones and it is not uncommon for a government to wage war against a segment of its own population. Today’s wars spare no one, and vulnerable groups The numbers indicate large-scale confl ict and such as children, once protected from harm, have displacement. As of 2011, there were an estimated become easy targets. Images of soldiers rescuing 26.4 million internally displaced persons (IDPs) “enemy” children from crossfi re have been rele- and 10.5 million refugees around the world gated to history books. Today, children are not (UNHCR, 2013 ). Tragically, the numbers also just caught in the crossfi re but intentionally tar- show that children are not spared in today’s wars. geted by militia groups. Combatant groups regu- Among war-affected populations, almost half are larly plant colorful landmines specifi cally to children, who have been directly or indirectly sub- attract “enemy” children. Rape and amputation jected to violence (Boothby, Strang, & Wessells, are other tactics commonly employed in warfare, 2006 ; UNHCR, 2011a ) . Children are victims en intended to divide kinship loyalties and erode the masse. A survey in Rwanda in 1996 shed light on social fabrics of communities. the scale of children’s exposure to confl ict. Of the With the Geneva Conventions discarded by children interviewed, 70 % had seen someone many actors, and the distinction between combat- killed or injured, 80 % had lost a family member, ant and noncombatant blurred, the difference and 96 % had witnessed violence (Machel, 2001 ) . between enemy and friend is also morphing. In One study of asylee children in Europe found that today’s wars it is less common for soldiers of dif- 60 % of them had been exposed to violence fering nationalities to battle. Instead, today’s wars, (Montgomery & Foldspang, 2005) . A 1989 study whose main casualties are civilians, often occur of more than 500 children in Mozambique found within the con fi nes of a country, pitting country- that 77 % had witnessed murder, 88 % had wit- men, friends, and neighbors against each other. nessed physical abuse or torture, 51 % had been Tensions and violence commonly arise between physically abused or tortured, 63 % had witnessed rape or sexual abuse, and 64 % had been abducted B. Magid , MIA, MPH (*) from their families. These millions of war-affected Columbia University, Mailman School of Public Health , children become ensnared as victims of wars in New York , NY , USA many capacities: in addition to witnessing vio- e-mail: [email protected] lence, or being uprooted from homes and commu- N. Boothby , PhD nities, they may serve as child soldiers and become Director of the Program on Forced Migration and Health, separated from family members or orphaned. Columbia University, Mailman School of Public Health , New York , NY , USA Child soldiers are perhaps the most visible e-mail: [email protected] manifestation of the tragic effects that war has on

C. Fernando and M. Ferrari (eds.), Handbook of Resilience in Children of War, 39 DOI 10.1007/978-1-4614-6375-7_4, © Springer Science+Business Media New York 2013 40 B. Magid and N. Boothby children. The image of a small child holding an are affected by and respond to the threats of AK-47 twice his or her size is common, but armed confl ict with an eye towards identifying precise statistics about the number of child soldiers interventions that may protect and promote their in the world are nearly impossible to come by. developmental well-being. What is clear is that where there is con fl ict, there are almost certainly child soldiers. According to the Child Soldiers Global Report, non-state armed Psychological and Developmental groups in at least 24 countries recruited child sol- Outcomes diers, and nine governments used child soldiers in armed confl ict in 2008 (The Coalition to Stop the The psychological and developmental well-being use of Child Soldiers). While it is easy to think of of boys and girls of all ages may be profoundly child soldiers as perpetrators, it is crucial that we affected by a range of confl ict-related events, remember they are also victims. including: Unfortunately, child soldiers are only the tip of the iceberg. Children are often recruited to pro- the violent death of a parent or close relative; separation from family; witnessing loved ones being mote an engineered vision of “progress,” “justice,” killed or tortured; displacement from home and or “nationhood” (Boothby, 2008 ) . Parties to a community; exposure to combat, shelling and other con fl ict—including national armies—frequently life-threatening situations; acts of abuse such as take advantage of impoverished situations to being abducted, arrested, held in detention, raped, tortured; disruption of school routines and commu- recruit children into their ranks. Youth wings of nity life; destitution and an uncertain future liberation movements fall subject to politicization (UNICEF, 2011 ) . and militarization. In fact, the inability to protect children from political strife has been a leading Some also participate directly in violent acts. reason for fl ight among refugees (Boothby). Furthermore, various forms of deprivation that Today, children are caught in the ideological result from protracted armed con fl ict profoundly struggles that accompany political and ethnic strife, affect children of all ages. Indeed, the absence of as soldiers and non-soldiers (Boothby, 2008) . In food, shelter, sanitation, medical care, education, addition to the highly publicized plight of child and other necessities required for normal growth soldiers, more than one million children have been and development is among the primary casualties separated from their families or orphaned over the of armed con fl ict and communal violence. past decade, and at least two million have been What is immediately noticeable, though, is killed (UNICEF, 2011 ) . During the same period at that children of con fl ict who live through the least six million have been permanently disabled same situations may have different psychological or seriously injured by confl ict (UNICEF). and developmental outcomes. If a house is The sheer number of children affected by confl ict bombed, one sibling may walk out unharmed, points to the need to develop psychosocial support while another suffers from broken bones. programming. However, the fi eld is still in its Similarly, two children may have different emo- infancy: programs remain scarce and are not well tional responses to the same event. Although two integrated into the broader humanitarian frame- children may live through the same war, protec- work. The evidence base for psychosocial programs tive factors may insulate one child over another remains weak, and more research and evaluation is and frame that child’s immediate experiences as needed for this fi eld to perform optimally. well as long-term developmental outcomes. Humanitarian responders are still struggling An example from one of our experiences in to develop models that are scalable and cost- Kabul, Afghanistan, is illustrative. Two infants effective. Programs that target small numbers were woken by Taliban bombings of a residential of children would neither be appropriate nor neighborhood in Kabul and both began to cry. cost-effective in a context of widespread need. It One baby’s mother was able to pick up her child is therefore important to understand how children and coax her back to sleep. However, the other 4 Promoting Resilience in Children of War 41 infant was left to cry herself to sleep because her family prior to his abduction. His mother was family was not available. In the following days deeply religious, and this foundation in fl uenced her mother reported that she remained agitated Israel throughout his time with Renamo. Although and had trouble eating or sleeping ( Boothby, he was sometimes forced to commit brutal acts Crawford, & Halprin, 2006 ) . during the day, Israel would pray for forgiveness This anecdote tells us something about the at night, and his moral compass remained intact nature of resilience in children. One baby, who throughout his time with Renamo. Additionally, benefi tted from her mother’s protection immedi- after undergoing disarmament, demobilization, ately after the bombings, was quickly able to and reintegration (DDR), Israel was reunited with return to a state of normalcy. However, the other his sister, who was a positive in fl uence in his life. infant, who was not insulated from the event by He was also reaccepted by his community and external protective factors, remained frightened provided with a cleansing ceremony—a local for days. Both infants were exposed to the same ritual that is believed to promote healing and event, but due to their external realities, the event recovery. Vasco, on the other hand, came from a led them to different short-term reactions. It may troubled family and may not have absorbed the not be the bombardments themselves, but the same protective attitudes, behaviors, and skills protective factors available to children immedi- that seemed to buffer Israel. ately before, during, and after the bombardments Identifying sources of risk and resilience among that are key in determining developmental out- children growing up in war zones is not an exact comes (Boothby, Crawford, & Halprin, 2006 ) . science; nonetheless, it does seem that there are a Similar trends emerge regarding child soldiers. variety of factors that in fl uence children’s out- The difference between two former child soldiers comes. Among these factors is the degree to which that came out of a longitudinal study of former children were exposed to violence prior to dis- child soldiers in Mozambique also highlights placement (Boothby, 2008 ; Smith, Perrin, Yule, some of the factors that may be at play and that Hacam, & Stuvland, 2002 ; Thabet & Vostanis, account for differing outcomes (Boothby, 2006 ) . 2000) , as well as the degree to which children were Both Vasco and Israel were in the ranks of Renamo supported after displacement (Boothby, 2008 ; as children; however their outcomes varied drasti- Boothby, Crawford, & Halprin, 2006 ; Garbarino cally 16 years after demobilization. The outcome & Kostelny, 1996 ; Thabet & Vostanis, 2000 ) . of Vasco, a Renamo youth leader, was negative, Some of the variables that in fl uence how vio- and he was never able to fully reintegrate into lence affects children’s long-term development are society; he remained uncontrollably violent and the nature of the violence; the protective mecha- drank heavily. Although he had been married, his nisms in place before, during, and after a child wife left him because he was too aggressive. On experiences violence; and the extent to which a the other hand, Israel, 12 years of age at the time child can assign meaning to his or her experience of his abduction by Renamo, is a success story. (Boothby, 2008 ; Boothby, Crawford, & Halprin, Israel was rehabilitated, married with two chil- 2006; Dawes, 1990; Garbarino & Kostelny, 1996 ; dren, and praised as a model neighbor and father. Gibson, 1989; Kostelny, 2006; Punamaki & Why did Israel become a productive member of Suleiman, 1990) . If risk factors accumulate and society, while Vasco remained violent years later? outweigh protective factors, negative develop- What distinguishes these two boys, both of whom mental outcomes become more likely. Although served as child soldiers with Renamo? we cannot be present to pick up and comfort every Outcomes of child soldiers may differ dramat- crying child or provide cleansing ceremonies to all ically from one person to another, depending former child soldiers, we can assist in setting up an upon the type, degree, and duration of trauma enabling, protective environment—where moth- (Wessells, 2006 ) . Although it is hard to hold ers are attuned to the needs of their children or all variables constant, Israel’s outcome may be child soldiers are supported by their communities additionally due to the positive in fl uences of his in a way that is meaningful. 42 B. Magid and N. Boothby

Because war zones present multiple risks to these questions (Bronfenbrenner, 1979, 1986 ) . children, their situation cannot be understood in According to Bronfenbrenner, the family, includ- terms of a single traumatic event, such as the ing the extended family, is the key microsystem exposure to violence, displacement, a physical within which children develop and where basic injury, or the death of a parent. Instead, a number protections and needs are provided. Outside the of researchers have employed a risk-accumula- family, schools and houses of religious activity tion model (Sameroff, Seifer, Barocas, Zax, & provide the fi rst encounter with social institutions Greenspan, 1987 ) to provide insights into the and are important spheres of interaction between outcomes of children in con fl ict and post-con fl ict children, their peers, and key adults such as teach- situations (Garbarino & Kostelny, 1996 ; Kostelny, ers. At a wider macrosystemic level, children’s 2006 ; Macksoud & Aber, 1996 ) . This model sug- socialization and development occur within gests that most children can cope with low levels social systems that include norms with respect to of risk, but it is the accumulation of risk that children’s rights, rules of law, forms of con fl ict jeopardizes development, especially when no resolution, cultural bereavement processes, and compensatory forces are at work. Specifi cally, educational opportunities. children appear to be able to cope with one or two Armed confl ict, in particular, provides an eco- major risk factors in their lives, but when risk logic shock or destabilization that creates a cul- accumulates, with the addition of a third, fourth, ture of violence that damages child protection and fi fth factor, there is a signi fi cant increase in and support at multiple, interacting levels. At the the likelihood of developmental damage. level of the macrosystem, war shatters societal To prevent this increase in developmental peace and social trust, contests the legitimacy of damage, this model highlights the importance of institutions and government-defi ned laws, minimizing risks. At a diplomatic level, tools ampli fi es poverty and structural violence, and have been employed in recent years to reduce damages infrastructure and institutions of child dangers and risks in confl ict in Sudan, the support such as schools and health clinics Democratic Republic of Congo (DRC), Sierra (Machel, 2001 ) . It also establishes a societal Leone, Nepal, and elsewhere. These include norm of physical violence, divides the popula- efforts to ensure that parties to a con fl ict abide by tion, and creates structural violence through the human rights and humanitarian law, as well as denial of access to services necessary for meeting advocacy to ensure that belligerents do not block basic human needs. the humanitarian spaces or hinder the delivery of However, in spite of the system-level shocks lifesaving assistance to war-affected populations. of confl ict, within this ecologic framework, At the community level, ensuring that war- armed confl ict does not tend to produce large- affected populations have timely access to food, scale, population-wide trauma (Bracken, 1998 ; medicine, shelter, water, and sanitation is also Wessells, 1999 ) . Among con fl ict-affected popu- critical. lations, trauma plays a relatively minor role The model also highlights the importance of compared to other mental health and psychoso- maximizing opportunities for children’s normal cial issues (IASC, 2007 ; Wessells, 2008 ) . In growth and development. Again, a key challenge fact, affected populations tend to respond with is scale: how is resilience supported, not just for resilience, even in the face of great adversity, one child, but for entire communities of children? and an appropriate framework will promote resil- In other words, while the international commu- ience and risk reduction within a community nity cannot be present to support each individual (Boothby, 2008 ) . child, are there ways to support these types of An ecologic approach to understanding chil- opportunities in cost-effective and scalable ways? dren and war thus begins with a thorough exami- The social ecologic approach developed by nation of the protective capacities (and de fi cits) Urie Bronfenbrenner is helpful in answering of key people and systems that surround children. 4 Promoting Resilience in Children of War 43

It should form the basis for thinking, with appro- be provided from within a community and not by priate breadth, of potential in fl uences on chil- outside interveners. dren’s well-being, but also should be suffi ciently Potential protective social resources include focused to frame clear actions that will promote “families, local government offi cers, community child protection and well-being. The goal is to leaders, traditional healers (in many societies), identify features of both micro- and macrosys- community health workers, teachers, women’s tems that together can be seen to form a potential groups, youth clubs and community planning protective shield around children, not eliminating groups, among many others” (IASC, 2007 , p. 5). risks and vulnerabilities but protecting children In addition to social resources, the IASC guide- from their full impact. lines highlight the indigenous economic, health, religious and spiritual resources, and skills that exist within communities affected by emergen- IASC Guidelines on Mental Health cies. These resources should be identifi ed and and Psychosocial Support incorporated into a psychosocial program. The guidelines explain that “…key tasks are to iden- In 2007, after a 2-year consultative process, the tify, mobilize and strengthen the skills and capac- Inter-Agency Standing Committee (IASC)1 pub- ities of individuals, families, communities and lished its Guidelines on Mental Health and society…” (IASC, p. 11). These tasks should be Psychosocial Support in Emergency Settings integrated into the broader agenda as they “tend (IASC, 2007 ) . The guidelines “re fl ect the insights to reach more people, often are more sustainable, of practitioners from different geographic regions, and tend to carry less stigma” (IASC, p. 11). disciplines and sectors, and re fl ect an emerg- Community-centered, empowering approaches ing consensus on good practice” in this fi eld are key, not only to ensure best results during an (IASC, p. 1). Key to the guidelines is the premise emergency but also to ensure sustainable and sus- that social supports are essential to buffer and bol- tained bene fi ts. ster mental health and psychosocial well-being. Thus, in many ways, the IASC guidelines have embraced the social ecologic model as a way to Four Layers of Support promote resilience in children. Indeed, the guidelines seek to promote protective capacities and the The IASC guidelines organize programs and reduction of risks in children affected by emer- interventions in a pyramid (see Fig. 4.1 ), which is gencies. While the guidelines are universal, they in keeping with the social ecologic approach. also aim to avoid a “one-size- fi ts-all” approach by Responses should be designed to reduce risk and emphasizing the importance of cultural sensitiv- create opportunities at all four levels: ity, local ownership, and religious contextualiza- 1. Basic services and security tion. They further recognize the complex situations 2. Community and family supports of those affected by emergencies: individuals and 3. Focused, nonspecialized supports communities are certainly victims, in some 4. Specialized services regards, but they are also active agents and heal- Because different people require different ers. The guidelines are premised on the reality interventions, all layers of the pyramid are impor- that the vast majority of psychosocial support will tant and should be implemented simultaneously. However, the supports towards the bottom of the pyramid—or those that are more psychosocial or social ecologic in nature—are intended for the 1Created in 1992, the IASC aims to unite both UN and broadest number of people. At the top of the nongovernmental humanitarian organizations for the com- pyramid sit the mental health-style interventions, mon goal of increased cooperation and efficiency. Establishing UN policies and interagency guidelines is which tend to be necessary only for a small per- among its duties. centage of the emergency-affected population. 44 B. Magid and N. Boothby

Fig. 4.1 Intervention pyramid for mental health and psychological support in emergencies. Each layer is described below

Basic Services and Security basic needs therefore has effects that are both physical and psychological. All levels of the pyramid rest on the foundation In refugee and IDP camps, the protective of “basic services and security,” which promote capacities of community members and other peo- well-being and resilience in children, families, ple close to the child may have been undermined. and communities. At the base of the pyramid, the Traditional leaders may no longer be able or will- goal is to provide for people’s “basic” or physical ing to negotiate cessations of military action; reli- and protection needs: interventions that focus on gious leaders may encourage violence rather than promoting security, governance, food, shelter, tolerance; health care facilities may not represent water, and health care. However crucial, securing a consistently protective space for children; and these necessities in a way that is participatory and schools may become indoctrination vehicles or promotes dignity, mental health, and psychoso- even recruitment grounds for political factions. cial well-being is indeed a challenge. Thus, an assessment of the protective capacities Historically, parents’ abilities to protect their of important people and potential protective children have been compromised seriously by actors needs to take place. Assessments may need con ﬂ icts and other emergencies. Crisis-affected to focus on how the emergency has affected: families often are in a weaker position to provide • Family livelihoods material support for their children and also may • Gender, labor, and childcare roles be too overburdened with survival concerns to • Teachers’ roles, corporal punishment, indoc- provide adequate emotional support. Forced trination, and recruitment in schools migration and economic pressures often require • Roles of traditional and religious leaders and women to assume work roles that involve longer their commitments to child protection separations as caregivers from their children than A key goal of such an assessment is to ascer- are normal. The stress on families is exacerbated tain the extent to which a given emergency has by the collapse of traditional livelihood strate- disrupted the capacity of communities to use gies, which may involve food collection, seasonal fully a wide range of intricate social mechanisms migration, and raising livestock, for example. An that previously were used to maintain social emergency focus on the affected population’s cohesion within and between affected members. 4 Promoting Resilience in Children of War 45

Accordingly, it usually will make sense to members may often be the most essential protec- consider means of supporting or—where they tive action of all. The community and family sup- have failed completely—reestablishing tradi- ports tier also includes mass communication on tional mechanisms that have a protective value. effective coping, positive parenting, formal and There are likely other features of community life, nonformal educational activities, livelihood shaped by the harsh physical and economic options, accessing women’s group, youth clubs, conditions and deeply engrained cultural atti- and other social networks (IASC). The organiza- tudes and practices, which are deemed profoundly tion of structured and monitored foster care, hostile to the welfare of children. mother-child groups, and children’s club and Two major concerns that require careful assess- sports activities are examples of assistance pro- ment and response in emergencies are the com- grams that fall within this category. moditization of children as a source of labor and Access to education, informal education the exploitations of girls (and their sexuality) opportunities, and other potentially protective through marked gender disparity. The commoditi- activities should be assessed routinely. Education zation of children as economic units may be exac- is a child’s universal right—a right that does not erbated by war, famine, and con fi nement in IDP end when war breaks out. Conversely, the loss of and refugee camps. Children and especially girls education has been found to be a primary stressor may be required to remain home for longer peri- for displaced or emergency-affected families ods of time to care for younger siblings. Females (IASC, 2007 ) , and children not involved in school- also may be expected to assume dangerous roles ing may be at increased risk of poor developmen- (e.g., fi rewood collection in hostile environments tal outcomes (Dawes, 1990 ) . The importance of outside subsidized camps). Although emergencies fast mobilization of structured activities and infor- may challenge household livelihoods severely, mal education for war-affected children has been long-standing cultural norms and values regarding well documented (Apfel & Simon, 1996 ) . In situ- childhood and especially children’s roles in the ations where school infrastructure has been badly household economy will need to be addressed damaged, the main intervention may simply be strategically in emergency settings. one that provides for a sense of community and an opportunity to resume, however modestly, the trajectory of emotional and cognitive development, Community and Family Supports to learn new skills, and to live in a morally ordered environment. Moreover, the timely resumption of The second tier, “community and family sup- informal or formal schooling can be the optimal ports,” is required for those who need assistance intervention for providing basic psychosocial sup- in reestablishing key social supports to ensure port for large numbers of war-affected children. their security and well-being. Second tier sup- As the IASC guidelines point out, the resumption ports, which may be geared towards the commu- of formal education can: nity or towards the individual, are more restore a sense of normalcy, dignity and hope by specialized than the fi rst tier support of the pyra- offering structured, appropriate and supportive mid. Although this layer is not intended to reach activities. Many children and parents regard par- as many as the basic supports outlined above, it ticipation in education as a foundation of a successful childhood. Well-designed education also still constitutes a “wide-scale” intervention. helps the affected population to cope with their Community and family level supports include situation by disseminating key survival messages, family tracing and reuni fi cation programs for enabling learning about self-protection and sup- separated children. Orphaned children and those porting local people’s strategies to address emergency conditions (2007, p. 148). who are separated from their families may face greater risks such as homelessness, exploitation, Another major stressor for war-affected popu- and recruitment (IASC, 2007 ) . Reuniting chil- lations is the inability to perform proper burials dren with their parents or other extended family for the deceased or the inability to engage in 46 B. Magid and N. Boothby

cultural, religious, or spiritual practices. Indeed, program also incorporated a family tracing and in some cultures, the failure of a loved one to reunifi cation element, traditional cleansing and perform these practices may have signifi cant healing ceremonies, community sensitization spiritual and social ramifi cations. The guidelines campaigns, livelihood activities, and apprentice- therefore locate local conceptions of death and ships. Although a center-based program is not worldview within this second layer of support necessarily the most appropriate way to provide and argue in favor of “assisted mourning and rehabilitation and healing support in general, the communal healing ceremonies” (IASC, 2007 , boys positively rated their experience at the p. 13). The ability of a survivor to create meaning Lhanguene Center with caretakers and other child through faith and belief systems has been linked soldiers in general. The Lhanguene Center used to positive outcomes after individual and collec- professionals to prepare and support laymen and tive tragedies (Boothby, Crawford, & Halprin, women to work with a highly victimized group of 2006 ; Honwana, 1998 ; Marsella, Friedman, boy soldiers and incorporated elements of focused Gerrity, & Scur fi eld, 1996 ) . psychosocial support into its program, while accepting that healing must take place within a community and that livelihood features are cru- Focused, Nonspecialized Supports cial elements of long-term healing. The tracing and reunifi cation program was also an essential One level up the pyramid are “focused, nonspe- element of this rehabilitation program, indicating cialized supports” which apply to a compara- that a combination of IASC “layers of support” is tively small number of the affected population often required for high-risk groups of children. and require interventions by trained and supervised workers. For example, this includes basic mental health care by primary health care work- Specialized Services ers and emotional or livelihood support for survivors of gender-based violence (GBV). This third The fi nal tier or tip of the support pyramid set of interventions focuses speci fi cally on highly addresses the needs of the comparatively small victimized groups, including child soldiers and percentage of an affected population that requires survivors of GBV, among other groups. In addi- professional services to function. Assistance at tion to psychosocial support, such programs often this level “…should include psychological or include self-help and livelihood support to ensure psychiatric supports for people with severe men- healing and to ensure that restoration of the self is tal disorders whenever their needs exceed the grounded in a poverty reduction strategy. capacities of existing primary or general health One example of “focused, nonspecialized sup- services. Such problems require either (a) referral ports” was a program carried out by Save the to specialized services if they exist, or (b) initia- Children in Mozambique beginning in 1988 at tion of longer-term training and supervision of the Lhanguene Rehabilitation Center in Maputo. primary/general health care providers” (IASC, It originally provided reintegration assistance— 2007 , p. 13). Depending on the size of the affected in the form of psychological and social assis- population, there may be several thousand indi- tance—to 39 boys (between ages 6 and 16) who viduals who require medication, outpatient ser- had been abducted by Renamo and trained as vices, hospitalization, and/or other specialized fi ghters. This program required trained profes- interventions. sionals, and four interrelated components were Funding for specialized professional services integrated into the program: establishment of is comparatively scarce in emergencies that take safety and appropriate codes of conduct, reestab- place in developing parts of the world where men- lishment of self-regulatory/impulse control pro- tal health systems may not exist beyond the cesses, promotion of security vs. survival-seeking nation’s capital. This is one of the reasons why behavior, and support of meaning-making. The the response to mental health concerns in Aceh, 4 Promoting Resilience in Children of War 47

Indonesia, following the 2004 Asian tsunami is so remarkable. It is important to note that prior to the Moving Forward Asian tsunami, Aceh, Indonesia, had been plagued with a long-standing civil war. As a result, formal Humanity has been plagued by war since the or government-supported social and mental health beginning of recorded history. But over the course services were severely lacking. of the past few decades, we have seen a shift in For example, when the tsunami struck, there the norms that govern con fl ict. Rarely are battles was only one in care facility in Banda Aceh, the fought on Western soil, and war mainly affects provincial capital, which was caring for over 330 those in the so-called global south—those who patients in a 220-patient facility. There was one already suffer from severe poverty, a dispropor- psychiatrist and seven nurses and almost all tionate disease burden, and low levels of edu- patients received the same medication. Many cation. Indeed, no fragile or con fl ict-affected families refused to take their ailing relatives to the country has yet achieved a single Millennium Banda Aceh hospital and instead cared for them Development Goal (MDG), while such countries the best they could at home—but without medica- as an aggregate lag 40–60 % behind other tion or support. As humanitarian agencies began low- and middle-income countries in MDG their assessments in tsunami- and war-affected health and education achievement (Organisation communities, they also found scores of these indi- for Economic Co-operation and Development viduals chained to beds, posts, and front porches (OECD), 2011 ) . One of the most troubling char- for their own protection. Families had to work and acteristics of today’s wars is the blurring of the could not leave their ill relatives home alone. distinction between combatant and noncombatant Several forward-thinking Indonesians seized and the resulting broadening of the battle fi eld. the opportunity to leverage tsunami funding to War and uprooting have direct effects on child develop a decentralized mental health system for development. Placing these many and varied the entire province. With an initial focus on Axis effects within an ecologic framework is useful as I disorders, the program sought to establish a it develops the awareness of providers to the “household-to-hospital continuum” of care, oper- many domains in which war and communal vio- ating at provincial, district, subdistrict, and vil- lence may take their toll. Recently this framework lage levels. Key to this continuum was training has also been operationalized within the IASC and placement of mental health nurses in subdis- Guidelines on Mental Health and Psychosocial trict health clinics. These nurses screened patients Support in Emergency Settings . This important at the clinic, ensured they received proper medi- development, in turn, illuminates the many ele- cations, and trained and supported village-based ments of humanitarian intervention required to volunteers. The community volunteers, in turn, protect children and enable them to cope more launched public awareness campaigns, identi fi ed effectively in situations of con fl ict. To be sure, people in need of treatment, and supported fam- our collective task as an international community ily efforts to care for relatives with psychological is to promote children’s capacity for resilience by disorders. At the provincial level, the program minimizing risks and maximizing opportunities. was able to increase the availability of state of the The IASC guidelines, built fi rmly on a social art medications and also add two more psychia- ecologic framework, offer a range of practices trists to assist with inpatient care and provide for how to do so in ways that build upon local ongoing support of mental health activities at the capacities and empower survivors. subdistrict clinics. Eventually, additional inpa- As a fi eld of practice, however, the provision tient care units were established at district of psychosocial care to children in crises is still in hospitals as well. A 2007 evaluation of USAID- its infancy. Widely differing conceptual supported programs in Aceh, Indonesia, con- approaches from addressing PTSD to reinforcing cluded that Aceh now has the best functioning social support networks have been adopted to jus- mental health systems in Indonesia. tify interventions, but little evidence actually 48 B. Magid and N. Boothby exists to support the ef fi cacy of these approaches Dawes, A. (1990). The effects of political violence on chil- or to indicate how they might be employed to dren: A consideration of South African and related studies. International Journal of Psychology, 25 , 13–31. reinforce one another better. The international Garbarino, J., & Kostelny, K. (1996). The effects of politi- community still is largely unable to identify cal violence on Palestinian children’s behavior prob- suf fi cient consensus regarding psychosocial lems: A risk accumulation model. Child Development, goals, strategies, or outcomes. This lack of an evi- 67 , 33–45. Gibson, K. (1989). Children in political violence. Social dence base for effective interventions undermines Science and Medicine, 7 , 659–667. donor countries’ con fi dence in psychosocial Honwana, A. (1998). “Okusiakala Ondalo Yokalye”: Let investments and leaves humanitarian workers us light a new fi re. Local knowledge in the post-war wondering whether their efforts made a differ- healing and reintegration of war-affected children in Angola . Luanda, Angola: Christian Children’s Fund/ ence. Consistent and rigorous evaluations of Angola. program impact will be at the heart of efforts to IASC. (2007). IASC guidelines on mental health and psycho- professionalize this fi eld of practice in the years social support in emergency settings . Geneva: IASC. to come. Internal Displacement Monitoring Centre (IDMC) and Norwegian Refugee Council. (2009). Internal displacement : Global overview of trends and developments in 2009 . Kostelny, K. (2006). A culture-based, integrative approach. References In N. Boothby, A. Strang, & M. Wessells (Eds.), A world turned upside down: Social ecological Apfel, R., & Simon, B. (Eds.). (1996). Mine fi elds in their approaches to children in war zones (pp. 19–38). hearts: The mental health of children in war and com- Bloom fi eld, CT: Kumarian Press, Inc. munal violence . New Haven, London: Yale University Machel, G. (2001). The impact of war on children . Press. Vancouver, British Columbia: UBC Press. Boothby, N. (2008). Political violence and development: Macksoud, M., & Aber, J. (1996). The war experiences An ecologic approach to children in war zones. Refugee and psychosocial development of children in Lebanon. and Mental Health: Child and Adolescent Psychiatric Child Development, 67 , 70–88. Clinics of North America, 17 (3), 497–514. Marsella, A., Friedman, M., Gerrity, E., & Scur fi eld, R. Boothby, N. (2006). When former child soldiers grow up: (1996). Ethno cultural aspects of posttraumatic stress The keys to reintegration and reconciliation. In N. disorder. Washington, DC: American Psychological Boothby, A. Strang, & M. Wessells (Eds.), A world Association. turned upside down: Social ecological approaches to Montgomery, E., & Foldspang, A. (2005). Seeking asy- children in war zones (pp. 155–178). Bloomfi eld, CT: lum in Denmark: Refugee children’s mental health Kumarian Press, Inc. and exposure to violence. The European Journal of Boothby, N., Crawford, J., & Halprin, J. (2006). Public Health, 15 (3), 233–237. Mozambique child soldier life outcome study: Lessons Organisation for Economic Co-operation and Development learned in rehabilitation and reintegration efforts. (OECD). (2011). Achieving the MDGs— Addressing Global Public Health, 1 , 87–107. confl ict , fragility and armed violence . Retrieved April Boothby, N., Strang, A., & Wessells, M. (2006). A world 13, 2011, from OECD http://www.oecd.org/document turned upside down: Social ecological approaches to /19/0,3746,en_21571361_42277499_46008211_1_1_ children in war zones . Bloom fi eld, CT: Kumarian 1_1,00.html Press, Inc. Punamaki, R., & Suleiman, R. (1990). Predictors and Bracken, P. (1998). Hidden agendas: Deconstructing post effectiveness of coping with political violence among traumatic stress disorder. In P. Bracken & C. Petty Palestinian children. British Journal of Social (Eds.), Rethinking the trauma of war (pp. 38–59). Psychology, 29 , 67–77. London: Free Association Books. Sameroff, A., Seifer, R., Barocas, R., Zax, M., & Bronfenbrenner, U. (1986). Ecology of the family as a Greenspan, S. (1987). Intelligence quotient scores of context for human development: Research perspec- 4-year-old children: Social environmental risk factors. tives. Developmental Psychology, 22 , 732–742. Pediatrics, 79 , 343–350. Bronfenbrenner, U. (1979). The ecology of human devel- Smith, P., Perrin, S., Yule, W., Hacam, B., & Stuvland, R. opment . Cambridge, MA: Harvard University Press. (2002). War exposure among children from Bosnia- Child Soldiers Global Report. (2008). The coalition to Herzegovina: Psychological adjustment in a community stop the use of child soldiers. Retrieved May 3, sample. Journal of Traumatic Stress, 15 , 147–156. 2011, from http://www.childsoldiersglobalreport. Thabet, A., & Vostanis, P. (2000). Post-traumatic stress org/fi les/country_pdfs/FINAL_2008_Global_ disorder reactions in children of war: A longitudinal Report.pdf study. Child Abuse and Neglect, 24 , 291–298. 4 Promoting Resilience in Children of War 49

UNHCR. (2011a). Children . Retrieved February 19, Wessells, M. (2008). Trauma , peacebuilding and develop- 2011, from UNHCR http://www.unhcr.org/pages/ ment : An Africa region perspective . Retrieved May 06, 49c3646c1e8.html 2011, from Trauma, Development and Peacebuilding UNHCR. (2011b). Refugee fi gures . Retrieved February Conference http://www.incore.ulst.ac.uk/pdfs/IDRC 19, 2011, from UNHCR http://www.unhcr.org/ wessels.pdf pages/49c3646c1d.html Wessells, M. (2006). Child soldiers: From violence to pro- UNICEF. (2011). Child protection from violence, exploita- tection. Cambridge, MA: Harvard University Press. tion and abuse: Children in con fl ict and emergencies . Wessells, M. (1999). Culture, power and community: Retrieved February 19, 2011, from UNICEF http:// Intercultural approaches to psychosocial assistance www.unicef.org/protection/index_armedconfl ict.html and healing. In K. Nader, N. Dubrow, & B. Stamm UNHCR. (2013). Figures at a Glance . Retrieved (Eds.), Honoring differences: Cultural issues in the February 8, 2013, from UNHCR http://www.unhcr. treatment of trauma and loss (pp. 276–282). New org/pages/49c3646c11.html York: Taylor & Francis. Child Mental Health, Psychosocial Well-Being and Resilience 5 in Afghanistan: A Review and Future Directions

Peter Ventevogel , Mark J.D. Jordans, Mark Eggerman , Bibiane van Mierlo , and Catherine Panter-Brick

ent kinds of violence (Panter-Brick, Goodman, Introduction Tol, & Eggerman, 2011) : are mental health outcomes primarily driven by war-related trauma, The impact of war on child and adolescent mental family-level violence and/or structural barriers health is an issue that sits high on the global pub- taking the form of institutional, social and lic health agenda, especially where it concerns economic stressors? Of course, a protracted war young people living in low-income countries exacerbates poverty, weakens social institutions, (Patel, Flisher, Hetrick, & McGorry, 2007 ) and drives poor health and often increases social and con fl ict zones (Morris, van Ommeren, Belfer, economic inequalities. But such a macro-level Saxena, & Saraceno, 2007 ) . One key debate in view of the consequences of war does not neces- the literature on ‘con fl ict and child health’ focuses sarily help to understand the everyday experi- on the relative importance of exposure to differences, emotional lives and social realities of children in confl ict zones. It is essential for P. Ventevogel (*) research to carefully assess the main drivers Department of Research and Development , of child and adolescent mental health, in order HealthNet TPO, Amsterdam , The Netherlands to understand which cluster of childhood War Trauma Foundation, Diemen, The Netherlands adversities has the greatest impact, to reach e-mail: [email protected] specifi c insights that have both local and global M.J.D. Jordans signifi cance and to underscore which interven- Research and Development Department, HealthNet TPO , tions might be most effective. Amsterdam , The Netherlands Another key debate in the public health and Centre for Global Mental Health, London School of child development literature centres on the con- Hygiene and Hygiene, London, UK e-mail: [email protected] ceptual understandings of ‘risk’ and ‘resilience’. Both risk and resilience matter to child well- M. Eggerman MacMillan Center for International and Area Studies, being: it is necessary to assess both the vulnera- Yale University, New Haven, CT, USA bilities and the strengths of children, families and e-mail: [email protected] communities living with protracted confl ict. B. van Mierlo However, research on mental health in humanitar- Research and Development Department, HealthNet TPO , ian settings is still dominated by a paradigm nar- Amsterdam , The Netherlands rowly focused on individual responses to e-mail: [email protected] potentially traumatic events: a broader under- C. Panter-Brick standing of resilience is only nascent (Panter- Department of Anthropology & The Jackson Institute for Global Affairs , Yale University , New Haven , CT , USA Brick, 2010 ) . As argued by Layne, Waren, Watson, e-mail: [email protected] and Shalev ( 2007 ) , the fi elds of developmental

C. Fernando and M. Ferrari (eds.), Handbook of Resilience in Children of War, 51 DOI 10.1007/978-1-4614-6375-7_5, © Springer Science+Business Media New York 2013 52 P. Ventevogel et al. psychopathology and traumatic stress research social well-being and/or prevent or treat mental have been dominated by studies investigating a disorder’(Wessells & Van Ommeren, 2008 ) . This ‘shopping list’ of risk and protective factors, with approach entails a wide lens on child mental little understanding of the intervening variables health that includes epidemiological and clinical that mediate or moderate pathways of in fl uence. data on ‘problems’ and ‘disorders’ as well as By contrast, resilience research is attentive to contextual data on economic, cultural and social social contexts and developmental processes, structures that impact vulnerability and resilience beyond the study of individual attributes shaping in everyday lives. worse-than- or better-than-expected health out- This chapter thus provides a synthesis of child- comes. Thus a key emphasis of resilience research focused research and intervention literature is to contextualise developmental and social tra- related to mental health and psychosocial well- jectories, identifying what critical changes need being in Afghanistan. Our intent is to inform the to be made in social, educational and material research agenda and service provision strategies environments to turn individual trajectories for Afghan children and adolescents. We also towards more favourable health outcomes discuss a framework for developing initiatives to (Panter-Brick et al., 2011 ) . Contexts and resource promote mental health and psychosocial well- provision are of central importance to turning being within this group, and make recommenda- points fostering trajectories of resilience. This tions for future directions. conceptual framework is particularly useful to bridge major gaps between scientifi c evidence and policy-making pertaining to war-affected Afghan Childhood in Social Context children. For a state-of-the-art review of fi ndings on ecological resilience relevant to children We begin this section with a brief historical and adolescents exposed to political violence background of the country, and then highlight in low- and middle-income countries, see the contextual aspects of childhood in Afghanistan chapter by Tol and colleagues in this volume pertaining to socialisation, education and health. ( Tol et al., 2013). This chapter reviews the literature on child mental health and psychosocial well-being in A History of War, Poverty and Sharp present-day Afghanistan. Use of these terms Inequalities needs some clari fi cation. ‘Mental health problems’ and ‘mental disorders’ are terms in the Afghanistan has had a long history of invasion vocabulary of psychiatrists, psychologists, epide- and war. Situated at the crossroads of the Middle miologists and policy-makers. However, many East, the Asian steppes and the Indian subconti- social scientists and humanitarian workers prefer nent, this country has been a battleground of to focus attention on ‘psychosocial well-being’— many great powers, from Alexander the Great to referring to a ‘dynamic relationship that exists Genghis Khan, the Indian Mughals and the between psychological and social processes, each British Empire. Afghanistan became an indepen- continually in fl uencing the other’ (Williamson & dent entity when the legendary Ahmad Shah Robinson, 2006 ) . Thus psychosocial well-being Durrani united the Pashtun tribes in 1747 and refers not only to the subjective nature of one’s founded the Durrani dynasty. The monarchy was experiences but also to the social nature of life abolished in 1973, followed by a communist coup stressors, behavioural responses and contribu- d’état in 1978 (Dupree, 1980 ) . Since then, the tions made to the community (Strang & Ager, country has been in a nearly constant state of tur- 2003 ) . We follow here the consensus established moil with cycles of heavy violence and protracted in the humanitarian sector (IASC, 2007 ) : the armed confl ict. The invasion of the Soviet Union composite term ‘mental health and psychosocial in 1979 led to a 10-year-long jihad , or ‘holy war’, support’ describes ‘any type of local or outside by opponents of the Afghan communist regime support that aims to protect or promote psycho- who identi fi ed themselves as mujahedeen . That 5 Child Mental Health, Psychosocial Well-Being and Resilience in Afghanistan… 53 war generated an estimated one million deaths related to lack of possibilities for education and and six million refugees (Physicians for Human employment—Afghanistan has a rapidly urban- Rights, 1998 ) . In 1992, 3 years after the with- ising population estimated at 29.8 million, half of drawal of Soviet forces, a loose alliance of sev- which (14.9 million) is under the age of 18 eral different mujahedeen groups succeeded in (UNICEF, 2011 ) . toppling the communist government. A struggle for political power between these groups then led to a 4-year civil war, often structured by ethnic Childhood in Afghanistan and Islamic sectarian divisions and driven by the ambitions of rival warlords. During this period, Afghan society is patriarchal (elder men are deci- large parts of the capital Kabul were destroyed, sion-makers), patrilineal (a child belongs to his and most of its inhabitants were internally dis- father’s family) and patrilocal (the girl moves to placed or took refuge abroad. The rapid rise of her husband’s household at marriage). The core the Taliban, a fundamentalist group originating social and economic unit is the extended family, from the southern parts of the country and mostly although its infl uence has to some extent been trained and educated in Pakistan, brought some eroded by social changes linked to forced dis- stability (Rashid, 2001 ) . Their interpretation of placement and urbanisation. The home and fam- Islamic law imposed severe restrictions on all ily are private domains. Surrounding walls shield aspects of daily life (Rasekh, Bauer, Manos, & family life from public view, and walls of silence Iacopino, 1998 ) . Violations of Taliban laws and habitually shield family problems from outsiders. decrees were met with harsh sentences: public While family life is recognised as a nexus of care beatings, imprisonment, torture and execution. and protection, desperate poverty, poor family Access to education for girls was severely dynamics and loss of key family members can restricted; women were not allowed to leave the turn families into harsh and unloving environ- house without male chaperone—a mahram . ments for children (De Berry et al., 2003 ) . In 2001, massive US bombings and a US-led Afghan children usually have no ‘adolescence’ invasion drove the Taliban out of power. The as conceptualised in the Western world, that is, no signing of the Bonn Agreement (December 2001) transitional life stage situated within peer groups then created a framework for the country’s recon- before social adulthood. Traditionally, Afghan struction and the dissolution of factional armies boys from the age of 10 to 12 years, or even led by ‘warlords’. In recent years, however, the younger, move directly into an adult world country has seen a violent resurgence of the (Dupree, 1980 ) , while girls are given in marriage Taliban, particularly in the Pashtun-dominated around puberty. In contemporary Afghanistan, south and south-east, and frequent terrorist individuals older than 14 are considered adults attacks on ‘Western targets’ which include gov- rather than children (Loughry et al., 2005 ) , ernment schools, foreign embassies, security per- and this is also the legal age of employment. sonnel and aid organisations (Fergusson, 2010 ) . Particularly in nonurban areas, children assume Considerable external funding earmarked for social responsibilities early and have limited time reconstruction efforts has led not only to better for play. Social life is rigorously gendered and access to health care and education but also to often includes systematic exposure to violence. widening socio-economic inequalities and a Some 30 years ago, Afghan street games were growing discontent with the Afghan government described as rough but including war games only (Donini, 2007 ) . Even young urban elites readily rarely (Dupree, 1980 ; Van Oudenhoven, 1979 ) ; identify security and governance issues as their nowadays, according to personal communications top social concerns, along with family stressors from Afghan colleagues, street games include that have the most lasting impact on physiologi- violent re-enactments of the war, and children’s cal stress (Panter-Brick, Eggerman, Mojadidi, & drawings readily show disturbing images of McDade, 2008 ) . The demographics of the armed con fl ict, death and injury (De Berry et al., country are certainly increasing frustrations 2003; Save the Children USA, 2002 ) . 54 P. Ventevogel et al.

A central concept in the socialisation of Afghan Health Care children is tarbia , a word found in both Arabic and Persian, commonly translated as ‘training’ or After the fall of the Taliban, Afghanistan had ‘education’ while also implying ‘upbringing’ or (and still has) some of the worst health indicators ‘civility’. It includes both adab (politeness and in the world. Life expectancy was estimated at 45 good manners) as well as akhlaq (morality) years for males and 44 years for females. The (Karlsson & Mansory, 2007 ) . One qualitative maternal mortality ratio (maternal deaths per study involving both children and adults in Kabul 100,000 live births) is the second in the world, at concluded that tarbia was a term used to refer to 1400 (UNICEF, 2011 ) . One in 11 women face a children’s manners and the quality of their rela- lifetime risk of death from causes related to preg- tionships with others. Good tarbia entailed good nancy or childbirth. The under- fi ve mortality rate manners and proper language, respect for elders, is estimated at 199/1000, the second highest in bodily cleanliness and hospitality. The concept is the world; almost 40 % of the surviving under- gender-speci fi c: a girl must display modesty fi ve population are underweight. (lowering her gaze outside the home, not looking Progress has been made over the past years, around or making eye contact with boys, keeping especially with respect to access to health care. her head covered), but this is not expected of boys The primary health care system offers a ‘basic (De Berry et al., 2003 ) . Among the main qualities package of health services’ (BPHS), developed Afghan girls are expected to acquire in the pro- to address the basic needs of the Afghan popula- cess of becoming a woman are ‘acceptance, suf- tion (Waldman, Strong, & Wali, 2006 ) . The fering and patience’ (Billaud, 2012 ) . BPHS is comprised of core health services, including maternal and newborn care, family planning, child health and immunisation, and Education management of communicable diseases such as tuberculosis, malaria and HIV. With backing At the end of the Taliban era, around 80 % of the from the Ministry of Health and non-governmen- schools had been destroyed. In 2002, the Afghan tal organisations (NGOs), and after some hesita- government launched a ‘Back to School’ cam- tion on the part of international donors, mental paign, which resulted in huge expansion in school health and disability services were included in attendance throughout the country from about the BPHS in 2003, and their relative importance 900,000 to nearly 6.4 million in 2008. The per- has grown in revised versions of the package centage of girl’s primary school attendance has (MOPH, 2009 ) . grown from almost 0 % in 2001 to over 37 % in For health care in general, there has been a 2007 (UNESCO, 2010a ) . The gender gap in edu- signifi cant improvement in coverage of health cation is narrowing, but girls still lag far behind care services. One study showed that in 2002 boys in school enrolment, especially at the sec- less than 40 % of the Afghan population had ondary level. In general, the education of girls is access to health services, but by 2007 this fi gure increasingly accepted; many Afghans now see it had risen to an estimated 82 %. The relatively as a religious obligation within Islam (farz ), quick recovery of health care structures is largely though often on the condition that older girls are attributed to the close collaboration between taught by female teachers (Karlsson & Mansory, government, donors and implementing NGOs 2007 ) . The adult literacy rate is pegged at 28 %, (Arur et al., 2010 ; Sabri, Siddiqi, Ahmed, Kakar, with a strong gender inequality (43 % males, & Perrot, 2007 ) . A nationwide survey also found 13 % women; UNDP, 2007 ) . There are still many that the government BPHS had partially reached challenges for programmes of state-sponsored its goal of targeting the most vulnerable, includ- education, related to both economic and political ing disabled people and members of female- insecurity. In particular areas of the country, headed and poorer households; these groups schools are increasingly regarded as justi fi able were indeed visiting health centres relatively targets by insurgents (UNESCO, 2010b ) . more often than others. However, the study also 5 Child Mental Health, Psychosocial Well-Being and Resilience in Afghanistan… 55 showed that such vulnerable groups still face Psychosocial Distress considerable dif fi culties in using health facilities and that their out-of-pocket expenditures were Decades of war and con fl ict have had a signi fi cant higher than those of other population groups impact on health and well-being across almost all (Trani, Bakhshi, Noor, Lopez, & Mashkoor, domains of children’s lives, due to exposure to 2010 ) . The quality of health care provided to violence, pervasive poverty, ongoing insecurity, Afghan children aged less than 5 years has also strained family relations, disrupted networks of improved (Edward et al., 2009 ) . No data are social support, curtailed education and poor available regarding the coverage of mental health health. A 1998 needs assessment and situation services within the basic health care system analysis for child protection agencies in fi ve prov- although overall the access to basic mental inces found that security and safety-related prob- health services has signi fi cantly improved lems were the most important threats to child (WHO, 2013 ) . well-being and that support for families and caregivers was required to provide an adequate livelihood for their children (Sellick, 1998 ) . In 2003, Child and Adolescent Mental Health, UNICEF and Save the Children published a qual- Distress and Resilience itative study on the well-being of children in Kabul 2 years after the fall of the Taliban: The In this section, we review the existing literature children of Kabul , Discussions with Afghan on child and adolescent mental health (age £ 18 Families (De Berry et al., 2003 ) . While children years) in Afghanistan. From May 2011 to August reported many disturbing past experiences, they 2012, we conducted a comprehensive review of were most worried by and preoccupied with this literature, using online databases, PubMed ongoing, day-to-day threats and pressing con- and PsycINFO, with the following search terms: cerns, such as the risk of becoming disabled due ‘Afghan*’ and ‘child*’ or ‘adolescent’ and ‘men- to landmines, unexploded ordnance (UXO) and tal’ or ‘psychosocial’, in abstracts, titles or key- traf fi c accidents, economic hardship and poverty, words and without a limit on date of publication. and problems and tensions in the family. Partici- In addition, we searched available databases on pants stated that poverty was a major source of Afghanistan, including published reports and the latter: parents worried about feeding, clothing unpublished studies presenting primary research and providing care for children, which took its toll data. We excluded literature unrelated to mental on relationships within the family and also put health or psychosocial support, and media reports extra pressure on children themselves. The study or scientifi c publications focused solely on adults also highlighted children’s dif fi culties stemming and/or Afghan refugees in high-income coun- from the loss of and/or separation from family tries. We included, however, reports on Afghan members, due to both deaths and disappearances child refugees in neighbouring countries such as during years of con fl ict and as a result of pro- Pakistan and Iran, given their cultural and socio- tracted illnesses or traffi c accidents. economic similarity to Afghanistan. We found a My father died, and then I lived with my uncle and total of 43 publications suitable for full text he died also, and then I lived with another uncle but review, and subsequently excluded 23 for not he also died, and then I lost all my protectors (Focus meeting the inclusion criteria or for reporting on group discussion with boys; De Berry et al., 2003 ) . data sets already included and retained 20 for full The main impact of war on children has been that discussion (Table 5.1 ). After presenting their they grew very afraid, also during the war no one main fi ndings, we contextualise these studies by could give good ‘tarbia’ to their children (Focus group discussion with mothers; De Berry et al., 2003 ) . drawing upon a much larger body of scientifi c publications; reports by the Afghan government, Such fi ndings are echoed in an unpublished international agencies and NGOs; and media survey in four districts in northern Afghanistan reports. which assessed the psychosocial and mental Table 5.1 A review of literature on child and adolescent mental health and psychosocial well-being in Afghanistan Authors Study design Objective Setting Study population Main fi ndings and conclusion Catani, Cross-sectional survey Establish the extent of Urban district in Kabul 287 children (ages 7–15) In addition to multiple exposure to war- or disaster- Schauer, cumulative traumatic affected by war and from two schools in related traumatic events, children also indicated high and Neuner and stressful experiences violence in the past Kabul, 2005 levels of exposure to family violence ( 2008 ) related to war and family violence in schoolchildren in Kabul Catani et al. As above, see Catani See Catani et al. (2008 ) See Catani et al. (2008 ) See Catani et al. (2008 ) Boys reported higher overall amounts of traumatic ( 2009 ) et al. (2008 ) events, speci fi cally domestic violence. Boys have higher rate of PTSD (26.1 %) compared to girls (14.1 %). Average of 4.3 different types of violent incidents at home. Child labour was a common phenomenon and associated with an increased likelihood of experiencing family violence for girls De Berry Explorative study using Identify well-being goals Kabul 321 children (ages 7–13) Afghan families considered their children’s emotional et al. (2003 ) ethnographic methods for children, threats to 116 children (ages 13–18) and social development important, and highlighted the (key informant interviews, psychosocial well-being 215 parents central importance of tarbia — obedience, manners and focus group discussions) and existing coping correct conduct—in their upbringing. Child well-being resources was dependent on the availability of opportunities for personal and social development, their personal characteristics and the immediate situation around them. Children in Kabul drew on many resources to cope with challenges; some coping mechanisms were found to be comforting in the present but to have potentially negative long-term consequences Eggerman and Thematic analysis of Analyse how constructs See Panter-Brick See Panter-Brick et al. Adults were primarily concerned with overcoming Panter-Brick responses to open-ended of hope and suffering et al. (2009 ) (2009 ) economic dif fi culties, while children prioritised ( 2010 ) questions from children frame the life experiences problems in their learning environments as well. and caregivers in a of schoolchildren and Education was perceived as the key to social and strati fi ed randomised their caregivers in light economic improvement of the family. Respondents sample of schools (see of reported stressors derived hope from a sense of moral and social order Panter-Brick et al. 2009 ) and professed solutions embodied in the expression of key cultural values: faith, family unity, service, effort, morals and honour. These values form the bedrock of resilience, drive social aspirations and underpin self-respect and dignity. However, respondents also reported strong feelings of entrapment caused by a combination of economic impediments, social expectations and cultural dictates which frustrated the realisation of personal and social aspirations Authors Study design Objective Setting Study population Main fi ndings and conclusion Gupta (1997 ) Cross-sectional survey Identify psychopathology Kabul during Community sample 72 % had experienced the death of a family member with self-report in children Taliban rule in 1996 (n = 310) of children between 1992 and 1996. 41 % had lost one or more questionnaires aged 8–18 years parents because of the con fl ict. Nearly half had seen many people killed in rocket and artillery attacks. Over 80 % of the children indicated that they were often so sad that they felt they could not cope with events and felt that life was not worth living HealthNet 399 structured Assessment of mental Four districts School-age children, Moderate but omnipresent psychosocial problems, TPO (2008b ) questionnaires; 22 focus health and psychosocial (Baghlan, Kapisa, parents, teachers, with 25 % of children indicated for some form of group discussions; 40 key well-being; coping Kunduz, Parwan) community elders, psychosocial support. Current stressors (poverty, informant interviews; and barriers to service traditional healers social injustice, child marriages) reportedly cause 12 case studies provision and health care staff most frequently reported problems (aggression, substance abuse, distress, disturbed peer relations, suicide attacks, family violence). Boys report more complaints than girls HealthNet Exploratory participatory Rapid assessment Uruzgan Province in Local key informants Psychosocial concerns that were prioritised by TPO (2008c ) assessment; individual of perceived MHPS Southern Afghanistan (governmental leaders, participants included (a) domestic and family interviews (n = 19) and 5 problems and local formal and informal violence, (b) drug abuse, (c) general psychological group discussions ( n = 49) resources in the context mental health care and symptoms, (d) poverty, (e) tribal con fl icts and (e) of NGP programme psychosocial service malpractices in marriage customs. As child-speci fi c design providers) psychosocial and mental problems respondents mentioned fear and anxiety, concentration problems, development problems and epilepsy Hoodfar Ethnographic research Map experiences, Urban areas in Iran 100 Afghan refugees Afghan girls and boys are not passive victims of ( 2008 ) using participant concerns, self-perceptions (Mashhad, Tehran, (aged 12–18) in Iran circumstances but actively adopt strategies to deal observation, focus group and coping strategies Qom aged) (2001) with unwanted family dynamics (marriage, discrimi- discussions and key of Afghan youth in Iran 51 Afghan refugees nation). Young Afghans seek to introduce fundamental informant interviews (aged 12–18) in Iran changes into their families and communities often (2002–2003) using the legitimate force of religion Izutsu Cross-sectional study Describe physical and Refugee camps in 100 Afghan children The majority of children showed signs of hopeless- et al. (2005 ) mental health status of Pakistan in the early aged 6–14 ness, suicidal feelings and other mental health Afghan refugee children post-Taliban period dif fi culties Kassam and Brief exploratory study Explore mental health Afghan refugee camp in 61 participants (including Distress was communicated on a collective level. Nanji (2006 ) using focus group situation of Afghan Karachi, Pakistan (1999) adolescents) Mental illness was often equated with severe psychotic discussions and key refugees in Karachi illness. Somatic symptoms were a common way of informant interviews expressing distress. Social and community-based approaches that drew on natural coping strategies were recommended to improve mental health (continued) Table 5.1 (continued) Authors Study design Objective Setting Study population Main fi ndings and conclusion Loughry Quasi-experimental Develop instruments for 7 villages in Northern 267 children (8–14 years), Developed a culturally grounded, quantitative scale et al. (2005 ) design child psychosocial Afghanistan 145 adults for assessing Afghan child psychosocial well-being. well-being Quantitative data showed the non-psychosocial Compare psychosocial intervention had better outcomes for child well-being with non-psychosocial than the psychosocial intervention intervention Omidian and Questionnaires; inter- Compare impact in the 4 schools for Afghan 4 schools. Sample size of The attitudes of teachers who received psychosocial Papadopoulos views with teachers, classroom environment refugees in Peshawar, people interviewed is not training had changed substantially. By helping ( 2003 ) students and parents; for teachers who received Pakistan, November mentioned teachers to better understand their own emotions and classroom observations psychosocial training vs. 2002 that of their students, they became better teachers. those who did not Their way of teaching was more relaxed, they exhibited patience, were more friendly and helpful and felt able to fi nd out about the students’ problems and to help resolve many of them Panter-Brick Strati fi ed random sample; Evaluate mental health, 24 schools in three 1,011 male/female Children’s most distressing lifetime trauma included et al. (2009 ) interviews with children, suffering and trauma provinces (Kabul, 11–16-year-old schoolchil- accidents, painful medical treatment and domestic and caregivers and teachers exposure among Afghan Bamyan, Mazar-e- dren, 1,011 caregivers, 358 community-level violence, not just war-related events. schoolchildren and their Sharif), 2006–2007 classroom teachers Mental health outcomes were strongly associated with caregivers; assess multiple number of lifetime traumatic events and with outcomes and triangula- caregivers’ mental health status. Emotional problems tion across child, parent were more prevalent than behavioural disorders. The and teacher reports research highlights the value of school-based initiatives to raise awareness of mental health, and to address wider issues of everyday suffering and resilience Panter-Brick Longitudinal study; Examine 1-year mental 9 schools (Kabul) 234 male/female With the exception of post-traumatic stress symptoms, et al. ( 2011 ) gender-balanced, health trajectories for 11–16-year-old schoolchil- mental health outcomes improved in the absence of a strati fi ed random sample, multiple outcomes; assess dren (64 % of baseline targeted intervention. Family-level events such as with follow-up 1 year the relative impact of risk sample) and their traumatic beatings, stressful con fl ict and violence after baseline, after and protective factors caregivers worsened mental health outcomes; improvements in Panter-Brick et al. (2009 ) ; using individual, family family life and relationships had protective effects. interviews with children and area-level variables Post-traumatic stress symptoms remained dependent and caregivers on lifetime trauma exposure; by contrast, other mental health problems associated with intervening-year family-level violence rather than war-related violence Authors Study design Objective Setting Study population Main fi ndings and conclusion Raj, Gomez, Open-ended interviews Identify Afghan Religious leaders, Three major towns Informants reported recognition of the poor social and and Silverman ( N = 102) perspectives on the causes police, teachers, Afghan (Kabul, Jalalabad health consequences of child and forced marriage for (2011 ) of and potential solutions staff of non-governmen- and Mazar-e-Sharif) mothers and infants. Recommended solutions centred to child and forced tal organisations and on child marriage prevention; most informants felt marriage government of fi cials little could be done for married girls Sellick (1998 ) Semi-structured inter- Needs assessment and Urban and rural 500 children (aged 6–18) Security and safety-related problems were the most views with convenience situation analysis for locations in fi ve in fi ve provinces important threats to Afghan child well-being. Support samples of children child protection agencies provinces (Kabul, Herat, to families and caregivers is required to provide an supplemented by focus on the effects of Mazar-e-Sharif, adequate livelihood for children. Agency assistance group discussions with con fl ict on children in Jalalabad, Kandahar) needs to be guided by local vulnerability analyses, parents and adults Afghanistan with special attention to disability and gender working with children Slugget (2003 ) Key informant interviews Situation analysis related Afghanistan (Kabul) Senior staff in UN, NGOs Cases of child sexual abuse are not made public, with senior staff to child sexual abuse in especially in the case of girls due to the high value Afghanistan placed on their virginity. There is strong social stigma directed at abused children, and such abuse brings shame upon their families Smith ( 2008 ) 319 semi-structured Identify and understand Urban and rural sites in More than 200 adult To some extent, domestic violence against children is interviews, 56 focus stress factors and four provinces (Kabul, men and women from 61 an accepted way of disciplining children, although group discussions individual and societal Nangarhar, Bamyan and different families there is social disapproval regarding the use of attitudes regarding Herat), 2006–2007 violence; child abuse is seen as a problem, and mainly violence on children attributed to the inability of adults to control their anger within the family Trani and Nationwide Evaluate the prevalence 175 clusters in all 34 People of all ages in 2.7 % of all Afghans ful fi lled the (strict) criteria for Bakhshi (2006 ) population-based of disability and access provinces 5,250 selected households disability; among those aged 0–9 years, the fi gure was survey with probability to public services for 1.4 %, rising to 2.4 % for the 10–19 age group. Over proportional to size persons with disability 20 % of Afghans share a household with a person who sampling has a disability. Prevalence of severe learning disability was 0.26 % and of epilepsy/seizures 0.51 %. People with disabilities had higher levels of mental distress Wessells and Semi-structured Identify key risks and Northern Afghanistan 200 children and Key issues affecting child well-being were landmines; Kostelny interviews and focus issues of child protection/ in early post-Taliban 120 adults protection and support for the most vulnerable; (2002 ) group discussions well-being; identify period disarmament, demobilisation and reintegration vulnerable groups (DDR); informal education; gender discrimination; and drug abuse. Vulnerable groups included ex-child soldiers; children who had been internally displaced, orphaned or separated from their families; children with disabilities; working children; and victims of sexual exploitation 60 P. Ventevogel et al. health problems of 399 school-age children, and Coping and Resilience the perceptions of parents, teachers and other community stakeholders regarding them For Afghan families, resilience to adversity is the (HealthNet, 2008b ) . Gender discrimination and cornerstone of survival and well-being, signify- social injustice, unmet basic needs and poverty, ing emotional, social and economic fortitude in continued insecurity and violence, and marriage- the face of war, displacement, social confl ict, related issues were reported as causing children’s severe illness and crippling debt. As De Berry psychosocial and mental health problems. While et al. ( 2003 ) showed, the emotional and social war and confl ict-related traumatic events were development of children is a paramount social commonly mentioned as a cause of psychosocial and cultural issue. Among the most important and mental health dif fi culties, structural socio- prerequisites for child well-being were morality, economic problems and recurrent stressors (mal- respect, faith, positive feelings, good relation- treatment of children by adults, domestic violence ships and correct behaviour, as well as physical and traf fi c accidents) were also seen as contribut- health—all values which would help one to cope ing to much of the perceived distress of children. with challenging life circumstances. Children More recently, a systematic survey of mental saw that families adopted coping strategies that health, lifetime trauma exposures, daily stressors were effective in the short term but problematic and social resilience was conducted with a ran- in the long term: hiding the truth, overprotection, dom sample of 1,011 children and 1,011 caregiv- use of physical punishment, violence and taking ers in three areas of the country (Kabul, revenge (De Berry et al.). Building on a similar Mazar-e-Sharif and Bamyan; Panter-Brick et al., understanding of emic representations of emo- 2009 ) . The qualitative component of the study tional and social priorities, Loughry et al. ( 2005 ) featured a content analysis of responses elicited, constructed a quantitative measure of children’s in face-to-face interviews conducted in Dari and well-being, consisting of several subscales to Pashto, regarding the main problems faced in assess feelings, social relations and coping strate- daily life and the solutions envisaged. For both gies, for use in NGO project evaluations of psy- male and female caregivers, economic stressors chosocial interventions. were identi fi ed as the most signi fi cant day-to-day Six cultural values fundamental to upbringing, problem, while for 11–16-year-old boys and girls, psychosocial well-being and fortitude were stressors pertaining to education were the most identi fi ed in Eggerman and Panter-Brick’s larger- signi fi cant. Afghan adults and children alike scale interdisciplinary study (2010 ) : underscored the overriding importance of eco- 1. Faith in Islam ( iman) plays a fundamental role nomic insecurity as ‘the root of all man’s misery’, in framing life experiences in Afghanistan; it using the Dari expression iqtisad kharab (‘bro- is a source of strength, perseverance and hope ken economy’) to label a state of socio-economic in the face of hardship and uncertainty, at both ‘entrapment’ (Eggerman & Panter-Brick, 2010 ) . the individual and family levels. Faith helps Poverty led to overcrowding in the home, individuals make sense of what happens to strained social relationships and domestic them; this can be articulated in expressions of confl ict. Economically frustrated men become resignation—an acceptance that all life pro- ‘ill natured’ ( bad khalqi), an expression denoting ceeds from the will of God, and is ultimately dif fi cult, abusive or morally reprehensible behav- beyond the control of the individual. iour. Violent behaviour at home was often attrib- 2. Family unity and harmony (wahdat and itti- uted to takleef asabi (‘a mental problem’). For faq). Afghan households and families attribute example, one young girl expressed the linkages great importance to peaceful resolution of dis- between economic frustrations, poor mental putes within the primary reference group, and health and domestic violence as follows: adherence of all members to consensus decisions. My father’s salary is not enough for us, he has tak- 3. Service (khidmat ). A critical value in the leef asabi and he beats us. If he fi nds a decent job then maybe he will calm down (Interview with a Afghan cultural system is the ability to make 16-year-old girl; Eggerman & Panter-Brick, 2010 ) . useful contributions to the well-being of 5 Child Mental Health, Psychosocial Well-Being and Resilience in Afghanistan… 61

others, to ‘serve’ parents, family, community be a source of suffering, and may encourage inac- and country. Failure to ‘serve’ can be a source tivity or even paralysis in dealing with adversity of shame, and viewed as a sign of weakness in (Wessells & Strang, 2006 ) . Feelings of entrap- character. ment led to considerable personal distress and 4. Perseverance and effort (koshesh ). In order to social tensions, potentially reaching the point of achieve a goal, one needs to be persistent. violence and attempted suicide. Eggerman and Children often stated that they could improve Panter-Brick (2010 ) identi fi ed three forms of their lives through ‘hard work and koshesh ’. entrapment: 5. Morals (akhlaq ). This refers to cultural codes 1. Poverty, overcrowding and other harsh socio- governing appropriate and morally correct economic realities prevent people from dem- behaviour, deference to parents and commu- onstrating cultural values and meeting social nity elders, modesty in dress and comport- obligations, individually or collectively. ment and good manners in day-to-day 2. Individual ambitions clash with expectations relationships. inherent in the values of morality, ‘service’ 6. Social prominence, respectability and honour and ‘family unity’. ( izzat). By fulfi lling their parent’s ambitions 3. Cultural dictates, particularly those surround- for them, by working hard, demonstrating ing marriage decisions and the social position good morals and serving others, children hope of women in family and society, are them- to achieve respect and social recognition. selves a cause of direct suffering. These six cultural values underpin the sense of resilience in Afghan culture. They provide a moral framework to order experiences of suffer- Mental Health Disorders in Children ing, as well as hope and the promise of a better life (Eggerman & Panter-Brick, 2010 ) . Hope and Rigorous data on the prevalence of child and ado- resilience were closely connected: lescent mental health disorders in Afghanistan The only way to make life better is to be hopeful… are scarce. The fi rst large-scale epidemiological If a person has hope, then he or she can work and survey of common mental health problems was acquire knowledge to make their life better published in 2009: as mentioned above, this was (Interview with an Afghan mother; Eggerman & a multi-stage random sample of 1,011 school- Panter-Brick, 2010 , p.76). based children to assess adversity, experiences This sense of hope centred on accessing the of trauma and life stressors, and resilience. resources needed to create social and economic Importantly, it included a multi-informant assess- opportunities for one’s family. Children went to ment (child, caregiver and teacher) of emotional/ school in the hope of advancing the economic behavioural psychiatric diffi culties and prosocial situation of their household—and also bore the strengths, based upon both symptoms and impact burden of such expectations. In this context, on social life (across four domains of home, ‘hope’ was the bedrock of resilience as well as classroom, leisure and peer activities). It also the crux of social suffering. included assessment of depression and post-trau- Indeed, there can be no simplistic understand- matic symptoms, based on international instru- ing of promoting ‘culture’ as resilience or using ments, and featured a combination of international ‘hope’ as a simple index of well-being. Efforts to and locally constructed scales (Miller, Omidian, adhere to cultural values often contributed to et al., 2006 ) to assess caregivers’ mental health feelings of entrapment, for instance, when men (Panter-Brick et al., 2009 ) . The instruments were married several wives to demonstrate their social validated, with Dari and Pashto translations copy- standing, or when school attendance was inter- righted ( http://www.sdqinfo.org ). The survey rupted so that boys could ‘serve’ the household showed that one out of fi ve schoolchildren economy, or to allow girls to be married off into (22.2 %) met the criteria for probable psychiatric another family. While faith is clearly central to disorder, with girls two-and-a-half times more resilience in Afghanistan (Kanji, Drummond, & likely to have disorders than boys. Children who Cameron, 2007 ) , religious beliefs can themselves had suffered fi ve or more traumatic events were 62 P. Ventevogel et al. two-and-a-half times more likely to have a psy- associated with unexpected mental health chiatric disorder, as well as three times more improvements, for both children and caregivers likely to report symptoms of post-traumatic in the study cohort. stress, than those who had experienced four or Previous studies have generated a great deal of less. The study showed that caregiver mental valuable contextual data on the extent of war- health was correlated with the well-being of the related deaths affecting children during the early children under their care: there was a 10 % years of Taliban control (Gupta, 1997 ) , emotional increase in the likelihood of child psychiatric dis- despair and suicidal feelings in refugee camps order for each and every symptom of psychologi- (Izutsu et al., 2005 ) , and the burden and war- cal distress reported by caregivers. related and domestic violence (Catani et al., 2009 ) . A follow-up survey was undertaken in Kabul— However, these studies did not triangulate data but not in other areas of the country, due to logis- from multiple informants, used nonvalidated tical and security problems. This represents the questionnaires, and speci fi cally looked for links fi rst longitudinal survey of family-level mental between direct exposure to war-related violence health in Afghanistan, with follow-up data on 115 and psychopathology. In a context where studies boys, 119 girls and 234 caregivers. The research in con fl ict zones are increasingly common, several aimed to test the extent to which individual-level, authors have warned that prevalence rates derived family-level and community-level exposures to from trauma-focused psychiatric epidemiology adversity predicted a 1-year change in mental are of limited value to community-based organisa- health outcomes such as psychiatric dif fi culties, tions working to promote mental health and psy- depression and post-traumatic stress. It examined chosocial well-being (Bolton & Betancourt, 2004 ; which aspects of violence and poverty were the Miller, Kulkarni, & Kushner, 2006 ; Rodin & van most critical predictors of changes in child and Ommeren, 2009 ; Ventevogel, 2005 ) . Furthermore, adult mental health status, and conversely, which recent evidence from confl ict zones, including aspects of the family and community environ- Afghanistan, has shown that in the genesis of men- ment were the best predictors of mental health tal health problems and psychosocial distress, recovery (Panter-Brick et al., 2011 ) . war-related trauma does not necessarily outweigh The weight of the evidence indicates that even the ‘structural’ daily stressors associated with the in a context of militarised violence, cumulative struggle to make a living. Even traumatic experi- ‘everyday’ socio-economic stressors are critical ences, from the perspectives of children, are not determinants of mental health and well-being: solely contingent on war-related violence but are these daily stressors impose a major burden on related to family-level and community-level vio- family relationships, triggering domestic violence—such as punitive beatings; disputes between lence, and were identifi ed in this research as the relatives or neighbours; criminal acts, including main predictor of 1-year changes in mental health robberies and stabbings; or physical harassment burden. Yet over the 1-year follow-up period, by local hooligans and/or police (Panter-Brick child and adult mental health outcomes improved et al., 2009 ) . Social stressors in the family-level for the cohort as a whole, for all measures except environment are also demonstrably associated post-traumatic stress symptoms. This improve- with biomarkers of stress such as immune compe- ment occurred in the absence of a dedicated men- tence and blood pressure, over and above other tal health intervention, or even better political social and political factors reported as ‘top stres- and economic security. The follow-up pertained sors’ in Kabul (Panter-Brick et al., 2008 ) . to Afghan families who had kept their near-adolescent children in school: in the context of Afghanistan, this was a signifi cant expression of Self-In fl icted Injury and Suicide hope for socio-economic advancement and resilience to social and economic challenges—and Women and girls in Afghanistan have limited continued school attendance was demonstrably ways to ‘protest’ when they disagree with 5 Child Mental Health, Psychosocial Well-Being and Resilience in Afghanistan… 63

decisions made about them, particularly in Drug Use choosing a marriage partner or in controlling use of their time and labour. They may present with Afghanistan is the world’s largest producer of health problems at local clinics or hospitals sim- opium and heroin, and the origin of more than ply because visits to health centres are often one 90 % of the heroin consumed in Europe and other of the few acceptable ways to leave the house, and countries. According to surveys by the United because being ill draws attention to the serious- Nations Ofﬁ ce of Drugs and Crime, Afghanistan ness of their malaise. In addition, Afghan teenage is home to nearly one million problem drug users, girls may seek resolve in self-injury, such as beat- roughly 8 % of the population between 15 and 64 ing themselves severely when they are highly years old (UNODC, 2009 ) . An estimated 60,000 stressed (Mann, 2006 ; Omidian & Miller, 2006 ) . children are heroin users—approximately 0.7 % In extreme cases, women and girls may go as of the total Afghan child population (UNODC, far as attempting suicide, often by burning them- 2005 ) . Around 50 % of drug users in the north and selves or by taking poison. A study carried out by south of the country are reported as giving opiates the international NGO Medica Mondiale docu- to their children (UNODC, 2009 ) . Afghan folk mented cases based on medical records at central traditions include the use of raw opium to allevi- hospitals in Kabul, Wardak and Herat provinces; ate common physical complaints, e.g. to suppress this study found that girls as young as 12 years children’s coughs and allow them to sleep. It is old had committed self-immolation, while girls likely that the abundance of psychological stres- aged 16–19 were particularly at risk. Forced child sors in overcrowded urban settings and among marriage and abuse from in-laws were among the displaced populations with limited or no resources most frequent reasons given to explain self-immo- and social support networks fuels opiate use lation, which often occurred after girls spoke out among those who previously only considered opi- against the violence to which they were subjected ate use for medicinal or social purposes. These or sought help in alleviating the violence (Medica processes may disproportionately affect youth in Mondiale, 2007 ; Raj, Gomez, & Silverman, urban settings (Todd, Macdonald, et al., 2012 ; 2008 ) . The high number of suicidal attempts Todd, Nasir, et al., 2012) . In the Western town of among young Afghan women may be indicative Herat alone, there are some 2,000 drug-addicted of the dif ﬁ culties they face in attempting to recon- children. One of them, 17-year-old Mohammad cile a ‘modern’ feminine identity with ‘traditional’ Zarif, told how he became addicted to opium Afghan roles (Billaud, 2013 ) . The United Nations while cutting poppy plants in nearby Farah news network IRIN quotes an 18-year-old girl province: receiving treatment for her burn injuries in a hos- I’m not happy that I’m an addict. But I can’t pital in the capital, Kabul, four months after she stop - there is no treatment for me. There is no was married against her will: real employment, either, and I do anything I have to in order to get food and drugs. (Behnam & I did not know how to end the misery of torture and Afzali, 2006 ) daily beatings I got from my cruel husband. So I poured petrol on myself and set myself ablaze. I did not like him [the husband] even at the beginning… but there was no solution because I was married by my father. (IRIN, 2006 ) Vulnerable Subpopulations

There are no comprehensive statistics on the Gender-Speci fi c Risk Factors number of suicides in Afghanistan. However, anecdotal reports suggest the problem is significant The system of purdah separates the male domain (Tang, 2006 ) , and there has been a concerted effort from the closely regulated female domain. It is an by the Afghanistan Independent Human Rights important part of men’s honour to protect a Commission (AIHRC) and other advocacy groups woman from outside in fl uences. This protection to address the problem (AIHRC, 2006a ) . results in a narrowly de fi ned code of conduct and 64 P. Ventevogel et al. far-reaching restrictions on female movements. Girls in Early or Forced Marriages Many men consider seclusion of women the only way to protect them. During Taliban rule the By custom, marriage occurs at a young age, extreme isolation of women, in particular those although among educated people, the wedding is in the cities who were confi ned to small apart- often postponed until the completion of school. ments that they could hardly leave, led to consid- The legal minimum age for marriage is 16 years; erable mental distress (Dupree, 2004 ; Rasekh however, the Afghan Ministry of Women’s Affairs et al., 1998 ) . However, this ‘ purdah -related reports that an estimated 57 % of girls are married depressive state’ is not only related to Taliban before the age of 16, with a mean age of marriage rule but engrained in Afghan society (De Jong, of 17.8 years for women and 25.3 years for men 1999 ) . The position of women and girls is subject (MOWA, 2008 ) . Several thousand girls in to rapid and sometimes dramatic change. Many Afghanistan are married as early as 10 years of women and girls who have lived in refugee camps age. Forced marriage was estimated to be the in Iran or Pakistan have seen the relatively higher norm rather than the exception, reportedly degree of participation of women in society, and accounting for between 60 and 80 % of marriages have often had the opportunity to pursue an edu- (Afghanistan Human Development Report, 2007 ) . cation (Hoodfar, 2008 ) . The work of many NGOs In a survey among 102 Afghan NGO workers, and the new government to bolster the rights of government of fi cials, religious leaders, police women and girls has had a clear impact, but is of fi cers and teachers, most acknowledged the det- also cause of considerable tension within fami- rimental social and health outcomes of these lies and communities. Attempts to explicitly link practices for mothers and infants, and advocated the position of women and issues such as domes- for child marriage prevention; however, the con- tic violence to mental health and the promotion sensus was that little could be done to assist girls of women’s rights may in fact exacerbate who were already married (Raj et al., 2011 ) . the problem of domestic violence, since men In a study carried out in Kabul, many young will often simply not accept purdah -related stress girls raised serious concerns about early mar- as a possible source of female problems (Van de riage, saying that they were not prepared for Put, 2002 ) . pregnancy (Slugget, 2003 ) . An 18-year-old Interestingly, in the above-mentioned study of mother of four, who was married at age 13 to a children in four northern provinces of Afghanistan 59-year-old man as his third wife stated: (HealthNet, 2008b ) , boys reported higher levels My husband is too old; he cannot work and cannot of problems on most indicators (functional bring anything like brush or anything for us. My impairment, resources and coping, psychological husband’s fi rst wife died last year in child birth, the diffi culties, conduct problems, hyperactivity and other wife is not well. So now, at 18, I take care of all these children, four of mine and fi ve of theirs. peer problems). No signifi cant differences were (FIFC, 2004 ) found for post-traumatic stress and depressive symptoms. The counter-intuitive fi nding that After marriage a girl will usually move to the boys report more problems than girls may be husband’s family. An important and often con fl ict- explained by a greater exposure of boys to con- ridden relationship is that of the newly married textual stressors—they enjoy more freedom of woman and her mother-in-law. Sometimes two action, are more mobile and are more likely to be families exchange girls, with each marrying a son employed in work environments that may expose from the other family, in order to avoid dowry them to abuse. It may also be that they are more costs or the division of inheritable property, par- willing to express complaints in a research con- ticularly land holdings. The decision to exchange text. We should therefore be careful not to under- girls between two families is often made when estimate the problems that boys face, particularly the children are still young, sometimes even in rural areas. immediately after birth; thus, in most cases, the 5 Child Mental Health, Psychosocial Well-Being and Resilience in Afghanistan… 65 girl has no in fl uence on the arrangement. Such Mazar-e-Sharif, Panter-Brick et al. (2009 ) found badal marriages may strengthen the ties between that two in ten were working outside school hours families, and in this respect they provide support in low-wage or unpaid occupations. Paid work and protection. However, they also increase the included peddling low-value goods (e.g. glasses vulnerability of the women involved; for instance, of water, plastic bags, toilet paper) on the street, if a husband mistreats his wife, her relatives may weaving carpets and working as apprentices (for take revenge on his sister, who was married into car mechanics or tailors) for less than $1 US a the other family and lives in their household. week; unpaid work included tending market stalls In Pashtun custom, violent crimes (such as and working in family-run shops, restaurants and murder) can at times be settled peacefully through other enterprises. Catani et al. ( 2008 ) found a decision by the tribal jirga (council) that a girl that—in two schools in Kabul—39 % of school- from the perpetrator’s family or clan be given in children aged 7–12 (49 % of the boys vs. 29 % of marriage to someone from the victims’ family the girls) reported daily work. On average, chil- (Medica Mondiale, 2007 ) . The girls who are dren who were compelled to contribute to the involved in these practices (known as baad ) often family’s income generation worked 6.7 h⁄day suffer maltreatment and abuse, which they have (SD = 3.01) with a range of 1–13 h⁄day. no means to resist. The prevalence of these Child labour is often linked to family poverty. exchanges has not been quanti fi ed, nor are they For children who do not attend school, child permitted under Afghan state law. Nevertheless, labour is likely to be more prevalent, particularly a recent report on ‘traditional’ justice mecha- in rural, farming areas, where children are often nisms acknowledged the continued existence of called upon to participate in farm labour, or in the practice while characterising it as ‘an excep- larger cities, where children may work on the tion—not a norm’ and pointing out that its accep- streets to contribute to family income (UNICEF, tance as a vehicle for the settlement of disputes 2005 ) . Forms of child labour amounting to inden- varied between areas of the country, being alto- tured slavery can be found in carpet-weaving gether prohibited by some groups (Afghanistan workshops, brick factories and car repair estab- Human Development Report, 2007 ) . lishments (Dupree, 2004 ) .

Child Labour Child Soldiers

The law on labour in Afghanistan stipulates 14 A rapid assessment by UNICEF in 2003 found an years as the minimum legal age at which children estimated total of 8,000 combatants under the age can be employed; employment of children aged of 18 in Afghanistan. A programme for 13 as apprentices is also permitted. The most Disarmament, Demobilisation and Reintegration recent available report on working children from (DDR) was set up for child soldiers, and in 2007 the AIHRC showed that in fact a considerable more than 5,000 former child soldiers partici- number of children under the age of 13 were pated (Coalition to Stop the Use of Child Soldiers, employed or required to work by their families, 2008) . The programme worked with NGO part- often for long hours, and at the expense of attain- ners who developed community programmes to ing an education (AIHRC, 2006b ) . A subsequent provide education, life skills and vocational train- AIHRC study of children aged 5–18 in predomi- ing, and psychosocial support (Wessells, 2006 ) . nantly rural areas found that just over half were In some areas, demobilised child soldiers have working (AIHRC, 2007a ) . returned home, but have faced problems reinte- Child labour is also common among children grating in the absence of vocational training and who are able to attend school. In their 2006–2007 psychosocial support (HRW, 2004 ) . Some critics study of 11–16-year-old children attending of this programme have argued that child soldiers randomly selected schools in Kabul, Bamyan and do not appear to have more psychological prob- 66 P. Ventevogel et al. lems than children who have not been associated trated in this quote from a report by Save the with armed militia and recommend that the DDR Children on the subject: programme for children should be combined with I feel miserable. I can’t play football with my the programme for adults (Chobrok, 2005 ) . friends anymore or help my mother bring up water from the well. Why has this happened to me? I am so disappointed with my life. I don’t understand why this has happened. (10-year-old Ali; he lost Children with Disabilities one leg while the other was severely injured.)

Children with Physical Disabilities. The high Children with Intellectual Disabilities. A nation- level of malnutrition, birth complications, acci- wide epidemiological survey on disability found a dents and untreated medical conditions in point prevalence of 0.11 % for learning disabili- Afghanistan gives rise to high numbers of dis- ties (Trani & Bakhshi, 2006 ) . The case abled children. According to the most recent, identifi cation was through self-report by family carefully conducted survey by Handicap members, who were asked if there was a member International (2005), there are an estimated in the household who had delayed/slower speak- 196,000 school-aged children with disabilities in ing ability or delayed walking/mobility develop- Afghanistan; less than one in four of them attend ment compared to other members of the family, or school. Children with disabilities have tradition- who demonstrated behaviour that did not corre- ally been seen as less worthy of social investment, spond to their given age. In neighbouring Pakistan which leads to exclusion of disabled children from using a less restricted de fi nition, the prevalence of services (Turmusani, 2004 ) . Disabled children mental retardation was found to be considerably and adults also show more signs of mental distress higher than in industrialised countries: nearly one than others (Bakhshi, Trani, & Noor, 2006 ) . in 50 children had severe mental retardation and Increasing access to education in Afghanistan one in 15 mild mental retardation (Durkin, Hasan, over the last decade has not signifi cantly reduced & Hasan, 1998 ) . Many of the risk factors for men- the marginalisation of children with disabilities tal retardation in the Pakistan study are present in (Trani, Bakhshi, & Nandipati, 2012 ) . Afghanistan: perinatal diffi culties, consanguine- According to the United Nations Mine Action ous marriages, high rates of neonatal infections, Centre for Afghanistan (UNMACA), Afghanistan postnatal brain infections (cerebral malaria), mal- has one of the highest landmine casualty fi gures nourishment of pregnant women and young chil- in the world. About 70,000 Afghans have either dren, and head trauma. The diffi cult living been killed or disabled by landmines in the past conditions faced by many Afghan families, two decades. Children are especially vulnerable including poor nutrition, hygiene and health care, to injury from these weapons, often in the course lead to many developmental problems in children. of performing everyday chores such as gathering Excessive numbers of infants are born with con- wood, tending livestock and collecting water for genital abnormalities, which are probably the their families. While overall annual fi gures for result of maternal malnutrition during early foetal new mine victims are decreasing, the number of development. Developmental milestones are victims under 18 years is increasing (ICBL, signi fi cantly delayed for many Afghan children 2007 ) . In addition, UXO is easily mistaken by (Miller, Timouri, Wijnker, & Schaller, 1994 ; children for a toy or an interesting object to inves- Prasad, 2006 ) . tigate. In a study in Kabul in 1995, roughly 85 % of all UXO victims were children (Save the Children USA, 2003 ) . Violence Against Children There is no systematic research on the mental or psychosocial consequences of injuries due to Domestic Violence Against Children . In landmines or UXO on children in Afghanistan. Afghanistan violence in families is widespread, The effects are assumed to be profound as illus- and beating children is, in general, not consid- 5 Child Mental Health, Psychosocial Well-Being and Resilience in Afghanistan… 67 ered immoral when it is not excessive. The didn’t listen to me and asked me to cook food now. Afghan Independent Human Rights Commission I became angry and did not say anything to him. At the same time my son came to me and I asked (AIHRC) has drawn attention to the high level of him to wash his face, I told him to take water and domestic violence reported by children in both wash his face but he didn’t listen to me and asked rural and urban areas. In one study, over half of me to do it. I was angry with my husband, but the children interviewed by AIHRC reported I couldn’t say anything to him so I took a big stone and I threw it at my son and shouted to him, do experiencing physical violence at home; the what I am telling. I am not your servant. report authors also point out that as many chil- Unfortunately, the stone broke one of his teeth and dren were worried about answering the question, his mouth was bleeding. (Mother of a six-year-old rates of domestic violence are likely to be under- son; Smith, 2008 : 51) reported (AIHRC, 2007b ) . In her study of children in two schools in poor neighbourhoods in Women in the large-scale study by Eggerman Kabul, Catani et al. ( 2008 ) found that while 39 % and Panter-Brick (2010 ) recounted similar expe- of respondents had directly experienced war- riences of becoming violent due to frustration related events, 10 % reported having suffered at with their circumstances: least one injury due to maltreatment at home. My husband is a driver, but he doesn’t own the car Children had experienced an average of 4.3 he drives, so he has to give a large part of what he different types of domestic violence, with most earns to the owner. We have to share a house with children reporting three or more event types. four other families, we live in the separate rooms of the house and it’s diffi cult. My mind gets weaker Predictors of domestic violence included a and weaker, and I get upset and beat the kids. history of experiencing war trauma, family size, Yesterday I beat my daughter, then I felt bad about engagement in child labour and poverty. it and slapped myself on the face. (Woman, aged Smith (2008 ) interviewed Afghan adults about 28; Eggerman & Panter-Brick, 2010 :75) their views on and experience of violence against children in the home, and found that they Prospective data, from a baseline and follow- identi fi ed two distinct categories: violence used up study, have most clearly shown the impact of as a means of disciplining children and violence domestic violence on child mental health: while resulting from adult anger, stress or frustration. cross-sectional data only point to associations In the communities where the research was car- between variables, longitudinal data can assess ried out, violence towards children by family the relative causal impact of different types of members is accepted and widely practised. Much violence and socio-economic stressors. In their violence directed at children relates to how the follow-up study, Panter-Brick and colleagues adult is feeling, with adults under stress venting concluded that violence inside the family was the their anger on their children. Many people would most critical predictor of mental health trajecto- be keen to adopt nonviolent means for disciplin- ries, even in the context of exposure to extraordi- ing their children but do not know how: nary levels of collective violence (Panter-Brick Beating children also is not good. When I had my et al., 2011 ; Panter-Brick & Eggerman, 2012 ) . fi rst daughter I beat her a lot when she was very The quality of past-year family relationships was small but now I know that we should not beat chil- key to changes in depression and other psychiat- dren because they do not understand. So parents ric diffi culties: domestic violence (reported as should not beat their children. But when my husband fi ghts with me and I’m angry I beat my chil- stressful), severe beatings (reported as trauma) dren. And when I’m tired from doing housework and family con fl ict predicted worse outcomes, I beat my children very hard if they do not listen to while family ‘harmony and unity’ (Dari: ittifaq me. Once I had washed the clothes and it was three and wahdat )—a sense of family cohesion and thirty and I was very tired. My husband had been doing construction work at home. When I fi nished connectedness—predicted better outcomes. By the clothes and without giving me any break to contrast, exposure to militarised violence had no drink tea, he asked me to cook food for dinner. discernable impact on mental health changes over I said ok after having some tea I will cook. But he the period of study. Thus family environments 68 P. Ventevogel et al. may outweigh collective violence in predicting Khan ( 2009 ) reports the story of a boy whose father psychiatric burden, including depressive symp- died when he was 5 years old, and whose mother toms (but not post-traumatic stress, for which remarried and sent him to live with his grand- lifetime trauma exposure trumped all other risk mother; the latter asked him to collect wood to sell and protective factors). Family relationships are in order to contribute to her household income: also central to developmental resilience, as evi- Some people were giving me money and started to denced by better-than-expected prospective men- sexually use me. I was happy with that because it tal health outcomes. was the easiest way to have money for my grandmother. Now it is my business, even if it is shame- ful. If there is another alternative, I will stop it. Sexual Violence Against Children . In Afghanistan (Schoolboy in Kabul; cited in Khan, 2009 ) it is very dif fi cult to fi nd information on sexual abuse of children. Most information is from press Severe sexual violations against boys are reports or anecdotal accounts as no offi cial statis- thought to be most common in south and south- tics are available (IRIN, 2007, 2008 ) . Sexual abuse east of the country (FICF, 2004) but are also well against a child is considered an offence against the known in the north. There is also evidence of young honour of the family and not specifi cally a crime male adolescents being systematically exploited against the child itself (Slugget, 2003 ) . Among and sexually abused by tribal leaders, militia com- Afghans, child abuse is thought to affect boys manders or other powerful men, as part of a prac- more frequently than girls, as the latter are sup- tice known as bacha bazi [lit. ‘playing with boys’]. posed to be protected within the safety of their Often poor and orphaned, these boys are bought by homes; abuse of girls is therefore a particularly older men to dance at parties, and are sexually ‘taboo’ subject, and hidden within the family. abused by them afterwards; such gatherings also Worldwide, marriages involving underaged serve as marketplaces, with good-looking boys girls show higher rates of mother and child mor- being traded by their ‘owners’ for money. In 2008 tality, due to problems during labour, miscar- the US Department of State Bureau of Democracy, riages or unsafe abortions, and also higher risk Human Rights, and Labor concluded that ‘child for infertility in the mother and disability for their abuse was endemic throughout the country, rang- infants (WHO, 2009 ) . Medical reports in ing from general neglect, physical abuse, abandon- Afghanistan suggest that reproductive health ment, and con fi nement to work in order to pay off problems of young women constitute a health family debts,’ and that ‘sexual abuse of children burden, with case reports of girls as young as 12 remained pervasive’ (USDS, 2008 ) . years presenting with vaginal and anal bleeding resulting from early consummation of marriage (WCRWC, 2002 ) . Children in Detention In Afghanistan, the unavailability of female sexual partners for men outside of marriage seems The majority of children in detention are male to provoke the use of young boys as sexual part- (75 %), and a signifi cant number are in custody ners. In a cross-sectional sample of 4,750 men for minor offences or are illegally detained (ages 18–35) in the recruitment process for the (AIHRC, 2008 ) . Children face jail for ‘moral’ Afghan National Army, 18.3 % reported having offences, such as sodomy or adultery for boys, had sexual relations with boys. Very few of them and running away from an oppressive home life (2.6 %) reported ever using condoms in such con- for girls. For adults in the prison system, torture tacts (Todd, Macdonald, et al., 2012; Todd, Nasir, is reported as routine procedure, particularly et al., 2012 ) . Traditionally, the ‘keeping’ of hand- to gain a confession. Conditions in government some boys is a marker of status and prestige for jails are poor, and there is a lack of adequate men. The practice visibly continues today, with legal representation for children, as well as a militia commanders and other important leaders history of corruption in the judicial process. accompanied by teenage ‘tea boys,’ and truck Moreover, children—particularly boys—are likely drivers by a young assistant referred to as a ‘wife’. to experience violence when arrested (AIHRC). 5 Child Mental Health, Psychosocial Well-Being and Resilience in Afghanistan… 69

a step-by-step approach and a willingness to work Services to Assist Afghan Children with existing community-based and governmen- and Youth tal structures is required. Effort must be put into the creation of networks and the nurturing of col- Psychosocial well-being of children can be lective action to improve the lives of Afghan chil- affected by traumatic events and by daily stres- dren and their families. sors. Traumatic stressors may include war-related Several organisations provide services for events, but also family con fl ict and community- Afghan children; however, existing initiatives are level violence not directly related to war (Panter- fragmented, and many extant programmes are in Brick et al., 2009 ) . Daily stressors consist of social the embryonic stage at best. Such efforts are often and economic hardships in everyday life, related initiated and run by international NGOs and reach to physical ill health, malnutrition, crowding, relatively small numbers of targeted groups; they unemployment, low wages, illiteracy and gender- may not be fi rmly rooted in Afghan social struc- based discrimination including domestic violence, tures and may not prove to be sustainable. social isolation and barriers to equitable access to International consensus documents such as the health, educational and vocational resources IASC guidelines on mental health and psychoso- (Arntson, 2001 ; De Berry et al., 2003 ; Miller, cial support in emergency settings (IASC, 2007 ) Omidian, Rasmussen, Yaqubi, & Daudzai, 2008 ; recommend that services must be connected Omidian & Miller, 2006 ) . Thus, the call from within a multi-layered support system, in order to public health advocates for a population-based, cater for a range of people affected in different youth-focused model, which explicitly integrates ways who may require different kinds of mental mental health with other health and welfare initia- health and psychosocial support (Fig. 5.1 ). We tives in low- and middle-income countries (Patel will provide an overview of existing initiatives in et al., 2007 ) , is highly relevant for Afghanistan. terms of this framework of interrelated services. Successful mental health and psychosocial A small percentage of people experience intol- support programming in Afghanistan has to take erable suffering and have signi fi cant dif fi culties into account the complex political, socio-eco- in daily function; they would need access to clini- nomic and cultural situation of the country. It is cal, psychological, psychiatric or other highly hard to build sustainable systems of care, and in specialised supports. A majority of people man- Afghanistan this requires taking community vari- age to cope with dif fi culties and distress through ation into account in the design, implementation access to local, non-formal support systems bol- and evaluation of programme initiatives. It stered by the re-establishment of adequate secu- requires collaboration with organisations and rity, governance and services that meet basic groups at community and district level, and with survival needs. In between these extremes are formal structures such as ministries and pro- people affected by disruptions in key family and grammes at national and provincial level. community support networks, who will bene fi t Interventions have to address huge gaps between from efforts such as tracking down missing fam- national-level policies and local priorities in the ily members and effecting a reuni fi cation, com- lives of ordinary people. Community relations munal healing ceremonies, formal and non-formal with the outside world and regional political education, livelihood activities and the strength- elites are often mediated through personal rela- ening of hope and social capital (Jordans, Tol, tionships with powerful decision-making ‘key Komproe & de Jong, 2009 ; Jordans, Tol, et al., fi gures’ at the national level. Until these higher- 2010 ; Wessells & Van Ommeren, 2008 ) . level elites are willing to allow transformation of existing power relations, it will be dif fi cult to change social systems where change is required Layer 1: Basic Services and Security to meet the goals of quality and equity in access to basic services, and the effectiveness ability of The most important interventions to improve programmes will be limited. Given this situation, mental health and psychosocial well-being for 70 P. Ventevogel et al.

Fig. 5.1 Intervention pyramid for mental health and psychosocial support (IASC Reference Group MHPSS, 2010 )

Afghan children and youth have apparently noth- political instability. The continued violence ing to do with psychosocial support and mental between anti-government insurgents and pro- health care. The best guarantee for improved government forces, including foreign military mental health status is the normalisation of liv- troops, prevents a normalisation of life for many ing circumstances and the alleviation of severe Afghans. In particular, attacks by Taliban on problems resulting from poverty and insecure schools catering for girls and other public ser- livelihoods. Programmes to promote income vices for women increase the sense of insecurity generation and reduce children’s workloads will among the population. Loughry et al. ( 2005 ) have direct bene ﬁ cial effects on children and present a salient illustration of the importance of their families. The development of infrastruc- providing basic needs to improve psychosocial ture, health and educational services are impor- well-being. Using a quasi-experimental design, tant elements of the reconstruction of the project compared the effects after 9–14 Afghanistan, as well as initiatives that bring months of a ‘psychosocial’ intervention, consist- together youth, local communities and stake- ing of child-centred spaces and activities facili- holders to increase general child safety, as tated by Child Well-Being Committees (described exempliﬁ ed by demining and road safety cam- below in layer 2) with an intervention to improve paigns (De Berry, 2008 ) . basic services: a water sanitation programme consisting of the construction of wells using a Example : Building water wells improves psycho- participatory process. A questionnaire-based social well - being measure indicated that the water intervention had An important impediment to healthy psycho- greater impact on children’s well-being than the social development is ongoing violence and psychosocial intervention. 5 Child Mental Health, Psychosocial Well-Being and Resilience in Afghanistan… 71

Layer 2: Community and Family-Level that aim to mobilise, monitor and guide child Support protection efforts. The committees address a variety of issues relevant to children such as health The second layer represents services to enable and hygiene, child protection, parenting skills people to maintain good mental health and psy- and monitoring the protection of vulnerable chil- chosocial well-being by accessing key commu- dren in the community. During evaluations in nity and family support (Van Mierlo, 2012 ) . In 2005, children felt safer, went to school more the Afghan context, appropriate activities for often, made friends with children from other eth- children and youth might consist of promoting nic groups and—according to their parents— alternative disciplining techniques and providing exhibited better behaviour (Loughry et al., 2005 ) . child-rearing support. Examples include aware- A 2006 follow-up revealed signifi cant changes in ness-raising workshops for parents, teachers or children’s self-reported behaviours: negative local religious leaders, involving adolescents in behaviours such as fi ghting with and hitting other meaningful activities to prevent substance abuse, children declined. In remote Faryab province, training community members to better provide girls reported a dramatic increase in their ability psychosocial support, and discouraging child to speak up in a group. This fi nding was corrobo- abuse and maltreatment, social exclusion, gender rated by reports from community members, one discrimination and domestic violence. Further of whom described the children as follows: options include the activation of social networks They are aware of their rights . They know things in through youth clubs or the development of recre- the right ways. They are able to prepare songs and ational spaces to provide opportunities for shar- poems and [know] how to gather information ing experiences and mutual learning. A similar about the problems in the community. The change is positive. Children share information with other approach is the promotion of ‘child-centred children and attempt to have the other children spaces’, places where children who have often involved in the activities. Children will know what lived with war all their lives can resocialise to do when they are adults, how to resolve prob- through play and education in the norms and val- lems and to allow children to participate (Women’s Community Committee Member; USAID/DCOF, ues of peaceful Afghan society (Snider & 2007 ) . Triplehorn, 2003 ) . We give two examples of interventions offering community-level and family support undertaken in Afghanistan: Example : Promotion of physical education and play in schools and communities Example : Child Well -Being Committees , giving The NGO ‘War Child Holland’ implemented children a voice in decision -making psychosocial activities in schools and in commu- Since 2002, three major international NGOs nities throughout Herat and Kabul (Ventevogel, (Child Fund Afghanistan, Save the Children USA van Huuksloot & Kortmann, 2005 ) . A component and International Rescue Committee) formed the of this programme was getting non-school- Consortium for the Psychosocial Care and attending working children back to school. Protection of Children, with the objective to Communities are encouraged to develop chil- ‘improve, in a sustainable manner, the psychoso- dren’s clubs as a means through which issues cial well-being and development opportunities of affecting children could be identi fi ed, explored Afghan children, enabling primary and second- and addressed through subsequent advocacy ary stakeholders to cope better with the effects of campaigns. The programme used community- a poverty-stricken, protracted confl ict environ- relevant indicators related to social change, such ment through participatory, community-based as increased opportunities to meet peers and programming’ (USAID/DCOF, 2007 ) . The back- escape from isolating and monotonous home- bone of this approach is the establishment of based activities, improved balance between Child Well-Being Committees, consisting of a work-related responsibilities and leisure activi- mixed group of children, adolescents and adults ties, less violent games (which often trigger 72 P. Ventevogel et al. memories of confl ict), more positive interactions ensure appropriate follow-up support, ongoing between children, the understanding and accep- training and supervision. Omidian and Lawrence tance by adults of children’s right to play, and the ( 2007) describe how they use ‘focusing’ self- importance of play for child development and therapy—a therapeutic technique of ‘bringing well-being. A 2006 evaluation of the school- and attention to the body in a gentle, accepting community-based work found that there has been way and becoming aware of felt sensations, lead- an increase in parent’s support for children’s play ing to insight, physical release and positive life and learning. Girls in particular had received change’—which connects well with the rich increased support from adults to play and attend Afghan heritage of Islamic Su fi philosophy and school; many girls had not been permitted to play Farsi poetry. before. The attendance of girls and working children in learning activities was seen as a clear Example : Helping school teachers to provide expression of increased support, as some of these psychosocial support required a small fee from parents for participa- In Afghanistan many teachers have no notion tion. As one mother stated: of teaching beyond academic instruction and lack I have fi ve daughters and they are all involved in the necessary skills to promote the social and the NGO activities . They are in different courses emotional development of children. Organisations and they are learning things like tailoring and such as Save the Children USA and UNICEF English . We have an activity now . We did not have have made an effort to integrate training on psy- any when we were in Iran , because they looked down on us because we are Afghans . Now I am chosocial support into the primary school teacher happy that my daughters can learn things that I curriculum. With approval of the Afghan Ministry could not . We want to open fi rst aid and beauty of Education, a training module was developed classes . We are also learning table tennis (Woman on how teachers could offer psychosocial support in Herat Province; report by War Child Holland, 2007). and take measures to protect children. The module aimed to help teachers integrate traditional Afghan coping strategies for promoting emotional well-being into their work. The Ministry of Layer 3: Focused Nonspecialised Education prepared and distributed the training Supports package to all primary school teachers in Afghanistan (De Berry, 2004 ) . Similar approaches The third layer consists of focused support for have been taken to train teacher in psychosocial people who require individual, family or group wellness models and to enable them to provide interventions by trained and supervised workers improved psychosocial support to children in who are not necessarily specialists in mental health the classroom (Omidian, 2012; Omidian & and psychosocial support. Interventions within Papadopoulos, 2003 ) . this layer can include a system of caseworkers who provide psychosocial support to families and individuals. In Afghanistan, HealthNet TPO has Layer 4: Specialised Services developed community-based psychosocial work using para-professional psychosocial workers as The pyramid’s top layer represents specialised the backbone of the service (HealthNet, 2008a ) . interventions required for a small percentage of Structured psychosocial group interventions for people with severe psychological complaints or children and youth with symptoms of moderate mental disorders. Appropriate interventions distress have not been documented for Afghanistan, include services to treat substance abuse in ado- but there is some evidence for its effectiveness in lescents, and the identi fi cation and treatment of other settings (Bolton et al., 2007 ; Jordans, severely depressed children. Afghanistan does Komproe, et al., 2010 ; Jordans, Tol, et al., 2010 ; not have specialised services for child psychiatry Tol et al., 2008 ) . Organising such services requires or child psychology (Ventevogel, Nassery, a long-term commitment by skilled helpers to Azimi, & Faiz, 2006 ; Rahimi & Azimi, 2012 ) . 5 Child Mental Health, Psychosocial Well-Being and Resilience in Afghanistan… 73

Institutional mental health services hardly exist, regard to the provision of mental health services with just one national mental health hospital and in Afghanistan (WHO, 2013 ). One speci fi c prior- four psychiatric wards in general hospitals. The ity is tailoring mental health and social services to proportion of child and adolescent users of these the needs of children and adolescents. mental health services is low (WHO-AIMS, 2006 ) . Given the extreme scarcity of Afghan mental health professionals and limited fi nancial Conclusions resources, the establishment of specialised mental health services for children in the country still This chapter has provided a focused study of has a long way to go. research and intervention efforts related to child The World Health Organization advocates the mental health and well-being in Afghanistan. We inclusion of mental health services within existing reviewed the structural adversities that challenge primary health care services (WHO, 2008 ) . This Afghan children and adolescents, in terms of war, entails training health care workers to identify displacement, poverty, widening inequalities, mental, neurological and substance use disorders, social expectations and restricted opportunities installing a system of clinical supervision and reg- for education and health care. We reviewed the ular medication supply, and promoting awareness- evidence base for psychosocial distress and men- raising activities in communities. In Afghanistan tal health disorders, emphasising the importance this approach has been developed by NGOs such of family dynamics and the capacity for resil- as HealthNet TPO in eastern Afghanistan and the ience. A fundamental take-home lesson from International Assistance Mission (IAM) in the Afghanistan is that the family is a central institu- western provinces around Herat (Ventevogel et al., tion shaping child health and well-being—in 2012 ; Ventevogel, Faiz, & van Mierlo, 2011 ; terms of both everyday distress and everyday Ventevogel & Kortmann, 2004 ) . resilience. Six fundamental cultural values—faith Afghan NGOs such as Windows for Life ( iman ), family unity and harmony (wahdat and (WFL), Humanitarian Organization Supporting ittifaq), service (khidmat ), perseverance and effort Afghans (HOSA) and Medica Mondiale provide ( koshesh ), morals (akhlaq ), and respectability and psychosocial services through psychosocial coun- honour (izzat )—underpin the sense of resilience sellors who have had intensive training in a vari- in Afghan culture. These key values provide a ety of counselling techniques and are extensively moral framework to make sense of suffering, reg- supervised. These services are not speci fi cally ulate social behaviour, maintain a sense of hope geared towards children and adolescents. A recent and human dignity, and give a sense of coherence randomised control trial among Afghan women to past experiences and future aspirations. ( n = 61), diagnosed with poor mental health symp- A second key point is that family relationships toms by local physicians, compared the impact of and cultural values are themselves a driver of routine medical treatment (treatment as usual) poor mental health, where war, poverty and dis- with psychosocial counselling (for 5–8 sessions) crimination steal away the wherewithal to realise following a purposively developed protocol. At economic and social milestones. Family relation- 3-month follow-up, the patients who had received ships become marred by confl ict, while ambitions psychosocial counselling showed a drastic to adhere to cultural values are frustrated by dire decrease in symptoms of depression and anxiety poverty or powerlessness—this drives ordinary and an enhancement of coping strategies, while people into a sense of entrapment, especially with no such improvements were seen in the control regard to cultural dictates governing reproductive group (Ayoughi, Missmahl, Weierstahl, & Elbert, and economic decisions. Such drivers of psycho- 2012 ) .We may conclude that adding psychosocial logical distress and social entrapment are espe- services into the basic health care services of cially relevant for children who are forcibly Afghanistan has proven to be both feasible and married, children in forced labour, children with effective. Yet there is still a long road ahead, physical or intellectual disabilities, children who despite the impressive progress made to date with face domestic or sexual violence, and children 74 P. Ventevogel et al. using illicit drugs or resorting to self-injury. strengthen coping and resilience in families and ‘Everyday stressors’, rooted in poverty and vio- local communities, and initiatives that enable lence, generate lasting psychological distress in community-based health workers and teachers to children and adolescents, over and above the assist children who present psychosocial prob- more dramatic forms of trauma associated with lems that cannot be handled with simple family the brutality of war. or community support. Specialised clinical inter- The implication of such research fi ndings is ventions, constituting the very top of the pyra- that structural injustices in Afghanistan (includ- mid, target children and adolescents with severely ing gender and ethnic discrimination, lack of disabling mental disorders and substance use dis- stable employment opportunities and exposure to orders, who cannot be adequately supported violence) need to be addressed through a multi- within other layers of the service system. level system of interventions that cuts across sec- We believe it is essential to view services pro- tors of health, education, employment and social vision within such a broad perspective to ensure work. Indeed, with respect to child mental health, that culturally relevant interventions to improve policy-makers, researchers and practitioners have mental health and psychosocial well-being begun to move well beyond a primary consider- encompass efforts to build resilience, rather than ation of the acute negative impacts of war-related just focus on at-risk groups of children. Building violence. Efforts to design integrated, effective resilience in Afghanistan entails strengthening and equitable access to basic health, social and families and communities, addressing the main economic services are still fragmented, but there factors which weaken helpful social ties: poor is a sense that real progress has been made to governance, economic and political insecurity, date, and that formal evaluation of concrete ini- severe overcrowding, recurrent domestic vio- tiatives will provide an important next step lence and unequal opportunities for education towards the consolidation of basic service provi- and advancement. We therefore call for broad sion. Because education is often perceived as the community-oriented approaches to address issues gateway to social and economic success, and of mental health and psychosocial well-being, because Afghans often express hope in the future giving speci fi c attention to the physical needs in terms of social prominence and economic and social aspirations of children and adoles- milestones, initiatives to improve the quality of cents. To be successful, such initiatives are best education are crucially important. Other inter- embedded in a multi-sectoral approach that ventions have focused on livelihoods and com- addresses larger issues pertaining to poverty munity governance, such as building wells and reduction, environmental safety, quality health establishing child-centred spaces. Yet other pro- and education, family dynamics and stability of grammes have been concerned with fostering governance, livelihoods and social structures—a community-based psychosocial support, includ- matter of securing a stable future and dignity at ing training psychosocial workers or group inter- the most crucial social level, that of the family. ventions based on therapeutic techniques such as focusing. This is a rich tapestry of interventions but one that needs better integration in existing Summary Points systems in such a way that sources of resiliency are strengthened rather than undermined. • The study of psychosocial distress in children The best way forward is to answer to the sim- and adolescents in Afghanistan needs to con- ple logic of a pyramid structure with intercon- sider the critical importance of ‘everyday’ nected layers of interventions: the bottom layer adversity rooted in poverty and domestic vio- of the pyramid encompasses initiatives for equi- lence and not merely focus on the direct effects table access to broad-based services such as of military violence. health care, education and shelter. The middle • The bedrock of resilience is hope, underpinned layers of the pyramid focus on activities aimed to by cultural values which provide a moral 5 Child Mental Health, Psychosocial Well-Being and Resilience in Afghanistan… 75

framework to cope with life adversity; how- Commission. Retrieved from http://www.aihrc.org.af/ ever, the pursuit of these cultural values may reports_eng.htm . Accessed 16 January 2009. AIHRC. (2008). Justice for children. The situation of foster a sense of entrapment. children in confl ict with the law in Afghanistan . • Family is the most important context for child Kabul: Afghanistan Independent Human Rights well-being, distress and resilience. Children in Commission. especially dif fi cult circumstances confront Arntson, L. (2001). Review of psychosocial support activities in the former soviet embassy compound early marriage, forced labour, curtailed educa- IDP camp . Kabul: Save the Children. tion, domestic or sexual violence, disabilities, Arur, A., Peters, D., Hansen, P., Mashkoor, M. A., self-injury and illicit drugs. Steinhardt, L. C., & Burnham, G. (2010). Contracting • To build upon concrete but still-fragmented for health and curative care use in Afghanistan between 2004 and 2005. Health Policy and Planning, 25 , efforts to improve child mental health in 135–144. Afghanistan, interventions need to address the Ayoughi, S., Missmahl, I., Weierstahl, R., & Elbert, T. structural drivers of psychosocial distress, (2012). Provision of Mental Health Care Services in address the impact of family-level violence as Resource-Poor Settings: A randomised trial comparing counselling with routine medical treatment in well as military confl ict, assist families and North Afghanistan. BMC Psychiatry, 12 , 14. communities to cope with psychosocial prob- Bakhshi, P., Trani, J. F., & Noor, A. A. (2006). Towards lems and integrate specialised mental health wellbeing for Afghans with disability: The health interventions within general health care, social Challenge: National Disability Survey Afghanistan 2005 . Lyon/Kabul: Handicap International. and educational service provision. Behnam, S., & Afzali, S. (2006). Afghan Drug Boom Fuels Child Addiction Rates. Institute for War and Acknowledgements We wish to thank Ha fi zullah Faiz, Peace Reporting (IWPR). Retrieved from http:// M.D., former mental health programme manager of www.iwpr.net . http://iwpr.net/?p=arr&s=f&o=325631& HealthNet TPO in Afghanistan, and the staff members apc_state=heniarr2006 . Accessed 2 January 2008. of HealthNet TPO’s mental health programme in Billaud, J. (2012). Suicidal performances: voicing discon- Afghanistan; Ivan Komproe, Ph.D., from HealthNet TPO; tent in a girls’ dormitory in Kabul. Cult Med Psychiatry, Julian Smith, Eshaq Zakhizada and Najeeb Nuristani, 36(2), 264–285. from War Child Holland; and Michael Wessells, Ph.D., Bolton, P., & Betancourt, T. S. (2004). Mental health in from Columbia University. postwar Afghanistan. Journal of the American Medical Association, 292 , 626–628. Bolton, P., Bass, J., Betancourt, T., Speelman, L., Onyango, G., Clougherty, K. F., et al. (2007). Interventions for depression symptoms among adolescent survi- References vors of war and displacement in Northern Uganda. Journal of the American Medical Association, 298 , Afghanistan Human Development Report. (2007). 519–527. Bridging modernity and tradition—Rule of law and Catani, C., Schauer, E., & Neuner, F. (2008). Beyond indi- the search for justice. Kabul: Centre for Policy and vidual war trauma: Domestic violence against children Human Development. in Afghanistan and Sri Lanka. Journal of Marital and AIHRC. (2006a). Evaluation report on the general situa- Family Therapy, 34 , 165–176. tion of women in Afghanistan . Kabul: Afghanistan Catani, C., Schauer, E., Elbert, T., Missmahl, I., Bette, Independent Human Rights Commission. Retrieved J.-P., & Neuner, F. (2009). War trauma, child labor, from http://www.aihrc.org.af/Evaluation_Rep_Gen_ and family violence: Life adversities and PTSD in a Sit_Wom.htm . Accessed 16 January 2009. sample of school children in Kabul. Journal of AIHRC. (2006b). An overview on situation of child labour Traumatic Stress, 22 , 163–171. in Afghanistan . Kabul: Afghanistan Independent Chobrok, V. (2005). Demobilizing and reintegrating Human Rights Commission. Retrieved from http:// Afghanistan ’s young soldiers (Rep. No. Report 42). www.aihrc.org.af/reports_eng.htm . Accessed 16 Bonn, Germany: BICC. January 2009. Coalition to Stop the Use of Child Soldiers. (2008). Child AIHRC. (2007a). The general situation of children in Soldiers Global Report 2008. London: Coalition to Afghanistan . Kabul: Afghanistan Independent Human Stop the Use of Child Soldiers. Rights Commission. Retrieved from http://www.aihrc. De Berry, J., Fazili, A., Farhad, S., Nasiry, F., Hashemi, S., org.af/reports_eng.htm . Accessed 16 January 2009. & Hakimi, M. (2003). The children of Kabul: AIHRC. (2007b). Economic & social Rights in Afghanistan Discussions with Afghan families . Kabul: Save the II. Kabul: Afghanistan Independent Human Rights Children USA and UNICEF. 76 P. Ventevogel et al.

