Documento creado: 20 de marzo de 2008
Air & Space Power Journal - Espańol  Primer  Trimestre 2008


Child Soldiers: Are US Military Members
Prepared to Deal with the Threat?

Lieutenant Colonel Judith A. Hughes, USAF

This is not just a problem for academia, but it is a problem that has clear policy implications that should concern us all. . . . Our soldiers must deal with the complex dilemma of facing children on the battlefield without proper intelligence warnings or training to help prepare or guide them.

—P. W. Singer

Child SoldiersThe United States (US) military is engaged in unprecedented locations around the globe. Child soldiers are pervasive around the globe as well. US special forces have faced armed children in Mogadishu in 1993, in Kosovo in 1999, and more recently in Afghanistan and Iraq. Child soldiers are not a new phenomenon for US military forces, but they are an expanding problem with implications for the future and for the mental health of our troops in combat.
The ongoing conflicts in Afghanistan and Iraq represent the most sustained period of American military combat operations since the Vietnam War. Studies done with Army and Marine infantry troops returning from combat operations in Iraq and Afghanistan note an incidence of post-traumatic stress disorder (PTSD) similar to rates seen in Vietnam.
1 Soldiers fighting today face many of the same challenges as troops fighting in Vietnam. These universal psychological themes of combat include exposure to and involvement in killing and facing threats to their own lives. The National Center for PTSD cautions that despite combat similarities, it is essential to “appreciate the specific demands and context of these new wars in order to raise awareness of civilians back home . . . to estimate the need for clinical services, and to make other policy recommendations.”2 The increasing likelihood that US troops will face child soldiers in combat more frequently and be required to kill them may be one of those unique differences.

The Scope of the Problem

The growing volume of literature on the subject of child soldiers may be the first hint that the problem is getting worse instead of better. The problem is not unique to one particular country or region of the globe. Children may be active soldiers in combat in over 75 percent of the world’s conflicts. The actual number of child soldiers is hard to quantify. Amnesty International cites research that estimates 300,000 child soldiers are exploited in over 30 countries but points out that efforts are under way to collect more reliable data on the actual number of children who are soldiering.3 Current Human Rights Watch Web sites also give the figure of 300,000 child soldiers, but it is interesting to note that literature published in the late 1990s also estimated the same number of children. The lack of change in these numbers may represent not a stagnant growth pattern but more likely the difficulty of getting accurate data.

The Human Rights Watch group has published separate books describing the scope of the problem of child soldiers in Liberia, Sudan, and Burma. With the recent establishment of US Africa Command, it is especially relevant to note that much of the current literature on child soldiers references Africa and, most notably, the Lord’s Resistance Army in northern Uganda, which has become “infamous” for being composed almost entirely of children.4 The Global Report on Child Soldiers, published in 2004, confirmed that 8,000 child soldiers were estimated to be in Afghanistan, all recruited into factional armed groups and militaries, including the Taliban and the Northern Alliance. Research done in Iraq paints almost the identical picture. Although 18 is the minimum volunteer age for official military service, the 2004 Global Report documented that under the Ba’ath party government, there had been widespread military training of children, citing the formation of the Ashbal Saddam (Saddam Lion Cubs) group. This group was formed after the 1991 Gulf War, specifically recruited children aged 10 to 15 years, and sent them to three weeks of training in fighting and infantry tactics. The US Department of State estimated that there were 8,000 members of this group in Baghdad alone and that this was only one of several armed groups recruiting and employing child soldiers.6

Given the previous statistics, it is natural to question “why” or “how” this has happened. Several reported trends made recruiting child soldiers easier. Poverty, persistent fighting, and demographics are only a few. Singer postulates that the decision to employ child soldiers is a deliberate and systematic choice and highlights the fact that “generational disconnections caused by globalization, war, and disease” have created potential recruits.7 Consider the implication of demographics alone: half the people in sub-Saharan Africa are under the age of 18, and the Islamic world has one of the highest percentages of children in its population. Youth under the age of 24 make up 50 to 60 percent of the populations in Yemen, Saudi Arabia, Iraq, and Pakistan.8 There has also been a proliferation of small arms that are lighter and easier for children to operate. In addition, children are often less inhibited by the consequences of their actions and are therefore capable of even more violence than an adult soldier may be.

