War, forced displacement, and alcohol abuse: experiences and perceptions of war-affected south Sudanese refugee youth living in Bidibidi refugee settlement in northern Uganda

Refugees are at high risk of alcohol abuse due to their experiences of structural, physical, sexual, and psychological violence in their countries of origin, during flight, and within host communities. Given the prolonged civil war in their country, South Sudanese have continued to flee profound forms of violence and now constitute the largest population of refugees in Uganda. However, little is known about their displacement experiences, as well as the reality of alcohol use and abuse within refugee settlements. Drawing upon the direct voices of a sample of war-affected South Sudanese young people, this article explores their experiences of forced displacement and their links to alcohol abuse, as well as their perceptions regarding appropriate alcohol treatment interventions for refugees in the camp. A total of 22 semi-structured qualitative interviews were conducted with 14 refugee youth (aged 18-25) alongside eight adult key informants who work with the youth (religious leaders, sports coaches, educators, social workers, and settlement administrators). Using thematic analysis, the study revealed a series of key themes influencing and shaping the high incidence of alcohol abuse among the youth. These included traumatic wartime and migration experiences, family separation, poor prospects, and the ubiquitous availability of alcohol in the settlement. In addition, we show how alcohol operates as a strategic tool for survival for the youth, as well as highlight how these perceptions can help to inform alcohol treatment interventions in the Bidibidi refugee settlement. To our knowledge, this is the first in-depth study of alcohol abuse among war-affected South Sudanese refugee youth in Uganda, addressing a significant gap in the current literature on war-affected youth, forced displacement, and alcohol abuse. We contend that involving youth in the design of interventions can be helpful for culturally sensitive and relevant prevention, treatment, and care in refugee settings. In addition, providing employment opportunities and meaningful engagement for growth through social participation can help to address harmful alcohol use among youth in the camps.

Umwana w'umugore: The gendered realities of girls born of conflict-related sexual violence and their mothers in post-genocide Rwanda

This article explores the challenges, needs and capacities of girls born of conflict-related sexual violence during the 1994 Rwandan genocide against the Tutsi. Twenty-nine interviews and 11 focus groups were conducted with girls born of genocidal rape, alongside 44 interviews with mothers of children born of genocidal rape. In a society where Umwana w'umugore - being 'the child of a woman' - is considered an insult for children born of rape, gendered realities profoundly shape girls' experiences. Data reveal that girls born of genocidal rape face challenges related to identity and belonging, multiple forms of violence and economic challenges. Moreover, girls sustain the indirect consequences of gender-based injustices committed against their mothers, making stigma and social exclusion shared and intergenerational experiences, alongside mutual care and support. Policy development must take into account the unique needs of girls born of rape, the precarious situation of their mothers and broader gender inequalities.

Transgenerational trauma in Rwandan genocidal rape survivors and their children: A culturally enhanced bioecological approach

Multiple theories, including attachment, family systems, and epigenetics, among many others, have been invoked to explain the mechanisms through which trauma is transmitted from one generation to the next. To move toward integration of extant theories and, thus, acknowledgement of multiple pathways for transmission of trauma, the authors explore the potential of applying a culturally enhanced bioecological theory to transgenerational trauma (TGT). Data from in-depth qualitative interviews in Rwanda more than two decades after the genocide, with 44 mothers of children born of genocidal rape, and in-depth interviews and focus groups with a total of 60 youth born of genocidal rape, were analyzed according to the processes of culturally enhanced bioecological theory. The findings from a hybrid inductive and deductive thematic analysis suggest that a culturally enhanced bioecological theory of human development allows for an integrated, multi-dimensional analysis of individual, family, cultural, and societal factors of transmission of TGT. Some facets of the data, however, are not accounted for in the theory, specifically, how some mothers were able to create and sustain a positive bond with their children born of genocidal rape, despite societal and family pressure to abandon or abort them. Nonetheless, the findings demonstrate how a culturally enhanced bioecological theory can be an important overarching framework for developing policies and practices to help interrupt or mitigate TGT, strengthen resilience, and facilitate healing for children born of genocidal rape, their mothers, and their families.

