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TORTURE Volume 16, Number 2, 2006
93
Mental states of adolescents exposed
to war in Uganda: finding appropriate
methods of rehabilitation
Kennedy Amone-P’Olak, MSc*
Abstract
Background: Reintegration after war brings with
it enormous challenges. One such challenge is to
find appropriate methods of rehabilitation during
the reintegration process. This article describes
the rehabilitation, using traditional therapy, of for-
merly abducted adolescents exposed to war events
who have experienced psychological distress.
Methodology: In a cross-sectional design, 294
adolescents aged 12 to19 at three rehabilitation
centres participated in the study. Two checklists
specifically designed for the study were adminis-
tered to the adolescents and social workers: the
War Experiences Checklist and Psychological
State Checklist. The War Experiences Checklist in-
cludes 54 different war events broadly categorised
under nine themes: separation, role in combat,
deprivations, rituals in captivity, injury and be-
ing a victim of violence, witness to traumatic war
events, laying landmines and staging ambushes,
participation in violence, and sexual abuse. The
Psychological State Checklist consists of 22 items.
Structured interviews were used with centre coor-
dinators and traditional leaders to elicit informa-
tion on strategies of rehabilitation and traditional
therapies of rehabilitation respectively. Descrip-
tive statistics were used to analyse data from the
checklists while data from the interviews were tri-
angulated and subjected to thematic examination
in a multistage analyses.
Results: Adolescents were exposed to disqui-
eting war events and participated in dreadful
atro cities. Consequently, many were psychologi-
cally distressed with unhealthy mental states that
needed cleansing according to the native Acholi
traditional practices of reconciliation and reinte-
gration. Four rituals used in the rehabilitation
and reintegration are critically examined in this
paper.
Conclusion: Although mired in controversy over
legitimacy, scope, and disagreement over proce-
dures, the traditional structures for reconciliation
and reintegration, such as the cleansing rituals, are
still widely recognised and can play an important
role in the process of reintegration at the local
level.
Key words: mental states, adolescents, war experi-
ences, rehabilitation, Uganda.
Introduction
This section sets the background to the
conflict in Northern Uganda involving the
Uganda government army, the Uganda
People’s Defence Force (UPDF), the Lord’s
Resistance Movement/Army (LRM/A) and
the Sudanese People’s Liberation Move-
ment/Army (SPLM/A).
Background to the conflict in Northern Uganda
The conflict in Northern Uganda is an
intricate one. Two rebel groups have been
*)
Rijksuniversiteit Groningen
Hanzeplein 1
9700 RB Groningen
The Netherlands
k.p.amone@med.umcg.nl
CLINICAL KNOWLEDGE
TORTURE Volume 16, Number 2, 2006
94
fighting since 1983: the LRA has been fight-
ing against the UPDF in Northern Uganda
and Southern Sudan since 1986 and the
SPLA fought against the government of
the Sudan in Southern Sudan from 1983
to 2005 when they signed a peace accord.
Northern Uganda shares a border with
Southern Sudan. The LRA has had bases in
Southern Sudan and the SPLA had safe ha-
vens in Northern Uganda. The government
of Uganda has supported the SPLA for a
long time and used it to fight the LRA. Until
recently, the LRA has had the support of the
government of Sudan and has used the LRA
in turn to fight the SPLA. Both countries,
in effect, were involved in a proxy war with
each other. Subsequently, on both sides
of the border, two civilian populations are
trapped between the fighting forces.1,2
The LRA is a rebel group fighting in
Northern Uganda where the Acholi ethnic
group traditionally live and where more than
90% of the population are internally dis-
placed and are unable to return home due
to the war. Led by Joseph Kony who claims
to be a spirit medium, the LRA claims it is
fighting to establish a government based on
the biblical Ten Commandments. The rebel
group professes to fight a spiritual war but
has committed many atrocities, like abduc-
tion of young boys and girls, rapes, killing of
unarmed people, mutilation, sexual enslave-
ment, etc. against the people whom they
purport to fight for.3,4
The SPLA operates from across the
border with Uganda in Southern Sudan.
They purport to represent the interest of the
Southern Sudanese who are subjugated and
oppressed by the Islamic and Arab regime
in the north of the country. Just like the
LRA, the SPLA is known to have forcibly
recruited adolescents and children into its
ranks and have committed human rights
abuses against the civilian population.1
The people in Northern Uganda loathe
the LRA for its cruelty against them and
they do not like the UPDF either for hu-
man rights violation against them and for
failure to protect them from the marauding
LRA fighters who have internally displaced
an estimated 1.7 million people, especially
women and children. The local people also
accuse the government of lack of political
will to end the rebellion.3,5 Although the
civilian population in Northern Uganda
loathes the LRA for their pernicious activ-
ities against them, 85% of the LRA fighters
are made up of their own children whom the
LRA has forcibly abducted and conscripted
into their ranks.2,3,6
Abductions of children and adolescents
The most notorious aspect of the conflict
in Northern Uganda is the forced recruit-
ment and abduction of young boys and girls
and the torture, physical and sexual abuse,
and enslavement of those abducted by rebel
commanders. To date, it is estimated that the
LRA has abducted over 25,000 children.4
Subsequently, Jan Egeland, the United Na-
tions Undersecretary for Humanitarian
Affairs, has described the conflict as “the
world’s biggest neglected humanitarian cri-
sis”. In captivity, the abductees live in con-
stant terror of sudden attacks from UPDF
soldiers, sexual abuse by rebel command-
ers, threat of death, diseases, and extreme
deprivations and hardships such as lack of
water, food, and clothing, among others.
