A High-level View on Reform Needs for Peace Operations

This article combines an analysis of current reform efforts, and reform needs that I see following my four previous posts on the impact of trauma on sustainable peace and reconciliation. So, partly, you will see language coming from there. Opposed to these four pieces, this one does not make reference to external sources through footnotes. If you want to “check the fact-checking” for my conclusions, read the more detailed analysis.

Since taking office January 2017, the UN Secretary General has made the reform of how the UN engages in the field of peace and security a top priority. His vision includes efforts to improve the complex architecture through which the many UN actors within the Secretariat and within UN agencies contribute. More importantly, it also includes improving the conceptual approach: A historically grown delineation between peacekeeping and peacebuilding efforts, with the latter following the former, is being gradually replaced by more integrated approaches which put conflict prevention at the fore. Sustained peace and security is the best approach to prevent relapse into renewed conflict.

In his own words, the SG describes the challenge in his report to the General Assembly and the Security Council on peacebuilding and sustaining peace: “An important breakthrough … was the recognition that efforts to sustain peace were necessary not only once conflict had broken out but also long beforehand, through the prevention of conflict and addressing its root causes. More countries have recently experienced violent conflict than at any time in nearly three decades. Forced displacement has reached unparalleled levels. In too many places, the cohesion of societies and the well-being of people are at risk. Building a common vision of society must involve paying attention to the causes of those problems. In the resolutions, it was recognized that the international community must redouble its efforts to support Member States in preventing crises that exact such unacceptable and growing human and financial tolls.

The Secretary General thus points at the inherent connection between well-being of people, the cohesion of societies, and the likelihood of violent conflict: Health, including mental health, and cohesion of communities and societies are inseparable. In the currently increasingly challenged global system, with a rise of populism, nationalism, disregard of achievements on human values and rights, and erosion of vital elements of democracy including the rule of law, international organizations such as the United Nations are experiencing distrust and at times open hostility. A credible implementation of the UN SG’s vision requires to give him utmost support.

UN policy has not kept up with developments in peacekeeping, which has seen an increasing number of mandates that have changed the principles which have traditionally defined it as based on consent, limited use of force, and impartiality. The 2008 Capstone Doctrine sought, based on the findings and recommendations of the 2000 Brahimi Report, and on the aforementioned principles, to place peacekeeping within a spectrum of “Peace and Security Activities”, a “range of activities undertaken by the United Nations and other international actors to maintain peace and security throughout the world”.


Whilst the Capstone Doctrine places peacekeeping within a larger set of concepts, the other elements remain largely undefined policy wise. This is also true for UN Special Political Missions. As one of the consequences of a changed environment in which these missions operate, peacekeeping has focused more and more on the grey zone with peace enforcement, making it more difficult to create a distinction to peace enforcement which is required if one is to uphold the traditional principles of peacekeeping. Peacekeeping is challenged by having a conceptual identity that is less reflected in contemporary mandates. With regard to it’s current reform, there is a common tendency to focus on those parts of this reform that make operations fit for work in less benign environments where there is less and less consent of stakeholders with the presence of a UN operation that includes more coercive capabilities. As another consequence, the distinction between peacekeeping operations and special political missions, which have been growing over the years since then, has become more difficult as well. At the same time, no follow up to the Capstone Doctrine took place. The “scattershot, incoherent and occasionally contradictory or competitive international efforts as a significant source of failed peacebuilding efforts”, as described by the SG in his 18 January 2018 report, comes as no surprise.

The 2015 report of the “High-Level Independent Panel on United Nations Peace Operations”, in conjunction with the 2015 “Report of the Advisory Group of Experts for the 2015 Review of the United Nations Peacebuilding Architecture” have set the stage for the current reform activities. Yet, a unifying policy that would reflect the views of all stakeholders within the United Nations how best to combine existing tools under the primacy of the Secretary General’s vision of putting conflict prevention to the fore is not yet visible.

At the same time, again with the SG’s own words in his report as of 18 January 2018, “the 2030 Agenda for Sustainable Development contains the blueprint of the common vision of society towards which the world is trying to move. Inclusive and sustainable development not only is an end in itself but also happens to be the best defence against the risks of violent conflict. The 2030 Agenda also contains the promise to leave no one behind in the quest to build such societies.

It can, therefore, be argued that the reform vision of the UN requires a fundamental discussion about how to proceed with outdated and incomplete doctrine: Peace operations need to be more integrated, which is one of the objectives behind the SG’s reform initiative of the peace&security architecture of the UN Secretariat: The UN is currently implementing a new organizational setup. This absorbs most capacity that is not already consumed by operational needs. However, in order to drive change, in this fundamental discussion there is a need for guiding strategic principles for mandating peace operations, and how they integrate the political objectives of the UN and its constituency. Growing rifts between members of the UN Security Council, and between the driving forces of the Security Council and the general constituency represented in the UN General Assembly can significantly paralyze future success of this reform.

If identifying root causes of conflict, as stated by the SG, sits at the heart of conflict prevention activities, then identifying root causes for relapse into conflict is a core activity of conflict prevention as well. It has often been stated that, in order to get peacekeeping done right, important opportunities of assistance during the early “golden hours” need to be addressed better. This is true for transnational threats including the combined effects of transnational organized crime, violent extremism, and terrorism, but it is also true for early assistance to peacebuilding, which often is missing recognition in mandating peacekeeping operations. Even more then this is vital if a renewed strategy of the United Nations is meant to lead to more integration and coherence between what currently is understood as peacekeeping and as peacebuilding.

Innovative approaches are needed in support of the Secretary General’s vision to make the entire system fit for contributing to the 2030 Agenda for Sustainable Development. The context between conflict- and war related trauma of entire young generations and their caregivers through many forms of abuse on one hand, and the ability of communities and a society to move forward towards sustainable peace on the other hand, remains part of the scattershot activities of actors attempting to help, but without a guiding high-level policy.

At all times children have witnessed their fathers being killed and their mothers being brutally raped, and they have suffered from the same cruelties themselves, committed by armies, militias, gangs, and mobs. Children have been separated from their parents, endured unspeakable atrocities. This is the reality until today. Nowhere this is more devastating for communities and societies than when acts of severe war crimes or genocide are being committed. Generations suffer. Never before in human history the number of civilian casualties has outnumbered the military casualties as much as today. In contemporary conflicts, as much as 90 percent of casualties are among civilians, most of whom are women and children. Women in war-torn societies face specific and devastating forms of sexual violence, systematically deployed to achieve military or political objectives. It is in this context that entire traumatized generations emerge.

Children grow up with the consequences of what has been done to them and their parents, others again grow up with the knowledge that they are born because their mothers were raped. Raped mothers struggle with acceptance in patriarchal societies. Raped men even more. Children of rape, raised by a traumatized raped mother already struggling to love her unwanted child unconditionally, they also experience being pariahs in their communities. In all this suffering, childhood trauma is different from the trauma of adult survivors of conflict in that trauma is perceived as an event or a series of events in life for adults. It is defining the life of children. It is their never ending reality, and the younger they are, the fewer, if any, cognitive tools they have to comprehend what happens to them and to put it into a context of accountability of others. Mental health is severely affected by irreparable damage to the developing brain, and mitigating coping mechanisms within families or communities are dysfunctional or absent.

Sustained severe trauma through conflict-related violence profoundly impacts on the world of a toddler who has no concept of complex human relations. Subsequently, the adult survivor will suffer from a deformed capacity to establish healthy human relations. Because of neurophysiological damage inflicted by enduring trauma this is true for all cultures.

The International Community is also defined by the helplessness of many who care about humanity and decry the atrocities through soldiers, militia, gangs, mobs, violent extremists and international terrorists against civilian populations including children, whether in Syria, Yemen, Afghanistan, Iraq, Somalia, Sudan/Darfur, South Sudan, Central African Republic, Democratic of Congo, Burundi, Niger, Mali, Libya, recently Mozambique, Myanmar, and so many other places. Increasingly the divisions within the UN Security Council do not allow finding a common position that can be enforced. In cases of mandates being given to UN or partner organizations, we are confronted with an increasing inability to stop atrocities under our eyes, and to help countless trauma victims in the aftermath of conflict: Respect for ceasefires or commitment to peace agreements is as much waning as the acceptance of the UN itself, not least because of the disunity amongst those who constitute the UN: Member States, and especially the Security Council Members. Peace operations that can not sufficiently engage in deterring atrocities lose political credibility, such as in South Sudan, peace operations that engage in order to protect civilian populations with robust means, such as in Mali or the Democratic Republic of Congo find themselves being accused of bias, increasingly getting under fire themselves. The plight of civilians, especially children, continues. Billion-dollar peacekeeping operations get stuck in conflict where there is no peace to keep, losing capacity and credibility to contribute to peacebuilding.