Encountering children and child soldiers during military deployments: the impact and implications for moral injury

Background: During a deployment, soldiers must make seemingly impossible decisions, including having to engage with child soldiers. Such moral conflicts may continue to affect service members and veterans in the aftermath of a deployment, sometimes leading to severe moral distress, anguish, and personal crises. Service providers have increasingly argued that as a diagnosis, Post-Traumatic Stress Disorder (PTSD) cannot account for these deeply personal and painful moral conflicts. In light of this, the concept of moral injury has been introduced to better capture the profound forms of guilt and shame that may be experienced by service members and veterans. Objective: This paper addresses encounters with children and child soldiers during military deployments, as well as the risk for moral injury during and following these encounters, and their implications. This exploratory paper brings together existing literature on the topic to introduce, illustrate, and offer potential and promising interventions. Results: Given the potential moral conflicts that may ensue, military personnel who encounter child soldiers during a military deployment may be at risk for moral injury during and following these encounters. The introduction of the concept of moral injury provides a way for these largely unnamed personal and painful moral conflicts and violations to be recognized, addressed, and with appropriate care, remedied. Although there is limited research into their effectiveness at treating moral injury, individual and group-based interventions have been identified as potentially beneficial. Conclusion: As encounters with children during deployments are likely to continue, systematic research, training, healing interventions and prevention strategies are vital to support and protect children in conflict settings, as well as to ensure the mental health and well-being of service members and veterans. HIGHLIGHTS Profound moral conflicts may affect service members and veterans in the aftermath of a military deployment, sometimes leading to severe moral distress, anguish, and personal crises. The concept of moral injury has been introduced to better capture the profound forms of guilt and shame that may be experienced by service members and veterans.Encountering children and child soldiers during a military deployment, may present unique challenges, stress, and moral crises leading to potentially moral injurious events. In particular, transgression-based events which result from an individual perpetrating or engaging in acts that contravene his or her deeply held moral beliefs and expectations such as harming children, and betrayal-based events, which results from witnessing or falling victim to the perceived moral transgressions of others, may lead to lasting psychological, biological, spiritual, behavioural and social impairments.Interventions applied in both an individual-based context such as Cognitive Processing Therapy, Impact of Killing, Adaptive Disclosure, and a group-based context such as Acceptance and Commitment Therapy and Resilience Strength Training, have been identified as potentially beneficial to addressing moral injury. However, more research is required to ascertain appropriate and effective intervention and healing strategies.

An arts-based approach with youth born of genocidal rape in Rwanda: The river of life as an autobiographical mapping tool

Given the tragedy of war and genocide, words often cannot adequately capture the complexity of war-related experiences. Researchers are increasingly utilizing the arts to enable multiple forms of expression, as well as for its therapeutic and empowering qualities. This paper outlines the use of the "river of life," an arts-based autobiographical mapping tool, conducted with 60 youth born of rape during the genocide against Tutsi in Rwanda who continue to live with this intergenerational legacy of sexual violence. The article begins with a review of current arts-based methods and their relevance for war-affected populations and an overview of the genocide, sexual violence, and the lived realities of children born of rape. We then outline the "river of life" mapping tool, where participants drew their life histories using the metaphor of a river, addressing the ebbs and flows of their lives and the obstacles and opportunities they encountered. Developed in collaboration with local researchers, participants were invited to share the meaning of their drawing with researchers, explaining key events throughout their life course, utilizing metaphors, and symbolism to convey their experiences. The article highlights how the "the river of life" facilitated key insights into the post-genocide experiences of children born of rape, and the long-term impacts at the family, community and societal levels, and proved to be especially helpful in enabling youth participants to process and communicate their histories of genocide and experiences of stigma and discrimination. The "river of life" was also reported by participants as having unintended positive effects, including closure and clarity in navigating their past and their futures. While not without limitations, we argue that this mapping tool represents an important addition to arts-based methods that can be used with populations who have experienced profound forms of violence and marginalization.

Interpreters working in mental health settings with refugees: An interdisciplinary scoping review

The consequences of language barriers are some of the most fundamental challenges refugees and asylum seekers face, undermining both the accessibility of mental health services and the quality of the services received. This scoping review provides the first synthesis of research on interpreters working in mental health settings with refugees, one of the most prominent yet understudied strategies to improving language access and the cultural appropriateness of services for this unique population. Comprehensive searches were conducted in PsycINFO, Medline, Web of Science, Social Services Abstracts CAIRN, and Erudit for relevant journal articles and book chapters published up to April 2019. A total of 84 peer-reviewed studies met the inclusion criteria. Publications represented a range of disciplines including social work, linguistics, psychology, anthropology, public health, medicine, psychiatry, and nursing. Six thematic areas were identified: (1) Lack of adequate interpretation as barrier to care; (2) Emotional impact of interpreting on the interpreter; (3) Training and supervision; (4) Impact of the interpreter on the process of psychotherapy/mental health intervention; (5) The impact of the interpreter on the intervention outcome; and (6) The role of the interpreter. The results indicate that despite undeniable challenges, including concerns around confidentiality and bias, when clinicians and refugee clients do not share proficiency in a common language, interpreters have a positive impact on refugee clients' quality of care and clinical outcomes. The implications of these findings for host countries providing mental health services for refugees globally are considered and recommendations offered. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

"Though My Father was a Killer, I Need to Know Him": Children born of genocidal rape in Rwanda and their perspectives on fatherhood

BACKGROUND

There is increasing interest in understanding the contributions of fathers to child and family psychosocial conditions. However, fatherhood has been largely unexplored in relation to children born of conflict-related sexual violence.