De Berry, J. (2004). Community psychosocial support in IASC. (2007). IASC guidelines on mental health and psy- Afghanistan. Intervention, 2 , 143–151. chosocial support in emergency settings . Geneva: De Berry, J. (2008). The challenges of programming with Inter-Agency Standing Committee. youth in Afghanistan. In J. Hart (Ed.), Years of confl ict: IASC Reference Group MHPSS. (2010). Mental health Adolescence, political violence and displacement and psychosocial support in humanitarian emergen- (pp. 209–229). New York: Berghahn. cies: What should humanitarian health actors know? De Jong, E. (1999). Mental health assessment, Ghurian Geneva: Inter-Agency Standing Committee Reference and Zendah Jan districts, Herat province, Afghanistan . Group for Mental Health and Psychosocial Support in Brussels, Belgium: Médecins Sans Frontières. Emergency Settings. Donini, A. (2007). Local perceptions of assistance ICBL. (2007). Factsheet Afghanistan . International to afghanistan. International Peacekeeping, 14(1), Campaign to Ban Landmines. Retrieved from http:// 158–172. www.icbl.org/lm/2007/afghanistan . Accessed 27 Dupree, L. (1980). Afghanistan . Princeton, NJ: Princeton December 2007. University Press. IRIN. (2006). Desperate women choose suicide . Reuters Dupree, N. H. (2004). The family during crisis in AlertNet, November 29, 2006. Afghanistan. Journal of Comparative Family Studies, IRIN. (2007). War , poverty and ignorance fuel sexual 35 , 311–331. abuse of children . (Kandahar) 6 June, 2007. Durkin, M. S., Hasan, Z. M., & Hasan, K. Z. (1998). IRIN. (2008). Little support for victims of child sexual Prevalence and correlates of mental retardation among abuse . (Kabul) 16 June, 2008. children in Karachi, Pakistan. American Journal of Izutsu, T., Tsutsumi, A., Sato, T., Naqibullah, Z., Wakai, Epidemiology, 147 , 281–288. S., & Kurita, H. (2005). Nutritional and mental health Edward, A., Dwivedi, V., Mustafa, L., Hansen, P. M., status of Afghan refugee children in Peshawar: Peters, D. H., & Burnham, G. (2009). Trends in the A descriptive study. Asia-Paci fi c Journal of Public quality of health care for children aged less than 5 Health, 17 , 93–98. years in Afghanistan, 2004-2006. Bulletin of the World Jordans, M. J. D., Tol, W. A., Komproe, I. H., & de Jong, Health Organization, 87 , 940–949. J. T. V. M. (2009). Systematic review of evidence and Eggerman, M., & Panter-Brick, C. (2010). Suffering, treatment approaches: Psychosocial and mental health hope, and entrapment: Resilience and cultural values care for children in war. Child and Adolescent Mental in Afghanistan. Social Science & Medicine, 71 , Health, 14 , 2–14. 71–83. Jordans, M. J., Tol, W. A., Komproe, I. H., Susanty, D., Fergusson, J. (2010). Taliban . London: Bantam Press. Vallipuram, A., Ntamatumba, P., et al. (2010). FIFC. (2004). Human security and livelihoods of rural Development of a multi-layered psychosocial care sys- Afghans, 2002Ð2003 . Boston: Feinstein International tem for children in areas of political violence. International Famine Center Youth and Community Program Tufts Journal of Mental Health Systems, 16(4), 15. University. Jordans, M. J. D., Komproe, I. H., Tol, W. A., Kohrt, B., Gupta, L. (1997). Psychosocial assessment of children Luitel, N., Macy, R. D. M., et al. (2010). Evaluation exposed to war related violence in Kabul . Kabul: of a classroom-based psychosocial intervention in UNICEF. confl ict-affected Nepal: A cluster randomized HealthNet TPO. (2008a). Rehabilitation through controlled trial. Journal of Child Psychology and Psychosocial care: Consolidation and further devel- Psychiatry, 51 , 818–826. opment of the psychosocial program in Afghanistan . Kanji, Z., Drummond, J., & Cameron, B. (2007). Amsterdam: HealthNet TPO. Resilience in Afghan children and their families: HealthNet TPO. (2008b). Psychosocial and Mental Health A review. Paediatric Nursing, 19 , 30–33. Assessment of Children in Afghanistan, July to Karlsson, P., & Mansory, A. (2007). An Afghan dilemma: September 2008 . Kabul: Amsterdam: HealthNet TPO Education, gender and globalisation in an Islamic Afghanistan. context. Studies in International and Comparative HealthNet TPO. (2008c). Psychosocial and Mental Health Education 72 . Stockholm: Institute of International Needs Assessment in Uruzgan , Afghanistan . Kabul, Education at Stockholm University. unpublished report submitted to the Dutch Consortium Kassam, A., & Nanji, A. (2006). Mental health of Afghan for Uruzgan II (DCU-II). Amsterdam: HealthNet refugees in Pakistan: A qualitative rapid reconnais- TPO. sance fi eld study. Intervention, 4 , 58–66. Hoodfar, H. (2008). The long road home: Adolescent Khan, S. (2009). Rapid assessment of male vulnerabilities Afghan refugees in Iran contemplate ‘return’. In J. to HIV and sexual exploitation in Afghanistan. Final Hart (Ed.), Years of con fl ict. Adolescence, political Report . London: Naz Foundation International. violence and displacement (pp. 165–187). New York: Layne, C., Waren, J., Watson, P., & Shalev, A. (2007). Berghahn. Risk, vulnerability, resistance, and resilience: Towards HRW. (2004). Afghanistan: Child soldier use. Briefi ng an integrative conceptualization of posttraumatic for the 4th UN Security Council open debate on chil- adaptation. In M. Friedman, T. Keane, & P. Resick dren and armed confl ict . New York: Human Rights (Eds.), Handbook of PTSD (pp. 497–520). London: Watch. Guilford Press. 5 Child Mental Health, Psychosocial Well-Being and Resilience in Afghanistan… 77

Loughry, M., Macmullin, C., Eyber, C., Ababe, B., Ager, health: A school-based survey in Afghanistan. Lancet, A., Kostelny, K., et al. (2005). Assessing Afghan 374 , 807–816. Children’s psychosocial well-being . A multimodal Panter-Brick, C. (2010). Con fl ict, violence, and health: study of intervention outcomes. (Unpublished report) Setting a new interdisciplinary agenda. Social Science CCF, Oxford University, Queen Margaret University. & Medicine, 70 , 1–6. http://www.forcedmigration.org . Panter-Brick, C., Goodman, A., Tol, W., & Eggerman, M. Mann, C. (2006). Les shahidé du monde traditionnel: le sui- (2011). Mental health and childhood adversities: cide des jeunes fi lles afghanes. Recueil Alexandries , A longitudinal study in Kabul Mental health and child- Collections Esquisses . Retrieved from http://www.reseau- hood adversities: A longitudinal study in Kabul, terra.eu/article439.html . Accessed 2 August 2012. Afghanistan. Journal of the American Academy of Medica Mondiale. (2007). Dying to be heard: Self- Child and Adolescent Psychiatry, 50 , 349–363. immolation of women in Afghanistan. Findings of a Panter-Brick, C., & Eggerman, M. (2012). Understanding research project . Kabul: Medical Mondiale. culture and resilience: The production of hope. In M. Miller, K. E., Kulkarni, M., & Kushner, H. (2006). Beyond Ungar (Ed.), The social ecology of resilience (pp. 369– trauma-focused psychiatric epidemiology: Bridging 386). New York: Springer. research and practice with war-affected populations. The Patel, V., Flisher, A. J., Hetrick, S., & McGorry, P. (2007). American Journal of Orthopsychiatry, 76, 409–422. Mental health of young people: A global public-health Miller, K. E., Omidian, P., Quraishy, A. S., Quraishy, challenge. Lancet, 369 , 1302–1313. N., Nasiry, M. N., Nasiry, S., et al. (2006). The Physicians for Human Rights. (1998). The Taliban’s war Afghan symptom checklist: A culturally grounded on women: A health and human rights crisis in approach to mental health assessment in a confl ict Afghanistan . Cambridge, MA: Physicians for Human zone. The American Journal of Orthopsychiatry, 76 , Rights. 423–433. Prasad, A. N. (2006). Disease pro fi le of children in Kabul: Miller, K. E., Omidian, P., Rasmussen, A., Yaqubi, A., & The unmet need for health care. Journal of Daudzai, H. (2008). Daily stressors, war experiences, Epidemiology and Community Health, 60 , 20–23. and mental health in Afghanistan. Transcultural Rahimi, Y. A., & Azimi, S. (2012). War and the crisis Psychiatry, 45 , 611–638. of mental health in Afghanistan. International Miller, L. C., Timouri, M., Wijnker, J., & Schaller, J. G. Psychiatry, 9(3), 55–57. (1994). Afghan refugee children and mothers. Archives Raj, A., Gomez, C., & Silverman, J. G. (2008). Driven to of Pediatrics & Adolescent Medicine, 148 , 704–708. a fi ery death: The tragedy of self-immolation in Morris, J., van Ommeren, M., Belfer, M., Saxena, S., & Afghanistan. The New England Journal of Medicine, Saraceno, B. (2007). Children and the Sphere stan- 358 , 2201–2203. dards on mental and social aspects of health. Disasters, Raj, A., Gomez, C. S., & Silverman, J. G. (2011). 31 , 71–90. Multisectorial Afghan perspectives on girl child mar- MOPH. (2009). Basic package of health services riage: Foundations for change do exist in Afghanistan. 2009/1388 . Kabul: Ministry of Public Health. Violence Against Women, 2011 , March 29. MOWA. (2008). Women and men in Afghanistan: Baseline doi: 10.1177/1077801211403288 . statistics on gender. Kabul: Ministry of Women’s Rasekh, Z., Bauer, H. M., Manos, M. M., & Iacopino, V. Affairs. (1998). Women’s health and human rights in Omidian, P. (2012). Developing culturally relevant psy- Afghanistan. Journal of the American Medical chosocial training for Afghan teachers. Intervention, Association, 280 , 449–455. 10 (3), 237–248. Rashid, A. (2001). Taliban: The story of the Afghan Omidian, P., & Lawrence, N. J. (2007). A community Warlords . London: Pan Books. based approach to focusing: The Islam and Focusing Rodin, D., & van Ommeren, M. (2009). Explaining Project of Afghanistan. Folio, Journal for Focusing enormous variations in rates of disorder in trauma- and Experiential Therapy, 20 , 152–164. focused psychiatric epidemiology after major emer- Omidian, P., & Miller, K. (2006). Addressing the psycho- gencies. International Journal of Epidemiology, 38 , social needs of women in Afghanistan. Critical Half, 1045–1048. 4 , 17–22. Sabri, B., Siddiqi, S., Ahmed, A. M., Kakar, F. K., & Omidian, P., & Papadopoulos, N. (2003). Addressing Perrot, J. (2007). Towards sustainable delivery of Afghan children’s psychosocial needs in the class- health services in Afghanistan: Options for the future. room: A case study of a training for trainers . Peshawar, World Health Bulletin, 85 , 712–718. Pakistan: International Rescue Committee. Save the Children USA. (2002). Afghanistan: Children in Panter-Brick, C., Eggerman, M., Mojadidi, A., & McDade, crisis . Westport: Save the Children USA. T. W. (2008). Social stressors, mental health, and Save the Children USA. (2003). Children and landmines . physiological stress in an urban elite of young Afghans Westport: Save the Children USA. in Kabul. American Journal of Human Biology, 20 , Sellick, P. (1998). The impact of confl ict on Afghan 627–641. children . Kabul: UNICEF/Save the Children. Panter-Brick, C., Eggerman, M., Gonzalez, V., & Safdar, Slugget, C. (2003). Mapping of psychosocial support for S. (2009). Ongoing violence, suffering and mental girls and boys affected by child sexual abuse in four 78 P. Ventevogel et al.

countries in south and central Asia . Dhaka, UNESCO. (2010b). Education under attack. Paris: United Bangladesh: Save the Children. Nations Educational, Scientifi c and Cultural Smith, D. (2008). Love , fear and discipline: Everyday Organization. violence toward children in Afghan families . Kabul: UNICEF. (2005). Investing in the children of the Islamic Afghanistan Research & Evaluation Unit (AREU). world . New York: UNICEF. Available at http://www.areu.org.af . UNICEF. (2011). The state of the world’s children 2011 . Snider, L., & Triplehorn, C. (2003). Assessment of CCF’s New York: UNICEF. emergency entry program into Afghanistan: Its impact UNODC. (2005). Afghanistan drug use survey, 2005 . on child well-being and protection . Richmond: Kabul: United Nations Of fi ce for Drug Control & the Christian Children Fund. Ministry of Counter Narcotics of the Government of Strang, A. B., & Ager, A. (2003). Psychosocial interven- Afghanistan. tions: Some key issues facing practitioners. UNODC. (2009). Afghanistan’s drug use survey 2009 . Intervention, 1 , 2–12. Kabul: United Nations Of fi ce for Drug Control. Tang, A. (2006). Afghan women commit suicide by fi re . USAID/DCOF. (2007). Internal evaluation integrated Reuters News Agency, November 18, 2006. consortium report . Kabul: NGO consortium for the Todd, C. S., Macdonald, D., Khoshnood, K., Mansoor, psychosocial care and protection of children (Child G. F., Eggerman, M., & Panter-Brick, C. (2012). Opiate Fund Afghanistan, Save the Children USA, use, treatment, and harm reduction in Afghanistan: International Rescue Committee). Recent changes and future directions. The International USDS. (2008). Afghanistan Country Report on human Journal on Drug Policy, 23 (5), 341–345. rights practices . Washington: US Department of State— Todd, C. S., Nasir, A., Mansoor, G. F., Sahibzada, S. M., Bureau of Democracy, Human Rights, and Labor. Jagodzinski, L. L., Salimi, F., et al. (2012). Cross- Van Mierlo, B. (2012). Community Systems Strengthening sectional assessment of prevalence and correlates of in Afghanistan: A way to reduce domestic violence and blood-borne and sexually-transmitted infections to reinforce women’s agency. Intervention, 10, 134–145. among Afghan National Army recruits. BMC Van de Put, W. (2002). Addressing mental health in Infectious Diseases, 12 , 196. Afghanistan. Lancet, 360 (Suppl), s41–s42. Tol, W. A., Jordans, M. J. D., Kohrt, B. A., Betancourt, Van Oudenhoven, N. (1979). Common Afghan street T. S., & Komproe, I. H. (2013). Promoting Mental games . Lisse, The Netherlands: Swets & Zeitlinger. Health and Psychosocial Wellbeing in Children Ventevogel, P. (2005). Psychiatric epidemiological stud- Affected by Political Violence. Part I: Current ies in Afghanistan: a critical review and future direc- Evidence for an Ecological Resilience Approach. In tions. Journal of the Pakistan Psychiatric Society, C. Fernando & M. Ferrari (Eds.), Handbook of 2(1), 9–12. Resilience in Children of War (pp. xxx-xxx). New Ventevogel, P., & Kortmann, F. (2004). Developing basic York: Springer. mental health modules for health care workers in Tol, W. A., Komproe, I. H., Susanty, D., Jordans, M. J. D., Afghanistan. Intervention, 2 , 43–54. Macy, R. D. M., & De Jong, J. T. V. M. (2008). Ventevogel, P., van Huuksloot, M., & Kortmann, F. Children and communal violence in Indonesia: Cluster (2006). Mental health in the aftermath of a complex Randomized Trial of a psychosocial school-based emergency: the case of Afghanistan. In J. O. Prewitt intervention. Journal of the American Medical Diaz, R. Srinivasa Murthy, & R. Lakshminarayana Association, 300 , 655–662. (Eds.), Advances in Psychological and Social Support Trani, J. F., & Bakhshi, P. (2006). Understanding the chal- after Disasters. New Delhi, India: Voluntary Health lenge ahead: National disability survey in Afghanistan Association of India Press, 83–93. 2005 . Lyon, France: Handicap International. Ventevogel, P., Nassery, R., Azimi, S., & Faiz, H. (2006). Trani, J. F., Bakhshi, P., Noor, A. A., Lopez, D., & Psychiatry in Afghanistan, country profi le. Mashkoor, A. (2010). Poverty, vulnerability, and pro- International Psychiatry, 3 , 36–38. vision of healthcare in Afghanistan. Social Science & Ventevogel, P., Faiz, H., & van Mierlo, B. (2011). Mental Medicine, 70 , 1745–1755. health in basic health care: Experiences from Nangarhar Trani, J. G., Bakhshi, P., & Nandipati, A. (2012). Province. In J. F. Trani (Ed.), Development efforts in ‘Delivering’ education; maintaining inequality. The Afghanistan: Is there a will and a way? The case of case of children with disabilities in Afghanistan. disability and vulnerability. Paris: l’Harmattan. Cambridge Journal of Education, 42 , 345–365. Ventevogel, P., van de Put, W., Faiz, H., van Mierlo, M., Turmusani, M. (2004). Applying the minority perspective Siddiqi, M., & Komproe, I. H. (2012). Improving to disability in Afghanistan . Disability World 26. access to mental health care and psychosocial support http://www.disabilityworld.org . in a fragile convict setting: A case study from UNDP. (2007). Human Development Report 2007/2008 . Afghanistan. PLoSMedicine, 9 (5), e1001225. New York: United National Development Programme. Waldman, R., Strong, L., & Wali, A. (2006). Afghanistan’s UNESCO. (2010a). Country programming Afghanistan health system since 2001: Condition improved, prog- 2010Ð2011 . Kabul: United Nations Educational, nosis cautiously optimistic . Kabul: Afghanistan Scienti fi c and Cultural Organization. Research and Evaluation Unit. 5 Child Mental Health, Psychosocial Well-Being and Resilience in Afghanistan… 79

WCRWC. (2002). Fending for themselves. Afghan refu- social support in emergency settings. Intervention, 6 , gee children and adolescents working in urban 199–218. Pakistan. New York: Women’s Commission for WHO. (2008). Mental Health Gap Action Programme: Refugee Women and Children. Scaling up care for mental, neurological and substance Wessells, M. (2006). Child soldiers. From violence to pro- use disorders . Geneva: World Health Organization. tection . Cambridge: Harvard University Press. WHO. (2009). Mental health aspects of women’s repro- Wessells, M., & Kostelny, K. (2002). After the Taliban: ductive health; a global review of the literature . A child-focused assessment in the northern Afghan Geneva: World Health Organization and United provinces of Kunduz, Takhar, and Badakshan . Kabul: Nations Population Fund. CCF International/Child Fund Afghanistan. WHO. (2013). Building back better : Sustainable mental Wessells, M., & Strang, A. (2006). Religion as a resource health care after disaster . Geneva: World Health and risk. The double-edged sword for children in situ- Organization. ations of armed con ﬂ ict. In N. Boothby, A. Strang, & WHO-AIMS. (2006). Report on mental health system in M. Wessells (Eds.), A world turned upside down. Afghanistan. Kabul: WHO and Ministry of Public Social ecological approaches to children in war zones Health. (pp. 199–222). Bloom ﬁ eld: Kumarian. Williamson, J., & Robinson, M. (2006). Psychosocial Wessells, M., & Van Ommeren, M. (2008). Developing interventions, or integrated programming for well- inter-agency guidelines on mental health and psycho- being? Intervention, 4 , 4–25. P a r t I I Child Soldiers When Children Become Killers: Child Soldiers in the Civil War 6 in Sierra Leone

Tunde Zack-Williams

hand, the warlords who see the people not as the Introduction motive force for change, but as target of their bes- tiality. To some extent the dilemma is false and There is a preponderance of child combatants, self-imposed by a social science (a Minotaur both boys and girls in modern warfare, both new based on labyrinthian logic) 3 that seeks objectiv- wars and traditional interstate con fl icts. The phe- ity and neutrality, what the late Nigerian political nomenon of child soldier is a universal feature of scientist Claude Ake has referred to as ‘the most modern interstate wars as well as new wars , pernicious form of imperialism’. 4 For Ake, which has caught the attention of many writers Western Social Science either consciously or on child soldiers. 1 Child soldiers are no longer inadvertently seeks to foist capitalist values and the project of exotica—globalisation has meant capitalist development in order to serve imperial- that children of refugees and asylum seekers from ist interests; in recent African history, no policy war-torn societies are now part of the caseload of has served this aim better than IFI-sponsored many social workers in Western countries. 2 structural adjustment programmes (SAPs), which In writing about the brutal civil war in Sierra has destroyed the nascent manufacturing sectors Leone, one is reminded of the observation by the in these countries through privatisation, system- South African sociologist, Omar Badsha who in induced stag in fl ation and unnecessary exposure his Amulets & Dreams: War, Youth & Change in to competition and dumping from more matured Africa, UNISA Press, 2002, opined, ‘… how Western industries. We shall see presently that does one represent Africa without extending the the war was not the product of either atavistic pervasive in fl uence of Afro-pessimist?’ (p. 3). tendencies on the part of young people in Sierra Dear I say! One runs the risk of being trapped in Leone or population pressure on land resources the web of another African pathology for the con- due to Malthusian scenario a la Robert Kaplan, 5 sumption of Western audience. Equally, not to but it was the consequence of bad economic poli- speak out can invite the accusation of collabora- cies, corruption, bad governance and the margin- tion with those who created the conditions for alisation of young people in this corner of West civil war: on the one hand, both the international Africa. The war points to both the resilience of fi nancial institutions (IFIs) and their accomplices, young people, including their capacity for cre- the local exploitative classes, and on the other ative survival strategies 6 and the hardship they have endured in post-colonial Sierra Leone. Sierra Leone is situated on the northwestern seaboard on * T. Zack-Williams ( ) the Atlantic coast, just south of latitude 10° and Department of Sociology , University of Central Lancashire , Preston , UK west of longitude 10° (8° 27 ¢ N/11° 46 ¢ W). In the e-mail: [email protected] north and northeast, it is almost surrounded by

C. Fernando and M. Ferrari (eds.), Handbook of Resilience in Children of War, 83 DOI 10.1007/978-1-4614-6375-7_6, © Springer Science+Business Media New York 2013 84 T. Zack-Williams the Republic of Guinea, on the southeast by the Prelude to War Republic of Liberia and on the southwest by the Atlantic Ocean. The country’s fi rst contact with In 1961, with a relatively effi cient civil service Europe was in 1364 when Norman traders from and independent judiciary and an economy Rouen and Dieppe visited this land with some of fuelled by mineral and agricultural exports, the fi nest natural harbours in the world, 7 but were Sierra Leone became an independent state within compelled to abandon trade with the region due the commonwealth as the 100th member of the to civil war in France. 8 The next contact in 1462 United Nations with much hope for sustainable was more enduring as it saw the visit of Pedro da development and democracy. The country had Cintra, a protégé of Prince Henry the Navigator experienced a relatively free and fair elections in of Portugal who named the territory Sierra Lyoa , 1957 based on a limited franchise. However, in i.e. mountains of lions, because of the undulating 1967, following a disputed election in which the mountain ranges. From this discovery until the incumbent leader was defeated by the main oppo- late eighteenth century, though there were several sition party—the All People’s Congress other visitors, the territory remained (for (APC) —a coup was unleashed by the Force Europeans) a hunting ground for slaves, who Commander, Brigadier David Lansana, on the were brutally exported to the New World. advice of the Prime Minister, Sir Albert Margai, However, in 1787, a treaty was signed with local his kith and kin. 11 The coup put an end to the African royalties, who conceded land to the experiment in democracy 12 and marked the begin- British for the resettlement of former slaves who nings of a sustained period of instability and had fought for the British in the American War of decline, culminating in the civil war in 1991. 13 In Independence and had been promised freedom. 1968, after a year of military rule, the young Many of these freed men and women were fi rst of fi cers calling themselves the National transported to Nova Scotia, Canada, where they Reformation Council (NRC), who had over- were promised land, which never materialised, thrown Lansana and had established a junta based before making their way to London, where they on middle ranking of fi cers, were in turn ousted soon became destitute and were labelled as the by a group of non-commissioned of fi cers, who Black Poor. In 1787, 430 of these destitute summoned the erstwhile successful leader of the Africans were transported to the Province of APC to assume power. After a brief period of Freedom, Freetown, marking the beginnings of a coalition government, Stevens soon got rid of unique process of the British project of moder- opposition members in his administration and his nity in Africa. 9 After initial dif fi culties, including bid to control the lucrative diamond sector attacks from neighbouring communities, the set- embarked on creating and strengthening of the tlement grew as more freed men and women were shadow state. 14 The APC remained in power settled in the colony and through internal migra- from 1968 until they were removed from power tion. 10 In 1792, the colony was handed over to the in the middle of the civil war in 1992 by a group Sierra Leone Company and in 1799 Freetown of young offi cers calling themselves the National became Africa’s fi rst municipality. In 1808, Provisional Revolutionary Council (NPRC), Sierra Leone became a Crown colony, marking whose leader was 27-year-old Captain Valentine the beginnings of a golden age for the territory, Strasser. By the time the ailing Siaka Stevens left culminating in the city being described as the offi ce in 1984, Sierra Leone was in deep trouble: Athens of West Africa as Freetown became asso- the country was saddled with massive debt ciated with the dynamics of modernity, education incurred from Stevens’ decision to host the and progress, a marked contrast to the condition annual jamboree of African Heads of State in of the city at the beginning of the current 1980; corruption and the smuggling of the coun- millennium. try’s gold, diamonds and agricultural produce 6 When Children Kill 85 were widespread; the impact of the second hike Taylor too was displeased by what he saw as in oil price was running through the economy, as Sierra Leone’s double standard in allowing its well as the fall in export earnings and rise in the airport and airspace to be used by the Nigerian value of imported goods. The net result was the Air Force to strafe his troops in Liberia as they long route to the IFIs in search of SAPs, whose were about to capture the capital, Monrovia. As a conditionality exacerbated the country’s ailment consequence, the Liberian warlord swore revenge as devaluation and reduction in government and promptly armed his old friend Foday Sankoh expenditure led to stagfl ation and widespread and his fi ghters consisting of exile Sierra unemployment, in particular among the country’s Leoneans, Burkinabes and Liberians. They youth. In the ensuing crisis, the country’s export attacked Sierra Leone from the southeast corner collapsed and so did the social and physical adjacent to the Liberian border and once a bridge- infrastructure. Many young people were forced head had been established they started recruiting to abandon their education as the impoverished children to join their fi ghting force. As we shall parent could neither afford the fees, nor could see presently, whilst some children volunteered they forego the contributions children and young to join Sankoh’s ragtag army calling itself the people could make to the family income. Revolutionary United Front (RUF), thousands The economic and political trajectory of Sierra were brutally conscripted into the ranks of the Leone was not dissimilar to that of neighbouring RUF and in no time they were socialised into Liberia, whose President had hosted the drugs and violence, in most cases against their Organisation of African Unity (OAU) annual immediate relations and friends, in order to pre- conference in 1979 and was subsequently over- vent the young people returning to their commu- thrown the following year as part of what became nities. The civil war did not only set Sierra known as IMF riots due to shortage and exorbi- Leone’s developmental prospects back half a tant prices for rice, the country’s stable. The coup century, reduced most of the citizens to interna- resulted in the death of President Tolbert, killed tional pauper and global mendicant, but the name by Master Sergeant Samuel Doe, a young non- of the nation soon became synonymous with col- commissioned of fi cer who virtually wiped out lective brutality. the Liberian President’s family. This was followed in 1989 by the country’s fi rst civil war. Two years later, the Liberian contagion got hold Child Combatant and the Sierra Leone of Sierra Leone when Liberian warlord, Charles Civil War Taylor, had met Sierra Leone’s rebel leader Foday Sankoh in Benghazi, Libya, where both had One major feature of the civil war was the utilisa- undergone military training under the auspices of tion of child combatants by both sides: the gov- Colonel Muammur Gadda fi . The latter had a ernment and its allies the Civil Defence Force on grudge against Stevens and the APC, for after the one hand and the rebel and their allies the supporting Stevens’ candidacy as chair of the Armed Forces Revolutionary Council on the OAU, in 1980, Stevens under pressure from the other. In what follows, we want to look at the part Americans failed to support Gaddafi ’s bid as children played in the civil war, how they were chair. Stevens’ departure did not end the antago- recruited/how they became soldiers and who nism, for Gaddafi had been quoted as referring to were the child soldiers. A small number of chil- Stevens’ successor Major General Joseph Momoh dren volunteers fought in the national army in as a scout for as he argued, military men do not particular during the military interregnum of have power bestowed upon them (as Steven did Captain Strasser (1992–1994), when the army with Momoh), but like himself, they simply seize was expanded by recruiting from the urban power. déclassé groups, whom some writers have 86 T. Zack-Williams referred to as lumpen or lumpenproletariat . 15 were described as rebel wef (i.e. wives of rebels) Furthermore, the RUF abducted thousands of and their children as rebel pikin (i.e. children boys and girls into its people’s army in areas that of rebel). they invaded and, according to Peters and Richards, signifi cant number of children volunteers joined the RUF to seek revenge for loss of Who Were the Child Soldiers? educational opportunities and destruction of their villages. 16 The government’s allies, the Civil A child soldier according to the United Nations Defence Force and the rebel junta (the Armed defi nition is anyone under 18 years of age who is Forces Revolutionary Council) also recruited engaged in combat. In Sierra Leone where the child combatants into their ranks. Indeed, the war was not fought along ethnic or religious line, military unpreparedness of government forces any child was open to abduction and eventual was such that the rebels moved in quickly into the conscription into the fi ghting forces, in what has east of the country, where they promptly occu- been referred to as the lottery for life . In practice, pied the rich diamond mining area of Kono mainly street children and those from poor house- District. In order to mine diamonds in exchange holds (from all ethnic groups) were captured by for weapons, large number of young men and the warlords. As we have noted, some were vol- women were conscripted from their towns and unteers, others abducted by both government and villages to work in the diamond pits of Kono. The rebel forces of the RUF led by Foday Sankoh, same was true of government forces who also who were the fi rst to utilise child soldiers, but the recruited child soldiers, resulting in the indict- government side too used child soldiers, both ment of the leader of the Civil Defence Force, the national army during the rule of NPRC and Chief Samuel Hinga Norman, by the Special the various elements in the Civil Defence Force. Court trying those most responsible for human Indeed, the head of the Kamajors, the core ele- rights abuse in the country’s civil war, as well as ment in the Civil Defence Force, Chief Samuel the emergence of Sobel (soldier/rebel) recalci- Hingha Norman was arraigned before the Special trant soldiers who fought on both sides in the Court charged with war crimes and crimes against civil war as well as being involved in illegal dia- humanity. Indeed, Chief Norman did not have mond mining. 17 time to answer the charges as he subsequently The number of children who fought in the died in the custody of the court. civil has been put as between 5,000 and 10,000. According to the Truth and Reconciliation Commission (TRC), of the 6,774 children who What Impelled Sierra Leonean were demobilised, only 513 were girls. This Children to Join Social Movement? fi gure belies the fact that signi fi cantly more girls were abducted by the rebel fi ghters, who trans- Among those who joined the national army, many formed them overnight from innocent little girls would have seized the opportunity of employ- into commanders wives’ who were left out of the ment in the army to run away from life as street reintegration programmes; and peacekeepers children, where life was quite gruesome, precari- meant to protect them became customers of sex . 18 ous and dangerous and where they were con- The TRC described it as: stantly subjected to bullying and intimidation by That was a terrible mistake. Thousands of girls older members usually referred to as Brahs or were not admitted into the demobilisation pro- Alejos. Dangerous as it is, life with the army programme. These girls were abandoned and had to vides some excitement away from the drudgery fend for their survival. Many have been exposed to of life on the street: food is certain and one does further violations and continue to suffer. not have to hustle all the time for a living. Life as Many were afraid of rejection from their street children had prepared many for the danger families, in particular those with children, who of military life, and regular remuneration was a 6 When Children Kill 87 bonus. Above all the uniform and the gun brought bond of trusts and reciprocity, which collectively status and power and the opportunity to take constitute social capital. In an earlier work, I have revenge against previous transgressors. 19 argued that the emergence of the phenomenon A signifi cant number of the young fi ghters of child soldiers in Sierra Leone is a direct effect who joined the RUF were drawn to the millenar- of the rupture in the intergenerational bargain, ian appeal of the RUF and its charismatic leader, the ambiguity of the current generation, the state who was revered and referred to by the fi ghters as and global capitalism. 23 I also noted that this pape (father). 20 For many of these young fi ghters, can lead to anomie in the socialisation process the populism and promise of the RUF leadership and to alienation of a signifi cant section of the had a good ring in their ears. The promise of a population resulting in bellicose contestation of better future, pride in their nation, away from the state. poverty, powerlessness and one-party dictator- Whilst ergonomics and technological devel- ship was a stimulant to action, one that will opment in gun production has aided the child use deliver better education, industry and jobs. These of such weapons, it was the crisis of peripheral promises were embedded in the RUF manifesto: capitalism, the bad governance and the marginalisation of young people and their needs that We are therefore fi ghting for democratic empower- drove young people in Sierra Leone to join a ment to enable us to reclaim our sense of ourselves as enterprising and industrious Africans, using the social movement in order to challenge for state history of our glorious past to create a modern hegemony. The emergence of peripheral capital- society contributing to world peace and stability ism in Sierra Leone in the form of mining and through advancement in agriculture, architecture, agricultural production for the external market medicine, science and technology, industry free trade and commerce. In other words we are fi ghting led to the proletarianisation of sections of the for food and good drinking water for all. We are rural masses, and over a period of time, they fi ghting for affordable energy, fuel and power, became dependent, not on the moral economy, including access to appropriate technology so that but the market for their reproduction. This depen- we can build for ourselves modern houses, health care, education and recreational facilities… we are dence was always tenuous, since there was never tired of poverty, bad drinking water, poor housing, enough economic opportunities to meet the needs second hand clothing and footwear, and our state of the rural masses seeking employment; as a of self-imposed backwardness…we are tired of consequence, they tended to return to the pre- being down and out and on the ground… we are crying out against hunger, disease and depriva- capitalist sector for their sustenance. Indeed, the tion…We are tired of state-sponsored poverty and pre-capitalist sector constantly acts as a subsidy degradation. We are tired of our children dying of for the wage bill of the capitalist sector, as indi- preventative diseases…We are tired of rural folks rect wages in the form of welfare rights are often being exploited. 21 denied. It was not long before it became clear that This populist manifesto was designed to solicit the elasticity to cope of the rural sector was at support from the socially excluded sectors of breaking point. The crisis was characterised by society and to foster a sense of agency, thus the massive balance of payment defi cit, stagfl ation manifesto continues: and high unemployment—particularly among the The people take up arms in order to take back their multitude of young people leaving elementary power and use this power to create wealth for and secondary schools that now migrated from themselves and generations to come by construct- the rural areas to urban and peri-urban areas to ing a new African society in Sierra Leone consis- eke out a living. Many of these students from the tent with the highest ideals of our glorious past and the challenges of the modern world we live in. 22 rural areas migrated to the mining fi elds as tributors, 24 and others moved into the major towns Another factor which impelled children in where they swelled the ranks of street children. Sierra Leone into armed movements challenging The crisis impacted on their immediate aspiration for state hegemony is the rupture in the intergen- to go to school and obtain a job, an opportunity erational bargain and the destruction of the which was available to the previous generation, 88 T. Zack-Williams who they saw as having failed them. The situa- mein pikin (looked-after) children were contained tion was exacerbated by the impact of SAP, and by both the state and by traditional values, embed- its harsh conditionality transformed a bad situa- ded in such sayings as government pikin (child of tion into a socio-economic catastrophe for the the government)—who needs to be treated well. young people of this unfortunate land. 25 Structural However, as the crisis of peripheral capitalism adjustment turned out to be the medicine that far ensued, driven by the conditionality of SAPs, from curing the patient’s symptoms left it in a which denuded the state of authority, foster par- comatose state. ents found that they could not afford to send the For these post-colonial youth, the situation children to school, due to the austerity regime so was stark: not only was the job situation hope- typical of the adjustment programmes since less, but they now found themselves in the midst teachers and other public service workers were of a one-party dictatorship, which did not brook either the fi rst to be laid off or had to work for any opposition or alternative views. In the geron- months without wages or salaries. The foster tocracy, which constituted the ruling elite, the children were taken out of the educational system young men and women (youth), who constitute and became full-time domestic servants, this time over 40 % of the population, were relegated to the without a salary, whilst the biological children of status of non-people. Not only where they the foster parents were sent to school. Caroline deprived of the right to vote and to stand for Bledsoe has argued that whilst modern education of fi ces as the public space was crowded by old is highly valued, it creates ambivalence insofar as party stalwarts who had been recycled for these the educational process disrupts ‘the ideal rela- positions since independence, but they were tionship of debt and recompense linking master totally marginalised politically and economically. and student’. 27 In short, fostering and the ward- Furthermore, the one-party dictatorship which ship system under conditions of crisis tend to pro- ruled Sierra Leone from 1968 until it was removed duce a mass of alienated young people in the from power in 1992 by the military marginalised country, who are no longer prepared to abide by the south and east regions of the country, which traditional (paternalistic) norms of child rearing were opposition stronghold, with the result that and parental authority which they consider these areas lagged behind in development. 26 exploitative. Even when pressure is brought to The crisis also impacted on social institutions, bear, many refuse to return to the mein pikin rela- not least the family, which suffered under the tionship, instead opting out to stay on the street, brunt of the neo-liberal onslaught leading to its hustling in the outer limits of the diamond fi elds, continued atomisation. In Sierra Leone, informal the dock areas or around market stalls. fostering historically has offered a mechanism for poor families to cope with poverty and deprivation in child rearing by informally fostering Relationship of Child Soldiers their children to relatively more af fl uent relations, and the Social Movement friends or in fl uential members of the community such as teachers or even neighbours. The assump- As we have seen, street children in the urban tion has always been that this relationship is sym- areas have been a major source of child combat- biotic, i.e. that it would benefi t the child and the ants, though many others were abducted from foster parents alike. The former would have the their villages. Whilst the phenomenon of street bene fi t of education and a better future, whilst children has been associated with the favelas of the foster parents would have someone to help with Latin America and the shanty towns of Asia, domestic chores. In practice, the weaker partner nonetheless, Africa had no immunity, as can be in an unregulated relationship was always the seen from the phenomenon of raray boys (street child. In the context of a relatively strong state in boys) in Sierra Leone, 28 a diverse group of deraci- the colonial and early post-colonial period, any nated boys and young men. Children in stable excesses from such foster parents towards these family relationship are not impelled to become 6 When Children Kill 89 child combatants, simply because the route to the qualities which make child soldiers such an child soldiering, i.e. the status of street children, invaluable part of new wars in Africa. Children is one that is not an option for the children of the with their ability to obey orders without question rich and privileged. Many of the former child are said to make good soldiers. Furthermore, combatants had been separated from families and children are ready to please adults in order to gain relations and the social movement acts as surro- their approval, and this is particularly the case in gate family; others such as Augustine in Brett Africa where the Victorian ethics of ‘children and Specht (2004) signed up to gain the necessi- should be seen and not heard’ is quite strong. ties of life: Thus Badsha has argued that children are militar- When the rebels invaded the town of Makeni, my ily useful partly due to the ‘changes in arms parents fl ed the town and even myself, but without which have made possible to delegate military knowing that my parents had left…When I got into tasks to individuals who are neither strong nor town, I found no body to be responsible for me. So technically competent.’ 32 Because of their will- when the rebels came, I decided to go to them so that they could give me food to eat and survive. 29 ingness to please, it is said that children make brave and loyal fi ghters. Furthermore, as a group Whilst for some youngsters, military life is a with no formal dependence or responsibilities, means to an end, for example, it provides a meal they are seen as dispensable, hence can be dis- ticket and substitute education; however, for oth- patched to undertake risky and dangerous tasks, ers, it is time for payback, thus Momoh from where older soldiers might retreat, such as intel- Sierra Leone in Peters and Richards’ sample ligence behind enemy’s line; their unsuspecting signed up because he sought revenge: persona renders them less visible to the enemy, as I fi rst knew about the war when my father was such ideal for lobbing hand grenades in crowded killed…So I joined. There was nothing else I could situation. They act as labourers to transport looted do then…I joined willingly because I did not have goods and hardware. any body to encourage me…My fi rst reaction was to take revenge and kill many soldiers who attacked our village at that time who had killed my father…by that time the high school was burnt, all of my belong- The Effect of Children’s Involvement ings burnt down, no education for me again, and my in the Civil War mother was ill and abandoned in our house and died, so I thought that I can never be a human being again in the world. No mother, no brother, no father. 30 As noted above, one causal factor for the civil war was the marginalisation of youth and the Another respondent in Peters and Richards’ feeling of powerlessness among young people in felt totally empowered, which was exercised over Sierra Leone. The pre-war conditions of children adults: ‘I like it in the army because we could do and young people in the country can be described anything we liked to do. When some civilian had as dismal: high unemployment and underemploy- something I liked, I just took it without him doing ment, child traf fi cking, widespread sense of anything to me. We used to rape women. Anything hopelessness as SAPs and bad governance put I wanted to do I did. I was free’. 31 For many of pay to progress in education, health and social these kids, military life empowers them in a soci- services and infrastructural development. Sierra ety where children’s right are non-existent or Leone has one of the highest rates of child mor- regularly violated. tality in the world with one in three dying before the age 5. 33 The right of the child, whilst enshrined in colonial legislation, 34 was neglected and vio- Role and Function of Child Soldiers lated as the state gradually abandoned any right of social citizenship, in the ignominious route to Many of the positive qualities of child rearing in one-party dictatorship. Indeed, child neglect and Africa, such as respect for adults and those in injustice had become part of the everyday life of position of authority, bravery and obedience, are children and young people in pre-civil war Sierra 90 T. Zack-Williams

Leone as both the formal and informal mecha- impelling them to social movements in search nisms for safeguarding children had collapsed of a new order. For a while, the gerontocratic- under the strain of booty capitalism. For example, traditional elites had to listen to the grievances, Rachel Harvey pointed out in 2000 (in the middle this is particularly true of the traditional fraction of the war) that Juvenile justice in the country of the governing class, who had been driven out was in urgent need of modernisation. 35 As such in of their chiefdom, in some cases for well over a the post-war era, it is dif fi cult to identify war-in- decade. The traditional rulers on their part were duced effects from that which was the product of concerned about unruly young men who were pre-war failed state syndromes. 36 The war of now challenging traditional authorities and course produced widespread destruction of the demanding a new order. The young men in par- physical and social infrastructure as mines were ticular were not prepared to go back to the bad occupied and looted, and both government and old days of cruel and ‘autocratic rule by the chiefs private buildings were destroyed, catapulting the and their Freetown allies’. In short, there was an country to the bottom of the UN Human intergenerational confrontation between the tra- Development Index. Children were both victims ditional chiefs and the urban elites on the one of the war and perpetrators of wanton violence hand, and the young men and women, who were against the civilian population. The UN not only victims of the war but also had played a Convention on the Rights of the Child (CRC) major part in trying to bring change to their social notwithstanding, children in Sierra Leone had conditioning. been denied rights of citizenship, i.e. protection The stakes were raised when the elders refused by the state and right to education. The war cre- to forgive the cadets for the atrocities they ated a loss generation of young people, deprived unleashed on the community . The young people of protection from the state and their community, too were angry and blamed the elites for loss of who also lost educational opportunities in order educational opportunity, political and economic to prepare them for adult life. The situation was marginalisation and poor governance. In short, even more severe for girls, the majority of whom the traditional authorities were now being held to were deprived of basic education and transformed account for their past actions by the former reb- into sex slaves. els. This act of defi ance as it was perceived by However, the phenomenon of child combat- Westerner donors, the new defi ners of African ants and the general precarious position of chil- culture and morality, argued that this was ‘alien dren in Sierra Leone brought their parlous state to to traditional African culture’. In the view of the the attention of the world. Participation in the war new de fi ners, the chiefs were seen as the natural politicised the nation’s youth and gave them a glue that binds an unchanging tribal society. sense of empowerment as the two main political Without the consent of this externally revered parties sought their votes in the post-war elec- fraction of the ruling class, it was felt that the lib- tions. This politicisation is clearly refl ected in eral peace could not be delivered. As the process popular culture in such genre as Emerson’s Bobor of reintegration approached, the gerontocrats felt Belleh , Too Foot Arata ; Daddy Saj’s Corruption empowered as their consent was needed if the E Do So Pack and Go, referring to the gluttonous young people were to be pardoned for their past kleptocratic elites to change their ways. The acts in order to be reintegrated into society. The youth of the country used the space provided by situation was ominous for the girls, who were their new found democracy to position them- refused a return to school by head teachers, on selves to protect their interests. We have seen the presupposition that these ‘rebel wives would how control of the barrel of the gun prior to dis- corrupt their girls’. Those who returned from the armament and demobilisation had given a sense bush with children were rejected not only by head of power to the young people over some adults teachers but also by parents. In the end, it appeared and how their complaints over abuse by tradi- that the young people were destined to lose out as tional authorities had been a major grievance the alliance of Western governments and their 6 When Children Kill 91 local protégés in the non-governmental commu- Thus almost 10 years after hostilities ended, nities decided that it was imperative to return to many young people in Sierra Leone are asking if the governance pattern of the pre-war years, with anything has changed in Sierra Leone. Was the the chiefs as the voice of the people. violence worth the effort? At the head of this re-traditionalisation of governance was the British Department for International Development, which failed to build The Resilience of Sierra Leone’s ‘constructive relationships between chiefdoms Children in the Post-con fl ict Era and local governments’ instead simply reshuffl ed the ‘agrarian class relationships or old ways of According to the American Psychological doing politics. This in turn requires a reform of Association, 40 resilience is a multidimensional the chieftaincy system and the resolution of local construct which involves the bidirectional inter- political tensions arising from decentralization’. 37 action between individuals and their environ- Meanwhile, the rural community continues to ment, including family friends, community and suffer under what Richard Fanthorpe has called society. Looking at the resilience of African the leash of custom, as the international commu- American youth, the APA proposed four portraits nity continued to deliver the liberal peace through of resilience: fast-track decentralisation in post-confl ict Sierra • Critical mindedness which shields them Leone, thus swinging the balance in favour of the against discrimination and provides the basis traditional rulers. 38 of critique of existing social conditions Susan Shepler 39 in an insightful article has • Agency or active engagement at home school argued that the international human rights regime, and among peers with positive impact on their and in particular the CRC, is often in confl ict environment with the local understandings. She has argued • Flexibility promoting adaptation to cognitive, that the new idea of a child—anyone under social, emotional and physical demands in a 18—therefore not to be held accountable helped bicultural setting the young people, who would now be forgiven as • Finally, communalism, the celebration of they seek reintegration. This appears to be con- social bonds, social duties and collective well- tradictory to the traditional defi nition of the child being and individual responsibilities. In her view the These are useful tools to understand resilience new human rights regime bestows rights on chil- among children and young people in Sierra dren—to be treated well and right to be educated, Leone. For example, critical mindedness among which they may now start demanding without young people in Sierra Leone is developed not to any responsibilities to parents, the rest of their protect them against racism, but against ageism, family and traditional rulers. Thus she observed: ethnicity and discrimination against rural inhabitants; they actively engaged in interaction with There is a sense that children having rights inverts peers and adults alike; demonstrate adaptability the social hierarchy in some ways similar to the ways in which child soldiers dramatically inverted and fl exibility in various situations at home, with social hierarchy during the war. (p. 205) parents, teachers and other adults and siblings; and they bond communally with peers, family In other words, the con fl uence of war and the members and other groups. Children from emo- new human rights regime produced role incon- tionally stabled families, i.e. the vast majority of gruity in the mind of former child combatants. children in the country, will display positive val- Thus despite their victory over adults, they were ues both to adults and other children, even at still seen as children, who by standing up to adults times of seemingly anomic break down. This is were seen as insolent and demonstrating uppiti- particularly true as religious beliefs (African reli- ness ( fi t yai ), beyond control who need to be gious beliefs, Christianity and Islam) are strong reined in, in order to restore the status quo ante . in the country. This fact concerning the rural 92 T. Zack-Williams nature of the Sierra Leone population needs to be The youths continued to show resilience, factored into any analysis of young people’s resil- many buoyed by their life as street kids and sub- ience in the country. The resilience of most young sequently as child soldiers; this was re fl ected in people is fostered by what the APA calls multiple their role in the production of popular music, identity factors, particularly dealing with locality, visual art and drama. Following the Disarmament religion and ethnicity, all factors which are not Demobilisation and Reintegration, the former violently contested in their country. child combatants showed much resilience in their The quality of resilience in a community new civilian roles as mechanics, carpenters and impacts upon the development of children as well joiners, taxi drivers and security personnel to as their ability to contribute to societal develop- politicians. Through the media, young people in ments. Sierra Leonean children with the maxim Sierra Leone continued to articulate their frustra- of no success without struggle have been brought tions and concerns of the post-war kleptocracy into the world with this ideology central to resil- that ruled their country and to challenge the polit- ience as their guiding principle. They do not ical class to respect democracy and end corrup- expect much from the state, not least one that has tion. In the 2007 post-war elections, some of the failed to protect them from violence and poverty. former child soldiers played a pivotal role in the In the rural areas, children as young as 4 years of victory of the opposition APC. Not only did the age help in the family farm, and given the low youth constitute some 65 % of the Sierra Leone level of school registration, many continue to population, but 56 % of the 2.6 million registered work throughout their childhood. In a geronto- voters were under 32 years of age. 42 The mass cratic society where age is valorised, children unemployment 43 and widespread poverty 44 among tend to be lower down the pecking order for food the young fostered an esprit de corps, as young and other essentials. Many children, even those traders selling (mainly of imported and locally in school, wake up very early to walk miles to produced compact discs) were organised into fetch water or to the farm or school. As we have cooperatives; many were former child combat- seen the process of informal fostering has further ants, who had fi nished their post-demobilisation toughened up any of these looked-after children . training only to be thrown once more into the The failed economic policies which have typi fi ed unemployment heap. post-colonial Sierra Leone have hardened the The reality is that the underfed and unpro- children and young people as many of them have tected children and young people in Sierra Leone gone without the basic necessities of life, and have shown great resilience or as it is said locally, they feel a sense of betrayal. wee pikin dem tranger, i.e. our children are resil- The immediate effect of the war was to ient. The resilience of many of these young peo- embolden young people in Sierra Leone, whose ple is epitomised by the fact that many of them existential characteristic was de fi ned as a group were to overcome their adversities, having sur- who can be seen, but not heard. By the time the vived decades of IFI-sponsored structural adjust- war ended, however, they had made their pres- ment policies; almost three decades of APC ence felt largely because of their role as child autocracy in which not only the last vestiges of combatants in challenging adults for the future of democracy disappeared but also the social and the state. This new status was reinforced by physical infrastructure had collapsed even before Western NGOs who called for new rights for war broke out. As we have seen, whilst some children in Sierra Leone, which, with the help of young people in the country brought violence UNICEF, was later enshrined in a new Children’s and mayhem to their communities, young people Act in Sierra Leone. 41 However, this new de jure were also the targets of much violence before, position was not matched with economic and during and after the war. Young people were in social opportunities, as the former child combat- search of advocates, in a country where the ants were reduced to dependence on adults and maxim of child rearing is no success without traditional rulers for jobs and protection. struggle 27. It needed a bloody civil war to force 6 When Children Kill 93 the authorities to listen to children and for 9. See A.B. Zack-Williams, ‘Africa and the Project of Parliament to pass a law protecting the rights of Modernity: Some Re fl ections’, in O. Uduku and A.B. Zack-Williams (eds.) Africa Beyond the Post- the child. The interests and concerns of children Colonial: Political and Socio-Cultural Identities , and young people have never been central to the Ashgate, Aldershot, 2004, p. 20–38. post-colonial governing classes in Sierra Leone, 10. On the history of the Krio or Creoles, see A. Wyse, where political succession was their main con- The Krio of Sierra Leone: An Interpretive History , C. Hurst and Company, London, 1989; A. Porter, cern in the politics of spoils, accumulation and Creoledom: A Study of the Development of Freetown dispossession. For many young people in Sierra Society , London, 1963. Leone, they are the real lost generation of that 11. For the events leading to the coup and its immediate country, whose future had been mortgaged by aftermath, see J. Cartwright, Politics in Sierra Leone, 1947Ð1967 , Toronto University Press, 1970. politicians who marginalised the interests of 12. G. Collier, Sierra Leone: Experiment in Democracy in young people, creating an intergenerational crisis an African Nation, New York University Press, New leading to war. Nonetheless, we have seen how York, 1970. many children, including former child combat- 13. A. Bundu, Democracy by Force? A Study of International Military Intervention in the Confl ict in ants, have demonstrated resilience by seizing Sierra Leone from 1991 to 2000 , Universal Publishers, new opportunities in training and work to earn a USA. living. Many students are now more engaged 14. W. Reno, Corruption and State Politics in Sierra with society than in the immediate period prior to Leone , Cambridge University Press, 2008. 15. I. Abdullah (ed.), Between Democracy and Terror: the outbreak of war. To consolidate whatever The Sierra Leone Civil War , Dakar, Codesria, 2004; I. gains that have been accrued by young people, Abdullah & Muana, ‘The Revolutionary United Front they will have to become more politically and of Sierra Leone’, in C. Clapham (ed.) African economically engaged. Guerrillas , James Currey, 1998, p. 172–193. 16. K. Peters & P. Richards, ‘Why We Fight: Voices of Youth Combatants in Sierra Leone’, Africa , 68 (2), 183–210. 17. See report by General Vijay Jetley, Command of UN Troops in Sierra Leone, as quoted in M. Kaldor and J. Notes Vincent, Case Study Sierra Leone: Evaluation of UNDP Assistance to Confl ict-Affected Countries , 1. I. Cohn, Child Soldiers: The Role of Children in www.undp.org/evaluation/document/…con fl ict Sierra Armed Con fl ict , Clarendon, Oxford, 1994. Leone pdf accessed 28.06.11. 2. T. Zack-Williams, ‘Child Soldiers in Sierra Leone and 18. The Truth and Reconciliation Commission Report 2004. the Problems of Demobilisation, Rehabilitation and 19. K. Peters and P. Richards, ‘Why we Fight: Voices of Reintegration into Society: Some Lessons for Social Youth Combatants in Sierra Leone’, Africa , Vol. 68, Workers in War-torn Societies’, Social Work No. 2, 1998, p. 183–210. Education , Vol. 25, No. 2, March 2006, p. 119–128. 20. For a similar approach to the study of religious upris- 3. A. Gouldner, ‘Anti-Minotaur: The Myth of a Value- ing in an African city, see P. Lubeck’s, ‘Islamic Protest free Sociology’, Journal of Social Problems , Vol. 9, Under Semi-peripheral Capitalism: Yan Tatsine No. 3, Winter, 1962. Explained’, Africa , 55 (4), 1985, p. 369–389. 4. C. Ake, Social Science as Imperialism. The Theory of 21. Revolutionary United Front, Footpaths to Democracy Political Development , Ibadan University Press, 1982. Toward a New Sierra Leone , Vol. 1, p. 20–35. 5. R. Kaplan, ‘The Coming Anarchy: How Scarcity, Crime, 22. Ibid, p. 24. Over-Population and Diseases are Rapidly Destroying 23. ‘Child Soldiers in Sierra Leone and the Problem of our Planet’, Atlantic Monthly, February 1994. Demobilisation, Rehabilitation and Reintegration into 6. A.B. Zack-Williams, ‘Crisis, Structural Adjustment Society: Some Lessons for Social Workers in War- and Creative Survival in Sierra Leone’, Africa torn Societies’, Social Work Education: The Development , Vol. 18, No. 1, 1993, p. 53–65. International Journal, Vol. 25, No. 2, March, 2006, p. 7. A.B. Zack-Williams, ‘Freetown: “Athens of West 119–128. Africa” to a City Under Siege: The Rise and Fall of 24. A.B. Zack-Williams, Tributors, Supporters and Sub-Saharan First Municipality’, in O. Enwezor, C. Merchant Capital: Mining and Underdevelopment in Basualdo, U.M. Bauer, S. Ghez, S. Maharaj, M. Nash, Sierra Leone , Avebury, Aldershot, 1995. O. Zaya (eds.) Under Siege: Four African Cities 25. A.B. Zack-Williams, ‘Sierra Leone: Crisis and Freetown, Johannesburg, Kinshasa, Lagos , Despair’, Review of African Political Economy, No. Documenta 11_Platform 4, Hatje Cantz, p. 287–314. 49, 1990, p. 22–33. 8. T.N. Goddard, The Handbook of Sierra Leone , Grant 26. A.B. Zack-Williams, ‘Sierra Leone 1968-1985: The & Richards, 1925, p. 11. Decline of Politics and the Politics of Decline,’ in A. 94 T. Zack-Williams

Jones and P.K. Mitchell, Sierra Leone Studies at Leone’, African Affairs , Vol. 105, No. 418, January Birmingham 1985 , p. 201–208. 2006, p. 27–49. 27. C. Bledsoe, ‘“No Success Without Struggle”: Social 39. S. Shepler, ‘The Rites of the Child: global Discourses Mobility and Hardship for Foster Children in Sierra of Youth and Reintegrating Child Soldiers in Sierra Leone’, Man, New Series , 1990, 25, 1, p. 81. Leone’, Journal of Human Rights, Vol. 4, 2006, p. 28. I. Abdullah, ‘Bush Path to Destruction: The Origin 197–211. and Character of the Revolutionary United Front 40. American Psychological Association (APA) Resilience (RUF/SL)’, in Africa Development, Special Issue, in African American Children and Adolescents A Lumpen Culture and Political Violence: The Sierra Vision for Optimal Development Resilience in African Leone Civil War , Vol. 22, Nos. 3 & 4, 1997. American Children and Adolescents: A Vision for 29. R. Brett and I. Specht, Young Soldiers Why They Optimal Development; http://www.apa.org/pi/fami- Choose to Fight, Lynne Rienner, Boulder, Colorado, lies/resources/resiliencerpt.pdf , Read 23.01.12. 2004, p. 107. 41. The Child Rights Act 2007, which provides for the 30. Quoted in Brett and Specht, ibid, p. 69. promotion of the rights of the child compatible with 31. Peters and Richards, 1998, p. 194. the Convention on the Rights of the Child, adopted by 32. O. Badsha, Amulets & Dreams: War, Youth & Change the General Assembly of the United Nations on 20th in Africa, UNISA Press, 2002, p. 9. November, 1989, and its Optional Protocols of 8th 33. L. Schlein, UNICEF: Children in Sierra Leone September, 2000; the African Charter on the Rights Vulnerable to Exploitation, leonenet < leonenet@list- and Welfare of the Child and for other related matters. proc.umbc.edu > Date: 14/11/2005 20:15:26. It also repeal the Corporal Punishment Act. Amends 34. The Children and Young Persons Act (31st December the Protection of Women and Girls Act (Cap 30). 1945). Amends the Prevention of Cruelty to Children Act 35. Juvenile Justice in Sierra Leone: An Analysis of (Cap. 31). Amends the Children and Young Persons Legislation and Practice, www.essex.ac.uk/armedcon/ Act (Cap. 44). Amends the Muslim Marriage Act story_id/000013.htm —20th July 2011. (Cap. 96). Amends the Armed Forces of Sierra Leone 36. A.B. Zack-Williams, (ed.) When the State Fails: Act, 1961 (No. 34 of 1961). Amends the Interpretation Interventions in the Civil War in Sierra Leone , Pluto Act, 1971 (No. 8 of 1971) . Press, forthcoming (2011). 42. Z. Wai, ‘The role of youth and the Sierra Leone 37. P. Jackson, ‘Reshuf ﬂ ing an Old Deck of Cards? The Diaspora in Democratic Awakening’ in A.B. Zack- Politics of Local Government Reform in Sierra Williams, The Quest for Sustainable Development Leone’, African Affairs, Vol. 106, No. 422, January and Peace: The 2007 Sierra Leone Elections , Nordic 2007, p. 95–111. Institute of African, Uppsala, Sweden, 2008, p. 53. 38. R. Fanthorpe, ‘On the Limits of Liberal Peace: Chiefs 43. At a rate of between 65 and 70 %, ibid. and Democratic Decentralization in Post-war Sierra 44. Over 60 % of the population is in poverty, ibid. The Fallacy of the Ticking Time Bomb: Resilience of Children 7 Formerly Recruited into Armed Forces and Groups

Lindsay Stark and Mike Wessells

Media campaigns and advocacy platforms have of pathology that needs to be addressed through a frequently perpetuated images of formerly medical model via treatments such as counseling. recruited children as “a lost generation”—a cadre This paradigm is problematic on numerous lev- of young people who have committed unspeak- els. It focuses almost exclusively on wartime trauma, able atrocities during war and who are beyond thus assuming that formerly recruited children’s rehabilitation. One NGO declared recently that dif fi culties and traumatic experiences end once they “failure to act will create a ticking time bomb of are released from the armed force or armed group angry, alienated and traumatized youth whose with which they served. Following release, how- only skills they have to rely on are those they ever, formerly recruited children face a multitude of learned at war” (Child Soldiers, 2008 ) . In many stresses including potential fear of reprisals or com- con fl ict and post-con fl ict settings, this emphasis munity hostilities, stigmatization, family violence, on the trauma of formerly recruited children 1 has chronic poverty, and inability to earn a living dominated response efforts. Many responders (Boothby, Crawford, & Halperin, 2006; Garbarino have perceived these children as suffering a form & Kostelny, 1996 ; Stark, Boothby, & Ager, 2009 ) . These problems are often not of clinical proportions, yet formerly recruited children frequently say that these are their greatest sources of distress. 1 We use this term to refer to the full range of children Additionally, by focusing on de fi cits, the covered by the Paris Principles ( http://www.un.org/chil- trauma approach tends to underestimate children/con fl ict/english/parisprinciples.html), which use the dren’s abilities to cope with distress and to slightly cumbersome phrase “children associated with armed forces or armed groups.” It is used for convenience function, that is, to fi ll socially expected, age-ap- and is not intended to overshadow the enormous cultural propriate roles. In fact, many formerly recruited variation in regard to how childhood is defi ned in different children and youth exhibit resilience, which is contexts, the roles children play during their time with defi ned as the capacity to adapt and function armed forces and groups, or the multitude of ways in which children are “recruited” into warring factions. reasonably well despite exposure to adversity (Masten, Best, & Garmezy, 1990 ) . A growing L. Stark (*) Columbia University, Mailman School body of evidence indicates that the majority of of Public Health , Program on Forced Migration war-affected youth fi nd a way to move on and and Health New York , NY , USA become functional members of their families e-mail: [email protected] and communities. Such fi ndings suggest the need M. Wessells for a new paradigm for understanding and sup- Randolph-Macon College, Columbia University, porting formerly recruited children as they Mailman School of Public Health, Program on Forced Migration and Health, New York, NY USA. attempt to leave their wartime identities behind e-mail: [email protected] and reintegrate into civilian life.

C. Fernando and M. Ferrari (eds.), Handbook of Resilience in Children of War, 95 DOI 10.1007/978-1-4614-6375-7_7, © Springer Science+Business Media New York 2013 96 L. Stark and M. Wessells

Programmatically, a resilience paradigm is young people do not want to be treated as if they useful because it emphasizes the importance of were dependent children. Having learned active building on the existing strengths of children, skills of planning and organizing inside armed families, and communities. A resilience paradigm forces and groups, they want to put those skills to also points the way toward a different way use in the civilian arena rather than sit and learn of working which is based on strengthening adult-prescribed skills such as tailoring. empowerment, young people’s agency and voice, A recent study illustrates how it is possible to and collective action to support children’s reinte- build on young people’s agency through partici- gration. In contrast, a defi cits approach underesti- patory action research (PAR), in which young mates children’s adaptive capacities and often people themselves defi ne reintegration, identify leads to the development of programs that regard the problems that block it, and take steps to formerly recruited children as passive victims and address the problems (McKay, Veale, Worthen, offer individualized supports such as counseling. & Wessells, 2010 ) . Recognizing that programs This chapter explores the learning that has on disarmament, demobilization, and reintegra- taken place around resilience- and strengths-based tion (DDR) have typically marginalized women approaches to helping formerly recruited children and girls, this study focused on the reintegration reintegrate into civilian life. It examines the impor- of formerly recruited girls, including girl-moth- tance of agency and relationships in supporting ers, in Sierra Leone, Liberia, and Uganda. A key reintegration, contesting the adult-centric and indi- fi nding was that these young women de fi ned vidualistic approaches seen frequently in war reintegration in highly relational terms. Far from zones. Next, it analyzes how reintegration is sup- thinking only about their individual mental health ported by fi ve key elements—psychosocial inter- and well-being, they defi ned reintegration to ventions, cultural and spiritual practices, education, mean that “they and their children are accepted, livelihoods, and family and community mobiliza- respected and included as contributing family tion and reconciliation. Recognizing the enormity and community members” (McKay et al.). This of the ethical challenges associated with efforts to defi nition was arrived at following many hours of reintegrate formerly recruited children, the chapter discussion that focused on their practical prob- concludes with a re fl ection on various Do No lems such as their stigmatization and voiceless- Harm issues and how they can be managed. ness. In fact, at the start of the 3-year project, most girls reported that they were so low and invisible that they could not even attend commu- Agency and Relationship nity meetings, much less speak during them. In this context, the process of de fi ning reintegration Hidden power dynamics, particularly the privileg- is less a technical task than one of acquiring voice ing of adult perspectives, frequently impede effec- and regaining one’s sense of dignity and agency. tive reintegration. Typically, reintegration Elaborating on what they meant by “reinte- programs have been conceptualized, implemented, gration,” the young women discussed a circular and evaluated by adults. From a resilience per- process in which they exhibited respectful, appro- spective, this adult-centric approach is misguided priate behavior and earned respect and accep- because it disempowers children and youth, infan- tance as a result, which in turn increased their tilizes them, and regards them as bene fi ciaries motivation to abandon the fi ghting and unruly rather than as people who have the capacity to behavior that they had initially exhibited follow- cope and adapt. This approach mitigates against ing their release. They discussed also the impor- the sense of self-effi cacy that supports healing fol- tance of being contributing family members, lowing exposure to overwhelming events. From a having a livelihood to help support themselves practical standpoint, adults tend not to be in touch and their children, caring for their children’s with the main concerns of children and youth. As a appearance and hygiene, and showing good result, adults are in a poor position either to respond mothering skills. They also talked about the to those concerns. Also, many formerly recruited importance of giving back to their communities. 7 The Fallacy of the Ticking Time Bomb… 97

To achieve reintegration, the young women through intensely relational processes. The visible formed peer groups of approximately 20–25 girls importance of social relations serves as a poignant who met on a weekly basis and who listened and reminder of the limits of individualized approaches discussed issues in respectful ways, supported each that focus primarily on the well-being of individ- other, managed confl ict, and engaged in collective ual children. In all aspects, effective reintegration problem solving. The girls also chose to develop is a social process of rebuilding relationships livelihood projects such as selling small items in between them and their families and communities the local marketplace, animal husbandry, or start- and helping them to have a meaningful social role ing a bakery. Supportive women and other as well as fi nd civilian identities. infl uential community members helped to mediate between the girls and the communities, who had initially feared them, encouraged community mem- Key Reintegration Supports bers to include the girls and their children in their activities, and mobilized resources such as land to Effective reintegration requires a system of miti- help the girls in livelihood projects such as farm- gating and preventive supports. Without attention ing. Over time, communities developed a sense of to prevention, the risks are high that demobilized ownership over the project, thereby opening the children will be re-recruited or that the DDR doors for, and supporting, the girls’ reintegration. efforts will create a revolving door that brings new Three key fi ndings from this project under- child recruits in as the demobilized children leave. scored the girls’ relational view of reintegration. To intermix mitigation and prevention, practitio- First, the peer groups provided valuable psycho- ners are increasingly moving away from narrowly social support that built confi dence, helped the constructed supports designed speci fi cally for for- girls fi nd their voice, and enabled coping through merly recruited children in favor of holistic sup- problem solving and talking. Without this supports provided by national systems of child port, the girls could probably not have bene fi tted protection. These systems address a wide array of from traditional reintegration supports such live- sources of vulnerability, including family separa- lihoods because they were too stigmatized. tion, displacement, sexual violence, traf fi cking, Second, livelihoods activities were essential in and HIV and AIDS, among many others. It is enabling the girls to ful fi ll their roles as mothers beyond the scope of this chapter to discuss the full and contributing members of their families and range of supports needed to establish holistic pro- communities. Third, the girls’ well-being was tection systems. Instead, the focus will be on some inextricably linked with that of their children. of the main supports needed for reintegration. The girls earned income, reentered education, became seen as “serious,” and participated in community meetings. Yet it was equally impor- Psychosocial Supports tant, in their view, that they had become good mothers and their children, who previously had Many of the mental health and psychosocial sup- been shunned, were now included and could go ports established for formerly recruited children to school and play with other children. had been guided by assessments of DSM-based This relational view of reintegration fi ts well symptoms and disorders, particularly post-trau- with a social ecological framework for understand- matic stress disorder (PTSD), which has been ing children’s development (Boothby et al., 2006 ; estimated to affect from 30 % to over 90 % of Bronfenbrenner, 1979 ; Dawes & Donald, 2000 ) . war-affected children (Ajdukovic & Ajdukovic, This framework emphasizes that individual devel- 1998 ; Annan, Blattman, & Horton, 2006 ; Green, opment occurs through interactions with others in 1994 ; Husain et al., 1998; Mollica, Mclnnes, the context of overlapping social spheres of fam- Poole, & Tor, 1998 ) . Quite often, such data have ily, community, and society. Consistent with this led to the establishment of counseling services. idea, the girls in the PAR study developed and However, most of the measures used in these reintegrated into their families and communities studies have not been validated in non-Western 98 L. Stark and M. Wessells countries and may be inappropriate due to their reduce the stigma of formerly recruited girls. The individual focus and cultural speci fi city. third layer, which applies to a much larger per- Notwithstanding media images of all children centage of the population, consists of family and being traumatized, one cannot assume that all community supports such as education and steps formerly recruited children have been affected in to reunify families. The bottom layer is the rees- the same way. In general, exposure to greater tablishment of security and steps to meet basic “doses” of traumatic experience tend to produce survival needs, the provision of which makes it stronger effects, and children who had been in possible for natural sources of support from fam- armed groups longer tend to be more strongly ily members, religious leaders, and others to take affected. For example, a girl who had spent a day effect. carrying heavy loads for an armed group will likely be affected differently from a girl who had survived sexual abuse in an armed group. Cultural and Spiritual Practices Similarly, children who had preexisting vulnerabilities tend to be more strongly affected than are A central feature of resilience approaches is that children who were less vulnerable or had better they build upon local assets and modes of coping, coping skills. Impact also varies according to at the community level (Norris, Stevens, whether and how children impute meaning to Pfefferbaum, Wyche, & Pfefferbaum, 2008 ) as their experiences. A boy who joins an armed well as the individual level. In contrast to Western group as a freedom fi ghter out of a strong com- approaches to healing, which frequently have mitment to a cause may fi nd meaning in fi ghting, been imposed from the outside and encounter may feel a sense of camaraderie with his group, problems of acceptance and sustainability, a resil- and may survive an attack from a rival group ience approach uses local understandings to guide without developing signifi cant signs of trauma. A the analysis of young people’s problems and boy who has been forced to fi ght against his will, seeks to identify and strengthen local modes of and who feels isolated, afraid, and confused, on healing and coping, provided that they fi t with the other hand, may present with signs of anxiety international human rights standards. and depression following a similar attack. Western approaches have typically used a med- In addition, fi eld experience has repeatedly ical model that emphasizes the physical causation indicated the need for holistic approaches that go of ailments and guides the use of Western inter- beyond trauma counseling. Formerly recruited ventions, including the use of medications, which children frequently report that their biggest may be unsustainable or inappropriate in the local sources of distress are not past traumas but cur- context. In many non-Western cultures, however, rent problems of living such as joblessness, stig- people view health and well-being in terms of matization, and insecurity. Lack of access to relationships between individuals and their sur- education is often one of their greatest self- roundings, their ancestors, and among themselves reported problems. To address these issues, it is (Honwana, 1997, 1998a) . Both the causes of ill- essential to develop a comprehensive, layered ness and the remedies are believed to lie in the system or reintegration supports (Wessells, spiritual world (Honwana, 1997) . The spiritual 2006b ) . Following the IASC Guidelines on beliefs and practices are signifi cant means of cop- Mental Health and Psychosocial Support in ing since they enable people to fi nd meaning and Emergency Settings ( 2007 ) , one can envision the restore well-being in their lives after traumatic layered system in the form of an intervention experiences (Lee & Sue, 2001 ; Swartz, 1998 ) . pyramid. The top layer of the pyramid consists of For example, girls returning from armed the important specialized supports such as coun- groups in particular areas of Sierra Leone seling that are needed by a small minority of chil- described having noro, a form of spiritual con- dren. The second layer consists of focused tamination or bad luck. This spiritual contamina- supports such as livelihoods supports or steps to tion was attributed to rape and other wartime 7 The Fallacy of the Ticking Time Bomb… 99 activities, and affected almost every aspect of and to anticipate and take steps to prevent the girls’ lives. Girls believed that bad luck affected negative unintended consequences that may arise their relationships, impeded their ability to get through support of traditional practices. While married or fi nd love, and caused bad behavior, there are no universal guidelines in how to negative emotional states, and negative self- support positive local practices while discourag- perceptions. The girls’ contamination caused them ing negative ones, key informants within the to feel isolated from the community and unable to communities will often be able to provide critical participate in communal activities. As a result of guidance in moving forward in an ethical and their contamination, the girls believed they were culturally sensitive manner. unable to work and earn an income or to function within society (Kostelny, 2004 ; Stark, 2006 ) . In rural areas of Sierra Leone where people Education adhered to traditions, these spiritual af fl ictions were viewed as communal rather than as indi- Education is one of the most frequently identi fi ed vidual problems since angry spirits could cause priorities and a source of hope for formerly illness in one’s family, crop failures, or other recruited children (McKay & Mazurana, 2004 ; problems. Both the girls and their families sought Peters & Richards, 1998; Williamson & Carter, ritual cleansings and other rituals performed by 2005; Women’s Commission, 2005 ) . Recruitment indigenous healers as a means of purging the into armed forces and groups interrupts children’s angry spirits and spiritual toxins and helping schooling. Signifi cant barriers to effective educa- the girls to put the past behind them. Typically tion remain even after a cease fi re has been estab- these ceremonies were organized and paid for lished. Many post-con fl ict areas struggle from a by family and community member who saw lack of schools and a shortage of teachers. Even this as essential for the girls’ reintegration and when schooling is available, formerly recruited recovery. In other cases, local and international children may be deterred from attending classes NGOs helped to support these processes. Similar due to stigma from classmates and teachers. practices have been documented in Angola, Others have diffi culties concentrating or may Mozambique, Uganda, the Democratic Republic refuse to sit in a classroom with much younger of the Congo, and throughout sub-Saharan Africa children (Wessells, 2006a ) . Having returned (Annan et al., 2006 ; Boothby et al., 2006 ; recently from the bush, formerly recruited chil- Honwana, 1998a, 1998b ) . In Asia, too, people dren may fi nd it dif fi cult to relate to their fellow understand many ailments, including mental ill- classmates, their teachers, and the contents of their nesses, as having spiritual causes and remedies courses. Many returning children are expected to (Eisenbruch, 1991 ; Gielen, Fish, & Draguns, contribute to a family’s income, and may have to 2004 ; van de Put & Eisenbruch, 2004 ) . prioritize income generation over schooling. These beliefs and practices have received a While the barriers described above affect both fair amount of attention in recent years, and have formerly recruited boys and girls, girls have a inspired a more culturally grounded approach to number of additional obstacles as well. Girls are interventions. While this is a positive develop- often encouraged to stay home, as their education ment, it is important to view local practices with is not valued as highly as the male members of a critical eye and avoid the romantic and demonic their family. In addition, girls in many countries stereotypes that have arisen at fi eld level. Local are expected to leave school if they are married or beliefs and practices are dynamic and complex, have their own children. Some girls are actually and some local practices, such as female circum- kept home as a means of protection, because of cision, are harmful. Possibly, the same indigenous fears of exploitative teachers and the high risk of healers who perform useful cleansing rituals may sexual violence at or on the way to school also perform harmful traditional practices. It is (Murphy, Stark, Wessells, Boothby, & Ager, important to support only positive practices, 2011 ; Wessells, 2006a ) . 100 L. Stark and M. Wessells

The importance of enabling the full participa- girl-mothers, education may be a viable option tion of formerly recruited children is evident in only if it is coupled with a livelihood. From recent research in northern Uganda, which a resilience standpoint, the key is to engage reported that each additional year of education formerly recruited children as co-decision mak- was associated with a 5 % increase in daily wages. ers in designing, implementing, and evaluating Better educated children tended to engage in less appropriate forms and venues of education and risky occupations and were less vulnerable to in linking education with interventions such as repeat recruitment or abductions (Annan et al., livelihoods. 2006 ) . Sadly, the same study reported that formerly recruited children were half as likely to be enrolled in school as other children in their com- Livelihoods munity. Additionally, they were a third less likely to graduate from primary to secondary school, In identifying their most pressing issues and and were twice as likely to be fully illiterate needs, formerly recruited children frequently pri- (Annan et al. 2006 ). oritize economic stressors. Returned youth are Participation in quality education also offers often ridiculed for being unable to afford cloth- important immediate benefi ts. Education helps to ing, shoes, or school uniforms. Others may suffer build cognitive competencies, which are impor- because they are unable to afford treatment for tant sources of coping and problem solving. Well- lingering physical ailments, including sexually designed education also provides psychosocial transmitted illnesses; still others speak about the support by enabling positive interactions between responsibility they feel to help their family fi nd teachers and students and among students and by money to put food on the table. providing a regular routine that establishes a Economic well-being is closely linked to sense of normalcy, safety, and continuity social status and identity for children returning (McCallin, 1999 ; Tomaševski, 2001 ; UNICEF, from armed forces and groups (Wessells, 2006a ) . 2003 ) . If teachers and education staff are well In Mozambique, for example, many returned prepared, schools are places for identifying and youth expressed a desire to earn money in order supporting highly vulnerable children, referring to get “a wife and family” (Boothby et al., 2006 ) , them for more specialized support if necessary. which was a way of being like other people of By participating in the social role of students, one’s age and fi lling an age-appropriate social education can help formerly recruited children role. Similarly, for girls in Sierra Leone who meet social expectations and redefi ne their iden- returned from armed forces, marriage was a criti- tity as something other than “a soldier” (Human cal marker of social acceptance. Many girls did in Rights Watch, 1994 ) . fact marry following their return, and they attrib- However, it is useful to place education for uted this to the fact that they had been able to formerly recruited children in critical perspec- earn money, which had elevated their status and tive, as enrollment alone does not guarantee the made them more desirable as marriage partners short- and long-term benefi ts described above (Stark, 2006 ; Wessells, 2006a ) . (Sommers, 2003 ) . Too often, educators and stu- Emerging evidence also suggests that the eco- dents lack the training needed to create a support- nomic prospects for formerly recruited children ive environment for formerly recruited children. may vary according to how old children were when Also, traditional educational settings and they entered armed forces or groups. In Uganda, approaches may be poorly suited to meeting the children who had been abducted at a young age needs of formerly recruited children. Experience earned slightly more than children who had not in some settings suggests that it is useful to pro- been abducted into armed forces (Annan et al., vide nonformal education, including catch-up 2006 ) . In contrast, children who were recruited classes designed speci fi cally for formerly from the age of 12 years or above suffered in terms recruited children. For some children such as of their ability to earn an income following their 7 The Fallacy of the Ticking Time Bomb… 101 return. These children earned, on average, half as many contexts, fewer professional options have much as those who had not been recruited (Annan traditionally been considered appropriate for girls et al.). It is hypothesized that these children missed (McKay & Mazurana, 2004 ; Stark, 2006 ) . Thus, formative years in armed groups that might have when training has become available for a limited otherwise been spent in school or learning a trade. number of tailors, for example, those spots have These fi ndings echo the Life Course Theory, which tended to go to boys (Verhey, 2001 ) . Additionally, puts forward the notion that historical forces shape livelihoods training may need to be adapted in the social trajectories of family, education, and order to be of most use to girls. A study in the work, which in turn infl uence behavior and pat- Democratic Republic of Congo (DRC) found that terns of development (Elder, 1998 ) . Additional most girls needed small-scale activities that more research is needed to determine whether the pat- quickly generated an income because they did tern documented in the Ugandan context general- not have the time or life options to participate in izes to other contexts as well. the time-intensive training schemes that many Despite the importance of economic strength- programs required (Verhey, 2004 ) . In the PAR ening and livelihoods programming, a key ques- study discussed above, similar challenges arose tion is how to enable effective economic supports. for young mothers who struggled to juggle moth- At fi eld level, programs frequently provide voca- ering responsibilities with tasks related to earn- tional training, which is in high demand among ing an income. Learning how to provide formerly recruited youth (Wessells, 2006b ) . gender-appropriate aid is a major task for future However, vocational training does not guarantee livelihoods programming. the ability to earn a sustained income. Too often, vocational training is conducted without a proper market analysis of which skills are sustainable in Community Mobilization the local economy, and the focus is on training and Reconciliation youth in only one or two trades. The resulting fl ooding of the market leaves youth feeling frus- An enduring lesson from the fi eld is that reinte- trated that they cannot support themselves with gration is a community and family process as their newly acquired skill. Frustration and pro- well as an individual change process (Verhey, longed unemployment can propel formerly 2001) . The success of the interventions described recruited youth back into armed forces and above depends not only on the returned child, but groups. on the health and well-being of the broader com- Although a systematic market analysis is the munity. From the standpoint of a resilience essential fi rst step (CIDA, 2005; Unicef, 2007 ; approach, it is a high priority to build community Save the Children, 2004 ) , formerly recruited chil- resilience (Wessells, 2006a ) , which is a collective dren need more than vocational skills for earning analogue of individual resilience (Norris et al., an income. Many need to learn basic business 2008 ) . skills such as how to keep track of income and In the context of reintegration programming, expenditures, how to save, and how to develop building community resilience requires strength- and follow a budget. They also need to learn ening community agency through collective plan- interpersonal skills in the marketplace and how to ning and action to address local problems, and add and subtract. Basic, age-appropriate literacy the internal mobilization of community resources. and numeracy skills, as well as training on how to To achieve community agency and ownership of comport one’s self during a business transaction, the reintegration process is diffi cult since war can be critical supports to vocational training shatters social unity and trust, and creates fear programs (Annan et al., 2006 ; ILO, 2008 ) . and competition over scarce resources. In practi- Discrimination against girls has been a cal terms, community members frequently fear signi fi cant obstacle to recent livelihoods pro- the youth who had previously attacked them, gramming, owing in part to the fact that, in stigmatize them, or actively seek revenge. 102 L. Stark and M. Wessells

Community reconciliation is the foundation settings is a poignant reminder that reintegration for repairing the damage that has been done, and programs cannot succeed by attempting to recon- for creating a space where formerly recruited struct the relations that had antedated the confl ict. children feel welcomed, safe, accepted, and hope- Successful reintegration efforts must have a ful about the future. No single universal model of transformational orientation that seeks to reconciliation exists, and many models incorpo- strengthen social justice and link local reintegra- rate elements of truth, justice, forgiveness, recon- tion efforts with wider work to build peace. struction, and peace (see Kreisberg, 2004 ; Lederach, 1997 ; Rouhana, 2000 ) . Yet, at the crux of all of these models are the concepts of repara- Do No Harm Issues tion and transformation of relationships that have been damaged as a result of war. Work to reintegrate formerly recruited children, To support community reconciliation in Sierra like all humanitarian efforts, frequently has unin- Leone, one program facilitated collective plan- tended consequences, some of which cause harm. ning and stimulated cooperation between formerly For example, a frequent error is to assume that recruited youth and youth who had been part of children who exhibit resilience need no support. villages that had been attacked (Wessells & Jonah, In cases such as Northern Ireland, politicians 2005 ) . Neighboring villages that had cooperated have misappropriated the term “resilience,” using historically came together to identify projects that it to deny mental health bene fi ts to children on would support their children. Frequently selected various sides of the political violence. projects included rebuilding schools, building However, to say that children are resilient is health posts, or repairing bridges that supported not to imply that they have not been affected by travel to and commerce with other areas. Following war and need no support (Cairns & Dawes, 1996 ) . intergroup discussions among youth, including All war-affected children need and are entitled to the activation of traditional means of handling supports—though, as indicated by the interven- confl ict without violence, youth work teams were tion pyramid for mental health and psychosocial formed that subsequently built the community supports, different children may need different projects. The teams consisted of equal numbers of kinds of support. A young mother who had for- youth who had and had not been part of armed merly been recruited may function relatively well groups, respectively. Together, these activities yet may need a variety of livelihood, education, helped to reestablish a sense of social trust and and psychosocial supports. Taking a resilience interdependence and to enable the collective approach is about how support is provided—it action that is needed to cope with diffi cult circum- is not about whether support is provided. The stances. In addition, relations among the youth resilience idiom would itself become a source of improved, as did relations between the wider harm if it were used to cover up or distract atten- community and the formerly recruited youth. As tion from the trauma, substance abuse, spiritual the latter worked on the community projects, they problems, and other mental health and psychoso- made restoration for the harm they had done, and cial issues that can affect formerly recruited community members came to see them as poten- children. tially constructive citizens. At every step, a key to working effectively Mediation with families, confl ict resolution, with formerly recruited children is to maintain a traditional cleansing ceremonies, and welcoming stance of critical awareness regarding the ways in returned children back into churches and mosques which research and programming can cause unin- have also all helped bring about remarkable trans- tended harm. Although these issues have war- formations for returned children, their families, ranted more extensive discussion, it is valuable to and the broader community (Stark, 2006 ; analyze here the issues of excessive targeting and Williamson & Cripe, 2002 ) . The importance of power dynamics that frequently lead to prevent- nonviolent approaches to confl ict in post-confl ict able harm. 7 The Fallacy of the Ticking Time Bomb… 103

Excessive Targeting focus research, assessments, or programmatic supports exclusively on predefi ned categories of Targeting is a way of meeting the speci fi c needs vulnerable people. A sounder strategy is to rec- of at-risk children and of focusing scarce pro- ognize that vulnerability is highly contextual and gramming and funding resources on children to learn from affected people what the main who are most vulnerable. For example, from a sources of vulnerability are and who is in the programming perspective, a moderate amount of most desperate situation. As indicated by the targeting is sensible, even necessary, to develop Paris Principles, it is useful to include a mix of supports that meet the speci fi c needs of formerly vulnerable children in studies or programs that recruited girl-mothers. A less targeted approach are designed primarily to support formerly of making education available to all children recruited children. The dif fi culty, however, is that would probably not help many formerly recruited a single village or town may include children girl-mothers who could not attend school due to who are vulnerable from diverse sources—family stigmatization and lack of income. From a donor separation, HIV and AIDS, gender-based vio- perspective, targeting makes it possible to sup- lence, and so on—and each source may require a port the most vulnerable people and to obtain different program approach or focus. Further, “more bang for the buck.” there may be donor restrictions that limit the use Although targeting itself is not problematic, a of funding for children who had not been frequent cause of unintended harm is excessive recruited. In this case, it is useful to obtain mul- targeting. For example, researchers who want to tiple sources of funding to support children hav- learn about the situation of formerly recruited ing different needs. However, in the highly fl uid, girls may enter villages and cities, interviewing chaotic situation that often exists soon after the only formerly recruited girls. Yet this can stigma- signing of a cease fi re, this is more challenging tize the girls and add to their burden of suffering. than it sounds. Nevertheless, awareness of the Similar problems arise in regard to programming problem of excessive targeting and a quest for a that is guided by donor funding provided more comprehensive approach are useful in man- specifi cally for formerly recruited children. In aging the situation. Sierra Leone, Liberia, and other countries, this practice created charges that aid was “blood money” since it was used to support the youth Power Dynamics who had previously attacked villages. In addition, reverse stigmatization occurred as people in very Reintegration work also faces thorny ethical and poor villages became angry and jealous when practical issues centered around power dynamics, they saw formerly recruited youth return home both within groups of affected people and between better dressed than they themselves could afford. humanitarians and affected people. As discussed This excessive targeting created social divisions earlier, community ownership is of fundamental at the moment when unity was a high priority. A importance in a resilience approach. Yet what if sad irony is that the frequently made assumption no coherent “community” exists? In urban con- that formerly recruited children are among the texts that are home to refugees from many differ- most vulnerable is often untrue. Children who are ent countries, there may be little sense of inside armed groups sometimes have greater community, and various subgroups may struggle access to food and medicines than do the young for control over basic resources such as land and people who live in areas under attack. In such water. Even within seemingly homogeneous situations, exclusive support for formerly communities, there is likely to be a hidden power recruited children is discriminatory and harmful. structure in which some people, for example, the No simple blueprint exists for avoiding exces- chief’s clan, enjoy infl uence and privileges that sive targeting, and solutions to this problem are other people do not have. In most communities, highly contextual. In general, it is wise not to there are marginalized people who have little 104 L. Stark and M. Wessells

status or voice. To manage these complexities toward ethical practice. It is through a resilience within a resilience framework, it is important to approach that formerly recruited youth achieve avoid the trap of supporting only local power the full voice, agency, and dignity that are their elites, reach out to different subgroups, and take an fundamental rights even amidst adversity. inclusive approach to programming that respects the voice and agency of marginalized people. The power dynamics between affected people References and humanitarians, many of whom come from developed countries of the global North and West, Ajdukovic, M., & Ajdukovic, D. (1998). Impact of dis- are no less problematic. Despite the importance placement on the psychological well being of refugee of enabling local people’s agency and respecting children. International Review of Psychiatry, 10 , their culture, outside interveners hold the power 186–195. Annan, J., Blattman, C., & Horton, R. (2006). The state of that is associated with money, education, and youth and youth protection in northern Uganda: scientiﬁ c legitimacy. Not uncommonly, outsiders Findings from the Survey for War Affected Youth . who lack humility and a spirit of mutual learning Kampala: UNICEF. with affected people impose their preconceived Boothby, N., Crawford, J., & Halperin, J. (2006). Mozambican child soldier life outcome study: Lessons ideas and approaches, thereby marginalizing learned on rehabilitation and reintegration efforts. local people and their cultural beliefs and prac- Global Public Health, 1 (1), 87–107. tices. For example, in northern Uganda, some Bronfenbrenner, U. (1979). The ecology of human devel- formerly recruited youth who believed that they opment. Experiments by nature and design . Cambridge, MA: Harvard University Press. needed traditional cleansing were told by Cairns, E., & Dawes, A. (1996). Children: Ethnic and Christian evangelical workers that they only political violence—A commentary. Child Development, needed to pray. In cases such as this, reintegra- 67 (1), 129–139. tion efforts become a form of neocolonialism that Child Soldiers. (2008). A ticking timebomb . Available at: thwarts agency and building on local assets. The http://www.planusa.org/contentmgr/showdetails.php/ id/353396 http://www.planusa.org/contentmgr/show- resulting harm is preventable by taking a self- details.php/id/353396 critical stance and vesting local people with CIDA (Canadian International Development Agency). greater power to guide programming. (2005). Support to former child soldiers: Programming and proposal evaluation guide . Quebec: Canadian International Development Agency (CIDA). Dawes, A., & Donald, D. (2000). Improving children’s Conclusion chances. In D. Donald, A. Dawes, & J. Louw (Eds.), Addressing childhood adversity (pp. 1–25). Cape Efforts to support reintegration raise myriad other Town: David Philip. Eisenbruch, M. (1991). From post-traumatic stress disor- issues about the ethics of practices such as failing der to cultural bereavement. Social Science and to work on prevention, working only with boys, Medicine, 33 (6), 673–680. supporting harmful traditional practices, asking Elder, G. (1998). The Life course as development theory. formerly recruited children to recount their worst Child Development, 69 (1), 1–12. Garbarino, J., & Kostelny, K. (1996). The effects of politi- experiences, interviewing children when little cal violence on Palestinian children’s behavioural psychosocial support is available, exploiting problems: A risk accumulation model. Child images of formerly recruited children for pur- Development, 67 (1), 33–45. poses such as raising funds, and providing only Gielen, U., Fish, J., & Draguns, J. (Eds.). (2004). Handbook of culture, therapy, and healing . Mahwah, NJ: Erlbaum. short-term support when reintegration is a longer Green, B. (1994). Psychosocial research in traumatic process that is measured in years. Finding ways of stress: An update. Journal of traumatic stress, 7 (3), preventing and managing these and other ethical 341–362. issues is an essential part of supporting the young Honwana, A. (1997). Healing for peace: Traditional healers and post-war reconstruction in Southern people’s reintegration. Ultimately, the adoption of Mozambique. Peace and Conﬂ ict: Journal of Peace a resilience approach is itself an important step Psychology, 3 (3), 293–305. 7 The Fallacy of the Ticking Time Bomb… 105

Honwana, A. (1998a). Sealing the past, facing the future: disaster readiness. American Journal of Community Trauma healing in rural Mozambique (Vol. 3). London: Psychology, 41 , 127–150. Conciliation Resources, Accord. Peters, K., & Richards, P. (1998). Why we fi ght: Voices of Honwana, A. (1998b). Okusiakala O’Ndalu Yokalye: Let youth combatants in Sierra Leone. Africa, 68 (2), us light a new fi re . Luanda: Christian Children’s 183–210. Fund. Rouhana, N. (2000). Interactive con fl ict resolution: Issues Human Rights Watch. (1994). Easy prey: Child soldiers in theory, methodology, and evaluation. In P. Stern & in Liberia . New York, NY: Human Rights Watch D. Druckman (Eds.), International con fl ict resolution Children’s Rights Project. after the Cold War (pp. 294–337). Washington, DC: Husain, S. A., Jyotsna, N., Holcomb, W., Reid, J. C., National Academy Press. Vargas, V., & Nair, S. N. (1998). Stress reactions of Save the Children UK. (2004). Crossing borders: The children and adolescents in war and siege conditions. Demobilization and Reintegration of Rwandan Boys American Journal of Psychiatry, 155 , 1718–1719. and Girls Associated with Armed Groups in the Inter-Agency Standing Committee. (2007). IASC guide- Democratic Republic of Congo. Unpublished. lines on mental health and psychosocial support in Sommers, M. (2003). Education in emergencies . emergency settings . Geneva: IASC. Washington, DC: Creative Associates International. International Labor Organization (ILO). (2008). Improving Stark, L. (2006). Cleansing the wounds of war: An exami- skills and productivity of disadvantaged youth. nation of traditional healing, psychosocial health and Employment working paper no. 7 . Geneva: ILO. reintegration in Sierra Leone. Intervention: Kostelny, K. (2004). What about the girls? Cornell International Journal of Mental Health, Psychosocial International Law Journal, 37 (3), 505–512. Work and Counseling in Areas of Armed Confl ict, 4 (3), Kreisberg, L. (2004). Comparing reconciliation actions 206–218. within and between countries. In B.-S.-T. Yakov (Ed.), Stark, L., Boothby, N., & Ager, A. (2009). Children and From confl ict resolution to reconciliation . Oxford: fi ghting forces: Ten years on from Cape Town Oxford University Press. Disasters. The Journal of Disaster Studies Policy and Lederach, J. (1997). Building peace. Washington, DC: U. Management, 33 (4), 522–547. S. Institute of Peace. Swartz, L. (1998). Culture and mental health . Cape Town: Lee, J., & Sue, S. (2001). Clinical psychology and culture. Oxford University Press. In D. Matsumoto (Ed.), The handbook of culture & Tomaševski, K. (2001). Education: From lottery back to psychology (pp. 287–305). New York: Oxford rights. International Children’s Rights Monitor., 14 (3), University Press. 14–17. Masten, A. S., Best, K. M., & Garmezy, N. (1990). UNICEF (United Nations Children’s Fund). (2003). Resilience and development: Contributions from Technical notes: Special considerations for program- the study of children who overcome adversity. ming in unstable situations . New York, NY: UNICEF Development and Psychopathology, 2 , 425–444. Programme Division. McCallin, M. (1999). The refugee experience: Psychosocial Unicef. (2007). Independent Final Evaluation of the training module . Oxford: Refugee Studies Centre. Demobilization of Child Soldiers and Socioeconomic McKay, S., & Mazurana, D. (2004). Where are the girls? Reintegration of War-Affected Young People in Girls in fi ghting forces in Northern Uganda, Sierra Afghanistan (D&R) Project. Unicef: New York. Leone, and Mozambique: Their lives during and after Available at: http://www.dol.gov/ilab/projects/asia/ war. Montreal: International Centre for Human Rights Afghanistan_ChildSoldiers_feval.pdf. and Democratic Development. Van de Put, W., & Eisenbruch, M. (2004). Internally dis- McKay, S., Veale, A., Worthen, M., & Wessells, M. placed Cambodians: Healing trauma in communities. (2010). Community-based reintegration of war- In L. Rasco & K. Miller (Eds.), The mental health of affected young mothers: Participatory action research refugees: Ecological approaches to healing and adap- (PAR) in Sierra Leone, Liberia, and northern Uganda . tation. Routledge. Available at: http://PARgirlmothers.org Verhey, B. (2001). Child soldiers: Preventing, demobiliz- Mollica, R. F., Mclnnes, K., Poole, C., & Tor, S. (1998). ing and reintegrating. Africa Region Working Paper Dose—Effect relationships of trauma to symptoms of Series No. 23. World Bank, Washington, DC. depression and post-traumatic stress disorder among Verhey, B. (2004). Reaching the Girls: Study on Girls Cambodian survivors of mass violence. British Journal Associated with Armed Forces and Groups in the of Psychiatry, 173 , 482–488. Democratic Republic of Congo. Save the Children and Murphy, M., Stark, L., Wessells, M., Boothby, N., & Ager, the NGO Group: CARE, IFESH and IRC. Available A. (2011). Fortifying barriers: Sexual violence as an at: http://www.crin.org/bcn/details.asp obstacle to girls’ school participation in northern Wessells, M. (2006a). Child soldiers: From violence to pro- Uganda. In Julia Paulson (Ed.), Con fl ict, education tection . Cambridge, MA: Harvard University Press. and peacebuilding: Oxford studies in comparative Wessells, M. (2006b). A living wage: The importance education . Oxfordshire: Symposium Books. of livelihood in reintegrating former child soldiers. Norris, K., Stevens, S., Pfefferbaum, B., Wyche, K., & In N. Boothby, A. Strang, & M. Wessells (Eds.), Pfefferbaum, R. (2008). Community resilience as a A world turned upside down: Social ecologies of metaphor, theory, set of capacities, and strategy for children and war . Connecticut: Kumarian Press. 106 L. Stark and M. Wessells

Wessells, M., & Jonah, D. (2005). Reintegration of former Williamson, J., & Cripe, L. (2002). Assessment of youth soldiers in Sierra Leone: Challenges of reconcili- DCOF supported child demobilization and reintegra- ation and post-accord peacebuilding. In S. McEvoy- tion activities in Sierra Leone . Washington, DC: Levy (Ed.), Youth and post-accord peacebuilding . USAID. South Bend, Indiana: University of Notre Dame Press. Women’s Commission for Refugee Women and Children. Williamson, J., & Carter, L. (2005). Children’s reintegra- (2005). Learning in a war zone: Education in northern tion in Liberia . Washington, DC: United States Agency Uganda. New York: Women’s Commission for for International Development (USAID). Refugee Women and Children. Children of War in Colombia and Iraq 8

Marla J. Buchanan, Kasim Al-Mashat, Liliana Cortes, Branka Djukic, Beheshta Jaghori, and Alanna Thompson

In modern warfare, 10 % of the people who are killed are soldiers and 90 % civilians— one-half of which are children (De Jong, 2010 ) .