The children and adolescents are forced to
kill, mutilate, torture, raid, burn villages, loot
and commit other hideous atrocities against
each other and against their communities in
the region.1,2,5
However, since 2000, there have been
drastic changes in the conflict. Four ma-
jor factors have accounted for this change.
Firstly, in 2001, the United States govern-
CLINICAL KNOWLEDGE
TORTURE Volume 16, Number 2, 2006
95
ment blacklisted the LRA as a terrorist or-
ganization.7 This subsequently led to the sec-
ond major reason for the change: an increase
in cooperation between the governments of
the Sudan and Uganda to rout out the rebels
and the cessation of support to the rebels by
the government of the Sudan which did not
want to be seen by the West as supporting a
terrorist organisation. Consequently, many
rebel commanders have been killed and large
caches of their weapons and ammunitions
captured in Southern Sudan and Northern
Uganda. This cooperation has enabled the
government of Uganda to send troops into
southern Sudan to destroy rebel bases there.
Thus, coupled with lack of support from the
Sudanese government, the rebels have been
tremendously weakened. The third reason
for a major change in the conflict has been
the peace pact between the SPLA and the
government of the Sudan that has enabled
the SPLM to participate in the government
in Sudan leaving little room for the LRA to
maintain bases in Southern Sudan. Finally,
the International Criminal Court (ICC) has
indicted five top commanders of the LRA
and has issued an international warrant of
arrest for the indicted rebel leaders.8 This
has led to renewed international interest in
the war and thus pressure has mounted on
the UPDF and LRA from all sides leaving
the rebels in disarray.
Literature review
Adolescence is usually recognised as a stress-
ful period of development in which, physical,
social and intellectual transform ation and
adjustments have to be dealt with concur-
rently. Exposure to war disrupts this transi-
tion further and makes adjustment even
more complicated.9-14 This disruption is
linked to difficulties with social, psychologi-
cal, health, and physiological functioning
such as depression, withdrawal, alienation,
somatic complaints, behavioural problems,
attachment disorder, Posttraumatic Stress
Disorder (PTSD) symptoms and crucial
etiological factors in the development of
psychopathology in adulthood.9,15 War ex-
periences like sexual abuse, killings, beating,
fighting in battles and exposure to dead
bodies and body parts, smelling burning
bodies, hearing screams for help, violent
death of a parent, witnessing the killing of
close family members, separation, displace-
ment, terror attacks, and bombardments are
associated with acute posttraumatic stress
symptoms and behavioural and emotional
problems.11
Past studies have shown that trauma due
to conflict and violence may have serious
consequences for future adult development
of adolescents13,16. However, other studies
have also indicated that it is not always true
that all adolescents in difficult circumstances
become troubled adults or develop emo-
tional problems; in fact, recovery from emo-
tional and behavioural problems before
reaching adulthood is fairly common.16,17
Cultural differences in registering trauma
and methods of rehabilitation may be impor-
tant in explaining the difference in the stud-
ies. Subsequently, it is imperative that the
methods of rehabilitation are studied. The
use of western therapeutic methods of reha-
bilitation in non-western settings have been
invariably criticised for its medical and indi-
vidual leaning and labelling of survivors.18
Yet few studies have explored traditional
methods of psychotherapy within the local
cosmology in a non-western setting espe-
cially in Africa. This article is an assessment
of war experiences and mental states and is
a critical examination of traditional methods
of rehabilitation used by three rehabilitation
centres in the districts of Gulu and Kitgum
in Northern Uganda where formerly ab-
ducted children are being rehabilitated be-
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TORTURE Volume 16, Number 2, 2006
96
fore reintegration with their parents/guardi-
ans or relatives in the community.19 For
example, cleansing rituals are one way that
rehabilitation draws on what happened to
the children in the past as a means of com-
ing to terms with and making sense of the
present.
Methodology
Participants and rehabilitation centres
The study was conducted in three rehabilita-
tion centres in the districts of Gulu and Kit-
gum in Northern Uganda from August to
October 2004. Participants were adolescents
who were abducted, lived in rebel captivity,
and experienced war situations ranging from
one month to ten years (M = 7.8 months,
SD = 2.01) and were rescued or escaped
within the six months previous to the study:
166 (56.5%) less than a month before, 98
(33.3%) between one and three months be-
fore and 30 (10.2%) between three and six
months before carrying out the study. A total
of 294 out of 852 adolescents resident in
three rehabilitation centres: Gulu Support
the Children’s Organisation (GUSCO) with
249 residents, World Vision Children of War
Rehabilitation Centre (WVC) with 438 resi-
dents, and Kitgum Concerned Women’s As-
sociation rehabilitation centre (KICWA)
with 165 residents were invited to partici-
pate in the study. GUSCO and WVC are lo-
cated in Gulu District and KICWA is lo-
cated in Kitgum District. A simple random
sampling using random table numbers was
performed to select the required number of
adolescents from the three centres. Those
who were randomly selected were then asked
to participate in the study. A total of 294 ad-
olescents aged 12-19 participated (M =
14.6), of which 216 (73.5%) were boys and
78 (26.5%) were girls. Of these, 57
(19.4%) adolescents were from KICWA, 86
(29.3%) from GUSCO, and 151 (51.4%)
from WVC. The adolescents identified
themselves as Catholics (68.4 %), Anglicans
(26.9%), Muslim (1.7%) and others (2%).
