15 October 2018

Over 600 former child soldiers in Yambio County, South Sudan, are participating in demobilization process which will support their reintegration into the community

In South Sudan’s Yambio County, the demobilisation of child soldiers who were forced to fight during the country’s long civil war is underway. These children would like to return to their old lives, but some struggle with all that they have experienced.

Doctors Without Borders (MSF) runs a mental health support programme to help them come to terms with their experiences as they reintegrate into the community.

South Sudan’s civil conflict has had many dark chapters, but one of the worst is the forced recruitment of children into the ranks of competing armed groups. These young combatants were highly prized by their adult commanders as they would often follow orders without understanding the impact of their actions.

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Members of the community patiently wait for an opportunity to see one of MSFs medical staff in Yambio.  Photo: Philippe Carr/MSF

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A mother brings her child for a vaccination. At the same time children are able to meet with the mental health teams for consultation. Photo: Philippe Carr/MSF

The former child soldiers are often traumatised: separated from their families and forced into a brutal life of violence and forced labour.

In some cases the children were beaten and sexually abused. The horrors many saw in battle are seemingly impossible for them to forget.

But over the last six months a group of government and non-government organisations, including MSF, have worked to reintegrate these children back into their communities. MSF psychologists and counsellors have played a key role, providing mental health care to the children. In total, 632 have been enrolled in the demobilisation programme, with different groups graduating throughout the year.

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Throughout the week the team the mobile teams visit out reach locations close to the homes or the schools of the demobilized children to set up its temporary clinics.  Photo: Philippe Carr/MSF

“It is important to realise that not all the children need psychological counselling,” says Rayan Fattouch, MSF mental health activities manager in Yambio. “The human spirit is resilient and has its own way of coping with problems. But some of the kids show symptoms of post-traumatic stress or have flashbacks, which can lead to anxiety and depression.

These strong emotions are not only around their experiences as soldiers. Many are fearful of an uncertain future. They are afraid of how they will be accepted by their communities and what will come of their lives.

Demobilisation can be a complicated situation. Former child soldiers realise that, during their years of captivity, life has moved on and the world they knew has changed. In some cases, families were forced to move away and can´t be found. In others, family members may have died. These types of realisations can have a detrimental lasting effect.

Some child soldiers do not always receive a welcomed return. Their former communities are often afraid to accept former child soldiers back. During the years spent fighting, some armed groups used the children to loot supplies from civilians.

Armed groups extorted protection money from these communities, and those who could or would not pay may sometimes face violent confrontations. Part of the reintegration process involves helping communities to appreciate the circumstances of the children while in armed captivity and to take the time to look at their own experiences during that restive period.

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MSF has a number of locations in and around villages of Yambio town which its mobile team regularly visits, where both the former child soldiers and the community can access medical treatment. Photo: Philippe Carr/MSF

“Some of the children carry the burden of guilt,” says Carol Mwakio Wawud, an MSF psychologist with the programme. “This is not just about something they might have done or seen while in uniform - some still feel guilty about being captured and being taken from their families. In their minds it was their fault.”

Mwakio and other MSF mental health staff try to help them understand that they were not entirely responsible for their actions while in uniform. “We remind them that their commanders were the ones who were in charge and forced them to commit atrocities. This was a period of their life when they had no control, but now the future offers lots of possibilities,” Mwakio added.

Trust is at the heart of the relationship between the counsellors and their young clients. This is not just part of the psychologist´s ethical code, it is a crucial bond needed to ensure these young patients can express themselves freely.

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Everybody works to set up the clinic. Within a few minutes the tents are ready. Photo: Philippe Carr/MSF

“Every detail is taken into consideration to make the psychological consultations for these sensitive cases as comfortable as possible. This is important so that we can develop a bond of trust”, Mwako said. “Details like where our client sits during our sessions are really important. We let them see the entrance of the tent, so they know that there is nobody listening. Our aim is to show them that they have regained control over their own lives.”

It is important that the child is well looked after. They have been promised, and desperately need basic amenities. Many of these children feel insecure; they worry they might be dragged back into their old lives. In such circumstances, any improvements to their mental health can be lost quickly. If

they feel that the demobilisation programme has let them down in some capacity, disillusionment sets in. There is even a risk that some will want to return to their old lives.

“Nearly all the children want to return to a normal life and a future,” says Paul Maina, the MSF programme manager. “When you talk to them they all want to go to school like other kids their age. They know that it is only through education that they will be able to secure a new life.”

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Throughout the week the team the mobile teams select a new location either close to the homes or the schools of the demobilized children to set up its temporary clinics. Photo: Philippe Carr/MSF

The healthcare system in South Sudan is rudimentary and there are few local mental health professionals that can look after the needs of the children and their communities. To counter this, South Sudanese members of staff in the project are being trained as counsellors. These trainees are participating in an accelerated training programme and in the months to come will be able to support cases under supervision.

The programme in Yambio is helping the children turn their lives around. But this is just one small part of the country that needs a great deal of healing.

It is estimated that, across the country, 19,500 children served as combatants during the conflict and need to be demobilised. While some may find their own ways of dealing with the past, others will need help in this new chapter of their lives.

Read more about MSF's work in South-Sudan

Find more information here about why mental health care for African youth matters.