Global migration of surviving traumatized young people throws them into the merciless arms of organized criminals and spills them into societies which are overwhelmed and increasingly hostile. Across the globe, whether in the U.S., Europe, or in Bangladesh facing refugees from Myanmar, traumatized children continue to experience severe traumatizing even in places they have been told might be their hope for a better future. Families with cruel abuse stories at their place of origin find themselves in another horror: The arrest of the adults and the forced and cruel separation of their infants, toddlers and children from them without any prospect to know how to maintain contact, or when they may be re-unified. Children who have been thrown on smuggler’s boats by their parents experience that a country denies access to a port of entry to vessels operated by aid organizations. Trauma becomes a constant fact of life. Alienation both on the side of victims and receiving host societies’ communities leads to “why bother” on either side. Antagonization leads to mutual resentment and hate. The spiral of conflict continues. Deported forced migrants come back to their country of origin, with little hope for peace, security, and some economic future. What do we know about the impact of mass trauma on children and adults by conflict and war? How well do we understand the connection between healing of individuals and communities, and societies, on the one hand and reconciliation as a core pre-condition for lasting peace?

On a high-level policy level, a much better appreciation of the damaging neurophysiological consequences of sustained childhood trauma within communities within and post conflict is necessary. A health-focused discussion needs to happen, recognizing the importance for peacebuilding efforts. Notwithstanding the different conditions created by different conflicts for whether, and how, the effects of severe trauma can be addressed through international assistance, its impact itself on communities and a society are deep. Whilst the crippling, life long, and intergenerational impact of trauma, especially during early childhood, on individual mental and physiological health is well documented and increasingly better understood, less knowledge exists about how it affects conflict- and post-conflict communities in different cultural settings. Even less studies have been undertaken on how such communities affected by large scale mental health deficiencies contribute to societal healing, or are supported in healing by those societies they exist in. Yet, any practitioner will agree on the relevance, perhaps with varying degrees of helplessness when it comes to the question how to help. Studies about how to overcome this within peace operations do not exist.

Closely connected to efforts raising awareness, a path towards identifying mitigating measures within peace operations needs to be charted. This is important in order to make a difference to the current situation: Practitioners and policy-makers acknowledging the problem in principle, but not sure about how to better and more holistically address it. However, the impact on building sustained peace, including through reconciliation, is critical. Therefore, the question must be how to incentivize an increased focus within support efforts for peace and security.

Without doubt, scattershot efforts to the best of the abilities of many actors do exist, including through humanitarian actors working in peace operations with so-called multi-dimensional mandates. An effort collecting views, practice, and potential best practice needs to be undertaken.

A new approach – Part Four in a series on Trauma and Conflict

In Part I I have shown that pro-longed and intense trauma creates dysfunctionality in many forms, and that the impact of trauma during formative periods of brain development goes even deeper1.


(Picture taken from: https://www.cdc.gov/violenceprevention/acestudy/about.html, retrieved June 27, 2018)

The longer a young child exposed to repeating trauma through forms of childhood abuse, the higher are both chances of, and the depth of, life-long badly damaging consequences. One very important reason for the unmitigated impact of trauma sits with that parents or caregivers either are the source of the child’s trauma (abuse of any form), or that they are not appropriately able to nurture a traumatized child.


(Picture taken from: https://www.cdc.gov/violenceprevention/acestudy/about.html, retrieved June 27, 2018)

Children who, for example, get victimized by sexual abuse through third persons, depend on that their caregivers are able to respond appropriately. If they don’t or can’t, life-long dysfunctions include severe depression, compulsive pain medication leading to addiction, and a general struggle with building healthy relationships. Health problems can be severe, leading to premature death, including through substance abuse, and suicide.

In Part III I am referencing studies that confirm this for children who survive abuse in countless forms happening in conflict and war. There is evidence for that social relationships and the existence of culture-specific coping strategies, can mitigate the impact of trauma. Healing can happen. But where there is an absence of these mitigating factors, because the parents are traumatized themselves, and because cultural mechanisms struggle or have broken down entirely, dysfunctionality becomes a feature of communities and even an entire society. The plight of caregivers deprives the traumatized children from healing.

How can we expect that large percentages of trauma survivors do not influence the functioning of communities and societies? It might be difficult to find studies that confirm the relationship between trauma-induced life-long and inter-generational dysfunctional behavior on the level of entire communities and the ability of communities and a society to move to lasting peace including through its ability to reconcile. But simple logic tells that this is the case: Reconciliation is, as I have said, about restoring inner harmony, integrating memory and behavioral impact of trauma into a healthy form of living. Dysfunctional individuals can not contribute to restoring a healing and healthy community, as the community is made from these individuals who need to heal in order to contribute their healthiness to the Whole. My personal experiences in this regard, stemming from living in and visiting so many communities support this. So goes the experience of every health worker, every humanitarian, every peacekeeper. We do collectively know that a country relapses into internal conflict easier than plunging into an internal all-out conflict without having suffered from precedents. We do know that vulnerable communities in a weakened society are subject to efforts of violent extremism and international terrorism to establish control by a reign of terror.

How can we neglect a fact that is so obvious?

  • Is it because we have to mainstream the understanding of what trauma really does?
  • Is it because we are simply overwhelmed and do not know an answer to the question what could be done?
  • Is it, as I have shown, that we collectively fail to act appropriately on assisting complex systems to regain their balance?
  • Is it that we still have to act more boldly on the UN Secretary General’s vision and intent to put conflict prevention front and center? Effective peacebuilding is conflict-prevention, and thus it can not be emphasized, in my view, enough how important it is to factor early peacebuilding into peace operations. After all, the United Nation’s “Capstone Doctrine2” from 2008 emphasizes exactly that. But I know of no comprehensive follow-on to the Capstone Doctrine. It explicitly sets a framework for peacekeeping, within a larger realm that encompasses conflict prevention and peacebuilding. The larger realm remains insufficiently addressed since 2008.
  • Why is global policy not matching reality?

In the most recent comprehensive analysis of UN Peacekeeping Doctrine in book form3, “UN Peacekeeping Doctrine in a New Era: Adapting to Stabilisation, Protection and New Threats“, Chiyuki Aoi, Cedric de Coning, and John Karlsrud4 bring it to the point when they describe how mandates given to the most recent peacekeeping operations challenge the traditional UN peacekeeping principles. The authors argue that these missions operate without a peace agreement in place and that, as a result, the current focus is on projecting more force, including undertaking offensive operations at times, engaging in intelligence and using special weapons and tactics.

We have heard the UN Secretary General and his Undersecretaries constantly referring to that we deploy peacekeeping operations into environments where there is no peace to keep. In short, the focus which is absorbing almost all energy of policy- and decision makers is heavy on the military side. More or less the rest of all energy currently goes into reform efforts of the United Nations and UN peace operations. The above book makes the case that this development widens a gap between existing peacekeeping policy and practical developments on the ground. Anticipating that more of the same may come in Syria, Yemen, or elsewhere, this is of concern for the collective of twenty authors from all over the globe and with in-depth practical and academic perspective on peace operations of the UN.

Whilst my series here on trauma is not the place for a larger analysis of these developments, it can, however, be said that the development of policy how to effectively contribute to restoring peace and security runs breathtakingly behind the rapidly changing reality on the ground. This gap may contribute to challenges on advising political bodies, such as the Security Council, on what should be done, what needs to be done when being confronted with the heavy-handed conflicts of these days, and their consequences for communities and societies. Policy with no operational impact is as problematic as operational decisions based on outdated policy.

For example, I have repeatedly argued that we continue to miss the “golden hour” of early engagement through peacekeeping operations by not being provided with the necessary expertise to address the endemic consequences of emerging transnational crime influencing such peacekeeping processes negatively: “Let us get boots on the ground first” is a mantra that can often be heard. But the difficulties addressing root causes immediately makes it almost impossible to address emerging threats later.

If we engage with peacekeeping within a larger framework as we, I believe, have to, then we want to get it right. We want to see that the enormous effort, including the human tolls that we take, do effectively help getting communities and societies on a path to peace. It appears to me that those have a point who argue giving up the traditional division between peacekeeping and other forms of activities towards a unified term “peace operations”. The entire reform of the United Nations initiated by its current Secretary General is based on this.

In this series of articles I argue that the same is true for the impact of trauma on post-conflict development: We think reconciliation only later, we associate it with peace building. Like with emerging threats that include transnational organized crime, we appear to prioritize a select toolset which, though it is necessary at times, must be incomplete if it is not taking into account threats that can not be mitigated by military capacity. We postpone other action, or leave it to others, and it may be that we collectively fail to follow up.

Reconciliation empowers societies to chart their own way towards lasting peace. Whilst this is widely acknowledged, it would also appear that efforts of the assisting international community fostering this healing power have been futile. I have witnessed many discussions about how model processes, such as the South African path towards seeking truth and reconciliation, could be adopted for different post-conflict societies. But looking just at the very same country today, South Africa’s crisis of endemic corruption also demonstrates the relevance of a truly owned rule of law for a sustainable way forward. The relevance of security and rule of law for economic development, and vice versa, has become part of the core of contemporary multidimensional mandates of peace operations. What is missing is the recognition that reconciliation belongs to the critical needs from the outset on, too, and how to support it. Today, reconciliation is considered being part of a peacebuilding process, which may be emphasized later. The “paramedic approach” of peacekeeping operations focuses on protection of civilians and on political processes. Assistance to restoring security capacities is considered a secondary task which may require later action. Even more so, this is true for reconciliation. Parts of the process are recognized in what we call “transitional justice”, but even there we seem to fail seeing the relevance of deep trauma on individuals, communities, and the society as a whole.

