IK Notes Indigenous Healing of War–Affected Children in Africa Edward C. Green, Ph.D. and Alcinda Honwana, Ph. D. C hildren in war-torn countries of Af- rica and elsewhere are often direct tions such as Save the Children and the Christian Children’s Fund have devel- or indirect victims of violence, and/or oped various types of so-called psycho- witnesses to various horrors associated social programs to assist war-affected with war. Children as young as seven or children. Yet therapeutic techniques eight are forcibly conscripted and in- for war-affected children remain at a doctrinated as child soldiers or porters very preliminary stage of development. in several African countries. Girls as It is not known to what extent western well as boys often suffer, some being psychotherapeutic techniques for forced into sexual or other service at PTSD—which were originally devel- early ages. In conflicts where terroriz- oped to treat American veterans of the ing civilians has become a routine Vietnam war—would be appropriate means to political and military ends, and effective for children in Africa and women and children are deliberately other less-developed areas. One of the targeted for torture and death. Glo- concerns with the PTSD is the very no- bally, there are at least one million chil- tion of post-traumatic stress disorder. dren separated from their parents be- In these contexts, it is problematic to cause of war, and there are many thou- talk about trauma as the past (post), if sands who have been traumatized even one understands the notion of violence more directly by war. Child victims of to be broader than direct exposure to this sort often exhibit symptoms of war situations (military attacks, post–traumatic stress disorder (PTSD), landmines, etc.), and to encompass to use the Western psychiatric label. spheres like poverty, hunger, displace- Symptoms of PTSD and related stress ment and the like. Another concern No. 10 reactions common in children include: with the PTSD lies in its therapeutic July 1999 avoidance/numbing, as in cutting off of feelings and avoidance of situations that provide reminders of traumatic IK Notes reports periodically on Indig- enous Knowledge (IK) initiatives in events; insomnia, inability to concen- Sub-Saharan Africa. It is published by trate, “intrusive re-experiencing,” such the Africa Region’s Knowledge and Learning Center as part of an evolving as nightmares and flashbacks; lethargy, IK partnership between the World confusion, fear, aggressive behavior, so- Bank, communities, NGOs, develop- cial isolation, and hopelessness in rela- ment institutions and multilateral orga- nizations. The views expressed in this tion to the future, and hyper–arousal as article are those of the authors and World Bank evidenced in hyper–vigilance and exag- should not be attributed to the World Bank Group or its partners in this ini- gerated startle responses. tiative. A webpage on IK is available at In recent years, UNICEF, USAID, and http://www.worldbank.org/aftdr/ik/ various private, voluntary organiza- default.htm 2 techniques which are centered on the individual patient. There is evidence from throughout Africa that mental or Such focus ignores local beliefs in the role that ancestral and psychiatric disorders are among the conditions for which malevolent spiritual forces play in the causation and healing modern or western medical help is least likely to be sought. of the affliction. It also undermines family and community African people generally turn to indigenous forms of therapy involvement and active participation in the healing process. in case of mental health. Empirical studies of the relative ef- During early psychosocial programs for war-affected chil- fectiveness of different forms of western psychotherapy in dren in Mozambique and Angola, community leaders, tradi- fact show that virtually all psychotherapies do the patient tional healers and families showed tremendous knowledge of some good and all are potentially effective when embedded how to heal the ‘social wounds of war in war–affected chil- within social and cultural specificities. This may suggest that dren and adults. Such disorders are in fact quite treatable by as psychotherapists, indigenous African healers may be at traditional healers, based on indigenous understandings of least as effective as modern medical specialists, especially how war affects the minds and behavior of individuals, and on among those who share a common African culture. shared beliefs of how spiritual forces intervene in such pro- Anthropological research done in Mozambique and Angola cesses. During the implementation of these programs, people shows that war related psychological trauma is directly linked expressed no need for help in addressing children’s’ specific to the power and anger of the spirits of the dead. The impos- mental or behavioral manifestations. What they needed, they sibility of performing proper burials in times of war does not said, was help in finding missing family members and in es- allow for these spirits to be placed in their proper positions in tablishing schools, pre-schools, creating jobs opportunities the world of the ancestors, so they are considered to be bitter for the youth, and promoting a stable social environment in and