A summer camp in Gaza

Last week, I wrote about my journey of recovery and healing after being shot nine years ago. In today’s issue, we’re going to look at how war and conflict affects children’s mental health – and some positive stories of recovery.

In the late 1990s, the Rwandan Ambassador to Israel, Michel Rugema, visited a mental health center for Holocaust survivors. The center focused on helping senior adults still struggling with the horrors of their childhood – losing their parents, living in concentration camps or being hidden in stranger’s homes, separated from their families and living alone in attics or basements for years.

From 1990 to 1994, Rwanda had suffered a civil war that displaced hundreds of thousands of people and killed hundreds of thousands more. Ambassador Rugema had come to ask the therapists for advice on helping more than 110,000 orphaned children.

Ambassador Rugema’s question still concerns many people around the world today – from the Tigray war in Ethiopia to Syrian and Afghan children growing up in refugee camps to school shootings in the United States. According to the BMJ (British Medical Journal), as many as one in five children and adults affected by conflict may experience poor mental health, compared with a mean global prevalence of one in 14.

No child should have to witness death or endure displacement. But thanks to the work of researchers, mental health professionals, teachers and community workers, we know more about how to help traumatised children than we did 25 years ago. Here are some of their findings:

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Sierra Leone

selections taken from “Social acceptance helps mental health after war trauma” published by NIH Research Matters

Researchers analysed data from a 15-year study of more than 500 former child soldiers who participated in Sierra Leone’s Civil War from 1991 to 2002. During the war, several warring factions abducted children and forced them into armed groups. An estimated 15,000 to 22,000 boys and girls of all ages were subject to sexual violence, forced use of alcohol and drugs, hard physical labor and acts of violence until the war ended.

Researchers found that acceptance and support from community and family may lessen the toll of mental health conditions experienced by former child soldiers. Their findings suggest that re-integration into their communities may help war-affected youth achieve better life outcomes after traumatic events. The study shows that former child soldiers who were accepted by their family and community were much less likely to suffer from high levels of anxiety or depression.

“Sierra Leone’s child soldiers experienced violence and loss on a scale that’s hard to comprehend,” says study author Dr. Stephen Gilman of NICHD. “Our study provides evidence that there may be steps we can take to modify the post-war environment to alleviate mental health problems arising from these experiences.”

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Iraq

selections taken from “Efficacy of an Internet-based intervention for posttraumatic stress disorder in Iraq: A pilot study” published by Science Direct

As we are seeing now in Afghanistan, conflicts and wars can leave a country without educated, trained professionals in a range of disciplines. In an article for Foreign Policy last week, Kelly Kimball wrote that the Taliban are “driving out the very people they need to make the country governable.”

As Iraq has also suffered decades of conflict, many physicians and mental health professionals have left the country. To continue to care for people suffering with PTSD, researchers worked with Arabic-speaking mental health professionals to provide internet-based treatment.

In this pilot study of internet-based care, researchers saw impressive results. They write, “The intervention resulted in a highly significant decrease in symptoms of PTSD, depression and anxiety. Quality of life was higher at post-treatment. All treatment effect sizes were in the large range, indicating a significant improvement in mental health symptoms and quality of life.”

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Palestine

selections taken from “Children’s prolonged exposure to the toxic stress of war trauma in the Middle East” published by The BMJ

A study of practitioners in refugee camps in the West Bank, Palestine found that psychosocial service providers face an array of challenges including lack of qualified, specialist staff, financial constraints, political conflict, and poor community awareness. Even where therapists are available, some communities stigmatise therapy and mental health support. This stigma means that people are less likely to access help even when services are offered.

The good news is that programmes to help traumatised children don’t always have to look like a traditional, Western concept of psychotherapy. Studies have shown that activities like meditation, breathing techniques, guided imagery and self-expression through writing, drawing, movement, drama and music can strengthen children’s coping strategies, resilience and wellbeing. Moreover, these activities are low cost and can be delivered by teachers, community volunteers, non-governmental organisations and others, with training from mental health professionals.

This year, I was honoured to support exactly this type of programme for children in Palestine where my donation to KinderUSA was used to organise a summer camp for children in Gaza. On the first day of camp, 69 girls and 48 boys played games (with prizes!), sang, danced, painted and ate lunch together.

Here are some reflections from the children:

Malak, 12:

“We did not play or were happy for more than a year because of Covid-19. Then the war came. We were very afraid, the sound of the bombing everywhere. But thanks for Allah, the war ended and today I went to camp. I played a lot and was happy. For the first time I felt safe and free.”

Ruba, 9:

“I danced with the clowns and got an award. I wish all days were as beautiful as this day.”

Salah, 10:

“During the war, we left our home and I did not play for a while. Today is the most relaxed day after the war and I hope I can go to camp every day to stay happy.”

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In the beginning of today’s issue, I wrote about Ambassador Rugema’s visit to a mental health center for people who survived the Holocaust as children to ask how to help children in Rwanda. Sometime later, he received this letter from center’s clinical director:

Dear Mr. Ambassador,

In modern war, the real losers are the children. After they come back to society, there is no home anymore and they have the need to feel wanted and protected, their feelings to be respected and understood, the stories of their experiences and memories to be heard, even when they have no voice.

When they only shout in anger, please understand that they have lost their tears and have forgotten the words to express their inner pain. In order to become who they really are, they need help to learn and accept what has happened to them, in a surrounding that respects the individual differences and recognizes their losses and traumatic experiences from then and the sequels now.

Thank you. By asking this question, I understand that you will not forget them.