The present study supports the notion of the long-term resilience – when provided with support in socio-economic reintegration - of former child soldiers, as was found earlier in a smaller study with Mozambiquan child soldiers [12
]. Overall, the findings illustrate that former child soldiers in Burundi feel by and large socially integrated within communities, with high work/employment rates, literacy rates above national average (66%) and no differences in present functioning and mental health compared to never-recruited peers. This perspective of resilience is further supported by several trends.
First, several years after demobilization the majority of the former child soldiers appear to function no different than their non-recruited peers. The two groups are surprisingly similar in current socio-economic functioning and mental health status. We hypothesize that post-program improvements (most notably in social integration) had a buffering effect for current mental health problems, which contributed to the non-difference between both groups at present. This will need to be confirmed in a future study, but this is congruent with the findings by Betancourt and colleagues that with increased community acceptance youth showed significant improvements in all outcomes investigated [14
]. Child soldier status and experiences (including combat) explained very little variation in present functioning, with the number of activities performed during recruitment the only recurring predictor. This compares to data from other studies that demonstrate a strong negative association between child soldiering and functional status [3
]. The cross-sectional study of Kohrt and colleagues [3
], for example, demonstrated that former child soldiers displayed greater severity of mental health problems compared to never conscripted children. It appears that in time, and after participating in a support program, the effects of soldiering fade to an extent, and more current concerns and stressors take the overhand (i.e. poverty, unemployment), much alike the general population.
Second, socio-economic reintegration trajectories showed significant improvements over time. While this trend was present for each of the indicators, it was especially salient for perceived economic opportunity and social integration. The positive trend in economic opportunity can in our opinion best be explained by former child soldiers’ engagement in, or hope for, new occupational activities or skills (as a result of the support program), and the trend in social reintegration by the normalizing and equalizing effect of performing occupational activities, much alike everyone else, and the associated sense of recognition and utility within their respective communities. Taking into account that lost economic opportunity was considered one of the most devastating legacies of recruitment and that social or community acceptance is considered a major indicator for successful reintegration [10
], these are salient findings. The findings in the present study are congruent with a key conclusion in the study by McKay and colleagues, that “to garner one’s own resources to move them from being marginalized young mothers to contributing and respected members of their communities was considered true integration” [10
]. Similarly, community connection and a sense of future were also identified as protective factors among Columbian former child soldiers in the study by Cortes and Buchanan [22
]. In addition, the improvement in social acceptance is important in light of studies demonstrating the centrality of stigma and discrimination in predicting post-conflict adjustment and well-being [6
]. Changes in household economic wellbeing and work satisfaction were much more modest, mostly due to the pervasive unemployment and poverty in Burundi.
The observed reintegration trajectories suggest a positive role of the support program, given that practically all reported change occurred between pre and post participation. In addition to change trajectories, hierarchical regression analyses also point towards the positive effects of the reintegration program. In comparison, Betancourt and colleagues [14
] found no significant changes in levels of community acceptance – in the absence of an intervention - two years after baseline measurements. While coaching, on-the-job and vocational training and provision of material kits were associated with improved socio-economic reintegration trajectories, a sense of satisfaction with received services is most strongly and recurrently associated with better outcomes.
Third, we see modest signs towards positive gain for former child soldiers. They outperform, albeit slightly, their never recruited peers in perceived economic opportunity. The activities performed during association appear to provide a sense of empowerment. The respondents reported to have gained skills and experiences that they could use post-demobilization. In a study among former child soldiers in Nepal, a similar trend was detected [38
]. The authors posit the concept of ‘unbalanced agency’ to refer to the discrepancy between the benefits that children gain through participation in armed groups and the obvious risks associated with it.
Fourth, the present levels of mental health complaints and impairment in daily functioning is not higher than rates found among the general population in other studies in similar post-conflict and neighboring settings (i.e. Rwanda, Uganda) [30
]. Still, the presented (mental) health complaints call for serious attention, especially depression and health problems since they are most strongly associated with reduced current socio-economic functioning, more so than gender or previous experiences during association with armed groups. This is something that should be explored in future studies.