When considering the pressures from these negative global trends, it is not surprising that some children join these groups “voluntarily” but often when they perceive it as the only option for survival. Recent studies by the International Labor Organizations credited “volunteers” for composing two-thirds of the child soldiers in four Central African countries. Human Rights Watch reports and UNICEF-sponsored studies identified the following as the common reasons children chose to become soldiers: avenging family killings, protection from the warring group itself, access to regular meals, the need of orphans for someone to care for them, and pressure from the peer group.9

The ultimate goal of organizations that employ child soldiers is to foster dependency so the child feels bound to the group. Discipline is extremely important and often maintained by use of extreme and arbitrary violence. Several sources report that children are often forced to take part in ritualized killings soon after they have joined the group.10 They are forced to kill or be killed. The victims may be enemy prisoners, other children, or, most offensive, the child’s own family or neighbors. Insisting on violence against their own family increases children’s isolation since they no longer have a place they feel they can ever safely return to in the future. Physical dependency is also encouraged. Alcohol, drugs, and food are all used to control behavior and even to exploit children’s natural tendency toward fearlessness.11 Many children start out in support roles, but that does not shield them from the harsh battle environment. Children are often used as porters, but if they are too weak to carry their assigned load, they may be beaten, abandoned, or killed.12 Other support functions include cooks, spies, messengers, and sexual service, the latter especially problematic for young girls pressed into service.

US Military Policy, Strategy,
and Practice

There is no doubt that US troops will continue to encounter child soldiers in many different environments, but has US military policy or strategy prepared our troops and those responsible for keeping them fit to fight for these encounters?

Psychological Health Assessment
of Military Troops

The lasting psychological consequences of causing destruction and perpetrating violence have been strikingly under-researched. For some, the shame and guilt inducen by killing of any kind in combat can arguably be uniquely scarring.

—PTSD Fact Sheet, 2005

There is a Department of Defense (DOD) requirement for all deploying service members to participate in pre- and postdeployment screening. Military members complete a questionnaire that is reviewed by a medical professional. Almost half of the 18 questions on the postdeployment form query for contributing factors or symptoms of depression, anxiety, and PTSD. One of the critiqued limitations of this questionnaire is that it seeks information only on what happened to military members, not what the military members did. The postdeployment questionnaire does not ask if the member killed anyone. The postdeployment survey was initially designed as a one-shot snapshot of a member’s health at that moment, but research has shown that to be insufficient for an effective evaluation of a member’s mental-health status.13 The DOD has corrected this flaw with the Post-Deployment Health Reassessment (PDHRA) survey, which has the goal of identifying health concerns from military members three to six months after returning from deployment. Specific questions attempt to assess for signs and symptoms of impaired psychological adjustments and ask military members to identify exposures they believe may have affected their health. Lists of exposures range from the application of DEET insect repellent to lasers and depleted uranium but do not list exposure to killing or child soldiers. The lack of specificity about encountering or killing child soldiers may be a flaw in the medical community’s threat-surveillance assessment.

Policy and Strategy Specific to Child Soldiers

There is a dearth of published literature on the military’s response to the threat of child soldiers, including lack of literature on troops’ predeployment training needs and psychological response to encountering and killing children in combat. Despite the awareness of this emerging problem, the majority of the US military has not adopted any official policies or prepared doctrine specific to this issue. In June 2002, the Center for Emerging Threats and Opportunities (CETO), a US Marine Corps think tank, sponsored a seminar that examined the implications of child soldiers for US forces. This seminar had representatives from each military service, the State Department, government and nongovernment organizations (NGO). In addition to providing a synopsis of the problem of child soldiers and identifying several strategic-level interventions targeted by the international community, the seminar and subsequent report highlighted several key points with specific tactical implications for military members.14 The report also recommended that military doctrine describe the child-soldier phenomenon and address specific ways to deal with it. It encouraged training for all troops, especially before deployment and particularly for those groups likely to encounter child soldiers. The report concluded by recommending that war-game scenarios be modified to include child-soldier issues. Pursuant to the November 2002 report, there has not been much public evidence of adoption of the recommendations. As of December 2007, war-game scenarios at the military senior service schools have not included or familiarized participants with any type of child-soldier experience.15 Following the CETO seminar, two of the presenters were invited to brief the 11th Marine Expeditionary Unit (MEU) prior to a scheduled deployment to Iraq in January 2004. A presenter from the Center for Defense Intelligence and the CETO director confirmed it was an ad hoc exercise with no follow-up and no systematic training for other units.16

Not only is the combat community not focused on preparing for or mitigating the threat of child soldiers, but the military medical community does not appear to be leaning forward in those arenas either. The Center for Study of Traumatic Stress falls under the Department of Psychiatry at the Uniformed Services University of the Health Sciences and maintains an extensive Web site with numerous linked resources and publications. There is an entire section dedicated to military psychiatry, but it does not contain anything specific about the impact of child soldiers in combat.17 The center is internationally renowned for its work in the area of PTSD as well as the psychological effects of terrorism, bioterrorism, traumatic events, disaster, and combat, yet does not address the psychology associated with encountering or killing child soldiers.

