PTSD in Former Child Soldiers in the Democratic Republic of Congo

Introduction

In the year 2000 the Optional Protocol to the Convention on the Rights of the Child was produced by the United Nations. The protocol stipulated that no child under the age of 18 would be forced into armed service, and since then it has been ratified by over 110 countries. Amnesty International claims that this may have just been a public relations ploy because eleven years after the ratification of the protocol it is estimated that over 300,000 boys and girls under the age of 18 are serving in armies around the world. (Human Rights Watch, 2008)(SOS Childrens Villages, 2008) Though the estimates vary, it is proposed that nearly one tenth of all child soldiers are in the Democratic Republic of the Congo.

Epidemiology

Post Traumatic Stress Disorder (PTSD) is a term that was coined in the mid 1970s and first included in the DSM III. (Bayer, Klasen, & Adam, Association of Trauma and PTSD Symptoms With Openness to Reconciliation and Feelings of Revenge Among Former Ugandan and Congolese Child Soldiers, 2007) It is the psychological and/or physical trauma, which manifests in a person after the experience of prolonged or acute trauma; this traumatic experience usually relates to the threat of harm or death. (Bayer, Klasen, & Adam, Association of Trauma and PTSD Symptoms With Openness to Reconciliation and Feelings of Revenge Among Former Ugandan and Congolese Child Soldiers, 2007) There are physiological changes in brain chemistry, which change the mental status and actions of the individual suffering from PTSD. It is estimated that up to 90% of people are exposed to trauma in their lifetime, however only approximately 8% ever have Post Traumatic Stress Disorder. The severity of the trauma and the developmental period in which the trauma is experienced are postulated to be indicators for developing PTSD. (Coalition to Stop the Use of Child Soldiers, 2008)

Children are at particularly high risk for developing Post Traumatic Stress Disorder. Childhood trauma is reported to cause more long-term effects than traumatic experiences in adulthood. Often adults will develop PTSD, which stemmed from events earlier in their lives. (US National Library of Medicine, 2011) Due to the high prevalence of PTSD in traumatized children it is not surprising that a reported 97% of former child soldiers report significant symptoms of Post Traumatic Stress Disorder. (Bayer, Klasen, & Adam, Association of Trauma and PTSD Symptoms With Openness to Reconciliation and Feelings of Revenge Among Former Ugandan and Congolese Child Soldiers, 2007)

Historical analysis of the issue

The history of the DRC is both complex and convoluted. It has been riddled by conflict for decades, has been occupied for centuries and suffers from a civil war that has turned its people against each other. Fighting in this civil war was attributed to the desire for fair sharing of the vast resources, which have been proven time and again, to be in “someone else’s” position. (SOS Childrens Villages, 2008) The Congo is rich in agricultural and mineral resources.  In addition to it’s largest crops, coffee and sugar, the DRC produces palm oil, rubber, tea, cotton, cocoa, quinine, cassava, manioc, bananas, plantains, peanuts, root crops, corn, fruits, and wood products. (CIA World Fact Book, 2011) Furthermore, the Democratic Republic of the Congo’s most lucrative resources include the mining of diamonds, gold, copper, cobalt, coltan, zinc, and tin. (CIA World Fact Book, 2011) The area is essentially a cornucopia of potential wealth; combined with the lack of stability in leadership, this has lead to a corruption and conflict. 

This unfairly brief synopsis of the history of the Congo serves as a backdrop for the human rights violations that Child Soldiers are currently facing. This should lead to a better understanding of the context in which the atrocities are taking place so that a more holistic solution can be developed. What is now the Democratic Republic of the Congo has undergone multiple transformations in its history. The origin of occupation in the area dates back as far as the fifth century B.C. when it was the Umpeba Depression; this area eventually transformed into the pre-Colonial civilization called the Kingdom of Luba. Luba was a wealthy kingdom, rich in natural resources such as diamonds, iron, and copper and had established a peaceful central government with distributed power via chieftanships by the 16th century.  The relative calm of the civilization was disturbed by slave traders from Arab Nations, Zanzibar, and ultimately the invasion of King Leopold II from Belgium. (Exenberger, 2007)