Procedures
Permission was obtained from the Uganda
National Council for Science and Technol-
ogy, local district authorities, centre coordi-
nators, social workers and individual ado-
lescents to conduct the study. The Research
Committee of Gulu University approved
the study. Informed consent was obtained
from all adolescents aged 18 years and
above. Those below 18 year of age assented
to participating in the study prior to the
investigators obtaining consent from their
parents, guardians, or centre coordinators in
situations where their parents or guardians
could not be traced. The centre coordinators
and social workers at the three rehabilita-
tion centres also agreed to participate in the
interviews. The centre coordinators invited
the adolescents who accepted to participate
in the study. The items in the checklist about
their war experiences were read out aloud
to them individually and the research assist-
ants filled the checklist for them. Reading
the items aloud was considered appropriate
because some of the adolescents were il-
literate. The questionnaire took between 30
and 45 minutes to fill. The interview with
the centre coordinators and social work-
ers took about 30 minutes while that of the
elders/traditional leaders who performed the
ceremonies took between 45 and 60 min-
utes. The social workers at the centres filled
in the Psychological State Checklist to rate
the mental states of the adolescents. It is im-
portant to note here that some adolescents
and their parents did not agree to participate
in the traditional rituals and instead opted
to attend Pentecostal Churches and pray for
their children instead. It was not possible to
establish the number and characteristics of
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TORTURE Volume 16, Number 2, 2006
97
adolescents or their parents/guardians who
did not agree to participate in the rituals.
Measurements
There were two checklists used in the study:
one was to measure mental states and the
other war experiences. Mental states were
measured using a 22-item Psychological
State Checklist specifically designed for this
study to collect information from the centre
about the mental states of the adolescents
based on records available. This was filled
out by the social workers well versed with
the mental states and psychological distress
of the adolescents invited to participate in
the study. The War Experiences Checklist
consists of 54 items structured around the
themes of: “separation from parents and
relatives”, “exposure and role in combat”,
“deprivations and other hardships”, “par-
ticipation in rituals while in captivity”,
“injured and was victim of violence and
intimidation”, “witness to beatings, mutila-
tion, abduction, killings, and village raids”,
“laying landmines and staging ambushes”,
and “sexual abuse”. Both checklists consist
of “yes” and “no” items.
There were two structured interview
schedules: one was for the centre coordina-
tors to document the strategies of rehabilita-
tion being used at particular centres. The
principle investigator and research assistants
visited each centre for at least two weeks to
observe the methods of rehabilitation used
to corroborate the information given by the
centre coordinators and social workers at the
centres about the strategies for rehabilita-
tion. The second structured interview was
for elders (traditional leaders) to document
why and when the rituals were performed,
the requirements for the rituals, who per-
forms them and why, the procedure of per-
forming the rituals and their meanings. The
protocols were developed for the purpose of
this study and were all translated and back-
translated from English to Luo, the native
language of the Acholi ethnic group and the
participants. Both the checklists and inter-
view schedules were developed in collabora-
tion with the centre coordinators and social
workers on the basis of assessment tools
used by Non-governmental organisations
(NGOs) in the field of rehabilitation such
as World Vision, UNICEF, GUSCO, and
KICWA, among others.
Demographic characteristics
Demographic characteristics (age, religious
affiliation, school attendance, whether both
parents are living or not, length of stay in
captivity, time of rescue, etc.) were included
as items in the participants’ questionnaires
and interview schedules.
Data analyses
Descriptive statistics were used to analyse
the adolescents’ war experiences and mental
states. Frequency counts of the endorse-
ments were taken and percentages of the
total endorsement by participants tabulated
and presented. Data from records of re-
sponses from the structured interviews with
the social workers, centre coordinators and
the traditional leaders or elders who per-
formed the rituals were carefully analysed
and transformed into meaningful broader
content categories by the research assistants
and the principle investigator, to arrive at the
methods of rehabilitation used at the centres
through group discussions and analysis.
Data from the records about the rituals
were examined and triangulated by inter-
viewing other traditional leaders and elders
to ascertain whether the reasons for carrying
out the ritual, when the ritual is normally
performed, requirements, who carried out
the rituals, procedure for carrying it out
and the meanings were the same. In analys-
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TORTURE Volume 16, Number 2, 2006
98
ing the themes about the rituals, records of
interviews by the different Research Assist-
ants were compared, discussed, and carefully
analysed and transformed into meaningful
content categories covering why, when, how,
and by whom the rituals were performed.