The triangular relationship between providing security and order, applying criminal justice, and allowing meaningful penal management based on humanitarian principles and human rights is well known and often quoted as an example for the need for integrated thinking. However, the triangular relationship between governance, rule of law, and reconciliation is less strategized and even lesser operationalized.

2 In it’s own words, the Capstone Doctrine as of 2008 aims to define the nature, scope and core business of contemporary United Nations peacekeeping operations, which are usually deployed as one part of a much broader international effort to build a

sustainable peace in countries emerging from conflict. It identifies the comparative advantages and limitations of United Nations peacekeeping operations as a conflict management tool, and explains the basic principles that should guide their planning and conduct. In doing so, it reflects the primary lessons learned during the past sixty years of United Nations peacekeeping. It draws on landmark reports of the Secretary-General and legislative responses to these reports, as well as relevant resolutions and statements of the principal organs of the United Nations.


3 UN Peacekeeping Doctrine in a New Era: Adapting to Stabilisation, Protection and New Threats (Global Institutions) (p. 1). Taylor and Francis. Kindle Edition; Loc 385

4 Ibid, Introduction – Addressing the emerging gap between concepts, doctrine, and practice in UN peacekeeping operations

The impact of trauma on communities and societies ravaged by conflict and war – Part Three in a series on Trauma and Conflict

How trauma and reconciliation are linked needs to be examined from the perspective of an individual, a community, and a society. Reconciling⁠1 means to restore to friendship or harmony, or to settle or solve conflicts. Thus, an individual may heal from consequences of a traumatic event by restoring inner harmony, integrating memory and behavioral impact of trauma into a healthy form of living. In that sense an individual reconciles his/her memory as a condition for a path to learn healthier forms of behavior than those which he/she suffered from through trauma. Psychotherapy is based on that, and so are all, very successful, self-help groups following the 12-Step-principles⁠2.

But what happens if trauma, triggered by the same events, essentially affects all members of a community, or a majority? What happens if these events last for a long time, when those who suffer have no way to escape? Recent history is filled with so many examples, whether Syria, Yemen, or so many more. 

However, let me introduce a country in which I spent four years of my life: I lived in Sarajevo, the capital of Bosnia & Herzegovina, between 2008 and 2012, arriving twelve years after the end of an all-out war.

When Bosnia&Herzegovina declared it’s independence from Yugoslavia, the Yugoslav People’s Army laid siege to the town between April 1992 and February 1996. For 1425 days⁠3, Sarajevo’s citizens had to move under sniper fire and mortar shelling raining down on them from hilltops overlooking the city. They had to flee from violence along frontlines moving backward and forward multiple times. Frontlines where ground forces of the Yugoslav People’s Army and the Bosnian government defense forces clashed for years. Every surviving Sarajevan who came out of that with severe trauma. Bosniaks, Croats, and remaining Serbs.

Bosnia & Herzegovina is home to a multi-ethnic society in which individuals mainly identify themselves as members of either the Bosniak, the Croat, or the Serb nation. For centuries they had lived together in peace. Sarajevo was the glaring example for a multi-ethnic and multi-religious society, Muslims, Catholics, and Orthodox Christians lived together, the rate of inter-marriages was high. Sarajevo’s hospitality and friendliness during the Olympic Winter Games of 1984 are unforgotten. 

The brutal atrocities between 1992 and 1996, carried out under General Ratko Mladic and under political control of Radovan Karadzic and Slobodan Milosevic changed that, forever. Between 2008 and 2012 I was the Head of a European Union Mission assisting in restoring police and the rule of law. In this Mission hundreds of local Bosnian staff members served alongside their international colleagues. Thus, I had ample opportunity to listen to members from all walks of life of today’s Bosnian society. The memories of the war, the impact of traumatic memories, they run deep in every individual I met. Bosniaks, Serbs, Croats have slowly restored a way of living peacefully together. However, the fearful memories of the past impact on them in every aspect of today’s life.

What struck me most was the seeming inability of these three nations living in one State to move on into reconciling with the past. The historical narrative has become very different: Bosniaks in Bosnia will tell a different history opposed to, say the Bosnian Serbs. Nowhere is this more visible than in acknowledging the Srebrenica genocide. There is simply no joint narrative, and I have not seen successful efforts to find a path towards reconciliation. The efforts of all sides are frozen. Until today, the annual commemoration at the Potocari memorial and graveyard site happens without participation of political representatives of the Republica Srpska, the Serb part of the Federation of Bosnia & Herzegovina. As another example, Bosnia & Herzegovina knows the concept of “Two Schools Under One Roof⁠4”. An unknowing passer-by would see Bosniak and Croat school children use the same school. But in reality, they are enlisted into two distinctly different schools. Why else than for the purpose of establishing a different history, and maintaining a different identity?

Years earlier, between 2000 and 2004, I lived in Kosovo. The violent conflict between Milosevic’s Serbian Forces and the Kosovo-Albanian Kosovo Liberation Army had just ended less than a year earlier, through a military campaign carried out against Milosevic by NATO. Very early at the beginning of the post-conflict period in Kosovo, I saw the same like later in Bosnia: Ethnic Albanian and ethnic Serb children did not receive any joint education⁠5. The memory of communities in Kosovo is altered forever. I lived both in Albanian neighborhoods and Serb enclaves. Especially in Serb enclaves, depression and fear ran high. 

These are just two illuminating examples of a more comprehensive personal experience which I made in post-conflict societies all over the World. I share this experience with hundreds of thousands of people in the peace and humanitarian community. One has to get out of the “international bubble”, out of the walled compounds and protected hotels and out of heavily armored vehicles. By living with and within ravaged communities, the heuristic knowledge about the depth of impact of trauma is gained. But what is it that academic research tells us?

The PubMed Central (PMC)⁠6 is a free full-text archive of biomedical and life sciences journal literature at the U.S. National Institutes of Health’s National Library of Medicine (NIH/NLM). As of this writing, it offers access to 4.9 Million articles from 2138 journals that participate fully, 330 NIH portfolio journals, and 4692 selective deposit journals.

 A research of it’s database with the search term “PTSD” offers 33.829 articles. The search term “PTSD conflict war” leads to 3273 references. “PTSD reconciliation” leads to 362 offerings.  “PTSD reconciliation war” references 219 articles. Amongst these, I have undertaken an initial scoping which is not complete. I selected articles that could give some answers to the questions above. To document this, all examined literature can be found in the footnote section⁠7. 

I find the following statements being supported by the selection of scientific research that I have examined:

  • Communities and societies that have come out of conflict include an extraordinary high percentage of individuals with health conditions including PTSD, and other forms of trauma impact, including depression. The impact of war on the mental health of members of communities is most significant.
  • Women are more affected than men, other significant groups with high numbers of trauma survivors include children, elderly, and the disabled.
  • Some studies find very high percentages of trauma survivors in children in refugee camps and displaced populations, and almost as high amongst their caregivers.
  • Among war-affected youth, the association between war exposure and psychological distress is mediated by daily stressors. The breakdown of societal structures in conflict directly affects the impact of trauma on mental health. Within childhood, experiences of family violence and external violence were significantly related to increased mental health symptoms.
  • The availability (or not) of physical and emotional support affects the consequences of traumatization. The use of cultural and religious coping strategies is frequent in developing countries. Where such traditional spiritual and religious support structure break down, coping strategies are severely hampered.
  • Physical disability and depression and PTSD correlate. 
  • Mental disturbances and feeling upset correlate.
  • Trauma effects from conflict, such as somatization, PTSD, anxiety disorder, major depression, alcohol and drug misuse, and functional disability are trans-cultural.
  • Studies support that the above symptoms are the same for victims of rape and forms of conflict-related sexual exploitation and abuse. 
  • Effective public mental health services are needed to address large scale effects of traumatization.
  • The impact of trauma in such societies can be traced for decades, there is also supporting evidence for intergenerational consequences.
  • The trauma impacting on victims and perpetrators of violence leads to different coping strategies. Perpetrators of violence against civilian populations might display less symptoms. The impact of trauma on former child-soldiers can be mediated through family- and community-based care. Conversely, where this is not the case, severe traumatization persists.
  • Some studies mention that there is no established consensus on how war- and conflict-related traumatization should be addressed from a public health perspective.
  • One study (South Sudan) finds that most participants thought reconciliation was not possible without prosecuting perpetrators or compensating victims and did not support amnesty. Participants with probable PTSD were more likely to endorse confessions, apologies, and amnesty, and to report that compensation and prosecution were not necessary for reconciliation. The more traumatic events people experienced, the more they endorsed criminal punishment for perpetrators and the less they endorsed confessions.
  • One study, based on 160 reports, finds that the five most commonly reported activities were basic counseling for individuals; facilitation of community support of vulnerable individuals; provision of child-friendly spaces; support of community-initiated social support; and basic counseling for groups and families. Most interventions took place and were funded outside national mental health and protection systems.

To reduce the findings and my own conclusions even more: 

(1) Conflict- and war-related trauma affects communities and societies significantly and this impact spans over generations.

(2) The most vulnerable suffer most.

(3) Large scale coping strategies depend on the availability of culture-specific services and functions that often have broken down in conflict.

