Introduction

In May 2015, at the beginning of the so-called ‘refugee crisis’, the European Commission devised the ‘hotspot approach’ to help Member States at the Southern EU-borders manage increasing migratory pressure. Under this approach, European Union (EU) agencies (European Asylum Support Office [EASO]), European Border and Coast Guard Agency (EBCG, FRONTEX), and Europol started to work on the ground with Greece and Italy in the identification and registration processes of newly arrived migrants and asylum applicants. The objective of this was to ensure that all new arriving persons were immediately registered and pointed, as soon as possible, to the correct direction (that is, application for asylum, return to their home country or relocation to another EU-country), and as such to avoid so-called ‘secondary movements’ to other European countries.

Greek reception and identification centres (RICs) opened their doors in early 2016, together with the Greek government adjusting its asylum legislation (Law L4375/2016), formalising the existence of RICs. As an extension to the EU-Turkey agreement, which was finalised on 20 March 2016, five new first reception centres were created on the Aegean islands of Lesvos, Kos, Chios, Leros and Samos, all in close proximity to the EU-Turkey border. The islands’ geography posed an additional movement restriction for the arriving refugees, extra to the one created by the police and authorities on arrival. The initial examination of their asylum application could lead to relocation to the Greek mainland or abroad in case of proved vulnerability, or deportation to Turkey in case of rejection.

International organisations, NGOs and human rights observatories have repeatedly shed light on the living conditions in Greek RICs (see for example, ECRE, 2016; FRA, 2016; HRW 2016, 2018; Avocats Sans Frontieres, 2019), and scholars have demonstrated the human rights abuses in these hotspots and the effects of the living conditions there on the refugees’ physical and mental health (Rozakou, 2017; Jones, 2019; Boccagni and Righard, 2020).

Social work in Greek reception and identification centres

Professionals working in these centres include, among others, asylum authorities, security staff and social workers. The work of frontline social workers in providing services for refugees and asylum seekers is generally considered difficult and stressful (Robinson, 2014).

Introduction

The hotspot approach

So much ink has been spilled about the so-called ‘refugee crisis’ of 2015 that it is almost impossible to refer to it without the fear of falling into endless repetition. Reports from international organisations state that in the period between January 2015 and September 2015, the largest number of refugees since World War II moved into Europe. During those months, an estimated 1,000,000 refugees arrived in Europe, about 850,000 of whom via Greece as gateway and mainly via the islands of Lesvos and Samos. Among them, there were thousands of unaccompanied minors; minors travelling without their parent/legal guardian. In May of the same year, the European Commission introduced ‘The hotspot approach to managing exceptional migratory flows’ as defined in the European Agenda on Migration and formally endorsed by the European Council on 25– 26 June 2015. In early 2016, Greece legally introduced the establishment of these centres with Law L4375/2016. Under this law, five so-called hotspots, officially titled ‘Registration and Identification Centres’ (RICs), were created on the islands of Lesvos, Samos, Kos, Leros and Chios. A few days before the Greek law, the ratification of the EU-Turkey Statement came into effect stating that:

With this agreement, ‘the corresponding regimes, which have long been criticized by Europeans for their infringements of human rights and the rule of law, would now be seen as guaranteeing sufficient protection for refugees’ (Fassin, 2016: 1).

The impact of the ‘hotspots’ in Greece on the migration management was immediate and severe (Afouxenidis et al, 2017; Kourachanis, 2018). Suddenly, Greece changed from being one of the main gateways – together with Italy and Spain – towards Northern Europe, to being the main migrant detention centre in the EU. Thousands of people kept arriving to the Greek islands, only to find out that they were no longer allowed to leave, but had to proceed with their asylum application at the RICs. If they refused to apply for asylum at the ‘hotspot’, they were immediately subject of deportation to Turkey.

Unaccompanied young refugees form a particular group amongst refugee children and adolescents. Although they are often identified as a homogenous group, they largely differ, such as in their educational backgrounds, migration motives and expectations, mental health status and wellbeing, and familial contexts. The process of familial separation throughout the migration trajectory and settlement process leads to complex and dynamic processes of searching for renewed equilibriums between new social networks in the host country, maintaining relationships with and receiving support from family members in the home country and meeting (supposed) expectations from and continuous caring for family members back home. Given the important of social support and family loyalties to the wellbeing of these young refugees, both practitioners and policy-makers need to take hold of these complex aspects in their daily care practices and policy-making.

