This sample Child Soldiers Research Paper is published for educational and informational purposes only. Like other free research paper examples it is not a custom research paper. If you need help with writing your assignment, please use research paper writing services and buy a research paper on any topic.
Child soldiers can be any person under 18 associated with an armed group and fulfilling many roles that may or may not involve combat. An estimated 300 000 children across the globe are members of state militaries and other armed groups. Although armed groups used children throughout history, the widespread availability of small arms has made it physically possible for children to participate in a more lethal combat, thereby increasing their participation value. Children become involved in armed groups through abduction, threats, pressure, and manipulation. Voluntary association also occurs in the context of poverty, gender and ethnic discrimination, and state-sponsored violence. Among published studies of child soldiers, high levels of exposure to violence are reported. Moreover, post-traumatic stress disorder may affect more than half of all child soldiers at some point after association with armed groups. Postconflict factors such as educational and economic deprivation, stigmatization, and discrimination have been associated with adverse outcomes. Reintegration and rehabilitation is particularly difficult for girl soldiers. Potential protective factors for successful reintegration include community sensitization, cleansing rituals, transitional periods in interim care centers, religious support, psychosocial counseling, family mediation, and skills-based vocational training. Policy and advocacy is needed to provide educational and employment alternatives to children in place of joining armed groups; and, regulation and control of small arms trade is needed to reduce recruitment of children by armed groups.
- Ethical Conduct of Research and Interventions with Former Child Soldiers
- Child Soldier Experience in Life-History Context
- Presoldier and noncombatant experience
- Experience of child soldiers during association with armed groups
- Reintegration and postcombatant experience
- Reintegration Programs, Traditional Healing, and Other Interventions
- Mental Health of Former Child Soldiers
- Future Directions for Research and Intervention
One of the most pressing issues in global conflict is the exploitation of children by armed groups. An estimated 300 000 children across the globe are members of state militaries and other armed groups (UNICEF, 2003). The military recruitment of children has taken place in 86 countries and territories worldwide with approximately half of all child soldiers in African countries (Coalition to Stop the Use of Child Soldiers, 2008). Reflecting this pattern, the vast majority of published research on child soldiers comes from studies in Sierra Leone, Uganda, and Mozambique. Child soldiers are involved in a range of political conflicts such as formally recognized wars, terrorist activities, and ethnic conflict. Although armed groups have used children throughout history, the widespread availability of small arms has made it physically possible for children to participate in a more lethal manner and thus be of greater value to armed groups (Wessells, 2006).
The popular image, often used by organizations to raise funds to support intervention programs for former child soldiers, depicts rogue armed groups violently tearing children away from idyllic family settings and those children as faultless passive victim, psychologically devastated, and irreversibly damaged as a result of conflict. The story continues that these haphazard militias shatter children’s lives through the dehumanizing experiences of war, drugs, and crime. These children are also exposed to traumatic experiences and are often forced to commit atrocities themselves. Child soldiers are thus imagined as severely disabled because of the effects of psychological trauma. The final goal for recovery and rehabilitation is the return to and reunification with the child soldier’s family.
Although these portrayals do reflect actual cases, the situation of child soldiers is far more varied and complex (Betancourt et al., 2008a; Wessells, 2006). UNICEF and other groups working with child soldiers recognize that children associated with armed groups may assume a range of roles and are not always combatants: the 2007 Paris Principles refer to child soldiers as “children associated with armed forces or armed groups” (CAAFAG) meeting the following criteria:
any person below 18 years of age who is or who has been recruited or used by an armed force or armed group in any capacity, including but not limited to children, boys, and girls used as fighters, cooks, porters, messengers, spies, or for sexual purposes. It does not only refer to a child who is taking or has taken a direct part in hostilities.
UNICEF (2007): p. 7
Moreover, the reasons that children become associated with armed groups vary considerably. Contexts that promote recruiting children into armed groups are the result of larger national and international processes that produce local vulnerability. Poverty, gender and ethnic discrimination, and legacies of state-sponsored violence create circumstances in which children voluntarily join armed groups. Reintegration is also a complex process that varies widely across different conflicts and can be very different for children in the same conflict. While it might be assumed that removing a child from an armed group is the best approach, it is not a panacea to assure psychosocial well-being. The very focus of reintegration programs operates with an assumption that former child soldiers were previously integrated into their communities. In reality, some child soldiers join armed groups because they feel excluded from society. Reintegration not only means returning back home but also building and sustaining positive relationship, regaining identity, and managing their intrusive thoughts and reveries amidst the stigma they face as former child soldiers (Boothby and Thomson, 2013). Moreover, the tremendous variation in exposure to traumatic events during involvement with armed groups and in resilience among child soldiers throws into question whether psychological trauma is a universal response (Wessells, 2006). Lastly, local definitions of ‘children’ vary within and between cultural groups, such that individuals identified as ‘child soldiers’ by humanitarian groups may locally be considered adults (Kohrt and Maharjan, 2009). This diversity must be considered when understanding the experiences of child soldiers to best inform interventions to prevent recruitment of children into armed groups and to facilitate positive reintegration after leaving armed groups.
Ethical Conduct of Research and Interventions with Former Child Soldiers
Before discussing research and interventions, it is crucial to consider the ethical conduct when working with current and former child soldiers. Child soldiers are victims of exploitation through exposure to military association. Research and intervention should not be another form of exploitation. In conflict settings, research and intervention has the potential to violate the ‘do no harm’ ethic (Betancourt, 2011; Kohrt et al., 2010a; Wessells, 2009).