(4) There is little analysis of the effects of traumatization on post-conflict reconciliation.

(5) There is, however, a dire need to look into how the international community factors this context into work assisting in peacekeeping, peacebuilding, and conflict prevention processes.

August 26, 2002, the General Assembly of the World Psychiatric Organization approved a statement on mental health implications of disasters. It begins as follows⁠8: 


“The World Psychiatric Association would like to draw the attention of psychiatrists and other mental health professionals, health authorities, decision-makers and the general public to the serious and potentially catastrophic psychological and psychopathological effects of disasters. These effects can be diverse in character, intensity and potential for chronicity, but acute stress reactions, post-traumatic stress disorder (PTSD), mood, anxiety and psychotic disorders, and permanent changes in the personality are the ones that, if left untreated, may have the most serious consequences. Disasters can result from a variety of causes such as earthquakes, floods, hurricanes, fires, naval and plane accidents and terrorist attacks, but also from acts and consequences of war and negative conditions affecting important groups of population like famine, sanctions, forced migrations and similar deprivations. All of them produce very serious effects on the population and particularly on children, having a negative impact on the social structure and systems, which increases the effect of the disaster on individuals and population.”


So, whilst it appears that a context between trauma and reconciliation can be established, these findings are a first indicator for that the context with reconciliation, and thus the context with efforts to sustain peace, requires more attention.

Do policy of the United Nations and political decision-making processes such as by the Security Council take the above impact into account? What do we know about systematic or non-systematic efforts of peace operations to factor this into their mandated work. What do we know to which extent peace building efforts take this into account? Are there practices and best-practices?

1 https://www.merriam-webster.com/dictionary/reconciled

2 A twelve-step program is a set of guiding principles outlining a course of action for recovery from addiction, compulsion, or other behavioral problems.

https://en.wikipedia.org/wiki/Twelve-step_program; retrieved June 19, 2018

3 For many more comprehensive documentaries, here a brief video:

4 https://en.wikipedia.org/wiki/Two_schools_under_one_roof

5 At least for ten years preceding the Kosovo-Albanian insurgency, Milosevic maintained rigid control over the previous largely autonomous province of the former Yugoslavia, surely leading to the same effect, but with the curricular written under Belgrade’s control. After the war, the Kosovo-Albanian leadership in Pristina wrote the curriculae for the Albanian schools, and Belgrade maintained as much control as possible over the northern parts of Kosovo and Kosovo-Serb enclaves south of the river Ibar.

6 https://www.ncbi.nlm.nih.gov/pmc/

7 (1) Mental health consequences of war: a brief review of research findings; R. SRINIVASA MURTHY, RASHMI LAKSHMINARAYANA; in World Psychiatry 5:1, February 2006; 

retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1472271/pdf/wpa050025.pdf, June 20, 2018

(2) Post-traumatic stress symptoms among former child soldiers in Sierra Leone: follow-up study, Theresa S. Betancourt, Elizabeth A. Newnham, Ryan McBain, and Robert T. Brennan;  THE BRITISH JOURNAL OF PSYCHIATRY, 2013 Sep; 203(3): 196–202; 

Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3759030/, June 20, 2018

(3) Psychological Consequences of Rape on Women in 1991-1995 War in Croatia and Bosnia and Herzegovina; Mladen Lončar, Vesna Medved, Nikolina Jovanović, and Ljubomir Hotujac; in Croat Med J. 2006 Feb; 47(1): 67–75.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2080379/, retrieved June 20, 2018

(4) Mental health of victims of sexual violence in eastern Congo: associations with daily stressors, stigma, and labeling; An Verelst, 1 Maarten De Schryver,2 Eric Broekaert,3 and Ilse Derluyn; BMC Womens Health. 2014; 14: 106; Published online 2014 Sep 6. doi: 10.1186/1472-6874-14-106

Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4237834/, June 20, 2018

(5) The structure of post-traumatic stress disorder and complex post-traumatic stress disorder amongst West Papuan refugees; Alvin Kuowei Tay, Susan Rees, Jack Chen, Moses Kareth, and Derrick Silove; in: BMC Psychiatry. 2015; 15: 111; Published online 2015 May 7. doi: 10.1186/s12888-015-0480-3;

Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4459680/, June 20, 2018

(6) Youth mental health after civil war: the importance of daily stressors; Elizabeth A. Newnham, Rebecca M. Pearson, Alan Stein, and Theresa S. Betancourt; in: Br J Psychiatry. 2015 Feb; 206(2): 116–121; doi: 10.1192/bjp.bp.114.146324

Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4312966/, June 20, 2018

(7) Prevalence and factors associated with Posttraumatic Stress Disorder seven years after the conflict in three districts in northern Uganda (The Wayo-Nero Study); James Mugisha, Herbert Muyinda, Peter Wandiembe, and Eugene Kinyanda; in BMC Psychiatry. 2015; 15: 170. PMCID: PMC4513792; Published online 2015 Jul 24. doi: 10.1186/s12888-015-0551-5

Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4513792/, June 20, 2018

(8) Relationships of Childhood Adverse Experiences With Mental Health and Quality of Life at Treatment Start for Adult Refugees Traumatized by Pre- Flight Experiences of War and Human Rights Violations; Marianne Opaas, and Sverre Varvin, Dr.Philos, MD; in J Nerv Ment Dis. 2015 Sep; 203(9): 684–695. PMCID: PMC4554230; Published online 2015 Aug 31. doi: 10.1097/NMD.0000000000000330

Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4554230/, June 20, 2018

(9) Cognitive-Behavioral Therapy versus Other PTSD Psychotherapies as Treatment for Women Victims of War-Related Violence: A Systematic Review; N. Inès Dossa and Marie Hatem; in ScientificWorldJournal. 2012; 2012: 181847. PMCID: PMC3345529; Published online 2012 Apr 19. doi: 10.1100/2012/181847

Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3345529/, June 20, 2018

(10) Trauma and posttraumatic stress disorder in South Africa: analysis from the South African Stress and Health Study; Lukoye Atwoli, Dan J Stein, David R Williams, Katie A Mclaughlin, Maria Petukhova, Ronald C Kessler, and Karestan C Koenen; in BMC Psychiatry. 2013; 13: 182; Published online 2013 Jul 3. doi: 10.1186/1471-244X-13-182 

Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3716970/, June 20, 2018

(11) Pathways from Victimization to Substance Use: Post Traumatic Stress Disorder as a Mediator; Jung Yeon Lee, Judith S. Brook, Stephen J. Finch, and David W. Brook; in Psychiatry Res. 2016 Mar 30; 237: 153–158; Published online 2016 Jan 22. doi: 10.1016/j.psychres.2016.01.049

Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4769948/, June 20, 2018

(12) Posttraumatic stress disorder, trauma, and reconciliation in South Sudan; Lauren C. Ng, Belkys López, Matthew Pritchard, and David Deng; in Soc Psychiatry Psychiatr Epidemiol. 2017 Jun; 52(6): 705–714; Published online 2017 Apr 11. doi: 10.1007/s00127-017-1376-y;

Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5510537/, June 20, 2018

(13) From War to Classroom: PTSD and Depression in Formerly Abducted Youth in Uganda; Nina Winkler, Martina Ruf-Leuschner, Verena Ertl, Anett Pfeiffer, Inga Schalinski, Emilio Ovuga, Frank Neuner and Thomas Elbert; in Front Psychiatry. 2015; 6: 2. PMCID: PMC4348469;  Published online 2015 Mar 3. doi: 10.3389/fpsyt.2015.00002

Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4348469/, June 20, 2018

(14) Mental health and psychosocial support in humanitarian settings: linking practice and research; Wietse A Tol, Corrado Barbui, Ananda Galappatti, Derrick Silove, Theresa S Betancourt, Renato Souza, Anne Golaz, and Mark van Ommeren; in Lancet. 2011 Oct 29; 378(9802): 1581–1591; Published online 2011 Oct 16. doi: 10.1016/S0140-6736(11)61094-5

Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3985411/, June 20, 2018

(15) The enduring mental health impact of mass violence: A community comparison study of Cambodian civilians living in Cambodia and Thailand; Richard F Mollica, Robert Brooks, Svang Tor, Barbara Lopes-Cardozo, and Derrick Silove; in Int J Soc Psychiatry. 2014 Feb; 60(1): 6–20; Published online 2013 Feb 7. doi: 10.1177/0020764012471597

PMCID: PMC4737641 NIHMSID: NIHMS753770 PMID: 23396287

Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4737641/, June 20, 2018

(16) Transgenerational consequences of PTSD: risk factors for the mental health of children whose mothers have been exposed to the Rwandan genocide; Maria Roth, Frank Neuner, and Thomas Elbert; in Int J Ment Health Syst. 2014; 8: 12. PMCID: PMC3978019 Published online 2014 Apr 1. doi: 10.1186/1752-4458-8-12

Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3978019/, June 20, 2018

(17) Traumatic episodes and mental health effects in young men and women in Rwanda, 17 years after the genocide; Lawrence Rugema, Ingrid Mogren, Joseph Ntaganira, and Gunilla Krantz; in BMJ Open. 2015; 5(6): e006778. PMCID: PMC4480039; Published online 2015 Jun 24. doi: 10.1136/bmjopen-2014-006778

Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4480039/ Jun 20, 2018

(18) Aggression inoculates against PTSD symptom severity—insights from armed groups in the eastern DR Congo; Tobias Hecker, Katharin Hermenau, Anna Maedl, Maggie Schauer, and Thomas Elbert; in Eur J Psychotraumatol. 2013; 4: 10.3402/ejpt.v4i0.20070. PMCID: PMC3651955; Published online 2013 May 13. doi: 10.3402/ejpt.v4i0.20070

Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3651955/ June 20, 2018

8 Disasters and Mental Health (World Psychiatric Association) (Kindle Locations 3385-3390). Kindle Edition.  Emphasis (bold text) added by me.