Data from the interview were again cross-
examined, triangulated, and validated by the
research assistants and principal investigator
and later all the recordings were compared,
discussed, and consensus reached.
Results
War experiences
The adolescents were exposed to a wide
range of war events while in rebel captivity.
These experiences were grouped into eight
categories based on thematic analyses and
similarity. The categories included: “separ-
ation from parents and relatives”, “exposure
to and role in combat”, “deprivations and
other hardships”, “participation in rituals
while in captivity”, “injured and was victim
of violence and intimidation”, “witness to
beatings, mutilation, abduction, killings, and
village raids”, “laying landmines and staging
ambushes”, and “sexual abuse” (Table 1).
Experiences highly endorsed by participants
were: thinking that they would be killed,
long distance treks, death threats, seeing
dead bodies and body parts. About 75% of
the adolescents participated in beating or
killing captured escapees, often their village
mates, relatives or friends, while 22% burnt
houses with people inside and another 5%
reported that they mutilated captives. Over
4% witnessed their parents being killed and
slightly above 6% killed their relatives. About
18% were forced to lie on dead bodies or
carry dismembered body parts, which was
believed to imbue courage and make them
hard hearted. More than 75% saw people
dying of hunger and 16% drank urine in-
stead of water to quench thirst. Sixty-five of
the 78 girls in the sample reported that they
were sexually abused and none of the male
adolescents reported being sexually abused.
The war experiences were therefore the basis
upon which the rituals were performed. The
adolescents who agreed to participate in the
rituals attended the general rituals such as
traditional African dances and drama, step-
ping on an egg, burning clothes that the par-
ticipants returned with from rebel captivity.
Girls who were sexually violated and those
who participated in killing either intention-
ally or were forced to kill had to elaborate
rituals to cleanse them from the activities
they participated in or were subjected to.
Mental states of the adolescents
while at the rehabilitation centres
In addition to the war experiences the ado-
lescents were exposed to, a catalogue of
signs were used to assess the mental state of
the adolescents at the centres (Table 2). In
all the centres, at least 94% reported some
form of mental state associated with their
war experiences. The following mental states
were dominant: “hopelessness” (89.8%),
“sensitive” (65.3), “suspicious” (63.9), “in-
terrupted thoughts” (57.1) and “depressed”
(55.8). Alternately, the following mental
states were less reported: “Crying, screaming
and groaning” (18.3%), “Aggressive” (16.3),
“The social workers found the adolescent
difficult to deal with” (14.9%), “Self-de-
structive” (12.9%), “Paranoia” (12.2%), and
“Compulsive behaviour” (11.2%). However,
there were gender differences in report-
ing the following mental states: depres-
sion (Boys: 47.7%; Girls: 78.2%), crying,
screaming and groaning (Boys: 8.3%; Girls:
46.2%), aggression (Boys: 22.7%; Girls:
7.7%), and “Self-destructive” (Boys: 13.4%;
Girls: 6.4%). According to the Acholi trad-
itional culture, these symptoms of severe
emotional and psychological distress in the
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TORTURE Volume 16, Number 2, 2006
99
CLINICAL KNOWLEDGE
Table 1. Categories of war events experienced by 294 adolescents in rebel captivity.
n % (yes)
Separation from parents and relatives
1. I thought I would be killed while in rebel captivity 291 99
2. I thought I would never see any of my relatives or friends again 288 98
3. I was told that my parents were already dead 254 86.4
4. I dropped out of school 55 18.7
5. I am the only survivor in the family 13 4.4
Exposure to and role in combat
6. I witnessed people being abducted during a village raid 290 98.6
7. I carried heavy loads over long distances 289 98.3
8. I saw dead bodies or body parts after battles 283 96.3
9. I saw seriously wounded people during battles 279 94.9
10. I narrowly escaped death during a battle 252 85.7
11. I participated in battles with government soldiers 131 44.6
12. I participated in killing a person (people) during battle(s) apart from relatives 116 39.5
13. I was injured or wounded in battle 71 24.1
Deprivations and other hardships
14. I walked long distances without rest 292 99.3
15. I slept in the bushes 290 98.6
16. I ate grass, leaves, and other wild plants previously unknown to me 238 80.9
17. I was imprisoned in rebel captivity 237 80.6
18. I saw people dying of hunger 223 75.9
19. I was so hungry and nearly starved to death 204 69.4
20. I survived death after a serious beating with wire locks and slapped with hot machetes 159
54.1
21. I ate one meal a day and sometimes a few times a week 111 37.8
22. I drank urine instead of water 48 16
23. I participated in nursing seriously wounded rebel fighters 47 16
Participated in rituals while in captivity
24. I was anointed with oil and ochre (sign of cross put on my forehead,
back, chest, and back of hands) 290 98.6
25. I was forced to lick human blood to give me courage and keep away ghosts 63 21.4
26. I was forced to smear myself with the blood of a dead person 62 21
27. I was told to lie on dead bodies or carry dead body parts to give me courage 53 18
28. I smeared myself with human blood in order to be brave 47 16
