All drawings by Ambassajer Welday.

When children and adolescents have survived traumatic and violent situations, rehabilitative care is a life saver. In the refugee camps in northern Ethiopia, CVT counselors work with hundreds of Eritrean refugee children who have escaped from their homes in Eritrea, most commonly without their parents or other family members.

These children fled because they were facing a future in which their youthful dreams collided with a dark reality: most Eritrean children are forced into indefinite military service. And the young people know the stories of what that life is like: many are beaten, tortured, sexually assaulted. A child conscripted into the military may not see his or her family for years.

As a result, many of these children flee to Ethiopia by themselves, a journey that involves danger and extreme risk. When they reach the safety of the refugee camps, they are faced with not only having to cope with the traumatic experiences they’ve just endured along with daily stressors, but also with permanent separation from their families. Sadly, for some unaccompanied children, the hopeless feelings are too much and they attempt suicide.

Caring for these children takes multiple forms. Sandra Githaiga, psychotherapist/trainer – child specialist, CVT Ethiopia, has focused a large part of her recent work on developing clinical tools designed especially for work with children and adolescents affected by trauma and loss. On joining CVT this year, Sandra assessed and revised existing tools used in counseling sessions by the team, seeking to enhance their effectiveness with children. It was important, Sandra said, to “take into account age appropriate content, cultural context and current literature reviews on evidence-based interventions for Unaccompanied and Separated Children (UASC).”

This analysis and review resulted in a revision of the manual used for group counseling with children and adolescents, a new three-session psychoeducation curriculum (for both children and caregivers), and the development of two new tools for the work with children: a workbook and a storybook – one with the story of a girl named Salamawit, and the other the story of a boy named Tesfay. In group counseling sessions with children, the counselors share the storybooks, incorporating aspects of the fictional child’s story into each of the ten sessions. The workbooks are used for home practice, journaling and reminders of the counseling tools and coping skills used in each session.

The storybook is introduced in the first week of counseling. The children read the story of a refugee child who escaped from Eritrea and came to the camp. The child, for example Salamawit, felt sad and afraid and was trying to cope with the difficult situations she had survived and horrible sights she saw, as well as the separation from her family. She was referred to CVT and came for counseling.

The storybooks contain illustrations by Ambassajer Welday, an artist who is a refugee in the camps. His drawings are engaging for the children and reflect the feelings they experience.

Each week, the children take their workbooks with them to do the home practice exercises and then bring them back to the counseling group the next week. For many children, it is difficult to articulate their feelings, so the storybook is very helpful with normalizing their feelings and allowing them to project. Sandra said, “In Session 2 for example, we explore feelings and take clients through an activity ‘What’s in my Heart?’ This activity allows children to view their world at the moment and develop vocabulary and identify physical and emotional sensations to promote healthy expression and management of emotion. In this exercise, we refer back to the story and the previous discussion we had about Salamawit’s feelings.”

Sandra added, “We use examples like this because with children, non-verbal behavior and cues are very important. They might not be able to explain their feelings, but they can relate to and reference the story.”

These tools have been making a difference. Sandra said, “Overall, the children are feeling more engaged. It used to be a challenge to get the children to arrive on time, but now, we frequently see that the children are waiting at the center when the counselors arrive. We also have materials such as badminton rackets, hula hoops, dominoes, soccer, cards and books they can use before sessions start, so many children arrive early to socialize and play, another way of reinforcing their psychological health.”

Although the new materials are in the pilot process, the counselors are able to observe improvements.  Sandra noted that reflecting and introspection behaviors by the children from these activities have developed. “We see the improvement, and the follow-up assessments show the results,” Sandra said. “The feedback I get from the counselors is that the children are much more engaged.”

Child-Friendly Tukuls

In addition, last year CVT finished construction of child-care tukuls in both camps, new structures especially designed to be inviting and welcoming to children and which demonstrate to parents and caregivers that the children will be in friendly, caring hands.

The CVT child-care tukuls give a warm welcome, painted with brightly colored murals that depict animals, children and flowers that catch the eye and let little ones know they can play here. The interiors are spacious, with toys and coloring materials the children can use during childcare, psychoeducation sessions or group counseling sessions.

When not being used for child groups, these tukuls provide space for safe child care for mothers in CVT’s women’s group counseling who wish to focus on their healing in their hour and a half sessions.

Suicide Prevention

The counseling team has done extensive outreach in the camp to educate community leaders and caregivers about the warning signs for children who are suicidal. They have been involved in gatekeeper trainings with religious leaders, teachers and other adults who have regular contact with children, to help them to recognize signs and symptoms of problems, identify and understand risk factors, learn how to respond to a suicidal child or adolescent, and to ensure they know what services are available and where to refer the young person.

Psychoeducation

CVT works in partnership with the Norwegian Refugee Council (NRC), whose social workers are the primary caretakers for unaccompanied children. NRC regularly refers at-risk children to CVT. In addition, CVT holds three-session psychoeducation workshops over a three-week period in the NRC child friendly spaces in the camps. The psychoeducation provides information and support to children to better understand and cope with various stressors.

The three topics include:
1. Identifying and normalizing symptoms – counselors use the storybooks in these sessions to help children identify their feelings.
2. Coping skills – these sessions focus on building skills, identifying emotional red flags such as thoughts of self-harm or suicide, and coping strategies.
3. Personal safety – the team uses these sessions to work on keeping children safe from sexual and gender-based violence (SGBV).

The counselors meet with dozens of children multiple times for psychoeducation every month. “Because there have been suicides and attempted suicides among the children in the camps, we work with children on coping skills; we help them identify red flags,” Sandra said. “We have them think about stress in their lives, the sources of stress in the camp, and help them develop their own coping and safety strategies. We also train caregivers as well to recognize the risk factors for suicide, which include having witnessed or been near suicide attempts by other children. This is a common experience as a result of the group home setting most of the unaccompanied children live in. We want to be very careful about the possibilities of copycat behavior.”

The new tools have been getting positive results and now that training for the counseling team is completed, the new books are in use across the children’s counseling groups. Progress with these children means good possibilities of more progress with others as well.

CVT’s work with Eritrean refugees in Ethiopia is funded by a grant from the U.S. State Department’s Bureau of Population, Refugees, and Migration.