potentially harmful to their killers and passers-by. Social which to function. pollution may arise for being in contact with death and bloodshed. Individuals who have been in a war, who killed or were around killings are believed to be potential contamina- IK Notes would be of interest to: tors of the social body. Thus, cleansing and purification ritu- als are essential for their reintegration in the communities. In 1994, during the first project in Angola specifically to help war-traumatized children, it was found that children Name were already being helped by indigenous psychotherapy, pro- Institution vided by indigenous healers in the form of ritual purification ceremonies. This was provided for both ex-combatants and Address children who had either participated in or witnessed blood- shed. The earlier Children and War project in Mozambique found similar treatments for children. In both countries, these therapies appeared to be effective, at least in the short-term. Traditional healing for war-affected children in Angola and Mozambique seems to consist principally of puri- Letters, comments, and requests for publications should be addressed to: fication or cleansing rituals, attended by family members and the broader community, during which a child is purged and Editor: IK Notes purified of the “contamination” of war and death, as well as Knowledge and Learning Center Africa Region, World Bank of sin, guilt, and avenging spirits of those killed by a child sol- 1818 H Street, N.W., Room J5-171 dier. These ceremonies are replete with ritual and symbolism Washington, D.C. 20433 E-mail: pmohan@worldbank.org whose details are distinctive to the particular ethnolinguistic group, but whose general themes are common to all groups. 3 In the day of his arrival his relatives took him to the ndumba This case emphasizes the non-interaction with family and (the house of the spirits). There he was presented to the ances- friends before ritual cleansing. The child is kept out of the vil- tral spirits of the family. The boy’s grandfather addressed the lage until the ritual is performed, and cannot greet people spirits informing them that his grandchild had returned and and sleep in his bed until the ritual proceedings are over. As thanked the spirits for their protection as his grandson was mentioned above, although children may be asked about war able to return alive (...) A few days later a spirit medium was experiences as part of treatment, this is not a fundamental invited by the family to help them perform the cleansing rituals condition for healing. The ceremony aims at symbolically for the boy. The practitioner took the boy to the bush, and there cleansing the polluted child and putting the war experience a small hut covered with dry grass was build. The boy, behind him, to “forget” (note the symbolism of being forbid- dressed with the dirty clothes he brought from the RENAMO den to look back, in the example from Uige). Food taboos and camp, entered the hut and undressed himself. Then fire was set other kinds of ritual restrictions are applied. In the Uige, for to the hut, and an adult relative helped out the boy. The hut, the example, fish and fowl must be avoided by the cleansed per- clothes and everything else that the boy brought from the camp son for 1-2 months, after which the person must be reintro- had to be burned. A chicken was sacrificed for the spirits of the duced to the food by the traditional healer who officiated at dead and the blood spread around the ritual place After that the ceremony. the boy had to inhale the smoke of some herbal remedies, and The Okupiolissa ritual from Huila in Angola clearly shows bath himself with water treated with medicine (Fieldnotes, the active participation of the community in these rituals, Mozambique). and stresses the idea of cleansing from ‘impurities. This healing ritual brings together a series of symbolic The community and family members are usually excited meanings aimed at cutting the child’s link with the past (the and pleased at the homecoming. Women prepare themselves war). While modern psychotherapeutic practices emphasize for a greeting ceremony (...) Some of the flour used to paint the verbal exteriorization of the affliction, here through symbolic women’s foreheads is thrown at the child and a respected meanings the past is locked away. This is seen in the burning older woman of the village throws a gourd filled with ashes at of the hut and the clothes and the cleansing of the body. To the child’s feet. At the same time, clean water is thrown over talk and recall the past is not necessarily seen as a prelude to him as a means of purification (...) the women of the village healing or diminishing pain. Indeed, it is often believed to dance around the child, gesturing with hands and arms to open the space for the malevolent forces to intervene. This is ward away undesirable spirits or influences. (...) they each also apparent in the following case from Uige (Angola). touch him with both hands from head to foot to cleanse him of impurities. The dance is known as: Ululando-w-w-w. When the When the child or young man returns home, he is made to ritual is complete, the child is taken to his village and the villag- wait on the outskirts of the village. The oldest woman from the