In April 2005, the National Center for PTSD published a PTSD fact sheet highlighting the unique circumstances and mental-health impact of the wars in Afghanistan and Iraq. Despite the previously cited number of child soldiers documented to be operating in those countries, the fact sheet mentions only “ambiguous civilian threats” and makes no specific reference to child soldiers as a unique threat that may have a negative mental-health impact. This report did reference the aftermath of violence, including killing, although it did not provide any specific information on the aftermath of killing children in combat. However, a 2006 PTSD study that targeted battle-injured soldiers attempted to measure combat exposure as one of the variables and did specifically ask the participants if they shot at others or saw innocent victims of war.18 Although neither of these criteria were analyzed separately or in a causal modality, this may be one of the first studies in the medical community demonstrating an interest in these factors that could be linked to exposure to child soldiers.

Some mental-health experts would argue there is no need to drill down to such a detailed level. Research in the arena of human resilience has summarized that although 50 to 60 percent of the US population will be exposed to traumatic stress, only 5 to 10 percent of the population develops PTSD.19 The understudied question that remains unanswered is “What are the predisposing elements that promote resilience in the majority of the population?” Unfortunately, there has not been enough research to determine if some military members may be more resilient to the trauma of killing a child, or if there are specific interventions that can foster this resilience and prevent negative psychological outcomes.

Policy and Strategy Specific
to Killing in Combat

Despite the lack of specific information related to killing children in combat, there is research concerned with killing in combat. In 1947 US Army lieutenant colonel S. L. A. Marshall claimed that only 15 to 25 percent of American infantryman in World War II fired their weapons directly at enemy soldiers. Marshall states that “fear of killing, rather than fear of being killed, was the most common cause of battle failure in the individual.”20 Marshall’s declaration did appear to motivate the Army to change its training focus. In a revised program of instruction, the focus was not only on teaching a man to shoot a target but also on conditioning soldiers to kill. In this program, referred to as operant conditioning, the US Army began to use realistic, human-shaped targets that would actually fall when hit. More recently, the US armed forces have incorporated paint bullets, state-of-the-art video firearms simulators, and laser-engagement simulators into training scenarios to help inoculate soldiers against combat stress.21 Lt Col Dave Grossman, a psychologist and retired Army ranger who specializes in training military units about the psychology and physiology of combat, emphasizes that “in the end, it is not about the hardware, it is about the ‘software’ . . . training and mental readiness.” 22

Dr. Theodore Nadelson, an Army veteran, cautions that training does not “release all soldiers from their resistance to killing. . . . Training must remove conscripts from the framework of the inhibiting force that civilization has raised against killing.”23 One method that helps to overcome this inhibition is the process of dehumanizing the enemy. Assigning a lower human value to an enemy helps overcome the moral hesitation that civilization has instilled against killing. Physical distance from the enemy may impact the success of dehumanization.24 If a soldier is forced to kill the enemy in close combat, he may not be able to deny the element of humanity to his enemy. This becomes a more difficult task for Westernized societies when the enemy is a child. Grossman postulates the following caution:

Being able to identify your victim as a combatant is important to the rationalization that occurs after the kill. If a solider kills a child, a woman, or anyone who does not represent a potential threat, then he has entered the realm of murder (as opposed to a legitimate sanctioned combat kill), and the rationalization process becomes quite difficult. Even if he kills in self-defense, there is enormous resistance associated with killing an individual who is not normally associated with relevance or a payoff. 25

Current military strategy may not adequately take this natural resistance into account to help troops better prepare for the environments in which they may find themselves operating.

Implications for US Forces

There are several reasons why the threat of child soldiers should be on the US military’s radar scope. Being unprepared to encounter child soldiers risks decreasing the effectiveness of US combat forces. Situations that require our troops to kill child combatants could contribute to increased negative psychological outcomes. Additionally, populations other than just our combat troops may need to be prepared to interface with this growing threat because more of these children may be treated by our forward-deployed medical troops, processed through detainee operations centers, or become part of media stories that may influence larger audiences than just our military public-affairs personnel.

Mental-Health Consequences

As a warrior it is your job to go into danger, but you can do something about how you respond to it. . . . If there is no sense of helplessness because your training has taught you what to do, there is no PTSD. If there is no horror because you have been inoculated against seeing blood, guts and brains, there is no PTSD.

—Dave Grossman

Research has clearly demonstrated a relationship between war-zone exposure and psychological effects in military members and shown that reliable information in advance can reduce psychological vulnerability.26 Preparation may include lectures, visualization, reenactments, and group discussions which often may be led by line officers in charge instead of mental-health professionals.