OBJECTIVE

This paper aims to explore the realities and perspectives of children born of rape during the 1994 Rwandan genocide and in particular, their views on fatherhood and their biological fathers (who were perpetrators of sexual violence).

PARTICIPANTS AND SETTINGS

The sample included 60 youth (29 females/31 males), aged 20/21 years old. Participants were recruited through professional networks in three regions of Rwanda. Youth participants were aware of the circumstances of their birth.

METHODS

In-depth qualitative interviews and focus group discussions were used to garner youth's perspectives and experiences. Inductive forms of data analysis were used whereby through careful reading and coding of transcripts the researchers identified key themes that were emerging from the data.

RESULTS

Youth participants reported ambivalent and often conflictual feelings towards their father, tension-filled relationships with their mother, and maltreatment perpetrated by step-fathers. Despite their absence, fathers held a significant, vital and symbolic role in participants' perceptions of themselves, sense of identity, and family belonging.

CONCLUSIONS

Children born of rape live with the intergenerational legacy of sexual violence in a context of father absence, strained family relationships, and community stigma. Specific father-related challenges need to be addressed when planning family, community and social policies and programs for children and youth in post-conflict societies.

The Intergenerational Legacy of Genocidal Rape: The Realities and Perspectives of Children Born of the Rwandan Genocide

Brutal acts of sexual violence were documented on a mass scale during the 1994 Rwandan genocide. While existing scholarship on sexual violence has significantly increased our understanding of the challenges confronting survivors, gaps in knowledge remain regarding the lived experiences of children born of genocidal rape. This study sought to explore the realities and perspectives of children born of genocidal rape, and the existing opportunities and challenges they experienced in postgenocide Rwanda. Interviews and focus groups were conducted with 60 participants born of genocidal rape in Rwanda. Findings highlight the key challenges that these youth face in the postgenocide context, including struggles with identity and belonging, ambivalence in the mother-child relationship, and a desire to learn of their biological origins and heritage. The findings suggest that children born of conflict-related sexual violence face a distinct set of challenges and needs that have yet to be formally addressed. Our findings highlight the need for the development of programs, policies, and services specific for this important, yet overlooked group of young people affected by armed conflict.

Diverse perspectives on interdisciplinarity from Members of the College of the Royal Society of Canada

Various multiple-disciplinary terms and concepts (although most commonly “interdisciplinarity,” which is used herein) are used to frame education, scholarship, research, and interactions within and outside academia. In principle, the premise of interdisciplinarity may appear to have many strengths; yet, the extent to which interdisciplinarity is embraced by the current generation of academics, the benefits and risks for doing so, and the barriers and facilitators to achieving interdisciplinarity, represent inherent challenges. Much has been written on the topic of interdisciplinarity, but to our knowledge there have been few attempts to consider and present diverse perspectives from scholars, artists, and scientists in a cohesive manner. As a team of 57 members from the Canadian College of New Scholars, Artists, and Scientists of the Royal Society of Canada (the College) who self-identify as being engaged or interested in interdisciplinarity, we provide diverse intellectual, cultural, and social perspectives. The goal of this paper is to share our collective wisdom on this topic with the broader community and to stimulate discourse and debate on the merits and challenges associated with interdisciplinarity. Perhaps the clearest message emerging from this exercise is that working across established boundaries of scholarly communities is rewarding, necessary, and is more likely to result in impact. However, there are barriers that limit the ease with which this can occur (e.g., lack of institutional structures and funding to facilitate cross-disciplinary exploration). Occasionally, there can be significant risk associated with doing interdisciplinary work (e.g., lack of adequate measurement or recognition of work by disciplinary peers). Solving many of the world’s complex and pressing problems (e.g., climate change, sustainable agriculture, the burden of chronic disease, and aging populations) demands thinking and working across long-standing, but in some ways restrictive, academic boundaries. Academic institutions and key support structures, especially funding bodies, will play an important role in helping to realize what is readily apparent to all who contributed to this paper—that interdisciplinarity is essential for solving complex problems; it is the new norm. Failure to empower and encourage those doing this research will serve as a great impediment to training, knowledge, and addressing societal issues.

