Yida, — Karim* and his four friends, all aged 13, stop along the side of the road to take inventory of their remaining supplies. With their lightweight bags featuring Bob Marley and Winnie the Pooh strewn about, the boys lay out what stock they have left to travel the last 20 kilometres to Yida refugee settlement in South Sudan.
In recent weeks, nearly 3,500 Sudanese children have arrived in Yida. As aerial bombardments become increasingly frequent just across the border in Sudan's South Kordofan state, UNHCR protection staff have monitored hundreds of unaccompanied children who, like Karim, have fled violence and arrived in Yida alone.
"Because of very heavy fighting at home, my mother sent me ahead to Yida," Karim tells UNHCR.
Child psychologist Myriam Oteiza recently arrived in Yida to explore the mental health and psychosocial needs of refugees. She is particularly concerned about the most vulnerable, including unaccompanied children, older people, refugees living with disability and single mothers.
"The people of the Nuba Mountains have been at war for decades," Oteiza says. "They have learned to survive and are incredibly resilient, but years of fighting and exposure to violence have had a dramatic impact on these communities, particularly on the children."
Travelling in a group of five, Karim and his companions left their village near Umdorein, in the Nuba Mountains, with the understanding that their mothers, elders and younger siblings would be following behind. "As soon as I get to Yida, I will find my older brother," Karim says. The other boys also mention family members or neighbours they plan to join in the settlement.
Between them, they count half a litre of water, some spare clothes and two bags of sesame seeds, a crop that flourishes even in the dry season in South Kordofan state. Noting a few ramshackle shelters and shops nearby, the boys hope to find some clean water before setting off again.
Yida refugee settlement is home to nearly 60,000 refugees from South Kordofan, with 70 per cent aged under 18 years. Among them are more than 1,300 children who, like Karim, were separated from their families while trying to reach safety.
With basic services such as water, shelter and food now readily available in Yida, Oteiza says it is no surprise that children begin showing symptoms of suffering as soon as their primary needs are met and they begin to feel safer.
"If a child starts to have recurrent nightmares or draws aeroplanes dropping bombs, it gives us clues that this child has experienced traumatic events and doesn't have the words to ventilate his or her emotions," she explains. "Now that many of these children have reached relative safety, the real challenge is figuring out how best to protect this child emotionally."
When people are struggling just to survive during war, flight and displacement, she adds, there is no time to focus on their own psychosocial needs. Mental health dysfunctions typically come to the forefront almost as soon as people begin to feel safe and protected.
UNHCR is helping thousands of children like Karim as soon as they reach Yida. For those who have family in the camp, UNHCR protection staff help them locate their relatives-although this can be a challenging task in a sprawling settlement like Yida.
For unaccompanied children without family members in the camp, UNHCR identifies a foster family from the same village or community. In each scenario, UNHCR ensures that the children's physical needs are met-in terms of water, shelter, food and more-and that they are provided a safe and secure emotional environment.
Oteiza expects to complete her initial assessment of the refugees' psychosocial needs in a few weeks. She will then work with communities to identify a range of culturally appropriate coping mechanisms and support activities to help children, and communities at large, begin to heal.
"Cinema and radio clubs, drama groups and other structured psychosocial activities are non-intrusive ways that children and adults can use to express their worries, their dreams and their concerns," she says. Such activities can help refugees begin to overcome their fears and develop the tools to find emotional stability and security. These longer-term programmes can be implemented with limited resources in many of the camps in Unity state and elsewhere in South Sudan.
While refugee children may manifest psychological symptoms more overtly, UNHCR is also taking steps to assist parents traumatized by displacement and the struggle to provide for their children the way they could at home.
"Because war disrupts the entire social fabric of a community, you cannot help children like Karim without also helping adults like his mother, who was forced to send him ahead on his own," says Oteiza. "We will work with all layers of communities to help them heal and make a lasting impact."
* Name changed for protection reasons
By Kathryn Mahoney in Yida, South Sudan