Conflict Related Violence Directed Toward Children in an IDP Setting
Creators: name: Espiritu, Jennifer, MD.
Publisher: name: The University of North Carolina at Chapel Hill University Libraries
Year: 2008

description: Due to a variety of factors, Africa has been afflicted by conflict more than any other continent, undergoing more than 20 civil wars since the 1960s. A recent study of displaced Sierra Leonean children in internally displaced person (IDP) camps found that almost 80% of them had experienced a death in their immediate family, and more than half of them had witnessed the killing of a parent, sibling, or other close relative. No information was given for children who were the direct victims of violence. The burden of armed conflict upon children is so significant that UNICEF uses it as one of the five factors considered in measuring a child’s risk of threatened well-being up to the age of 18. The other four are under-five mortality, moderate or severe underweight, lack of primary schooling, and the likelihood of risk from HIV/AIDS. Sierra Leone was deemed the second most dangerous country in the world for children. Sierra Leonean women and children have also been specifically targeted in raids by child soldiers trained by rebels. Both have been the deliberate victims of machetes used to cripple and mark their victims. In 1999, a study by the Medical Foundation for the Care of Victims of Torture found that 69% of their sample of Sierra Leonean women had been raped and 72% had been beaten at least once. A 2000 study of Sierra Leonean adults in IDP camps in The Gambia found that more than 90% of the sample had experienced forced separation from family, near death experiences, witnessing the murder of family members or friends, lack of food or water, and lack of shelter. Physicians for Human Rights (PHR) conducted a subsequent survey of women in IDP camps in Sierra Leone in 2001, which was later published in JAMA. The survey included demographics, self-perceptions of physical and mental health, personal experiences of war related violence, household experiences of war related violence, opinions regarding punishment of the perpetrators, and attitudes on women’s role in society and human rights. Ninety-four percent reported experiencing sexual violence by armed combatants. Numbers for both child abuse and gender based violence (GBV) increase in the face of disaster, conflict or other events that force populations to uproot and move to other locations. However, the circumstances of a complex humanitarian disaster can sometimes inhibit researchers and clinicians from determining the prevalence of, or patients’ experience of human rights violations in child IDPs. Underreporting of GBV when directly questioned has been documented as high as 70%.11 For child abuse, underreporting has been attributed to fear, perceived low efficacy, ambivalence, and self-blame. Similar to GBV, because of cultural norms or safety concerns, inquiring about the presence of child abuse can often be difficult if not impossible. The World Health Organization’s 2007 report on ethical and safety recommendations regarding the study of violence in emergencies notes that participation in violence inquiries can be dangerous and sometimes life threatening to both participants and those screening individuals for exposure to violence. Previous studies have shown that mothers’ mental health problems can place children at increased risk for intentional injury. Alternatively a history of sexual abuse in a child has been shown to affect the psychsocial functioning of non-offender mothers. These findings suggest that maternal mental health may also be related to conflict-related violence directed toward children (CRVDC). Using the same data from the PHR study on human rights violations and households, we now have an opportunity to examine the ability of demographic and psychosocial variables to predict CRVDC in the children of women who were administered these health needs assessment surveys in IDP camps in Sierra Leone. Modeling such as this could be used to identify those children in need of specialized services, when direct questioning may be unsafe or unreliable. Our purpose is to determine how well the presence of maternal health indicators identifies an increased probability for conflict-related violence directed toward children in a Sierra Leonean IDP population compared with the absence of such indicators.