"We are children like others": Pathways to mental health and healing for children born of genocidal rape in Rwanda

Despite the well-documented prevalence of rape as a strategy of war, little is known about the specific psychological consequences to children born of conflict-related sexual violence. The results of data analysis of 7 focus groups and 60 in-depth interviews with children born of genocidal rape in Rwanda indicated that they are carrying the trauma of their own stigmatization and marginalization, are burdened with their mothers' trauma, and, we conclude, symbolize unresolved collective trauma for the society. Analysis also reveals that healing for these young adults requires interpersonal and intrapersonal compassion and acceptance, a meaningful connection with a peer group, societal recognition, and empowerment to help contribute to and transform their lives and societies. Each of these pathways to healing-intrapersonal, interpersonal, and social-is contingent upon the other, and none can be considered in isolation. To support this largely invisible population striving to fulfill their potential, opportunities need to be created for self-acceptance and acceptance by mothers, families, and communities; sharing and building emotional and social bonds with their cohort group; formal recognition; official social rituals to validate their experiences and those of the mother-child dyad in the context of culture and community; and for socioeconomic opportunities to enable them to fully participate in building the future of Rwanda.

Mothers of children born of genocidal rape in Rwanda: Implications for mental health, well-being and psycho-social support interventions

We explored the reality of mothers of children born of rape during the Rwandan genocide, particularly as it related to psychological well-being, stigma, recovery, and discussed relevant issues for mental health and psycho-social support interventions. Forty-four mothers participated in semi-structured qualitative interviews. Participants reported long-term psychological impacts resulting from sexual violence. Stigmatization and rejection from family and community aggravated psychological distress and affected their capacity to recover. Given participants' demonstrated capacity to overcome adversity, culturally appropriate mental health interventions are needed to promote well-being and social reintegration of mothers who bore children born of rape, while reducing stigmatization.

“I Asked Myself If I Would Ever Love My Baby”: Mothering Children Born of Genocidal Rape in Rwanda

The 1994 Rwandan genocide was characterized by brutal acts of widespread sexual violence against women that, for some, led to unwanted pregnancy, childbirth, and motherhood. This study explores the perspectives and experiences of 44 Rwandan women with children born of genocidal rape through in-depth qualitative interviews. Emerging from the data are the themes of identity and belonging, ambivalence, and truth-telling in the mother–child relationship. Findings highlight the lasting and intergenerational legacy of genocidal rape, and practice and policy implications are discussed.

When war is better than peace: The post-conflict realities of children born of wartime rape in northern Uganda

This paper examines the realities and perspectives of a sample of 60 children born of wartime rape within the Lord's Resistance Army (LRA), and currently living in northern Uganda. These children were born to mothers who were abducted by the LRA, held captive for extended periods of time, repeatedly raped and impregnated. The paper explores the multiple challenges that these children face in the post-war period including, rejection, stigma, violence, socio-economic marginalization, and issues of identity and belonging. Participants underscored the profound violence and deprivation that they experienced while in LRA captivity. However, because of post-war marginalization, participants individually and collectively articulated that wartime was better than peacetime. Multiple systems of support are needed to ensure the rights and protection of these children and importantly, to address and reverse young people's perceptions that "war is better than peace".

Research as intervention? Exploring the health and well-being of children and youth facing global adversity through participatory visual methods

Global health research typically relies on the translation of knowledge (from health professionals to the community) and the dissemination of knowledge (from research results to the wider public). However, Greenhalgh and Wieringa [2011. Is it time to drop the 'knowledge translation' metaphor? A critical literature review. Journal of the Royal Society of Medicine, 104(12), 501-509. doi: 10.1258/jrsm.2011.110285 ] suggest 'that while "translation" is a widely used metaphor in medicine, it constrains how we conceptualize and study the link between knowledge and practice' (p. 501). Often the knowledge garnered from such research projects comes from health professionals rather than reflecting the lived experiences of people and communities. Likewise, there has been a gap in 'translating' and 'disseminating' the results of participatory action research projects to policymakers and medical practitioners. This paper will look at how using participatory visual methodologies in global health research with children and youth facing global adversity incorporates the multiple functions of their lived realities so that research becomes a means of intervention. Drawing from a literature review of participatory visual methods as media, content and processes of global health research, this paper raises practical, theoretical, and ethical questions that arise from research as intervention. The paper concludes by exploring what lessons emerge when participatory visual methodologies are integrated into global health research with children and youth facing global adversity.

Tactical maneuvering and calculated risks: independent child migrants and the complex terrain of flight

Similar to refugees in general, independent child migrants are frequently constructed in academic and popular discourse as passive and powerless or as untrustworthy and potentially threatening. Such portrayals fail to capture how these youth actively navigate the complex experiences of forced migration. Drawing on interviews with independent child migrants who arrived in Canada and on the conceptual framework of social navigation, we argue that contrary to being powerless, and despite significant structural barriers, these youth deliberately and thoughtfully navigate flight by making strategic decisions and taking calculated risks thereby ensuring their survival and well-being.