In a report by UNICEF (2006 ) , it was estimated recruited or captured as child soldiers or, as the that two million children have been killed by ICRC prefers, as “children associated with armed armed confl icts, six million were injured and forces or armed groups” (p. 10). disabled, more than one million were displaced Many research studies show that children who or separated from their parents and twenty mil- experience war and are exposed to armed confl ict lion were left homeless. Three years later, the are at risk for both physical and mental health International Committee of the Red Cross (ICRC) problems. Although the majority of research on reported that in 2008, eighteen million children children in war-torn countries has focused on were forced to leave their homes either as refu- medical statistics and mortality rates, several stud- gees or as internally displaced persons (2009, p. 1). ies have investigated the severity of Posttraumatic These displaced and unaccompanied refugee Stress Disorder (PTSD) and prevalence rates children either escape or are sent away from their among children living in war zones with estimates homes and communities to resettlement countries ranging from 35 to 95 % (Becker, Weine, Vojvoda, such as the Netherlands, the UK and the USA & McGlashan, 1999 ; Dyregov, Gupta, Gjestad, & (Hodes, Jagdev, Chandra, & Cunniff, 2008 ) . The Mukanoheli, 2000 ; Fox & Tang, 2000 ; Qouta, risks for children remaining in countries with Punamaki, & Sarraj, 2008 ; Tang & Fox, 2001 ; armed confl ict are dire: ‘Children are imprisoned, Thabet & Vostanis, 2000 ) . As Thabet, Ibraheen, raped, maimed for life, even killed. Armed Shivram, Winter, and Vostanis (2009 ) note in their confl ict tears families apart, forcing thousands of research in schools in the Gaza Strip, there are a children to fend for themselves and to care for number of risk factors related to PTSD that very young siblings’ (ICRC, 2009 , p. 1). Children include both the type of exposure and the amount are placed into forced labour or slavery, detained of exposure to war trauma. The risk factors include in camps, taken in unlawful adoption and forced loss of family members and support networks, into prostitution and early marriages. Many are “proximity to the zone of impact, degree of life threat, forced evacuation and displacement, parental response and parental psychopathology, family ambivalence and economic hardship” (p. 227). Qouta, Punamaki, and Sarraj (2008 ) also found that in the wars in the Gaza Strip “military vio- M. J. Buchanan , ECPS (*) • K. Al-Mashat • L. Cortes lence profoundly impacted children’s cognitive B. Djukic • B. Jaghori • A. Thompson development, including memory, problem solv- Department of Educational and Counselling Psychology, ing and moral reasoning, emotional expression and Special Education, University of British Columbia, 2517-2125 Main Mall , Vancouver , BC , Canada , V6T 1Z4 and recognition and social development, includ- e-mail: [email protected] ing parent–child relationships and peer and sib-

C. Fernando and M. Ferrari (eds.), Handbook of Resilience in Children of War, 107 DOI 10.1007/978-1-4614-6375-7_8, © Springer Science+Business Media New York 2013 108 M.J. Buchanan et al. ling relations” (p. 314). But not all children in to contextually signi fi cant differences in each armed confl ict develop posttraumatic stress. As country, each community, each family and indi- Qouta et al. (2008 ) explain: vidual child participant. We conclude this chapter with a review of protective factors that may hold life threat, violence and losses form a risk for promise in ameliorating the suffering of children increased psychological distress. There are however, a myriad of child, family and society related from the trauma of war. factors and psycho-socio-physiological processes that protect child development and mental health.… Exposure to trauma is crucial in predicting distress, Colombian Child Soldiers while familial and developmental issues are important in building resilience. (p. 310) In 2008, the Coalition to Stop the Use of Child Appraisal of the traumatic event is also a Soldiers estimated that there were as many as signifi cant element in the development of PTSD 300,000 children under the age of 18 currently given that “a single occurrence or one character- serving in government forces or armed rebel or istic of a trauma is usually not enough to cause militia groups around the world in more than 30 psychopathology. Rather, it is the meaning countries. Several researchers have found that the attached to the trauma and subjective appraisal community response upon a child soldier’s return and consequences that are crucial” (Ozer & is fear and mistrust. “Females were frequently Weiss, 2004 ) . Witnessing humiliation and degrad- seen as sexually promiscuous or de fi led, while ing treatment and experiencing violence towards many youth-males and females alike were treated parents and other family members can be more with apprehension” (Betancourt, Agnew-Blais, traumatizing than being a direct victim of mili- Gilman, Williams, & Ellis, 2010 , p. 18). Research tary violence (Qouta et al., 2008 , p. 311). conducted on the trauma of child soldiering sug- It is well documented that the research on gests that involvement in violent acts, stigma from children of war has focused heavily on the psy- community and family members towards child chopathological outcomes for children. New soldiers and lack of family support are contribut- research in the fi eld of child refugees and chil- ing factors to the mental health of former child dren associated with armed groups stresses that soldiers (Betancourt & Khan, 2008 ; Kohrt et al., we also need to understand how the trauma of 2008; McKay & Wessells, 2004 ; Wessells, 2009 ) . war is mediated by children’s coping capacities, Most of the research on child soldiers describes belief systems, cultural ideologies and familial the deleterious effects of this experience; few and social relationships. studies have focused on the resilience of child soldiers. In this section, we describe a research project that was conducted in Colombia with child Overview of the Chapter soldiers who were either captured by or surren- dered to government forces and were participat- In this chapter we present the fi ndings of two ing in a reintegration programme in Bogotá. qualitative research studies on children of war conducted at the University of British Colombia, Canada. These narrative studies were conducted Understanding the Confl ict in Colombia with former child soldiers and with in Colombia children in war-torn, occupied Iraq. We present a historical overview of each country, discuss the In Colombia, armed confl ict has been ongoing effects of war on children and their families for more than 50 years between government and present fi ndings with regard to protective fac- armed forces and guerrilla groups to gain control tors that helped build resilience among the chil- over land, mineral resources and oil. All sides dren in our studies. It should be noted that the of the con fl ict have committed human rights protective factors for these two studies vary due violations and political violence continues today 8 Children of War in Colombia and Iraq 109

( CSUCS, 2008 ) . Even though hard data on child Disorders of Extreme Stress (SIDES, Pelcovitz soldiers has been diffi cult to obtain (Wessells, et al., 1997 ) to identify children with no or mild 2009 ), the of fi ce of the Public Advocate trauma-related symptoms and who were nomi- (Defensoria del Pueblo) released a report in 1996 nated by staff members in the reintegration pro- on Colombian child soldiers. The report con- gramme as resilient. Only six children (four boys cluded that up to 30 % of some guerrilla units and two girls) were interviewed for this study. were made up of children. In urban militias, 85 % Six narrative accounts resulted from in-depth of the recruits were under 18 years of age. The individual interviews with six former child sol- most signifi cant factor contributing to the recruit- diers. An across-narrative thematic analysis ment of child soldiers is poverty and poor living revealed main themes that underscore their cop- conditions. According to Colombian Statistics in ing mechanisms and resiliency. In this chapter, 2001, two out of three Colombian children lived we used pseudonyms for each participant to pro- below the poverty line, and one out of ten was tect their anonymity. destitute. Many children leave school by grade fi ve and join illegal armed groups. Human Rights Watch (2003 ) estimates that there are over 14,000 Sense of Agency child combatants in Colombia. After Myanmar and Burundi, Colombia deploys the greatest All of the former child soldiers used determina- number of child soldiers. During 2002, the num- tion and initiative to plan and execute alternatives ber of deserters from guerrilla or militia groups in their lives both during their captivity and increased dramatically, as did the number of child engagement as a child soldier and also during combatants who escaped captivity (Human their escape. The most signifi cant fi nding was Rights Watch, 2003 ). The Colombian govern- their ability not to succumb to the psychological ment, responding to the number of child soldiers domination of leaders in the armed groups by seeking asylum and support, implemented reha- reminding themselves of their past family connec- bilitation programmes to assist children in their tions and their communities—remembering their transition back into their communities. The roots. They showed autonomy, self-confi dence Colombian Family Welfare Institute (ICBF) has and an internal locus of control—factors com- provided assistance to more than 750 former monly associated with resilience (Werner & child combatants (660 had been captured by the Smith, 1992) . As they stated they had to actively police or army). Ninety-two of these child sol- defend themselves, choosing on a daily basis not diers had given themselves up to the authorities. to die by taking action during times of danger and In 2006, co-author Liliana Cortes travelled to by seeing opportunities when they arose. Several Colombia and gained permission to interview of the boys liked the power that came with owning former child soldiers in one of the government’s a gun; it gave them a sense of control over their rehabilitation and reintegration programmes. The unsafe environment. Several of the child soldiers purpose of this narrative inquiry was to under- deserted, which could have cost them their lives stand the experiences of former child soldiers and and put them in great peril. the resources that the children drew upon to overcome the trauma of war. The context for the children in this study “spanned a period when the Social Intelligence, Empathy and Affect drug dealing business in Colombia was most Regulation prominent and terrorist acts and other forms of violence were common, especially in rural areas” All of the participants displayed skill at reading (Cortes & Buchanan, 2007 ) . A group of 23 for- the social codes and rules within their armed mer child soldiers were screened using the Child’s group and behaved in ways that reduced the risks Reaction to Traumatic Events Scale (CRTES, to their lives. These abilities not only kept them Jones, 1994 ) and the Structured Interview for out of danger but also increased their chances of 110 M.J. Buchanan et al. survival. For example, one girl chose to “marry” Sense of Future, Hope and Growth another soldier to protect her from being sexually abused by others in the armed group. Natalie The participants spoke about their experiences as stated that the commandants liked her a lot a child soldier in the past tense; they did not iden- because she was hard working and followed tify as a soldier or combatant any longer. They orders well. “I like to analyze what I should do also spoke about their war experiences as painful and shouldn’t do, so that I don’t make mistakes past experiences. They shared that during their and have something to be sorry about later on”. war experiences they often dreamed about their All of these former child soldiers were able to freedom and their future lives. They held onto integrate and obtain group membership by using hope. The participants also described their war social intelligence to gain social acceptance and experiences as growth experiences. Andres’s respect. They were able to use empathic abilities quote sums it up quite well: to take on the perspective of others and control their emotional responses during times of duress, One of the things that helped me survive was thinking about the future and in deserting. I realized that skills necessary to their survival. it was not going to be forever. To me I think the future is more important than the past, and it’s one of the reasons I deserted. As soon as I fi nish the Shared Experiences, Connection reintegration program I will take the right road and return to the country. to Caregivers and Sense of Community The children in this study demonstrated resil- This theme re fl ects the participants’ skills at ient capacities to overcome child-soldiering fi nding meaningful support by connecting with a experiences and were able to use their experience caregiving fi gure and making community con- as a source of future growth. Although most of nections. They shared their experiences of being the research on child soldiers has concentrated a child soldier with peers both before and during on the negative and traumatic experiences of the reintegration programme and claimed that these children, few studies have focused on chil- this active coping strategy helped build their dren who have survived and thrived despite the resilience. Sharing their experiences was one of trauma of war. As Betancourt and her colleagues the main factors that helped them overcome the recommend: trauma of war (Cortes & Buchanan, 2007 ) . They also chose a strong parental fi gure within the successful reintegration and rehabilitation depends on a number of factors, including family and armed group or formed a strong bond with community acceptance, access to educational and another member of the armed group who gave training opportunities to help war-affected youth them strength to continue on or to escape. As achieve self-suffi ciency and maintain productive Carlos stated, “The group becomes your family roles in the community as well as the behaviour of the youth themselves (Betancourt et al., 2010 , p. 18). where the commander is your father and the other fi ghters are your brothers and sisters”. As Cortes and Buchanan note, remembrance of a caregiving fi gure was a signi fi cant factor in their survival: Iraqi Children’s Experience of War All the participants had the experience of an inti- and Occupation mate and fulfi lling tie to a signifi cant adult in their childhood. All had at least one supportive and lov- Understanding the Context of War ing adult fi gure in their early childhood. Having that and Occupation in Iraq memory of that person not only served as a safe haven but also provided a template to be emulated in some of the relationships they established with Over the last 30 years, Iraq has experienced a comrades.… Participants often called on the mem- brutal dictatorship, armed con fl ict, economic ory of their care-giving fi gure for comfort and sanctions, armed occupation and terrorism. The grounding in moments of despair and they attributed their survival to the connection that they man- following events have destabilized and crippled aged to preserve. (Cortes & Buchanan, 2007 , p. 50) the country’s economic, social and political 8 Children of War in Colombia and Iraq 111

systems: (a) The dictatorship of Saddam Hussein been killed since 2006, 100 have been kidnapped, that began in 1979; (b) the Iraqi invasion of and over 3,250 have fl ed the country” (p. 158). Kuwait; (c) the 1990 UN economic sanctions that She further states “street child phenomenon lasted for 12 years; (d) the 1991 Persian Gulf War comprises about one million children responsible in which the coalition forces deployed Iraq’s for their own or their family’s survival, but there infrastructure such as bridges, hospitals, schools are a mere 22 state care centres in Iraq accom- and water and sewage treatment facilities; and modating only 698 children” (pp. 158–159). fi nally (e) “Operation Iraqi Freedom” and the Drug addiction and prostitution are increasing invasion of Iraq in 2003. In the fi rst year after the among Iraqi youth as a result of daily witnessing Gulf War, it was reported that 170,000 children of violence and desperation to survive (Damon, died from infections, diarrhea and malnutrition. 2007 ) . Thus, given the economic, political and These fi gures reached 500,000 for children under social conditions described here, it is apparent age fi ve by 1998 (Ayra & Zurbrigg, 2003 ) . that the current situation in Iraq is dire for Iraqi According to Daponte and Garfi eld ( 2000 ) , the children of war. economic sanctions accounted for a 4-fold rise in the health risks of Iraqi children due to shortages in food, water and medicine. UNICEF’s ( 2007 ) Research in Iraq Following “Operation report estimated that two million children in Iraq Iraqi Freedom” suffer from malnutrition and disease: one in every four is chronically malnourished or starving. The In December 2003, co-author Kasim Al-Mashat US Institute of Peace and War (2007) claimed travelled to Iraq to conduct research with Iraqi that child deaths have increased by 150 % due to children who survived “Operation Iraqi Freedom” factors such as diarrhoea and pneumonia result- which had of fi cially ended in May 2003. Kasim ing from contaminated water, starvation, was born in Mosul, speaks fl uent Arabic and insuf fi cient medicine, physicians fl eeing the Maslawi, an Iraqi dialect. The purpose of the country, violent deaths due to assassinations or study was to understand the psychological impact terrorist activities and deteriorating health ser- of the war on Iraqi children, the coping capacities vices. “Diseases that were under control under of Iraqi children and what future hopes they held. the previous regime, such as cholera, hepatitis, Using a convenience sampling procedure through meningitis and polio, have returned” (Ismael, local contacts in Mosul, 12 Iraqi children volun- 2008 , p. 156). The under- fi ve mortality rate in teered to participate in this qualitative focus Iraq is one of the highest in the Middle East group study (11 children lived in Mosul during region (Awqati et al., 2009 ) . the bombardment and one child lived in Baghdad The school system in Iraq has almost col- during the US “shock and awe” campaign). Their lapsed, with approximately 2,750 schools having socio-economic status was lower-middle class to been destroyed. The Minister of Education in upper-middle class. Several of the children’s par- Iraq reported that 4,000 more schools are needed ents were unemployed at the time of the inter- (Zehr, 2008 ) . Decline in enrolment is high with view. The children ranged from nine to 13 years more boys attending school than girls. of age, with six male and six female participants. Two separate focus group interviews were con- Paralyzing poverty, the horror promoted by death ducted in two locations: the fi rst group of four squads, and kidnapping [of teachers and children] for ransom serve to further aggravate children’s children lived near the former president’s palace education. … many parents unable to make ends in Mosul and the other focus group took place meet, stopped their children from attending school, near the Iraqi intelligence headquarters also in and sent them to work as cheap cleaning labour or Mosul. The children were originally screened for even as street beggars (Ismael, 2008 , p. 157). the study using the Child’s Reaction to Traumatic Ismael, in her article on a lost generation of Events Scale (CRTES, Jones, 1994 ) . It should be Iraqi children, stated that “according to the UN noted that we attempted to fi nd children who offi ce for humanitarian affairs, 180 teachers have scored in the low range, but only one child scored 112 M.J. Buchanan et al. below 28; the boys scored slightly higher than the They missed being in school and were bothered girls. The median score for this group on the that they could no longer play outdoors. Most of the CRTES was 35, which indicated that the majority children lived through horri fi c ordeals. Some had of the children were experiencing moderate to witnessed their friends being hit by shrapnel in the high degrees of posttraumatic stress reactions. playground, while others witnessed gruesome This is consistent with Dyregov and colleagues’ decapitations and the deaths of neighbours and study ( 2002 ) in which they found high levels of loved ones. Some of the children had experienced PTSD among Iraqi children during the First Gulf guns being pointed at them. The majority of chil- War (85 %) and in a 10-year follow-up study. dren were also distressed by the sounds of daily Before the focus group, the children were asked patrolling by the helicopters and airplanes of the to refl ect upon four questions and to respond by occupying army that fl ew over their neighbour- either writing a short narrative or drawing a pic- hoods. They had dif fi culty sleeping and reported ture of their story. During the focus group, the chil- many physical complaints (headaches, stomach dren shared their stories and pictures with the other aches were most common). They all struggled with group members. The four questions were as fol- grief, loneliness and isolation. The majority of the lows: (a) What was your experience of the war? children had intrusive dreams and images. The fol- (b) What meaning did the war have for you? (c) lowing is a deeply revealing narrative written by How are you doing now and what helped you one of the children in the group: cope? (d) What are your hopes for the future? A thematic content analysis was conducted using …they had planes fl ying… [and] the strike happened. There was a man on the top of the roof, his Krueger and Casey’s (2000 ) focus group method. head was decapitated.… and my other friend… A validity check was conducted with an Iraqi psy- was hit by fi ve shrapnel in his leg. It looked like chiatrist living in Mosul who reviewed the fi ndings donair.… My face became red; I vomited the whole and the procedures used and veri fi ed the trustwor- night and could not sleep.… I remembered terrify- ing nightmares… I kept dreaming about him. My thiness of the study. dad kept on saying just open your eyes. I try to open my eyes, and read passages from the Koran. My eyes are open, but I still dream about him. I am Main Findings of Iraqi Children of War asleep but awake … It was like I was in the same place again.… I also woke up in the morning with a headache and vomiting. We provide a condensed version of the responses to these four questions and highlight the main fi ndings Seven children reported that they thought that for this chapter. Both groups of children experi- they were going to die and that they believed that enced heavy missile attacks and heavy fi ghting. they might not survive the next day. Although we As we reported previously (Al-Mashat, Amundson, did not measure depression among these chil- Westwood, & Buchanan, 2006 , p. 197): dren, it was evident from the group interviews and their drawings that these children felt hope- Five children reported the death of a family mem- less, isolated and carried a great deal of grief. ber during the time of the war. Four out of the fi ve lost family members from natural causes (i.e., ill- One of the ways that Iraqi children made ness) while one child reported that a family mem- sense of their war experience was by taking on a ber had been shot. Four out of the twelve children “tough bravado” role (Al-Mashat et al., 2006 ) . reported knowing someone from their family who Many of the children’s mannerisms and speech was physically injured but survived the war. Eight of the children reported that they had temporarily focused on the political ideology of the war. They moved out of their homes at some point during the shared a sense of shame and concern that Iraqis war, which meant moving in with other relatives. were viewed by other neighbouring Arab coun- Some children moved away for months while oth- tries as people who allowed the presence of an ers returned to their homes after four days. occupying army. The children held hostilities All of the children missed their daily routines towards the American troops and the majority and their life before the bombardment and invasion. shared that they were not frightened by their 8 Children of War in Colombia and Iraq 113 weaponry. They expressed a fear of dying in vain name a few), the authors report that the Iraqi ado- and wished that if they were to die, they would lescents in their study were coping fairly well. rather die as martyrs. Martyrdom has a unique These fi ndings highlight the signi fi cance of cultural relevance relating to the deep sense of understanding the cultural context that western nationalism and honour, as well as to religious mental health professionals and healthcare pro- beliefs relating to the afterlife. The children viders need to take into consideration when work- shared their thoughts about martyrdom as an ing with Iraqi children and Iraqi refugees. indirect way of showing strength and resilience. Patriotism, religious ideology and parental sup- It should be emphasized that, despite their port are key aspects of their experience that need thoughts, none of these children’s families were to be incorporated into treatment planning efforts. involved in militias or rebel forces. They were There is imminent need in Iraq to address the not involved in any attacks on US forces, nor did well-being of its children, as they are the future they have access to any weaponry. As Kasim of this country. Government support by NGOs, explains: “their thoughts about death [martyr- the World Health Organization and UNICEF is dom] may function as a tool that provides them not enough. As Ismael (2008 ) writes: with strength and allows them to express a sense of pride and control” (p. 205). The children did … the degradation of the child’s status fl ows from conscious policy decisions that have been made by not engage in typical childlike conversations; occupation authorities. Neo-liberal prerogatives instead, they sounded like the older adults in demanded the dismantling of Iraq’s social sector, their lives. These children had very few future the destruction of its working and middle classes, hopes except to fi ght the enemy, remove the and the creation of a pliable non-representative Iraqi government. “Reconstruction” of Iraq has occupying army or “die as martyrs”. become a cruel farce, and the engineering of social Other coping strategies employed by the chil- collapse and fractured identity have created a dren, besides being courageous and proud, were widespread environment of violence and hopeless- engaging in activities to distract them from the ness. It is in this environment that Iraq’s next generation is being raised. (p. 151) bombardment and explosions such as listening to music, watching television, reading books, doing Yet, the children in this study were united in homework and playing with friends or siblings at their sense of nationalism. Their coping strate- home. Staying close to their parents was reported gies of prayer, active engagement in the political as another coping strategy as parents provided struggle and connection with community and them with comfort and support, which helped to family gave us a sense of hope in the long strug- reduce their fears and insecurities. The use of gle they face. Although it will take a global effort prayer was another coping strategy used by the to repair the physical and psychological damage children to minimize their fears and bring them of war and occupation on Iraq’s next generation, comfort and strength. They often read passages the voices of the children in our study give us from the Koran when they felt afraid. hope for their continued survival. The fi ndings in our study are corroborated by Carlton-Ford, Ender and Tabatabai’s study (2008 ) among 1,000 randomly selected adolescents in Protective Factors for Children of War Baghdad in 2004. They found that Iraqi adolescents had a heightened sense of self-esteem in Research is only beginning to address protective reactions to the threats of war. Iraqi children had a factors that help children exposed to the trauma of high sense of national pride. They felt reverence war. Before reviewing this literature, it must be to the ideas of sacrifi cing themselves for the sake stated that safety and survival are crucial factors of maintaining the honour and dignity of their that must be in place before addressing ways to country. Despite the daily challenges of living in a ameliorate the effects of war trauma upon chil- war-torn country (lack of food, clean water, elec- dren. If children are starving, suffering from dis- tricity, educational opportunities and healthcare to ease and living in danger zones where their lives 114 M.J. Buchanan et al. are still at risk due to armed confl ict, their safety thus emphasize the role of constitutional character- must come fi rst. It is obvious that these conditions istics, family relations and early childhood interactions as important determinants of child resilience must be met fi rst before treatment and interven- in life-endangering conditions. (p. 318) tions can be employed to alleviate the psychosocial impact of war. This is an important point As Thabet and colleagues ( 2009 ) recommends, given that the child soldiers in our fi rst study were it is important for NGOs working with survivors safely housed in a reintegration programme where of war trauma to support parents and to provide interventions and treatment were available. effective parenting education in the aftermath of However, in our second study, the children of Iraq war, given the strong support for parental factors were in the midst of armed con fl ict during the in ameliorating the effects of armed confl ict. In time of the research. The differences in protective both of the studies presented in this chapter, we factors and coping strategies therefore will vary did not inquire specifi cally about parenting edu- signifi cantly given the different cultural and polit- cation. It would be benefi cial in future research to ical contexts. include parental education given Qouta’s et al., It is also important to note that assumptions ( 2008 ) and Thabet’s et al., (2009 ) fi ndings. about what is “normal” or “abnormal” or patho- Community acceptance and peer support are logical are culturally embedded constructs. As also factors that ameliorate the effects of war Lustig and colleagues point out (2004 ) , trauma upon children (Betancourt & Khan, 2008 ; checklists or structured interviews focusing on Betancourt et al., 2010 ; Miller & Rasmussen, posttraumatic symptoms may fail to capture stress 2010) . Our study among Colombian child sol- reactions, such as grief, loss or readjustment diers supports this, as does Betancourt’s et al., dif fi culties … awareness of one’s own and other’s ( 2010) work with former child soldiers in Sierra culture, history, values, family and community structures is crucial to providing culturally sensitive Leone. The negative consequence of social stigma assessment and treatment ( p. 29). plays a signi fi cant role in the psychosocial adjustment of children returning from war. Thus, fam- Lustig and colleagues ( 2004 ) reviewed the lit- ily and community acceptance mediates the erature on stressful experiences and stress reac- effects of war experiences for children exposed tions of child and adolescent refugees and found to armed violence. Again NGOs and government that posttraumatic stress “was mediated by coping of fi cials have an important role in creating com- strategies, belief systems and social relations” (p. munity interventions to de-stigmatize children 25). Several researchers have confi rmed that pro- who have been involved in armed con fl ict. tective factors include perceived parenting sup- There is also support in the literature that reli- port (Betancourt & Khan, 2008 ; Thabet et al., gious beliefs, commitment to an ideology and 2009 ) , parents’ own coping styles and caregiver prayer are protective factors for children of war mental health (Betancourt & Khan, 2008 , Dybdahl, (Al-Mashat et al., 2006; Hodes et al., 2008 ) . In 2001 ; Thabet et al., 2009 ) . More research is needed both of our studies reported here, we found that to differentiate the roles of mothers and fathers in the children used prayer and religious beliefs and children’s coping as “fathers continue to be under- a political ideology to sustain them during great represented in research.… the death of the father adversity and life-threatening conditions. on the family circumstances might be more impor- Empirical research also provides evidence that tant than the direct effect of his death on the chil- fundamental adaptive systems such as attach- dren” (Thabet et al., 2009, p. 233). Resilient ment, agency, intelligence and creativity, behav- children in Qouta and colleagues’ study ( 2008 ) iour regulation and social interactions with differed from the traumatized children in that: family, peers, school and community systems play a major role in the development of resilience their parents both had good family mental health in children (Masten, 2001 ; Masten & Obradovic, and their mothers rarely used punitive child rearing practices.… family and other intimate relations are 2007) . Our study with child soldiers in Colombia, salient for resilience and resources.… Our results con fi rms Masten’s work in that the participants 8 Children of War in Colombia and Iraq 115 demonstrated a strong sense of agency, social are other sources of psychological trauma [such as intelligence and meaningful connections with child abuse and intimate partner violence]” (p. 14). community and caregivers. Reuniting with fam- These guidelines are helpful and point to the ily and friends were signifi cant factors in their necessity of fi rst attending to the current daily recovery from the trauma of child soldiering. stressors before implementing interventions to Qouta and colleagues ( 2008 ) found that “ fl exible address the effects of war-related trauma among information processing and high cognitive capac- children. As researchers in the fi eld of traumatic ity were associated with good psychological stress point out, not all children develop posttrau- adjustment and could even protect children’s matic stress in the aftermath of war. There is evi- mental health from the negative impacts of mili- dence that children exposed to the trauma of war tary violence” (p. 315). They claim that continu- have strong coping capabilities within themselves ing a child’s formal education during times of and that resilience can be built through the sup- armed confl ict appears to have a signifi cant buf- port of family and community. Yet as UNICEF fer effect. The results from our study among Iraqi and The International Committee of the Red school children support Qouta’s et al., ( 2008 ) Cross note, attending to children of war is an claim as the children stated that doing homework enormous task given the number of children in helped them cope during the period of continued refugee camps today. The voices of the children bombardment. They also reported that playing from Colombia and Iraq in our two projects call with siblings and friends at home and staying us to action. There is much still to be done in both close to parents were coping strategies that sup- of these countries and worldwide. Focusing on ported their resilience. child resilience in war-torn countries brings us It is important to remember, as Miller and hope. It does not, however, alleviate our global Rasmussen (2010 ) argue, that not all stress reac- responsibilities to respond to their suffering. tions are caused by war exposure: the stigma of poverty, social marginalization, political exclusion and other “daily stressors” must also be con- References sidered when developing interventions to address the trauma of war. They provide four important Al-Mashat, K., Amundson, N. E., Buchanan, M., & guidelines that should be considered when imple- Westwood, M. (2006). Iraqi children’s war experi- menting an integrated intervention model to ences: The psychological impact of “Operation Iraqi Freedom”. International Journal for the Advancement address the mental health of children exposed to of Counselling, 28 (2), 195–211. armed con fl ict and post-con fl ict settings. They Awqati, N. A., Ali, M. M., Al-Ward, M. J., Majeed, F. A., are as follows: Salman, K., Al-Alak, M., et al. (2009). Causes and dif- ferentials of childhood mortality in Iraq. BMC Guideline 1: “It is important to undertake a rapid and con- Pediatrics, 9 , 40–49. textually grounded assessment of locally salient daily Ayra, N., & Zurbrigg, S. (2003). Operation in fi nite injus- stressors before developing mental health and psycho- tice: Impact of sanctions and prospective war on the social interventions” (p. 13). people of Iraq. Canadian Journal of Public Health, Guideline 2 : “Before providing specialized clinical ser- 94 (1), 9–11. vices that target psychological trauma, fi rst address Becker, D., Weine, S., Vojvoda, D., & McGlashan, T. those daily stressors [such as poverty, family violence, (1999). PTSD symptoms in adolescent survivors of unsafe housing, social isolation, employment to name “ethnic cleansing”: Results from a one-year study. a few] that are particularly salient and can be affected Journal of the American Academy of Child and through targeted interventions” (p. 14). Adolescent Psychiatry, 38 , 775–781. Guideline 3 : “When specialized mental health interventions Baker, J. A. III & Hamilton, L. H. (2007). The Iraq Study are indicated [such as depression, anxiety, substance Group Report: The way forward, a new approach. misuse], interventions should go beyond PTSD to Report from U.S. Institute of Peace. Washington, DC. address the diverse forms of distress that may result http://www.usip.org/programs/initiatives/iraq-study- from exposure to war-related violence and loss” (p. 14). group Guideline 4 : “It is essential to take into account that not all Betancourt, T. S., Agnew-Blais, J., Gilman, S. E., symptoms of trauma are necessarily related to confl ict Williams, D. R., & Ellis, B. H. (2010). Past horrors, exposure. Even in situations of armed confl ict, there present struggles: The role of stigma in the association 116 M.J. Buchanan et al.

between war experiences and psychosocial adjustment Krueger, R. A., & Casey, M. A. (2000). Focus groups: among former child soldiers in Sierra Leone. Social A practical guide for applied research. London: Sage Science & Medicine, 70 , 17–26. Publications. Betancourt, T. S., & Khan, K. T. (2008). The mental health Lustig, S., Kia-Keating, M., Knight, W. G., Geltman, P., of children affected by armed confl ict: Protective pro- Ellis, H., Kinzie, K. D., et al. (2004). Review of child cesses and pathways to resilience. International and adolescent refugee mental health. Journal of the Review of Psychiatry, 20 (3), 317–328. American Academy of Child and Adolescent Carlton-Ford, S., Ender, M. G., & Tabatabai, T. (2008). Iraqi Psychiatry, 43 (1), 24–36. adolescents: Self-regard, self-derogation and perceived Masten, A. S. (2001). Ordinary magic: Resilience threat of war. Journal of Adolescence, 31, 53–75. processes in development. The American Psychologist, Cortes, L., & Buchanan, M. J. (2007). The experience of 56 (3), 227–238. Colombian child soldiers from a resilience perspec- Masten, A. S., & Obradovic, J. (2007). Disaster prepara- tive. International Journal for the Advancement of tion and recovery: Lessons from research on resil- Counselling, 29 , 43–55. ience in human development. Ecology and Society, CSUCS (2008). Child soldiers: Global report 2008. 13 (1), 9. Coalition to stop the use of child soldiers . London, UK. McKay, S., & Wessells, M. G. (2004). Post-traumatic Damon, A. (2007). Iraqi women: Prostituting ourselves to stress in former Uganda child soldiers: Comment. The feed our children. CNN. http://www.cnn.com/2007/ Lancet, 363 (9421), 1646. WORLD/meast/08/15/Iraq.prostitution/index.html . Miller, K. E., & Rasmussen, A. (2010). War exposure, Accessed 16 Aug 2007. daily stressors, and mental health in con fl ict and post- Daponte, B. O., & Gar fi eld, R. (2000). The effect of eco- confl ict settings: Bridging the divide between trauma- nomic sanctions on the mortality of Iraqi children focused and psychosocial frameworks. Social Science prior to the 1991 Persian Gulf War. American Journal & Medicine, 70 , 7–16. of Public Health, 90 (4), 546–552. Ozer, E., & Weiss, D. S. (2004). Who develops posttrau- De Jong, J. T. V. M. (2010). A public health framework to matic stress disorder? Current Directions in translate risk factors related to political violence and Psychological Science, 13 (4), 169–172. war into multi-level preventive interventions. Social Pelcovitz, D., van der Kolk, B. A., Roth, S. H., Mandel, E., Science & Medicine, 70 , 71–79. Kaplan, S., & Resick, P. (1997). Development of a cri- Dybdahl, R. (2001). Children and mothers in war. An out- teria set and a structured interview for disorders of come study of a psychosocial intervention program. extreme stress (SIDES). Journal of Traumatic Stress, Child Development, 72 (4), 1214–1230. 10, 3–16. Dyregov, A., Gjestad, R., & Raundalen, M. (2002). Qouta, S., Punamaki, R., & Sarraj, E. E. (2008). Child Children’s exposure to warfare: A longitudinal study. development and family mental health in war and mili- Journal of Traumatic Stress, 15 (1), 59–68. tary violence: The Palestinian experience. International Dyregov, A., Gupta, L., Gjestad, R., & Mukanoheli, E. Journal of Behavioral Development, 32(4), 310–321. (2000). Trauma exposure and psychological reactions Tang, S., & Fox, S. (2001). Traumatic experiences and to genocide among Rwandan children. Journal of mental health of Senegalese refugees. The Journal of Traumatic Stress, 13 , 3–21. Nervous and Mental Disease, 189 , 507–512. Fox, S., & Tang, S. (2000). The Sierra Leonean refugee Thabet, A. A., Ibraheen, A. N., Shivram, R., Winter, E. A., experience: Traumatic events and psychiatric seque- & Vostanis, P. (2009). Parenting support and PTSD in lae. The Journal of Nervous and Mental Disease, 188 , children of a war zone. The International Journal of 490–495. Social Psychiatry, 55 (3), 226–237. Hodes, M., Jagdev, D., Chandra, N., & Cunniff, A. (2008). Thabet, A. A., & Vostanis, P. (2000). Posttraumatic stress Risk and resilience for psychological distress amongst reactions in children of war: A longitudinal study. unaccompanied asylum seeking adolescents. Journal Child Abuse & Neglect, 24 , 291–298. of Child Psychology and Psychiatry, 49 (7), 723–732. UNICEF. (2006). State of the world’s children 2006 . NY: International Committee of the Red Cross (2009). Children UNICEF. of War . www.icrc.org . UNICEF. (2007). Little respite for Iraq’s children in 2007 . Ismael, S. T. (2008). The lost generation of Iraq: Children NY: UNICEF. caught in the crossfi re. International Journal of Werner, E. E., & Smith, R. S. (1992). Vulnerable but not Contemporary Iraqi Studies, 2 (2), 151–163. invincible: A longitudinal study of resilient children Jones, R. T. (1994). Child’s Reaction to Traumatic Events and youth . New York: McGraw Hill. Scale (CRTES): A self report stress measure . Wessells, M. (2009). Supporting the mental health and Blacksburg, VA: Virginia Polytechnic Institute. psychosocial well-being of former child soldiers. Kohrt, B. A., Jordans, M. J. D., Tol, W. A., Speckman, R. Journal of the American Academy of Child and A., Maharjan, S. M., Worthman, C. M., et al. (2008). Adolescent Psychiatry, 48 (6), 587–590. Comparison of mental health between former child World Report 2003. Human Rights Watch http://www. soldiers and children never conscripted by armed hrw.org/legacy/wr2k3/ groups in Nepal. Journal of the American Medical Zehr, M. A. (2008). Iraqi children’s education deserves Association, 300 (6), 691–702. higher priority. Education Week, 27 (33), 8. Part III Institutional Support for Children A f f e c t e d b y W a r Child Friendly Spaces: Promoting Children’s Resiliency Amidst War 9

Kathleen Kostelny and Michael Wessells

Armed con fl ict creates profound protection and are destroyed, teachers are dispersed, and travel to psychosocial risks that threaten children’s devel- school becomes too dangerous because of attacks, opment and well-being. In war zones, children landmines, sexual violence, and other dangers. typically comprise half the population, and they In war zones, most children experience multiple face a multitude of interacting risks such as attack, risks. As these risks accumulate in children’s lives, abduction, recruitment into armed forces, land- there is an increased likelihood of negative devel- mines, traf fi cking, sexual exploitation, HIV and opmental and psychosocial outcomes, such as fear- AIDS, and dangerous labor, among others fulness, anxiety, aggression, and hopelessness (Machel, 2001 ; Of fi ce of the Special Represen- about the future (Garbarino & Kostelny, 1996a ; tative of the Secretary General for Children and Garbarino, Kostelny, & Dubrow, 1991 ) . However, Armed Con fl ict, 2009 ; Wessells, 2006 ) . In addi- risks and other defi cits provide only part of the tion to these physical protection threats, some of picture of children’s lives in war zones. Even in the greatest risks to children are psychosocial: dangerous circumstances, there are protective fac- children in war zones are often separated from tors such as being in the care of one’s parents, reli- their caretakers, suffer the death of family mem- gious beliefs and practices, and having access to bers and friends, have their homes destroyed, and friends and others who provide social support. are forced to fl ee to new areas (Bernard van Leer These protective factors in the family and commu- Foundation, 2005 ; Wessells & Kostelny, 1996 ; nity, as well as individual sources of resiliency that Williamson & Robinson, 2006 ) . Many children children have, can offset many of the negative descend into crippling poverty as their families developmental outcomes that could otherwise lose sources of work and income, while others occur (Donald, Dawes, & Louw, 2000 ; Kostelny, suffer from harassment, discrimination, and exclu- 2006 ) . Broadly, when risk factors outweigh sion, particularly when forced to fl ee to new areas protective factors, children will suffer negative out- with different ethnic populations. Furthermore, comes. However, if the protective factors outweigh education for children abruptly stops when schools the risk factors, children will likely exhibit resilience. In war zones, most children exhibit remarkable resil- K. Kostelny (*) ience and defy the media stereotypes of a “Lost Columbia Group for Children in Adversity, Generation.” Children who exhibit resilience may New York , NY , USA still need support, though not the specialized sup- e-mail: [email protected] ports that are needed by severely affected children. M. Wessells From this standpoint, it is vital in war zones to Randolph-Macon College, Columbia University, use a dual strategy of reducing the risk factors that Mailman School of Public Health, Program on Forced Migration and Health , New York , NY , USA harm children and strengthening the protective e-mail: [email protected] factors that support children’s well-being.

C. Fernando and M. Ferrari (eds.), Handbook of Resilience in Children of War, 119 DOI 10.1007/978-1-4614-6375-7_9, © Springer Science+Business Media New York 2013 120 K. Kostelny and M. Wessells

Consistent with social ecological frameworks of other challenges caution against romanticized child development (Bronfenbrenner, 1986 ; Dawes views of CFSs, and they invite us to take a more & Donald, 1994 ) , it is important to do this at mul- critical, refl ective stance as practitioners. tiple levels, such as the family, community, and This chapter provides an overview of the society. Pragmatically, this means avoiding a functions and potential usefulness of CFSs and defi cits approach that focuses only on the risks also analyzes the signifi cant challenges that arise and problems that exist. Equally important is in implementing them in war zones, including fi nding and building upon the strengths—the post-confl ict zones. The fi rst section discusses assets, resources, and modalities of coping that the purpose and the functions of CFSs, outlining are local protective factors. These protective fac- the prospective bene fi ts for children who partici- tors are present in every group of people but may pate in them. To situate CFSs in context, the sec- not be readily apparent to outsiders. The focus on ond section presents case studies from strengths as well as de fi cits is part of the founda- Afghanistan and Uganda. The third section tion of a resilience approach to supporting chil- examines various challenges to effective imple- dren’s psychosocial well-being. mentation of CFSs, and offers suggestions on In war zones, one of the most widely used how to manage these challenges in a manner that means of reducing the risks to children while helps to systematize and strengthen practice in strengthening protective factors for children is to regard to CFSs. establish Child Friendly Spaces (CFSs). Most CFSs aim to provide a mixture of protection, psychosocial, and educational support for children, who are de fi ned under international law to include The Purpose and Functions of Child people between birth and 18 years of age. CFSs Friendly Spaces are favored by many agencies because they can be organized rapidly and can support large numbers Broadly, the purpose of CFSs is to support the of children of different ages. Also, they are rela- resilience and well-being of children and young tively low cost and can be adapted to different people through community-organized, structured environments. In fact, they can be organized under activities conducted in a safe, child-friendly, and a tree, inside tents, or in whatever safe buildings stimulating environment. As outlined in recently which are available. As discussed below, they also developed Inter-Agency Guiding Principles on serve as a useful foundation for engaging with a CFSs, “the speci fi c objectives are to: (1) mobilize community, mobilizing people and networks, and communities around the protection and well- developing other programs. The usefulness of being of all children, including highly vulnerable CFSs has led to their enshrinement in standards children; (2) provide opportunities for children to and guidelines such as the Inter-Agency Network play, acquire contextually relevant skills, and for Education in Emergencies (INEE) Minimum receive social support; and (3) offer intersectoral Standards (2010 ) and the Inter-Agency Standing support for all children in the realization of their Committee (IASC) Guidelines on Mental Health rights. Depending on the context, CFSs are also and Psychosocial Support (2007 ) . used for a variety of other purposes such as lay- The fact that CFSs are widely used, however, ing a foundation for restarting formal education does not imply that they are easy to implement and supporting national education systems, effectively or are well understood. In fact, there is enabling wider work on issues such as child pro- a paucity of hard evidence regarding whether and tection and early child development, stimulating how CFSs produce positive outcomes for chil- efforts on disaster preparedness and disaster risk dren. Implementers of CFSs face a daunting array reduction, and raising funds. Some of these activ- of challenges such as how to include the most ities extend beyond the emergency context into vulnerable children and how to achieve a well- the early recovery period or even into longer-term coordinated approach among agencies. These and development” (UNICEF, 2010 , p. 1). 9 Child Friendly Spaces: Promoting Children’s Resiliency Amidst War 121

CFSs serve three primary functions: protec- the CFSs start up, the natural helpers frequently tion, psychosocial support, and nonformal become animators of activities or even paid staff education. Each of these promotes children’s who help to organize the CFS. Through the work well-being and resilience. of the natural helpers and the activation of their networks, the community is mobilized to re fl ect on the situation of children and to use its knowl- Protection edge and resources for supporting the care and protection of children. Indeed, CFSs may them- Amidst chaotic and dangerous circumstances, selves become sites for communal discussions CFSs can provide the safety and security that are about children and how to support highly vulner- crucial for a child’s healthy development. able children such as separated children. Following armed confl ict, danger to children fre- In order for CFSs to serve their protective quently arises from protection threats such as function, careful attention is given to making the gender-based violence, living or working on the CFS itself a safe, protective environment. This is streets, sexual exploitation, traffi cking, exposure frequently achieved by training animators con- to landmines, crime, and drugs. Destroyed or ducting activities on child safety policies and a damaged structures expose children to broken code of conduct that seeks to keep children free glass, exposed electrical wires, and other harmful from abuse, exploitation, violence, and neglect. materials. Being in a safe, supervised space where An important element of this training is in the use children can engage in normalizing activities of positive discipline methods, which render cor- reduces the risks of physical harm and also the poral punishment unnecessary. For teenagers, negative emotional outcomes that result from discussions of gender relations and sexual vio- ongoing fear and anxiety from being in danger- lence can help to prevent gender-based violence. ous environments (Garbarino & Kostelny, 1996b ; Through education and awareness raising for Kostelny & Wessells, 2004, 2005 ) . children, families, and communities about risks CFSs can be useful in mobilizing communi- in the larger environment—including fi ghting, ties to create a protective environment for chil- landmines, and threats to health—CFSs further dren. War often shatters the normal protective contribute to children’s protection. functions served by families and community processes such as the activities of women’s groups, youth groups, religious groups, and traditional Psychosocial Support practices. Particularly if CFSs are implemented in a highly participatory, empowerment-oriented CFSs promote psychosocial well-being and manner rather than a top-down manner, the pro- recovery from stressful events through supportive cess of organizing CFSs engages community activities that normalize life for children and leaders, parents, women’s associations, youth enable positive social interaction. These activi- groups, and other subgroups in the community in ties include structured activities with peers and the care and protection of children. adults, informal education, and play and expres- Typically, there are initial discussions about sive activities that are culturally relevant that help what the main threats to children are and about children master stressful events, gain essential what is needed to help support children and youth. life skills that increase competency and resil- These discussions also identify natural helpers ience, and help children regain a sense of stability whom children and young people go to for sup- and hope. Most children can cope with past and port and who are respected by parents and com- present risks through being able to socially inte- munity leaders. By engaging these natural helpers grate with other children and being in the care of in planning and implementing the CFSs, there is competent, caring adults (Garbarino, Dubrow, immediate access to the networks, resources, cul- Kostelny, & Pardo, 1992; Werner & Smith, 2001 ) . ture, and creativity of the affected community. As Following the enormous disruptions to children’s 122 K. Kostelny and M. Wessells lives in their homes, schools, and communities engaging. In addition, participation builds chil- that occur with armed confl ict, CFSs help children’s agency, which improves their psychosocial dren regain a sense that things will be better and well-being. Following overwhelming experi- returning to “normal” again. ences, regaining a sense of control and self- Play and expressive activities are also impor- effi cacy is essential for coping and well-being. tant in helping children mitigate negative impacts. Children’s participation should be age appropriate In addition to promoting social interaction, play and often includes steps such as children choosing allows children the opportunity to work through their own activities and the organization of youth- and master diffi cult experiences. Expressive to-child supports. As children develop their sense activities, such as drawing, drama, and storytell- of self-effi cacy and empowerment, they are more ing, also help children relieve pent up feelings likely to become effective agents of their own and make sense of stressful events. In addition, protection and psychosocial well-being. play contributes to children’s healthy development. Through play, children develop important cognitive, perceptual, and motor skills, and they Nonformal Education exercise their imagination and creativity. Supporting children to engage in cultural War-affected children frequently identify access activities can also foster psychosocial well-being to education as one of their greatest needs and as and resilience. These cultural activities, such as their pathway to a better future. From a psycho- singing, dancing, and participating in spiritual or social standpoint, going to school socializes and community rituals, are crucial resources for chil- builds valuable support networks and life skills, dren. Such resources help children fi nd meaning and being a student is an age-appropriate role that in regard to past and current events, confi rm one’s gives children a sense of meaning and place in cultural identity and sense of belongingness, their families and societies (Nicoli & Triplehorn, resume familiar activities, and restore hope. 2003 ; UNESCO, 2010 ) . To enable CFSs to fulfi ll its psychosocial func- Because war often destroys schools and dis- tions, it is important to make CFSs bright, engag- rupts formal education, a useful strategy in war ing environments that feature children’s art and zones is to develop nonformal education, taking local toys. The focus is on structured, interactive care to complement and support the reestablish- games and activities with children and adults, as ment of formal education (INEE, 2010 ) . For chil- well as free play, which helps children master dren whose schooling was interrupted because of dif fi cult experiences. Fun and diverse activities armed con fl ict, CFSs provide similar types of can promote specifi c life skills and competencies routines, structure, and continuity that promote such as cooperation, problem-solving, communi- hope and well-being (Martone, 2007 ; Nicoli, cation, and creativity. However, ongoing capacity 2003; Sinclair, 2002 ) . Participation in CFSs that building for CFS staff and volunteers is essential teach important cognitive skills such as basic lit- for effectiveness. Through training and mentor- eracy and numeracy contributes to children’s ing, CFS workers can learn how to organize cognitive competence. This competence is of activities that are appropriate for girls as well as vital importance since cognitive competence boys, how to engage children of different ages, enables effective problem-solving, which is key and how to include children with disabilities. for one’s resiliency, protection, and well-being in They can also learn how to make referrals for the face of adversity. In addition, CFSs can also children who may need additional psychosocial help to develop valuable life skills such as those or health support. of cooperation and nonviolent con fl ict manage- Supporting children’s participation also con- ment. These are important for building civil soci- tributes to the effectiveness of CFSs since chil- ety and transforming cultures of violence. dren are often quite adept at choosing activities It is important to recognize the interrelations that are normalizing, culturally appropriate, and and synergies between these three functions 9 Child Friendly Spaces: Promoting Children’s Resiliency Amidst War 123 of protection, psychosocial well-being, and non- gled to obtain basic necessities of survival, and formal education in regard to supporting chil- many children experienced protection threats dren’s resiliency. Without safety and protection, such as exposure to landmines and unexploded there can be no psychosocial well-being. In fact, ordnance, dangerous labor, and traf fi cking. At the creation of a protective environment is a risk of early marriage were girls, some as young cornerstone of psychosocial well-being since as 8 years old, whose impoverished parents sought it decreases children’s exposure to risk and to obtain a “bride price” for their daughters. Since strengthens protective factors. As children’s psy- Afghanistan was one of the most heavily mined chosocial well-being improves, so does their abil- countries in the world, signifi cant numbers of ity to learn and to participate fully in education, teenagers had lost a limb to landmines, and were which in turn improves their psychosocial well- stigmatized and unable to attend school. being, resiliency, and capacities for self-protection. During the Taliban era, girls had not been per- Despite the current weak evidence base, a reason- mitted to attend school, and many communities able working hypothesis is that CFS’s effective- had no school. Yet children, parents, and com- ness increases through the dynamic interplay munity elders identifi ed education as their pri- among these three functions of protection, psy- mary need for children. In this context, ChildFund chosocial well-being, and nonformal education. Afghanistan organized CFSs with a strong focus on nonformal education. The planning of the CFSs was done in close cooperation with the pro- Two Field Exemplars vincial Ministry of Education in order to ensure that the CFSs complemented and supported the To situate CFSs in context, it is useful to consider formal education system. The CFSs were set up two fi eld examples from Afghanistan and Uganda, in tents, mosques, homes, and fi elds with sepa- respectively. The Afghanistan example is useful rate CFSs for boys and girls according to cultural because it illustrates a child participatory norms. Each village selected volunteers, some of approach and linkages with other aspects of child whom were former teachers, who were commit- protection. The Uganda example is useful because ted to working with children. The CFSs taught of its emphasis on young children and its evalua- basic literacy and numeracy skills, health and tion approach. Both examples help to illustrate hygiene messages, and landmine awareness. some of the challenges in achieving the intended Cultural activities, including singing and story- objectives of CFSs. telling, were also incorporated. These local activities were backed by a wider strategy of building government capacities for education, such as Afghanistan strengthening teacher training to include child participatory methods and using alternatives to Afghan children and families suffered decades of corporal punishment. war, grinding poverty, and natural disasters, Ongoing capacity building for CFSs anima- including earthquakes, drought, and fl oods. By tors included training on participatory activities 2001, six million Afghans were refugees living in with children and being able to identify and refer crowded refugee camps in neighboring countries, the most severely affected for more specialized while approximately two million were internally support. The ongoing training was necessary in displaced and lacked the protections given to ref- part to offset the cultural norm wherein teachers ugees under international law. After the Talibans disciplined students with a large stick. Also, the were overthrown in 2001, refugees and internally animators who had been teachers ran the CFSs as displaced persons (IDPs) desired to return to their if they were miniature schools and used the hier- villages, yet most villages had been decimated by archical, nonparticipatory approach to education the confl ict, and community mechanisms were that had been customary in Afghanistan. In such weak or broken. Upon return, most adults strug- a situation, it was impossible to create overnight 124 K. Kostelny and M. Wessells

CFSs that were supportive environments and that Northern Uganda built children’s agency. Children’s agency, however, was supported by In northern Uganda, decades of armed con fl ict by wider protection activities that complemented the the Lord’s Resistance Army (LRA) had severely CFSs. In particular, Child Well-being Committees affected children and families. As many as 60,000 that monitored and responded to child protection children had been abducted (SWAY, 2007 ) , while threats were established using a child participa- thousands of others, called “night commuters,” tory methodology. First, a group of approximately poured nightly into towns seeking protection. By 10 boys (or girls) engaged in risk mapping by 2006, security had increased, and IDPs had begun drawing their village and identifying where bad returning home, though many remained in camps things happened to children. The children com- because their former homes had been destroyed municated their fi ndings to villagers by conduct- and they continued to get some emergency assis- ing role plays that showed, for example, young tance. In 2006, Christian Children’s Fund (now children being injured as they fell into uncovered ChildFund) started a number of CFSs in northern wells. Typically, these role plays stirred great Uganda. excitement and led the adults to re fl ect how they In the large IDPs camp of in Gulu district, could do a better job of protecting the children. there were no developmentally appropriate activ- Coupled with facilitation by ChildFund staff, the ities for young children. Children were left in the re fl ection led to the formation of Child Well-Being care of older siblings or alone, while their parents Committees that included a mixture of adults and left for most of the day to work cultivating vege- children, with separate committees for males and tables for their family to eat, as well as to sell. females. Over the next 2 years, the committees Though children were usually left in the care of played an active role in addressing protection older siblings, many of the young children were threats, and children were active members of these still unsupervised as the older siblings left them committees. Over time, forced early marriage of to engage in their own activities. As a result, young girls was reduced by collaborating with young children were exposed to a number of pro- imams whose awareness had been raised in regard tection threats, including being injured in road to the harmful effects of early marriage. Initially accidents, starting fi res while trying to cook for there been concerns that the approach might give themselves, fi nding dangerous objects such as young people too much power and might elicit discarded alcohol containers while playing, and backlash from adults. Yet the children led the way being sexually abused. and found appropriate means of participating To address this situation, three CFSs were while also demonstrating respect for elders. In the organized for children 3–6 years of age. The intervention sites, both parents and children CFSs were conducted in the morning, and groups reported that the combination of CFSs and Child were organized according to age (3 years, 4 and Well-Being Committees had helped to create a 5 years, and 6 years). Activities included singing, protective environment for children. learning the alphabet, numeracy skills, storytell- As the situation stabilized and schools ing, games, free play, helping clean the CFSs, reopened, care was taken to avoid competition and learning hygiene skills. between the CFSs and the schools. CFSs did not Thirty Child Activity Leaders facilitated run during school hours but shifted toward pro- activities for more than 1,300 children. The Child viding other forms of support such as after school Activity Leaders were volunteers from the camp recreation and life skills development. Because who had been selected by the community and who teenagers had few supports and wanted to become were trained on young children’s protection needs, literate, some CFSs were transformed into liter- psychosocial needs, and implementing develop- acy centers. This example illustrates how CFSs mentally appropriate activities. Each week, the are transitional supports that phase out as the sit- activity leaders incorporated a new theme into uation changes, in this case by being transformed activities, such as teaching children the zone into other kinds of supports for young people. where they lived in order to avoid separation, or 9 Child Friendly Spaces: Promoting Children’s Resiliency Amidst War 125 teaching children how to wash their hands before from the Strengths and Diffi culties Questionnaire, eating and after using the latrine. The theme was which has been used in many countries. To iden- incorporated into the various activities children tify locally appropriate indicators of child well- participated in throughout the week. being, a free listing procedure was used in which In conjunction with the CFSs, a Child Well- local adults listed things that show a child is well Being Committee—comprised of community or happy. Some of these locally generated items— leaders—provided oversight and support for the such as sharing, being helpful, and playing with CFSs. The committee members visited the CFSs other children—corresponded with items from daily, supported the volunteers, and engaged the the Strengths and Dif fi culties Questionnaire. community in monthly meetings on children’s Other items were unique to this context and protection and well-being, including such topics included having a good appetite, being obedient as malaria control, children’s hygiene, and camp and well mannered, and having good hygiene. cleanliness. The volunteers and committee mem- Of note is that some of these items are quite bers received food and nonfood items from the different from those that might have been organization to motivate and compensate them expected from Western respondents. For exam- for their time. ple, the importance that local people attached to To identify the outcomes of the CFSs for chil- knowing how to use the latrine correctly and to dren, research was conducted in April 2007 washing hands after use of the latrine probably (Kostelny & Wessells, 2008 ) . It took advantage of refl ect the realities of life in the camps. Although the fact that near the CFS sites there were children latrine use might not seem an important protec- who lived in comparable circumstances but who tion issue initially, its importance increases when had no access to CFSs or other outside interven- one considers that diarrhea and related diseases tions. This afforded the opportunity to compare are signifi cant sources of morbidity and mortality the children who had or had not received the CFS in IDP camps in northern Uganda. Also, people intervention, thereby separating CFS outcomes in Uganda think of well-being not in individualis- from those that might have been attributable to tic but in relational terms. To have a child who improvements in the general economic or politi- defecates near a neighbor’s dwelling is to dam- cal situation. The data obtained from the compari- age the fabric of social relations. son group identifi ed important protection and The results showed that participation in CFSs psychosocial needs to guide future programming. had produced measurable improvements in chil- The methodology included a mixture of quali- dren’s protection, psychosocial well-being, and tative and quantitative methods and emphasized education. In particular, CFS participants were caretakers’ perceptions of their children’s well- safer than children in the comparison group since being and safety. Focus group discussions were while they were in a protected, supervised space, conducted with separate groups of elderly care- they did not suffer fi res in the home, sexual vio- givers, single mothers, widows, and camp leaders lence, or being hit by cars on the road. Furthermore, in both groups. Open-ended questions and prob- children attending the CFSs were reported by their ing questions were used to learn about risks and caregivers to have more positive social interactions dangers to young children’s well-being that had with peers and adults, and learned more life skills been present a year ago and also about the current than children who did not attend CFSs. Teachers risks and dangers to young children. The reasons reported that the children who had participated in for any changes were also explored. the CFSs demonstrated greater school readiness Quantitative data were collected from house- and social competencies, such as sharing. holds of randomly selected children who had par- These results are best regarded with caution ticipated in CFSs. In the comparison group, because the matching across groups was impre- households were randomly selected from each cise and children were not assigned to be CFS zone in the camp. The quantitative data were col- participants or nonparticipants on a random basis. lected using a questionnaire that included items Nevertheless, the research suggests that CFSs 126 K. Kostelny and M. Wessells do have positive outcomes in diverse domains. exclusive access to assessment information, and An important step in the development of CFSs develop programs rapidly in a noncollaborative internationally will be the regular conduct of approach. In many emergencies, external NGOs systematic evaluations that focus not on process that want to establish CFSs conduct their own indicators but on actual outcomes for children. assessments and then either keep the information Hopefully, the emphasis will be not solely on collected to themselves or share it sparingly. Westernized indicators and measures but also on Also, they work to get into high-need areas locally derived indicators and measures that are quickly and to get the jump on other agencies by contextually validated and culturally appropriate. establishing CFSs quickly. In some cases, this rush to show immediate activity and results, which donors frequently demand, leads to agen- Challenges cies working in the areas that are most accessible rather than those which have the greatest needs. Signi fi cant challenges to the development of These challenges to the coordination of work effective CFSs arise from the dangerous, chaotic, on CFSs are ampli fi ed by the fact that in a large- and time-urgent nature of armed confl ict. Often scale emergency, a great number of agencies seek the areas that have the greatest needs are the most to implement CFSs, which are viewed as part of diffi cult to access, and security problems may the frontline response to children’s needs. In a block access to large numbers of children and dynamic, chaotic situation in which many agen- families. Even if access is achieved, logistics and cies pour into a confl ict zone and begin setting up security problems may make it impossible to CFSs, it is inherently challenging to track and organize CFSs on a signi fi cant scale. coordinate activities across agencies. This chal- However, many of the greatest challenges owe lenge is particularly great since no controls or to the humanitarian response itself. This can be regulations exist that require agencies to work seen in the tendency of agencies to develop CFSs collaboratively. in a re fl ex-like manner, without having conducted In addition, there is little harmonization of a careful assessment to determine whether they approaches in regard to CFSs. In fact, agencies are needed, safe, and contextually appropriate. differ considerably in how they engage with com- Also, the lack of a strong evidence base makes it munities, as some agencies emphasize commu- very dif fi cult to know whether CFSs are effective nity mobilization, whereas others deliver CFSs in in a particular context and which design features a service modality. Whereas some agencies and implementation modalities are most effec- emphasize all three functions of CFSs— tive. These and other challenges associated with protection, psychosocial support, and nonformal the humanitarian response can be prevented education—some agencies may focus primarily through a mixture of awareness of the problems on only one function such as psychosocial sup- and the willingness to take concerted steps to port. Large differences also occur in the extent to address them. In this spirit, this section identifi es which CFSs take a multisectoral approach and some of the most signi fi cant problems and offers integrate elements of information sharing, health, suggestions for managing them. and hygiene. At the end of the day, these agencies can say they are implementing CFSs but in fact may be doing very different things. Coordination Challenges arise also from the fact that CFSs sit at the intersection of three domains—protection, Coordination is always a profound challenge in education, and mental health and psychosocial sup- humanitarian crises, owing in no small part to the port. It has been inherently challenging to reach competitive nature of the humanitarian enter- across the respective protection and education clus- prise. Since agencies compete for funding, they ters as well as the coordination subgroup that often often seek to “plant their fl ag,” gain early and forms around mental health and psychosocial 9 Child Friendly Spaces: Promoting Children’s Resiliency Amidst War 127 support. Each coordination group is busy with its clusters. The principles call for the coordination own areas of technical need, and time pressures mechanisms to do much more than convene meet- make it diffi cult for practitioners to attend multiple ings for purposes of information exchange. The coordination meetings. mechanisms should actively identify and address To achieve the necessary levels of coordina- gaps in coverage, develop coordinated approaches tion, agencies should take a collaborative, inter- to training and capacity building, and share tools agency, multisectoral approach that is designed such as those used for capacity building and to harmonize approaches and provide compre- evaluation purposes. hensive coverage while avoiding gaps. A signi fi cant step toward this harmonization of approaches is the development of the fi rst inter- Quality agency Principles for Child Friendly Spaces in Emergencies : Field Testing Version (UNICEF, A recurring lesson from the fi eld is that it is con- 2010 )1 and the process of fi eld learning to siderably easier to establish CFSs than it is to strengthen them that will take place over the next achieve appropriate levels of quality in their few years. These principles call for all CFSs to implementation. Amidst the rush to set up CFSs, adhere to these principles: agencies sometimes organize what is best regarded • Take a coordinated, interagency approach as a collection of recreational activities rather than which links the various sectors or clusters, such a set of processes that have been carefully designed as protection, health, education, and shelter. to achieve specifi c objectives. Among the greatest • Conduct an assessment. challenges is the low levels of capacity of many • Use CFSs as a means of mobilizing the com- local and national people who implement CFSs in munity to care for and protect children. zones of armed con fl ict. For example, relatively • Organize integrated supports and services. few CFS workers in large-scale emergencies have • Make CFSs highly inclusive and nondiscrimi- a good understanding of child development and natory, including highly vulnerable girls as how to organize activities that aid the develop- well as boys, children with disabilities, chil- ment and well-being of young people at different dren who are infected or affected by HIV and stages. Furthermore, understandings of how to AIDS, and children at different stages of engage children who have disabilities may be development. quite low. In societies in which parents discipline • Ensure that CFSs are safe and secure. their children through the use of corporal punish- • Make CFSs safe, stimulating, and supportive ment, workers may have little understanding of, environments. or skill in using, nonviolent forms of discipline. • Provide ongoing training and follow-up sup- To achieve appropriate levels of quality, it is port for animators and staff. essential to have well-de fi ned objectives and out- • Monitor and evaluate CFS programs and use comes that guide the organization of CFSs and to the information to improve the quality of provide ongoing training and capacity building to practice. strengthen the skills of CFS workers. A key part of • Develop and follow an appropriate phaseout capacity building is fi eld mentoring and problem- strategy. solving, as 1- or 2-week trainings are insuffi cient The principles stipulate that while one cluster for preparing local workers to handle the complex (such as protection or education) or group takes situations that inevitably arise. In addition, it is the lead in coordinating work on CFSs, it is cru- advisable to take a phased approach to implemen- cial to link and collaborate with other sectors or tation in which CFS workers implement basic activities and processes before they attempt to implement activities and processes that require 1 The second author was the lead consultant in the devel- higher skill levels. For this reason, the interagency opment of these principles. principles provide guidance on initial and more 128 K. Kostelny and M. Wessells advanced steps. Another necessity is an effective resulting harm would outweigh any good that the system of monitoring and evaluation, without CFSs might have caused. which it is impossible to know whether CFSs CFSs may also cause harm by virtue of the are achieving their intended objectives. Work on way in which the affected community is engaged monitoring and evaluation should focus not only or not engaged. Too often, CFSs are established on process indicators related to, for example, the following a brief consultation with affected numbers of children who participate in CFSs, but people and in a service modality. This approach, also on indicators related to children’s outcomes like the tokenistic participation that is visible in and well-being. After all, the purpose of CFSs is many humanitarian settings, disempowers people to improve children’s well-being. at a moment when they need to regain their sense of self-effi cacy. In some cases, CFSs may be imposed on affected people, thereby reproducing Do No Harm patterns of colonial domination. The dynamics of imposition can also come from within, as groups One of the greatest challenges in regard to CFSs of affected people say they want external agen- is to avoid causing unintended harm, which can cies to set up CFSs as services since they hope occur in many ways. Poor coordination is fre- that the agencies will bring more food, health quently a source of violations of the Do No Harm care, and other necessities (Wessells, 2008 , imperative, since it can result in duplicate assess- 2009) . Conversely, efforts to avoid external ments that leave affected people feeling frustrated imposition may set up CFSs through existing and angry over the fact that NGO workers arrive community networks and social structures, repeatedly in their camp or setting and ask ques- including traditional leadership structures. tions, yet they do little to improve people’s well- However, these structures may be guided by local being. Harm may also result from inappropriate power elites and may exclude people who are placements of CFSs. For example, if CFSs were stigmatized or who live in the margins. located near military bases or sites of military To ful fi ll the potential of CFSs and wider operations, the participation of children in the humanitarian accountability, it is essential to CFSs could place them at risk of recruitment, avoid causing harm through work on CFSs. The attack, or sexual exploitation. Similarly, if an challenges outlined above are poignant remind- agency established CFSs in tents that inadver- ers of the complexities inherent in organizing tently displayed the color of particular political CFSs in zones of armed con fl ict. These and other groups, local people or armed groups might see Do No Harm challenges can be prevented by the CFS as politically active and detain or attack adhering to the interagency principles outlined participants. above and attending to and managing the power CFSs can also cause harm when they fail to dynamics of the local context. A high priority for support the education system. Not uncommonly, prevention is to work with ethical awareness, CFSs are established as parallel systems that have which is essential for supporting and protecting little or no contact with the formal education sys- children in their hour of need. tem. In the absence of coordination with the education system, CFSs may compete with schools for child participants or even for teachers, who References may earn higher salaries working for external NGOs. In addition, CFSs can cause damage by Bernard van Leer Foundation. (2005). Responding to enabling harmful practices toward children. If, young children in post-emergency situations. In M. McCallin (Ed.), Early childhood matters . The for example, children are beaten, sexually Hague the Netherlands: Bernard van Leer exploited, or discriminated against in CFSs, the Foundation. 9 Child Friendly Spaces: Promoting Children’s Resiliency Amidst War 129

Bronfenbrenner, U. (1986). Ecology of the family as a Martone, G. (2007). Educating children in emergency set- context for human development research perspectives. tings: An unexpected lifeline. New York: International Developmental Psychology, 22 , 723–742. Rescue Committee. Dawes, A., & Donald, D. (1994). Childhood & adversity: Nicoli, S. (2003). Education in emergencies: A tool kit for Psychological perspectives from South African starting and managing education in emergencies . research . Cape Town: David Philip. London: Save the Children UK. Donald, D., Dawes, A., & Louw, J. (2000). Addressing Nicoli, S., & Triplehorn, C. (2003). The role of education childhood adversity . Cape Town: David Phillip. in protecting children . London: Humanitarian Practice Garbarino, J., Dubrow, N., Kostelny, K., & Pardo, C. (1992). Network. Children in danger: Coping with the consequences of Of fi ce of the Special Representative of the Secretary community violence. San Francisco: Jossey-Bass. General for Children and Armed Confl ict. (2009). Garbarino, J., & Kostelny, K. (1996a). The effects of Machel study 10 year review: Children and confl ict in political violence on Palestinian children’s behavioral a changing world . New York: UNICEF. problems. Child Development, 67 , 33–45. Sinclair, M. (2002). Planning education in and after Garbarino, J., & Kostelny, K. (1996b). What do we need emergencies. Paris: UNESCO Institute for Educational to understand children in war and community vio- Planning. lence? In R. Apfel & B. Simon (Eds.), Mine fi elds in SWAY (Survey of War-Affected Youth). (2007). Making their hearts: The mental health of children in war and reintegration work for youth in northern Uganda . communal violence (pp. 33–51). New Haven: Yale Retrieved December 1, 2008, from http://www.sway- University Press. uganda.org/SWAY.ResearchBrief.Reintegration.pdf Garbarino, J., Kostelny, K., & Dubrow, N. (1991). No UNESCO. (2010). Psychosocial assessment of education place to be a child: Growing up in a war zone . in Gaza and recommendations for response . Paris: Lexington, MA: Lexington Books. UNESCO. IASC. (2007). IASC guidelines on mental health and psycho- UNICEF. (2010). Principles for child friendly spaces in social support in emergency settings . Geneva: IASC. emergencies. Field testing version developed and INEE. (2010). Minimum standards for education: reviewed by the Child Protection Working Group, the Preparedness, response, recovery . New York: INEE. Education Cluster Working Group, and the IASC Kostelny, K. (2006). A culture-based, integrative approach: Reference Group on Mental Health and Psychosocial Helping war-affected children. In N. Boothby, A. Support in Emergency Setting. Retrieved January 1, Strang, & M. Wessells (Eds.), A world turned upside 2011, from http://www.psychosocialnetwork.net down: Social ecological approaches to children in war Werner, E., & Smith, R. (2001). Journeys from childhood zones (pp. 19–37). Bloomfi eld, CT: Kumarian. to midlife: Risk, resilience, and recovery . Ithaca, NY: Kostelny, K., & Wessells, M. (2004). Internally displaced Cornell University Press. East Timorese: Challenges and lessons of large-scale Wessells, M. (2006). Child soldiers: From violence to pro- emergency assistance. In K. Miller & L. Rasco (Eds.), tection. Cambridge, MA: Harvard University Press. The mental health of refugees: Ecological approaches Wessells, M. (2008). Do no harm: Challenges in organiz- to healing and adaptation (pp. 128–225). Hillsdale, ing psychosocial support to displaced people in emer- NJ: Erlbaum. gency settings. Refuge, 25 (1), 6–14. Kostelny, K., & Wessells, M. (2005). Psychosocial aid to Wessells, M. (2009). Do no harm: Toward contextually children after the Dec 26 tsunami. Lancet, 366 (9503), appropriate psychosocial support in international emer- 2066–2067. gencies. American Psychologist, 64 (8), 842–854. Kostelny, K., & Wessells, M. (2008). The protection and Wessells, M., & Kostelny, K. (1996). The Graca Machel/ psychosocial well-being of young children following U.N. study on the impact of armed con fl ict on chil- armed confl ict: Outcome research on child centered dren: Implications for early child development . New spaces in Northern Uganda. Journal of Developmental York: UNICEF. Processes, 3 (2), 2–12. Williamson, J., & Robinson, M. (2006). Psychosocial Machel, G. (2001). The impact of war on children . Cape interventions, or integrated programming for well- Town: David Philip. being? Intervention, 4 , 4–25. Resilience in Orphans of War in Sri Lanka 1 0

Chandi Fernando and Michel Ferrari

Research literature on children of war re fl ects the studied under the heading of resilience: (1) ‘beat- challenges of studying both the losses associated ing the odds’ in the context of situations of high with war and how to promote psychosocial well- cumulative risk for developmental problems, (2) being in children, despite these experiences. coping well under dif fi cult circumstances, (3) Ideally, such studies should include culturally bouncing back after some catastrophe or severe situated and meaningful ways to help children deprivation, and (4) posttraumatic growth follow- maintain psychosocial well-being in light of war- ing adversity that transformatively reorganises time experiences—in other words, to help them developing systems so that they function better be resilient. A culturally sensitive and compre- than before (Masten, 2011 ; Masten, & Narayan, hensive picture must account for both psycho- 2012). Although most research has focused on logical and sociocultural aspects of resilience individual resilience, the socioecological systems that maintain or restore psychosocial well-beings in which individual development is embedded (Panter-Brick, & Eggerman, 2012 ) : The socio- (e.g. families, religious traditions) can also be cultural aspect requires assessing social institu- studied. tions and cultural meaning systems within which Within this broad framework, the two major people orient their lives; the psychological aspect approaches characterising resilience research requires assessing both externalising and inter- identifi ed by Masten and Powell ( 2003 ) remain nalising concerns that in fl uence resilience. important: a variable-focused approach and a per- According to Masten ( 2011 ) ‘resilience can be son-focused approach. Variable-focused approaches de fi ned most broadly as follows: The capacity of a examine links among competence, adversity and a dynamic system to withstand or recover from number of potential protective factors indexed by signifi cant challenges that threaten its stability, variables that describe differences among individu- viability, or development’ (p. 494). Thus, resil- als and the nature of their interactions with the ience refers to patterns of positive adaptation in the world. In contrast, person-focused approaches context of signifi cant risk or adversity, as inferred identify people who meet de fi nitional criteria for from measurements of risk exposure and positive resilience as compared to individuals with maladaptation. Several kinds of phenomena have been adaptive development who have experienced similar levels of risk but demonstrate markedly different C. Fernando (*) • M. Ferrari outcomes. Importantly, dynamic systems can them- Applied Psychology and Human Development , selves be variable or person (agent) focused. Ontario Institute for Studies in Education, Person-focused resilience research considers how University of Toronto , Bloor Street West 252 , agents interact dynamically with their environment Toronto , ON , Canada M5S 1V6 e-mail: [email protected] ; so as to remain resilient—something well addressed [email protected] by social–ecological models of resilience.

C. Fernando and M. Ferrari (eds.), Handbook of Resilience in Children of War, 131 DOI 10.1007/978-1-4614-6375-7_10, © Springer Science+Business Media New York 2013 132 C. Fernando and M. Ferrari

Social–ecological resilience . Social–ecological depends on environmental factors that trigger and models of resilience (Bronfenbrenner, 1979, sustain them. 2005; Tol, Jordans, Kohrt, Betancourt, & Finally, Ungar ( 2012 ) believes that the mean- Komproe, 2013 ; Ungar, 2012 ) show how resil- ing systems that individuals and their communi- ience depends on skilful navigation of nested sys- ties embody and endorse (e.g. about the good life tems of meaningful sociocultural activity; in other or the nature of trauma, its sources and the ability words, resilience is not a feature of a person alone for individuals to fully recover from trauma) but of a person within an ecology. According to determine which resources families, secular or Ungar (2011, 2012) , the personal attributes that religious institutions and communities provide. allow people to cope with hardship are expressed They also determine personal decisions about when a child’s social and physical ecologies sup- what internal and external resources (opportuni- port or develop processes that protect them from ties) individuals value and consider accessible. risk and promote positive development. Such meanings are constructed and expressed Ungar (2012 ) elaborates Kurt Lewin’s (1951 ) both individually and collectively within commu- view that behaviour is a function of a person in nity institutions like families, churches and orphan- interaction with their environment. For Ungar ages. Collective co-construction implies that the (2012 ) , a scienti fi c study of resilience must assess meaning of situations is negotiable and ‘re fl ects a set of observable behaviours associated with the relative power of those involved to argue for adaptive outcomes in contexts of adversity. Such the legitimacy of their experience’ (Ungar, 2012 , positive adaptive outcomes are essentially what p. 23). In other words, as for Masten (2007, 2011 ) , Masten describes as competence or ‘doing OK’. risk and resilience must be understood in terms of In the pioneering Project Competence studies, complex interactive processes embedded in social the criteria for positive adaptation centred on the and physical ecologies that contain levels of risk concept of psychosocial competence de fi ned as that exceed the norm (Wyman, 2003 ; Wyman et al., effective performance of developmental tasks 1999). These compensatory, promotive and pro- that were salient for an individual’s given age, tective processes contribute most to successful society and historical period (Masten et al., 1995, coping when individuals, families and communi- 1999 ) . In American society, they identify three ties face signi fi cant exposure to adversity. broad developmental tasks considered important Despite their differences, both Masten and throughout middle childhood and adolescence: Ungar are certainly correct in stressing the impor- (1) school achievement (academic competence ), tance of understanding resilience as a dynamic (2) getting along with other children (social com- system that exists within nested layers of a socio- petence) and (3) following rules of conduct in the cultural ecology. An obvious bridge between home, school and community (conduct ). these two views is Kurt Fischer’s Dynamic Skill The important refi nement Ungar adds to Theory (Fischer & Bidell, 2006 ) , a person-cen- Masten’s view is that competent behaviour that tred theory of human development that proposes indicates resilience is necessarily a function of that development is best understood as dynamic the strengths and challenges children experience system of co-ordinated skills developed within within a complex ecology. This is because, ‘[the particular socioecological settings. Importantly, ability of] the social and physical ecology to pro- for Fischer, we can identify two levels of skilled vide resources for internal integration and exter- performance: a functional level of skill—in which nal adaptation is constrained by the opportunity previously learned skills are performed in famil- structure that surrounds the individual....opportu- iar settings—and an optimal level of skill, in nity dramatically in fl uences developmental tra- which people perform to their maximum level jectories by making resources available and with social support from more knowledgeable accessible’ (Ungar, 2012 , p. 21). In other words, others—often within social institutions like fami- resilient behaviour—whether adaptive or mal- lies, schools or other community institutions. adaptive coping (Bottrell, 2009 ) —always Dynamic systems as understood by Fischer and 10 Orphans of War in Sri Lanka 133

Bidell (2006 ) allow us to consider the optimal of children, the need to understand the sequelae dynamics that are protective, compensatory and of war on child development in this population promotive of well-being within psychosocial is critical. Additionally, since systematic torture ecological systems. and trauma tactics by Sri Lanka’s political Following Vygotsky (1934/1986) , one addi- factions were commonly used to dehumanise tional point seems noteworthy: cultural meaning individuals and disrupt families and communi- systems themselves are evolving and developing, ties, it is also essential to identify protective and provide powerful tools for individual self- factors within individuals and communities that regulation, and therefore for resilience. For promote resilience in the presence of these and example, when individuals engage in prayer or other adversities (Catani et al., 2010 ; Chase, meditation, they use a psychological tool that has Doney, Sivayogan, Ariyaratne, Satkunanayagam, been handed down for generations specifi cally & Swaminathan, 1999 ; Dubow et al., 2012 ; Reddy, designed to develop a certain kind of subjectivity. 2003 ; Wolmer, Hamiel, & Laor, 2011 ) . Orphanages Childhood is a particularly important time to are one such communal institution that helps pro- appropriate and eventually master these tools mote resilience in children affected by war or other (Friedrich, in press ; also Foucault, 2005 ) . traumatic life events. Within this broad developmental framework, we propose that in-depth comparative case stud- Orphanages in Sri Lanka. Previous research in ies are the best way to comprehensively study the Sri Lanka (Fernando, 2000 , 2006 ) revealed that, effects of war on children—that is, the psycho- unlike the Western defi nition of orphan that logical and sociocultural risks and opportunities implies the loss of parents through death, a child for resilience that particular social–ecological within an orphanage in Sri Lanka is referred to as contexts provide. In this chapter, we will focus on an orphan regardless of the status of biological orphanages in Sri Lanka, comparing the cases of parents. Thus, children within orphanages have a orphan children affected by war to those orphaned variety of background histories. For example, a for reasons other than war. The social–ecological child may have lost both parents, one parent or context we focus on in this chapter is the social have both parents still alive: What is critical is institution of Buddhist orphanages, supporting that the orphan’s parents are unable to care for both war orphans and those orphaned for reasons their child and have placed that child into an other than war. orphanage. Sri Lankan orphans may remain in contact with their parents, and so orphanages are more akin to a children’s home or boarding Sri Lanka school, where basic needs are met. As found in our previous research (Fernando, Sri Lanka is an island about 30 km off the South- 2000 ; Fernando & Ferrari, 2011 ) , the role of Eastern coast of India. Its population of about 19 caregivers within the orphanages is also distinct. million is 74 % Sinhalese and 18 % Tamils, with Administrators oversee the functioning of the the remaining percentage consisting of Moores orphanage, including fi nances, building mainte- (7 %), Burgher, Malay and Veddah (1 %) nance, public relations, personal support for the (Peebles, 2006 ) . Sri Lanka has a rich history that children and provision of basic necessities. includes periods of prosperity mixed with for- Matron caregivers are responsible for providing eign invasions and indigenous cultural con fl ict. daily routines and meeting children’s basic needs From 1983 to 2008, tensions between Tamil sep- by overseeing the cooking, cleaning, providing aratists and the Sinhalese majority erupted in emotional support, helping with homework, guid- civil war, resulting in tens of thousands of people ing and disciplining children and helping foster dead and thousands more displaced and prosocial interactions among them and respect traumatised—many of them children. As milita- for their elders. Teachers tutor children, provide ristic tactics involved the purposeful victimisation direction and support and help the children 134 C. Fernando and M. Ferrari achieve academically. In this way, orphanage everyone to be in the average range), Sandtray matrons and staff compensate for family environ- analysis (constructions and narrative about a ment and signi fi cant attachment relationships. choice of 300 miniatures), stages of faith inter- Since Sri Lanka is predominantly a Buddhist view (adapted from Fowler, 1981 ) and a sentence country, the practice and philosophy of Theravada completion task, along with observations and a Buddhism is found to be integral to life in many clinical interview. Adult measures included the orphanages. Within Buddhist orphanages, chil- adapted stages of faith interview and a sentence dren often engage in daily meditative practice completion task. The researchers travelled to the (e.g. metta or loving-kindness meditation), learn home or institution of each participant to conduct Buddhist teachings, (e.g. Jatha Kathava or char- the assessments. This approach allowed the acter stories), have places of worship available to researcher to become better acquainted with par- them (e.g. shrines within the orphanage grounds) ticipants and their cultural environments. Scoring and engage regularly with monks for teaching was completed by two raters, with inter-rater reli- and guidance. ability over 90 %. The fi ndings discussed below refl ect a synthesis of information from across these different data sources that generated gen- Case Studies of Nonwar and War eral themes about the children and caregivers in Orphans these different settings.

Data were collected on seventy-seven participants Two Nonwar Orphanages (62 children and 15 caregivers) in Sri Lanka, all of Nonwar Orphanage for Boys in Colombo Singhalese descent. The children ranged between The fi rst setting is a nonwar orphanage in 5 and 18 years of age, and their caregivers ranged Colombo run by six monks (including the chief between 25 and 80 years of age (mean age of 45). monk) and two female caregivers, it is a self-con- Participants included Singhalese war orphans and tained compound that includes a temple for the nonwar orphans from Buddhist orphanages, and a public and buildings for administration, eating, comparison group of children from intact fami- sleeping, playing and worship. It is an all-boys lies; however, this chapter will focus on the facility, housing 20 children, ages 5–13 sustained fi ndings for children and caregivers in two set- by donations from the community. Children are tings: nonwar orphans and war orphans. brought to the orphanage by family members due Participants reside in two geographical locations: to parents’ inability to maintain them in their urban (Colombo) and rural settings (outside of home villages. Most children maintain contact Kandy). All children and caregivers were practis- with their parents and family, and are reintegrated ing Buddhists.1 Information on the children was into their families of origin once they are better collected in the summer of 2002, during a tempo- able to provide for them. rary ceasefire in the civil war.2 The children’s relationships with caregivers All participants completed the following were described as positive, supportive and struc- assessment battery. Children’s measures included tured, with the provision of boundaries and mod- Goodenough-Harris drawings of a man and elling of behaviour. Close relationships were woman (a measure of cognitive ability showing reported between the children, who frequently reported relationships that are familial in nature. They reported being able to play, learn, share 1 Similar results were found at a Christian orphanage, not diffi culties and resolve disputes positively with considered in this chapter (see Fernando, 2006 ; Fernando one another, indicating that caregivers facilitate & Ferrari, 2011 ) . these relationships by supporting positive confl ict 2 For fi ndings about developmental aspects of this study, including the comparison-groups children, see Fernando resolution and offering enriching opportunities ( 2000, 2006 ) and Fernando and Ferrari (2011 ) . for play, work and learning. 10 Orphans of War in Sri Lanka 135

Children within this group are given with facilitate relationships by supporting positive basic requirements, such as food, clothing and con fl ict resolution and by offering opportunities shelter. The orphanage environment is stimulat- for play, work and learning. ing, with opportunities for learning, enrichment and maturity. Particularly, monks are active in Summary. These two nonwar orphanage settings teaching the children about Buddhism, guiding make available a social–ecological context that faith practice, counselling them, helping them provides important opportunities for children. meet their academic goals and providing them However, given their own personal challenges, with enriching experiences, such as social out- children are not all equally able to access these ings. Many of the children go on to secure good opportunities, even when residing in an orphan- jobs, education and marriage prospects. A number age. This point is made clearer by considering the of children have also chosen to become monks challenges experienced through what we call after living in the temple environment. idioms of risk and idioms of resilience, because they are often not merely personal challenges, Nonwar Orphanage for Boys and Girls but set within the children’s broader social ecol- in Colombo ogy. The fi ndings below re fl ect a synthesis of all A second nonwar Buddhist orphanage in of the data sources available from this project. Colombo for boys and girls, birth to 5 years of age, was also observed with assessments made of Challenges that generated risk. Overall, children both staff and children. This orphanage is also a from this group were separated from their fami- self-contained compound, with buildings for lies and placed in orphanages because their sin- administration, eating, sleeping, playing, wor- gle, widowed or divorced mothers were unable to ship, including a playground and a school. (Also adequately provide for them. Many mothers after within the compound is a home for elders, with the death or separation from their husbands would whom the children visit). The orphanage is sus- frequently begin a process of re-educating them- tained largely through donations from the com- selves and/or looking for employment so they munity and is run by a committee of several could support their families. During this period members, a chief matron, two caregivers and a of re-education, children were often placed in the Montessori school teacher. The children are also orphanage to assure consistent shelter, food and involved with monks from a local temple. With educational opportunities. This fi nding is consis- the exception of the monks, all committee mem- tent with previous research, in that children of bers and caregivers are female. All members single and/or widowed and uneducated mothers share various responsibilities, including meeting are at increased risk for negative and disturbed fi nancial goals, providing basic necessities and behaviour (Dybdahl, 2001; Masten & Powell, emotional, educational and religious support. 2003; Rutter & Quinton, 1977 ; Sameroff, Siefer, Children come from homes where mothers had Baracos, Zax, & Greenpsan, 1987 ) . been widowed or left by husbands, and so are struggling fi nancially to provide adequate childcare. The Opportunities for resilience . Despite these chal- children are housed at this orphanage until age fi ve lenges, unique to this situation is the opportunity and then transferred to other orphanages in the city. for mothers to place their children in temporary During this time, the child’s biological family is care while they re-educate themselves and fi nd allowed to visit them. According to caregiver secure jobs, while remaining in contact with reports, the children’s relationships with caregivers their child in a continued parenting role. In fact, are positive, supportive and structured. Close rela- many children remained in contact with their tionships are also reported between the children, mothers, family and extended family and returned with opportunities to play and learn. Caregivers home for visits or had their mothers visit them. 136 C. Fernando and M. Ferrari

During visits, the mothers would frequently bring harsh or punitive nor overly lenient (Cauce, them toys and educational books, would take time Stewart, Rodriquez, Cochran, & Ginzler, 2003 ) . to teach them and would also instil the value of In addition to the support received from their Buddhism and of a good education. Therefore, mothers, most children reported feeling that the these children were essentially co-parented by chief monk was like a father to them—a relation- orphanage caregivers and given opportunities to ship frequently described as warm, close and receive basic necessities; social, religious and characterised by careful monitoring, discipline, educational opportunities; and consistent caregiv- consistency and love. Although, caregiving is not ing that these mothers would not have been able a typical role assumed by monks, they have to provide. These mothers thus have the security increasingly begun providing respite for children of knowing that their child’s needs are being met of war. Within this context the role is unique to while they build a stable life for their families. Sri Lankan Buddhist history and has subsequently In this sense, the orphanage has a transitional become an idiom of resilience. Despite the newness function, supporting mothers towards a more sta- of this caregiver role, how the chief monk exe- ble future. In addition to the fl exibility and the cuted his duties was consistent with previous social opportunities afforded to children by the research fi ndings for promoting resiliency and orphanages, they also provide emotional support decreasing negative behaviours in children and security for mothers. This likely promotes (Machel, 2001 ) . effective parenting, allowing the mothers to Positive relationships were also formed between develop warm, close relationships with their chil- the children and the other six monk caregivers. dren. Through this interaction, a fl exible, dynamic Although these monks did not appear to have the and sensitive social ecosystem is established, pro- same parental role as the chief monk, the children moting resilience for both mothers and children. went to them when they needed guidance and sup- With this support, children have been found to port. As the orphanage had a strong commitment to engage in stable and nurturing relationships with Buddhist philosophy and practice, these monks parents and primary caregivers, while families were also involved in teaching and guiding the chil- and communities feel secure and con fi dent in pro- dren in Buddhism. The children reported that these moting recovery from trauma (Machel, 2001 ) . interactions were not only benefi cial in helping The children from this setting were resilient cope with dif fi culties and feeling secure, it also and frequently reported positive interactions with inspired them to engage Buddhism at a deeper level their mothers, including feeling loved, provided by becoming monks. From this interaction a men- and cared for, secure about their future and able to toring relationship was formed, wherein the chil- cope with their past. This is consistent with previ- dren were provided with positive role models who ous research fi ndings (Pynoos et al., 1995 ; Qouta, helped with goal-setting and achievement, possibly Punamaki, Montgomery, & El Sarraj, 2007), fostering resilience. These fi ndings are consistent which demonstrate that for children living in with previous research where evidence of the stressful conditions, the emotional state and bene fi ts of informal one-to-one community-based behaviour of the mother were primary mediators mentoring. For example Big Brothers /Sisters found between the child’s psychological functioning that the availability of a mentor for 1 year and the traumatic experience. When the mother signi fi cantly reduced negative behaviour in at-risk remained calm and effective in adversity, without children, including fi rst-time drug use by 46 %, vio- minimising the seriousness of the situation, the lent behaviour by 33 % and absenteeism in school prognosis was better than when she was not pres- by 52 % (Luthar & Zelazo, 2003 ; Werner, 2000 ) . ent or overwhelmed by the situation. Behaviour of Opportunities such as schooling, social and children was also infl uenced positively if mothers religious activities were also present for these were able to cultivate close and warm relation- children. Consequently, they wished for success ships with them, monitor their whereabouts and in education, a good job and being able to pro- provide ‘precision parenting’ without being overly vide fi nancially for their families. They spent 10 Orphans of War in Sri Lanka 137 time purposefully choosing vocational goals and to fi nancial and administrative tasks but also have engaging in planning with caregivers to obtain close working relationship with the children and the requirements to meet these goals, most likely the matrons. Each board member is assigned six promoting the resilience demonstrated within children for whom they are personally responsi- these children. Again, these fi ndings are consis- ble. They meet with the children on a weekly tent with previous studies showing that planful basis to offer counselling, monitor progress and competence is signi fi cantly associated with ensure that the children have their basic, educa- higher educational attainments and occupational tional and vocational needs met. Progress at these levels and a lower rate of multiple marriages meetings is documented and shared with all (Clausen, 1991, 1993 ; Kumpfer, 2002 ; Rutter, administrators at board meetings, to ensure qual- 2006 ) . ity of care and services for the children and In many ways the situation for war orphans is to obtain help from outside agencies if needed. similar, but there are important differences in For example, if specialised counselling is systemic opportunities to promote resilience. required, referrals are made to outside agencies, or if academic and vocational needs are of con- War Orphanage for Girls in Colombo cern, appropriate teachers are contacted. The war orphanage is located in a self-contained Administrators have working relationships with compound, which includes buildings for adminis- specialist teachers at the orphanage, including tration, eating, sleeping, playing, worship, and an teachers for Buddhist classes, skill development educational centre and playground. It is an all- and academic tutoring. Administrators are also girls Buddhist facility, housing 20 girls, ages involved in decisions regarding arranged mar- 5–18. Children are brought to the orphanage by riage prospects and postsecondary planning. family members or outreach aide workers due to According to caregivers, the children’s rela- unsafe conditions and parents’ inability to main- tionships with caregivers are reported to be posi- tain them in their home villages. As children are tive, supportive and structured, with boundaries from the North and Eastern Provinces in Sri Lanka and modelling of behaviour. Close familial-like where the warring is the greatest, many have been relationships are also reported between the chil- exposed to war-related trauma, including raids on dren, who say that they are able to play, learn, their villages, witnessing of death, loss or injury share dif fi culties and resolve disputes positively of family members and limited access to resources, with one and other. They also indicate that the such as school, safe shelter and food. Most of the caregivers facilitate these relationships by sup- children typically come from backgrounds where porting positive con fl ict resolution and offering mothers are widowed due to war and are unable to enriching opportunities for play, work and learn- fi nancially provide for the children. Placement in ing. In addition to stability with caregivers and the orphanage thus allows for access to resources, friends, children within this group are provided and better educational and vocational opportuni- with basic requirements, such as food, clothing ties. The orphanage is sustained largely on dona- and shelter. The orphanage environments are fre- tions from the community quently described as stimulating, with opportuni- The orphanage is run by a board of several ties for learning and maturity. Particularly, committee members, three matrons and, several caregivers report that they teach the children volunteers, including school teachers, skill and about Buddhism, guide them in faith practice and trade teachers and religion teachers. The children help them develop academic skills. are also involved with monks from local temples. All members share various responsibilities, Challenges that generated risk. Children from including meeting fi nancial goals, providing the war orphan group were typically exposed to basic necessities and emotional, educational and more risk factors than the nonwar orphan groups. religious support. Board members attend not only Children from this group had been placed in an 138 C. Fernando and M. Ferrari orphanage as their families were affected by the the children in the orphanage as their family. war. Specifi cally, the warring left children father- Although they reported being happy for the less, with widowed and single mothers unable to opportunities provided within the orphanage, provide adequate resources for their families. they considered their home villages their home. Additionally, their communities were reported to This was in contrast to the other half of the have little social cohesion and minimal resources children in this orphanage setting who remained because of the warring. Children thus lived in in contact with their mothers, went home for hol- conditions of poverty, with food insecurity and idays or whose mothers visited them at the no access to schooling. Despite attempts by moth- orphanage. Although these children reported pos- ers to provide for their children at home, in refu- itive feelings about being able to spend time with gee camps or informal settlements, these children their biological mothers, they regarded the were separated from the families and placed in orphanage caregivers as mothers, the other chil- the war orphanage in an effort to provide safety, dren in the orphanage like sisters and the orphan- shelter, food and educational opportunities. age as their home. In some cases, the children Additional risks for these children included com- preferred being at the orphanage with the care- ing from large families, mothers being poorly givers over being at home with their biological educated and unable to fi nd consistent work. parents. Children within this setting were thus exposed to These fi ndings suggest that—for the children several challenges previously identi fi ed by who demonstrate competence with no internalis- researchers as predicting higher rates of negative ing concerns—a sense of personal security or outcomes, including low social status, large fam- increased secure attachment may be provided by ily size, admission into the care, poverty, lack of the consistency of visits and contact with parents. social support, low level of maternal education, Frequent contact may provide the assurance of single parenthood, maltreatment and war their parents’ well-being in a war zone, allowing (Jordans, Tol, Komproe, & de Jong, 2009 ; Masten them to be more open to opportunities to integrate & Powell, 2003 ; Rutter & Quinton, 1977 ; better into the orphanage, which is now their main Sameroff et al., 1987 ) . social–ecological context for development. A unique risk within this setting was lack of Additionally, sustained attachment to their bio- contact with biological parents after being placed logical parents may afford them the opportunity in the orphanage. Half the children reported miss- to form deeper relationships with the orphanage ing and being concerned about parents. Within caregivers. These fi ndings are consistent with pre- this subgroup of children, one child’s parents had vious research that found that resilient youngsters died during the warring and another did not know from highly troubled backgrounds tend to iden- her parents whereabouts; for the others, mothers tify more strongly with their residential homes remained in the warring areas, and though the than with biological parents, despite these rela- children had hopes of reuniting with them, these tionships being described as positive, because the meetings were frequently cancelled. All of these residential homes became their main context of children reported crying and feeling sadness over living (Rutter, 2006 ) . Additionally, studies have this separation. Clinical concern was raised found that resilient adaptation is possible when regarding internalising dif fi culties for all but one children have strong connections with at least one of these children as they tended to produce supportive adult (Luthar & Zelazo, 2003 ; Sroufe, sandtray stories of loss and displacement, Egeland, Carlson, & Collins, 2005 ) . appeared affectively fl at and gave minimal Tragically, these patterns were not evident for responses to interview questions pertaining to the orphans whose biological parents were still their families (see Fernando, 2006 ; Fernando & alive, but not in contact with them on a regular Ferrari, 2011 ) . Although they reported feeling basis. These children may have felt insecure in loved and cared for by the caregivers, they did not their relationship with their parents due to lack of consider them like mothers, nor did they regard consistent contact. As many of these children 10 Orphans of War in Sri Lanka 139 experienced severe war trauma in their home vil- sessions with various professionals and helping lages, they may rightly worry about their parents’ prepare for postsecondary entrance exams and well-being. This concern may in turn be trauma- completion of applications. Caregivers later tising for these children, if they psychologically reported that many former residents had gone on revisit war scenarios where they were exposed to to become doctors, lawyers, nurses and other pro- personal adversity and loss. For these reasons fessionals, thus demonstrating that purposeful they may have dif fi culty forming a secure attach- planning was most likely fostering resiliency ment with a caregiver and fully integrating into within the children. the orphanage. This in turn makes it diffi cult for These fi ndings are consistent with previous them to access the opportunities made available studies showing that planful competence is by their residing in the orphanage. signi fi cantly associated with higher educational These fi ndings are also consistent with previ- attainments and occupational levels and a lower ous research (Garbarino, 2001 ; Garbarino, rate of multiple marriages (Clausen, 1991, 1993 ; Dubrow, Kostelny, & Pardo, 1992 ) , which found Rutter, 2006 ) . Speci fi cally, research on Western that parent–child relationships characterised by populations revealed that although many children continuous threat of separation and lack of raised in institutions felt at the mercy of fate and warmth and support jeopardised the child’s nor- experienced a lack of purpose or control over mal development. Particularly, within contexts of their lives, some resilient children made deliber- community violence, primary caregivers were ate choices with their careers and choice of mar- sometimes too depressed or overwhelmed to riage partner. This decision to use foresight and form a secure attachment to their child, placing take active steps in dealing with challenges was these children at increased risk of maladaptive found to be linked to positive school experiences behaviour, including feelings of estrangement and obtaining goals. The pleasure, accomplish- and constriction of affect. For these children, par- ment and success of school may have helped the ents remaining in war zones and displaying young people acquire a sense of self-worth and inability to attach to their children may be a par- feeling that they were able to control what hap- ticular risk within this context. pened to them (Kia-Keating & Ellis, 2007 ; Quinton & Rutter, 1988 ; Rutter, 2006 ) . Opportunities for resilience. Despite the pres- Despite their high-risk backgrounds, the chil- ence of internalising dif fi culties with several dren within this study tended to plan key life orphans, all but one child demonstrated external decisions and have active support from caregiv- resilience. Not only did all children report wish- ers in this purposeful planning, all which may ing for success in education and getting a good promote resilience. Unlike the Western sample, job, they spent time purposefully choosing voca- in which only a minority of the children demon- tional goals and engaging in purposeful planning strated resilience, all children in this setting with caregivers, teachers and tutors to obtain engaged in this process. This may be due to the these goals. These vocational goals frequently support received from the caregivers as well as involved becoming doctors or nurses so they the opportunities presented within the orphanage. could help those in need, as well as helping to This fi nding is strikingly different from Western improve the orphanage and support their parents studies which found that most residential facili- and families. ties provide remarkably few opportunities for the The war orphanage was run by a board of pro- young people to exercise responsibility, auton- fessional women who emphasised educating the omy and control over their lives (Rutter, 2006 ) . children so they could obtain successful careers Many aspects of parenting repeatedly found and marriages and become good citizens. The to foster resilience in previous research are also caregivers were actively involved in helping the available to these children. However, recent children build their futures, purposeful planning, research urges investigators to move beyond curriculum development, arranging information these common aspects of parenting to incorporate 140 C. Fernando and M. Ferrari speci fi c interactions that address challenges tai- foster trust and sense of coherence and opportunities lored to particular risk conditions (Barber & for school, work, church or military leads to new Doty, 2013 ; Cauce et al., 2003 ) . A tailored experiences likely to foster competence and self- approach is used by caregivers within this set- esteem (Werner, & Smith, 2001 ). ting. Of particular interest is the role of the administrator-caregiver. Each administrator is Resilience and Faith Practices assigned a small number of children for whom The risks and opportunities of nonwar and war they are responsible. Their duties include orphans differ in important ways, even if they weekly counselling and monitoring of the chil- share what is essentially the same social–ecolog- dren, and reporting progress to the board of ical environment of the orphanage. However, directors. Decisions regarding the children’s both groups also share a cultural meaning system progress and needs would be dealt with accord- that involves the Buddhist faith. What can we ingly at this level. Additionally, the administra- learn about the role of faith practices in promot- tors have positive working relationship with the ing resilience in these two types of orphans? matrons and teachers such that children’s progress is closely monitored. Administrators are Resilient Orphan Children also involved in decisions regarding arranged Resilient orphans in both the war and nonwar marriages and postsecondary planning. orphanages reported that Buddhism was impor- Administrators emphasised providing a warm, tant to them, and their discussions emphasised secure environment, with emotional, social and regular practices that included mindfulness medi- religious support. This fl exible and dynamic tation, loving-kindness meditation, reciting ‘parenting style’ likely promotes resilience Gathas (e.g. the fi ve precepts), observing sil within the children. (a religious ritual), reading Jatha Kathava (char- These results are consistent with fi ndings from acter stories of the Buddha), listening to bana Emory Cowen’s Primary Mental Health Project (spiritual teachings) and worshipping the statue (Cowen, Hightower, Pedro-Carroll, Work, Wyman, of Buddha. These practices are designed to help & Haffey, 1996 ) whose goals were to prevent cultivate understanding about life’s circum- mental health problems among children showing stances, help one become a better person and early signs of maladjustment. For this study, at- reach a higher state of being in future lifetimes risk students were referred to non-professional (what Foucault, 2005 calls ‘techniques of self’). women called child associates, whose relation- Children reported that these activities helped ships with children developed across approxi- them cope with everyday dif fi culties, provided mately 20 sessions at school. Child associates guidelines for developing into a person with good were selected based on personal qualities such as character, and provided solace and understanding warmth and empathy. They received rigorous when dealing with life circumstance. They training and ongoing supervision by the Primary reported that ideally, they wanted to become spir- Mental Health Project professional staff. itually mature, so they could overcome suffering Additionally, there was a regular exchange of through understanding, be reborn into a better information between them, teachers and school life and eventually attain nirvana. mental health professionals to determine the nature Overall, these faith practices seem to promote of interventions for individual children, to review resiliency in these children in a number of ways: the changes observed and to chart further courses On a micro level, they offer structure and encour- of action. From this study, the warm, trusting asso- age cognitive restructuring and acceptance of ciate–child relationship seems to form the founda- their trauma, perhaps cultivating a sense of con- tion on which signi fi cant attitudinal and behavioural trol in children’s lives; on a macro level, these change in children was built. Additionally, previ- rituals promote integration into the larger com- ous studies demonstrated that the availability of munity. Indeed, structure and routine following competent caregivers and supportive adults who exposure to trauma can stabilise children and 10 Orphans of War in Sri Lanka 141 promote healthy adaptation (Machel, 2001 ) by compassion for others—for example, through the providing a safe environment for growth, explo- practice of Mithree, precepts and Jatha Kathava, ration and fi nding value even in dif fi cult life which guide social conduct. By engaging actively experiences. Additionally, the rituals and routines in faith practices that support these values, chil- reported by resilient orphans are consistent with dren can become integrated into a broader com- the traditional strategy proposed within munity with similar values, fostering feelings of Buddhism, with its focus on ethical action, con- belonging that restores or promotes well-being templation and cultivation of wisdom, and the (De Zoysa & Wickrama, 2011 ; Spilka et al., 2003 ; opportunity to transform the mind from being Trainor, 1997 ) . rigid, closed and prone to self-injury to one that is Unfortunately, children with internalising open and accepting even of hardship (Dockett, diffi culties were unable to integrate into family, Dudley-Grant, & Bankart, 2003 ; Hayes, 2003 ) . community and thus into religious communities. Resilient orphans regularly engage in faith rit- The inability to integrate into these frameworks uals, frequently speaking about how these prac- prevented them from reaping the healing benefi ts tices helped them cope with long-term trauma and of belonging to a supportive religious community daily diffi culties. As the central tenet of Buddhism and its practices. is that ‘life is dukka (suffering)’, children in the orphanage may benefi t from the practice of Karma. One particular meaningful concept of directly accepting their own challenges as exam- importance to resilience in this study is the notion ples of a necessary suffering integral to all life of karma. Karma literally translates as ‘action’ experience. In this sense, it may be helpful for and usually refers to the law of action that rewards these children to think positively, accepting the good actions with good consequences and bad reality of their bad experiences, not blame them- actions with bad consequences. Asma (2005 ) selves for things outside of their control, and notes that karma is conceived and applied differ- building on whatever good aspects there may be, ently in different times and cultures. For example, even in bad situations. This is consistent with past some people extend karma across lifetimes, link- research that found it is protective for people to ing trauma in one lifetime to some unobservable accept their negative experience rather than to past transgression, and folk Theravada Buddhism deny or distort what happened to them, and to permits such notions. focus on positive aspects in order to incorporate In some sects of Hinduism, karma can be the whole into their personal schema (Main, extreme, binding every activity; however, within Kaplan, & Cassidy, 1985 ). As research in this area the Theravada Buddhism of Sri Lanka, only is scant, the impact of these Buddhist self-prac- actions based on choices generate karma, and the tices certainly warrants further consideration. binding causal power of karma applies only to Unlike Western therapeutic ideas of healing those actions that stem from conscious intentions, from psychic trauma, many children within the not accidental actions or those fl owing from orphan group reported a desire to achieve nibbana physical laws. Of course, all cultural meaning (i.e. nirvana), be reborn to their parents in a future systems are personally negotiated when crafting birth or move to a better station in future lifetimes. narratives of identity (Hammack, 2011 ) —some- These personally meaningful beliefs, in conjunc- thing integral to resilience. We see this clearly tion with the ritual efforts to attain nibbana, may when examining how views on karma were offer the children a sense of predictive control—a assessed with caregivers and children to under- form of secondary control which assures a person stand its in fl uence on shaping resilience. that things will turn out alright in the end (Spilka, Although all orphans accepted the notion of Hood, Hunsberger, & Gorsuch, 2003 ) . karma, they all felt they were not to blame for Buddhist self-practices not only focus on the their life circumstance and they were not suffer- suffering individual but also involve experiencing ing because of past actions. This tendency to not 142 C. Fernando and M. Ferrari internalise blame could be because most of their psychological well-being in children who have been caregivers held the same beliefs and may have victims of war. Special care should be taken to help relayed that message to them. The orphanage children engage in these practices and externalise caregivers who did believe that children’s suffer- their suffering so as to allow communities help them ing may be due to karma reported that they did to heal. not share this sentiment with the children, but instead focused on helping them accept their circumstances and create a better life. In this man- References ner, a safe niche was created for the children that promoted resilience. Asma, S. T. (2005). The gods drink whiskey: Stumbling toward enlightenment in the land of the tattered Buddha . New York: HarperOne. Barber, B., & Doty, B. (2013). Handbook of resilience in Conclusion children of war . New York: Springer. Bottrell, D. (2009). Understanding ‘marginal’ perspec- Overall, clinical formulations created from the tives: Towards a social theory of resilience. Qualitative interviews with caregivers and children from the Social Work, 8 , 321–340. Bronfenbrenner, U. (1979). The ecology of human devel- war and nonwar orphanage settings reveal that opment . Cambridge, MA: Harvard University Press. war orphans were typically exposed to more risk Bronfenbrenner, U. (Ed.). (2005). Making human beings than nonwar orphan children. Warring left these human: Biological perspectives on human develop- children fatherless, with the widowed and single ment . Thousand Oaks, CA: Sage. Catani, C., Gewirtz, A. H., Wieling, E., Schauer, E., mother unable to provide adequate resources. Elbert, T., & Neuner, F. (2010). Tsunami, war, and Children subsequently lived in conditions of pov- cumulative risk in the lives of Sri Lankan schoolchil- erty and food insecurity, with no access to school- dren. Child Development, 81 (4), 1176–1191. ing. Despite attempts by mothers to provide for Cauce, A. M., Stewart, A., Rodriquez, M. D., Cochran, B., & Ginzler, J. (2003). Overcoming the odds? Adolescent their children, they were separated from the fami- development in the context of urban poverty. In S. S. lies and placed in the war orphanage. Luthar (Ed.), Resilience and vulnerability: Adaptation Despite exposure to various levels and types of in the context of childhood adversities (pp. 343–363). risk, all but two children appear to be doing well in New York: Cambridge University Press. Chase, R., Doney, A., Sivayogan, S., Ariyaratne, V., areas of academic motivation, peer relationships Satkunanayagam, P., & Swaminathan, A. (1999). and conduct. And most children appear to have Mental health initiatives as peace initiatives in Sri positive relationships with caregivers. The clinical Lankan schoolchildren affected by armed confl ict. formulation also suggests that Buddhism is impor- Medicine, Con fl ict, and Survival, 15 , 379–390. Clausen, J. S. (1991). Adolescent competence and the tant to the orphan children and that they engage in shaping of the life course. The American Journal of faith practices on a regular basis. However, the Sociology, 96 , 805–842. clinical formulations show that a subset of chil- Clausen, J. S. (1993). American lives: Looking back at the dren—those who have unpredictable contact with children of the great depression . New York: Free Press. Cowen, E. L., Hightower, A. D., Pedro-Carroll, J. L., biological parents—are struggling with internalis- Work, W. C., Wyman, P. A., & Haffey, W. G. (1996). ing dif fi culties that show a lack of existential resil- School-based prevention for children at risk: The pri- ience, even if social resilience is observed. mary mental health project . Washington, DC: As seen in this study, resilience is a dynamic pro- American Psychological Association. cess that involves shifting balance of protective and De Zoysa, P., & Wickrama, T. (2011). Mental health and the role of cultural and religious support in the assis- risk factors even within the same social– ecological tance of disabled Veterans in Sri Lanka. Journal of context of the Sri Lankan orphanage. It is important, Military and Veteran’s Health, 19(3). Retrieved from then, to be alert to the internalising diffi culties that http://www.jmvh.org/article.php?article=292 can prevent children from accessing the opportuni- Dockett, K. H., Dudley-Grant, G. R., & Bankart, C. P. (Eds.). (2003). Psychology and Buddhism: From indi- ties provided by these contexts, especially by faith- vidual to global community. New York: Kluwer based self-practices that can help promote Academic. 10 Orphans of War in Sri Lanka 143

Dubow, E. F., Huesmann, L. R., Boxer, P., Landau, S., The resilience framework (Longitudinal research in Dvir, S., Shikaki, K., et al. (2012). Exposure to politi- the social and behavioral sciences: An interdisciplin- cal con ﬂ ict and violence and posttraumatic stress in ary series) (Vol. 3, pp. 179–224). New York: Kluwer Middle East youth: Protective factors. Journal of Academic. doi: 10.1007/0-306-47167-1_9 . Clinical Child and Adolescent Psychology, 41 (4), Lewin, K. (1951). Field theory in social science; selected 402–416. doi: 10.1080/15374416.2012.684274 . theoretical papers. In D. Cartwright (Ed.), New York: Dybdahl, R. (2001). Children and mothers in war: An out- Harper & Row come study of a psychosocial intervention program. Luthar, S. S., & Zelazo, L. B. (2003). Research in resil- Child Development, 72 (4), 1214–1230. ience: An integrative review. In R. J. Haggerty, L. R. Fernando, C. (2000). The effects of war on children: An Sherrod, N. Garmezy, & M. Rutter (Eds.), Stress, risk ecological integration. Unpublished master’s thesis, and resilience in children and adolescents: Processes OISE/University of Toronto mechanisms and intervention . New York: Cambridge Fernando, C. (2006). Children of war in Sri Lanka: University Press. Promoting resilience through faith development . Machel, G. (2001). The impact of war on children: Doctoral dissertation, University of Toronto, Canada. A review of progress since the 1996 United Nations Fernando, C., & Ferrari, M. (2011). Spirituality and resil- report on the impact of armed con ﬂ ict on children . ience in children of war in Sri Lanka. Journal of British Colombia: UBC Press. Spirituality in Mental Health, 13 , 1–26. Main, M., Kaplan, N., & Cassidy, J. (1985). Security in Fischer, K. W., & Bidell, T. R. (2006). Dynamic develop- infancy, childhood and adulthood. In I. Bretherton & E. ment of action, thought, and emotion. In R. M. Lerner Waters (Eds). Growing pains of attachment theory and (Ed.) & W. Damon (Series Ed.), Handbook of child research. Monographs of the Society for Research in psychology: Vol. 1. Theoretical models of human Child Development, 50 (Serial no. 209), pp. 66–106. development . New York: Wiley Masten, A. S. (2007). Resilience in developing systems: Foucault, M. (2005). The Hermeneutics of the subject : Progress and promise as the fourth wave rises. Lectures at the College de France , 1981-1982 (Trans.). Development and Psychopathology, 19 , 921–930. New York: Picador (Original work published 1997). Masten, A. S. (2011). Resilience in children threatened by Fowler, J. W. (1981). Stages of faith: The psychology of extreme adversity: Frameworks for research, practice, human development and the quest for meaning . San and translational synergy. Development and Francisco: Harper & Row. Psychopathology, 23 , 493–506. Friedrich, J. (in press) Vygotsk’y idea of psychological Masten, A. S., Coatsworth, J. D., Neeman, J., Gest, S. D., tools. In Anton Yasnitsky, René van der Veer & Michel Tellegen, A., & Garmezy, N. (1995). The structure and Ferrari (Eds.), Handbook of cultural-historical theory . coherence of competence from childhood through Cambridge, UK: Cambridge University Press. adolescence. Child Development, 66 , 1635–1659. Garbarino, J. (2001). An ecological perspective on the Masten, A. S., Hubbard, J. J., Gest, S. D., Tellegen, A., effects of violence on children. Journal of Community Garmezy, N., & Ramirez, M. (1999). Competence in Psychology, 29 (3), 361–378. the context of adversity: Pathways to resilience and Garbarino, J., Dubrow, N., Kostelny, K., & Pardo, C. maladaptation from childhood to late adolescence. (1992). Children in danger: Coping with the conse- Development and Psychopathology, 11 (1), 143–169. quences of community violence . San Francisco, CA: Masten, A. S., & Narayan, A. J. (2012). Child develop- Jossey-Bass. ment in the context of disaster, war and terrorism: Hammack, P. L. (2011). Narrative and the politics of iden- Pathways of risk and resilience. Annual Review of tity . New York: Oxford University Press. Psychology, 63 , 227–257. Hayes, R. P. (2003). Classical buddhist model of a healthy Masten, A., & Powell, J. L. (2003). A resilience frame- mind. In K. H. Docket, G. R. Dudley-Grant, & C. P. work for research, policy and practice. In R. J. Bankart (Eds.), Psychology and Buddhism: From indi- Haggerty, L. R. Sherrod, N. Garmezy, & M. Rutter vidual to global community. New York: Kluwer (Eds.), Stress, risk and resilience in children and ado- Academic. lescents: Processes, mechanisms and intervention . Jordans, M. J. D., Tol, W. A., Komproe, I. H., & de Jong, New York, NY: Cambridge University Press. J. T. V. M. (2009). Systematic review of evidence and Panter-Brick, C., & Eggerman, M. (2012). Understanding treatment approaches: Psychosocial and mental health culture and resilience: The production of hope. In M. care for children in war. Child and Adolescent Mental Ungar (Ed.), The social ecology of resilience (pp. 369– Health, 14 , 2–14. 386). New York: Springer. Kia-Keating, M., & Ellis, B. H. (2007). Belonging and Peebles, P. (2006). The history of Sri Lanka . Westport, connection to school in resettlement: Young refugees, CT: Greenwood. school belonging, and psychological adjustment. Pynoos, R. S., Steinberg, A. M., & Wraith, R. (1995). A Clinical Child Psychology and Psychiatry, 12 (1), developmental model of childhood traumatic stress. In 29–43. D. Cicchetti & D. J. Cohen (Eds.), Developmental psy- Kumpfer, K. L. (2002). Factors and processes contributing chopathology (Risk, disorder, and adaptation, Vol. 2, to resilience. In M. D. Glantz & J. L. Johnson (Eds.), pp. 72–95). Oxford: Wiley. 144 C. Fernando and M. Ferrari

Qouta, S., Punamaki, R.-L., Montgomery, E., & El Sarraj, Ungar, M. (2011). The social ecology of resilience: E. (2007). Predictors of psychological distress and Addressing contextual and cultural ambiguity of a positive resources among Palestinian adolescents: nascent construct. The American Journal of Trauma, child, and mothering characteristics. Child Orthopsychiatry, 81 , 1–17. Abuse and Neglect, 31 (7), 699–717. Ungar, M. (2012). Social ecologies and their contribution Quinton, D., & Rutter, M. (1988). Parenting breakdown: to resilience. In M. Ungar (Ed.), The social ecology of The making and breaking of intergenerational links . resilience: A handbook of theory and practice (pp. Aldershot: Avebury. 13–31). New York: Stringer. Reddy, L. R. (2003). Sri Lanka: Past and present . New Vygotsky, L. (1986). Thought and language (A. Kozulin, Delhi: APH. Trans.). Cambridge, MA: The MIT Press. (Original Rutter, M. (2006). Implications of resilience concepts for work published 1934) scienti ﬁ c understanding. Annals of the New York Werner, E. (2000). Protective factors and individual Academy of Sciences, 1094 , 1–12. resilience. In J. P. Shonkoff & S. J. Meisels (Eds.), Rutter, M., & Quinton, D. (1977). Psychiatric disorder- Handbook of early intervention (2nd ed., pp. 115– ecological factors and concepts in causation. In H. 132). New York, NY: Cambridge University Press. McGurk (Ed.), Ecological factors in human develop- Werner, E. E., & Smith, R. S. (2001). Journeys from ment . Amsterdam: North Holland. childhood to midlife: Risk, resiliency, and recovery . Sameroff, A., Siefer, R., Baracos, R., Zax, M., & Ithaca, NY: Cornell University Press. Greenpsan, S. (1987). Intelligence quotient scores of 4 Wolmer, L., Hamiel, D., & Laor, N. (2011). Preventing year old children: Social-emotional risk factors. children’s posttraumatic stress after disaster with Pediatrics, 79 , 343–350. teacher-based intervention: A Controlled Study. Spilka, B., Hood, R., Hunsberger, B., & Gorsuch, R. Journal of the American Academy of Child and (2003). The psychology of religion: An empirical Adolescent Psychiatry, 50 (4), 340–348. approach (Vol. 3). New York: Guilford. Wyman, P. A. (2003). Emerging perspectives on context Sroufe, A., Egeland, B., Carlson, E., & Collins, A. (2005). speci ﬁ city of children’s adaptation and resilience: The development of the person: The Minnesota study Evidence from a decade of research with urban children of risk and adaptation from birth to adulthood . New in adversity. In S. S. Luthar (Ed.), Resilience and vulner- York, NY: Guilford. ability: Adaptation in the context of childhood adversities Tol, W. A., Jordans, M. J. D., Kohrt, B. A., Betancourt, T. (pp. 293–317). New York: Cambridge University Press. S., & Komproe, I. H. (2013). Handbook of resilience Wyman, P. A., Cowen, E. L., Work, W. C., Hoyt-Meyers, in children of war . New York: Springer. L., Magnus, K. B., & Fagen, D. B. (1999). Caregiving Trainor, K. (1997). Relics, rituals and representation in and developmental factors differentiating young at- Buddhism: Rematerializing the Sri Lankan Theravada risk urban children showing resilient versus stress- tradition . Cambridge, UK: Cambridge University affected outcomes: A replication and extension. Child Press. Development, 70 , 645–659. P a r t I V Resilience Among Refugees Relational Resilience 1 1

Colette Daiute

In this chapter, I therefore, argue that since human Overview development is a mutual process of individuals and societies, resilience in displacement is a In this global era, considering the developmental social phenomenon. effects of displacement is a priority for research To build that argument, I review scholarly and practice. Much research on risk and resil- defi nitions of resilience among young people dis- ience among young people displaced by war and placed by war and other forms of political vio- other forms of violence has focused on individual lence1 and offer an analysis of the nature of traits and capacities leading to vulnerability or separations displaced peoples endure and the resilience. Nevertheless, research and practice attendant losses and gains associated with resil- have increasingly indicated that most children ience. I conclude by explaining that research and youth deal with displacement in quite norma- from diverse theoretical perspectives behooves us tive ways, as they would in other developmental to understand and examine resilience as a rela- contexts (Daiute, 2010 ; Fernando & Ferrari, tional process. The chapter focuses on a variety 2011 ) . Beyond physical and psychological nur- of social relations identifi ed in research, indicat- turance, the social and political integration of ing that children’s cognitive and emotional young people into the contexts where they live is responses emerge in language and other means of also basic to their development. Food and shelter interaction with family, community, and nation as are, of course, essential to provide in emergen- they make sense of the world around them and cies, but human development cannot occur in the how they fi t. I illustrate this process with exam- absence of social interaction. After all, displace- ples from my research with young people grow- ment is a political phenomenon (Dawes, 2008 ) , ing up during and after the wars of the 1990s in so the consequences do not occur primarily the former Yugoslavia (Daiute, 2010 ) , and dis- within individuals, but within purposeful activi- cuss how the study design and analysis advance ties in actual contexts. Because people’s goals theory, research, and practice during and after and strategies develop interactively, the sociopo- con fl ict-related displacement. litical life of communities that host refugees must include young people seeking asylum, if 1 In this chapter, “political violence” refers to war, armed- those communities are going to develop as well. confl icts involving insurgency groups, paramilitaries, politically motivated violent acts like forced displacements, recruitment into armed confl ict, ethnic cleansing, racist C. Daiute (*) rapes, deportations, consequences of violence like assisted The Graduate Center, City University of New York , and spontaneous fl eeing during acute phases of violence, New York , NY , USA migration when violence has led to long-term poverty or e-mail: [email protected] chaos, return migration when situations allow, etc.

