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Download The EARLY CHILDHOOD BEFORE, DURING AND AFTER WAR AND DISPLACEMENT IN NORTHERN UGANDA by THERESA MCELROY B.Sc.O.T., The University of British Columbia, 1998 M.I.H., Curtin University of Science and Technology, 2006 A THESIS SUBMITTED IN PARTIAL FULFILLMENT OF THE REQUIREMENTS FOR THE DEGREE OF DOCTOR OF PHILOSOPHY in THE FACULTY OF GRADUATE STUDIES (Interdisciplinary Studies) THE UNIVERSITY OF BRITISH COLUMBIA (Vancouver) April 2012 © Theresa McElroy, 2012 Abstract Background: Research from numerous fields of science is providing strong evidence demonstrating that the conditions young children live within mould their health and developmental trajectories. While science and policy call for nurturing environments to preserve developmental potential, the current global reality is that war and civil unrest displace millions of children from their homes, desecrating their social supports and environments. Furthermore, little research has drawn attention to the experience of the youngest children during and after war. Objective: To holistically document the environments of young children (0 to 3 years) before, during and after a 20-year war and mass internal displacement in northern Uganda in order to deepen current understandings, address research gaps and inform interventions. Methods: This applied ethnography used purposive sampling in three sites of the Amuru District over a one-year period. Interviews, focus groups, longitudinal case studies, participant observation, document review, and photo documentation with young children, caregivers (siblings, parents, and others) and community leaders explored multiple views on early childhood health and development. Results: War and displacement seriously thwarted caregivers from employing their extensive knowledge and traditional care practices that protected and nurtured their young children in rural agrarian communities. Young children were exposed to numerous, cumulative factors that previous research has documented as risks to well-being and long- term developmental potential. This risk persisted well into post-conflict resettlement. However, despite dire conditions, there were also factors that acted to protect children and examples of children’s healthy functioning. Conclusions: Disrupted social structures and environments appear to influence young children's health and developmental futures in all phases of war, displacement and resettlement. Results suggest that the efforts by state and the international community to mitigate risk and promote positive development for vulnerable young children were insufficient and incommensurate with the degree of evidence supporting the critical importance of the early years. Future efforts must build on local culture and address the most relevant and pressing needs of children in close collaboration with families and communities. The rebuilding of healthy, peaceful societies depends upon the preservation of the immense human capital and boundless potential within children. ii Preface This thesis is based on work conducted in communities of the Amuru District of Northern Uganda. With the guidance of my doctoral supervisors (Catherine Backman, Richard Mathias, University of British Columbia, Canada), and Herbert Muyinda (Makerere University, Uganda), the members of my doctoral committee (Robert Armstrong, Charles Larson and Patricia Spittal), and input from the Child Health and Development Centre Faculty (Makerere University), I was responsible for planning the data collection and designing all interview guides. In the field in Northern Uganda Stella Atim (Research Assistant) collected all oral data in the local language (Luo). I conducted interviews that could be done in English along with the observation of young children in camps and villages. I supervised all data collection, reviewed all translated data, and lead discussions on emergent themes throughout data collection. Ketty Akello Otim, Samuel Lakor and Lucy Apio contributed to the transcription and translation of research transcripts - assisting Stella Atim. I conducted all primary analysis checking in with Catherine Backman and Patricia Spittal to confirm emerging themes. I wrote this thesis manuscript in its entirety. Portions of this thesis from chapters 1, 2, 5 and 7 have been published in the International Journal of Pediatrics under the title “Risks to early childhood health and development in the post conflict transition of northern Uganda” manuscript #820290. I wrote this manuscript as first author, with contributions from fellow authors Stella Atim, Charles P. Larson and Robert W. Armstrong. This is an Open Access Journal and thus I retain the copyright of this work, released under a "Creative Commons Attribution License," enabling the unrestricted use, distribution, and reproduction of an article in any medium, provided that the original work is properly cited. This research received approval from the University of British Columbia, Behavioural Research Ethics Board (Reference number H09-00300) on March 17, 2009. Approval was also granted from the Uganda National Council of Science and Technology on June 23, 2009 (Reference number SS2214) and the Republic of Uganda Office of the President on June 15, 2009 (Reference number ADM 154/212/01). iii Table of contents Abstract ..............................................................................................................................ii Preface...............................................................................................................................iii Table of contents ..............................................................................................................iv List of tables......................................................................................................................ix List of figures .....................................................................................................................x List of excerpts from field journals..................................................................................xi List of abbreviations ........................................................................................................xii Glossary of Luo (Lwo) words and local usage of English words ................................xiii Acknowledgements ........................................................................................................xiv Dedication ......................................................................................................................xvii Chapter 1: Introduction and literature review ..................................................................1 1.1 War, displacement and children...............................................................................1 1.2 Early childhood: setting the stage for the life course ................................................3 1.2.1 The biological basis of developmental outcomes ..........................................4 1.2.2 Risk and outcomes .......................................................................................5 1.2.3 The impact of context and culture on development .......................................9 1.2.4 Protective factors and positive adaptation...................................................10 1.3 Northern Uganda: war, displacement and its aftermath..........................................12 1.3.1 A brief introduction to Acholi history and culture:.........................................12 1.3.2 The experience of war and displacement....................................................15 1.3.3 The aftermath of war and displacement ......................................................18 1.4 Conceptual model ..................................................................................................19 1.5 Research question and study objectives ................................................................21 1.5.1 Research question ......................................................................................21 1.5.2 General objective ........................................................................................21 1.5.3 Specific objectives ......................................................................................22 Chapter 2: Methods..........................................................................................................23 2.1 Synopsis ................................................................................................................23 2.2 Guiding methodology and conceptualizations ........................................................23 iv 2.3 Sampling................................................................................................................24 2.3.1 Population and site selection.......................................................................24 2.3.1.1 Pabo Sub County....................................................................................25 2.3.1.2 Omee II camp and surrounding villages in Amuru Sub County................26 2.3.1.3 The villages of Anaka Sub County ..........................................................28 2.3.2 Participant selection....................................................................................28 2.4 Ethics.....................................................................................................................32 2.4.1 Permissions, introductions and recruitment of participants..........................33 2.5 The research team: background, training and team
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