Patrick Vinck

Returning home: forced conscription, reintegration, and mental health status of former abductees of the Lord's Resistance Army in northern Uganda

BackgroundSince the late 1980s, the Lords Resistance Army (LRA), a spiritualist rebel group in northern Uganda, has killed and mutilated thousands of civilians and abducted an estimated 52,000 to 75,000 people to serve as soldiers, porters, and sex slaves for its commanders. This study examines the types of violence to which former abductees have been exposed and the extent to which these acts have affected their psychological well-being.MethodsThis is a cross-sectional study of 2,875 individuals selected through a multi-stage stratified cluster sampling design conducted in 8 districts of northern Uganda. Multivariate logistic regressions were performed with symptoms for Post-traumatic Stress Disorder (PTSD) and depression as the main outcome measures.ResultsOne-third of the respondents (33%) self-reported having experienced abduction (49% among the Acholi, the largest tribal group in northern Uganda). Over half (56%) of all the respondents and over two-thirds of those who experienced abduction met the criteria for symptoms of post-traumatic stress disorder (PTSD). Multivariate analysis shows that several factors increased the risk of former LRA abductees developing symptoms of PTSD. These factors included gender (females were more susceptible than males), being a member of the Acholi ethnic group, participating in or witnessing a cumulative number of traumatic events, and encountering difficulties re-integrating into communities after abduction. Factors associated with increased risk of meeting criteria for symptoms of depression included older age of males at the time of abduction, lower score on social relationship scale, high incidence of general traumatic event exposure, high incidence of forced acts of violence, and problems reintegrating into communities after abduction.ConclusionAbduction and forced conscription of civilians has affected the psychological well-being of a significant number of northern Ugandans. The sources of psychological trauma are multiple, ranging from witnessing to being forced to commit violent acts, and compounded by prolonged exposure to violence, often for months or years. Community-based mental health care services and reintegration programs are needed to facilitate the reintegration of former abductees back into their communities.

Association of exposure to intimate-partner physical violence and potentially traumatic war-related events with mental health in Liberia

Liberias wars between 1989 and 2003 resulted in hundreds of thousands of casualties and millions of victims. Gender-based violence was widespread during the conflict. Since the end of the war, however, little attention has been paid to ongoing violence against women, especially within the household. This research examines the relationships between intimate-partner physical violence, war experiences, and mental health nearly ten years after the end of the war. The study is based on a nationwide cross-sectional, multistage stratified cluster random survey of 4501 adults using structured interviews during a six-week period in November and December 2010. The main outcome measures are prevalence of intimate-partner physical violence, exposure to potentially traumatic war-related events, symptoms of Post-Traumatic Stress Disorder (PTSD) and depression. Among adult women, 37.7% (95%CI, 34.9-40.5; n = 852/2196) reported lifetime exposure to intimate-partner physical violence and 24.4% (95%CI, 22.1-26.9; n = 544/2196) reported incidence of intimate-partner physical violence over a one-year recall period. Among men, 23.2% (95%CI, 20.8-25.9, n = 475/2094) reported having severely beaten their spouse or partner over their lifetime; the incidence over the one-year recall was 12.2% (95%CI, 10.4-14.2, n = 259/2094). Among adult residents in Liberia, 10.6% (95%CI, 9.5-11.7, n = 546/4496) met the criteria for symptoms of depression, and 12.6% (95% CI, 11.5-13.9, n = 608/4496) met the criteria for symptoms of PTSD. Intimate-partner physical violence as a victim and as a perpetrator was significantly associated with exposure to potentially traumatic war-related events, especially among men. Among women, experiencing intimate-partner physical violence was associated with symptoms of PTSD and depression. Among men, perpetrating intimate-partner physical violence was associated with symptoms of PTSD and depression after adjusting for exposure to potentially traumatic war-related events. These findings suggest that intimate-partner physical violence may be a continued stressor in post-war societies that needs to be recognized and addressed as part of the reconstruction effort.

When the War Ends: A Population-Based Survey on Attitudes about Peace, Justice, and Social Reconstruction in Northern Uganda

Twenty-one years of war, destruction, and the displacement of over 1.5 million people have turned northern Ugandan into a humanitarian disaster. One of the war’s principal perpetrators has been the Lord’s Resistance Army (LRA). A significant shift in the war occurred in late 2005 when the LRA withdrew its forces to the southern Sudan and then crossed the Nile, assembling in Garamba National Park in the Democratic Republic of Congo. In the summer of 2006, peace talks between the Government of Uganda and the LRA commenced in Juba, and a first Cessation of Hostilities Agreement was signed on 26 August 2006. With the withdrawal of the LRA to the Congo, security in northern Uganda has improved considerably. Some displacement-camp residents have moved to new settlement sites closer to their villages. Yet others fear leaving the relative safety of the camps until a final peace agreement has been signed and the LRA fighters have been demobilized. This is a delicate stage of the conflict, and a deeper understanding of the needs and desires of affected populations will be crucial to a long-term resolution.This report presents the findings of a population-based study conducted by the Human Rights Center, University of California Berkeley, Payson Center for International Development, Tulane University, and the International Center for Transitional Justice. The research was based on a cross-sectional survey of 2,875 individuals, supplemented by in-depth qualitative interviews, in eight districts of northern Uganda most affected by the conflict from April to June 2007. The study capture attitudes about peace, justice, and social reconstruction while peace talks were taking place between the Ugandan government and the LRA in Juba, south Sudan.

