The power of sweet words: Local forms of intervention with war-affected women in rural Sierra Leone

1. Civil war in Sierra Leone: The impact on women and girls

From 1991 to 2002, the small coastal West African nation of Sierra Leone was engulfed in a brutal civil war. The antecedents of the war have been linked to myriad interrelated factors including a patrimonial crisis, state complicity, political corruption and oppression, a crisis of youth, and greed (Abdullah, 2004; Keen, 2005). In 1991, a rebel group called the Revolutionary United Front (RUF), supported by then Liberian President Charles Taylor, began waging attacks in the eastern province of Sierra Leone. Despite counter-attacks from the Sierra Leonean Army and other armed groups, the RUF made its way to the capital city of Freetown leaving a path of destruction along the way (Denov, 2010; Keen, 2005). The decade-long war was characterized by widespread violence against civilians, the recruitment of child soldiers, the pillage of rural institutions and industrial assets, and the mass looting of village property. The war ultimately led to the death of over 50,000 people, the displacement of more than 2 million people, the amputation of more than 10,000 people, and the destruction of the country’s limited infrastructure (Women’s Commission, 2008).

It is widely recognized that armed conflict has a particularly negative impact on the lives of women and girls (Copelon, 1995; Whitbread, 2004). Armed conflict often exacerbates the gender inequalities that exist in different forms and to varying degrees in all societies, and render women and girls particularly vulnerable when conflict erupts. Women and girls are often targeted by armed groups, their bodies repeatedly used as the battleground on which war is waged (Médecins sans Frontières, 2008; Seifert, 1992, 1994). During Sierra Leone’s civil war, women and girls were victims of numerous forms of gender-based violence and gross human rights violations including sexual violence and slavery, physical torture and mutilation, forced abductions into armed groups, and forced marriages (Nowrojee, 2005). Many women and girls were abducted by the rebels and repeatedly raped throughout their captivity, in some cases giving birth to children. In an attempt to quantify the problem, Physicians for Human Rights (PHR) (2002) conducted a survey of female heads of households in communities of displaced persons. PHR calculated that between 215,000 and 257,000 Sierra Leonean women and girls may have been subjected to sexual violence during the conflict period.

In the post-conflict context, women and girls have continued to face profound socio-economic marginalization, as well as physical and psychological health problems associated with repeated sexual and physical violence, including sexually transmitted infections, gynaecological complications, recurring nightmares, and difficulties with intimacy (Denov, 2006; McKay, 2004; Schroven, 2006). In addition, many women and girls faced rejection upon return to their communities, particularly if it became known that they had been associated with armed groups (Coulter, 2009; Denov and Maclure, 2007). Within the realm of the political, women and girls were, for the most part, not included in post-conflict decision-making processes and were largely excluded from discussions on post-war reconstruction programs (McKay, 2004). In fact, many reconstruction programs worked to reinforce existing power imbalances between males and females rather than contributing to the establishment of new social roles (McKay, 2004).

2. International responses to the civil war

In 2002, when the war came to an end, human security and reconstruction efforts became priorities for the government of Sierra Leone and the international community. Aid streamed in from a variety of sources, most notably from the European Union, the United Kingdom, the African Development Bank, the United States International Development Agency and various branches of the United Nations (M’Cormack-Hale, 2010). At the height of humanitarian interventions, there were approximately 250 NGOs operating in the country, more than half of which were international (Coulter, 2009). Donors focused primarily on emergency relief, including providing shelter to refugees and displaced persons, transport infrastructure, food security and medical supplies (M’Cormack-Hale, 2010). Initiatives were also put in place to restore social networks which had been damaged by the war, such as family reunification programs. Rehabilitation and reintegration projects were established for former combatants, most notably the nationwide Disarmament, Demobilization and Reintegration program.

In addition to emergency relief, mental health concerns figured prominently in the programming of many agencies in post-war Sierra Leone. As examples, Médecins sans Frontières integrated a vast mental health program into its healthcare services, including the establishment of a mental health facility in Freetown, the training of local staff in mental health issues and the inauguration of a project to integrate mental health concerns into primary health care (De Jong et al., 1999). The British Red Cross added trauma counselling to their child advocacy and rehabilitation program in the hopes of helping children ‘deal with their trauma and cope with everyday life’ (British Red Cross, n.d., para. 3). The Centre for Victims of Torture initiated several programs addressing mental health issues, including a trauma healing program for Sierra Leonean refugees in Guinea, individual and group counselling in war-affected areas, and the training of local staff in mental health issues and community awareness campaigns (Stepakoff et al., 2006). These represent but a few of the international initiatives and interventions related to mental health.