ers celebrate his return. A party is held in his home where only village throws maize flour at the boy and anoints his entire traditional beverages (...) The child must be formally pre- body with a chicken. He is only able to enter the village after sented to the chiefs by his parents (...) the child sits beside the this ritual is complete. After the ritual, he is allowed to greet his chiefs, drinking and talking to them, and this act marks his family in the village. Once the greeting is over, he must kill a change of status in the village. chicken, which is subsequently cooked and served to the fam- ily. For the first eight days after the homecoming, he is not al- These cleansing and purification rituals involving child sol- lowed to sleep in his own bed, only on a rush mat on the floor. diers have the appearance of what anthropologists call rites During this time, he is taken to the river and water is poured of transition. That is, the child undergoes a symbolic change on his head and he is given manioc to eat. As he leaves the site of status from someone who has existed in a realm of sanc- of the ritual, he must not look behind him. tioned norm-violation or norm-suspension (i.e., killing, war) 4 to someone who must now live in a realm of peaceful behav- ment programs to sustain the gains achieved in the psychoso- ioral and social norms, and conform to these. In the case pre- cial and emotional sphere, and which cannot be dissociated sented above from Huila, the purified child acquires a new from the rest. status which allows him to sit besides the chiefs and interact Therefore, the approach of donor organizations, NGO and with them. Until the transition is complete (through ritual other organizations involved in humanitarian aid for war-af- performance), the child is considered to be in a dangerous fected children should take into account local understand- state, a marginal, “betwixt and between,” liminal, ambiguous ings of war trauma and indigenous strategies for dealing with state. For this reason, a child cannot return to his family or it. They should work towards promoting stable, secure, cul- hut, or sleep in his bed, or perhaps even enter his village, un- turally-familiar environments in which children can gain a til the rituals have been completed. sense of competence and security in a more predictable Manifest symptoms associated with PTSD and related world by encouraging self-reliance through reliable commu- stress disorders reportedly disappear shortly after these cer- nity development projects. their families, or with appropriate emonies, after which the family, indigenous healers and local foster families if necessary. chiefs direct attention toward helping to establish an endur- The project of the Christian Children’s Fund in Angola tries ing, trusting relationship between the traumatized child and to build upon existing indigenous healing practices and family members, and with adults of good character. These strengths, and complementing these with its psychosocial in- ritual interventions are also intended to re-establish spiritual terventions such as those just described. Evaluations of this harmony, notably that between the child and its ancestor project and the earlier “Children and War” project in spirits. The re-establishment of normal relationships and ac- Mozambique have shown that such an informal partnership tivities with other children may not be part—or a major between indigenous healers, with their ritualistic therapies, part—of these indigenous healing rituals. But, healers, vil- and donor-assisted programs, with emphasis on the family lage elders, teachers and other child caregivers readily under- and social adjustment of the child, may provide a model of stand this when presented with the idea during project-sup- how indigenous and Western-scientific approaches can be ported training seminars, in both Angola and Mozambique. pursued together to provide maximum benefit to children in Play therapy, drawing, drama, dance and story-telling are need. Furthermore, such a model of cooperation and sharing some of the techniques introduced in these seminars. of responsibility serves to validate indigenous healing and be- There is no doubt that these rituals are instrumental in liefs, which tends to energize and mobilize local people who, building family cohesion and solidarity, and in dealing with ultimately, need to develop sustainable, culturally acceptable the psychosocial and emotional side of these children s prob- solutions to help themselves. lems. The fact is, however, that they return to an impover- ished countryside struggling with basic survival needs, and many with no schools, hospitals, no vocational training or job opportunities which would allow them to envisage the pros- pects of a better future. Thus, while these rituals are impor- tant they need to be complemented by community develop- The authors would like to thank the Christian Childrens Fund, Save the Children (USA), the Children and War Project and the Displaced Children and Orphans Fund, USAID, for use of information from their programs. We would also like to thank Mike Wessells for useful comments and suggestions. Edward C. Green can be contacted at: egreendc@aol.com Alcinda Honwana can be contacted at honwana@beattie.uct.ac.za