Harm can manifest as threats to safety and discrimination of former child soldiers, their families, and their communities. Research and intervention may expose child soldiers who have tried to hide their association with an armed group, thus placing them and their families in danger of revenge by other soldiers or aggrieved civilians. To address this potential harm, the best practices of research and service provision have advocated for working with the broader community, not exclusively focusing on child soldiers. Additionally, participation in research and interventions should not automatically identify a child as a former combatant publicly. A solution to this is the development of research and intervention programs that target a range of vulnerable children, rather than only child soldiers. For example, programs can also work with children with family members who have been targets of enforced disappearance, children whose family members have been tortured, and children in families who have been forcibly displaced. Research also risks stigmatization of former child soldiers (Annan et al., 2011; Betancourt et al., 2010a; Kohrt et al., 2008). Mental health problems carry a strong stigma in most parts of the world (Sartorius et al., 2005). Focusing on normative language related to idioms of distress can give children a therapeutic opportunity to share feelings and emotionally support other children in a nonstigmatizing atmosphere (Karki et al., 2009).
Participatory research is one approach that can help address some of the potential harms when research and intervention programs are dictated by outside actors. Participatory research provides a strong connection between research and intervention salient to the local community. Child soldiers identified psychosocial problems affecting them and processes to address these needs (Karki et al., 2009). The children themselves developed indicators to evaluate the effectiveness of interventions.
Child Soldier Experience in Life-History Context
Understanding the experience of child soldiers requires that the soldier experience be considered in the broader context of life history. Former child soldiers have a range of potential risk and resilience factors related to (1) presoldier and noncombatant experiences, (2) experiences during association with armed groups, and (3) postcombatant reintegration experience (see Figure 1).
Figure 1. Framework for life-history approach to risk factors for psychosocial problems among former child soldiers.
Presoldier and noncombatant experience
Exposure to trauma and other stressors as a child soldier cannot be considered the sole determinant of psychosocial well-being for former child soldiers. If all children’s problems are attributed exclusively to war, interventionists and policy makers risk misapplication of care in resource poor settings (Derluyn et al., 2013). More detailed knowledge of the impact of political violence versus other chronic social problems can lead to better-informed interventions in postconflict settings with scarce resources (IASC, 2007). Children’s experiences before becoming a child soldier and the experience of stressors outside of their combatant roles need to be taken into account. One of the important issues is to understand that the threats to child well-being are structural conditions in the presoldier context. Contexts that promote recruiting children into armed groups are the result of larger national and international processes that produce local vulnerability. Poverty, gender and ethnic discrimination, and legacies of state-sponsored violence create circumstances in which children voluntarily join armed groups (Kohrt et al., 2010b). Poverty, especially, is an impediment to well-being of children. Poverty creates risks for violence and exploitation of children.
Countries where children are exploited through involvement in armed group are also likely to be countries where children are exploited for labor in other domains (United Nations, 2005). Children are relied upon heavily for labor in most subsistence agricultural settings. Children are also trafficked to urban centers and other countries for manual labor and commercial sex work. Children have been used for their labor in garment factories, brick manufacturing plants, and mines where they are vulnerable to both mechanical and respiratory injuries.
Another preconscription issue is the lack of education in many settings vulnerable to conflict. The opportunity for education is tied strongly to economic status and potential to avoid conscription (Betancourt et al., 2008b). The quality of education is tied strongly to economic status and potential to avoid conscription. In Mozambique, school drop-out students were recruited into armed forces with promises of better future (Boothby and Thomson, 2013).
Another major problem for children worldwide is abuse and neglect. Due to high rates of alcoholism, caregivers expose children to domestic violence and abuse. In addition to abuse, children suffer from neglect: because of endemic poverty, children are often unable to have their basic needs met. Moreover, in conflict-affected countries in Africa and Asia, there are few laws to protect children from child abuse and even fewer avenues for enforcement in most settings where children have been conscripted into armed groups (United Nations, 2005). Abuse and neglect creates vulnerability to recruitment. Child marriage is also child abuse. Child marriage was a common historical practice and still occurs in many settings where children have been used as combatants. Legacies of child marriage make girls vulnerable to being abducted as ‘bush wives’ for older men in military groups (McKay and Mazurana, 2004). In Nepal, fleeing from child marriage was a reason girls cited for joining armed groups (Kohrt et al., 2010b).
Gender discrimination is a profound factor that increases vulnerability to a range of psychosocial and mental health problems. Countries with a legacy of exploiting children as combatants score on the lower end of the Gender Development Index and Gender Empowerment Index. This pattern reflects the difference between women and men in the burden of labor; women are more poorly compensated than men. Lack of empowerment of girls may make them vulnerable to recruitment into armed groups as sexual slaves (Stark, 2006). In some settings, lack of opportunities for women may lead girls to join armed groups as a form of empowerment (Kohrt et al., 2010b).
Experience of child soldiers during association with armed groups
The first issue to consider regarding association with armed groups is how a child was conscripted, as this may be a major determinant of subsequent well-being. Children become involved in armed groups through abduction, threats, pressure, manipulation and voluntary association. It is helpful to consider a division of risk factors for conscription into ‘push factors’ and ‘pull factors’ (Somasundaram, 2002). ‘Push factors’ are those factors that place an individual at risk of recruitment. Poor economic conditions, unemployment, and inability to meet basic needs in the community were reasons for joining. Children may join because of lack of opportunities in their communities and family problems. Girls may join to escape abusive marriages or may join prior to entering forced marriages. ‘Pull factors’ are aspects of the armed group that include both methods of recruitment, enticement, and promises made to children.
The most extreme ‘pull factor’ is abduction. Across the studies included in a recent systematic review (Betancourt et al., 2013a), abduction was the main mechanism by which children reported becoming involved with an armed group. Children in Mozambique were forcibly be made to join armed groups through kidnapping and abduction where they go through a series of cohesive and inhuman training and indoctrination before being integrated into armed forces; the children were kidnapped, separated gender-wise, and boys forcibly sent to armed forces while girls were made to serve the soldiers (Boothby and Thomson, 2013). In a study in Uganda among 330 sample child soldiers 99.7% were forcefully abducted (Klasen et al., 2013). However, in a Nepal study, nearly half of study participants joined without abduction (Kohrt et al., 2008), as did 18 out of 19 former child soldiers in the study from Sri Lanka (De Silva et al., 2001). In a study from El Salvador of 293 former child soldiers, 73.7% of study participants reported joining voluntarily and 3.4%reported forced conscription (Santacruz and Arana, 2002). In these studies, ideological reasons for joining voluntarily included revenge, martyrdom, and ‘desire to defend the motherland.’ Other subjects reported joining out of fear of abduction.