Given their strong and powerful presence in post-conflict Sierra Leone, international initiatives have tended to dominate the scholarly, policy, and practice discussions and literature on the country’s post-war recovery (De Jong and Kleber, 2004; Gupta and Zimmer, 2008; Hirsch, 2001). In contrast, aside from a few studies (Coulter, 2005; Kaindaneh and Rigby, 2010; Stark, 2006), little attention has been paid to local forms of post-conflict interventions and, in particular, their impact on women and girls. In light of this, drawing on in-depth interviews with 10 female participants living in rural Sierra Leone, this article explores local forms of social work assistance provided to women in the post-conflict context. We explore who provided post-war support, what forms the assistance took, the tools and techniques of local practitioners and their approach to social work practice, as well as the perceived impact of the local interventions. In examining these post-conflict interventions, we highlight the unique local approaches to practice, and importantly, their implications for international social work practice and research.

3. Methodology

This study relied upon in-depth interviews to gather the views and perspectives of 10 female participants living in a rural area in the south of the country. This region and its people had experienced many years of active fighting and rebel insurgencies. It was thus deemed an appropriate location to explore the experiences of war-affected women. Using a purposeful sampling technique, two populations were targeted for the study with the following inclusion criteria: 1) social workers ¹ who provided support to women in the post-conflict period, and 2) war-affected women ² who remained in the country during the conflict. In addition, to be included in the study, the women were required to be over the age of 18 at the time of the interview. In total, four social workers and six war-affected women were interviewed. Recruitment was facilitated by Defence for Children International Sierra Leone – a local organization that the authors had previously collaborated with on numerous research projects, and who assisted with participant recruitment, as well as interview translation and transcription. Given the organization’s ongoing advocacy work, it had strong community ties, facilitating initial introductions to potential participants. Participants were also recruited through the help of local community leaders who were familiar with social workers and war-affected women in the community.

The social worker participants, who were female elders in the community, ranged in age from 45 to 70 years. All of these participants were mothers and all of them had lost at least one immediate family member during the war. Alongside their social work roles in the community, three of the four women were also engaged in agriculture and fishing as forms of subsistence. The remaining woman was the founder and director of a local organization for war-affected women and girls. In relation to the sample of war-affected women, their ages ranged from 19 to 40 years. They too were all mothers and had between two to six children each. For their livelihoods, these participants were engaged in subsistence farming and all reported difficulties providing basic needs to their families.

Open-ended, qualitative interviews with the 10 female participants were conducted by the first author in 2010. A key aim of the interviews was to gain not only a ‘thick description’ of participants’ experiences during and following the war, but also their reflections and interpretations of these experiences. Questions posed to participants explored women’s wartime and post-conflict experiences, the post-conflict needs of women and girls, local forms of psycho-social help, support they received in the months following the end of the conflict, as well as the perceived impact of this support. Interviews, which were audio-taped with permission, were conducted in Mende and translated into English.

In post-war Sierra Leone, relationships between international researchers and local populations have often been plagued by imbalances of power and experiences of exploitation. This, alongside the sensitive nature of the research, made ethical issues of paramount importance throughout the course of the study. Prior to selecting participants, meetings were held with local village chiefs and community and religious leaders to ensure community approval of the study. Topics of discussion during these meetings included the proposed project, the purpose of the research, the research process, and informed consent. Once the community leaders had approved the project, individual meetings were held with potential participants to explain the nature of the research, its goals and objectives, alongside the process of informed consent.

No interview was conducted without obtaining the full and informed consent of each participant. Participants were guaranteed anonymity and assured that all information gathered would remain confidential and used for research purposes only. There were, however, important risks to consider. Participants were being asked to share potentially traumatic and painful wartime events, which could evoke varying levels of distress. Those who were still suffering from the trauma of war and its related effects could experience heightened anxiety by speaking about it in detail. Individuals who were coming to terms with their experiences of violence could have been afraid to reopen old wounds. We were thus highly aware of the potential for re-victimization. Support structures were put into place to ensure that participants were provided with ongoing support during and in the aftermath of interviews. For example, following interviews, two female social workers from Defence for Children International Sierra Leone (DCISL) were available to speak to participants who wished to have ongoing support. In the longer-term, community leaders were available to provide assistance if participants wished to discuss any issues pertaining to the research.

As with all self-report data, the interviews with participants were invariably affected by their memory of events, as well as their willingness to divulge personal information. It is possible that participants may have altered or exaggerated aspects of their stories. This may be especially apparent in post-war contexts where individuals may be increasingly cognizant that emphasizing their victims status, particularly to outsiders and humanitarian workers, may be crucial to obtaining aid and assistance (Honwana, 2006). The potential flaws of self-disclosure must therefore be taken into account when considering participants’ stories. However, these potential limitations were offset by the fact that staff members at DCISL had worked alongside the social worker participants on past community projects, and were able to substantiate the positive impact that these participants had on the lives of women in the post-conflict period. Similarly, staff members at DCISL had had previous professional encounters with the war-affected women participants and were aware of their wartime histories and experiences. We were thus able to corroborate participants’ narratives.

