Graduate School of Development Studies

A Research Paper presented by:

John McNamara Kielty(Canada)

in partial fulfillment of the requirements for obtaining the degree of

MASTERS OF ARTS IN DEVELOPMENT STUDIES

Specialisation:Children and Youth Studies

(CYS)

Members of the examining committee:

Prof. Linda Herrera (supervisor)Prof. Dr. Jan Pronk (reader)

1

THE REHABILITATION OF FORMER CHILD SOLDIERS: CONFLICTING CHOICES

The Hague, The NetherlandsNovember, 2009

2

Disclaimer:This document represents part of the author’s study programme while at the Institute of Social Studies. The views stated therein are those of the author and not necessarily those of the Institute.Research papers are not made available for circulation outside of the Institute.

Inquiries:

Postal address: Institute of Social StudiesP.O. Box 297762502 LT The HagueThe Netherlands

Location: Kortenaerkade 122518 AX The HagueThe Netherlands

Telephone: +31 70 426 0460

Fax: +31 70 426 0799

3

Acknowledgements

First, a very big Apoyo Matek to Tabu Simon for his extraordinary invitation for me to come live with him and his family in Gulu this past summer. It was a joy getting to know Susan, Carol, Clifford, Giovana and Robert and the Gulu Gang, Uganda and barbequed pork. TIG! Memories for a life time. Thank you.

To my parents and brothers who have always been supportive of everything I do, thank you for everything.

To the A-team, you three made my year. Sweat, blood and tears baby. We did it! Look forward to many more diners, drinks and wherever and whenever.

What a year it has been. Thanks to all ISS students and faculty for making my time in The Hague a learning experience in so many ways. Catch you all on the road ...

4

Abstract

International experts and organisations have struggled to come to a consensus on how to implement Western psychologically based rehabilitation programs for former child soldiers in non-Western settings. Scholarship recognises the inherent claim and value of indigenous healing practices in the rehabilitation of former child soldiers. Nevertheless, Western interventions continue to predominate. The contrasting approaches represent conflicting choices in how to design and implement rehabilitation programs. This dynamic is a reality on the ground in the district of Gulu, northern Uganda where the conflict between the government and Joseph Kony’s Lord’s Resistance Army has abated in recent years.

Former child soldiers in northern Uganda have been abducted and, for many, experienced extreme traumatic events. Those worst affected require support to be successfully rehabilitated and to function on par with those in the community. Local Acholi culture has been severely affected by the conflict which in turn has profoundly weakened the ability of Acholi traditional healing practices to support psychosocial rehabilitation. Local and international NGOs implement Western psychologically based rehabilitation programs as well as alternative approaches such as creative activities and sport.

Based on two months fieldwork in Gulu, interviews with formerly abducted children who have and are going through the process of psychosocial rehabilitation, provide a participant’s perspective on how different program approaches are received locally. Coupled with interviews from relevant development actors, this research provides useful insight for rehabilitation program designers and implementers to understand the effects of conflict on traditional healing practices, the role of individual skill development throughout the rehabilitation process and the consequences of Western dominated rehabilitation programming.

5

Relevance to Development StudiesPeace building in post conflict settings has a variety of challenges. As a group vulnerable to rejection by the community, successful rehabilitation reduces the chances of returnees becoming obstacles to development in the community. The methods use to support former child soldiers to have normal social has important implications for the nature of development. Scholarship calls for a balance between indigenous healing practices and Western psychology based rehabilitation methods. In reality this is not the case. Those involved in rehabilitation and in international development in general can benefit from understanding the consequences of Western dominated interventions.

Keywords[Child Soldiers, Psychosocial Rehabilitation, Rehabilitation, Traditional Healing, Northern Uganda, Acholi, PTSD, Counselling]

Contents

Abstract 4Maps

6List of Acronyms 7Introduction 81.1 Indication of the Problem 91.2 Child Soldiers 101.3 The International Response: Failed Prevention and

the Development of Rehabilitation Approaches 131.4 Rehabilitation Approaches in Non-Western Settings 151.5 Understanding Rehabilitation in Northern Uganda

Within the Context of the Ongoing Evolution of Program Guidelines 18

1.6 Research Questions 191.7 Methodology 191.8 Considerations and Limitations 21

Chapter 2 Analytical Framework23

2.1 Culture 236

2.2 Psychosocial Rehabilitation 24

Chapter 3 Conflict, Culture and Context: Traditional Healing and Rehabilitation Approaches in Gulu District 263.1 A Relationship in Conflict: Young People and

Traditional Culture 263.2 Development Organisations & Pyschosocial

Rehabilitation: Different Approaches for Different Actors 30

Chapter 4 Western Intervention Methods: The Agency of the Individual within the Rehabilitation Process 344.1 Counselling 344.2 Community Pressure and Individual Survival 364.3 Alternatives to Counselling 374.4 Self Dependency 40

Chapter 5 Conclusion: Responding to the Realities & the Future of Traditional Healing 42References 45Appendices 48

Annex A: Interviews and Observations 48

7

Maps

Northern Uganda

8

List of Acronyms

Acronym Name

CRC Convention of the Rights of the ChildGUSCO Gulu Save the Children OrganisationGWED-G Girls and Women Economic Development – GuluICC International Criminal CourtIES Impact Evaluation ScaleIDP Internally Displaced PeopleLRA Lord’s Resistance ArmyNGO Non Governmental OrganisationOP Optional Protocol (to the CRC)PTSD Post Traumatic Stress DisorderUN United Nations

9

Introduction

In northern Uganda, after 22 years of civil war, the rehabilitation of former child soldiers continues amidst a society’s strive to rebuild. This research explores conflicting choices to the rehabilitation of approximately 20,000 formerly abducted children who were forced into service for the Lord’s Resistance Army (LRA) and as a result committed atrocities and subject to extreme abuse. Experts agree that rehabilitation programs for former child soldiers should be culturally sensitive, but there is no consensus on a single approach as to how this can be best achieved. To explore how current debates about rehabilitation approaches are applied in the field, I sought out to understand the perspectives of formerly abducted children in these programs, NGO workers that implement the programs, and members of the community in Gulu district of northern Uganda.

For program designers and implementers, determining what approaches should be used in rehabilitation programs for former child soldiers is significant for several reasons. Unless programs are culturally sensitive, they risk imposing the world views implicit in these approaches which are products of a particular culture. The importation of foreign people, approaches and ideas that dominate over their local equivalents is particularly sensitive in countries that have been colonised, such as Uganda which gained independence from Britain in 1962. In addition to respecting local world views and cultural practices, culturally sensitive programs are more likely to support the successful rehabilitation of former child soldiers because they make sense of how the participant experiences and understands the world. Managing this process correctly is important because successful rehabilitation and social reintegration of returnees contributes to the lasting peace of communities. Depending on how programs are designed, rehabilitation attempts can support individuals to live productive lives or possibly experience frustration and rejection that can drive former child soldiers to anti-social behaviour and undermine peace building.

Initially, my entry point to research on conflict affected children, which then came to be former child soldiers, was through sport. Development through sport is used by many

10

grassroots organisations, international NGOs and UN agencies to address a wide range of issues including psychosocial support for young people who have experienced traumatic events in their lives. Understanding, however, that sport is one development tool among many approaches to rehabilitation spurred my interest to understand the larger rehabilitation context.

The literature on how interventions can support the psychosocial rehabilitation of young people affected by conflict focuses on ensuring that programs do not impose foreign methods that are products of another culture in non-Western settings. In the 1980s, targeted interventions for the perceived trauma of children affected by war failed due to their exclusive use of psychological approaches of Western medicine (Honwana 2006). As a response to this trend, Kostelny explains that “to construct culturally relevant approaches, it is essential to use and to learn from local approaches, placing culture at the center of psychosocial work” (Kostelny 2006: 29).

Understanding culture as fundamental to rehabilitation guided my research to explore participant, practitioner and community perspectives on the use of traditional healing practices, Western trauma based tools such as counselling and alternative approaches such as creative activities and sport. Basing my research in the town of Gulu in northern Uganda was useful because of the use of traditional practices for the formerly abducted as well as the substantial international NGO and UN presence that have imported their own programs.

Through the examination of programs on the ground and learning from those involved, this study provides insight into: the effects of conflict on formerly abducted children and their acceptance of traditional healing practices, local attitudes towards counselling and other Western rehabilitation approaches such as creative activities and sport, income generating activities and the role of individual skill development throughout one’s rehabilitation. Findings in these areas contributes to understanding the complex dynamics between a post conflict context, the individual and culture which can inform programs to implement programs best suited for a particular environment. And depending on the actual balance of programs, the long term viability of traditional healing practices can be jeopardised.

11

This paper consists of five chapters. In Chapter 1, I briefly review why child soldiering is an issue today and what their experiences are. A review is also given of the international response to child soldiering through international treaties dealing with the rehabilitation of child soldiers. A discussion of the evolution of rehabilitation approaches. Also included in this section is a presentation of my methodology which explains how and why the study was carried out as it was with the attendant considerations and limitations. Chapter 2 is a discussion of how culture influences notions of rehabilitation and trauma and ‘psychosocial’ rehabilitation as accounting for the considerations of non-Western settings. Chapter 3 is focused on Gulu district and explores the effects of conflict on young people and the relationship between traditional rehabilitation and formerly abducted children. Also included is the response of various development actors in psychosocial programming. Chapter 4 seeks to understand the perspective of participants, community members, NGO practitioners and actors in Gulu district towards rehabilitation approaches including counselling, creative activities and sport as well the importance of self sufficiency. Chapter 5 provides some conclusions that will be useful to rehabilitation program designers and implementers as well as those involved in cross cultural interventions generally.

1.1 Indication of the ProblemPsychosocial rehabilitation programs for former child

soldiers presents a challenge in implementing two seemingly different approaches. In accordance with expert consensus, rehabilitation programs for former child soldiers are to balance local cultural resources such as traditional healing practices with Western approaches such as those based on Western psychology and alternative methods such as creative activities and sport. While the prescription about how programs should be implemented calls for balance, there is an assumption that traditional healing practices can function in post conflict settings and that local participants will accept traditional practices.

All efforts should be made to acknowledge the importance of cultural resources and to make good use of them. However, it is worthwhile to explore whether the reality reflects the rhetoric in regards to the ability to use traditional healing practices in rehabilitation programs as

12

well as the participant’s perception of indigenous and Western approaches.

1.2 Child SoldiersCurrently it is estimated by the UN that there are

250,000 “exploited” child soldiers in armed forces today (UN 2009a). The pain that child soldiers have caused and endured around the world is well documented. According to Alcinda Honwana, “the scale of the contemporary problem is unprecedented, both in the numbers of the young people involved and in the degree of their participation (Honwana 2006: 27). Graca Machel’s seminal report commissioned by the UN to explore the impact of armed conflict on children is credited with bringing the plight of child soldiers to global attention(Rosen 2007: 298). The report argues that the nature of modern conflict has changed and makes children more vulnerable. For example, civilian deaths now make up 90 percent of casualties as compared to 5 percent in previous decades which results in more death and injury among children (Machel 1996: 9). In the decade leading up to the 1995 report, it is estimated that 2 million children died, 4 million were mutilated and disabled (Machel 1996: 33-34), and 1 were million orphaned (UNICEF 1995).

The extent of the rise of child soldiers, according to Honwana, “is a defining feature of our times (Honwana 2006: 27). Within this category, there is a distinction made between children who are forcibly abducted and those who volunteer. However, the notion of voluntarily joining an armed force as a young person is a false choice, since young people face social and economic pressures to join an armed group as a means of survival and advancement (Machel 1996: 12).

While the Machel report brought the issue of children in conflict and child soldiers to greater attention, the phenomenon itself has a long history. The etymology of the word ‘infantry’, for instance, indicates the presence of children in conflict since the middle ages. Infantry derives from the Italian word Infante which referred to the children who followed knights into battle during the middle ages (Honwana 2006: 26). While there may be historical precedence for the use of children in conflict, the nature and magnitude of the problem has changed. War itself has changed. “The massive instrumentalization of children in combat” (Honwana 2006: 28) occurs for several reasons. New technology has made lighter and smaller weapons

13

which are now easier for children to use and are readily available due to the expansion of the global arms trade (Honwana 2006: 26,Machel 1996: 10). As well there is a popular perception that children are targeted for soldiering because they are easily influenced which is considered incomplete by Honwana considering the concerted global strategy to use children in conflict (Honwana 2006: 44). Most wars today are intrastate conflicts in which child soldiers are most likely to be used by non-state actors such as local militia, liberation and rebel groups that have few resources and little inclination to follow international convention barring the use of child soldiers (Rosen 2007: 298).