The Trauma of Children in Conflict and War – Part Two in a series on Trauma and Conflict

The stories about pillaging and raping soldiers and marauding militias are part of the entire history of mankind. There is no doubt that this shameful aspect of human cruelty haunts us since our earliest pre-historical times. In narratives it plays a side role at best. The heroism and the suffering of the soldier comes first. However, at all times children have witnessed their fathers being killed and their mothers being brutally raped, and they have suffered from the same cruelties themselves, committed by armies, militias, gangs, and mobs. Children have been separated from their parents, endured unspeakable atrocities, survived the murder of their peers under piles of dead bodies or hiding in the bush. This is the reality until today. And never before in human history the number of civilian casualties has outnumbered the military casualties as much as today.

Nowhere this is more devastating for communities and societies than when acts of genocide are being committed. Generations suffer. The Holocaust, the genocide of Srebrenica, or the genocide in Rwanda are only examples of these darkest chapters of mankind, which is still persisting against all vows to let it never happen again. Ethnic and political cleansing by brutal dictators adds, during World War II, and today: Even where genocide could be prevented by bold action, such as perhaps recently in Burundi, or the Central African Republic, the run-up violence exceeds all imagination, creating thousands or hundreds of thousands of victims surviving the worst atrocities of mankind.

Children grow up with the consequences of what has been done to them and their parents, others again grow up with the knowledge that they are born because their mothers were raped. Raped mothers struggle with acceptance in patriarchal societies. Raped men even more. Children of rape, raised by a traumatized raped mother already struggling to love her unwanted child unconditionally, they also experience being pariahs in their communities1. As has been said earlier, childhood trauma is different from the trauma of adult survivors of conflict in that trauma is perceived as an event or a series of events in life for adults. It is defining the life of children. It is their never ending reality, and the younger they are, the fewer, if any, cognitive tools they have to comprehend what happens to them and to put it into a context of accountability of others. For young children, often the only way to make sense to painful events is to believe that they themselves must be responsible for it.

If their mothers and fathers suffer from being unable to love them unconditionally, they inevitably believe they are responsible for what happens. If a mother is separated by militias from her infant, and if the mother or the infant, or both, are abused, the infant will conclude that it is punishment for something they are responsible for themselves. If children are abducted by Boko Haram, or recruited as child soldiers by the Lord’s Resistance Army, mere survival under conditions known as “Stockholm Syndrome” will add.

Trauma therapy is over-boarding with stories of adult survivors of childhood abuse who finally recognize that the inability, say for example, of their mother to prevent them from their father’s rage, also constitutes abuse: Their mothers could not save them. Understanding abuse requires to take the view of the victim, notwithstanding whether malicious intent, involuntary action, or omission constituted the trauma. Abuse profoundly impacts on the world of a toddler who has no concept of complex human relations. Subsequently, the adult abuse survivor will suffer from a deformed capacity to establish human relations, in countless variations.

That black sheep within their own peacekeeping forces and civilian parts of peace operations contribute to this trauma in conflict and post-conflict situations, is collectively shame-driving the International Community. This sits at the heart of current zero-tolerance efforts against sexual exploitation and abuse of local populations by soldiers, police, and civilians in national or multilateral engagement of United Nations2 and regional actors, such as NATO, EU, AU, and others. Being aware of the harm beyond imagination, the International Community at least has begun to “clean it’s own side of the street”, which is laudable.

But the International Community is also defined by the helplessness of many who care about humanity and decry the atrocities through soldiers, militia, gangs, mobs, violent extremists and international terrorists against civilian populations including children, whether in Syria, Yemen, Afghanistan, Iraq, Somalia, Sudan/Darfur, South Sudan, Central African Republic, Democratic of Congo, Burundi, Niger, Mali, Libya, recently Mozambique, Myanmar, and so many other places. Increasingly the divisions within the UN Security Council do not allow finding a common position that can be enforced. In cases of mandates being given to UN or partner organizations, we are confronted with an increasing inability to stop atrocities under our eyes, and to help countless trauma victims in the aftermath of conflict: Respect for ceasefires or commitment to peace agreements is as much waning as the acceptance of the UN itself, not least because of the disunity amongst those who constitute the UN: Member States, and especially the Security Council Members. Peace operations that can not sufficiently engage in deterring atrocities will lose political credibility, such as in South Sudan, peace operations that engage in order to protect civilian populations with robust means, such as in Mali or the Democratic Republic of Congo find themselves being accused of bias, increasingly getting under fire themselves. The plight of civilians, especially children, continues.

The situation is getting worse: The systematic use of violence against civilian populations, and especially of sexual violence as a weapon of war and conflict, spreads. Until recently the opinion that conflicts and victims of armed conflict constantly fell to a low after the end of the Cold War could be heard frequently3. Since a few years however, voices, including the Secretary General of the United Nations himself, express worry about the renewed increase of conflicts4 and the return of the Cold War5. These messages seem to indicate another, reverse, trend in terms of numbers of conflicts. Research is surfacing that demonstrates that 60 % of conflicts in the early 2000s relapsed within five years6. The trend towards an ever more increasing share of civilians in casualties from conflict and war is reaching horrible numbers: In contemporary conflicts, as much as 90 percent of casualties are among civilians, most of whom are women and children7. Women in war-torn societies can face specific and devastating forms of sexual violence, which are sometimes deployed systematically to achieve military or political objectives. It is in this context that entire traumatized generations emerge.

Global migration of surviving traumatized young people throws them into the merciless arms of organized criminals8 and spills them into societies which are overwhelmed and increasingly hostile. Families with cruel abuse stories at their place of origin, attempting to get into the United States, find themselves in another horror: The arrest of the adults and the forced and cruel separation of their infants, toddlers and children from them without any prospect to know how to maintain contact, or when they may be re-unified9. Across the globe, whether in the U.S., Europe, or in Bangladesh facing refugees from Myanmar10, traumatized children continue to experience severe traumatizing even in places they have been told might be their hope for a better future. Children who have been thrown on smuggler’s boats in Libya by their parents experience that a European country denies access to a port of entry11. Trauma becomes a constant fact of life. Alienation both on the side of victims and receiving host societies’ communities leads to “why bother”. Antagonization leads to mutual resentment and hate. The spiral of conflict continues.

Heartbreaking stories on display in memorial sites such as Potocari12 on the Srebrenica genocide, or the memorial site in Kigali on the Rwandese genocide exemplify the plight of children with examples. And every now and then, media is creating attention, such as on the children of rape in Rwanda. The world needs examples in order to generate understanding and compassion, but does this translate into action in light of the sheer size? What do we know about the impact of mass trauma on children and adults by conflict and war? How well do we understand the connection between healing of individuals and communities, and societies, on the one hand and reconciliation as a core pre-condition for lasting peace?

So, how well do we understand the threat, how well do we understand the vulnerability of peace processes by this threat, and how much do we know about mitigation of this threat? As a deeply involved practitioner since almost twenty years my answer is depressing: Those who know appear to be overwhelmed. Political operatives defining policy are aware but have to make priority decisions that have to exclude this problem, simply because of it’s magnitude and the limitations both on knowledge how to help, and how to generate willingness and resources to do so. Boots on the ground come first. But if the trauma of entire generations contributes to most crucial impediments to reconciliation processes, is it not that we should focus on, at least, to the same extent? Again, as a practitioner, my experience is that prevention will be acknowledged as being necessary by All, but it does not generate awareness and public willingness to act: The story of a dog biting a man does not carry news. The story of a man biting a dog will make the news. The story of preventing a man to bite a dog hasn’t been tested and may be similarly boring than the story of a dog biting a man, except from a bit of amusement in social media. In the same vein, robust military action may catch the public attention, but the more silent work of civilians, and international police under the UN umbrella, assisting in the recovery of communities and societies from conflict, does not.

If this already is true, how much more must be true in relation to a phenomenon of whole young generations being badly traumatized and how this may carry forward the potential for future conflicts? In his book “The Responsibility to Protect”13 Gareth Evans sums up a disappointing account of scientific methods to predict conflict, so that preventative action can focus on it. At the end we only know one thing, he says: The likelihood of conflict is twice as high in countries where there was a conflict earlier. For me, a link to entirely traumatized generations is obvious.

11A very insightful example is this documentation by France24:

Against the odds: The Rwandan women raising a family despite genocide and rape – France 24


22For the UN: https://peacekeeping.un.org/en/standards-of-conduct; retrieved June 18, 2018

Other organizatons have established similar policies

33http://www.fallen.io/ww2/ leads to an amazing data visualisation within an interactive documentary that examines the human cost of the second World War and the decline of battle deaths in the years since the war.