Across the published studies of child soldiers, high levels of exposure to violence during association were reported. For example, several studies found that over 70% of child soldiers were severely beaten by armed forces, with similar rates reported by boys and girls (Amone-P’Olak, 2005; Amone-P’Olak et al., 2007; Bayer et al., 2007; Betancourt et al., 2011; Klasen et al., 2010; Kohrt et al., 2008). In an Ugandan study, more than half of the 330 sample child soldiers reported being directly involved in fighting, looting property, and injuring and killing other people (Klasen et al., 2013).
High levels of sexual abuse among girls were observed in samples from Sierra Leone (44%; Betancourt et al., 2011) and Uganda (30%; Klasen et al., 2010), as well as a mixed sample from Uganda and the DRC (57%; Bayer et al., 2007). Within the armed groups in Mozambique, girls were made to serve the commanders and soldiers as wives, servants and cargo carriers (Boothby and Thomson, 2013). Many girl child soldiers from African countries have reported sexual violence. This contrasts with Asian countries including Sri Lanka, Nepal, and the Philippines where intimate sexual or personal relationships without the female’s consent and commander’s approval were forbidden and would be punished. However, girls in the Philippines and Colombia have agreed to sexual relationships within groups if they knew it brought them some kind of benefits (Stevens, 2014). Boys were also victims of sexual abuse in these settings, although only Amone- P’Olak (2005) found higher rates of sexual abuse among boys (81 vs 72%) as compared to girls.
Reintegration and postcombatant experience
While it might be assumed that removing a child from an armed group is the best approach, it does not assure psychosocial well-being. Increasingly, researchers have shown that the postcombatant reintegration experience is one of the main determinants of mental health, psychosocial well-being, educational outcomes, and livelihood (Annan et al., 2013).
Former child soldiers struggle with community stigma upon return home (Annan et al., 2009; Burman and McKay, 2007; Denov and Maclure, 2007; Denov, 2010; Shakya, 2010; Stark, 2006). For many adults, child soldiers are seen as threatening and morally corrupted (Boyden, 2003). In Sierra Leone stigma and perceived discrimination for being a former child soldier was significantly associated with worsening of posttraumatic stress symptoms over time (Betancourt et al., 2013b). In El Salvador, participants who experienced stigma scored higher on a psychological impact scale, as did youth who experienced feelings of disappointment upon return home (Santacruz and Arana, 2002). Longitudinal data from Sierra Leone indicated that stigma predicted higher levels of hostility/ externalizing problems (such as behavioral problems characteristic of attention deficit disorder, oppositional defiant disorder, and conduct disorder) as well as deficits in prosocial behaviors over time, even after adjusting for war exposures (Betancourt et al., 2010a,c). In Uganda, abductees and non-abductees experienced similar levels of family and community rejection, while non-abductees were more likely to engage in prosocial behaviors such as participation in politics and community activities (Blattman, 2009).
Stigma may be connected with local idioms of distress associated with perpetration of violence. A study in Uganda found that the failure of reintegration was associated with widespread community resistance due to perceived unaccountability for the crimes committed and persecution from revenging spirits (cen) of those who have been killed (Akello et al., 2006). Community members perceived that minors committed war crimes and were free from punishment for their acts. Regarding cen, community members and child soldiers themselves perceived that child soldiers were being punished by spirits of persons they had killed. Therefore, the community avoided these child soldiers because of fear of their violent pasts and their affliction with spiritual afflictions related to their misdeeds.
Across settings, girls appear to suffer greater stigma and negative experiences during reintegration. There are estimated 120 000 female child soldiers worldwide and reintegration is particularly difficult for them (Stevens, 2014). Studies that stratified community acceptance by gender indicated differences in the ways families and communities treated returning boys compared to girls. In Sierra Leone, female former child soldiers experienced lower rates of acceptance as compared to their male counterparts (Betancourt et al., 2010b) and were commonly described as being akin to ‘prostitutes’ (Betancourt et al., 2008b). Girls in one study from Uganda also reported experiencing less community support (Annan et al., 2011). The trend continues even in Nepal where a study reported girl child soldiers experiencing gender-based community stigma related to local perceptions that their Hindu purity had been violated (Kohrt et al., 2010b). However, in a longitudinal study among child soldiers of Sierra Leone, girls demonstrated higher rates of improvement across the 4- year follow-up period (Betancourt et al., 2013b).
In addition to stigma and discrimination, postconflict factors such as educational and economic deprivation are associated with adverse outcomes (Betancourt et al., 2010a; Blattman and Annan, 2010; Wessells, 2009). Most studies have found that former child soldiers felt ill-equipped to contribute to their family economy upon return to civilian life (Annan et al., 2006; Boothby et al., 2006). In Uganda, access to resources have been identified as an important factor to help the child soldiers break away from their child soldier experiences, cope with bad feelings and mental health problems including nightmare, suicidal thoughts, and hallucination (Vindevogel et al., 2013a).
