In the face of war: examining sexual vulnerabilities of Acholi adolescent girls living in displacement camps in conflict-affected Northern Uganda

The intersection between war, displacement and HIV/AIDS is particularly striking in Northern Uganda. The over two-decade war between the Government of Uganda (GoU) and Joseph Kony and his rebel force, the Lord’s Resistance Army (LRA), has been characterized by the killing and maiming of civilians, child abductions, widespread displacement, various forms of sexual and gender-based violence, and the destruction of the social and economic fabric of society[1–3]. These experiences have left the entire population traumatized and at a heightened risk of contracting HIV/AIDS.

Northern Uganda, or Acholiland as it is often referred to, is comprised of three districts, Gulu, Kitgum, and Pader and spans an area of 28,000 square kilometres, equivalent to the size of Rwanda. Over a million and a half people reside between the three districts, of which 99% are of Acholi ethnicity and 1% other tribes. Acholiland is a vast and sparsely populated area with considerable agriculture and livestock development potential. The Acholi are traditionally a people of agriculturalists and livestock breeders and prior to the conflict, ninety percent of people in the northern region lived in rural areas.

In 1986, after President Museveni took power in Uganda, the rebel factions that have mobilized to resist this government can be characterized by transitions of increased terror, with Joseph Kony being the craft perpetrator of some of the greatest human rights violations the world has ever seen. Even though Joseph Kony and his rebel force, the LRA, professed to fight a spiritual war for the Acholi people against the GoU and its military, the Ugandan People’s Defence Forces (UPDF), the majority of Acholi people did not respect or voluntarily assist the LRA. This repudiation can largely be attributed to the enhanced phase of terror inflicted upon the civilian population after the peace talks brokered by Betty Bigombe in 1994 fell apart. Rape, landmines and the mass abduction of children as combatants became the signature work of the LRA. To this day, the facial mutilations of women who had their lips, ears and noses severed at gunpoint are visible in displacement camp settings.

When the peace talks failed, the Sudanese government allegedly began to heavily support Joseph Kony[4]. By providing safe refuge in the form of encampments, land to cultivate, materials to build homesteads, hospitals for treatment of war-related injury and even pharmaceuticals for treatment of common infections such as sexually transmitted infections (STIs), the Sudanese supported the LRA by enabling them to systemize their incursions into Uganda from protected base camps in the Sudan. To a large extent the Sudanese support of the LRA, including weapons, ammunition and landmines, was the key factor in consolidating Joseph Kony’s reign of terror as the longest child hostage crisis in human history[4].

By October of 1996 the casualty levels were high, the numbers of abducted children numbered close to five thousand and, the conflict had intensified with rebel incursions becoming a normal part of daily life. Due to the focused efforts of the LRA the GoU facilitated the shift of villagers into Internally Displaced Peoples (IDP) camps, and approximately 210,000 villagers moved from their homes into government-sanctioned camps[4]. Voluntary movement was not considered an option. At the time, most of the camps were located in the Kilak, Aswa and Nwoya counties of Gulu district, as they were the most affected by rebel incursion. By the year 2000, there were approximately 23 government-recognized camps in the region[4].

In the wake of September 11^th, 2001, and with increased pressure by the US government on Islamic states supporting terrorism, the Sudanese and Ugandan governments committed to improving bilateral relations. In March 2002, the Ugandan government launched ‘Operation Iron Fist’ (OIF), a military offensive against the LRA. Thousands of ground troops and air support were deployed. The government’s intention was to resolve the situation in the North using military force, and diminish the effects of what was becoming an international embarrassment for the government. In response, the LRA rebels poured back across the Ugandan border and sought revenge against the civilian population with intensified attacks on communities, increasing abductions and forced recruitment. The number of abducted children under 18 years of age jumped from approximately 12,000 as of June 2002, to nearly double that by June 2003 and at least 30,000 by May 2004[5].

As LRA attacks and abductions increased, and districts in Northern Uganda previously relatively unaffected by the war became targets of the LRA’s insurgency, unprecedented numbers of people fled their homes and were displaced into IDP camps all over Acholiland. The total number of people displaced and aid-dependent swelled. While in August 2001 there were an estimated 480,000 IDPs, by 2005 the total number of displaced persons had expanded to over 1.8 million, which accounted for over 90 percent of the population of Northern Uganda[6–8]. At that time, nearly 70 percent of the displaced population was under 25 years of age[9]. With the majority of people in the northern region now in camps, an unintended consequence of OIF was the complete destruction of Northern Uganda’s economic base, agriculture. Like many conflict-affected regions across Africa, Acholiland - once a very fertile region of the country - was left neglected, untended and uncultivated.