The term child soldier is not exclusive to being involved in combat, but instead encompasses the wide range of activities that a young person can perform after being recruited or forcibly abducted. The Coalition to Stop the Use of Child Soldiers provides the following description of child soldiers:

The Coalition considers a child soldier any person under the age of 18 who is a member of or attached to government armed forces or any other regular or irregular armed force or armed group, whether or not an armed conflict exists. Child soldiers perform a range of tasks including: participation in combat, laying mines and explosives, scouting, spying, acting as decoys, couriers or guards; training, drill or other preparations; logistics and support functions, portering, cooking and domestic labour; and sexual slavery or other recruitment for sexual purposes (2004: 15).According to Machel, considering the tens of thousands

of child soldiers in recent decades, “most are adolescents, though many child soldiers are 10 years of age or younger. While the majority are boys, girls also are also recruited” (Machel 1996: 11). Child soldiers exist in every region of the world and between 2004-2007 in 19 countries they were involved in government forces or non-state armed groups (Coalition 2008), yet it is in Africa where child soldiering has taken place in 13 countries with approximately 100,000 child soldiers (Coalition 2004: 31). In Uganda, the number of children abducted is staggering. Most accounts of the number of children and women who have been abducted by the LRA during the 22 year conflict are similar to UNICEF’s figure of over 25,000 (UNICEF, 2008). However, according to Annan et al, this number increases to 66,000 when “abductions of any length, accounting for those who died, have not yet returned, and

14

who did not pass through a reception centre” are all taken into consideration(Annan et al. 2007: 5).

Many are inspired to come ‘out of the bush’ after listening to radio broadcasts from other formerly abducted children who verify that once out of the LRA they are treated well and are able to take advantage of the Amnesty Act of 2000 which pardons all but the top LRA leadership from prosecution (UNHCR 2007: 27). These children are returning home to communities that have themselves suffered greatly from attacks by the LRA. The recent absence of rebel attacks in northern Uganda in the past several years has facilitated the return home of most of the 1.8 million internally displaced people (UNICEF January - March 2008). The sheer number of displaced people, most of whom were of the Acholi tribe, is an indication of the large scale effects the conflict has had on the local population. One of the country’s many tribes, the Acholi populations is approximately two million are indigenous to Paler, Kitgum and Gulu districts in the north of the country; an area that is referred to as Acholiland.

The tragedy of the conflict for the Acholi people is filled with bitter irony. The LRA, led by Joseph Kony, commits massacres against the Acholi people who are the very people the LRA claims to be fighting for against the government in Kampala. The government, against which many Acholi have strong historical animosity towards (Kroes 2008: 24-25), forcibly moved the population into internally displaced people’s (IDP) camps in 1996. As Atkinson explains, moving to the camps was supposedly for the protection of civilians from the LRA which proved to be the opposite since civilians were not protected against LRA abductions, killing and rape in addition to attacks by even the military that was charged to protect them (Atkinson et al. 2006: 3). Regarding young people, the years spent in the camps is commonly referred to as the cause for antisocial behaviour and the loss of traditional values among the youth (Interview 21). As describe by Baines et al, “children in northern Uganda and especially those living in IDP camps – have suffered terribly over the past two decades of war and can be seen as the main victims of this conflict” (Baines et al. 2006: 17)

Tindifa claims that the portrayal of Kony as a lunatic killer fits a pattern of Western media racism and the government’s attempt to nullify the idea of a political motive for the conflict (Tindifa 2006: 27). Nevertheless, the

15

LRA has forced children to commit and endure torture and abuse of every sadistic possibility. Such experiences can have severe consequences for children:

A brutal system of severe punishments for disobedience as well as rewards for carrying out the orders of commanders most likely has a brainwashing effect on the young people, who often internalize the attitudes of their torturers over time and become “willing” actors and perpetrators of atrocities. ... It can be argued that, for physical and psychological survival, abductees often have no other choice but to become part of the terror system, at least for a certain time and to a certain extent (Atkinson et al. 2006: 4). Children who emerge from the ‘bush’ by escaping or

being captured by government forces are victims and perpetrators of violence at the same time. Those in most need of rehabilitation and treatment at receptions centres by social workers include:

children that have participated in atrocities, who have severe physical or psychological health problems, including disability; whose behaviour is potentially dangerous to others; whose families have ceased to exist or reject them; girls who have been severely abused, and girls who have become mothers while in armed forces (Jareg 2005: 3).And while the victims of LRA attacks are deserving of

reparations (Amnesty 2008), to achieve long term peace and stability for the whole community, it is important to that the formerly abducted receive proper rehabilitation for the lasting effects of traumatic experiences the abuse that was inflicted on them in order to support their reintegration back into the their local communities and support long term peace building.

1.3 The International Response: Failed Prevention and the Development of Rehabilitation Approaches

In the wake of greater international awareness of child soldiering around the world, international treaties have been adopted in an attempt to prevent recruitment and support the reintegration of former child soldiers. The Convention of the Rights of the Child (CRC) was a watershed moment in establishing child specific rights. Coming into effect in 1989, it is the most widely ratified convention with 193 parties to the convention (UN 2009c). However, as described by Rosen, the CRC came as a “bitter disappointment to anti-child soldier advocates” because of

16

its weak language on the obligations of state parties and making the cut off of recruitment into armed forces at 15 years instead of 18 (Rosen 2007: 301). To address the shortcomings of the CRC, two Optional Protocols (OP) to the CRC entered into force in 2002 including the OP on the involvement of children in armed conflict (UN 2000) which has 125 signatories to date (UN 2009d). The OP protocol’s major achievement was to increase the age of recruitment for state parties, in which it states that state actors shall “ensure that persons who have not attained the age of 18 years are not compulsorily recruited into their armed forces” (UN 2000: Article 2).

Despite the adoption of the CRC and various other international agreements intended to protect against not just child soldiering but children’s vulnerability in conflict, “grave violations against children in conflict situations continue” (UN 2009b: 2). The government of Uganda ratified the CRC in 1990 and the OP in 2002 (UN 2008: 6). In compliance with the OP the government enacted national legislation UPDF Act, Cap 307 that forbids recruitment of those under 18 into the military (UN 2008: 9). As for the LRA, the idea that an international agreement could end their reign of terror is inconceivable given their wanton disregard for human life which now continues in Central African Republic.

Referring specifically to rehabilitation, the CRC indicates that state actors should promote physical rehabilitation and social reintegration of child victims including those from armed conflict (UN 1990: Article 37). The OP adds more specific language to rehabilitation and reintegration by referring to the need for state parties to support technical cooperation and financial assistance in consultation with relevant international organisations (UN 2000: Article 7). Outlining rehabilitation within these international treaties has facilitated the rehabilitation of over 100, 000 former child soldiers since 1998 (UN 2009b). While this is a great achievement, the underlying question is to understand on what basis are programs designed?

UNICEF, closely involved in the development of the CRC, has been instrumental in developing common guidelines for the challenges surrounding child soldiers. In 1997, UNICEF led the effort to organise the Cape Town Principles for relevant UN agencies and NGOs working in Africa to “develop strategies for preventing recruitment of children, demobilising child soldiers and helping them to

17

reintegrate into society” (UNICEF 2007: 4). As a follow up, UNICEF again worked with relevant organisations to update the rehabilitation approach for former child soldiers based on lessons learned. The Paris Commitments were the result and include a second Paris Principles and Guidelines document that provides greater detail useful for program implementation. Within international rehabilitation work, initial vague descriptions of physical rehabilitation and social reintegration came to be articulated as ‘psychosocial’. This inclusive term attempts to address Western and non-Western conceptions of individual and health by including “social, cultural and psychological” in rehabilitation (Ager et al. 2009: 526) The guidelines dedicate little space to psychosocial support explicitly but states that

[it] should be incorporated into the release process at the earliest stages and into all stages of reintegration programming to assist children, families and communities in developing and building their strengths and resilience and involving them actively in their own recovery(UNICEF 2007: 39). As a central element to rehabilitation and reintegration,

the approach on which psychosocial programs are based is significant because they have a fundamental impact on the participants. For Akena Charles, a team leader with Gulu Save the Children Organisation (GUSCO), rehabilitation is supporting the formerly abducted child to achieve a level of functioning similar to that of her peers (Interview 22).

Within the larger project of reintegration, Jareg explains psychosocial support facilitates the participant to address the psychological challenges on an individual basis as well as the social challenges stemming from experiencing traumatic events:

Six programmatic areas should be addressed when planning for the recovery and social integration of children associated with armed forces: restoring family relationships; relationships with the community; children’s, health –physical and psychological; organised learning opportunities; vocational training and income generation; recreation and play. These aspects of rehabilitation and reintegration need to be integrated within an holistic approach based on a ‘child rights and child development framework’ (Jareg 2005: 4-5).The psychological and social aspects of rehabilitation

intersect with every part of a person’s life and is therefore the crucial starting point from which to understand rehabilitation.

18

The Paris Principles Guidelines document takes on counselling within Jareg’s balanced approach. Section 7.75.5 elaborates specifically on counselling as useful but that it can only work when not forced on a child and implemented alongside traditional approaches (UNICEF 2007: 39-40). Yet to suggest that traditional counselling and traditional healing practices can simply be implemented alongside each other belies the complexity of the relationship between rehabilitation approaches, as well as former child soldiers and their cultural values in a post conflict context. Each context must be studied in and of itself in order to devise the most appropriate program given the particular circumstances.

Machel’s report itself recognised the need for cultural sensitivity (Machel 1996: 11), but the process to develop appropriate tools for the various contexts in which psychosocial rehabilitation programs are implemented has occurred slowly and is ongoing. Now, the Paris Principles address rehabilitation best practices specifically by articulating the need for a balance between local culture and Western approaches to rehabilitation. This is part of the effort to reverse the previous trends which imposed Western rehabilitation practices in non-Western settings. The reason for the focus on traditional healing is because “healing practices ... are grounded in local beliefs” (Kostelny 2006: 24) and are thus a product of culture. For, as Kostelny describes, “all children are part of a culture that shapes their development, provides meaning, transmits beliefs and values, and structures roles and responsibilities” (Kostelny 2006: 24). However, this assumes that because returnees live within a particular culture that traditional healings practices can automatically apply to rehabilitation. The total exclusion of one of the approaches may not be the answer, but balancing indigenous and Western approaches is not that straight forward either.

1.4 Rehabilitation Approaches in Non-Western Settings

The failure and rejection of Western only approaches to rehabilitation programs for former child soldiers in non-Western settings was the impetus towards accepting traditional healing practices in psychosocial rehabilitation programs. Despite this fundamental shift in the debate, Summerfield maintains that, unfortunately, “Western

19

approaches to mental health are seen as an automatic part of the humanitarian response, even for victims of war in nonWestern countries” (Derek Summerfield 2002: 1106). Examining the root of Western interventions, Honwana points to Boothby’s research on an early rehabilitation program at the Lhanguene Rehabilitation Centre in Mozambique in 1987 for the children who had fought as part of the RENAMO rebel group, which was administered by an American psychologist. Honwana states, “neither their social isolation nor the process of verbally reliving their most horrible experiences was helpful in enabling them to make the transition into peacetime society (Honwana 2006: 138-139). According to Summerfield, “the very idea of Western talk therapy or counselling, with its focus on detached introspection, is alien in most non-Western cultures” (Summerfield D. 2004: 43). And according to Kostelny counselling practices that encourage emotional expression through talking-may be inappropriate, or even harmful” (Kostelny 2006: 25).

A 1999 study in Freetown Sierra Leone was carried out to examine traumatic stress of randomly selected adults who had endured the consequences of 9 years of conflict and the accompanying gruesome human rights abuses. Using an Impact of Event Scale (IES) to measure the effects of traumatic events including post traumatic stress disorder (PTSD), the researchers concluded, “the IES showed that 99% of respondents had scores that indicated very high levels of disturbances, indicative of severe PTSD in western Europe” (Jong et al. 2000: 267). Considered against the definition of PTSD that, as Wessells notes, “includes dysfunctionality, by which is meant an inability to perform expected daily tasks such as going to school or working”, (Wessells 2006: 136) the results showing 99% PTSD begs credulity.