Data analysis began with a process of open coding. Interviews were read carefully and important concepts, words, events and phrases were highlighted. Following this, a process of information ‘memoing’ began where the researchers aggregated ideas based on the substantive codes (Glaser, 1998). This itemization step provided the detailed information necessary to produce a detailed illustration, which would constitute the basis of the framework emerging from the original information. Finally, a visual map of the data was produced, illustrating the relationships between concepts. With respect to local social work interventions, four overarching themes became apparent: 1) the importance of advice, 2) the use of self-disclosure in practice, 3) religious references and 4) forgetting the events of the war. These four themes will be discussed further below.

The study had several limitations. First, conducting interviews in the same geographical location likely produced a largely homogenous sample. Three of the four social workers originated from the same village, possibly limiting the diversity of helping experiences with war-affected women. Second, given the small sample size, the findings of this study can in no way be generalized to the experiences of all war-affected or Sierra Leonean women. Nonetheless, the findings raise important issues regarding local interventions and their impact on war-affected women.

4. Local forms of intervention and approaches to practice: Exploring local tools and techniques

The magnitude of the civil war meant that every citizen of Sierra Leone struggled to return to a sense of normalcy after the fighting subsided. At the end of the conflict, local social workers addressed myriad issues with very few resources. The research uncovered two overarching types of help provided by local social workers: 1) concrete forms of help such as food assistance and financial aid, and 2) psycho-social support. Undoubtedly, one of the most pressing needs at the end of the war was the lack of goods and services. All participants mentioned the difficulties associated with hunger and food scarcity. During the conflict, infrastructure had been destroyed and farm land and livestock had been pillaged. In response to this pressing need, social workers reportedly provided food to less fortunate families or invited women to farm on their land. Other social workers invited women to partake in revenue-generating activities such as collective wood-chopping or communal farming and fishing.

Psycho-social support was also a major component of help offered to women in the early post-conflict period. As one participant stated: ‘we were all displaced, we had nothing to give each other except sweet words’. According to participants, the bulk of meaningful emotional and psycho-social support for women was provided by local social workers.

Local social workers and war-affected women were asked about the approaches used in psycho-social interventions. The interviews revealed several key approaches to local practice. These included advice-giving and directive practice, self-disclosure and references to religion, as well as the importance of forgetting. As will be demonstrated in the following section, these local helpers utilized a variety of skill sets, and focused heavily on principles of solidarity and spirituality rather than clinical diagnostics and psychology. The war-affected women, all of whom were survivors of wartime sexual violence, deemed these approaches and techniques as essential to their post-conflict healing and recovery.

5. Discussion: Conflicting professional paradigms?

As noted earlier, international organizations held a powerful presence and provided much of the post-conflict aid and intervention in post-conflict Sierra Leone. As such, international humanitarian aid workers and social workers from the Global North were intricately involved in post-conflict counselling and support. However, as the above data suggest, tensions appear between local Sierra Leonean approaches to practice and those typically found in the Global North. One only has to consult a current social work Code of Ethics within the context of the Global North to identify these tensions. As social workers from Canada, we will refer to the Code of Ethics put forth by the Canadian Association of Social Workers (CASW). ⁴ In relation to professional boundaries and self-disclosure, the CASW Code of Ethics stipulates that social workers should: ‘strive for impartiality in their professional practice, and refrain from imposing their personal values, views and preferences on clients’ (CASW, 2005: 9). However, this professional value addressed in the CASW Code of Ethics appears to contradict local practices in Sierra Leone, whereby social workers often provide directive advice. All social work participants in our study reported that impartiality is intentionally avoided and self-disclosure is deemed a core element of practice.

The inclusion of religious references when providing counselling to women represents another area of tension. The CASW Code of Ethics highlights the importance of client self-determination: ‘[Self-determination is] a core social work value that refers to the right to self-direction and freedom of choice without interference from others’ (CASW, 2005: 11). This core value appears to conflict with local Sierra Leonean practice, particularly regarding religious references. Instilling the fear of God or suggesting a religious figure as a source of comfort, as was reported by the Sierra Leonean social workers, would not be perceived as acceptable professional practice in the context of the Global North. Finally, the notion of ‘forgetting’ may be highly counter-intuitive to social work practitioners from the Global North who tend to emphasize the use of ‘talk therapy’, whereby in the ‘retelling’ of events, an individual is said to gain insight into his or her own personality, ultimately aiming to alter individual behaviour (Bracken, 1998).

