**5.2 The experience of the war**

The consultations carried out and the reports made by the community mobilizers gave us the opportunity to trace the war experiences of those children. Eighteen percent (17.68%) of the children actually fought in the war and 61.74% worked either as cooks and cleaners in houses, or carried goods or worked as security guards. Information on the exact nature of involvement was available for 20.58% of the children.

A number of dramatic stories were told; like the one of this 17-years-old teenager from *Kébouébo*. He attended the 8th Grade in another town where he was sequestered for two weeks at the time the town was attacked by the rebels. In the course of his captivity, he was sodomized on a regular basis by a group of six armed men. Upon escaping, he returned to his village where he met a group of armed men from Liberia. He told that *'' when they asked me to come with them, it was to avenge my parents…but I thought of what these people did to me, I saw red and wanted to kill…they did not force me to take up arms.''*

We met in the same village a pregnant female teenager of 14. She had been captured in the bush. Her family had been massacred under her eyes, she was forced to cook the dead body

Just below 1% (0.9%) of the children born during the war were aged less than 5 years. Figure

Ninety-two (92.2%) of the children did not go to school: Fifty-eight percent (57.7%) of them dropped out of school due to the war (0.3% at Kindergarten, 52.8% at primary school and 4.6% at secondary school) , 34.5% have never gone to school and only 7.8% attended school ( 4.6% at primary school and 3.2% at secondary school). Among these children, 86.8% had no

The consultations carried out and the reports made by the community mobilizers gave us the opportunity to trace the war experiences of those children. Eighteen percent (17.68%) of the children actually fought in the war and 61.74% worked either as cooks and cleaners in houses, or carried goods or worked as security guards. Information on the exact nature of

A number of dramatic stories were told; like the one of this 17-years-old teenager from *Kébouébo*. He attended the 8th Grade in another town where he was sequestered for two weeks at the time the town was attacked by the rebels. In the course of his captivity, he was sodomized on a regular basis by a group of six armed men. Upon escaping, he returned to his village where he met a group of armed men from Liberia. He told that *'' when they asked me to come with them, it was to avenge my parents…but I thought of what these people did to me, I* 

We met in the same village a pregnant female teenager of 14. She had been captured in the bush. Her family had been massacred under her eyes, she was forced to cook the dead body

**5. Results** 

Fig. 2. Distribution of age

**5.2 The experience of the war** 

activity while 13.2% were farmers, fishers or breeders.

involvement was available for 20.58% of the children.

*saw red and wanted to kill…they did not force me to take up arms.''*

**5.1 The socio demographic characteristics** 

More than half of the children were male (60.3%) against 39.7% female.

2 below shows the distribution of the children by age category.

of her mother as food for her tormentors, and one of them desired to take her as his wife. At the time we met her, she had being living for over one year in another village without any link with her family and was pregnant with her second child.

Many children told their war experiences, how they stood up to defend their villages and their region; many of them witnessed atrocities and some of them carried the physical marks of their contribution to the war.

According to these children, their involvement in the war was motivated by revenge (13.91%); defense of the country/village (4.35%); liberation of their farms (3.19%); solidarity (2.32%); imitation of others (0.8%); and no reason (75.36%).

Ten percent of the children (10.43%) joined the conflict in 2002; 29.27% in 2003; 4.06% in 2004; and 1.74% in 2005. Over fifty percent of the children (54.5%) of the children did not specify the period of their involvement in the war; 4.35% were engaged in the war below the age of 10 and 49.86% between 12 and 15.

Over fifty percent (56.81%) saw a man being killed but 20.87% did not witness such a scene. Eight percent (8.41%) of the children said they did not have any reaction to a person being killed, 25.51% were afraid, 9.27% were upset, 4.93% were delighted, 2.32% felt pity, 1.45% revolted, and 3.78% said they felt traumatized. Just under ten percent (9.86%) joined deliberately the armed group to make war and 36.52% were inspired by someone they knew and 26.38% followed a parent. A third (30.43%) had learned how to manipulate weapons and 27.64% were trained in a camp. Among those who had been trained in a camp, one could list 46.8% of children recruited by an armed Liberian group called *LIMA*, 33.0% were recruited by *ZAKPRO* (an Ivoirian militia), 12.8% were recruited by *FLGO* (an Ivoirian militia for the liberation of the western region), 3.2% were recruited by *APWE* (the Alliance of Wê Patriots), and 2.1% were recruited by an unidentified special force. Forty percent (41.16%) said there were children in camps during the war. Their number varied from less than five to more than thirty. All of them talked about the presence of girls among the child soldiers whose size reached sometimes 20, according to the groups. They served as cooks, (20%), fighters (5.22%) cleaners and maids (3.19%), security guards (2.32%), and as porters (2.03%). The number of girls used for sexual purposes was not specified. Forty percent (38.26%) of the children reported to have an affective and physical proximity with someone among the rebels.

