Encountering children and child soldiers during military deployments: the impact and implications for moral injury

Abstract

Background: During a deployment, soldiers must make seemingly impossible decisions, including having to engage with child soldiers. Such moral conflicts may continue to affect service members and veterans in the aftermath of a deployment, sometimes leading to severe moral distress, anguish, and personal crises. Service providers have increasingly argued that as a diagnosis, Post-Traumatic Stress Disorder (PTSD) cannot account for these deeply personal and painful moral conflicts. In light of this, the concept of moral injury has been introduced to better capture the profound forms of guilt and shame that may be experienced by service members and veterans. Objective: This paper addresses encounters with children and child soldiers during military deployments, as well as the risk for moral injury during and following these encounters, and their implications. This exploratory paper brings together existing literature on the topic to introduce, illustrate, and offer potential and promising interventions. Results: Given the potential moral conflicts that may ensue, military personnel who encounter child soldiers during a military deployment may be at risk for moral injury during and following these encounters. The introduction of the concept of moral injury provides a way for these largely unnamed personal and painful moral conflicts and violations to be recognized, addressed, and with appropriate care, remedied. Although there is limited research into their effectiveness at treating moral injury, individual and group-based interventions have been identified as potentially beneficial. Conclusion: As encounters with children during deployments are likely to continue, systematic research, training, healing interventions and prevention strategies are vital to support and protect children in conflict settings, as well as to ensure the mental health and well-being of service members and veterans. HIGHLIGHTS Profound moral conflicts may affect service members and veterans in the aftermath of a military deployment, sometimes leading to severe moral distress, anguish, and personal crises. The concept of moral injury has been introduced to better capture the profound forms of guilt and shame that may be experienced by service members and veterans. Encountering children and child soldiers during a military deployment, may present unique challenges, stress, and moral crises leading to potentially moral injurious events. In particular, transgression-based events which result from an individual perpetrating or engaging in acts that contravene his or her deeply held moral beliefs and expectations such as harming children, and betrayal-based events , which results from witnessing or falling victim to the perceived moral transgressions of others, may lead to lasting psychological, biological, spiritual, beha...

The nature and impacts of deployment-related encounters with children among Canadian military Veterans: a qualitative analysis

“…related to mission framework, deployment environment, occupational impacts, and formal supports), often eliciting moral conflicts, challenges in decision-making, and intense reactions such as shock, mistrust, and anger. These findings are consistent with previous reviews and editorials (Denov, 2022 ; Ein et al, 2022 , 2023 ), emphasizing training and policy gaps which leave personnel inadequately prepared to manage the tactical and psychological implications of deployment-related encounters with children. Of note, such implications may also be legal and political, and serve to exacerbate consequences to soldiers and to children.…”

“…Importantly, deployment-related encounters with children have been characterized as potentially morally injurious events (PMIEs) (Denov, 2022 ; Ein et al, 2023 ), defined as experiences that deeply transgress a person’s deeply held moral beliefs leading to distress and impairment (Litz et al, 2009 ). Epidemiological research on stressful deployment experiences in the context of the Canadian mission to Afghanistan reveals high exposure to PMIEs, with 58% of returning soldiers endorsing exposure to at least one type of PMIE, and 43% reporting experiences where they were unable to help women and children who were suffering (Nazarov et al, 2018 ).…”

Canadian Armed Forces Veterans’ Perspectives on the Effects of Exposure to Children in Armed Conflict During Military Service: Protocol for a Qualitative Study

“…[1,2] International deployments increasingly involve exposure to complexities less common in previous conflict eras, including engagement with unmarked enemy combatants, suicide bombings, and encounters with children. Importantly, while deployment-related encounters with children have been shown to be associated with mental health and other consequences in military personnel, [3] and have been conceptualized as potentially morally injurious events (PMIEs; i.e., events that can lead to mental health impacts due to a violation of moral beliefs or values) [4,5], the effects of such encounters remain largely understudied. For example, approximately 58% of the 33,500 Canadian military personnel deployed in NATO operations in Afghanistan experienced PMIEs, with 43% of these individuals endorsing having experienced PMIEs involving women and children.…”

“…[5,16] As such, military personnel are increasingly at risk for serious psychological sequelae due to exposure to these situations, which in many ways are representative of prevailing conceptualizations of PMIEs. [4,5,16] Consequences of PMIE exposure are serious, as research has demonstrated consistent associations with PTSD, depression, anxiety, and most concerningly suicidality. [1,9] Furthermore, studies have shown that exposure to and direct involvement in PMIEs is associated with PTSD symptom severity, even after controlling for exposure to combat (e.g., receiving enemy fire, going on patrols), [17,18] showcasing that distinct qualities of deployment events can have particular impacts on mental health.…”

“…Military organizations remain inadequately prepared to deal with the complex psychological and operational requirements of service members deployed in conflict zones where children are recruited and used [ 5 , 16 ]. As such, military personnel are increasingly at risk for serious psychological sequelae due to exposure to these situations, which in many ways are representative of prevailing conceptualizations of PMIEs [ 4 , 5 , 16 ]. Consequences of PMIE exposure are serious, as research has demonstrated consistent associations with PTSD, depression, anxiety, and most concerningly suicidality [ 1 , 9 ].…”