**3. Situation analysis**

In 2004, we took interest in the issues of psycho-trauma. At that time, despite the importance of the problem, there was insufficient interest in the issue and inadequate research had been carried out on it Cote d'Ivoire. The few studies that had come out were done in preparation for a doctorate of medicine dissertation and these studies were conducted among adults. Researches were about psychiatric disorders (depression, anxiety, and psychosis), but the issue of psycho trauma was not tackled. The situation of children was ignored.

A number of factors account for the relative lack of research on psycho-trauma among children and adolescents.

As a rule, in African societies, the child and adolescent mental disorders are completely neglected. Instead, people are more concerned with the mental well being of parents and guardians. Some reform to improve the mental health of adults has occurred though more needs to be done. In African societies, to resort to psychiatric care means madness. Psychiatry is still stigmatized and a number of people refuse to accept the value of psychiatric care. The Brazzaville WHO conference held in 2005 came up with solutions for a better follow-up of mental health issues among children and adolescents.

When, finally, the issue of child soldiers emerges, it was more or less unwelcome, more or less unrecognized and not readily accepted by the Government. People working within a national non-governmental organization (NGO) to rehabilitate former child soldiers expressed their desire to be backed up in rehabilitation efforts by qualified mental health specialists. Convinced that these children were at risk of the traumatic effects of war and were at risk of developing post-traumatic stress disorders, it became urgent, for this NGO, to evaluate the mental health of the former child soldiers in preparation to help the children. In June 2006, an assessment mission went to the western region of the country to assess the real needs in the field of psychosocial reform program for former child soldiers. The terms of reference of this consultancy were to assess the mental health situation of 400 child soldiers and their families living in five (5) villages on the *Guiglo-Toulepleu* road (*Kaade,* 

*Behoue, Ke-Bouebo, Pehe and Pantrokin*) and to assist them psychologically. This activity ran from June 2006 to August 2008. In that period, a number of working sessions in *Guiglo*, a western region city, were conducted in order to work with the NGO staff in assisting the former child soldiers, but secondarily with Liberian young refugees (we will not discuss here). Our additional task was to support psychologically the personnel and to help them in their psychosocial activities.

In Côte d'Ivoire, that experience was unheard of because children's psycho traumatic experiences were not well appreciated and were ranked as second-class activity. Ivoirian psychiatrists did not invest in this area, leaving the field to humanitarian agencies. Similarly, Jézéquel (2006) underlines that, in the case of conflicts in Africa, the issue of child soldiers has been initially the prerogative of aid agencies. For him, child soldiers have become the symbols of an African continent on the decline, a "heart of darkness" alien to European culture. It becomes the object of a new "aid agency crusade", a western neo-interventionism paralleling the civilizing missions of the past.

At the beginning, this mission proved difficult on account of the nonexistent consensus national structure to provide various forms of assistance for victims of traumatic stress in Côte d'Ivoire, including the availability of competent human resource and material means, difficulties to access the area to carry out research (distances, situation and insecurity on the

In 2004, we took interest in the issues of psycho-trauma. At that time, despite the importance of the problem, there was insufficient interest in the issue and inadequate research had been carried out on it Cote d'Ivoire. The few studies that had come out were done in preparation for a doctorate of medicine dissertation and these studies were conducted among adults. Researches were about psychiatric disorders (depression, anxiety, and psychosis), but the issue of psycho trauma was not tackled. The situation of children was

A number of factors account for the relative lack of research on psycho-trauma among

As a rule, in African societies, the child and adolescent mental disorders are completely neglected. Instead, people are more concerned with the mental well being of parents and guardians. Some reform to improve the mental health of adults has occurred though more needs to be done. In African societies, to resort to psychiatric care means madness. Psychiatry is still stigmatized and a number of people refuse to accept the value of psychiatric care. The Brazzaville WHO conference held in 2005 came up with solutions for a

When, finally, the issue of child soldiers emerges, it was more or less unwelcome, more or less unrecognized and not readily accepted by the Government. People working within a national non-governmental organization (NGO) to rehabilitate former child soldiers expressed their desire to be backed up in rehabilitation efforts by qualified mental health specialists. Convinced that these children were at risk of the traumatic effects of war and were at risk of developing post-traumatic stress disorders, it became urgent, for this NGO, to evaluate the mental health of the former child soldiers in preparation to help the children. In June 2006, an assessment mission went to the western region of the country to assess the real needs in the field of psychosocial reform program for former child soldiers. The terms of reference of this consultancy were to assess the mental health situation of 400 child soldiers and their families living in five (5) villages on the *Guiglo-Toulepleu* road (*Kaade,* 

This activity ran from June 2006 to August 2008. In that period, a number of working sessions in *Guiglo*, a western region city, were conducted in order to work with the NGO staff in assisting the former child soldiers, but secondarily with Liberian young refugees (we will not discuss here). Our additional task was to support psychologically the personnel and

In Côte d'Ivoire, that experience was unheard of because children's psycho traumatic experiences were not well appreciated and were ranked as second-class activity. Ivoirian psychiatrists did not invest in this area, leaving the field to humanitarian agencies. Similarly, Jézéquel (2006) underlines that, in the case of conflicts in Africa, the issue of child soldiers has been initially the prerogative of aid agencies. For him, child soldiers have become the symbols of an African continent on the decline, a "heart of darkness" alien to European culture. It becomes the object of a new "aid agency crusade", a western neo-interventionism

At the beginning, this mission proved difficult on account of the nonexistent consensus national structure to provide various forms of assistance for victims of traumatic stress in Côte d'Ivoire, including the availability of competent human resource and material means, difficulties to access the area to carry out research (distances, situation and insecurity on the

better follow-up of mental health issues among children and adolescents.

