Child soldiers.

Over the past 20 years the number of children recruited into armed conflict, as combatants, spies, labourers and sex slaves, has increased substantially (Wessells, 2009). In this issue, we focus on the research that has been done in recent years to identify the extent of this problem and, in particular, the efforts that are being made to discover the most effective ways of rehabilitating former child soldiers into society.

Aoife Singh and Ashok Singh have reviewed evidence on the mental health consequences of being a child soldier, which can be summarised as comprising mainly posttraumatic stress disorder, depression, anxiety and substance misuse. Child soldiers are not a homogeneous group. Their outcomes are likely to be influenced by their experiences before, during and after the conflict. There will be substantial differences in terms of the length of time they spent with an armed group, their experiences within that group and the degree and quality of post-conflict support they receive. Wessells (2009) suggests that the majority of former child soldiers exhibit significant resilience, but the extent to which they can successfully be reintegrated into their community of origin strongly influences longer-term adjustment. Thus, there are many potentially exacerbating and mitigating factors that render unwise generalised statements concerning the degree of risk to child soldiers’ mental health.

Brandon Kohrt and his colleagues agree that we know little of the needs or efficacy of interventions to support former child soldiers and aid their social integration. They describe lessons learned from their work with the Transcultural Psychosocial Organization in Nepal, where both insurgent Maoist groups and government forces conscripted large numbers of children. Because their intervention was with conflict-exposed children in general, not just with those who had been soldiers, they address some of the questions raised by the Singh review.

Kohrt and colleagues emphasise that, for some children who participated in armed groups, it is the experiences they have after returning home that are the most troubling and liable to provoke a deterioration in mental health. Ways of managing their reintegration, to optimise outcomes, are discussed in a fascinating review by Theresa Betancourt of her work in Sierra Leone, which has followed up former child soldiers for the best part of a decade. She concludes that services should be based on need rather than labels; all three articles concur on that important point.