According to American Psychiatric Association’s authoritative Diagnostic and Statistic Manual (DSM-IV), cited in Vivo, there are 6 criteria to diagnose PTSD, including “severe problems in social or occupational every day functioning” (Vivo 2007: 7). The severity of trauma is key because the lack of adherence to this criteria allows for an over diagnosis, regardless of whether the nature of PTSD reflects local beliefs on health. Alternative diagnosis could include Acute Stress Response and Acute Stress Disorder which are less severe on the grounds of shorter duration and intensity of symptoms (Henley 2005: 7). According Liesbeth Speelamn, a child psychologist working

20

with former child soldiers in Uganda since 2001, it is the notion of functionality that has been lost in common usage and which allows for the PTSD label to be applied recklessly. Speelman goes on to add that in northern Uganda “most child soldiers experience trauma, are they traumatised? It’s questionable. And as for PTSD, it’s not a large number” (Interview 24).

If the study in Freetown were accurate, this would mean that that vast majority of the population would be incapacitated and unable to lead their daily lives. Commenting on the same study in Sierra Leone, Summerfield argues that to suggest that virtually all of the population is dysfunctional, “risks [PTSD] being clinically meaningless and a ‘pseudocondition’ ” (D. Summerfield 2001: 97). The case in Sierra Leone epitomises the imposition of Western ideas of the self and mental health in a non-Western setting. According to Jong such practices are widespread (Jong et al. 2000: 267).

Assuming the applicability of Western approaches in non-Western settings has been a fundamental mistake of rehabilitation programs. Referring to “indigenous worldviews and systems of meaning”, Honwana contends that “in order to be effective, the healing strategies to deal with the problems faced by children affected by war in Africa need to take into account, and be inscribed within, these healing systems and world views” (Honwana 2006: 156). In the article, Religion and Politics: Taking African Epistemologies Seriously, Ellis and ter Haar describe how African religious views are widely perceived to be superstitious. Distinctive features of African religion include a belief in the spiritual world in which “spirit idioms” have specific identities and can exercise their power over events and phenomena in the world (Ellis and ter Haar 2007: 389).

As a product of African religion, Honwana explains the basis of traditional healing practices that typifies African approaches to rehabilitating former child soldiers:

The Cartesian dichotomy that separates body and mind in Western epistemology is not recognized in these cases ... Because their wrongdoings can affect their families and villages as well, the family members – including both the living and the dead – are directly involved in the cleansing and healing process. The ancestors are believed to have a powerful role in protecting their relatives against evil and misfortune (Honwana 2006: 117).

21

This description aptly applies to Acholi culture in which the attitudes about the relationship of the individual to the community and spirituality are and shape particular practices such as healing. This definitional of culture is fundamental to understanding the rehabilitation of former child soldiers and is elaborated upon here. Acholi religion and traditional healing practices is an example of African spirituality. Atkinson et al.’s thorough study of Acholi traditional healing fills a gap in the literature to understand not only the mechanics of the many different ceremonies for different circumstances, but the rich layers of meaning behind actions and symbols that are particular to the context of Acholi culture. As mentioned in Atkinson et al.’s study, ‘traditional’ refers to “the living traditions of the people” as they are practiced today and not those from an idealised past (Atkinson et al. 2006: 9). Though, that does not mean that the practices are any more relevant. Based on Atkinson’s et al.’s study, the following provides a basic introduction to traditional healing in Acholi culture.

Depending on the ailment, spirits can be attributed as the cause of illness or misfortune. For example, ancestors or chiefdom joggi are associated with minor illnesses or misfortune. Whereas Free joggi, including Cen, are attributed with causing more serious disturbances. Cen is the vengeful spirit of a dead person that can haunt its killer, their family and clan as well as any person that comes upon the dead body. The type of ceremony used to cleanse the person afflicted with Cen depends on what the nature of involvement with the person who was killed. For a killer, symptoms of Cen can include nightmares, trembling, shouting, aggressive and random behaviour (Atkinson et al. 2006: 52-71).

Citing Okot p’ Bitek (1971), Atkinson writes that a central aspect of Acholi culture has been focused on understanding why bad things happen and how to respond to it (Atkinson et al. 2006: 42). One common example of a traditional ceremony to cleanse one of haunting spirits is Mato Oput which seeks to reconcile two clans after a murder has been committed. While traditional culture has suffered through the conflict, the ritual has been performed for returning child soldiers who have killed and is well known as an example of Acholi traditional healing (Atkinson et al. 2006: 78-91). Rituals such as Mato Oput can support psychosocial effects in several ways such as through a “reduction of unspecific stress in the community (for example, feeling haunted by spirits), the reaffirmation of

22

positive cultural values, an increase in community cohesion, the improvement of interpersonal relationships” (Atkinson et al. 2006: 126).

The applicability of traditional Acholi rituals depends on the degree to which they are accepted by the people themselves. As Atkinson acknowledges, and what is most significant for traditional healing and formerly abducted, that the relevance of traditional approaches for young people is decreasing because those “who have grown up during a time of war with restricted possibilities to experience or participate in such practices” (Atkinson et al. 2006: 114). This is primarily due to the government, in 1996, forcibly moving two million people, of which one million were Acholi and 90% of its population, into IDP camps. There “the population languishes in squalid, disease-ridden camps, mostly unable to cultivate and dependent on food aid for survival”(Atkinson et al. 2006: 1). The role of the community is implicit in traditional. In Gulu district its relevance has suffered because of the conflict but also because of the dominance of Western NGOs that import their own methods. Since the benefits for the returnee and the community are known (Ager et al. 2009), and in lieu of weakened traditional rituals, it is useful to focus on a re-examination of the individual within communal psychosocial rehabilitation.

1.5 Understanding Rehabilitation in Northern Uganda Within the Context of the Ongoing Evolution of Program Guidelines

Conflict may disrupt cultural resources such as healing practices, but “the role of outsiders should be to help restore traditions by assisting in community empowerment and building local capacity through facilitation, training, and technical assistance(Kostelny 2006: 29). Kostelny’s position carries the basic assumption that culture and its tradition, though damaged, can carry on after conflict. And according to the Inter-Agency Standing Committee (IASC), a body created by the UN General Assembly to enhance humanitarian assistance, psychosocial support programs should “not assume that methods from abroad are necessarily better or impose them on local people in ways that marginalise local supportive practices and beliefs” (IASC 2008: 11).

23

However there are risks in simplistic classifications of Western and non-Western. Every non-Western setting is not the same nor are the effects of each conflict on a society the same. Assuming the applicability of traditional healing ignores the potential for cultural rupture due to the effects of conflict. Therefore, in each context, it is important to understand how the consequences of conflict affect the relationship between former child soldiers and the beliefs that underpin traditional rituals and subsequently, what are the consequences for returnees accepting traditional healing practices.

Despite the ongoing refinement of implementation guidelines, using culturally grounded programs as a reference is a useful prism through which to examine the practices of rehabilitation programs in the field and the perspectives of those involved. If traditional practices are fractured, how does the community perceive the use of Western rehabilitation methods? How is the individualism of Western approaches reconciled within the community?

The balance, such as it is, between traditional and Western approaches is not a blanket formula that can be imposed in non-Western settings. Determining how to design rehabilitation practices that respect local culture are very relevant for practitioners in the field. In northern Uganda, the variety of rehabilitation approaches seemingly mirror the multitude of organisations. Therefore, with an established practice of traditional healing rituals for formerly abducted children, and a mass of international organisations with that have imported their own rehabilitation approaches, exploring the experience and perspectives of those involved in rehabilitation programs for former child soldiers in Gulu district of Northern Uganda will provide insight into questions of the significance of the relationship between the effects of conflict on culture in different contexts, local perspectives on Western counselling and alternative approaches, as well as the role of the individual in one’s own rehabilitation that will be useful for program designers and implementers who are faced with the seemingly conflicting choices of rehabilitation approaches.

1.6 Research QuestionsMain Research QuestionsWhat are the conditions for practicing traditional

rituals?24

How are Western rehabilitation approaches perceived locally?

Sub-Questions

What effects does conflict have on the relationship between traditional cultural values and the acceptance of traditional rituals by former child soldiers?

What is the role of the individual in international approaches to rehabilitation?

1.7 MethodologyGiven the conflict in northern Uganda, the use of

traditional practices for returning child soldiers and the plethora NGOs implementing rehabilitation programs, Northern Uganda was an ideal location to learn from the participants themselves about how they feel about their rehabilitation experience and the various approaches. Prior to arriving in Uganda, my colleague Robert Okeny arranged for my introduction to GUSCO, which works exclusively with formerly abducted children. With this first contact, I travelled and lived in Gulu town for two months. GUSCO was my first point of contact and I was able to attend their community dialogues in the villages which provided access to interviewees. However I became immersed in the community and travelled from town to various locations in Gulu district including Lamogi, Palaro, Odek and Atiak sub-counties to hear the stories of formerly abducted children directly and the perspectives of NGO practitioners and members of the community.

Data was collected primarily through semi structured one on one interviews and focus groups. This gave me the flexibility to respond to new information while covering the range of issues I had identified through an accessible conversational approach. This approach was preferable to questionnaires because it allowed me to adjust my interviews based on the person and context. Given the over 30 interviews I conducted this was the most useful and practical tool. Conversely, life study interviews would have been too narrow due to its in depth approach with a small number of subjects. This would not have allowed me to gain insight into the diversity of opinions needed to understand how various approaches are perceived locally. While semi structured interviews provided the flexibility to access a

25

wide range of actors it also allowed me to understand the reasons behind their perspectives.

Interviews with NGO staff and white collar workers were conducted in English due to a generally a high level of proficiency. In the villages, proficiency levels were inconsistent. Therefore, especially for focus groups, I was able to make use of interpreters. Interviews notes were hand written and coded usually after every interview.

Applying the principle of doing no harm was forefront in my mind. At all times I abided by NGO guidelines given to me by GUSCO and War Child. Prior to every interview, I introduced myself, the institution and the purpose of this study in exploring how to best implement rehabilitation programs. For formerly abducted children I assured them of their anonymity. Prior to taking any pictures, permission was always requested. All of this was done verbally. Since my research was focused on rehabilitation practices and their lives after captivity in general, my questions did not probe into their experiences with the LRA lest discussing these topics cause discomfort or even hardship. Additionally, the experience of former child soldiers in captivity are well documented and the specifics of their experiences would not have aided my analysis aside from possibly finding correlations to time spent with the LRA and difficulty in rehabilitation which I was not equipped to assess.

Semi Structured Interviews:33 Interviews were conducted, one on one and focus

group, with formerly abducted children, mix of abducted and non-abducted, parents of abducted and non-abducted, community counsellor, academics and NGO practitioners from GUSCO, WCH, St. Monica’s Girls Tailoring School, GWED-G, Save the Children in Uganda. For a detailed list of interviews see Annex A.

With formerly abducted children, I introduced the purpose of my research in broad terms; to understand their rehabilitation programs and experiences. This guided their answers in the general area of my interest without being too vague so that they did not know what they were answering or too particular so as to tell them what I wanted to hear. Within in the interview, I sought to cover areas including, how they felt about the rehabilitation practices, how they felt after participating in it, how are their conditions and attitudes today, how have/do others support

26

or hinder your reintegration. Questions about their attitudes towards particular rehabilitation methods such as counselling and traditional healing, were open ended with phrasing such as “did you find it useful or not useful?”

From the focus groups, it was difficult to get a sense of the discussion because of my lack of Acholi language abilities which would aid me in understanding the group dynamic when people converse among themselves over a given question. For the most part though, when an individual spoke, others listened attentively and each spoke in turn. To spur debate, I would ask the group if they agreed with the previous respondent’s answer. Also, I have included the replies of multiple respondents to a given question in order to better present the views of the group.

Research participants were reached in different ways. Over time, I was able to make more contacts and through each meeting I was introduced to other individuals who could possibly be interviewed. As an outsider, this tactic worked exceptionally well as the recommendations from colleagues and friends gave me access to people and organisations that I would have not otherwise had. As a result, the research sampling is random.

ObservationOver the course of 8 weeks, as a participatory observer, I lived with a local family and sought to immerse myself with as much information about local rehabilitation programs and NGO work taking place in Gulu district. I had countless conversations with NGO workers and took every chance possible to visit the field.

Secondary DataThrough secondary research, using database for

academic journals, I have been able to provide the contextual background and analysis to child soldiers, the conflict in Acholiland, and Western and traditional rehabilitation approaches to the rehabilitation of former child soldiers in order to provide a foundation to understand the current situation of rehabilitation approaches and local perspectives of on Western approaches.

27

1.8 Considerations and LimitationsChildren who grew up in IDP camps are also prone to

experiencing trauma and being traumatised just as young people who were forced to serve for the LRA (Wessells 2006: 133). And while there is overlap in rehabilitation programs between the two groups, widening this paper’s scope to include all young people affected by the conflict was not feasible. However, the findings relating to the nature of rehabilitation can be useful in considering the design of programs for young people in non-Western settings more generally.

