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A Fighting Chance

Looks at two studies which demonstrate that the psychic toll of war is greater today than in past wars. Ivanka Zivcic's study of Croatian children reported in 'Journal of the American Academy of Child and Adolescent Psychiatry'; Richard Mollica's study of 1,000 Cambodians, reported in 'JAMA,' Vol. 270, No. 5; Study details.

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.