This is the crucial point: this extraordinary visualization puts battle field deaths and civilian deaths until WW2 into a proportion that demonstrates the ever higher number of civilian casualties. However, the project is not able to generate other figures than battle field deaths for the time post WW2 until 2015. Towards the end of the demonstration, the argument that we live within an extraordinary long period of peace is being upheld.

44Sebastian von Einsiedel, Louise Bosetti, James Cockayne, Cale Salih & Wilfred Wan – Civil War Trends and the Changing Nature of Armed Conflict;

United Nations University, Centre for Policy Research; April 25, 2017;

https://cpr.unu.edu/civil-war-trends-and-the-changing-nature-of-armed-conflict.html, retrieved June 17, 2018


88See my article “Why global cooperation on peace and security is needed – An argument against divisiveness from the perspective of fighting organized crime”, June 9, 2018


99For many:

I Can’t Go Without My Son,’ a Mother Pleaded as She Was Deported to Guatemala – The New York Times


Statement of APA President Regarding the Traumatic Effects of Separating Immigrant Families


U.N. Rights Chief Tells U.S. to Stop Taking Migrant Children From Parents – The New York Times


1111Italy’s New Populist Government Turns Away Ship With 600 Migrants Aboard – The New York Times


1313Gareth Evans: The Responsibility to Protect: Ending Mass Atrocity Crimes Once and For All; Brookings Institution Press (September 4, 2009)

The Impact of Trauma on Individuals – Part One in a series on Trauma and Conflict


a : an injury (such as a wound) to living tissue caused by an extrinsic agent

b : a disordered psychic or behavioral state resulting from severe mental or emotional stress or physical injury

c : an emotional upset

Work in neurophysiology has altered traditional views on brain development and the impact of trauma. It is now better understood how thought processes, behavior and memory are formed. The notion that the brain develops until early adulthood and then remains neurologically static for the rest of its life is replaced by the concept of neuroplasticity2 which teaches that literally everything we do or get exposed to creates physical pathways between neurons or leads to pruning of existing pathways between connected neurons. The brain keeps resonating to external stimuli by changing itself on a physiological level for its entire life.

The view that traumatic experiences cause a disordered psychic or behavioral state is too narrow. A quick Google search finds many variations of an understanding that differenciates between physical damage by physical trauma, and psychological trauma as a damage inflicted to the psyche. However, it is now increasingly acknowledged that every traumatic event leads to neuronal changes which are beginning to be understood and which include temporary or lasting brain damage. In plain language: Some physical trauma leads to wounds that one can see because they are bleeding, traumatic events can inflict physical damage that is visible on a MRI or PET scan3. Survivors of severe trauma often suffer from a brain condition with biological, psychological, social and spiritual manifestations. Lacking public awareness is responsible for erroneous or plainly wrong, even moral, judgment of trauma survivors and their struggle.

Ever since the end of the Vietnam war psychology and psychotherapy grappled with what became known as post-traumatic stress disorder, or PTSD. Growing understanding about its severe impact led to efforts helping soldiers, police officers, public servants, nurses and other vulnerable groups, all of which are mostly composed of adults, with exceptions being mostly cases of catastrophes that include children. Responses comprise first-line support which includes a debriefing by a trained individual who will refer cases of visible and more severe affects to specialists. Public views often equal trauma with PTSD, the understanding of consequences of all forms of trauma and it’s consequences is too limited. A huge variety of known self-harming and self-destructive behavior is rooted in exposure to trauma. Depression and addiction medicine present examples of a growing understanding how childhood abuse affects the entire lifetime4 of individuals. This still evades broader public awareness: The view that depression equals weakness and addiction equals moral failure can be found in large swaths of discussions which would occasionally be sprinkled with sensational news such as about mass shootings by military veterans, for example.

In cases of mass exposure to traumatic events the coping ability of a society is limited: Man-made catastrophes and natural disasters with large numbers of victims strain first-line responders and second-line support mechanisms beyond limitations and imagination. Whilst the size of societies can act as a buffering mechanism that mitigates the societal effect of trauma on individuals, mass exposure of a community alters the entire community, not only individual members. Like in the case of individuals, these consequences can affect following generations.

It is the impact of trauma on the brain development of infants and children that gives reason to most serious concern: Significant consequences for the concept of self, self-esteem, empathy and the capacity for intimacy are amongst those aspects documented by a sound body of scientific research, at least in the Western world. Today we know that brief exposure of infants, children and adolescents to highly traumatic situations and longer exposure to less traumatic but longer-lasting events cause the same catastrophic consequences5. Child abuse in all forms belong to the events that constitute extreme forms of this trauma. Yet, a public understanding of the term “child abuse” is too narrow as well6. Immediate7 and life-long deviation from a healthy norm include depression, self-destructive behavior ranging from compulsive disorders to addiction, rage and anxiety and premature death in countless forms, from suicide through overdosing to cancer.

The life-long manifestations from early childhood trauma root in the specific vulnerability of the developing brain. As David Eagleman8 puts it: “In a newborn brain, neurons are relatively unconnected to each other. Over the first two to three years, the branches grow and the cells become increasingly connected. After that, the connections are pruned back, becoming fewer and stronger in adulthood.” It is, therefore, that early childhood trauma impacts on the neurophysiological development of the brain. This is also the reason why long-lasting exposure to trauma has a lasting impact notwithstanding its intensity.

Imagine a pristine piece of grassland. Once trespassers begin to cross this land, there will not be a random use of all possible connections between all possible points. Instead, after a short while pathways will emerge. Some of them will get more trodden over time, some remain small, some will not be used after some time. From now on trespassers will use existing paths. Just crossing the land the shortest possible way will not be a convincing option any longer. After years or decades main paths may have become roads. Within human society roads are known that exist for thousands of years, today’s super highway may have carried caravans of traders millenia ago. In the same way the developed brain builds and prunes along pathways that have formed during the initial development phase. Because the brain learns from any event, trauma throughout this formative period is especially prone to form lifelong consequences. Trauma can deform vital pathways in the brain and affects whole regions and their interaction and contribution to the whole. Pruning and building new pathways may lead to later correction, but only partially. Like a severe wound leaves a life-long scar, and pain, the same is true for the physical reality of the brain.

A second profound impact of early childhood trauma may be especially related to longer lasting traumatic events: They cause stress. Stress leads to release of stress hormones9. A part of the brain’s response to stress is a cascade of biochemical changes in hypothalamus, pituitary, and adrenal glands, as well as in the sympathetic nervous system. According to Louis Cozolino10, increased levels of glucocorticoids, epinephrine, and endogenous opioids are particularly relevant to a discussion of the psychological impact of stress and trauma, in that they alter attention, cognition, and memory. Long exposure of the developing brain to trauma effectively leads to that it is permanently exposed to hormones that hold functions both in the realm of pain and the realm of pleasure. A proneness to mental disorders such as depression and addiction is created early on. Likewise, the permanent activation of the amygdala within a fight-or-flight reaction causes the permanent repetition under exposure of events or situations that the brain later associates to the initially learned trigger during childhood trauma, as they do for PTSD victims11. However, to the child traumas are not experienced as events in life, but as life defining12. The effects of early and severe trauma are extremely widespread, devastating, and difficult to treat13.

Whilst it can be assumed that these two major consequences are culturally neutral, a third complex of trauma consequences may depend on a social context. In western societies it is well documented that early childhood trauma, especially through forms of abuse, creates psychological and spiritual manifestations: The concept of self, and of self-esteem, is negatively affected. “Abusive parenting creates a painful sense of shame, inadequacy, or superiority in children, which, if left unacknowledged and untreated, results in the prolongation of these wounds into adulthood14.” It is very obvious that the wide definition of childhood abuse often runs confrontational to traditional parenting. Sentences about the forming of character through (mild) forms of physical violence can be found in many societies, and as long as, for example, the punishment of children is still legal if approved by parents in some jurisdictions in the United States of America, this will continue. However, contemporary science and therapeutic fieldwork tell another story.

11 Merriam Webster Dictionary


22 Neuroplasticity: The brain’s ability to reorganize itself by forming new neural connections throughout life. Neuroplasticity allows the neurons (nerve cells) in the brain to compensate for injury and disease and to adjust their activities in response to new situations or to changes in their environment.


33 Encyclopedia Britannica:

“Studies employing positron emission tomography (PET) and functional magnetic resonance imaging (MRI) have shown that people with symptoms of PTSD have altered activity in the brain, primarily in the regions of the medial prefrontal cortex, thalamus, and anterior cingulate gyrus.”