Respondents were generally positive towards each of the programs and endorsed the means of implementation. There was generally an uncritical attitude towards notions of Western psychology such as trauma and counselling practices. Widespread positive support of an imported idea does not necessarily imply some sort of deception or inaccuracy, and instead may actually reflect a high degree of indigenisation.

For local government workers, however, there is a material interest in maintaining the status quo. For their role in coordinating the local community and other efforts to support the NGO’s work in the community, local leaders receive bicycles to perform the requested activities and credit for their mobile phones. Some communities have several NGOs working in it which means that some leaders could benefit several times over.

Since I was a visitor, I did not have access to a secure meeting location and meetings would be outside under the mango tree where meetings often take place. This was a challenge to keep numbers manageable since sometimes other potential participants for the focus group would join the interview in mid-session. Participants were not concerned by the location of our meetings and returnees readily spoke about their experience as one in front of others indicating that concerns about concealing their past was not an issue.

Difficulty in coordinating with local leaders via NGO contacts made it challenging to secure one on one interviews with formerly abducted children. Also, participants walked far distances to the meetings, which created pressure to conduct group interviews as opposed to making individuals wait hours before their turn.

28

For the various meetings, I lacked a private interpreter to conduct each interview with me, which meant that with each NGO there was a different person who interpreted the questions and replies. This makes the variable in translating terms more likely and possibly creates inconsistencies in translating words and ideas. Additionally, questions originated in English using English terms to describe phenomena such as rehabilitation. Using Western vocabulary in non-Western setting can limit the ability for individuals to provide responses outside a Western framework.

29

Chapter 2 Analytical Framework

2.1 CultureTo address the conflicting rehabilitation choices of

Western and traditional healing involves reconciling the underlying difference in world views of each. Kostelny explains the difference as it relates to childhood:

While Western ideas of childhood view the child as an autonomous entity or as developing into one, other countries (including most war zones) children’s identities are defined mainly in terms of their social relations and social roles; people have collectivist identities that honour the good of the group over any individual good (Kostelny 2006: 21).The distinctions Kostelny draws between Western and

collectivist identities mirror the contrast of cultures in Gulu and the context in which young people are examined.

Experts call for a balance between two fundamentally different perspectives for programs in non-Western settings, but the massive influence of international NGOs and UN agencies betrays another reality. With over 220 NGOs in the town of Gulu (Interview 9), the city is a major development hub. The application of traditional practices alongside NGO programs as a general rule is not clear. Traditional rituals are common for returnees, though mostly taken on by community elders, the implementation of imported practices is widespread. Terms such as trauma, PTSD and psychosocial rehabilitation are common language among local NGO workers and lay people.

It is within the Acholi context of collectivist values and severely affected children that Western psychological approaches attempt to address a child’s trauma. An interesting counterpoint to accusations of imposing individualistic methods is to refer to Ellis and ter Haar’s argument that Christianity in Africa should not be seen as an imposition. Its presence should not be seen as a break with the Africa’s spiritual past but as representative of the changing nature of world views and their ability to incorporate new ideas (Ellis and Ter Haar 2007: 388). Accordingly, widespread acceptance of PTSD oriented counselling would also indicate indigenisation.

The question of indigenisation strikes at the core of the issue because of the perceived incompatibility between the collectivist identities of non-Western settings and the

30

individualism of the West. Yet, the ‘core symptoms’ of trauma are similar across cultures and include:

Problems re-experiencing traumatic events, having nightmares and intrusive thoughts. [Those who have experienced a traumatic event] are suffering from hyper arousal, including poor sleep, poor concentration, and irritability. Avoidance symptoms are also common, especially those involving reminders that trigger memories of the past and violence. Numbing and social withdrawal, however, can vary depending on individual or situational differences (B. Drozdek 2007: 9).

While the symptoms of trauma are the same across cultures, the context in which they are interpreted and acted upon are different (B. Drozdek, J.P. Wilson 2007: 373). The primacy of context is recognised, but yet to be adequately accounted for in rehabilitation programs. In the West, the focus on the individual excludes other aspects of a person’s life which is fundamental to understanding life experience in other cultures. Therefore, the universal existence of symptoms does not mean they have the same meaning in each context, which renders the use of terms such as PTSD invalid (D. Summerfield 2004: 233-239) or as Kleinman cited in Wessells describes it, a categorical fallacy (Wessells 2006: 137).

The predominance of Western culture and science globally supports an assumption of the superiority of the products of Western society. Drozdek looks at Western society to understand how Western medicine, including PTSD and counselling, is a product of its own culture:

The Western industrial culture overemphasizes the self-assertive and neglects the integrative tendencies. This culture prefers rational over intuitive thinking, analysis over synthesis, reductionism over holistic approach and linear over non-linear thinking (B. Drozdek 2007: 3).

The products of Western medicine are symptomatic of Drozdek’s description of Western culture. Instead of representing a universal phenomenon, PTSD was developed by American psychologists to treat soldiers returning from the Vietnam War. As Summerfield argues, various antisocial behaviours became subsumed under one rubric. The creation of PTSD is in fact a product of social and political forces that worked to develop a new disorder (D. Summerfield 2001: 95). Simple questions raised by Summerfield raise important questions as to the fundamental validity of PTSD. With each new addition of the Diagnostic and Statistical Manual of Mental Disorders,

31

new disorders appear and others disappear. Questioning the seemingly flighty existence of disorders, Summerfield asks “where were they before?” And “where did they go?” (D. Summerfield 2001: 97). This transience of disorders begs the ability of Western science to claim that its diagnosis objectively and exclusively reflects reality.

The rise of individualism and the medicalisation of the human condition are distinct cultural aspects of modern Western society. Presenting Western medicine as “universal knowledge” betrays its true nature as an “ethnomedical system” peculiar to a particular culture (D. Summerfield 2004: 233-239).

2.2 Psychosocial RehabilitationIn light of the inherent cultural bias that sees

rehabilitation as mental health and divorced from spirituality and the social world, reconciling the different approaches therefore means that international rehabilitation implementers have to change according to the context. Reflecting this attempt to change rehabilitation practices, the term ‘psychosocial’ rehabilitation is used by international organisations and is intended to “indicate commitment to non medical approaches” (Ommeren et al. 2005: 71).

According to Ager et al “the term ‘psychosocial’ encompasses social, cultural and psychological” spheres as elements in a child’s recovery (Ager et al. 2009: 526). The process of rehabilitation is to support the recovery of the former child soldier and according to Akena Charles of GUSCO, this is achieved “when the functioning of the returning children is on par with those in the community. Children can relate freely and get involved with community. Child rights are protected” (Interview 22).

While rehabilitation is a long term process, its success for formerly abducted children can be thought of as the ability to deal with the past in a way that minimises the symptoms of trauma, puts one in a position to socialise with others and support oneself. These criteria for successful rehabilitation, in this context, are used to indicate a positive outcome generally. Part of the long process of rehabilitation is simultaneous with reintegration of returnees to their home communities. This is part of a formal disarmament demobilisation and reintegration process which is “the formal and controlled discharge of active combatants from armed forces or other armed groups”(UNICEF 2007: 8).

32

For those children most affected, the process of rehabilitation starts in the centre and will continue long after a returnee leaves the reception centre. Jareg describes the process:

The process of re-uniting a child with his/her family and facilitating their community membership is, of course, also a complex process, which is partly dependent on the success of the ‘rehabilitation’ process. ‘Reintegration’ eventually becomes indistinguishable from ‘rehabilitation’ as the child’s psychosocial progress is inextricably linked with their once again becoming members of the community(Jareg 2005: 3). Rehabilitation, then, is a lengthy process that makes use

of both indigenous and Western approaches addressing the individual, communal and spiritual aspects of the returnee’s trauma.

Appreciating the complexities of cultural identities and the purpose of psychosocial rehabilitation, it is possible to best understand the perspectives of those involved in rehabilitation programs in order to understand the effects of conflict on traditional healing. As well as to know how the role of the individual plays out given the opposing views of the self in relation to health. More broadly, the role of local and international development actors and the degree to which the rhetoric of balanced programs reflects reality will not only be instructive for program design and implementation, but indicate to what extent international development is living up to its commitment to respect and partner with traditional healing practices.

33

Chapter 3 Conflict, Culture and Context: Traditional Healing and Rehabilitation Approaches in Gulu District

Local development professional describe how the forced relocation of the majority of Acholi people into IDP camps became a threat in itself to the people and to Acholi culture due to the prolonged wretched social conditions that had to be endured. The effect has been a rupture in the relationship between traditional cultural values and youth which has reduced the acceptance of traditional healing practices among formerly abducted children. Today, in lieu of government services, Gulu district is abound with development organisations implementing a variety of rehabilitation programs. Among the organisations are local and international NGOs such as GUSCO and War Child Holland that are the primary organisations studied for their different approaches to psychosocial rehabilitation.

3.1 A Relationship in Conflict: Young People and Traditional Culture

Traditional values and social relations have been damaged through a whole generation of Acholi youth growing up IDP camps. Ajok Margaret, of UN Human Rights, advocates on behalf of women and children to the government for more programs and reparations because the only current psychosocial programs are for formerly abducted children. Having seen the paltry social services provided for young people before they are detained by police, Ajok states that because of camp life, “[youth] have no respect, the cultural values have eroded. In the camps, toys are the only guns, young people only know violence (Interview 23).

Several interviewees stressed the profound impact living in the camps had on young people. Adokorach Christine of CRR explained that the camps were lawless, had rampant alcoholism, and prostitution due to the vulnerable state of women. Girls were affected by rape and increased sexual activity. Boys are susceptible to becoming drunkards, no hope for the future, no work ethic. They

34

expect relief, such as WFP food handouts, and when it is no longer there they become thieves (Interview 10).

Victor Ochen, whose brother and several classmates were abducted, and who started the African Youth Initiative Network (AYINET) adds another account. Today’s youth have been born and raised in camps where they ate one meal a day, and even slept in the bush when the situation in the camps was too dangerous. Youth made decisions based on desperation. They witnessed abuse and participated in it as well. Victor goes on to say that in addition to the threat of LRA attacks and negative social pressures, the government also committed attacks including rape which is why in 2005 they army starting testing for HIV within in its own ranks (Interview 20).

As people have begun moving from the IDP camps back to the villages, a community counsellor near Gulu town in Unyama attributes many of the major current social problems to the experiences in the camps. There is a high risk of “rape and defilement” for women. Generally, men have no interest to cultivate land. They see no purpose in returning to the villages. Children and youth see what their parents are doing and refuse to go to school, they have bad manners and some start drinking at 9 years old, become thieves, join gangs and smoke marijuana (Interview 26). Director of the NGO Girls and Women Economic Development in Gulu (GWED-G), Angwech Pamela Judith adds that the conflict has brought AIDS among children, child headed households, orphans, school drop outs. Children are influenced by the violence. When they draw, they draw fighting. When they play games, they are shooting games (Interview 31).

Fabius Okumu – Alya, Director of the Institute of Peace and Strategic Studies at Gulu University, argues that the camp system led to a total degeneration of the social fabric in Acholi culture. Most damaging however for the continuity of culture between generations was the loss of the evening fireside gathering called the Wong-oo (Interview 21, 28). Wang-oo was the focal point where the continuity of traditional values and customs took place (Atkinson et al. 2006: 37). According to Fabius Okumu – Alya, the Wang-oo was held every evening, the household ate and listened to the elders’ stories which served as both entertainment and moral education and conflict resolution (Interview 21).

35

There was simply no space made to recreate the Wang-oo in the same way as it had existed. Consequently, for over 20 years, the lack of a formal space to bind the community in the midst of serious social problems severely undermined the status of elders and the continuity of traditional values from one generation to the next. Several older respondents decry the loss of Acholi cultural traits such as such respect for the patriarch, child work, but not labour, and increasing individualistic attitudes of young people (Interview 28, 29). l, the role of elders as described by Sister Okello was central to the lives of young people. They would spend a lot of time together and be moulded according to the values of the older generation in order to prepare them for their future. So many things have happened and young people go to movies and discos. When there were disputes, elders used to mediate, but now “young are learning from the young. Now, it is rare for young people to sit with elders”(Interview 18). Traditional chiefs used to be a fountain of power, but this was lost in the camps since they had no status. Power rested with those that who coordinated food distribution (Interview 21).