C. Fernando and M. Ferrari (eds.), Handbook of Resilience in Children of War, 147 DOI 10.1007/978-1-4614-6375-7_11, © Springer Science+Business Media New York 2013 148 C. Daiute

in pathological ways, so some researchers De fi ning “Resilience” “… address the growing evidence for the human capacity to thrive even after the most diffi cult of Resilience has been defi ned as “good outcomes in experiences [and] enumerate individual differ- spite of serious threats to adaptation or develop- ences and contextual factors associated with ment” (Masten, 2001 , p. 228). More speci fi cally, a resilient outcome” (Mancini & Bonanno, 2009 ). good outcomes are “desirable social outcomes Distinguishing resilience from recovery, Bonanno and emotional adjustment, despite exposure to has, moreover, explained that “resilience is more considerable risk” ( Betancourt & Khan 2008 , common than often believed and that there are p. 317; Luthar, 1993; Rutter, 1985 ). Most research multiple and sometimes unexpected pathways to identi fi es resilience as a characteristic of the indi- resilience” (2004, p. 20). While “recovery vidual, with phrases such as “resilient child” connotes a trajectory in which normal functioning (Betancourt & Khan 2008 ; Cortes & Buchanan, temporarily gives way to … psychopathology 2007 ; Fergusson & Horwood, 2003 ; Masten & (e.g., symptoms of depression or posttraumatic Powell, 2003 ), “invulnerable child” (Anas, Regan, stress disorder [PTSD])… resilience re fl ects & Barrett, 2007), or “resilient personality type” the ability to maintain a stable equilibrium” (Masten et al., 1999 ) . Research focused on resil- and “more than the simple absence of psychopa- ience as an individual phenomenon tends to thology” (p. 20). assume that the major effect of serious threats to Although scale-based measures most typically well-being is psychopathology, measured with ask research participants to indicate which listed assessments of posttraumatic stress, depression, items they have experienced, scholars have also aggression, and other sorts of problems. used naturalistic discourse like clinical interviews Interest in trauma and, in particular, PTSD (Weine, 2004 ) and narratives (Cortes & Buchanan, (posttraumatic stress disorder) as a response to 2007; Fernando & Ferrari, 2011 ) to distinguish extreme events fl ourished after it was included as pathological from healthy mental pro fi les. a disorder in the DSM 2 -III in 1980. Research A study in Colombia, for example, involved ana- de fi ning resilience as an individual phenomenon lyzing narratives by six Colombian child soldiers identi fi es personal traits and/or pro fi les via who did not exhibit trauma-related symptoms assessments using measures of psychopathology after experiencing armed combat to understand with children affected by armed confl ict and other how these “resilient children” managed the catastrophes. Such measures of psychopathology effects of war (Buchanan et al., this volume; include the ASEBA (Child Behavior Checklist Cortes & Buchanan, 2007 ) . The researchers and Youth Self-Report), State-Trait Anxiety identifi ed four themes that indicated “a wide rep- Inventory, and Vineland Adaptive Behavior ertoire of strengths and resources that seemed to Scales and the Beck Depression Inventory. War- facilitate the ability of these youths to overcome related trauma outcomes identifi ed in research the trauma of war (1) a sense of agency, (2) social using such measures include sleep disruptions by intelligence, empathy, and affect regulation, (3) nightmares of violent experiences and daytime shared experience, caregiving features, and com- disruptions by intrusive thoughts about inhuman munity connection, and (4) a sense of future” (p. cruelty (Bonanno, 2004 ; Weine, 2004 ). Other 319). Originally designed to identify these indi- outcomes include aggressive, withdrawn, and viduals’ resilient traits, the study also revealed depressed orientations to one’s life and to others. numerous social processes such as shared experi- Results show, however, that many young ences, care giving, and community connection. people exposed to extreme risks do not respond Consistent with such fi ndings, researchers from an increasing range of disciplines including anthropology, children’s studies, and develop- 2 DSM stands for ‘Diagnostic and Statistical Manual of mental psychology have broadened their methods Mental Disorders’ to include ethnography, observational studies, 11 Relational Resilience 149 narrative inquiry, and clinical interviews to emotional, and social resources to interact with consider social as well as individual dimensions the range of material and symbolic systems rele- of resilience. Prominent social sources of resil- vant across locations where they have lived ience include the family, the social group, and the (Alinejad, 2011 ; Daiute, 2010 ) . A study with 137 political structure. One study reports, “There are young people who experienced displacement in … a myriad of child , family and society related the 1990s wars across the former Yugoslavia factors and psycho-socio-physiological processes revealed, for example, that these youths focused that protect child development and mental health. selectively on challenges and opportunities of They include, e.g., loving and wisely guiding their everyday present situations in the aftermath parenting, children ’ s fl exible and high cognitive of war, and the participants’ present subjective capacity, fl exible and multiple coping strategies orientations drew selectively on the past and pos- and narrative and symbolic nocturnal dreaming, sible future (Daiute). That study involving par- as well as social support and good peer relations. ticipants in an intervention to write youth history Different models explain psychological distress for newsletters in community centers across the and positive resources, including child resilience. region offered consistent results indicating the Exposure to trauma is crucial in predicting dis- interaction of participants’ expressive activities tress, while familial and developmental issues are and the kind of information they shared. For important in building resilience” (Punamaki example, the young people used certain genres, et al., 2011 ) . such as autobiographical narratives, to focus on Since biological families are not always intact present circumstances and other genres, such as during displacements, a familiar social group can fi ctional narratives, to focus on past experiences. also serve basic integrative functions: “recovery In addition, while the narrative genres were from trauma depends, for example, on both indi- highly re fl ective, letters these young people wrote vidual and group strengths and is highly to public of fi cials were relatively directive toward in fl uenced by supportive elements in the wider how they believed society should be organized to environment” (Boyden & Mann, 2005 , p. 6). help them in their plight. Acknowledging the importance of giving as well That resilience is a social process also becomes as receiving social support, researchers observe evident when displaced youth deal in nuanced that resilience involves not only adults’ support ways with the multiple and sometimes contradic- of children but also children’s intentions and tory sociopolitical situations they encounter. The action to support others: “… children are capable following narrative by Krusko, 3 a 19-year-old of acting upon their circumstances and in fl uencing refugee of the 1990s wars in the former Yugoslavia the direction of their own lives and those of oth- to the United States, foregrounds a present ers” ( Hart, 2008a, 2008b , p. 1). Such social dilemma of having chosen opportunity with defi nitions of resilience also imply a “critique of residual feelings of being “torn,” feeling “guilty,” assumptions about victimhood that had previ- and “regrets” for having chosen “too good an ously underwritten many studies and the majority opportunity to miss.” of organizational interventions” (Hart, p. 1), which has led to the fact that “‘resilience’ is My mom and uncle had a con fl ict. My mom was inviting my uncle to move to America but he was steadily replacing ‘trauma’ as the focus of psy- torn because he had to leave his elderly parents. He chologically oriented enquiry” (Hart, p. 1). ended up moving anyway but with much dif fi culty. When researchers notice that resilience is a My uncle felt that he was abandoning his parents social process, the complex nature of displace- and my mom felt guilty for being pushy, but she thought it was too good of an opportunity to miss. ment comes into view. Displacement is not, for He moved here but he still regrets leaving his fam- example, a one-way journey, nor the conse- ily, we all do. quences of displacement necessarily consistent with a medical trajectory from disease/injury to recovery. Instead, individuals enact cognitive, 3 Participant names are pseudonyms chosen by them. 150 C. Daiute

When asked to comment on a con fl ict among of the aggressors, although clearly problematic in people of diverse backgrounds in the United some ways, could, in the context of seemingly States, this same youth focused on past experi- inconsistent arguments to get along with every- ences with “Serbian people” that render her one, provide an important foundation for solidar- unable to do what she knows would provide the ity with a known community, as one attempts to “best” and “most ef fi cient” outcomes. make transitions to less familiar social communi- Not all groups can get together and provide the ties. Displaced children and youth deal as best best outcomes. Working together results in [the] they can with psychosocial challenges wrought of most ef fi cient outcome, however, for instance, I con fl icting realities, such as between violence cannot work with any Serbian people because of done to their people, their positions as potential our past experience. discriminators of others in culturally heteroge- While this young woman’s cousins who neous environments, their positions as discrimi- remained in Sarajevo sound more like teens nated against in their new homes, and expectations focused on peer relations as described in prior that newcomers will get along with each other as developmental research (Erikson, 1980 ), children well as with mainstream youth. In the U.S. for and adolescents, like Krusko, who escaped at example, Bosnians and Serbs are immigrants fac- least some of the violence of war readily elicit ing common discrimination, as indicated in the sociopolitical relations interacting with speci fi c narrative by a Bosnian immigrant “American kids problematic situations in their experience and would always pick on” foreigners “telling that we opportunities for the future, even if seemingly get everything for free from government, we slight to others. While confl icts with peers or par- don’t pay taxes” and other threats rather than ene- ents have been reported as universal adolescent mies. Young people’s integration of such dilem- concerns, research methods grounded in situated mas is, thus, resilient as it addresses multiple and activity, like the study described above, indicate a diverse realities, including past confl icts and cur- more realistic selective focus on threats and rent opportunities. opportunities, which may or may not involve par- This brief summary of research indicating the ents and peers. Seemingly working hard to make interaction of expressive mode, the context of sense of having been (at least) twice a victim, problematic experiences (war, displacement, Krusko, like others in our study, is torn between etc.), and the context of expression (such as nar- “our past experience” with Serbian people and rations for different audiences) indicate young the present, wherein she realizes that—as one of people’s abilities to deal with the complexity of many minorities in the U.S.—people must displacement as a social phenomenon (Daiute, get along. Consistent with such identi fi cation of 2010) . It may be resilient to recount an experi- problems and the social nature of those problems ence as traumatic in one situation, while not in is the social nature of any supportive processes another, and it is worth considering such varia- for such displaced youth. tion in our ongoing research on development and Further analysis of the refl ections of displaced well-being in the aftermath of war. Having children and youth indicates, moreover, that rea- identifi ed the need to account for social dimen- sons for holding on to the past may be as resilient sions of resilience, we turn now to the separations as they are problematic. For example, when young caused by displacement and relatively unexam- people express guilt for leaving their home coun- ined social supports therein. try during war, even though they did not make the choice to do so, they may be reserving an option to return, thus minimizing their sense of loss. Separations Seemingly contradictory remarks like Krusko’s above, and many others, could function as narra- Political violence causes different kinds of sep- tives to explain frightening events (Smorti et al., arations. Many children born in the midst of 2011 ) . In other words, holding on to resentment war and its consequences have never known a 11 Relational Resilience 151 peaceful family life, harmonious extended com- nature of displacement, “UNHCR’s [United munity, or supportive social institutions. For Nations High Commissioner for Refugees] most children who have known such relationships recent annual report shows that the number of even for a short time, political violence chal- forcibly displaced people has risen, while those lenges their development by separating them going home voluntarily fell last year” ( www. from rights as well as relationships available at unhcr.org , 2010 ) . Most of the displaced are, home. Such separations deny many young peo- moreover, under age 18. Even when young people offi cial affi liations such as citizenship and ple fi nd asylum in relatively stable countries, the attendant rights to education, healthcare, where they may have access to employment, and peer groups (Hart, 2008a, 2008b ). Although schools, or other institutions, the path to citizen- differing in nature and effect, each social-rela- ship in rich countries has become increasingly tional sphere of activity plays a different impor- dif fi cult. tant role in children’s resilience. The number of people forcibly displaced During the 4-year siege of Sarajevo, for worldwide has risen to 43.3 million at the time of example, thousands of people—mostly women this report, the highest since the mid-1990s, and children—fl ed in convoys, fi rst to other parts exacerbated by the record low numbers of of Europe and then to the United States and else- repatriations over the past 20 years ( www.unhcr. where. Fleeing from bombing attacks differs org , 2010) . For statistical purposes, the various from forcible displacements by gun-wielding status conditions of these displaced persons are intruders or rapists, as experienced in villages refugee, asylum seeking, return refugee, inter- across the former Yugoslavia, Rwanda, and else- nally displaced , and stateless people ( www.unhcr. where, in a process described as “ethnic cleans- org). To illustrate the diffi culty facing refugees ing” (Silber & Little, 1995). Millions of children even in the best circumstances, research indicates in over thirty countries worldwide have had to the protracted lack of formal resolution of dis- fl ee their homes because of such political vio- placed people’s status in the country, which in lence just in the past two decades. Although many cases is stalled over many years. The some families have relatives to stay with on safer UNHCR statistics con fi rm, for example, low ground, most people affected by such violence rates of recognition of refugee status, in fi ve of are poor, without means to pay for transportation the six countries reporting the largest number of or visa fees, even if they have relatives in safe applications for asylum in 2009: South Africa havens, so they wind up in shelters or refugee (222,324), the United States (43,530), France camps, sometimes for extended periods of time. (42,118), Malaysia (40,063), Canada (33,970), Children orphaned by these attacks may be and Germany (27,649). The respective recogni- moved en masse, left to fend for themselves and tion rates for refugee status for these hundreds of for siblings, kidnapped, or recruited to serve thousands of individuals (a majority who are with the aggressors who caused their many below the age of 18) are very low: In descending dif fi culties. Often because political violence order of these “positive” acknowledgements of extends over long periods of time, instability refugee status are Malaysia (97.3 %), Canada leads to multiple waves of refugees, which even- (53.2 %), the United States (43.7 %), Germany tually appear to be voluntary, even though their (36.5 %), France (11.1 %), and South Africa migration is due, at least in part, to political or (9 %). Displacement can defi ne entire childhoods, economic instability. as evidenced also in policies like the D.R.E.A.M Given the relatively recent acknowledgement Act proposed by the United States Congress in that the time-space arc of political violence 2001, still not passed at the time of this writing. extends beyond acute violent events (Collier, This Act to ease the path to citizenship for young 2003 ; Daiute, 2010 ; www.unhcr.org , 2010 ; 2011 ) , adults who had been brought to the U.S. illegally any analysis of separation must be increasingly as young children, living here their entire lives, nuanced. Highlighting the widespread and durable and completing college has been stalled, along 152 C. Daiute with the possibility for these youths to compete When children are displaced, they lose the for legal jobs and thus create what for some may bene fi t of diverse kinds of relationships—most be the only social support they will have—creat- poignantly with family and friends—but also ing their own families. powerfully with multiple communities, including Detailed explanations of these circumstances the mainstream society and interest groups, are beyond the scope of the present discussion, beyond. In many cases, multinational and state but an extended refugee or illegal status means institutions fail to ensure children’s rights prom- that displaced young people’s fates are suspended ised in treaties like the Convention on the Rights in global and local politics. In summary, among of the Child and constitutions. Political violence myriad separations from family, community, and robs children of the nurturance of shelter and institutions experienced by displaced youth is the food and, equally important, of family and others separation from certainty, the lack of a pathway who offer emotional sustenance of love, under- to the future, which depends on a sense of what a standing, familiar practices, shared goals, and good life can be, realistic opportunities, and language. Political negligence, such as the failure means of achieving opportunities in the local sit- to pass legislation like the D.R.E.A.M Act, leaves uation. Even when refugees’ new “homes” young people in limbo subjecting them to further provide pathways to citizenship, there may be abuse. Since situations where violence has the ongoing discrimination or resentment, which can most devastating effects often already include take many years to overcome both objectively experiencing poverty, instability, and prior his- and subjectively (Suárez-Orozco et al., 2004 ) . In tory of violence, family contexts may already the next section, we consider psychosocial effects have been disrupted. These separations limit of such exclusions. secure relationships of various kinds which allow children to express themselves freely, critically, and creatively with little fear of retribution, while Losses increasingly abandoning them to unfamiliar situations reducing open deliberation and debate, The news was that the government didn’t allow immigrants into the U.S. any more. also necessary for development. Everyone involved would be angry and sad because Complicating the sense of isolation, whether they might have been waiting for other family actual or imagined, is an often-frustrated longing members (Jenny, 14, refugee to the U.S.). for the people and environment of the homeland. Across diverse separations, children suffer in In order to learn about the nature of resilience, specifi c ways. Personal losses vary in relation to researchers have broadened their methods to the nature and severity of their separations from include information about contexts, social rela- homeland, family, familiar cultural and linguistic tions, and children’s personal experiences. relations, and the attendant interactions with Ethnographic research (Boyden & Mann, 2005 ) , loved ones, neighbors, and familiar institutions. interview studies ( Barber, 2008 ; Weine, 2004 ), Separations may be benefi cial in the short term if and practice-based research (Daiute, 2010 ) exam- they remove children from bombings, shootings, ining the interactions of individuals in society explosions, rapes, and attendant harms, but offer information about social relations and resil- research indicates that refugees, kidnapped and ience. Such studies have offered fi ndings about traffi cked youth, and in some cases those who children’s understandings of their experiences— migrate during or after acute phases of con fl ict, from the perspectives of diverse others as well as suffer from isolation or exclusion. In addition to from their own personal experiences. Discursive psychological problems are feelings of isolation analyses of how young people express themselves due to sociopolitical problems like discrimina- offer information about context and relationships tion, alienation from mainstream values, activi- embedded in specifi c activities. That young peo- ties, and in fl uence. ple growing up during and after political violence 11 Relational Resilience 153 narrate personal experiences consistent with fear of known and unknown dangers beyond. local norms and, in contrast, narrate fi ctional Some scholars have explained that societal exclu- stories counter to those norms suggests the sions result in a loss of identity or falsely imposed context-sensitive nature of expression and, identity as indicated in the opening narrative moreover, the importance of future inquiry that “American kids tell us we get everything free merges form and content. Such fi ndings lead to from government,” and echoed in reports of being development of new theories to generate research told, “you’re a refugee” (Mann, 2008 , p. 44), questions and methods about the lives of dis- resulting in a feeling of being in “hiding” (Mann, placed young people. p. 44) or a “wandering soul” (Suárez-Orozco When open to responses other than automatic et al., 2004 ) . traumatic emotional reactions, we learn about a Those fi ndings are consistent with an analysis range of consequences, including children’s sense of the central metaphors of narrative plots by of loss of mutual understanding, responsibility Bosnian youth refugees and immigrants to the (Hart, 2008a, 2008b) , yearning for safe spaces to United States, which overwhelmingly focus on play (Hyder, 2005) , learn, and contribute to soci- issues in the family and peer group at home, ety (Daiute, 2010 ) . Such losses are mentioned Bosnian institutions, or reported communications more than loss of food and shelter. Interestingly, with Bosnians “back home.” An analysis of the above story by a 14-year-old girl whose fam- “icons”—plot-central symbolic objects—in ily fl ed Bosnia when she was a toddler implicates narratives by young Bosnians in the U.S. and exclusionary U.S. politics, “The news was that peers in Sarajevo indicated, for example, a pref- the government didn’t allow immigrants into the erence for intimate settings and characters by the U.S. any more,” the emotional life and goals of U.S. group compared to the public settings of everyone involved who would be “angry and sad narratives by the Bosnian domicile group. While because they might have been waiting for other the U.S. group wrote narratives about con fl icts in family members.” What is also interesting is that the family and among close friends, their peers in Jenny offers this fi ctional story before it actually Bosnia and Herzegovina wrote narratives about happened, indicating its presence in the discourse confl icts in public squares and on public trans- context, such as by her parents, and a dread of portation (Daiute & Lucic, 2010 ) . Given the psy- possible effects of such politics. Jenny and others chosocial function of narrating, such a difference may fear an ongoing discrimination if she remains in imagery indicates a signifi cant life focus, per- in the U.S., extended separation from family and haps as a safe space for symbolic exploration. friends who remained in Bosnia, or some related Although offering but a sketch of the precari- possibility. ous nature of refugee lives in new homelands, Children also bemoan the loss of stable insti- these examples from qualitative studies of dis- tutions, not in those words, but in their under- placed youth indicate the stalled nature of refu- standing that there is no employment for their gees’ comfort. Formal distinctions among parents, older siblings, and eventually for them- “recognition” as a refugee compared to “pend- selves. In some situations, children understand ing” or “rejected” applications for “asylum” sta- that the most stable means of survival and devel- tus suggest the extended nature of exclusion. opment may be the institutions of violence, such A displaced child or teen may thus spend decades as in child soldiering (Daiute & Botero, 2012 ; Sta of formative life stalled in a limbo status even Maria, 2006 ). Another major effect of the loss of when recognized as a refugee, before patriation is family is premature responsibility. Orphaned even considered. That stories of wandering souls children must care for siblings, a remaining par- become increasingly pronounced in generations ent, or even distant relatives (Mann, 2008 ). Social over time is a quite poignant result of research on exclusion also limits mobility (Mann, 2008 ) , as successive generations of immigrants (Suárez- many report not leaving their neighborhoods for Orozco & Quin-Hillard, 2006 ) . 154 C. Daiute

It was also in the 1st month of my arrival. I went to Gains translate for my uncle, he had appointments in hospital he got so offended that he started shouting at her. They ended up calling cops, but we left and A major microprocessing company intended to they just rescheduled his appointment. I want to build a multi-billion dollar facility in this area cre- have decent life. I’m not girl who dreams about ating hundreds of high-paying jobs. Arguments money. between local businesses and townships/cities persuaded the company to start its operation in a different part of the state (20, male Bosnian refugee to In summary, when open to consider the nature the U.S.). of violent contexts and young people’s under- As expressed in this narrative by a 20-year-old standings of those contexts, we learn that young male who left Bosnia during the 1990s war, people can continue to use and to develop physi- another orientation of forcibly and voluntarily cal, cognitive, social, and emotional abilities, displaced youth is their recognition of possibility refl ecting in complex ways on their situations. in their new lands (Daiute, 2010 ) . These youths Children observe what is going on around them, offer imagery about moving beyond dif fi culties, interact with others about events and people, and like the “local businesses and townships/cities monitor their own responses. Such sociocog- persuaded the company to start its operation in a nitve processes may, moreover, come into play different part of the state.” Such future orientation in order to satisfy needs for food and shelter, by displaced youth can interact with the nostalgia suggesting that needs are a system rather than a and dread expressed by Krusko and Jenny, but the hierarchy with biological needs taking prece- absence of such an orientation is notable among dence over all others (Maslow, 1943) . Research Bosnian youth and others who remained in war- methods must be increasingly open to consider torn areas without economic prospects. Consistent the complex nature of children’s responses with such observations elsewhere, researchers within contemporary geopolitical processes. have begun to identify some positive responses, Today, for example, children displaced by the in particular when they acknowledge resilience. war in Sri Lanka may be as likely to travel on No one advocates violence as a context for foot, convoy, or airplane for rescue to very dif- growing up, but environments that force respon- ferent situations, which could change again sibility, hypervigilance to dangers, and the need within the year. We need theories and methods to adapt to unfamiliar people and circumstances appropriate for comparing the resilience pro- also have effects that children speak about or cesses of those children, because effects are researchers interpret as positive. Such positive de fi ned within global systems that are neither effects expressed by displaced or kidnapped one directional in location nor cause. youth include gaining skills from serving as med- ics in the fi eld of battle (Sta Maria, 2006), joining causes to demand that local revenue from oil Explaining Resilience deposits in Nigeria be returned to local people (Akinwumi, 2006 ), and gaining a sense of mas- The prior review of separations, losses, and gains tery from premature responsibility as parents as experienced by displaced children and youth often occurs with young orphans who raise emerges across studies from a range of theoreti- younger siblings in refugee camps (Mann, 2008 ) . cal perspectives. Some scholars explaining resil- A sense of compassion rarely reported in research ience beyond individual traits have suggested that on adolescence emerges from conversations with it is more normal than special and, in that sense, young people burdened with major responsibili- an adaptive process. “Resilience appears to be a ties. Although interwoven with frustrations, such common phenomenon that results in most cases refl ections also seem to lead to clarifi cation of from the operation of basic human adaptation goals, as in this narrative by 19-year-old Melissa, systems. If those systems are protected and in a Bosnian displaced to the United States. good working order, development is robust even 11 Relational Resilience 155 in the face of severe adversity” (Masten, 2001 , socializes the next to its ways applies less than in p. 227). Building on analyses suggesting that situations of cultural stability. Instead, children resilience may be a norm, we can consider the develop in society via their uses of language and nature of those adaptive processes, in particular, thought to deal with and improve their environ- elucidating the social nature of the process. We ments. This mutual interaction of individual and ask, “How does this adaptation occur?” society requires an examination of young peo- One scholar referred to diverse approaches to ple’s activities and meanings not only in terms of studying the effects of confl ict on child develop- causes and effects but as mutual mediations of ment as pre- and post-Machal, referring to the historical and geographic systems de fi ning every- seminal 1996 United Nations commissioned day lives. report that drew attention to the plights of children growing up in the web of political violence and its consequences (Hart, 2008a, 2008b ) . The Meaning in Activity Systems 1996 report highlighted the exploitation of children’s vulnerability, specifi cally when recruited A fi rst step toward this developmental approach as child soldiers. When considered in relation to is to zoom back from the fi gure of the individual the Convention on the Rights of the Child ( 1989 ), child defi ned in terms of self-contained capaci- interventions by nongovernmental organizations, ties that fl ourish or fail and to examine the and the increasing range of scholarly disciplines broader system of relations among individuals, interested in children’s role in geopolitical phe- groups, and institutions. If political violence is nomena, researchers began to focus on children’s not the activity of isolated individuals, then lives and their rights. When acknowledging these research on resilience should focus on relations rights as “living rights,” a concept to disclose among individuals and manifestations of vio- how children seize rights “as they actively engage lence. Extending the original ideas of cultural- with issues that confront them and establish the historical theory (Vygotsky, 1964 ) , scholars conditions for developing a common ground for working in that tradition have proposed that action” (Hanson & Nieuwenjuys, 2013 ), research- activity systems are contexts for meaning and ers can broaden theoretical perspectives beyond change: “Activity theory is an integrated those that focus on effects within the individual approach to the human sciences that … takes the alone. object-oriented, artifact mediated collective From a cultural-historical perspective, social activity system as the unit of analysis, thus bridg- interactions are foundational and catalytic in ing the gulf between the individual subject and human development. When defi ning develop- the societal structure” (Engestrom et al., 1999 ). ment in terms of the uniquely human capacities This means that studying individuals—their of meaning making—language and thought lives, their understandings of their lives, and the (Vygotsky, 1964 ) —we understand that children connection of individual lives to one another— need to participate with others to create goals and involves examining activities in social relations strategies for dealing with their circumstances, as in real time where meaning is created. These well as responding emotionally to challenges. As interdependent meanings are embodied in the children interact with their environmental cir- symbol systems people invent and use to orga- cumstances, they perceive and act on events and nize life. Just as human civilization has pro- relationships in specifi c times and places. In situ- gressed from using writing to count livestock to ations of war and other dramatically changing using writing for persuasive, aesthetic, and other circumstances like new neighborhoods, homes, purposes, young people master symbol systems families, and places where people speak unfamil- to make sense of their environments and their iar languages where people fi nd newcomers roles in those environments, especially when strange, the assumption that each generation those environments are unfamiliar. 156 C. Daiute

Phase in a Political-Violence System Time-Years Locations Key Events-Agreed-upon Displacements of child/youth cohorts to >>>

Period Before First Clear Violence

Period when Tensions Build

Violence in Region

Provocations of Violence

Acute Period of Violence

Major Violent Events

Displacements from - to

Aftermath conditions – Political,

economic, social prospects for youth

Subsequent displacements/migrations .

Economic Instability, Unemployment

Fig. 11.1 Dimensions of an activity-meaning system to sample for understanding effects of displacement of war- affected youth

An example of an activity-meaning system for other consequences of interest). This framework research on the effects of violence is a political is created from historical review of events lead- violence system (Daiute, 2010 ) . The former ing up to displacement of a speci fi c group, and Yugoslavia is an example of a developmental the subsequent spatial and temporal trajectories system because the generation was born in the of the group. Data for such a framework include country of Yugoslavia, experienced wars that historical, archival, and ethnographic documents broke it apart, and now live across numerous as a basis for the design of an empirical study of countries, with some oriented toward Western meaningful activities, most importantly, to elicit Europe, others eastward toward Mecca, and still young people’s perspectives. The geopolitical others positioned between old alliances to Russia system in my prior study was the former and the European Union (EU). Young people Yugoslavia, from creation in 1948 through 2007 who began life in Yugoslavia were raised by par- when I collected data from the generation of ents educated and employed in that socialist sys- young people who had grown up during and after tem, then passed childhood during a war, and are the war (Daiute, 2010 ) . now approaching adulthood in countries transi- As shown in Fig. 11.1 , a model includes the tioning to capitalist democracies in very different time, space, and activity dimensions relevant to ways. The tensions that matter to young people displacement of this generation of youth. The across these situations are far from obvious. relevant time periods of key political events A developmental researcher can create a (leading up to and away from acute periods of framework of the political violence system rele- violence) anchor the chart on the left, the locations vant to the circumstances of displacement (and of those events is included in the next column, 11 Relational Resilience 157 with institutions, stake holders, and speci fi c data of similarities and differences in the youth-envi- collection events in the subsequent columns. In ronment relation. For this reason, young people this way, we understand that a complex of factors sharing ethnic and religious traditions—like the leads to a complex of events leading to Bosnian youth growing up during the Balkan displacement. Relevant to that, for example, are wars—may narrate con fl icts in terms of concerns various waves of displacement of children who and strategies. Drawing on theory that young peo- began their lives during times of peace, con fl ict, ple use narrative activities to make sense of their or the aftermath and fl ed between different experience in specifi c time-space contexts, we locations at different times. For example, as invited youth growing up in the 1990s wars to share indicated with illustrations in this chapter, a group their experiences of confl ict, as one piece of the of Bosnian families fl ed their homeland during broader social history of the former Yugoslavia. the siege of Sarajevo, while others with similar Activities in a workshop “to create a social ethnic, religious, and socioeconomic backgrounds history of the former Yugoslavia from youth remained. Narratives and other discursive perspectives and to share these perspectives activities by both groups have offered important across contexts” included a range of narratives insights about experiences of displacement. of con fl ict. Sixty-four youths between the ages Having de fi ned such an activity-meaning system, of 13 and 24, 38 in Bosnia and Herzegovina and a researcher can determine how to sample groups 26 in the U.S., wrote narratives of con fl ict from with different displacement histories, as we did three perspectives designed to engage diverse when working with young Bosnians who had social-relational stances (among other activi- been displaced by the war and those who remained ties in a 5- to 6-hour workshop). These narra- in Bosnia (Daiute & Lucic, 2010 ) . Designing a tive activities varied in terms of suggested focal political violence system requires historical and characters (peers, adults, hypothetical persons cultural knowledge of a myriad of relevant actors in the community) evocative of different his- and events, and such a design offers a realistic torical periods (past, present, future) and imply- and necessary backdrop for studying human ing different narrator—audience relations (more development in contemporary globalization, and less explicit exposure of the young narrator where movements of information, people, and as a character in the narrative). Invitations for resources are the norm rather than aberrations. these diverse narratives conformed to the same From the perspective of the individual, development general framework, with variations for focal interacts within the range of dimensions in characters (peer, adults, or community): Write Fig. 11.1 , which future research can re fi ne. We about a time when adults you know (or the refer to this process of meaning making in context “ community ”) had a confl ict or disagreement . as mediation. What happened ? Who was involved ? Where Mediation is a process of interaction between was it ? How did those involved think and feel young people and the circumstances where they about the con fl ict ? How did they (you ) handle live to create and share meaning via symbolic it ? How did it all turn out ? tools: “a means by which human external activity To examine how Bosnian youth living in is aimed at mastering, and triumphing over, Bosnia and Herzegovina (BiH) and in the U.S. nature” and the resulting “signs” or knowledge perceived and interpreted confl ict, a two-phase that is “a means of internal activity aimed at mas- analysis drew also on previous cultural-historical, tering oneself” (Vygotsky, 1978, p. 55). This sociolinguistic research, and literary theory about developmental process posits that young people speci fi c features of narrative discourse that indi- are especially attuned to their environments—the cate the narrator’s purpose. To illustrate the challenges and opportunities. bene fi t of sampling across displaced and non- To explore such processes of development in displaced groups in a political violence system, context, an illustrative inquiry focuses on the cul- I focus on differences in analyses of the 46 narra- tural tool of storytelling in two contexts evocative tives of confl ict among adults produced by these 158 C. Daiute two groups (See Daiute, 2010 ; Daiute & Lucic, Consistency in the kinds of icons by young peo- 2010 , for more detailed reports). ple living in the same location is likely to be The literary device of emplotment as a strat- focused on threats, opportunities, or other salient egy narrators use to create a “concordance of dis- features at the time, such as discrimination against cordances” or to “grasp” together the myriad immigrants in the U.S. or political-economic elements in terms of the reason why they are instability in BiH. recounting this narrative in this way (Ricoeur, The icon analysis showed that young people 1984 ; 1995 ) . In languages that mark time on whose families remained in BiH during and after verbs as well as with words like “before” and the war narrated confl icts focused on tensions in “after” (like those in this study), time has proved public space, while those in the U.S. focused on to be a powerful dimension narrators use, among confl icts in more private contexts. Icons in adult- other linguistic devices, to indicate how they are focused narratives of confl ict by participants in making sense of events. This sense making is BiH tended to be tensions among unnamed indi- indicated by the “icons,” the symbolic center of viduals or “society” in public events, such as in narrative confl icts and “psychosocial dynamics,” transportation with “arguments on public trans- the device narrators use to indicate why narrators portation,” “on the bus,” and “drivers at a cross- are telling this story in this way. Icons are, in road” and at sporting events, clubs, and brief, what narrators perceive as important and dedications, with “a monument for children killed “psychosocial dynamics” their interpretations of during the war.” In contrast, icons in the adult- those features. focused narratives by participants displaced to The icon analysis identifi es the specifi c social the U.S. tended to occur in the more intimate or physical object (activity) at the center of a nar- context of family and the neighborhood around rative con fl ict—the peripeteia or trouble (Bruner, relationships such as “my cousin’s parents’ 2003 ). As a structural feature of narrative, icons house,” “a fi ght with my parents,” “inviting my are the center of a narrative con fl ict, an environ- uncle to move to American,” and “two of my mental object, a character, event, emotion, or neighbors got in a fi ght.” some other real-life referent that is salient enough With the icon as the focal point in the narrative to motivate con fl ict. The icon in the following employment, the psychosocial dynamic emerges narrative is, for example, “a student brought a as the narrator’s reason for telling this story in gun to school and threatened” as the material and this way. The psychosocial dynamic is the goal- symbolic center of the con fl ict. directed way in which the narrator resolves the A student brought a gun to school and threatened various elements of the story he or she chose to another student asking from him a small amount of tell, refl ecting on the recounted events and char- cannabis. Some students were appalled by the pos- acters. Since real-time narrators, compared to session of weapons, others by cannabis, and some experienced authors, tend to discover the pur- by both. As for myself, I was a bit disgusted by the gun but, at the same time, it could be expected poses of their stories in the telling, often implic- from such persons. itly, they use their sociolinguistic knowledge rather than marking their purpose explicitly as The phase “a student brought a gun to school one would with a moral or epilogue. The emplot- and threatened” is the icon because the plot ment is expressed in Aida’s sentence “I was a bit revolves around it as the narrator offers the con- disgusted by the gun but, at the same time, it clusion “As for myself, I was a bit disgusted by could be expected from such persons,” where the gun…” indicating the central focus on the Aida makes her point by connecting events in the threatening gun rather than on cannabis, for past to a hypothetical “at the same time” from her example, not all participants who may have wit- perspective as narrator in the time of telling. nessed this fact of life chose to share a story about Compiling such temporal moments is relative to it and any narrator who deemed it worthy of shar- the overall narrative, which, in this case, is ori- ing could have developed it in diverse ways. ented primarily to the past. The psychosocial 11 Relational Resilience 159

Table 11.1 % Emplotments by youth in BiH and the U.S. and to consider moral issues (26.7 % compared expressing psychosocial dynamics narrating con fl icts among to 0 % in BiH narratives). adults As shown in the following narrative, young Psychosocial dynamic by Narr activity in BiH in U.S. Bosnians in the U.S. tended more to narrate #Emplotments in adult-focused narratives 19 15 around interpersonal issues in private life (in this Uncertainty 42.1 26.7 case a couple with interpersonal differences also Identify contradiction 36.8 13.3 Minimize/distance 15.8 13.3 framed in terms of family and religion) and con- Clarify af fi liation/relationship 5.3 13.3 sider process (in this case fi guring out how all Clarify identity 5.3 0 those systems interact and the role of loved ones Consider process 0 40 looking on, such as the young author). The narra- Consider moral issues 0 26.7 tor, 19-year-old Cinderella, ties together the vari- Suggest injustice 0 13.3 ous tensions among characters in this narrative Express hope/desire 0 0 by shifting to the present for her commentary, “I support her.” dynamic analysis indicated that beyond the There are two adults that had a con fl ict with each other. The husband wanted to get highlights in his different focal points of narrative icons, young hair (blond ones in dark hair) and wants to get a people connected to their social and physical tattoo on his arm of their childs name written. She environments in very different ways. Of the nine took this offensively to the religion that prohibits different psychosocial dynamic categories such acts and to their marriage, lack of communication, and trust. So she came to me and decided to identifi ed across hundreds of narratives in the full get a divorce. There are many other things leading database (narratives of confl ict among adults, up to the divorce not just the hair dye and tattoo. peers, and the community), narratives by dis- I support her. placed and non-displaced Bosnian youth differed The following narrative of a confl ict among by at least 5 % in seven categories. adults by Nightwish emerged as typical by youth Psychosocial dynamics accounting for all nar- in BiH, revolving around tensions in public life rative emplotments in our database included (1) and considering contradiction. The emplotment clarify af fi liation ( relationship ), (2) “This is why the old man got into confl icts many uncertainty / ongoing challenge , (3) identify times with others and he always gets a ‘shorter contradiction /irony , (4) clarify identity, (5) sug- end of the stick’” expresses the contradiction that gest injustice /unfairness , (6) express hope / desire , adults (the war generation) permeate the environ- (7) consider process , (8) consider moral / cultural ment with tensions but then feel like victims. issues , and (9) minimize / justify. Table 11.1 presents the percentages of narrative emplotments There is not enough place in our public transporta- expressing different psychosocial dynamics in tion, and to make it even worse our retired senior citizens are getting up at 8 am and going as if they the narratives of confl icts among adults by have to be someplace, while some people must go Bosnian youth in BiH and in the U.S. As indi- to school or work. Retired people are occupying cated by these percentages, youth in BiH used most of our space in all public transportation…. adult con fl ict narratives more to identify contra- there is one old man that is really primitive. Whenever he enters the trolley he rudely tells some- dictions (36.8 % compared to 13.3 % in US nar- one to get up so that he can sit, as if that is some- ratives) and to express uncertainty (42.1 % one’s duty and not just a show of good manners. compared to 26.7 % in U.S. narratives). In con- This is why the old man got into con fl icts many trast, Bosnian youth in the U.S. used the same times with others, and he always gets a “shorter end of the stick.” The con fl ict is never resolved. narrative genre more to consider processes in the society (40 % compared to 0 among youth in The pattern of using narrating to consider pro- BiH), to consider moral/cultural issues (26.7 % cesses and uncertainty by the U.S. participants is compared to 0 in BiH narratives), to suggest injus- not a surprising orientation by young immigrants, tice (13.3 % compared to 0 in BiH narratives), who as newcomers must actively make sense of 160 C. Daiute an unfamiliar world. What emerges as surprising an interactive orientation of people in systems of in the comparison of narrating across these real spaces and times. Building on explanations contexts is that those who remained in the war of this process as “ordinary” adaptation via uses zone with ongoing instability use narrating to of symbolic thought to mediate harsh environ- consider personal identity and to distance from ments, researchers can seek a new set of terms adults (indicated by their identifying contradic- consistent with this new scholarly narrative. tions), as one might expect from previous theories Based on previous research, the concept “rela- of adolescent development. When youth in BiH tional resilience” is promising for guiding ongo- do focus on con fl icts among adults, they distance ing research and practice. Although diverse themselves from those tensions, which are pre- individuals and groups may have different values sented as petty and persistent, while those in the and goals, inclusion as a legitimate participant in U.S. align with their elders to embody a shared interpersonal and public discourse seems central alienation, as in the narrative above. Compare that in the resilience process and, thus, worth ongoing relatively empathetic orientation by the displaced inquiry. Given that language and genres like nar- youth to the more judgmental attitude in the narrating are human tools akin to fi re, narrating must rative by her cousin who remained in Bosnia. be going on in all situations of displacement. The icon analysis indicates what attracts the Since many children are separated from loved young narrators’ attention as they interact with ones and institutions like school early in life, the actual and imaged issues in the environment their language skills would be more rudimentary and, in brief, what is worthy of confl ict in their than those presented above, but recounting events environment. The psychosocial dynamic analysis and sharing perceptions are likely to occur every- indicates, moreover, how the narrator relates to where as these communicative acts assist with that attention-worthy symbol, at least at the survival. Individuals create and use symbolic moment of narrating. By extending research on tools, like narrating, to make sense of their envi- the nature of narrating as a symbolic process for ronments and how they fi t. To the extent that connecting with the social and physical worlds to these narratives interact with those around them, learn about how youth growing up diverse chal- whether, ideally as valued, or at least as legiti- lenging situations understand their environments, mate, the discursive process is a developmental we must also emphasize thought processes to one. Such individual and societal relation is, complement emotional reactions like trauma moreover, a two-way process, because just as common in prior research. More importantly for individuals are unlikely to thrive in societies that the present discussion, we offer this analysis as a exclude them, societies with alienated individu- way of de fi ning culture not only in terms of past als are likely to develop pathologies. tradition but also in terms of the challenges and The extended tradition of studying effects of opportunities of daily life. political violence and displacement as an aberra- tion akin to disease can give way to a new movement of studying the material and symbolic Toward Relational Resilience circumstances of human life—as imperfect as it is. Ongoing research to promote and understand rela- Relational resilience is a process of ongoing tional resilience requires expanded research development through discursive activity in social designs, including interventions that continue and political milieu. Relational resilience is a beyond the research period. Designing research to concept that includes many spheres of social con- include perspectives across activity-meaning nection, including interpersonal and societal, systems loosens assumptions that effects are among various groupings of individuals, peoples, contained—in individuals or in periods post-dis- and institutions. In this way, the concept of rela- placement. Instead, as illustrated in the example tional resilience expands the focus of research above, when we consider the orientations of refu- from the psychological profi les of individuals to gees from Bosnia in relation to those of peers who 11 Relational Resilience 161 remained there, social and political inclusion tive. International Journal for the Advancement of emerges as important. Research in mainstream Counseling, 29 , 43–55. Daiute, C. (2010). Human development and political vio- institutions like schools and nongovernmental orga- lence . New York: Cambridge University Press. nizations with diverse stakeholders is most likely to Daiute, C., & Lucic, L. (2010). Situated cultural develop- promote interaction, ongoing meaning making, and ment among youth separated by war. International sustainability of social inclusion goals and activi- Journal of Intercultural Relations, 34 (6), 615–628. doi: 10.1016/j.ijintrel.2010.07.006 . ties. Rather than assuming a speci fi c ideal life as the Dawes, A. (2008). Political transition and youth violence background for aberrations, like displacement, in post-apartheid South Africa: In search of under- research can advance to consider the diversity of standing. In J. Hart (Ed.), Years of con fl ict: Adolescence, life circumstances. For children, dealing with the political violence, and displacement (pp. 89–110). New York: Berghahn Books. life where they fi nd themselves is, after all, a living Daiute, C. & Botero, P. (2012, July). Narrating displace- right (Hanson & Nieuwenhuys, 2013 ). ment through Colombian community development dealing with violence. Paper presented at the International Society for the Study of Behavioral Development (ISSBD), Edmonton, CA. References Engestrom, Y., Miettinen, R., & Punameki, R. L. (1999). Perspectives on activity theory. New York: Cambridge Alinejad, D. (2011). Mapping homelands through virtual University Press. spaces: Transnational embodiment and Iranian diaspora Erikson, E. H. (1980). Identity and the life cycle . bloggers. Global Networks, 11 (1), 1470–2266. New York: W.W. Norton. Akinwumi, O. (2006). Youth participation in violence in Fergusson, D. M., & Horwood, L. J. (2003). Resilience to Nigeria since the 1980s. In C. Daiute, Z. Beykont, C. childhood adversity: Results of a 21-year study. In R. Higson-Smith, & L. Nucci (Eds.), International per- J. Haggerty, L. R. Sherrod, N. Garmezy, & M. Rutter spectives on youth con fl ict and development (Eds.), Stress, risk and resilience in children and ado- (pp. 73–85). New York: Oxford University Press. lescents: Processes, mechanisms and intervention . Anas, A., Regan, J., & Barrett, D. (2007). The silent vic- New York: Cambridge University Press. tims: Effects of war and terrorism on child develop- Fernando, C., & Ferrari, M. (2011). Spirituality and resil- ment. Psychiatric Annals, 37 (8), 586–589. ience in children of war in Sri Lanka. Journal of Barber, B. (2008). Contrasting portraits of war: Youths’ Spirituality in Mental Health, 13 , 1–26. varied experience with political violence in Bosnia Hanson, K., & Nieuwenhuys, O. (2013). Living rights, and Palestine. International Journal of Behavioral social justice, translations. In K. Hanson & O. Development, 32 , 298–309. Nieuwenhuys (Eds.), Reconceptualizing children’s Betancourt, T. S., & Khan, K. T. (2008). The mental health rights in international development (pp. 3–28). of children affected by armed confl ict: Protective pro- New York: Cambridge University Press. cesses and pathways to resilience. International Hart, J. (Ed.). (2008a). Years of confl ict: Adolescence, Review of Psychiatry, 20 (3), 317–328. political violence, and displacement. New York: Boyden, J., & Mann, G. (2005). Children’s risk, resilience, Berghahn Books. and coping in extreme situations. In M. Ungar (Ed.), Hart, J. (2008b). Introduction. In J. Hart (Ed.), Years of Handbook for working with children and youth: confl ict: Adolescence, political violence, and displace- Pathways to resilience across cultures and contexts ment (pp. 1–20). New York: Berghahn Books. (pp. 3–26). Thousand Oaks, CA: Sage Publications. Hyder, T. (2005). War, confl ict and play. New York: Open Bruner, J. (2003). Making stories: Law, literature, life . University Press. Cambridge, MA: Harvard University Press. Luthar, S. (1993). Annotation: Methodological and con- Bonanno, G. (2004). Loss, trauma, and human resilience ceptual issues in research on childhood resilience. have we underestimated the human capacity to thrive Journal of Child Psychology and Psychiatry, 34 (4), after extremely aversive events? The American 441–453. Psychologist, 59 (1), 20–28. Mancini, A., & Bonanno, G. A. (2009). Predictors and Boyden, J., & Mann, G. (2005). Children’s risk, resilience, parameters of resilience to loss: Toward an individual and coping in extreme situations. differences model. Journal of Personality, 77 (6), Buchanan, M.J., Al-Mashat, K., Cortes, L., Djukic, B., 1805–1832. Jaghori, B., & Thompson, A. (this volume). Mann, J. (2008). Doing nothing and being good: Social Bruner, J. S. (1986). Acts of meaning. Cambridge, MA: relationships and networks of support among adoles- Harvard University Press. cent Congolese refugees in Dar es Salaam. In J. Hart Collier, P. (2003). Breaking the confl ict trap: Civil war and (Ed.), Years of con fl ict: Adolescence, political vio- development policy. Washington, DC: The International lence, and displacement (pp. 38–57). New York: Bank for Reconstruction and Development. Berghahn Books. Cortes, L., & Buchanan, M. J. (2007). The experience of Maslow, A. H. (1943). A theory of human motivation. Columbian child soldiers from a resilience perspec- Psychological Review, 50 (4), 370–396. 162 C. Daiute

Masten, A. S. (2001). Ordinary magic: Resilience in Higson-Smith, & L. Nucci (Eds.), International development. The American Psychologist, 56 , perspectives on youth con fl ict and development 227–238. (pp. 29–42). New York: Oxford University Press. Masten, A. S., Hubbard, J. J., Gest, S. D., Tellegen, A., Suárez-Orozco, C., Suárez-Orozco, M., & Todorova, Garmezy, N., & Ramirez, M. (1999). Competence I. (2004). Wandering souls: Adolescent immigrant in the context of adversity: Pathways to resilience and interpersonal concerns. In G. DeVos & E. DeVos maladaptation from childhood to late adolescence. (Eds.), Narrative analysis cross-culturally . Lanham, Development and Psychopathology, 11 , 143–169. MD: Rowman & Little fi eld. Punamaki, R.-L., Qouta, S., Miller, T., & El-Sarraj, E. Suárez-Orozco, M., & Quin-Hillard, D. (2006). (2011). Who are the resilient children in conditions of Globalization: Culture and education in the New military violence? Family- and child-related factors in Millennium. The Ross Institute, Berkely: UC a Palestinian community sample. Peace and Con fl ict, Press. 17 , 389–419. United Nations Convention on the Rights of the Child Ricoeur, P., (1984) Time and narrative (Vols. 1 and 2). (1989). Available at www.crin.org Chicago: University of Chicago Press. Vygotsky, L. S. (1978). Mind in society: The development Ricoeur, P. (1995). Oneself as other. Chicago, IL: of higher order thinking . Cambridge, MA: Harvard University of Chicago Press. University Press. Rutter, M. (1985). Resilience in the face of adversity: Vygotsky, L. S. (1964). Thought and language . Cambridge: Protective factors and resistance to psychiatric disor- MIT Press. der. The British Journal of Psychiatry, 147 , 598–611. Weine, S. (2004). When history is a nightmare . Silber, L., & Little, A. (1995). The death of Yugoslavia . New Haven, CT: Yale University Press. London: Penguin, BBC Books. Weine, S., Klebic, A., Celic, A., & Bicic, M. (2008). Smorti, A., Massetti, I., & Pasqualetti, E. (2011). Narrative Tasting the world: Life after wartime for Bosnian teens memories of stressful events. Paper presented at the in Chicago. In B. K. Barber (Ed.), Adolescents and International Society of Cultural and Activity Research war: How youth deal with political violence (pp. 255– (ISCAR) Meetings, Rome, Italy. 280). New York: Oxford University Press. Sta. Maria, M. (2006). Pathways to Filipino youth involve- www.unhcr.org (2010) ment in violent confl ict. In C. Daiute, Z. Beykont, C. www.unhcr.org (2011) Coping and Adaptation: A Narrative Analysis of Children and Youth 1 2 from Zones of Confl ict in Africa

Jacqueline McAdam

Introduction Background

In this chapter, narrative inquiry is used to research Over the course of my career, I have become coping and adaptation of nine young people who have increasingly interested in the process of coping lived, as children, in situations of confl ict in Africa. and adaptation that results in a positive outcome. My study draws upon theories of resilience, the study Positive outcome refers to a state of mental health of risks and opportunities, identi fi ed within the fi eld that enhances an individual’s human potential, of human development. This research adds to a grow- often referred to as resilience. The dichotomy ing body of knowledge that seeks to understand the between my experience working with at risk role of culture, and the process of coping and adapta- youth in Canada and that of youth in adversity in tion for those in extreme adversity. To design cultur- Kenya was puzzling. The extreme situations of ally appropriate policies and practices for children of economic poverty in which these youth lived war, both the “emic” or culturally specifi c behavioral were immediately apparent: characteristic and “etic,” more universally defi ned However, despite the desperate situations that the human characteristics, must be more clearly under- youth from Kenya came from, they possessed a stood for this population (Poortinga, 1997 ) . sense of hope, gratitude and resilience that seemed Background research af fi rms the relevance of foreign to the youth with whom I had worked in Canada. Although lacking in material wealth, they this study. The theoretical framework and the were on the whole psychologically healthier. methodology are also expanded upon. The profi les I wanted to know more about these differences in of the participants that may have in fl uenced the the relation to the cultural factors that enhance or risks and opportunities are then discussed. Narrative hinder well-being and psychological health for children and youth. (McAdam-Crisp, 2006 , p. 3) excerpts are incorporated to enhance the readers’ ability to understand the analysis of coping and My interests were both sel fi sh and philan- adaptation. The discussion analyzes the pathways thropic. I wanted to learn more about the human to resilience, their potential cultural relativity, and condition, to incorporate this wisdom into my the application to policy and practice for children own process of self-discovery, and to enhance the and youth in zones of con fl ict. Following limita- lives of others. This interest peaked while work- tions and areas of further research are identifi ed. ing in Rwanda and Ethiopia:

My previous child development courses had not J. McAdam , PhD (*) provided a theoretical framework for understand- Department of Child & Youth Care, ing and addressing the effects of war on children. University of Victoria , Victoria , BC , Canada Most courses were provided from a western per- e-mail: [email protected] spective. Where the vast majority of children are

C. Fernando and M. Ferrari (eds.), Handbook of Resilience in Children of War, 163 DOI 10.1007/978-1-4614-6375-7_12, © Springer Science+Business Media New York 2013 164 J. McAdam

not the victims of war, and virtually none are the for children in extreme adversity. Research on victims of genocide. (McAdam-Crisp, 2006 , p. 6) the cultural aspects of coping and adaptation for What could theory tell me about the choices in those in extreme adversity is in its infancy. In the the face of adversity that these individuals in late 1980s and early 1990s, academics and other Kenya, Rwanda, and Ethiopia had made, and how researchers were also beginning to study the psy- might culture shape this outcome? chological health of young people in extreme adversity (Aptekar, 1988 ; Barker & Knaul, 1991 ; Blanc, 1994 ; Boyden & Gibbs, 1995; Garbarino, Kostelney, et al., 1991 ; Veale & Adefrisew, Theoretical Framework 1992) . Cross-cultural models and theories of human develop were also being explored (Berry, The challenge was fi nding a theoretical frame- Dasen, et al., 1997 ; Berry, Poortinga, et al., 1992, work that could explicate the complex nature of 1997 ; Gardiner & Kosmitzki, 2002 ; Super & coping and adaptation across cultures for children Harkness, 1997 ) . and youth in extreme adversity. I began by exam- This study utilizes three theories of human ining the research on children at risk. The work of development. The ecological model developed Balwin and Balwin et al. (1990 ); Garmezy and by Bronfenbrenner ( 1979 ; Bronfrenbrenner & Rutter ( 1983 ) ; Masten ( 2001) ; Rutter ( 1975) ; and Morris, 2006) , frequently used to understand Werner and Smith ( 1992) among others provided resilience (Fraser, 1997 ) , provides a systemic valuable information. Resilience theory (i.e., the framework to examine the child as part of the study of the interplay between risks and opportu- whole. The developmental niche theory by Super nities) provided a point of departure. Masten and Harkness (1997 ) looks at cultural symbols. ( 2001 ) notes that “Resilience models also under- This theory is governed by two overriding prin- scored the importance of tracking progress in ciples that are relevant to this study: terms of positive development and achievements First, that a child’s environment is organized in a in expected developmental tasks, along with non-arbitrary manner as part of a cultural system, improvement in symptoms” (p.501). Risks, then, including contingencies and variable fl exibility, have the potential to derail normative or positive thematic repetitions, and systems of meaning: and development. Comparatively, opportunities are second, that the child has an inborn disposition, including a particular constellation of temperament de fi ned as internal and external characteristics that and skill potentials as well as species-speci fi c help individuals to buffer risk, cope, and adapt. potentials for growth, transformation, and the orga- These include both biological and environmental nization of experience into meaning. Both the envi- factors, such as intelligence, physical health, tem- ronment and the individual are seen as open systems in the formal sense, that is, ones that participate in perament or disposition, support from individuals structured interchanges with the external systems. and family, economic situation, and living environment. That said, risks defi ned by the previous This theory recognizes different cultural prac- scholar as, for example, divorce, a mentally ill tice that infl uence a child’s development, such as parent, poverty, and sexual or physical abuse pri- the physical and social setting, customs of child- marily relate to those in the Western world were rearing and care, and the psychology of the care- the minority of children live. This minority-world taker. Vygotsky’s (Kozulin, 1990 ) sociocultural research infers knowledge based on the profi les of theory was employed as a mean of recognizing approximately 25 % of the world’s children. the historical nature of development within a Consequently, minority-world research and theo- defi ned context. These three theories provided a ries may be limited in their ability to de fi ne the template within which the notion of risks and pathways to resilience for those in extreme adver- opportunities, as de fi ned by theories of resilience, sities, from different cultural contexts. is examined. Narratives provide the data within I am certainly not the fi rst to recognize the which to analyze the cultural aspects of coping potential limitations of minority-world theories and adaptation for those in extreme adversity. 12 Coping and Adaptation… 165

Studies and reports that support this inquiry the research. This method also provides a tool for draw on the work of scholars, such as Sack, others to comprehend the situation without actu- Angell, et al. ( 1986 ) ; Aptekar and Boore ( 1990 ) ; ally witnessing it themselves, with the hope that Garbarino, Kostelney, et al. (1991 ) ; Tolfree this awareness will inform the development of (1995 ) ; Boothby ( 1996 ) ; Machel ( 1996 ) ; Aptekar culturally appropriate strength-based practices. and Stocklin (1997 ) ; Sack, Chanrithy, et al. The research process included an interview (1999 ) ; Boyden and Mann ( 2000 ) ; Doná, that was guided by the following questions. The Kalinganire, et al. ( 2001 ) ; Mann (2001 ) ; and fi rst question, presented below, constituted the Ungar (2011 ) . These scholars helped to expand telling of the story. theory in relation to cultural aspects of coping Question #1: and adaptation. For example, the ecological I am interested in hearing the story of your life. model and developmental niche theory recognize You can start wherever you like along this line. a child’s need for attachment. Attachment theory I want to learn more about how you became the identifi es the importance of a child’s attachment person you are today and the experiences and people you met along the way. There is no right way to to the mother (Bowlby, 1969 ) , yet children and tell this story. Time is not a concern. I also want youth across cultures have diverse family compo- you to know that you can stop at any time. sitions. Mann ( 2001) discusses the importance of Additionally, along the way I may ask you to clar- siblings in the context of the African family ify or expand on certain details. If you don’t have any questions, please begin. which is typically large: The second question was intended to help me Sustained interdependence of siblings and cousins identify the situations of adversity as defi ned by across the life span means that the responsibilities of child care can be shared within a large social the participants. network. Children in this context typically have Question #2: multiple caregivers, and experience exclusive How do you think these experiences have either maternal care only in the fi rst few months of life. added to or hindered your present situation? (Mann, 2001 , p. 19) Each interview was recorded and later tran- Large extended families that increase the scribed for analysis. The analysis is shaped by adult-child ratio, regardless of maternal attach- theories of resilience, within the scope of human ment, have also been shown to provide a psycho- development. The following expands on the logical buffer (Perry, 2004 ) . This example fi ndings. illustrates cultural nuances within the fi eld of human development that begs further inquiry. The work of other scholars provided a context for understanding the multitude of factors contribute Participants to the discussion of resilience across cultures. The profi les of each participant are analyzed in accordance with theories of human development Methodology: The Research Process that recognize the systemic interaction between various risks and opportunities. Explicating the A qualitative methodology was utilized because it circumstance and characteristics of the partici- provides a vehicle for the social construction of pants helps us understand and analyze the inter- knowledge, as opposed to a presupposed frame- play between the risk and opportunities: work in which participants respond to de fi ned Each participant is identifi ed by a pseudonym, to areas of knowledge. Narrative research provides a ensure con fi dentiality. There are 9 participants in voice for youth to share in accordance with their total. They include 6 males; Christian, Peter, Hassan, own personal style and needs, in a manner that is Gathia, Françoise, Roberto, and 3 females Lydia, Pauline and Julia. Certain speci fi c information that not voyeuristic but compassionate of the narrators could lead to their identifi cation has also been gen- story, within the con fi des of the ethical mandate of eralized or changed. Information on the participant’s 166 J. McAdam

siblings is also included, where relevant, as a mean and her family are considered to be Burundian of illustrating a broader range of experiences that refugees. She commented that prior to the outbreak impact coping and adaptation for children and of the Rwandan genocide, life was peaceful in youth. (McAdam-Crisp, 2006 , p. 74) Rwanda. Githia’s family fl ed Sudan to Ethiopia where he lived on and off through his childhood. Based on the fi ndings from this study, all of Hassan, also Sudanese, continued to live in Sudan the participants were physically healthy at birth. until approximately the age of 8 years. Christian’s family had the economic means to move to Kenya, They all identi fi ed themselves as being aligned and then relocate a number of years later, back to with a spiritual belief. Three of the participants an area of Uganda, which was not affected by acknowledged their ethnic heritage as part of confl ict. Comparatively, Julia and Pauline who are their identity. All of the participants spoke an both from Sierra Leone were free of the adversities of con fl ict up until the age for 6 and 13 years con- ethic language; English or French was often their secutively. Then they lived within the context of second or third language. war for the next 6–7 years. Françoise from the Theories of human development, specifi cally DRC lived in the midst of a low grade con fl ict until the ecological model, help to defi ne other cir- the age of approximately 19 years and Peter who is from Rwanda until the age of 7 years. (McAdam- cumstances that impact risk and opportunities. Crisp, 2006 , p. 75) For example, the macrosystems affi rm the importance of examining the country of origin and the The age at which the confl ict impacts these circumstances within the country of origin that young people, the resulting losses, and the feel- might have impacted these young people lives. ings of autonomy and choice within the midst of The developmental niche illustrates the impor- con fl ict in fl uences the risk outcome. tance of examining aspects of the living environment and family dynamics and examining the cultural meanings and symbols (Super & Family Structure Harkness, 1997 ) . Drawing on the social cultural theories, this analysis explores the individuals The polygamist nature of the African family was within these structures that helped these young identifi ed in four of the narratives in which par- people reach their zone of proximal development, ticipants referred to a number of maternal fi gures. a de fi ned aspect of this theory. One participant spoke of how his uncle married his mother after his father died, a defi ned custom in many parts of Africa. Participants did not use The Country of Origin terms such as “half-brother or half-sister” or “step-parents” the cultural norm is “all members” All of the participants were born and raised in are family. This extended family structure, typi- Africa, a criterion of the participant selection cal of more collectively based cultures, normal- process. Countries of origins included Angola, izes the expansive nature of supports these young Sierra Leone, Sudan, Democratic Republic of people receive from others. Congo (DRC), Burundi, Rwanda, and Uganda, The structures that characterize a family are each has been or is a zone of continual con fl ict culturally defi ned, but the assumptions that fami- and war. That said, the participants’ relationship lies provide a place of support and belonging are with the con fl ict was, of course, unique. Some universal. The loss of this structure is also univer- were born into confl ict whereas others had a sally de fi ned as a risk. To this end, two of the period of stability prior to the con fl ict: participant’s parents are both still alive. For instance, Roberto, Lydia, Christian, Githia, and Hassan, were all affected by con fl ict within the fi rst year of life. Roberto, born in 1984, lived within the Living Situation confi nes of the Angolan war for 10 years. Lydia’s family fl ed from Burundi to Rwanda when she was only 5 months old. She identi fi es more with Participants lived in both urban and rural environ- Rwanda than Burundi; however, technically she ments. Seven of the participants lived in situations 12 Coping and Adaptation… 167 considered to be middle to upper class, for example, they owned their own house and car, and were able to send their children to school prior to the war. Comparatively Lydia and Roberto lived in situations de fi ned as impoverished, living rurally in mud hits, neither had access to school, and both worked alongside their parents. The degree of change to the participants living environment as a result of war helps to further understand the risks or opportunities. For instance, life in a refugee Fig. 12.1 Cycle of war and con fl ict camp for those from impoverished situations provided access to resources that had been previously unavailable. Consequently, this change might be time, this journey was not the central focus of her more accurately de fi ned as a protective opportu- story. Yet, the fact she was a Burundian refugee nity as opposed to a risk: for others, their quality in Rwanda was a risk, due to ongoing strife of life decreased, for although it might not have between the two countries. Segments of the nar- impacted their physical health, they psychologi- ratives illustrate various aspects of the journey cally had to rede fi ne and recreate their sense of and provide a context for the reader to understand identity. Change in social or economic status can the analysis. either enhance risk or act as a protective factor.

A Beginning: The Death of a Parent Narratives Five of the nine participants (Peter, Lydia, The narratives of these nine participants are more Roberto, Pauline, and Françoise) all lost their than the telling of their stories. Descriptive narra- parents as a result of the con fl ict. Peter was the tives in form and content provide a framework youngest when his parents were killed; his narra- for understanding the risks, and the opportunities tive describes this experience. that enhanced these young people’s ability to cope. The narratives of war and adversity often Peter’s narrative: I lived in Rwanda with my parents and my two sis- followed a de fi ned pattern (see Fig. 12.1 ). ters, my two young brothers; we are fi ve children For those that had lost their parents, the story in the family. So, in 94 when the genocide hap- began with this loss. This also signifi ed a journey pened, we had to leave. My dad said, “Ok I have to to safety or a defi ned place of belonging that pro- take my family away from this place,” because we were living in the city. He put us in the car, all of vided a sense of security. Many took years to fi nd us, everybody in the family, and he was trying to a place of belonging and safety and, for years, take us in a safe environment. But on our way we lived in situations of displacement or within the met the rebel soldiers. They stopped him because confi nes of a refugee camp, prior to fi nding a he was driving us. So my dad is stopped, and when he stopped the fi rst question was “We want money,” place of stability. Others lived within the context and then he said, “I don’t have money in the car, so of war for many years. The majority of the narra- if you guys want money, let’s go back to home tives began with the loss of a parent. Many of the maybe I’ll get you money, but leave me.” So he participants experienced similar risks; however, wanted to give them money so that they can save his life, but then something else happened and then each was nested within the con fi nes of a speci fi c he ended up dying like that. narrative in relation to their experiences of war and adversity. Frequently the cycle repeated itself The fact that Peter’s father had died was only when war broke out again. Lydia’s story began understood in hindsight. Over the course of what with her family fl eeing Burundi; however, due to he describes as an hour, his mother and two sis- the fact that she was only 4–5 months old at the ters also left the car. Peter waits in the car with 168 J. McAdam his brother of 1 and 5 years. He expanded on his before their arrival in Canada. Roberto and Peter feeling of confusion regarding his desire to stay were both children when their parents died, and in the car, and the factors that infl uenced his deci- are defi ned as unaccompanied minors in situa- sion to leave: tions of confl ict. These young people drew upon the support of their community and relatives to So, from there we waited, the group that told us to cope and survive; this did not necessarily result in follow them, we couldn’t follow them because we had the hope that our parents would be back and safety or stability. Roberto ends up staying with a our sisters would be back. So I stayed with my two relative only to be scooped abducted by the rebel young brothers and then, um, we stayed for another soldiers one afternoon while at school: long time and then another group came, and then my younger brother who was 5 years said, “Ok, They caught us, all of us in there, and they put us in Peter, if you don’t want to come with me, I’m leav- the truck. We were heading to the camp. So they ing because, see now all of these people are leav- drove us a few miles away from the school and ing and we are going to stay here and hear all the then they stopped, somewhere, at another village, sounds of guns and people dying and you are see- to get more people. And that’s where we got a ing, so let’s go.” So when he left, I followed him, chance, me and my friends, and we jumped out of but I couldn’t leave the car, because of the young the truck and started running. One of us were run- baby who was in the car and I couldn’t hold the ning in different direction as my friend. So then baby, to take the baby with me. So, I said, OK, they start shooting at us but I was, like, I didn’t get maybe for meanwhile let me stay maybe my par- shot. Since then, after jumping the truck, I never ents will be back and maybe they can drive us and turn back or looking back to my village. I kept run- then we go. We started following the group of ning, running, running. people. Roberto ended up in a nearby village after Peter’s decision to leave the car is determined fl eeing from the truck, and again meets someone within a span of a number of hours. Lydia’s unex- who offers to take him to a safe place. Roberto pected loss of her father, and the death of her story begins again after a 2 day journey to mother due to illness a number of years later, Zambia: results in her caring for her three younger sib- He was a good man. We stayed there for like 2 lings and a journey to safety. Roberto’s parents weeks or so I guess, but he said, No, this is not a were killed over a span of 2 years. His journey good place for you because the Angola govern- from Angola starts following the death of his ment do send the military to come to Zambia because a lot of people run away from Angola, so mother, who was killed while Roberto remained they go way to Zambia or Zaire or Congo up there. hiding in the bushes outside their small rural hut. So what if you got caught in different countries These participants lost both of their parents they send you back again, wherever you came before the age of 13 years. Comparatively, Pauline from. He was worried maybe I might get caught in the city. He was like, OK, just I wait, I know where from Sierra Leone, raised by a single father, and I’m going to take you, where you are going to stay. Francoise from the DRC lost their signifi cant I was like, OK. He asked me to go to the tool box parental fi gures in late adolescence. Gathia and and drove away. Next thing I know he said, OK, Hassan, both from Sudan, lost their fathers as a this is South Africa, Port Elizabeth. And it’s much better than where you came from. So good luck my result of war, but their mothers are still alive. man. And he gives me a few dollars. And I’m like, Christian’s and Julia’s parents are both living, OK, you can survive here. thus their narrative begin with a journey to safety. Roberto’s narrative illustrates the ongoing risks. For those that lost their parents these risks are greater. Roberto remains displaced, begging The Journey to Safety to survive, on the streets of South Africa for the next 4 years. Risks along the journey included both physical Peter’s narrative also illustrates the precari- and psychological hardships. For many the jour- ousness of his survival. Traveling with his brother ney spanned a number of countries and continents of 5 years, he relays the following experience, at 12 Coping and Adaptation… 169 the age of 7 years upon reaching a river that they Upon the death of her mother, Lydia was must cross to arrive safely in Uganda: responsible for the care of her three siblings. A week later her youngest brother, who was just I tied my arms with the rope and then I went in the 2 years old, and was still nursing when his mother water, and then they pulled me. My brother stayed. Remember we left. We left the one young baby in died, falls into a fi re. Lydia expands on this the car. So, when my, after crossing, I started to event: crying because my brother was still in Rwanda. But the river, it wasn’t too big. It wasn’t like here When my younger brother fell down in the fi re, in river Akagara, which is big. It wasn’t wide. So it I was talking to my friend, in the morning, my was like this. You are here and then you see some brother cannot move his body, he was so swollen, of this (the people on the other side). So my brother he was almost going to die, it was too serious. They was there crying and I was here crying. There were were even going to remove his arm and so I talk to so many people waiting to cross but they couldn’t my friend about how my brother is very very sick, cross. And as you are waiting people are coming and he is going to die in a couple of days. She says and they are shot they fall in the water. They jump your brother’s fi ne leave him alone he will be fi ne. in the water and then they die when you are seeing. So I feel so sorry for my brother and I didn’t want So people were dying while you are seeing them to lose my brother the same week as I lost my mom who are still helping them still. Many people died I just take him there (to the hospital) myself, yeah and they knew how to swim because I had no other choice. I took him into the So, when we crossed–when they crossed–in the hospital we didn’t have money, we didn’t have any not more than an hour, there was this, the wind came identi fi cation to say we’re Burundian or Rwandan and the tree, the big tree had to fall down and it to be able to enter the hospital so when I got there crossed that river from Rwanda to Uganda. But the the doctor’s like well “who you guys are?” I’m, tree was in Rwanda. So, I had like very many peo- like, just help me. My brother’s really sick and ple, like 600 hundred people cross it using that tree. I don’t have any place to take him and then he just Like, the tree it crossed the whole river. And people accepted him and started giving him some crossed using that tree to cross. And my younger medication. brother, the man from Uganda went in Rwanda Upon leaving the hospital life continues to be using this same tree and brought my young brother. diffi cult until they are fi nally placed in a refugee Peter, similar to the others, completed his camp for Burundians, in Rwanda. journey by entering a country of asylum, yet others experienced years of displacement and additional risks. The Refugee Experience

Life in the refugee camp provided elements of Displacement security, food, and schooling, but there were also a number of difﬁ culties. Hassan, a refugee from An extensive period of displacement was a reality Sudan, shares his experience: for Roberto, Lydia, and Pauline. Here is an So my life at the refugee camp in Kenya was really excerpt of Lydia’s narrative which expands on the terrible. We would wait for the UNHCR to provide circumstances of her displacement: us with rations every month. We would go to a dis- tribution centre where we received our ration. And When my mom got sick, a friend we use to stay in you know, one has to go as early as possible, her living room, she said she can’t take us anymore, because there will be many other refugees waiting yeah, she said we had to be out, so it was really for food and you go, say, at about 6 (am). My really hard, you know during the genocide, people mother was the one who did the walking. I don’t some people leave their place, and move to Zaire, know if, like, typical of African countries, it’s like to different place to a safe place, so there was the a man or, you know, a male doesn’t want to associ- house, when people use to live in before 1994, so it ate himself with things that are belongs to the is life in the bush, it didn’t have any roof or door kitchen or things that are closer to the kitchen, so it you just walk in and stay in, that’s why probably is something that is there. But I mean, because we my mom died, because she was get sick we were were in Sudan that mentality was challenged and outside, because the cold the mosquitoes, and sometimes we would go and bring the rations and didn’t have any blanket or anything else, I could my mother would tell me to go and get some water, say my mom died because the hungry and cold and like I belong to the kitchen, kind of. Which is what not being treated well while she was sick… I disagree with. 170 J. McAdam

Hassan’s narrative illustrates dif fi culties of war for extended periods of time. A number of regarding the food-ration system in the camp. the participants lived for years in the context of Participants who resided in the camps with their war before fl eeing. Julia, from Sierra Leone, parents were more likely to have access to the expands on how many of her family members required resources. As with most family struc- were killed before they had time to fl ee. She tures, parents, most frequently mothers, advo- states “my grandfather was killed by the rebels cated and provided for their children. For instance, the fi rst day they entered our village. He was the Peter was one of the youngest participants to fi rst person to be killed” (McAdam-Crisp, 2006 , enter the camp and his stay was also the longest. p. 105). This impacted the family structure as a As an unaccompanied minor he and his young result of his fi ve wives moving in with her family. brother relied on others in the camp for support. She also expands on the impact of the war on her Peter’s narrative illustrates this phenomenon: brothers, one of whom is now dead: Going to school in the camp was a problem for me. My older brother who is 24 years old, but he’s We have the primary schools in the settlement, already dead, he was a soldier. I remember him where all the kids go to. But I couldn’t go there taking a knife, saying that he’s going to kill every- like, if I go there, where will I get lunch? I didn’t one in the house. It was really hard for me and my have anywhere to sleep. Like just sleeping in the mom and my brothers actually, and all the family. bush. You know, when in the refugee camp. But at All of us, we are in the house; we never came out fi rst it was hard and the only way I used to get my like for a day, because he was standing outside say- lunch and food for the living is just to go and see ing he’s going kill us because he has been injected the rest of the families that has the kids and join with what they call cocaine in Africa, that gives other kids who have their parents. If they staying kids mind for their parent and their families. So it for lunch, if their parents, I don’t know where they was kind of hard for us until my dad take a reaction used to get food, maybe if they have worked for and then they have to tie him, and after that we providing manual labour to the Nationals and they didn’t saw him for more than three years get maybe bananas or cassava or potatoes. If they cooked them to their kids, and then I go and join. Her other brother was also recruited as a sol- I wasn’t, I think, I am like what I am now because dier, but due to his age, she adds “he only carried I wasn’t shy. If I was shy I would have died because luggage; he did not fi ght he was too young” of hunger and in the camps the many many kids died because of cholera, malaria, like things were (McAdam-Crisp, 2006 , p. 105). worse. The people who died in the camp, they were more like the people who died in the hillside still. So, very many people are dying but I don’t consider myself to like, be blessed because I did not Pathways to Resilience: Coping die. Like, many of my friends, the people I knew in and Adaptation the camp, like the kids after like spending 6 months in the camp. I got to know some few kids who were very close to me that we used to play games Hardships were often couched within the subtle- together. But some of them died. ties of opportunities. The ability of these young The refugee experience can span months and people to draw upon internal and external oppor- years. The amount of time a young person spends tunities acted as de fi ned coping mechanisms and in the camp and the nature of this experience are enhanced resilience. Highlighted for the purpose a point of inquiry regarding both risks and of this chapter are some of the characteristics opportunities. within the individual, family, and community that helped these young people cope and adapt.

Living Within the Context of War The Individual

War results in individuals fl eeing their countries The participants all spoke of the dif fi culties and of origins, being displaced or becoming a refugee the psychosocial impact on their sense of well- in a country of asylum, or remaining in a context being. Many still grieve the loss of their family 12 Coping and Adaptation… 171 members and the loss of cultural traditions. For give up, and say, no more shy” (McAdam-Crisp, instance, Lydia spoke of her regrets over not 2006 , p. 113). These young people were also able properly burying her mother. Many grieved the to share their emotional state. Peter’s narrative loss of those they had been separated from. Lydia, provides an illustration of a response from his Peter, and Paulina were all separated from sib- teacher, as a result of his visual distress: lings and each longed for closure. Physical and And she said, ok, from now you will be getting psychological characteristics that seem to con- food-- lunch at my place with your young brother tribute to an individual’s ability to cope and adapt after school. You will come study in the morning. are examined. Firstly, age and physical size were Come to my place and have lunch, and then go to the refugee camp and stay. both protective opportunities. Masten ( 2011 ) supports the notion of age and states: Peter believes she helped him because he was Resilience research also suggests that developmen- doing well in school. tal timing plays a role in resilience and must be Experience also reinforced the personal considered in interventions. Young children and schema of the participants. A personal schema is adolescence will have different experiences in war more refl ective of one’s values, beliefs and atti- and disaster, different capacities and support for responding, and different responses to interven- tudes, and predisposition, as opposed to one’s tions (p. 502) cognitive ability. Gilgun and Abrams ( 2005 ) note: The fact the participants were over the age of 4 years at the time of the confl ict and separation Schemas can be thought of as mental representa- from their families meant that each had spent the tions or internalized working models that help early years of their life with their parents and people make sense of their experience through assimilation and accommodation. In assimilation, family. The capacities of the brain to develop key individuals fi t in new experience into existing structures within the neocortex and limbic sys- schemas, and in accommodation, they modify and tem that facilitate coping and adaptation are transform their schemas to incorporate new highly dependent on the care and protection of a information. signi fi cant fi gure during this stage of develop- Resilient individuals are inclined to have an ment (Lewis, Amini, et al., 2001 ) . Additionally exaggerated optimistic personal schema. They the fact that the participants were old enough to are more likely to “see the cup half full.” For control outbursts such as crying was also an asset. instance, in the face of adversity, Peter and Lydia Babies are often abandoned due to the increased both refer to themselves as lucky. The following risk of soldiers identifying those in hiding due to narratives illustrate this interplay. the sound of the baby’s cry. Small physical stat- ures were also an asset as bullets were often Lydia shares the following comment: directed above them. I am the survivor. It was really tough. Even when after my Dad passed away, we lost my brother Determination, self-effi cacy, an intuitive sense Bonaventure. We didn’t see him for a year. We of others, and the ability to show and share emo- found him at the refugee camp. It was really tough tional distress were all identifi ed coping mecha- this time. It became really, really hard. We are lucky we are together right now. nisms for the participants. These were not necessarily consciously employed, but illustrate This refers to the fact that all four of her sib- characteristics of resilience that provide the oppor- lings survived, even though both her parents die. tunity to move from a state of adversity to a state Some experiences often seem like miracles in de fi ned as psychologically healthier. This was the face of such extreme adversity, and for some particularly relevant for those that had lost their this helps them move forward. This is juxtaposed parents. Lydia states, “Myself I used to be shy to the phenomenon of “survival guilt” in which when I was young, but soon my parents past away one fi xates on the injustice of their survival over and I see that no one was able to help me so, I just another. 172 J. McAdam

After being in a refugee camp for 2 years, Participants shared the following comments about Peter’s narrative illustrates this point: their parents and family. Lydia comments “my mother was very kind and very understanding. She I spend 2 years there and then my brother that I left helped us a lot. My dad got frustrated, he got fed up in the car in Rwanda who was 1 year old, he came. and beat us sometime, but I don’t blame him, after Because the lady who knew us, was working with they died I felt that way, it was too much work” She my mom, she told me that she saw our car parked feels badly that she was not able to bury her mother somewhere and then she went to see if my parents properly. “I just want to go back to re-bury my were there, and then she founded him there. And mom, in the right place, so I want to go back and then she took the baby from out of the car. She saved bury her properly, that’s what I want to do” she the baby. And then she reached in Uganda, reaching adds. Roberto states that “I learned a lot from my in Uganda she wasn’t expecting to meet me, and my mom, because she was a pretty strong person from young brother. She came to Uganda. “Oh, you are what I can remember” she told him, “if you want to here! This is your young brother.” And I don’t know get along with people you don’t do bad thing to what I really, really, I don’t know right now, now them. Stay away from people that you know is not that boy is 12 years and he is going to school in good people” Peter tells how his mother would Uganda, my younger brother is also in Uganda. He take food to the Burundian refugees in his country. goes to school there. But I called my young brother, It is through his mother that he fi rst learned about like as in miracle. And then the lady said I’m not refugees. (McAdam-Crisp, 2006 , p. 118) going to give you this young boy until he turns to 6 years. And when he turns to 6 years, she handed Positive memories of the love of another over him to me and the lady went, but I don’t where human being help these young people move for- she is now. (McAdam-Crisp, 2006 , p. 117) ward (Frankl, 1963 ) . Peter, Lydia, and Pauline are all reunited with The extensive nature of the African family in sibling that they had assumed to be dead. For some itself provides a network of support. For this rea- this affi rmed their belief in a higher power, a son bonds between relatives and siblings are de fi ned protective factors, that reinforces their will signifi cant. In fact, the need to care for one’s to live. Just as risks that are beyond our realm of younger siblings, in the case of Lydia and Peter, experience decrease our ability to cope, experi- provides a purpose beyond self that can increase ences of a positive nature that are beyond our realm one’s will to live. Many of the participants still of experience may increase our ability to cope. had siblings and cousins that continue to provide a sense of family. Social networking sites such as Facebook and Skype have helped them maintain The Family these connections. Adults, often parents, who can advocate on Each participant was examined in the context of behalf of a child, are one of the key elements of the his or her family. Although it is hard to assess the family structure that provides for the care and pro- importance of birth order, it was interesting to tection of children. For instance, Christian speaks note that six of the nine participants were fi rst- of the support he received from his grandfather born children. That said, fi rst-born children and uncles in the absence of his father. This sup- within a collective family structure have more port for unaccompanied minors is severely com- responsibility, an opportunity that can increase promised without an adult who can advocate on self-assurance and con fi dence (Gardiner & their behalf. Examples throughout the narratives Kosmitzki, 2002 ) . Theory and common sense af fi rm that children need advocates: people that assert that families provide a forum within which believe in them and encourage their potential. relationships skills are shaped and formed. Positive relational experiences in our family enhance our ability to recreate these relationships The Community in the future. Although many of the participants in this study lost their parents they did not lose The community refers to the structures and the ability to remember the positive attributes of individuals beyond the family. Both the ecologi- these relationships: cal model and developmental niche stress the 12 Coping and Adaptation… 173 importance of the interplay between the individ- structures in the midst of con fl ict. It should be ual and the environment as a means of under- noted that none of the participants revealed that standing the pathways of development and, in they had actively participated in the confl ict. this case, resilience. Schools, churches, hospitals, Nonformal education programs offered by NGOs and political structures impacted the communi- within the refugee camp environment were also ties in which each participant lived. The narrative helpful. Lydia expresses her delight in the follow- stories refer continuously to the support these ing illustration: young people, especially those who were unaccompanied minors, received from the community Like when I was in the refugee camp the dif fi culty was when I ran out of food but then by the other in the form of friendship, housing, and medical time I was kind of busy taking care of my stuff, my services. This also reinforces the social cultural own responsibilities. But then being in PSI, I was premise that it is through others that we are able so happy because it was my fi rst time I could meet to reach our zone of proximal development or other people and sit down and talk and get more ideas, look at me I have never been at school, so more simply put our developmental potential. like it was a good challenge, to be able to talk to Being part of a community also af fi rms a sense of people, to be able to know those stuff and then belonging. As noted by Cam fi eld (2010 ) , exclu- I can be able to get out, to present myself to oth- sion from activities that children defi ne as impor- ers, it wasn’t any diffi cult it was really good. (McAdam-Crisp, 2006 , p. 123) tant signifi cantly reduced their sense of well-being. Mann ( 2010 ) fi ndings of Congolese refugee chil- The participant’s community also provided a dren in Tanzania asserts that “it was the social venue for generating income. Lydia, Françoise, exclusion, discrimination and harassment that and Roberto were able to work in the informal they experienced on a daily basis and the insecu- economic hawking goods, selling vegetables, and rity and unpredictability of daily life that threat- providing services, such as carrying people’s ened to overwhelm them” (p. 268). Support from suitcases at a train station to support themselves the community is an important protective factor. It and their siblings. Working or the act of generat- is hard to defi ne if this support is more forthcoming income for oneself is a skill that allowed par- ing in collectively based cultures or if it is basic ticipants to increase feeling of ef fi cacy and human nature to want to reach out to others in self-reliance in order to take care of themselves need. For instance, after the Rwandan genocide and those who were important to them. based on the large number of children that had lost It is the interplay between the individual, fam- parents, billboards with the slogan “one child one ily and community that enhances and provides family” were used to campaign for foster families. valuable opportunities that increase the potential Many families took in children. It is questionable for coping and adaptation. One cannot be defi ned if such a campaign slogan in the minority world in isolation from the other. For instance, individ- where the birth rate is dropping, and many are uals and families living in hostile environments if choosing not to have children, in favor of careers, not impacted physically are affected psychologi- independence, and fi nancial gain, would have the cally. These young people encountered many same results. Consequently the values enshrined risks. It is hard to fully isolate the dynamic nature in the collective culture provide opportunities that of the psychological process that de fi ned resil- helped these young people cope. ience; however, comparisons can be made to Refugee camps, schools, military training, understand coping in regards to culture. and contact with nongovernment organizations (NGOs) were also identifi ed community structures that made a difference in the lives of the Discussion participants. Although the refugee camp was defi ned as diffi cult, it also provided an avenue for Theories of resilience that are Western based schooling and medical resources. Those who did address the experiences of those in the minority not have consistent access to school spoke of how world where the vast majority of children and military training provided access to school and youth do not live in situations of war and adversity. 174 J. McAdam

However, minority-world research provides a younger siblings and their lack of maladaptive benchmark upon which information can be mea- coping. These fi ndings support the fundamental sured and compared. Comparisons help to deter- importance of attachment and affi rm that it is not mine the “etic” or universally de fi ned norms, risk, merely de fi ned in relation to the mother, as was and protective opportunities regardless of culture fi rst proposed by Bowlby (1969 ) . and those that are “emic” or dependent on a speci fi c Werner and Smith (2001 ) , Garmezy ( 1993 ) , cultural context (Poortinga, 1997 ) . Brie fl y, this Rutter (1983 ) , Masten ( 2011 ) , and Balwin et al. study affi rms the diverse nature of human devel- ( 1990 ) provide examples of a deductive approach opment, specifi cally childhood and adolescence, to the notion of risk and protective opportunities. across cultures and the dynamic nature of resil- This means that a certain number of risks (e.g., ience (Ungar, 2011 ) . Rutter (1983 ) expanded on above 4) will have a higher probability of leading the outcome of adolescent girls who have moved to a maladaptive outcome. This approach is also between an institutional setting and a disruptive embedded in the diathesis stress model in which home environment, and the probability of early a combination of stressors result in a negative motherhood. Although early motherhood in Africa outcome (Butcher, Mineka, et al., 2010 ) . Risks would most likely be the norm, the stories of Lydia, relate to those within the individual, family, and Roberto, and Peter defy the dependent nature of community and include such things as complica- these adolescent girls. At the age of 14 years, Lydia tions at birth, a mentally ill parent, family insta- cared for her sick mother and provided for her bility, and chronic poverty. How do these risks three younger siblings following her mother’s correlate to those who live in situations of war death. Peter was going to school and working to and adversity? Using a social constructionist support his younger brothers and Roberto was approach, the various risks that the participants working on the city streets in South Africa to sup- encountered and their cumulative effects were port himself. These young people are social actors. extracted from the interviews. The risks to which They challenge the Western notion of adolescence the participants in this study were exposed were as a dependent stage of development. Peter’s jour- different from those de fi ned in the minority ney with his brother to safety challenges the world. The only exception was chronic poverty, Western expectations of childhood. which is de fi ned as a universal risk that has cumu- The participants in this study also help us lative effects. In relation to the above studies, the expand theories of attachment. The participants risk factors de fi ned in this research study might in this study were not deprived of parental attach- more aptly be de fi ned as the death of both par- ment before the age of 4 years. Sroufe et al. ents, the journey to safety, displacement, and (2005 ) support the importance of early attach- chronic poverty. In summary, based on the fi nding ments in the formation of resilient characteristics. of this study, it seems that an abundance of pro- However the siblings of the participants did not tective opportunities may be far more indicative experience these same advantages with their par- of one’s survival than the magnitude of the risks ents. Risks were buffered by a sibling, in the case that were experienced. Risks that do not kill us of Lydia’s young brother who fell into the fi re, weigh less heavily in the midst of protective and the support of another adult, in the case of opportunities that can enhance survival and per- Peter’s young brother. Mann ( 2004 ) af fi rms the sonal well-being. importance of sibling relations for those in situations of adversity in a cross-cultural context. Following the death of his parents, a friend of Limitations Peter’s mother who had found his young brother in the car, cared for him until the age of 6 years. Qualitative data has the unique ability to reveal a This fact is potentially signifi cant in relation to great deal of information about a select phenom- this young boy’s psychosocial health. Both Lydia enon, but in isolation this type of data only illus- and Peter speak with pride at the success of their trates a slice of the truth. Identifying the 12 Coping and Adaptation… 175 limitations provides an opportunity to explore generalized. Yet if these narratives represent the other areas of research and refl ect in more depth elite, what are the stories of the faceless children upon the need to know more. For instance the and youth that remain in situations of con fl ict? majority of young people in this study were fi rst- This study has de fi ned limitations, and areas born children. Research on birth order identi fi es for further inquiry, but it equally adds to a body fi rst-born children as more ambitions and self- of knowledge that seeks to develop and apply reliant (Paulhus, Trapnell, et al., 1999 ) . However culturally ethical practices. So often we hesitate research on how this might or might not transfer to act, as we need to know more; there is a worry across cultures is limited. The majority of the about doing no harm, but I would offer, based on participants in this study were from urban areas my experience working in war zones and the of Africa. This is not representational of the gen- results of this research, that we know enough to eral population of the continent—which is pri- strengthen both policies and practices for chil- marily rural—but might illustrate the availability dren and youth in war zones. This study reaffi rms of resources, such as schools and health centers, the vulnerabilities of those who have lost their in urban centers that can enhance coping. parents, their need for mentorship, and advocacy Additionally this group, although they are all for their basic needs. It provides support for non- from Africa, are not homogenous. For instance, formal educational programs that have the ability 41 years of war in a country, such as Angola, to reach young people who have been marginal- means that three to four generations have normal- ized by war. Policies and practices that support ized and survived this adversity. Studies of holo- the informal economy and the development of caust survival have illustrated that three youth entrepreneurs are also needed to enhance generations later the birth weight of babies of this the potential for these young people to overcome lineage is still statistical lower (Hazani & Shasha, issues of poverty. 2008 ) . To fully understand the impact of war, a select group of individuals would have to be interviewed from Angola and compared to those Conclusion that had not experienced the same historical adversity. Ethnic origin might also pose a similar This study identifi es patterns of survival that limitation that could either enhance or deter an poses both risk and opportunities for young peo- individual’s coping abilities. For instance, Hassan ple in war zones. The study reinforces the sys- described himself as a Dinka and spoke of pride temic nature of coping and adaptation, a model of his cultural heritage. The cultural heritage of that de fi es the Western individualistic model of the other participants did not support their sense psychotherapy for those in the majority world. of identity in the same way. It allows us to understand and learn about the As with any study, there are limitations that circumstances of those that lost their parents, the provide opportunities for future research and journey to safety, displacement, the refugee expe- areas to refl ect upon in regards to the analysis. rience, and the hazards of living in war zones. This study, although expansive in content, drew Drawing on theories of resilience couched within upon an elite group of participants. This group three different models of human development, was defi ned as elite because they had all survived the risk and opportunities of those in the majority horrifi c circumstances and ended up as unaccom- world that live in extreme adversity are defi ned panied minors or adults in Canada. The majority within the cultural context of Africa. In the major- of unaccompanied minors in situations of con fl ict ity world young people are social actors; the do not travel internationally. This study draws notion of childhood and adolescence as a depen- upon the experience of those that illustrated high dent state is challenged. The extensive nature of levels of physical survival and psychological family and siblings provides supports that would resilience. For this reason it cannot be assumed not necessarily be available to those in the minor- that these characteristics can be categorized or ity world. This study illustrates a multitude of 176 J. McAdam risks. This study is not deductive: it cannot tell us Boothby, N. (1996). Mobilizing communities to meet the that those who experienced a certain number of psychosocial needs of children in war and refugee crisis. In R. J. Apfel & B. Simon (Eds.), Mind fi elds in risks survived because they were outweighed by their hearts the mental health of children in war and a greater number of protective factors. That said, communal violence . London: Yale University Press. the experience of risks over an extended period of Bowlby, J. (1969). Attachment and loss . New York: Basic time, in the absence of any opportunities, may be Books. Boyden, J., & Gibbs, S. (1995). Children of war response a stronger indicator of maladaptive coping than to psycho-social distress in Cambodia . Geneva: the risks. Practices that can increase the abun- The United Nations Research Institute for Social dance of protective factors for children of war Development. enhance resilience regardless of the risk. The Boyden, J., & Mann, G. (2000). Children’s risk, resilience and coping in extreme situations: Background paper abundance of protective factors, in the midst of to the consultation on children in adversity (pp. 1–25). risks, seems to be a much stronger indicator of Oxford: Refugee studies and Centre for child-focused one’s ability to survive and cope than measure- anthropological research. ments of risks. Protective opportunities more Bronfenbrenner, U. (1979). The ecology of human development: Experiments by nature and design . Cambridge, adequately allow us to defy the risks that life MA: Harvard University Press. presents. Protective factors de fi ned in relation to Bronfrenbrenner, U., & Morris, P. (2006). The bioecologi- the individual in the context of the family and the cal model of human development. In R. M. Lerner & community and the social capital in each must be W. Damon (Eds.), Theoretical models of human development: Handbook of child psychology (Vol. 1, p. abundant. 793). New York: Wiley. Butcher, J., Mineka, S., et al. (2010). Abnormal psychology . Toronto: Pearson. Cam fi eld, L. (2010). Stew without bread or bread without References stew: Children’s understanding of poverty in Ethiopia. Children and Society, 4 , 271–281. Aptekar, L. (1988). Street children of Cali. London: Duke Doná, G., Kalinganire, C., et al. (2001). My child is yours University Press. and ours—The Rwandan experience of foster care for Aptekar, L., & Boore, J. (1990). The emotional effects of separated children . Kigali, Rwanda: UNICEF. disaster on children: A review of the literature. Frankl, V. E. (1963). Man’s search for meaning . NY: International Journal of Mental Health, 19 (3), 77–90. Washington Square. Aptekar, L., & Stocklin, D. (1997). Children in particu- Fraser, M. W. (Ed.). (1997). Risk and resilience in child- larly diffi cult circumstances. In J. W. Berry, P. R. hood an ecological perspective . Washington, DC: Dasen, & T. S. Saraswathi (Eds.), Handbook of cross National Association of Social Workers. cultural psychology (Vol. 2, pp. 377–412). Needham Garbarino, J., Kostelney, K., et al. (1991). No place to be Heights, MA: Allyn & Bacon. a child growing up in a war zone. San Francisco: Balwin, A., Balwin, C., & Coles, R. (1990). Stress- Jossey-Bass Inc. resistant families and stress-resistant children. In J. Gardiner, H., & Kosmitzki, C. (2002). Lives across cul- Rolf & N. Garmezy (Eds.), Risk and protective factors tures: Cross-cultural and human development . Boston, in the development of psychopathology . New York: MA: Allyn & Bacon. Cambridge Press. Garmezy, N. (1993). Children in poverty: Resilience Barker, G., & Knaul, F. (1991). Exploited entrepreneurs: despite risk. Psychiatry, 56 , 127–136. Street and working children in developing countries . Garmezy, N., & Rutter, M. (1983). Stress, coping and W. Paper. New York, U.S.A., CHILDHOPE. development in children . New York: McGraw-Hill. Berry, J. W., Dasen, P. R., et al. (1997). Handbook of Gilgun, J., & Abrams, L. (2005). Gender adaptations, cross-cultural psychology volume 2 basic processes resilience, and the perpetration of violence. In M. and human development. Needham Heights, MA: Ungar (Ed.), Handbook for working with children and Allyn & Bacon. youth: Pathways to resilience across cultures and con- Berry, J. W., Poortinga, Y. H., Segal, M, & Dasen, P. R. texts (pp. 57–70). Thousand Oaks: Sage Publications. (1992). Cross-cultural psychology. Cambridge: Hazani, E., & Shasha, S. (2008). Effects of the holocaust England, Cambridge University Press. on the physical health of the offspring of Survivors. Berry, J. W., Poortinga, Y. H., et al. (1997). Handbook of Israel Medical Association Journal, 10 (April), cross-cultural psychology: Vol 1. Theory and method . 251–255. Boston, MA: Allyn & Bacon. Kozulin, A. (1990). Vygotsky’s psychology . Cambridge, Blanc, C. S. (1994). Urban children in distress global pre- MA: Harvard University Press. dicaments and innovative strategies. Florence, Italy: Lewis, T., Amini, F., et al. (2001). A general theory of United Nations Children’s Fund. love . New York: Random House. 12 Coping and Adaptation… 177

Machel, G. (1996). Promotion and protection of the rights Rutter, M. (1975). Helping troubled children . New York: of children impact of armed confl ict on children (pp. Plenum Press. 1–78). New York: United Nations Department for Rutter, M. (1983). Pathways from childhood to adult life. Policy Coordination and Sustainable Development Child Psychology and Psychiatry, 30 (1), 23–51. (DPCSD). Sack, W. H., Angell, R. H., Angell, R.H., & Manson, S., Mann, G. (2001). Networks of support: A literature review (1986). The psychiatric effects of massive trauma on of care issues for separated children . Stockholm: Save Cambodian children: In the family, home, and the the Children Sweden. school. Journal of American Academy of Child and Mann, G. (2004). Separated children: Care and support in Adolescent Psychiatry, 25, 377–383. context. In J. Boyden & J. de Berry (Eds.), Children Sack, W. H., Chanrithy, H., & Dickason, D., (1999). and youth on the front line: Ethnography, armed Twelve years of follow-up study of Khmer youths who con fl ict and displacement . New York: Berghahn suffered massive war trauma as children. Journal of Books. American Academy of Child and Adolescent Mann, G. (2010). ‘Finding a life’ among undocumented Psychiatry, 38(9), 1173–1179. Congolese refugee children in Tanzania. Children and Sroufe, L. A., Egeland, B., et al. (2005). The development Society, 24 (4), 261–270. of the person: The Minnesota study of risk and adapta- Masten, A. (2001). Ordinary magic: Resilience process in tion from birth to adulthood. New York, NY: development. American psychologist, 56 (3), 227–328. Guilford. Masten, A. (2011). Resilience in children threatened by Super, C., & Harkness, S. (1997). The cultural structuring extreme adversity: Framework for research, and prac- of child development. In J. W. Berry, P. R. Dasen, & T. tice, and translational synergy. Development and S. Saraswathi (Eds.), Handbook of cross-cultural psy- Psychopathology, 23 , 493–506. chology (p. 2). Needham Heights, MA: Allyn & McAdam-Crisp, J. L. (2006). More than luck: A retro- Bacon. spective study of the cultural and developmental risks Tolfree, D. (1995). Roofs and roots . Arena: Aldershot. and opportunities of children and youth from zones of Ungar, M. (2011). The social ecology of resilience: con fl ict in Africa. In Human and social development Addressing contextual and cultural ambiguity of a (pp. 161). Santa Barbara: Fielding Graduate University. nascent construct. American Journal of Ph.D. Orthopsychiatry, 81 (1), 1–17. Paulhus, D., Trapnell, P., et al. (1999). Birth order effects Veale, A., & Adefrisew, A. (1992). Study of street children on personality and achievement within families. in four selected towns of Ethiopia . Addis Abba, Psychological Science, 10 (6), 482–488. Ethiopia: Ministry of Labour and Social Affairs, Perry, B. (2004). Maltreatment and attachment a neurode- Unicef, University College Cork. velopmental perspective. Early Years: Relationships, Werner, E. E., & Smith, R. S. (1992). Overcoming the Vancouver, BC. odds: High risk children from birth to adulthood . Poortinga, Y. H. (1997). Towards convergence? In J. W. Ithaca, NY: Cornell University Press. Berry, Y. H. Poortinga, & J. Pandey (Eds.), Handbook Werner, E. E., & Smith, R. S. (2001). Journey from child- of cross-cultural psychology (Vol. 1, pp. 347–387). hood to midlife: Risk, resilience, and recovery . Ithaca: Boston: Allyn & Bacon. Cornell University Press. Pathways of Success Experiences Among the “Lost Boys” of Sudan: 1 3 A Case Study Approach

Laura Bates , Deborah J. Johnson , and Meenal Rana

In recent years, changes in the nature of warfare 1992 to 2001). After being expelled from Ethiopia have increased the risks for children. In the due to a regime change in May 1991, they lived decade 1986–1996, UNICEF ( 1996 ) estimates temporarily in displacement camps in Sudan that two million children were killed in wars and before making the trek to Kenya (Bixler, 2005 ) . one million orphaned or separated from their par- During their fl ight they experienced multiple ents. Statistics on the total number of children traumas, such as attacks by enemy soldiers and separated from their parents are lacking, but in wild animals, witnessing the deaths of friends and 2003, 12,800 unaccompanied refugee children family members, and suffering from chronic applied for asylum in developed countries—4 % adversities such as lack of food, water, and medi- of total asylum applicants (UNHCR, 2004 ) . cal care. In the camps they had limited access to These children, living without the support and adult support, education, or work opportunities protection of adults, are a particularly vulnerable (Bixler; Geltman et al., 2005 ) . Most of these group (Hepburn, Williamson, & Wolfram, 2004 ) . youth ended up in Kakuma refugee camp in Occasionally, it is deemed in the best interest of Kenya, where they lived in peer groups with lim- children without adult support (known as sepa- ited adult supervision for nearly a decade. In rated or unaccompanied children) to resettle them 2000–2001, the United Nations resettled a in another country, especially when their parents selected group of youth who were determined to are deceased or untraceable and they are unlikely be unlikely to be reunited with family in North to return to their own country because of continu- America, Europe, and Australia. The rest remained ing confl ict. Such was the case for a group of in refugee camps until the peace agreement of youth known in the media as the “Lost Boys” of 2005 ended the civil war in Southern Sudan. Sudan. Some 3,800 youth were recommended for These refugee youth, mostly boys, were sepa- resettlement in the United States (Bureau of rated from their families as young children (typi- Population, Refugees, and Migration, 2005 ) . The cally between 4 and 12 years of age) during the majority of those resettled were members of the Sudanese Civil War; they lived apart from their Dinka tribe, the largest tribe in Southern Sudan parents in refugee camps initially in Ethiopia (late (Bixler, 2005 ) . Those who were determined to be 1980s to May 1991) and later in Kenya (June less than 18 years of age were resettled through the Unaccompanied Refugee Minor Program and placed with foster families. They received ser- L. Bates (*) • D. J. Johnson • M. Rana vices such as casework, cultural orientation, University Outreach and Engagement, fi nancial aid, and tutoring until they were age 18 Michigan State University , 93 Kellogg Center, 219S. Harrison Road , East Lansing , MI 48824 , USA and assistance in attending college until the age e-mail: [email protected] of 21. The youth who were deemed to be at least

C. Fernando and M. Ferrari (eds.), Handbook of Resilience in Children of War, 179 DOI 10.1007/978-1-4614-6375-7_13, © Springer Science+Business Media New York 2013 180 L. Bates et al.

