Physical Psychological And Socioeconomic Sequelae

The main difficulties faced by former child soldiers and those trying to help them are limited healthcare access and social stigma. Local hospitals do not have the equipment or the medications to provide adequate treatment, and as a result many child soldiers go without medical attention for long periods of time. Common combat-related injuries include hearing loss, blindness, and limb amputations, usually from landmines or grenades. Prostheses are in high demand because so many amputees are still growing and need frequent replacements. Sexually transmitted diseases (STDs), malaria, skin and respiratory diseases, malnutrition, bone deformation from carrying heavy loads, as well as drug and alcohol addiction are widespread.

*Verso Publishing, London

"Department of Emergency Medicine, Brown University, Memorial Hospital, Providence, Rhode Island

Apart from the physical injuries sustained by child soldiers, another area of concern for aid agencies and healthcare workers is the psychological health of these children. A recent Belgian study revealed the extent of this problem in a voluntary survey of former child soldiers of Uganda's notorious Lord's Resistance Army. Of the 301 children interviewed, 77% had witnessed at least one killing, 39% had been forced to kill, 39% had abducted other children, 63% had looted and burned civilian homes, and 52% had been seriously beaten. A secondary survey was conducted on a randomly selected subgroup of 75 children, of whom 71 agreed to participate. They completed a questionnaire designed to evaluate the extent of posttraumatic stress disorder (PTSD). A score of greater than 24 on the impact of event scale-revised (IES-R), which is a self-report scale akin to the DSM-IV criteria for PTSD, indicates clinically significant symptoms. The mean IES-R score was 53.5, with 97% of participants falling into the clinically significant category. Symptoms reported by respondents included nightmares, memory problems, drug and alcohol abuse, and an inability to function in social life. Similar findings have been reported in Sri Lankan child soldiers, including somatiza-tion, depression, PTSD, and a more severe reactive psychosis termed malignant PTSD.

Growing up in a culture of war, particularly during a child's vulnerable and impressionable formative years, only reinforces the role of violence as the primary means of conflict resolution. These psychological and emotional problems have as much a debilitating effect as their physical handicaps, seriously impeding a child's ability to work productively and interact normally in society.

The issue of social stigmatization particularly affects girls, who are often dependent on being accepted into a family in order to support themselves and, in many cases, the children of their military "husbands." As a result, it is extremely difficult for outsiders to make contact with former girl soldiers and address their needs. Interviews and tests for STDs, rape trauma, and other conditions are almost impossible to conduct without identifying girls as former fighters, which may result in their being rejected by the adoptive family. Furthermore, girls, many pregnant or with small children, are greatly underrepresented in demobilization and reintegration programs.

A Human Rights Watch report from December 2002 on the status of former child soldiers in Angola revealed that the vast majority of those interviewed wanted to return to school and find work, but had no means of doing so. Scarce resources mean that governments have focused on the needs of adults, leaving behind large numbers of hungry, jobless, and homeless youths who return to violence as their only means of survival.

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