The current study finds that girls are more at risk to suffer from depression and PTSD complaints, a replication of the findings by Kohrt and colleagues [3
] directly after demobilization, but otherwise show no difference in the reintegration trends compared to boys. The latter is surprising as previous studies have demonstrated former girl soldiers to be more vulnerable for experiencing reintegration difficulties like stigma [6
] and functional complaints [4
]. With many girls falling through the cracks of the reintegration services in other DDR systems [1
], it may be that the reintegration process in Burundi was more gender-equitable, especially since this was emphasized in ILO’s economic reintegration strategy [39
]. Additionally, Humphrey and Weinstein in their large survey also conclude that gender is not a predictor for increased difficulties for reintegration into civilian life [11
]. Furthermore, another study in Northern Uganda demonstrated that most women returning from armed groups were resilient and well reintegrated socially [40
The most important limitation to this study is related to the retrospective nature of the design. All scores are based on recollections, which is sensitive to introducing recall bias. Regarding the retrospective design, those with high levels of current mental health problems and psychosocial distress are more likely to appraise earlier experiences negatively and recall stressful life events, and they are less likely to recall experiences of support [41
]. Second, the lack of a control group makes it harder to determine causality of the socio-economic improvements. With a control group, there would be greater ability to assess what changes in mental health, social indicators, and economic activity would have occurred in the absence of any formal intervention. For example, it is conceivable that the reported changes are due to factors other than the support program, such as increased security, passage of time, increased reconciliation or other humanitarian efforts. Yet, given that most of the change occurred in the short time span between pre- and post program participation suggests that it had an impact on the reported changes. This is also confirmed by the results from the hierarchical regression analyses. The findings of this paper should be interpreted with caution. Future research should include a control group and a longitudinal design with a baseline measure to facilitate attribution of changes over time to reintegration activities.
Another limitation is that the standard symptoms checklists, while demonstrating good internal consistency, were not assessed for construct or concurrent validity within the Burundian context. The qualitative approach used does address transcultural equivalence of the tools. However, a validation study is required to determine to what degree the instruments distinguish between individuals with and without a particular syndrome or disorder [33
]. This may have had an impact on the proportion of caseness within the sample. To adjust for the common risk of inflated prevalence when using non-validated instruments, we have determined caseness based on a combination of symptoms levels and function impairment, which is a technique used in other cross-cultural studies [30
]. To address the limitation of generalizability due to un-validated instruments, further research is necessary to assess construct validity of the measures for this specific population. Finally, the use of non-random sampling procedures for the interviews may limit the representativeness of the sample. The present study included only beneficiaries of integration support, yet many other former child soldiers do not receive any such support [1
], their long-term wellbeing should be assessed in future studies.
This study has several implications for policy and practice. Policy makers and program planners may interpret these findings as heartening. Long-term socio-economic and mental health outcomes are not different between former child soldiers and never recruited children, with participation in an economic support program appearing to contribute to perceived improvements over time. Based on the finding that the association between outcomes and program satisfaction is the strongest in the tested model, one could argue for increased participation in designing reintegration services to augment the match between needs and services and build on their positive coping (and developed skills) as a result of being recruited, in order to increase satisfaction. Such shift has also been advocated by others [8
]. It should be noted that a reverse causality of this finding is also possible, i.e. individuals with more positive outcomes are most likely to be satisfied by the program. Second, future (economic) reintegration packages should emphasize apprenticeship activities (e.g. vocational- and on-the-job training, coaching). Third, while it poses inherent limitations, retrospective tracer studies may offer a useful method for the assessment of long term outcomes and an alternative to prospective longitudinal studies in absence of pre-planned studies. For researchers interested in studying complex interventions in low-resource settings it provides for an additional tool to strengthen the evidence base and elucidate processes to be included in future more rigorous efficacy studies.
Finally, we would argue that successful reintegration is about the equality in opportunities, participation, wellbeing and social functioning of former child soldiers compared to those of their never-conscripted peers. 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. From such a perspective the results of this study are hopeful, but no more hopeful than the general situation of Burundi, with a population that is faced with significant socio-economic adversities, structural marginalization and continued community violence. The results do not diminish the undergone hardship or invasive consequences of the respondents’ experiences, but demonstrate that despite these, and with the support from reintegration services, former child soldiers have integrated seemingly well.