War Refugees
War, especially civil war such as the one now fragmenting
Yugoslavia, exact a tremendous cost. There are all the wasted lives,
squandered resources, and the overwhelming expense.
But even after the shelling stops, the payments may never end. Two
new studies demonstrate that the psychic toll of war is greater today
than in past wars. Long after soldiers lay down their arms and displaced
civilians return home, the trauma within increasingly threatens prospects
for nations to recover socially, economically, politically.
The problem is partly modern warfare. As war becomes a faceless
clash between machines, more innocents are caught in the crossfire.
UNICEF data show that while nine times as many soldiers as civilians died
in wars in the early part of the century, nine times more civilians than
soldiers have died in recent conflicts. The stress that civilians suffer,
according to a study of refugees in Croatia and another from
battle-scarred Cambodia, begets depression and disability that don't go
away.
Psychiatrist Ivanka Zivcic, M.D., of the University of Rijeka in
Croatia looked at two groups of Croatian children ages nine to 15. One
group had endured an average of three months in the Croatian war zone,
living through prolonged bombing, before being displaced by the war.
Almost half of their fathers were away at the front fighting. A third of
them experienced a death in the immediate family.
Both groups, Zivcic found, had more depression and other
psychological symptoms than did kids studied before the war. But the
displaced kids showed many more negative emotions, particularly fear and
sadness, and many fewer positive emotions, especially joy, than their
nonrefugee counterparts.
Both parents and teachers miscalculated the stress the children
experienced. They tended to underestimate their negative feelings and
overestimate their positive ones-perhaps because they felt unable to
protect hem from the atrocities of war.
The presence of a nurturing adult is a child's best buffer against
hardship. But parents who are themselves overwhelmed by stress are unable
to lend psychological support to others, even their own children, Zivcic
reports in the Journal of the American Academy of Child and Adolescent
Psychiatry.
Over 100,000 Croatian children have been displaced by the fighting,
perhaps a third of them without their mothers. In Cambodia, the numbers
are even more bleak. Under the bloody Khmer Rouge regime from 1975 to
1979, as many as three million people, or 40% of Cambodia's population,
may have lost their lives. By 1982, 350,000 Cambodians were forced into
eight refugee camps in deplorable condition.
Although most have since been repatriated, life is anything but
normal, reports a team specializing in refugee trauma led by Harvard
physician Richard Mollica, M.D. In 1990, they interviewed nearly 1,000
Cambodians who had survived the Khmer Rouge to be interned in a refugee
camp. All had endured insufficient food, shelter, and water. Over half
experienced the murder of a friend or family member, and almost 40% had
been raped or sexually abused.
Today, the team reports in JAMA (Vol. 270, No. 5), a full 55% meet
Western criteria for clinical depression. Fifteen percent suffer from
posttraumatic stress disorder. And nearly 75% are tortured by extremely
negative thoughts or memories of their experiences.
The psychic distress is mirrored in somatic malaise. Despite
excellent access to medical care, 87% now consider themselves to be in
fair or poor health, and nearly 20% said their health status hindered
their ability to work for at least three months. The health problems and
psychological trauma, Mollica concludes, will seriously impede many from
earning a living under the competitive postrepatriation
conditions.
Relief efforts for refugees traditionally concentrate on filling
empty stomachs and mending broken bones. But Mollica and Zivcic suggest
that more attention be paid to repatriating alienated psyches.
PHOTO: Cambodian refugees
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