Exposure to intense combat and, more significantly, atrocity, were major factors impacting the frequency of negative psychological outcomes in the Vietnam War.27 In addition to a psychological cost, PTSD has monetary and societal costs. It is not uncommon for combat veterans, as well as individuals in the general population diagnosed with PTSD, to be diagnosed with major depression, anxiety disorders, and alcoholism concurrently.28 Vietnam War veterans diagnosed with PTSD are reported to have higher rates of additional psychiatric disorders as well as medical conditions, are heavy users of medical services, and also have higher unemployment rates. 29

A 2004 study of US combat infantry units concluded that the military subjects were at significant risk for mental-health problems including PTSD, major depression, substance abuse, social and employment impairment; it also noted that they would require increased use of health services.30 Similar to Vietnam War studies, this research demonstrated a strong relationship between specific combat experiences and the prevalence of PTSD. There is no clear answer to the question of why some troops develop PTSD and others do not, although research has confirmed the existence of some potentially linked relationships. The Operation Iraqi Freedom-II Mental Health Advisory Team report chartered by the US Army surgeon general demonstrated that “lower perceptions of combat readiness, [lower] levels of training, and [lack of] confidence in the unit’s ability to perform the mission” were linked to an increase in mental-health problems.31 Studies have demonstrated a connection between “indicators of global intelligence and the development of combat-related PTSD,” citing research proving that lower prewar intelligence predicted greater postwar PTSD in Vietnam veterans.32 A 2005 RAND report examined combat stress reactions (CSR) and urban warfare. CSR is defined as any response to combat stress that renders a soldier combat ineffective. Interviews did confirm that the civilian threat in an urban environment may be a key risk factor for CSR with civilian casualties being identified as one of the major factors related to short- and long-term stress reactions. 33

The report recommended that future research should examine the specific psychological impacts of operating in this environment. Child soldiers remain a part of this civilian threat, which needs to be examined in more detail. Although there is a renewed focus on psychological preparation for deployment, nothing in current predeployment training programs specifically addresses the child-soldier threat or its potential impact on combat effectiveness.
Role of Media and Public Support

In the reports on the initial engagements with child soldiers, both the Arab and international press focused on the immediate act of U.S. soldiers shooting Iraqi children, rather than on the context that led them to be forced into such a terrible dilemma. The children were portrayed as heroic martyrs defending their Gomes, facing the American Goliath. . . . The potential backlash could imperil already tenuous support from regional allies and harden attitudes elsewhere against giving aid to the U.S. in the broader war on terrorism. Finally, the effect caused by seeing photographs of tiny bodies could become potent fodder for congressional criticism and antiwar protesters.

—P. W. Singer

Media coverage and public support are additional factors that may impact service members’ psychological adaptation process. Research cited in the 2005 PTSD fact sheet confirms public opinion as a factor that affects how troops view their deployment and their trauma exposure.34 Media coverage of the threat of child soldiers has the potential to sway the currently questionable public opinion and global support for the wars in Iraq and Afghanistan and become a public-affairs nightmare. With the known ripple effects of this type of media coverage, the US military should be concerned about its influence on global and national public opinion and the psychological adaptation of individual military members.

Looking beyond Combat Forces

Combat troops are not the only military members who might interact with child soldiers. Deployed military medics are often responsible for caring for casualties of combat, even enemy forces who might remain in their care much longer than US casualties, who are quickly moved out of theater to more definitive care. With the increasing likelihood that US troops will be engaged in combat against child soldiers, it is a very real possibility that military medics, in addition to treating these patients’ physical wounds, should know what can be done to help these children begin the process of rehabilitation instead of just returning them to the control of their fighting units. Communication with Army medical leaders, Air Force Special Operations (AFSOC) medical leaders, and recently deployed medical professionals confirms that neither current doctrine nor any training program addresses this issue.

Detainee operations is another arena outside the battlefield where US military forces may interact with child soldiers. A Human Rights Watch report published in April 2003 and a letter to the secretary of defense were written in response to the US military’s acknowledgement that children ranging in age from 13 to 15 years were included among the detainees at Guantanamo.35 These documents do acknowledge that the children being held may have participated in armed conflict despite the United Nations adoption of the Rome Statute of the International Criminal Court, which stipulates that no children under age 15 can be recruited into armed forces or used to take part in hostilities.36 The United States, as well as 122 other signatories, is a signer of the Optional Protocol to the Convention on the Rights of Children in Armed Conflict, which increases the minimum age for participation in hostilities and recruitment into the armed force to 18.37 Under this protocol, the United States also has responsibilities to assist in the demobilization and rehabilitation of former child soldiers.