Reintegration means building positive relationships and coping with their intrusive feelings and stigma they face as former child soldiers (Boothby and Thomson, 2013). Family, community and peer support have been identified as important factors facilitating successful reintegration and psychosocial well-being. Family and community acceptance along with religious and spiritual cleansing ceremonies are important factors that facilitated successful social reintegration of former child soldiers of Mozambique (Boothby and Thomson, 2013). In Sierra Leone, higher levels of family acceptance were linked to lower average levels of emotional distress among participants (Betancourt et al., 2010a,c). In this setting, caregiver–child open communication about traumatic experiences, and perpetration of violence in particular, might have a beneficial effect on positive adjustment outcomes (Borisova et al., 2013). Caregiver’s adequate knowledge of direct violence was predictive of reported levels of depression among adolescents and of positive adjustment outcomes like prosocial attitudes, confidence, and self-agency. Supportive parenting was associated with better psychosocial adjustment in one study of Ugandan child soldiers (Derluyn et al., 2004). In Nepal, peer-related support was a strong predictor of psychosocial well-being: former child soldiers having strong peer support experienced increased hope and fewer posttraumatic stress disorder (PTSD) symptoms as well as reported better performance in daily functioning (Morley and Kohrt, 2013).
In Uganda, access to resources was linked with the child soldiers overcoming their current challenges, belonging to their returned environment, and a sense of being whom they wanted to be (Vindevogel et al., 2013a). Returning to and staying in school was associated with higher levels of confidence and prosocial behaviors among youth in a Sierra Leone study (Betancourt et al., 2010b).
Reintegration Programs, Traditional Healing, and Other Interventions
Facilitating successful reintegration of former child soldiers is one of the goals of the United Nations disarmament, demobilization, and reintegration (DDR) framework. Reintegration programs for child soldiers typically comprise economic and education support packages such as vocational training, apprenticeships, micro-finance loans, and formal or informal schooling. The intention of these programs is to prevent or mitigate the social, economic, and psychological sequelae of participation in an armed group. DDR programs should also involve caregivers and families in tangible ways to promote psychosocial well-being of reintegrated child soldiers (Borisova et al., 2013).
Potential protective factors for successful reintegration include community sensitization, cleansing rituals, transitional periods in interim care centers, religious support, psychosocial counseling, family mediation, and skills-based vocational training (Boothby, 2006; Kryger and Lindgren, 2011; Williamson, 2006). Attending school and training programs is considered critical in helping war-affected youth attaining a sense of normalcy and safety in their everyday lives while also increasing their future employment opportunities (Betancourt and Khan, 2008). In a study in Uganda, former child soldiers who were given the opportunity to continue their education scored lower on assessments of depression, compared to those who directly entered vocational training (Ovuga et al., 2008). Involvement of family is also crucial for effective interventions. In Sierra Leone inclusion of family-based elements resulted into greater impact of an intervention (Betancourt et al., 2013b).
A study of multisectorial reintegration assistance in Burundi found that former child soldiers who were socially integrated within communities had high work/employment rates, literacy rates above national average, and no differences in present functioning and mental health compared to never-recruited peers (Jordans et al., 2012). While coaching, on-the-job and vocational training and provision of material kits were associated with improved socioeconomic reintegration trajectories, a sense of satisfaction with received services is most strongly and recurrently associated with better outcomes. Community connection and a sense of future were also identified as protective factors among Colombian former child soldiers (Cortes and Buchanan, 2007). In the study, six Colombian child soldiers identified the factors that helped them overcome the effects of war. Feeling connected to the community and hope for the future were key factors. This was reflected in Nepal as well were having a sense of foreshortened future (i.e., thinking that one will not live as long as one’s peers) was one of the strongest predictors of poor functioning in school, work, and social activities among children exposed to political violence (Kohrt et al., 2011).
Given the high burden of stigma and psychosocial problems among former child soldiers, using traditional healing rituals is an important trend in humanitarian interventions, particularly as combined with Western mental health services. Psychosocial practitioners, as well as anthropologists and other social scientists, have increasingly questioned the appropriateness and effectiveness of Western psychiatric therapies for survivors of mass violence, especially for children (Bracken and Petty, 1998; Psychosocial Working Group, 2003; Summerfield, 1998). In a Mozambique study, these traditional ceremonies played a vital role in rebuilding community trust and cohesion, as these ceremonies were believed to clean the child soldiers from their ‘contaminated’ atrocities of war (Boothby and Thomson, 2013).
In a study of former male child soldiers in Mozambique, traditional cleansing rituals were seen as promoting community acceptance (Boothby, 2006). In Sierra Leone, communities and families employed ‘rituals of welcome’ to incorporate returned girl soldiers into acceptable social positions (McKay and Mazurana, 2004). Honwana (2006) describes traditional healers in Angola conducting communal cleansing rituals for child soldiers to purify them of their exposure to killing. In Mozambique, traditional healers facilitated reintegrating ex-combatants by ‘taking the war out of the people,’ (Nordstrom, 1997: p. 146).
Reunification rituals or rituals of reintegration, however, may come at a cost to former child soldiers. For example, child soldiers are threatening to adults because they do not fall into socially expected roles of submission to adult authority (Boyden, 2003). Rituals may restore the expected socially submissive role of children, but this may represent a lost opportunity for children to gain a greater voice in social processes. The issue of girl soldiers exemplifies this challenge. Traditional rituals often reinforce gender discrimination by promoting the status of ‘(older) males’ and “threaten the human security and well-being of women and girls” (Denov, 2007). Furthermore, Denov adds, “when assessing whether ‘culture is always right’, one cannot discount . the reality and implications of gendered exclusionary practices.” Girl soldiers are particularly threatening for patriarchal societies. Therefore, adults use ritual to disempower girls and return them to socially acceptable subjugated roles. This raises the question of whether restorative rituals are the best practice for reintegration of child soldiers, particularly for girl soldiers. In Nepal, girls soldiers refused to participate in rituals during reintegration because they were perceived as a form of subjugation and antithetical to the reason they originally joined armed groups (Kohrt, 2015).
