The scratching of crayons on paper fills the air as the children at Lazare camp in war-ravaged Central African Republic draw scenes from daily life. They draw armed men. Armoured vehicles. And they use red. Lots of red. In a makeshift tent, glasses perched on her nose and her feet in the dust, psychologist Mamie Nouria Meniko pores over the creations — an indicator of the children’s mental health, and a much-needed outlet. “Their problem is that they suffer daily exposure to violence,” she says. The 43-year-old Congolese runs a Red Cross programme at the displaced people’s camp to identify and help kids suffering from post-traumatic stress disorder (PTSD). “Drawing helps children to express what they are feeling. It shows what children cannot say out loud,” Nouria Meniko says. “Sometimes, some of them start crying as soon as they start drawing.” Years of violence The town of Kaga Bandoro housing the camp is a case study for the instability and violence that plagues the CAR. Some 330 kilometres (about 200 miles) north of the capital Bangui, the town lies on a strategic junction of routes used by nomadic cattle-herders. For five relentless years, Kaga Bandoro was in the hands of armed groups — militias who control four-fifths of the troubled country. Typically claiming to defend specific ethnic groups or religions, the militias fight for resources and carry out extortion and acts of violence. In a nationwide population of 4.5 million, thousands have lost their lives, nearly 650,000 have fled their homes and another 575,000 have left the country, according to UN figures as of December last year. Many children have seen beatings, rape or murder. Some have seen their homes invaded, their parents humiliated, hurt, abducted or killed. In Kaga Bandoro, relative calm returned last month with the arrival of the armed forces after the government and 14 warlords signed a peace pact in February — the eighth in a series of treaties. For now at least, the militiamen are confined to their base, although sporadic violence continues on the outskirts of town. Troubled kids The Red Cross programme has enabled Nouria Meniko to identify 233 children aged five to 15 who bear symptoms of PTSD. Seated on a mat, she asks a group of six children: “Who had a bad dream last night?” Three hands are raised. Holding her little sister on her lap, 10-year-old Florine confides her nightmare. “My mother and father came to pick me up but I told them I couldn’t come,” she says. Her parents were killed in 2013 by the Seleka, a mainly Muslim armed group. To help the children manage their trauma, the psychologist teaches them breathing and relaxation techniques. “When I feel bad, I do these exercises and I think of a nice meal,” says Florine, whose name has been changed to protect her identity. Dead father To her right sits 12-year-old Herve, attending his third therapy session. Herve’s drawings always show the same things: pickup trucks with machine guns mounted on the back. A body in a river. A hand in a well. A house on fire, with his dad inside. “I have to draw to get the images out of my head and be able to sleep,” he says. Herve’s mother, widowed by the Seleka in 2013, says the sessions have helped the boy and her relationship with him. “Before, he used to cry all night. This week, he’s only woken up five times.” The therapy also helps parents understand why a child may be craving attention or behaving aggressively. “Before, when he didn’t obey me and did something silly, I used to hit him,” Herve’s mother admits. “I didn’t understand. But now I know why he did that, and we talk to each other.” ‘Vicious circle’ Professor Jean-Chrysostome Gody, the head doctor at Bangui’s paediatric hospital, says mental problems linked to conflict are widespread in a country that has been gripped by violence since 2003. But the issue is also taboo. “It’s a real public-health problem,” Gody says. “Untreated trauma can cause depression and even lead to violence — it fuels the vicious circle.” Children such as Florine and Herve who have witnessed extreme violence have a lifelong burden, adds Nouria Meniko. “We can’t wipe out anything out,” the psychologist says with a sigh. “What we try to do is to help them live with the trauma.”