#### **5.3 Evidence of psychopathology**

Over two percent (2.61%) of the participants had already had problems with the law (arrests by the police for offence). None had a previous record of psychiatric illness; 52.17% were sexually active with, at times, several partners (63.33% had 1, and 36.67% had as many as 6 sexual partners). Fewer than ten percent of the children (9.57%) had been victims of sexual abuse and violence (70% for girls against 30% for boys); many of the girls had served, as sexual slaves for the rebels. Twenty seven percent of girls involved in the research were teenage mothers. The teenage mothers justified these early motherhoods on the basis that the traditional *Guéré* cosmogony (the ethnic group of the region) required girls to give birth to prove their capacity to give life, which similarly gives them the status of being woman. Just over fourteen percent(14.49%) of the children reported the use of cannabis, gunpowder; 37.39% the use of various brand of locally brewed alcohol (*distilled cane sugar* or *Koutoukou (distilled palm wine*, or some adulterated alcohol); 16.52% smoked tobacco; and 0.3% inhaled solvents (glue). All the children showed evidence of mental health problems among which insomnia ranked first. There were a group of traumatized children presented with clear

War in Côte d'Ivoire and Management of Child's Post Traumatic Stress Disorders 169

Mental Health Problem (Symptom) Frequency Percent (%) Behavior disorder (theft) 281 81.45 Insomnia 265 76.87 Anxiety 261 75.8 Disorder of character 249 72.24 Easily moved to tears 143 41.6 Sadness 114 33.0 Social isolation, withdrawn 98 28.4 Delirium or hallucinations 54 15.6 Memory disturbance 47 13.8 Suicidal gestures or behavior 40 11.6 Logorrhea 39 11.3

Table 1. Symptom patterns of mental health problems among former child soldiers

Depressions (F32.11, F32.8 57 20.29% Acute psychosis (F22.0, F23.31) 36 12.81% Anxiety (F41.1, F41.2) 34 12.10% Schizophrenia (F20.0, F20.1) 4 01.42%

feeling of suffocation, 22.30% loss of appetite and 06.10% enuresis

Table 2. Frequencies of probable psychiatric disorders among former child soldiers

A number of the children had various forms of health problems (hypo gastric pains among children who had been raped, dermatological diseases, sequelae of head injury, deafness,

The somatic problems were dominated by74.75% headaches, 67.97%palpitations, 29.10%

It is important to underline here some socio cultural characteristics observed in that region, as a minimum knowledge of the cultural environment in which one wants to act

A latent conflict existed between children and adults. Precarious economic situation and poverty were important in the region. The involvement of the children in the project, financed by national and international structures was backed by a food donation (rice, oil). Parents had been complaining sometimes because they were willing to receive themselves the provisions or they claimed the provisions of their children, when the latter had given up their activities with the project. The children were used as foils by parents, but there existed between them a conflict of authority reflecting the reversal of social order from the war.

10) diagnoses present in table 2 below.

probable psychiatric disorders among

Post-traumatic stress disorders

former child soldiers

**5.4 The somatic problems** 

ear infections, and lumbar pains).

**5.5 The socio-cultural aspects** 

significantly influences one's ways of life.

(F43.1)

Psychiatric diagnosis was possible among 81.45% of the children with the following (CIM

Frequency Percent (%)

150 53.38%

memories of war events: the war was still present in their mind and the eventuality of its resumption was not warded off; the children frequently formulated this eventuality. The children's personalities were characterized by narcissistic fragility and failures. They openly expressed their anger, their aggressiveness and their tendency to revolt. One could note, at times, a great pessimism associated with a feeling of a future blocked and a social disinvestment. The children moved about in the village in groups. For example, in August 2006, in the course of the parade of the children of *Ké-bouébo*, they arrived in battle order chanting war songs wielding tanks, rock launchers, Kalashnikovs, and pistols sculpted in bamboo fiber. An important fact is to be noted: in *Pantrokin*, the former child soldiers surveyed showed evidence of psychiatric disorders linked to the war. When we asked them about their mental condition, they reported that they had received some form of traditional treatment (plant-made medicine). However the nature of this treatment has not been revealed.

Fig. 3. Bamboo rifle made by a child-Ke-bouébo

The children were showing different psychic disorders *(one child could show one or more symptoms*).


Table 1. Symptom patterns of mental health problems among former child soldiers

Psychiatric diagnosis was possible among 81.45% of the children with the following (CIM 10) diagnoses present in table 2 below.


Table 2. Frequencies of probable psychiatric disorders among former child soldiers

#### **5.4 The somatic problems**

168 Post Traumatic Stress Disorders in a Global Context

memories of war events: the war was still present in their mind and the eventuality of its resumption was not warded off; the children frequently formulated this eventuality. The children's personalities were characterized by narcissistic fragility and failures. They openly expressed their anger, their aggressiveness and their tendency to revolt. One could note, at times, a great pessimism associated with a feeling of a future blocked and a social disinvestment. The children moved about in the village in groups. For example, in August 2006, in the course of the parade of the children of *Ké-bouébo*, they arrived in battle order chanting war songs wielding tanks, rock launchers, Kalashnikovs, and pistols sculpted in bamboo fiber. An important fact is to be noted: in *Pantrokin*, the former child soldiers surveyed showed evidence of psychiatric disorders linked to the war. When we asked them about their mental condition, they reported that they had received some form of traditional treatment (plant-made medicine). However the nature of this treatment has not been

revealed.