In the Conference of Berlin in 1885, King Leopold II “obtained” Luba and claimed it as private property, renaming it the Congo Free State. Many infrastructure projects were implemented in the Congo Free State but all had the monetary interests of King Leopold in mind, with little to no regard for the citizens of the colony. (Exenberger, 2007) Rubber was the main export during this time as the Congolese people were brutalized in the trade, many killed or de-limbed for not producing the set quotas. (O'Hanlon, 1998) In 1908, amid an outcry from foreign governments about the human rights violations happening in the Congo Free State, the Belgian government reclaimed the area as a Belgian colony, no longer private property of the king and called it the Belgian Congo. (Exenberger, 2007) During this period, Belgian law applied in the colony and many of the atrocities diminished or ceased altogether. The history of the colonists remained, however, and tensions between white colonists and African nationals persisted largely due to the condescending and often violent nature of the Belgians.(Microsoft Encarta online )

Tensions continued to grow in the area and in the late 1950’s, a movement developed called the Mouvement National Congolais, which was lead by Patrice Lumumba. (O'Hanlon, 1998) In elections Lumumba was voted in as the Prime Minister next to President Joseph Kasavubu. A series of other parities arose during this period and tensions again were high. Yet through the conflict the Beligian Congo obtained its independence in late June of 1960 and was yet again renamed, this time called the Democratic Republic of the Congo. In September of that same year the president, Kasavubu dismissed Lumumba from his position. (Exenberger, 2007) Lumumba declared publicly that it was unconstitutional to do so and a large-scale crisis quickly developed between the former Prime Minister and their respective supporters. Amidst the chaos a military leader originally appointed by Lumumba, Joseph Mobutu, staged a mutiny and overtook the government. Because he was staunchly opposed to communism the United States helped to fund Mobutu’s overtake of the government, seeing him as a powerful ally in the Cold War.  Despite the fact the Lumumba was not a communist, but rather a Nationalist, he realized that he was facing a coup d’état and asked for aid from the Soviets. Unfortunately it was too little too late and he was unable to withstand the powerful alliance between the United States and Mobutu. Early the following year the governments of Katanga, Belgium, and the United States collaborated to kidnap and assassinate Patrice Lumumba, all with the incentive of garnering power over the economic cornucopia that was the Congo. (Exenberger, 2007) Widespread chaos resulted and a series of interim governments sprouted until Mobuto Sese Seko became president in 1971 and the name of the area yet again changed, this time to the Republic of Zaire. (Exenberger, 2007)

Seko established a one party system in which elections could be held but he was always the only candidate. Despite relative stability the government was guilty of extreme human rights violations and corruption. Mobutu accumulated wealth close to four billion U.S. dollars, which he is accused of hoarding in a Swiss bank account. (O'Hanlon, 1998) He let the country fall into debt only slightly greater than his own wealth and ceased public works projects. 

Over the next two decades the conflicts of neighboring countries bled into the borders of Zaire and an uprising began which sought to kick Mobuto out of power.  Mobuto fled the country and power was taken over by Laurent-Désiré Kabila, who again renamed the country to Democratic Republic of the Congo. (O'Hanlon, 1998) He remained in power until he was assassinated in 2001. His son, Joseph, who subsequently went through two rounds of controversial elections, eventually received the popular vote and succeeded Kabila.  

The convoluted and violent history of the Congo is a virtual breeding ground for human rights violations. The Post Traumatic Stress Disorder, which affects the current and former child soldiers, is the direct result of a traumatic and stressful history of the country and its people. (Exenberger, 2007) Only by understanding the long standing violence that has perverted the humanity of the armies, both within and surrounding the Democratic Republic of the Congo, is it possible to imagine a solution for the trauma these children have experienced.  