INTRODUCTION

CHILD SOLDIERING IN NORTHERN UGANDA

In northern Uganda, a civil war has been waging for more than two decades between the rebel faction Lord's Resistance Army (LRA) and the Ugandan Government. Although, the roots of this conflict reach back to the colonial era and the conflict has known many episodes; an intensification occurred when Yoweri Museveni, president of Uganda, seized power in 1986 and Joseph Kony, leader of the LRA, set up his guerrilla campaign.

The battlefield of this conflict is situated in the northern districts of the country, where the Acholi population resides. The LRA adopted various civiliantargeting strategies from a political and operational aim, resulting in numerous civilian casualties. Attacks on villages, the maiming of civilians, ambushes, massacres and other atrocities were countless during this emergency. It is estimated that over a million and a half had to flee their homes and reside in internally displaced persons camps4 and that thousands of children sought protection as night commuters in town each night. Furthermore, the conflict limited their access to security, food, employment, education and health services.

One of its adopted strategies, mainly targeting children, is the violent abduction and forced recruitment of minors to serve as child soldiers. It is estimated that so far about 25,000 children have been forcibly involved as child soldiers in the LRA. These children are used to empower the LRA by filling its ranks and are thereby actively engaged in the battle against the government and people of Uganda.

In captivity, abducted children live in harsh circumstances, are exposed to several potentially traumatising events and are made perpetrators of atrocities against their own people. There can be no doubt that these experiences affect the child's well-being and development. Research has found that they are psychologically distressing, resulting in high rates of post-traumatic stress symptoms among former child soldiers. These in turn pose serious threats to the long-term rehabilitation and reintegration of the former child soldiers.

INTRODUCTION

This chapter aims to outline an overview of psychosocial caretaking activities organised by rehabilitation centres (RCs) for former child soldiers in northern Uganda. The conflict in northern Uganda is sometimes referred to as ‘one of the most forgotten conflicts in the world’ or ‘one of the worst violations of children's rights anywhere in the world’. For over 20 years this country has suffered from a cruel and bloody war between the government army (Ugandan People's Defence Force, UPDF) and the Lord's Resistance Army (LRA), a rebel group under the command of Joseph Kony. The LRA had a tremendous impact on daily life as it concentrated its terror on the civilian population by looting and attacking villages, burning houses, and, worst of all, by mutilating, killing and abducting children and adults. It is estimated that over the course of the conflict, Kony and his army were responsible for the deaths of about one million people, while nearly two million people were forced to live in camps for internally displaced persons (IDP) for several years.

The abduction or use of children for the purpose of forced conscription and sexual exploitation is even today an important problem, as it is estimated that between 250,000 and 300,000 children are deployed as child soldiers in 17 conflicts worldwide. Northern Uganda had its share, with estimations ranging from 24,000 to 38,000 children to as many as 66,000 children and young adults between 14 and 30 years old. Even more striking, Annan et al. found that more than one third of male youths and one fift h of female youths questioned in their study reported being abducted. Once abducted by the LRA, children were confronted with very difficult living conditions and without doubt life became a true struggle for survival. It started at the moment of abduction, when many children were tied, beaten and/or given heavy loads to carry.

INTRODUCTION

Although clashes between social groups are as old as mankind, the characteristics of warfare and how it is conceptualised have changed through history. During recent decades, a shift has become clear from wars between states to conflicts within states, which appear to be characterised by a mixture of political, economic, military and social forces in competition for power and scarce resources, thereby violently targeting civilians who now compromise up to 90 per cent of war casualties. The case of the Democratic Republic of the Congo, the focus of this paper, is a striking example of such contemporary prolonged conflict, frequently referred to as a ‘Complex Political Emergency’ (CPE).

Following these changed dynamics and conceptualisations, the international community has simultaneously been confronted with the limitations of its traditional humanitarian principles and approaches. Subsequent to past failures when intervening in CPEs, new ideas of development relief and conflict sensitivity have arisen, introducing ‘community-based’ as the new buzzword in the intervention field. While these new trends have stimulated humanitarian agencies to broaden their scope into maximising contextual conditions for sustainable peace and development, they have equally been criticised for entailing unintended consequences, reproducing structural inequalities and providing simplified and unsustainable solutions.

