Background
Where armed conflict exists, child soldiers
1[
1] will almost certainly be involved. The military recruitment of children and their use in military activities has taken place in one form or another in at least 86 countries and territories worldwide [
1]. Even though the past years have seen promising international legal efforts to combat recruitment of children in armed conflicts, the impact of these initiatives still remains insufficient [
1]. The plight of former child soldiers has also received significant attention in the academic literature. This is likely due to the assumption that this is a particularly vulnerable population given their traumatic experiences during recruitment and conscription, which is substantiated by several studies [
2,
3]. Research further demonstrates that the vulnerability of former child soldiers is not limited to the time of conscription; the process of reintegration proves to be an additional stressor for their vulnerability [
4‐
6]. Post-conflict factors such as educational and economic deprivation, stigmatization and discrimination have been associated to adverse outcomes [
6‐
8]. We use the term child soldier to reflect the Paris Principles definition of children associated with armed forces and armed groups, which refers to “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”[
9].
Despite international attention and the earmarking of substantial financial resources for child soldier prevention and reintegration programs, there are surprisingly few systematic assessments of the long term outcomes of such programs and trajectories [
10,
11]. To the best of our knowledge only two longitudinal reintegration studies have been conducted; a study of life-outcomes of 39 male former child soldiers in Mozambique [
12,
13], and a study into the risk- and protective factors and mental health among 260 former child soldiers in Sierra Leone [
14,
15]. Another study, among 658 formerly-recruited girls and other vulnerable young women in Liberia, Uganda, and Sierra Leone, used participatory action research to understand factors contributing to successful reintegration and enable self-help processes [
10]. Finally, one cross-sectional study among 1043 ex-combatants in Sierra Leone assessed the determinants of successful reintegration [
11]. These studies, combined with other cross-sectional and observational studies, have highlighted post-demobilization factors and interventions that have been associated with successful reintegration, e.g. community sensitization, cleansing rituals, transitional periods in interim care centers, religious support, psychosocial counseling, family mediation and skills & vocational training [
13,
16,
17]. The role of the family in reconnecting children [
6,
18] and the use of welcoming rituals or traditional healing practices [
19] have further been emphasized to aid adaptation and community reconciliation.
The struggles of youth returning from armed conflict are well documented and constitute a threat to their wellbeing. Ugandan women, for example, were met with systematic violence upon family reunification after escaping from the rebel groups [
20]. Another study in Uganda found that the failure of reintegration efforts of former child soldiers, was associated with widespread community resistance (due to perceived unaccountability for the crimes committed), ambiguous blending of religious (e.g. notion of repentance) and cultural concepts as
cen (the revenging spirits of those who have been killed) [
21]. On the other hand, several authors have argued that despite the experienced hardship the majority of former child soldiers cope well with their situation [
8,
13,
16,
17]. Boothby describes the former child soldiers to have become productive, capable, trusted and caring adults, with better performance on several socio-economic indicators compared to the national average. Manifestations of resilience that are reported include a sense of agency, social connectedness, positive outlook on the future and spirituality among Columbian former child soldiers [
22].
The United Nations outlines the goal of disarmament, demobilization and reintegration (DDR) as a process of removing weapons from the hands of combatants, taking the combatants out of military structures and helping them to integrate socially and economically into society, thereby seeking to support ex-combatants so that they can become active participants in the peace process [
23]. 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. There is an urgent need for more knowledge on the long-term reintegration outcomes of former child soldiers and the impact that reintegration programs have in that process.
Burundi, a country in central Africa, has suffered from a 10-year civil war that formally ended with the ceasefire agreement between the government and the last active armed group (Forces Nationales de Libération, FNL) in 2006. Currently, the country is beginning to reap the dividends of the peace process, but it faces formidable challenges in reviving the shattered economy and forging national unity and political instability has remained. Throughout the 10 years of conflict, both Burundian armed forces and insurgent armed political groups recruited and involved children in a variety of capacities. No reliable figures exist on the number of children who have been conscripted, however estimates range between 6,000 and 7,000 [
24]. In 2003, after the signing of peace accords with the main rebel parties, prior to the final ceasefire agreement of 2006, Burundi started with the DDR process.