44 Centers for Disease Control and Prevention


Page last reviewed April 01, 2016, retrieved June 16, 2018

55 A very good example is the self-examination abuse-checklist in: Carnes, Patrick J., A Gentle Path Through the Twelve Steps: A Classic Guide for All People in the Process of Recovery; Hazelden Publishing; Expanded, Updated edition, June 1, 2012; Kindle edition; pg. Loc 662 of 3435

66 For Pia Mellody, childhood abuse can be constituted by any less than nurturing behavior of parents and caregivers.

77 Complex Trauma in Early Childhood

by Kim Cross LSCSW, B.C.E.T.S.;

The American Academy of Experts in Traumatic Stress;


Copyright 2014, retrieved June 16, 2018

88 David Eagleman, The Brain: The Story of You; Vintage; Reprint edition (October 6, 2015); Kindle eBook edition, pg 9

99 A good general description:”

Adrenaline, Cortisol, Norepinephrine: The Three Major Stress Hormones, Explained”

The Huffington Post, https://www.huffingtonpost.com/2013/04/19/adrenaline-cortisol-stress-hormones_n_3112800.html; April 19, 2013, retrieved June 16, 2018

1010 Cozolino, Louis, The Neuroscience of Psychotherapy: Healing the Social Brain; Second Edition; Norton Series on Interpersonal Neurobiology; W.W. Norton & Company, June 21, 2010; Kindle Edition; pg 240

1111 Ibid, pg 264 ff.

1212 Ibid, quotation of Christopher Bollas, pg. 267

1313 Ibid, pg. 267

1414 Pia Mellody, Lawrence S. Freundlich, The Intimacy Factor; HarperOne; Reprint edition (October 13, 2009); Kindle edition, pg 11

Us, and Them

What does your brain need to function normally? Beyond the nutrients from the food you eat, beyond the oxygen you breathe, beyond the water you drink, there’s something else, something equally as important: it needs other people. Normal brain function depends on the social web around us. Our neurons require other people’s neurons to thrive and survive.

David Eagleman, The Brain; Chapter introduction to Chapter 5: Do I Need You?; 2015; New York

Unnoticed by many, neuroscience, the science of the brain, has made progress over the past ten to twenty years which one can perhaps only describe with moving from the medieval ages to enlightenment with lightning speed. We research on the brain since hundreds of years, may be even much more, if all early attempts to understand it are included. We do apply modern methods of science since a century, or more. But it is the cutting edge result of research of the past fifteen years which makes us say that we are entering a new phase of understanding who we are; who we are not; what is constituting our conscious self awareness; and how this is embedded into a much larger context of the subconscious which we mostly are not aware of. But even more, modern neuroscience begins to help us understanding to which extent we need the interrelationship between us and others, and what it means for the “self”, and what it does to us. The borderline between the self and the outer world becomes more and more porous. We are all more interconnected with the entire world than the concept of an independent self makes us want to believe.

David Eagleman’s book is based on a PBS series “The Brain”. These six episodes are the most awesome piece of popular science made public I have come across in many years. It should be viewed in schools and universities, and everybody can, you can get it in the iTunes Store, for example.

In Chapter 5, findings of neuroscience are demonstrated that connect to my personal understanding of the effects of trauma, how it affects me, and people like me. Chapter 5 also includes important clues to understanding societal interactions of many people that lead to violence, destruction, xenophobia, and genocide. As Eagleman says, brains have traditionally been studied in isolation, but that approach overlooks the effect that an enormous amount of brain circuitry has to do with other brains. Our brains are primed for social interaction, from a moment on we appear to not have memories of, from the moment we are given birth. Babies at the age of one year have a complex capacity to differentiate between trustworthy action and the opposite, before even understanding language.

The self does not exist in isolation to others. We know that, we would agree to it, and perhaps the extent to which this is true can be seen when looking at persons who suffer from having less ability to empathize, such as persons suffering from autism, or from sociopathy. Both are deficiencies in complex interaction of subsystems of the brain circuitry. By no means they are moral or behavioral deficiencies, emerging understanding goes deep into the knowledge of the brain being interconnected with other brains.

The understanding of how individuals relate to Ingroups and Outgroups, to groups to which we belong, and to groups we feel we do not belong, it all is affected by how the trillions of synapses of a brain relate to other sets of trillions of synapses, and billions of those. It is kind of a challenge to accept that interdependency with others is not something that we decide, but that is built into our fabric on most fundamental levels. To those who are challenged by the thought that we depend on entities outside of ourselves on a deep level, here is another thought: The average adult human being is carrying several pounds of living matter that appear to not belong to the body itself, with entirely different DNA, living in co-existence, sometimes parasitic, sometimes in symbiosis: Bacteria. But it goes beyond: Take these bacteria away from your body, and you will die in a very short while. You can simply not exist without of these billions and billions of other living beings inside yourself.

The same goes with empathy. Empathy is a fundamental mechanism of the brain, and it is activating the same brain circuitry that is activated when you feel pain. Especially when you are being left out: If people do not cooperate with you, but leave you out, fMRI scans show that the parts of your pain fire up which also light up when you feel physical pain.

So, belonging to a group makes us feel good. Meaning that the question arises how we relate to people which we wold categorize as not being part of the groups we feel good with.

It is here where Eagleman’s book is becoming so fascinating read for me: He is referring to the genocide in Rwanda, the genocide in Srebrenica, and also making it clear that so many more of these situations exist, like the killing of millions of Armenians by Turks in 1915, or the Nazi Holocaust, and much more. All of a sudden, when reading his book, I am back in Sarajevo: Eagleman interviews Hasan Nuhanovic, who worked as a translator in the United Nation’s mission UNPROFOR on the compound where his family was seeking refuge. He survived, and he lost his family, when the UN commander decided to open the gates, exposing 8.000 Bosniak Muslims to the hellhounds of Ratko Mladic’s genocidaires. I know Hasan personally, I employed him in the European  Union Police Mission, we revered him, and we made it a regular habit to have him educating the International Community about the consequences of the genocide in Srebrenica.

Eagleman tries to understand what transforms neighbors into killers. Individuals who have been in more or less peaceful coexistence for a lifetime, and their ancestors since hundreds of years, they seem to be able to mutate into monstrous torturers and killers within a brief moment.

I would not conclude, from what I understand, that the reasons for this are entirely understood. But neuroscience offers clues: Empathy works with Ingroups. The brain shows visibly less activity in circuitry related to empathy when considering somebody to be part of an Outgroup. As he says, these areas of the brain become short-circuited, they do not longer participate in decision making. Empathy disengages. We don’t care any more. To me, this is the entry point into dehumanization.

Read, or watch, his experiment: Brain scan people who see pictures of hands being stabbed by a needle, and how the brain reacts in case you tell the person that this hand belongs to somebody in a group you identify with, or not. The same picture can create either a firestorm in the brain, let me say, in case you are a Democrat and you are being told that this person is a Democrat, or a Republican. Or, a German, and a migrant from North Africa. Or a Christian, and a Muslim. Depending on which side you belong to, your brain reacts different to the same picture, depending on how you label the picture: For example, the medial prefrontal cortex (mPFC) of the brain is engaging differently in case we are thinking of other people, or inanimate objects: People looking at pictures of homeless people show much less activity in the mPFC compared to pictures of people they relate to. Dehumanization, made visible on a brain scanner.

Now, I am leaving the narrative of Eagleman’s book of my beautiful city Sarajevo to the reader. But I do ask how this translates into contemporary empathy with people suffering in conflict areas, and when they arrive, millions of them, having successfully escaped, at the borders of, say, European Union States.

Think about it: Your reaction to a picture of a child found on a shore, drowned because the boat overloaded with refugees capsized, it creates viral replication in social media, storms of empathy flare up, because you can identify: A child is a child. But if you see troves of people waiting at some European countries border, your reaction might be different, though the only real difference is that these people did not drown, they made it. Empathy makes all the difference in your reaction.

I want to leave it there for today. My thoughts go deeper, naturally I am trying to find an entry point into the xenophobic elements of a discussion that also has justified elements, such as respect of migrants for societal values in those countries welcoming migrants escaping from horrible violence, and the way how the social networks in these societies appear to explode with fear, and hate.

Education is the key. The great simplifiers, those who trumpet their rallying sounds for hate from the TV stations and the Internet, they need to be countered by an educated debate. Fair, tough with those who disrespect values, but also tolerant with those who may want to learn values they have never been exposed to before.

How can I blame somebody who, from the moment of being a baby on, has been either taught male supremacy, or female subordination? We all learn from copying what our parents and caregivers tell us.

But we can engage in discussions, learn, and help in learning.

On Trauma and Societies

This entry amends and deepens my earlier article “Trauma – An Entry Point”. So some is a repetition, but put into a larger context.

There is a group of conditions with damaging impact which’s members, at first sight, may seem disparate. These conditions fundamentally affect development, personality, and behavior, and impact on forming relationships. Scientific understanding of these conditions, and what they do to individuals, has made significant progress over the past decades.

However, in my experience they also impact on communities, and societies, especially when some of them occur on a large scale, to a huge number of members of a society, as a consequence of violent conflict.

To my knowledge, this area is less charted, in psychology, and in sociology.

The three conditions are:

(1) Trauma;

(2) Compulsive behavior and addiction and their interrelationship; and

(3) Certain personality disorders which, at least, seem to occur as a consequence of trauma especially when exposed to it at an early stage of life.

These conditions can be examined using a multidisciplinary approach including genetic, neuronal, biochemical and environmental/behavioral  sciences. This is especially useful when it comes to the various degrees of their influencing each other and working together.

These conditions, in principle, can be seen in any living organism, at least of some complexity, and to varying degrees, again depending on the complexity of the organism in question.