Fig. 3. Bamboo rifle made by a child-Ke-bouébo

*symptoms*).

The children were showing different psychic disorders *(one child could show one or more* 

A number of the children had various forms of health problems (hypo gastric pains among children who had been raped, dermatological diseases, sequelae of head injury, deafness, ear infections, and lumbar pains).

The somatic problems were dominated by74.75% headaches, 67.97%palpitations, 29.10% feeling of suffocation, 22.30% loss of appetite and 06.10% enuresis

#### **5.5 The socio-cultural aspects**

It is important to underline here some socio cultural characteristics observed in that region, as a minimum knowledge of the cultural environment in which one wants to act significantly influences one's ways of life.

A latent conflict existed between children and adults. Precarious economic situation and poverty were important in the region. The involvement of the children in the project, financed by national and international structures was backed by a food donation (rice, oil). Parents had been complaining sometimes because they were willing to receive themselves the provisions or they claimed the provisions of their children, when the latter had given up their activities with the project. The children were used as foils by parents, but there existed between them a conflict of authority reflecting the reversal of social order from the war.

War in Côte d'Ivoire and Management of Child's Post Traumatic Stress Disorders 171

The range of drugs used was voluntarily restricted in order to promote their rational use by the field agents who have no medical background. Dosage has been at their minimum to facilitate handling and limit the risk of side effects e.g. chlorpromazin, which is usually prescribed in dosages of 200 to 300 or 400 mg per day, was given in with maximum dosages ranging from 150 -200 mg in our sample . This permitted, in most cases, drug taking without

The molecules recommended in international literature in the treatment of post-traumatic stress disorder and co-morbid states, such as paroxetin and hydroxyzin were not used, especially because of their high price and the difficulties involved in their availability in

Once the first positive effects of the treatment were reported, the organizers discontinued further use of the drugs. Reports indicated that some parents even took the drugs with the view to enjoying their sedative effects. Thus, with one chlorpromazine tablet in the evening,

We asked the organizers to take back the drugs to avoid drug misuse, and to administer the

The NGO had a package of drugs available to field workers based on drug prescriptions. Living in the community, they distributed a sufficient quantity every week and ensured

In order to provide comprehensive health care to the children, we referred some of them to other specialists as follows: the children who needed surgical consultation (2), gynecological consultation (1), general medicine consultation (2), ophthalmological consultation (1), ENT consultation (2), and urological consultation (2). It proved important to carry out electroencephalogram (EEG) for 3 children and an x-ray of the lumbar vertebrae for one child. Consultations required that children be sent down to *Guiglo*. As for the EEGs, (which

Beside the activities implemented by the volunteers, such as literacy campaigns, animal breeding, agriculture, training of volunteers and the populations about post-traumatic disorder, a number of therapeutic activities were initiated: family drawing, game, and

Concerning drawing, the instructions were "*draw your house and your family before, during and after the war*"*.* All the children took up this activity, even those who had never gone to school. Their drawings were full of memories of their trauma. The lines were strong, violent testifying to an internal aggressiveness and violence. The dominant colors were black, red and orange. Few children were imagining a return to normal life after the war. They had drawn their house destroyed by the war and which remained the same after the war; not

It seemed important to initiate some psychotherapeutic activities. The children had come off, in this context, with objects from their environment, most of the time it was bamboo or raffia. Children with the most important psychic disorders had built objects recalling the

Working tools and activity comment cards were difficult to use because there were no specialized education officers among the field teams. Even if the officers showed interest,

war, while those who overcame their problem had drawn houses, churches and cars.

they slept well and they could the next day return to their farms without effort.

were disrupted later), the children had to come down to Abidjan.

difficulty.

rural areas.

drugs to the children.

good treatment compliance.

**6.3 Additional examinations** 

**6.4 Psychotherapeutic action** 

rebuilt but over grown with weeds.

therapeutic workshops.

Income generative activities have been impaired by the way children perceived them. The activity which did not kick off well enough was truck farming. Boys were saying that *'' cultivating okra, egg-plant was sauce''* meaning that they are ingredients to cook sauces, and that it is women who cook, therefore this activity could not be exercised by men. In a number of regions in Côte d'Ivoire, truck gardening, especially those destined to daily consumption are the prerogative of women.

Poultry also did not fare well. Chick distribution created jealousy in some villages, but children themselves had problems in adapting. Without wasting time, either they ate up the chickens or some children embezzled the products of the sale.

The activities, which were the most successful, were sewing and carpentry because the children were put in apprenticeship. The boss himself monitored their vocational project.

An important rate of early pregnancies was observed. Girls explained that to be considered as a woman, one has to prove one's fertility. To be a mother is to achieve the status of a woman.

Excision of the young women was still carried out in this region; girls and boys put it that it is important to do it, if a woman was not excised this would bring bad luck to her husband.