The current study aimed to assess reintegration trajectories several years after demobilization, looking broadly at socioeconomic and mental health indicators of a large group of former child soldiers and never recruited peers, both of whom participated in an economic support program. To the best of our knowledge, it is one of few studies that compare the long-term socio-economic and mental health status between these groups. The retrospective tracer methodology is used frequently in empirical studies among graduates to assess the long-term match between received education and subsequent career paths, also in low and middle income settings [
25,
26]. The objectives of the present study were two-fold. First, it aimed to compare the present socio-economic and mental health status of former child soldiers and never-recruited peers after participating in an economic support program 4 years prior. Second, the study aimed to assess the role of an economic support program in the perceived reintegration trajectories of both groups through retrospective analyses of socio-economic indicators before receiving support (T1; 2005–06) and immediately afterwards (T2; 2006–07). The study does not, however, evaluate the effectiveness of the program. The present study design is an innovative strategy that was selected in absence of prospective and longitudinal data. In this paper we refer to reintegration as the “process by which children transition into civil society and enter meaningful roles and identities as civilians who are accepted by their families and communities, which is achieved when the political, legal, economic and social conditions needed for children to maintain life, livelihood and dignity have been secured” [
9].
Results
The sample (N=643) consisted of 470 boys (73.1%) and 173 girls (26.9%), aged between 14 and 30 years (mean 22.54; SD 3.51), of whom 267 (43.3%) were presently married. Six hundred thirteen (95.3%) respondents were Christian, 16 Muslim (2.5%) and 14 reported no religious affiliation (2.2%). Table
1 shows demographic information, as well as recalled baseline scores on outcome measures, separately for former child soldiers and never recruited respondents. There were significant differences between both groups for gender, age, literacy and baseline level of social integration, with former child soldiers demonstrating lower perceived social integration. Former child soldiers joined the armed groups at an average age of 14.6 years old (SD = 3.02) and stayed associated for an average of 4.2 years (SD = 2.45). The majority of them reported to have made the decision to join the armed groups voluntarily (69.4%) followed by forced recruitment or abduction (16.3% and 8.4%, respectively). The reasons for ‘voluntary’ recruitment were mainly to gain material benefits (32.6%), out of fear (16.2%), the prestige of being associated with armed groups (13.5), peer influences (13.0%), ideology (10.7%), desire for vengeance (7.3%) and a sense of being socially excluded (6.6%). Once recruited the activities that the former child soldiers were asked to carry out included combat experience (50.7%), being a porter (58.4%), cooking food (40.7%), being a sentry (11.7%), spying (12.6%) or delivering messages (2.0%). Total percentages exceed 100% as each person could respond with multiple answers to the above items.
Table 1
Sample characteristics
Male, N (%) | 391 (86.5%) | 79 (41.4%) | .000 |
Age a, mean (SD) | 23.53 (3.19) | 20.31 (3.16) | .000 |
Household members, mean (SD) | 5.02 (2.32) | 5.40 (2.36) | .066 |
Literacy, N (%) | 391 (87.1%) | 152 (80.0%) | .031 |
Outcome baseline indicators b, mean (SD) | | | |
Social integration | 14.80 (4.15) | 18.71 (2.86) | .000 |
Economic opportunities | 7.83 (2.94) | 8.07 (3.12) | .366 |
Household wellbeing | 12.83 (3.34) | 13.23 (3.61) | .187 |
Work satisfaction | 11.50 (2.45) | 11.60 (2.52) | .692 |
Program endorsement, mean (SD) | 14.77 (3.99) | 15.44 (3.69) | .057 |
We wanted to assess present socio-economic functioning and mental health of former child soldiers as proxy-outcome indicators of long-term reintegration, and compare that to never-recruited peers. The level of impairment in daily functioning among the child soldiers group was rather low with a mean score of 9.99 (SD=3.86), considering the 7 to 35 response scale. With regards to mental health problems, we saw prevalence rates of 13.3% depressive disorder, 14.3% anxiety disorder and 5.9% PTSD, based on the algorithm that combines above cut-off symptoms scores with function impairment scores. Table
2 further shows that there were no significant differences for present functioning impairment or mental health problems between former child soldiers and never recruited respondents. However, there was a gender difference: former girl child soldiers have significantly more depression (t(161)=2.18; p=.043) and PTSD (t(154)=2.04; p=.031) symptoms at present compared to never recruited girls.