Sense of coherence and its association with exposure to traumatic events, posttraumatic stress disorder, and depression in eastern Democratic Republic of Congo.

The Democratic Republic of Congo is the scene of some of the worst atrocities in recent history. However, in the face of traumatic experience, only a minority of people develops symptoms that impair their functioning. The sense of coherence proposed by Antonovsky (1987) is a theoretical construct reflecting an individuals overall wellbeing and ability to cope with stress. This study explores the relationships between sense of coherence, exposure to traumatic events, symptoms of posttraumatic stress disorder (PTSD), and depression. Results suggest an association between a high sense of coherence and high education levels, high income, and positive social relationships. Furthermore, the study found that sense of coherence is inversely correlated with cumulative exposure to violence and symptoms of PTSD and depression.

The Lord's Resistance Army and Forced Conscription in Northern Uganda

On 13 October 2005, the International Criminal Court unsealed warrants of arrest for five senior leaders of the Lords Resistance Army (LRA) for the forced conscription of children and other war crimes in northern Uganda. We compiled a database of 25,231 children and youth who had been registered by receptions centers in northern Uganda after their return from the LRA. Most of the LRA returnees were thirteen to eighteen years old (37 percent) and nineteen to thirty years old (24 percent). Twenty-four percent of the LRA returnees were female and 76 percent were male. The average length of abduction was 342 days, and the median number of days of abduction was ninety-two days. Among women aged nineteen to thirty years old, the average length of abduction was four and one half years. At the multivariate level, gender, age, and the interaction between them were associated with length of captivity (F-Statistic = 229.8, p-value = 0.0001). Using triangulation methods, we estimate the LRA abducted 54,000 to 75,000 people, including 25,000 to 38,000 children, into their ranks between 1986 and 2006.

An assessment of antenatal care among Syrian refugees in Lebanon

BackgroundAfter more than three years of violence in Syria, Lebanon hosts over one million Syrian refugees creating significant public health concerns. Antenatal care delivery to tens of thousands of pregnant Syrian refugee women is critical to preventing maternal and fetal mortality but is not well characterized given the multiple factors obtaining health data in a displaced population. This study describes antenatal care access, the scope of existing antenatal care, and antenatal and family planning behaviors and practice among pregnant Syrian refugees in various living conditions and multiple geographic areas of Lebanon.MethodsA field-based survey was conducted between July and October 2013 in 14 main geographic sites of refugee concentration. The assessment evaluated antenatal services among a non-randomized sample of 420 self-identified pregnant Syrian refugee women that included demographics, gestational age, living accommodation, antenatal care coverage, antenatal care content, antenatal health behaviors, antenatal health literacy, and family planning perception and practices.ResultsIn total, 420 pregnant Syrian refugees living in Lebanon completed the survey. Of these, 82.9% (348) received some antenatal care. Of those with at least one antenatal visit, 222 (63.8%) received care attended by a skilled professional three or more times, 111 (31.9%) 1–2 times, and 15 (4.3%) had never received skilled antenatal care. We assessed antenatal care content defined by blood pressure measurement, and urine and blood sample analyses. Of those who had received any antenatal care, only 31.2% received all three interventions, 18.2% received two out of three, 32.1% received one out of three, and 18.5% received no interventions. Only (41.2%) had an adequate diet of vitamins, minerals, and folic acid. Access, content and health behaviors varied by gestational age, type of accommodation and location in Lebanon.ConclusionsStandards of antenatal care are not being met for pregnant Syrian refugee women in Lebanon. This descriptive analysis of relative frequencies suggests reproductive health providers should focus attention on increasing antenatal care visits, particularly to third trimester and late gestational age patients and to those in less secure sheltering arrangements. With this approach they can improve care content by providing early testing and interventions per accepted guidelines designed to improve pregnancy outcomes.

Association of Exposure to Violence and Potential Traumatic Events With Self-reported Physical and Mental Health Status in the Central African Republic