18 years old were resettled as adults and received from family and ambiguous loss, or not knowing limited support. The adults, called “majors,” the fate of their missing parents (Luster, Qin, received cultural orientation, volunteer mentors, et al., 2009) , exposure to violence, and chronic and fi nancial assistance for only a few months, adversity (Bixler, 2005; Duncan, 2001 ; Geltman after which they had to become self-supporting. et al., 2005 ; Luster, Qin, et al., 2008, 2009 ) . They received assistance with job search skills Masten and Powell ( 2003 ) proposed that com- for a few years but did not receive any support for petence be judged in terms of how well the child continuing education. is mastering developmental tasks that are salient This summative chapter will review fi ndings for people of a given age, society or context, and from 8 years of research following this group’s historical period. Research has established that adjustment and adaptation to life in a very differ- many children manage to do well despite expo- ent culture. Several waves of data collection were sure to trauma or chronic adversity (Luthar, conducted about their experiences, examining top- 2003) . Studies of children exposed to risk have ics such as early adjustment, living in foster fami- identi fi ed protective factors associated with resil- lies, adaptation, and educational resilience. We ience that fall into three categories: (a) individual also explored their experiences of separation from characteristics, (b) relationships, and (c) commu- parents in Africa and coping with loss, as well as nity resources (Masten & Powell, 2003 ) . Cultural the eventual reconnection of some with their birth factors may also play an important role in how families. Data were collected in 2002, 2007, and separated youth cope with stressors (Mann, 2008 (2, 7, and 8 years after their resettlement, 2004 ) . Duncan ( 2001 ) attributed the resilience respectively). We also investigated the challenges that she observed in the Sudanese youth in the they faced and how they adapted from the perspec- refugee camp primarily to three individual char- tive of agency caseworkers and foster parents. acteristics: (a) religious faith, (b) a strong desire In this chapter we review their adaptation over for education, and (c) a desire to contribute in a time and investigate the developmental pathways positive way to rebuilding Sudan. of four successful young men from our study 10 years after resettlement. Through case study analysis we will explore the following questions: Research on Unaccompanied (1) How do the Sudanese refugee men describe and Separated Children success 10 years after resettlement? (2) Are there speci fi c life circumstances and resettlement con- Children exposed to high levels of trauma prior to texts that may have contributed to greater or resettlement are at high risk of adjustment prob- lesser success? (3) What challenges did they face lems, particularly among children who lack and how did they cope with these challenges? parental support ( Bean, Derluyn, Eurelings- Bontekoe, Broekaert, & Spinhoven, 2007 ) . Prior research on factors that in fl uence the long-term Theoretical Framework adjustment of unaccompanied children following resettlement is limited; however, the available Our research used a resilience framework to study research studies suggest some important consid- the adaptation of these youth. Masten and Powell erations for successful adaptation that fi t within a (2003 , p.4) de fi ne resilience as “patterns of posi- risk and resilience theoretical framework. tive adaptation in the context of signi fi cant risk or These studies have identifi ed positive personal adversity.” A risk factor can be defi ned as a char- attributes associated with successful adjustment acteristic of the person or of the context that among unaccompanied minors: intellectual abil- increases the likelihood of a negative develop- ity, language skills, and a commitment to educa- mental outcome ( Werner & Smith, 2001 ) . Clearly, tion (Maegusuku-Hewett, Dunkerley, Scour fi eld, the Sudanese refugee youth were exposed to & Smalley, 2007 ) ; future orientation and opti- multiple risks in Africa, including separation mism (Maegusuku-Hewett et al.); and personal 13 Pathways of Success Experiences Among the “Lost Boys” of Sudan: A Case Study Approach 181 traits appealing to adults (Moskovitz, 1983 ) . First, we examined their adjustment in the fi rst Relationships are also critical for children sepa- few years after resettlement from multiple per- rated from their parents, including foster parents spectives. Seventy youth—24 major males, 41 (Hek, 2007 ; Moskovitz) and adult members of minor males, and 5 minor females—completed the youth’s own ethnic community (Legarretta, measures of posttraumatic stress, behavioral 1984) . Community resources, such as school adjustment, education, employment, and sources support for educational success (Kia-Keating & of support. Forty-nine youth participated in 9 Ellis, 2007 ) and support from the resettlement focus groups and 10 foster parents participated in agency (Hek, 2007 ) , also contribute to positive 2 focus groups. Five agency caseworkers were adjustment. interviewed. The challenges in early adjustment for all youth involved learning to negotiate in a new cul- Research on Resettled Sudanese ture and deal with the effects of trauma. Table 13.1 Refugee Youth summarizes the key fi ndings on their early adjustment. Minor youth had a great advantage over the Since 2002 our research team has been following major youth because of the resources available to the adjustment of Sudanese refugee youth reset- them through the foster care system. Overall, in tled in our area. Between 2002 and 2008 there the fi rst 2 years both majors and minors were have been three rounds of data collection focus- functioning well in work, school, and personal ing on three general areas: (1) early adjustment of relationships, despite the fact that some youth young adults and unaccompanied minors; (2) ret- reported signifi cant symptoms of posttraumatic rospective refl ections on their experiences of stress. A high percentage of both groups reported separation, loss, and reconnection with birth fam- having supportive relationships. ilies; and (3) the experience of foster care for the Our second substudy explored their experi- unaccompanied minors. Using the risk/resilience ences of separation and loss; Table 13.2 summa- framework, we have studied the successes and rizes our fi ndings. The sample for this study challenges of the youth and how they adapted to included ten young men (mean age 25.8 years), their new environment from their own perspec- seven majors and three minors, who participated tive as well as from the perspectives of others in semi-structured interviews 7 years after involved in their care. resettlement.

Table 13.1 Early adjustment to life in the United States for Sudanese refugee youth Risks Protective factors Key ﬁ ndings Psychological Personal attributes Education a primary goal for most Posttraumatic stress and other Sociability Most majors working, half in school effects of trauma Adaptability Most minors in school, some working Survivor’s guilt Spirituality Had to learn new conceptualizations Basic needs Relationships of race in America Becoming self-supporting Cultural brokers—foster parents, mentors Many found missing families after (majors) Sudanese peers peace agreement (2005) Relationships Reconnection w/ lost family members Negotiating relations with (post 2005) foster parents (minors) Community resources Learning about school, Resettlement agencies, caseworkers American peer culture New educational opportunities (minors) Cultural Negotiating a new culture Prejudice based on race and immigrant status Data sources: Bates et al. (2005 ) ; Luster, Bates, and Johnson (2006 ) ; Luster, Johnson, et al. (2008 ) ; Luster, Qin, et al. (2008 ) 182 L. Bates et al.

Table 13.2 Experiences in Africa Risks Protective factors Key fi ndings Psychological Personal attributes Most signi fi cant stressors were living Multiple traumatic events, Spirituality, sociability without adult support and coping with such as witness to death, Resourcefulness, persistence ambiguous loss attacks by wild animals, and Future orientation Hope for reuni fi cation brought “strength” bombing Commitment to education Elders provided contact w/ culture and Early separation for parents Self-ef fi cacy suggested coping strategies Ambiguous loss, not knowing Relationships Psychological presence of parents fate of parents and family Peers important through remembered advice members Tribal elders, teachers, and caretakers and moral stories Basic needs in camps Cultural notions of mastery helped them Chronic adversity, including Temporary families accept things that can’t be controlled lack of food, water, and Psychological presence of parents medical care Community Lack of educational Camp activities opportunity Churches Relationships School Limited support from adults Culture Cultural events in camps Cultural values, experience w/ self-reliance, and alternate family forms Data sources: Bates, Luster, Johnson, Qin, and Rana (In press); Luster, Qin, et al. (2008, 2009 )

They remembered experiencing multiple family members still in Africa, which relieved traumatic events and adversity due to lack of some of the stress that youth experienced, adult support and resources to meet basic needs. although they took on added responsibility for The most signi fi cant stressor they described was family members. living without support and coping with ambigu- Our third substudy examined the foster care ous loss, which Boss ( 2006) defi nes as not know- experience retrospectively from the perspectives ing if a loved one is living or dead. Boss identifi es of the minor youth and their foster parents 8 years ambiguous loss as particularly stressful for sur- after resettlement, at which time most, but not all, vivors because the loved one remains psycho- youth had left their foster homes. Nineteen youth logically present although physically absent. The and 15 foster parents participated in semi-struc- youth identifi ed several factors that helped them ture interviews. Table 13.3 summarizes the to cope. They considered a future orientation and fi ndings. maintaining hope to be essential to survival. Parent and youth perspectives differed in sev- Many expressed the view that those who dwelt eral key aspects (Luster et al., 2010 ) . While youth on their lost past became depressed and even emphasized personal agency and the in fl uence of died (Luster, Qin, et al., 2008) . The youth peers as factors in success, parents tended to described relationships with other adults, partic- focus on developmental history. Some parents ularly tribal elders, that gave them support and promoted rapid acculturation, while youth guidance. The youth also mentioned cultural val- emphasized bicultural competence. In the current ues, such as respect for elders, close peer rela- round of data collection, we returned to four tionships, and an emphasis on early self-reliance males who had participated in earlier studies to as helpful in coping. After 2005, many youth examine their perspectives on success as young were able to reconnect with parents and other men who have reached adulthood. 13 Pathways of Success Experiences Among the “Lost Boys” of Sudan: A Case Study Approach 183

Table 13.3 Unaccompanied minor youth’s experiences in foster care Group Risks Protective factors Key fi ndings Youth Psychological Individual attributes Education a primary goal perspective Mental health issues Motivation, hard work of resettlement Alcohol use/abuse Educational aptitude Focused on helping those Acculturation stress Focus on education left behind Family relationships Immigrant optimism Changes in foster care Con fl icts w/ foster parents Avoidance of alcohol placements led to better reautonomy and trust Relationships fi t overall Cultural differences Foster parents Successful youth Early parenthood for a few American and Sudanese peers combined best aspects of Education Teachers and counselors both cultures through Lack of educational preparation Psychological presence of parents selective acculturation Limited English language skills Community resources Successful youth willing Problems with peers in schools Churches to seek help from others School policies Foster care agency Financial constraints Culture Memories of “where we come from” Bicultural facility Foster parent Psychological Individual attributes Differing de fi nitions of perspective Mental health issues Sociability “success” Alcohol abuse Adaptability Parents focused on rapid Acculturation stress Relationships acculturation; youth Needs of family members in Africa Parental support emphasized bicultural Educational Connections to Sudanese peers competence Lack of basic skills Positive American peer relationships Parental commitment Lack of resources for ESL, low Community exceeded agency expectations of teachers Involvement in school activities expectations Culture Culture Parents retained strong Involvement in negative aspects of Maintaining connections to native culture attachment to youth 7 American youth culture years after placement Data sources: Bates et al. (under revision); Luster, Qin, Bates, Rana, and Lee ( 2010 ) ; Luster, Saltarelli, et al. ( 2009 ) ; Qin et al. (Revisions pending); Rana, Qin, Bates, Luster, and Saltarelli (2011 )

We used case study methodology, appropriate Method to understanding the experiences of Sudanese youth in great depth (Yin, 1994 ) . The unit of We used purposive sampling by selecting youth analysis was individuals (Yin). Where available, based on our prior knowledge of their successes we used the data from earlier interviews to place from our earlier studies. We conducted in-depth their experiences in a longitudinal context. The interviews with four youth: two who came to the other purpose of examining the earlier data was United States as minors and lived in a foster fam- to triangulate the recent data, a process described ily and two who came as young adults and lived as chain of evidence by Yin. independently. Two men were interviewed face We used the following steps in the data analy- to face and two by telephone. Ninety-minute sis (Yin, 1994 ) : (1) the ﬁ rst author arranged the semi-structured interviews explored the com- data in arrays, categorizing them under themes, plexities of personal attributes and contexts that such as success, challenges, disappointments, led to successes of these youth. The interview and adjustment/coping, including the evidence protocol included several topics, including for each case; (2) the third author reviewed the accomplishments and challenges, factors contrib- categories in each array to con ﬁ rm the accuracy uting to their success, relationships, and future of the data; (3) the team agreed upon the com- goals. monalities and differences among the four cases. 184 L. Bates et al.

In the next section, we present each case followed not married or engaged and has no children. He by a summary of the men’s perspectives on fac- identi fi es as a Catholic. He is a member of a tors that contributed to their success and that of smaller tribe in Southern Sudan but is related by other Sudanese refugees who resettled with marriage to the Dinka tribe. them. Angelo believes that his education is his most signi fi cant accomplishment, “…because knowledge is something that once you acquire it, it’s Findings very hard for somebody to take it away from you. You can lose money in no time [laughs] so…con- Case Study Descriptions tinuing to go to school is the most signi fi cant accomplishment so far.” His greatest disappoint- In describing the cases, we have used pseud- ment was also education-related: not qualifying onyms and omitted potential identifying data to to go to medical school. protect the con fi dentiality of the participants. For Another challenge for Angelo has been the each case study we fi rst describe the young man’s social isolation that he feels in American culture. current situation, including his personal and fam- This feeling has been exacerbated by moving ily circumstances, education, and employment. away from the state in which he resettled for bet- Then we describe his perceptions about his ter job opportunities. In Africa, he said, people accomplishments, challenges and disappoint- are more social and help others, even if they are ments, and strategies he used to cope with chal- strangers. He sees Americans as busy people who lenges. Finally, we present his goals and hopes don’t take time to socialize and are sometimes for the future. Demographic information about reluctant to help others over safety concerns. the four men are presented in Table 13.4 . Angelo reconnected with lost family members in Africa and has returned to Sudan several times Case Study 1 : Angelo. Angelo is 27 years old and since then. He maintains a friendly relationship entered the United States as an unaccompanied with his foster mother but does not talk with her minor; he lived with a foster family for 2 years. often because, like his fellow Americans, he is He is an American citizen who lives in a small “busy.” Midwest town, where he moved for a job oppor- Success can be bolstered or emerge from how tunity. There are not many immigrants in the area. challenges are managed. When asked how he He works full time in a fi eld related to his B.Sc. coped with challenges, the fi rst thing he men- degree. Angelo came to the United States rela- tioned was his ability to seek and use help from tively well prepared educationally; while in the others: “Always being reminded to seek for help refugee camp, he attended a private school for 2 is something that is always very important. years on a UNICEF scholarship. He has a mas- Because nobody is an island and you need other ter’s degree in business from an online university people to realize your goal.” He also stated that and is working on a Ph.D. in organizational man- adaptability is important because life can’t always agement. He lives alone, with the nearest be controlled, “…of course, life, you have to deal Sudanese community about 50 miles away. He is with it [laughs].” He feels that the opportunity

Table 13.4 Overview of case study participants Name Age Major or minor Education Employment Marital status Children Angelo 27 Minor MA, PhD in process Yes, full time Single No John 25 Minor MPH, starting PhD No Married No Mangok 29 Major BA Yes, full time Single No Jafar 33 Major Less than high school Yes, full time Engaged Yes 13 Pathways of Success Experiences Among the “Lost Boys” of Sudan: A Case Study Approach 185 to get an education was a great resource. He called names such as “monkey” and accused of overcame his initial disappointment at not going coming to take jobs from Americans. On the to medical school, because “I still work in the other hand, after living with a white family he health care fi eld and there are many other things was perceived by some of his fellow refugee I can do with other degrees.” youth to be “too white”: His goals for the future include completing his All these prejudice I’m not saying it’s just only Ph.D. and getting a job working overseas in an American….it’s the same thing because those peo- international agency using his human resource ple [other Lost Boys] have been brainwashed into and business skills. He would like to get married it is ok to do this and hip hop and all this stuff…. Well me, I don’t want to be like them…. and start a family, but has no immediate plans. Long term, he thinks about starting an online col- He also feels stress from having too much to lege in Africa and possibly teaching and doing do, trying to help those left behind while also business: “When you get older you like to have continuing his education and speaking about something where you like to do [sic]. When you Sudanese issues. build a school, you always have people who like John names a number of personal attributes to go to school.” that have helped him to overcome life’s challenges: goal orientation, adaptability, sociability, Case Study 2 : John . John is 25 years old and and the capacity to make good decisions. His entered the United States as an unaccompanied description of how a refugee must adapt is telling: minor. He lived for 3 years in a foster home while “…if you are a refugee you have to be fl exible, completing high school. He has bachelor’s and like a chameleon you have to adapt quickly, oth- master’s degrees in public health. He recently erwise it’s very hard to survive in many, many relocated out of state to pursue a Ph.D. and is not societies because really that’s the key….” currently employed. This year he married another Religion has been most the powerful support Sudanese refugee but they have no children; both in his life. He believes that God showed him the are US citizens. He belongs to the Dinka tribe plan for his life: and has reconnected with family in Sudan. My life story has taught me not to mess myself up John named several major accomplishments. in America none of this time, my Lord, Jesus Christ First is completing his master’s degree and being brought me [i.e., didn’t bring me] out of all these accepted into a Ph.D. program. He has also been atrocities just to blow the opportunity of [by] not going to college and waste my time with drinking awarded a Foreign Language and Area Studies and partying. Fellowship to study Arabic. A second milestone was his marriage. His third accomplishment was Among the supports that God brought to him starting a nongovernmental organization (NGO) was his foster mother, who helped him make with friends to raise money for a health clinic in good decisions about school, professors who their home village. He has spoken about Sudanese acted as mentors, and his family in Sudan, who issues throughout the country and at the United helped him with his dowry. He maintains ties Nations where he met First Lady Laura Bush. with his foster mother, who attended his wedding John attributes all his successes to the will of and sits on the board of his NGO. God: “So it’s been accomplishments through the In the future he would like to fi nish his Ph.D. grace of God, so I thank God for that….” and fi nd a way to help those left behind. He would John has experienced disappointments. His like to fi nd a job working in Sudan, perhaps help- initial goal was to go to medical school, but he ing them to build the new nation’s health care was not accepted. He has also experienced social system. He also plans to continue his efforts to isolation living with a white foster family in a grow his NGO and fi nd ways to fund and staff it. community that was almost all white. He was In the future, he would like to have children, and subjected to racial and anti-immigrant prejudice he and his wife are both very committed to help- from students in his high school, where he was ing Sudan. 186 L. Bates et al.

Case Study 3 : Mangok. Mangok is 29 years old He attributed his ability to overcome these and lives in the area where he was resettled 10 challenges to his determination and eagerness to years ago. He entered the United States as a get an education. He was also motivated by views “major,” so he did not receive educational or fam- he remembered hearing expressed by his parents ily support and had to become self-supporting and elders in the village that the Southern Sudanese quickly. However, he did have several American were oppressed because they lacked education. mentors with whom he maintains contact. He is As he gained experience, he observed on his own currently living with American friends in the that people who had education were better off. He area. When he arrived in the United States, he had mentors and friends in America who gave him had a tenth grade education. He completed his support and guidance. He said that the schools in B.A. in December from a local university. He is the refugee camps were an important resource for employed in a job that is not related to his degree. him: “Actually if the United Nations has not He is single and has no children. He is a member decided to provide basic education to the refugees, of the Dinka tribe and has reconnected with lost yes, I should have had a dream without a school.” family members in Sudan. He made a short visit Someday he would like to have a job with an to his home village 2 years ago. When he became agency working in Sudan. In the near future, if he a United States citizen, he decided to return to his does well on the aptitude exams, he may apply to African name instead of the name given to him law school, because his father was on the village when he converted to Christianity. court and he thinks law would be a good career. In Mangok’s mind, getting his university He would like to return to Sudan soon for a lon- degree is his greatest accomplishment. He com- ger visit with his family and plans to continue pleted his General Equivalency Degree (GED) by raising money to sustain the health clinic. He studying on his own and then earned associate’s may marry someday if he fi nds the right girl. and bachelor’s degrees: Moreover, he hopes to return to Sudan to live It is a dream I have been dreaming since I was in some day: “I’d love to live in Sudan. It is home. I the refugee camp. Except that in the refugee camp know there are a lot of challenges, but it’s worth I cannot imagine coming to America…..I thought it. It’s a good place to live.” maybe the end of my education would be the 12th grade, which was offered by the United Nations. Case Study 4 : Jafar. Jafar is 33 years old and He continued to support himself while in came to the United States as a major. He lives in school, and after 2005 he took on responsibility the city where he resettled with some of his for the medical care and education of his family friends who arrived with him. He still has the fi rst in Sudan. His second major accomplishment was job he got after resettlement, working in the working with John and others to build a health warehouse of a local retail chain. He has not clinic in Sudan. fi nished high school, but has passed several parts The major challenges in Mangok’s life have of the GED exam. He received only 1 year of concerned the stress of having to work while also schooling in Sudan before the war broke out and going to school and dealing with the fi nancial was 14 years old before he had the chance to strains of meeting his family and school respon- resume schooling in the refugee camp, so he was sibilities. He had to schedule classes around work far behind other children of his age. He is a mem- and struggled to fi nd the time and energy to study. ber of one of the smaller tribes of Southern Sudan, Because family members in Sudan did not count as are his housemates. He is a US citizen. He and as dependents in qualifying for fi nancial aid, he his fi ancé, who is also a Sudanese refugee, have a ended up with less aid and more loans. His 2-year-old son; they live in another city, where responsibilities to his family were a major worry: his fi ancé has a job. He has also found his mother “So my mother and my sister and my uncle… and other family members living in Sudan and they were part of the responsibility that I was visited them in 2008. He is a member of a local talking about. I was able to let them go see a doc- Christian church and received a Christian name, tor and pay a lot of money for their treatment.” but has returned to using his African name. 13 Pathways of Success Experiences Among the “Lost Boys” of Sudan: A Case Study Approach 187

Jafar considers the birth of his son to be his too, so I don’t want him to live on with his mom major accomplishment: “First of all, what I really without me in his life. That will not be okay for me. want to mention here is the most accomplishment that I’m really happy about it is me having a baby He sees education as a means to provide for boy.” He is also proud of his work history, as he his family, so his son will have educational oppor- has worked continuously with the same employer tunities that he missed. His other goal is to build since he arrived without any breaks in employ- a school for his home village. Since returning ment. He is pleased that his employment has from his visit, he has organized a group at his enabled him to support his family here as well as church to start fund raising: to help relatives in Sudan. He feels that getting So when I get to the village I fi nd children in the along well in the community where he lives, and village they don’t have any school. And the few avoiding any trouble with the law, are also elders who came and visit me, all they were talking accomplishments. about was the school… So that gives me some thought that maybe if I come back here I can be One of his major challenges has been trying to able to ask people around who are willing to help make educational progress while simultaneously me so that I can build school for these children working to support family. When his father died who are going without school so that they can build in Sudan in 2005, he deferred study and worked better future. extra hours to save money for a visit. The visit allowed him to form a closer relationship with his mother, which has relieved some of the stress he Factors Contributing to Success was feeling about their well-being. However, for All Youth maintaining a strong connection to his fi ancé and child in another city and helping to support his The young men interviewed had varying son leave little time to pursue his educational de fi nitions of success. Education was an impor- goals. tant goal for all, but family formation, a good He deals with his disappointments and chal- work history, and efforts to take responsibility for lenges by taking things one step at a time, main- family or for Sudan in general were also consid- taining a positive outlook, and remaining fl exible: ered successful adaptations. However, not taking I’m a kind of person, I always don’t stress myself advantage of opportunities, not striving, was con- about anything that is going wrong in my life or sidered unacceptable. John expressed this per- bad that can disturb me…. So sometimes you don’t spective. “…calling someone successful is a little plan for something that might come up. So they just bit complicated…. because successful is not nec- happen at their own time and you have to fi nd a way to deal with them. And I’ve been good in that. essarily going to school, it could be you are working, you know. My frustration goes to those Lost Although supporting both of his families is a Boys that…were doing nothing.” source of stress, those relationships are also a When asked why some Sudanese youth were principal source of strength for him in dealing more successful than others in adapting to life with life. He maintains close relationships with after resettlement, the men articulated some com- the men he lives with, who he considers a second mon themes. First, three of the men mentioned family. His American mentors also live close by lack of educational aptitude and opportunity to and make themselves available to help if needed. go to school as major barriers. As Mangok put it, In the future, Jafar would like to live with his “People are different. There are those who can fi ancé and son, either in his home city or in theirs. understand education better and those who can- He feels that being with his family will help him not….. Some didn’t understand it very well and to achieve his educational goals: others didn’t have as good a start in education.” That will help me much better to concentrate on He mentioned some youth who took ESL classes other stuff that I’m doing whether at school or in for which they had to pay, and got discouraged life-wise. And because my son is getting bigger after failing repeatedly. John talked about the 188 L. Bates et al. lack of resources “majors” faced often in reach- lenges that might appear daunting to others, such ing their goals, “Those people who were 18 and as blocked pathways to opportunity, prejudice, above, it was hard for them. Good luck living in and even mental health dif fi culties. America, you have to fi nd a job, you have to go Their success “toolkit” includes how they to school, you have to do everything on your defi ne success in life as well as their varied strat- own.” egies for achieving their core goals. Consistent Another overall theme was personal choices coping strategies seen throughout their develop- that youth made. Angelo talked of how some ment include a focus on education, keeping cul- youth didn’t use their time effectively, choosing to tural values, maintaining relationships, helping focus on work and recreation, rather than continu- those who have been left behind, and looking ing their education. John and Mangok talked of toward the future. Even the meaning-making is youth who became involved in negative aspects of part of the “toolkit.” Newer additions to their suc- American youth culture, “forgot where they came cess toolkit include: transitioning to family, actu- from,” and became distracted from their goals. alizing aid systems to family and community in Three of the men talked of emotional vulner- Sudan, coping with isolation and racialized or abilities or temperamental characteristics that immigrant-based prejudices, and adjusting their impeded progress for some of them. John men- meanings of success to the realities of context tioned that some youth suffered from posttrau- and opportunity. The focus on education is evi- matic stress, while Mangok attributed drinking dent throughout our research, even among those, problems for some men to frustration about their like Jafar, who have not made much educational educational failure. Jafar believed that some peo- progress. The purpose of education is not only to ple react to frustration by getting into trouble: be self-supporting but also to assist those left behind. Because some of these young men…have been It is noteworthy that these separated youth separated from their partners for so long, or from their family…and coming here they fi nd the life have had supportive relationships across contexts even becomes more dif fi cult because the life we with peers, adults in refugee camps, American fi nd here is completely something different for us mentors, and foster parents. Reconnection with from where we came from. So it makes some peo- family in Sudan has brought a greater sense of ple to be really frustrated and they don’t know… how to deal with this kind of life. So as a result, belonging, but also more responsibility. There is some of them become pretty wild and they get in a sel fl essness in how they go about family rela- trouble easily that way. tionships, focusing on their responsibilities. The factors they have identifi ed as contributing to their success are consistent with a resil- Discussion ience framework of individual characteristics, relationships, and resources or opportunities Review of the early data and the current case (Masten & Powell, 2003 ) . Consistent with previ- studies reveal a number of key pathways to suc- ous research (Mann, 2004 ) , cultural beliefs and cessful adaptation for Sudanese refugee youth values have been an important adjustment tool over time. Mainstays in their adjustment have for this group, who resettled as adolescents. been personal characteristics of faith, fl exibility, Largely absent from youth’s perceptions of the sociability, and a positive outlook toward life. risks they faced are mental health issues related Their faith helped them to make meaning of their to their traumatic experiences. Although foster experience, the “unfolding design” of what is parents and caseworkers viewed mental health as “meant to be.” This belief is at the core of their a major factor in who was successful (Luster fl exibility and an outlook that allows one to “rise et al., 2010 ) , youth emphasized how each adapted above” as well as maintain a strong sense of pur- to their common experience in Africa. What is pose. They also have a sense of personal agency most remarkable about them is that, whatever the that their personal choices make a difference. challenges, each continued to strive toward their From this perspective, the young men face chal- larger dream. These young men have not been 13 Pathways of Success Experiences Among the “Lost Boys” of Sudan: A Case Study Approach 189 turned back by what they have faced, but track so our evidence is anecdotal on this group. continue ever forward, adapting the plan as the However, since some of the of the youth we have road reveals itself. interviewed over time have experienced chal- Observing their progress over the past 10 lenges such as drinking and problems with the years, we have come to believe that their response law, we believe that the defi nitions of success after trauma goes beyond resilience or the ability among the less successful would not differ dra- to cope with stress. Calhoun and Tedeschi ( 2006 ) matically from those highlighted in these case describe a transformative process they have called studies. Second, our studies do not address the posttraumatic growth, which appears similar to unique issues of unaccompanied refugee females, what we have observed in these individuals. because the small sample available did not allow Based on clinical research, they propose that, us to develop themes related to their adjustment although trauma results in many negative out- pathways.2 comes, some people eventually experience a positive sense of personal growth. They describe a growth process that encompasses three general Implications for Policy and Practice transformations: (1) a changed perception of the self, including awareness of one’s vulnerability Our research has several implications for policy but also of one’s strength; (2) a greater sense of and practice. First, educational success is a key connectedness to others and heightened compas- strategy, and support for refugee youth who lack sion for those who suffer; and (3) a greater sense basic educational skills may be critical to their of purpose and meaning in life, sometimes rooted successful adaptation. Second, these youth who in deep spirituality. The concepts and measure- resettled without family support benefi ted greatly ment of posttraumatic growth are still in develop- from ongoing relationships with mentors from ment, and the application of the model to children the new culture, even years after resettlement. is in the earliest stages (Kilmer, 2006 ) . Although resettlement agencies tend to view Nevertheless, we believe this model presents a mentors and even foster families as temporary promising approach to research into the mecha- support, we found that the most successful youth nisms of adaptation among children who have used relationships with supportive older adults been exposed to war. some 10 years after their arrival. Third, these There are several limitations to our study. youth, who entered the culture as adolescents These case examples were chosen from a group maintained strong ties to their home culture. of youth who were largely successful, and refl ect Thus, strategies to promote successful adaptation the perspectives of the most successful among should emphasize developing bicultural compe- them. For ethical reasons, we were unable to tence over assimilation. Finally, services to those interview the fi ve youth whom we know from experiencing mental health problems must be foster parent interviews were in prison or suf- culturally acceptable and build upon the inherent fered serious mental problems. While this calls strengths that all of these youth have demon- for some caution, most males that we have been strated just by surviving. able to track in the minor group have completed high school degrees, are pursuing broader educa- Acknowledgements We would like to acknowledge our tional and career goals, and forming adult rela- project leader, Dr. Tom Luster, who passed away in 2009. tionships.1 The major youth are more diffi cult to We also thank all of the young men and women who have shared their experiences with us over the past 10 years.

1 Of the 89 minors resettled in our area, over 80 % had 2 Of the youth resettled in Lansing, less than 10 % completed high school by the time they left the support of were female, and all were resettled minors. Five females the foster care agency. Of the 19 youth interviewed in participated in our data collection about early adjustment 2007, 100 % had completed high school, and 84 % were and three were interviewed about their experiences in pursuing higher education. foster care. 190 L. Bates et al.

References Kia-Keating, M., & Ellis, B. H. (2007). Belonging and connection to school in resettlement: Young refugees, school belonging, and psychological adjustment. Bates, L., Baird, D., Johnson, D. J., Lee, R. E., Luster, T., Clinical Child Psychology and Psychiatry, 12 (1), & Rehagen, C. (2005). Sudanese refugee youth in fos- 29–43. ter care: The “Lost Boys” in America. Child Welfare, Kilmer, R. P. (2006). Resilience and posttraumatic growth 84 (5), 631–648. in children. In L. Calhoun & R. Tedeschi (Eds.), Bates, L., Johnson, D. J., Rana, M., Luster, T., Qin, D. B., Handbook of posttraumatic growth: Research and & Saltarelli, A. (under revision). Fostering Sudanese practice (pp. 264–287). Mahwah, NJ: Erlbaum. refugee youth: Parent perspectives. In S. Chuang & U. Legarretta, D. (1984). The Guernica generation: Basque Gielen (Eds.), Perspectives on family dynamics in refugee children of the Spanish Civil War . Reno: immigrant families in a global context . New York: University of Nevada Press. Springer Science Business Media. Luster, T., Bates, L., & Johnson, D. J. (2006). Risk and Bates, L., Luster, T., Johnson, D. J., Qin, D. B., & Rana, resilience. In F. A. Villarruel & T. Luster (Eds.), The M. (In press). Sudanese refugee youth: Resilience crisis in youth mental health (Vol. 2, pp. 27–52). among undefended children. In D. J. Johnson, D. Westport: Praeger Publishers. Agbenyiga, & R. Hitchcock (Eds.), Vulnerable chil- Luster, T., Qin, D., Bates, L., Johnson, D. J., & Rana, M. dren : Global challenges in education , health , and (2008). The Lost Boys of Sudan: Ambiguous loss, child rights . New York: Springer. search for family, and reestablishing relationships with Bean, T., Derluyn, I., Eurelings-Bontekoe, E., Broekaert, family members. Family Relations, 57 , 444–456. E., & Spinhoven, P. (2007). Comparing psychological Luster, T., Qin, D., Bates, L., Johnson, D. J., & Rana, M. distress, traumatic stress reactions, and experiences of (2009). The Lost Boys of Sudan: Coping with ambigu- unaccompanied refugee minors with experiences of ous loss and separation from parents. American adolescents accompanied by parents. The Journal of Journal of Orthopsychiatry, 79 (2), 203–211. Nervous and Mental Disease, 195 (4), 288–297. Luster, T., Qin, D. B., Bates, L., Rana, M., & Lee, J. A. Bixler, M. (2005). The Lost Boys of Sudan: An American (2010). Successful adaptation among Sudanese unac- story of the refugee experience. Athens: University of companied minors: Perspectives of youth and foster Georgia Press. parents. Childhood, 17 , 197–211. Boss, P. (2006). Loss, trauma, and resilience: Therapeutic Luster, T., Saltarelli, A. J., Rana, M., Qin, D. B., Bates, L., work with ambiguous loss . New York: W.W. Norton & Burdick, K., et al. (2009). The experiences of Sudanese Company. unaccompanied minors in foster care. Journal of Bureau of Population, Refugees, and Migration. (2005). Family Psychology, 23 (3), 386–395. Support for unaccompanied minors. U.S. Refugee Luthar, S. S. (2003). Resilience and vulnerability: Program News, 3(4), 1. Retrieved April 18, 2008 from: Adaptation in the context of childhood adversities . http://www.state.gov/g/prm/rls/45960.htm New York: Cambridge University Press. Calhoun, L. G., & Tedeschi, R. G. (2006). The founda- Maegusuku-Hewett, M. T., Dunkerley, D., Scour ﬁ eld, J., tions of posttraumatic growth: An expanded frame- & Smalley, N. (2007). Refugee children in Wales: work. In L. Calhoun & R. Tedeschi (Eds.), Handbook Adaptation in the face of adversity. Children and of posttraumatic growth: Research and practice (pp. Society, 21 (4), 309–21. 1–23). Mahwah, NJ: Erlbaum. Mann, G. (2004). Separated children: Care and support in Duncan, J. (2001, May). Sudanese “Lost Boys” in the context. In J. Boyden & J. de Berry (Eds.), Children United States: Adjustment after six months. Paper pre- and youth on the frontline: Ethnography, armed sented at the United States Catholic Conference, con ﬂ ict and displacement (pp. 3–22). New York: Washington, DC. Berghahn Books. Geltman, P. L., Grant-Knight, W., Mehta, S. D., Lloyd- Masten, A. A., & Powell, J. L. (2003). A resilience frame- Travaglini, C., Lustig, S., Landgraf, J. M., et al. (2005). work for research, policy, and practice. In S. S. Luthar The “Lost Boys” of Sudan: Functional and behavioral (Ed.), Resilience and vulnerabilities: Adaptation in health of unaccompanied refugee minors resettled in the context of childhood adversities (pp. 1–25). New the United States. Archives of Pediatric and Adolescent York: Cambridge University Press. Medicine, 159 , 585–591. Moskovitz, S. (1983). Love despite hate: Child survivors Hek, R. (2007). Using foster placements for the care and of the holocaust and their adult lives. New York: resettlement of unaccompanied children. In R. K. S. Schocken Books. Kohli & F. Mitchell (Eds.), Working with unaccompa- Qin, D. B., Saltarelli, A. J., Bates, L., Rana, M., Lee, J. A., nied asylum seeking children: Issues for policy and prac- Johnson, D. J., et al. (Revisions pending). “My culture tice (pp. 109–24). Basingstoke: Palgrave Macmillan. makes me make good decisions”: Cultural appropria- Hepburn, A., Williamson, J., & Wolfram, T. (2004). tion and adaptation of Sudanese refugee youth. Journal Separated children: Care and protection of children in of Adolescent Research . emergencies . Westport, CT: Save the Children Federation, Rana, M., Qin, D. B., Bates, L., Luster, T., & Saltarelli, A. Inc. Retrieved 8/1/08 from: http://www.savethechildren. J. (2011). Factors related to educational resilience org/publications/technical-resources/child-survival/ among Sudanese unaccompanied minors. Teachers SEPARATED_CHILDREN_CONTENTS.pdf College Record, 113 (9), 2080–2114. 13 Pathways of Success Experiences Among the “Lost Boys” of Sudan: A Case Study Approach 191

UNHCR. (2004). Trends in unaccompanied and separated Werner, E. E., & Smith, R. S. (2001). Journeys from child- children seeking asylum in industrialized countries , hood to midlife: Risk, resilience, and recovery . Ithaca, 2001 –2003 . Retrieved 9/20/06 from: http://www. NY: Cornell University Press. unhcr.org/statistics Yin, R. K. (1994). Case study research: Design and meth- UNICEF. (1996). The state of the world’ s children . ods (2nd ed.). Thousands Oak: Sage Publications. Retrieved 4/20/07 from: http://www.unicef.org/sowc96/ No Place Like Home: Resilience Among Adolescent Refugees 1 4 Resettled in Australia

Julie Ann Robinson

There is nothing that brings out genuine human endeavour and courage more than the refugee experience. There is nothing like having to cling to every bare breath, to see life reduced to a scarce trickle… Very rarely do we get to see human nature stripped of all that it depends on to learn that human nature is itself enough. Hai-Van Nguyen, Australian citizen, former child refuge from Vietnam (Nguyen, 2004 , p. 203)

of the protection of that country; or who, not hav- Refugees ing a nationality and being outside the country of his former habitual residence as a result of such events, is unable or, owing to such fear, is unwill- Due to the dif fi culties inherent in conducting ing to return to it (United Nations High research in con fl ict zones, much of what we know Commissioner for Refugees, 2007b , p.16). about the effects of war on children and adoles- However, refugee status is awarded only if a cents has been gained from research on refugees. speci fi c legal process, a “refugee status determi- Children and adolescents are strongly represented nation”, demonstrates that the person’s claims among the world’s refugees. In 2011, 45 % of ref- and evidence meet this defi nition. Until this legal ugees were below 18 years of age (United Nations process has been completed, the person is an High Commissioner for Refugees, 2012 ) . “asylum seeker” (United Nations High Commissioner for Refugees, 2005 ) . At the end of 2011, the UNHCR estimated that there were 15.2 De fi nition of Refugee million refugees and 895,000 asylum seekers whose applications had not yet been adjudicated The United Nations’ (UN) Convention and (United Nations High Commissioner for Protocol on the Status of Refugees de fi nes a refu- Refugees, 2012 ) . gee as a person who Although the UN convention allows for refu- owing to well-founded fear of being persecuted for gee status to be awarded to people who have not reasons of race, religion, nationality, membership been affected by armed con fl ict, in practice, the of a particular social group or political opinion, is outside the country of his nationality and is unable vast majority of refugees result from “confl ict- or, owing to such fear, is unwilling to avail himself generated forced displacement” (United Nations High Commissioner for Refugees, 2010 ) . This is the joint result of high prevalence and selection resulting from legal requirements: armed confl ict is the most common context for persecution that J. A. Robinson , PhD (*) leads to fl ight from one’s homeland, and evidence School of Psychology , Flinders University , GPO Box 2100 , Adelaide , SA 5001 , Australia that one’s fears are “well-founded” is most read- e-mail: julie.robinson@ fl inders.edu.au ily available in contexts of armed con fl ict.

C. Fernando and M. Ferrari (eds.), Handbook of Resilience in Children of War, 193 DOI 10.1007/978-1-4614-6375-7_14, © Springer Science+Business Media New York 2013 194 J.A. Robinson

Durable Solutions Countries of Resettlement

The UNHCR recognizes three durable solutions A small number of nations participate in UNHCR for refugees: (1) repatriation to their country of resettlement programmes by offering to accept an origin, (2) “local” integration into their country annual quota of refugees. However, there is a mis- of asylum and (3) resettlement in another coun- match between demand for placements and their try. Resettlement is the least common durable availability in both their total number and their solution. It is proposed by the UNHCR only when number for speci fi c countries of origin. In 2011, it judges that the refugee cannot return home or only 62,000 refugees were resettled with UNHCR’s remain in the host country (United Nations High assistance (United Nations High Commissioner Commissioner for Refugees, 2003 ) and is possi- for Refugees, 2012 ) . In addition, although Afghani ble only when resettlement places are available. refugees were by far the most numerous single For many years, there has been a marked group (2.6 million) in 2011, they were not among shortfall in resettlement places. For example, the the four main benefi ciaries of the UNHCR reset- UNHCR estimated that 800,000 people needed to tlement programme, which is largely determined be resettled in 2011. The total available resettle- by the preferences of receiving countries (United ment places could meet just over 10 % of this Nations High Commissioner for Refugees, 2012 ) . demand (United Nations High Commissioner for A small additional number of refugees are Refugees, 2012 ) . Due to this shortfall and the resettled outside UNHCR programmes. As a prolonged nature of con fl icts, many refugees result, statistics from countries of resettlement experience a “protracted refugee situation”. Thus, suggest that a total of 79,800 refugees were reset- most refugees have survived both armed con fl ict tled across 26 countries during 2011. The main in their homeland and also many years of living country of resettlement was the USA (over 51,000 “in limbo” in refugee camps or urban centres in refugees). Three countries, the USA, Canada and countries of asylum. At the end of 2011, about Australia, accounted for 92 % of opportunities 7.1 million refugees hosted in 26 countries had for resettlement for refugees (United Nations been living in exile for at least 5 years (United High Commissioner for Refugees, 2012 ) . Nations High Commissioner for Refugees, 2012 ) . In many cases, the wait is far longer. For example, Lhotsampa refugees from Bhutan have been Example of a Country of Resettlement: warehoused in camps in eastern Nepal for about Australia 20 years (Lama, 2008 ) . Not surprisingly, many refugees outstay their welcome in places of Australia provides humanitarian visas in three asylum: categories: refugees accepted as part of the To keep going was like living on bleakness. It was UNHCR resettlement programme, refugees and impossible to stay where we were coming from, for other displaced people who have been the victim we were unwanted. Nor was it possible to keep going, of gross human rights violations and who have a for we were unwelcome wherever we would go. sponsor in Australia; and individuals who enter Bojana Bokan, Australian citizen, former child refugee from Croatia Australia, claim asylum and are subsequently judged to meet the UNHCR defi nition of a refu- (Bokan, 2004 , p. 55) gee (Karlsen, 2011 ) . Most research has been conducted with chil- Although the number of humanitarian visas dren who reach a country of resettlement, even provided by Australia in 2010–2011 was large by though these represent a minority of all child international standards (13,750), it was small in refugees. the context of its total migration programme 14 War and Adolescent Refugees 195

(168,700) (Karlsen, 2011 ) . Australia has a long people in one’s social network (Machel, 2001 ) . history as a “country of migration”. At the 2011 The indirect effects of armed confl ict on refugees census 43.1 % of all Australians reported that are often mediated through social upheaval and they were born overseas or had at least one parent increasing chaos in their region. Indirect effects who was born overseas (Australian Bureau of include the loss of a sense of security and predict- Statistics, 2012 ) . Therefore, the context in which ability, the lack of structure in daily life, the shat- refugees are resettled in Australia is very differ- tering of family and community support networks, ent from that in many European countries of and the loss of the infrastructure that supports resettlement, where permanent in-migration has positive child development (e.g. when schools or a shorter history and a smaller scale. For exam- water, sanitation or medical services are damaged ple, in 2010, most immigrants to Norway had or destroyed) (Machel, 2001 ; Stichick, 2001 ) been residents for less than 6 years, and immi- and disrupted access to surviving services grants and Norwegian-born persons with immi- (Shemyakina, 2011 ) . Children bear a dispropor- grant parents represented only 11.4 % of the tionate burden of the direct and indirect effects of population (Statistics Norway, 2010 ) . armed confl ict (Pearn, 2003 ) . Thus, before they A sizeable proportion of humanitarian entrants depart from their homeland, most child refugees to Australia are under 18 years of age (30 % experience both danger and the widespread females; 33 % males between 2004 and 2009) impoverishment of their social ecology as a result (Refugee Council of Australia, 2009 ) . No sys- of armed confl ict (Betancourt & Khan, 2008 ) . tematic data is collected on these children’s expo- But children may also play an active role in this sure to armed con fl ict. However, most come from confl ict. Through participation in armed forces or countries in which active warfare is taking place. through resistance to these, some child refugees have been perpetrators as well as victims of the negative effects of armed con fl ict (Warf, Ways in Which Armed Confl ict Affects Eisenstein, & Stahl, 2009 ) . Child Refugees During internal displacement within their home country, children fl eeing war have an increased Armed confl ict can affect child refugees “at risk of mortality (Avogo & Agadjanian, 2010 ) , home”, during internal displacement in their encounter many daily stressors (Mels, Derluyn, country of origin (e.g. Sudan, Afghanistan), while Broekaert, & Rosseel, 2010 ) , are particularly vul- in countries of asylum (e.g. Egypt, Pakistan), after nerable to armed con fl ict and are often at the repatriation to their country of origin, and follow- mercy of armies, police forces and militias who ing resettlement in another country (e.g. Australia, control their access to basic needs and determine Sweden) (Lustig et al., 2004 ) . when and where routes of escape and places of rest are available (Holmes, 2010 ) . They are often subject to human rights violations (e.g. Internal Homeland Displacement Monitoring Centre, 2010 ) . Because the process of displacement is chaotic, separation In their country of origin, refugees anticipate and from family members, including separation of then cope with devastating events and daily has- children from caregivers, is common (e.g. Bean, sles that are the direct and indirect results of Eurelings-Bontekoe, & Spinhoven, 2007 ) : armed confl ict (Miller & Rasmussen, 2010 ) . “At You can only be happy if you know where they are, home” direct effects include the experience or your brothers and sisters and parents, and if they threat of death and injury, conscription into the can be with you. If my mum and brothers and cous- armed forces, destruction of possessions and/or ins can be here with me, I’d be a citizen for real. Kuet, Australian citizen, former child refugee means of sustenance, being witness to violence from Sudan directed towards others, and loss of signi fi cant (Elia, Deng, & Jok, 2005 , p.112) 196 J.A. Robinson

Country of Asylum Grossman, 2001) .In addition, life in exile is typi fi ed by high levels of daily hassles Even once they reach a country of asylum, (Paardekooper, De Jong, & Hermanns, 1999 ; confl ict in their homelands and local violence Rasmussen et al., 2010 ) and dif fi culty in meeting continue to exert direct and indirect affects on basic needs (Corbett & Oman, 2006; Lustig et al., child refugees (United Nations High 2004) . In several countries of asylum, including Commissioner for Refugees, 2007a ) . One mech- Australia and the UK, children seeking asylum anism for this is the bidirectional relationship are also at risk of immigration detention until between concentrations of displaced people and their refugee status determination has been confl ict. Armed confl ict often follows refugees as fi nalized (Lorek et al., 2009 ; Silove, Austin, & they cross into a country of asylum. Refugee Steel, 2007 ) . camps and urban centres hosting refugees usually contain individuals with con fl icting allegiances, their populations can be targets for conscription Repatriation (Achvarina & Reich, 2006 ) , and the presence of refugees adds to pre-existing tensions: “In some Past con fl ict continues to cast a shadow over refu- cases, such as the confl icts in Rwanda and the gees who are eventually repatriated to their home- Democratic Republic of the Congo, protracted land after violent con fl ict is perceived to have refugee situations may have been the principal ended (Fu & van Landingham, 2010 ) . They return source or catalyst for con fl ict, rather than a mere to countries where basic community infrastruc- consequence” (Loescher, Milner, Newman, & ture needs to be reconstructed, there are often Troeller, 2008 , p. 5). ongoing security issues, con fl ict has changed In addition, it is common for refugees to be relationships between social groups, and the housed in areas in which even the host population social meanings of processes, places and people has limited security and in which refugees com- have been transformed (Eastmond, 2006a, 2006b ) . pete with the host population for scarce resources However, little is known about the experiences of (Martin, 2005 ) . There are also ample opportuni- adolescents (Farwell, 2001 ; Loughry & Flouri, ties for cultural differences to contribute to 2001) who have been repatriated, and even less is con fl ict between refugees and host populations: known about younger child refugees who have The locals thought that due to the Afghan people been repatriated (Pantic & Kraljevic, 2003 ) . their country was going backward, that drugs were being spread in their country due to Afghans, and God knows, many things more. They looked at us Resettlement like shouther (the Untouchables of the Hindu religion). Ghulam-e-Ali, Australian citizen, former Afghan The small percentage of child refugees who resettle refugee in Western countries usually do so while the con fl ict (Ghulam-e-Ali, 2004 ) in their homeland is ongoing. Past and present con fl ict continues to cast a long shadow even over The indirect affects of armed confl ict on child these children. Past experience of con fl ict is kept in refugees in countries of asylum include disrup- memory through stories about the family’s history tion of parenting and inability to meet basic (Bek-Pedersen & Montgomery, 2006 ) : needs. Armed confl ict can disrupt the relation- My memories are few and far between, but my par- ship between parents and children in many ways, ents remember it with vivid accuracy… Having including reducing parents’ attention to their told their story, they have embedded themselves in children (Pynoos, Steinberg, & Wraith, 1995 ) , history. impairing the quality of parenting (Hammen, Hai-Van Nguyen, Australian citizen, former child refugee from Vietnam Shih, & Brennan, 2004 ) or contributing to emotional abuse or neglect (Yehoda, Halligan, & (Nguyen, 2004 , p. 199–204) 14 War and Adolescent Refugees 197

Ongoing con fl ict in their home country or in and in countries of resettlement may have long- countries of asylum also often has psychological term effects on child refugees’ developmental and fi nancial consequences for resettled refugees trajectories by undermining core systems and limits opportunities for family reunion (e.g. Feder, Nestler, & Charney, 2009 ; Yehoda (McDonald-Wilmsen & Gifford, 2009 ) . Other et al., 2001 ) . indirect infl uences of ongoing confl ict on child refugees include “cultural bereavement” (Lustig et al., 2004 ) and the perseveration of strategies Mental Health of Child Refugees for adaptation to armed confl ict in contexts where these are no longer adaptive: Psychopathology When I arrived in America, though I had left the war physically far behind, in my mind, the soldiers There have been a large number of recent reviews were still chasing to kill me, my stomach was of research concerning the mental health of child always hungry, and my fear and distrust kept me refugees including those by Rousseau ( 1995 ) , from opening up to new friendships. Loung Ung, author of Lucky child and First Keyes (2000 ) , Lustig et al. (2004 ) , Fazel, Wheeler, they killed my father and Danesh (2005 ) , Ehntholt and Yule (2006 ) , Crowley ( 2009 ) and Montgomery ( 2011 ) . These (Ung, 2010 ) conclude that, as a group, child refugees show elevated levels of emotional and behavioural Children Born in Exile problems. Most of these reviews are restricted to the mental health of resettled refugees. While some child refugees have vivid memories The authors of these reviews and others have of the armed con fl ict in their homeland, others criticized the existing research literature on a were born in countries of asylum or resettlement number of grounds. In particular, researchers and have never seen their “homeland”. This does have focused on a narrow range of mental health not mean that they are unaffected by the events problems. For example, although recent research that led to their parents’ fl ight. Children of exile has focused on post-traumatic stress disorder are exposed to past armed confl ict through stories (PTSD), a long history of research suggests that about the family’s history (Bek-Pedersen & child refugees may show a spectrum of concur- Montgomery, 2006 ) , and past and present con fl ict rent psychological symptoms, including “at home” may deprive children of their cultural depressed affect, anxiety, fear of recurrence, heritage, disempower their caregivers (Guribye, guilt, worry and grief (Espié et al., 2009 ; Nielsen 2010 ) , contribute to impoverished rearing condi- et al., 2008 ; Richman, 1993 ) . Additional short- tions and create uncertainty about the future. For comings in the literature include the imposition example, hearing narratives about their parents’ of Western constructions of mental health onto past experience of torture has been shown to pre- these symptoms, reliance on Western measures, dict child refugees’ levels of anxiety (Montgomery, ignoring refugees’ own perceptions of their needs 1998) and the violent death of a grandparent pre- and downplaying child refugees’ resilience and dicts child refugees’ sleep disturbances, even when strengths (Betancourt & Khan, 2008 ; Holli fi eld the torture and death occurred before the child was et al., 2002 ; Summer fi eld, 2000 ; Watters, 2001 ) . born (Montgomery & Foldspang, 2001 ) . Indeed, child refugees often show good adaptation, even while reporting symptoms of mental health problems (Sack et al., 1993 ; Slodnjak, Cumulative Stress 2002 ; Geltman et al., 2005 ) . There is often no statistical association between child refugee’s men- Although each single stressful event may be of tal health problems and measures of wider limited duration, the accumulated experience of adaptation, such as academic achievement physical and psychological adversity “at home”, (e.g. Fox, Burns, Popovich, Belknap, & Frank- during displacement, in countries of fi rst asylum Stromborg, 2004). 198 J.A. Robinson

A Resilience Approach enhanced faces the diffi culty of selecting the most appropriate comparison group. Research Most studies that have assessed positive adapta- has variously used matched samples from the tion among child refugees have adopted a resil- general population living in the same community ience approach. Resilience refers to a dynamic (e.g. Fazel & Stein, 2003 ) , matched samples from process encompassing positive adaptation within other minority groups living in the same commu- the context of signifi cant adversity (Luthar, nity (e.g. Fazel & Stein), large samples from the Cicchetti, & Becker, 2000 ) . Murphy (1962 ) dif- general population in the host country (e.g. Vaage ferentiated between two dimensions of adapta- et al., 2009 ) and children receiving clinical care tion. External domains involve adaptation to the in countries of resettlement (e.g. Mollica, Poole, environment (e.g. school achievement and accep- Son, Murray, & Tor, 1997 ) . tance by peers). Internal domains of adaptation One shortcoming shared by all these compari- re fl ect maintenance of internal integration (e.g. son groups is the dif fi culties they pose in identi- mental health). fying the sources that contribute to any elevated Most resilience research attempts not only to prevalence in positive or negative adaptation that document positive adaptation but also to identify is found. Child refugees differ from these groups factors or processes that infl uence positive adap- not only in experiences of armed confl ict but also tation during periods of adversity or recovery in many other factors, including migration stress (Masten & Osofsky, 2010 ) . Such factors and pro- and acculturative stress. cesses may be described as “promotive” (show a Migration is a source of stress because it positive main effect), “protective” (show a posi- entails substantial social and economic costs tive interaction effect), “risk” (show a negative without a guarantee of benefi t (Beiser, 1999 ) . main effect) or “vulnerability” (show a negative Stress may result from anticipation of change, interaction effect). Research shows that some experience of change during migration, and post- factors and processes are associated with several migration readjustment. Even among voluntary domains of adaptation. This is consistent with the migrants, relocation may be associated with notion that similar adaptive systems underlie a increased mental health problems (e.g. Bhugra, variety of positive and negative outcomes in 2004 ) although this is not always the case human development. A large number of resources (Stillman, McKenzie, & Gibson, 2006 ) . with the potential to support resilience have been Acculturation is a developmental process identi fi ed. However, it is unclear whether these towards adaptation that includes gaining compe- are effective among children exposed to armed tence within more than one cultural setting (Sam con fl ict. Previous research shows that many fac- & Oppedal, 2002 ) . It is prompted by continuous, tors and processes that infl uence individual diffi rst-hand contact between two distinct cultural ferences in adaptation in the context of relatively groups. This intercultural contact holds the poten- benign life circumstances lose their potency in tial for both growth and confl ict. When confl ict the context of extreme external stressors (Luthar occurs, individuals may encounter acculturative et al., 2000 ) . stress if they cannot easily change their repertoire of behaviours and attitudes (Berry & Sam, 1997 ) :

Methodological Issues in the Study Leaving your country… means a break with all that one knows about living—how to earn a liveli- of the Effects of Armed Con ﬂ ict hood, how to ﬁ t in to (sic) a society, how to respond on Child Refugees to a landscape, how to touch, smell and taste… Even if the change to a new way of life is success- Comparison Groups fully managed, the shock of loss remains. Najeeba Wazefadost, Australian citizen, former child refugee from Afghanistan Research seeking to determine whether adapta- (Wazefadost, 2005 , p.68) tion among resettled child refugees is impaired or 14 War and Adolescent Refugees 199

Linking Outcomes to Direct and Indirect First, voluntary migrants rarely encounter hard- Effects of Armed Con flict ships of the types that typify child refugees’ lives in their homelands and countries of asylum. Only Impaired adaptation among resettled child refu- some of these hardships are attributable to armed gees has often been attributed to their earlier confl ict (United Nations High Commissioner for exposure to armed con fl ict. The main grounds for Refugees, 2007a ) . Second, voluntary migrants this are positive correlations between retrospec- rarely come from the same cultural backgrounds tive measures of exposure to confl ict-related as forced migrants and, in general, forced traumatic events and measures of current prob- migrants have a greater “cultural distance” lems in adjustment. Such associations have been (Hofstede, 2001 ) to travel. Third, persons awarded found for a range of negative outcomes, includ- voluntary migration and humanitarian visas are ing post-traumatic stress symptoms (Almqvist & selected by different criteria. These criteria may Broberg, 1999 ; Heptinstall, Sethna, & Taylor, favour high levels of adaptation among voluntary 2004 ; Hodes, Jagdev, Chandra, & Cunniff, 2008 ) , migrants (Sam, Vedder, Ward, & Horenczyk, internalizing and externalizing problems (Bean 2006) although the “healthy migrant” phenome- et al., 2007 ) and sleep disturbances (Montgomery non has not always been found among children & Foldspang, 2001 ) . (Stevens & Vollebergh, 2007 ) , perhaps because However, this approach has a number of short- migrant selection processes focus on attributes of comings. First, it is unclear how exposure to war adult family members. Fourth, the current living trauma is best assessed: total number of traumatic circumstances of resettled forced and voluntary events experienced, the range of different types of migrants may differ. Some of these differences events, the duration of exposure, its intensity (e.g. between voluntary and forced migrants may also personal experience/witness) or some other met- in fl uence the adaptive systems that underlie ric. Second, measures that require children (or human development. their parents) to recall exposure to traumatic events and situations raise ethical dilemmas. Third, retro- spective measures often have poor validity. Fourth, Sampling focusing on exposure to discrete traumatic events ignores the many other direct (Allwood, Bell- Almost without exception, research about reset- Dolan, & Husain, 2002 ; Smith, Perrin, Yule, tled refugees focuses on a single country of reset- Hacam, & Stuvland, 2002 ) and indirect effects of tlement. Within this constraint, most studies of armed confl ict on child refugees. These are child refugees adopt one of three sampling strate- diffi cult to quantify and rarely assessed. gies. Some studies focus on refugees from a sin- An alternative approach is to use a research gle country of origin (e.g. Rousseau & Drapeau, design in which the effects of exposure to direct 2003; Vaage et al., 2009 ) or single geographic and indirect effects of armed con fl ict are inferred region of origin (e.g. Montgomery & Foldspang, by comparing the adaptation of child refugees 2007 ) , regardless of their length of tenure in their with that of child voluntary migrants who also host country or their status. Other studies focus have limited or no knowledge of the host com- on refugees with a specifi c status, such as “unac- munity’s language and who are attending the companied minors” or “women at risk”, regard- same school. Like child refugees, child voluntary less of the country of origin or length of tenure in migrants have experienced migration stress and the host country (e.g. Bean et al., 2007 ; Hodes acculturative stress. Unlike child refugees they et al., 2008 ) . Other studies focus on a speci fi c usually have not experienced forced migration as period during resettlement, regardless of refu- a result of armed con fl ict. gees’ country of origin or speci fi c status (e.g. This alternative design has the potential to Almqvist & Broberg, 1999 ) . capture the diversity of effects of armed con fl ict. Like most other studies of adaptation among However, it too has a number of shortcomings. child refugees, this study focused on adolescents, 200 J.A. Robinson since self-report measures of emotional and The study inferred the effect of armed con fl ict behavioural problems that have high cross- by comparing adaptation among child refugees cultural validity are available for this age group. with that among child voluntary migrants. In order to understand the extent to which differences in adaptation identifi ed in this study could The Current Study be attributed to factors associated with past and present effects of armed con fl ict, this study also This study examines adaptation among child examined the contribution of four aspects of ado- humanitarian entrants who were newly arrived in lescents’ current life circumstances, only some of Australia. Humanitarian entrants to Australia which are likely to have been shaped by armed have access to a specialist resettlement pro- con fl ict. These included one factor (social sup- gramme in addition to the services made available port) that has a promotive function for several to other immigrants. Most services in the special- domains of adaptation (e.g. Davidson & Demaray, ist programme are limited to the fi rst 6 months 2007; Decker, 2007 ) , and three factors (perceived after arrival. They provide on-arrival reception discrimination, con fl ict in supportive relation- and assistance, accommodation services, infor- ships, marginalization acculturation style) that mation and referrals, case coordination, and short- have a risk function for several domains of adap- term torture and trauma counselling services tation (e.g. Berry & Sam, 1997 ; Choi, He, & (Department of Immigration and Citizenship, Harachi, 2008 ; Sanders-Phillips, Settles-Reaves, 2012 ). The additional services that are available Walker, & Brownlow, 2009 ) . Discrimination is a to both refugees and other immigrants include particularly salient factor for many refugees: migrant health services, migration resource cen- Being a refugee… will guarantee you racism no tres and English language classes for children and matter what race you come from…. adults. In particular, all newly arrived child Lual Makuei Deng, Australian citizen and for- migrants who are not fl uent in English are eligible mer child refugee from Sudan for up to 24 months in a specialist orientation pro- (Deng, 2005 , p. 148) gramme that provides intensive English language The four variables relating to adolescents’ instruction and an introduction to schooling in current life circumstances could serve risk and Australia. Most child and adolescent refugees promotive and/or vulnerability and protective entering Australia attend these programmes, one functions. The current study focuses on their risk of which was the recruitment site for participants and promotive functions (i.e. main effects) rather in the current study. than their role as moderators of stressors because Following Masten, Best, and Garmezy ( 1990 ) , main effects are likely to be more robust than children who maintained positive adaptation (i.e. interactive effects in variable-focused analyses in functioning that was within the normal range or which positive adaptation is measured on a con- better) despite signi fi cant adversity were judged tinuum (Luthar et al., 2000 ) . The study also to be resilient. The study measured a broad range includes person-oriented analyses. Previous of symptoms of emotional and behavioural prob- research on resilience shows that person-oriented lems and included measures of positive adapta- and variable-oriented approaches often yield sub- tion. Such positive adaptation was judged to stantively different sets of insights and conclu- refl ect resilience, since it was assumed that all sions (Luthar et al.). child refugees had experienced signifi cant adversity. Following Masten and Powell ( 2003 ) , the The study had three aims: study focused on two external domains of adapta- 1. To determine whether students with exposure tion that refl ect competence in age-salient devel- to armed con fl ict (forced migrants) differ from opmental tasks: school achievement and other newly arrived adolescents (voluntary acceptance by peers. It also focused on one aspect migrants) with respect to two dimensions of of internal integration: mental health. external adaptation (academic progress and 14 War and Adolescent Refugees 201

peer acceptance) and one dimension of internal item was rated using a 3-point scale. An example integration (mental health), as assessed by item assessing support is “At school there are (1) the prevalence of emotional and behav- adults I can talk to who give good suggestions ioural problems and (2) the most common and advice about my problems”. An example types of emotional and behavioural problems item assessing confl ict is “There are people in my 2. To identify current life circumstances that may family who I get upset with or angry at (even if I also contribute to individual differences in don’t show it)”. This study used the total support emotional and behavioural problems, aca- (alpha = 0.84) and total confl ict scores (inter-item demic progress and peer acceptance, focusing correlations above 0.40). on one potential promotive factor (social support) and three potential risk factors (perceived Perceived discrimination. Students reported on discrimination, confl ict in supportive relation- discrimination directed towards themselves and ships, marginalization acculturation style) other members of their group using a 6-item scale 3. To identify patterns among these outcomes adapted from Verkuten and Thijs (2002 ) . Each among adolescents with a refugee background item was rated using a 5-point scale. An example item is, “How much have you been called names or teased at school because of your X background?” Method This study used the total score (alpha = 0.79).

Participants Marginalization acculturation style . Students reported on their acculturation style using the The sample included 73 adolescents holding per- Acculturation Attitude Scale (Sam, 1995 ) . This manent humanitarian visas (“forced migrants”; study focused on the marginalization subscale, mean age 14.7 years; 38 (52.7 %) females) and 43 which contained 4 items (alpha = 0.72). adolescents holding permanent family or skilled migration visas (“voluntary migrants”; mean age Adaptation 15.2 years; 23 (53.4 %) females). All students Peer acceptance and academic progress . had arrived in Australia between 6 and 24 months Students’ homeroom teachers rated their accep- before taking part in the study and had been tance by peers and their rate of academic prog- judged to have insufﬁ cient literacy in English to ress over the previous 2 months using single-item allow placement in a mainstream school. All were 7-point Likert scales. For academic progress, enrolled at same specialist high school, which teachers responded to the question, “Compared provides intensive English language instruction with other students in the New Arrivals Program, and orientation to schooling in Australia to all what is the rate of progress for this student over “new arrivals” in the state of South Australia. the last 2 months?” For peer acceptance, teachers responded to the question, “Compared with other children, how popular is this child with his/ Measures her peers?”

Current Life Circumstances Emotional and behavioural problems . The Youth Social support and conﬂ ict within social support Self - Report (YSR, Achenbach & Rescorla, 2001 ) networks. Students reported on four types of was used to assess a broad range of self-reported social support (emotional, instrumental, informa- emotional and behavioural problems. The 2001 tional and companionship support) received from version of the YSR was based on data from adults at school, peers and family members using Australia, England and the United States. 15 items derived from the Vaux Social Support Responses to the 112 items are recorded on a Record (Vaux, 1988 ) . They also reported on three-point Likert-type scale (“Not True”, interpersonal con ﬂ ict with these agents. Each “Somewhat or Sometimes True”, “Very True or 202 J.A. Robinson

Often True”). Sample items include, “I worry a lot” and “I physically attack people”. T-scores Results for total problems that are above 64 are “in the clinical range” for Western samples. The struc- Preliminary Analyses ture of the scale and the summative scores it yields have good cross-cultural validity, includ- Associations between measures of adjustment . ing in Australia and in several refugee source A preliminary analysis showed that none of the countries (Achenbach et al., 2008 ; Ivanova et al., three measures of adjustment were redundant for 2007 ) . This study focused on the total problems adolescent forced or voluntary migrants. The score (alpha = 0.95). strongest associations accounted for less than 45 % of the variance. The three outcome measures showed similar patterns of association among stu- Procedure dents who were forced migrants and those who were voluntary migrants. There was a moderate, Translated letters of introduction and consent positive correlation between teacher-rated aca- forms were distributed to parents and students. demic progress and teacher-rated acceptance by Students for whom consent was obtained were peers (forced migrants: r (58) = 0.66, p < 0.001; withdrawn from their classes in language groups voluntary migrants: r (29) = 0.41, p < 0.05). The so that they could complete the above measures. two groups differed in the association between A variety of aids were available to support stu- self-reported emotional and behavioural problems dents’ completion of the questionnaires in and measures of adaptive behaviour. There were English, including (1) English-speaking research weak negative associations for forced migrants assistants, (2) simultaneous translation by (academic progress: r (63) = −0.30, p < 0.05; accep- Bilingual School Support Of fi cers and (3) struc- tance by peers: r (60) = −0.30, p < 0.05), but no tural supports, more speci fi cally, (i) replacement associations for voluntary migrants (academic of numerals on numerical rating scales with progress: r (29) = −0.05, n.s.; acceptance by peers: visual analogues (drawings of jars fi lled to differ- r (29) = −0.33, n.s.). ent levels), (ii) concrete examples of the visual analogues (jars fi lled to these different levels) Evidence of resilience among adolescents hold- available for manipulation, (iii) use of rulers as ing humanitarian visas . A little over three quar- aids for correct placement of answers, (iv) hori- ters (76.6 %) of forced migrants showed emotional zontal lines between items to clearly separate and behavioural problems within the normal them and (v) items numbered on both left and range for Western populations (Table 14.1 ) . right margins Moreover, about half of these students showed

Table 14.1 Descriptive statistics for three outcome variables for adolescent forced and voluntary migrants who had recently been resettled in Australia Measures Adolescents Voluntary migrants (n = 43) Forced migrants (n = 83) % Mean (SD) % Mean (SD) Current circumstances Social support 2.4 (0.5) 1.7 (0.6) Perceived discrimination 1.6 (0.7) 1.9 (0.8) Con ﬂ ict in supportive relationships 1.6 (0.4) 1.0 (0.7) Adaptation Teacher-rated academic progress 4.4 (0.9) 3.5 (1.1) Teacher-rated peer acceptance 4.4 (1.0) 3.5 (1.1) Total emotional and behavioural problems 16.3 23.4 within the clinical range for Western samples 14 War and Adolescent Refugees 203

Table 14.2 Relationship between ﬁ ve predictor variables and three outcome variables among adolescent forced and voluntary migrants who had recently been resettled in Australia (n = 117) Outcome variable Teacher-rated Teacher-rated Self-reported total emotional academic progress peer acceptance and behavioural problems Predictor variable Standardized beta t Standardized beta t Standardized beta t Visa category −0.271 −2.4* −0.310 −2.6* −0.243 −2.7** Perceived discrimination −0.295 −2.7** −0.159 1.4 0.362 4.0** Social support −0.043 −0.4 −0.030 −0.2 −0.116 −1.2 Con ﬂ ict in supportive −0.022 −0.2 −0.044 −0.4 0.211 2.4* relationships Marginalization −0.69 −0.6 −0.071 −0.6 0.171 1.8 acculturation style Model (above) Adjusted R 2 = 0.158 Adjusted R 2 = 0.105 Adjusted R 2 = 0.301

F(5,73) = 3.9, p < 0.01 F(5,70) = 2.8, p = 0.02 F(5,73) = 3.9, p < 0.01 a * p < 0.05 ** p < 0.01

average or above average academic progress respectively). However, surprisingly, there was (50.8 %) and levels of acceptance by peers no difference between forced migrants and vol- (51.7 %). untary migrants in the prevalence of scores for total emotional and behavioural problems within the clinical range for Western populations Variable-Centred Analyses (C 2 (1) = 0.9, p > 0.05) (Table 14.1). That is, although visa type contributed to individual dif- Inferring the Effect of Exposure to Armed ferences in scores for emotional and behavioural Con flict on Newly Resettled Adolescents problems (Table 14.2), most of these scores were The type of visa that was held by students within the normal range. The everyday impor- accounted for variance in all measures of tance of the “cost of exposure to armed con fl ict” adjustment (see Table 14.2 ). Despite evidence on mental health identifi ed in the regression anal- of resilience among humanitarian entrants ysis is, therefore, unclear (Table 14.2 ) . (above), on average they had poorer outcomes Visa type also appeared to in fl uence the nature than their peers who were voluntary migrants. of emotional and behavioural problems that stu- Holding a humanitarian visa was negatively dents reported. Only one of the fi ve most preva- associated with external adaptation (teacher- lent emotional and behavioural problems reported rated school progress and peer acceptance) and by the two groups of students showed overlap positively associated with problems in internal (Table 14.3 ). It is also interesting to note that only integration (total emotional and behavioural one of the fi ve most prevalent problems reported problems). by forced migrants was a symptom of PTSD For the two measures of external adaptation, (“feels too guilty”). the effect of visa status was further quanti fi ed using a MANOVA. One might infer a “cost of Current Life Circumstances Associated exposure to armed con fl ict” from the lower mean with Outcomes scores for academic progress and peer acceptance The two measures of external adaptation showed among forced migrants than among voluntary associations with few variables, other than visa migrants (Table 14.1 , F (1) = 13.8, p < 0.001, status (Table 14.2 ). Peer acceptance was not 2 2 eta = 0.141 and F(1) = 13.7, p < 0.001, eta = 0.140, associated with any of the four current life 204 J.A. Robinson circumstances assessed in this study. Academic Person-Centred Analysis progress was associated with only one current circumstance, perceived discrimination. In both Patterns of Outcomes Among Adolescent cases, the regression model including visa type Forced Migrants and current circumstances accounted for 10–16 % A person-focused approach was used to aggre- of the variance in adaptation. gate students holding humanitarian visas into In contrast, emotional and behavioural prob- clusters based on their patterns of adaptation. lems were associated not only with visa status but A cluster analysis identifi ed three clusters of stu- also with both perceived discrimination and dents (Table 14.4 ). The largest cluster contained con fl ict in supportive relationships. The regres- students who showed both good external adapta- sion model including visa type and current cir- tion and good internal integration (“resilient”). cumstances accounted for over 30 % of the The mean scores for students in this cluster were variance in emotional and behavioural problems very similar to those for voluntary migrant stu- (Table 14.2 ). dents without exposure to the effects of armed Two of the variables that were related to many con fl ict (Table 14.1 ). The other two clusters were outcomes in previous research (social support of equal size and showed either poor external and marginalization acculturation style) were not adaptation (“struggling at school”) or poor inter- associated with any measure of adjustment nal integration (“mental health concerns”). No assessed in this study. students were identi fi ed who showed both poor external adaptation and poor internal integration. Two risk factors associated with current cir- Table 14.3 Five most prevalent self-reported emotional and behavioural problems among adolescent forced and cumstances differentiated the three clusters: per- voluntary migrants who had recently been resettled in ceived discrimination and confl ict in supportive Australia social relationships (F (2) = 5.6, p < 0.01 and F(2) = 9.3, Adolescents p < 0.01, respectively). Students in the resilient Voluntary migrants (n = 43) Forced migrants (n = 83) cluster reported less discrimination (M = 9.0) than Secretive Must be perfect students in either the “struggling at school” or Demands attention Demands attention “mental health concerns” clusters (M = 13.1 and Withdrawn Enjoys little M = 12.9, respectively), and reported less con fl ict Dependent Fears doing bad in supportive relationships ( M = 1.1) than students Lonely Feels too guilty in the “mental health concerns” cluster (M = 2.5).

Table 14.4 Three patterns of adaptation identi ﬁ ed among adolescent forced and voluntary migrants who had recently been resettled in Australia (n = 55) Cluster name n Domain Characteristics Struggling at school 15 External Slow academic progress (M = 2.3) Low peer acceptance (M = 2.4) Internal Total emotional and behaviours problems within the normal range (M = 56.4 a ) Mental health concerns 15 External Average or above average academic progress (M = 3.5) Average or above average peer acceptance (M = 3.8) Internal Total emotional and behavioural problems within the clinical range for Western samples (M = 67.2a ) Resilient 25 External Above average academic progress (M = 4.4) Above average peer acceptance (M = 4.2) Internal Total emotional and behaviours problems within the normal range (M = 47.3 a ) a The cut score for the clinical range in Western samples is 64 14 War and Adolescent Refugees 205

therefore students in the resilient cluster can be Discussion judged to have met several of Western societies’ expectations for competence during adolescence Risk (Masten & Coatsworth, 1998 ) . Given their exposure to past and present effects of armed confl ict The present study sought to infer some of the devel- and given the stresses associated with resettle- opmental costs of exposure to armed con fl ict by ment, this is no small accomplishment. examining the extent to which visa type (humani- It should be noted that individual differences tarian/voluntary migrant) in fl uenced adaptation in adaptation among students holding humanitar- among adolescents. Holding a humanitarian visa ian visas may not refl ect differences in resilience. was associated with poorer competence in two age- That is, they may not primarily be due to differ- salient developmental tasks, school achievement ences in adolescents’ deployment of internal and acceptance by peers, and in one aspect of inter- resources and their access to external resources. nal integration, mental health. No measure of cur- Individual differences in adaptation may instead rent life circumstances showed a similar pervasive refl ect differences in exposure to adversity. It is in fl uence on adaptation. The two visa groups also likely that adolescent forced migrants differ in reported different symptoms of poor mental health. the number, types, intensity and duration of expo- The person-focused analyses con fi rmed Luthar sure to direct and indirect effects of armed et al.’s (2000 ) conclusion that no single dimen- confl ict, but no data are available to demonstrate sion of adaptation is a good index of resilience, this. However, data do show that adolescents in due to how often profi les of adaptation show the “resilient” cluster reported less current adver- unevenness. For each of the dimensions of adap- sity, lower levels of perceived discrimination and/ tation considered, some adolescents who met the or lower levels of interpersonal confl ict, than criterion for positive adaptation belonged to clus- their peers in other clusters. That is, some adoles- ters with more favourable outcomes (resilient) cents who appear more resilient than their peers while others belonged to clusters with less favour- may simply have faced lower proximal risk able outcomes (“struggling at school” or “mental (Luthar et al., 2000 ) . health problems”). This is consistent with Cicchetti’s (1993 ) proposition that many outcomes are included in within normal, abnormal Prevention and resilient developmental trajectories. This study identifi ed a large group of adolescent forced migrants who showed positive outcomes on Resilience all three dimensions of adaptation that were assessed. Despite this, previous research warns that “there are These fi ndings regarding the developmental cost of no invulnerable children” (Masten & Obradovic, exposure to armed con fl ict need to be interpreted 2007, p. 23). Adaptation is a developmental process in context. Most adolescents in both visa groups in which new vulnerabilities and strengths emerge showed average or above average academic prog- with changes in developmental potential and devel- ress and peer acceptance and relatively few emo- opmental context (e.g. Werner & Smith, 1982 ) . In tional and behavioural problems. In addition, no our enthusiasm to celebrate their resilience, it is adolescents holding humanitarian visas showed important to remember that armed confl ict is pre- poor adaptation on more than two out of the three ventable. Maintaining peace can be costly, but dimensions of adaptation assessed in this study. probably less costly than waging war and address- Indeed, almost half these students showed good ing its consequences for multiple generations. This adaptation on all three dimensions. These dimen- study shows that some of the costs of violent sions were chosen to encompass a variety of confl ict continue to be paid by those who are stage-salient tasks (Masten et al., 1995 ) , and removed to safety on the other side of the world. 206 J.A. Robinson

Moreover, the present study did not assess all child’s attachment network) while in other cases of the developmental costs of forced migration they simply identify contexts in which the proxi- documented in previous research, such as cultural mal causes of disruptions in developmental tra- bereavement (Lustig et al., 2004 ) : jectories have an increased prevalence (e.g. It is here that my true personality blossomed. I armed confl ict is a context in which there is an fi nally understood the meaning of life… And yet I increased prevalence of malnutrition, resettle- still do not think of Australia as the country that ment is a context in which there is an increased I can call home. prevalence of discrimination). Zina Romanov, Australian citizen, former child refugee from Ukraine The cumulative risk posed by these disruptions has a measurable developmental cost for (Romanov, 2004 , p. 186) child refugees. However, in at least some con- In countries of resettlement, children fl eeing texts, it is also possible to document widespread armed confl ict face additional sources of adver- evidence of resilience despite these costs. sity that are also preventable. In particular, Recognition of this resilience can itself be a pow- results from both variable-focused and person- erful tool by which child refugees can make focused analyses con fi rmed previous evidence meaning of their experiences: that the experience of discrimination is a par- We are stronger and more resilient than we ever ticularly important stressor in resettlement for knew. We survived, that should be enough but it adolescent refugees (e.g. Liebkind, Jasinskaja- isn’t. We must work hard to become whole again Lahti, & Solheim, 2004; Montgomery & …to live the life that was intended for us before it Foldspang, 2007 ) . In this study, it was associ- was disrupted by war and horrors… I believed this is the ultimate triumph, to not just survive wars but ated with both poorer external adaptation (aca- to thrive in peace… And in the end, we would not demic progress) and poorer internal integration only win over the war, …but we will be left stron- (mental health). ger for it. Loung Ung, author of Lucky child and First they killed my father (Ung, 2010 )

Conclusion Acknowledgements This research could not have been conducted without the altruism of teachers, parents and The review of prior research and the empirical students at the Adelaide Secondary School for English and the support of staff in the ESL programme, Department study reported in this chapter suggest some of the of Education and Children’s Services, South Australia. diverse ways in which exposure to armed con fl ict The author also acknowledges her great debt to Joh may in fl uence the development of child refugees. Henley, Megan Reeve and Amanda Wallace for data col- The pattern of fi ndings suggests that exposure to lection and to Michael Oliver, Katie Selby and Dunjar Nedic for assistance in data analysis. the effects of armed con fl ict can act both as a direct infl uence on child refugees’ developmental trajectories and outcomes (e.g. injuries) and as a References risk marker. Risk markers do not cause individual differences in developmental trajectories. Achenbach, T., Becker, A., Doepfner, M., Heiervang, E., Instead they serve as markers of disruptions in Roessner, V., Steinhausen, H.-C., et al. (2008). underlying processes (e.g. loss of meaning in Multicultural assessment of child and adolescent psy- life, disruption of social support networks) that chopathology with ASEBA and SDQ instruments: Research fi ndings, applications, and future directions. do causally affect developmental trajectories Journal of Child Psychology and Psychiatry, 49 , (Luthar et al., 2000 ) . In some cases, variables 251–275. that are risk markers may contribute to the dis- Achenbach, T. M., & Rescorla, L. A. (2001). Manual for ruptions in underlying processes (e.g. armed the ASEBA school-age forms & profi les . Burlington, VT: University of Vermont, Research Center for confl ict may cause the death of members of a Children, Youth, & Families. 14 War and Adolescent Refugees 207

Achvarina, V., & Reich, S. F. (2006). No place to hide: nurse practitioners. Journal of the American Academy Refugees, displaced persons, and the recruitment of of Nurse Practitioners, 21 , 322–331. child soldiers. International Security, 31 , 127–164. Davidson, L. M., & Demaray, M. K. (2007). Social sup- Allwood, M. A., Bell-Dolan, D., & Husain, S. A. (2002). port as a moderator between victimization and inter- Children’s trauma and adjustment reactions to violent nalizing-externalizing distress from bullying. School and nonviolent war experiences. Journal of the Psychology Review, 36 , 383–405. American Academy of Child and Adolescent Psychiatry, Decker, C. L. (2007). Social support and adolescent can- 41 , 450–457. cer survivors: A review of the literature. Psycho- Almqvist, K., & Broberg, A. G. (1999). Mental health and Oncology, 16 , 1–11. social adjustment in young refugee children 3 ½ years Deng, L. M. (2005). My experience as a refugee. In S. after their arrival in Sweden. Journal of the American Dechian, J. Deveraux, & E. Sallia (Eds.), No place like Academy of Child and Adolescent Psychiatry, 38 , home: Australian stories (pp. 145–148). Kent Town, 723–730. SA: Wake fi eld Press. Australian Bureau of Statistics. (2012). 2011 Census Department of Immigration and Citizenship. (2012). Fact reveals one in four Australians is born overseas . Media Sheet 66–Humanitariam Settlement Services. release 21 June, 2012. http://abs.gov.au/websitedbs/ Canberra: Commonwealth of Australia. http://www. censushome.nsf/home/CO-59 . immigov.au/media/fact-sheets/66hss.htm. Avogo, W. A., & Agadjanian, V. (2010). Forced migration Eastmond, M. (2006a). Transnational returns and recon- and child health and mortality in Angola. Social struction in post-war Bosnia and Herzegovina. Science & Medicine, 70 , 53–60. International Migration, 44 , 5–166. Bean, T., Eurelings-Bontekoe, E., & Spinhoven, P. (2007). Eastmond, M. (2006b). Transnational returns and recon- Course and predictors of mental health of unaccompa- struction in post-warBosnia and Herzegovina. nied minors in the Netherlands: One year follow-up. International Migration, 44 , 141–166. Social Science & Medicine, 64 , 1204–1215. Ehntholt, K., & Yule, W. (2006). Practitioner review: Beiser, M. (1999). Strangers at the gate: The “boat peo- Assessment and treatment of refugee children and ple’s” fi rst ten years in Canada . Toronto: University adolescents who have experienced war-related trauma. of Toronto Press. Journal of Child Psychology and Psychiatry, 47 , Bek-Pedersen, K., & Montgomery, E. (2006). Narratives 1197–1210. of the past and present: Young refugees’ construction Elia, D., Deng, K., & Jok, A. (2005). We are now in this of a family identity in exile. Journal of Refugee one place. In S. Dechian, J. Deveraux, & E. Sallia Studies, 19 , 94–112. (Eds.), No place like home: Australian stories (pp. Berry, J., & Sam, D. (1997). Acculturation and adaptation. 107–112). Kent Town, SA: Wake fi eld Press. In J. W. Berry, Y. H. Pootinga, M. H. Segall, J. Pandey, Espié, E., Gaboulaud, V., Baubet, T., Casas, G., Mouchenik, & C. Kagitcibasi (Eds.), Handbook of cross-cultural Y., Yun, O., et al. (2009). Trauma-related psychologi- psychology: Social behavior and applications (2nd cal disorders among Palestinian children and adults in ed., pp. 291–326). Boston: Allyn & Bacon. Gaza and West Bank, 2005–2008. International Betancourt, T. S., & Khan, K. T. (2008). The mental health Journal of Mental Health Systems , 3, 21. http://www. of children affected by armed confl ict: Protective pro- ijmhs.com/content/3/1/21 . cesses and pathways to resilience. International Farwell, N. (2001). ‘Onward through strength’: Coping Review of Psychiatry, 20 , 317–328. and psychological support among refugee youth Bhugra, D. (2004). Migration and mental health. Acta returning to Eritrea from Sudan. Journal of Refugee Psychiatrica Scandinavica, 109 , 243–258. Studies, 14 , 1–69. Bokan, B. (2004). To be someone…. In S. Dechian, H. Millar, Fazel, M., & Stein, A. (2003). Mental health of refugee & E. Sallia (Eds.), Dark dreams: Australian refugee sto- children: Comparative study. British Medical Journal, ries (pp. 53–56). Kent Town, SA: Wakefi eld Press. 327 , 134. Choi, Y., He, M., & Harachi, T. (2008). Intergenerational Fazel, M., Wheeler, J., & Danesh, J. (2005). Prevalence of cultural dissonance, parent–child confl ict and bond- serious mental disorder in 7000 refugees resettled in ing, and youth problem behaviors among Vietnamese western countries: A systematic review. Lancet, 365 , and Cambodian immigrant families. Journal of Youth 1309–1314. and Adolescence, 37 , 85–96. Feder, A., Nestler, E. J., & Charney, D. S. (2009). Cicchetti, D. (1993). Developmental psychopathology: Psychobiology and molecular genetics of resilience. Reactions, refl ections, projections. Developmental Nature Reviews Neuroscience, 10 , 446–457. Review, 13 , 471–502. Fox, P., Burns, K., Popovich, J., Belknap, R., & Frank- Corbett, M., & Oman, A. (2006). Acute malnutrition in Stromborg, M. (2004). Southest Asian refugee chil- protracted refugee situations : A global strategy . dren: Self-estern as a predictor of depression and Geneva: United Nations High Commissioner for scholastic achievement in the U.S. International Refugees and World Food Program. http://www.unhcr. Journal of Psychiatric Nursing Research, 9, org/publ/PUBL/469b6b0c2.pdf . 1063–1072. Crowley, C. (2009). The mental health needs of refugee Fu, H., & van Landingham, M. J. (2010). Mental and children: A review of literature and implications for physical health consequences of repatriation for 208 J.A. Robinson

Vietnamese returnees: A natural experiment approach. Lama, M. P. (2008). Bhutanese refugees in Nepal. In G. Journal of Refugee Studies, 23 , 160–180. Loescher, J. Milner, E. Newman, & G. Troeller (Eds.), Geltman, P., Grant-Knight, W., Mehta, S., Lloyd- Protracted refugee situations: Political, human rights Travaglini, C., Lustig, S., Landgraf, J., et al. (2005). and security implications (pp. 277–302). New York: The “lost boys of Sudan”: Functional and behavioral United Nations University Press. health of unaccompanied refugee minors resettled in Liebkind, K., Jasinskaja-Lahti, I., & Solheim, E. (2004). the United States. Archives of Pediatrics & Adolescent Cultural identity, perceived discrimination, and paren- Medicine, 159 , 585–591. tal support as determinants of immigrants’ school Ghulam-e-Ali. (2004). Life. In S. Dechian, H. Millar, & adjustments: Vietnamese youth in Finland. Journal of E. Sallia (Eds.), Dark dreams: Australian refugee Adolescent Research, 19 , 635–656. stories (pp. 133–138). Kent Town, SA: Wakefi eld Loescher, G., Milner, J., Newman, E., & Troeller, G. Press. (2008). Introduction. In G. Loescher, J. Milner, E. Guribye, E. (2010). Breakdown in coping resources Newman, & G. Troeller (Eds.), Protracted refugee among Tamil refugees in Norway. 21st Biennial situations: Political, human rights and security impli- Conference of the International Society for the Study cations (pp. 3–19). New York: United Nations of Behavioral Development, Lusaka, Zambia, 18–22 University Press. July, 2010. Lorek, A., Ehntholt, K., Nesbitt, A., Wey, E., Githinji, C., Hammen, C., Shih, J. H., & Brennan, P. A. (2004). Rossor, E., et al. (2009). The mental and physical Intergenerational transmission of depression: Test of health dif fi culties of children held within a British an interpersonal stress model in a community sample. immigration detention center: A pilot study. Child Journal of Consulting and Clinical Psychology, 72 , Abuse & Neglect, 33 , 573–585. 511–522. Loughry, M., & Flouri, E. (2001). The behavioral and Heptinstall, E., Sethna, V., & Taylor, E. (2004). PTSD and emotional problems of former unaccompanied refugee depression in refugee children: Association with pre- children 3–4 years after their return to Vietnam. Child migration trauma and post-migration stress. European Abuse & Neglect, 25 , 249–263. Child & Adolescent Psychiatry, 13 , 373–380. Lustig, S. L., Kia-Keating, M., Knight, W. G., Geltman, Hodes, M., Jagdev, D., Chandra, N., & Cunniff, A. (2008). P., Ellis, H., Kinzie, D. J., et al. (2004). Review of Risk and resilience for psychological distress amongst child and adolescent refugee mental health. Journal of unaccompanied asylum seeking adolescents. Journal the American Academy of Child and Adolescent of Child Psychology and Psychiatry, 49 , 723–732. Psychiatry, 43 , 24–36. Hofstede, G. (2001). Culture’s Consequences: Comparing Luthar, S. S., Cicchetti, D., & Becker, B. (2000). The con- values, behaviors, institutions, and organizations struct of resilience: A critical evaluation and guide- across nations (2nd ed.). Thousand Oaks, CA: Sage. lines for future work. Child Development, 71 , Holli fi eld, M., Warner, T. D., Lian, N., Krakow, B., 543–562. Jenkins, J. H., Kesler, J., et al. (2002). Measuring Machel, G. (2001). The impact of war on children . trauma and health status in refugees: A critical review. London: Hurst & Company. Journal of the American Medical Association, 288 , Martin, A. (2005). Environmental con fl ict between refu- 611–621. gee and host communities. Journal of Peace Research, Holmes, J. (2010). A scandal that needs to end. Forced 42 , 329–346. Migration Review, 36 , 4–6. Masten, A., Best, K., & Garmezy, N. (1990). Resilience Internal Displacement Monitoring Centre. (2010). Still at and development: Contributions from the study of risk: Internally displaced children’s rights in North- children who overcome adversity. Development and West Pakistan. Geneva: Internal Displacement Psychopathology, 2 , 425–444. Monitoring Centre. Masten, A., & Coatsworth, J. D. (1998). The development Ivanova, M. Y., Achenbach, T. M., Rescorla, L. A., of competence in favorable and unfavorable environ- Dumenci, L., Almqvist, F., Bilenberg, N., et al. (2007). ments: Lessons from research on successful children. The generalizability of the Youth Self-Report syn- American Psychologist, 53 , 205–220. drome structure in 23 societies. Journal of Consulting Masten, A., Coatsworth, J. D., Neemann, J., Gest, S., and Clinical Psychology, 75 , 729–738. Tellegen, A., & Garmezy, N. (1995). The structure and Karlsen, E. (2011). Refugee resettlement to Australia : coherence of competence from childhood through What are the facts? Canberra: Parliamentary adolescence. Child Development, 66 , 1635–1659. Library, Department of Parliamentary Services, Masten, A. S., & Obradovic, J. (2007). Competence and Commonwealth of Australia. http://parlinfo.aph. resilience in development. Annals of the New York gov.au/parlInfo/download/library/prspub/1276913/ Academy of Science, 1094 , 13–27. upload_binary/1276913.pdf;fi leType=application/ Masten, A. S., & Osofsky, J. D. (2010). Disasters and their pdf#search=%22background%20note%20 impact on child development: Introduction to the spe- (parliamentary%20library,%20australia)%22 . cial section. Child Development, 81 , 1029–1039. Keyes, E. F. (2000). Mental health status in refugees: An Masten, A. S., & Powell, J. L. (2003). A resilience frame- integrative review of current research. Issues in Mental work for research, policy, and practice. In S. S. Luthar Health Nursing, 21 , 397–410. (Ed.), Resilience and vulnerability: Adaptation in the 14 War and Adolescent Refugees 209

context of childhood adversities (pp. 1–25). New York: Pearn, J. (2003). Children and war. Journal of Paediatrics Cambridge University Press. and Child Health, 39 , 166–172. McDonald-Wilmsen, B., & Gifford, S. M. (2009). Refugee Pynoos, R. S., Steinberg, A. M., & Wraith, R. (1995). A resettlement , family separation and Australia ’s humani- developmental model of childhood traumatic stress. In tarian programme . Research Paper No. 178, PDES D. Cicchetti & D. J. Cohen (Eds.), Developmental psy- Working Papers. http://www.unhcr.org/4b167ae59.html . chopathology: Vol. 2. Risk, disorder, and adaptation Mels, C., Derluyn, I., Broekaert, E., & Rosseel, Y. (2010). (pp. 72–95). Oxford: Wiley. The psychological impact of forced displacement and Rasmussen, A., Nguyen, L., Wilkinson, J., Vundla, S., related risk factors on Eastern Congolese adolescents Raghavan, S., Miller, K. E., et al. (2010). Rates and affected by war. Journal of Child Psychology and impact of trauma and current stressors among Darfuri Psychiatry , 51 , 1096–1104. refugees in Eastern Chad. The American Journal of Miller, K. E., & Rasmussen, A. (2010). War exposure, Orthopsychiatry, 80 , 227–236. daily stressors, and mental health in con fl ict and post- Refugee Council of Australia. (2009). Refugees in confl ict settings: Bridging the divide between trauma- Australia 2004–09: Useful statistics. Sydney: Refugee focused and psychosocial frameworks. Social Science Council of Australia. http://www.refugeecouncil.org. & Medicine, 70 , 7–16. au/docs/refugeeweek/2009/Refugee_stats_04-09.pdf . Mollica, R. F., Poole, C., Son, L., Murray, C. C., & Tor, S. Richman, N. (1993). Annotation: Children in situations of (1997). Effects of war trauma on Cambodian refugee political violence. Journal of Child Psychology and adolescents’ functional health and mental health sta- Psychiatry, 34 , 1286–1302. tus. Journal of the American Academy of Child and Romanov, Z. (2004). Zina’s story. In S. Dechian, H. Adolescent Psychiatry, 36 , 1098–1106. Millar, & E. Sallia (Eds.), Dark dreams: Australian Montgomery, E. (2011). Trauma, exile and mental health refugee stories (pp. 183–186). Kent Town, SA: in young refugees. Acta Psychiatrica Scandinavica. Wake fi eld Press. Supplementum, 124 (Suppl 440), 1–46. Rousseau, C. (1995). The mental health of refugee chil- Montgomery, E. (1998). Refugee children from the dren. Transcultural Psychiatric Research Review, 32 , Middle East. Scandinaviam Journal of Social 299–331. Medicine, Suppl. 54:1–152. Rousseau, C., & Drapeau, A. (2003). Are refugee children Montgomery, E., & Foldspang, A. (2001). Traumatic an at-risk group? A longitudinal study of Cambodian experiences and sleep disturbance in refugee children adolescents. Journal of Refugee Studies, 16 , 67–81. from the Middle East. European Journal of Public Sack, W., Clarke, G., Him, C., Dickason, D., Goff, B., Health, 11 , 146–153. Lanham, K., et al. (1993). A 6-year follow-up study of Montgomery, E., & Foldspang, A. (2007). Discrimination, Cambodian refugee adolescents traumatized as chil- mental problems and social adaptation in young refu- dren. Journal of the American Academy of Child & gees. European Journal of Public Health, 18 , Adolescents Psychiatry, 32 , 431–437. 156–161. Sam, D. L. (1995). Acculturation attitude among immi- Murphy, L. B. (1962). The widening world of childhood: grants as a function of perceived parental attitudes Paths toward mastery . New York: Basic Books. toward cultural change. Journal of Early Adolescence, Nguyen, H.-V. (2004). Journey to freedom. In S. Dechian, 15 , 238–258. H. Millar, & E. Sallia (Eds.), Dark dreams: Australian Sam, D. L., & Oppedal, B. (2002). Acculturation as a refugee stories (pp. 198–204). Kent Town, SA: developmental pathway. In W. J. Lonner, D. L. Dinnel, Wake fi eld Press. S. A. Hayes, & D. N. Sattler (Eds.), Online readings in Nielsen, S. S., Norredam, M., Christiansen, K. L., Obel, psychology and culture (Vol. 8). Washington, USA: C., Hilden, J., & Krasnik, A. (2008). Mental health Center for Cross-Cultural Research. among children seeking asylum in Denmark—The Sam, D. L., Vedder, P., Ward, C., & Horenczyk, G. (2006). effect of length of stay and number of relocations: A Psychological and sociocultural adaptation of immi- cross-sectional study. BMC Public Health, 8, 293. grant youth. In J. W. Berry, J. S. Phinney, D. L. Sam, http://www.biomedcentral.com/1471-2458/8/293 . & P. Vedder (Eds.), Immigrant youth in cultural tran- Paardekooper, B., De Jong, J. T. V. M., & Hermanns, J. M. sition. Acculturation, identity, and adaptation across A. (1999). The psychological impact of war and the national contexts (pp. 117–142). NJ: Lawrence refugee situation on South Sudanese children in refu- Erlbaum Associates. gee camps in Northern Uganda: An Exploratory Study. Sanders-Phillips, K., Settles-Reaves, B., Walker, D., & Journal of Child Psychology and Psychiatry, 40 , Brownlow, J. (2009). Social inequality and racial dis- 529–536. crimination: Risk factors for health disparities in chil- Pantic, Z., & Kraljevic, R. (2003). How we understood dren of color. Pediatrics, 124 , S176–S186. the repatriation process: Story about return told Shemyakina, O. (2011). The effect of armed con fl ict on through several pictures done by children. In Z. Pantic accumulation of schooling: Results from Tajikistan. (Ed.), Repatriation as a part of reconstructive process Journal of Development Economics, 95 , 186–200. in torture survivors (interpersonal and intrapersonal doi: 10.1016/j.jdeveco.2010.05.002 . process) (pp. 25–31). Zagreb, Croatia: International Silove, D., Austin, P., & Steel, Z. (2007). No refuge from Rehabilitation Centre for Torture Victims. terror: The impact of detention on the mental health of 210 J.A. Robinson

trauma-affected refugees seeking asylum in Australia. children in Southern Africa, 2005–2007 . Geneva: Transcultural Psychiatry, 44 , 359–393. United Nations High Commissioner for Refugees. Slodnjak, V., Kos, A. & Yule, W. (2002). Depression and United Nations High Commissioner for Refugees. parasuicide in refugee and Slovenian adolescents. (2007b). UN convention and protocol on the status of Criss, 23, 127–132. refugees . Geneva: UNHCR Media Relations and Smith, P., Perrin, S., Yule, W., Hacam, B., & Stuvland, R. Public Information Service. http://www.unhcr. (2002). War exposure among children from Bosnia- org/3b66c2aa10.html . Hercegovina: Psychological adjustment in a commu- United Nations High Commissioner for Refugees. (2010). nity setting. Journal of Traumatic Stress, 15 , 147–156. 2009 Global trends: Refugees, asylum-seekers, return- Statistics Norway. (2010). National overviews . http://www. ees, internally displaced and stateless persons . ssb.no/innvandring_en/ . Accessed 22 August, 2010. Geneva: United Nations High Commissioner for Stevens, G. W. J. M., & Vollebergh, W. A. M. (2007). Refugees. http://www.unhcr.org/4c11f0be9.html . Mental health in migrant children. Journal of Child United Nations High Commissioner for Refugees. (2012). Psychology and Psychiatry, 49 , 276–294. UNHCR global trends 2011. http://unhcr.org/4fd9e6266. Stichick, T. (2001). The psychosocial impact of armed html . confl ict on children: Rethinking traditional para- Vaage, A. B., Tingvold, L., Hauff, E., Ta, T. V., Wentzel- digms in research and intervention. Child and Larsen, T., Clench-Aas, J., et al. (2009). Better mental Adolescent Psychiatric Clinics of North America, 10 , health in children of Vietnamese refugees compared 797–814. with their Norwegian peers—A matter of cultural dif- Stillman, S., McKenzie, D., & Gibson, J. (2006). Migration ference? Child and Adolescent Psychiatry and Mental and mental health: Evidence from a natural experi- Health, 3 , 34. http://www.capmh.com/content/3/1/34 . ment. Working Papers in Economics 06/04, University Vaux, A. (1988). Social support: Theory, research and of Waikato, Department of Economics. http://ideas. intervention . New York: Praeger. repec.org/p/wai/econwp/06-04.html . Verkuten, M., & Thijs, J. (2002). School satisfaction of Summer fi eld, D. (2000). Childhood, war, refugeedom and elementary school children: The role of performance, “trauma”: Three core questions for mental health pro- peer relations, ethnicity and gender. Social Indicators fessionals. Transcultural Psychiatry, 37 , 417–433. Research, 59 , 203–208. Ung, L. (2010). Loung Ung on Lucky Child . http://www. Warf, C., Eisenstein, E., & Stahl, C. (2009). Children, harpercollins.com/author/authorExtra.aspx?authorID adolescents and war: The systematic engagement of =13997&isbn13=9780060733957&displayType=boo youth in collective violence. Adolescent Medicine kinterview . Accessed 21 September, 2010. State of the Art Review, 20 , 949–960. United Nations High Commissioner for Refugees. (2003). Watters, C. (2001). Emerging paradigms in the mental Framework for durable solutions for refugees and health care of refugees. Social Science & Medicine, persons of concern . Geneva: United Nations High 52 , 1709–1718. Commissioner for Refugees. http://www.unhcr.org/ Wazefadost, N. (2005). Journey to freedom. In S. Dechian, refworld/docid/4124b6a04.html . Accessed 21 J. Deveraux, & E. Sallia (Eds.), No place like home: September, 2010. Australian stories (pp. 68–73). Kent Town, SA: United Nations High Commissioner for Refugees. (2005). Wake fi eld Press. Refugee status determination . Geneva: United Nations Werner, E., & Smith, R. (1982). Vulnerable but invincible: High Commissioner for Refugees. http://www.unhcr. A study of resilient children . New York: McGraw-Hill. ie/pdf/43144dc52.pdf . Yehoda, R., Halligan, S. L., & Grossman, R. (2001). United Nations High Commissioner for Refugees. Childhood trauma and risk for PTSD: Relationship to (2007a). Through the eyes of a child: Refugee children intergenerational effects of trauma, parental PTSD, and speak about violence—A report on participatory cortisol excretion. Development and Psychopathology, assessments carried out with refugee and returnee 13, 733–753. Pathways to Resilience: The Role of Education in War-Zone Immigrant 1 5 and Refugee Student Success

Lana Stermac, Allyson K. Clarke, and Lindsay Brown

became disabled, and over one million were Introduction to War and Youth separated from families or orphaned (UNICEF, 1996 ) . Estimates of homelessness among chil- The past decade has seen an escalation of wars, dren in confl ict zones range from 12 million to a military con fl icts and civil destabilization staggering 200 million (UNICEF, 1996 ) . In addi- throughout the globe. The United Nations esti- tion to the disruption of domicile, family compo- mates that more than 23 million people have been sition and cohesion, schooling, health care and killed in 149 major wars throughout the world social services, a child’s sense of safety, security since 1945 (Sivard, 1993 ) . This has affected and and control can be markedly altered through a continues to affect both indigenous populations war experience (Goldson, 1996 ) . within war-zone areas and the migration of people from almost every continent across the globe. While military confl icts and wars impact all peo- The Effects of War on Youth ple, including both civilians and combatants, the effects on children and youth are particularly Besides the immediate and largely overt effects harsh. In a comprehensive review of war and of war on children, other long-term or less-visible children, Goldson (1996 ) states that in compari- effects are noted. Exposure to trauma associated son to all victims, children suffer the most severe with war and military combat may be particularly effects when exposed to conditions of war. As an damaging and insidious for youth (e.g. Charron exceptionally vulnerable group, children are dis- & Ness, 1981 ; Sack, 1996 ) . Among the serious proportionately affected by displacement and effects of trauma exposure are the high rates of separation from families, abduction and kidnap- both developmental and posttraumatic stress dis- ping, injury and death. It is estimated that in the order (PTSD) documented in studies of youth past several decades, over two million children exposed to war zones (e.g. Catani et al., 2010 ; have been killed or died directly from con fl ict in Sack, 1996 ) . In addition to stress disorders, symp- war zones, many more have been injured or toms of depression and anxiety are common and can lead to nightmares, diffi culty in concentrating, depression and a sense of hopelessness about the future. L. Stermac (*) ¥ A. K. Clarke ¥ L. Brown The sequelae of traumatic exposure in young Department of Applied Psychology & Human individuals can include specifi c age-related dis- Development , Counselling Psychology Program, Ontario ruptions in various areas of development (Green Institute for Studies in Education, University of Toronto , Toronto , ON , Canada et al., 1991 ; Kendall-Tackett, 2002 ) . Changes in e-mail: [email protected] socio-emotional development resulting from