The experience of children and youth in the camps affected the acceptance of traditional practices in the rehabilitation of the formerly abducted. The benefits of the rituals can only be maximised for all if the participants subscribe to the ideas on which the ceremonies are based. Young people are not only participants in rehabilitation programs but also community members whose acceptance of the returnee supports their psychosocial recovery by not stigmatising through calling the returnee a killer for example. Therefore the incongruity between the beliefs of formerly abducted children and other young people in the community with those of their elders who lead the rituals has consequences. If the effectiveness of traditional practices is compromised due to cultural detachment, then this can pose difficulties for rehabilitation and possibly the peace and reconciliation for the entire community.

The attitudes of formerly abducted children who participated in traditional Acholi healing ceremonies vary. One of the activities that GUSCO organises for children who have returned to the reception centre from captivity is to burn the clothes they had worn when they first arrived as part of a ceremony to symbolise leaving their past behind. In a focus group discussion with formerly abducted children, they gave various views on the purpose of burning clothes: “it doesn’t work. Cen (evil spirit) cannot leave a

36

person by burning clothes. Burning clothes is just for hygiene.” Another said, “burning clothes happens because after returning others might recognise the clothes as stolen from someone they know,” and “clothes are burned because of lice”. For most in the group, they believe that burning clothes cannot do away with Cen, but it’s the first step in doing away with memories (Interview 6). Regardless of whether burning clothes was thought to have had any use, the mixture of responses provides an indication of the different attitudes towards Cen and the spiritual world on which traditional healing is based. When asked specifically about the ceremonies intended to cleanse them of Cen after returning to the village, such as the ceremony of stick and the egg, responses included, “it doesn’t help, it’s just tradition” and “nightmares only exist in a person’s memory” (Interview 6). The variety of explanations and sceptical views contrasts with those of other returnees who were more positive about their views and experiences with traditional healing.

A focus group in Palaro sub-county of three formerly abducted children, two males and one female who have been back in the community for 3, 5 and 8 years, attributed their ability to integrate into the community with the affects of the traditional rituals and community sensitisation. As one respondent said, the traditional ceremony she went through changed the community’s attitude towards her and showed that the community still loves her. The effects were immediate as her nightmares stopped. The other male respondent indicated that he strongly believes in the rituals because it is the culture and referred to vague consequences for the individual if he did not participate. The female respondent was resigned to the status quo saying that ever since she was born the traditional practices were already there, if elders believe it then who is she to deny the them (Interview 27). These participants have strong positive comments in support of traditional healing, though for different reasons of which some possibly allude to social pressure.

If some participants do not subscribe to the ideas that underpin the activities, seen more clearly in the first focus group, then it begs the question, for whom do the rituals benefit? Liesbeth Speelman, adds to this point when she points out that “stepping on egg shells doesn’t end stigmatisation” (Interview 24). A viewpoint reiterated by Okumu who says that “Cultural traits such as stepping on egg shells doesn’t bind people anymore.” (Interview 21).

37

Explaining further, Speelman contends that the approach to rehabilitation as it existed previously in Acholiland was not just stepping on egg shells, but a society that supported each other. According to these two commentators, the meanings that bind participants to the rituals no longer exist and nor are the social support systems to facilitate the rehabilitation and reintegration that the rituals represent.

For some however, there is no question as to the ability of traditional healing to serve as a primary rehabilitation tool. Accompanying the participants of the focus group in Palaro was a youth leader. The purpose of him joining the meeting was not clear, since the meeting had been arranged by the local government office. He said that for those who did not participate in the rituals, the nightmares were driving them insane (Interview 27). This absolutist perspective is echoed by Okidi- Lumedo David M., an author promoting Acholi cultural values, who contends that if an individual does not accept the cleansing ceremony, then the community will not accept the individual and that the person will carry on with criminal behaviour. And all those who have gone through the ceremony will no longer have nightmares whereas those who have not had the cleansing do have nightmares (Interview 28). Such perspectives clearly put the locus of control over the individual’s rehabilitation in the community. The effect of this is that if a returnee does not conform to communally defined traditional mechanisms or any other manifestation of communal expectations, then the individual’s rehabilitation has no chance of success in the eyes of the community.

While nightmares may end for some, rehabilitation and reintegration are long term processes that depend on community support. Epitomising traditional healing through rituals with 100% a success rate not only begs credulity but also does an injustice to the community cooperation that is supposed to take place after a ritual. As part of the individual and community’s rehabilitation, effort needs to made to restore community capacity and attitudes to support returnees.

A position that presents traditional practices in Acholiland as able to perform as before ignores several important points. A divorce between the cultural traditions of the elders and young people including former child soldiers, weakens the attachment to the cultural values that underpin traditional healing practices. Therefore it cannot

38

be assumed that the widespread belief in the efficacy of the rituals is the same as it once was. As Sister Okello states, “forgiveness is a process that has to begin in each individual’s heart” (Interview 18). If the participants and community do not believe in the rituals, then merely performing rituals does not necessarily mean that it has the same effect on the participant as it once would have. At the very least, belief in the rituals cannot be said to be universal.

Furthermore, there is the question of whether traditional ceremonies are applicable in the current context at all. Okumu makes an often repeated claim that the traditional practices are overwhelmed by the scale and nature of the conflict since they were not intended to address large scale massacres(Interview 21). Prior to the conflict the ritual had been last used for individual murders in the 1950’s and 60’s (Interview 21, 25). Keller adds that rituals to cleanse those who have killed were intended for inter-clan incidents up to simple murder” and that “killings during times of war traditionally did not require Mato Oput” (2008: 231).

The International Criminal Court (ICC) has indicted five of the LRA top leadership and is well known throughout Uganda though for many in the north its reputation is poor (Interview 20). In Acholiland, preference for traditional justice, as opposed to the ICC, is attributed the culture’s emphasis on forgiving (Kasaija 2006: 6). Lauren Gould, PhD candidate at the Centre for Conflict Studies at Utrecht University studying Acholi reconciliation, suggests that the initial attitude of forgiveness to former child soldiers gives way to the reality of living next door to someone who may have perpetrated violence in the community. The desire of the average person wanting to leave the camps enabled them to think that once they returned to life in the village, the social problems plaguing life in the camps would go away. Now, after many have made the transition, life has not gotten easier and now people are disappointed. It is these conditions, according to Gould, that creates animosity towards former child soldiers. Young people returning from the LRA are now being denied their land rights by communities because of what they did while in captivity arguing that they do not deserve land (Interview 25). A sense of community and reconciliation appear to suffer in conditions of social breakdown.

39

Attitudes aside, the ability of traditional practices to satisfy its own criteria falters on practical grounds. Okumu raises the point that for many acts of violence committed by the LRA, the identities of the attackers are not known which is central to identifying the culprit and the clan who all will provide compensation (Interview 21)(Atkinson et al. 2006: 90). So when rituals are carried out, what sense of personal justice to the victims is there? (Interview 21) Furthermore, many rituals prescribe compensation to be paid which is practically impossible for most people and their communities to afford (Atkinson et al. 2006: 82) (Interview 24).

The relevance of traditional healing practices for former child soldiers has been undermined by a fundamental detachment in young people’s relationship with traditional beliefs and relationships. Furthermore, the nature of the conflict also seriously weakens the application of traditional rituals on its own terms. Given the predicament of traditional healing, it is valuable to understand what is the reaction of the government and development actors towards the psychosocial rehabilitation of returnees.

3.2 Development Organisations & Pyschosocial Rehabilitation: Different Approaches for Different Actors

In Gulu town the omnipresence of NGOs and UN agencies is clear. There are 220 NGOs in Gulu (Interview 9) conducting every type of development project. Even within psychosocial rehabilitation there are numerous organisations each with their own approach. In conducting interviews regarding psychosocial rehabilitation, terms such as trauma, traumatised and counselling are used effortlessly by NGO workers and lay people alike. The language and ideas of psychologically based interventions are well entrenched.

First and foremost, it is the responsibility of the government as the primary duty barer to provide social services. While the years of conflict may have provided an excuse for poor service provision, despite the LRA’s withdrawal from Uganda and the relative peace they left behind, NGO’s remain the main service providers, which is likely to remain for the foreseeable future.

Uganda’s country report on the CRC’s OP of children in armed conflict portrays a flattering role of the government

40

facilitating a rich NGO environment through which the formerly abducted receive the psychosocial treatment they need (UN 2008: 31). This is in direct contrast to a report from Amnesty International that acknowledges the usefulness of the initial psychosocial support that the formerly abducted receive at reception centres during the first couple of weeks out of captivity, but that the government is failing its responsibility to provide long term mental health services (Amnesty 2008: 14).

According to the former highest government officer in neighbouring Lira district, at the district level, there has been an investment in government capacity, since “previously, the problems of children were not taken seriously. Now there is a deliberate effort [by government] to address the challenges of children” (Interview 19). While the infrastructure and training may be in place, the ability or willingness of the government to manage NGO implementation, quality and to guide the transition of service delivery to the government is in question (Interview 21, 15, 9).

NGOs have rushed to fill the gap left by government. Constantly driving through the dusty streets of Gulu town are the various 4x4s with decals proclaiming which UN agency or international NGO to which the vehicle belongs. For many local NGOs and even local government trucks, donor names such as UNICEF are prominently displayed alongside the local recipient organisation. According to Donald Odero of Save the Children in Uganda, the “government is the nucleus in the development process. NGOs are just supposed to bridge the gap” (Interview 11). But who fills the gap between the NGOs?

Uganda’s 2007 report to the CRC states that “World Vision, Gulu Support the Children Organisation (GUSCO), Concerned Parents’ Association (CPA), Rachele and Kitgum Concerned Women’s Association (KICWA) show that so far, over 25,000 formerly abducted children have gone through rehabilitation centres (UN 2008: 16). This massive effort to support the reintegration of formerly abducted children is generally conducted independently without consistent cooperation to develop a common approach and best practices for psychosocial support. While a guidelines document was produced in 2004 by a group of relevant NGOs and UNICEF in Gulu, it pertained to creating minimum standards for reception centres and once handed

41

over to the government there has been little follow up on monitoring psychosocial best practices (Interview 11, 24).

According to Adolf Gerstl, regional coordinator of the EU’s Northern Uganda Rehabilitation Program (NUREP), €4.7 million was provided to 6 NGOs to for ‘software’ related programs in the first half of 2009. Such programs are made up of a mixture of livelihoods, psychosocial, training, peace building and conflict resolution. Yet, regarding their psychosocial programs, all the organisations selected use various methods to implement their programs. Monitoring and evaluation is done to ensure the application was executed properly, but is not measured against the best practices within a topic (Interview9). The lack of tools to measure how programs perform underscores the need for a greater consensus on program implementation methods.

One the most common methods for rehabilitation is trauma counselling which is used by GUSCO in its reception center for formerly abducted children. GUSCO is an indigenous organisation started by the parents of abducted children in 1997 to care for children returning from captivity and supported the rehabilitation of 7,769 returnees as of 2007 (Gusco 2009). Prior to its inception, children were held in military barracks and let go into the street looking for their parents. GUSCO also supports reintegration through family tracing and vocational training (Interview 11). However, counselling is a central element of its rehabilitation approach.

When the formerly abducted come to the GUSCO’s reception centre, for a minimum of three weeks, children become part of an established routine to instil healthy living habits and to acclimatise returnees to life outside the bush. Upon arrival, social workers administer a mental health assessment to determine if a returnee is suffering from PTSD and then provide the appropriate counselling based on their condition (Interview 30). This process is based on documents such as the Assessment of war affected adolescents and adults in Northern Uganda: A Manual for Counsellors and Interviewers that assess health in terms of ‘psychotraumatisation’ without accommodating for Acholi world views of spirituality and connection to the community (Vivo 2007: 4-12).

A trained GUSCO social worker, with a degree in social work from Msamizi Institute of Social Development in Kampala, describes the counselling process. Over time trust

42

is built and a child can come to speak about their past experiences go through counselling. For example, a child who has come to the centre and is not speaking due to trauma and runs out of soap will come and ask for more soap. Even these simple interactions builds trust. Over time, a dialogue forms, the purpose of which is to make the child realise what happened is in the past and to look to the future (Interview 30). Providing the opportunity but not forcing dialogue is consistent with rehabilitation guidelines (UNICEF 2007: 40). Nevertheless, according to an external evaluation on GUSCO, “Children are also invited to share their ‘abduction story,’ including their experiences in captivity ... All children are interviewed individually to ‘open their file’” (Barnett et al. 2004: 25) or in other words, speak at length about their experience. And while a traditional healer or pastor may be requested by the program participant (Interview 3)(Barnett et al. 2004: 30) the schedule of daily counselling at the reception centre prioritises counselling based on PTSD in order to support recovery through exploring the traumatic experiences of the former child soldiers.

