Torture against children in rebel captivity in Northern Uganda: physical and psychological effects and implications for clinical practice.
BACKGROUND
Although torture in adults is well documented, studies that document its use against children, especially during war, are rare. This study documented the use of torture against children and its physical and psychological consequences during the war in Northern Uganda.


METHODS
Changes to the skin were examined by medical assistants, photographs taken, and allegations of torture verified in an interview and the case histories filed upon admission to the rehabilitation centres. The sample included 183 children aged 12 to 18 (mean age 14.8, SD 2.9) of which 60 were physically examined in two rehabilitation centres. The impact of torture was assessed using the Impact of Event Scale Revised (IES-R) in a multiple regression model.


RESULTS
Medical examinations showed visible evidence of physical trauma. Torture methods included burns, beatings, carrying heavy objects, gunshots, cuts with bayonets and machetes, long distance treks, etc. resulting into scars and keloids in different parts of the body. The scars were consistent with injuries inflicted on purpose. The children scored highly on the subscales of IES-R indicating severe symptoms of posttraumatic stress. The experience of torture explained between 26 to 37 per cent of the variance in symptoms of posttraumatic stress.


CONCLUSIONS
The physical trauma is consistent with histories and reports filed upon admission to the rehabilitation centres indicating that the children were indeed tortured. As a result of the torture, the children were psychologically distressed. The challenge for clinicians is to employ a holistic approach of treating survivors of torture by recognising not only the physical complaints but stress symptoms as well. This is because the mental states of debilitation, dependency, dread and disorientation that is induced in victims may have long-lasting consequences just like the physical and psychological consequences.
Amone P'Olak
Kennedy
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Department of Psychiatry, Interdisciplinary Centre for Psychiatric Epidemiology, University Medical Centre, The Netherlands. k.p.amone@med.umcg.nl
D000223:Adaptation, Psychological; D000293:Adolescent; D002648:Child; D002649:Child Abuse / Q000523:psychology*; D002921:Cicatrix / Q000523:psychology; D005260:Female; D006801:Humans; D008297:Male; D008889:Military Personnel / Q000523:psychology; D002666:Psychology, Child; D013313:Stress Disorders, Post-Traumatic / Q000523:psychology*; D014104:Torture / Q000523:psychology*; D014454:Uganda; D014857:Warfare; D014948:Wounds, Gunshot / Q000523:psychology*