Within this ‘new aid paradigm’, the mental health of war-affected societies has gained attention, as psychological problems in civilians, resulting from their massive exposure to violence, have been increasingly recognized as threats to the development and long-term security of society. Firstly, psychologically and socially well-functioning people and societies are considered an essential prerequisite for the rehabilitation and rebuilding of political, social and economic institutions. Secondly, as is confirmed in recent findings on the association of post-traumatic stress symptoms on the one hand with feelings of revenge and negative attitudes towards reconciliation on the other, mental health problems could undermine peace-building processes and may eventually lead to renewed or sustained violence.

GENERAL BACKGROUND

The recruitment of child soldiers has been hitting the headlines in politics and the media for many years. However, many commentators seem to forget that a much broader circle of children is affected by armed conflicts in general. While there are no reliable estimates of the number of children currently living in waraffected areas worldwide, UNICEF (2006) reports that conflicts in the decade to 2006 killed more than two million children and left another six million injured or permanently disabled, twenty million homeless, and over one million separated from their parents. Countless others have been orphaned, raped or forced to witness acts of violence. It is estimated that during war, 5 per cent of child deaths result from direct violence and 95 per cent from malnutrition, illness or infection. Even when children are not directly affected by exposure to violence or disease, their lives may be changed by the burden of displacement, the loss of caregivers, socio-economic hardship, the destruction of infrastructure, crops and livestock, etc. In consequence, the many challenges in dealing with children affected by armed conflict extend far beyond the issue of the recruitment and subsequent demobilisation of child soldiers to include also questions concerning the rehabilitation/recovery, reintegration and reconciliation – not necessary in that order – of all youths.

It is striking that, in general terms, academic work has taken a rather narrow view of these issues as well. International law has focused on a number of very specific issues, such as age limits for the recruitment of children in children's rights law, and the punishment of recruiters of children in international criminal law. The discipline of psychology has put its emphasis on the effects of traumatic exposure on individuals and their recovery therefrom, although it has been looking for a more psychosocial perspective, trying to incorporate the broader war-affected context. Finally, studies in the field of transitional justice have paid remarkably little attention until recently to the role of children in transitional justice mechanisms, both as victims and as offenders.

INTRODUCTION

The challenges of reintegration in post-conflict settings have been a focus of attention in Uganda, which experienced over 20 years of armed conflict between the government of Uganda and the rebel Lord's Resistance Army (LRA) that ended only five years ago. War-affected children in Uganda include not only those who were abducted by rebel forces, but all those children and adolescents who suffered – amongst other difficult experiences – internal displacement, loss of livelihood and caregivers, and disruption of infrastructure and services during the prolonged armed conflict. Several studies have highlighted the important interaction between exposure to possible traumatising experiences, available social and professional support and children's mental health in conflict settings. Simultaneously, a large number of interventions have been created in these conflict settings to tackle the possible impact of traumatising experiences on the mental health of war-affected young people.

This paper will focus on the fit between children's mental health needs on the one hand and the programming responses for children in (post-)conflict settings on the other hand by providing, firstly, an overview of child- and adolescenttraumatising experiences and their outcomes; secondly, discussing the interventions that have been used with war-affected children and adolescents to improve their mental health; and, lastly, discussing practice implications for the fit between mental health needs and feasible programming responses.

TRAUMATISING EXPERIENCES AND MENTAL HEALTH NEEDS OF WAR-AFFECTED CHILDREN IN NORTHERN UGANDA

A mental health disorder can be defined as ‘the presence of psychological distress; impairment in psychological, social, or occupational functioning; or, any disorder that is associated with an increased risk of suffering death, pain disability or loss of freedom’. Mental health problems among war-affected children have been well documented in Uganda. Most of these studies have focused on post-traumatic stress disorder (PTSD), although the prevalence rates of PTSD in these studies vary considerably, ranging from 97 to 27%.

Other mental health problems have also been documented, including depression, generalised anxiety disorders and substance abuse.