Three broad thematic areas emerged that described the sexual vulnerabilities of displaced adolescent girls: 1) Understanding the Devastation of the Present: Erosion of Cultural Processes and Belief Systems and the Collapse of Livelihood; 2) Living in ‘Double Jeopardy’: Vulnerability in the Light of Day and Vulnerability at Night, and; 3) Access to Reproductive and Sexual Health Information.

It is well known that displaced people, particularly girls and women, are at a much higher risk than the rest of the population for communicable diseases and other health concerns including HIV/AIDS[27]. However, the combination of economic, social, biological, and behavioural factors that increase adolescent girls’ sexual vulnerability in times of war and render them disproportionately susceptible to HIV/AIDS is not yet perfectly understood.

In study interviews many women commented that, “we have lost control of our children” and “we are experiencing complete familial and cultural breakdown”. This research process has furthered our understanding of parental and extended family frustration and anguish regarding the vulnerability of their daughters living in squalor, impoverished and hungry. The lack of control they feel they have over the well being of the girl-child stands in stark contrast to the systems of protection in existence prior to IDP camp relocation. In many ways women – grandmothers, aunties and mothers – were the active witnesses/player/consenters in the transition of their daughters from adolescence to womanhood. However, the personal security and support offered to girls by their families was virtually extinguished upon the advent of war. Traditional mentoring systems and cultural norms that previously governed girls’ sexual behaviour and provided cultural cohesion and guidance in supporting and protecting young girls from risky behaviours, have largely been eroded by war-induced displacement. In IDP camps the mentoring systems are limited by the close proximity between families, thus restricting the traditional comfort that had been associated with the grandmother’s hut. Further, cultural norms governing girls’ sexual behaviour have disintegrated because the family unit is now broken-up and dispersed among other families. These findings demonstrate that children no longer have a culturally ‘safe’ place to go for information on sexual matters.

Research suggests that the erosion of belief systems and a shift in cultural norms governing girls’ sexual behaviour in times of conflict helps to explain their heightened sexual vulnerability during war[28]. This breakdown increases the likelihood of early sexual debut, unprotected sexual activity and larger numbers of sexual partners[17, 29]. It is clear that the erosion of family and other social and cultural processes needs to be meaningfully addressed through appropriate programming if the vulnerability of girls in conflict settings is to be mitigated. The Government of Uganda is reinstating plans for ‘resettlement’ in the northern region as relative peace prevails[30]. Post-conflict prevention planners must recognize that the realities of girls will not necessarily change when peace ensues. Although the long-term effects of conflict on children is rarely discussed, available evidence suggests that girls’ vulnerability to sexual and intimate partner violence does not necessarily end with the cessation of armed conflict; in fact in many instances their vulnerability is exacerbated by reconstruction programmes that fail to specifically target their needs[16, 17]. Therefore, any planning for resettlement must incorporate the adequate provision of basic humanitarian services, including HIV prevention programming, particularly for children already traumatized by war. Moreover, as people are leaving camps and moving back to their home villages there is more room to build multiple huts for one family. Hence, families should be encouraged and supported in building several huts for their homestead and resettling according to clan and/or in close proximity to members of extended families (i.e. cluster homes), as the Acholi once resided before the war. Living with and/or near family members will help reinstate traditional child protection components of the Acholi compound, family and moral value systems while also providing increased security for adolescent girls. Indeed, research suggests that in places where values and principles mirrored by familial and clan obligation remain strong despite the war, kinship-related interventions may provide the only opportunity for consistent programming in conflict settings[31].