Cultural determinants of outcome

The recruitment of children as soldiers is a curious problem. To most people it seems cruel and inhumane, but there must be a reason that rebel groups decide to recruit children. The malleability of children is what is thought to be their main appeal. (Bayer, Klasen, & Adam, Association of Trauma and PTSD Symptoms With Openness to Reconciliation and Feelings of Revenge Among Former Ugandan and Congolese Child Soldiers, 2007) An adult is set in their ways. They have formed opinions about life and people and the government. They have alliances and are not dependent like children are. “Recruitment” of child soldiers often occurs during raids where their entire families are killed and their homes destroyed. (Bayer, Klasen, & Adam, Association of Trauma and PTSD Symptoms With Openness to Reconciliation and Feelings of Revenge Among Former Ugandan and Congolese Child Soldiers, 2007) They are often given only two options: to be killed or to join the militia. After experiencing this intense traumatic episode children join their captors and are essentially brain washed. The Stockholm Syndrome which can occur is emphasized and then children not only become reliant upon their captors, but actually come to believe in what they are fighting for. (Betancourt, Simmons, Borisova, Brewer, Iweala, & de la Soudière, 2008)

Tertiary Prevention

In order to stop the cycle of violence which persists in the Democratic Republic of the Congo it is important that child soldiers are removed from the militias and placed in rehabilitation programs so that they do not continue the vicious cycle and grow up to recruit more young children. Unfortunately, the stigma usually associated with mental illness is even more pervasive in areas like the Democratic Republic of the Congo, where mental health has not become widely accepted as a legitimate medical condition. The accumulation of factors discussed earlier in this report combined with the stigma make for a very precarious environment in which to establish a rehabilitation program. (Betancourt, et al., 2010)

There are only a handful of mental health programs in the Congo. They are usually understaffed, over occupied, and under qualified to treat the vast and various cases that come through their doors. (Dickenson, 2009) Furthermore there are no effective programs currently in place to remove child soldiers from the militias and place them in recovery programs.  A successful tertiary prevention model must include a system for removing child soldiers from militias, several safe and accessible treatment facilities, and unique and effective methods for treating former child soldiers.

 

Role of the state in creating or maintaining inequity/ health disparity

Stories from former child soldiers throughout Africa are so heart wrenching that they seem unreal. Children are forced to kill entire families, often people they know and sometimes forced to eat their remains.  Children too young to hold a gun, sometimes three-years-old, are given whistles to blow as they walk in front of the rebels acting as human mine sweeps for potential enemies. (Kohrt, et al., 2008)  Since 1998 millions of civilians have died, nearly half of whom were children under 5 years old. (Kohrt, et al., 2008).

Post Traumatic Stress Disorder, the condition that results from prolonged exposure to a state of heightened anxiety, is experience in nearly 100% of former child soldiers. (Honwana, 2002) (Betancourt, et al., 2010) There are resilience factors such as a child’s ability to cope with negative emotions, but it is supposed that regardless of an individuals’ resiliency, all children who have been forced into rebel groups require intense therapy and rehabilitation. (Betancourt & Khan, The mental health of children affected by armed conflict: Protective processes and pathways to resilience, 2008) The most successful approach taken thus far in the DRC (Wessells, 2004) is also the approach that will be taken in this research proposal; it is the tertiary level of prevention and involves the treatment of these “child veterans”.  Treating PTSD in children is very different than treating it in adults. Due to the environment these children are living in, an even more complex approach needs to be taken to ensure that they can begin productive and happy lives. (Bayer, Klasen, & Adam, Association of Trauma and PTSD Symptoms With Openness to Reconciliation and Feelings of Revenge Among Former Ugandan and Congolese Child Soldiers, 2007)

The role of the state in this particular situation is complicated. Since the government is currently so unstable the most effective rehabilitation programs are run by private organizations or NGOs. The main roll of the government should be to ban the use of child soldiers and to enforce that ban. 