We all know the story of the dog where it’s owner knows or suspects that the animal has been abused, say, the dog was rescued from being chained and beaten frequently, for example. We immediately see the impact, some animals are extremely anxious, others may be aggressive and can not be held around children. I have not seen anyone who does not understand the causal consequence between the abuse and the behavior of an animal. The dog may even have been adopted for reasons including pity. Animal adoption online markets are full of narratives about abuse.

My experience with human beings who have experienced trauma, especially early trauma, is different. The layers of human development from child to adult, and within an adult’s life, seem to make the causal context less visible. I may hear on a party sentences like “Our new dog was clearly abused as a puppy”. I can neither remember or imagine a similar easygoing discussion about a human being. These conversations are very different.

It appears to me that we can readily appreciate the impact of violence on an animal, but my personal experience with the set of reactions when confronted with somebody who has been subjected to violence, to trauma, to injustice on an extraordinary scale, is different. The scale of reactions includes indifference, disinterested attitude, or inability to appropriately interact with such an individual. Reactions can include gossip to third people like “He or she should get over it”, they can, not only in extreme cases, even outright victimize and traumatize this individual again.

Why? I struggle to come up with a comprehensive answer, but to me it stands out that the topic of abuse appears to be a societal taboo: Victims, if they can remember that they were abused, regularly don’t talk. The reasons include shame, and alienation by others. Every police officer knows (or should…) the term “secondary victimization”. It happens, for example, to rape victims, through the sometimes helpless, sometimes outright malicious, and always inappropriate reactions of family, friends, law enforcement, and justice.

Moreover, in my experience the reactions to human abuse appear to include other elements which make the consequences so difficult to see, and to deal with. They include uneducation, sometimes almost medieval belief, and disinterest. As an example, I take a sentence many of us have heard all too often: “A slap does not harm a child, it’s good for the child”.

Despite well-documented negative impact on the development of children, this belief is very common. To my disbelief, I had even to learn that some State legislation in the U.S. still allows physical punishment of children. Just read this one.

I do believe that massive experience of violence, and especially sexual and gender based violence on a mass scale which occurs in conflict, not seldom deliberately used as a weapon of war, of individual and societal destruction, leads to the occurrence of all three conditions on a scale that affects that societies’ ability to move on, and to reconcile, or not. I have made practical experience of that everywhere where I have worked.

Our ability to appreciate these phenomena and to relate to the behavioral consequences of their existence in an individual is radically different, in my view, within the three following groups, which I introduced in my first article:

(A) Those who don’t have one or several of these conditions;

(B) Those who have, and often don’t know; and

(C) Those who recover from one or several of these conditions, and/or integrate the knowledge of their partly unalterable consequences consciously into their lifes.

These three constituencies mix and may communicate about these issues on basis of a vastly different understanding:

The person who is not affected (A) has limitations to relate, and thus, to understand. Relapse into addictive behavior, compulsive disorders, anxieties, anorexic behavior, just to name very few, appear to be alien to these persons. They have genuine difficulties grappling with relating to why this is happening, beyond an intellectual level. Read “Confessions of a Sociopath: A Life Spent in Plain Sight” by M.E. Thomas. Try to relate to her narrative, assuming you, the reader, are not a sociopath. It’s really demonstrating the case.

The person who is affected (B), does not, at least fully, know and/or is in a condition excluding understanding, through complex denial mechanisms. This person is genuinely unhappy and may even be ready to admit that, but understanding does not suffice and denial adds. The denial can be visible to (A), but that person has often no idea what this denial really means, and how it works. Often, a person (A) concludes that a person (B) is weak. An addict has character deficiencies, full stop. A traumatized abuse victim is weak, he or she should get over it. Full stop. A personality disorder, like, let me just say, frequent panic attacks and inability to be with other people, may establish pity at best. But that person is weak, full stop.

In order to appreciate my entry point into this discussion, read, for example, the definition of the American Society for Addiction Medicine ASAM. According to this definition, based on what we now know through sophisticated science, addiction is a brain disease. I will come to addiction much later, the point here is “brain disease”. The very same way, trauma is a wound inflicted on the brain.

Whilst we may talk about brain injuries and diseases on a neuronal level in educated academic discussions, my impression is that much of society approaches these conditions including from a perspective treating them as character deficiencies.

The person who recovers (C), increasingly understands, as his or her recovery progresses. Recovery is hard work. Thus, the recovering person develops an intimate understanding of what happened, and why.

It is from this perspective that I see and want to examine the impact on societies where large groups of individuals are victimized. Understanding the impact helps finding better ways to help addressing it, increasing the ability of a society to reconcile.

Because if there is no reconciliation, there is high likelihood of relapse into new conflict.

For further reading, here is just one personal account. I will use some more in future entries.

Trauma – An Entry Point

So far, I have been writing about peace, justice, and security. This blog is also about conflict, trauma and reconciliation. And frankly, it is perhaps the biggest unexplored land that I need to enter, to cross, and attempt to map. Trauma is one of the most challenging terms I have ever been dealing with.

My knowledge about trauma is growing. As I write, I also contribute with this to my own recovery from trauma. So this will be part of a healing process, quite frankly. As this is a public blog, there only will be a very limited disclosure.

I am so aware of how difficult it is, in general, to understand what trauma does to an individual, and in cases of massive trauma by conflict, to communities and societies. From what I am learning and researching, the effects of trauma on societies may be better explored than methods to address recovery from trauma on a societal level.

In my professional experience, this recovery process appears to be a crucial factor for reconciliation in a society that has experienced conflict. I will try, how many blog entries down the road, and repeatedly, to explain and to reflect on supporting methods for recovery from individual trauma. My feeling since a while is that there is much potential for finding better ways to support the process of societies that have been traumatized through conflict, on their way towards reconciliation.

Because if they don’t, the common experience in my line of work is that these societies have a higher chance to relapse into conflict. History is full of proof for this.

Thinking about how to find the best common understanding for this topic, I want to note that there are several categories of individuals who need, when reading about trauma, to understand that their own experience with it massively defines their way, and even their ability, to relate to what I am going to write.

In a simplification, three groups stand out to me:

(1) Those who are lucky that they grew up without being subjected to their own trauma;

(2) Those who are trauma victims and don’t know;

(3) Those who actively recover, using a large variety of tools for it, based on what science learns about trauma, and on recovery tools that work.

Each of these groups have a massively different ability to understand the notion of trauma, with some similarities between the first two groups. The best understanding might be within the third group, to which I belong. Thus, I also know from my own experience how challenging it may be for those who understand trauma better, to explain it, on basis of their own experience. Because this group is labeled in different ways, there often is the complete absence of understanding what suffering from trauma means. Lifelong. Reactions go across the whole spectrum, including muted silence and aversion, to ridiculing, and moral judgement.

Which leads me to my second last general comment: I would believe that as of today, many who deal with trauma and its consequences would agree to that a multidisciplinary explanatory model and recovery approach is necessary. Explaining the mechanism of traumatization, and the approaches to healing, went through a huge scientific learning process over the past few decades. It is still ongoing, but there truly is exciting progress. Thats why both the knowledge about trauma and its effects, but also what trauma means for communities and societies at large, are so incredibly relevant and, perhaps, insufficiently explored and understood. My suspicion is that, as a result, we struggle with finding more effective methods of assisting recovering societies, in my line of work.

My last general comment: Science is knowledge, is enlightenment, is allowing humanity to develop tools. The opposite is the darkness that we often associate with the medieval ages. Believe me, from my viewpoint, which is supporting science, we are not out of the woods of the medieval ages yet. Specifically when it comes to contemporary understanding of behavior, learning, nurturing, and abuse in all its various forms, I see the medieval ages in full existence. The result is an uninformed approach of morality, and it has a huge impact in societies which believe that they are educated, and believing that the darkness of not knowing is just for labeling “elsewhere”.

I will give examples.

Here is one for starters: Follow these two links below. I may continue to work myself into the issue of trauma from various viewpoints, using these examples, and others. I deliberately refrain from judging the extremely different events that are reported in these articles too much, except that they both upset me equally:

During the same 30 minutes whilst riding on a train home, I read the news about that Boko Haram, in their most recent attack, killed hundreds, if not thousands of innocent people, with utmost cruelty, and for sure with what always comes with it: torture, and rape, unspeakable horror and suffering. Then I read about a father in Florida calling the cops for witnessing his punishing his 12-year-old daughter with slaps on her buttocks.

The common denominator for my later dissection: Trauma. And whilst All here would agree that Boko Haram’s actions are coming from Hell, yet there is a common understanding that physical abuse of children is justified for “educational” purposes. Even more, the notion I grew up with, including the sentence “A little slapping is healthy for children”, this notion is more widespread than I would have hoped, after so many decades of educational progress. It is truly medieval, as one can see, it’s still the law, even in some Southern parts of the United States.

So, the challenge is education about the effects of trauma. I will attempt to contribute.

Here are the links.

Dad Calls Cops to Watch Him Spank 12-Year-Old Daughter


Deadliest-Ever Boko Haram Raid Leaves Hundreds Dead in Nigeria: Reports


I really can not say: Enjoy reading…