In essence, when examining examples of accepted norms and values of social work practice from the Global North and that of local social workers in Sierra Leone, important disparities emerge. These helping paradigms differ according to the worldviews and the collective values on which they are based. Importantly, comparing and contrasting them is not done with the intent of judging the value of one approach over the other, but instead to acknowledge differing cultural ways of dealing with tragedy and recovery. The disparities point to a deep-seated tension in the field of post-conflict social work and international practice – that of conflicting professional paradigms. Social workers from the Global North working in post-conflict settings may enter into therapeutic relationships with war-affected individuals using their own professional templates, worldviews, values, and paradigms. These paradigms, as we have seen here, may conflict with local understandings and ways of seeing and doing. In terms of policy-making and program development, similar patterns emerge. Commenting on a United Nations Development Program post-conflict program in Sierra Leone, Keen (2005) noted: ‘people making the decisions hardly identify with the people they are making the decisions for’ (p. 313).

6. Implications for international social work practice and research

While representing a very small sample precluding any broad generalizations, the findings of this study nonetheless have important implications for social work practice and research, particularly for international workers operating in post-conflict settings. The data challenge a fundamental assumption that external intervention is critical for the mental health recovery of war-affected groups (De Jong and Kleber, 2004). The most important individuals in the healing process of war-affected women were unquestionably local social workers. Ten years after the war, interviewees had more constructive comments to make regarding local social workers than the foreign professionals who came to the area to deliver aid. In fact, none of the war-affected women mentioned an international aid worker/social worker as having had a significant impact in their healing process. Such findings point to a need to advocate for supporting local capacities, as well as the inclusion of local helpers in internationally-funded programs, which will not only benefit war-affected individuals, but also will help rebuild the social capital networks that may have been damaged by the conflict. Local social workers’ implicit understanding of local resources, of social networks and other cultural components of healing render them as ideal candidates to provide counselling and support to other women.

Social work paradigms from the Global North may conflict with local practice and local ways of knowing and healing. As noted, the practice of ‘truth-telling’, where one is said to derive benefit from expressing emotions verbally, did not, according to participants, concur with local ways of healing. Notions of self-determination and the importance of religious-based practice raise other points of contention. In emergency settings such as war and disaster, international workers often have limited time to reflect upon the intricacies involved in cross-cultural practice and the unintended consequences and iatrogenic effects that such interventions may bring. When dealing with cultural and symbolic issues such as healing, grief and trauma, the complexities grow further. In addition, histories of colonization, hierarchies of power and divergent social locations make ongoing critical reflection and analyses of power relations intrinsic to working relationships with war-affected individuals and communities.

The data also highlight the complexities relating to perceptions of war-affected communities. Much of the literature on post-conflict mental health has, for the most part, painted a disempowering picture of women affected by war. For example, some authors have focused primarily on issues of victimization or vulnerability (Jefferson, 2004; Last, 2000). Others have emphasized women’s propensity to develop post-conflict mental health illnesses (Ai et al., 2002; Mollica et al., 1987). Although important, this scholarship may ultimately contribute to the perpetuation of women being viewed as ‘weak’ and ‘helpless’ in post-conflict settings. The interview data point to women’s various helping capacities and leadership roles. Therefore, a more balanced perception of war-affected women is needed that acknowledges women’s agency and capabilities as community leaders and advocates.

In relation to future research and programming directions, the research speaks to the need for greater attention to be placed on local ways of doing. More research should be devoted to the exploration of indigenous forms of social work and alternate ways of knowing across cultures and across conflicts. It is also necessary to develop programs which draw upon and reflect local conceptualizations of violence, suffering, grief, and reconciliation, as well as the specific socio-cultural and historical context of each conflict. Creating interventions which fail to take into account these unique factors are likely to hold little relevance for affected populations.

Importantly, the perspectives of war-affected populations are rarely included in the search for solutions to post-conflict challenges. In some cases, post-conflict program strategies may be decided upon in North American and European offices, far removed from the conflict-affected areas. Social work research would thus do well to not only include the voices of war-affected populations in meaningful ways, but also to include a wider range of studies that explore community-based helping mechanisms and local leadership in times of crisis.

The ‘internationalization’ of the social work profession, while important and valuable, may unwittingly create and perpetuate dominant paradigms and ‘ways of knowing’ that have the capacity to marginalize or silence local knowledges and indigenous forms of practice. This article has attempted to highlight local forms of knowledge and practice in post-conflict Sierra Leone which were perceived by war-affected women as central to their post-war healing. It should, however, be noted that indigenous forms of knowledge and practice are not entirely a panacea. Research and practice has highlighted that social injustice, inequality, and forms of exploitation and oppression may, at times, permeate indigenous practices and local interventions (Baingana et al., 2005; Denov, 2007). Nonetheless, local knowledges must be carefully, rigorously and respectfully included in order to ensure relevant and effective practice.