War Child Holland is not the first stop for children coming out of the bush but its use of creative activities and sport serves as a useful contrast to GUSCO’s counselling as a means to support the trauma former child soldiers have faced in order to achieve normal functionability. WCH’s activities are part of a program that supports formerly abducted children and at the same time others who were not abducted. This approach avoids stigmatising the formerly abducted by not singling them out as ‘different’ and providing them with extra resources while others go without. These programs provide a type of individual therapy and support the development of life skills while preventing the worsening of trauma symptoms. And while the program focuses on the group as a whole, it provides individual therapy for young people within a communal context. Individuals learn the life skills they need to guide making healthy and productive choices for their future while simultaneously being integrated socially (Interview 24)(Interview 35).

Other programs in which participants and personnel were interviewed include two other local organisations. St.Monica’s Girls Tailoring School focuses specifically on developing vocational, such as tailoring, catering, secretarial and computer training, skills that formerly abducted and other vulnerable girls can use to be self

43

supporting. GWED-G implements psychosocial programs and is an implementing partner for the WCH supported girls football team.

GUSCO’s counselling work in the reception centre, WCH’s individual recovery and social integration through creative and sport activities as well as St. Monica’s and GWED-G all work towards support the successful rehabilitation of formerly abducted children. Interviews with participants, parents, non-abducted children, NGO implementers and other development actors provide perspectives on whether the different approaches are acceptance locally and thus the degree to which they are compatible with local culture.

44

Chapter 4 Western Intervention Methods: The Agency of the Individual within the Rehabilitation Process

According to field research conducted for this paper in the northern Ugandan district of Gulu, participants had positive experiences while engaged in various types of rehabilitation approaches. To determine local perceptions towards imported methods, interviews with programs participants were key and supported by other community and development actors. Participants, mainly from GUSCO, WCH but also from others such as St. Monica’s Girls Tailoring Center, GWED-G and Unyama community counselling, have a positive attitude towards PTSD oriented counselling, supportive community counselling, and creative activities and sport. The strong desire of former child soldiers to increase their life chances through education and to support oneself with an income, crystallise a link between the reception centre, social reintegration and self dependency in which the role of individual skill development is key to successful rehabilitation.

4.1 CounsellingSeveral unexpected insights into the perspective of

participants in rehabilitation programs were learned during a large focus group with formerly abducted children on the border with Sudan. It was a two hour motor bike trek from the town of Gulu along the country roads to Bibia parish in Atiak sub county. My colleague, Tabu Simon, remarked how incredible it was to be in this area as dusk approached and still be safe. For him, it was a sign that peace had arrived. But were those who had gone through GUSCO’s program at peace with themselves and the community?

Lending stark imagery to the serene surroundings of thatched huts, the focus group participants mentioned that as members of the LRA, they could move freely, in the area in which we were sitting, just a few years before. In discussing their experiences at the GUSCO reception centre, prayer and counselling became two parallel topics that provided an interesting point of reference to learn more about the role of each in rehabilitation. As one

45

respondent explained, their rescue from the LRA was because of God, which is why some had become born again Christians. Another described their perception of the relationship between the two, “all rehabilitation is prayer and counselling hand in hand together. They are difficult to separate. Prayers are included in counselling practice” (Interview 6).

Even though prayer was combined with counselling, there were distinct perceptions as to the function of each. For one respondent, “counselling helped because I stopped doing the things of before, it provided moral guidelines”. And another said that “counselling is more important because it allows for reform. If there were only prayers, a person would still do atrocities.” As to a question on what they saw as the difference between counselling and prayer, their answers included: “counselling talks facts, prayer is general” and “counselling brings a person face to face with what they’ve done. The person feels it. Prayers are too general to get advice”(Interview 6). The respondents in this group indicate that counselling, as compared to prayer, is a useful tool to reform behaviour. The respondents are aware of what benefits their rehabilitation and express a preference for ones that can aid them in concrete ways to deal with the challenges of changing their actions.

GUSCO’s counselling practices experienced by focus group participants in Palaro sub-county also received positive comments. Of the three formerly abducted children, the first male respondent expressed that counselling allowed him to share and know that he is not the only one with problems stemming from the violence they committed and observed while in the LRA. The second male and female respondent both indicated that counselling was instrumental to give them hope for the future (Interview 27).

In Unyama, just outside of Gulu town, the only support for the formerly abducted is a local counselling centre. The little funding they receive through GWED-G does not even go towards paying the local staff who provide counselling to the community and among them many formerly abducted girls and girl mothers. In an interview with a formerly abducted girl who came back from captivity, forced marriage and a child due to rape, counselling as her primary source of hope was clear. Even just arriving at the counselling centre, women seemingly spilled out of the office, which upon entering only had enough room for one

46

desk. By the time everyone had made way for our meeting to start in the office, those who were inside now made up a large group sitting outside. Many of these women are part of a group of 30 formerly abducted girls from Unyama and the surrounding region. When they have problems such as flashbacks and are struck with fear or are discriminated against by the community, they come to the counselling centre to receive positive feedback and encouragement. As the former girl mother now a young adult makes clear, the counselling gives them the comfort to persevere through their daily challenges (Interview 26).

The experience at St. Monica’s Girls Tailoring Center, which has been taking formerly abducted girls since the beginning of the conflict, contends that the difference counselling makes in a child is clear. Those who go through GUSCO are less aggressive and more polite than those who go back to their village straight from captivity (Interview 8). A student, who was not abducted herself, describes formerly abducted girls who start at St. Monica’s as aggressive and suffering from nightmares. When counselling happens, there is a change, it gives them courage and helps one forget what has taken place (Interview 13).

For many returnees, systems of support and counsellors to facilitate personal empowerment may not be available considering that approximately one third of returnees may pass through reception centres such as GUSCO’s. However, according to Victor Ochen’s experience with organising programs to support those affected by the conflict, former child soldiers often do more to stigmatise themselves due to feelings of worthlessness. As a result, they do not interact with others or ask for help, since they think that they are an inconvenience to others (Interview 20). Counselling is one tool that enables the formerly abducted to begin moving forward in their attitude towards oneself and others and eventually to pursue school or work. Indicative of counselling’s importance in the community is Adokorach Christine’s, program manager at CRR, description that even in the context of food shortages and experiencing the trauma of war that women’s main priorities are schooling and counselling (Interview 10).

A sense that counselling is thought to be a cure all by respondents is understandable. In a community such as Unyama where there has been no government health services police used to be the only recourse for support.

47

Often assault charges would go away because of bribes and people felt helpless. Now there is a place to turn to (Interview 26).

Counselling was identified as a very useful tool for returnees to deal with their traumatic experiences with the LRA as well as a key means of support once back in the community.

4.2 Community Pressure and Individual Survival

As the counselling centres demonstrate, the community is at the same time a challenge and a support for the formerly abducted to achieve functioning on par with their peers. At the core is the whether the individual has the opportunity to advance their rehabilitation in order to function in the community alongside their peers. However stresses from the community challenge returnees to rely on themselves and support mechanisms that bolster individual strength.

Sensitisation and other activities that facilitate the community to support the individual are key to creating an environment that accepts the returnee and allows them to reintegrate (Interview 4)(Interview 27)(Interview 35). Depending on how people react to a girl mother, the community itself can be another source of anxiety thus compounding the challenges involved in an individual’s psychosocial rehabilitation. In Unyama, the returned girl mother says that while an individual family may be happy to see their daughter back, the community discriminates. As she explained, in the eyes of the community, “the worst thing you can do is return from captivity with a child.” For her, not having parents and with a child from captivity makes life difficult. There is never anyone to help take care of the baby, so she works with the baby on her back. Furthermore, “when children play with each other, if the child of a formerly abducted mother beats another, then the community says it’s because there is no father and we should go back to the bush. Indicating that having the child was not her choice, the girl mother says that it “wasn’t our way” (Interview 26). Without family and as a girl mother, she is more vulnerable to discrimination from the community.

Sister Okello’s experience as deputy director at St. Monica’s reiterates that for girls who come with children

48

back to the village, communities “may not wish to receive them”. Therefore mothers are more difficult to settle. The burden for boys less is since family relations and education opportunities do not suffer as a result of being abducted (Interview 18). But if girls have been with another man then marriage is not possible and as a result move from guy to guy (Interview 16).

As the focus group participants in Palaro noted, stigmatisation was rampant when they returned but community sensitisation by GUSCO was a major support in improving their social relations (Interview 27). Seemingly, NGOs are revitalizing processes of community support that have suffered as a result of the conflict.

Community acceptance, just like rehabilitation, can also be a long term process. In Palaro, the focus group of three formerly abducted children, two males and one female, acknowledged that years after returning, stigma persisted in the community. Abuse was most likely to take place after people have been drinking (Interview 27).

While counselling can take place in a group setting, alternative approaches such as creative activities and sport are more social in that returnees participate in these psychosocial programs alongside non-abducted children. This approach supports a returnee on an individual basis within a group setting thus facilitating their reintegration into the community.

4.3 Alternatives to CounsellingContrasting GUSCO’s focus on counselling, WCH’s Ideal

program works in schools in Gulu district conducting creative games and activities with students in class including abducted and non-abducted children. WCH strives to be participatory. Children are asked to identify the causes of conflict in their lives and community and come up with solutions to the problems. By engaging the students, ages 10-14, they identify the challenges in their lives and are part of the process to develop the skills needed to deal with those problems. The program is not conducted solely for the formerly abducted as it is believed that this adds to stigmatisation. Instead, a dual benefit of supporting the psychosocial rehabilitation of the formerly abducted along with the non-abducted, who may have also experienced trauma in the IDP camps, can be addressed simultaneously.

49

The students themselves endorse the program’s inclusivity when they noted that “we have many different children, they come to the group to learn”, “there are children who don’t have parents, so it’s good for them”, and “it makes children be respectful, so it’s good for children” (Interview 17).

One of the first activities of the program is to ask the children what do they like and do not like, and what brings conflict. Atingo Jackie, psychosocial program designer for WCH, explains that this activity allows the program implementer to understand why the children feel the way they do(Interview 15). After asking the students what they drew, many eager and dutiful responses followed. One respondent answered that “a picture of child carrying gun” brings conflict and what does not bring conflict is “a child carrying a book”. This type of interactive approach actually defines the content of the weekly program for a particular group (Interview 17).

Through creative exercises such as drawing and games, positive messages are delivered and practical skills are learned through students’ own suggestions to a given problem. Fighting over a pen was a common example given by students who also devised the solution. Those who are fighting should be separated and the pen should then be taken to the teacher in order to find out who owns it. Those fighting should ask forgiveness and reconcile(Interview 17). In this way, group activities support the formerly abducted and conflict affected children generally by providing individuals with the ability to make decisions that lead to greater individual and social harmony.

In a group interview with students participating in WCH’s Ideal program, all the students indicated that they support the program. They offered several reasons including that the program: is “nice”, “improves relations with friends”, “changes your ideas”, “good if you have difficulties mentally”, “encourages people not to fight”, “see friends”, “unites people”, “good ideas” (Interview 17). The program is well received by the students of this school. However, reflecting the limitations of NGOs, not every student in the school can participate since it is not feasible for WCH to implement a program for between 1,000 to 2,000 students in each school.

As demand for WCH’s programs grew, the Big Deal program was initiated in order to reach school drop outs who were recommended by the community to participate

50

due to antisocial behaviour such as getting involved in gangs, aggressive behaviour, stealing. The ages of participants from a focus group of Big Deal participants in Lamogi sub county ranged from 15-20 and had completed the 18 week program one year prior. The social tools that participants were trained in supported them to make decisions that facilitated positive and healthy relationships with others which for many was a breakthrough (Interview 16).

To shape the weekly modules in order to be most relevant to their lives, the WCH facilitator asked participants what good things they have done in their life as well as the bad things. Each weekly module incorporated the feedback of participants who identified several main challenges including conflict with themselves, with friends and relationships. Speaking for the group, one participant said that the things they were taught and the training they received “changed people’s lives” (Interview 16). The respondents pointed to an example of a useful tool that facilitated peaceful resolution. It was explained that “when you have a problem that you can’t resolve on your own, go to a third party, then go to the person and explain your behaviour and then forgive” (Interview 16).