The peer-reviewed literature on former child soldiers includes few systematic studies of interventions to inform major policy decisions. In Côte d’Ivoire, 345 former child soldiers were enrolled in trauma-focused counseling supplemented by therapeutic workshops, literacy workshops, and resocialization exercises (Bissouma et al., 2010); in a pilot study in Liberia, 130 former child soldiers participated in a brief trauma-focused intervention (Gregory and Embrey, 2009). Two intervention trials were conducted in northern Uganda: Bolton and colleagues conducted a randomized controlled trial of Interpersonal Therapy with 314 war-affected youth (Betancourt et al., 2012; Bolton et al., 2007). Ertl et al. (2011) used three arms to compare Narrative Exposure Therapy, an academic catch-up and supportive counseling group, and a waitlist control condition among 85 former child soldiers, with significantly greater reduction of PTSD symptoms in the narrative group. In a randomized controlled trial in the Eastern DRC, Narrative Exposure Therapy for Forensic Offender Rehabilitation (FORNET) was offered to 15 ex-combatants with the goal of reducing traumatic stress and appetitive aggression compared to ‘treatment as usual.’ The results showed that FORNET helped reducing the severity of PTSD symptoms but not the levels of appetitive aggression (Hermenau et al., 2013). More research is needed to identify effective common elements in child soldier interventions as well as context specific elements for successful promotion of well-being.
Mental Health of Former Child Soldiers
It is difficult to make generalized conclusions about prevalence of mental health problems among former child soldiers, and it is especially difficult to isolate the effect of soldiering trauma on mental health among the range of other stressors that child soldiers experience such as poverty, lack of education, and stigma and discrimination. Variations in prevalence rates of mental health problems are in part attributable to problems in methodology, sampling, and instrumentation. There is notable heterogeneity in PTSD prevalence among studies with similar research designs. For example, in studies of formerly abducted youth in rehabilitation centers in northern Uganda, documented PTSD rates ranged from 99% (Amone-P’Olak, 2005; Amone-P’Olak et al., 2007) to 27% (Okello et al., 2007). Also in northern Uganda, one study investigating PTSD symptoms among 71 former child soldiers determined that PTSD symptoms were present in 97% of the sample (Derluyn et al., 2004).
It is now being suggested that research should extend beyond PTSD to tackle what is currently known about perpetration-induced trauma (Klasen et al., 2013). Another measure called Development Trauma Disorder (DTD) has been developed. In an Uganda study 80% of the sample former child soldiers met criteria for DTD while only 33% met criteria for PTSD, which supports that classic PTSD symptoms do not capture the overall trauma affect (Klasen et al., 2013).
Children may continue to suffer from psychological problems years after reintegration. In Uganda the effect of war-related trauma was seen even 6 years after the end of the war reflecting the adverse and long-term mental health effect on former child soldiers (Amone-P’Olak et al., 2014). Postwar environment are a key determinant of continued mental health problems in former child soldiers (Amone-P’Olak et al., 2014).
One question is whether child soldiering has a more negative impact on girls compared to boys. Female gender was a predictor of poorer mental health in studies in Sierra Leone (Betancourt et al., 2011) and Nepal (Kohrt et al., 2008). In the Sierra Leone research, more females scored within the clinical range for anxiety (80% girls vs 52% of boys) as well as depression (72% girls vs 55% of boys). When controlling for war exposures, female gender was significantly associated with lower levels of confidence and prosocial behaviors over time (Betancourt et al., 2010b, 2011). In the Nepal sample, there was a significant interaction between gender and child soldier status: girl soldiers had six times greater odds of having PTSD compared to those never conscripted, whereas boy soldiers had nearly three times greater odds of having PTSD compared with never-conscripted boys (Kohrt et al., 2008).
Comparing samples of children in the same conflict who were not conscripted in armed groups to child soldiers is an approach to identify the unique contribution of child soldiering on mental health. In studies with comparison groups, PTSD prevalence was greater among former child soldiers compared with never-conscripted children (Kohrt et al., 2008; MacMullin and Loughry, 2004; Okello et al., 2007; Vindevogel et al., 2013b). In Nepal, this distinction was maintained even after controlling for exposure to violence (Kohrt et al., 2008). By contrast, studies fromnorthern Uganda found little difference in psychosocial distress levels between former child soldiers and comparison groups (Betancourt et al., 2013b).
Future Directions for Research and Intervention
With the growing knowledge about child soldiers, there are new directions in prevention and reintegration activities. Jordans and colleagues (Jordans et al., 2012) argue that successful reintegration is about the equality in opportunities, participation, well-being, and social functioning of former child soldiers compared to those of their never-conscripted peers. Reintegration also means building positive relationship in face of stigma they face as former child soldiers (Boothby and Thomson, 2013). Whether or not a former child soldier has found employment, is married, received education, or experiences few mental health problems are indicators of long-term reintegration primarily vis-à-vis the average of the population at large or their peers.
There is a need to consider long-term development of mental health care services rather than services that attend to acute relief efforts. World regions affected by war and armed conflict often lack a standing and effective mental health care system, especially for children. There is a need to consider how the energy, human resources, and finances invested during the postconflict period can be extended to services that will last beyond the acute bolus of support. Amone-P’Olak et al. (2014) argues that policies and interventions to reduce long-term mental ill-health should address both postwar environment and mental health care as complementary. Strengthening the health systems in war-affected regions to respond to the mental health situation through both psychosocial interventions and mental health treatment should be prioritized (Amone-P’Olak et al., 2014). Moreover, in postconflict settings, mental health and psychosocial problems after war may be as related to chronic structural violence factors as to war-related exposures. Interventions should strongly consider chronic social problems as well as war trauma.
To prevent recruitment of child soldiers, interventions at the national level are needed to promote the inclusion of children’s issues and voices. Through dialogue with policy makers, advocacy is needed for increased child protection to tackle abuses such as forced child marriage and child conscription in armed groups, as well as further capacity building of local institutions concerned with human rights protection, which currently often take place in a culture of impunity. Further initiatives are required whereby children’s voices could be incorporated in planning, designing and monitoring, and evaluation of child protection programs. At the macro-social level, there also needs to be interventions to address the issues of poverty, ethnic discrimination, gender discrimination, protection of human rights, and decentralization of power.