C. Fernando and M. Ferrari (eds.), Handbook of Resilience in Children of War, 211 DOI 10.1007/978-1-4614-6375-7_15, © Springer Science+Business Media New York 2013 212 L. Stermac et al. trauma in childhood, for example, may include ( 2006 ) , for example, report that childhood the construction of internal working models of maltreatment may result in changes that can the world as dangerous and of the self as hopeless impair cognitive, language and academic skills. and helpless (Kendall-Tackett, 2002 ). Biological Bremner et al.’s ( 1995) work with survivors of abnormalities, dysregulation of neurochemical childhood abuse found that immediate and systems, poor tolerance for arousal and diffi culty delayed recall as well as verbal short-term mem- modulating affect (Van Der Kolk, 1988 ) can also ory may be impaired for survivors in adulthood. be symptoms associated with trauma exposure. Cook, Ciorciari, Varker, and Devilly ( 2009 ) dem- Traumatic exposure may interfere with the cen- onstrated that adults with childhood trauma had tral processes of attention, memory and motiva- higher EEG coherence, suggesting the trauma tion that affect youth and can result in a young had a lasting impact on neural connectivity. In a person’s inability to concentrate, learn new mate- study of various forms of abuse, DePrince, rial and attend to appropriate stimuli. Resultant Weinzierl, and Combs (2009 ) found that execu- emotional and behavioural disturbances (Kolb & tive function performance involving working Whishaw, 1984 ; Mellman & Davis, 1985 ; memory, inhibition, auditory attention and pro- Vasterling & Brewin, 2005 ) can all have implica- cessing speed tasks was negatively impacted in tions for various aspects of youth development community samples of children experiencing and functioning, including how youth with histo- either familial or nonfamilial trauma. ries of trauma perform in schools and academic Studies examining speci fi cally war-related settings. In this chapter, we focus on the educa- trauma exposure among youth suggest that simi- tional outcomes and issues facing youth who lar problems related to learning may exist. have histories of trauma, in particular those from Punamaki (2001 ) , for example, found that Chilean war zones or areas of military combat. child refugees whose family had been subject to political imprisonment, execution, disappearance or expulsion from the country had dif fi culty with Trauma and Learning learning. In an extensive review of the neuropsychological effects of starvation, torture, beatings, In addition to the biological and social-emotional imprisonment and other head injury experiences effects of traumatic stress, studies of trauma- in refugee populations, Weinstein, Fucetola, and exposed youth focus also on cognitive function- Mollica ( 2001) report on the signifi cant extent of ing related to learning. In order to understand this neurological impairment and traumatic brain fully, it is important to examine how learning injury among victims of mass violence and war- processes for children and youth who have been related trauma. exposed to war zone and other forms of trauma may be affected by their experiences and how these youth perform within schools. As noted Relationship Between Mental Health above, many of the casualties of war and migra- Symptomology and Learning tion are children, and the identi fi cation of their Outcomes educational needs and academic performance is of great importance. In addition to the above-mentioned challenges to Educators, researchers and clinicians have learning potential, the emotional and psychologi- documented various effects that trauma exposure cal distress of trauma exposure may also lead to may have on an individual’s learning or ability to academic problems. In a Canadian study of function well within educational environments. Central American and Southeast Asian refugee These studies examine the effects of war trauma students, learning diffi culties were signifi cantly as well as various forms of early trauma expo- associated with hyperactivity, social isolation and sure, most notably child maltreatment. Watts- somatization for Central American students, while English, Fortson, Gibler, Hooper, and De Bellis for Southeast Asian students academic problems 15 Pathways to Resilience… 213 were signi fi cantly associated with somatization, as well as perceived effi cacy. For example, aggression and depression (Rousseau, Drapeau, Kia-Keating and Ellis (2007 ) conducted a study & Corin, 1996 ) . Sri Lankan children who had with 76 adolescent Somali refugees who had expe- lived under conditions of extreme ethnic con fl ict rienced a number of adversities prior to resettling for considerable periods of time demonstrated a in the United States. The results indicated that number of behavioural disturbances associated increased exposure to war, violence and displace- with lower academic performance, particularly ment was associated with higher levels of depres- for boys (Prior, Virasinghe, & Smart, 2005 ) . sion and PTSD symptoms, as well as a lower sense Similarly, in a study of Central American and of self-effi cacy. Conversely, higher levels of a Cambodian seventh and eighth graders, traumatic sense of school belonging were associated with a family experiences occurring in the adolescent’s lower degree of PTSD and depression symptoms lifetime were associated with greater academic (Kia-Keating & Ellis, 2007 ). problems for both groups, and particularly for The symptoms of PTSD reported by many older Central American males (Rousseau & survivors of trauma, such as intrusive thoughts, Drapeau, 2000 ) . Overall, however, there was no memory and attention diffi culties, and sleep association between academic failure and mental impairment, can also affect scholastic perfor- health diffi culties (Rousseau & Drapeau). mance. In a comprehensive review of PTSD and Berthold’s (2000 ) study of 144 Khmer adolescents memory, Isaac, Cushway, and Jones (2006 ) found who moved to the United States as children found evidence that individuals who suffer from PTSD that they reported considerable emotional have de fi cits in episodic memory above and diffi culties, with one-third meeting criteria for beyond those resulting from impaired attention PTSD and almost two-thirds endorsing depressive from depression or anxiety. Others (e.g. Cook symptoms. Thirty per cent had been reprimanded et al., 2009 ; Saigh, Mroueh, & Bremner, 1997 ) for behaviour problems at school during the past suggest also that there has been some evidence to year, including disobeying rules, disruptive or implicate PTSD as the cause of poor academic lewd behaviour, truancy, weapons-related issues performance. For example, Saigh et al. (1997 ) and threats or violence (Berthold, 2000 ). Higher found that traumatized Lebanese adolescents academic achievement among this group of Khmer with PTSD had learning diffi culties evidenced by adolescents was associated with experiencing lower scores on achievement assessments. A later lower levels of exposure to violence over their study by Bremner, Vermetten, Afzal, and lifetime and having fewer reported behaviour Vythilingam (2004 ) further con fi rmed that problems at the present time (Berthold, 2000 ) women with histories of early childhood abuse In a study of refugee children living in trauma who had met criteria for PTSD had defi cits Australia, Driver and Beltran ( 1998 ) found that in verbal declarative memory. the majority of children interviewed experienced disturbing psychological symptoms, including nightmares, intrusive memories and somatic Potential Challenges in Academic complaints, as well as diffi culties with concentra- Environments tion, attention and motor coordination. These children exhibited a number of academic Studies examining the educational experiences diffi culties, including problems with reading, and academic achievements of war-zone immi- mathematics, handwriting and homework com- grant and refugee youth identify a number of pletion, which the authors attribute at least in part other relevant issues that may also impact a stu- to premigration experiences and ongoing dent’s academic abilities and success. When diffi culties with cognitive and sensory motor pro- entering a new and unfamiliar school system— cesses (Driver & Beltran, 1998 ). particularly in situations where premigration aca- Traumatic experiences and psychological dis- demic experiences were limited, unstable or tress may also infl uence one’s sense of belonging, interrupted—the initial postmigration assessment 214 L. Stermac et al. and placement process can be challenging and discrimination and differential treatment from requires the sensitive and appropriate determina- peers, as well as teachers and school personnel, tion of appropriate grade level, as well as an that may impact their academic experiences assessment of any learning disabilities or psycho- (Baffoe, 2007 ; Fantino & Colak, 2001 ; Kapreilian- logical diffi culties (Kapreilian-Churchill, 1996 ) . Churchill, 1996 ) . Even when placed in appropriate courses, it can be challenging for students and their families to adapt to the structure, curriculum and learning Academic Success Among Immigrant expectations of the new school system, as well as and Refugee Youth to potentially different values and attitudes regarding discipline, authority and the value of The School Environment extracurricular activities (Cole, 1998 ; Driver & Beltran, 1998 ; Kapreilian-Churchill, 1996 ) . While migration and adaptation to a new country For many, the challenge of learning a new lan- presents various challenges for immigrant and guage poses an additional barrier to adjustment, refugee youth, educators and researchers point to academic advancement and the development of optimal pathways to successful posttraumatic social relationships (Cole, 1998; Driver & adjustment. Among the factors consistently Beltran, 1998 ; Kapreilian-Churchill, 1996 ) . In a identi fi ed as important in facilitating positive out- 2000 study of Southeast Asian refugee youth liv- come for trauma-exposed youth is the availability ing in Canada, participants commonly reported of schooling and the school environment. having diffi culty adjusting to school due in part In a study of Cambodian survivors of terror, to stress, insecurity and academic dif fi culties West (2000 ) found that ‘optimism, social support, associated with limited English fl uency (Hyman, self-reliance, and access to education’ were asso- Vu, & Beiser, 2000 ) . These same participants ciated with resilience and stress-related growth. also described having diffi culty adjusting to unfa- Lin, Suyemoto, and Kiang ( 2009 ) also point to miliar cultural values in the school system, such the positive role of education in healing from per- as different approaches used by teachers, greater sonal and familial experiences with trauma expectation for class participation and emphasis through facilitated communication. Hones ( 2007 ) on opinion questions as opposed to fact memori- notes how a ‘pedagogy of engagement’ within zation (Hyman et al., 2000 ). schools that includes critical teaching and a focus The adjustment to an unfamiliar school system on multiple intelligences is benefi cial to students can also be challenging for parents and families. with trauma histories. Mireles ( 2010 ) reviews the For example, parents may fi nd it dif fi cult to com- effi cacy of the Trauma Sensitive Schools Program municate with school personnel due to language in the US as a specialized model of hope and or cultural barriers, and may feel uninformed recovery for trauma-exposed students. Others about the workings of the system or unable to (e.g. Perrier & Nsengiyumva, 2003 ) identify assist their children in completing academic speci fi c aspects of curriculum that are inquiry- assignments (Cole, 1998 ; Driver & Beltran, 1998 ) . based and hands-on (such as science activities) as In a qualitative study of African refugee and contributing to the recovery process for war-trau- immigrant youth, Baffoe (2007 ) found that a small matized students. Researchers suggest that inter- sample of eight parents and four community lead- ventions can be helpful when they are culturally ers complained about the lack of formal orienta- appropriate (Perrier & Nsengiyumva, 2003 ) and tion and support programmes available to assist facilitate the development of effective coping them in integrating into the new school system. strategies (Punamaki, 2001 ; West, 2000 ) . Finally, although school may represent a safe Previous research by Stermac, Brazeau, and place for many (Kapreilian-Churchill, 1996 ) , Kelly ( 2008 ) found that war-zone immigrants some refugee youth, particularly those from vis- who participated in community-based educa- ible minority groups, may experience racism, tional programmes spoke of positive educational 15 Pathways to Resilience… 215 experiences which may have contributed to their school accomplishments. In fact, refugee students sense of well-being. In this study, both male and with higher achievement reported greater PTSD female participants stated that the social and symptoms than those with low achievement; these community connections made through attendance fi ndings challenge the idea that those who experi- in educational programmes resulted in receiving ence war trauma automatically suffer devastating additional supports and experiencing a greater consequences academically, and raise questions sense of belonging. Abel and Friedman’s (2009 ) as to what contributes to their resilience (Slodnjak, study in Israel found that when displaced chil- Kos, & Yule, 2002 ) . dren with trauma symptoms engaged in regular Similar fi ndings are reported in studies exam- activities, such as school, an improved outcome ining the academic achievements of refugee stu- was facilitated. Klingman (2001 ) notes the value dents in Canadian schools. A study of 91 refugee of the school environment in allowing students to youth in Alberta found that over half (53 %) were experience ‘unifi ed grief’ when exposed to a col- ‘on track’ to attend postsecondary school, while lective trauma. Overall, there is a general consen- approximately 27 % were likely to complete high sus within this literature that schools are an school but unlikely to proceed on to postsecond- appropriate site for prevention and intervention ary education. The remaining 20 % were deemed for trauma-exposed youth to take place (Abel & to be ‘behind’, either having dropped out of Friedman, 2009 ; West, 2000 ) . school or were in a grade below that appropriate for their age (Wilkinson, 2002 ) . Women, youth with healthier parents, those who had been in Factors Associated with Academic Canada for longer, those living in larger urban Success centres and those who believed they were placed in an appropriate grade after their arrival in Despite the identi fi ed risk factors associated with Canada were more likely to be on track. Refugees trauma exposure, research suggests that many from former Yugoslavia were also more likely to war-zone and other immigrant and refugee youth be on track for postsecondary education, perhaps are able to succeed academically postmigration because of greater similarity in ethnic and cul- and, in many cases, overcome obstacles through- tural background compared to the Canadian out their academic careers. A number of studies majority (Wilkinson, 2002 ). point to factors related to the positive educational Likewise, a study of Central American and experiences and academic achievements of these Cambodian seventh and eighth graders attending students. For example, in an international study of school in Montreal found that refugee adoles- 110 Soviet refugee adolescents attending high cents achieved similar academic results compared school in the United States, those with higher lev- to their classmates (Rousseau & Drapeau, 2000 ) . els of acculturation to American culture had higher Acculturation was linked to avoiding academic grades, a stronger sense of school belonging and failure for Central American girls, while length fewer disciplinary issues (Trickett & Birman, of time in Canada was associated with academic 2005 ) . While English language ability was ini- success for Central American boys (Rousseau & tially hypothesized to contribute to academic suc- Drapeau, 2000 ). cess, this study found that, in fact, it was their A series of recent Canadian studies conducted sense of American identity, not English skills, by Stermac, Elgie, Dunlap, and Kelly ( 2010 ) and which predicted positive school outcomes such as Stermac, Elgie, Clarke, and Dunlap ( 2012 ) inves- higher GPA (Trickett & Birman, 2005 ) . A study of tigated the educational experiences and academic eighth-grade refugee students from Bosnia and achievements of immigrant youth from war-zone Herzegovina and their Slovenian non-refugee areas in Africa, Asia, Central America, Europe peers found that both groups were comparable in and the Middle East. Their fi ndings for 15-year- terms of academic achievement, and that PTSD old high school students indicated that these symptomology did not negatively impact their youth performed at comparable—and in some 216 L. Stermac et al. cases, superior—levels as Canadian-born and 2003 ) , Iranian child refugees (Almqvist & non-war-zone immigrant students (Stermac et al., Brandell-Forsberg, 1997 ) and some Cambodian 2010 ) . Speci fi cally, youth from war-zone coun- adolescent refugees in the US (Kinzie, Sack, tries had similar marks in language and science Angell, Manson, & Rath, 1986 ) . Other research, as students born in Canada or non-war-zone however, demonstrates that some individuals countries, as well as signifi cantly higher mathe- report no signifi cant long-term problems even matics marks relative to Canadian-born youth. In following exposure to the extreme conditions of addition, war-zone youth reported higher levels war or military confl icts, or that they recover soon of academic engagement and self-ef fi cacy than afterwards. Canadian-born youth and comparable levels of For example, Stermac et al.’s (2008 ) work in social engagement. War-zone students saw them- this area found that individuals reporting severe selves as identifying with and participating in distress and negative effects of extended war- their academic programmes, and held positive trauma exposure in premigration environments attitudes towards learning, schoolwork, teacher did not report enduring symptoms postmigration. relationships and their own abilities. Preliminary Posttraumatic stress symptoms of re-experienc- fi ndings from a study of older high school stu- ing, avoidance or numbing, and arousal associ- dents indicated similar results (Stermac et al., ated with previous trauma and reported at high 2012 ) . This research supports the fi nding that levels in the premigration environment were not immigrant youth from war-torn countries are reported at signifi cant levels in the new environ- achieving academic success within the Canadian ment. Studies of youth in Rwanda who had suf- school system. fered extreme violence and destruction in the genocide of 1995 demonstrated that many of the children denied posttraumatic stress symptoms Are War-Zone Youth Resilient? (UNICEF, 1996 ) . Older survivors of war in Nicaragua stated that they continued to function The above review highlights a number of impor- in the face of ongoing adverse conditions tant fi ndings in the broad area of educational out- (Summer fi eld & Toser, 1991 ) . In their study of comes for trauma-exposed immigrant and refugee refugee children living in Australia, Driver and students. The transition to a new and often unfa- Beltran ( 1998) assert that not all children were miliar culture and learning environment can be impacted in the same negative way by their trau- dif fi cult for any individual and may be particu- matic past and identify a number of factors as larly challenging for youth with a history of contributing to healthy adaptation, including the trauma, adversity and displacement. While not all provision of postmigration practical, fi nancial refugee youth suffer or require specialized atten- and emotional support for the family. In a study tion, many individuals may face additional devel- of Chilean child survivors of military-based opmental and academic challenges above those trauma in Chile, Punamaki ( 2001 ) found that experienced by Canadian-born and non-refugee early and substantial psychosocial assistance was immigrant youth due to their displacement and associated with the facilitation of effective cop- traumatic events experienced prior to migration ing and good mental health in adulthood. (Cole, 1998 ; Kapreilian-Churchill, 1996 ) . These fi ndings suggest that stressors associ- Studies of the long-term psychological effects ated with war, civil unrest and forced migration of traumatic stressors present mixed results with are not synonymous with the development of dis- respect to the enduring effects of trauma. For orders, and that traumatic stress does not neces- some individuals, these effects may persist for sarily render individuals unable to cope or thrive. signifi cant periods of time following the initial This work indicates also that some youth are able war-trauma exposure such as those reported to develop positive strategies that promote adap- among Croatian children (Kuterovac-Jagodic, tation and resilience in the face of trauma and 15 Pathways to Resilience… 217 upheaval associated with war. In a review article Western psychological programmes within war- examining positive change following trauma and zone and confl ict areas and warn that the Western adversity, Linley and Joseph ( 2004 ) identify fi ve perceptions of trauma and healing may not be sets of variables including cognitive/affective, universal. Therefore, they argue that it is neces- sociodemographic, personality, coping, religion sary to understand this through a cultural lens and and social support that are associated with adap- call for interventions that are community- and tive adjustment or what has been termed as ‘post- group-based, and self-sustainable. Similarly, traumatic growth’. West ( 2000) found that healing was facilitated The identi fi cation of personal, sociocultural, when cultural context was integrated into all sites economic or other variables critical to the devel- of intervention, such as community programmes, opment of resilience and good academic perfor- social resources and health services in Cambodia. mance for youth who have suffered war-related In Israel, interventions in schools are based on trauma is a newly emerging and important area of crisis intervention as needed within that environ- investigation. Researchers and educators have ment (Abel & Friedman, 2009 ) . This further identifi ed various coping skills and factors associ- emphasizes the need to understand the culture in ated with resilience among immigrant youth who which one is attempting to facilitate healing. have experienced war and civil unrest. For exam- Punamaki (2001 ) noted also the importance of ple, ideological commitment has been associated early psychosocial interventions when responding with lower levels of distress among children to trauma. The author found that cohesive families exposed to political violence (Punamaki, 1996 ) . with low-level confl ict were best able to support An increase in prosocial behaviour was observed their children during a time of con fl ict. Abel and among Lebanese children who were separated Friedman (2009 ) also reported that family cohe- from their parents or had witnessed people killed sion was related to the child’s display of trauma during the civil unrest of the late 1970s and 1980s symptoms and that parent symptomology and (Macksoud & Aber, 1996 ) . Adaptive coping strat- response affected young children. Punamaki’s egies have been noted among Palestinian children (2001 ) study concluded that children with effec- exposed to political strife over the past decade, as tive coping strategies had more positive learning compared to non-refugee children (Punamaki & experiences and less mental health diffi culties. Suleiman, 1990 ) . Distraction has been identi fi ed West (2000 ) also emphasizes the importance of as a coping strategy used by Sudanese children coping skills and noted that Cambodian partici- living in camps (Paardekooper, de Jong, & pants stated that their coping skills allowed them Hermanns, 1999 ) . Tibetan refugee children who to survive and later allowed them to reconceptual- migrated to India in the past 20 years reported ize their losses and dif fi culties into strengths. using religion, community and identi fi cation with Therefore, interventions should be initiated early, the struggle for independence to cope success- reconnect individuals with their natural world, fully with traumatic stress (Servan-Schreiber, Lin, support the family and help children develop effec- & Birmaher, 1998 ) . tive coping skills within their cultural context. Our previous research examining the educational transitions of war-zone immigrant and ref- What Helps Foster Resilience ugee students suggests also that a number of and Strong Academic Performance? variables may be important in determining optimal educational outcomes among students with Factors associated with enhancing the academic histories of trauma exposure (Stermac et al., performance of youth who have suffered trau- 2008) . Our work with students who performed matic experiences are only beginning to be rec- well academically indicates that factors related to ognized. Perrier and Nsengiyumva ( 2003 ) language facility, pedagogy, curriculum inclu- comment on the dif fi culty of implementing siveness and support services may be critical to 218 L. Stermac et al. their development of self-con fi dence and aca- References demic success. Students noted that acknowledging and recognizing their cultural background, Abel, R. M., & Friedman, H. A. (2009). Israeli school and developing language pro fi ciency and the avail- community response to war trauma: A review of selected literature. School Psychology International, ability of individual and community educational 30 (3), 265Ð281. supports were critical to their positive experiences Almqvist, K., & Brandell-Forsberg, M. (1997). Refugee and achievements (Stermac et al., 2008 ). Results children in Sweden: Post-traumatic stress disorder in from our studies, based on large data sets, revealed Iranian preschool children exposed to organized violence. Child Abuse & Neglect, 21 (4), 351Ð366. also that students performing well developed a Baffoe, M. (2007). Navigating two worlds: Culture and number of teacher-facilitated competencies, cultural adaptation of immigrant and refugee youth in including perceptions of academic self-ef fi cacy, a Quebec (Canadian) educational context. Dissertation that potentially contributed to greater engage- Abstracts International: Section A. Humanities and Social Sciences, 68 (5-A), 2168. ment, and hence success, with academic aspects Berthold, S. M. (2000). War traumas and community vio- of the school (Stermac et al., 2010 ) . Student per- lence: Psychological, behavioral, and academic out- ceptions of the extent to which they saw their comes among Khmer refugee adolescents. Journal of instructors as strong and interested in them and Multicultural Social Work, 8 (1Ð2), 15Ð46. Bremner, J. D., Randall, P., Scott, T. M., Capelli, S., the extent to which they felt they were made to Delaney, R., McCarthy, G., et al. (1995). Defi cits in feel like a number were related to the develop- short-term memory in adult survivors of childhood ment of their self-confi dence and competence. abuse. Psychiatry Research, 59 , 97Ð107. Bremner, J. D., Vermetten, E., Afzal, N., & Vythilingam, M. (2004). Defi cits in verbal declarative memory function in women with childhood sexual abuse-related Conclusion posttraumatic stress disorder. The Journal of Nervous and Mental Disease, 192 , 643Ð649. Despite decades of migration from global con fl ict Catani, C., Gewirtz, A. H., Wieling, E., Schauer, E., Elbert, T., & Neuner, F. (2010). Tsunami, war, and zones, limited knowledge of the sequelae of trau- cumulative risk in the lives of Sri Lankan schoolchil- matic stress on the learning needs of immigrant dren. Child Development, 81 (4), 1176Ð1191. and refugee students has restricted the develop- Charron, D. W., & Ness, R. C. (1981). Emotional distress ment of guidelines and ‘best practices’ for this among Vietnamese adolescents: A statewide survey. Journal of Refugee Resettlement, 1 (3), 7Ð15. group of students. The accumulating work in this Cole, E. (1998). Immigrant and refugee children: area both nationally and internationally suggests Challenges and opportunities for education and mental that a number of contextual factors may have an health services. Canadian Journal of School important role in successful educational adapta- Psychology, 14 (1), 36Ð50. Cook, F., Ciorciari, J., Varker, T., & Devilly, G. J. (2009). tion and academic achievement among immigrant Changes in long term neural connectivity following and refugee students from war-zone areas. These psychological trauma. Clinical Neurophysiology, factors include aspects of language acquisition 120 (2), 309Ð314. opportunities, institutional supports, instructional DePrince, A. P., Weinzierl, K. M., & Combs, M. D. (2009). Executive function performance and trauma practices and teacherÐstudent engagement strate- exposure in a community sample of children. Child gies. Our previous research suggests that the Abuse & Neglect, 33 (6), 353Ð361. presence of these critical contextual factors may Driver, C., & Beltran, R. O. (1998). Impact of refugee enhance student confi dence and resiliency and trauma on children’s occupational role as school students. Australian Occupational Therapy Journal, presents the most optimal pathway to educational 45 (1), 23Ð38. and academic achievement and success. The Fantino, A. M., & Colak, A. (2001). Refugee children in presence and engagement with these factors may Canada: Searching for identity. Child Welfare, 80 (5), be described as ‘best practices’ in supporting the 587Ð596. Goldson, E. (1996). The effect of war on children. Child development of academic success among immi- Abuse & Neglect, 20 (9), 809Ð819. grant and refugee students with histories of war- Green, B. L., Korol, M. S., Grace, M. C., Vary, M. G., trauma exposure. However, research in this area Leonard, A. C., Gleser, G. C., et al. (1991). Children remains preliminary. and disaster: Age, gender, and parental effects on 15 Pathways to Resilience… 219

PTSD symptoms. Journal of the American Academy Paardekooper, B., de Jong, J. T. V. M., & Hermanns, J. M. A. of Child and Adolescent Psychiatry, 30 (6), 945Ð951. (1999). The Psychological impact of war and the refugee Hones, D. F. (2007). “A meeting place for us”: Milpera, a situation on south Sudanese children in refugee camps in newcomer high school. Multicultural Education, northern Uganda: An exploratory study. Journal of Child 14 (4), 8Ð15. Psychology and Psychiatry, 40 (4), 529Ð536. Hyman, I., Vu, N., & Beiser, M. (2000). Post-migration Perrier, F., & Nsengiyumva, J. (2003). Active science as a stresses among Southeast Asian refugee youth in contribution to the trauma recovery process: Canada: A research note. Journal of Comparative Preliminary indications with orphans from the 1994 Family Studies, 31 , 281Ð293. genocide in Rwanda. International Journal of Science Isaac, C. L., Cushway, D., & Jones, G. V. (2006). Is post- Education, 25 (9), 1111Ð1128. traumatic stress disorder associated with specifi c Prior, M., Virasinghe, S., & Smart, D. (2005). Behavioural de fi cits in episodic memory? Clinical Psychology problems in Sri Lankan schoolchildren: Associations Review, 26 (8), 939Ð955. with socio-economic status, age, gender, academic Kapreilian-Churchill, I. (1996). Refugees and education progress, ethnicity and religion. Social Psychiatry and in the Canadian schools. International Review of Psychiatric Epidemiology, 40 (8), 654Ð662. Education, 42 , 349Ð365. Punamaki, R. (1996). Can ideological commitment pro- Kendall-Tackett, K. (2002). The health effects of childhood tect children’s psychosocial well-being in situations of abuse: Four pathways by which abuse can infl uence political violence? Child Development, 67 (1), 55Ð69. health. Child Abuse & Neglect, 26 , 715Ð729. Punamaki, R. (2001). From childhood trauma to adult Kia-Keating, M., & Ellis, B. H. (2007). Belonging and well-being through psychosocial assistance of Chilean connection to school in resettlement: Young refugees, families. Journal of Community Psychology, 29 (3), school belonging, and psychosocial adjustment. 281Ð303. Clinical Child Psychology and Psychiatry, 12 (1), Punamaki, R., & Suleiman, R. (1990). Predictors and 29Ð43. effectiveness of coping with political violence among Kinzie, J. D., Sack, W. H., Angell, R. H., Manson, S. M., Palestinian children. British Journal of Social & Rath, B. (1986). The psychiatric effects of massive Psychology, 29 (1), 67Ð77. trauma on Cambodian children: I, the children. Journal Rousseau, C., & Drapeau, A. (2000). Scholastic achieve- of the American Academy of Child Psychiatry, 25 (3), ment of adolescent refugees from Cambodia and 370Ð376. Central America. Adolescence, 35 (138), 243Ð258. Klingman, A. (2001). Israeli children’s reactions to the assas- Rousseau, C., Drapeau, A., & Corin, E. (1996). School sination of the prime minister. Death Studies, 25, 33Ð49. performance and emotional problems in refugee chil- Kolb, B., & Whishaw, I. Q. (1984). Neonatal parietal dren. The American Journal of Orthopsychiatry, 66 , lesions in rats: A model for cerebral crowding, epi- 239Ð251. lepsy and learning disabilities. Behavioural Brain Sack, W. H. (1996). Multiple forms of stress in Cambodian Research, 12 (2), 203Ð204. adolescent refugees. Child Development, 67 , 107Ð116. Kuterovac-Jagodic, G. (2003). Posttraumatic stress symp- Saigh, P. A., Mroueh, M., & Bremner, D. (1997). Scholastic toms in Croatian children exposed to war: A prospective impairments among traumatized adolescents. study. Journal of Clinical Psychology, 59 (1), 9Ð25. Behaviour Research and Therapy, 35 (5), 429Ð436. Lin, N., Suyemoto, K., & Kiang, P. (2009). Education as Servan-Schreiber, D., Lin, B. L., & Birmaher, B. (1998). catalyst for intergenerational refugee family commu- Prevalence of posttraumatic stress disorder and major nication about war and trauma. Communication depressive disorder in Tibetan refugee children. Disorders Quarterly, 30 (4), 195Ð207. Journal of the American Academy of Child and Linley, P. A., & Joseph, S. (2004). Positive change follow- Adolescent Psychiatry, 37 (8), 874Ð879. ing trauma and adversity: A review. Journal of Sivard, R. L. (1993). World military and social expenditures Traumatic Stress, 17 (1), 11Ð21. 1993 (p. 20). Washington, DC: World Priorities Inc. Macksoud, M. S., & Aber, J. L. (1996). The war experi- Slodnjak, V., Kos, A., & Yule, W. (2002). Depression and ences and psychosocial development of children in parasuicide in refugee and Slovenian adolescents. Lebanon. Child Development, 67 (1), 70Ð88. Crisis, 23 (3), 127Ð132. Mellman, T. A., & Davis, G. C. (1985). Combat-related Stermac, L., Brazeau, P., & Kelly, T. C. (2008). Traumatic fl ashbacks in posttraumatic stress disorder: stress and mental health among war-zone immigrants Phenomenology and similarity to panic attacks. The in Toronto. International Journal of Health Promotion Journal of Clinical Psychiatry, 46 (9), 379Ð382. and Education, 46 (2), 57Ð64. Mireles, T. (2010). From coping to thriving: Hope and the Stermac, L., Elgie, S., Clarke, A. K., & Dunlap, H. (2012). role of education in trauma recovery. PhD disserta- Academic experiences of war-zone students in canada. tion, Brandeis University, The Heller School for Journal of Youth Studies, 15(3), 311Ð328 . Social Policy and Management, United States— Stermac, L., Elgie, S., Dunlap, H., & Kelly, T. (2010). Massachusetts. Retrieved February 8, 2011, from dis- Educational experiences and achievements of war-zone sertations & theses: Full text. (Publication No. AAT immigrant students in Canada. Vulnerable Children 3404451). and Youth Studies, 5 (2), 97Ð107. 220 L. Stermac et al.

Summer ﬁ eld, D. A., & Toser, L. (1991). ‘Low intensity’ Watts-English, T., Fortson, B. L., Gibler, N., Hooper, S. war and mental trauma in Nicaragua: A study in a rural R., & De Bellis, M. D. (2006). The psychobiology of community. Medicine and War, 7 (2), 84Ð99. maltreatment in childhood. Journal of Social Issues, Trickett, E. J., & Birman, D. (2005). Acculturation, school 62 (4), 717Ð736. context, and school outcomes: Adaptation of refugee Weinstein, C. S., Fucetola, R., & Mollica, R. (2001). adolescents from the former Soviet Union. Psychology Neuropsychological issues in the assessment of refu- in the Schools, 42 (1), 27Ð38. gees and victims of mass violence. Neuropsychology UNICEF. (1996). The state of the world’s children 1996 . Review, 11 (3), 131Ð141. Retrieved April 29, 2012 from UNICEF website: West, C. D. (2000). Pathways of thriving and resilience: http://www.unicef.org/sowc96/cover.htm Growth responses to adversity and trauma in two Van Der Kolk, B. A. (1988). The biological response Cambodian communities: A comparative study between to psychic trauma. In F. M. Ochberg (Ed.), Post- Lowell, Massachusetts and Phnom Penh, Cambodia . traumatic therapy and victims of violence (pp. 25Ð38). MA thesis, University of Massachusetts Lowell. New York: Brunner/Mazel. Wilkinson, L. (2002). Factors in ﬂ uencing the academic Vasterling, J. J., & Brewin, C. R. (2005). Neuropsychology success of refugee youth in Canada. Journal of Youth of PTSD: Biological, cognitive, and clinical perspec- Studies, 5 , 173Ð193. tives . New York: Guilford Press. P a r t V Extending Our Understanding of the Effects of War on Children: Theory and Practice Political Violence, Identity and Psychological Adjustment 1 6 in Children

Orla T. Muldoon

con fl ict which may socialise young people into The Psychological Sequelae engaging with and maintaining the con fl ict. of Political Violence Turning fi rst to short-term reactions, the type of anxiety manifested will be related to the child’s Concern for children growing up in situations of developmental level, as well as the trauma expe- political violence is not new. Cairns ( 1996 ) in his rienced (Grant et al., 2003 ). Acute stress reac- comprehensive review of the available literature tions include nightmares, exaggerated startle tracks the development of research in this area, reactions, somatic complaints and sleep distur- from early studies of children in the UK during bance. It is worth noting, however, that anxiety is World War II through to more recent literature. considered a normal reaction to highly stressful His analysis points to the host of individual (e.g. experiences. Empirical evidence supports this temperament), familial (maternal psychological point. In one of the few longitudinal studies avail- health) and societal level variables (e.g. dominant able, Milgram and Milgram ( 1976 ) assessed group position) that impact on children’s levels of anxiety in 10- to 11-year-old children 4 adaptation to the stress of war and con fl ict. He months prior to, and subsequently during, the also details the methodological and practical Yom Kippur War of 1973. Though children’s dif fi culties facing researchers in this area. Despite anxiety levels were comparable to US norms these, a considerable body of evidence now prior to the war, this was not the case after the describes the reactions of children and young onset of the violence, as anxiety levels had risen people who have experienced political violence. signi fi cantly. Not surprisingly, the psychological cost of war Klingman ( 1992 ) studied the acute stress reac- can be high. Though they can be considered as tions in Israeli students over the fi rst and fourth conceptually distinct (Pine & Cohen, 2002 ) , a week of the Gulf War. Over this time, self- range of short-term and long-term consequences reported levels of psychological disturbance have been documented (Muldoon, 2004 ; Udwin, decreased signifi cantly. Similarly, Gidron, Gal, 1993 ) . In this chapter, our analysis is concerned and Zahavi (1999 ) in their study of Israeli bus with the consequences of war for individual commuters found that commuting frequency was psychological resilience on the one hand, and negatively related to anxiety about terrorist the wider social risk associated with exposure to attacks, which the authors interpreted as a desensitisation effect. In Northern Ireland, a longitudinal study by McIvor ( 1981 ) again emphasises the * O. T. Muldoon ( ) role of habituation and desensitisation. She asked Department of Psychology , University of Limerick , Limerick , Ireland recently arrived students about their fi rst impres- e-mail: [email protected] sions of Northern Ireland on arrival and 1 year later.

C. Fernando and M. Ferrari (eds.), Handbook of Resilience in Children of War, 223 DOI 10.1007/978-1-4614-6375-7_16, © Springer Science+Business Media New York 2013 224 O.T. Muldoon

Reference to the political violence were preva- 2012). Dawes, Tredoux, and Feinstein ( 1989 ) lent in the accounts received following arrival estimated rates of PTSD at 7% in 7- to 17-year- but not 1 year later, again leading the author to olds who had been exposed to 6 weeks of epi- conclude that these students had habituated to the sodic violence during the apartheid era in South con fl ict. Africa. Sack, Clarke, and Seeley (1995 ) in a study The confl icts of recent decades have been of adults that survived Pol Pot’s regime as chil- unlike many that have preceded them. Many have dren and resettled in the US found a high level of been, or continue to be, both long running and psychopathology. The group had witnessed intractable, (e.g. Israel-Palestine, Northern severe trauma including execution of their fami- Ireland, Sri Lanka, Basque region). Even when lies and work camps and a high proportion mani- political agreement is reached, intermittent and fested PTSD across time (32%), and a small but ongoing violence continues, and leads to an signifi cant proportion (7%) had co-morbid ‘uneasy peace’ (MacGinty, Muldoon, & Ferguson, depression and PTSD. 2007 ). It is perhaps because of this intractability Other strategies that may be employed to that the process of habituation can be seen as cope with ongoing confl ict situations are denial adaptive in terms of psychological health (Bar- and/or distancing. In line with the previous Tal, 2007). Indeed habituation to a backdrop of studies which suggest that levels of anxiety political violence, as evidenced by Gidron et al. was related to impact of confl ict, Cairns and (1999 ) and McIvor (1981 ) (outlined above), is Wilson ( 1984) demonstrated that psychologi- one of the explanations most often offered for the cal denial and distancing can be effective in fi nding that young people appeared to display reducing the impact of the threat of political few psychological symptoms as a result of ‘the violence. Using a design that matched two troubles’ in Northern Ireland. During the most towns that differed only in terms of their levels violent years of the confl ict, a wide variety of of violence (the fi rst with high levels of vio- psychological constructs were studied in Northern lence, and the second, relatively low levels), Ireland. Joseph, Cairns, and McCollam ( 1993 ) they examined mental health and perceptions found no difference in the level of depressive of levels of violence. Whilst overall levels of symptomatology reported by two groups of psychopathology appeared to be higher in the 11-year-olds, one group living in an area charac- high-violence town, individuals living in the terised by high levels of violence and the other high-violence town, who perceived the area, living in an area of low violence. Similarly, inaccurately, to have little or no violence, had Donnelly (1995 ) reporting on a sample of 887 better mental health. In effect, denying the exis- adolescents found no evidence of elevated rates tence of the confl ict can facilitate psychological of depression in Northern Ireland. Murray and well-being. Similarly, other studies have sup- Clifford (1988 ) found that the level of anxiety ported the contention that denial and distanc- reported by 15- to 16-year-olds in Northern ing may be useful strategies for coping with the Ireland was equivalent to norms obtained from stress of political con fl ict. In a study of Israeli young people living in the comparatively peace young people living in a violence-prone border of North America, and self-esteem pro fi les of town and a more peaceful area, Rofe and Lewin Northern Irish young people have been found to ( 1982 ) found that the group living in the border be similar to the pro fi les of UK and US compara- town scored higher on a repression scale, fell tors (Muldoon, 2000 ; Muldoon & Trew, 2000 ) . asleep earlier and had fewer dreams with vio- On the other hand, the observed incidence of lent themes than their counterparts in the more post-traumatic stress (PTS) symptoms as a result peaceful area. The authors concluded that the of exposure to political violence is highly vari- residents of the border town, having experi- able, and controversy persists with regard to the enced more political violence, have developed designation of PTS as a disorder, i.e. PTSD (post- strategies to avoid thinking or ruminating about traumatic stress disorder; see Muldoon and Lowe, violent events. 16 Political Violence, Identity, and Adjustment 225

The experience of political violence has also Second, in many instances, and in particular where been related to aggressive and delinquent behav- the confl ict is ongoing or intractable, children and iour and concerns about lower levels of moral young people appear to be capable of habituating behaviour in children and young people. An or distancing themselves to the violence which increase in juvenile crime during wartime was they live through. Habituation or distancing is less fi rst documented in World War I (Leeson, 1917 ) likely where the degree of threat is high, not least and a similar increase again in World War II because it is not adaptive. PTS appears to be rela- (Titmus, 1950 ). This has been variously attrib- tively low in populations affected by confl ict, uted to increased thrill-seeking behaviour, excite- though its incidence appears higher when assessed ment attached to the notion of confl ict, decreased out of the original war context. Finally, there parental supervision during times of violence/ appears to be evidence of acting out or aggressive stress, normalisation of violence, social model- reactions in response to political violence. ling, as well as the anxiety and loss of control experienced by young people as a result of the con fl ict (Muldoon & Cairns, 1999 ) . Issues Arising from the Research Support for this position comes from a number of studies that have used standardised A focus on psychopathological consequences of psychometric measures as indices of externalis- political violence in children has dominated the ing behaviour problems (Fee, 1980 ) as well as research in this area for many years. This can indices of juvenile crime (Shoham, 1994 ) . In a variously be attributed to a range of causes. large-scale study, McWhirter (1984 ) found that First, developmental psychopathology has pre- Northern Irish 9- to 10-year-old children scored dominated as a paradigm in this area over the last higher on measures of psychoticism than a UK two decades. Second, there is a tacit assumption comparison group. Additionally, children from throughout the literature that experiences in more violent areas in Northern Ireland had higher childhood and adolescence exert substantial scores then those from peaceful regions. Eysenck in fl uence in later life. Third, a focus on psycho- and Kay ( 1986 ) replicated this fi nding in 12- to pathology facilitates the construction of war and 14-year-old children. Fee ( 1980 ) found evidence political violence as aberrant. that the incidence of antisocial disturbance in Taking each of these issues in turn, the domain Northern Irish children, particularly boys who of developmental psychopathology has now had the greatest experience of violence, was evolved into a rich and deeply complex area that higher than would be expected. More recently, encourages a research focus across the various Muldoon and Trew (2000 ) demonstrated that domains of children’s lives (McMahon, Grant, children’s self-assessment of their behaviour, and Compas, Thurm, & Ey, 2003 ) . To focus exclu- not their global self-esteem, was related to their sively on psychopathology or subjective well- experience of violence, though not other stres- being effectively reduces the possibility of sors. Importantly, experience of violence was identifying developmental sequelae that operate also related to socio-economic status in this large- across social, educational and psychological scale study of 8- to 11-year-old children. Ferguson domains. Second, in relation to the in fl uence of and Cairns ( 2002 ) have described lower levels of childhood experience on later life, there is now moral development in children from a number of considerable evidence to suggest that experiences con fl ict-affected areas (2002). Taken together across life, not just childhood and adolescence, these fi ndings do appear to suggest that indices of can be represented as series of gains and losses aggressive or acting out behaviours are linked to (Baltes, Reuter-Lorenz, & Rolser, 2006 ) . Indeed experience of political violence. the current emphasis on lifespan development From this review there are a number of points effectively emphasises the need to widen devel- worthy of restatement. First, anxious reactions to opmental lenses to include all stages of life, not the experience of political violence are normal. just early life. 226 O.T. Muldoon

Third, the focus on psychopathology con- from the dominant or majority group (Muldoon structs political violence as aberrant and atypical. & Trew, 2000 ; Muldoon, Trew, & McWhirter, Based on the statistics above, it is fair to say that 1998 ) . In effect the asymmetry in power rela- political violence is both an endemic and recur- tions between groups is evidenced in terms of rent global phenomena. However political vio- those who are most and least affected by the lence affects the most vulnerable. It is widely violence in any given confl ict (Pratto, Sidanius, acknowledged that many of those most severely & Levin, 2006 ) . affected by war and political violence are resi- dent in the poorest regions of the world. In the past decade estimates are that over two million Social Identity as an Interpretative children have been killed in armed con fl icts, Framework another six million have been permanently disabled, and more than 250,000 children continue Reviewing this evidence therefore it is clear that to be exploited as child soldiers (United Nations, much of the literature in this area is essentially 2007 ). Worldwide, the rate of mortality associ- Western and individualistic in orientation. This is ated with political violence varied from 1 per despite the fact that there is ample evidence that 100,000 population in high-income countries to group-level variables are essential to our under- 6.2 per 100,000 population in low- and middle- standing of political violence. This argument can income countries (WHO, 2002). Further the be made on a number of related dimensions. First, highest rates of fatalities due to war were in exposure to political violence is related to group African countries, with approximately 32 fatali- membership (as above). Second, intractable ties per 100,000 of the population (WHO, 2002 ). political confl ict has a strong collective or group Besides the many thousands who are killed each component (Bar-Tal, 2007; Kelman, 1999 ) . In year, huge numbers are injured, including some situations of intractable political con fl icts—such who are permanently disabled. Others are raped, as the Israeli-Palestinian confl ict, the confl ict in tortured, or suffer disease and famine. Again, the Basque region and that in Northern Ireland—a available evidence suggests that those at highest struggle over territory, power or resources pre- risk of these experiences are those living in the vails that is resistant to change (Rouhana & Bar- least af fl uent nations of the world (Cairns, 1996 ; Tal, 1998 ). Generally the struggle over power or WHO, 2002 ). resources is linked to group memberships (e.g. Similarly, con fl ict experiences themselves Catholic and Protestant or Arab and Jew), group are not evenly distributed within the population memberships in which people are heavily (Bryce, Walker, Ghorayeb, & Kan, 1989 ; Cairns, invested. Thirdly and most importantly, social or 1996 ; McAuley, 1988; McGrath & Wilson, collective identities, crucial components of the 1985 ; Muldoon & Trew, 2000 ; Simpson, 1993 ; self, are derived from shared and valued group Smyth, 1998 ). Within Northern Ireland, which memberships. is a relatively af fl uent area globally but one of Collective identifi cation is widely acknowl- the most disadvantaged in the UK and EU, there edged as playing a pivotal role in intractable is considerable evidence that violent experi- political confl ict (Bar-Tal, 2007; Kelman, 2001 ). ences have not been and continue to be unevenly Identity, essentially a social construct, affects distributed across the population. In line with behaviour, affect and cognition at the individual fi ndings from other regions (Bryce et al., 1989 ; and societal level (Tajfel, 1982 ) . Though mark- Simpson, 1993 ), evidence suggests that young ers of identity may be based on nationality, reli- people from deprived backgrounds generally gion or ethnicity, these differences are frequently report greater experience of political violence recreated and underlined by social groups and than their middle-class counterparts: boys expe- in everyday practice (Stevenson & Muldoon, rience more than girls, and minority or subordi- 2010; Hammack, 2010 ) . The recreation of these nate group members experience more than those boundaries is facilitated by cultural practices, 16 Political Violence, Identity, and Adjustment 227 language and history. Until recently, the role of own group is related to self-reported experience social identity in the stress process was very of violence (Bryce et al., 1989 ; Hammack, much seen as a secondary issue. This however 2010; Lowe & Muldoon, 2010 ). would seem to be problematic in situations of Two important consequences fl ow from political violence where much of the stress increased identifi cation with one’s own group. experienced is fundamentally related to group First, increased social identi fi cation has conse- memberships and social identities (Hammack, quences for social attitudes. Indeed social iden- 2010 ; Muldoon, Schmid, & Downes, 2009 ) . tity theory was originally developed as an The integrated social identity model of stress explanatory framework to understand intergroup (ISIS) (Haslam, 2004; Haslam & Reicher, 2006 ) discrimination and hostility. Developed in the therefore is a welcome development arguing as it aftermath of the Second World War and the asso- does that social identity is critical to understand- ciated pogroms, academics were concerned about ing the stress process, not least because stress has the potential for cruelty and inhumanity that had important social dimensions. The ISIS differs developed during this time. Effectively it was this fundamentally from the transactional model of interest that gave rise to the development of social stress (Lazarus & Folkman, 1984 ) . The transac- psychology and the subdiscipline of intergroup tional model argues that social identities may relations. play an important role in buffering stress reac- Increased identi fi cation with one’s own group tions but fundamentally sees the stress process as effectively gives rise to in-group bias. Academics a transaction at the level of the individual. On the have hotly contested whether this increased bias other hand, ISIS sees groups as being integral to towards one’s own group necessarily results in the experience and perception of stress, as collec- out-group derogation. Much of this debate has tive resources that can alter the meaning and been fuelled by experimental research undertaken experience of stress as well as adaptive social and in laboratory settings. What it is not attuned to is psychological supports. This theoretical position the reality of many real-world situations and in is certainly consistent with research undertaken particular patterns of identifi cation that tend to be in the Middle East (Hammack, 2006 ; Barber associated with intractable confl ict. In such situa- 2001 ) and Northern Ireland (Muldoon, tions, identities are often constructed as opposi- McLaughlin, Rougier, & Trew, 2008 ) . tional, and these identities are pervasive, easily By placing social identities at the centre accessible and unquestioned (Hammack, 2006 ; of the stress process, how valued group mem- Muldoon, McLaughlin, & Trew, 2007 ; Muldoon, berships structure adaptation to stress can be Trew, Todd, McLaughlin, & Rougier, 2007 ) . considered. This provides a powerful explana- These oppositional identities also tend to be neg- tory framework for interpreting the available atively interdependent, and as a result relations evidence. For example the experience of dis- between the groups are constructed as zero sum crimination at the hands of an out-group has games (Bar-Tal, 2007 ; Kelman, 2001 ). In this been repeatedly demonstrated to consolidate identity context, then, bias towards one’s own in-group identi fi cation and increase negative group may be fundamentally related to negative attitudes to that out-group (Jetten, Branscombe, attitudes to the out-group. Schmitt, & Spears, 2001 ) . Whilst ethical con- Certainly available data supports this conten- straints mean that the same experimental evi- tion, though limited studies on the effects of dence is not available to causally link experience confl ict experiences on attitudinal factors have of violence to identifi cation, it is reasonable to been undertaken. One study by Crawford (1993 ) assume that the same psychological processes undertaken in the Basque region suggests that are triggered as a consequence of violence identity strength, ethnocentrism and rigidity are experienced at the hands of the out-group. signifi cantly higher in those who approve of vio- Certainly, both qualitative and survey evidence lence compared to those who do not. Further, suggest that levels of identi fi cation with one’s those in favour of independence from Spain (the 228 O.T. Muldoon ideological aim of the Basque region) were signi fi cantly more pro-violence than those who Conclusions favoured the status quo. In a similar vein, research on intergroup forgiveness in Northern Ireland The importance of social identity to the experi- suggests that those with the greatest experience ence of confl ict can be demonstrated both theo- of con fl ict have the lowest propensity to forgive retically and empirically. Research evidence, (McLernon, Cairns, Hewstone, & Smith, 2004). such as that reviewed in this chapter, emphasises In another study of Northern Irish adolescents, the importance of the context within which war Muldoon and Wilson ( 2001 ) in a survey of ado- experiences occur. Available studies suggest that lescents found that young people were more short-term stress reactions in response to political likely to accept political violence and even see it violence are normal, yet long-term exposure is as having a use, where they had both prior experi- associated with habituation which can facilitate ence of the political violence and a strong individual psychological resilience and making it identi fi cation to their own group. easier for children and young people to get on The second important consequence of with the day-to-day business of life. Habituation increased identifi cation with one’s own group is appears to be particularly likely where experi- that identifi cation appears to play a protective ences encountered are less threatening (Muldoon role in terms of psychological well-being. et al., 1998) . This habituation or desensitisation In-group bias facilitates the development of posi- explains, in part, why young people appear to be tively valued distinctiveness, and this sense of resilient at least in terms of psychological well- positive identi fi cation with the group can act as a being in many situations of con fl ict. Effectively social and psychological resource to deal with then the con fl ict or war experiences evolve into adversity. Available research evidence supports banal or background experiences of the confl ict— this view. Muldoon, Schmid, and Downes ( 2009 ) the abnormal becomes normal. demonstrated in a large-scale study in Northern The way in which confl ict embeds into the Ireland that national identity mediated the rela- background of life can evolve very differently as tionship between experience of violence and psy- a consequence of social identities and group chological well-being. There, evidence suggested memberships such as gender, socio-economic that identities structured experience and adapta- status and group position. The quality and quan- tion to experience of violence. Similarly Kellezi, tity of political violence encountered is very Reicher, and Cassidy’s (2009) study of Kosovo highly related to the groups to which people are Albanians, who had survived the armed con fl ict affi liated and differs in relation to ethnicity and in 1999, found lower levels of depressive mood group status. These different negative experi- and anxiety and higher levels of self-effi cacy in ences mean that identities become consolidated respondents who felt that their national or reli- around the con fl ict. The often radically different gious identity was consolidated by their wartime experiences of the confl ict linked to group mem- experience. The authors go on to describe the role bership, together with the identity consolidation of social support from close others in negotiating brought about by the negative experiences of war, the traumas of war. They outline particular prob- can mean that groups have very different and lems faced by those who suffered stigmatising very blinkered perspectives on the same confl ict. trauma such as rape during the con fl ict and the This inability to see beyond the injustices of one’s problems that arose in families and communities own group or to understand the anxieties can act where the needs of victims were either ignored or to perpetuate and maintain hostile relations. the victims themselves ostracised. Effectively, Available evidence that we have reviewed sug- families and communities, through their gests that standard psychometric indicators of responses, could be seen to act as facilitators and/ psychoticism and antisocial behaviour are com- or barriers in accessing important support networks paratively higher in young people living in and resources. con fl ict-affected areas. Such fi ndings raise a 16 Political Violence, Identity, and Adjustment 229 number of issues that merit consideration. resolution efforts. First, those affected by con fl ict Interestingly, though young people score com- are heavily invested in the identities that under- paratively higher scores on these psychological pin the confl ict. Young people displaced as a con- measures in Northern Ireland, there is no evidence sequence of the confl ict are best served by of altered levels of delinquency or truancy remaining embedded within families and com- (Muldoon et al., 2000 ). Indeed within regions and munities that enact and support their existing neighbourhoods affected by endemic violence, social identities. Within con fl icted regions, efforts tough-mindedness, rejection of standard moral at resolution and mutual understanding must codes and acting out behaviours may represent acknowledge the value of all identities not only functional psychological acquisitions that are in terms of psychological well-being but also in imperative for those who believe that they must terms of their social value. This is the basis for protect or advance the legitimate interests of their reconciliation. Because of the extent of the invest- group. This of course is consistent with the clear ment in these often oppositional identities, evidence that child soldiers and decoys are com- appeals based on the plight of the out-group are monplace during confl icts and often young people unlikely to be able to stop aggressive or hostile are keen and committed protagonists to the actions. Appeals that emphasise the need for in- confl ict (Cairns, 1996; Hammack, 2010 ) . Indeed group, in which so much is invested, to act young people seeking to effect social change in humanely and morally are much likely to reap the face of systemic injustice and adversity may reward. Ultimately the best interests of all— well require a toughness that is neither functional social, political and psychological resilience— nor desirable in peaceful contexts. are promoted by interfering with the creation of Finally, and again, consistent with the conten- social identities that are enmeshed in violence tion that social identities are central to confl ict and breaking the cycle of violence. experiences, those who show the highest level of resilience tend to be those with the strongest ideological commitment or identifi cation with their References own group. Social identities are also fundamentally related to exposure to political violence, and Baltes, P. B., Reuter-Lorenz, P. A., & Rolser, F. (2006). those with the strongest identities tend to be those Life-span development and the brain: The perspective of biological co-constructivism . London: Cambridge with the most experience of adversity and of University Press. course the most hostile attitudes to the traditional Barber, B. K. (2001). Political violence, social integration, ‘enemy’. So whilst social identities can be seen and youth functioning: Palestinian youth from the as a psychological resource for dealing with the Intifada. Journal of Community Psychology, 29 (3), 259–280. confl ict, they can also be seen as the psychologi- Bar-Tal, D. (2007). Sociopsychological foundations of cal substrate that maintains the con fl ict. It is per- intractable foundations. American Behavioral haps because of this that young people with Scientist, 50 (11), 1430–1453. strong national or religious identities are often Bryce, J. W., Walker, N., Ghorayeb, F., & Kan, J. M. (1989). Life events, response styles and mental health pathologised in con fl ict situations and political among mothers and children in Beirut, Lebanon. violence (Stevenson & Muldoon, 2010 ). On the Social Science and Medicine, 28 (7), 685–695. one hand this distances those with the least expe- Cairns, E. (1996). Children and political violence . Oxford: rience of the confl ict from taking ownership of Blackwell. Cairns, E., & Wilson, R. (1984). The impact of political the confl ict and being part of the solution. On the violence on mild psychiatric morbidity in Northern other it serves to ostracise those most affected by Ireland. The British Journal of Psychiatry, 145 , 631. the con fl ict further and effectively consolidating Crawford, C. J. (1993). Basque attitude towards political a continuing sense of injustice. violence: Its correlation with personality variables, other sociopolitical attitudes, and political party vote. A number of lessons can be learned from this Aggressive Behavior, 19 (5), 325–346. analysis and applied to support both children and Dawes, A., Tredoux, C., & Feinstein, A. (1989). Political young people affected by con fl ict and con fl ict violence in South Africa: Some effects on children of 230 O.T. Muldoon

the violent destruction of their community. Lazarus, R. S., & Folkman, S. (1984). Stress, appraisal International Journal of Mental Health, 18 , 16–43. and coping . NY: Springer. Donnelly, M. (1995). Depression among adolescents in Leeson, C. (1917). The child and the war: Being notes on Northern Ireland. Adolescence, 30 (118), 339–350. juvenile delinquency . London: PS King & Son. Eysenck, S. B. G., & Kay, w. (1986). A cross cultural Lowe, R. D., & Muldoon, O. T. (2010). Religious and eth- study of Northern Ireland and English children. Irish nonational identi fi cation and political violence. Journal of Psychology, 7 , 98–105. Ethnopolitics, 9 (1), 71–83. Fee, F. (1980). Responses to a behavioural questionnaire MacGinty, R., Muldoon, O. T., & Ferguson, N. (2007). No of a group of Belfast children. In J. Harbison & war, no peace: Northern Ireland after the agreement. J. Harbison (Eds.), A society under stress: Children Political Psychology, 28 (1), 1–11. and young people in Northern Ireland (pp. 31–42). McAuley, P. M. (1988). On the fringes of society: Adults Somerset: Open Books. and children in a disadvantaged Belfast community Ferguson, N., & Cairns, E. (2002). The impact of political (Doctoral dissertation, Queen’s University of Belfast, con fl ict on moral maturity: A cross-national perspec- 1988). tive. Journal of Adolescence, 25 (5), 441–451. McGrath, A., & Wilson, R. (1985). Factors which Gidron, Y., Gal, R., & Zahavi, S. (1999). Bus commuters infl uence the prevalence and variation of psychologi- coping strategies and anxiety from terrorism: cal problems in children in Northern Ireland. In Annual An example of the Israeli experience. Journal of Conference of the Developmental Section of the British Traumatic Stress, 12 (1), 185–192. Psychological Society, Belfast . Grant, K. E., Compas, B. E., Stuhlmacher, A. F., Thurm, McIvor, M. (1981). Northern Ireland: A preliminary look A. E., McMahon, S. D., & Halpert, J. A. (2003). at environmental awareness . Paper presented to the Stressors and child and adolescent psychopathology: Beiennial Conference of the International Society of Moving from markers to mechanisms of risk. Behavioural Development. Toronto, Canada. Psychological Bulletin, 129 (3), 447. McLernon, F., Cairns, E., Hewstone, M., & Smith, R. Hammack, P. L. (2006). Identity, confl ict, and coexistence (2004). The development of intergroup forgiveness in life stories of Israeli and Palestinian adolescents. Northern Ireland. Journal of Social Issues, 60 (3), Journal of Adolescent Research, 21 (4), 323–369. 587–601. Hammack, P. L. (2010). Identity as burden or bene fi t? McMahon, S. D., Grant, K. E., Compas, B. E., Thurm, E. E., Youth, historical narrative and the legacy of political & Ey, S. (2003). Stress and psychopathology in children con fl ict. Human Development, 53 , 173–201. and adolescents: Is there evidence of specifi city? Journal Haslam, S. A. (2004). Psychology in organisations: The of Child Psychology and Psychiatry, 44 , 1,107–133. social identity approach . London: Sage. McWhirter, L. (1984, May). Is getting caught in a riot Haslam, S. A., & Reicher, S. (2006). Stressing the group: more stressful than seeing a scary movie or moving to Social identity and the unfolding dynamics of responses a new school. Paper presented to the Annual to stress. Journal of Applied Psychology, 91 , 1037–1052. Conference of the Northern Ireland Branch of the Jetten, J., Branscombe, N. R., Schmitt, M. T., & Spears, R. British Psychological Society, Northern Ireland. (2001). Rebels with a cause: Group identi fi cation as a Milgram, R. M., & Milgram, N. A. (1976). The effect of response to perceived discrimination from the main- the Yom Kippur war on anxiety level in Israeli chil- stream. Personality and Social Psychology Bulletin, dren. The Journal of psychology, 94(1), 107–113. 27 (9), 1204–1213. Muldoon, O. T. (2000). Social group membership and Joseph, S., Cairns, E., & McCollam, P. (1993). Political self-perceptions in Northern Irish children: A longitu- violence, coping and depressive symptomatology in dinal study. British Journal of Developmental Northern Irish children. Personality and Individual Psychology, 18 (1), 65–80. Differences, 15 (4), 471–473. Muldoon, O. T. (2004). Children of the troubles: The Kellezi, B., Reicher, S., & Cassidy, C. (2009). Surviving impact of political violence in Northern Ireland. the Kosovo confl ict: A study of social identity, Journal of Social Issues, 60 , 453–468. appraisal of extreme events, and mental well-being. Muldoon, O., & Cairns, E. (1999). Children, young peo- Applied Psychology, 58 (1), 59–83. ple and war: Learning to cope. In E. Frydenburg (Ed.), Kelman, H. (1999). The interdependence of Israeli and Learning to cope (pp. 322–337). Oxford: Oxford Palestinian national identities: The role of the other in University Press. existential con fl icts. Journal of Social Issues, 55 , Muldoon, O. T., Trew, K., & Kilpatrick, R. (2000). The 581–600. legacy of the troubles on the young people’s psycho- Kelman, H. C. (2001). The role of national identity in logical and social development and their school life. con fl ict resolution: Experiences from IsraeliÐ Youth and Society, 32 (1), 6–28. Palestinian problem-solving workshops . Oxford: Muldoon, O. T., & Lowe, R. D. (2012). Social identity, Oxford University Press. groups and post-traumatic stress disorder. Political Klingman, A. (1992). Stress reactions of Israeli youth Psychology., 33 , 259–273. during the Gulf War: A quantitative study. Professional Muldoon, O. T., McLaughlin, K., Rougier, N., & Trew, K. Psychology: Research and Practice, 23 (6), 521–527. (2008). Adolescents explanations of paramilitary 16 Political Violence, Identity, and Adjustment 231

involvement. Journal of Peace Research, 45 (5), Rofe, Y., & Lewin, I. (1982). The effect of war envirww- 681–695. wonment on dreams and sleep habits. In N. A. Milgram Muldoon, O. T., McLaughlin, K., & Trew, K. (2007). (Ed.), Stress and anxiety (Vol. 8). NY: Hemisphere. Adolescents’ perceptions of national identifi cation and Rouhana, N. N., & Bar-Tal, D. (1998). Psychological dynam- socialisation: A grounded analysis. British Journal of ics of intractable ethnonational con fl icts: The Israeli– Developmental Psychology, 25 , 579–594. Palestinian case. American Psychologist, 53(7), 761. Muldoon, O. T., Schmid, K., & Downes, C. (2009). Sack, W. H., Clarke, G. N., & Seeley, M. S. (1995). Political violence and psychological well-being: The Posttraumatic stress disorder across two generations of role of social identity. Applied Psychology, 58 (1), Cambodian refugees. Journal of the American Academy 129–145. of Child and Adolescent Psychiatry, 34 (9), 1160–1166. Muldoon, O. T., & Trew, K. (2000). Children’s experience Shoham, E. (1994). Family characteristics of delinquent youth and adjustment to con fl ict related events in Northern in time of war. International Journal of Offender Therapy Ireland. Peace & Con fl ict: The Journal of Peace and Comparative Criminology, 38 (3), 247–258. Psychology, 6 , 157–176. Simpson, M. A. (1993). Bitter waters: Effects on children Muldoon, O. T., Trew, K., & McWhirter, L. (1998). of the stress of unrest and oppression. In J. P. Wilson & Perceptions of stressful life events in ten year old B. Raphael (Eds.), International handbook of traumatic Northern Irish children: A ten year comparison. stress syndromes (pp. 994–1006). New York: Plenum. European Child & Adolescent Psychiatry, 7 , 36–48. Smyth, M. (1998). Half the battle: Understanding the Muldoon, O. T., Trew, K., Todd, J., McLaughlin, K., & impact of the troubles on children and young people . Rougier, N. (2007). The nature and meaning of iden- Derry: INCORE. tity in Northern Ireland after the Good Friday Stevenson, C., & Muldoon, O. T. (2010). Socio-political Agreement. Political Psychology, 28 , 89–103. context and accounts of national identity in adoles- Muldoon, O. T., & Wilson, K. (2001). Ideological com- cence. British Journal of Social Psychology, 49 (3), mitment, experience of confl ict and adjustment in 583–599. Northern Irish adolescents. Medicine, Con fl ict & Tajfel, H. (1982). Social psychology of intergroup rela- Survival, 17 , 112–124. tions. Annual Review of Psychology, 33 , 1–39. Murray, M., & Clifford, S. (1988). Anxiety and aspects of Titmus, R. (1950). Problems of social policy. History of health behaviour adolescents in Northern Ireland. the second world war, United Kingdom Civil Series . Adolescence, 23 , 661–666. London: HMSO and Longmans. Pine, D. S., & Cohen, J. A. (2002). Trauma in children and Udwin, O. (1993). Children’s reactions to traumatic adolescents: Risk and treatment of psychiatric seque- events. Journal of Child Psychology and Psychiatry, lae. Biological Psychiatry, 51 (7), 519–531. 34 (2), 115–127. Pratto, F., Sidanius, J., & Levin, S. (2006). Social domi- United Nations (2007). http://www.un.org/children/ nance theory and the dynamics of intergroup relations: con fl ict/english/index.html. Taking stock and looking forward. European Review World Health Organisation. (2002). Reducing risks: of Social Psychology, 17 (1), 271–320. Promoting healthy life . World health report 2002. How Can a Majority Be Resilient? Critiquing the Utility of the 1 7 Construct of Resilience Through a Focus on Youth in Contexts of Political Confl ict

Brian K. Barber and Samuel Benjamin Doty

resilience would be understood with more Introduction de fi ned parameters. Ironically, rather than providing the expected One of the fundamental limitations to the cur- clarity as to resilience and its prevalence, exami- rent understanding of the construct of “resil- nation of the literatures on con fl ict youth raises ience” is the concern that in testing for the fundamental challenges to the utility of the con- prevalence of resilient functioning (and thereby struct itself. In short, the consensus conclusion trying to validate the salience of the construct), from reviews of the literatures is that majorities researchers have not investigated populations at of youth exposed to or involved in political high enough risk to adequately establish a real con fl ict do not manifest notable dysfunction. This test of whether the functioning they observe can fi nding appears to directly contradict the expecta- properly be considered resilient (Vanderbilt- tion from much of the writing on resilience, Adriance & Shaw, 2008 ) . Given the dramatic namely, that only a small minority of youths and sustained adversity that accompanies war, would be able to functioning well in such severe the study of functioning within contexts of contexts. political confl ict would seem a suitable, if not The chapter begins by clarifying presumptions ideal, remedy for this limitation. That is, because about some fundamental features of resilience the adversity of political con fl ict is so obvious, and follows with a brief review of the paradoxi- extreme, and often extended, assessing the func- cal fi ndings from the con fl ict literatures. It then tioning of youth in such acute and often chronic discusses reasons why the expectation of wide- conditions should provide a rather clearer and spread dysfunction in con fl ict youth is inapt. more straightforward indication of how many, if Finally, it acknowledges several limitations of any, function in a manner that should be consid- the research literature on confl ict youth and out- ered resilient. In turn, thereby, the construct of lines how rectifi cation of those limitations might inform on the viability of the construct of resilience. The overall conclusion from all of these B. K. Barber (*) discussions is that the construct of resilience— Founding Director of the Center for the Study of Youth depending, of course, on how it is construed— and Political Violence, Professor of Child and Family might well be fi tting as an adjective de fi ning the Studies, University of Tennessee , Knoxville , TN , USA basic human capacity of dealing with adversity, e-mail: [email protected] but that is not useful if referring to a set of indi- S.B. Doty viduals who appear to be uniquely adaptive in Social Science Research Institute, Duke University , Durham , NC , USA contexts as severe as political confl ict (see Barber e-mail: [email protected] 2013 for an elaboration of these ideas).

C. Fernando and M. Ferrari (eds.), Handbook of Resilience in Children of War, 233 DOI 10.1007/978-1-4614-6375-7_17, © Springer Science+Business Media New York 2013 234 B.K. Barber and S.B. Doty

that risk is required 1 to distinguish resilience from De fi ning Resilience the positive adjustment that some youths manifest without signifi cant risk exposure, and from compe- Resilience is a problematic construct. It is used tence that is seen as an asset or individual-level widely, but disparately, both inside and outside of promotive component of the resilience process. social science. Within the social sciences its Similarly, Masten and Reed (2002 ) note that chil- usage is particularly ambiguous. For example, dren who exhibit good outcomes can be thought of Layne, Warren, Watson, and Shalev ( 2007 ) iden- as competent and well adjusted, but to be consid- tify at least eight different defi nitions of resilience ered resilient, children must have overcome a threat used in the trauma literatures. They, along with or hazard to adaptation. Rutter ( 2006) adds that others (e.g., Luthar, Cicchetti, & Becker, 2000 ; while both social competence and positive mental Richardson, 2002 ) , recommend that any discus- health are important concepts, they refer to some- sion of resilience be overtly clear as to how the thing different than resilience, which he de fi nes as construct is being considered or defi ned in any relatively positive (psychological) functioning given study and that, overall, progress needs to when combined with serious risk experiences. be made at more clearly defi ning its parameters. At the same time, however, the various resil- Considering resilience in the context of political ience literatures are not of one mind on the distinc- con fl ict is particularly appropriate for such a tiveness of resilience from general adjustment. clarifi cation because that context typically Despite being conceptualized as adaptation to involves both sustained adversity and exposure to extraordinary challenge, some resilience scholars multiple, acute events, which are the respective are not sure that it differs from adaptation to more domains of two main literatures that explore ordinary challenges (Sameroff & Rosenblum, resilience: developmental psychopathology and 2006 ) , and see it as an extension of the study of trauma studies. As noted by Layne et al. ( 2007 ) , normal development, rather than a qualitatively both of those literatures employ the construct distinct fi eld (see Layne et al., 2007 for a discus- inconsistently and vaguely. sion). Relatedly, others note that it is also not clear In our own effort to be clear conceptually, we if the many protective factors that have been found ground our analysis of resilience in a set of pre- to be correlates of the process of resilience are in suppositions about the construct that the varied fact uniquely related to resilient functioning or, literatures appear to share: (1) resilience requires rather, protective of positive functioning regard- risk; (2) resilient functioning is uncommon ; and less of risk (Masten & Coatsworth, 1998 ; Masten (3) political confl ict can entail such extreme & Curtis, 2000; Masten & Reed, 2002 ) . For that adversity that resilience would be even rarer . reason and others, the fi ndings relative to resilience do not offer insight into which individuals will end up experiencing diffi culty or not (Unger, Resilience Requires Risk 2004 ) —a seemingly fundamental requirement of an effort that intends to identify uniquely function- There have been many challenges to the viability ing individuals (i.e., those who are “resilient”). of the construct of resilience based on conceptual In sum, it appears in much of the literature that and methodological pitfalls, as well as question- the construct of resilience is defi ned and justifi ed able scienti fi c value (e.g., Luthar et al., 2000 ; by its distinction from normative adaptation. That Vanderbilt-Adriance & Shaw, 2008; see Doty, resilient functioning could only be evident in 2010 for a recent review of the complexities of the contexts of risk and adversity suggests that these construct). In part as defense in the face of those conditions demand a different level or type of challenges, some resilience researchers have adaptation. Others who study resilience are not clari fi ed that what distinguishes resilient function- sure that the distinction is clear or valid. ing from more general competent functioning is that it occurs in the context of risk or threat. Thus, for example, Fergus and Zimmerman (2005 ) note 1 Unless otherwise noted, italicization is ours for emphasis. 17 How Can a Majority Be Resilient?… 235

Resilient Functioning Is Uncommon from a signi fi cant decrement in functioning occa- sioned by an exposure to stress. Such a recovery In distinguishing resilient functioning from nor- view of resilience is consistent with that of others mative adaptation, the implication is made that (e.g., Bonanno, 2005, 2008 ; Carver, 1998 ; Masten, such functioning is uncommon. Thus, resilient 2001 ) . Finally, the literatures on thriving or post- children or youth (who, as above, have necessar- traumatic growth make a similar claim of unique- ily been exposed to risk) are those who exhibit ness. Carver ( 1998 ) , for example, notes that behavior that de fi es or is better than expectations thriving in the face of adversity is distinctive from (Aisenberg & Herrenkohl, 2008; Cicchetti, 1996 ; other forms of growth in that it occurs in circum- Luthar, 1991 ; Luthar et al., 2000 ; Masten & stances in which growth is unexpected . Curtis, 2000 ; Masten & Powell, 2003 ) . Though In sum, a further essential feature of the think- phrased somewhat differently, Rutter (2006, ing on resilience appears to be that such function- 2007) makes essentially the same point when ing (i.e., adaptive functioning in the context of indicating that the term resilience refers to those risk) is not ordinary. That is, certain individuals individuals who function relatively well despite function effectively in the face of risk and they do suffering adversity or stress of a type or severity so unexpectedly and remarkably (Layne et al., that would be expected to cause serious conse- 2007; Vanderbilt-Adriance & Shaw, 2008 ) . quences. Similarly, Luthar et al. (2000 ) describe Veteran readers of resilience literatures will be resilient children as those who don ’ t succumb to immediately aware that this construal of resil- risk-induced negative outcomes. ience as extraordinary is inconsistent with a con- Another line of reasoning that can be read to trasting rendering in the resilience literatures that support this view of resilience as extraordinary is suggests that it is more ordinary than it is unusual the debate about whether resilience should be (e.g., Bonanno, 2004 ; Masten, 2001 ) . More will considered as resistance or recovery. Thus, rather be said about this later in the chapter. Suffi ce it than revealing competent adjustment to or mas- for the moment to make the point that careful tery of life’s challenges, for some the construct analysis of many conceptualizations of resilience describes a distinctive response in the face of (particularly, resistance) can lead to the expecta- challenge or risk. As examples, Rutter (2006 ) tion that it re fl ects an uncommon imperviousness notes that resilience implies relative resistance to to the expected injury of stress, trauma, or adver- risk and Wexler, DiFluvio, and Burke ( 2009 ) sity, or an unusual ability to recover quickly from write of resilient youth as those who escape risk. any decrement in functioning. Hoge, Austin, and Pollack (2007 ) conclude that resilience reveals a decreased vulnerability to stress in reaction to traumatic experiences, such Political Confl ict as the Ultimate that resilience demonstrates a heightened ability Challenge to Resilience to handle stress (i.e., as opposed, e.g., to having recovered from injury). Similarly, Westphal and The third presumption of the conceptual founda- Bonanno (2007 ) characterize resilient individuals tion of resilience relevant to the purposes of this as those who do not struggle to the same extent as chapter has specifi cally to do with the uniqueness those who are more traumatized (in part, perhaps, of contexts of political confl ict to defi ning resil- because of their greater fl exibility or behavioral ience. First, before treating that explicit context, it elasticity ; Bonanno, 2005 ) . should be noted that more generally many who Otherwise, Layne et al. ( 2007 ) explicitly sepa- write about resilience logically contend that resil- rate resistance from resilience. For them, resis- ience will be lower in contexts of high risk; that tance (consistent with the above) refers to the children have low odds of success in such contexts; ability of individuals to maintain functioning under and, that if that risk is sustained, children cannot stressful conditions, whereas resilience describes sustain resilience (see Vanderbilt-Adriance & those who relatively quickly and fully recover Shaw, 2008 for a recent review). Others suggest 236 B.K. Barber and S.B. Doty that maladjustment is inevitable in the face of the best that one could expect would be that marked adversity (e.g., Luthar, 1991 ) . some young people would escape severe psy- As to political confl ict as a context, there is chological problems. proportionally less research attention to it in the vast literatures on resilience (as compared to other contexts, such as poverty, health emergen- The Paradox of the Competence cies, and grief). Nevertheless, reference to war as of Confl ict Youth illustrative of an ultimately risky context appears regularly in writings on resilience. Thus, for Rather than support these expectations, the litera- example, Masten and Reed ( 2002 ) refer to the tures on youth functioning in the context of polit- massive trauma of war and Luthar and Cicchetti ical confl ict paradoxically contest them. Thus, (2000 ) to the serious life adversities it contains. despite the obvious destructiveness that often Moreover, characterizations of the extremity of characterizes political con fl ict, there is in fact no war’s risk and trauma are such that a revised stan- support in the substantial literatures for wide- dard for determining resilient functioning in such spread maladaptive functioning in these popula- contexts has been recommended. Speci fi cally, tions. To the contrary, commentaries and reviews rather than concluding resilience based on evi- on the topic regularly conclude that majorities of dence of positive functioning in the face of stress young people do not manifest notable dysfunc- (as is typically done when determining resilient tion. This determination is made broadly: via functioning), some suggest that contexts such as anecdotal reports, a variety of research studies, war are so extreme that the mere absence of and extensive reviews of them (e.g., Almedom, psychopathology or maladjustment would be 2005 ; Almedom & Glandon, 2007 ; Barenbaum, suffi cient to signal resilience (Luthar & Cicchetti, Ruchkin, & Schwab-Stone, 2004; Boyden, 2003 ; 2000; Luthar et al., 2000 ; Vanderbilt-Adriance & Cairns, 1996 ; Cairns & Dawes, 1996 ; Daiute, Shaw, 2008 ) . Such a downgrading of the standard 2006; Doty, 2010; Gilligan, 2009; Layne et al., for determining resilience implies that virtually 2007; Miller & Rasmussen, 2010 ; Panter-Brick, all—or certainly the majority—of young people 2010 ; Sagi-Schwartz, 2008 ) . Moreover, the con- facing these extreme circumstances would be clusion appears to apply to all major categories of seriously impacted psychologically, and those youth involvement (i.e., coerced involvement as who are faring best among them would be those child soldiers, passive victimization, and volun- who have somehow escaped psychopathology. tary activism; e.g., Annan, Blattman, Carlson, & Mazurana, 2008 ; Annan, Blattman, & Horton, 2006; Barber & Schluterman, 2009 ; Blattman & Summary Annan, 2007 ; Wessells, 2006 ; Wessells & Kostelny, 2009 ) . To summarize, in preparing to analyze the To be clear, there is certainly evidence of posi- validity of the construct of resilience via a focus tive correlations between war exposure and nega- on the extreme contexts of war or other forms tive functioning. However, those correlations are of political confl ict, we have identifi ed three typically weak, and in as many as 20 % of the fundamental presumptions that the varied resil- studies, the correlation is either not signifi cant or ience literatures appear to make. In short, they it is negative (i.e., the higher the exposure, the suggest that resilience, by defi nition, refers to a lower the problem behavior score; see Barber & unique, nonnormative type of functioning that Schluterman, 2009 for a review). Thus, there are, is exhibited in the face of adversity. And, actually, two related challenges that these fi ndings because of the debilitating effects of adversity, make to the resilience presumptions: fi rst, the such resilient functioning is unexpected. absence of widespread dysfunction and, second, Further, it would be especially uncommon in the presence in some youth of growth as a func- contexts of severe adversity, such as war, where tion of con fl ict exposure. 17 How Can a Majority Be Resilient?… 237

Paradoxically, therefore, instead of confi rming strongest evidence for the view of resilience as the viability of the construct of resilience (by normative—emanating as they do from research revealing that only a limited set of individuals on the type of high-risk populations that have here- survive the adversities of war), the literatures tofore not informed debates about resilience (see challenge it (in showing that most adapt effec- chapter opening). In so supporting this normative tively). Presuming for the moment that this con- view of resilient functioning, the fi ndings appear clusion of majority adaptive functioning among to challenge all three of the features of resilience youth populations in zones of political confl ict is outlined above. That is, majority adaptive func- valid, it begs the fundamental question of how it tioning in such contexts directly contradicts the is possible for a majority to be resilient. That is, if opposite expectation of minority adaptation (and resilience de fi nes a unique group of individuals— the associated anticipation of high prevalence of a group that would be of even smaller size because psychological dysfunction). In so doing, it also of the severity of the risks it is exposed to—then reinforces the skepticism about the uniqueness of it is logically untenable for the group to also be resilience from normative functioning, to the characterized a majority. This reveals, in other extent that resilient functioning is distinguished words, a dissonance that requires some resolu- only by its evidence in the context of risk. tion. Below, we will address some of the key limitations of the research literature on youth and political confl ict with an eye to whether Critiquing the Conceptualization recti fi cation of them would help resolve this con- of Risk and Trauma tradiction. First, however, it is important to expand on the contradiction mentioned above The conceptual ambiguities within the resilience regarding the degree to which resilience is ordi- literatures aside, the paradox between expecta- nary or extraordinary. tions (that few would be “resilient”) and the As explained above, much of the writing sup- fi ndings (that most are “resilient”) deserves atten- porting the validity of the resilience construct sug- tion. Emphatically, explanation of this paradoxi- gests that it is not ordinary (hence, the need to study cal fi nding could not be made by asserting that it because it is different from normative function- contexts of political con fl ict are without substan- ing). For some, however, evolution in the study of tial risk. That is, the dissonance could not be resilience reveals that it is actually more ordinary resolved by reconceptualizing the nature of war than extraordinary (e.g., Bonanno, 2004, 2008 ; and con fl ict as not dangerous, such that there Masten, 2001 ) and that this is so even in contexts of would be no reason to question normative func- severe adversity (Masten, 2001 ) . Instead of resil- tioning. Such settings are unambiguously risky, ient functioning being unique or unexpected, they given the very high exposure that young people write of it as a basic defi ning feature of humans and have to harsh, often brutal circumstances that other living things (Richardson, 2002 ) ; as a funda- cause injury and death and trigger major disrup- mental characteristic of normal coping skills , not a tions to essential services, as well as infl ict real sign of exceptional strength (Bonanno, 2008 ) ; of damage to infrastructure, social networks, and an intrinsic recovery process (Bonanno) by which social ecology (Barber, 2001, 2008 ; Betancourt & humans recover normal rhythms of daily life Khan, 2008) . The picture becomes all the more (Summer fi eld, 2002 ) ; and that majorities of people severe when considering conscripted youth who exposed to potentially traumatic events exhibit beyond witnessing the harshness of violence are stable , healthy functioning (Hoge et al., 2007 ; often coerced to perpetrate it (Wessells, 2006 ; Westpahl & Bonanno, 2007 ) . Wessells & Kostelny, 2009 ) . In order to resolve The fi ndings from the research literatures the dissonance, one is left, therefore, to question on youth and political confl ict are actually the presumptions underlying the expectation that very much in sync with this latter construal more or most young people in these contexts of resilience. Indeed, they offer perhaps the would evidence maladaptive functioning. 238 B.K. Barber and S.B. Doty

The Presumed Inevitability degree that it is perceived as such (e.g., Lazarus, of Dysfunction 1998, 2001; Lazarus & Folkman, 1984 ) , the subjective experience of individuals (and cultures) is The expectation that resilience in the face of critical in de fi ning the perception and impact of political confl ict would be remarkable hinges on an event or experience. This is particularly salient conceptions of risk and trauma. Inspection of the in the context of political con fl icts that typically resilience, risk, and trauma literatures reveals at surround national, cultural, or ethnic identity, least two standards for conceptualizing and deter- which infuse events or aspects of confl ict with mining risk or trauma, both of which warrant ideals and values that can impart essential mean- thoughtful challenge: the “universality” of risk ing relative to the legitimacy, urgency, and moral- and trauma, and the statistical determination of ity of con fl ict. Such differential meaning can risk and trauma. literally determine what about con fl ict is or is not stressful, as perceived by youth themselves (e.g., The “Universality” of Risk and Trauma Barber, 2009a ; Hammack, 2011 ; Jones, 2002 ; To the degree that de fi nitions of risk and trauma Punamäki, 1996 ) or on the part of caregivers are provided by researchers, many share the (Betancourt & Khan, 2008 ) . essential criterion that the riskiness or traumatic Barber found, for example, that depending on nature of events or circumstances of concern are the historical and political circumstances inform- experienced universally . In order for an event to ing the con fl ict, the identity-relevant narratives of qualify as a risk or as adversity, for example, the youths from differing confl icts read very differ- experience would need to be considered a stres- ently. In quantitative data from large samples, sor to most people (Betancourt & Khan, 2008 ) . majorities of youths from Gaza and Bosnia (both Likewise, trauma associated with PTSD (the of whom had experienced several years of sus- most commonly studied outcome in research on tained political confl ict) reported several years the impact of war and con fl ict) is formally de fi ned later to have grown from experiences with their as a stressor that “would evoke signifi cant symp- respective confl icts (Barber, 2008 ) . Nevertheless, toms of distress in most people ” or “would be in-depth interview data from individuals sug- markedly distressing to almost anyone ” (Criterion gested notable differences in how they processed A for DSM - III and DSM -III -R , respectively; their respective experiences. Because of the Weathers & Keane, 2007 ) . clarity of the meaning of their particular confl ict A fundamental problem with this expectation is (i.e., that it was a continuation of an historical the inherent presumption that events are under- struggle for basic rights and self-determination), stood and processed similarly across individuals Palestinian youths interpreted the confl ict as and cultures. It is worth noting that, once again, enhancing. Despite extensive exposure to and there is equivocation within the resilience writings participation in political violence (see Barber & even regarding this point. Some resilience schol- Olsen, 2009) , they did not focus on trauma and ars, for example, note a substantial heterogeneity injury, rather on qualities of national pride, social in child response to adversity at the individual cohesion, and the clear and enhancing role for level (e.g., Rutter, 2006 ; Unger, 2004 ) . Others note themselves as youths in the confl ict. Bosnian that culture plays a de fi ning role as to what consti- youths, on the other hand, were plagued by the tutes risk (Betancourt & Khan, 2008 ; Eggerman & irrationality or lack of meaning of the war they Panter-Brick, 2010 ; Gilligan, 2009 ) . Nevertheless, endured. In stark contrast to the Gazans, their as Wexler et al. (2009 ) have recently criticized, narratives were saturated with memory and dis- overall the resilience literature appears to largely course on confusion, pain, and suffering (Barber, ignore the value that people and communities 1999, 2009a; see also Jones, 2002 ) . Thus, the place on various experiences of their lives. degree to which youth are able to fi nd coherent Consistent with classic stress and coping the- meaning to their experiences, at social and per- ory that asserts that an event is stressful to the sonal levels, will impact their adaptation to it, 17 How Can a Majority Be Resilient?… 239 specifi cally regarding their identities (Gibson, Finally, a further challenge to the universality 1989 ; Hammack, 2010 ; Jones, 2002 ) . of distress in the face of adversity is the empirical These fi ndings are consistent with other work fi ndings of competent functioning in extreme that has highlighted the salient role of political contexts (such as social and parental health adver- ideology in how youths process their confl ict sities, environmental stress, and severe personal experiences and their adaptation to it (e.g., Hoge grief, stress, or trauma). Scholars characterize et al., 2007 ; Nguyen-Gillham, Giacaman, Naser, such adaptation variably as “resilience,” “hardi- & Boyce, 2008; Punamäki, 1996 ; Punamäki, ness,” “fortitude,” “strength,” and “posttraumatic Qouta, & El-Sarraj, 2001 ; Slone & Shoshani, growth” (see Almedom, 2005; Barber, 2009b ; 2008 ) . They are consistent also with assertions Westpahl & Bonanno, 2007 for reviews of these about youth functioning outside the realm of literatures). Regarding the latter, Tedeschi and political con fl ict. Wexler et al. ( 2009 ) , for exam- Calhoun (2004 ) explicitly distinguish posttrau- ple, when commenting on their research on indig- matic growth from resilience (which they charac- enous and sexual minority youths, noted the role terize as an ability to go on after hardship) in that of group af fi liation in helping young people view posttraumatic growth extends beyond resistance personal diffi culty as collective struggle and the or avoidance of damage. For them, rather, it sig- role of ideological commitment and resistance to nals a qualitative change in functioning that oppression in predicting positive functioning. refl ects transformative growth past pre-trauma In this discussion of the particularity of youth levels of adaptation. There is debate about post- functioning in contexts of political con fl ict, it is traumatic growth—surrounding, for example, the important to recognize also that part of this dif- degree to which it refl ects self-enhancing bias ferential has to do with the fact that confl icts are (and whether that would actually be adaptive) themselves not homogenous. Wars and other (Westpahl & Bonanno, 2007 ) or that it requires politically driven con fl icts are not uniform and, concrete behavioral manifestations before actual therefore, it is not reasonable to presume that growth could be considered (e.g., Hobfoll et al., those experiencing different instances of them 2007) —but the fact that a substantial number of would themselves function uniformly in response. individuals profess to have grown signals a nota- Political con fl icts, in fact, vary substantially in ble diversity in response to risk and adversity. their structure (i.e., the degree, proximity, and type of violence that characterize them) and The Statistical Determination of Risk opportunity for youth involvement (Barber, and Trauma 2008 ) , and also in the plausible scenarios for The expectation of widespread disability is even confl ict resolution (e.g., whether or not the less tenable when considering that risk research- con fl icting peoples remain living together; Cairns ers do not typically hold to this standard of the & Darby, 1998 ; Gallagher, 2004 ; Jones, 2002 ) . universality of impact of risk and trauma (i.e., This challenge to the universally distressful resilience research rarely tests prevalence and, nature of political con fl ict is consistent with con- when so, it employs questionably informative cerns of social scientists and psychiatrists about populations: Vanderbilt-Adriance & Shaw, the tendency to exaggerate the prevalence of 2008) . Instead, most of the work relies on statis- posttraumatic stress disorder. Collectively, they tical correlations to de fi ne risk. For example, note the Western orientation to individual psy- Johnson (2007 ) notes that only a few studies of chology and its tendency to pathologize norma- risk actually de fi ne the construct, and those that tive stress (Barenbaum et al., 2004 ; Becker, 1995 ; do suggest that an event is considered a risk if it Boothby, Strang, & Wessells, 2006 ; Boyden, is correlated with a negative outcome (e.g., 2003 ; Friedman, Resick, & Keane, 2007 ; Gilligan, Gutman, Sameroff, & Cole, 2003 ) or increases 2009 ; Kleinman, Das, & Lock, 1997 ; Layne the probability of developmental or adjustment et al., 2007, 2009a ; Pupavac, 2004 ; Summer fi eld, problems (e.g., Gerard & Buehler, 2004 ; Ladd & 2000, 2003 ; Unger, 2004 ) . Burgess, 2001 ) . 240 B.K. Barber and S.B. Doty

Apart from the fact that a variable that is in that the determination of what is risky and correlated with a negative outcome is not neces- traumatic is often based on statistical correlations sarily causally related to that outcome—and thus that do not suggest or imply widespread conse- could be considered a risk marker and not a risk quences within a population. Given the inconsis- factor (Kraemer, Stice, Kazdin, Offord, & Kupfer, tency in how con fl icts manifest themselves and 2001 ) —a correlation, even if causal, gives no real the variability in how youth perceive and cope indication as to the proportion of a population within them, it would be more appropriate per- that might suffer the negative consequence of the haps to refer to experiences in confl ict settings as risk. Hence, using statistically signifi cant corre- potentially disruptive or traumatic (e.g., Bonanno, lates of negative outcomes to determine risk 2005 ; Westpahl & Bonanno, 2007 ) rather than to would not justify the expectation under discus- a priori designate them as such. sion here that most youth experiencing the risks of war would be suffering substantially from them. As Kraemer ( 2003 ) clari fi es, if a standard Needed Improvements in Confl ict of a nonzero correlation is used to establish risk, Research Related to Resilience almost any variable could qualify if samples were large enough. She recommends, rather, that To this point, the discussion has presumed that before risk can be concluded, some indication of the general conclusion from the confl ict youth the potency should be offered. Similarly, Roisman literatures of majority adaptive functioning is (2005 ) admonishes for distinguishing statistical valid. Although those research fi ndings, as noted risk from genuine adversity when determining above, are consistent across a range of research resilience. approaches, con fl icts, and populations, the The best that one can say from such empirical research base nevertheless has substantial limita- fi ndings is that, on average, there is some possi- tions. It is possible, therefore, that the general bility of negative functioning in the face political conclusion is inadequate or premature. In this violence. To point, Luthar and Cicchetti ( 2000 ) section, we address some of the research limita- acknowledge that much of the resilience litera- tions with an eye to whether and how recti fi cation ture has focused on factors that have statistical of those limitations might inform on the discus- associations with adjustment dif fi culty, and, con- sion at hand. A full set of recommendations for sistent with the review of empirical fi ndings how the research could be improved is offered in offered above, Rutter (2000 ) has noted that these Barber (2009c ; see also Panter-Brick, 2010 ) . associations between individual risk factors and Three are particularly relevant to the present dis- negative outcomes are typically small. cussion because they implicate issues that have been addressed in the resilience literatures: (1) specifying con fl ict exposure , (2) specifying Summary domains of youth functioning , and (3) assessing functioning over the long term . In summary, challenges to the expectation that the risk and trauma of war has widespread impact on youth can be made on both logical and statisti- Specifying Exposure cal grounds. Such an expectation is illogical unless one ignores the substantial variability in One of the main limitations of the research on how individuals and cultures conceive and youth and political confl ict is the general failure respond to events and circumstances in their lives. to distinguish types of exposure, as opposed to This is a particularly salient concern for under- calculating aggregated risk or trauma scores. standing the impact of political confl ict given Even though virtually all discussions and indexes its ideological grounding. The expectation is of war trauma or political life events include also unwarranted from an empirical point of view some attention to a diversity of dif fi culty that war 17 How Can a Majority Be Resilient?… 241 presents to children and youth (e.g., violence community violence. As both Aisenberg and exposure, loss, deprivation; e.g., Allwood, Bell- Herrenkohl (2008 ) and Barbarin, Richter, and de Dolan, & Husain, 2002 ; Colletta & Cullen, 2000 ; Wet (2001 ) have reviewed (each citing work by Macksoud & Aber, 1996 ; Mollica, McDonald, Trickett: e.g., Trickett, Durán, & Horn, 2003 ) , Massagli, & Silove, 2004 ; Slone, 2009 ) , most violence can be experienced variously: directly, studies aggregate such diverse experiences in an indirectly, vicariously, by witnessing, or differen- overall trauma index (often because sample size tially by domain (i.e., in the family or in the com- does not permit otherwise). Further, since much munity). In the realm of political violence, Layne or most of the items comprising such indices et al. ( 2010) have admonished for the same preci- refer to violence exposure, the tendency is to con- sion, reiterating the logic of distinguishing between clude or imply, therefore, that the essential risk to direct and witnessed political violence and also youth of political con fl ict is the aggregate, or recommending attention to such experiences as cumulative, amount of violence they witness or life threat; traumatic death; loss and displacement; participate in. and threat or harm to, or loss of, loved ones. Such a conclusion would be short-sighted— Regarding violence per se, Panter-Brick, not alone because the averaged scores in fact Goodman, Tol, and Eggerman ( 2011 ) recently include exposure types that are not exclusively or found that family violence, more so than political explicitly related to violence but also because it is violence, impacted the well-being of Afghani likely that such “nonviolent” exposures are where youth. In our own work, we have begun to address the more acute or lasting injuries from war lie. this issue by comparing models that tested aggre- While violence exposure most certainly is a con- gated exposure (17 items) against models that sequence of war for many young people, political clustered those exposures according to type confl ict generates other conditions that pose (assault, intimidation, loss) or domain (personal, direct and powerful risks to development, which, family, and community). In samples of Bosnian if left unmeasured or inadequately measured, and Palestinian youths, aggregated exposure foreclose an assessment of the real impact of explained the least amount of variance in a variety political con fl ict on young people. Some studies of measures of youth psycho-/social/civic func- have found, for example, that disruptions in tioning compared to both the type or domain access to resources in the social domain (e.g., confi gurations of exposure. Type of exposure, on loss of life, displacement, separation, loss of the other hand, explained the most variance. social support, reduction in social networks) Moreover, the long-term effect of the specifi c and economic domain (e.g., economic self- types of exposure was different. That is, when suf fi ciency, ability to buy certain types of food, analyzed in relation to numerous dimensions of hunger, breakdown of basic services, cuts in elec- psychosocial functioning several years after the tricity, demolition of homes, access to health (retrospectively) reported con fl ict, it was appar- care, imprisonment) are signifi cantly related to ent in both samples that exposure to intimidation greater dif fi culty among youth and adults, and was correlated with later positive functioning (or often more so than exposure to violence (e.g., lower levels of negative functioning) but that Al-Krenawi, Graham, & Sehwail, 2001–2002; exposure to loss was generally associated with Betancourt, 2004; Colletta & Cullen, 2000 ; later negative functioning. Findings for assault Eggerman & Panter-Brick, 2010 ; Farhood et al., were mixed (Barber, Olsen, & Spellings, 2011 ) . 1993 ; Giacaman, Husseini, Gordon, & Awartani, This trend toward specifi cation in the research 2004 ; Jones & Kafetsios, 2005 ; Kuterovac- on con fl ict youth actually runs opposite to a Jagodic, 2003 ; Mollica et al., 2004 ; Punamäki, movement in risk and resilience research, wherein Muhammed, & Abdulraham, 2004 ; Salo, it is cumulative exposure that has become the Punamäki, & Qouta, 2005 ) . focus. For example, resilience researchers have This need to distinguish types of confl ict expo- noted a relationship between the likelihood of sure mirrors that in research on nonpolitical, problem behaviors and the number of risk factors 242 B.K. Barber and S.B. Doty

(Canavan, 2008 ) , as tallied by summing the number social functioning that such a narrow focus of risk factors or negative life events in the child’s encourages (e.g., Barber, 2009b ; Dawes & Cairns, life (Masten & Reed, 2002 ) . Recognizing that 1998 ; Summer fi eld, 2000, 2003 ) . Relatedly, many youth are exposed to multiple risk factors, Nguyen-Gillham et al. ( 2008 ) note that concen- this shift has been a corrective to the resilience trating on individual psychopathology when fi eld’s previous focus on single risk factors or the studying political confl ict implies that the sick- implication that risk factors act independently of ness of war resides in the individual—who is to each other (Aisenberg & Herrenkohl, 2008 ; recover from it as if from an illness. It encour- Fergus & Zimmerman, 2005; Rutter, 2000 ; ages, in other words, a distracting focus on indi- Sameroff & Rosenblum, 2006 ) . vidual capacity instead of recognizing and In sum, at least at its present stage of develop- studying the failures of the ecology at providing ment, the research on the impact of political adequate resources and meaning for youth to confl ict on youth would benefi t substantially by function. greater specialization as to types of exposure. In short, the motivation in the con fl ict litera- Doing so runs contrary to the recommendation in tures to seek more broadly within the realms of the resilience literatures to aggregate exposure, youth functioning is to more effectively or pre- but it would provide clarifying detail as to the cisely discern the impact of confl ict, recognizing relative challenges that discrete types of exposure that the traditional focus on psychopathology pose to young people. It would assist, therefore, cannot have adequately captured the impact, in knowing more surely if there are specifi c ele- from either holistic or cultural perspectives ments of political con fl ict involvement or expo- (Bracken, Giller, & Summer fi eld, 1995 ; sure that do compromise large proportions of Summer fi eld, 1999 ) . Many have recommended youth populations. the establishment of culturally relevant measures of functioning (e.g., Ager, 2002 ; Betancourt et al., 2009; Bolton, 2001 ; Giacaman et al., 2007 ; Specifying Youth Functioning Mataria et al., 2009 ; Miller et al., 2006 ; Panter- Brick et al., 2009 ; Stark, Wessells, & Boothby, One area in which the resilience and confl ict 2009 ). Thus, in addition to assessing psychologi- youth literatures are united is the encouragement cal functioning, a more culturally appropriate for measuring functioning broadly—even though assessment of well-being would be to focus on the two bodies of literature appear to have come social relationships and social isolation (Boyden, to the recommendation in different ways. As for 2003 ; Layne et al., 2009b ; Wessells & Kostelny, the research on the effects of political confl ict, 2009) ; socioeconomic conditions, such as the vast majority of studies have focused on neg- employment and education (e.g., Boothby, ative psychological outcomes as the sole or prime Crawford, & Agostinho, 2009 ) ; civic involve- indicator of youth well-being (see Barber & ment; developing a collective identity (e.g., Schluterman, 2009 for a review, and for continu- Ashmore, Deaux, & Mclaughlin-Volpe, 2004 ) ; ing illustrations of the restricted focus, see, e.g., the on-time achievement of culturally sanctioned Cummings et al., 2012 ; Dubow et al., 2012 ; statuses such as marriage and having children Hobfoll, Mancini, Hall, Canetti, & Bonanno, (Hogan, 1978 ) ; self-esteem/ef fi cacy (e.g., Earls 2011 ) . Not only is a singular focus too narrow to & Carlson, 2001 ) ; and future orientations, par- capture the holistic complexity of youth experi- ticularly regarding confl ict and peace (e.g., ence, but the admonition to assess it more broadly Cairns, Hewstone, Niens, & Tams, 2005 ; Dawes has been stimulated also from a cultural perspec- & Finchilescu, 2002 ; Lavi & Solomon, 2005 ; tive. Among many culture-based concerns are McLernon & Cairns, 2006 ) . Finally, and most pathologizing normative stress (e.g., Honwana, relevant to context of political confl ict itself, 2006 ; Kleinman & Desjarlais, 1995 ) and the recent work is beginning to acknowledge the arti fi cial isolation of individual functioning from uniquely political domains of well-being and 17 How Can a Majority Be Resilient?… 243 functioning characteristic of populations who recommending that assessments be made of both live under chronic political constraints (Barber, negative and positive functioning (i.e., not simply McNeely, & Spellings, 2012 ; Giacaman et al., multiple measures of problematic functioning; 2007, 2011 ; Giacaman, Rabaia, & Nguyen- Barber, 2009b ; Bonanno, 2008 ) . For their part, Gillham, 2010 ; Mataria et al., 2009 ) . resilience researchers have recommended As for the resilience literatures, the recommen- expanding the scope of inquiry to include a two- dation to study multiple dimensions of function- factor understanding of health (Unger, 2004 ) , ing has emanated from the empirical evidence integrating the pathogenic and salutogenic that resilience—however measured—does not approaches to functioning (Almedom & Glandon, manifest itself across multiple domains (e.g., 2007) , and distress plus functioning (Luthar, Luthar et al., 2000 ) . This is to say that resilience is 1991 ) . Con fl ict researchers have similarly noted not continuous, even, or steady across realms of the need to study positive outcomes as well as functioning (Bonanno, 2008 ; Canavan, 2008 ; pathology (Barber, 2009b; Betancourt & Khan, Luthar et al., 2000 ; Wexler et al., 2009 ) . As 2008; Nguyen-Gillham et al., 2008 ; Slone & Herrenkohl, Herrenkohl, and Egolf ( 1994) noted Shoshani, 2008 ) . some time ago, positive functioning in the aca- The few studies that have studied both positive demic sphere, for example, does not ensure and negative functioning in populations of youths healthy functioning in other realms (e.g., the emo- in confl ict zones have found both to be predicted tional-interpersonal sphere). Therefore, one must by con fl ict exposure (see Barber & Schluterman, study functioning broadly before concluding 2009, for a review). In one recent effort to do so, resilience. Indeed, resilience researchers are cau- we found that it was the frequency of youths’ tioned (by some proponents of the resilience con- own activism in confl ict (as compared to their struct) to not discuss resilience in a general or exposure to con fl ict) that was predictive of later global way but rather to restrict it to discreet positive functioning (personally, socially, and domains of functioning (e.g., academic; antisocial civically; Barber & Olsen, 2009 ) . Youths’ own behavior) (Vanderbilt-Adriance & Shaw, 2008 ) . involvement in political activism is too rarely Interestingly, they note that restricting the measured when assessing the impact of political conceptualization of resilience to one or a limited confl ict. Rectifying this defi ciency would be number of domains might actually call into ques- another way to specify confl ict exposure (as rec- tion the viability of the construct—i.e., how can it ommended above) while at the same time illus- be resilience if it is not generalized (Luthar et al., trating the complex—sometimes positive—effects 2000 ; Vanderbilt-Adriance & Shaw, 2008 ) ? They of exposure. Such a focus on activism would be conclude in favor of retaining the construct, albeit particularly timely given the ongoing wave of a domain-specifi c one (Layne et al., 2007 ) . It is youth civil disobedience and protest in the Middle unclear, then, where the resilience fi eld lies, that East (Barber & Youniss, 2012 ; Youniss, Barber, is, whether the recommendation is to downsize & Billen, 2012 ) . resilience to a domain-speci fi c phenomenon or to In sum, the limited scope of inquiry within the restrict its application to only those that manifest research on the effects of political con fl ict it broadly, as in Masten and Reed’s ( 2002 ) sug- qualifi es the general conclusion of majority com- gestion that resilience is con fi gural. In that con- petent functioning reviewed above. Given that strual, resilient functioning would be concluded this conclusion has been made by looking at a if the individual is doing well in multiple ways, very narrow window of functioning (negative or cumulatively across settings (Aisenberg & psychological functioning), it is conceivable that Herrenkohl, 2008 ) . a different conclusion would be made if a more That de fi nitional issue aside, when it comes to comprehensive and culturally sensitive approach the recommendation to assess functioning more to youths’ lives was pursued. The nature of that holistically for individuals who face adversity, conclusion is unclear, however. By expanding the con fl ict and resilience literatures are united in studies to assess more holistic representations of 244 B.K. Barber and S.B. Doty youth functioning, it is possible that we will assessing if and how experience with political discern domains of functioning that re fl ect nota- con fl ict complicates their forward progress, ble injury from confl ict exposures, but equally particularly as they become adults, form fami- possible that other domains will evidence adap- lies, and participate in the support and gover- tive functioning. nance of their societies. Moreover, in con fl icts in which political autonomy is limited and tensions and episodic con fl ict persist, understand- Studying Youth Over the Longer Term ing how youths’ past and current experiences with confl ict shape attitudes toward confl ict (its The third area of needed improvement in the acceptability, willingness to participate in it research on youth and political confl ict relevant again, etc.), peace, acceptable resolutions, types to the discussion of resilience is the need to view of governmental systems, etc. becomes an the longer-term functioning of young people who important part of the assessment of the impact are exposed to or involved in political con fl ict. of political confl ict. Although some short-term longitudinal studies The further advantage of charting the longer- are emerging (e.g., Panter-Brick et al., 2011 ) , the term course of young people’s lives is the ability majority of studies of effects of political confl ict to assess the relative impact of confl ict exposure, are cross-sectional. One exception is the research i.e., to better situate it with other key social, eco- on the youths of the US civil rights movement of nomic, and political developments and/or condi- the 1960s that shows them to be “ideal citizens” tions at work in post- or continuing-confl ict 25 years following their experiences of being societies. To this end, important recent work has beaten and jailed (Fendrich, 1993 ; Whalen & begun to focus explicitly on the role—indeed, the Flacks, 1989 ) . Given the focus on stress and commanding in fl uence of—economic and politi- trauma of most work on con fl ict youth, and the cal conditions in the lives of individuals in humanitarian crises generated during bursts of con fl ict zones (Eggerman & Panter-Brick, 2010 ; intense confl ict, it is understandable that assess- Giacaman et al., 2007 ; Mataria et al., 2008; Miller ments of functioning are made during or shortly & Rasmussen, 2010 ) . after con fl ict in order to quickly intervene. In the resilience literatures, temporal con- However, proximal-to-con fl ict assessments cerns are commonly discussed and are nuanced. provide a restricted view into the (perhaps tem- Again, in the effort to more precisely de fi ne what porary) effects of political confl ict on young peo- “resilience” is, scholars have regularly raised ple. Thus, a guiding motive in the political confl ict issues of time. Beyond general calls to look to literatures to look more long term is to continue the long term (e.g., Rutter, 2006 ) , relevant ideas to answer the basic question of how, and to what range from the possibility that the real impact(s) degree, con fl icts affect young people. A particu- of exposure to potentially traumatic events may lar advantage of shifting to the longer-term func- take time to become evident (as in Bonnano’s tioning of young people who are exposed to or ( 2005 ) query as to whether long-term costs may involved in political con fl ict is that it encourages outweigh shorter-term coping); individuals have and facilitates the broadening of the scope of trajectories of symptom or growth development functioning described above. In other words, the over time (Layne et al., 2007) ; and the related preoccupation with psychic stress that is charac- notion that adjustment is a process wherein risks teristic of proximal-to-con fl ict assessments and/or resources develop overtime in “cascades” should give way to a more holistic assessment of (Luthar, Sawyer, & Brown, 2006) or “caravans” young people’s lives. (Hobfoll, 2001 ) that synergistically determine Apart from the problems related to applying one’s overall quality of functioning. Beyond stress and trauma models across populations these issues of longevity and the processes that discussed earlier, more purchase on the durable accompany it, scholars interested in the construct impact of political con fl ict might be gained by of resilience have repeatedly suggested that 17 How Can a Majority Be Resilient?… 245 resilient functioning may not be stable, noting, Summary for example, that resilient functioning is not a steady state (Wexler et al., 2009) , fl uid This section sought to acknowledge limitations (Herrenkohl et al., 1994) , or static, but rather of the research on the impact of political con fl ict episodic (Nguyen-Gillham et al., 2008 ) or inter- on youth and contemplate if recti fi cation of those spersed with setbacks (Luthar, 1991 ) . limitations might bear on reconciling the discrep- This is to say, therefore, that while linear ancy between expected dysfunction in youth time may reveal some impacts, it may not ade- experiencing the adversities of political confl ict quately capture the complexity of functioning and the general fi nding that most do not. The since that functioning is itself in fl ux. To draw research base is limited in at least three funda- it out one step further, it might be the case that mental ways: lack of specifi cation of exposure even long-term views on the functioning of a types, a very narrow focus on psychopathology population of young people may distort the when considering effects, and an absence of lon- picture. Thus, regardless of how distal to the ger-term evidence for functioning. It is not clear, moments of exposure a longer-term assessment however, that remedying these defi ciencies would might be, if it is still a one-time measurement, meaningfully temper any overall conclusion it will have missed the fl uctuations that may about the prevalence of adaptive functioning. have occurred prior to the assessment (and that Rather, addressing the limitations would provide might well follow the assessment). Only regu- more (and needed) speci fi city to the fi ndings. lar tracking over time would reveal the fl ux of Thus, it is possible that when modeling the functioning. Acknowledging and mapping this diverse types of exposures that war presents potential instability is especially critical in young people, it will be discerned that the pro- contexts that themselves are unstable, such as portion of youth experiencing specifi c forms of areas of political con fl ict where economic and con fl ict exposure might be more challenged than political dynamics change substantially and those who experience others. Similarly, by mov- regularly over time and thereby provide shifting to a more holistic assessment of youth func- ing narratives that challenge or compel changes tioning in confl ict zones, we are likely to specify to young people’s identities (Barber, 2010 ; the effects even further, potentially learning that Hammack, 2011 ) . in certain domains of life, con fl ict youth may In sum, because of the cross-sectional limita- struggle, sometimes substantially, but in others tions to most of the research on the effects of they have adapted effectively. Finally, while it is political con fl ict, it is possible that the conclu- ostensibly possible that longer-term views of sion of majority adaptive functioning among functioning would reveal the expected wide- youths in such contexts could be premature or spread dysfunction, there is no evidence that certainly incomplete. Although (as Punamaki would support such an eventuality. (2001) has reviewed) various studies of child functioning after exposure to political violence (and natural disaster) show, in fact, an overtime Conclusion reduction in symptoms, there is enough variability among studies and inconsistency in their This chapter was framed around a concern in the fi ndings to leave the question of long-term resilience literatures that the prevalence of resil- impact not clearly answered. Regarding resilience is unclear, and perhaps even infl ated, ience, while such temporal tracking of function- because investigations have not assessed children ing will certainly add useful data to demonstrate or youth who live in very high-risk contexts. In the relative stability of the construct, it is not focusing on what is known about the functioning clear that it would necessarily alter the expecta- of young people in the contexts of political tion as to what proportions of the populations confl ict (i.e., contexts that include extreme adver- could be considered “resilient.” sity), we sought to address this speci fi c issue and, 246 B.K. Barber and S.B. Doty thereby, the broader question of the utility of the defi nition of the construct. As such, not only is it construct of resilience for understanding con fl ict inconsistent with the empirical evidence, it is also youth. As part of this analysis, we also inspected discordant conceptually with the line of reason- the research literatures on functioning in contexts ing within resilience thinking itself that has been of political con fl ict for limitations that might bear recommending that adaptive functioning is nor- on a conclusion about the usefulness of the con- mative, even under adversity (Bonanno, 2005 ; struct of resilience to understanding these Masten, 2001 ) . Other dif fi culties that accompany populations. the task of identifying a level or type of function- Overall our conclusion from this exercise is ing that would be called resilient are the need to that the construct of resilience (depending on distinguish it from related or relevant constructs how it is de fi ned) is not particularly useful for (e.g., resistance, recovery) and to de fi ne its understanding young people’s experience with parameters, such as how stable or generalized political confl ict. Most generally, the problem (i.e., across domains) adaptive functioning must lies with the stark contrast between (a) the be before it qualifi es as resilience. In other words, fi ndings that most people, including children and it seems very unclear what resilience actually youths, do not manifest notable dysfunction as a means. consequence of their experiences with political In order to avoid the implication that resilience confl ict and (b) the expectations that would be is a personal characteristic (i.e., that some indi- drawn from guiding principles of the construct viduals possess it and others do not), resilience about widespread dysfunction. In short, ground- theorists clari fi ed long ago that it is a process or ing defi nitions of resilience describe it as effec- an interaction between individual and context tive functioning in adverse environments (i.e., (e.g., Luthar et al., 2000 ) . This appropriate atten- distinguished from other construals of effective tion to context has, however, included an functioning in less adverse environments), that insuffi ciently critical perspective toward adver- such functioning is unexpected (because of the sity, that is, presuming that adverse experiences severity of risk), and that it would be particularly are invariably traumatic or debilitating. Thus the so for war contexts given their gravity of adver- disjuncture between expectations that relatively sity and potentially traumatic conditions. One few would survive the adversities of war and the would expect, therefore, that of all places, it contradictory fi ndings lies in the expectation would be in these most challenging of circum- itself. The premature de fi nition of events as stances that the prevalence of resilience would be debilitating does not acknowledge the following: found. That the majority appears to function fi rst, that contexts of political confl ict vary effectively poses real challenges for these signi fi cantly from each other; second, that indi- conceptualizations. viduals and cultures defi ne, perceive, and respond As many have noted there are numerous con- to challenging and adverse events differently; and ceptual diffi culties within the various renderings third, that this heterogeneity of perception and of resilience (Vanderbilt-Adriance & Shaw, response would be particularly salient in contexts 2008 ) . For us, one of the most fundamental of political confl ict given the subjective (i.e., ide- appears to surround an essential feature of the ological) basis for them. construct. That is, asserting that resilient func- In short, to the degree that resilience would be tioning is qualitatively different than positive used to help de fi ne the impressive capacity of functioning, development, or coping necessarily humans to move forward when challenged and implies that such advanced functioning is unique: injured, it would seem that evidence from the both because it cannot be explained by normative con fl ict literatures offers meaningful, con fi rming processes and it would be less prevalent (due to evidence. But then, the value added to under- the adversity). Thus, this uniqueness or extra- standing normative processes of the construct is ordinariness of resilience appears inherent in the unclear. To the extent that it is used to suggest 17 How Can a Majority Be Resilient?… 247 that there would be an unexpected or remarkable that presume to know what about them should subpopulation which functions effectively, it be studied). Given the evidence that when con- seems unhelpful and inappropriate. Most impor- sulted young people are able to articulate with tantly, that construal encourages the continued sophistication their complex experiences with imposition of theoretical models and designs that political con fl ict (Barber, 2009a ; Hammack, presume inaccurately that events or conditions 2011) , there is every reason to believe that an are inherently risky or traumatic and use understanding of how the majority of young signi fi cant correlations of low magnitude to tau- people move forward with their lives in these tologically reinforce those presuppositions. extreme contexts without substantial dysfunc- There are meaningful implications of this tion would be facilitated by careful, thoughtful, distinction. Apart from the important academic and thorough consultations with youths issues of clarifying conceptualization and the- themselves. ory and the increase in knowledge it would Finally, the recognition that human resil- facilitate through more refi ned hypotheses iency is evident even in highly adverse condi- (Layne et al., 2007 ) , and the risk of harm to tions encourages a more targeted effort at individuals participating in trauma-targeted determining which of these populations of clinical interventions that may exacerbate youth actually do end up suffering substantially. trauma by interfering with natural recovering Even if majorities piece together the resources (Bonanno, 2008 ) , there are also valuable impli- to move forward, that still leaves alarming cations for research design and its relevance to numbers of young people who struggle and suf- programming. First, presuming competent fer, sometimes severely. Thus, far from encour- functioning in the face of adversity instead of aging a laissez-faire or dismissive attitude expecting widespread trauma would encourage toward the awfulness of war (Betancourt & a more deliberate and careful analysis of the Khan, 2008 ) , such a shift in focus would actu- strengths that de fi ne the effective functioning ally heighten and sharpen attention to its tragic of youths in these circumstances. Unless one casualties and more effectively understand and takes a “resistance” perspective (which we do meet their needs (Bonanno, 2005 ; Kraemer, not favor simply because the adversities of 2003 ) . Given what seems to be known about political con fl ict are clearly severe enough to human capacity to adapt to adversity, such a require adaptation), competent functioning in search would seek diligently to identify the con- these contexts does not mean that youths are spiracy of conditions and circumstances that impervious to adversity, but rather, that they effectively compromise that capacity. To that have faced and endured it and have found ways end, while it must certainly be true that individual to move forward nevertheless (e.g., Masten & characteristics interact with contextual factors Reed, 2002 ) . This is not something that they do (e.g., Dumont, Widom, & Czaja, 2007 ; Hobfoll, on their own, of course. Research would do 2001 ) , the research across disciplines is abun- well, therefore, to better identify and map this dantly clear that such a search should focus resourcefulness at all levels: socially, cultur- strongly on the (compromised) availability of ally, economically, politically, and psychologi- social, economic, educational, cultural, and cally (e.g., Unger, 2004 ) . This matrix of political resources that all individuals, youths resources would likely vary across con fl icts and in particular, need to move forward with their shift across time, especially for those con fl icts lives (Betancourt & Khan, 2008 ; Giacaman that persist (Barber, 2010 ) . et al., 2004 ; Hobfoll, 2001 ; Masten, 2001 ; Importantly, such a focus would also encour- Panter-Brick, 2010 ; Unger, 2004 ) . age more attention to the perspectives of youths themselves. Surprisingly, there is still relatively Acknowledgement Appreciation expressed to Paul D. little consultation with young people as to the Page, Carolyn Spellings, and Mingzhu Xia for assistance nature of their experiences (in favor of models with literature reviews. 248 B.K. Barber and S.B. Doty