One respondent’s answer indicated that she was a formerly abducted girl who had come back from the LRA with a child from a forced marriage. Referring to how the program has supported her, she said that now she knows how to take care of her child. Previously, she used to think of beating the child because of the absent father, but has now come to think of the child as hers and treats it well (Interview 16).

When asked what were the most important module themes and how the activities in the program supported them, many positive answers were provided. The module on conflict helped one participant realise he was a trouble maker. The emotion module supported another in “dealing with my emotions, thinking before acting”. Tools to deal with relationships supported participants on “how to mend relationships, create friends”. Another participant in the focus group would fight and be left out of social groups because of aggressive behaviour. Speaking of the affect of WCH’s program, she the respondent said that “after the training I changed” (Interview 16).

Many mentioned that learning how to resolve conflicts peacefully was a main benefit of the program, but not the

51

only one. The program also provided an opportunity to socialise and as one respondent emphasised, the program “gives the opportunity to get to know people not just to solve problems”. Others referred to useful skills such are farming skills and how to take care of her house (Interview 16). Having learned concrete tools that help participants take better care of themselves, dependents and establish healthy relationships, all respondents were emphatic that they and others be able to continue to benefit from programs like these.

Some programs, and organisations, focus on sport as the primary vehicle to deliver messages that facilitate a change in a young person’s psychosocial situation. Victor Ekesu, director of Right To Play in Lira, a non-Acholi district also greatly affected by the conflict, argues that the “failure to live harmoniously can be ingrained, key is to build a new generation that will appreciate each other. Games bring people together” (Interview 19).

Director of GWED- G, Angwech Pamela Judith, explains that due to the conflict, schools stopped sports programs. Now GWED-G implements WCH football activities for female youth ages 9-17. Teams of 30 girls practice and play matches. These activities are accompanied by dialogues which are opportunities to learn about issues important to leading a healthy life including information on reproductive health, gender based violence, AIDS counselling and lifestyle. Providing youth with information “helps young people to make decisions on their own and encourages children to think about the future (Interview 31).

After watching an impressive practice match, I spoke with the group of 30 girls, aged 9-17, who played on the Pacoh girls football team supported by War Child and GWED-G. All the girls were eager to tell me why they enjoyed football and how it had changed them for the better. Punctuating the positive mood surrounding the team, one player said of the future that, “I want to kick like Ronaldo!” (Interview 33).

The existence of a girls team at all is a major achievement in itself. Historically, girls were not supposed to raise their legs above knee level and girls playing football was unheard of (Interview 32). Solely on their own initiative, the girls started the team four years prior when they were living in IDP camps after which War Child began to provide funding and support. In asking about their experience playing football, responses resounded with

52

positive replies including that “it helped me socialise”, “respect parents”, “stop abusing others”, “leave friends with bad influence” (Interview 33).

In answering questions about their experience and perspectives, one player voluntarily identified herself as a formerly abducted girl. Eager to answer every question first, she explained that initially she just wanted to be in a quiet place but participating in “football changed my life completely. It ended the discrimination directed towards me by other young people. It is so good, now I have respect for others, associate with others”(Ibid.). Group activities offer the opportunity for an individual to benefit in their own way while at the same time inculcating the group with behaviour that promotes peace in the community. Inclusive activities also reduce opportunities for stigmatisation by not singling out former child soldiers. A focus group of parents in Parlo sub-county noted that community resentment does occur, for example, when reintegration packages are given to the formerly abducted, while others receive no other material support (Interview 34).

The communal nature of sport can bring together young people with different experiences, enabling each to benefit in their own way. For the formerly abducted girl, she is now socialising in a normal context alongside her peers. In this sense, she is at the same point of departure to advance or not further in life, just like anyone else. A logical next step in her successful rehabilitation is to consider how she will support herself in the future.

4.4 Self DependencyInitially, my interviews were focused on people’s

attitudes towards their rehabilitation experience relating to traditional rituals, counselling, alternative rehabilitation approaches and factors influencing their rehabilitation since returning from the LRA to present day. However, sitting in the villages where these young people live, the notion of examining rehabilitation in retrospective terms sidelined the conditions and concerns of the participants today and their future well being. However, throughout the interviews, the needs and desire for education and the importance of vocational training to make money was clear. The overtly individual nature of doing something oneself, in studying and working, highlighted the ultimate role of agency in improving one’s own situation.

53

Having a supportive and financially capable family were indicated as two important elements needed to prosper (Interview 26, 19). Over the course of many interviews, it was often mentioned by young people and parents that they or others could not afford the fees to send their children to school (Interview 8, 17, 16, 33, 34). For some returnees without parents and girl mothers, they are left to their own devices to overcome the lack of resources in the community or outright rejection (Interview 26).

The dynamics of community acceptance and survival are evident in the focus group discussion with formerly abducted in Palaro sub-county. The first respondent indicated that it took 1 month to feel accepted, the second respondent 2-3 months and the third, a female, 4-5 months. Now the males are able to earn a living through petty business such as selling used clothes. For the female however, after a problem with her sewing machine that has rendered it inoperable, she has no other source of income and feels the advancements she made in life are slipping backwards because she cannot support herself (Interview 27).

In Unyama, the formerly abducted girl mother was determined to create her own reality. Despite the difficulty of her experiences as part of the LRA and back in the community, during the interview she spoke with confidence and purpose. The interview ended with a comment on the one thing that could help her move her life forward, “all I want to do is to find a way to make money”. Ever the self starter, she then she made a pitch for me to sponsor soccer equipment for the football team she has started with other formerly abducted girls (Interview 26).

An individual’s use of skills to advance can be most widely seen in vocational skills for income generating activities. Yet, be they economic, social or mental coping mechanisms, the skills used by returnees at different stages in their rehabilitation facilitate their advancement. Through counselling, former child soldiers are given the tools to cope with their past and enhance their opportunities to move forward. Counselling at GUSCO or supportive counselling in the community, participants find great value in talking about their problems with others. The role of the community is a key element is rehabilitation, and its attitude towards a returnee can change over time being the source of both positive and negative influences. Even when confronted with discrimination the returnee can persevere

54

and survive as many do. But it is especially in these circumstances that it is evident how the mental, social and vocational skills of the individual are necessary to navigate the various obstacles involved in rehabilitation. This is does not discount the importance of the community in any way, since without it an individual’s rehabilitation is meaningless. As the final arbiter of acceptance, the community may be the most important factor in an individual’s successful rehabilitation. However, in the context of the rehabilitation debate in which the individual has been eschewed due to the excessively individualistic nature of previous Western programs, the fostering of various types of individual skill can be seen as part of a continuum of individual skill development necessary for rehabilitation within concurrent communal processes.

55

Chapter 5 Conclusion: Responding to the Realities & the Future of Traditional Healing

In addressing the main research questions, this research found the conditions to practice traditional healing to be fundamentally weakened due to the effects of the conflict with the LRA. Contrasting the opinions of vocal critics, it was very interesting to see that Western rehabilitation practices to have widespread support among participants. These findings are elaborated upon below and include a reflection on fundamental dynamic of the international NGO presence in Gulu and its influence on the viability of traditional healing irrespective of the effects of the conflict.

The profound effects of conflict in Gulu show the importance of understanding context. In order to ultimately implement rehabilitation programs for former child soldiers that will be accepted by participants, understanding how conflict affects the relationship between traditional cultural practices and youth is of value. In the district of Gulu, the effects of the IDP camp conditions on young people and their relationship with traditional cultural values is central for understanding the weakened ability of traditional healing practices for former child soldiers in Gulu. The effects of the cultural rupture can be seen in the ambivalent attitude of some interviewees to traditional healing practices. As a result, the normal assumption of using a balance of traditional practices and Western approaches is thrown into question. Traditional practices should not be abandoned due to the disruption in cultural practices that can be expected with conflict. At the same time it cannot be assumed that every context is affected by conflict in the same way. Despite the effort among program implementers and designers to prevent the imposition of Western approaches, rehabilitation efforts cannot assume that traditional practices can be used simply because they are indigenous. Each context must be understood in and of itself in order to determine how to design programmes that can best meet the psychosocial needs of former child soldiers.

The relevance of the acceptance of traditional practices by participants may be relevant but not dire for many in

56

Gulu. Many will face challenges of stigma from the community, but as can be seen from those interviewed over time, they have survived and can find work while stigma, at least, decreases over time. However, for the more vulnerable, such as girl mothers who are often rejected outright by the community, their daily realities depend on support mechanisms that bolster their survival as an individual. Therefore, the use of traditional ceremonies is unlikely to support such vulnerable groups.

Considering the criticisms of Western interventions imposing foreign world views through the diagnosis of PTSD and the use counselling, it was surprising that many participants were very positive about their counselling experience. For returnees, talking about problems with a stranger is widely accepted by participants and the community. The Formerly abducted who participated in GUSCO’s counselling sessions at the reception centre describe counselling as an enabler that supported them to change their behaviour and deal with their past. This is an interesting finding because it contrasts with critics such as Summerfield who contend that exploring the past is a foreign imposed approach and harmful. For participants in GUSCO and in the community, counselling provided individuals with concrete tools to address their current challenges in order to avoid dysfunctional or anti social behaviour in order to move past their negative experiences.

Just as counselling provides individuals with the skills to manage their trauma, WCH’s creative and football activities also foster individual skill development, but focused within a social setting. Participants in the Ideal and Big Deal programs emphasised how they have learnt conflict resolution skills and as a result have positive attitudes and are better able to socialise. For a formerly abducted girl with a baby from a forced marriage, the program has supported her to move beyond seeing her child as a product of rape and instead provide the baby with loving care. Participants in the girls football team also gave their resounding approval of the positive effects of football, as one former female child soldier said “football changed my life completely” (Interview 33). What is surprising here about the testimonies of individuals in these groups is the individual therapeutic effects that these activities have within a group setting. They provide a dual purpose of supporting the individual with the skills for positive interaction while simultaneously facilitating social reintegration. In the Ideal, Big Deal and football team,

57

there was a strong sense of attachment to the group beyond just participating in activities.

In discussing the current realities with formerly abducted, other children and youth and parents it became evident that education and earning an income was a priority for so many people. The girl mother who told me, “all I want to do is to find a way to make money”(Interview 26) impressed upon me the role of individuals in their own rehabilitation and reintegration process. The desperate need and desire to support oneself is evident in vulnerable groups. The individual is the agent that propels her own rehabilitation, but at the same time the role of the community is indispensable. Community acceptance provides the conditions for the potential of individual agency.

All these findings apply and are useful to design programs with an understanding of the effects of conflict and conceptualising the role of the individual throughout rehabilitation in a way that has been largely ignored. Nevertheless, the entire paradigm in which rehabilitation programs operate in Gulu is lopsided and disingenuous. Rehabilitation programs in Gulu could continue as they are and be accepted as has shown to be the case, but that would make a mockery of the notion of striving for a balance between indigenous and Western approaches. That counselling, and even the more culturally neutral creative and sport activities, is accepted leaves the impression that nothing is being lost since the participants have no objection to them. This is analogous to the dying out of indigenous language. When a young person learn English as her mother tongue instead of the local language, she too feels no loss. But in fact there is a tremendous loss of knowledge, values and identity associated with the language. The same is true of traditional healing and other expression of traditional culture.

Conflicting choices between a dichotomy of approaches gives way to one which obliges Western development agencies to live up to their mantra of respecting traditional healing by implementing it alongside imported methods. Whether or not traditional healing practices or other cultural resources are effective in the way they once were, there remains is an obligation among visiting organisations that implement locally to support the revival of local resources as much as possible.

58

The whole notion of balance is undercut by the reality of psychosocial rehabilitation programs on the ground. The lack of government activity in this area has allowed the prodigious growth of NGOs in Gulu to create de facto guidelines on rehabilitation approaches. Former child soldiers, as judged by interviews, have benefited from the programs in which they participated in. However there seems to be little effort to implement programs alongside local cultural practices, be they traditional healing or otherwise. This situation allowed imported methods to proliferate and done nothing to support the recovery of traditional healing practices. While the attitude of participants may be agreeable to imported programs that does not necessarily mean that there is not an imposition of some sort. Given the position of NGOs to influence rehabilitation approaches in Gulu, there needs to be an honest commitment to honouring the spirit of balance and the utilisation of cultural resources. Being in a post conflict context with little government action and a dominant culture of international NGOs, the opportunity exists to face the changes in Acholi culture represented in the new attitudes and beliefs of children and youth to create a local solution instead of abdicating that responsibility and relying on imported methods.

