AWH is a very slim young person of middle height, with active uneasy eyes that never rest. He was interviewed in March 2003 when he was 15 years old by a locally trained interviewer using the PDS. This PTSD diagnosis was confirmed within a two-week period by an expert using the CIDI, after which AWH was invited for therapy. He was very shy when he came. In fact, he approached the house then ran back into the street. After some time, he slowly approached again. Both the therapist and the interpreter put in a lot of effort to make him feel welcome and comfortable. As we later learnt, he lost both parents during the civil war in Somalia. This was without question his "worst event".
He has lived by himself since the age of 14 in the camp, but fended for himself since the age of 9. He had no family in the camp or anywhere else, as far as he knew. At the time of his parent's death in Somalia, he recalled a younger brother and sister, but he had never heard of them again. He has been a registered refugee in Uganda since 1998.
His initial drawing at the beginning of therapy shows the tiny lonely figure of a child, placed in the middle of the large white sheet of paper, nothing else. He named it " a boy".
The beginning of NET was challenging, since he seemed to recall very little of his early years as a child in Somalia. He was also very economical with words and upon being asked to place flowers for good events in his life, he found there was no event that would deserve a flower. He simply placed two stones on his lifeline, one for the day his parents were shot in front of him, one for the time he reached Nairobi as a refugee, a time when he had to struggle hard to stay alive in the absence of any aid.
After NET 1 (session 1), he did recall his early years in quite some detail and even remembered some joyful events; for one of which he later placed a flower: 'the time I used to play football with my dad in the evenings in our compound'.
After having witnessed the death of his parents and being able to escape through the back of the house, he was completely on his own. He escaped Mogadisho with a group of strangers, survived Nairobi by himself, eating left-overs at hotel garbage dumps and finally smuggled himself into Uganda by hiding in the back of a bus.
Excerpts of his story read:
I was born in Mogadisho, Somalia. I do not know my exact birthyear, I think it is 1986. I grew up with both my parents. I have a sister who is 2 years younger called Halimo and a 4 years younger brother called Mohamed. We lived in a part of town called ...
My mother had fair brown hair and skin. She was young and I loved her a lot. I was her first-born and her favourite. She even told me so. My father was of darker complexion. He was also a young man in those days. He was hard working. He had a shop close by in the market. He would usually leave in the morning and return home in the evening. Sometimes when he came home, he played with us in the evening. We played football together. Those were good times. I do not know how old I was then; I just remember that I was very young...
When I remember those days I get sad. All these memories come back and I only know what I have lost. The years went by and I used to live like this until the war broke out. I don't remember the year, but I was still young... One day we fled from home in the late afternoon...We went with a car to a place called Bal'aad, about 30 km out of town...
Eventually we went back home to Mogadisho. I must have been about 10 years by then. A few months later, the war reached us again. It was early in the morning. A group of about 10 civilian men reached came to our house. They were armed with guns...
I stood very near to my parents. I was so scared. Suddenly I heard the sound of bullets. One of the soldiers had started shooting. The moment I saw that he pulled the trigger and heard the first bullet, I panicked. I started running. I felt such great fear. I ran inside the house and tried to hide myself behind a door in one of the rooms. I was shivering, fearing, thinking, they will also come for me, they will come and kill me'. I still have a heart beat now, when I recall that moment. After some time it went quiet outside. I still stood behind the door, silent, not moving. After a while I slowly moved towards the window and peeped out. What I saw was terrible. My mother and my father had been hit by the bullets. They were both lying on the ground. My mother had fallen on top of my father. They both had blood on their clothes. My mother had blood on her face and her stomach. They were not moving anymore, they had died. Until that day, I had never seen a dead person. I felt horror. I was so afraid of them, shocked by what I saw. I only thought of running away, leaving this place. I escaped through the back of the house and jumped over the fence. This was the last time I have seen my parents and also the last time I had been in our home in Mogadisho...
While fleeing, I joined strangers in the street. So many people were trying to flee. I simply ran with them. When these people reached their destination, they branched off from the road. It was night time by then. I was alone. I hated my life. I followed the road and finally fell asleep under a bush. I had given up about life by then. I felt like I had died as well. I knew about the danger of wild animals and lions, but I did not care...
This is how I came to Uganda. When we reached Kampala I saw a group of Somalis and went to greet them. They took me in and I lived with them for a few weeks. They also showed me how to register as a refugee with UNHCR. I remember the day I came to Nakivale Refugee Camp. I was so surprised how people can live in a place like this. I stayed with the Somali family that found me in Kampala for about two years in the camp. Finally, Red Cross helped me to build my own house in 2000, I was about 14 years then. Since then I live alone. I started going to school when I came to Nakivale. I will graduate from P7 at the end of this year. I have learnt how to live by myself; I can do everything by myself. I never ask for help. No one can help me anyway. I have never heard about my brother and sister again. Whether they are still alive and if so, where I could find them. But now I am ready to look for them.
As mentioned before, he has been surviving on his own since the age of 9 years. This has probably led to his enormous shyness but also an amazing sense of self-reliability. 'I can do everything by myself. I never ask for help. Anyway who could help me?' There is also a strong feeling of sadness and loneliness around him that is very moving. Our local translator Haji, who is also trained as a NET therapist, was moved to free flowing tears at several moments of AWH's life recall, specially when he spoke about his loneliness and desperation.
AWH is a smart boy, so he frequently challenged the concept of therapy in the beginning. 'It won't make my parents come back, and it won't change my life situation'. AWH has never really entered a state of expressing strong emotions like crying or anger during therapy. He said he could not cry, also not by himself. There were however visible signs of emotional processing like tears and strong heartbeat especially during NET 1 and 2.
AWH reported having strong PTSD symptoms when he started therapy, especially continuous nightmares and flashbacks, mainly related to the day his parents were killed. Re-experiencing actually increased, he said, once therapy was started. After NET 4 he talked of having fewer symptoms. In his last session AWH talked about wanting to try and trace his family with the help of the Red Cross. He was especially interested in finding his two younger siblings.
When the sum of symptoms were counted according the CIDI-K section, AWH had a sum score of 12 in the CIDI pre-test. This had decreased to 8 in the CIDI post-test immediately after the end of therapy, and 9 at the nine-month follow-up. At the nine-month follow-up, AWH was looking well-dressed, and had put on both height and weight. He had completed his primary school education at the camp primary school and spoke confidently of his plans. He had also joined the camp soccer team and played along with the group now every evening, a significant behavioural change, given that he previously would not even talk or socialize with others. He was not more friendly than usual, but admitted significant symptom reduction to an expert evaluator who had never seen him before.