29. I participated in eating cooked human flesh to give me courage 1 0.3
Injured and was victim of violence and intimidation
30. I was threatened with death if I failed to obey orders 292 99.3
31. I was injured in a Helicopter Gunship attack by government troops 101 34.3
32. I was beaten up and sustained serious injuries in rebel captivity 89 30.2
33. I was injured in battle with government soldiers 76 25.8
Witnessed beatings, death and mutilations
34. I witnessed people being flogged or beaten 291 99
35. I witnessed people being killed with machetes, or knives 200 68
36. I witnessed people being mutilated 118 40.1
37. I witnessed the family home being burnt 55 18.7
38. I was forced to carry a dead person for a long distance 53 18
39. I witnessed a sibling being killed 15 5.1
40 I witnessed my parent being killed 13 4.4
41. I witnessed children being exchanged for guns and ammunitions 7 2.4
The table continues on next page
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100
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n % (yes)
Participation in beatings, mutilation, abductions, killings, village raids
42. I participated in abduction of other people and village raids 230 78.2
43. I participated in beating and killing captured escapees 219 74.5
44. I participated in burning houses without people inside 90 30.6
45. I participated in burning houses with people inside 66 22.4
46. I participated in killing my own relatives 18 6.1
47. I participated in mutilating body parts of people captured 14 4.8
Laying landmines and staging ambushes
48. I participated in ambushing a vehicle 65 22.1
49. I saw a vehicle with passengers blown up in a land mine blast 50 17
50. I witnessed people being blown up in a land mine blast 49 16.7
51. I participated in laying land mines 16 5.5
Sexual abuse (only girl participants reported sexual abuse)
52. I was sexually abused by rebels or fellow abductees 65 83.3
53. I have child (ren) with rebel fighters 38 48.7
54. I was sexually abused by fellow abductees 13 4.4
Table 2. The mental states of the adolescents as recorded in their files (N = 294).
Signs used to describe the mental state Males (n=216) Females (n = 78) Total %
1. Worried and upset 198 72 270 91.8
2. Hopelessness 201 63 264 89.8
3. Sensitive 140 52 192 65.3
4. Suspicious 128 60 188 63.9
5. Interrupted thoughts 139 29 168 57.1
6. Depressed 103 61 164 55.8
7. Absentmindedness 133 28 161 54.8
8. Lack of concentration 129 28 157 53.4
9. Irritation 109 28 137 46.6
10. Memory problems 113 23 136 46.3
11. Tense 116 18 134 45.6
12. Calm 101 28 129 43.9
13. Passive 83 38 121 41.2
14. Hallucinations 67 21 88 29.9
15. Phobic 53 21 74 25.2
16. Incoherent speech pattern 48 20 68 23.2
17. Aggressive 49 6 55 18.7
18. Crying, screaming and groaning 18 36 54 18.3
19. Difficult to deal with 31 13 44 14.9
20. Paranoia 28 8 36 12.2
21. Compulsive behaviour 21 11 33 11.2
22. Self-destructive 29 5 24 8.2
adolescents are taken to be a sign of con-
tamination, that the gods were unhappy, and
of being possessed by “cen” (bad spirits), the
spirits of those they have killed or harmed.
They are therefore thought of as “contam-
inated” where this can come out anytime
to cause unpredictable conduct that might
harm others.20,21 Consequently, there was
need to cleanse them of these “bad spirits”
and reconcile them with the community.
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101
That the adolescents were forcibly recruited
into rebel ranks gives a strong motivation to
forgive, reintegrate and reconcile them with
the community they committed so many
crimes against.
Strategies for rehabilitation
at different centres
For the purpose of this study, the follow-
ing general rituals were performed to most
of those who returned from rebel captivity
and agreed with the practice: traditional
music, dances, and drama. Besides these
general rituals, this study will focus on four
major rituals: stepping on an egg, burning
of clothes, ritual for sexually violated girls,
and ritual for those who killed deliberately
or were forced to kill while in rebel captiv-
ity. Traditional leaders and elders from the
Acholi Council of Elders (Rwodi Moo),
under the tutelage of the Paramount Chief
of the Acholi, were the ones who normally
conducted these rituals using traditional
leaders and elders from the communities.
Traditional music and dances
Native Acholi traditional music and dances
were performed in all three centres. The
music and dances performed are the com-
mon ones normally performed in communi-
ties in the Acholi area where the adolescents
originate. The adolescents at the centre sing
songs of forgiveness, reconciliation, and
perseverance. All Acholi traditional dances
are normally accompanied by songs, ulula-
tions, drumming, and an array of traditional
instruments. The traditional dances include
Laraka raka (a native courtship dance),
Bwolla (a native royal dance), and Dingid-
ingi (a native dance for young girls). These
dances are usually performed with elegance,
pride, joy, and gusto intended to promote
positive self-image, rejuvenate the sense of
pride, make them happy, and boost their
self-esteem apparently dampened by the
traumatic experiences they underwent while
in rebel captivity. The adolescents also learnt
to be together and cooperate for the purpose
of being happy and making other people
happy, contrary to what they experienced
while in rebel captivity. This is therefore a
general therapy where most adolescents at
the centres participate irrespective of what
they went through while in rebel captivity.