The weakness of traditional healing in Gulu can be attributed to the effects of conflict, but the perpetuation of this situation is avoidable. Unless the development sector in Gulu and the local community work together to devise ways for traditional healing and cultural resources to be relevant for former child soldiers, and also the general youth population in Gulu, the knowledge and values of Acholi culture will be lost and the result will be a future generation heavily influenced by imported beliefs and practices. The significance rests beyond the mechanics of achieving a balance between two approaches but to understand what kind of world views are former child soldiers and young people being moulded into.

"And in the end then, it really comes down to a choice: do we want to live in a monochromatic world of monotony, or do we want to embrace a polychromatic world of diversity. Margaret Mead the great anthropologist said before she died, that her greatest fear was that as we drifted toward this blandly amorphous generic worldview, not only would we see the entire range of the human imagination reduced to a more narrow modality of thought,

59

that we would awake as if from a dream one day having forgotten that there were other possibilities."(Davis 2008)

ReferencesAger, A., N. Boothby and L. Stark (2009) 'Children and Fighting

Forces: 10 years on from Cape Town', Disasters 33(4): 522−547.

Amnesty (2008) 'Left To Their Own Devices: the continued suffering of victims of the conflict in northern uganda and the need for reparations'. London: Amnesty International.

Atkinson, R., M. Balthazard, C. Obonyo A, F. Okot X and T. Harlacher (2006) 'Traditional Ways of Coping in Acholi: Cultural provisions for reconciliation and healing from war'. Kampala: Caritas Gulu Archdiocese.

Baines, E., E. Stoyer and M. Wierda (2006) 'War-Affected Children and Youth in Northern Uganda: Toward a Brighter Future'. Chicago: John D. and Catherine T. MacArthur Foundation.

Barnett, K., E. Jareg and M. O’Reilly (2004) 'Gulu Support the Children Organisation 2002-2005: Evaluation and Lessons Learnt'.

Coalition (2004) 'Child Soldiers Global Report 2004'. London: Coalition to Stop the Use of Child Soldiers.

Coalition (2008) Facts and Figures on Child Soldiers. Retrieved November 5 2009, from http://www.childsoldiersglobalreport.org/content/facts-and-figures-child-soldiers.

Davis, W. (Writer) (2008) The World Wide Web of Belief and Ritual, Talks. USA: www.oted.org.

Drozdek, B. (2007) 'The Rebirth of Contextual Thinking in Psychotraumatology', in B. Drozdek, J.P. Wilson (Eds) (ed.), Voices of Trauma: Treating Psychological Trauma Across Cultures (pp. 395). New York: Springer.

Drozdek, B., J.P. Wilson (2007) 'Are We Lost in Translations?: Unanswered Questions on Trauma, Culture and Post-Traumatic Syndromes and Recommendations for Future Research ', in B. Drozdek, J.P. Wilson (Eds) (ed.), Voices of

60

Trauma: Treating Psychological Trauma Across Cultures (pp. 367-387). New York: Springer.

Ellis, S. and G. ter Haar (2007) 'Religion and Politics: Taking African Epistemologies Seriously ', Journal of Modern African Studies 45(3): 385–401.

GUSCO (2009) GUSCO Annual Report 2007. Retrieved 10/05/09, from http://gusco.org/.

Henley, R. (2005) Helping Children Overcome Disaster TraumaThrough Post-Emergency Psychosocial Sports Programs Unpublished Working Paper. Swiss Academy for Development.

Honwana, A. (2006) Child Soldiers in Africa. Philadelphia: University of Pennsylvania Press.

IASC (2008) 'IASC Guidelines on Mental Health and Psychosocial Support in Emergency Settings: Checklist for Field Use'. Geneva: Inter-Agency Standing Committee.

Jareg, E. (2005) 'Crossing Bridges and Negotiating Rivers: The Rehabilitation and Reintegration of Children Associated with Armed Forces' [electronic version], Coalition's Psychosocial Resources: 1-10. www.child-soldiers.org/resources/psychosocial (accessed 07/10/09).

Jong, K.d., M. Mulhern, N. Ford, S.v.d. Kam and R. Kleber (2000) 'The Trauma of War in Sierre Leone', The Lancet 355(9220): 2067-2068.

Kasaija, A.P. (2006) Civil Society and Conflict Resolution: The Role of the Acholi Religious Leaders Peace Initiative (ARLPI) in the Northern Uganda ConflictPaper presented at the conference '7th Annual Conference of the International Society for Third Sector Research (ISTR)'. Retrieved 10/05/09.

Keller, L.M. (2008) 'Achieving Peace with Justice: The International Criminal Court and Uganda Alternative Justice Mechanisms', Connecticut Journal of International Law 23(209): 210-278.

Kostelny, K. (2006) 'A Culture Based Integrative Approach', in N. Boothby, A. Strang, M. Wessells (Eds) (ed.), A World Turned Upside Down: Social Ecological Approaches to Children in War Zones (pp. 19-39). Bloomfield: Kumarian Press.

61

Kroes, H. (2008) 'The Journey Home: Multi Discursive Perceptions on the Movement Patterns of Internally Displaced Persons, Northern Uganda'. PhD thesis, University of Leiden, Leiden.

Machel, G. (1996) 'Impact of Armed Conflict on Children': UNICEF.

Ommeren, M.V., S. Saxena and B. Saraceno (2005) 'Mental and Social Health During and After Acute Emergencies: Emerging Consensus?' [electronic version], Bulletin of World Health Organization 83: 71-77. http://www.searo.who.int/LinkFiles/List_of_Guidelines_for_Health_Emergency_Menta_social-health.pdf (accessed 07/10/09).

Rosen, D.M. (2007) 'Child Soldiers, International Humanitarian Law, and the Globalization of Childhood', American Anthropologist 109(2): 296–306.

Summerfield, D. (2001) 'The Invention of Posttraumatic Stress Disorder and the Social Usefulness of a Psychiatric Category', BMJ 322: 95-98.

Summerfield, D. (2002) 'Effects of War: Moral Knowledge, Revenge, Reconciliation and Medicalised Concepts of “Recovery”', BMJ 325: 1105-1107.

Summerfield, D. ( 2004) 'Cross Cultural Perspectives on the Medicalisation of Human Suffering', in G. Rosen (ed.), Posttraumatic Stress Disorder: Issues and Controversies (pp. 233-247). New York: Wiley.

Tindifa, S.B. (2006) 'Listen to the People! Towards an Inclusive Approach to the Peace Process in Northern Uganda' (Working Paper): HURIPEC.

UN (1990) Convention on the Rights of the Child. Retrieved. from http://www2.ohchr.org/english/law/crc.htm.

UN (2000) Optional Protocol to the Convention on the Rights of the Child on the Involvement of Children in Armed Conflict. Retrieved 29/09/09, from http://www2.ohchr.org/english/law/crc-conflict.htm.

UN (2008) Uganda Country Report of The Optional Protocol to the Convention on the Rights of the Child on the Involvement of Children in Armed Conflict. Retrieved 22/06/09. from.

62

UN (2009a) Ex Child Soldiers: From Victims of War to Protagonists of Peace. Retrieved. from http://www.un.org/children/conflict/pr/2009-06-26216.html.

UN (2009b) Report of the Special Representative of the Secretary-General for Children and Armed Conflict. Retrieved. from.

UN (2009c) Status: Convention on the Rights of the Child. Retrieved 29/09/09, 2009, from http://treaties.un.org/Pages/ViewDetails.aspx?src=TREATY&mtdsg_no=IV-11&chapter=4&lang=en.

UN (2009d) Status: Optional Protocol to the Convention on the Rights of the Child on the Involvement of Children in Armed Conflict. Retrieved 29/09/09, 2009, from http://treaties.un.org/Pages/ViewDetails.aspx?src=TREATY&mtdsg_no=IV-11-b&chapter=4&lang=en.

UNHCR (2007) 'Making Peace Our Own: Victims’ Perceptions of Accountability, Reconciliation and Transitional Justice in Northern Uganda'.

UNICEF (1995) Healing Minds As Well As Bodies. Impact of Armed Conflict on Children: Information Retrieved 29/09/09, from http://www.unicef.org/graca/.

UNICEF (2007) Paris Commitments: Principles and Guidelines on Children Associated with Armed Forces or Armed Groups. Retrieved 06/10/09. from http://www.diplomatie.gouv.fr/en/IMG/pdf/Paris_Conference_Principles_English_31_January.pdf.

UNICEF (January - March 2008) 'Humanitarian Situation Report'. Kampala: UNICEF Uganda Country Office.

Vivo (2007) 'Assessment of War Affected Adolescents and Adults in Northern Uganda: A Manual for Counsellors and Interviewers' (Manual): Vivo.

Wessells, M. (2006) Child Soldiers: From Violence to Protection. London: Harvard University Press.

Appendices63

Annex A: Interviews and Observations#1 Observation GUSCO staff meeting, July 13, 20092 Observation GUSCO community dialogue, July 15, 2009 3 Interview (one on one) Anthony Paklaki, Social Worker, GUSCO, at GUSCO Reception Center in Gulu town, July 16, 2009 4 Interview (one on one) Pastor Oyera Martin Leko, Dino Parish, Odek sub-county, Friday July 175 Interview (focus group) with 10 community Leaders from Odek sub-county, included local counsellors 1- 3 and local parish leaders, Friday July 17, 20096 Interview (focus group) formerly abducted children, Bibia, Atiak sub-county. Included 10 males responded ages 15-30, Wednesday July 29, 20097 Interview (one on one) Obalo Fred Otim, Parish Chief, Atiak sub-county, July 30, 20098 Interview (one on one) Acire B Bernard, Instructor at St. Monica’s Girls Tailoring Centre, Gulu town July 31, 20099 Interview (one on one) Adolf Gerstl, Regional Coordinator, Northern Uganda Rehabilitation Program, NUREP office, Gulu town, August 2, 200910 Interview (one on one) Adokorach Christine, Program Manager, Center for Reparation and Rehabilitation, CRR office, Gulu town, August 4, 200911 Interview (one on one) Donald Odero Save the Children, August 4, 200912 Interview (one on one) Anthony Ajok, Education Field Coordinator, United Movement To End Child Soldiering, GUSCO office Gulu town August 5, 200913 Interview (one on one) student at St. Monica’s Girl Tailoring Center, Gulu town, August 7, 200914 Interview (one on one) Manuela Schweigkofler, Technical Advisor, Horizont 3000, Austrian Organisation for Development Co-operation, Caritas, Gulu town August 6, 200915 Interview (one on one) Atingo Jacky War Child Holland, Agwayugi Lamogi sub county, August 7, 200916 Interview (focus group) War Child Holland Big Deal group, Agwayugi Parish, Lamogi sub-county, August 7, 200917 Interview (focus group) War Child Holland Ideal group, Agwayugi Parish, Lamogi sub-county, August 7, 200918 Interview (one on one) Sister Assumpta Acein Okello, Deputy Director, St. Monica’s Girls Tailoring Centre, Gulu town, Wednesday August 12, 200919 Interview (one on one) Victor Ekesu, Coordinator, Right To Play Lira, Former local council 5 for Lira district Friday August 14, 200920 Interview (one on one) Victor Ochen, Co-Director African Youth Initiative Network, Friday August 14, 200921 Interview (one on one) with Fabius Okumu – Alya, Director, Peace and Strategic Studies, Gulu University, August 20, 2009

64

22 Interview (one on one) Akena Charles, team leader, GUSCO, Gulu town, August 20, 200923 Interview (one on one) Ajok Margaret, UN Human Rights, August 20, 200925 Interview (one on one) Lauren Gould, Leiden University, Gulu town, August 20, 200926 Interview (one on one) Huma Polline Unyama, director of Unyama Counselling Center, and formerly abducted who is a girl mother, August 25, 200927 Interview (focus group) Formerly Abducted Children, 2 males, 1 females, ages 17-29, Gulu district, Palaro sub county, August 26, 200928 Interview (one on one) with Okidi- Lumedo David M., Acholi author, Gulu town, August 27, 200929 Interview (one on one) Olanya Cons Bernard, headmaster in Amuru, August 27, 2009-09-09 30 Interview (one on one) Akidi Beatrice, social worker, GUSCO, Gulu town August 19, 200931 Interview (one on one) Angwech Pamela Judith, GWED-G, Gulu town, August 19, 200932 Interview (focus group) 16 parents of girls football team in Pacoh, Tuesday August 25, 200933 Interview (group discussion) 30 Pacho girls football team, August 25, 200934 Interview (focus group) 8 Parents of children in Palero, August 26, 200935 Interview (one on one) Lakony Joel, Social Worker Trainer, War Child Holland, Gulu town August 7, 2009

65