In May 2005, the Office of the Surgeon General of the Army released the results of a report that examined detainee medical operations for Operation Enduring Freedom , Operation Iraqi Freedom, and Guantanamo Bay. The only mention of children falls under the section that reviews theater preparation for detainee medical care. A noted shortfall was lack of personnel, supplies, and equipment to deal with specialty subsets of the Iraqi civilian and detainee population; pediatrics was cited as one of those subsets.38 A section of the report outlines recommendations for future training for those medics preparing to work in the arena of detainee care. There is no request for information or strategic or tactical policy guidance related to treatment or rehabilitation of child soldiers. This author believes these gaps reflect the military community’s lack of focus on this population subset rather than the fact that the medics were already so well educated about child soldiers that they did not report a need for education and training. Clearly, child soldiers have broad implications for many military populations in varied environments.

Recommendations

The following recommendations may mitigate some of the shortfalls identified and position the US military to respond affirmatively to the question of whether it is prepared to manage the threat of child soldiers.

Training and Predeployment Preparation

Revamping troop preparation and training is the area that has the potential for the most impact on mitigating potentially negative consequences of encounters with child soldiers. The existence and potential for participation of child soldiers in combat should be a part of country-specific intelligence that is collected and reported in predeployment briefings. The intelligence and medical communities should identify what the likelihood is of encountering child soldiers, how they are used, and what the military members can expect. This threat assessment should be communicated not only to combat troops but also to all those preparing to deploy.

The RAND study that examined combat-stress reactions and their implication for urban warfare concluded with 13 recommendations for prevention that targeted commanders and noncommissioned officers (NCO). Tough and realistic training, intelligence, and rules of engagement (ROE) were three of those recommended areas of action.39 The report suggests a three-tiered system of training, referred to as Stress Exposure Training, which not only highlights the importance of identifying stressors in the operational environment ahead of time but also emphasizes the individual’s response, teaches the necessary skill sets, and stresses confidence building through realistic training. A briefing similar to the one presented to the 11th MEU should be mandatory for operational and strategic leaders so that tactical ROEs can be decided upon and become part of the predeployment training scenarios. 40

Singer cautions that a “microsecond’s hesitation” could cost US troops their lives, so deliberate, preparatory efforts are essential to overcome individual shock towards our adversary’s tactic of employing child soldiers and to condition our forces to react quickly.41 Child-soldier scenarios should be added to war games at all levels of training, with consideration given to including child silhouettes in simulator-training exercises. There are tactical as well as strategic implications and beneficial lessons to be taught and learned. Research has demonstrated the value of practicing skills under stressful training situations and established that the more realistic training is, the greater the chance the desired skill will be adopted.42 Some literature on pretrauma training cautions that the evidence for such a strong relationship is tentative, noting that more controlled research needs to be done to determine the extent that training in advance can reduce negative psychological outcomes. 43

Medics and personnel working in detention centers also need to have clear ROEs outlined. They must understand the special needs of child soldiers and the ways they can help break the control that armed fighting groups can have on children. They should also be encouraged to establish relationships with NGO organizations that can assist with the immediate needs of child soldiers and encourage rehabilitation at the earliest opportunities. In a 2003 article entitled “Fighting Child Soldiers,” Singer makes several practical points about management of child soldiers that should be part of US military predeployment education and training programs, especially for combatants and medics.

Mental-Health Interventions

With the responsibility for training and preparation allocated to unit commanders and NCOs, the medical community should focus on the aftermath of the inevitable engagements with child soldiers. The military medical community must develop programs to deal with the psychological aftermath of US troops who must fire upon child soldiers in the course of warfare.45 The medical community must balance this approach with the knowledge that preventive measures are often more effective for protecting individual mental health and more cost-effective than postexposure mental-health treatments.

As there is no published research on the psychological implications of US troops engaging child soldiers, there have been no studies that confirm the effectiveness of any specific interventions. Recommendations are inferred from research done on the stress of killing, but the specific applicability in the child-soldier killing subset is unknown. Research has questioned the impact of postdeployment psychological debriefings on the rates of PTSD. Clear ROEs need to be established and incorporated into military guidelines for clinical treatment. All military medical providers should be aware of the protocols for treating suspected combat-stress reactions or PTSD and be prepared to engage early. Early intervention when symptoms are just beginning has been shown to prevent permanent psychological disorders in some cases. Most medical interventions start with an accurate assessment; therefore, continuing to review and analyze the data received from the PDHRA process cannot be overemphasized. This critical analysis by behavioral health specialists must also ascertain if any revisions to the survey should be adopted. Adding specific questions about exposure to killing, especially killing of women and children, should be considered.