CONTEXT For decades, the Central African Republic (CAR) has experienced violence, economic stagnation, and institutional failure. The latest wave of violence erupted in 2001 and continues to this day in some areas. Yet there has been little attention to the conflict and even less research to document and quantify the conflicts human cost. OBJECTIVE To study levels of violence in CAR, including mortality levels, and the association between exposure to violence and traumatic events with self-reported physical and mental health status. DESIGN, SETTING, AND PARTICIPANTS Multistage stratified cluster random survey of 1879 adults 18 years or older in selected households conducted in 5 administrative units of CAR (3 in the south, which has been free from recent violence, and 2 in the north, in which violence continues) between October and December 2009. MAIN OUTCOME MEASURES Mortality, morbidity, exposure to potential traumatic events, sense of insecurity, and meeting of symptom criteria for depression and anxiety using the Hopkins Symptom Checklist-25 with a cut-off score of 1.75. RESULTS The crude mortality rate (CMR) was 4.9 deaths (95% confidence interval [CI], 4.6-5.1) per 1000 population per month and self-reported CMR due to violence was 0.8 deaths (95% CI, 0.6-1.0) per 1000 population per month. Thirty-five percent reported their physical health status as being good or very good while 29% described it as bad or very bad. Respondents in northern prefectures reported higher rates of mortality, exposure to trauma, and insecurity and lower levels of physical health and access to health services compared with those in the south. The estimated prevalences of symptoms of depression and anxiety were 55.3% (95% CI, 51.6%-59.0%) and 52.5% (95% CI, 48.1%-56.8%), respectively. Exposure to violence and self-reported physical health were statistically associated with mental health outcomes (P < .001). Anxiety symptom scores were higher for respondents in the northern prefectures than those in the south (t = 2.54, P = .01). CONCLUSION A high proportion of adult respondents in CAR reported witnessing or having personally experienced traumatic events over the course of the conflicts, and more than half met symptom criteria for depression and anxiety.

Human rights, transitional justice, public health and social reconstruction

Mass violence, armed conflict, genocide, and complex humanitarian emergencies continue to create major social and public health disasters at the dawn of the 21st Century. Transitional justice, a set of policies designed to address the effects of war on traumatized communities and bring justice, lies at the nexus of public health, conflict, and social reconstruction. Despite the paucity of empirical evidence, advocates of transitional justice have claimed that it can alleviate the effects of trauma, deter future violence, and bring about social reconstruction in war-affected communities. Empirical evidence--including new data and analyses presented in this article--suggests a link between trauma, mental health and attitudes towards and responses to transitional justice programs, but there has been little theoretical discussion about the intersection between public health and transitional justice, and even less empirical research to generate discussion between these two fields. Yet, public health professionals have an important role to play in assessing the impact of transitional justice on communities affected by mass violence. In this paper, we offer a conceptual model for future research that seeks to examine the relationship between transitional justice programs and their potential value to the fields of medicine and public health and discuss the methodological issues and challenges to a comprehensive evaluation of this relationship. To illustrate the discussion, we examine new data and analyses from two cases of contemporary conflicts, eastern Democratic Republic of Congo (DRC) and northern Uganda.

Talking Peace: A Population-Based Survey on Attitudes About Security, Dispute Resolution, and Post-Conflict Reconstruction in Liberia

Liberia’s civil war between 1989 and 2003 left hundreds of thousands dead, and many more affected by the extreme violence that ravaged the country. Peacebuilding and reconstruction have been daunting challenges for a country that was divided and impoverished even before the war. The conflict destroyed or damaged almost all structures and institutions of the state, the economy, and everyday life. Much progress has been made since President Sirleaf’s government assumed office in 2006, but enormous challenges remain. As the second presidential election since the end of the war nears, Liberia is once again at an important juncture on the path to its peaceful reconstruction.This study was undertaken to contribute to a deeper understanding of: (1) the populations priorities for peacebuilding, (2) Liberians’ perceptions of their post-war security, and (3) existing disputes and dispute resolution mechanisms. The study is based on extensive consultations with local organizations, interviews with key informants, and a nationwide survey of 4,501 respondents randomly selected in each of the counties to represent the views of the adult population in Liberia. The survey was implemented in November and December 2010. Results are representative of the population at the county level and for the Greater Monrovia district.

After the First Trial: A Population-Based Survey on Knowledge and Perceptions of Justice and the Extraordinary Chambers in the Courts of Cambodia

On July 26, 2010, Kaing Guek Eav, alias Duch, was convicted of crimes against humanity and grave breaches of the 1949 Geneva Conventions for events that took place three decades earlier under the Khmer Rouge regime. Following this important milestone for the Extraordinary Chambers in the Courts of Cambodia (ECCC), the present study was implemented to (1) monitor public awareness and knowledge of the ECCC’s work, as well as of outreach and victim participation initiatives organized by the tribunal and local non-governmental organizations; (2) assess attitudes about justice and the desire for reparations for past crimes; and 3) recommend ways in which the ECCC, civil society, and the international community can continue to engage Cambodians in the work of the ECCC. This report presents the results of a survey of 1,000 Cambodians, aged 18 or above, randomly selected throughout the country to be representative of the adult population. The interviews were conducted anonymously and confidentially in December 2010 by a team of trained interviewers using a structured questionnaire. This is the second population-based survey conducted in Cambodia by the Initiative for Vulnerable Populations at UC Berkeley’s School of Law Human Rights Center. It is hoped that the findings will contribute to establishing a dialogue between the ECCC, the government, the Cambodian population, non-governmental organizations (NGOs) and the international actors on the role and impact of the ECCC, expectations of the population, and beyond the Court, what must be done to deal with the violent past.