References Adolescents and war: How youth deal with political violence . New York: Oxford University Press. Barber, B. K. (2009b). Viewing the complexity of adoles- Ager, A. (2002). Psychosocial needs in complex emergen- cents’ experience with political violence. In B. K. cies. Lancet, 360 (Suppl.), s43–s44. Barber (Ed.), Adolescents and war: How youth deal Aisenberg, E., & Herrenkohl, T. (2008). Community vio- with political violence . New York: Oxford University lence in context. Journal of Interpersonal Violence, Press. 23 (3), 296–315. Barber, B. K. (2009c). Moving forward with research on Al-Krenawi, A., Graham, J. R., & Sehwail, M. A. (2001– youth and political violence. In B. K. Barber (Ed.), 2002). Bereavement responses among Palestinian Adolescents and war: How youth deal with political widows, daughters and sons following the Hebron violence . New York: Oxford University Press. massacre. OMEGA—Journal of Death and Dying, 44 , Barber, B. K. (2010). The shifting complex of identity: 241–255. Issues of individual and contextual change informing Allwood, M. A., Bell-Dolan, D., & Husain, S. E. (2002). the narrative identities of confl ict youth: Commentary Children’s trauma and adjustment reactions to violent on Hammack. Human Development, 53 , 202–207. and nonviolent war experiences. Journal of the Barber, B. K. (2013). Annual research review: The experi- American Academy of Child and Adolescent ence of youth with political con fl ict: Challenging Psychiatry, 41 , 450–457. notions of resilience and encouraging research Almedom, A. M. (2005). Resilience, hardiness, sense of re fi nement. Journal of Child Psychology and coherence, and posttraumatic growth: All paths lead- Psychiatry . doi: 10.1111/jcpp.12056 . ing to the “light at the end of the tunnel”? Journal of Barber, B. K., McNeely, C., & Spellings, C. R. (2012). Role Loss and Trauma, 10 , 253–265. of political factors in wellbeing and quality of life dur- Almedom, A. M., & Glandon, D. (2007). Resilience is not ing long-term constraints and con fl ict. Lancet, 380 . the absence of PTSD any more than health is the absence Barber, B. K., McNeely, C., & Spellings, C. (2012). Role of disease. Journal of Loss and Trauma, 12 , 127–143. of political factors in wellbeing and quality of life dur- Annan, J., Blattman, C., Carlson, K., & Mazurana, D. ing long-term constraints and con fl ict: An initial study. (2008). The state of female youth in Northern Uganda: Lancet . Retrieved October 8, 2012, from http://www. Findings from the Survey of War Affected Youth thelancet.com/health-in-the-occupiedpalestinian-terri- (SWAY). A report for UNICEF Uganda. www.sway- tory-2012 uganda.org . Barber, B. K., & Olsen, J. A. (2009). Positive and negative Annan, J., Blattman, C., & Horton, R. (2006). The state of psychosocial functioning after political con fl ict: youth and youth protection in Northern Uganda: Examining adolescents of the fi rst Palestinian Intifada. Findings from the Survey of War Affected youth In B. K. Barber (Ed.), Adolescents and war: How (SWAY). A report for UNICEF Uganda. www.sway- youth deal with political violence. New York: Oxford uganda.org . University Press. Ashmore, R. D., Deaux, K., & Mclaughlin-Volpe, T. Barber, B. K., Olsen, J. A., & Spellings, C. R. (2011, (2004). An organizing framework for collective iden- April). War and youth: Assessing multiple contexts of tity: Articulation and signi fi cance of multidimension- con fl ict exposure and domains of functioning . ality. Psychological Bulletin, 130 , 80–114. Presented at the Society for Research on Child Barbarin, O. A., Richter, L., & de Wet, T. (2001). Exposure Development Biennial meeting, Montreal, Canada. to violence, coping resources, and psychological Barber, B. K., & Schluterman, J. M. (2009). An overview adjustment of South African children. The American of the empirical literatures on adolescents and political Journal of Orthopsychiatry, 71 (1), 16–25. violence. In B. K. Barber (Ed.), Adolescents and war: Barber, B. K. (1999). Youth experience in the Palestinian How youth deal with political violence . New York: intifada: Intensity, complexity, paradox, and compe- Oxford University Press. tence. In M. Yates & J. Youniss (Eds.), Roots of civic Barber, B. K., & Youniss, J. (2012, Fall). Egyptian youth identity: International perspectives on community ser- make history. Harvard International Review. vice and activism in youth . New York: Cambridge Barber, B. K., & Youniss, J. (2012). Egyptian youth make University Press. history. Harvard International Review . Retrieved Barber, B. K. (2001). Political violence, social integra- November 29, 2012, from http://hir.harvard.edu/ tion, and youth functioning: Palestinian youth from youth-on- fi re/egyptian-youth-make-history the Intifada. Journal of Community Psychology, 29 , Barenbaum, J., Ruchkin, V., & Schwab-Stone, M. (2004). 259–280. The psychosocial aspects of children exposed to war: Barber, B. K. (2008). Contrasting portraits of war: Youths’ Practice and policy initiatives. Journal of Child varied experiences with political violence in Bosnia Psychology and Psychiatry, 45 , 41–62. and Palestine. International Journal of Behavioral Becker, D. (1995). The de fi ciency of the concept of posttrau- Development, 32 (4), 298–309. matic stress disorder when dealing with victims of human Barber, B. K. (2009a). Making sense and no sense of war: rights violations. In R. J. Kleber, C. R. Figley, & P. R. Issues of identity and meaning in adolescents’ experi- Gersons (Eds.), Beyond trauma: Cultural and societal ence with political con fl ict. In B. K. Barber (Ed.), dynamics (pp. 99–110). New York: Plenum Press. 17 How Can a Majority Be Resilient?… 249

Betancourt, T. S., & Khan, K. T. (2008). The mental health The evolving science of mental disorder (pp. 253–254). of children affected by armed confl ict: Protective pro- New York: Cambridge University Press. cesses and pathways to resilience. International Colletta, N. J., & Cullen, M. L. (2000). The nexus between Review of Psychology, 20 (3), 317–328. violent con fl ict, social capital, and social cohesion: Blattman, C., & Annan, J. (2007). The consequences of Case studies from Cambodia and Rwanda . Washington, child soldiering . HICN Working paper, 22. DC: World Bank. Bolton, P. (2001). Cross-cultural validity and reliability Cummings, E. M., Merrilees, C. E., Schermerhorn, A. testing of a standard psychiatric assessment instru- C., Goeke-Morey, M. C., Shirlow, P., & Cairns, E. ment without a gold standard. The Journal of Nervous (2012). Political violence and child adjustment: and Mental Disease, 189 , 238–242. Longitudinal tests of sectarian antisocial behavior, Bonanno, G. A. (2004). Loss, trauma, and human resil- family confl ict, and insecurity as explanatory path- ience: Have we underestimated the human capacity to ways. Child Development, 83 (2), 461–468. thrive after extremely aversive events? American doi: 10.1111/j.1467-8624.2011.01720.x . Psychologist, 59 , 20–28. Daiute, C. (2006). General introduction: The problem of Bonanno, G. A. (2005). Resilience in the face of potential society in youth con fl ict. In C. Daiute, Z. F. Beykont, trauma. Current Directions in Psychological Science, C. Higson-Smith, & L. Nucci (Eds.), International 14 (3), 135–138. perspectives on youth confl ict and development (pp. Bonanno, G. A. (2008). The human capacity to thrive in 3–22). New York: Oxford University Press. the face of potential trauma. Pediatrics, 121 (2), Dawes, A., & Cairns, E. (1998). The Machel Study: 369–375. Dilemmas of cultural sensitivity and universal rights Boothby, N., Crawford, J., & Agostinho, M. (2009). of children. Peace and Con fl ict: Journal of Peace Mozambican child soldier life outcome study. In B. K. Psychology, 4 (4), 335–348. Barber (Ed.), Adolescents and war: How youth deal Dawes, A., & Finchilescu, G. (2002). What’s changed? with political violence. New York: Oxford University The racial orientations of South African adolescents Press. during rapid political change. In Childhood . London: Boothby, N., Strang, A., & Wessells, M. (2006). A world Sage. turned upside down: Social ecological approaches to Doty, B. (2010). The construct of resilience and its appli- children in war zones . Bloom fi eld, CT: Kumarian cation to the context of political violence. Pursuit — Press. The Journal of Undergraduate Research at the Boyden, J. (2003). Children under fi re: Challenging University of Tennessee, 1 (1), Article 11. assumptions about children’s resilience. Children , Dubow, E. F., Huesmann, L. R., Boxer, P., Landau, S., Youth and Environments, 13 (1). Retrieved July 2, Dvir, S., Shikaki, K., et al. (2012). Exposure to politi- 2006, from http://www.colorado.edu/journals/ cal con fl ict and violence and posttraumatic stress in cye/13_1/index.htm middle East youth: Protective factors. Journal of Bracken, P. J., Giller, J. E., & Summerfi eld, D. (1995). Clinical Child and Adolescent Psychology, 41 (4), Psychological responses to war and atrocity: The limi- 402–416. doi: 10.1080/15374416.2012.684274 . tations of current concepts. Social Science & Medicine, Dumont, K. A., Widom, C. S., & Czaja, S. J. (2007). 40 , 1073–1082. Predictors of resilience in abused and neglected chil- Cairns, E. (1996). Children and political violence . Oxford: dren grown-up: The role of individual and neighbor- Blackwell. hood characteristics. Child Abuse & Neglect, 31 , Cairns, E., & Darby, J. (1998). The confl ict in Northern 255–274. Ireland: Causes, consequences, and controls. American Earls, F., & Carlson, M. (2001). The social ecology of Psychologist, 53 , 754–760. child health and well-being. Annual Review of Public Cairns, E., & Dawes, A. (1996). Children: Ethnic and Health, 22 , 143–166. political violence—A commentary. Child Development, Eggerman, M., & Panter-Brick, C. (2010). Suffering, 67 , 129–139. hope, and entrapment: Resilience and cultural values Cairns, E., Hewstone, M., Niens, U., & Tams, T. (2005). in Afghanistan. Social Science & Medicine, 70 , 1–13. Intergroup forgiveness and intergroup con fl ict: Farhood, L., Zurayk, H., Chaya, M., Saadeh, F., Northern Ireland, a case study. In E. Worthington Meshefedjian, G., & Sedani, T. (1993). The impact of (Ed.), Handbook of forgiveness (pp. 461–476). New war on the physical and mental health of the family: York: Routledge. The Lebanese experience. Social Science & Medicine, Canavan, J. (2008). Resilience: Cautiously welcoming a 36 , 1555–1567. contested concept. Child Care in Practice, 14 (1), 1–7. Fendrich, J. M. (1993). Ideal citizens: The legacy of the Carver, C. S. (1998). Resilience and thriving: Issues, civil rights movement . Albany: State University of models, and linkages. Journal of Social Issues, 54 , New York Press. 245–266. Fergus, S., & Zimmerman, M. A. (2005). Adolescent Cicchetti, D. (1996). Developmental theory: Lessons from resilience: A framework for understanding healthy the study of risk and psychopathology. In S. Matthysse, development in the face of risk. Annual Review of D. Levy, J. Kagan, & F. Benes (Eds.), Psychopathology: Public Health, 26 , 399–419. 250 B.K. Barber and S.B. Doty

Friedman, M. J., Resick, P. A., & Keane, T. M. (2007). Hobfoll, S. E., Mancini, A. D., Hall, B. J., Canetti, D., & Key questions and an agenda for future research. In M. Bonanno, G. A. (2011). The limits of resilience: J. Friedman, T. M. Keane, & P. A. Resick (Eds.), Distress following chronic political violence among Handbook of PTSD: Science and practice (pp. 540– Palestinians. Social Science & Medicine, 72 (8), 1400– 561). New York: Guilford. 1408. doi: 10.1016/j.socscimed.2011.02.022 . Gallagher, T. (2004). After the war comes peace? An Hogan, D. P. (1978). The variable order of events in the examination of the impact of the Northern Ireland life course. American Sociological Review, 43 , con fl ict on young people. Journal of Social Issues, 60 , 573–586. 629–642. Hoge, E. A., Austin, E. D., & Pollack, M. H. (2007). Gerard, J. M., & Buehler, C. (2004). Cumulative environ- Resilience: Research evidence and conceptual consid- mental risk and youth maladjustment: The role of erations for posttraumatic stress disorder. Depression youth attributes. Child Development, 75 , 1832–1849. and Anxiety, 24 , 139–152. Giacaman, R., Husseini, A., Gordon, N. H., & Awartani, Honwana, A. (2006). Child soldiers: Community healing F. (2004). Imprints on the consciousness: The impact and rituals in Mozambique and Angola. In C. Daiute, on Palestinian civilians of the Israeli Army invasion of Z. F. Beykont, C. Higson-Smith, & L. Nucci (Eds.), West Bank towns. European Journal of Public Health, International perspectives on youth con fl ict and devel- 14 (3), 286–290. opment (pp. 177–192). New York: Oxford University Giacaman, R., Mataria, A., Nguyen-Gillham, V., Sa fi eh, Press. R. A., Stefanini, A., & Chatterji, S. (2007). Quality of Johnson, E. I. (2007). Capturing context: Conceptual and life in the Palestinian context: An inquiry in war-like statistical representations of ecological risk. conditions. Health Policy, 81 , 68–74. Dissertation Abstracts International: Section B: The Giacaman, R., Rabaia, Y., & Nguyen-Gillham, V. (2010). Sciences and Engineering, 67 (10-B), 6097. Domestic and political violence: The Palestinian pre- Jones, L. (2002). Adolescent understandings of political dicament. Lancet, 375(9711), 259–260. doi: 10.1016/ violence and psychological well-being: A qualitative S0140-6736(09)62005-5 . study from Bosnia Herzegovina. Social Science & Giacaman, R., Rabaia, Y., Nguyen-Gillham, V., Batniji, Medicine, 55 , 1351–1371. R., Punamaki, R.-L., & Summer fi eld, D. (2011). Jones, L., & Kafetsios, K. (2005). Exposure to political Mental health, social distress and political oppression: violence and psychological well-being in Bosnian The case of the occupied Palestinian territory. Global adolescents: A mixed method approach. Clinical Child Public Health: An International Journal for Research, Psychology and Psychiatry, 10 , 157–176. Policy, and Practice, 65, 547–559. doi: ht.tR.:l.Ldx. Kleinman, A., Das, V., & Lock, M. (1997). Social suffer- doi.org/10.1080/17441692.2010 528443 . ing . Berkeley: University of California Press. Gibson, K. (1989). Children in political violence. Social Kleinman, A., & Desjarlais, R. (1995). Violence, culture, Science & Medicine, 28 (7), 659–667. and the politics of trauma. In A. Kleinman (Ed.), Gilligan, C. (2009). ‘Highly vulnerable’? Political vio- Writing at the margin: Discourse between anthropol- lence and the social construction of traumatized chil- ogy and medicine (pp. 173–191). Berkeley: University dren. Journal of Peace Research, 46 (1), 119–134. of California Press. Gutman, L. M., Sameroff, A. J., & Cole, R. (2003). Kraemer, H. C. (2003). Current concepts of risk in psychi- Academic growth curve trajectories from 1 st grade to atric disorders. Current Opinion in Psychiatry, 16 , 12th grade: Effects of multiple social risk factors and 421–430. preschool child factors. Developmental Psychology, Kraemer, H., Stice, E., Kazdin, A., Offord, D., & Kupfer, 39 , 777–790. D. (2001). How do risk factors work together? Hammack, P. L. (2010). Identity as burden or bene fi t? Mediators, moderators, and independent, overlapping, Youth, historical narrative, and the legacy of political and proxy factors. The American Journal of Psychiatry, con fl ict. Human Development, 53 , 173–201. 158 , 848–856. Hammack, P. L. (2011). Narrative and the politics of iden- Kuterovac-Jagodic, G. (2003). Posttraumatic stress symp- tity . New York: Oxford University Press. toms on Croatian children exposed to war: A prospec- Herrenkohl, E. C., Herrenkohl, R. R., & Egolf, B. (1994). tive study. Journal of Clinical Psychology, 59 (1), Resilient early school-age children from maltreating 9–25. homes: Outcomes in late adolescence. The American Ladd, G. W., & Burgess, K. B. (2001). Do relational risks Journal of Orthopsychiatry, 64 , 301–309. and protective factors moderate the linkages between Hobfoll, S. E. (2001). The infl uence of culture, commu- childhood aggression and early psychological and nity, and the nested-self in the stress process: school adjustment. Child Development, 72 , Advancing conservation of resources theory. Applied 1579–1601. Psychology: An International Review, 50 , 337–370. Lavi, T., & Solomon, Z. (2005). Palestinian youth of the Hobfoll, S. E., Hall, B. J., Canetti-Nisim, D., Galea, S., intifi da: PTSD and future orientation. Journal of the Johnson, R. J., & Palmieri, P. A. (2007). Re fi ning our American Academy of Child and Adolescent understanding of traumatic growth in the face of ter- Psychiatry, 44 (11), 1176–1183. rorism: Moving from meaning cognitions to doing Layne, C. M., Beck, C. J., Rimmasch, H., Southwick, J. what is meaningful. Applied Psychology: An S., Moreno, M. A., & Hobfoll, S. E. (2009). Promoting International Review, 56 , 345–366. “resilient” posttraumatic adjustment in childhood and 17 How Can a Majority Be Resilient?… 251

beyond: Unpacking life events, adjustment trajecto- Masten, A. S., & Powell, J. L. (2003). A resilience frame- ries, resources, and interventions. In D. Brom, R. Pat- work for research, policy, and practice. In S. S. Luthar Horenczyk, & J. Ford (Eds.), Treating traumatized (Ed.), Resilience and vulnerability: Adaptation in the children: Risk, resilience, and recovery . New York: context of childhood adversities (pp. 1–25). New York, Routledge. NY: Cambridge University Press. Layne, C. M., Olsen, J. A., Baker, A., Legerski, J.-P., Masten, A. S., & Reed, J. M.-G. (2002). Resilience in Isakson, B., Pašalić, A., et al. (2010). Unpacking development (Ch. 6). In C. R. Snyder & S. J. Lopez trauma exposure risk factors and differential pathways (Eds.), Handbook of positive psychology (pp. 74–88). of infl uence: Predicting postwar mental distress in New York: Oxford University Press. Bosnian adolescents. Child Development, 81 , 1053– Mataria, A., Giacaman, R., Stefanini, A., Naidoo, N., 1076. doi: 10.1111/j.1467-8624.2010.01454.x . Kowal, P., & Chatterji, S. (2009). The quality of life of Layne, C. M., Warren, J. S., Hilton, S., Lin, D., Pasalic, Palestinians living in chronic con fl ict: Assessment and A., Fulton, J., et al. (2009). Measuring adolescent per- determinants. The European Journal of Health ceived support amidst war and disaster. In B. K. Barber Economics, 10 , 93–101. (Ed.), Adolescents and war: How youth deal with McLernon, F., & Cairns, E. (2006). Children’s attitudes political violence (pp. 145–176). New York: Oxford toward war and peace: When a peace agreement means University Press. war. International Journal of Behavioral Development, Layne, C. M., Warren, J. S., Watson, P., & Shalev, A. 30 (3), 272–279. (2007). Risk, vulnerability, resistance, and resilience: Miller, K. E., Omidian, P., Quraishy, A. S., Quraishy, N., Towards an integrative model of posttraumatic adapta- Nasiry, M. N., Nasiry, S., et al. (2006). The Afghan tion. In M. J. Friedman, T. M. Kean, & P. A. Resick symptom checklist: A culturally grounded approach to (Eds.), PTSD: Science & practice—A comprehensive mental health assessment in a confl ict zone. The handbook (pp. 497–520). New York: Guilford. American Journal of Orthopsychiatry, 76 , 423–433. Lazarus, R. S. (1998). Fifty years of the research and Miller, K. E., & Rasmussen, A. (2010). War exposure, theory of R.S. Lazarus . Mahwah, NJ: Erlbaum. daily stressors, and mental health in con fl ict and post- Lazarus, R. S. (2001). Conservation of Resources Theory confl ict settings: Bridging the divide between trauma- (COR): Little more than words masquerading as a new focused and psychosocial frameworks. Social Science theory. Applied Psychology: An International Review, & Medicine, 70 , 7–16. 50 , 381–391. Mollica, R. F., McDonald, L., Massagli, M., & Silove, D. Lazarus, R. S., & Folkman, S. (1984). Stress, appraisal, (2004). Measuring trauma, measuring torture. and coping . New York: Springer. Instructions and guidance on the utilization of the Luthar, S. S. (1991). Vulnerability and resilience: A study Harvard Program in Refugee Trauma’s Versions of the of high-risk adolescents. Child Development, 62 (3), Hopkins Symptom Checklist-25 (HSCL-25) & The 600–616. Harvard Trauma Questionnaire (HTQ) . Cambridge, Luthar, S. S., & Cicchetti, D. (2000). The construct of MA: Harvard Program in Refugee Studies. resilience: Implications for interventions and social Nguyen-Gillham, V., Giacaman, R., Naser, G., & Boyce, policies. Development and Psychopathology, 12 , W. (2008). Normalising the abnormal: Palestinian 857–885. youth and the contradictions of resilience in protracted Luthar, S. S., Cicchetti, D., & Becker, B. (2000). The con- con fl ict. Health & Social Care in the Community, struct of resilience: A critical evaluation and guide- 16 (3), 291–298. lines for future work. Child Development, 71 (3), Panter-Brick, C. (2010). Introduction: Con fl ict, violence, 543–562. and health: Setting a new interdisciplinary agenda. Luthar, S. S., Sawyer, J. A., & Brown, P. J. (2006). Social Science & Medicine, 70 , 1–6. Conceptual issues in studies of resilience: Past, pres- Panter-Brick, C., Eggerman, M., Gonzalez, V., & Safdar, ent, and future research. Annals of the New York S. (2009). Violence, suffering, and mental health in Academy of Sciences, 1094 , 105–115. Afghanistan: A school-based survey. Lancet, Macksoud, M. S., & Aber, J. L. (1996). The war experi- 374 (9692), 807–816. ences and psychosocial development of children in Panter-Brick, C., Goodman, A., Tol, W. A., & Eggerman, Lebanon. Child Development, 67 , 70–88. M. (2011). Mental health and childhood adversities: A Masten, A. S. (2001). Ordinary magic: Resilience pro- longitudinal study in Kabul, Afghanistan. Journal of cesses in development. American Psychologist, 56 (3), the American Academy of Child and Adolescent 227–238. Psychiatry, 50 , 349–363. Masten, A. S., & Coatsworth, J. D. (1998). The develop- Punamäki, R. L. (1996). Can ideological commitment pro- ment of competence in favorable and unfavorable tect children’s psychosocial well being in situations of environments: Lessons from successful children. political violence? Child Development, 67 , 55–69. American Psychologist, 53 , 205–220. Punamäki, R. L., Muhammed, A. H., & Abdulraham, H. Masten, A. S., & Curtis, W. J. (2000). Integrating compe- A. (2004). Impact of traumatic events on coping strate- tence and psychopathology: Pathways toward a com- gies and their effectiveness among Kurdish children. prehensive science of adaptation in development. International Journal of Behavioral Development, Development and Psychopathology, 12 , 529–550. 28 (1), 59–70. 252 B.K. Barber and S.B. Doty

Punamäki, R. L., Qouta, S., & El-Sarraj, E. (2001). Resiliency affected countries. Social Science & Medicine, 48 , factors predicting psychological adjustment after political 1449–1462. violence among Palestinian children. International Summer fi eld, D. (2000). Con fl ict and health: War and Journal of Behavioral Development, 25 , 256–267. mental health: A brief overview. British Medical Pupavac, V. (2004). Psychosocial interventions and the Journal, 321 , 232–235. demoralization of humanitarianism. Journal of Summer fi eld, D. (2002). Effects of war: Moral knowledge, Biosocial Science, 36 , 491–504. revenge, reconciliation, and medicalised concepts of Richardson, G. E. (2002). The metatheory of resilience ‘recovery’. British Medical Journal, 325 , 1105–1107. and resiliency. Journal of Clinical Psychology, 58 (3), Summer fi eld, D. (2003). Mental health of refugees. The 307–321. British Journal of Psychiatry, 183 , 459–460. Roisman, G. I. (2005). Conceptual clarifi cations in the Tedeschi, R. G., & Calhoun, L. G. (2004). Posttraumatic study of resilience. American Psychologist, 60 , growth: Conceptual foundations and empirical evi- 264–265. dence. Psychological Inquiry, 15 , 1–18. Rutter, M. (2000). Resilience reconsidered: Conceptual Trickett, P. K., Durán, L., & Horn, J. L. (2003). Community considerations, empirical fi ndings, and policy implica- violence as it affects child development: Issues of tions. In J. P. Shonkoff & S. J. Meisels (Eds.), de fi nition. Clinical Child and Family Psychology Handbook of early childhood intervention (2nd ed., Review, 6 , 223–236. pp. 651–682). New York, NY: Cambridge University Unger, M. (2004). A constructionists discourse on resilience: Press. Multiple contexts, multiple realities among at-risk chil- Rutter, M. (2006). Implications of resilience concepts for dren and youth. Youth and Society, 35 (3), 341–365. scienti fi c understanding. Annals of the New York Vanderbilt-Adriance, E., & Shaw, D. S. (2008). Academy of Sciences, 1094 , 1–12. Conceptualizing and re-evaluating resilience across Rutter, M. (2007). Resilience, competence, and coping. levels of risk, time, and domains of competence. Child Abuse & Neglect, 31 , 205–209. Clinical Child and Family Psychological Review, 11 , Sagi-Schwartz, A. (2008). The well being of children liv- 30–58. ing in chronic war zones: The Palestinian-Israeli case. Weathers, F. W., & Keane, T. M. (2007). The Criterion A International Journal of Behavioral Development, 32 , problem revisited: Controversies and challenges in 322–336. de fi ning and measuring psychological trauma. Journal Salo, J., Punamäki, R. L., & Qouta, S. (2005). The role of of Traumatic Stress, 20 , 107–121. adult attachment in the association between experi- Wessells, M. (2006). Child soldiers: From violence to pro- ences and post-traumatic growth among former politi- tection. Cambridge, MA: Harvard University Press. cal prisoners. Anxiety, Stress and Coping, 18 , Wessells, M., & Kostelny, K. (2009). Youth soldiering: An 361–378. integrated framework for understanding psychosocial Sameroff, A. J., & Rosenblum, K. L. (2006). Psychosocial impact. In B. K. Barber (Ed.), Adolescents and war: constraints on the development of resilience. Annals of How youth deal with political violence (pp. 105–122). the New York Academy of Sciences, 1094 , 116–124. New York: Oxford University Press. Slone, M. (2009). Growing up in Israel: Lessons on under- Westpahl, M., & Bonanno, G. A. (2007). Posttraumatic standing the effects of political violence on children. growth and resilience to trauma: Different sides of the In B. K. Barber (Ed.), Adolescents and war: How same coin of different coins. Applied Psychology: An youth deal with political violence (pp. 81–104). New International Review, 56 (3), 417–427. York: Oxford University Press. Wexler, L. M., DiFluvio, G., & Burke, T. K. (2009). Slone, M., & Shoshani, A. (2008). Effi cacy of a school- Resilience and marginalized youth: Making a case for based primary prevention program for coping with personal and collective meaning-making as part of exposure to political violence. International Journal resilience research in public health. Social Science & of Behavioral Development, 32 , 348–358. Medicine, 69 , 565–570. Stark, L., Ager, A., Wessells, M., & Boothby, N. (2009). Whalen, J., & Flacks, R. (1989). Beyond the barricades: Developing culturally relevant indicators of reintegra- The sixties generation grows up. Philadelphia, PA: tion for girls, formerly associated with armed groups, Temple University Press. in Sierra Leone using a participative ranking method- Youniss, J., Barber, B. K., & Billen, R. M. (2012). Children ology. Intervention, 7 , 4–16. in the garden of democracy: The meaning of civic Summer fi eld, D. (1999). A critique of seven assumptions engagement in today’s Egypt . Takaful: American behind psychological trauma programmes in war- University in Cairo. Resilience in the Lives of Children of War 1 8

James Garbarino and Edmund Bruyere

A developmental analysis of “children of war” “trauma” is greater and deeper than casual refer- ought to be simple: “war is bad for children.” ences would allow. Trauma is fi rst and foremost the However true this statement may be, it is experience of profound psychological threat. insuf fi cient for anything more than a moral judg- Herman (1992 ) , a clinical researcher who specializes ment. In this chapter we provide a developmental in sexual abuse cases, recognized that to be trauma- analysis of the lives of children who experience tized is to come face-to-face with human vulnerabil- war from the perspective of resilience in the face ity in the natural world and with the capacity for evil of trauma. Our approach grows out of an under- in human nature. Perhaps the most powerful simple standing of the role of trauma in the emotional and characterization is “an event from which you never spiritual life of youth immersed in the public social fully recover.” To use more conventionally psycho- violence of war (as opposed to the “private” vio- logical terms (Garbarino, 2008 ; Terr, 1995 ) , trauma lence of conventional domestic abuse and com- is the simultaneous experience of extremely power- munity crime). Our core thesis is that the experience ful negative feelings (overwhelming arousal) cou- of trauma is so powerfully implicated in the pled with thoughts that are beyond normal ideas of dynamics of public social violence—as cause and human reality (overwhelming cognitions). effect—that no efforts to prevent and ameliorate Trauma arises when a child cannot give mean- its effects will be effective if they do not address ing to overwhelmingly frightening experiences. this core issue. While no recipe or algorithm for This orientation is contained in the American program and policy development is possible, we Psychiatric Association’s de fi nition of posttrau- can provide a series of conceptual “tools” that pro- matic stress disorder in its Diagnostic and Statistical fessionals and policy makers addressing the impact Manual (DSM-IV), which refers to threatening of war on children and youth can use in this effort. experiences outside the realm of normal experi- We begin with the concept of trauma. ence that exceed the individual’s capacity to cope The word “trauma” has entered into common without dramatic distress (2000 ) . It is echoed usage around the world. But the real substance of repeatedly in fi rst-person accounts of war by children and youth—most notably child soldiers (e.g., J. Garbarino (*) Ishmael Beah’s (2008 ) autobiographic account of Director of the Center for the Human Rights of Children, war in Sierra Leone, A Long Way Gone). Loyola University , Chicago , IL, USA A traumatic experience that is cognitively and e-mail: [email protected] emotionally overwhelming may stimulate condi- E. Bruyere tions in which the process required to “under- Center for the Human Rights of Children, stand” these experiences itself has pathogenic Developmental Psychology, Loyola University, Chicago, IL, USA side effects. That is, in coping with a traumatic email: [email protected] event, the child may be forced into patterns of

C. Fernando and M. Ferrari (eds.), Handbook of Resilience in Children of War, 253 DOI 10.1007/978-1-4614-6375-7_18, © Springer Science+Business Media New York 2013 254 J. Garbarino and E. Bruyere behavior, thought, and affect that are themselves provides a developmental grounding for under- “abnormal” when contrasted with patterns prior standing the “natural” therapeutic efforts of adults to the event as well as when compared with (as parents) and for the “programmatic” efforts of patterns characterized by the untraumatized professionals (as teachers and therapists). How child. do child accommodations to traumatic events Chronic traumatic danger imposes a require- manifest? Without effective adult “teaching” (in ment for developmental adjustment (Garbarino, the Vygotskian sense), they are likely to include 2008 ) . According to Piagetian theory, these posttraumatic stress, alterations of personality, developmental adjustments result from the value shifts, and major changes in patterns of inability of the child to assimilate traumatic behavior. experiences into existing schema (conceptual One way to conceptualize these effects is to frameworks). By defi nition (e.g., the APA consider their impact of children’s emerging nar- de fi nition), trauma is outside the normal “schema” ratives. From the perspective of theorists who or conceptual frameworks of children. Thus, focus on the role of narrative in child develop- traumatic experiences require the child to alter ment (e.g., Bruner, 1986 ; Hammack, 2008 ; existing concepts to permit the new experiential McAdams, 2001 ) , chronic traumatic danger information to be integrated. This involves what demands that children rewrite their stories as well Piaget termed accommodation. In the case of as redirect their behavior. These accommodations chronic danger, children must accommodate their are likely to be especially pronounced when that psychic realities so that they allow for the process- danger derives from violent overthrow of day-to- ing of life’s atrocities. Put simply, children must day social reality, when communities are sub- adopt a negative view of the world. From a stantially altered, when displacement occurs, or Piagetian perspective, they have only their own when children lose important members of their emotional and intellectual resources to bring to families and social networks. In the case of chil- bear on this task. This increases the odds that how dren exposed to the chronic horrors of Pol Pot’s they accommodate to trauma will produce values Khmer Rouge regime in Cambodia in the 1970s, and patterns of behavior that are not optimal either 50% of children exhibited persistent symptoms from the child’s perspective or from the perspec- of PTSD 8 years after exposure (Sack et al., tive of the larger society. Neo-Piagetian approaches, 1993) . According to Van der Kolk, McFarlane, e.g., Fischer and Bidell’s “skill theory” ( 1998 ) , and Weisaeth ( 1996 ) , explosive outbursts of extend this to consider how coping with trauma anger, fl ashbacks, nightmares, hypervigilance, disrupts and changes the neurological systems of psychic numbing, constriction of affect, impaired the brain as they shape adaptive behavior. social functioning, and the loss of control over Lev Vygotsky’s model of development pro- one’s life are all characteristic of the traumatized vides additional dimensions to this analysis. By child, particularly those who have not been focusing on the intrinsically social nature of “taught” to fi nd alternative, positive meanings in development, this approach highlights the role of their lives. adults in mediating the child’s experience of No single variable can be isolated as the lead- trauma. The key is the concept of “zone of proxi- ing cause of the developmental damage that is so mal development,” which posits that the child is common among children living in war zones due capable of one level of functioning on its own, to political violence—such as conventional war but a higher level of functioning in relationships or insurgency. The same holds for those living with the “teacher,” who guides the child towards amidst civilian community violence, e.g., that enhanced development by offering responses that linked to gang activity (particularly in countries are emotionally validating and developmentally such as El Salvador), where chronic civilian vio- challenging. Fischer and Bidell ( 2007 ) have lence linked to gangs has its historical roots in explored how brain development incorporates political violence. Rather, it is the interplay of this process to differentiate between “functional” several social and developmental variables that competence and “optimal” competence. This dictates the course and severity of the child’s 18 Resilience in the Lives of Children of War 255 maladaptation. Some children in war zones thrive, the fact of the matter is that the human body can while others deteriorate. There are many factors easily be maimed or destroyed by acts of physical that contribute to the range of outcomes, factors violence. The day-to-day reality of many children that provide clues to the sources and dynamics of living with realities of civil war in the Sudan resilience. demonstrates this reality. War is one of the most important sources of In another scene Sam watches as hundreds of trauma for children and youth because it forces children arrive at night to a camp ran by the youngsters to come face-to-face with the dark Sudanese People’s Liberation Army, a refuge of side of human experience and, in so doing, evokes safety for these kids. Sam inquires about why so overwhelming negative arousal and overwhelm- many of these kids have come to the camp at ing negative cognitions. In our view, trauma night. He is informed that these children, as well related to war exposes children and youth to three as their parents, have learned the second dark of the “darkest secrets” of the human universe secret; despite all their power and authority adults (Garbarino, 2008 ) : cannot necessarily keep youngsters safe when an *Despite the comforting belief that we are physi- enemy (e.g., LRA) wishes them harm. Experiences cally strong, the fact of the matter is that the human in which parents, teachers, and other adults are body can easily be maimed or destroyed by acts of present but unable to protect children effectively physical violence. Images of graphic violence reveal this. demonstrate the reality of this to children and youth. In the fi nal scene, LRA rebels enter a village in the middle of the night, killing the men and women *The social fabric is as vulnerable as the physical body; despite all their power and authority adults and setting fi re to the village. They round up the cannot necessarily keep youngsters safe when an children. One boy is brought before his mother enemy wishes them harm. Experiences in which (who is kneeling) by the rebels. He is handed a parents, teachers, and other adults are present but club (clap) and told that if he and his brother want unable to protect children effectively reveal this. to live he must execute his mother. Initially, the *Anything is possible when it comes to violence; young boy refuses, but knowing the life of his there are no limits to human savagery. Any form of violence that can be imagined can be committed. brother is in jeopardy, he strikes his mother in the head with the lethal weapon. Tragically, this boy Three scenes from a 2011 fi lm based upon the learned the third dark secret: Anything is possible real life experiences of Sam Childers (“the when it comes to violence; there are no limits to Machine Gun Preacher”) illustrate these three human savagery. Any form of violence that can be “dark secrets.” imagined can be committed. In the fi rst scene, Sam makes his fi rst visit to a As we shall see, learning these secrets can remote village in Southern Sudan. Upon arrival drive children and youth to shut down emotion- he is confronted with the reality of the civil war— ally and/or engage in hedonistic self-destruction the inhabitants of the village had been slaugh- and antisocial behavior. tered by LRA (Lord’s Resistance Army) rebels Historically, the origins of war-related trauma the previous night. Because of this children come have generally been limited to fi rst hand encoun- face-to-face with the brutal deaths of their family ters with horror (Garbarino, 2008 ) . But things members (some of the people had been burned have changed. The media technologies that alive). A young boy, who is obviously trauma- emerged in the twentieth century added a new, tized by the brutality, runs into a grassy area out- unprecedented dimension to the psychology of side of the village. Moments later there is an terror by exposing children to trauma induced explosion. Sam runs to see if the boy is alright, by the vicarious experience of horror in full only to fi nd that the boy’s lower body has been spectrum imagery and sounds. One of the impor- blown off by a land mine. Sam comes face-to- tant elements of living in the current age is the face with the fi rst dark secret: That is, despite the growing recognition that modern mass media comforting belief that we are physically strong, permit the conveying of traumatic experiences 256 J. Garbarino and E. Bruyere beyond those who are in-person witnesses to the trauma, the effects are likely to be both more mass audience who are exposed to vivid visual emotionally disruptive and to include effects and auditory representations of horror via video- beyond the immediate emotional response, issues taped records and through the simulations in about the very meaning of life, spiritual, and video games. philosophical issues (Garbarino, 2008 ) . For example, this was observed in post- Another key to understanding the dynamics of occupation Kuwait in the early 1990s, when vid- chronic trauma is to discriminate between the eotapes of Iraqi atrocities were suf fi cient to elicit experience of trauma as “immunizing” vs. “sen- traumatic responses in children who identi fi ed sitizing” (Garbarino, 2008 ) . Childhood immuni- with the victims as their countrymen (Nader & zation is the process by which a child develops Pynoos, 1993 ) . This is evident in the emerging resistance to an “infectious agent” as the result body of research on the effects of violent video of being exposed to something that is derived war games. This research that demonstrates the from or similar to that infectious agent in order power of such media to induce desensitization to allow the child’s immune system to prevent and increase violent fantasies, beliefs, and behav- future illness when it subsequently encounters ior, much the way that violence on television the infectious agent in question. We are all famil- increases aggressive behavior in children iar with this model. You bring your child for an (Anderson et al., 2003 ) . injection that prevents the child from getting the Psychological connection to the immediate mumps or polio in the future. The validity of this victims of horror is capable of transmitting immunization model in psychological matters is trauma to children and youth secondhand. Add to a matter of debate. this the fact that trauma research reports that one In the case of sensitizing, the fi rst exposure of the elements in predicting whether or not a leads not to immunity in the future but to greater terrible event will produce long lasting psycho- vulnerability. For example, consider what hap- logical symptoms of trauma is the degree of con- pens when children are hospitalized without nection between the immediate victim and the parental presence. The psychological effects of remote-observing child who witnesses the event one hospitalization on children are usually rela- via media representation. This emergent defi nition tively minor. It is the second and subsequent hos- of trauma and the role of secondhand victimiza- pitalization that really causes problems because tion via exposure to visual and auditory images rather than immunizing the child against separa- of people with whom one has a psychological tion anxiety the fi rst hospitalization sensitizes the connection provide the fi rst step in understanding child to future separations (Rutter, 1989 ) . This is how youth react to war. true in many aspects of child development, par- The second step comes when we recognize the ticularly those having to do with mental health difference between single incidents of trauma problems. Thus, for example, infants who are (“acute” trauma) and repeated patterns of trauma separated from their parents become more, not (“chronic” trauma) (Garbarino, 2008 ) . In the fi rst less, likely to have problems with attachment if case, children experience emotional disruption but they experience disruptions of parenting in the generally respond well to adult efforts to restore a future. If an infant forms a strong attachment sense of safety. There is a well-developed set of bond, the child is prepared to bond anew if trans- techniques for achieving this return to emotional ferred to a new parental fi gure. In contrast, an equilibrium. They involve processing child ques- infant who has been already been subject to tions and concerns with accurate information to deprivation of the parent fi gure is a candidate for dispel rumors and myths, offering emotional reas- serious emotional problems if the second place- surance through return to comforting routines, and ment becomes a third and a fourth (Rutter). age-appropriate memorials and life celebrations One model involves habituation, “getting used (National Child Traumatic Stress Network, 2013 ) . to” the disruptive event. The other model involves However, when a child experiences repeated “kindling.” Kindling means that repeated exposure 18 Resilience in the Lives of Children of War 257 results in the need for less and less exposure to of arousal in the face of threat that others did; cause an effect (Kramer, 1997 ) . Depression seems further, they did not have dif fi culty violating to work like this, for example. It usually takes a moral prohibitions with regard to killing human major negative life event to precipitate a fi rst beings. Insofar as people with psychopathic per- depressive period. But it takes less negative stimu- sonalities were hostile, emotionally impover- lation to set off a second, and still less to set off a ished, and detached, they did not become third, just as once a fi re has been burning in a stove, symptomatic. it takes less and less kindling to reignite the fi re The possible implications of this fi nding for because the coals endure. In the case of kindling child development in situations of war are equally depression, the brain begins to adapt to the process chilling, but once again “with a twist.” In one of repeated stress in a way that makes it more and sense, Grossman and Siddle’s fi nding would sug- more vulnerable to arousal when challenging stim- gest that the children best able to survive func- uli occur (Kramer). tionally are those who have the least to lose So which is it in the case of war-related trauma, morally and psychologically. In James Gilligan’s immunization, or sensitization? The preponder- terms ( 1997 ) , such children are already emotion- ance of the evidence tells us the answer is sensiti- ally and spiritual “dead,” and thus experience no zation, but with a twist (Pynoos, 1994 ) . In one fear or inhibition. They view the world as having sense, the sensitization model is clear in the neither emotional barriers nor moral terrain. Our research on the effects of chronic trauma on child own interviews of youth incarcerated for murder development. “Prior experience of trauma” pops and other acts of severe violence expand this view up repeatedly when researchers ask which (Garbarino, 1999 ) . Some of the most violent children are more likely to be exhibiting distress youths construct elaborate defense mechanisms 6 or 12 months after a potentially traumatic event against anxiety, fear, and abandonment; these (Van der Kolk et al., 1996 ) . The twist is that one defense mechanisms culminate in the persona of of the common consequences of chronic trauma the cold-blooded “gangster.” often has the effect of making youth seem unaf- But how do “normal” soldiers cope with fected by future traumas. repeated trauma? Until the point of breakdown, A study in World War II asked, “what percent they usually adopt a guise of numbness, cool- of regular soldiers become psychiatric casualties ness, and detachment. They do this whether they from the traumatic stress of war after 6 months of are military personnel in the national or insur- constant combat experience?” The answer was gent army or “soldiers” on the mean streets of “98%.” Who were the 2% who did not become violent neighborhoods. That’s why the youth emotionally disabled by chronic combat? They who live in chronic war situations often appear were not the most emotionally robust and psycho- to be “cool” (in the sense of affectively bland logically healthy individuals. They were the psy- and/or nonchalant). Mostly they are not psycho- chopaths who experience neither the emotional paths (although some are). Mostly they are nor the moral stress of combat. Their emotional chronic trauma cases that have not yet reached systems were locked in the “off” position, and the point of collapse. And this is where the they had no moral trouble with killing. But the “twist” arises: children and youth exposed to war “normal” soldiers collapsed as the psychological (including child soldiers) can demonstrate resil- and moral toll of combat exhausted their emo- ience if they have the social, cultural, and psy- tional resources. The good news is that most of chological resources commensurate with the these soldiers recovered when given suf fi cient challenges they face Wessells, 2007 ) . rest, therapy, and the moral support of their friends, But marshalling these resources requires an family, and fellow soldiers. understanding of how trauma-related challenges The researchers concluded that people with can present themselves in the lives of children psychopathic personalities were stress-resistant and youth who have experienced war. Where because they did not experience the same degree does their trauma go, if not into the kind of overt 258 J. Garbarino and E. Bruyere disturbance and upset that is so common for fi rst- damage of being in diffi cult situations in which time trauma victims in the immediate aftermath trauma is likely. of their horrible experience? It may go inside in For example, research by psychologist George the form of nightmares. It may go into the abuse Bonanno and his colleagues (2004) fi nd that of substances as a form of “self-medicating.” soldiers who are rated high on hardiness before It may get displaced into rage that diverts energy they go off to war are less likely to suffer PTSD or from sadness. It may alter the way their brain serious depression when they go through combat. functions when aroused, attached to fears that Others resist the effects of traumatic experiences de fl ect attention from the primary fear. It may by developing unrealistically positive views of manifest as self-mutilation. themselves, by repressing memories of the events All this is particularly important for our con- to avoid confronting them, and by practicing posi- cerns, because it would seem that children are tive emotions to displace sadness, grief, and anger. particularly vulnerable to trauma. For example, In moderation, all of these may contribute to suc- Fletcher (2007 ) reports that 27% of teenagers, cessful coping, but hardiness seems to be the most 33% of middle schoolers, and 39% of younger promising avenue because it is more than simply children exhibit symptoms of PTSD when they refusing to confront traumatic experiences through actually encounter traumatic events. Davidson self-delusion or repression; it is a matter of coping and Smith ( 1990) found that when exposed to with adversity through positive strength. comparable potentially traumatic events, 56% of What are the elements of hardiness? One is children 10 years of age or younger experienced commitment rather than alienation (Bonanno, PTSD symptoms compared with 18% of those 11 2004) . People who do not withdraw socially and years of age and older. And, a study conducted on philosophically show greater resistance to the the effects of the Buffalo Creek disaster—a fl ash effects of experiencing traumatic events. In the fl ood that demolished an entire town in West face of the war or community violence, one child Virginia in the 1972—reported that the group says, “No matter what happens I still believe most vulnerable were the children between 6 there is goodness in the world,” while a second and 11 years of age (Newman, 1976 ) . This is child responds with, “I think all you can do is get just what you would expect in the real world as far away as you can and just forget about it.” in which parents try to protect children from A second element of hardiness is feeling in trauma. In that world, younger children are control rather than feeling powerless, but there more willing and able to be protected, teenagers are costs to this strategy (Bonanno, 2004 ) . It is are more able to protect themselves, and the chil- understandable that if people feel totally out of dren between these two groups are in the most control they are more likely to succumb to the vulnerable position of all, aware but relatively psychological and philosophical effects of trau- defenseless. matic events. One child responds, “There are But this vulnerability related to age and devel- things I can do to stay safe,” while another says, opment is not the whole story. Some children are “I am completely at the mercy of the terrorists; more vulnerable than others—even within the there’s nothing I can do about it.” same age. Why? Mental health professionals A third element of hardiness is seeing the world are coming to terms with the issues posed by the in terms of challenge rather than threat (Bonanno, reality that some individuals are more affected by 2004) . One child says, “We can fi nd ways to make traumatic events than others, and that individuals things more peaceful and I can be a part of those experience the effects of trauma differently. On efforts,” while another says, “All I feel is fear; the fi rst matter, it seems clear that some people fear that it will happen again and there is nothing approach traumatic events with what has been I can do about it.” Building upon these fi ndings, called “hardiness,” a kind of stress-resistance that psychologist Salvatore Maddi has developed a protects individuals in a healthy way from the training program to enhance hardiness—the 18 Resilience in the Lives of Children of War 259

“HardiTraining Program”—(Maddi, 2005 ) children experience, and thus may miss opportu- involving exercises designed to stimulate and nities to stimulate and nurture resilience. For reinforce the three elements of hardiness identi fi ed example, they may ignore the child’s distress by Bonanno. because as adults they don’t share that distress. The caution is that we must be careful not to They don’t engage in the important process of assume that kids who are coping well with trauma mirroring back what children are feeling as a way in their day-to-day activities (“functional resil- of validating and clarifying the child’s emotions. ience”) are necessarily at peace inside (“existen- For example, they may punish children for their tial resilience”) (Garbarino, 2008 ) . Some responses to trauma such as regression to earlier traumatized individuals who are very competent forms of behavior (like wetting the bed and thumb and successful on the outside are tormented on sucking) and sleep disturbances (like nightmares the inside. Related to this point is the fact that it and wanting to sleep with parents), rather than is not enough to look at the effects of trauma in see them as indications of the child’s struggle to the short run: some individuals are functionally cope with underlying stress and tension. We have resilient for long periods—perhaps throughout witnessed all of these in the lives of children and their adult lives—while falling prey to existential youth coping with war (Garbarino, Dubrow, & despair later in life. A study of Dutch resistance Kostelny, 1991 ) . fi ghters who were involved in the struggle against What are the barriers to an adult’s intelligent the occupying Nazi forces during World War II empathy? They may fl ow from the adult’s per- revealed that eventually all of them showed some sonality—notably self-absorption (narcissism). effects of their traumatic experiences, although in But they may also arise through adult emotional some cases it was not until decades later (Van der unavailability precipitated by crisis in the adult’s Kolk et al., 1996 ) ! Trauma changes you forever, life. Research with Palestinian children demon- but it may take a long time for that change to strated that in conditions of threat and terror become apparent. children do best when they face these threats in All this provides a basis for a set of principles the context of warm and supportive families to understand resilience in the lives of children in (Garbarino & Kostelny, 1996 ) . These are families war, principles that are based upon the goal of in which parents listen to their children and per- increasing emotional self-regulation and empa- mit them to enter into a positive dialogue about thy in the lives of children and youth traumatized the meaning of political events, rather than silenc- by exposure to war. These principles are intelli- ing them or punishing them for their fears and gent empathy, caregiver projection of con fi dence anxieties. Studies from around the world and in and competence, and compassion in the circle of North America document that adults who are caring (Garbarino, 2008 ) . able to see and hear the feelings of children and Two of the key terms in adult responsiveness respond respectfully and warmly to these feelings to traumatized children and youth are “empathy” are most likely to produce emotionally healthy (being able to feel what the child is feeling) and children. Whatever its origins, empathic adult “developmental perspective” (understanding that treatment of children is particularly important children are not just short adults). The blending when children are facing diffi cult life circum- of these two elements together produces what we stances like the trauma of living with the reality call “intelligent empathy” (Garbarino & Bedard, of war. 2001 ) . It is the foundation for responsiveness Children look to key adults in their lives for because it joins together an appreciation for what cues and clues about what to make of powerful the child is feeling and a capacity to respond to events that come to them via the mass media and those feelings in ways that are appropriate to the even directly from their observation of events in developmental status of the child. their immediate environment. This is one of the Where intelligent empathy is lacking, adults most important infl uences parents and teachers are not attuned and responsive to the emotions have on the children they care for and educate. 260 J. Garbarino and E. Bruyere

The child’s understanding of the world is very But though it is much more dif fi cult to feel concrete. For a child, the most powerful question true compassion for our enemies it is essential to is “how is my world?” How is my house, my par- achieve a lasting and just peace in the aftermath ents, my sisters, my brothers, my grandmother, of military success. It is quite one thing to talk in my grandfather, my aunts, my uncles, my cous- public about “bringing the perpetrators to justice” ins, my toys, my pets, and my school? If that and quite another to speak of exacting our much remains intact, the child is rich in the most revenge. important ways in which a child can be rich, and This does not mean simply ignoring evil, has access to some of the important foundations violence, and sin. It means that even in the face for resilience in the face of war zone experiences of human behavior that is evil, violent, and (Garbarino, 2008 ) . This is not a matter of children violates basic human rights (what those of us being selfi sh, so much as it is the way children who approach these issues from a religious per- think, concretely. In fact, they can extend their spective would call “sin”), we still care for the caring to other beings, but it is mostly a matter of offender, even as we seek to control that person’s them making an emotional connection with those dangerous behavior and protect ourselves and the beings fi rst so that they are added to the list of community. Indeed the crucial concept for those “my” attachments. For example, many children who seek to live by compassion not just senti- connect emotionally with animals, so it should mentality is “the circle of caring.” The circle of come as no surprise that surveys done during the caring describes the area of one’s life in which Gulf War in 1991, revealed that the most upsetting moral values apply; outside that circle the issues media image for many young children was that of are not so much moral as logistical. In the 1977 the water birds of Kuwait drowning in a sea of oil fi lm “Seven Years in Tibet,” a European friend of caused by the efforts of the feeling Iraqi forces to the young Dali Lama begins work on a building. sabotage the Kuwaiti oil fi elds (Garbarino). He arranges for workmen to dig a trench as the In perhaps the earliest research on the topic of start of building a foundation. As they begin work how children cope with living in a war zone, Freud monks approach them and ask them to stop the and Burlingham ( 1943) reported on children in digging because they are killing the worms. For World War II. She found that if parents could them, the circle of caring includes even the lowly maintain day-to-day care routines and project high worm. None of God’s creatures is excluded and morale, their children had a foundation of basic each creature deserves care and concern. trust from which to build as they sought to cope Every culture struggles with this issue of who with the stresses of war time life around them. is “in” and who is “out” of the circle of caring, The third principle underlying a complete particularly in times and places of war. Some of response to children and youth affected by war is the fi ercest warriors in armies throughout history compassion in the circle of caring. The Dali Lama have matched their blood-thirsty ruthlessness on teaches that compassion is more than a feeling the fi eld of battle with a soft caring for friends dependent upon the sympathetic nature of the and family. Even some of the most monstrous other. It is the ability to remain fi xed on caring for killers may have a small circle of beings for the other person regardless of what that person whom they care in a morally elevated fashion. does, not just out of sympathy for the other per- Hitler had his well cared for dog, and Nazi son but from the recognition that it is best for our- Germany had some of the most humane animal selves to live in a state of compassion rather than protection laws in Europe in the 1930s (Arluke & hatred. One of the Dalai Lama’s most important Sanders, 1996 ) . lessons is that true compassion is not just an emo- Conversely, even some of the kindest law- tional response but a fi rm commitment founded abiding citizens have holes in their circle of car- on reason (2011 ) . It is easy to feel hatred for our ing. We personally have encountered a loving enemies and sympathy of the victims of father and good neighbor who attends Ku Klux violence—human decency seems to demand it. Klan rallies where he applauds speakers who 18 Resilience in the Lives of Children of War 261 incite race hatred and bigotry. A friend in approach can impede the process of reconcilia- Germany tells of her loving father who for tion and healing once the political crisis is solved decades sensitively ministered to the needs of (Garbarino et al., 1991 ) . What is more, it deprives his patients but to his dying day maintained the child of the moral comfort afforded by the that if Hitler had succeeded in killing all the Jews world’s great spiritual teachings, which at their the world would be a better place. Human experi- offer the wisdom of believing in compassion, ence is complex and rarely one-dimensional universal dignity and reconciliation, regardless of (Garbarino, 2008 ) . whether someone is friend and foe (Armstrong, As we see it, the circle of caring must be as big 2009 ) . Of course, religious traditions are not so as we can tolerate—and then bigger still. After simply described in these terms. Armstrong rec- the attacks of 9/11, some wrote that even as we ognizes that once the silent profundity of spiritual seek to stop terrorism by healing the wounds that awareness is translated into speci fi c theological spawn it and immobilizing those who would and cultural terms, it can be transformed into commit it, we must not allow ourselves to dehu- something as imperfect as any human enterprise, manize our enemies but rather have compassion compromised by unconscious dark forces and for them, indeed our spiritual teachers would tell ego-driven behavior. An excellent illustration of us we must love them. Love the terrorist? Isn’t this is to be found in Gibbs ( 2005 ) analysis of the that exactly the message? (Garbarino, 2008 ) . dark side of the three Abrahamic religions (Islam, Thus, compassion is not just a “value” in the Christianity, and Judaism). Indeed, as Cavanaugh’s ethical sense; it is a valuable component in the ( 2009 ) wide ranging historical analysis reveals it psychological foundations of inner harmony and is “idolatry” whether it be religious or secular in well-being, and ultimately for resilience. nature that gives rise to the dehumanization of One of the hypotheses derived from observing “the other” that is at the root of societal violence. societies coping with terror and fear originating This is evident in the two faces of martyrdom in political crisis is that efforts to reassure chil- (Field, 2004 ) , one involving self-sacri fi cial vio- dren in the short term can easily poison their con- lence and, the other sacrifi ce of the ego on behalf sciousness for the future, making settling con fl icts of caring for the other. and reconciling the parties more dif fi cult in the Compassion is our principal resource in this long run (Garbarino et al., 1991 ) . For example, in struggle to maintain our spiritual integrity in the the Middle East we encountered a mental health face of worldly temptations to hate and dehuman- specialist who works with parents presenting a ize our enemies (Armstrong, 2010 ) . The perpe- case study of her efforts to help parents help their trators of trauma linked to war typically are young children cope with the deployment of their caught up in their own scenarios of revenge and father to the war zone front lines. Here are her retaliation. Often they have experienced personal words: “Remind the child of the time when there suffering or family loss, or historical victimiza- was a wasp in the house and his father squashed tion, and are seeking a way to give meaning to it with his shoe. Tell the child that there are that suffering through acts of violent revenge. bad people who want to hurt us and they are Mostly, they are individuals who are offered a like the wasp, and your father has gone out to political or ideological interpretation for their squash them.” situation by their leaders, or cultural support for The impulse to demonize and dehumanize the aggression against “the other” (Hoffman, 2006 ) . enemy is an understandable response to the chal- Sometimes these leaders are pathologically lenge of reassuring children in the midst of politi- calculating and cold in their exploitation of their cal con fl ict and violence. However, it does not followers. Sometimes these leaders themselves come without unfortunate side effects in the long are plotting revenge for what they have experi- run. For example, our experiences with the enced as victims of oppression. For them, the acts Israeli-Palestinian confl ict suggested that while they commit are not unprovoked assaults, but emotionally reassuring in the short run, this rather are their own, sometimes warped version 262 J. Garbarino and E. Bruyere of bringing the perpetrators to justice. As we see it, the needs of our egos can push us away from the we must not fear this understanding. We must not spiritual opportunities posed by trauma towards reject those who ask for understanding. We must the darkness that comes with revenge, anger, and remember the wisdom captured by the slogan that retaliation. He writes, “Injustice leads to rightful teaches “if you want peace work for justice,” indignation, attempts to repair the abuse, and “what Gandhi taught when he said,” “you must be grief about the loss. Grief is scary mainly because the change you wish to see in the world.” As we it seems to equal powerlessness. Its alternative, see it, here lies the path of profound resilience for revenge, is resistance to grief, since it substitutes the children of war (Garbarino, 2008 ) . retribution for sadness. It grants a false send of How adults handle the intense emotions and power because it is power over others, not power moral dilemmas associated with war, family vio- for resolving unfairness or transforming human lence, and criminal assault in the community will beings” (p. 90). teach children and youth a great deal about jus- How does this translate in the world? Richo tice, compassion, and revenge. Our goal should ( 1999 ) sees one of its manifestations in the appli- be to teach them at least two lessons: First, com- cation of the death penalty. “Capital punishment passion and understanding are founded in strength is an example of a historically legitimized form not weakness. Let us celebrate the helpers and of revenge. It is rationalized as deterrence. Our those who speak and act for justice and due pro- wounded ego engages the state to assure we can cess rather than for blood revenge. Second, pro- get even and not have to grieve so ardently or be tecting the stigmatized from scapegoating and so much at the mercy of life’s conditions. Once “guilt by association” is an important goal of we let go of ego, love gains precedence in our public institutions in a time of national crisis. hearts and we cannot be satisfi ed with punish- Dehumanization is the enemy. Each individual ment. We want the transformation of the offender, has a story to tell, a human story. restitution to us or the community, or the offend- The great psychiatrist Harry Stack Sullivan ers’ heartfelt restoration to humanity.” He is (1953 ) wrote that “Man is more simply human speaking of “common” criminals, but perhaps the than otherwise.” Despite the dated use of the same can be said of terrorists and others who masculine pronoun as the generic human refer- would make war on or with children and youth. ence, he meant two things of great importance. In this he is echoing the wisdom gained by Sister First, that whatever differences we may observe Helen Prejean ( 1994) in her work with individu- between humans we are all collectively and fun- als on death row. damentally the same. Second, that we must But what are we called to do in response to always seek a human explanation for the way those who hurt and despise us? Richo ( 1999 ) people behave, no matter how irrational, defi nes it as “utter reconcilability.” By that he demented, or monstrous it seems at fi rst glance. means that we must not allow our hurt egos and This is an excruciatingly dif fi cult task when the our dark sides to use the opportunity presented by behavior in question is war. But we believe it is traumatic events to liberate and validate our rage. essential that we do so for very practical as well Rather, we must seek out the greater wisdom of as very noble reasons. making peace with all and everyone. Every reli- The second lesson is that the experience of gious tradition and every spiritual path offers injustice offers spiritual opportunities just as it guidance on this matter. The Christian recipe for offers moral challenges. What determines whether divesting ourselves of ego violence and retalia- we seize and profi t spiritually from these experi- tion is in the Sermon on the Mount. There we fi nd ences or allow them to feed the dark side of the unpalatable recommendations that we turn human selves, our needs to be powerful, in con- the other cheek, bless those who hurt us, love trol, and angry? We fi nd guidance in the work of those who hate us. In short, reverse every auto- psychotherapist Dave Richo ( 1999 ) . Richo has matic reaction of ego. Richo sees this same looked closely and with unblinking eyes at how impulse in other religious traditions—Buddhism, 18 Resilience in the Lives of Children of War 263

Judaism, Hinduism, Islam—recognizing (as was • Resourcefulness. The hallmark of this attribute illuminated by) that these traditions have other is the ability to seek out and take advantage of voices within them as well. the limited emotional resources available in One of the central facts about human develop- an impoverished social environment. With ment is that it occurs “in context” (Bronfenbrenner, diminished social support (particularly paren- 1970 ; Garbarino, 2008 ) . Rarely does a cause- tal support), the resilient child will cling to effect relationship work the same way from set- any warmth and affi rmation that is attainable. ting to setting, as de fi ned by gender, social class, This requires children to be perceptive and ethnicity, temperament, community, family, sensitive to subtle changes in their environ- school, and culture. Thus, if we ask “does X ment as war is a time when parental attention cause Y?” the best scienti fi c answer is almost and availability are limited. The inability to always, “it depends.” This is the core principle of seize these scarce opportunities is costly to the an ecological perspective on human development child living in a war zone. Also, resourceful and it is essential in developing an understanding children are more likely to solicit necessary of resilience in children and youth affected by care and approval from adults other than their and involved in war. It is essential to understand parents. This allows these children to have that resilience operates in context, in the sense their developmental and social needs met by that it functions within what Bronfenbrenner means that are unavailable to less resourceful termed the organismic, micro-, meso-, exo-, and children. macro-systems of human experience. This means • Curiosity and the ability to conceptualize. it can arise from features of temperament and Together, these factors afford the child living individual intelligence, relationships with parents in a war zone the knowledge and perspective and teachers, the degree to which the various that are necessary to frame the war experience contexts of a child’s life provide positive synergy, most adaptively. The curious child is one who the degree to which policy makers outside the actively pursues a deep understanding of life child’s immediate social experience make deci- events. As active agents in their environment, sions that are child-focused, and the nature of the children explore ideas and collect information broader culture with respect to nurturing, heal- about the crisis through whatever resources ing, and protecting children in times of war and are available. The impact of this knowledge political con fl ict. allows children to accurately and adaptively Promoting resilience refers to ways in which conceptualize the adversity in their lives. adults can enhance the ability of kids to deal Additionally, it allows them to process the war with trauma constructively and successfully. experience as a community—or often as a A crucial component of this resilience is national epidemic—instead of as one that is con fi dence in the future. In the television age in experienced in seclusion. This insight works which kids live, trauma is brought into their against the feeling of isolation, as it compels lives in historically unprecedented ways, and children to become aware of the effect of the this trauma threatens kids’ foundations for hope war on other people. and future orientation, and in extreme cases • Altruism. Children who help others are aware replaces future orientation with “terminal think- of their ability to affect situations around ing” (Garbarino, 2001 ) . them. This process of giving and helping often In a review of the literature, Apfel and Simon protects children from being overcome by (1996 ) posit several factors that collectively con- feelings of helplessness. As actions are seen as tribute to successful childhood coping and adap- having power and in fl uence, coping becomes tive adult functioning that characterizes war’s self-initiated and deliberate. most resilient children. We fi nd their conclusions • Commitment to survival. The commitment to compelling and their reasoning from the avail- survive often coexists with a sense of purpose- able evidence persuasive. fulness and meaning. Children who regard 264 J. Garbarino and E. Bruyere

their lives as serving a higher purpose will be dangerous,” “School is dangerous place,” “I feel more apt to persevere in the face of trauma and all alone,” and “All I see in my future is more have a greater insight into their vulnerabilities. disappointment and failure?” Children with goals are likely to have this What does this understanding of the social sense of internal purpose. Being told to look maps of children suggest as principles for encour- after the family residence or to accompany a aging resilience in war-affected children and sibling to a combat-free territory can supply a youth? We see four guiding principles for pro- child with the psychic energy and sense of grammatic action: purpose to endure the atrocity and trauma that lies ahead. Emotional regulation issues for traumatized • Command of affect and ability to recall posi- youth : Self-medication in the form of illicit drug tive images. A resilient child will be able to use (including alcohol) is a signi fi cant issue for “compartmentalize” pain and anxiety and many such youth around the world (Duncan & delay the expression of affect for the good of Gold, 1982; Khantzian, 1999 ) . This “need” can- survival. There are many instances in which not be ignored or simply punished. Traumatized the overt expression of emotion is dysfunc- youth need alternative tactics and strategies for tional. For example, in order to avoid becom- dealing with the arousal issues associated with ing incapacitated, Bosnian children often had trauma. We believe that the use of consciousness- to postpone grieving until after evacuation orienting approaches such as meditation should was complete, and there was a safe environ- be part of any comprehensive program (perhaps ment in which to express their sadness. The in some cases in combination with psychiatric same is true for victims of torture, who must use of psychoactive drugs to permit the youth to await either a change of regime or resettle- stabilize emotions while processing trauma). ment in a safer country before beginning to Techniques such as trauma-focused cognitive process the traumatic experience. The result is behavioral therapy that permit processing of trau- not suppression or repression of appropriate matic memories without debilitating emotional affect, but rather postponement of affect until “fl ooding” can be part of this effort (Cohen, the child is in a context that is safe. In addition Mannarino, Berliner, & Deblinger, 2000 ) . These to the importance of suspending present psy- efforts provide the psychological “space” to pro- chic reality, it is equally important that chil- cess memories and yet protect the youth from dren be able to recall a more positive reality. being overwhelmed by reexperiencing the symp- As we see it, the ability to remember the for- toms of posttraumatic stress disorder. mer strengths of a now diminished social map is crucial to resiliency. This process of “glori fi ed Building meaning: The various crises in “mean- recall” protects children from over-internalizing ingfulness” experienced by war-traumatized the aspects of their present situation by allowing youth require special attention (Garbarino et al., them to conceptualize and interpret adversity as 1991) . Cooperative, pro-social projects can assist temporary and specifi c rather than stable and in this (and have the additional benefi t of allow- global. Thus, we are concerned about the conclu- ing violent youth to be seen as engaged in restor- sions about the world contained in a youth’s ative justice efforts that advantage the community social map. We can conceptualize these issues in and the youth). Spiritual development activities terms of a series of alternative conclusions that (e.g., insight meditation and prayer groups) can children and youth exposed to war may reach. also be useful in this effort. Efforts to involve Will it be “Adults are to be trusted because they traumatized and violent youth in caregiving (e.g., know what they are doing,” “People will gener- with plants, animals, and other dependent beings) ally treat you well and meet your needs,” “I am a can enhance a sense of meaningfulness (but of valued member of my society,” and “The future course must be undertaken with adequate adult looks bright to me?” Or, will it be “Strangers are supervision to prevent harm to the dependent 18 Resilience in the Lives of Children of War 265 beings involved in the project). These efforts In conclusion, there are no universal formulae stand in contrast to “get tough” approaches or recipes for rehabilitating violent and trauma- exemplifi ed in the “Boot Camp” militaristic tized youth and promoting resilience in the con- model, which led one such alternative effort to be text of war. Every programmatic effort must be called “From Boot Camp to Monastery” looked at in its social and cultural context. But (Garbarino, 1999 ) . the principles and concepts laid out in this chapter can provide the guidance necessary to sort Careful management of peer process : Efforts to through program elements and approaches to fi nd rehabilitate “delinquent” youth can be counter- valid approaches that are sensitive to local social productive if they fall into one or both of the fol- and cultural conditions and compatible with local lowing “traps.” First, if they rely on peer process resources and the promise to help children and for infl uence and change in groups in which a youth move through war-related trauma to emerge signi fi cant minority (perhaps 30%) are exhibiting on the other side psychologically and morally antisocial beliefs, rhetoric, and behavior, the net intact, and thus “resilient.” effect is likely to be a worsening of the less delinquent youth (rather than an improvement in the most delinquent youth) because the youth pro- References cess models and validates negative images (Dishion, McCord, & Poulin, 1999 ) . The princi- American Psychiatric Association. (2000). Diagnostic pal antidote to this problem is some mixture of and statistical manual-IV . Washington, DC: American Psychiatric Association. powerful control of group process and language Anderson, C. A., Berkowitz, L., Donnerstein, E., by pro-social adults, and systematic group com- Huesmann, L. R., Johnson, J. D., Linz, D., et al. (2003). position that limits the disproportionate involve- The in fl uence of media violence on youth. Psychological ment of the most delinquent youth. Although Science in the Public Interest, 4 (3), 81–110. Apfel, R. J., & Simon, B. (1996). Mine fi elds in their developed in work with violent delinquents, we hearts: The mental health of children in war and com- assume this model applies to children of war as munal violence . New Haven, CT: Yale University well. Second, intervention can be counterproduc- Press. tive if it focuses on “lecture” models, particularly Arluke, A., & Sanders, C. (1996). Regarding animals . Philadelphia, PA: Temple University Press. when these lectures involve emotionally intense Armstrong, K. (2009). The case for God . NY: Knopf. and threatening rhetoric. A prime example is the Armstrong, K. (2010). Twelve steps to a compassionate “Scared Straight” program in the United States life . NUY: Knopf. which employs “hard-core” adult criminals to Beah, I. (2008). A long way gone: Memoirs of a boy soldier . NY: Sarah crichton books. lecture delinquent and “predelinquent” youth Bonanno, G. A. (2004). Loss, trauma, and human resil- (often accompanied by threatening language and ience: Have we underestimated the human capacity to gestures). Research reveals this approach may thrive after extremely adverse events? American indeed “scare” more pro-social and sensitive Psychologist, 59 , 20–28. Bronfenbrenner, U. (1970). The ecology of human devel- youth (who are not at risk for long-term patterns opment . Cambridge, MA: Harvard University Press. of serious delinquent behavior) but serves to Bruner, J. (1986). Actual minds, possible worlds . increase the severity of antisocial behavior of Cambridge, MA: Harvard University Press. youth already involved in delinquent behavior— Cavanaugh, W. (2009). The myth of religious violence . NY: Oxford University Press. and thus at heightened risk for more serious Cohen, J., Mannarino, A., Berliner, L., & Deblinger, E. delinquent behavior (Lilienfeld, Lynn, Ruscio, & (2000). Trauma-focused cognitive behavioral therapy Beyerstein, 2010 ) . These youth tend to interpret for children and adolescents: An empirical update. the intense messages from the adult criminals not Journal of Interpersonal Violence, 15 , 1202–1223. Dalai Lama. (2011). How to be compassionate . NY: Atria as “I am scared of the consequences of my cur- Books. rent activities so that I will curtail my delinquent Davidson, J., & Smith, R. (1990). Traumatic experiences behavior,” but rather as “I am going to have to be in psychiatric outpatients. Journal of traumatic stress even more tough to survive in prison.” studies, 3 , 459–475. 266 J. Garbarino and E. Bruyere

Dishion, T., McCord, J., & Poulin, F. (1999). When inter- Hoffman, B. (2006). Inside terrorism . NY: Columbia ventions harm. American Psychologist, 54 , 755–764. University Press. Duncan, D. F., & Gold, R. S. (1982). Drugs and the whole Khantzian, E. J. (1999). Treating addiction as a human person . New York: Wiley. process: A plea for a measure of marginality . Field, R. (2004). Martyrdom: The psychology, theology, New York: Jason Aronson. and politics of self-sacri ﬁ ce . Westport, CT: Praeger Kramer, P. (1997). Listening to Prozac . NY: Penguin. Publishers. Lilienfeld, S. O., Lynn, S. J., Ruscio, J., & Beyerstein, B. Fischer, K. W., & Bidell, T. R. (1998). Dynamic develop- L. (2010). 50 great myths of popular psychology: ment of psychological structures in action and thought. Shattering widespread misconceptions about human In R. M. Lerner (Ed.) & W. Damon (Series Ed.), behavior . Malden, MA: Wiley-Blackwell. Handbook of child psychology : Vol . 1 . Theoretical Maddi, S. R. (2005). On hardiness and other pathways to models of human development (5th ed., pp. 467–561). resilience. American Psychologist, 60 , 261–262. New York: Wiley. McAdams, D. (2001). The psychology of life stories. Fischer, K. W., & Bidell, T. R. (2007). Dynamic develop- Review of General Psychology, 5 , 100–122. ment of action and thought . NY: Wiley. Nader, K., & Pynoos, R. (1993). The children of Kuwait Fletcher, K. E. (2007). Posttraumatic stress disorder. In E. after the Gulf crisis. In L. Leavitt & N. Fox (Eds.), The J. Mash & R. A. Barkley (Eds.), Assessment of child- psychological effects of war and violence on children hood disorders (4th ed., pp. 398–483). NY: Guilford (pp. 181–192). Hillsdale, NJ: Lawrence Erlbaum. Press. National Child Traumatic Stress Network. (2013). http:// Freud, A., & Burlingham, D. (1943). War and children . www.nctsn.org/. NY: Ernest Willard. Newman CJ. (1976). Disaster at Buffalo Creek. Children Garbarino, J. (1999). Lost boys: Why our sons turn violent of disaster: Clinical observations at Buffalo Creek. and what we can do about it . NY: Free Press. American Journal of Psychiatry, 306–312. Garbarino, J. (2001). Making sense of senseless youth Prejean, H. (1994). Dead man walking: An eye-witness violence. In J. Richman & M. Fraser (Eds.), The con- account of the death penalty in the United States . NY: text of youth violence: Resilience, risk and protection . Vintage. NY: Praeger. Pynoos, R. (1994). Posttraumatic stress disorder: A clini- Garbarino, J. (2008). Children and the dark side of human cal review . NY: Sidran. experience . NY: Springer. Richo, D. (1999). Shadow dance . Boston: Shambala. Garbarino, J., & Bedard, C. (2001). Parents under siege . Rutter, M. (1989). Pathways from childhood to adult life. NY: Free Press. Journal of Psychology and Psychiatry, 30 , 25–51. Garbarino, J., Dubrow, N., & Kostelny, K. (1991). No Sack, W., Clarke, G., Him, C., Dickason, D., Goff, B., place to be a child: Growing up in a war zone . NY: Lanhamm, K., et al. (1993). A 6-year follow-up study Lexington Books. of Cambodian refugee adolescents traumatized as Garbarino, J., & Kostelny, K. (1996). The impact of politi- children. Journal of the American Academy of Child cal violence on the behavioral problems of Palestinian and Adolescent Psychiatry, 32 , 431–437. children. Child Development, 67 , 33–45. Sullivan, H. S. (1953). The interpersonal theory of psy- Gibbs, S. (2005). Islam and Islamic extremism: An exis- chiatry . New York: Norton. tential analysis. Journal of Humanistic Psychology, Terr, L. (1995). Unchained memories . NY: Basic Books. 45 , 156–203. Van der Kolk, B., McFarlane, A., & Weisaeth, L. (Eds.). Gilligan, J. (1997). Violence . NY: Vintage. (1996). Traumatic stress: The effects of overwhelm- Hammack. (2008). Narrative and the cultural psychology ing experience on mind, body, and society . NY: of identity. Personality and Social Psychology Review., Guilford. 112 , 222–247. Wessells, M. (2007). Child soldiers: From violence to pro- Herman, J. (1992). Trauma and recovery . NY: Basic Books. tection. Cambridge, MA: Harvard University Press. Evidence-Based Resilience- Enhancing Intervention Methods for 1 9 Children Affected by Armed Conﬂ ict

Kirsi Peltonen and Esa Palosaari

Within the last 10 years, the concepts of risk and Further, Layne et al. ( 2009) suggest that, in order resilience have become more common in the to design and implement successful interventions intervention literature. In this chapter, we would among traumatized children, we need detailed like to draw from a wide array of literature to information from two important areas: (1) the help intervention planners and researchers fi nd causal pathways through which traumatic stress suitable and effective methods for enhancing may lead to persistent post-traumatic stress and resilience. developmental problems and (2) the causal path- Awareness of the importance of using both ways through which resilient trajectories of post- measures of vulnerability and resilience when traumatic adjustment are promoted. Based on assessing intervention effectiveness and mediat- this, Layne et al. ( 2009 ) recommend analyzing ing mechanisms has risen. For example, Brown the adaptive and maladaptive processes related to and Liao ( 1999 ) suggest that strategies to assess the post-trauma situation and, when fi nding a intervention impact should include the examina- group of people sharing similar risk and protection of variations in developmental trajectories, tive factors, starting an intervention with suitable both within a de fi ned population and across time. methods. The guidelines of Brown and Liao The essential steps they proposed are: ( 1999 ) and Layne et al. (2009 ) adhere to the idea 1. Determining the levels and variations in risk of a trajectory that starts from a traumatic event and protective factors and developmental and leads to either negative, neutral, or even posi- paths within a de fi ned population in the tive consequences for mental health and adjust- absence of intervention. ment defi ned by complex interactions between 2. Directing interventions at these risk and pro- protective and risk factors. They advise review- tective factors in an effort to change the devel- ing earlier literature on interventions carried out opmental trajectories in that population. in similar environments. Although we are skepti- 3. Evaluating variation in intervention impact cal about fi nding information about causality, we across risk levels and contexts. agree in principle with these proposals for designing theoretically sophisticated interventions. A recent summary by Davydov, Stewart, K. Peltonen (*) Ritchie, and Chaudieu (2010 ) proposes three Department of Psychology, University of Tampere , mental health resilience systems in the face of Tampere 33014 , Finland aversive events: health protection, health promo- e-mail: Kirsi.Peltonen@uta. fi tion, and harm reduction. The health protection E. Palosaari mechanisms refer to protective factors, capacities School of Social Sciences and Humanities/Psychology, University of Tampere , Tampere , Finland that a person has during traumatic experience. e-mail: esa.palosaari@uta. fi Harm reduction refers to a tendency to bounce

C. Fernando and M. Ferrari (eds.), Handbook of Resilience in Children of War, 267 DOI 10.1007/978-1-4614-6375-7_19, © Springer Science+Business Media New York 2013 268 K. Peltonen and E. Palosaari back after a trauma-related health disturbance. grade 5 comes from research designs including Finally, the health promotion system of resilience comparisons between groups that are not effec- refers to the vaccine effect of adverse events, tively randomized to conditions. At grade 6, the meaning that a person could develop some new quality of evidence is achieved from pre–post capacities and be stronger and equipped with evaluation with no comparison group or repeated more effective coping strategies the next time assessment on a single case for which an inter- they face adverse events. The promotion system vention is introduced at some point in the time therefore comes close to the concept of post-trau- series. Finally, at grade seven, endorsement is matic growth, which is de fi ned as “positive based on clinical experience by respected change resulting from one’s struggle with trauma” authorities, descriptions of programs, and case (Kilmer et al., 2009 ) . reports without study design. In this chapter we have included studies that fulfi ll the criteria at least at level 6 of the Need for Evidence-Based classi fi cation by Biglan et al. (2003 ) , requiring Interventions evidence from pre–post evaluation with no comparison group. Some of the reviewed interven- In the fi eld of clinical psychology, an increasing tions included nonrandomized or randomized number of interventions over the last decade have control groups and could therefore be rated higher demonstrated empirical support in terms of their on the classifi cation. While the strict defi nition of ef fi cacy (Forchuk, 2001; Schaeffer et al., 2005 ) . “evidence-based” involves upper grades in the However, controversies have emerged pertaining classi fi cation, we argue that the methods or tools to the de fi nition of evidence, particularly in the presented in this chapter are at least “evidence- mental health domain (Waddell & Godderis, 2005 ) . informed,” meaning that there is empirical evi- Because of the empirically supported interven- dence to show the effectiveness of the tions’ potential to improve the quality of services interventions. In other words, children who had (Schaeffer et al., 2005 ) , the concept “evidence- mental health problems, or were at risk of devel- based” needs an unambiguous defi nition (Biglan, oping them, improved on average if they used the Mrazek, Carnine, & Flay, 2003 ) . methods discussed in this chapter. Biglan et al. ( 2003 ) introduced a 7-grade Several authors have proposed to elaborate on classi fi cation that depicts the rules of evaluating resilience as a relevant construct in understand- the validity of conclusions on therapy effective- ing the mental health of children ( Howard et al., ness. The criteria include issues such as random 1999 ; Luthar et al., 2000 ), and this will be our assignment, use of a control group, sustainabil- approach in this chapter. We fi rst outline how the ity of positive results, and fi delity of implemen- concept of resilience is defi ned in relation to tations of the effective treatments, thus extending resilience-based intervention methods. Secondly, the meta-analytical requirements. The best, from experimental studies, we draw the factors or grade 1 evidence is from multiple well-designed, processes that have been shown to be protective randomized, and controlled trials or multiple when children are exposed to war and military well-designed, interrupted time-series experi- violence. Thirdly, and most importantly, we col- ments conducted by two or more independent lect methods that have been shown to be effective research teams. In addition, there must be ade- in enhancing factors or processes and formulate a quate documentation that the preventive inter- “toolbox” for practitioners and intervention plan- vention has been implemented in its intended ners. We will also report the age of the children setting with adequate training of personnel and participating in each study and the age of the monitoring of implementation and outcomes. children among whom a particular resilience- Grade 2 requires no documentation of the based method has demonstrably worked. This implementation and grade 3 requires no multi- aspect is too often forgotten in the literature and ple research teams, and at grade 4, there is no replaced by a rather general list of protective requirement of multiple trials. The evidence at factors. In other words, we present a handful of 19 Evidence-Based Resilience-Enhancing Intervention Methods… 269 methods for enhancing resilience and boosting dren in armed confl ict and the enormous worry protective factors especially designed for treating caused to those helping them, the history of inter- the long-term mental health consequences of ventions among children exposed to military vio- exposure to war on children’s mental health. lence is mainly a history of symptom-based Rather than presuming to present “quick fi xes,” interventions. The justifi able main goal has been we offer age- and content-specifi c tools that may to alleviate the suffering of most affected and be helpful in planning interventions. symptomatic children. As noted earlier, however, there are children in war conditions who do not develop noteworthy symptoms. Some experts say Symptom and Resilience-Based that this feature alone can be enough to defi ne a Interventions child as a resilient individual. Other experts, however, state that resilience is something more than The stress–diathesis model, introduced in the remaining asymptomatic during a limited period 1960s (e.g., Bleuler, 1963 ; Meehl, 1962 ; and of time after a traumatic event. Resilience means Rosenthal, 1963 ) and defi ned in conjunction with that a child has access to bene fi cial processes that the concept of vulnerability by Zubin and Spring continue to be their resources for a lifetime. These ( 1977 ) , serves as an important background theory resources prevent the occurrence of severe mental for explaining optimal and pathological adjust- health problems and can even allow the individual ment in traumatic stress. In the stress–diathesis to fl ourish. In other words a war-affected resilient model, the probability of mental health problems child may show a better adjustment than those is explained by the interaction of individual stress who have not experienced traumatizing events level and vulnerability. The model was fi rst pro- (for a review see Davydov et al., 2010 ). Nowadays, posed as a means to explain some of the causes of resilience-based methods have begun to be schizophrenia, but the later expansion of Layne included in symptom-focused interventions. (2009 ), for example, has brought it closer to Furthermore, a number of exclusively symptom- trauma interventions. Layne argues that greater based interventions, when delivered in groups, emphasis should be placed on positive outcomes may also serve to invigorate protective processes in conceptual models of adaptation to traumatic themselves, by bolstering social support and con- stress and thereby added on to researchers’ and nectedness among war-affected children, their practitioners’ methodological repertoires. When caregivers, and wider community (Betancourt & the trauma-related adjustment process is explained Williams, 2008 ; IASC, 2007 ) . with the help of the stress–diathesis model, one As the name says, symptom-based methods may argue that treatment of full-blown disorders aim at decreasing psychological symptoms. Only or prevention of the occurrence of disorder may when free of maladaptive processes that perpetu- be affected either by reducing vulnerability (with ate mental health problems such as depressive or resilience-based methods) or by decreasing the anxiety symptoms are children able to prosper stress level (with symptom-based methods). A and accomplish their healthy development. The further implication is that both children with and maladaptive processes can include denial, feel- without current symptoms can benefi t from psy- ings of insecurity, and deteriorated social rela- chosocial interventions. It is important to develop tions. A resilience-based approach, for its part, a theoretical framework that takes into account assumes that by enhancing children’s healthy and both children who have trauma-related symptoms adaptive cognitive, emotional, and social pro- and children who have experienced traumatizing cesses, mental health problems can be avoided or events, but not yet developed post-traumatic stress existing maladaptive processes prevented from disorder (PTSD) or other trauma symptoms. exacerbating. This means that trauma-related Before exploring the specifi c methods to symptoms can be prevented, for example, by enhance resilience, we discuss briefl y the nature helping children to develop their skills in prob- of intervention methods based on symptoms and lem solving, to express emotions, or to form and resilience. Because of the massive distress of chil- maintain their friendships (see Fig. 19.1 ). 270 K. Peltonen and E. Palosaari

Fig. 19.1 Resilience and symptom-based methods in mental health interventions

Interventions typically aim to promote social intact and will benefi t from their further buffer- and emotional well-being, capability to face ing. However, children with rather severe post- ongoing threat, peace-building, and ethnic toler- traumatic stress also have the capability to use ance. However, they are very seldom explicitly their intact resources such as peer support and measured as outcomes precluding a detailed creativity. Therefore, it could be argued that such understanding of which interventions promote children might indeed also benefi t from these resilience. There are some descriptive interven- methods. Other methods, such as graded expo- tion studies (Chase et al., 1999 in Sri Lanka; sure to traumatic events or meaning-making Woodside, 1999 in Croatia), and large numbers exercises concerning traumatic history, are surely of reports by organizations like the UN, Red needed in order to both treat their symptoms or Cross, and WHO, which clearly emphasize the disorder and achieve the full benefi t from resil- importance of resilience-based methods. ience-based methods. This is evidenced by our However, with only a few exceptions (Layne own research among Palestinian children. We et al., 2001 ; 2008 in Bosnia, Tol et al., 2008 in found that traumatized children with and without Indonesia), no intervention effectiveness studies PTSD bene fi tted from a purely resilience-based have been presented exploring increases in psy- intervention during acute war conditions by pre- chosocial adaptation in addition to decreases in venting the deterioration of friendships, which symptoms. We certainly need more research on would otherwise have taken place among the the ability of interventions to enhance healthy children studied ( Peltonen et al., 2012 ). development among war-traumatized children. We conceptualize resilience-based, preventive intervention methods as being those that aim to Background of Resilience-Enhancing enhance the adaptive/healthy processes decisive Methods for optimal development and that protect children from the effects of traumatic stress. Children A good theory provides methods for achieving without mental health problems will most likely be intervention objectives. Theory-driven interven- those who have such adaptive processes somehow tion planning requires an understanding of the 19 Evidence-Based Resilience-Enhancing Intervention Methods… 271 components of theories as well as an understanding detailed description of resilience-based intervention of their operational or practical forms (Kok et al., method can be obtained from this bibliographic 2004). In order to enhance resilience among chil- resource. dren in war areas we need to identify protective factors and processes in fl uencing successful outcomes (Betancourt & Khan, 2008 ) . While a com- Tools for Policy and Practice plete theory of child resilience in war conditions is still lacking, we can take advantage of the body The current guidelines on helping traumatized of empirical knowledge about the adaptive pro- children state that structured interventions are cesses involved in a child’s adjustment during effective with children with PTSD (National and after war experiences. Child Traumatic Stress Network, 2005; National By “empirical methods” we refer to those that Institute for Clinical Excellence, 2005 ) . Scienti fi c have been part of the experimentally studied evidence is available on Trauma-Focused intervention. A large array of UN and Red Cross Cognitive Behavioral Therapy (TF-CBT) (Cohen reports (IASC, 2007 ; International Federation & Mannarino, 2008 ; Cohen, Mannarino, Berliner, Reference Centre for Psychosocial Support, & Deblinger, 2000 ) and Eye Movement 2007 ) as well as descriptive articles (e.g., Chase Desensitization and Reprocessing (EMDR) et al., 1999 , in Sri Lanka; Woodside, 1999 , in (Rodenburg, Benjamin, de Roos, Meijer, & Croatia) report how to improve security, commu- Stams, 2009) . There is no experimental evidence nity reintegration, and community-based emer- on other systematic treatments such as play ther- gency education. However, although the methods apy or dynamic therapies (National Child described in the reports and articles may well be Traumatic Stress Network, 2005 ; National effective and are well documented, they do not Institute for Clinical Excellence, 2005 ) . When serve the two main goals of this chapter: (1) the scope is narrowed to war-traumatized chil- exploring the extent of evidence-based resilience- dren, the evidence is even weaker but CBT is still enhancing methods and (2) offering an evidence- supported (Ehntholt & Yule, 2006; Peltonen & based toolbox for intervention planners. The Punamäki, 2010 ) . Therefore, many of the inter- aforementioned documents are beyond the scope ventions in this chapter are applications of CBT of our review because they do not report experi- and include at least some of its elements and mental studies. techniques. At the moment, no recommendations We consider a resilience-based method to be exist for prevention among war children and there effective if, (1) in an experimental design, the are no guidelines on how to enhance resilience intervention has proved to be effi cient in increas- among children with subclinical levels of disor- ing resilience or in decreasing symptoms among ders or children that have not developed detect- war-affected children and (2) methods enhancing able signs and symptoms. However, the available optimal developmental processes are used as the scientifi c evidence allows the presentation of a only intervention or as a critical part of it. toolbox of methods which have produced prom- Table 19.1 presents protective factors and related ising results. resilience-enhancing intervention methods supported by empirical evidence. The right-hand column provides the reference to a scientifi c arti- Child’s Cognitive and Emotional Skills cle reporting the intervention effectiveness, participants’ age (at the level reported in the article), Qouta et al. (2001 ) showed that children were and country of origin. Following this information protected from negative long-term consequences there is a note Mn which refers to the reference of traumatic events if they showed mental for the study cited in Table 19.1 . While the infor- fl exibility. After experiencing stressful wartime mation about the techniques used in interventions events, children who had a realistic understand- is brie fl y described in the scienti fi c article, a more ing of the situation, the ability to mentally plan 272 K. Peltonen and E. Palosaari

3 ) : Stress inoculation training in schools, fourth to ) 2011

12 ): Psychosocial intervention, 6–17-year-old Palestinian ): Psychosocial intervention, 6–17-year-old ) : Psychosocial program, 10–15-year-old Kosovan refugees : Psychosocial program, 10–15-year-old )

4 ) : Interpersonal psychotherapy, 14–17-year-olds, in Uganda M 14–17-year-olds, : Interpersonal psychotherapy, ) ): Overshadowing the threat of terrorism, second to sixth ) : Child-friendly version of Narrative Exposure Therapy, Therapy, : Child-friendly version of Narrative Exposure ) 2006 2005 2007 2007 2005 ) : Refugee Health Program, children of all ages in former Yugoslavia Yugoslavia : Refugee Health Program, children of all ages in former )

14 2000

1 2 Constructing a narrative of the event and its consequences, reconstruction traumatic memory M children M Recreation activities in a community setting, “connectivity” (e.g., summer camps, using the internet to put children in touch with other settings), the establishment of “safe play” areas different fth graders in Israel M fi Ugandan children M 13–17-year-old Processing positive and negative experiences, breathing exercises, correcting negative thoughts, a safe place, progressive muscle relaxation, communication psychoeducation about aggression training, humor, ( Onyut et al. Barath ( ( Möhlen et al. M Promoting verbal and nonverbal expression of thoughts feelings through age-appropriate creative activities. Post-activity group discussion focusing on building skills graders in Israel M Promoting self-esteem and self-control, coping skills for mental distress, self-knowledge, critical thinking, and healthy moral reasoning ( Bolton et al. The use of creative techniques such as painting, playing, acting, and fantasy journeys Loughry et al. ( Reframing negative experiences. Becoming aware of thought patterns and learning how to reframe them positively ( Hamiel, and Laor Wolmer, Berger et al. ( Berger : = 13 years) 1993 M = 14 years) M : Palestinian, = 14 years) : Lebanese, 1990 M = 15 years; M 1995 : Palestinian 2001 : Palestinian : Columbian, 2001 2007 = 14 years) M : Palestinian, 2001 Protective factors and related resilience-enhancing intervention methods with empirical evidence Protective factors and related resilience-enhancing intervention methods with empirical evidence Self-ef fi cacy (Saigh, Mroueh, Zimmerman, & Fairbank, fi Self-ef Coping skills which fi t the situation (Punamäki & Suleiman, fi Coping skills which Sense of coherence: manageable, comprehensive, meaningful (Thabet, Ibraheem, Shivram, Winter, & Vostanis, 2009 ) Creativity (Punamäki, Qouta, & El Sarraj, 8.14 years; Weisenberg, Schwarzwald, Waysman, Solomon, & Klingman, Waysman, Schwarzwald, Weisenberg, 8.14 years; Protective factor factor Protective Children themselves Mental fl exibility ( Qouta, Punamäki, & El-Sarraj, Resilience-enhancing intervention method Sense of agency (Cortes & Buchanan, Table 19.1 Iraq, fi fth, seventh, and tenth graders) fi Iraq, Punamäki et al., 19 Evidence-Based Resilience-Enhancing Intervention Methods… 273 (continued)

2 2

5 ) : Teaching Recovery Techniques, mean age 12.5, Techniques, Recovery Teaching : ) 2005 ) : Trauma- and grief-focused group psychotherapy, and grief-focused group psychotherapy, Trauma- : )

2008 4 4 ): Overshadowing the threat of terrorism, second to sixth ) : Child-friendly version of Narrative Exposure Therapy, 13–17 Therapy, : Child-friendly version of Narrative Exposure ) 2007 2005 2001, ) : Children of all ages in former Yugoslavia M Yugoslavia : Children of all ages in former ) M Yugoslavia : Children of all ages in former )

2000 2000 3 years M Layne et al. ( ( Layne et al. promote active coping for Promoting impulse control in “acting-out” anger, anxiety and fear Search for basic values and personal goals ( Onyut et al. Berger et al. ( Berger Tasks of grieving with special emphasis on the ways in which traumatic losses Tasks angry group exercise to process members’ A may interfere with these tasks. discussion on the need to maintain a psychological A reactions to their losses. relationship with the deceased, accompanied by visualization exercise in which members retrieve or construct a non-traumatic image of the deceased. Reminiscing exercise in which members share memories of their loved ones et al. (2007): Overshadowing the threat of terrorism, second to sixth Berger graders in Israel M asylum-seeking children in various countries M 15–19-year-old schoolchildren in Bosnia M 15–19-year-old graders in Israel M Encouraging children to extend the narration beyond present, describe their hopes and aspirations for the future ( Yule Ehntholt, Smith, and Helping children to schedule their activities and look the future rather than the past (avoidance) Enhancing students’ emotional awareness, identifying and clarifying feelings, Enhancing students’ becoming aware of the connection between sensations and feelings. Stopping ooding: dealing with fears and rage-identifying signs of fear rage ﬂ emotional and learning how to express cope with them in a productive manner Barath ( Looking for a better future. Learning how to build plan dealing with future distress and developing a positive future outlook Barath ( = 15 years): M = 15 years; Kithakye, = M : Columbian, 2007 : Columbian, 2007 : Kenyan, 3–7 years) 2010 Sense of future, optimism (Cortes & Buchanan, Morris, Terranova, & Myers, Terranova, Morris, Protective factor factor Protective Emotion regulation (Cortes & Buchanan, Resilience-enhancing intervention method 274 K. Peltonen and E. Palosaari

7 7

5 ) : Psychosocial program, 10–15-year-old Kosovan refugees : Psychosocial program, 10–15-year-old )

4 4 ) : Interpersonal psychotherapy, 14–17-year-olds, in Uganda M 14–17-year-olds, : Interpersonal psychotherapy, ) ): Overshadowing the threat of terrorism, second to sixth ): Overshadowing the threat of terrorism, second to sixth ) : Psychosocial intervention, mean age 5.5 years M ) : Psychosocial intervention, mean age 5.5 years M ) ) : Trauma- and grief-focused group psychotherapy, 15–19-year- and grief-focused group psychotherapy, Trauma- : ) b b 2005 2007 2007 2007 2001 2001a, 2001a,

1 Layne et al. ( ( Layne et al. M Identifying interpersonal problems and assisting individual in building skills to manage these problems ( Möhlen et al. Bolton et al. ( ( Bolton et al. graders in Israel M old schoolchildren in Bosnia M graders in Israel M Dybdahl ( Education for mothers on how to recognize trauma symptoms in children, well-being, enhancement of understanding of children’s promoting mothers’ dence and ability to care for children, enhancement of mother–child fi self-con communication dence and ability to care for children. Promoting fi Enhancement of self-con understanding of her own well-being mother’s The combination of individual and family sessions. Psychoeducation for parents Resourcing parents and teaching them coping skills such as breathing, mindfulness meditation, relaxation, and guided imagery Dybdahl ( social support to others enrich their children to provide effective Teaching c goals and fi They also assist each other in forming speci personal relationships. plans for the future and in determining ways to reach these goals et al. ( Berger support system. Exploring social Building a social shield: enhancing children’s ll them, learning to ask for help and become more fi needs and ways to better ful empathic Berger et al. ( Berger : : 2001 1989 : refugee : Palestinian, = 10 years; M 2008 2001 : Israeli, 8–10 years; : Croatian, : Ugandan child soldiers, : Child survivors of Holocaust; 2001 2003 2010 : Palestinian, ninth grade) (Farhood, 2002 2001 = 14 years; Peltonen, Qouta, ElSarraj, and = M : Israeli, 1.5–5 years) : Israeli and Palestinian, 11-, 13-, and 15-year-olds) 13-, and 15-year-olds) : Israeli and Palestinian, 11-, 2011 : Palestinian : Kuwaiti 9–13 years) 2010 2001 ) : Palestinian 10–13 years) 1997 : Iranian 4–8 years; Bryce, Walker, Ghorayeb, & Kanj, Walker, : Iranian 4–8 years; Bryce, 2010 : Israeli, 8–10 years) (continued) 1999 2001 : Lebanese adolescents; Kuterovac-Jagodic, = 14 years) Perceiving both parents as loving and caring (Punamäki et al., Vengrober, Feldman & Society related Social support and peer relations (Barber, Perceptions of family support (Daud, af Klintberg, & Rydelius, & Rydelius, Perceptions of family support (Daud, af Klintberg, families from Iraq, 6–17 years; Thabet et al., 2009 : Palestinian, 12–16 years; 2009 Thabet et al., families from Iraq, 6–17 years; Harel-Fisch et al., age = 11–17 years) Almqvist & Adjukovic: Croatian; psychological well-being (Adjukovic & Mothers’ Broberg, Israeli, 1.5–5 years; Laor 2011: Vengrober, Lebanese, 5–7 years; Feldman & et al., Llabre & Hadi, Table 19.1 Table factor Protective Family related family cohesion (Barber, Sibling relations, social integration in family, Secure attachment (Cohen, Dekel & Solomon, Resilience-enhancing intervention method 1999 Punamäki ( No exposure to domestic violence (Klasen et al., Palestinian, ninth graders; Laor, Wolmer, & Cohen, Wolmer, Palestinian, ninth graders; Laor, Punamäki et al., M 19 Evidence-Based Resilience-Enhancing Intervention Methods… 275 . 13 13 (continued) ment Manual. Sarajevo, Bosnia: d Participants, Trauma Recovery Trauma d Participants, ed for UNICEF/Centre Crisis 0 ) : Health to Peace Initiatives, mean ) Intervention. Heidelberg: University of Intervention. Heidelberg: tudents’ resiliency: A teacher’s manual. teacher’s A resiliency: tudents’ rder after War, Terror or Torture. Seattle: or Torture. Terror rder after War, 1999 London sed intervention method can be obtained from the biblio- (at the level reported in article), and country of origin

11 ) : The School Mediation Program, 9–13-year-olds in Gaza The School Mediation Program, 9–13-year-olds : ) ) : Burundi, Sri Lanka, Indonesia, and Sudan, 8–14 years M ) : Burundi, Sri Lanka, Indonesia, and Sudan, 8–14 years M ) 2012 ): School-based mental health intervention, mean age 10 in Central 2010 2010 2008

