Theresa, a vivacious 16-year-old girl, last saw her parents when they were dragged away from her in a crush of people fleeing into neighbouring Guinea after a rebel attack on their town during the civil war (1991-2000).
She never found them again, and lived out the war and its aftermath in refugee camps, begging and selling her body to soldiers and men for scraps of food and money.
Today Sierra Leone is at peace and Theresa is living with an aunt in Koindu, a town in southeastern Sierra Leone that was a major rebel stronghold during the civil war.
She has a two year-old child, but does not know who the father is, because she has had many sexual partners since returning home.
She said her life has rarely felt like it was worth living. “I feel like I have no purpose, like there is no meaning to it,” she said. “I have no idea who the child’s father is. I have to struggle just to get clothes for us. I beg to eat.”
Alice Behrendt, who has studied the suicide risk of children in Togo, Burkina Faso, Liberia and Sierra Leone for the non-governmental organisation Plan International, said Theresa’s sense of hopelessness is common among war orphans, and even children who did not lose their parents during the war.
CLICK to read the story of other Sierra Leonean war orphans, brothers John and Mustapha and Joshua
High suicide risk
“Of all the countries I have studied, by far the most dramatic suicide rate was in Sierra Leone,” she said.
In Koindu, of the 180 children surveyed by Behrendt - 90 orphans and 90 other children - 59 percent had witnessed a suicide, and 70 percent had considered or attempted suicide themselves.
Among the orphans, only eight (out of 90) were not deemed a suicide risk.
“It’s not just the orphans who are at risk, because many children who did not lose their parents are living in environments where they are abused or which are violent in some way,” Behrendt said.
“The main difference for the orphans is that they generally have less self-esteem, lower social skills and more depression. There are more signs of post-traumatic stress disorder, more bedwetting and conduct problems.”
Female orphans were also likely to be involved in transactional sex she said. Fifty percent of the teenage girls interviewed by Plan International had got pregnant at some point and many had sexually transmitted diseases. “The girls prostitute themselves to survive. Some do it to pay their school fees.”
Communities are well aware of the problem, Behrendt says. However, local solutions have little in common with Western-style counselling and support mechanisms. Anyone found attempting suicide is punished either with a beating, or even by being taken to the police.
Lawrence James trained as a counsellor with a different NGO that used to work in Koindu; currently he receives funding from Plan International to visit suicidal orphans.
Breakdown of social relations
He blames the breakdown of social relations during the war for the total lack of support for the orphans. “People have lost their cultural values and their sense of community,” he said.
In a town where most people still live in burned out shells of ruined buildings with torn plastic and dry leaves as roofing, there is not enough to go around families, let alone to share with orphans.
“Poverty is the order of the day here,” he said. “Families just can’t cope with taking in another child - they want to focus on their own and themselves.”
James and two colleagues, Fatmata Bah and Mustapha Abdulai, work at improving relationships between orphans and their carers when they have them, and Plan International sometimes subsidises school fees so children can go to school.
Probing how children feel
The three counsellors also focus on helping the children build up the mental toughness to put their violent pasts behind them. Some of the children not only lost their parents in the war, but saw them killed, or were even forced to kill them themselves.
Often the counsellors are the first to probe how the children feel about what happened to them and those around them during the war. For the first week of treatment, the children usually just cry without talking.
Just getting them to speak about what happened to them is therefore seen as a victory.
But while family mediation and support can help, James says the good the counsellors can do is limited by the lack of economic opportunities or hope of a better life for the children.
Behrendt, the project manager, said as far as Plan International was concerned Koindu was just the beginning. The next step was to widen the catchment area to include children in more parts of Sierra Leone, Liberia and Guinea.
“There really is a story on every corner here,” she said. “Sometimes it feels like the towns are full of children that need help.”