How do you help a former captive reclaim her life?
That's the question mental health professionals face as they treat more than 200 women and children freed from the Islamist extremist group Boko Haram last Saturday in Nigeria.
According to reports, the majority of those rescued are children and a number of the teens and women are pregnant.
The physical and mental health needs boggle the mind: basic health screening for all and maternity care for those pregnant; post-traumatic care; social and community support; rape counseling for women whether pregnant or not. The Chief of the United Nations Population Fund has said that the organization is providing health screening as well as psychological counseling for the rescued women.
Dr. Theresa Betancourt, director of the Research Program on Children and Global Adversity at Harvard's T.H. Chan School of Public Health, studies the reintegration of children affected by conflict. She has led a 13-year study of 529 former child soldiers, a third of them girls, held in captivity in Sierra Leone — many for more than four years — when they were children. She talked with NPR about the kinds of problems the Nigerian girls might face and the support they will need.
Do you think the girls in Nigeria are getting the immediate care they need?
It sounds like they're starting with careful assessment and screening, both physical and mental. They're attending to pregnancy care but also immediate psychosocial care. There is concern that many of these pregnancies occurred in the context of abuse and rape and are unwanted, so there's the worry about maternal depression. We know that depression can impede a mother's ability to nurture. We have to be concerned about the well-being and development of their young babies. These mothers will need support and mentorship around taking on the role of mothers.
How long might the scars of this trauma last?
That depends a lot on how they were treated in captivity, exposure to traumatic events and many post-rescue factors. What's the nature of the community they're coming back to? The scars of such an experience are greatly affected by the social environment in the community they return to. Social support is critical, and we need to reduce stigma. If former child soldiers, for example, are stigmatized, it greatly exacerbates negative outcomes.
What might that kind of community stigma look and feel like to these returning girls, especially those who are pregnant?
In Sierra Leone, returning child soldiers were taunted and teased or even beaten. The girls were frequently seen as sexually promiscuous or defiled.
What kinds of things can help to reduce community stigma?
Perceptions of sexual impurity can make it hard for girls to marry, a hallmark of social acceptance. So community sensitization campaigns, like those held in Sierra Leone, are important. These were town hall-style meetings with community elders, parents and others. It kicked off a dialogue to get the community ready for the return home of the former child soldiers. It's also important for the immediate family of those returning as well as their social group to accept the captives back home.
And it's not a one-off. You need to keep monitoring community relationships and reinvigorating these campaigns. It's important to talk about the danger of ostracizing.
Has your research provided examples of girls who have lived through this kind of trauma, including pregnancy, and gone on to reclaim their lives?
Yes, definitely. We have a number of vignettes of young girls who have gone through horrific experiences of abduction and gone on to thrive. That possibility is there for these girls as well. We know that some of the protective factors in Sierra Leone included opportunities for girls to continue in their education, having adequate social support and lower levels of community stigma.
One girl was held for 2 1/2 years, beaten frequently resulting in a deformity of her leg and had a baby at a young age. She witnessed killings and atrocities. When she returned, she was frequently angry and had trouble getting along with peers. But her mother was dedicated to her, stayed by her side. She also had a teacher who was flexible with her, and the girl slowly became connected to school. Over time, her relationships with others and with the community started to improve. She went on to raise her child on her own with family support and remained a dedicated student. That can happen if you have people in your life who are there for you and stand by you.
Do you think Nigeria can provide the right support for these rescued girls and women?
I think Nigeria has a health system that is higher functioning than many other areas where children have been involved with armed groups. They have professionals who are leaders in global mental health and within the country.
There are still girls in captivity and they may face continued beatings and rape. Do you think they've given up hope?
In our data we saw many instances of how young girls kept hope alive. They maintained hope through social connections to one another. When they were released, many girls would call each other sister even though they weren't sisters. They had helped each other through, given each other solace, looked out for each other's safety, shared food. In our sample, some girls remain close to one another today.