*Behoue, Ke-Bouebo, Pehe and Pantrokin*) and to assist them psychologically.

to help them in their psychosocial activities.

paralleling the civilizing missions of the past.

**3. Situation analysis** 

children and adolescents.

ignored.

road), the impossibility to undertake a regular follow-up, and the persistent instability and insecurity in the zone

My initial survey carried out during the draft of my specialization in psychiatry dissertation entitled: *"The war and the medico-psychology situations of children received at CGI and colliged case in the community"* formed the background literature for our intervention in the region.

This map shows the division of Cote d'Ivoire after the outbreak of the War of 2002. The country was divided into three zones (government, CNW zone under the control of the rebels and trusted zone). Cote d'Ivoire has been reunited July 30, 2007. The red line materializes the axis Guiglo-Touleupleu.

Fig. 1. Map of Côte d'Ivoire

As a young psychiatrist leading the team, we were doomed to venture on the slippery field of psycho-trauma without reference or theory.

We had to cross the country from South to West (around 600km) under difficult conditions. We used to leave Abidjan at sunrise to reach *Guiglo* at sunset, most of the time after an endless journey on a car or on a *"gbaka"* (a dilapidated 18-20 seat mini-car). We had to go there at our own expenses. On site, the NGO personnel organized both activities and sojourn.

War in Côte d'Ivoire and Management of Child's Post Traumatic Stress Disorders 165

an action phase with psycho medical consultations, educative assistance by the organizers of

Children's psychiatric consultation took place every three months. Thus, for a week, the organizers made an assessment of the situation of children and the stock of global

A final assessment phase of the children's psychopathological situation was conducted after

We set up a data bank in order to study the psychopathological characteristics of the former

The collected data concerned the socio demographic (sex, age) and psychological characteristics (sexual activity, symptoms). This data gave us the opportunity to gather

We asked for educational and playing equipment: balls, toys, pencils and felt-tip pens, building in games, paint and drugs: haloperidol, chlorpromazin, levomepromazin, and

The NGO project started at the end of the year 2005. Our fieldwork kicked off in June 2006 with a series of consultations with 400 former child combatants. The objectives of the initial consultations were to assess the mental health needs of the children, to train the community mobilizers to be attentive to the needs of the children, to initiate and supervise the administration of drugs as indicated, and finally to provide psychotherapeutic services. We

We planned and conducted field activities in series, and each activity lasted seven days; field activities began with an assessment of the psychological needs of the children followed

We conducted community awareness campaigns to convince parents on the harmful effects of war on the psychological health of individuals. The campaigns were conducted at market places, and an average of 100 persons per village (300 persons were present in *Kaadé)*

At the end of the awareness campaigns, 177 persons asked for medical assistance though

Some major signs of psychic disorder were identified among parents including depression, psychosis and fear with a feeling of suspicion, demotivation with low performance at work

Following our assessment of children's mental health needs, we engaged them in a variety of therapeutic activities such as drawing (draw your house and your family, before, during and after the war), and we engaged the older children in income generating activities to determine how the children would adapt to work situations. In the course of implementing our fieldwork we wanted to observe how the children behaved, how the village and family environment might be a limiting factor, how the weather changes and seasons influenced the engagement of children and how the children's social and cultural factors might influence the future of the children. Our fieldwork ended in August 2008, four months after the NGO project ended in April 2008. We now present the results of our medical assistance

trihexyphenidyl (an antiparkinsonian) to palliate the side effects of neuroleptics.

received children either individually or in groups depending on their needs.

the structure (group therapy, literacy, re socialization), term assessment seminars.

assistance.

**4.3 Means** 

child soldiers.

intervention in the year 2008.

indicators to better plan our actions.

by the training of the community mobilizers.

only 30 people eventually came for consultation.

and an accentuation of poverty situation.

**4.4 Project implementation** 

attended the sessions*.*

to the former child soldiers.

At that time, there were instances of insecurity in the area and armed bands were still operating in spite of the program of disarmament set up by the Government.

At the same time, in these villages, there was no health center, and the people's somatic problems were difficult to solve (people had to go either to *Guiglo* or to *Toulepleu*); finally the NGO had to hire a male nurse. Schools were closed down and teachers had not come back. Some villages had no electricity and no telephone.

The traces of the war were visible everywhere: houses destroyed, walls riddled with bullet impacts, faces mirroring unspeakable suffering; misery and poverty seemed to be the daily companion of the population.

In such a situation, the implementation of this far-reaching project that consisted in rebuilding human lives, in giving back a meaning to life and to raising children psychically by healing their invisible wounds named traumas, proved to be an arduous but inspiring task. We needed to face a huge undertaking, that of children requesting care, not always psychic, but often somatic, that of parents for whom we were all doctors and who were begging for assistance, that of participants who were most of the time overworked, psychically suffering sometimes from the burden of the task, under the tough conditions of the mission. The question was to bring answers, a little satisfying to everybody and to each one.