The biggest challenge for the medical community probably lies in solving the issues associated with military members’ reluctance to seek out and receive mental-health care.46 Research indicates that several organizational barriers and stigmas still contribute to this reluctance despite the supposition that “no sane person would turn down antibiotics if the doctor prescribed them, and no reasonable warrior should turn away from psychological help if it is available and needed.”47 But mental-health disorders are often much more difficult to recognize, and there is a historical stigma associated with seeking out care for psychological illness that is not present with physiological illness. In a 2004 study of Army and Marine troops returning from tours of duty in Iraq and Afghanistan, only 23 to 40 percent of the troops who screened positive for a mental disorder sought out mental-health care in-theater or in the first year upon their return.48 This is an area that definitely needs more attention from the medical community.

The Air Force should continue to formalize the operational psychologist program begun in AFSOC and promote its expansion into other populations and military services. The Army does employ combat-stress teams, and care should be taken to see that they are distributed appropriately in areas of combat operation. The US Navy (USN) does employ psychologists on aircraft carriers, and psychologists have deployed with USN Sea, Air, and Land (SEAL) teams. The USN and US Marines should reexamine the playing field to ensure that the right medical assets are in place with the right troops. Having mental-health providers integrated into the “normal” or routine health-care team may help to decrease some of the negativism and encourage early intervention and treatment of psychological symptoms and disorders. We must dedicate energy towards identification and assessment of psychological threats, even if they are hard to separate from physical threats. The DOD should also support and participate in research that will contribute to the development of countermeasures to mitigate this risk. Clearly the complex threat of child soldiers needs greater emphasis so that the military can continue to promote a fit and healthy force.

Armed with the knowledge that public support may affect troops’ psychological adaptation, our public affairs officers must also prepare now for the ramifications of American military encounters with child soldiers. There is an obvious need for the DOD to develop doctrine that addresses the many unique aspects of this growing threat.

Additional Research

Clearly, gaps in the US military’s existing knowledge base have made it difficult to quantitatively measure the effect on US soldiers of encountering child soldiers; therefore, several recommendations are proposed as future research topics. One study should identify the mental-health consequences among US troops engaging with child soldiers. The study should also examine the impact of engaging child soldiers on combat effectiveness of US troops. Ideally, this study would compare units that engaged with child soldiers against those that did not. The previously referenced RAND report recommended future research to evaluate the psychological consequences of operating in an urban environment with a civilian population. Child soldiers are a large part of this new, emerging civilian threat, which definitely needs to be examined in more detail.

Other studies should examine the effectiveness of current therapies and interventions for reducing mental-health problems associated with engaging child soldiers. How do we know if interventions that minimize psychopathology associated with killing in general are working to help those who killed child soldiers and are not doing more harm than good? The military community should not assume that all killing in combat is the same without some type of empirical evidence to help support that assumption and dictate treatment modality. Closely related is a need for more research on resilience and attempts to identify what makes some individuals more resistant to long-term psychological conditions after exposure to traumatic events. The military population must be careful not to formulate too many assumptions from studies on combat killing in general that have not included experiences of facing and killing child soldiers.

We should also devote additional attention to identifying interventions that would decrease the negative stigma of mental-health care. Although well cited as an obstacle to care, not much guidance exists in the current literature to help providers and patients alike overcome this barrier. Lastly, we should consider establishing surveillance or monitoring systems that systematically collect data over time to monitor trends and other key factors related to the problem of child soldiers.49 Similar to what the public-health community uses to monitor infectious disease, we could use such systems to help units anticipate the involvement of child soldiers and the extent to which the problem is getting better or worse in a region. This information could be essential for military planning and helpful in future research.

Conclusion

Children with [AK-47s] are a new feature of the modern battlefield, and U.S. forces will have to deal with the dilemmas they present at some point. . . . For U.S. military planners, now is the time to pay greater attention to the phenomenon’s unique particularities, so that appropriate responses can be designed. Child soldier incidents will come sooner or later. The pertinent question is whether American troops will be prepared.

—P. W. Singer

The increased global presence of the US military is a trend that will continue for the foreseeable future. The use of child soldiers in combat environments around the globe also appears to be a growing trend. After examining the scope of the problem of child soldiers; assessing US military policy, strategy, and practice; and highlighting the implications for US forces, this author has concluded that US military members have not been properly prepared to face the unique threat of child soldiers.

The DOD has not been proactive in preparing personnel who may come in contact with this evolving dimension of warfare or in taking measures to mitigate potential mental-health problems from encounters with child soldiers. The US military, with cooperation between the line and medical communities, must come to terms with the inevitability of facing this type of enemy in current and future conflicts. Continuing to ignore this threat has strategic and tactical implications for the effectiveness of combat forces and the mental health of military members working in many different environments. Singer advocates that countries around the globe pay more attention to the child-soldier phenomenon in peace and postwar planning and ensure specific provisions to address child soldiers. Ignoring this responsibility leaves the children ready to begin the same cycle all over again in future generations. Ignoring the child-soldier phenomenon may perpetuate negative psychological outcomes in future generations of US military members.

