1. Roberts, Karen MSN, NP

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For many, thoughts of war and soldiers invoke images of strong, young men fighting the good fight. The reality, though, is that in many places, such as Sierra Leone, northern Uganda, and Mozambique, children as young as nine and 10 years of age, boys and girls alike, make up a significant portion of the fighting forces. Most of these children have been kidnapped from their villages and forced to be soldiers. Recent conflicts in several regions of Africa and Asia (including Cambodia and Uzbekistan), where the use of child soldiers is widespread, have gotten the attention of international organizations. While this attention has helped to improve the lives of these children, much of it has focused on boy soldiers; only recently has the particular plight of women and girls in war come to the attention of governmental and nongovernmental aid organizations. With increasing frequency, young girls are forced into service; because of their low status in many of these countries, they face special challenges when they return to their former lives after the fighting is over.


Susan McKay, PhD, BSN, believes that the fate of these girl soldiers after war is worth paying attention to. It's McKay's view that countries only do as well as their women and children; investment in the welfare of these girls will serve to safeguard the future. A professor of women's studies with adjunct faculty positions in the nursing and the international studies departments at the University of Wyoming, in Laramie, McKay has been a nurse for 40 years and has, as a nurse educator and researcher, focused on obstetrics and safe birthing practices. Her work in academia (centering on women and children) brought her into international settings, where her research led her to the realization that armed conflict is the greatest danger to those most vulnerable-women and children. McKay's focus on this work, which had not been done before, led her to begin teaching a course called "Women, War, and Health" in 1988 that she still teaches at Wyoming today.


McKay, with colleague (and former student) Dyan Mazurana, PhD, has written a book, Where Are the Girls? (published in 2004 by Rights and Democracy, the publications division of the International Centre for Human Rights and Democratic Development in Montreal), that details the results of their research on the role of girls in armed conflict. The book provides a clear picture of the problems and needs of these girls, as well as specific recommendations for change.

FIGURE. Girls in Sie... - Click to enlarge in new windowFIGURE. Girls in Sierra Leone demonstrating traditional gender play: when girls dance, boys play drums to accompany the dancing. Older women customarily teach the girls traditional gender-specific behavior in preparation for womanhood, but they have no chance to do so when girls are forced to serve in a fighting force, such as the Revolutionary United Front in Sierra Leone.
FIGURE. One of the g... - Click to enlarge in new windowFIGURE. One of the "girl mothers" (her face is blurred intentionally to protect her anonymity) interviewed by the author and research team members in western Sierra Leone in 2003 as part of a pilot study. This girl, as were other girls interviewed, had been impregnated while being forced to serve in the Revolutionary United Front. She was living with two friends, also girl mothers, in a houseful of people and was struggling to survive.

McKay and Mazurana, with a grant from the Canadian International Development Agency's Child Protection Research Fund, spent time in northern Uganda, Mozambique, and Sierra Leone in 2001, right after the civil war ended in Sierra Leone, and later in 2003, interviewing girls and those who work with them about the realities of war and its aftermath. In Sierra Leone they found a group of dedicated, compassionate workers (from a nongovernmental aid organization) who were unsure of how to help the girls. These girls had faced torture, sexual abuse, and deprivation, and were themselves sometimes perpetrators of violence. Many had borne children from the men who had captured them. When the war ended and these girls returned to their villages, they were usually treated as outcasts. They lacked health care and job training, were often considered unfit for marriage, and had no way to support themselves or their children. They were lost.


McKay cites the United Nations Fourth World Conference on Women, held in Beijing, China, in 1995, as being crucial to bringing attention to the dilemma of women and girls during war. One of the major obstacles to helping them, she says, "is denial by the public and government, as well as in many of the villages, that girls are, in fact, in fighting forces, and that they have special needs when they return to their homes. The official disarmament, demobilization, and reintegration programs generally do not include girls at all."


While McKay reports that the work is difficult, she is not without hope for the future. "I am periodically overwhelmed with grief at what these girls endure. It helps to stay focused on the incredible talent and resiliency of the people in the helping agencies, and the amazing human resiliency in the girls themselves," she says. "Many of the villages are invested in helping the girls, and in fact, that seems to be the most effective solution-getting community involvement to create healing rituals and reintegration programs. Our role, really, is to awaken the inherent capacity of communities to overcome this problem."


McKay would like to see the United States take a more active role in helping women and children affected by war. "The U.S. Department of Labor has recently funded an initiative in northern Uganda, with efforts that target girls, which is a good start, but I would like to see more interest." McKay also says the girls she studied are affected by the overarching HIV crisis in Africa and that armed conflict is the fastest contributor to the spread of HIV. "The overall international situation also affects these communities-for example, the wars in Afghanistan and Iraq shifted humanitarian aid workers out of Africa to those regions. The resources are few compared with the need." Greater assistance from the U.S. government could make a world of difference.


McKay often speaks to women's rights organizations and women's and children's advocacy groups, although she rarely speaks to nurses, something that she would like to see change. "The work that I do, and that the nongovernmental aid organizations do, is really the essence of nursing," she explains. "We are advocates for a population that is truly vulnerable and disenfranchised." She encourages nurses to volunteer, donate money, and encourage legislators to fund initiatives to help these special victims of war. Most of all, she urges nurses to "Go somewhere!! Not five-star hotels, but into the real lives of people. We in the West don't pay attention to how most people in the world live their lives. It really changes you."

FIGURE. No caption a... - Click to enlarge in new windowFIGURE. No caption available.

McKay continues her research in Africa and is tireless in her efforts. "I have a responsibility to let as many people know about this as possible," she says. "The girls trusted me enough to tell the story. I must pass it on." McKay wants to let the world know that abandoning these girl soldiers, who are victims of war in a very specific way, will only result in further cultural breakdown.