8 Jordans et al. ( ( Jordans et al. M age 11.9 in Croatia M age 11.9 Encouraging social support systems, engagement in recreational or traditional discussion and activities activities, and normalization through peer-group ( Peltonen et al. Community sensitization and psychoeducation through media such as radio Promoting communication skills. Exploring ethnic biases and prejudices: ict resolution” fl discussion of “creative con Sulawesi, Indonesia Reconnecting the child and group to his/her social context using resiliency-based themes and activities Tol et al. ( Tol Promoting peaceful and effective problem-solving skills and con fl ict resolution fl problem-solving skills and con Promoting peaceful and effective ( Santa Barbara, and Benner Woodside, Jordans et al. ( ( Jordans et al. : Eritrean 9–12 years) : Palestinian ninth grade; 1998 : Ugandan child soldiers, 2001 = 14 years) which refers to the reference of the intervention’s bibliographic resource listed below. While the information about bibliographic resource listed below. which refers to the reference of intervention’s n M 2010 = 17 years) : Palestinian, M 2001 : Sri Lanka; Klasen et al., ) : Sierra Leone, 2011 2010 : Osler, B. J. (1991). A workbook for survivors of War: A twelve-Step Trauma Recovery Workbook Supplement for Group Leaders an Workbook Recovery Trauma twelve-Step A War: workbook for survivors of A B. J. (1991). : Osler, Entwicklung und Evaluation einer Ressourcenorientierten : Möhlen H. Psychosoziale Hilfe fur traumatisierte Fluchtlingskinder. Intervention for traumatic Stress Diso Therapy (NET) as a Short-Term Narrative Exposure T.: Elbert, F., M., Neuner, : Schauer, D. (2003). Overshadowing the threat of terrorism: Developing s D., Horowitz, M., Gelert, L., & Sendor, R., Senderov, : Berger, Treat Adolescents: Group Therapy for and Grief Component Trauma A.M. & Pynoos, R. S. Steinberg, W.R., : Layne, C.M., Saltzman, Basic Books; 200 NY: York, New M., Markowitz, J., Klerman, G.: Comprehensive Guide to Interpersonal Psychotherapy. Weissman, : Psychosocial Intervention Programme for Mothers. Manual prepar A War. : Dybdah, R. (1999). Child Development and the Impact of : Qouta, S., ElSarraj, E., Punamäki, R.-L.: School Mediation. Gaza Community Mental Health Program. Gaza, Palestine 1 2 3 4 5 6 7 8 Hogrefe; 2005 M UNICEF Bosnia and Herzegovina; 2000 M Bergen Psychology, M In the right-hand column, the references in a scienti fi c article reporting the intervention effectiveness, participants’ age participants’ c article reporting the intervention effectiveness, fi In the right-hand column, references in a scienti After this information, there is a note M are presented. Good relations with institution personnel (Wolff & Fesseha, Good relations with institution personnel (Wolff Community attitudes towards traumatized children (Betancourt, Agnew-Blais, Gilman, Community attitudes towards traumatized children (Betancourt, & Ellis, Williams, Fernando & Ferrari, Protective factor factor Protective Resilience-enhancing intervention method techniques used in interventions is brie fl y described in the scienti fi c article, a more detailed description of resilience-ba fi y described in the scienti fl techniques used in interventions is brie graphic resource M Practical Introduction. Routledge, A Therapy: Arts in B. (ed.) (1993). Using the Creative Warren, Publications, Columbus, Ohio. M 2001 (In German) Adolescent Psychiatry, Department of Child and Heidelberg, M [Hebrew] War and Terror of Victims Center for Trauma Israel; Israel TelAviv, M M in Education, 13, 176–184 Work Theoretical dimensions of school-based mediation. Social A. (1991). Moriarty, Religion, spiritual support, community activity (Barber, Religion, spiritual support, community activity (Barber, years; Punamäki et al., 11–17 = age 276 K. Peltonen and E. Palosaari

are accompanied by a workbook. TRT TRT are accompanied by a workbook. reb: McMaster University and UNICEF kit for Supporting Long-Term Recovery. Recovery. kit for Supporting Long-Term t to the Bill & Melinda Gates Foundation. s. Bergen, Norway: Foundation for Children s. Bergen,

http://www.psychosocialcarechildren.org http://www.psychosocialcarechildren.org http://www.childrenandwar.org/resources/teaching-recovery-techniques-trt/ http://www.childrenandwar.org/resources/teaching-recovery-techniques-trt/

http://www.rand.org´/pubs/technical_reports/2006/RAND_TR413.pdf http://www.rand.org´/pubs/technical_reports/2006/RAND_TR413.pdf http://www.childrenandwar.org http://www.childrenandwar.org (continued) : Jaycox, L.H., Morse, L.K. Tanielian, T. Stein, B.D. How Schools Can Help Students Recover From Traumatic Experiences: A Tool A Experiences: Traumatic Stein, B.D. How Schools Can Help Students Recover From T. Tanielian, : Jaycox, L.H., Morse, L.K. : Information concerning manual availability can be obtained from the authors from August 8, 2011, resource package. Retrieved A ict: fl : Psycosocial care for children in con repor A An evaluation of psychosocial interventions supporting Palestinian children & youth: A. (2004). Ager, M., & : Loughry, Both manuals foundation and is available in two versions: war disaster. War The Manual can be obtained from Children and : : Bezic, I., Hart, B. & Uzelac, M.: Opening Door to Non Violence: a Peace Education Manual for Primary Schools in Croatia, Zag Violence: : Bezic, I., Hart, B. & Uzelac, M.: Opening Door to Non : Smith, P., Dyregrov, A., Yule, W., Perrin, S., Gjestad, R. & Gupta, L. (2000). Children and War: Teaching Recovery Technique Recovery Teaching War: Perrin, S., Gjestad, R. & Gupta, L. (2000). Children and W., Yule, A., Dyregrov, : Smith, P., 9 10 11 12 13 14 15 Table 19.1 Table M Santa Monica, CA: Rand Corp; 2006. M Oxford: Refugee Studies Centre M Arabic, Bahasa Malaysian, Chinese, English, French, and Japanese. versions are available in M M Of fi ce, Croatia 1996 M and War. Available: Available: and War. M 19 Evidence-Based Resilience-Enhancing Intervention Methods… 277 for the future, a wide selection of different coping underlying feeling of tension, common forms of skills, as well as the multifaceted skills needed to coping involved information seeking, checking, act and communicate with others did better in and wishful thinking. Punamäki and Suleiman the long run than did children with mental rigid- ( 1990 ) likewise found that children had to use a ity. Congruently, the Refugee Health Program wide variety of cognitive (defensive–purposive) aimed at promoting children’s coping skills for and emotional (helpless–courageous) coping mental distress, self-knowledge, and critical techniques in order to survive the internal confl ict thinking (Barath, 2000) . In interpersonal psy- of “horror and heroism.” Supporting the existence chotherapy, the verbal and nonverbal expression of a wide variety of coping skills in a shelter or of thoughts and feelings was supported, and in other acute military violence situation is impos- group discussions, teenagers were encouraged to sible. However, soon after the worst part is over, focus on developing communication skills interventions have focused on enhancing the cop- (Bolton, 2007 ). ing strategies of children. For example, in Berger Researchers assume that during military vio- et al. (2007 ) and Wolmer et al. ( 2011 ) interven- lence, children tend to narrow their emotional tions among Israeli children, children were taught and imaginative repertoire and use merely an to process and reframe their negative experiences analytical, “adultlike,” tone when talking about and subsequently use positive coping strategies. horri fi c scenes. Creative imagination concerning In a situation where a child is taken and war atrocities may feel too frightening, and there- recruited to become an active perpetrator of mili- fore, children prefer to be detached ( Punamäki, tary violence, the challenges for psychological 1997 ; Garbarino, Dubrow, Kostelny, & Pardo, survival are even bigger. Cortes and Buchanan 1992) . However, in a study by Punamäki et al. ( 2007 ) found that the ability to modulate, con- (2001 ) , creativity was found to be a protective tain, and process emotions in a healthy way factor among war-affected Palestinian children. helped Columbian child soldiers to keep focused In other words, if children were able to use their on what they wanted and needed to do to survive. creativity after an acute war situation, their men- Affect regulation among child soldiers seemed to tal health was better than among children who be a survival tactic in stressful moments because were restricted in their creative thinking. In their it enabled them to stop, think, and get a handle on psychosocial programs with Kosovan and their emotions before acting. In a somewhat dif- Palestinian children, Möhlen, Parzer, Resch, and ferent wartime context, Kithakye et al. ( 2010 ) Brunner (2005 ) and Loughry et al. (2006) utilized found that, among preschool-aged Kenyan chil- a wide variety of creative techniques such as dren, emotion regulation was associated with less painting, playing, acting, connectivity exercises, aggression and more prosocial postcon fl ict and fantasy journeys. Thus, children’s resilience behavior. At least three interventions have tack- might be supported by encouraging them to use led the issue of emotion regulation. Layne et al. their creativity or, rather, by not letting them lose ( 2001, 2008 ) utilized tasks of grieving and losses. their age-salient imagination and ability to play Berger et al. ( 2007) focused on enhancing chil- and create. dren’s emotional awareness and becoming aware Punamäki and Suleiman ( 1990 ) , along with of the connection between sensations and feel- Weisenberg et al. ( 1993 ) , have found evidence ings. Layne et al. ( 2001, 2008 ) , Berger et al. that during acute military violence, children are ( 2007 ), as well as Barath (2000 ) also helped chil- forced to solve the con fl icts between fear and dren to process their angry reactions and deal courage and fi nd the effective ways to handle with rage-identifying signs of fear. Children their emotions and behavior. Weisenberg and col- rehearsed how to express anger and rage in a pro- leagues studied children’s coping behaviors in ductive manner. the sealed room (a shelter against chemical and During military violence, children often expe- biological weapons) during Scud missile attacks rience a continuum of frightening events. The in the Persian Gulf War. While experiencing an basic process of constructing an autobiographi- 278 K. Peltonen and E. Palosaari cal memory by forming an understandable and More specifi cally, sibling relations, social coherent narrative of one’s life events could be integration in the family, and family cohesion challenged because of fragmented and emotional have been found to work as protective factors wartime experiences. However, the understand- against mental health problems among war- able narrative with a sense of one’s own agency affected children (Barber, 2001 ; Laor et al., 2001 ; and self-ef fi cacy predicts children’s well-being Peltonen et al., 2010 ; Punamäki et al., 2001 ) . in the long run (Cortes & Buchanan, 2007 ; These factors are supported in Bolton et al. (2007 ) Punamäki et al., 2001 ; Saigh et al., 1995 ; Thabet, intervention by identifying interpersonal prob- 2009 ). The child-friendly version of Narrative lems in the family and by helping to build skills Exposure Therapy is focused on these issues. In to manage these problems. The important focus safe conditions, the children are supported to on family as a whole was recognized in the inter- construct their own narrative of both positive and vention among Kosovan refugees by Möhlen negative life events. Additionally, the sense of et al. (2005 ) in which there were both individual optimistic future has shown to serve as a protec- and family sessions and psychoeducation of chil- tive factor (Cortes & Buchanan, 2007 ) and has dren’s trauma reactions for parents. been supported in several interventions (Barath, Parents’ role after traumatic experiences is 2000 ; Berger et al., 2007; Ehntholt et al., 2005 ; essential and Lewis and Granic ( 2000 ) state that Onyut et al., 2005) . Their suffering was allevi- there are critical periods when the need for paren- ated when children were taught how to develop a tal help is even more pronounced. It has been positive future outlook, to search for basic values shown that when children perceive their parents and personal goals, and to extend the narration as loving, caring, and supportive—in other words beyond the present and describe their hopes for when they have a secure attachment with parent the future. without exposure to harsh, or even abusive par- In addition to the techniques reported above, enting—that relationship protects the child’s relaxation techniques such as progressive body adjustment, despite the atrocities of war (Cohen, relaxation and guided imagery were included in Dekel, & Solomon, 2002 ; Daud et al., 2008 ; almost all interventions cited. It is noteworthy Feldman & Vengrober, 2011; Harel-Fisch et al., that the ability to maintain an optimal level of 2010; Klasen et al., 2010; Punamäki et al., 2001 ; activity and relaxation, and to avoid states of Thabet et al., 2009 ) . This optimal relationship is hyperarousal, is important to everyone—but is supported by mother’s own psychological well- especially needed when a child is experiencing being, which is associated with positive child something scary and appalling. Ability to relax is adjustment among war-exposed families one of the core elements of mental health and (Ajdukovic & Ajdukovic, 1993 ; Almqvist & could be regarded as a protective factor among Broberg, 1999 ; Bryce et al., 1989 ; Feldman & war-traumatized children, even though at the Vengrober, 2011 ; Laor et al., 2001 ) . Dybdahl’s present moment we were not able to fi nd experi- ( 2001a, b) intervention promoted mothers’ self- mental evidence to support this view among war- con fi dence and ability to care for children as well traumatized children. as mother’s understanding of her own well-being. Dybdahl also focused on mother’s ability to recognize trauma symptoms in children. When also Family and Society the mother–child communication is enhanced, the protective factor of secure attachment and Social processes operate at the peer, family, and parental support is enhanced. Berger et al. ( 2007 ) community level. Betancourt and Khan ( 2008 ) worked with parents by providing them with propose taking the ecological framework into resources and teaching them coping skills, such account in order to build comprehensive inter- as breathing, mindfulness, relaxation, and guided ventions which combat the negative consequences imagery. of war and enhance children’s and families’ Social support from peers and other people adjustment amid war-related stressors. outside the family is also important for child 19 Evidence-Based Resilience-Enhancing Intervention Methods… 279 well-being in war conditions (Farhood, 1999 ; outcomes. It seems, however, that the literature Kuterovac-Jagodic, 2003 ; Llabre & Hadi, 1997 ) . about the aspects that shield children’s mental Layne et al. ( 2001) replied to this need by teach- health in war conditions is well understood ing Bosnian children to provide effective social among intervention planners. In fact, although in support to others and to enrich their personal rela- most cases the focus is on symptom reduction tionship. During intervention children even and trauma recovery, very few interventions are assisted each other in forming speci fi c goals and purely symptom-based, without any resilience- plans for the future and in determining ways to based methods. In fact, it is easy to fi nd examples reach these goals. Likewise, Berger et al. (2007 ) of intervention methods concerning most of the helped children to build a social shield by enhanc- protective factors proposed. ing their support system. Children were guided to However, we have to bear in mind that more explore their social needs and ways to better fulfi ll sophisticated research designs, such as random- them. An important lesson for children was also ized controlled trials, may one day offer new and to learn ways to ask for help and become more even controversial evidence, and it is therefore empathic. Jordan’s et al. (2010 ) intervention, advisable to interpret the fi ndings in this review which took place in Burundi, Sri Lanka, Indonesia, with caution. There are also several techniques and Sudan, focused on encouraging social sup- described in scientifi c articles that have a good port systems, engaging in recreational or tradi- background theory to support their possible effec- tional activities, and normalization through tiveness but which so far have received only a peer-group discussion and activities. Promoting qualitative assessment. For example the interven- children’s communications skills, as well as tion of Harris (2010 ) focused on fostering the peaceful and effective problem-solving skills and sense of collective agency, self-worth, and confl ict resolution, was also the focus among restored capacity for positive interaction. With Croatian and Palestinian children (Woodside the help of dance and movement therapy, ex- et al., 1999 ; Peltonen et al., submitted). combatant teenagers learned how to dispel the On the societal level, religion, spiritual sup- rage and reconnect with others. Intervention port, and community activity might offer children offered them the liberty within a safe space to and adolescents ways to promote mental health in acknowledge their experiences and mourn their the long run (Barber, 2001; Fernando & Ferrari, suffering and that of those whom they had caused 2011 ; Klasen et al., 2010 ; Punamäki et al., 2001 ) . to suffer. This is in line with Klasen et al. (2010 ) Studies of the effects of ideological commitment study, which showed that were not Ugandan child on mental health after political violence have pro- soldiers utilizing cognitive processes NOT related duced divergent fi ndings (Laufer & Solomon, to guilt and motivation to seek revenge were pro- 2010 ; Oren & Possick, 2010 ; Punamäki, 1996 ) . tected from mental health problems. Some evidence exist that the community attitudes Batniji, Van Ommeren, and Saraceno (2006 ) towards traumatized children have a remarkable warn that interventions should not be mechanisti- effect on children’s well-being. Tol et al. (2008 ) cally implemented. Socially appropriate and have proposed techniques that help children to context-specifi c mental health responses should reconnect to their social context whereas Jordans be promoted. In war conditions, where the whole et al. (2010 ) have offered psychoeducation to sen- population is affected, high sensitivity is needed sitize the whole community through mass media. when offering psychosocial support for differen- tially vulnerable individuals. Both symptom- and resilience-based methods are thus needed. It is Implementation Advice and Future important to bear in mind that the same domain Directions in a child’s life such as family relations could serve as protective factor if they are optimal and As argued at the beginning of the chapter, the as risk factor if it were nonoptimal. But regard- enhancement of protective factors and resilience less of the quality of family relations at the base- is very seldom measured in terms of intervention line, children could benefi t from preventive 280 K. Peltonen and E. Palosaari intervention. The protective function of good make sense of the traumatic experience and avoid family relations could be buffered and/or the neg- the development of cognitive confusion and mal- ative or risk function of distorted family relations adaptive beliefs (Salmon & Bryant, 2002 ). could be diminished. In both cases, the outcome Perhaps re fl ecting the brief history of the of the intervention is more or less optimal family research domain and practical dif fi culties in relations, which in the long run fosters the resil- collecting data among war-traumatized chil- ience of the child. For example, coping style, dren, the variety of the age of participants was self-regulation, self-esteem, and locus of control wide in most studies exploring both protective are often referred to as internal variables that can factors and intervention effectiveness. Almost potentially serve either as resiliency or risk fac- all studies explored the mental health and tors in a child’s life (Vanderbilt-Adriance, & adjustment of school-aged children. The only Shaw, 2008) . Peer and family relations, for their exception were the fi ndings of mother’s psycho- part, are external variables that have the same logical well-being (Almqvist & Broberg, 1999 ) twofold nature (Brock, 2002 ) . and secure attachment between child and parent Nguyen-Gillham et al. (2008 ) criticize the pre- as protective factors (Feldman & Vengrober, vailing Western resilience research which under- 2011) and their enhancement with intervention estimates the meaning of communal support and techniques described by Dybdahl (2001a, b ) . care and the importance of peer and family sup- Many of the reviewed resilience-enhancing port. In their qualitative study, Nguyen-Gillham techniques require language skills that are and colleagues asked how adolescents living on not fully developed in preschool children. the West Bank interpret the concept of resilience Researchers should continue to identify the crit- in war conditions. Adolescents viewed supportive ical protective factors at each developmental relationships with family and friends as the key stage and the most effective ways to support elements of resilience. Consonant with that them with psychosocial interventions. For fi nding, social support in its various forms seems example the picture-based materials should be to be the most common method applied among innovatively used when implementing the tech- interventions in this review. Some criticism niques among younger children. related to individualized “Western-style” psycho- It seems that war-affected children living in social care could however be directed to the inter- institutions are somehow a forgotten population ventions reviewed here. The fact that most in the intervention literature. The great work of interventions are conducted in peer groups could Wolff and Fesseha (1998 ) as well as Fernando be seen as a rehabilitative factor as such, but the and Ferrari (2011 ) shows that good relations with family as a whole was very seldom taken as an institution personnel, sense of belonging, and active part of the intervention. Although exhaust- spirituality seem to support children’s adjusting wartime experiences limit parents’ resources ment. At the intervention model called Child- and take a toll on their parenting (Punamäki et al., Friendly Spaces (CFSs), these issues are 2001 ), parents should be informed of possible acknowledged and the opportunities to safety symptoms that their child may develop and and security are provided. The focus is on activi- offered a brief description PTSD symptoms ties in which children can engage in normalizing (Salmon & Bryant, 2002). Psychoeducation of activities in a safe, supervised space. CFS groups some form was offered in most interventions have taken place at least in Afghanistan and reviewed. It also is true that broader communal Uganda, but there is still a paucity of empirical interaction and participation as a healing element evidence regarding whether and how CFSs pro- of interventions is still rare among the interven- duce positive outcomes for children (Kostelny & tions studied. At best, patient and loving parent- Wessells, 2010 ) . ing enables children to regulate their emotions It is noteworthy that some protective factors, and offers adequate coping strategies. Adults such as mental fl exibility and creativity (Punamäki inside and outside the family can help a child to et al., 2001 ; Qouta et al., 2001 ) , seemed to show 19 Evidence-Based Resilience-Enhancing Intervention Methods… 281 their benefi cial function in child adjustment only Betancourt, T. S., & Khan, K. T. (2008). The mental health after the worst atrocities were over. In other of children affected by armed con fl ict: Protective processes and pathways to resilience. International Review words, when there is acute war and violence sur- of Psychiatry, 20(3), 317–328. doi: rounding children, even resilient children might 10.1080/09540260802090363 . suffer. However, in the aftermath of acute vio- Betancourt, T. S., Agnew-Blais, J., Gilman, S. E., Williams, lence, protective factors began to work and chil- D. R., & Ellis, B. H. (2010). Past horrors, present struggles: The role of stigma in the association between war dren who had managed to retain their mental experiences and psychosocial adjustment among former fl exibility and creativity, despite the horrors, had child soldiers in Sierra Leone. Social Science & no or fewer symptoms than children without Medicine, 70, 17–26. doi: 16/j.socscimed.2009.09.038 . these characteristics. A positive interpretation of Biglan, A., Mrazek, P. J., Carnine, D., & Flay, B. R. (2003). The integration of research and practice in the this is that by supporting the factors with the prevention of youth problem behaviors. American intervention methods described in this chapter, Psychologist, 58, 433–440. doi: 10.1037/0003- even those children who have less “naturally 066X.58.6-7.433 . occurring” protective factors are given the oppor- Bleuler, M. (1963). Conception of schizophrenia within the last fi fty years and today. Proceedings of the Royal tunity to reap more of their bene fi ts. We hope that Society of Medicine, 56, 945–952. the knowledge of naturally occurring strengths Bolton, P., Bass, J., Betancourt, T., Spellman, L., Onyango, among children in war zones will bene fi t the G., Clougherty, K. F., et al. (2007). Interventions for planning of preventive- and resilience-based depression symptoms among adolescent survivors of war and displacement in Northern Uganda. JAMA: interventions, without underestimating the nega- The Journal of the American Medical Association, tive consequences of war on child’s mental 298, 519–527. doi: 10.1001/jama.298.5.519 . health. Brock, S. E. (2002). Group crisis intervention. In S. E. Brock, S. R. Jimerson, & P. J. Lazarus (Eds.), Best practices in school crisis prevention and intervention (Chap. 20) (Vol. 2005). Bethesda, MD: National References Association of School Psychologists. Brown, C. H., & Liao, J. (1999). Principles for designing Ajduković, M., & Ajduković, D. (1993). Psychological randomized preventive trials in mental health: An well-being of refugee children. Child Abuse & Neglect, emerging developmental epidemiology paradigm. 17 , 843–854. doi: 10.1016/S0145-2134(08)80014-2 . American Journal of Community Psychology, 27, Almqvist, K., & Broberg, A. G. (1999). Mental health and 673–710. doi: 10.1023/A:1022142021441 . social adjustment in young refugee children 3½ years Bryce, J. W., Walker, N., Ghorayeb, F., & Kanj, M. (1989). after their arrival in Sweden. Journal of the American Life experiences, response styles and mental health Academy of Child and Adolescent Psychiatry, 38 , among mothers and children in Beirut, Lebanon. 723–730. doi: 10.1097/00004583-199906000-00020 . Social Science & Medicine, 28, 685–695. Barath, A. (2000). Treating war trauma in children and doi: 10.1016/0277-9536(89)90216-5 . youth from the former Yugoslavia (electronic version). Chase, R., Doney, A., Sivayogan, S., Ariyaratne, V., In N. Dimitrijevic (Ed.), Managing multiethnic local Satkunanayagam, P., & Swaminathan, A. (1999). communities in the countries of the former Yugoslavia Mental health initiatives as peace initiatives in Sri (pp. 355–368). Budapest: Local Government and Lankan school children affected by armed con fl ict. Public Reform Initiative. Medicine, Con fl ict and Survival, 15(4), 379–390. Barber, B. K. (2001). Political violence, social integration, Cohen, E., Dekel, R., & Solomon, Z. (2002). Long-term and youth functioning: Palestinian youth from the Intifada. adjustment and the role of attachment among Holocaust Journal of Community Psychology, 29 , 259–280. child survivors. Personality and Individual Differences, doi: 10.1002/jcop.1017 . 33(2), 299–310. doi: 10.1016/S0191-8869(01)00156-8. Berger, R., Pat-Horenczyk, R., & Gelkopf, M. (2007). Cohen, J. A., & Mannarino, A. P. (2008). Trauma-focused School-based intervention for prevention and treat- cognitive behavioural therapy for children and par- ment of elementary students’ terror-related distress in ents. Child and Adolescent Mental Health, 13 , 158– Israel: A quasi-randomized controlled trial. Journal 162. doi: 10.1111/j.1475-3588.2008.00502.x . of Traumatic Stress, 20(4), 541–551. doi:10.1002/ Cohen, J. A., Mannarino, A. P., Berliner, L., & Deblinger, jts.20225. E. (2000). Trauma-focused cognitive behavioral Batniji, R., Van Ommeren, M., & Saraceno, B. (2006). therapy for children and adolescents. Journal Mental and social health in disasters: Relating qualita- of Interpersonal Violence, 15 , 1202–1223. tive social science research and the sphere standard. doi: 10.1177/088626000015011007 . Social Science & Medicine, 62 (8), 1853–1864. Cortes, L., & Buchanan, M. J. (2007). The experiences of doi: 10.1016/j.socscimed.2005.08.050 . Colombian child soldiers from a resilience perspec- 282 K. Peltonen and E. Palosaari

tive. International Journal for the Advancement of Harel-Fisch, Y., Radwan, Q., Walsh, S. D., Laufer, A., Counselling, 29, 43–55. doi: 10.1007/s10447-006- Amitai, G., Fogel-Grinvald, H., & Abdeen, Z. (2010). 9027-0 . Psychosocial outcomes related to subjective threat Cryder, C., Kilmer, R., Tedeschi, R., & Calhoun, L. from armed conﬂ ict events (STACE): Findings from (2006). An exploratory study of Posttraumatic growth the Israeli-Palestinian cross-cultural HBSC study. in children following a natural disaster. The American Child Abuse & Neglect, 34, 623–638. doi: 10.1016/j. Journal of Orthopsychiatry, 76 , 65–69. chiabu.2009.12.007. doi: 10.1037/0002-9432.76.1.65 Harris, D. A. (2010). When child soldiers reconcile: Daud, A., af Klintberg, B., & Rydelius, P.-A. (2008). Accountability, restorative justice, and the renewal of Resilience and vulnerability among refugee children empathy. Journal of Human Rights Practice, 2 (3), of traumatised and non-traumatized parents. Child and 334–354. doi: 10.1093/jhuman/huq015 . Adolescent Psychiatry and Mental Health, 2 , 7. Howar, S., Dryden, J., & Johnson, B. (1999). Childhood doi: 10.1186/1753-2000-2-7 resilience: Review and critique of literature. Oxford Davydov, D. M., Stewart, R., Ritchie, K., & Chaudieu, I. Review Education, 25(3), 307–323. (2010). Resilience and mental health. Clinical Inter-Agency Standing Committee (IASC). (2007). IASC Psychology Review, 30(5), 479–495. doi: 10.1016/j. guidelines on mental health and psychosocial support cpr.2010.03.003. in emergency settings . Geneva: IASC. Dybdahl, R. (2001a). A psychosocial support program for International Federation Reference Centre for Psychosocial children and mothers in war. Clinical Child Psychology Support. (2007). Community-based psychosocial sup- and Psychiatry, 6, 425–437. doi: port. Trainer’s book. A training kit. Copenhagen: PS 10.1177/1359104501006003010. Centre Publications. Dybdahl, R. (2001b). Children and mothers in war: An Jordans, M. J., Tol, W. A., Komproe, I. H., Susanty, D., outcome study of a psychosocial intervention pro- Vallipuram, A., Ntamatumba, P., et al. (2010). gram. Child Development, 72 , 1214–1230. doi: Development of a multi-layered psychosocial care 10.1111/1467-8624.00343. system for children in areas of political violence. Ehntholt, K. A., Smith, P. A., & Yule, W. (2005). School- International Journal of Mental Health Systems, 4 , 15. based cognitive-behavioural therapy group intervention doi:10.1186/1752-4458-4-15. for refugee children who have experienced war-related Kilmer, R. P., Gil-Rivas, V., Tedeschi, R. G., Cann, A., trauma. Clinical Child Psychology and Psychiatry, 10 , Calhoun, L. G., Buchanan, T., & Taku, K. (2009). Use 235–250. doi: 10.1177/1359104505051214. of the revised posttraumatic growth inventory for chil- Ehntholt, K. A., & Yule, W. (2006). Practitioner review: dren. Journal of Traumatic Stress, 22 (3), 248–253. Assessment and treatment of refugee children and ado- doi:10.1002/jts.20410. lescents who have experienced war related trauma. Kithakye, M., Morris, A. S., Terranova, A. M., & Myers, S. Clinical Child Psychology and Psychiatry, 47(12), S. (2010). The Kenyan political con ﬂ ict and children’s 1197–2010. doi: 10.1111/j.1469-7610.2006.01638.x. adjustment. Child Development, 81 (4), 1114–1128. Farhood, L. F. (1999). Testing a model of family stress doi:10.1111/j.1467-8624.2010.01457.x. and coping based on war and non-war stressors, fam- Klasen, F., Oettingen, G., Daniels, J., Post, M., Hoyer, C., ily resources and coping among Lebanese families. & Adam, H. (2010). Posttraumatic resilience in former Archives of Psychiatric Nursing, 13 , 192–203. Ugandan child soldiers. Child Development, 81 (4), doi: 10.1016/S0883-9417(99)80005-3 . 1096–1113. doi:10.1111/j.1467-8624.2010.01456.x. Feldman, R., & Vengrober, A. (2011). Posttraumatic Kok, G., Schaalma, H., Ruiter, R.A., Van Empelen, P., & stress disorder in infants and young children exposed Brug, J. (2004). Intervention mapping: Protocol for to war-related trauma. Journal of the American applying health psychology theory to prevention pro- Academy of Child & Adolescent Psychiatry, 50(7), grammes. Journal of Health Psychology, 9(1), 85–98. 645–658. doi: 10.1016/j.jaac.2011.03.001. doi: 10.1177/1359105304038379. Fernando, C., & Ferrari, M. (2011). Spirituality and resil- Kostelny, K. & Wessells, M. (2010). Psychosocial ience in children of war in Sri Lanka. Journal of Assessment of Education in Gaza and Recommendations Spirituality and Mental Health, 13 , 52–77. doi: 10.1080/ for Response. UNESCO. Retrieved Feb 5, 2013 from 19349637.2011.547138 . http://resourcecentre.savethechildren.se/content/ Foa, E., Keane, T., & Friedman, M. (2000). Effective library/documents/psychosocialassessment-education- treatments for PTSD: Practice guidelines from the gaza-and-recommendations-response . international society for traumatic stress studies . New Kuterovac-Jagodic ´, G. (2003). Posttraumatic stress symp- York: The Guilford Press. toms in Croatian children exposed to war: A prospective Forchuk, C. (2001). Evidence-based psychiatric/mental study. Journal of Clinical Psychology, 59, 9–25. health nursing. Evidence-Based Mental Health, 4 , doi:10.1002/jclp.10114. 39–40. doi: 10.1136/ebmh.4.2.39. Laor, N., Wolmer, L., & Cohen, D. J. (2001). Mother’s Garbarino, J., Dubrow, N., Kostelny, K., & Pardo, C. functioning and children’s symptoms 5 years after (1992). Children in danger: Coping with the conse- SCUD missile attack. The American Journal of quences of community violence . San Francisco, CA: Psychiatry, 158 , 1020–1026. doi: 10.1176/appi. Jossey-Bass. ajp.158.7.1020 19 Evidence-Based Resilience-Enhancing Intervention Methods… 283

Laufer, A., & Solomon, Z. (2010). Political ideology and The management of PTSD in adults and children in psychological symptoms following terror. Youth Society, primary and secondary care. Retrieved Feb 4 2013, 41 (3), 414–433. doi: 10.1177/0044118X09333658 . from www.nice.org.uk/CG026NICEguideline . Layne, C. M., Beck, C. J., Rimmasch, H., Southwick, J. S., NCTSN (National Child Traumatic Stress Network). Moreno, M. A., & Hobfoll, S. E. (2009). Promoting 2005. Mental health interventions for refugee children “resilient” post-traumatic adjustment in childhood and in resettlement. White paper II from the national child beyond: “Unpacking” life events, adjustment trajecto- traumatic stress network. Refugee trauma task force. ries, resources, and interventions. In D. Brom, P. Pat- Nguyen-Gillham, V., Giacaman, R., Naser, G., & Bouyce, Horenczyk, & J. Ford (Eds.), Treating traumatized W. (2008). Normalising the abnormal: Palestinian youth children. Risk, resilience and recovery. East Sussex: and the contradictions of resilience in protracted con fl ict. Routledge. Health and Social Care in the Community, 16(3), 291–298. Layne, C. M., Pynoos, R. S., Saltzman, W. R., Arslanagic´, doi: 10.1111/j.1365-2524.2008.00767.x . B., Savjak, N., Popoviz, T., et al. (2001). Trauma/grief- Onyut, L., Neuner, F., Schauer, E., Ertl, V., Odenwald, M., focused group psychotherapy: School-based postwar Schauer, M., et al (2005). Narrative exposure therapy as intervention with traumatized Bosnian adolescents. a treatment for child war survivors with posttraumatic Group Dynamics: Theory, Research, and Practice, 5 , stress disorder: Two case reports and a pilot study in an 277–290. doi: 10.1037/1089-2699.5.4.277 . African refugee settlement. BMC Psychiatry, 5 , 7–9. Layne, C. M., Saltzman, W. R., Poppleton, L., Burlingame, doi:10.1186/1471-244X-5-7 G. M., Pasalic, A., Durakovic, E., et al. (2008). Oren, L., & Possick, C. (2010). Is ideology a risk factor Effectiveness of a school-based group psychotherapy for PTSD symptom severity among Israeli political program for war-exposed adolescents: A randomized evacuees? Journal of Traumatic Stress, 23 (4), 483– controlled trial. Journal of the American Academy of 490. doi: 10.1002/jts.20540 . Child and Adolescent Psychiatry, 47 , 1048–1062. Peltonen, K., & Punamäki, R.-L. (2010). Preventive inter- doi: 10.1097/CHI.0b013e31817eecae ventions among children exposed to trauma of armed Lewis, M. D., & Granic, I. (Eds.). (2000). Emotion, develop- con fl ict: A literature review. Aggressive Behavior, ment, and self-organization: Dynamic systems approaches 36 (2), 95–116. doi:10.1002/ab.20334. to emotional development, Cambridge studies in social Peltonen, K., Qouta, S., Sarraj, E. E., & Punamäki, R.-L. and emotional development (pp. 37–69). New York, NY, (2010). Military trauma and social development: The US: Cambridge University Press, xiii, 411pp. moderating and mediating roles of peer and sibling Llabre, M. M., & Hadi, F. (1997). Social support and psy- relations in mental health. International Journal of chological distress in Kuwaiti boys and girls exposed Behavioral Development, 34 (6), 554–563. to the Gulf crisis. Journal of Clinical Child Psychology, doi:10.1177/0165025410368943. 26 , 247–255. doi:10.1207/s15374424jccp2603_3. Punamäki, R.-L. (1996). Can ideological commitment Lloyd, E., Penn, H., Barreau, S., Burton, V., Davis, R., protect children’s psychosocial well-being in situa- Potter, S., et al. (2005). How effective are measures tions of political violence? Child Development, 67, taken to mitigate the impact of direct experience of 55–69. doi:10.1111/j.1467-8624.1996.tb01719.x. armed confl ict on the psychosocial and cognitive Punamäki, R.-L. (1996). Can ideological commitment development of children aged 0–8? In: Research evi- protect children’s psychological well-being in politi- dence in education library. London: EPPI-Centre, cal violence? Child Development, 67 , 55–69. Social Science Research Unit, Institute of Education, doi:10.1111/j.1467-8624.1996.tb01719.x. University of London. Punamäki, R. L. (1997). The mental health function of Loughry, M., Ager, A., Flouri, E., Khamis, V., Afana, A., dreaming and playing (pp. 259–271). Gaza: Gaza H., & Qouta, S. (2006). The impact of structured activ- Community Mental Health Program Publications. ities among Palestinian children in a time of confl ict. Punamäki, R., Muhammed, A. H., & Abdulrahman, Journal of Child Psychology and Psychiatry, 47(12), H. A., (2001). Impact of traumatic events on coping 1211–1218. 10.1111/j.1469-7610.2006.01656.x. strategies and their effectiveness among Kurdish chil- Luthar, S. S., & Cicchetti, D. (2000). The construct of resil- dren. International Journal of Behavioral Development, ience: Implications for interventions and social policies. 28(1), 59–70. doi: 10.1080/01650250344000271 . Development and Psychopathology, 12(4), 857–885. Punamäki, R. L., Qouta, S., & El Sarraj, E. (2001). Meehl, P. E. (1962). Schizotaxia, schizotypy, schizophre- Resiliency factors predicting psychological adjust- nia. American Psychologist, 17, 827–838. doi:10.1037/ ment after political violence among Palestinian chil- h0041029 dren. International Journal of Behavioral Development, Möhlen, H., Parzer, P., Resch, F., & Brunner, R. (2005). 25 , 256–267. doi:10.1080/01650250042000294. Psychosocial support for war-traumatized child and Punamäki, R.-L., & Suleiman, R. (1990). Predictors and adolescent refugees: Evaluation of a short-term effectiveness of coping with political violence among treatment program. The Australian and New Zealand Palestinian children. British Journal of Social Journal of Psychiatry, 39, 81–87. doi:10.1111/j.1440- Psychology, 29 , 67–77. doi:10.1111/j.2044-8309.1990. 1614.2005.01513.x tb00887.x. National Institute for Clinical Excellence. (2005). Clinical Qouta, S., El-Sarraj, E., & Punamäki, R.-L. (2001). Mental guideline 26. Post-traumatic stress disorder (PTSD). fl exibility as resiliency factor among children exposed 284 K. Peltonen and E. Palosaari

to political violence. International Journal of Vanderbilt-Adriance, E., & Shaw, D., (2008). Psychology, 36, 1–7. doi:10.1080/00207590042000010 Conceptualizing and re-evaluating resilience across Rodenburg, R., Benjamin, A., de Roos, C., Meijer, A. M., levels of risk, time, and domains of competence. & Stams, G. J. (2009). Ef fi cacy of EMDR in children: Clinical Child and Family Psychology Review, 11 , A meta-analysis. Clinical Psychology Review, 29 (7), 30–58. doi:10.1007/s10567-008-0031-2. 599–606. doi: 10.1016/j.cpr.2009.06.008 . Waddell, C., & Godderis, R. (2005). Rethinking evidence- Rosenthal, D. (1963). A suggested conceptual framework. based practice for children’s mental health. Evidence- In D. Rosenthal (Ed.), The Genian quadruplets (pp. Based Mental Health, 8 , 60–62. doi:10.1136/ 505–516). New York: Basic Books. ebmh.8.3.60. Saigh, P. A., Mroueh, M., Zimmerman, B. J., & Fairbank, J. Weisenberg, M., Schwarzwald, J., Waysman, M., A. (1995). Self-effi cacy expectations among trauma- Solomon, Z., & Klingman, A. (1993). Coping of tized adolescents. Behaviour Research and Therapy, school-age children in the sealed room during scud 33 , 701–704. doi:10.1016/0005-7967(94)00092-X. missile bombardment and postwar stress reactions. Salmon, K., & Bryant, R. A. (2002). Posttraumatic stress Journal of Consulting and Clinical Psychology, 61 , disorder in children: The infl uence of developmental 462–467. doi:10.1037/0022-006X.61.3.462 factors. Clinical Psychology Review, 22(2), 163–188. Wolff, P. H., & Fesseha, G. (1998). The orphans of Eritrea: Are doi. 10.1016/S0272-7358(01)00086-1 . orphanages part of the problem or part of the solution? The Schaeffer, C. M., Bruns, E., Weist, M., Stephan, S. H., American Journal of Psychiatry, 155, 1319–1324 Goldstein, J., & Simpson, Y. (2005). Overcoming Wolmer, L., Hamiel, D., & Laor, N. (2011). Preventing chil- challenges to using evidence-based interventions in dren’s posttraumatic stress after disaster with teacher- schools. Journal of Youth and Adolescence, 34 , 15–22. based intervention: A controlled study. Journal of the doi:10.1007/s10964-005-1332-0 American Academy of Child and Adolescent Psychiatry, Thabet, A. A., Ibraheem, A. N., Shivram, R., Winter, E. A., 50, 340–348. doi:10.1016/j.jaac.2011.01.002 & Vostanis, P. (2009). Parenting support and PTSD in Woodside, D., Santa Barbara, J., & Benner, D. G. (1999). children of a war zone. International Journal of Social Psychological trauma and social healing in Croatia. Psychiatry, 55(3), 226–237. doi: 10.1177/ Medicine, Confl ict & Survival, 15(4), 355–367. 0020764008096100. doi:10.1080/13623699908409477. Tol, W.A., Komproe, I.H., Susanty, S., Jordans, M.J.D., Yule, W. (2002). Alleviating the effects of war and dis- Macy, R.D., & De Jong, J.T.V.M. (2008). School-based placement on children. Traumatology, 8 (3), 160–180. mental health intervention for children affected by doi:10.1177/153476560200800304. political violence in Indonesia: A cluster randomized Zubin, J., & Spring, B. (1977). Vulnerability, a new view trial. JAMA, 300(6), 655–662. doi: 10.1001/ of schizophrenia. Journal of Abnormal Psychology, jama.300.6.655 . 86 , 103–126. doi:10.1037/0021-843X.86.2.103. P a r t V I Conclusion Resilience in Children of War 2 0 Michel Ferrari and Chandi Fernando

ﬁ ndings uncovered about how to study and how Introduction to promote resilience in children of war.

They caught us, all of us in there [at school], and Prevalence and Effects of War on Children . they put us in the truck. We were heading to the Modern warfare increasingly targets civilians. camp. So they drove us a few miles away from the Indeed, more than 23 million people have been school and then they stopped, somewhere, at killed in 149 major con fl icts since the end of another village, to get more people. And that’s where we got a chance, me and my friends, and we WWII. Worldwide, mortality rates associated jumped out of the truck and started running. One with political violence vary from 1 per 100,000 of us were running in different direction as my population in high-income countries to 6.2 per friend. So then they start shooting at us but I was, 100,000 population in low- and middle-income like, I didn’t get shot. Since then, after jumping the truck, I never turn back or looking back to my vil- countries, with the highest rate of war-related lage. I kept running, running, running. deaths in African countries at about 32 fatalities per 100,000. As a result of these con fl icts, there This vivid story by one of the participants are 27.1 million internally displaced persons and caught by rebels in McAdam’s chapter, shows 10.3 million refugees (UNHCR, 2011 ) . By more poignantly than any statistic or logical argu- another count, the number of people forcibly dis- ment, the terrible experiences that some children placed has now risen to 43.3 million, a fi gure undergo as victims of war. Many might think that exacerbated by the low numbers of repatriations such experiences would be impossible to over- that have occurred over the past 20 years ( http:// come, but in fact this volume shows the many www.unhcr.org , 2010). ways in which children show resilience in the Children are increasingly affected by modern face of such and sometimes even more diffi cult war (Williams & Drury, 2011 ) . UNICEF (1996) and tragic personal experiences. This fi nal chap- estimates that from 1986 to 1996 wars killed two ter reviews some of the main themes and main million children and left one million orphaned or separated from their parents. The International Committee of the Red Cross (ICRC) reported that in 2008, 18 million children were forced M. Ferrari (*) • C. Fernando to leave their homes either as refugees or as Applied Psychology and Human Development , internally displaced persons (2009, p. 1). In 2009, Ontario Institute for Studies in Education, University of 41% of refugees and asylum seekers were Toronto, Bloor Street West 252 , below 18 years of age (United Nations High Toronto , ON , Canada M5S 1V6 e-mail: [email protected] ; Commissioner for Refugees (UNHCR, 2010 ) ); [email protected] 4% of all asylum applicants in developed

C. Fernando and M. Ferrari (eds.), Handbook of Resilience in Children of War, 287 DOI 10.1007/978-1-4614-6375-7_20, © Springer Science+Business Media New York 2013 288 M. Ferrari and C. Fernando countries in 2003 were unaccompanied refugee can be as traumatic as the direct experience of children (UNHCR, 2004 ) ; living without the violence, as Ventevogel et al., (this volume) show support and protection of adults, these children for Afghan children; this can perhaps be explained are a particularly vulnerable group (Hepburn, through observational learning. Other studies Williamson, & Wolfram, 2004 ) , as described in cited support Ventevogel et al., on this point. For Bates and colleagues’ chapter on the “Lost Boys example, 60% of European asylum children had of Sudan.” been exposed to violence (Montgomery & Foldspang, 2007 , cited in Magid & Boothby, this Magid and Boothby note that the experience of volume). African children are especially vulnera- war is not a single risk, and the precise nature of its ble: a 1996 Rwandan survey found that 96% of risk to children depends on the nature of their expe- children surveyed had witnessed violence, 80% riences during warring. In fact, children in war had lost a family member, and 70% had seen zones face a wide range of interrelated risks: direct someone killed or injured. In the 1989 study of physical risk, risk of vicarious suffering by wit- Mozambican children previously mentioned, 88% nessing the abuse and death of those close to them, had witnessed physical abuse or torture, 77% had psychosocial risk of disruption of their family and witnessed murder, and 63% had witnessed rape or community life, and, certainly, risk of psychologi- sexual abuse (Boothby et al., 1991, 2006). cal trauma as a result of their war experiences (Werner, 2012 ; Williams & Drury, 2011 ) . Psychosocial Disruption Causing Suffering . As Kostelny and Wessells—and many other con- Direct Physical Suffering. Chapter authors tributors to this volume—highlight, some of the remind us that children are disproportionately greatest risks children face in situations of polit- affected by kidnapping and injury and are more ical violence are psychosocial. As Daiute (this likely to be victims of acts of abuse (i.e., to be volume) rightly points out, political violence abducted, arrested, held in detention, or tortured); causes many forms of separation and loss: chil- they are often forced into slavery, detained in dren often become separated from their home- camps, or unlawfully adopted. Sexual exploita- land, family, and the accompanying interactions tion is a major source of concern, including the with loved ones, neighbors, and familiar risk of HIV and AIDS, as children are sometimes institutions because of con fl ict. Beyond family, raped and forced into prostitution or early mar- children often experience disruption to their riages. Children are also taken as a source of communities, including the destruction of homes labor—often dangerous labor—and recruitment and neighborhoods, in addition to the loss of into the armed forces that exposes them to com- educational opportunity when schools are bat, shelling, and other life-threatening situations. destroyed, teachers dispersed, and travel to Some children become child soldiers and them- school becomes too dangerous (Bernard van selves participate in violent acts, but Magid and Leer Foundation, 2005; Shemyakina, 2011 ; Boothby are right to remind us that these children Wessells & Kostelny, 1996; Williams & Drury, are also victim of war. Magid and Boothby also 2011 ; Williamson & Robinson, 2006 ) . Sadly, note that African children are especially vulnera- some children born during political con fl ict ble, citing a 1989 study of Mozambican children have never known a peaceful family life or sup- in which 64% had been abducted from their fami- portive social institutions. lies and 51% had been physically abused or tortured (Boothby, Crawford, & Halprin, 2006 ; Mental Suffering . Given these potentially mas- Boothby, Upton, & Sultan, 1991 ). sive physical and psychosocial disruptions, children’s mental health is naturally at risk. Recent Vicarious suffering is also very prevalent among research on children of war has generally focused children. Indeed, indirect exposure to violence on post-traumatic stress disorder (PTSD), but a 20 Resilience in Children of War 289 long history of research suggests that such children Barber and Doty, free up resources for a more show a spectrum of psychological symptoms that focused effort to determine who is not resilient include depressed affect, anxiety, fear of recur- and under what circumstances. Far from propos- rence, guilt, grief, insomnia, enuresis, delin- ing a Panglossian view of resilience in the face of quency, and post-traumatic stress; acute stress adversity, all the contributors to this volume pro- reactions include nightmares, exaggerated startle pose a more nuanced study of both successful reactions, somatic complaints, and sleep distur- and unsuccessful coping with the brutality of war bance (Buchhanan et al., this volume; Espié et al., (Betancourt & Khan, 2008 ) that heightens our 2009 ; Muldoon, this volume; Nielsen et al., 2008 ; attention to its tragic effects on children, while Richman, 1993 ) . Unique to children, the type of proposing ways to minimize these effects anxiety manifested relates to the child’s develop- (Bonanno, 2005 ; Kraemer, 2003 ) . mental level, which frames their understanding Recent work by Bonanno, Westphal, and of events experienced (Bruyere & Garbarino, this Mancini (2011 ) supports this point. Using latent volume). 1 trajectory modeling to identify a set of prototypi- Counterintuitively, Barber and Doty (this vol- cal outcome patterns (resilience, recovery, chronic ume) contest the extent of this threat to the men- distress, delayed reaction, continuous distress, tal well-being of children and youth. According and distress followed by improvement), they to these authors, most youth exposed to political found that the most common outcome following violence show no sign of dysfunction, because a potentially traumatic event is a stable trajectory their understanding of their war experiences of healthy functioning or resilience. However, depends on the speci fi c nature and severity of such resilience is not the result of a few dominant those experiences and on how they are inter- factors, but rather of multiple independent pre- preted; even statistical analyses necessarily dictors of resilient outcomes, more specifi cally, re fl ect the probability of risk, not its certainty. personality, demographic variation (i.e., higher More generally, Barber and Doty claim that education, being male, and higher income), level research needs to examine: (1) the speci fi c type of trauma exposure, social and economic of confl ict exposure children have experienced, resources, a priori worldviews, and capacity for including the indirect effects of political con fl ict; positive emotions. Since most of these predictors (2) its effect on speci fi c domains of youth func- refer to dimensions of personal life that are virtu- tioning; and (3) the long-term effects of different ally impossible to change (e.g., gender) or are types of exposure. As Garbarino and Bruyere very diffi cult to change (e.g., personality, or note, some traumatic events’ effects are felt only social resources), it is important to consider care- years, even decades, after the events themselves. fully what we might do to help children exposed For Barber and Doty, the evidence shows that to war engage a trajectory of resilience, espe- most children are resilient even under extremely cially those who are at the highest risk. adverse conditions, an idea that at fi rst seems This importance is especially true in light of improbable but is supported by data presented in recent sobering fi ndings from a study of chronic the chapters by Stermac et al., Robinson, and political con fl ict experienced by now-adult Zack-Williams. Acknowledging this truth, say Palestinian residents of the West Bank, Gaza, and East Jerusalem (Hobfoll et al., 2011, 2012 ), in which resilience and resistance are relative terms 1 Stermac and Robinson, in their chapters, note a range of in the context of repeated or chronic traumatic short-term and long long-term consequences for the men- life-circumstances. What this means is that there tal health of child refugees. Most of these reviews are is no majority, nor even a substantive percentage restricted to the mental health of resettled refugees and of people living in such conditions who are symp- conclude that, as a group, child refugees show greater emotional and behavioral problems than nonrefugees; tom free, or experience only a few symptoms of trauma also affects learning (Punamaki, 2001; Stermac distress as their own previous work had argued et al., this volume). (Bonanno et al., 2011 ) . Although the overall 290 M. Ferrari and C. Fernando

patterns found in this study were similar to those Although psychiatrists, psychologists, epide- observed in earlier studies, the fl oor levels of low miologists, and policy-makers often speak in symptoms were noticeably higher. Adjusting this terms of “mental health problems” and “mental fl oor level of responding has major theoretical, as disorders” as the outcome of exposure to politi- well as practical implications. Most specifi cally, cal violence, many social scientists and humani- normal adaptive mechanisms that produce great tarian workers prefer to focus attention on resilience and resistance to psychological distress “psychosocial well-being,” de fi ned as a dynamic can be overpowered by ongoing mass casualties relationship that exists between psychological and economic depression brought on by war. and social processes (Williamson & Robinson, Indeed, this study found that loss of psychosocial 2006). 2 However, we need to think more broadly and material resources generated greater distress about protective factors that promote resilience. experiences at each time period measured, sug- Following Davydov and colleagues (2010 ), gesting the need for resource-based interventions Peltonen suggests that promoting mental health for people experiencing chronic trauma that focus and psychosocial support can be done in one of on personal resources (e.g., self-effi cacy, work three ways: skills), social resources (e.g., family and commu- I . Health protection fosters protective capaci- nity ties), material resources (e.g., food and liv- ties that a person has during traumatic ing accommodations), and condition resources experience. (e.g., job availability and accessibility). And in II. Harm reduction allows individuals to bounce fact, this is precisely the approach to research back after a trauma-related health distur- intervention adopted by all the contributors to bance. On this view, resilience is a special this volume, who universally propose means to case of harm reduction in the face of identifi ed promote psychosocial well-being. risk factors experienced. III. Health promotion develops new capacities that allow people to respond more effectively Promoting Psychosocial Well-Being to similar or new adverse events—i.e., be stronger or use better coping strategies—the Current research on the effects of political vio- next time they face new adverse events (anal- lence on children has primarily focused on the ogous to a “vaccine effect”). 3 pathological consequences of political violence While it is important to work from this more on individual children. This is partly due to the comprehensive perspective, the real dif fi culty is dominance of the developmental psychopathol- in fi nding ways to study psychosocial well-being ogy paradigm over the last two decades, as well as scienti fi cally. to the tacit assumption that childhood and adolescent experiences are formative for later life. All the authors in this volume, however, question this way of framing risk and resilience in children of war, arguing that resilience research must involve 2 In this volume, we follow a growing consensus estab- more than the study of individual attributes shap- lished in the humanitarian sector (IASC, 2007 ) and use ing worse-than- or better-than-expected health the composite term “mental health and psychosocial sup- outcomes; rather, it must contextualize develop- port” advocated by Ventevogel and colleagues to describe “any type of local or outside support that aims to protect mental and social trajectories, and identify critical or promote psychosocial well-being and/or prevent or changes to social, educational, and material envi- treat mental disorder” (Wessells & Van Ommeren, 2008 ) . ronments that can shift individual trajectories 3 Health promotion resembles the concept of post-trau- towards more favorable health outcomes despite matic growth, de fi ned as “positive change resulting from the severe diffi culties many civilians experience one’s struggle with trauma-positive change experienced as a result of struggle with major loss or trauma” (Triplett during wartime (Panter-Brick, Goodman, Tol, & et al., 2012; Kilmer et al., 2009; Calhoun & Tedeschi, Eggerman, 2011 , this volume). 2006 ; Tedeschi & Calhoun, 2004 ) . 20 Resilience in Children of War 291

Dif fi culty of Scientifi cally Studying Assessment of Interventions to Help Children of Effects of War on Children War . Efforts to assess the effects of speci fi c interventions used to help children of war are described Assessment of the Effects of War . Few people in chapters by Robinson, Stermac, Bates, and doubt that war is a dif fi cult and traumatic experi- their coauthors, for example, promoting success- ence, especially for children, but as the chapters ful immigrant resettlement or education. in this volume show, the effects of war on chil- Assessing the effects of such interventions has its dren are not so easy to study scienti fi cally. How own dif fi culties: for example, as Robinson notes, should we study the effects of war on children? it is diffi cult to establish a valid comparison group In fact, a variety of methods are available and for such studies. Some studies use matched sam- many have been used by authors in this volume, ples from the general population of the same com- including, ethnography, observation, narrative munity or matched samples from minority groups inquiry, epidemiological methods, and clinical in the same community (e.g., Fazel & Stein, interviews. These methods run the gamut from 2003) , large samples from the general population scale-based measures (in which participants indi- of the host country (e.g., Vaage et al., 2009 ) , or cate which listed items they have experienced) to children under clinical care in resettlement coun- naturalistic discourse analysis of clinical inter- tries (e.g., Mollica, Poole, Son, Murray, & Tor, views ( Weine et al., 2006 ) and personal narratives 1997 ) . All of these methods, however, make it (Cortes & Buchanan, 2007 ; Fernando & Ferrari, hard to determine the source of any positive or 2011 ) ; some even draw on historical archival negative outcome because child refugees differ material to understand the roots of long-standing from typical control groups in a variety of ways— confl icts. However, as Magid and Boothby (this for example, in their war experiences, migration, volume) point out, war zones present children or acculturative stress. Instead, Robinson pro- with multiple war-associated risks, and so risk poses a different research design that compares cannot be understood as the experience of a single the direct and indirect effects of war exposure by traumatic event (e.g., displacement, physical child refugees to that of voluntary migrant chil- injury, or the death of a loved one). dren attending the same school, who also have For this reason, some researchers have used a little or no knowledge of English. risk-accumulation model in which they propose that a certain number of risks (above 4) to an indi- What Is the Best Kind of Evidence for vidual within family and community (e.g., family Understanding Resilience? Rather than ask “who instability or chronic poverty) will have a higher is resilient?” it is better to ask “what conditions probability of leading to a maladaptive outcome. allow for and sustain resilience in individuals at Most children are thought capable of handling different moments in life? ”—the essential point low levels of risk, but accumulated risk jeopar- of Ungar’s (2011, 2012 ) social-ecological model. dizes development, unless compensatory forces Conditions that promote resilience can often are brought into play (Balwin, Balwin, & Coles, include the presence of speci fi c institutions like 1990 ; Rutter, 2006; Sameroff, Siefer, Baracos, schools or orphanages whose programs promote Zax, & Greenpsan, 1987 ; Werner & Smith, 2001 ) . and protect children, or specially engineered However, there is still no consensus on how to Child Friendly Spaces (Kostelny & Wessells, this assess risk and resilience, and although a range of volume). However, resources need to be mapped measures have been proposed (e.g., total number at all levels of a social ecology from cultural of traumatic events experienced, range of types beliefs down to biological predispositions, with a of events, duration of exposure, or intensity), consideration of how these different levels inter- each of these methods has limitations. act in a dynamic ways (Masten, 2007, 2011 ) . 292 M. Ferrari and C. Fernando

According to Barber and Doty (this volume) cycle. To test such hypotheses would mean research should better identify and map social, implementing sophisticated multilevel longitu- cultural, economic, political, and psychological dinal designs—something dif fi cult to do in resourcefulness as understood by youth them- resource-poor and politically unstable settings. selves. Such a resource map would vary across However, naturalistic designs may also shed con fl icts and over time, especially for long-stand- light on these hypotheses, as shown by many ing con fl icts (Barber, 2010 ) . Surprisingly, there is chapters in this volume. still relatively little consultation with young peo- Tol et al., (this volume) caution that we tend to ple as to the nature of their experiences and theo- rely too much on cross-sectional data and need to rists instead propose models that presume to study transactions (interpersonal dynamics) that know what should be studied to promote psycho- broaden the scope of studies of resilience beyond social well-being (Barber, 2009 ; Hammack, the individual to include interpersonal, sociocul- 2011 ; Stark & Wessells, this volume). Barber tural—and one might add cultural-historical— suggests that it is important to listen to the voices in fl uences on personal resilience. Without such of youth involved in confl ict themselves—a point transactional understanding, our evidence and echoed by Daiute, Buchanan, and many other conceptualization of resilience remains problem- contributors. Indeed, contributors are unanimous atic. They propose two promising research about the need to study children’s actual experi- approaches: (1) case studies can help uncover ences of war—not just assess their mental health. resilience processes in action in particular indi- The fruitfulness of this approach is evident in viduals; staggered baselines can test the impact chapters by Ventevogel, Dauite, McAdam, Bates, of protective factors on multiple cases, as Tol Fernando, Zack-Williams, and their coauthors. et al., show in their chapter. (2) Randomized con- It is also important that research include mea- trolled trials can explore moderators and media- sures of both external and internal resilience: tors of intervention effectiveness that can show external resilience has been objectively measured how resilience processes take place. Research in terms of school achievement or peer relations, should also look beyond the immediate impact of but internal resilience involves an existential sense war on children to assess the long-term impact of of well-being—what Garbarino and Bruyere calls political violence through longitudinal studies or “being at peace inside” or “existential resilience”— perhaps more easily through biographical studies that may be lacking even when external markers of older individuals who recount the long-term of resilience are present. This is the case for effects of war that they have experienced in child- orphans of war with internalizing dif fi culties, as hood, as we see in chapters by McAdam, Bates identifi ed and described by Fernando and Ferrari et al., and Dauite. ( 2011 , this volume). For Garbarino and Bruyere, Biglan, Mrazek, Carnine, and Flay (2003 ) have even when individuals have been successfully proposed a seven-grade classifi cation endorsed by supported in different ecological contexts, there is Peltonen that depicts “the golden rules” of evalu- the risk that internalized trauma can manifest itself ating research on therapy effectiveness: through their level of affective engagement, either • Grade 1 has evidence from multiple well- in the present or at some future point in time. designed, randomized, and controlled trials or multiple well-designed, interrupted time- What Is the Best Kind of Evidence to Gather in series experiments conducted by two or more Studying the Impact of War on Children ? independent research teams. In addition, these Peltonen notes the importance of considering studies provide adequate documentation that the unit of analysis to be the family, or specifi c the preventive intervention has been imple- community-based institutional settings such as mented in its intended setting with adequate orphanages, schools, or churches. For instance, training of personnel and monitoring of imple- consistent and supportive parenting might gen- mentation and outcomes. erate better coping skills in children that then • Grade 2 lacks documentation of the strengthen positive parenting in a reenforcing implementation. 20 Resilience in Children of War 293

• Grade 3 lacks multiple research teams. a powerful set of theoretical ideas and models • Grade 4 lacks multiple trials. about developing psychosocial well-being, and • Grade 5 lacks randomized comparison groups. any new theory would do well to build from and • Grade 6 lacks comparison group or repeated integrate them—or at least be clear on what assessment, using a single case for which an choices we must make between them in particu- intervention is introduced at some point in lar domains of study relating to resilience in time with pre-post assessments. times of war. • Grade 7 evidence is gleaned through clinical Let us review some of the main theories dis- experience by respected authorities, descrip- cussed in the volume and how they can be tions of programs, and case reports without expanded or integrated to provide a more com- formal study design. prehensive basis for future research. This classi fi cation system sets a very high standard for research data to be collected in war zones; Social -Ecological Models. One of the main much if not most existing data would not qualify frameworks used by chapter authors is as grade 1 quality. We should not let problematic Bronfenbrenner’s (1979, 2005 ) ecological evidence paralyze us, but rather use it as a spring- model of development. According to this model, board to gather better evidence, using methodolo- development takes place within concentric cir- gies such as action research and design experiments. cles of ever-expanding sociocultural context— In this regard, one might consider the progressive what Bronfenbrenner calls the microsystem, development of Child Friendly Spaces to be a per- mesosystem, exosystem, and macrosystem. fect example of this kind of developmentally and According to Bronfenbrenner, the family is the context-sensitive research. Even though develop- key microsystem that provides for children’s ers of these spaces may not consider the iterative basic needs and protects them; mesosystems are development of such programs to be research, they other institutions with which the child is directly are in fact a classic example of a design experi- engaged (e.g., schools or religious institutions); ment (Cobb et al., 2003 ; Gorard et al., 2004 ; Van exosystems have an indirect impact on the child den Akker et al., 2006 ), and, under the circum- (e.g., parents’ workplace); fi nally, macrosystems stances, such design experiments (in which one involves language and cultural beliefs that pro- can progressively raise the grade of evidence col- vide a blueprint for the other systems. Tol (this lected as one re fi nes an intervention over multiple volume) uses the term “ecological resilience” to iterations) is a useful design to add to those dis- direct attention to resilience processes operating cussed by authors in this volume. This approach is in different contextual systems. In the context of closely related to action research, in which the children and war, ecological resilience refers to researcher is an active participant in the planning assets and processes at all socio-ecological lev- and implementation of the research study. els associated with good developmental out- Kurt Lewin—who fi rst proposed action comes after exposure to situations of armed research—famously said, “Nothing is as practi- con fl ict. cal as a good theory” (1945, p.129). What such Broadening attention to contextual aspects of action research and design studies are likely to resilience allows the development of programs to show is that existing western models do not apply promote mental health and psychosocial well- universally, and that we need to develop better being for children affected by armed confl ict, theory. In the next section, we consider the kinds while incorporating cultural systems within which of theories used by authors in the volume, and they are embedded. Identifying health protective whether they can be creatively combined to gen- and promotive processes at broader social levels erate still more powerful tools for effective allows for the implementation of universal and research and intervention. selective public health prevention efforts that can reach larger populations groups. Such interven- Theory in Support of Effective Assessment and tions are both more feasible and more cost-effec- Intervention. The chapters in this volume provide tive in settings without extensive mental health 294 M. Ferrari and C. Fernando infrastructure and lacking specialized mental his model to make it more dynamic and develop- health professionals (de Jong, 2002 , 2010 ) . mental. As Tol and colleagues note, Bronfen- Those following a social-ecological model brenner’s (2005 ) later bioecological model stresses conceptualize risk and resilience at different the importance of biological dispositions within social and ecological levels. The aim of interven- the child that infl uence how they engage with dif- tion is thus to support children in their immediate ferent ecological levels, and the importance of microcontexts (by supporting families), in their the chronosystem (i.e., how all of these different mesocontext (by providing good opportunities systems behave dynamically over time). This for schooling, or Child Friendly Spaces), or in the more elaborate theory accords with developmen- macrocontext (by drawing on traditional beliefs tal ideas that other contributors to the volume and healing practices to promote well-being and have drawn upon in their chapters. Even so, it reintegration (e.g., of child soldiers)). An eco- falls short of explaining how transaction occurs logical approach also leads many contributors to between the macrosystem and other more proxi- emphasize the need to be culturally sensitive in mal systems of development; in particular, the interpreting risk and resilience, since different child’s own developing understanding. This cultures have different macrolevel understand- lacune can be remediated by incorporating the ings of child development and of psychological constructivist notion of development, especially trauma and recovery. when considered as a dynamic system. These different ecological levels also interact: for example, Stermac et al., (this volume) reports Constructivism. In 2011, Masten proposed a con- that language facility, pedagogy, curriculum inclu- structivist de fi nition of resilience within a broad siveness, and supportive services are all critical to dynamic systems view of development, saying academic success among immigrant youth, and that “resilience can be defi ned most broadly as that teachers can help promote self-effi cacy needed follows: the capacity of a dynamic system to to improve academic engagement. According to withstand or recover from signi fi cant challenges Tol et al., we have robust data demonstrating the that threaten its stability, viability, or develop- importance of the family microsystem, but we ment” (p. 494). Protective factors include effec- need to be careful in implementing protective tive parenting that buffers children from the social processes at the macrosystemic level. effects of war by giving them contextual stability Macrosystemic religious practices and ideological within the family unit. commitments can be a two-edged sword, both Although not mentioned by Tol et al., (this vol- helping people because they are personally mean- ume) or Masten ( 2011 ) , work by Fischer on ingful, but also trapping them when, for example, microgenetics and dynamic skill development gender inequality is considered integral to accepted can be used to expand the scope and mechanisms cultural practices (Tol et al., this volume). Finally, of learning and development, explaining how risk Rogoff (2003 ) is certainly right to emphasize that and resilience operate over the lifespan (see systemic levels are not separate spheres of action, Fischer & Bidell, 2006 ) . but different lenses through which to view chil- Fischer and Bidell (2006 ) propose that children’s participation in culture. Most research dren’s development is a set of dynamically con- investigating the effects of war on children is still structed skills embedded within particular concerned with family-level and individual-level sociocultural contexts. Socially supported chil- variables and their association with good devel- dren can perform skills at an optimal level in opmental outcomes; very little is known about novel contexts; however, when unsupported they mesosystem or macrosystem interactions. operate at a lower “functional” level in familiar As comprehensive and useful as Bronfen- contexts, and their skills are lost in unfamiliar brenner’s original model is, it can be improved contexts. Clearly, war is an extremely unfamiliar upon. In fact, Bronfenbrenner himself expanded context and only children who are supported by 20 Resilience in Children of War 295 their family or are in safe contexts like Child see also Yasnitsky, van der Veer, & Ferrari, in Friendly Spaces, will be able to cope effectively press) original theory is left out of Fischer’s with the disruption this entails. Furthermore, account that is critical to understanding the effects Fisher’s theory integrates both microgenetic and of political con fl ict and how to buffer children macrogenetic development across the lifespan. against them. As Daiute makes clear, for Vygotsky, When in unfamiliar contexts, both children and people not only develop skills through their own adults will see a signi fi cant degradation in their activities, they also appropriate meanings that span level of skill on any task, with only the most generations of cultural-historical development and expert recovering that skill quickly. This implies are manifest at the macrosystemic level—includ- that we can expect parenting and other skills to be ing meanings of personal and ethnic identity and dramatically affected by political confl ict, but also the narratives associated with them. for those skills to be restored with the proper scaf- folding and support to parents and families. Thus, Cultural - Historical Development . Within the Child Friendly Spaces can be one of the most cultural-historical understanding of human devel- effective ways of supporting skill development opment advocated by Vygostky (1934), narra- for children and parents in new and challenging tives of personal identity are themselves contexts. For immigrant children, newcomer pro- re fl ections of cultural narratives that span genera- grams and educational programs can help support tions and allow for very different interpretations parents/caregivers and children to assure that they of the same traumatic events. Here important function at their optimal level, and thus more protective factors are manifest in the ways that likely to show resilience in times of war, as seen people interpret events or are led to reinterpret in chapters by Bates et al., (this volume) and them—for example, through Buddhist mindful- Robinson (this volume). ness or metta (compassion) practices (Fernando Garbarino and Bruyere, and others like Masten & Ferrari, 2011 , this volume) or healing ceremo- (2011 ) , raise concern that these social-ecological nies to promote reintegration (Stark & Wessells, approaches ignore the biological aspect of trauma. this volume). Fischer’s theory has the advantage of integrating When dealing with culturally and historically neurobiological aspects of development into con- situated personal interpretations, risk and resil- siderations of contextual learning within a ience cannot be objectively quantifi ed—a key dynamic systems framework; more speci fi cally, point of Barber and Doty’s critique of much work brain development is theorized to embody a in the area of risk and resilience. This is what is dynamic system that includes sociocultural and perhaps most striking about the life stories dis- physical contexts of learning and performance. cussed in chapters by Bates et al., McAdam, and On this view, it is misleading to say that brain Daiute, which focus on how war experiences are architecture is shaped by adversity in early child- integrated into and shape later life experiences of hood (Karmiloff-Smith, 2009 ; Shonkoff, 2010 ; those who have suffered them. We agree with Shonkoff & Phillips, 2000 ) , since the effects of what Daiute calls “relational resilience,” that is, war experiences can have very different effects ongoing development that occurs through discur- on children of different ages—who are at differ- sive interaction within a particular social and ent moments of biological development, as political milieu. Relational resilience spans many Bruyere and Garbarino (this volume) suggest— levels of social activity in the ecological resil- or who have different types of war experiences. ience models mentioned earlier and seems per- Fischer’s dynamic systems theory integrates fectly consonant with the writings of Ungar both Piagetian and Vygotskian theories of human ( 2011, 2012) . Likewise, practices that are cultur- development and considers development to be a ally meaningful can be considered cultural tools web not a ladder, which fi ts well with an ecologi- supporting resilience that are historically situ- cal model of development like Bronfenbrenner’s. ated, and hence uniquely placed to help restore, However, one aspect of Vygotsky’s (1934/1982 ; sustain, and promote personal well-being. 296 M. Ferrari and C. Fernando

Lifespan Development. Insightful as these theories children—narratives necessarily situated within a by Bronfenbrenner, Masten, Fischer, and Vygotsky cultural-historical framework for understanding are, they still do not address lifespan development. lifespan human development and human resil- One such lifespan developmental theory—men- ience. Such ongoing appropriation of cultural tioned in passing by Muldoon (this volume)—is meanings is sometimes problematic in situations of that of Baltes, Lindenberger, and Staudinger con fl ict, when identities are constructed as opposi- (2006 ) . According to Baltes’ theory, development tional and negatively interdependent (Bar-Tal, is a ratio of gains and losses that necessarily 2012 , 2013 ; Muldoon, McLaughlin, & Trew, 2007 ; involves selection from among possible alterna- Muldoon, Trew, Todd, McLaughlin, & Rougier, tive actions, optimization of existing skills, and 2007 ) . As Muldoon, Barber, Dauite, and others in compensation for skills that are lost or missing. this volume note, collective identifi cation plays a The context of Baltes’ theory is how people crucial role in intractable political con fl ict (Barber, cope with the social, physical, and mental losses this volume; Bar-Tal, 2007 ; Hammack, 2011 ; associated with aging, including the commonly Kelman, 1999 ) . experienced declines associated with old age: Although only mentioned in passing by optimal development in old age is characterized Daiute, Ricoeur’s ( 1990 /1992) theory of personal by selective optimization with compensation. identity as necessarily a narrative situated This theory of development is particularly well between creative fi ction and cultural history suited to understanding resilience in children and seems particularly apt here, because it suggests their families in light of the disruption and losses that people co-construct their lives out of narra- associated with war, especially when they must tive elements given by culture, but creatively fl ee to other countries as immigrants of refugees. interpret the events of their lives in ways that can As chapters by Daiute (this volume) and Bates either perpetuate or dissolve confl ict. This is et al. (this volume) remind us, political violence clearly the case for participants interviewed in can lead to gains as well as losses for some chil- chapters by McAdam and Bates et al.: notice, for dren, as was the experience of those “lost boys of example, that the two “lost boys of Sudan” who Sudan” or Bosnian refugees who successfully arrived as majors (not minors) later chose to keep settled in the USA. Experiences of war thus offer their African names and wanted to help rebuild the potential for personal growth for people able Sudan, showing how their identity remains bound to overcome their own suffering, especially if up with their pre-refugee life and culture. The they are able to selectively optimize skills they events of life narratives are also necessarily tied developed in their home countries in new cultural to historical events that affect an entire genera- contexts. Furthermore, children and youth have tion of families and children growing up in times the advantage of continuing to gain functional of political con fl ict, as seen in chapters by Zack- capacity (through increased brain growth and Williams and Muldoon (this volume). associated increases in functional skills) and a These ideas provide rich frameworks from capacity for fl exibility and adaptation that is the which researchers can draw, helping them articu- envy of many adults. All these advantages can be late what is meant by resilient personal develop- selectively nurtured in the right environments, ment and psychosocial well-being in their especially the educational environments in coun- research and intervention studies with children tries that take these children in as refugees, as and youth. shown in chapters by Stermac et al., and Robinson, or in the Child Friendly Spaces described by Kostelny and Wessels in their chapter. Recommendations

Personal Development Through Narrative As Peltonen and Palosaari (this volume) state, a Meaning Making . Garbarino and Bruyere (this good theory provides methods for accomplishing volume) emphasize the importance of children’s intervention objectives. However, theory-driven narratives in understanding the impact of war on intervention planning requires understanding, 20 Resilience in Children of War 297 not only theories, but of their operational or prac- livelihood support for survivors of gender- tical forms (Kok et al., 2004). It is therefore based violence or child soldiers). important to consider how theoretical ideas about 4 . Specialized services, tailored to the needs of a development proposed in this volume lead to relatively small percentage of the affected speci fi c recommendations for helping promote population that need professional services to resilience in children who are victims of war. function (e.g., therapy). Ventevogel and colleagues give a wonderful Recommendation 1 : First do no harm . Wessells example of this pyramid in action in Afghanistan: (2008, 2009 ) is right to emphasize that the fi rst layer 1 (basic services and security ) was enhanced rule of any intervention to help victims of war by building water wells to improve general psy- must be, “do no harm.” This means that we must chosocial well-being of the Afghan population. be careful how we engage communities affected Layer 2 (community and family- level support) was by war. We need to stay alert to political power provided through Child Well-Being Committees within those communities we wish to help, so that gave children a voice in decision-making, or that groups do not feel disenfranchised or we do promoted physical education and play in schools not inadvertently side with one group over and communities; the NGO “War Child” also another. implemented psychosocial activities in schools and in communities throughout Herat and Kabul, Recommendation 2 : Build on the four IASC lev- with one component of this program aimed at get- els of intervention. Consistent with social-eco- ting working children back to school. Layer 3 logical frameworks of child development ( focused nonspecialized support) was provided by (Bronfenbrenner, 1979, 2005 ; Ungar, 2012 ) , it is helping school teachers provide psychosocial sup- important to develop theory and intervention at port; more specifi cally, Save the Children USA multiple sociocultural levels that include family, and UNICEF attempted to integrate training on community, and society. In effect, this is the psychosocial support into the primary school approach taken by the (IASC) when it published teacher curriculum. Layer 4 (specialized services ) its Guidelines on Mental Health and Psychosocial still needed further development, as Afghanistan Support in Emergency Settings (IASC, 2007 ) . is reported to lack specialized services for child These guidelines refl ect an emerging consensus psychiatry or child psychology (Ventevogel, on good practice from a wide range of disciplines Nassery, Azimi, & Faiz, 2006 , this volume). In and geographic regions. These guidelines orga- fact, there is only one national mental health hos- nize programs and interventions in a pyramid pital and four general hospital psychiatric wards, designed to reduce risk and create opportunities with few child and adolescent users of these men- at four levels: tal health services (WHO-AIMS, 2006 ). 4 1 . Basic services and security important to the Another way to support the IASC guidelines entire population experiencing a con fl ict (e.g., is developed by Peltonen and Palosaari in their by assuring access to food, drinking water, chapter for this volume. These authors provide a good sanitation, and medical services). “toolbox” of interventions that have been shown 2 . Community and family supports (e.g., through to be effective at different ecological levels. For family tracing and reunifi cation programs for example, at the individual level, they propose that separated children; access to education, infor- relaxation techniques and guided imagery can be mal education opportunities, and other potentially protective activities like Child Friendly Spaces). 4 Note that level 3 and level 4 services are often tailored to 3 . Focused , nonspecialized supports through supporting individuals in the ways that other contributors, interventions by trained and supervised work- like Buchanan and colleagues or Peltonen recommend: ers that apply to relatively fewer of the affected For example, programs can be targeted that promote a sense of agency, social intelligence and affect regulation, population (e.g., basic mental health care by a sense of community, and hope for personal growth in the primary health care workers; emotional or future. 298 M. Ferrari and C. Fernando very concrete ways to have children experience Education is equally critical for immigrants and work through the somatic effects of war and refugees (Williams & Drury, 2011 ) . Among exposure. At the family level they recommend refugees, Stermac et al. (this volume) found that interventions that focus on sibling relations, Canadian war-refugee children often do better social integration in the family and family cohe- academically than Canadian born children sion. At the community level, social support from because they are more academically engaged and peers and other people outside beyond family is have higher self-ef fi cacy, despite their war expe- also important for children’s well-being when riences. High academic engagement was also experiencing wartime conditions. characteristic of the immigrant youth described In addition to these socio-ecological supports, by Bates et al. and McAdam. However, Stermac it is also important to address the interpretations also notes that a sense of American identity and identities individuals cherish and sometimes among immigrant children (and not English consider lost to them, often associated with cul- profi ciency) is most predictive of positive school turally salient developmental markers integral to outcomes. Bates et al. (this volume) note that people’s own sense of living a good life. Healing mentors for immigrant and orphaned youth are rituals described by Stark and Wessells can be an needed for a lifetime commitment. We also need important step to accessing and restoring these culturally appropriate mental health support, not possible selves through cognitive reframing. only in the fi eld but in countries accepting immi- Sometimes cognitive reframing can help min- grant refugees who have been victims of political imize oppositional identities that may have deep violence. Ideally, Bates and colleagues believe it cultural-historical roots that set up the conditions is important to promote bicultural competence for present and future con fl ict as described by among immigrant youth. Zack-Williams, Muldoon, and by Barber and It is also important to specifi cally promote Doty (this volume). In other cases, for example, psychosocial well-being through educational with immigrants and refugees who are the focus efforts specifi cally designed to enhance resil- of work by Daiute, Stermac et al., Robinson, ience. Garbarino and Bruyere (this volume) pro- Bates et al., and McAdam (this volume), it is pose that the goals for such resilience training in important to determine what people themselves children should be emotional self-regulation, and believe is needed to live a good life, by their own intelligent empathy—two skills that could be standards, within a new cultural context that may incorporated into educational support for chil- provide its own risks and opportunities for per- dren to help them cope better with their experi- sonal fl ourishing. ences. In particular, support can be provided in three ways: (1) promote emotion regulation, for Recommendation 3: Enhance support at the com- example, through mindfulness training; (2) build munity level . A common theme throughout this positive meaning, through identity work or by volume is the importance of community-level promoting positive self-evaluations and feelings intervention that needs to be more fully developed of self-effi cacy; and (3) manage peer processes and applied. In particular, education is a critical carefully to avoid antisocial behavior. community-level support within war-affected Beyond education, authors mention other communities. In war zones, education can be pro- community-level supports such as community moted through Child Friendly Spaces—spaces rituals for healing and reintegration of former that also provide protection and psychosocial sup- child soldiers (Wessells, 2011 ; Stark & Wessells, port to children’s well-being. Challenges to set- this volume) and the use of communal faith prac- ting up good CFS are coordination (not competing tices and community institutions like orphanages among NGOs) and quality of programming. Mass (Fernando & Ferrari, this volume) and Child media campaigns can help with social reintegra- Friendly Spaces (Kostelny & Wessells, this vol- tion of child soldiers or other restorations as they ume). Engaging these community resources, both have been shown to be very powerful in other symbolic and institutional, is an important way to situations such as HIV prevention. promote resilience and psychosocial well-being. 20 Resilience in Children of War 299

In sum, the contributors to this volume all processes and pathways to resilience. International agree that a multipronged strategy is needed to Review of Psychiatry, 20 (3), 317–328. Biglan, A., Mrazek, P. J., Carnine, D., & Flay, B. R. help children affected by political violence, a (2003). The integration of research and practice in the strategy that involves both reducing the risk fac- prevention of youth problem behaviors. American tors that undermine and strengthening the pro- Psychologist, 58 (6/7), 433–441. tective factors that support their psychosocial Bonanno, G. A. (2005). Resilience in the face of potential trauma. Current Directions in Psychological Science, well-being. While it is diffi cult to study the 14 (3), 135–138. effects of war on children and youth, or the suc- Bonanno, G. A., Westphal, M., & Mancini, A. (2011). cess of interventions, in a rigorous scientifi c Resilience to loss and trauma. Annual Review of way, it is important not to be discouraged. By Clinical Psychology, 7 , 511–535. Boothby, N., Crawford, J., & Halprin, J. (2006). developing a more comprehensive developmental Mozambique child soldier life outcome study: Lessons theory, and through iterative methodological learned in rehabilitation and reintegration efforts. approaches (e.g., design experiments, case stud- Global Public Health, 1 , 87–107. ies, rigorously controlled trials) and better-tai- Boothby, N., Upton, P., & Sultan, A. (1991). Children of Mozambique: The cost of survival . Washington, DC: lored intervention strategies, we can improve US Committee for Refugees. the psychosocial well-being of children and Bronfenbrenner, U. (1979). The ecology of human devel- their families affected by war. opment: Experiments by nature and design . Cambridge: Harvard University Press. Bronfenbrenner, U. (Ed.). (2005). Making Human Beings Human: Biological Perspectives on Human Development. Thousand Oaks, CA: Sage Publications, References Inc. Calhoun, L. G., & Tedeschi, R. G. (2006). Foundations of Baltes, P. B., Lindenberger, U., & Staudinger, U. M. (2006). posttraumatic growth: An expanded framework. In L. Life-span theory in developmental psychology. In R. G. Calhoun, & R. G. Tedeschi (Eds.), Handbook of M. Lerner & W. Damon (Eds.), Handbook of child psy- post-traumatic growth: Research and practice. chology: Vol. 1. Theoretical models of human develop- Mahwah, NJ: Erlbaum ment (6th ed., pp. 569–664). Hoboken, NJ: Wiley. Cobb, P., Confrey, J., diSessa, A., Lehrer, R., & Schauble, Balwin, A., Balwin, C., & Coles, R. (1990). Stress- L. (2003). Design experiments in educational research. resistant families and stress-resistant children. In J. Educational Researcher, 32 (1), 9–13. Rolf & N. Garmezy (Eds.), Risk and protective factors Cortes, L., & Buchanan, M. J. (2007). The experience of in the development of psychopathology . New York: Columbian child soldiers from a resilience perspec- Cambridge Press. tive. International Journal for the Advancement of Barber, B. K. (2009). Making sense and no sense of war: Counselling, 29 , 43–55. Issues of identity and meaning in adolescents’ experi- Davydov, D. M., Stewart, R., Ritchie, K., & Chadieu, I. ence with political con fl ict. In B. K. Barber (Ed.), (2010). Resilience and mental health. Clinical Adolescents and war: How youth deal with political Psychology Review, 30 , 479–495. violence . NY: Oxford University Press. de Jong, J. T. V. M. (Ed.). (2002). Trauma, war, and vio- Barber, B. K. (2010). The shifting complex of identity: lence: Public mental health in socio-cultural context . Issues of individual and contextual change informing New York: Kluwer Academic/Plenum Publishers. the narrative identities of confl ict youth: Commentary de Jong, J. T. V. M. (2010). A public health framework to on Hammack. Human Development, 53 , 202–207. translate risk factors related to political violence and Bar-Tal, D. (2007). Sociopsychological foundations of war into multi-level preventive interventions. Social intractable con fl icts. American Behavioral Scientist, Science and Medicine, 70 , 71–79. 50 , 1430–1453. Espié, E., Gaboulaud, V., Baubet, T., Casas, G., Mouchenik, Y., Bar-Tal, D. (2012). Societal dynamics of intractable Yun, O., et al. (2009). Trauma-related psychological confl ict: A socio-psychological approach. Psicologia disorders among Palestinian children and adults in Sociale, 3 , 312–335. Gaza and West Bank, 2005–2008. International Bar-Tal, D. (2013). Intractable con fl icts: Socio- Journal of Mental Health Systems , 3, 21. http://www. psychological foundations and dynamics . Cambridge: ijmhs.com/content/3/1/21 . Cambridge University Press. Fazel, M., & Stein, A. (2003). Mental health of refugee Bernard van Leer Foundation. (2005). Responding to children: Comparative study. BMJ, 327 , 134. young children in post-emergency situations. Early Fernando, C., & Ferrari, M. (2011). Spirituality and Childhood Matters . The Hague: Bernard van Leer resilience in children of war in Sri Lanka. Journal of Foundation. Spirituality in Mental Health, 13 , 52–77. Betancourt, T. S., & Khan, K. T. (2008). The mental health Fischer, K. W., & Bidell, T. R. (2006). Dynamic develop- of children affected by armed confl ict: Protective ment of action, thought, and emotion. In R. M. Lerner 300 M. Ferrari and C. Fernando

(Ed.), Handbook of child psychology. Vol 1: Theoretical Muldoon, O. T., McLaughlin, K., & Trew, K. (2007). models of human development (6th ed., pp. 313–399). Adolescents’ perceptions of national identifi cation and New York: Wiley. socialisation: A grounded analysis. British Journal of Gorard, S., Roberts, K., & Taylor, C. (2004). What kind of Developmental Psychology, 25 , 579–594. creature is a design experiment? British Educational Muldoon, O. T., Trew, K., Todd, J., McLaughlin, K., & Research Journal, 30 (4), 577–590. Rougier, N. (2007). The nature and meaning of iden- Hammack, P. L. (2011). Narrative and the politics of tity in Northern Ireland after the Good Friday identity . New York: Oxford University Press. Agreement. Political Psychology, 28 , 89–103. Hepburn, A., Williamson, J., & Wolfram, T. (2004). Nielsen, S. S., Norredam, M., Christiansen, K. L., Obel, Separated children: Care and protection of children in C., Hilden, J., & Krasnik, A. (2008). Mental health emergencies. Westport, CT: Save the Children among children seeking asylum in Denmark—The Federation, Inc. Retrieved 8/1/08 at http://www. effect of length of stay and number of relocations: savethechildren.org/publications/technical-resources/ A cross-sectional study. BMC Public Health, 8 , 293. child-survival/SEPARATED_CHILDREN_ http://www.biomedcentral.com/1471-2458/8/293 . CONTENTS.pdf . Panter-Brick, C., Goodman, A., Tol, W., & Eggerman, M. Hobfoll, S. E., Johnson, R. J., Canetti, D., Palmieri, P. A., (2011). Mental health and childhood adversities: Hall, B. J., Lavi, I., et al. (2012). Can people remain A longitudinal study in Kabul Mental health and engaged and vigorous in the face of trauma? childhood adversities: A longitudinal study in Kabul, Palestinians in the West Bank and Gaza. Psychiatry, Afghanistan. J Am Acad Child Adolesc Psychiatry, 50 , 75 (1), 60–75. 349–63. Hobfoll, S. E., Mancini, A. D., Hall, B. J., Canetti, D., & Richman, N. (1993). Annotation: Children in situations of Bonanno, G. A. (2011). The limits of resilience: political violence. Journal of Child Psychology and Distress following chronic political violence among Psychiatry, 34 , 1286–1302. Palestinians. Social Science & Medicine, 72 (8), Ricoeur, P. (1990/1992). Oneself as another . Chicago: 1400–1408. University of Chicago Press. IASC. (2007). IASC guidelines on mental health and Rogoff, B. (2003). The cultural nature of human develop- psychosocial support in emergency settings . Geneva: ment . New York, NY: Oxford University Press. IASC. Rutter, M. (2006). Implications of resilience concepts for Karmiloff-Smith, A. (2009). Nativism versus neurocon- scienti fi c understanding. Annals of the New York structivism: Rethinking the study of developmental Academy of Sciences, 1094 , 1–12. disorders. Developmental Psychology, 45 (1), 56–63. Sameroff, A., Siefer, R., Baracos, R., Zax, M., & Kelman, H. (1999). The interdependence of Israeli and Greenpsan, S. (1987). Intelligence quotient scores of 4 Palestinian national identities: The role of the other in year old children: Social-emotional risk factors. existential con fl icts. Journal of Social Issues, 55 , Pediatrics, 79 , 343–350. 581–600. Shemyakina, O. (2011). The effect of armed con fl ict on Kilmer, R. P., Gil-Rivas, V., Tedeschi, R. G., Cann, A., accumulation of schooling: Results from Tajikistan. Calhoun, L. G., Buchanan, T., et al. (2009). Use of the Journal of Development Economics, 95 , 186–200. revised posttraumatic growth inventory for children. doi: 10.1016/j.jdeveco.2010.05.002 . Journal of traumatic stress, 22 (3), 248–253. Shonkoff, J. P. (2010). Building a new biodevelopmental Kraemer, H. C. (2003). Current concepts of risk in psychi- framework to guide the future of early childhood atric disorders. Current Opinion in Psychiatry, 16 , policy. Child Development, 81 (1), 357–367. 421–430. Shonkoff, J. P., & Phillips, D. A. (2000). From neurons Lewin, K. (1945). The Research Center for Group to neighborhoods: The science of early childhood devel- Dynamics at Massachusetts Institute of Technology. opment. Washington, DC: National Academy Press. Sociometry, 8, 126–136. Tedeschi, R. G., & Calhoun, L. G. (2004). Posttraumatic Masten, A. S. (2007). Resilience in developing systems: growth: Conceptual foundations and empirical Progress and promise as the fourth wave rises. evidence. Psychological Inquiry, 15 , 1–18. Development & Psychopathology, 19 , 921–930. Triplett, K. N., Tedeschi, R. G., Cann, A., Calhoun, L. G., Masten, A. S. (2011). Resilience in children threatened by & Reeve, C. L. (2012). Posttraumatic growth, mean- extreme adversity: Frameworks for research, practice, ing in life, and life satisfaction in response to trauma. and translational synergy. Development and Psychological Trauma: Theory, Research, Practice, Psychopathology, 23 , 493–506. and Policy, 4 , 400–410. Mollica, R. F., Poole, C., Son, L., Murray, C. C., & Tor, S. Ungar, M. (2011). The social ecology of resilience: (1997). Effects of war trauma on Cambodian refugee Addressing contextual and cultural ambiguity of a adolescents’ functional health and mental health status. nascent construct. American Journal of Journal of the American Academy of Child & Orthopsychiatry, 81 , 1–17. Adolescent Psychiatry, 36 , 1098–1106. Ungar, M. (2012). Social ecologies and their contribution Montgomery, E., & Foldspang, A. (2007). Discrimination, to resilience. In M. Ungar (Ed.), The social ecology of mental problems and social adaptation in young refugees. resilience: A handbook of theory and practice European Journal of Public Health, 18 , 156–161. (pp. 13–31). New York: Stringer. 20 Resilience in Children of War 301

UNHCR. (2004). Trends in unaccompanied and sepa- Werner, E. E., & Smith, R. S. (2001). Journeys from child- rated children seeking asylum in industrialized coun- hood to midlife: Risk, resilience, and recovery . Ithaca, tries , 2001Ð2003 . Retrieved 9/20/06 at http://www. NY: Cornell University Press. unhcr.org/statistics . Wessells, M. (2006). Child soldiers: From violence to pro- UNHCR. (2011). Refugee fi gures. Retrieved February 19, tection. Cambridge, MA: Harvard University Press. 2011, from UNHCR: http://www.unhcr.org/ Wessells, M. (2008). Do No Harm: Challenges in organiz- pages/49c3646c1d.html . ing psychosocial support to displaced people in emer- UNICEF. (1996). State of the world’s children. New York, gency settings. Refuge, 25 (1), 6–14. NY: Oxford University Press for UNICEF. Wessells, M. (2009). Do No Harm: Toward contextually United Nations High Commissioner for Refugees appropriate psychosocial support in international emer- (UNHCR). (2010). 2009 Global trends: Refugees, gencies. American Psychologist, 64 (8), 842–854. asylum-seekers, returnees, internally displaced and Wessells, M. (2011). The reintegration of formerly stateless persons. Geneva: United Nations High recruited girls: A resilience approach. In D. M. Cook Commissioner for Refugees (UNHCR). & J. Wall (Eds.), Children and armed con fl ict: Cross- Vaage, A. B., Tingvold, L., Hauff, E., Ta, T. V., Wentzel- disciplinary investigations (pp. 189–204). New York: Larsen, T., Clench-Aas, J., et al. (2009). Better mental Palgrave Macmillan. health in children of Vietnamese refugees compared Wessells, M., & Kostelny, K. (1996). The Graca Machel/ with their Norwegian peers—A matter of cultural dif- U.N. study on the impact of armed con fl ict on chil- ference? Child and Adolescent Psychiatry and Mental dren: Implications for early child development . New Health, 3 , 34. York: UNICEF. Van den Akker, J., Gravemeijer, K., McKenney, S., & Wessells, M., & Van Ommeren, M. (2008). Developing inter- Nieveen, N. (Eds.). (2006). Educational design agency guidelines on mental health and psychosocial research . New York, NY: Routledge. support in emergency settings. Intervention, 6, 199–218. Ventevogel, P., Nassery, R., Azimi, S., & Faiz, H. (2006). WHO-AIMS. (2006). Report on mental health system in Psychiatry in Afghanistan, country profi le. Afghanistan. Kabul, Afghanistan: WHO and Ministry International Psychiatry, 3 (2), 36–38. of Public Health. Vygotsky, L. (1982). Thought and language (A. Kozulin, Williams, R., & Drury, J. (2011). Personal and collective Trans.). Cambridge, MA: The MIT Press. (Original psychosocial resilience: Implications for Children, work published 1934). young people and their families involved in war and Weine, S., Feetham, S., Kulauzovic, Y., Besic, S., Klebic, disasters. In D. M. Cook & J. Wall (Eds.), Children M., Muvagic, A., et al. (2006). A family beliefs frame- and armed con fl ict: Cross-disciplinary investigations work for socially and culturally speci fi c preventative (pp. 57–75). New York: Palgrave Macmillan. interventions with refugee youth and families. Williamson, J., & Robinson, M. (2006). Psychosocial American Journal of Orthopsychiatry, 76 , 1–9. interventions, or integrated programming for well- Werner, E. E. (2012). Children and war: Risk, resilience, being? Intervention, 4 , 4–25. and recovery. Development and Psychopathology, 24 , Yasnitsky, A., van der Veer, R., & Ferrari, M. (Eds.) (in press). 553–558. The Cambridge handbook of cultural -historical psychology. New York, NY: Cambridge University Press. About the Editors

Chandi Fernando is a Clinical and School Psychologist. She has experience working in mental health agencies and schools in Toronto and Northern Ontario and most recently as an Adjunct Professor in the Department of Applied Psychology and Human Development at the Ontario Institute for Studies in Education, University of Toronto. She is actively involved in international research, with a focus on risk and resilience in children and communities. Her outreach work and research involves working with orphan and refugee torture and trauma victims of war in Sri Lanka.

Michel Ferrari is a Professor in the Department of Applied Psychology and Human Development at the Ontario Institute for Studies in Education, University of Toronto. His area of interest concerns psychological well-being and identity development. He has conducted international research on how individuals understand themselves within the context of their lives and cultures and is currently leading an international study of personal wisdom in China, India, Serbia, Ukraine, the USA, and Canada. Other work has explored related themes such as identity development in children with special needs, in particular those with Asperger’s syndrome. He is editor and coeditor of several books, the most recent being, The Scienti ﬁ c Study of Personal Wisdom (Ferrari & Weststrate, 2013, Springer).

C. Fernando and M. Ferrari (eds.), Handbook of Resilience in Children of War, 303 DOI 10.1007/978-1-4614-6375-7, © Springer Science+Business Media New York 2013 Index

A mental health disorders , 61Ð62 Adolescent refugees, Australia mental health services and psychosocial support , armed confl ict, child refugees 69Ð73 comparison groups , 198 physical disabilities , 66 country of asylum , 196 psychosocial distress , 55, 60 cumulative stress , 197 self-infl icted injury and suicide , 62Ð63 direct and indirect effects , 199 sexual violence , 68 exile , 197 socialisation of , 53Ð54 homeland , 195 refugees , 194 repatriation , 196 war, history of , 52Ð53 resettlement , 196Ð197 Afghanistan Independent Human Rights Commission sampling , 199Ð200 (AIHRC) current life circumstances , 203Ð204 child labour , 65 discrimination , 200 children in detention , 68 durable solutions , 194 domestic violence, children , 67 measures suicides, women and girls , 63 adaptation , 201Ð202 Afghan National Army , 68 current life circumstances , 201 Africa, coping and adaptation , 5 procedure , 202 adolescent girls, outcome of , 174 mental health, child refugees cultural aspects of , 164Ð165 psychopathology , 197Ð198 deductive approach , 174 resilience approach , 198 diathesis stress model , 174 participants , 201 human development theories , 164Ð165 person-centred analysis , 204 limitations , 174Ð175 person-oriented analyses , 200 maternal attachment , 165 positive adaptation , 200 narratives preliminary analyses , 202Ð203 death of parent , 167Ð168 prevention , 205Ð206 displacement , 169 resettlement countries , 194 journey to safety , 168Ð169 resilience , 205 living within context of war , 170 risk and promotive functions , 200 refugee experience , 167Ð170 variable-centred analyses , 203, 204 war and confl ict cycle , 167 Afghanistan opportunities, defi nition of , 164 CFSs , 123Ð124 parental attachment , 174 children and adolescents , 2 participants child labour , 65 country of origin , 166 child soldiers , 65Ð66 family structure , 166 coping and resilience , 60Ð61 human development theories , 165Ð166 in detention , 68 living situation , 166Ð167 domestic violence , 66Ð68 risk and opportunities , 165Ð166 drug use , 63 positive outcome , 163 early/forced marriages , 64Ð65 research process , 165 education , 54 resilience pathways gender-specifi c risk factors , 63Ð64 community , 172Ð173 health care , 54Ð55 family , 172 intellectual disabilities , 66 individuals , 170Ð172

C. Fernando and M. Ferrari (eds.), Handbook of Resilience in Children of War, 305 DOI 10.1007/978-1-4614-6375-7, © Springer Science+Business Media New York 2013 306 Index

AIHRC. See Afghanistan Independent Human Rights coordination , 126Ð127 Commission (AIHRC) Do No Harm , 128 All People’s Congress (APC) , 84 quality , 127Ð128 American Psychological Association (APA) , 91Ð92 in northern Uganda , 124Ð126 Armed confl ict purpose and functions of child refugees interrelations and synergies , 122Ð123 comparison groups , 198 nonformal education , 122 country of asylum , 196 protection , 121 cumulative stress , 197 psychosocial well-being and resilience , 121Ð122 direct and indirect effects , 199 Child Fund Afghanistan , 71 exile , 197 Childhood immunization , 256 homeland , 195 Child labour , 65 repatriation , 196 Child marriage , 64Ð65 resettlement , 196Ð197 Child mental health and psychosocial well-being sampling , 199Ð200 in Afghanistan , 74 evidence-based resilience-enhancing methods basic services and security , 69Ð70 child’s cognitive and emotional skills , 271, community and family support , 71Ð72 277Ð278 coping and resilience , 60Ð61 family and society , 278Ð279 drug use , 63 7-grade classifi cation , 268 focused nonspecialised supports , 72 implementation , 279Ð281 intervention pyramid , 70 protective factors , 271Ð276 mental health disorders , 61Ð62 symptom-based methods , 269Ð270 psychosocial distress , 55, 60 Armed Forces Revolutionary Council , 85Ð86 review of literature , 56Ð59 Attachment theory , 165, 174 self-infl icted injury and suicide , 62Ð63 Australia. See Adolescent refugees, Australia specialised services , 72Ð73 political violence, ecological resilience , 1Ð2 child-led indicators, Nepal , 34Ð35 B classroom-based psychosocial intervention, Baltes’ theory , 296 Indonesia , 35Ð37 Basic package of health services (BPHS) , 54 coping strategies , 14Ð15 Bonn Agreement , 53 cultural practices , 20Ð23 Bosnia and Herzegovina (BiH) , 157Ð160 current research and knowledge, limitations in , BPHS. See Basic package of health services (BPHS) 29Ð30 Bronfenbrenner’s theory. See Ecological model family connectedness , 16Ð17 Buddhist orphanages ideological commitment , 15 meditative practice , 134 intelligence/creativity , 16 nonwar orphans meso/exo-system , 19Ð20 for boys , 134Ð135 parenting practices and parental support , 17Ð18 for boys and girls , 135 peer relations , 18 resilience , 135Ð137 psychosocial intervention, Burundi , 34Ð35 risk factors , 135 religious beliefs , 16 resilience and faith practices , 140Ð142 school environment , 18Ð19 war orphans, girls theoretical framework , 11Ð14 committee members , 137 war-affected youth, Sierra Leone , 30Ð31 relationship with caregivers , 137 Child refugees resilience , 139Ð140 armed confl ict risk factors , 137Ð139 comparison groups , 198 Buffalo Creek disaster , 258 country of asylum , 196 Burundi , 34Ð35 cumulative stress , 197 direct and indirect effects , 199 exile , 197 C homeland , 195 Child abuse , 68 repatriation , 196 Child Friendly Spaces (CFSs) , 4, 280, 291, 293, 295, resettlement , 196Ð197 296, 298 sampling , 199Ð200 in Afghanistan , 123Ð124 mental health aim and usefulness of , 120 psychopathology , 197Ð198 challenges resilience approach , 198 Index 307

Children prevalence and effects , 287Ð288 coping and adaptation, Africa (see Africa, coping and psychological and developmental outcomes adaptation) in children of all ages , 40Ð41 evidence-based resilience-enhancing methods child soldiers , 41 ( see Armed confl ict) risk-accumulation model , 42 political violence social ecologic approach , 42Ð43 acute stress , 223 psychopathic personalities , 257 antisocial disturbance , 225 psychosocial disruption , 288 anxiety , 223 psychosocial well-being , 290 habituation , 224 PTSD , 258 juvenile crime , 225 recommendations , 296Ð298 psychological denial and distancing , 224 resourcefulness , 263 PTSD , 224 safety and survival , 113Ð114 research issues , 225Ð226 social-ecological models , 293Ð294 social identity spiritual development activities , 264 attitudinal factors , 227 spiritual opportunities , 262 collective identifi cation , 226 trauma , 253 ISIS , 227 vicarious suffering , 288 Northern Irish adolescents , 228 war zones , 39Ð40 psychological well-being , 228 Child soldiers , 3Ð4 Children of war , 2, 6Ð7 in Afghanistan , 65Ð66 adaptive systems , 114 cleansing rituals , 21Ð22 adult responsiveness , 259 in Colombia , 108Ð110 altruism , 263 formerly recruited children (see Formerly capital punishment , 262 recruited children) childhood immunization , 256 Iraqi children’s experience , 110Ð113 child soldiers , 253 in Nepal chronic traumatic danger , 254 child-led indicator scale , 32 in Colombia , 108Ð110 multivariate regression models , 32Ð33 commitment, survival , 263Ð264 policy changes , 33 community acceptance and peer support , 114 protective factors , 113Ð114 compassion , 260 psychological and developmental outcomes , 41 constructivism , 294Ð295 in Sierra Leone cultural and political contexts , 114 APC , 84 cultural-historical development , 295 child combatants , 85Ð86 curiosity and ability , 263 economic crisis , 85 developmental adjustment , 254 effects , 89Ð91 direct physical suffering , 288 Liberia , 85 effective assessment and intervention , 293 NPRC , 84Ð85 effects of , 291 resilience, post-confl ict era , 91Ð93 emotional disruption , 256 role and function , 89 emotional regulation, traumatized youth , 264 social movement , 86Ð88 habituation , 256 war-affected youth , 30Ð31 hardiness , 258 United Nations defi nition of , 86 IASC guidelines (see Inter-Agency Standing Child’s Reaction to Traumatic Events Scale (CRTES) , Committee (IASC)) 109, 111Ð112 impact of , 292Ð293 Child Well-Being Committees , 71, 124, 125 intelligent empathy , 259 Civil Defence Force , 85Ð86 interventions , 291 Cleansing rituals , 21Ð22 Iraqi children’s experience , 110Ð113 Coalition to Stop the Use of Child Soldiers , 108 kindling , 256Ð257 Colombian child soldiers , 3 lifespan development , 296 armed confl ict , 108Ð109 LRA rebels , 255 caregivers and community connections , 110 media technologies , 255 future, hope and growth , 110 mental suffering , 288Ð290 number of , 109 parental education , 114 sense of agency , 109 peer process , 265 shared experiences , 110 personal development , 296 social intelligence, empathy and affect regulation , Piagetian theory , 254 109Ð110 308 Index

Community , 278Ð279 Education Afghan children Afghan children , 54 Child Well-Being Committees , 71 formerly recruited children , 99Ð100 education , 123Ð124 Iraqi children , 111 physical education, promotion of , 71Ð72 in Nepal , 32 Africa, coping and adaptation , 172Ð173 nonformal education , 122Ð123 children of war , 114Ð115 parenting education , 114 cleansing ceremony , 41 war-zone immigrant and refugee students education , 45Ð46, 298 academic environments , 213Ð214 family tracing and reuniﬁ cation programs , 45 factors, academic success , 215Ð216 child soldiers in Nepal , 32Ð33 foster resilience and academic performance , Colombian child soldiers , 110 217Ð218 formerly recruited children mental health symptomology and learning girl soldiers, reintegration of , 97 outcomes , 212Ð213 mobilization and reconciliation , 101Ð102 military conﬂ icts and wars , 211 Sierra Leone school environment , 214Ð215 girl soldiers, cleansing rituals , 21, 99 socio-emotional development , 211 war-affected youth , 30Ð31 trauma and learning , 212 Convention on the Rights of the Child , 155 trauma exposure , 211 CRTES. See Child’s Reaction to Traumatic Events Scale war-zone youth , 216Ð217 (CRTES) Ethnic cleansing , 151 Culture , 20Ð23 Eye Movement Desensitization and Reprocessing formerly recruited children , 98Ð99 (EMDR) , 271 resilience in Afghanistan , 60Ð61, 73

F D Family , 278Ð279 Developmental niche theory , 164 Afghan children mental health and well-being Diathesis stress model , 174 child labour , 65 Disarmament, Demobilisation and Reintegration (DDR) coping strategies , 60Ð61 programme , 65Ð66 domestic violence , 66Ð68 Domestic violence , 67 girls in early/forced marriages , 64Ð65 D.R.E.A.M Act , 151Ð152 intellectual disabilities , 66 Drugs , 63 psychiatric disorders, follow-up survey , 62 Dynamic skill theory , 132Ð133, 295 psychosocial support , 71 sexual violence , 68 in Africa E coping and adaptation , 172 Ecological model , 164 structure , 166 child-led indicators, Nepal , 34Ð35 children of war , 45Ð46 children of war , 293Ð294 child resilience, political violence classroom-based psychosocial intervention, former child soldiers, reintegration of , 19Ð20 Indonesia , 35Ð37 parenting practices and parental support , 17Ð18 cultural macrosystem , 20Ð23 religious beliefs , 16 current research and knowledge, limitations in , 29Ð30 social support and adaptation , 17 meso/exo-system , 19Ð20 former child soldiers in Nepal , 32, 33 microsystem war-affected youth, Sierra Leone , 31 family connectedness , 16Ð17 Forced marriage , 64Ð65 parenting practices and parental support , 17Ð18 Formerly recruited children , 3 peer relations , 18 agency and relationship , 96Ð97 school environment , 18Ð19 reintegration supports Sri Lankan orphanages (see Sri Lankan orphanages) community resilience and reconciliation , person/ontogenic system 101Ð102 coping , 14Ð15 cultural and spiritual practices , 98Ð99 ideological commitment , 15 education , 99Ð100 intelligence and creativity , 16 livelihoods , 100Ð101 religious beliefs , 16 psychosocial supports , 97Ð98 psychosocial intervention, Burundi , 34Ð35 unintended harm theoretical framework , 11Ð14 excessive targeting , 103 war-affected youth, Sierra Leone , 30Ð31 power dynamics , 103Ð104 Index 309

G M Gaddafi , Muammur , 85 Mediation , 157 Gender-based violence (GBV) , 46 Mental health disorders , 61Ð62 Millennium Development Goal (MDG) , 47 Momoh, Joseph , 85 H Mozambican children , 288 Head Start program , 32 Mujahedeen groups , 52Ð53 Humanitarian Organization Supporting Afghans (HOSA) , 73 N Narrative Exposure Therapy , 278 I National Provisional Revolutionary Council (NPRC) , 84 IASC. See Inter-Agency Standing Committee (IASC) National Reformation Council (NRC) , 84 ICRC. See International Committee of the Red Cross Nepal, child soldiers (ICRC) child-led indicator scale , 32 IDPs. See Internally displaced persons (IDPs) multivariate regression models , 32Ð33 Immigrant and refugee students , 5 policy changes , 33 academic environments , 213Ð214 Nonformal education , 122Ð123 academic success Northern Uganda factors , 215Ð216 CFSs , 123Ð124 school environment , 214Ð215 formerly recruited children , 100, 104 foster resilience and academic performance , 217Ð218 mental health symptomology and learning outcomes , O 212Ð213 Operation Iraqi Freedom , 111Ð112 military confl icts and wars , 211 Organisation of African Unity (OAU) , 85 trauma and learning , 212 Orphans, Sri Lanka. See Sri Lankan orphanages war-zone youth , 216Ð217 Indonesia classroom-based psychosocial intervention , 35Ð37 P specialized services in , 46Ð47 ParentÐchild relationship , 18 Integrated social identity model of stress (ISIS) , 227 Person-focused resilience , 131 Inter-Agency Standing Committee (IASC) , 2 Piagetian theory , 254 basic services and security , 44Ð45, 70 Political confl ict , 6 community and family supports , 45Ð46, 71Ð72 adversity , 233 focused, nonspecialized supports , 46, 72 confl ict youth, competence of , 236Ð237 resources , 43 research specialized services , 46Ð47, 72Ð73 exposure , 240Ð242 Internally displaced persons (IDPs) , 287 longer-term impact , 244Ð245 in Afghanistan , 123 youth, functioning of , 242Ð244 in northern Uganda , 124, 125 resilience International Assistance Mission (IAM) , 73 contexts , 235Ð236 International Committee of the Red Cross (ICRC) , 107, defi nition , 234 287 function , 235 International fi nancial institutions (IFIs) , 83 risk , 234 International Rescue Committee , 71 risk and trauma Iraq , 3, 110Ð113 dysfunction , 238 ISIS. See Integrated social identity model of stress (ISIS) statistical determination of , 239Ð240 universality of , 238Ð239 Political violence K child mental health and psychosocial well-being Karma , 141Ð142 child-led indicators, Nepal , 34Ð35 Kosovan refugees , 278 classroom-based psychosocial intervention, Indonesia , 35Ð37 cultural macrosystem , 20Ð23 L current research and knowledge, limitations in , Lhanguene Rehabilitation Center , 46 29Ð30 Lhotsampa refugees , 194 ecological resilience theoretical framework , Liberia , 85 11Ð14 Lord’s Resistance Army (LRA) , 124, 255 meso/exo-system , 19Ð20 310 Index

Political violence (cont.) longer-term impact , 244Ð245 microsystem , 16Ð19 youth, functioning of , 242Ð244 person/ontogenic system , 14Ð16 coping and adaptation, Africa (see Coping psychosocial intervention, Burundi , 34Ð35 and adaptation, Africa) war-affected youth, Sierra Leone , 30Ð31 cultural meaning system , 133 displaced children and youth defi nition , 234 activity-meaning system , 155Ð160 defi nition of , 131 child development , 155 dynamic skill theory , 132Ð133 gains , 154 evidence-based resilience-enhancing methods human adaptation systems , 154Ð155 (see Armed confl ict) losses , 152Ð153 formerly recruited children separation , 150Ð152 agency and relationship , 96Ð97 psychological sequelae of community resilience and reconciliation , 101Ð102 acute stress , 223 cultural and spiritual practices , 98Ð99 antisocial disturbance , 225 education , 99Ð100 anxiety , 223 excessive targeting , 103 habituation , 224 livelihoods , 100Ð101 juvenile crime , 225 power dynamics , 103Ð104 psychological denial and distancing , 224 psychosocial supports , 97Ð98 PTSD , 224 function , 235 Post-traumatic stress disorder (PTSD) , 148, 197, 211, meaning systems , 132 213, 269, 288 nonwar and war orphans, Sri Lanka (see Sri Lankan classroom-based psychosocial intervention, orphanages) Indonesia , 35Ð37 opportunity structure , 132 political violence on children , 11 psychosocial competence , 132 psychosocial intervention, Burundi , 34Ð35 relational resilience , 4Ð5, 295 risk factors, Gaza Strip , 107Ð108 activity-meaning system , 155Ð160 Primary Mental Health Project , 140 child development , 155 Psychosocial distress , 55, 60 defi nition , 148Ð150 Psychosocial dynamic analysis , 158Ð160 gains , 154 Psychosocial support human adaptation systems , 154Ð155 Afghan children and youth , 74 losses , 152Ð153 basic services and security , 69Ð70 separation , 150Ð152 community and family support , 71Ð72 social and political integration , 147 focused nonspecialised supports , 72 resilient behaviour , 132 intervention pyramid , 70 risk , 234 specialised services , 72Ð73 Sierra Leone’s children, post-confl ict era , 91Ð93 CFSs , 121Ð122 social-ecological model , 132 formerly recruited children , 97Ð98 variable/person-focused approach , 131 Purdah-related stress , 63Ð64 Revolutionary United Front (RUF) , 30, 85 Risk coping and adaptation, Africa (see Coping R and adaptation, Africa) Refugee Health Program , 277 nonwar orphans, Colombo , 135 Refugees and trauma adolescent refugees, Australia (see Adolescent dysfunction , 238 refugees, Australia) statistical determination of , 239Ð240 Bosnian youth refugees and immigrants , 153 universality of , 238Ð239 coping and adaptation, Africa , 169Ð170 war orphans, Colombo , 137Ð139 defi nition of , 193 Risk-accumulation model , 42 displaced people’s status , 151 R U F . See Revolutionary United Front (RUF) Sudanese refugee youth (see Sudanese refugee youth) Resilience adolescent refugees, Australia (see Adolescent S refugees, Australia) Sankoh, Foday , 85 in children of war (see Children of war) Save the Children USA , 71 confl ict research Sexual exploitation , 288 exposure , 240Ð242 Sexual violence , 68 Index 311

Sierra Leone implications , 189 child soldiers , 3 Kakuma refugee camp , 179 child combatants , 85Ð86 mental health , 188 effect of , 89Ð91 method , 183Ð184 resilience, post-confl ict era , 91Ð93 posttraumatic growth , 189 role and function of , 89 resettlement, research social movement , 86Ð88 early adjustment , 181 war-affected youth , 30Ð31 experiences, Africa , 182 cleansing rituals, girl soldiers , 21 foster care system , 181 colonization , 84 parent and youth perspectives , 182 contact with Europe , 84 supportive relationships , 181 formerly recruited children unaccompanied minor youth’s experiences , 183 community reconciliation , 101Ð102 theoretical framework , 180 cultural and spiritual practices , 98Ð99 unaccompanied and separated children , 180Ð181 livelihoods , 100 Suicide , 63 location of , 83Ð84 Sociocultural theory , 164 Sri Lankan orphanages , 4 T caregivers, role of , 133Ð134 Taliban , 53 faith practice, resilient orphans , 140Ð142 Taylor, Charles , 85 meditative practice, Buddhist orphanages , 134 Theravada Buddhism , 134, 141 nonwar orphans Trauma-Focused Cognitive Behavioral Therapy for boys , 134Ð135 (TF-CBT) , 271 for boys and girls , 135 Truth and Reconciliation Commission (TRC) , 86 resilience , 135Ð137 risk factors , 135 orphan, defi nition of , 133 U religious beliefs , 16 Unaccompanied Refugee Minor Program , 179 war orphans, girls UN Convention on the Rights of the Child (CRC) , 90 committee members , 137 United Nations High Commissioner for Refugees relationship with caregivers , 137 (UNHCR) , 151, 193, 287 resilience , 139Ð140 United Nations Mine Action Centre for Afghanistan risk factors , 137Ð139 (UNMACA) , 66 StressÐdiathesis model , 269 Structural adjustment programmes (SAPs) , 83 Structured Interview for Disorders of Extreme Stress V (SIDES) , 109 Variable-focused resilience , 131 Sudanese refugee youth Violence case study Afghan children adaptability , 184 domestic violence , 66Ð68 disappointments and challenges , 187 sexual abuse , 68 education , 187 political violence (see Political violence) fi nancial aid , 186 health clinic , 186 NGO , 185 W participants , 184 War Child Holland , 71 racial and anti-immigrant prejudice , 185 Windows for Life (WFL) , 73 social isolation , 184 cultural beliefs and values , 188 Dinka tribe , 179 Y factors , 187Ð188 Youth Self-Report (YSR) , 201