Devoid of any means of livelihood in the camps, a people of agriculturalists and livestock breeders have been reduced to near total dependence on donated food and other humanitarian aid. The anguish of poverty and the extreme difficulties women and girls face to provide for their families in IDP camps is demonstrated in our results. With no land to cultivate or crops to harvest the opportunities are restricted for girls who are out of school to make money to procure items that they consider important (including soap, Vaseline, panties and dresses). These results are worrisome because of the potential for girls participating in transactional or survival sex relationships and early marriages, which inherently increase adolescent girls’ sexual vulnerability[32]. Mothers in this study indicted selling portions of WFP food rations to buy the things they felt their daughters needed to prevent the initiation of sex for exchange relationships. It is clear that in order to alleviate the vulnerabilities of adolescent girls in times of conflict, women and girls must be supported in providing for their families. The provision of marketable skills training in camp settings is therefore very important. However, appropriate skills training relevant to the market economy and camp living must be considered. For example, training in tailoring might not be relevant because there is no one to buy new clothing; however, with a micro-credit loan girls might be able to buy a bail of used clothing and sell it in a market. By decreasing the dependence of girls on men for economic security, adolescent girls’ sexual vulnerability will intrinsically be alleviated[17, 32]. Therefore, local and international NGOs must be encouraged to initiate and support appropriate marketable skills training (e.g., hairdressing and catering courses) to female camp residents, particularly adolescent girls who are not in school.

According to the Uganda AIDS Commission and reinforced by our study results, Ugandan youth begin sexual activity at young ages and with little information on sexuality thereby increasing their risk of contracting HIV/AIDS[33]. Traditionally, premenstrual sex was forbidden in Acholi culture and age of sexual debut ranged from 16–18 years. The diminishing age of sexual debut for girls observed in this study, reported by many women to be between 12–14 years old, is telling of adolescent girls’ increased sexual vulnerability in times of conflict. Often out of economic need girls are having sex earlier and with older men, and some men seek younger girls as sexual partners in the belief that they are more likely to be HIV-negative. Age disparities in sexual relationships increase the likelihood of sexual coercion and inhibit girls’ ability to control the terms of their sex lives including negotiating condom use, subsequently increasing their exposure to HIV[34].

Furthermore, literature suggests that early sex may increase the likelihood of early marriage and pregnancy, signalling the end of education for most girls and leaving adolescent girls even more at risk of poverty and sexual exploitation[35]. Our study results corroborated this literature, as the primary reasons reported by girls for dropping out of school were marriage and/or pregnancy, in addition to lack of money for school-related supplies (uniforms, books, meals). Moreover, our results demonstrated that girls who were not in school were being left behind in the camps for most of the day instead of accompanying and assisting their mothers in the gardens, due to fear of abduction. These circumstances left out-of-school girls unsupervised in camps during the day increasing the potential for sexual predation by men offering food and clothing in exchange for sex. A report by UNICEF found that after families, schools are the next perimeter of a protective environment for children[36]. Schools can be a powerful protective force in most children’s lives, especially for girls, as schools physically remove children from potential harm for much of the day and help children learn skills and gather information to protect themselves and delay on-set of sexual activity. The longer girls are kept in school their vulnerability to HIV infection lowers by approximately thirty per cent[36]. Consequently, in-light of the widespread benefits of education, including the physical protection and sexual security that schools can provide to adolescents, every effort must be made to ensure displaced girls have consistent and stable access and support in their academics in times of conflict. Therefore, educational responses from the Ugandan Government and NGOs in northern Uganda must prioritize the provision of policies and programmes that support adolescent girls in attending and maintaining their in-school status, particularly young mothers with children and girls who are married. Currently, due to restrictive national policy, girls who get married or become pregnant are generally forced out of school. After substantial time away, the majority of these girls do not end up re-entering the school system, mainly due to the stigma associated with older girls re-entering school with their younger peers and, lack of childcare support for young mothers[37]. As such, it is imperative that the Ministry of Education in Uganda restructure current educational policy so that young girls who become pregnant or get married are not forced to leave school. Moreover, this policy change must coincide with the development of special bridging centres (attached to government schools) for young mothers where they can continue with their formal education while their children are cared for. In addition, the Ministry must ensure that older girls who drop out of school are afforded the opportunity of accessing accelerated learning programmes, complementary educational initiatives which allow young people to catch-up with their studies relative to their peers, in-turn increasing the chances of school leavers re-entering the formal education system. Finally, the Government of Uganda and the Ugandan Ministry of Education must work with the districts and sub-districts in the North, as well as local NGOs and international donor agencies, to provide funding for all the ‘extras’ that keep children from entering/re-entering school or force school-going children to subsequently drop-out (i.e. uniforms, books, meals).