At a more fundamental level, structural violence including poverty, inequality, and militarization are key issues. Policy and advocacy is needed to reduce the small arms trade that makes child soldiers more appealing, and to reduce the provision of large arms to militaries. Moreover, there should be continued international political pressure to encourage more representative inclusion of women, and ethnic minorities in governments in conflict-affected countries to assure that their needs are met during the rebuilding of society. International political pressure is needed to ensure a transitional justice process that allows for the involvement and participation of children and youth in political processes in postconflict societies. A clear mechanism for children to express their political rights, such as in the Truth and Reconciliation Bill, and citizenship is needed to supplant the system of child exploitation by political groups. International pressure and monitoring bodies, such as the 1612 U.N. Task Force (United Nations, 2005), can foster enactment of child-centered legislation and assure that political and legal processes meet international standards.
- Akello, G., Richters, A., Reis, R., 2006. Reintegration of former child soldiers in northern Uganda: coming to terms with children’s agency and accountability. Intervention 4 (3), 229–243.
- Amone-P’Olak, K., 2005. Psychological impact of war and sexual abuse on adolescent girls in northern Uganda. Intervention: International Journal of Mental Health, Psychosocial Work & Counselling in Areas of Armed Conflict 3 (1), 33–45.
- Amone-P’Olak, K., Stochl, J., Ovuga, E., Abbott, R., Meiser-Stedman, R., Croudace, T.J., Jones, P.B., 2014. Postwar environment and long-term mental health problems in former child soldiers in northern Uganda: the WAYS study. Journal of Epidemiology and Community Health. http://jech.bmj.com/content/68/5/425
- Amone-P’Olak, K., Garnefski, N., Kraaij, V., 2007. The impact of war experiences and physical abuse on formerly abducted boys in northern Uganda. South African Psychiatry Review 10, 76–82.
- Annan, J., Blattman, C., Horton, R., 2006. The State of Youth and Youth Protection in Northern Uganda: Findings from the Survey of War Affected Youth. UNICEF, New York.
- Annan, J., Brier, M., Aryemo, F., 2009. From “Rebel” to “Returnee”: daily life and reintegration for young soldiers in northern Uganda. Journal of Adolescent Research 24 (6), 639–667.
- Annan, J., Blattman, C., Mazurana, D., Carlson, K., 2011. Civil war, reintegration, and gender in northern Uganda. Journal of Conflict Resolution 55 (6), 877–908.
- Annan, J., Green, E.P., Brier, M., 2013. Promoting recovery after war in northern Uganda: reducing daily stressors by alleviating poverty. Journal of Aggression, Maltreatment & Trauma 22 (8), 849–868.
- Bayer, C.P., Klasen, F., Adam, H., 2007. Association of trauma and PTSD symptoms with openness to reconciliation and feelings of revenge among former Ugandan and Congolese child soldiers. Journal of the American Medical Association 298 (5), 555–559.
- Betancourt, T.S., Borisova, I., Rubin-Smith, J., Gingerich, T., Williams, T., Agnew- Blais, J., 2008a. Psychosocial Adjustment and Social Reintegration of Children Associated with Armed Forces and Armed Groups: The State of the Field and Future Directions. Psychology Beyond Borders and the Francois-Xavier Bagnoud Center for Health and Human Rights/Harvard School of Public Health, Cambridge, Massachusetts, p. 97.
- Betancourt, T.S., Khan, K.T., 2008. The mental health of children affected by armed conflict: protective processes and pathways to resilience. International Review of Psychiatry 20 (3), 317–328.
- Betancourt, T.S., Simmons, S., Borisova, I., Brewer, S.E., Iweala, U., de la Soudiere, M., 2008b. High hopes, grim reality: reintegration and the education of former child soldiers in Sierra Leone. Comparative Education Review 52 (4), 565–587.
- Betancourt, T.S., Agnew-Blais, J., Gilman, S.E., Williams, D.R., Ellis, B.H., 2010a. Past horrors, present struggles: the role of stigma in the association between war experiences and psychosocial adjustment among former child soldiers in Sierra Leone. Social Science & Medicine 70 (1), 17–26.
- Betancourt, T.S., Borisova, I.I., Brennan, R.B., Williams, T.P., Whitfield, T.H., de la Soudiere, M., Gilman, S.E., 2010b. Sierra Leone’s former child soldiers: a followup study of psychosocial adjustment and community reintegration. Child Development 81 (4), 1077–1095.
- Betancourt, T.S., Brennan, R.T., Rubin-Smith, J., Fitzmaurice, G.M., Gilman, S.E., 2010c. Sierra Leone’s former child soldiers: a longitudinal study of risk, protective factors, and mental health. Journal of the American Academy of Child & Adolescent Psychiatry 49 (6), 606–615.
- Betancourt, T.S., 2011. Attending to the mental health of war-affected children: the need for longitudinal and developmental research perspectives. Journal of the American Academy of Child & Adolescent Psychiatry 50 (4), 323–325.
- Betancourt, T.S., Borisova, I., de la Soudière, M., Williamson, J., 2011. Sierra Leone’s child soldiers: war exposures and mental health problems by gender. Journal of Adolescent Health 49 (1), 21–28.
- Betancourt, T.S., Newnham, E.A., Brennan, R.T., Verdeli, H., Borisova, I., Neugebauer, R., Bolton, P., 2012. Moderators of treatment effectiveness for waraffected youth with depression in northern Uganda. Journal of Adolescent Health 51 (6), 544–550.
- Betancourt, T.S., Borisova, I., Williams, T.P., Meyers-Ohki, S.E., Rubin-Smith, J.E., Annan, J., Kohrt, B.A., 2013a. Research review: psychosocial adjustment and mental health in former child soldiers – a systematic review of the literature and recommendations for future research. Journal of Child Psychology and Psychiatry 54 (1), 17–36.