Table 2
Present levels of mental health symptoms and functioning impairment
| Mean (SD) | % | Mean (SD) | Mean (SD) |
p value |
p-value |
p-value |
Depressive symptoms | 27.72 (7.31) | 13.3 | 27.87 (7.34) | 27.37 (7.23) | .441 | .461 | .043 |
Anxiety symptoms | 20.85 (5.65) | 14.3 | 20.82 (5.69) | 20.91 (5.58) | .855 | .098 | .255 |
PTSD symptoms | 40.00 (12.42) | 5.9 | 40.43 (12.60) | 39.03 (11.99) | .208 | .603 | .031 |
Function impairment | 9.99 (3.86) | n/a | 10.13 (3.68) | 9.64 (4.30) | .144 | .850 | .605 |
Hierarchical regression analyses demonstrated predictors for present socio-economic functioning of former child soldiers (see Table
3). When adjusting for mutual effects of the different blocks, we saw that older age, not having a partner, lower functioning impairment, lower levels of depression- and health problems, received material kits and higher intervention satisfaction are associated with increased household wellbeing. Participating in awareness raising programs is negatively associated with household wellbeing. Increased social integration is associated with less depression symptoms, fewer activities conducted during associations, received vocational training and on-the-job training, and higher intervention satisfaction. Present levels of perceived economic opportunities are associated with higher number of conducted activities during association, less depression- and health- problems and higher intervention satisfaction. Finally, more activities conducted during association, less depression- and health- problems, received job-coaching and higher intervention satisfaction are significantly associated with higher present work satisfaction. At present 94.6% of the former child soldiers mention to have some sort of employment or to be working and 87.1% report to be literate.
Table 3
Predictors for socio-economic indicators (Burundi)
Demographics | δR
2
1 =.01* | | δR
2
1=.00 | | δR
2
1=.03** | | δR
2
1=.01 | |
Age | .12* | .11* | -.03 | | .08 | | .10 | |
Gender [male=1; female=2] | <.00 | | .01 | | -.12** | -.04 | -.05 | |
Marital status [no partner=0; partner=1] | -.15** | -.18** | .08 | | -.04 | | -.04 | |
Child soldier experience | δR
2
1=.01 | | δR
2
1=.05** | | δR
2
1=.01 | | δR
2
1=.01 | |
Number of activities during association | .09* | .07 | -.23** | -.13** | .13** | .15** | .12* | .11** |
Rejoined armed grou ps | .08 | | .06 | | .02 | | .02 | |
Duration of association | .04 | | -.02 | | <.00 | | <.00 | |
(Mental) health and functioning | δR
2
1=.31** | | δR
2
1=.20** | | δR
2
1=.34** | | δR
2
1=.28** | |
Anxiety symptoms | -.04 | | .04 | | .04 | | -.03 | |
Depression symptoms | -.23** | -.29* | -.47** | -.41** | -.36** | -.36** | -.27** | -.25** |
PTSD symptoms | -.08 | | .06 | | -.02 | | .04 | |
Functioning impairment | -.11** | -.10* | -.08 | | -.02 | | -.03 | |
Health problems | -.29** | -.26** | -.04 | | -.36** | -.30** | -.36** | -.32** |
Intervention received | δR
2
1=.08** | | δR
2
1=.08** | | δR
2
1=.09** | | δR
2
1=.07** | |
Intervention type | | | | | | | | |
Awareness | -.10* | -.12** | .05 | | | | | |
Coaching | | | .10* | .02 | | | .10* | .10* |
Vocational training | -.06 | | .11* | .11** | | | | |
Material kits | .12** | .11** | | | | | | |
Basic education | -.08 | | .03 | | | | | |
On-the-job training | | | .10* | .12** | | | .07 | |
Microfinance | | | .04 | | | | <.00 | |
Intervention satisfaction | .21** | .15** | .13** | .10** | .30** | .22** | .21** | .15** |
To better understand the above-mentioned findings, i.e. non-difference between groups on several indicators of current functioning and the role of participation in the support program, we have assessed and compared perceived change trajectories of both groups through retrospective assessment of socio-economic indicators before participating in the support and immediately afterwards. MANOVA analyses demonstrated significant changes over time reported program by the entire sample (see Table
4). Comparisons of mean scores between the different time points showed that the largest changes on indicators of socio-economic reintegration were seen between pre- and post program participation, statistically significant for each of the outcome measures. Between T2 and T3, we saw further minor improvements for social integration and household wellbeing (3 to 5%), no significant change for work satisfaction and a small reduction in perceived economic opportunity. Changes on mean scores were the largest for social integration and perceived economic opportunity (21 and 47% pre- post change, respectively).
