Sudan: late 1980s and trek to Ethiopia
Civil war, villages attacked
Separation from family
Ambiguous loss—not knowing if family members were alive or dead
Inadequate food while walking hundreds of miles to Ethiopia
Attacks by lions and hyenas on vulnerable members of group during trek
Constant fear of attacks by government army or bandits
Crossing a desert in eastern Sudan—thirst, dehydration and witnessing deaths
Ethiopian refugee camps in Panyido, Dimma, and Itang: Late 1980s to May, 1991
Grouped together with other children in the refugee camp with few adult caretakers
Youth from dozens of tribes living together, each speaking a different tribal language
Sanitation problems, contaminated drinking water, disease and death
Limited medical care
Mosquitoes (malaria) and chigger problems
Expelled from Ethiopia and returned to Sudan: May 1991 through August 1992
Violently expelled from camps by Ethiopian army; witnessed death of others by drowning in the Gilo River or being shot
Starvation in Pochalla and Pakok because of inability of relief agencies to deliver food
Witnessed the deaths of friends
Bombings by government forces
Attacks by snipers near Kapoeta
Illness, thirst, and lack of food during the trek to Kenya with little assistance from UN
Kakuma, Kenya: 1992 through 2001
Inadequate food rations starting in the mid 1990s
Females used as domestic servants, prevented from attending school
Lack of books, educational materials, and trained teachers
Difficulty attending class or concentrating on school because of malnutrition
Violence in the camp—tribal conflicts and attacks by local tribesmen
Disease and limited medical facilities
Restrictions on movement outside of camp
Lack of employment opportunities
Sense of no future until plans to resettle in the US emerged starting in 1998
After resettlement in the United States, most youth initially reported good adjustment; however, some continued to experience symptoms of PTSD resulting from their experiences in Africa. Among the youth who completed the PTSD measure, some reported many symptoms, but others reported none. The mean score for symptoms was 13.9, with a range of 0–41 out of a possible 51 points. The most common symptoms they reported were intrusive thoughts and feelings in the day or nightmares. The measure also asked about the effect of PTSD symptoms on their daily life: 53 % reported that symptoms interfered with “general happiness in life,” and 36 % said they interfered with “fun and hobby activities.” In addition, 27 % said symptoms interfered with schoolwork, and 26 % said symptoms interfered with relationships with family (youth who entered the United States before 18 years of age were placed with foster families).
Experience of Separation from Families and Ambiguous Loss
Two of the most significant stressors that the youth faced were living without parents and coping with ambiguous loss. In the ten in-depth interviews we conducted, the youth told us the circumstances of their separation from parents. Seven of the ten were separated when their villages were attacked by government troops or militias and one when the SPLA counterattacked, and civilians were caught in the cross fire. One youth described the chaotic scene:
When we leave the town, there was too much bombardment. And among the people who had escaped the town, no one was thinking about going back. The houses were destroyed. The people, they were crying. Everybody who escaped that chaos believed that those who are not out of the town are dead.
Two others were moved from their village in an attempt to protect them. However, one of these youth did not think his parents had a choice in the matter: “My family did not give me up saying something like we don’t love you. There was no choice. I have to go.” At the time of separation, the youth in our sample were between 3 and 12 years of age. Most reported fleeing into the bush to avoid the attack and losing track of family members in the chaos. After the original panic subsided, some youth had to decide whether to go back to the village to try to find family members or flee with other refugees. Some were with siblings or adult relatives or members of their village, but others did not know the other refugees with whom they fled to Ethiopia. Some were helped by other clan members during the trek because, as one youth noted, in the Dinka culture, “Any child is everybody’s child.”
All of the youth we interviewed noted a range of negative emotions they felt while in the camps in Ethiopia, including sadness, depression, fear, loneliness, and frustration. As one youth noted, “It was really a nightmare. It was really, really bad …. Some people would be calling their parent’s name at night.” Another youth described his experience of ambiguous loss, “From the beginning it is very hard because every night, day, you have to think about them. Sometimes you dream about them.” The situation of not knowing was very hard for many youth to bear, particularly at the beginning.