- Betancourt, T.S., Newnham, E.A., McBain, R., Brennan, R.T., 2013b. Post-traumatic stress symptoms among former child soldiers in Sierra Leone: follow-up study. The British Journal of Psychiatry 203, 196–202.
- Bissouma, A.C., Te Bonle, D.M., Yeo-Tenena, J.M.Y., Moke, B.L., Kipre-Koiho, A., 2010. Profil psychopathologique des enfants associés au combat à l’ouest de la Côte d’Ivoire. Neuropsychiatrie de l’Enfance et de l’Adolescence 58 (6–7), 410–415.
- Blattman, C., 2009. From violence to voting: war and political participation in Uganda. American Political Science Review 103 (02), 231–247.
- Blattman, C., Annan, J., 2010. The consequences of child soldiering. Review of Economics and Statistics 92 (4), 882–898.
- Bolton, P., Bass, J., Betancourt, T., Speelman, L., Onyango, G., Clougherty, K.F., Verdeli, H., 2007. Interventions for depression symptoms among adolescent survivors of war and displacement in northern Uganda: a randomized controlled trial. Journal of the American Medical Association 298 (5), 519–527.
- Boothby, N., 2006. What happens when child soldiers grow up? The Mozambique case study. Intervention: International Journal of Mental Health, Psychosocial Work & Counselling in Areas of Armed Conflict 4 (3), 244–259.
- Boothby, N., Crawford, J., Halperin, J., 2006. Mozambique child soldier life outcome study: lessons learned in rehabilitation and reintegration efforts. Global Public Health 1 (1), 87–107.
- Boothby, N., Thomson, B., 2013. Child soldiers as adults: the Mozambique case study. Journal of Aggression, Maltreatment & Trauma 22 (7), 735–756.
- Borisova, I.I., Betancourt, T.S., Willett, J.B., 2013. Reintegration of former child soldiers in Sierra Leone: the role of caregivers and their awareness of the violence adolescents experienced during the war. Journal of Aggression, Maltreatment & Trauma 22 (8), 803–828.
- Boyden, J., 2003. The moral development of child soldiers: what do adults have to fear? Peace and Conflict: Journal of Peace Psychology 9 (4), 343–362.
- Bracken, P., Petty, C., 1998. Rethinking the Trauma of War. Free Association Books, New York.
- Burman, M.E., McKay, S., 2007. Marginalization of girl mothers during reintegration from armed groups in Sierra Leone. International Nursing Review 54 (4), 316–323.
- Coalition to Stop the Use of Child Soldiers, 2008. Child Soldiers: Global Report 2008. London.
- Cortes, L., Buchanan, M.J., 2007. The experience of Columbian child soldiers from a resilience perspective. International Journal for the Advancement of Counselling 29, 43–55.
- De Silva, H., Hobbs, C., Hanks, H., 2001. Conscription of children in armed conflict – a form of child abuse. A study of 19 former child soldiers. Child Abuse Review 10, 125–134.
- Denov, M., 2007. Is culture always right? The dangers of reproducing gender stereotypes and inequalities in psychosocial interventions for war-affected children. In: Dowdney, L. (Ed.), Psychosocial Web Pge. Coalition to Stop the Use of Child Soldiers, London.
- Denov, M., Maclure, R., 2007. Turnings and epiphanies: militarization, life histories, and the making and unmaking of two child soldiers in Sierra Leone. Journal of Youth Studies 10 (2), 243–261.
- Denov, M., 2010. Coping with the trauma of war: former child soldiers in post-conflict Sierra Leone. International Social Work 53 (6), 791–806.
- Derluyn, I., Broekaert, E., Schuyten, G., De Temmerman, E., 2004. Posttraumatic stress in former Ugandan child soldiers. Lancet 363 (9412), 861–863.
- Derluyn, I., Vindevogel, S., De Haene, L., 2013. Toward a relational understanding of the reintegration and rehabilitation processes of former child soldiers. Journal of Aggression, Maltreatment & Trauma 22 (8), 869–886.
- Ertl, V., Pfeiffer, A., Schauer, E., Elbert, T., Neuner, F., 2011. Community-implemented trauma therapy for former child soldiers in northern Uganda. JAMA: The Journal of the American Medical Association 306 (5), 503–512.
- Gregory, J., Embrey, D.G., 2009. Reducing the effects of profound catastrophic trauma for former child soldiers: companion recovery model. Traumatology 15 (1), 52–62.
- Hermenau, K., Hecker, T., Schaal, S., Maedl, A., Elbert, T., 2013. Addressing posttraumatic stress and aggression by means of narrative exposure: a randomized controlled trial with ex-combatants in the eastern DRC. Journal of Aggression, Maltreatment & Trauma 22 (8), 916–934.
- Honwana, A., 2006. Child Soldiers in Africa. University of Pennsylvania Press, Baltimore, MD.
- IASC, 2007. Guidelines on Mental Health and Psychosocial Support in Emergency Settings. Inter-Agency Standing Committee, Geneva.
- Jordans, M.J.D., Komproe, I.H., Tol, W.A., Ndayisaba, A., Nisabwe, T., Kohrt, B.A., 2012. Reintegration of child soldiers in Burundi: a tracer study. BMC Public Health 12.
- Karki, R., Kohrt, B.A., Jordans, M.J.D., 2009. Child led indicators: pilot testing a child participation tool for psychosocial support programmes for former child soldiers in Nepal. Intervention: International Journal of Mental Health, Psychosocial Work & Counselling in Areas of Armed Conflict 7 (2), 92–109.
- Klasen, F., Oettingen, G., Daniels, J., Adam, H., 2010. Multiple trauma and mental health in former Ugandan child soldiers. Journal of Traumatic Stress 23, 573–581.
- Klasen, F., Gehrke, J., Metzner, F., Blotevogel, M., Okello, J., 2013. Complex trauma symptoms in former Ugandan child soldiers. Journal of Aggression, Maltreatment & Trauma 22 (7), 698–713.