Rehabilitation programs need to be established in areas that are easily accessible and safe. The programs need to be comprehensive and include a variety of different group and individual therapies as well as reintegration programs for the children, so they have a place and purpose once they become adults. If the new generation of youth can separate themselves from the violence that has plagued the Democratic Republic of the Congo, it will be possible to stop the cycle and bring about peace. Only when peace becomes a reality in the Congo will the use of child soldiers be a thing of the past. 

 

 

 

 

 

 

 

 

 

 

Works Cited

Bayer, C., Klasen, F., & Adam, H. (2007). Association of Trauma and PTSD Symptoms With Openness to Reconciliation and Feelings of Revenge Among Former Ugandan and Congolese Child Soldiers. Journal of the American Medical Association .

 

Bayer, C., Klasen, F., & Adam, H. (2007). Association of Trauma and PTSD Symptoms With Openness to Reconciliation and Feelings of Revenge Among Former Ugandan and Congolese Child Soldiers. Journal of the American Medical Association , 285 (556).

 

Betancourt, Borisova, Williams, Brennan, Whitfield, Soudiere, et al. (2010). Sierra Leone's Former Child Soldiers: A Follow-up Study of Psychosocial Adjustment and Community Reintegration. Developmental Psychology , 81 (4), 1077-1095.

 

Betancourt, T., & Khan, K. (2008). The mental health of children affected by armed conflict: Protective processes and pathways to resilience. International Review of Phychietry , 2 (3).

 

Betancourt, T., Simmons, S., Borisova, I., Brewer, S., Iweala, U., & de la Soudière, M. (2008 йил 1-November). High Hopes, Grim Reality: Reintegration and the Education of Former Child Soldiers in Sierra Leone. NIHPA Author Manuscripts , 565-587.

 

CIA World Fact Book. (2011, November 15). Decocratic Republic of the Congo. Retrieved December 15, 2011, from The world factbok: https://www.cia.gov/library/publications/the-world-factbook/geos/cg.html

 

Coalition to Stop the Use of Child Soldiers. (2008). Facts and Figures on Child Soldiers. Retrieved November 2011, from Child Soldiers Global Report 2008: http://www.childsoldiersglobalreport.org/content/facts-and-figures-child-soldiers

 

Dickenson, D. (2009). DR Congo Sente Sosame. European Commission Humanitatian Aid Department.

 

Exenberger, A. S. (2007). he Dark Side of Globalization. The Vicious Cycle of Exploitation from World Market Integration: Lesson from the Congo. Working Papers in Economics and Statistics .

 

Honwana, A. (2002). Negotiating Postwar Identities: Child Soldiers in Mozambique and Angola. In G. Bond, Contested Terrains and Constructed Categories. Coloradp: Westview Press.

 

Human Rights Watch. (2008 йил 3-December). Facts About Child Soldiers. Retrieved 2011 йил 29-September from Human Rights Watch News: http://www.hrw.org/news/2008/12/03/facts-about-child-soldiers

Kohrt, B., Jordans, M., Tol, W., MA, Speckman, R., Maharjan, S., et al. (2008). Comparison of Mental Health Between Former Child Soldiers and Children Never Conscripted by Armed Groups in Nepal. Journal of the American Medical Association , 691-702.

 

Microsoft Encarta online . (n.d.). European Control, Belgian Congo. Retrieved December 15, 2011, from Country Quest : http://www.countriesquest.com/africa/democratic_republic_of_the_congo_formerly_zaire/history/european_control/belgian_congo.htm

 

O'Hanlon, R. (1998). No Mercy: A Journey into the Heart of the Congo. New York, New York: Random House.

 

SOS Childrens Villages. (2008). Child Soldiers in DRC. Retrieved 2011 йил 30-September from SOS Children's Villages : http://www.child-soldier.org/child-soldiers-in-drc

 

US National Library of Medicine. (2011, March 5). PostTraumatic Stress Disorder. Retrieved November 14, 2011, from http://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0001923/

 

Wessells, M. (2004). Psychologial issues in reintegrating child soldiers. Cornell International , 37.