CHILD TRAUMA

William Yule, PhD Contributing editor, Child Trauma

The World Veterans Federation held its First International Conference on Psycho-social Consequences of War in the beautiful city of Dubrovnik, Croatia in April 1998. The Croatian Patriotic War Veterans Association hosted the meeting under the auspices of the European Society of Traumatic Stress Studies. Prominent among the presenters were many members and board members of ISTSS. More than 350 participants from more than 36 countries listened as Serge Wourgraft, president of the WVF, reminded them of the federation's objective to bring together those who have endured the sufferings of war to work for peace and ensure that the needs of veterans and their families are recognized and met. This note reports on the sessions that specifically considered the needs of children and families.

Robert Pynoos gave a masterly overview of the effects of war on adolescents spelling out the implications of adult adjustment, particularly if traumatic reactions go unattended. Pynoos described his project undertaken jointly with UCLA and UNICEF in Bosnia in which a 16-week intervention is being delivered to adolescents at the highest risk following careful screening of secondary schools.

Zahava Solomon followed by giving an overview of the impact of war stress on the families of veterans. Lessons from Israeli studies point to the need to consider direct and indirect effects of war trauma on veterans as well as their spouses and children. The cross-generational effects also are most keenly manifest among Israeli families.

Three symposia then permitted the presentation and discussion of work conducted mainly in Croatia and Bosnia. Many of the projects had been undertaken in collaboration with academics from the international community, and the influence of UNICEF and Psychosocial Advisor Rune Stuvland was evident. Gordana Kuterovac Jagodic from the University of Zagreb presented the results of a survey undertaken in Croatia which established the high rates of stress reactions among children. Vera Danes, a child psychiatrist from Sarajevo, described the impact of the war on the referrals to the university clinic. Not surprisingly, PTSD, rarely diagnosed pre-war, became a significant part of the university's work. Eva Delale described a project developed by the Society for Psychological Assistance from Zagreb. The organization made imaginative use of a two-week summer camp designed to deal with the traumatic stress presented by children. Participants were sensitive to the need to provide continuing support after the camp so that issues raised could be dealt with afterwards.

A team from the University of London described the large-scale projects based in Mostar and Zenica undertaken in collaboration with UNICEF and authorities in Bosnia. I described the overall framework intended to develop local capacity to meet the mental-health needs of children in a sustainable way. The project involved developing a skills-training package delivered to over 2,500 primary-school teachers. Patrick Smith presented the early results of a survey of 3,000 children in Mostar using a battery of self-completed questionnaires developed with UNICEF. A one-in-10 sample compiled data from mothers and established direct exposure to war traumas as more important than maternal reactions in determining the level of child traumatic-stress reactions. Sean Perrin described the development and delivery of training in Central Bosnia and highlighted problems overcome during the training of 2,600 primary-school teachers. Berima Hacam, a child psychologist from the Centre for Children and Families on Mostar, described how the program developed a community-based, accessible service in which a part-time psychologist and four part-time teachers trained for the project not only followed up the high-risk group identified in the survey but also acquired 130 new cases in 1997, mostly after the international advisors had left for home.

Hedi Fried from the Jewish community in Stockholm addressed the issue of meeting the needs of the children of Holocaust survivors. Elderly survivors shun therapy but can be involved in dialogue support groups with their children which opens communication across the generations.

Ellinor Major from the Psychosocial Centre for Refuges in Oslo presented her findings on a follow-up study of more than 450 Norwegian resistance fighters from World War II. The children of veterans who had been less able to discuss their experiences had more health and mental-health problems, though the majority of concentration-camp survivors coped remarkably well.

A cross-generational presentation by three members of the Gruden family from Zagreb highlighted the particular role and needs of young widows following the loss of their husbands in war. The issue of when and whether to remarry is a poignant and difficult one to negotiate. Nerima Becirevic described the model developed by the Catholic Relief Services in Bosnia to identify and meet the needs of high-risk families in Sarajevo.

Explicit in most of the discussion was the view that if the traumatic reactions of children and adolescents are not satisfactorily resolved, they will continue to display difficulties in interpersonal and intrapersonal adjustments leading in turn to future conflicts. Children become directly traumatized by seeing horrific war-related events and indirectly by its effects on their families. Returning veterans may deal with their own needs at the expense of those of their families and may even inflict abuse on them. Most of the intervention projects had adopted a model of identifying the families or children at the greatest risk and meeting some of their needs by training local counterparts to deliver support and therapy, often at a high level of sophistication. Closing speaker Ofra Ayalon from Israel raised and commented on the theme of the tension between simply providing services and doing so in a way as to gather data to evaluate them scientifically.

Psychosocial interventions are seen as an integral part of any peace and reconciliation process. Certainly, it was most heartening that under the auspices of the WVF, veterans and mental health professionals from countries so recently involved on opposing sides in armed conflict could come together to try to learn the lessons for a peaceful future.