One youth reported that he was hospitalized while in the camps for depression and mental illness. He did not report receiving help there; instead, the poor conditions and frequent deaths of other children made him decide that he had to help himself:
When I was hospitalized it was not like a good clinic that you should be in …. There is a blanket that you sleep in, and there is like thirty people in the room sleeping by each other. And when you will wake up tomorrow, you will find like maybe fifteen of them. Where are the rest? They are gone; they are dead. And that really blew my heart away. And I was like, do I have to die like them or do I have to do something else? And I guess my strong heart bring me out from that situation.
He and several others who participated in in-depth interviews reported the belief that some children actually died because of their inability to cope with ambiguous loss: “But those who used to think about their parents day and night were the depressed people. Actually some of them died.” Another observed, “So many kids were dying because they were thinking about something they left back …. And some people went crazy. You could stay with a person today, and tomorrow he would be dead. And you wouldn’t know what killed him. He was not, like, sick or anything. But part of it was they just have to think back about their families.”
When asked about the times when they missed their parents the most, youth often noted times when they struggled to obtain basic necessities that a parent naturally would provide. In the word of one youth:
Sometimes you have no clothes. Sometimes you see yourself as a person who has no parents. Those situations make you think of your parents. If my parents were here, they could have done this for me. They could have found me something to eat. They could have cooked for me. They could have made me sleep in a nice place.
Another youth reported missing his mother most when he got home from school, “The time that I would think about my mom was when I would get out of school—when I get home and lay down. So I was thinking about her a lot ….” Several youth also mentioned missing the guidance that parents give to their children about how to behave.
As time passed, the youth reported that gradually they came to terms with their situation and learned to live with the ambiguity of not knowing. With help from peers and encouragement from adult caretakers and tribal elders in the camps, they learned to focus on what they could control while maintaining hope of eventually being reunited with their families. As one youth said, “It happened. I did not have any control over it. I … wish it did not happen, but it did and I could not do anything about it.” Another noted, “Life is something you get used to.”
Protective Factors and Resilience
Consistent with Masten and Powell’s (2003) resilience framework, in the focus groups and in-depth interviews youth reported three types of protective factors that helped them to cope with the situation: (1) individual characteristics, (2) relationships, and (3) community support. Cultural values also seemed to play an important role in adjustment for some youth. Table 12.2 summarizes the protective factors we found in our research.
Protective factors identified in our research
Characteristics of the individuals
Religious faith: belief that God would protect them
Ability to elicit positive reactions and support from adults
Sociability and ability to maintain supportive peer relationships
A commitment to education
A future orientation—a desire to help rebuild Southern Sudan when the war is over
Resourcefulness and problem-solving skills/decision making skills
Self-efficacy that develops from dealing successfully with adversity over and over again
Personal coping strategies (e.g., focusing on the present situation, suppressing any thoughts of the past, tempering mastery)
Supportive peer relationships
Psychological presence of parents for older youth
Support from those assigned as teachers, caretakers, or foster parents
Involvement of tribal elders or mentors among the adults in the camp
Extra-familial factors and community resources
Activities provided in the Kakuma Refugee Camp—sports, drama club, a library, church youth groups
Cultural dances on Sunday afternoons
Churches in the camp
Cultural values and beliefs such as sharing with others and not damaging the reputation of the individual or the family
Previous cultural experience with alternate family forms, self-competence (Dinka)
Individual characteristics. Sociability, or the tendency to stay with the group, was essential to survival while in flight. One youth noted that those who strayed from the group or sat down to rest when the others moved on made “bad decisions” and were vulnerable to attacks by wild animals. Most of those who coped well with chronic adversity had the ability to elicit positive reactions and support from others; many of the youth told us of adult mentors who befriended them and helped them along the way.
Intelligence, or resourcefulness, was another characteristic of the youth we interviewed. In the series of interviews with one young man, the interviewer asked him if intelligence was an important factor in their survival. He noted resourcefulness or “street smarts” and good decision-making skills were more important than academic ability in school. Although other youth did not specifically mention intelligence as an attribute that helped them, they gave us numerous examples of their own resourcefulness. For example, one youth told of how he managed to cross the Gilo River between Ethiopia and Sudan without drowning, as so many of the refugees did. Although only a boy of age 7 or 8 at the time, he and his friends fashioned a raft from plastic that the UN had left in the refugee camp and floated across safely.