2.1 Geographical location and population of Jaffna, Sri Lanka
Sri Lanka is located in Southern Asia and to the south of India (Map 1). It got independence from British in 1948 as Ceylon which was amended to Sri Lanka in 1972 (David Cameron). Jaffna is one of the northern districts of Sri Lanka and its total population is 490,621. Among them, 41,637 children are from under five years and 102,697 children from 5-14 years. The majority of the population is Tamils (99.6%) and the rest of them are Sinhalese (0.2%) and Sri Lankan Moor (0.2%) (UNICEF, 2006).
2.2 Armed conflict between the Sri Lankan Government and the Liberation Tigers of Tamil Eelam (LTTE)
An armed conflict between the national forces of Sri Lanka and the LTTE started in 1983 when 13 government soldiers were killed by the LTTE in Jaffna on the issue of political rights of Tamil (David Cameron, 2009 and IDMC, 2010). In 2002, an initial cease-fire agreement was signed by the two parties but the conflict restarted in full scale in the middle of 2006. The prolonged armed conflict between the two groups ended in May 2009. About 280,000 populations (IDPs) escaped to govt-controlled area from October 2008 to June 2009 and most of these IDPs stayed in the camps of Va-vuniya, Mannar, Jaffna and Trincomalee (IDMC, 2010).
2.3 Child soldiers of the Sri Lankan Conflict
Children were employed as soldiers by the LTTE in Sri Lankan conflict. This recruitment was institutionalized after 1990. The child soldiers have played as the direct members of war and about 20-40% of their total force were children (Ruwan, 2010). Children in Jaffna district affected by conflict lack adequate protective and supportive environment and or family care. In 2005, the District Child Protection Committee reported 1,134 child abuse and neglect cases. Child recruitment is a serious concern especially as there are more than hundred children from Jaffna district which is the highest number of children from a single district (UNICEF, 2006).
2.4 Mental Health and psychosocial implications
The impact of war has serious effects on the child mental health which has been recorded since World War II (Barenbaum et al., 2004). According to the report of the German Technical Cooperation, 25% of Jaffna's children have been affected psychologically by the conflict (Reliefweb, 2005).
3. PROGRAMME RATIONALE
The families and communities which give protection for children's lives are badly destroyed by armed conflict (Wessells, 1998). The consequences of this armed conflict can make separation of children from their parents. These may result a devastating social and psychological impact on them; and children may linger to a continued exploitation. During war, unaccompanied children remain at the highest risk and they lack the necessary means of survival. Their rights are also violated and even the children are killed, raped and recruited as soldiers. Many children die from indirect impact of war which is caused by the disruption of food supplies, the destruction of health services, water and sanitation systems. The involvement of the children in community activities can be one of the most effective ways to protect children (UNICEF, 2010). War-related events may cause mental health problems and even a long-term psychopathology in children and adolescents. Children's social, emotional and cognitive development can be seriously affected by war trauma. The predictability, daily routine and daily habits can be lost which may affect the children's psychosocial development. Children experienced or been exposed to conflict may often feel anxieties and insecurities (Guardian, 2009).
So, it is essential to support healing and recovery to facilitate the healthy development of children. Children's participation in recreational activities and in enjoyable physical activities can remove their current idleness, bad memories and painful feelings. These activities should be operated in protected places where children's parents can join, help each other and involve in planning about children's needs.
4. DIFFERENT APPROACHES FOR PSYCHOSOCIAL SUPPORT TO WAR-AFFECTED CHILDREN
Save the Children (2004) mentions three approaches of psychosocial interventions for war affected children. The descriptions of each approach are given below:
4.1 Curative approach
The curative approach is mainly based on resolving trauma and healing the wounds of war affected children. Mental health specialists such as psychiatrists, psychologists and creative therapists are generally involved in this approach. It is generally based on treatment oriented and usually aims towards mental health service providers to provide therapy to trauma oriented children (Brechtje, 2007). A mixture of methods such as psychotherapy, small group counselling, and creative therapy are included in curative approach (Fazel & Stein, 2002).