Drama
The adolescents at the centres performed
several plays and role-plays. Again, the
themes in these plays are on reconciliation,
forgiveness, and perseverance just like in
the songs and traditional dances. The drama
is intended to change the attitudes of the
adolescents and to heal the social dislocation
and personal vendettas associated with the
war and eventually enable them to live in
harmony with each other and the commu-
nity to which they are to be integrated. The
plays are coloured with humour to make
the adolescents not only laugh but also be
happy again after years of unhappiness and
suffering in rebel captivity. Although this is
a western therapy, it has been adapted to the
local reality and culture.
Traditional cleansing rituals
In this article, four traditional cleansing
practices are reported. Many other trad-
itional practices besides these are performed
in communities. Stepping on an egg and
burning old clothes are general practices
for all who were abducted, missing, or who
have stayed in an unknown place or in the
wilderness for long, and who are believed
to be contaminated with some alien spirit.
However, there were specific rituals for those
sexually violated and those who killed in-
tentionally or inadvertently. These four trad-
itional practices are described below.
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TORTURE Volume 16, Number 2, 2006
102
Stepping on an egg
In ancient Acholi tradition (native tradi-
tion of the participants), any member of a
community who stays away from home as
in having been lost, abducted, missing, or
simply stayed away for long, is believed to
be contaminated with alien spirits. There-
fore, upon return, at the entrance to the
courtyard, the individual is made to step
on a freshly laid egg of a hen put between
a plant (locally known as “pobo” – a slip-
pery and smooth plant used as ropes in
local construction) split into two. The egg
is subsequently broken by the footstep and
the person enters the compound. At the
entrance of the parents’ house, water is
poured on the roof so that it drips on the
returnee as he or she enters the house. The
following day, a goat is slaughtered, local
beer is brewed, and villagers are invited
to celebrate and welcome the individual
back into the community. This ritual is
performed by the elders in the home and is
meant to decontaminate and purify the in-
dividual. The egg symbolises a fresh start, a
new beginning, and the beginning of life. It
also symbolises purity and innocence. The
slippery local plant symbolises a smooth re-
turn and the water washes away the impur-
ities and cleanses the individual.
Burning clothes
In all the three centres, the clothes that the
adolescent returned with from rebel captiv-
ity are burnt. Just like in stepping on the egg
and breaking it, burning clothes believed to
be “contaminated” or “tainted” represent a
break with the past and thus, the individual
has a fresh start in life. The rebels usually
loot clothes from the villages or remove
clothes from those whom they have killed.
They distribute the clothes to the combat-
ants or those in captivity. Burning these
clothes therefore accentuates a break with
the past life while embracing a new identity
and viewing themselves using new “spec-
tacles”.
Traditional cleansing ritual
for a sexually violated girl
Any act of rape or forceful carnal knowledge
of a girl or woman was treated with disdain
and perpetrators were severely punished
and reprimanded in the Acholi tradition.
Such acts were associated with bad luck and
misfortune on the part of the girl or woman
violated and therefore the girl or woman
needed cleansing. Usually a girl directly, or
through the mother, confesses that she has
been violated. A meeting of traditional lead-
ers and elders is convened to establish the
truth and decide on what to do. Once the
elders or traditional leaders establish the
truth and the perpetrator is known, a ritual
was performed to cleanse both the girl and
boy of the shameful act. The elders on both
sides would gather in the village, usually in
the home of the village elder, and the perpe-
trator was required to produce a goat.
The boy or man who violated the girl
was required to hold the head of the goat,
admit his guilt, and say that the goat will die
for his own fault and that the goat will wash
away his sins. He then spits in the mouth
of the goat. At the same time, the girl or
woman who was violated also spits in the
mouth of the goat and holds the hind legs of
the goat. The goat is then slaughtered and
the waste matter from the stomach of the
goat is smeared on the back of their hands
and legs and on the chest to cleanse them of
the act both were involved in. The elders eat
the carcass and bless the girl, wish her good
health, and assure her that nothing bad will
happen to her now that the ritual has been
performed. The bones from the carcass and
the water used for washing hands are poured
on their legs. Compensation in the form of
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103
cows or goats, as decided by the elders, is
given to the girl’s parents, or husband in the
case of a married woman. Thereafter, the
boy is strongly reprimanded and warned
never to indulge in such acts again. The
parents of the boy or man are asked to teach
their child to behave well. However, if the
girl was related to the boy (incest), the same
ritual was employed but no compensation
was involved. In former days, if the girl was
of the age of marriage, the boy or man was
forced to marry her if there was no blood
relationship. However, in circumstances
where the perpetrators were unknown or
were known but unable to appear before
the elders or traditional leaders such as in
the case of the adolescent girls, a goat was
slaughtered to cleanse the girl of the “bad
spirit” associated with the sexual violation.