Our study results demonstrated that girls were also vulnerable at night; our analysis uncovered a very concerning ‘internal’ night-commuting phenomenon whereby, due to privacy and security concerns, children moved from their family hut at night from the outskirts of camps to sleep in more central locations within their camp’s perimeters in a friend’s or relative’s hut without any adult supervision. Many parents reported the increased vulnerability of their daughters, in particular, to sexual predation during this internal nighttime movement. Unfortunately, the hundreds of children moving at night within the perimeters of the camps has not been highly recognized as a night-commuting phenomenon in and of itself, and has therefore not been properly assessed from either a research or a policy perspective. A concerted effort by researchers, policy makers and, programme planners to address these unique circumstances is urgently required.

In Northern Uganda, the Information, Education, and Communication (IEC) campaigns focused on the dissemination of HIV/AIDS information can be considered successful, as the majority of our study participants had a high awareness of HIV/AIDS and a high knowledge level of how to prevent infection. Yet what is apparent in our analysis is that girls are having difficulty translating knowledge of how to prevent infection into risk minimization practice. Many girls reported that condom availability in the camps was inconsistent or unavailable altogether. Moreover, several participants expressed the need for sexual health information and services in camps that was cognizant of the current realities and needs of adolescent girls and that would support them in the translation of HIV/AIDS awareness and knowledge to personal modification of sexual lifestyles. Combined, these findings are an indicator of the lack of appropriate sexual health programming that exists in camps and are of concern. With limited access to knowledge and means to protect one’s self, girls are inherently vulnerable to high-risk sexual activity[38]. It is well documented that war-related insecurity has diminished opportunities for NGOs and other organizations providing prevention programming to have a strong and consistent presence in displacement camps[17, 39, 40]. However, research demonstrates that reduced access to reproductive and sexual health services including relevant sexual health information increases the vulnerability of adolescents in particular[29]. Prevention programming planners in camps must realize that early sex, early marriage, and early pregnancies are the realities of adolescent girls living in displacement camps. Appropriate responses and innovative community-driven solutions acknowledging this actuality are urgently required to ensure adolescent girls have support and access to the information and means they need to protect themselves. For example, Spittal et al. (2008) developed the Wayo Programme, a reproductive health initiative in northern Uganda that trained women from the community to assume traditional Acholi, wayo-like counselling roles for the purposes of passing on sexual education and HIV prevention information from adults to younger women[31]. This is a highly successful and sustainable initiative because the women themselves are chosen by the community to become trained in STI prevention, condom use and reproductive health issues. They essentially resurrect roles that carried traditional respect; roles, which have now been lost or eroded due to prolonged conflict and displacement. Similar interventions that are built solidly upon indigenous knowledge and supported by the community must be supported and expanded. Furthermore, consultations must occur between the Wayo Programme, girls at risk, and other NGO and service providers in northern Uganda, including Save the Children, The AIDS Support Organization (TASO) and Straight Talk, on ways to increase access to condoms, condom information, VCT, STI treatment and antiviral care in camp settings. Strengthening reproductive health service provision to adolescent girls in times of conflict would improve their health outcomes considerably[17].

Departing from the recognition of a paucity of knowledge on the distinct vulnerabilities of adolescent girls in times of conflict, this study sought to explore the sexual vulnerabilities of displaced adolescent girls in Northern Uganda. Our analysis identified the erosion of traditional Acholi mentoring and belief systems that had previously served to protect the girl child’s sexuality, in addition to a collapse of livelihood in the face of war. These factors coupled with: being left in camps unsupervised and not in school during the day; movement within the perimeters of the camp at night away from the family hut to sleep in huts closer to the center of the camp due to fear of abduction and cultural considerations pertaining to privacy, and; inadequate access to relevant and adaptive sexual health information and programming in the IDP camps, have all contributed to adolescent girls’ heightened sexual vulnerability and subsequent enhanced risk for acquiring HIV/AIDS in conflict settings. It is safe to say that the lives of Acholi girls and women have been irrevocably impacted by over two decades of war and displacement. Conflict prevention planners, resettlement programme developers and policy-makers must recognize adolescent girls affected by armed conflict as having distinctive needs, which may not be the same as women, children or adolescent boys. Moreover, the unique needs of conflict-affected adolescent girls require distinctive responses.