Notes:

1. Charles W. Hoge et al., "Combat Duty in Iraq and Afghanistan, Mental Health Problems, and Barriers to Care," The New England Journal of Medicine 351, no. 1 (2004): 14.

2. Brett T. Litz, The Unique Circumstances and Mental Health Impact of the Wars in Afghanistan and Iraq (Washington, DC: National Center for Post Traumatic Stress Disorder, 2005).

3. Amnesty International, Child Soldiers: A Global Issue (London: Amnesty International, 2005), http://web.amnesty.org/pages/childsoldiers-background-eng (accessed 12 September 2005).

4. P. W. Singer, Caution: Children at War 4 (Winter 2001–2), http://carlislewww.army.mil/ usawc/Parameters/01winter/singer.htm (accessed 20 September 2005).

5. Coalition to Stop the Use of Child Soldiers, Child Soldiers Global Report 2004 (London: Coalition to Stop the Use of Child Soldiers, 2004), http://www.child-soldiers.org/resources/global-reports?root_id=159&category_id=165 (accessed 10 October 2005).

6. Ibid.

7. Singer, Caution: Children at War.

8. Graham E. Fuller, The Youth Factor: The New Demographics of the Middle East and the Implications for U.S. Policy (Washington, DC: Saban Center for Middle East Policy, Brookings Institution, June 2003), 2.

9. Human Rights Watch Africa and Human Rights Watch Children's Rights Project, Easy Prey: Child Soldiers in Liberia (New York: Human Rights Watch, 1994); Rachel Brett and Irma Specht, Young Soldiers: They Choose to Fight (Boulder, CO: Lynne Rienner Publishers, 2004); and Graca Machel, The Impact of War on Children (New York: PALGRAVE, 2001).

10. Singer, Caution: Children at War, 6.

11. Ibid., 8.

12. Mary Evelyn Jegen, "Casualties of Warfare: Children and Childhood," National Catholic Reporter, 1997, http://find.galegroup.com/itx/infomark.do?type=retrieve&tabID=T002&prodId=SPJ.SP00&docId=A19136141&userGroupName=maxw30823&version=1.0&source=gale.

13. Ibid.

14. Charles Borchini, Stephanie Lanz, and Erin O'Connell, "Child Soldiers: Implications for U.S. Forces" (Quantico, VA: Marine Corps Warfighting Laboratory, Center for Emerging Threats and Opportunities [CETO], 2002), 26.

15. USMC (Ret) Col Mike Lowe, 6 December 2007, Col Charley Higby, US Army War College Asst Dean for Academic Affairs et al., E-mail communication that attempted to ascertain if any of the services' senior service schools included child soldiers in any of its' wargaming scenarios., September 2005-January 2006.

16. Rachel Stohl, E-mail communication with author, September 23, 2005.

17. Center for the Study of Traumatic Stress, Military Psychiatry Resources, http://www.centerforthestudyoftraumaticstress.org/ education.military.shtml (accessed 7 January 2008).

18. Thomas A. Grieger et al., "Posttraumatic Stress Disorder and Depression in Battle-Injured Soldiers," American Journal of Psychiatry 163, no. 10 (2006).

19  George A. Bonanno, "Loss, Trauma, and Human Resilience. Have We Underestimated the Human Capacity to Thrive after Extremely Adverse Events?" American Psychologist 59, no. 1 (January 2004): 24.

20. S.L.A. Marshall, Men against Fire (New York: William Morrow, 1947).

21. Lt Col Dave Grossman, On Combat: The Psychology and Physiology of Deadly Conflict in War and Peace (Illinois: PPCT Research Publications, 2004), 207.

22. Ibid., 208.

23. Theodore Nadelson, Trained to Kill: Soldiers at War (Baltimore, MD: The Johns Hopkins University Press, 2005), 42.

24. Dave Grossman, On Killing: The Psychological Cost of Learning to Kill in War and Society (Boston: Little, Brown and Company, 1995); and Nadelson, Trained to Kill.

25. Grossman, On Killing, 174.

26. Todd Helmus and Russell Glen, Steeling the Mind: Combat Stress Reactions and Their Implications for Urban Warfare (Santa Monica, CA: RAND Corporation, 2005), 99.

27. Nadelson, Trained to Kill, 90.

28. Richard A. Bryant and Allison G. Harvey, Acute Stress Disorder: A Handbook of Theory, Assessment, and Treatment (Washington, DC: American Psychological Association, 2000); Robert J. Ursano, Brian G. McCaughey, and Carol S. Fullerton, eds., Individual and Community Responses to Trauma and Disaster: The Structure of Human Chaos (Cambridge: Cambridge University Press, 1994).