The Acholi people considered any sexual
act in the bush as a bad omen, especially on
the part of the girl. The goat is slaughtered,
waste matter from the goat is smeared on
the girls’ hands, feet, and chest and the girl
is blessed and reassured by the elders of a
normal life without the torment of the “bad
spirits” associated with her past ordeal.
Cleansing ritual after deliberate killing
and manslaughter
In the traditions of the Acholi, the taking of
human life is abhorred. An elaborate cleans-
ing ritual therefore followed deliberate or
inadvertent killing. Normally, the following
four steps are involved in the process after
seeking neutral third party mediation accept-
able to both sides.
a) Acceptance of responsibility by establish-
ing the precise truth about the incident,
that is, exactly how the incident hap-
pened and asking for forgiveness.
b) The guilty repenting and asking for for-
giveness
c) Payment of compensation in the form of
animals (or daughter in ancient times)
as is the practice and agreed upon by
the council of elders (locally known as
“Rwodi Moo” in Acholi). This compen-
sation is usually used to marry another
girl whose first child will be named after
the person who was killed so that the de-
ceased rests in peace.
d) Reconciliation (locally known as “Mato
Oput”). Mato in the native Language of
the Acholi means to drink, and Oput is a
plant commonly found in the Acholi re-
gion. Wherever the plant is found, many
others are found in the same place. It is
this togetherness that is cherished by the
Acholi to symbolise coming together. The
root of the plant is also bitter symbolising
the bitterness, pain, suffering, and death
that occurred between the two parties.
After all these steps have been followed – ac-
ceptance of third party mediation, accept-
ance of responsibility, knowing the precise
details of how the incident happened, and
acceptance to pay compensation – a day is
appointed to perform the reconciliation cer-
emony (“Mato Oput”). The mediator then
invites both parties to the ceremony usually
held by the roadside away from homesteads.
Each party approaches the venue from their
side of the road. The elders come with the
roots of an Oput plant that they have dug
from the wild. The outer cover of the roots
of the Oput plant is pounded by a virgin girl
and mixed with water and local brew and
put in calabash. The elders and the medi-
ators stay by the roadside waiting for both
parties.
When all is ready, the elders dispatch
messengers to call each side to approach
the venue. The aggrieved side approaches in
an aggressive manner while hurling insults
and swearing at the party that killed their
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TORTURE Volume 16, Number 2, 2006
104
child. The side of the perpetrator accepts
responsibility, asks for forgiveness, and agree
to compensate. However, the perpetrators
will also say they are ready to fight should
the other party fail to accept their terms.
At this point, the elders come in and hold a
long stick (locally known as layibi) between
the two parties and ask them to restrain
themselves, stop, put down their spears, and
accept reconciliation. They then point their
spears downwards to pay heed to the council
of elders. Both parties bow their heads and
pass the long sticks to the other side. Each
side will have come with a sheep. The sheep
will be put side-by-side (touching each
other) facing the opposite direction.
Both sheep will then be cut completely
in half while the blood from both sheep will
drop in the concoction (the outer cover of
the root of Oput plant pounded and mixed
with water and local brew made from sor-
ghum) already in the calabash. Each group
will select an agreed number of members
who will bend with both hands behind their
backs to drink from the concoction in the
calabash. If the deceased were male, they
would drink three times each and if the de-
ceased was a female, they would drink four
times each according to tradition. The sheep
will be shared between the two parties. The
head from one sheep and the bottom from
the other will be given to either party who
will go ahead to cook it. After each party has
cooked, they share the food and eat together,
thus the broken relationship has now been
normalised and restored. They can now
greet, shake hands, eat together, intermarry,
visit, etc.
Since both parties have now drank
from the same calabash, the elders’ curse
whoever will use the spear against each
other by bending the blade of their spears
symbolising an end to hostilities. The party
whose son or daughter is killed receives the
compensation and that marks the end of the
ritual. However, if the compensation were
to be used for any other future activity such
as in payment of dowry, etc., it must be
cleansed. In case of the adolescents return-
ing from rebel captivity, the ritual was per-
formed reconciling them with the commu-
nity who have borne the brunt of the war:
mutilation, deaths, rapes, and destruction to
property, among others. Symbolic compen-
sations are used instead of what used to be.
Elders are used to represent the community,
thus the adolescents are reconciled with the
community.
Discussion and concluxion
This study set out to assess exposure to war
experiences, mental states, and methods
using traditional therapies for rehabilitat-
ing adolescents exposed to war. Traditional
music and dances, drama, and traditional
cleansing rituals are used in a programme of
rehabilitation before the adolescents are re-
united with their parents or guardians in the
communities. The adolescents are reconciled
and accepted by their communities after
the traditional cleansing ceremonies and
are subsequently reintegrated into the com-
munity. This comes in the wake of criticism
against the use of western psychotherapies in
non-western settings.18,22
Mental states
War impacts on the mental health of ado-
lescents in many ways. In the case of the
participants in this study, worries, hope-
lessness, sensitivity, suspicion, interrupted
thoughts, among others, were reported. Also
commonly reported were gender differ-
ences in the manifestation of mental states.