4.2 Developmental approach
The developmental approach goes behind the traumatic experiences. It makes understanding the daily problems faced by children and the coping mechanism with stress situations. Common functioning in life-tasks, continuity and normalization of structures are geared by this approach. Family and community relations play an important role to increase children's coping potential (Stchick 2001
4.3 Approach that promote health psychosocial development
5. OVERVIEW OF INTERVENTION METHODS
5.1 Focussed therapeutic interventions
These methods address from a curative perspective, based on individual trauma and related psychosocial problems. Activities happen in individual or small group settings. Focussed therapeutic interventions generally address a longer-term, open relationship between therapist and client. A particular type of treatment including confrontation with past experiences and the expression of emotions are involved in therapeutic sessions. Psychotherapy, self-help groups, counselling, training of mental health workers, strengthening of public health system are some examples of focussed therapeutic interventions (Brechtje et al., 2007).
5.2 Child-centred group interventions
This intervention is structured by child-centred interventions with creative and recreational methods which focus on children's psychosocial problems and needs. The objective of the creative method is to support the protective factors to re-establish social coping mechanisms and to stop future disorders. Objectives are based on general psychosocial needs and concepts of healthy psychosocial development of children. Another method in child-centred interventions is recreational method which is usually less structured than the previous method and it does not particularly focus on specific development goals. It may offer the scope to play and has fun as a counterbalance to stressful events. Recreation gives children with moments of relaxation and may produce a healing effect. The activities will be conducted in a safe place and allow them to express their emotions and feelings (Brechtje et al., 2007).
5.3 Interventions aiming at normalising systems and structures
The aim of third category of interventions is to normalise systems and structures, and to rebuild an environment that is conducive to the child's recovery and reintegration. These methods follow the restoration of an environment that resembles normalcy. Rehabilitation of schools, rehabilitation and promotion of cultural rites and events, reestablishments of social networks, family interventions, provision of material support, skills and vocational training are examples of this type of intervention. (Brechtje et al., 2007). This method is referred to as 're-establishing the psychosocial network' by Barenbaum et al. (2004).
6. ASSESSMENT PRIOR TO PROGRAMME IMPLEMENTATION
Before implementation, a number of meetings will be conducted with key stakeholders, community leaders and religious leaders in each part of the proposed programme between April 2010 and May 2010 to identify the usefulness and degree of acceptance of the community. If the local community feels interest and believe that it will provide benefits to their children, then the programme will be sketched and implemented. For higher participation of children, the programme will give also emphasize on the participation of parents, community leaders and religious leaders as catalysts.
7. PROGRAMME GOAL AND PROPOSED INTERVENTIONS
7.1 PROGRAMME GOAL
The goal of the programme is to restart healthy development of Sri Lanka Children through psychosocial programs. It will include two types of vulnerable children such as children who are affected by conflict, and children who are affected by violence and abuse. The programme will include 30000 population (Direct: 27500 Children and Indirect: 2500, teachers and parents) and will be based on the town of Jaffna in northern Sri Lanka. The duration of the programme is two years. The programme will start on June 2010 and it will be completed on May 2012.
7.2 PROPOSED INTERVENTIONS:
The programme will be conducted on the basis of Child-centred group interventions. The details of the intervention techniques are described below:
7.2.1 Training programme for the school teachers
The school teachers have an important influence on the psychosocial development in children. Teachers will be included for this training programme. They will be trained on subjects such as cooperating with parents, stress in children, the traumatized child, loss and grieving in children. Before implementing the programme, the teachers will participate in a 5-hours training session on basic child development, current traumatic stress theory, loss and grief reactions. The teachers will also learn how to implement the structured trauma healing activities and to play therapy, art therapy, dancing and traditional exercises with the children. The activities will focus on the reduction of the children's emotional grief and PTS reactions that often hamper learning. The programme will include the following procedure to help the children:
a. Giving a protected environment to share the children's experiences in the conflict
b. Sharing the children's conflict related experiences in pairs or small groups
c. Allowing them to draw pictures about their bad memories and to share their pictures in small groups
d. Inviting them to write essays on war related experiences
e. Allowing them to perform traditional dances
f. Singing and playing musical instruments
7.2.2 Developing youth clubs for children
7.2.3 Regular semistructured group meetings with mothers
7.2.4 Theatre performances
7.2.5 Non-formal education
7.2.6 Awareness programme on child rights
This awareness campaign will include the community leaders, youth workers and teachers. The purpose of this programme is to develop an understanding of child rights in the local community. The campaign will be carried out by the teachers and will target not only the child rights, but also on the children's responsibilities. Information will be provided through different media channels, postering, drama and school based competitions, videos and a door to door campaign. It will cover the issues like awareness increasing for parents on child abuse. Life skill awareness for children will be also covered by this awareness programme.