Table 4
Within-group comparisons of mean scores (N=643)
Indicator | Mean (SD) | Mean (SD) | Mean (SD) | % Change | t-value; p
| % Change | t-value; p
| % Change | t-value; p
| F(df); p
| F(df); p
| F(df); p
|
Social integration | 15.97 (4.21) | 19.40 (2.61) | 20.29 (2.42) | 21.48 | 25.70; <.000 | 27.05 | 26.72; <.000 | 4.59 | 10.44; <.000 | F(2,1204)= 409.66; <.000 | F(2, 872)= 182.56; <.000 | F(2, 328)= 163.63; <.000 |
Economic opportunities | 7.90 (3.00) | 11.64 (2.86) | 11.38 (2.81) | 47.34 | 25.38; <.000 | 44.05 | 23.36; <.000 | -2.23 | -2.78; .001 | F(2, 1070)= 322.35; <.000 | F(2, 780)= 176.69; <.000 | F(2, 286)= 100.83; <. 000 |
Household wellbeing | 12.96 (3.42) | 14.31 (3.43) | 14.75 (3.27) | 10.42 | 14.68; <.000 | 13.81 | 15.22; <.000 | 3.07 | 4.49; <.000 | F(2, 1138)= 136.46; <.000 | F(2, 824)= 72.74; <.000 | F(2, 310)= 35.33; <.000 |
Work satisfaction | 11.53 (2.47) | 12.10 (2.27) | 12.20 (2.19) | 4.94 | 5.63; <.000 | 5.81 | 6.76; <.000 | .83 | 1.17; .245 | F(2,764)= 21.41; <.000 | F(2, 566)= 18.96; <.000 | F(2, 194)= 3.23; .042 |
Table
5 reports pure change scores and MANOVA results to illustrate comparisons of changes between former child soldiers and never recruited respondents. These analyses showed significant time x group interaction effect for social integration (F(2,1204)=113.18; p<.001) and economic opportunity (F(2,1070)=3.26; p=.039). Former child soldiers reported significantly more improvement on social integration, to the point that baseline differences between both groups were statistically not significantly different at present (t(df)=−.52(628); p=.604). The interaction effect for perceived economic opportunity is explained by a reduction in mean score between T2 and T3 among the never recruited respondents, compared to no change among former child soldiers.
Table 5
Between-group comparisons of mean changes
Indicator | Change, Mean (SD) | Change, Mean (SD) | Change, Mean (SD) | Change, Mean (SD) | Change, Mean (SD) | Change, Mean (SD) | F(df); p
| F(df); p
| F(df); p
|
Social integration | 4.32 (3.36) | 1.36 (2.02) | 5.45 (4.02) | 1.71 (2.54) | 1.12 (2.17) | .32 (1.77) | F(2, 1204)= 113.18; <.000 | F(2, 872)= 182.56; <.000 | F(2, 328)= 51.89; <.000 |
Economic opportunities | 3.88 (3.56) | 3.63 (3.60) | 3.68 (3.50) | 2.82 (3.46) | -.17 (2.74) | -.79 (3.57) | F(2, 1070)= 3.26; .039 | F(2, 780)= .83; .438 | F(2, 286)= 25.11; .019 |
Household wellbeing | 1.44 (2.34 | 1.28 (2.22) | 1.86 (2.88) | 1.77 (3.04) | .44 (2.16) | .46 (2.52) | F(2, 1138)= .19; .826 | F(2, 824)= .28; .755 | F(2, 310)= .70; .819 |
Work satisfaction | .65 (2.55) | .74 (2.29) | .94 (2.55) | .57 (2.34) | .21 (2.23) | -.10 (2.32) | F(2,764)=1.98; .139 | F(2, 566)= .37; .689 | F(2, 194)= .90; .408 |
Considering the large gender differences between former child soldiers and never recruited respondents, we ran analyses separately for boys and girls. The time effect remained significant for all outcome measures when comparisons were made for only girls and only boys. When comparing the time x group effect for both genders separately, we found that the significant interaction effect for perceived economic opportunities is present only among girls. This means that the smaller overall improvement in economic opportunity (or slight reduction between T2 and T3) among never recruited respondents is explained by change of the girls within this group.
Discussion
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,
15]. 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,
14,
15]. 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,
13], 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,
37]. 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,
35]. 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,
17], 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,
42]. 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,
34]. 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,
10,
17]. 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.
Competing interests
The authors declare that they have no competing interests.
Authors' contributions
MJ designed and supervised the study, conducted analyses and drafted the manuscript. IK has been involved in study design, statistical analyses and revising manuscript. WT has been involved in study design and revising manuscript. AN has been involved in the design of the study, acquisition of the data and revising of the manuscript. TN has been involved in the design of the study, overseeing data acquisition and revising of the manuscript. BK has been involved in study design, statistical analyses and revising manuscript. All authors read and approved the final manuscript.