Girls surpassed boys in showing depressive
symptoms; crying, screaming and groaning
while boys manifested more aggression and
self-destructive behaviours. This is consist-
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TORTURE Volume 16, Number 2, 2006
105
ent with past studies in Palestine, Sierra
Leone, and Bosnia Herzegovina.11,13,19,23-25
Among the girls in this study were those
who returned with children fathered by
rebel commanders. These child mothers will
face the added burden of looking after the
children, discrimination against them and
their children, and their children being living
reminders of their ordeal in captivity. This is
probably the reason why girls surpassed boys
in reporting distress symptoms. Adding fur-
ther strain, formerly abducted children may
find themselves in a discriminatory and inse-
cure environment because of the uncertainty
about when the war will end.
Rehabilitation methods
The successes of western therapeutic
methods have come under scrutiny in several
non-western theatres of war recently. Evi-
dence emerging from a study on the impact
of the traditional methods of rehabilitation
and reintegration at the rehabilitation cen-
tres in Northern Uganda suggests that the
children who spent time in the centres, in-
cluding those who participated in the rit uals,
might have better mental health and psy-
chosocial well-being compared to those who
have not gone through the centres.26,27 Many
of the formerly abducted children and some
of their parents and guardians besides the
community believe in the traditional rituals.
This is consistent with studies carried out in
Zimbabwe and Mozambique where adoles-
cents exposed to similar violence were sub-
jected to similar traditional healing resources
of rehabilitation and reconciliation.22,28,29
If the traditional methods of rehabilitation
prove to be successful, it will be very useful
in the healing process of not only individuals
but also members of a community trauma-
tised by violence within the local cosmology.
The traditional methods such as compensa-
tion may perhaps settle the indebtedness of
one lineage or community to another. Thus
the transgenerational nature of such vio-
lence, personal vendettas, and societal dis-
location resulting from the conflict can then
be settled.30-33
Limitations of the cleansing rituals
Although traditional structures have a big
role to play in reconciliation and reintegra-
tion at the community level, there are many
inherent weaknesses. Forced migration has
led to scattered settlements in displaced
people’s camps, leaving the traditional lead-
ers with no homogenous communities to
culturally supervise. Poverty and material
deprivation consequent upon the unend-
ing war have left the traditional structures
fragmented and weak. Both the traditional
leaders and the community are too poor to
provide the material requirements for the
rituals. Often the NGOs have come in to
support the traditional structures, but this
is not sustainable. Another weakness is the
disagreement over who the real traditional
leaders are. Some people in the communities
regard the current traditional leaders as
people who are interested in material gains
from NGOs and government.
There is belief in some parts of the com-
munity that the scales of the atrocities and
war events spanning over two decades are
unprecedented, overwhelming and beyond
the scope of traditional structures. For in-
stance, the international dimension of the
conflict is beyond the reach of traditional
structures. Another factor is that, it is simply
not easy to establish who killed who in the
circumstances, as it is enormously difficult
to establish the truth due to the scale of the
war, spiritual nature of the conflict. A lot
remains to be known about the war. In ad-
dition, the majority of the perpetrators were
children forced to commit gross and horren-
dous crimes against their own communities,
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TORTURE Volume 16, Number 2, 2006
106
thus making it difficult to distinguish perpet-
rators from victims.
Another complexity is that, while in rebel
captivity, many hideous rituals were also per-
formed on the children and many have bad
recollections of such rituals. It is therefore
difficult to determine whether the rituals
currently performed represent the belief sys-
tems of the adolescents or reinforce what
they have gone through already. Also, al-
though the fundamentals and interpret ations
are alike, there are minor procedural disa-
greements regarding the rituals, as the elders
do not completely agree on the pro cedures.
There are minor variations from one com-
munity to another.
In spite of these inherent weaknesses
and some disagreements, many people still
believe in cleansing rituals as methods of
reconciliation, and reintegration after dec-
ades of psychological trauma. Because the
society to which the adolescents are to be re-
integrated are still very communal in nature,
the communal approach and nature of the
traditional rituals are more meaningful and
important for repairing damage caused by
decades of war and maintaining social cohe-
sion. Subsequently, at the local community
level, traditional structures offer the possibil-
ity for reconciliation and reintegration.
Limitations of the study
The present study is based on cross-sec-
tional data. It is important to recognise that
no conclusions can be drawn about causality
or directions of influence. Another limitation
of the design was that the detection of men-
tal states as well as the methods of rehabili-
tation was made on the basis of self-reported
evaluations and observations, which may
have caused some bias. In addition, our sam-
ple comprised a specific sample of Ugandan
adolescents who have been exposed to vio-
lence. Generalizing the findings beyond the
sample would only be possible after several
replications with similar samples and popu-
lations, while including longitudinal studies.
However, if these results can be established,
they carry important implications for the
focus and content of intervention for, and
prevention of, mental health problems of
adolescents after the experience of traumatic
events.
Suggestion for further research
This study is a precursor to longitudinal
studies that are required to address the ef-
fectiveness of the traditional therapies for re-
habilitating adolescents exposed to violence
and cultural coping mechanisms and how
these can inform interventions. Also impor-
tant to study are other rituals not included
in this study.
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