8. MONITORING AND EVALUATION
Systematic evaluation is vital for project development, measuring its strengths and weakness, and constructing a form which can be applied to offer assistance in case of emergency. The evaluation of the programme will be verified through video recordings and the field workers report.
UNICEF.2010. Impact of armed conflict on children. [online] Available at: http://www.unicef.org/graca/ [Accessed March 21 2010].
Wessells, M.G. 1998. The changing nature of armed conflict and its implications for children: The Graca Machel/U.N. Study. Peace & Conflict: Journal of Peace Psychology, 4(4), pp.321-334.
Sri Lankan Guardian. 2009. PTSD in Sri Lankan Children. [online] Available at: http://www.srilankaguardian.org/2010/03/ptsd-in-sri-lankan-children.html [Accessed March 22 2010].
Central Intelligence Agency. 2010. The World factbook. [online] Available at: https://www.cia.gov/library/publications/the-world-factbook/geos/ce.html [Accessed March 22 2010]
David Cameron. 2009. Will Colombo make peace? [online] Available at: http://www.theglobeandmail.com/news/opinions/article977753.ece [Accessed March 22 2010]
Ruwan, M. J. 2010. PTSD In Sri Lankan Children. [online] Available at: http://www.srilankaguardian.org/2010/03/ptsd-in-sri-lankan-children.html [Accessed March 22 2010]
Internal Displacement Monitoring Centre. 2009. Sri Lanka: Continuing humanitarian concerns and obstacles to durable solutions for recent and longer-term IDPs. [online] Available at: http://www.internal-displacement.org/8025708F004BE3B1/(httpInfoFiles)/E52F8EDB6EC95876C125766A0045F597/$file/SriLanka_Overview_Nov09.pdf [Accessed March 22 2010]
Barenbaum, J.,Ruchkin, V. and Schwab-Stone, M. 2004. The psychosocial aspects of children exposed to war: practice and policy initiatives. J Child Psychol Psychiatry, 45(1) January, pp .41-62.
UNICEF. 2006. Displaced children and families at risk in Jaffna, Sri Lanka. [online] Available at: http://www.unicef.org/emerg/index_35967.html [Accessed on April 13 2010]
UNICEF. 2006. UNICEF Jaffna Zone Office Fact Sheet. [online] Available at: http://www.unicef.org/srilanka/Jaffna_Fact_Sheet_17_June.pdf [Accessed on April 13 2010]
Reliefweb. 2005. Sri Lanka conflict experience used for tsunami support. [online] Available at: http://www.reliefweb.int/rw/RWB.NSF/db900SID/RMOI-6AT5JJ?OpenDocument [Accessed on April 13 2010]
Many children have witnessed terrible scenes as they escaped to safety. Some saw their parents killed or were separated from them during the journey. These children will need intensive counselling in the near future (Inspire, 2010).
Inspire. 2010. Sri Lanka IDP Camps in Jaffna Request Assistance. [online] Available at: http://www.inspiredspace.org.uk/Articles/157442/Inspire/News/News_from_Inspire/Sri_Lanka_IDP.aspx [Accessed on April 13 2010]
Psychological First aid, Psychotherapy, Counselling, Relaxation techniques, CBT Conceptual model for psychosocial interventions in social and humanitarian crises .
SomasundaramInternational Journal of Mental Health Systems20071:5 doi:10.1186/1752-4458-1-5 Referral structure for management of mental health problems (at District Level).
SomasundaramInternational Journal of Mental Health Systems20071:5 doi:10.1186/1752-4458-1-5 Psychosocial intervention for war-affected children in Sierra Leone http://bjp.rcpsych.org/cgi/content/full/192/3/212
Brechtje, K. L., Donatien, D. G., Eveline, J. and Ans, D. J. 2007. State of the art psychosocial interventions with children in war-affected areas: War Child Holland. [online] Available at: http://cms2.warchild.nl/admin/download.php?...&fileId=1361
Barenbaum, J., Ruchkin, V. & Schwab, S. M. 2004. The psychosocial aspects of children exposed to war: practice and policy initiatives. Journal of Child Psychology and Psychiatry, 45(1), pp: 41-62.