29. Litz, The Unique Circumstances and Mental Health Impact of the Wars in Afghanistan and Iraq; and Susan M. Orsillo et al., "Current and Lifetime Psychiatric Disorders among Veterans with War Zone-Related Posttraumatic Stress Disorder," The Journal of Nervous and Mental Disease 184, no. 5 (1996).

30. Hoge et al., "Combat Duty in Iraq and Afghanistan," 14.

31. Operation Iraqi Freedom Mental Health Advisory Team, "Operation Iraqi Freedom (Oif-Ii) Mental Health Advisory Team (Mhat-Ii) Report," ed. The U.S. Army Surgeon General (The U.S. Army Surgeon General, 2005).

32. Litz, The Unique Circumstances and Mental Health Impact of the Wars in Afghanistan and Iraq; and Operation Iraqi Freedom Mental Health Advisory Team, "Operation Iraqi Freedom (OIF-II) Mental Health Advisory Team (MHAT-II) Report."

33. Helmus and Glen, Steeling the Mind, 128.

34. Litz, The Unique Circumstances and Mental Health Impact of the Wars in Afghanistan and Iraq.

35. Human Rights Watch, U.S., Guantanamo Kids at Risk (Human Rights Watch, 2004), http://hrw.org/english/docs/2003/04/24/usint5782.htm; and Lois Whitman, Letter to Secretary Rumsfeld on Child Detainees at Guantanamo: Human Rights Watch Urges Child Protections (Human Rights News, 2003), http://www.hrw.org/press/2003/04/us042403ltr.htm.

36. United Nations General Assembly, Rome Statute of the International Criminal Court (University of Minnesota, Human Rights Library, 2002), http://www1.umn.edu/humanrts/instree/Rome_Statute_ICC/romestatute.html.

37. United Nations General Assembly, Optional Protocol to the Convention on the Rights of the Child on the Involvement of Children in Armed Conflict (Office of the United Nations High Commissioner for Human Rights, 2000), http://www2.ohchr.org/english/bodies/ratification/11_b.htm.

38. Office of the Surgeon General of the Army, "Assessment of Detainee Medical Operations for OEF, GTMO, and OIF," (Department of the Army, 2005), 18-4.

39. Helmus and Glen, Steeling the Mind, 127-31.

40. Lt Col Judith Hughes, "Child Soldiers: Are U.S. Military Members Prepared to Deal with the Threat?" (Maxwell AFB, AL: Air War College, Air University, 2006).

41. P. W. Singer, "Fighting Child Soldiers," Military Review 83, no. 3 (May–June 2003): 26–31.

42. Grossman, On Killing; and Helmus and Glen, Steeling the Mind.

43. Bryant and Harvey, Acute Stress Disorder: A Handbook of Theory, Assessment, and Treatment, 167-68.

44. Singer, Fighting Child Soldiers.

45. Timothy Maier, Children Are Being Used as Soldiers: Third World Countries Increasingly Are Coercing Child Soldiers into Military Action, Raising Moral Dilemmas That Can Be Matters of Life and Death for Western Troops, News World Communications, 2002, http://find.galegroup.com/itx/infomark.do?type=retrieve&tabID=T002&prodId=SPJ.SP00&docId=A95150325&retrieveFormat=PDF&isAcrobatAvailable=true&userGroupName=maxw30823&version=1.0&isMultiPage=false&noOfPages=2&source=gale (accessed 20 September 2005).

46. Hoge et al., "Combat Duty in Iraq and Afghanistan" and Operation Iraqi Freedom Mental Health Advisory Team, "Operation Iraqi Freedom (OIF-II) Mental Health Advisory Team (MHAT-II) Report."

47. Grossman, On Combat, 290.

48. Hoge et al., "Combat Duty in Iraq and Afghanistan, Mental Health Problems, and Barriers to Care," 16.

49. James Mercy, to the author, e-mail, 30 November 2005.


Contributor

Lieutenatt Colonel (USAF) Judith A. Hughes Lieutenant Colonel (USAF) Judith A. Hughes, (BS, Saint Anselm College in Manchester, NH) is currently the commander of the 45th Medical Operations Squadron at Patrick AFB.  She is a registered nurse certified in ambulatory care nursing.  She has held numerous positions to include Air Staff, the Air Force Inspection Agency and various clinical assignments in both inpatient and outpatient arenas. Col Hughes is a 2006 graduate of the Air War College, Maxwell AFB, AL.

Disclaimer: The conclusions and opinions expressed in this document are those of the author cultivated in the freedom of expression, academic environment of Air University. They do not reflect the official position of the U.S. Government, Department of Defense, the United States Air Force or the Air University.


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