- Kohrt, B.A., Jordans, M.J., Tol, W.A., Speckman, R.A., Maharjan, S.M., Worthman, C.M., Komproe, I.H., 2008. Comparison of mental health between former child soldiers and children never conscripted by armed groups in Nepal. The Journal of the American Medical Association 300 (6), 691–702.
- Kohrt, B.A., Maharjan, S.M., 2009. When a child is no longer a child: Nepali ethnopsychology of child development and violence. Studies in Nepali History and Society 14 (1), 107–142.
- Kohrt, B.A., Jordans, M.J., Morley, C.A., 2010a. Four principles of mental health research and psychosocial intervention for child soldiers: lessions learned from Nepal. International Psychiatry 7 (3), 58–60.
- Kohrt, B.A., Tol, W.A., Pettigrew, J., Karki, R., 2010b. Children and revolution: the mental health and psychosocial wellbeing of child soldiers in Nepal’s Maoist Army. In: Singer, M., Hodge, G.D. (Eds.), The War Machine and Global Health. Altamira Press: Rowan & Littlefield Publishers, Inc., Lanham, MD, pp. 89–116.
- Kohrt, B.A., Jordans, M.J., Tol, W.A., Luitel, N.P., Maharjan, S.M., Upadhaya, N., 2011. Validation of cross-cultural child mental health and psychosocial research instruments: adapting the depression self-rating scale and child PTSD symptom scale in Nepal. BMC Psychiatry 11 (1), e127.
- Kohrt, B.A., 2015. The role of traditional rituals for reintegration and psychosocial wellbeing of child soldiers in Nepal. In: Hinton, A.L., Hinton, D.E. (Eds.), Legacies of Mass Violence. Cambridge University Press.
- Kryger, L.S., Lindgren, C.L., 2011. Fighting for a future: the potential for posttraumatic growth among youths formerly associated with armed forces in northern Uganda. Intervention 9 (1), 6–20.
- MacMullin, C., Loughry, M., 2004. Investigating psychosocial adjustment of former child soldiers in Sierra Leone and Uganda. Journal of Refugee Studies 17 (4), 460–472.
- McKay, S., Mazurana, D., 2004. Where Are the Girls? Girls in Fighting Forces in Northern Uganda, Sierra Leone, and Mozambique. Rights and Democracy, Montreal.
- Morley, C.A., Kohrt, B.A., 2013. Impact of peer support on PTSD, hope, and functional impairment: a mixed-methods study of child soldiers in Nepal. Journal of Aggression, Maltreatment & Trauma 22 (7), 714–734.
- Nordstrom, C., 1997. A Different Kind of War Story. University of Pennsylvania Press, Philadelphia.
- Okello, J., Onen, T., Musisi, S., 2007. Psychiatric disorders among war-abducted and non-abducted adolescents in Gulu district, Uganda: a comparative study. African Journal of Psychiatry 20, 225–231.
- Ovuga, E., Oyok, T.O., Moro, E.B., 2008. Post traumatic stress disorder among former child soldiers attending a rehabilitative service and primary school education in northern Uganda. African Health Sciences 8 (3), 136–141.
- Psychosocial Working Group, 2003. Psychosocial intervention in complex emergencies: a framework for practice. In: T.P.W. Group (Ed.), Working Paper. Queen Margaret University College, Edinburgh, p. 2.
- Santacruz, M.L., Arana, R.E., 2002. Experiences and psychosocial impact of the El Salvador civil war on child soldiers. Biomedica 22 (Suppl. 2), 283–397.
- Sartorius, N., Schulze, H., World Psychiatric Association, 2005. Reducing the Stigma of Mental Illness: A Report from a Global Programme of the World Psychiatric Association. Cambridge University Press, Cambridge, UK; New York.
- Shakya, A., 2010. Experiences of children in armed conflict in Nepal. Children and Youth Services Review 33 (4), 557–563.
- Somasundaram, D., 2002. Child soldiers: understanding the context. British Medical Journal 324 (7348), 1268–1271.
- Stark, L., 2006. Cleansing the wounds of war: an examination of traditional healing, psychosocial health and reintegration in Sierra Leone. Intervention: International Journal of Mental Health, Psychosocial Work & Counselling in Areas of Armed Conflict 4 (3), 206–218.
- Stevens, A.J., 2014. The invisible soldiers: understanding how the life experiences of girl child soldiers impacts upon their health and rehabilitation needs. Archives of Disease in Childhood. http://adc.bmj.com/content/99/5/458
- Summerfield, D., 1998. Protecting children from armed conflict. Children affected by war must not be stigmatised as permanently damaged. British Medical Journal 317 (7167), 1249.
- UNICEF, 2003. Fact Sheet: Child Soldiers. United Nations Children’s Fund, New York, p. 4.
- UNICEF, 2007. Paris Principles.
- United Nations, 2005. Security Council Resolution, 1612 (S/RES/1612-2005). United Nations, New York, p. 6.
- Vindevogel, S., Broekaert, E., Derluyn, I., 2013a. “It helps me transform in my life from the past to the new”: the meaning of resources for former child soldiers. Journal of Interpersonal Violence 28 (12), 2413–2436.
- Vindevogel, S., Schryver, M., Broekaert, E., Derluyn, I., 2013b. War-related experiences of former child soldiers in northern Uganda: comparison with non-recruited youths. Paediatrics & International Child Health 33 (4), 281–291.
- Wessells, M.G., 2006. Child Soldiers: From Violence to Protection. Harvard University Press, Cambridge, MA.
- Wessells, M.G., 2009. Do no harm: toward contextually appropriate psychosocial support in international emergencies. American Psychologist 64 (8), 842–854.
- Williamson, J., 2006. The disarmament, demobilization and reintegration of child soldiers: social and psychological transformation in Sierra Leone. Intervention 4 (3), 185–203.