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

ABSTRACT

Background: As armed conflict grows increasingly complex, the involvement of children in armed violence across diverse roles is rising. Consequently, military personnel are more likely to encounter children during deployment. However, little is known about deployment-related encounters with children and their impact on the mental health of military personnel and Veterans.

Objective: This study qualitatively examines the nature and impacts of deployment-related encounters with children.

Methods: We conducted semi-structured interviews with 16 Canadian Armed Forces Veterans, eliciting rich information on the nature of child encounters on deployment, the psycho-social-spiritual impacts of these encounters, and perceptions of support. Interview transcripts were analysed using thematic analysis.

Results: Six primary themes were identified: types of encounters (i.e. factual aspects of deployment-related encounters with children), contextual factors (i.e. aspects of the mission, environment, and personal context relevant to one’s experience of the encounter), appraisals of encounters (i.e. sensory or sense-making experiences relevant to the encounter), impacts of encounters (i.e. psycho-social, existential, and occupational impacts), coping strategies engaged in both during and after deployment, and support experiences, describing both formal and informal sources of support.

Conclusions: Encounters with children are diverse and highly stressful, resulting in impacts pertinent to mental health, including psychological and moral distress, and difficulties with identity, spirituality, and relationships. These impacts are prompted by complex interactions among appraisals, expectations of morality, cultural norms, and professional duties and are amplified by various personal factors (e.g. childhood maltreatment history, parenthood), feelings of unpreparedness, and lack of post-deployment support. Implications for prevention, intervention, and policy are discussed with the aim of informing future efforts to safeguard and support military personnel facing a high likelihood of encounters with children.

HIGHLIGHTS

• Deployment-related encounters with children result in diverse impacts, including psychological and moral distress, along with disruptions in identity, spirituality, and interpersonal relationships.

• Encounters with children during military deployments are diverse and highly stressful, characterized by complex interactions among appraisals and expectations of morality, cultural norms, and professional duties.

• Emphasis on feeling unprepared for encounters with children highlights the need for future efforts to safeguard and support military personnel facing such situations.

Antecedentes: A medida que los conflictos armados se hacen cada vez más complejos, aumenta la participación de los niños en la violencia armada en diversas funciones. En consecuencia, es más probable que el personal militar se encuentre con niños durante el despliegue. Sin embargo, se sabe poco sobre los encuentros con niños relacionados al despliegue y su impacto en la salud mental del personal militar y los veteranos.

Objetivo: Este estudio cualitativo examina la naturaleza y el impacto de los encuentros con niños relacionados al despliegue.

Método: Realizamos entrevistas semiestructuradas a 16 veteranos de las Fuerzas Armadas Canadienses, en las que obtuvimos abundante información sobre la naturaleza de los encuentros con niños durante el despliegue, las repercusiones psicosociales y espirituales de estos encuentros y la percepción del apoyo. Las transcripciones de las entrevistas se analizaron mediante análisis temático.

Resultados: Se identificaron seis temas principales: tipos de encuentros (es decir, aspectos fácticos de los encuentros con niños relacionados al despliegue), factores contextuales (es decir, aspectos de la misión, el entorno y el contexto personal relevantes para la propia experiencia del encuentro), evaluaciones de los encuentros (es decir, experiencias sensoriales o de sentido relevantes para el encuentro), impactos de los encuentros (es decir, impactos psicosociales, existenciales y ocupacionales), estrategias de afrontamiento aplicadas tanto durante como después del despliegue, y experiencias de apoyo, describiendo tanto fuentes formales como informales de apoyo.

Conclusiones: Los encuentros con los niños son diversos y muy estresantes, lo que tiene repercusiones en la salud mental, como el malestar psicológico y moral, y los problemas con la identidad, la espiritualidad y las relaciones. Estos efectos se deben a complejas interacciones entre las valoraciones, las expectativas de moralidad, las normas culturales y los deberes profesionales, y se ven amplificados por diversos factores personales (por ejemplo, antecedentes de maltrato infantil, paternidad), sentimientos de falta de preparación y falta de apoyo tras el despliegue. Se discuten las implicaciones para la prevención, la intervención y la política con el objetivo de informar los esfuerzos futuros para salvaguardar y apoyar al personal militar que se enfrenta a una alta probabilidad de encuentros con niños.

KEYWORDS:

• Military
• veteran
• deployment
• children
• child soldiers
• trauma
• stress
• moral injury
• mental health

PALABRAS CLAVES:

• Militar
• veterano
• despliegue
• niños
• niños soldados
• trauma
• estrés
• daño moral
• salud mental

1. Introduction

Military deployment environments pose distinct contextual and psychological demands that challenge the personal and occupational capacities of military personnel. Military roles as well as the mission demands of international deployments are becoming increasingly varied, often involving deeper engagement with the local populations and cultures (Fuhr, 2019; Thompson, 2015). This complexity is underscored by the growing number of children living in conflict zones and the increasing number of children who are being recruited and used in violence (Østby et al., 2023).

Despite progress in understanding the mental health impacts of different military stressors (Litz et al., 2018) little attention has been paid to the particular impacts that deployment-related encounters with children may engender. In a recent systematic review conducted by Ein and colleagues (Ein et al., 2022), only 17 publications were identified regarding this issue, highlighting the scarcity of research in this area. In addition, this review reports only one encounter by a female-identifying soldier, highlighting our lack of knowledge regarding the potential role that gender may play in exposure to and impacts of such experiences. Though minimal, this literature demonstrates that the effects of such encounters on wellbeing can include physical injuries, mental health concerns, moral struggles, sleep disturbances and social isolation. Importantly, of the few publications which provided any information on preparedness for encountering children, most underscored the lack of available training, policies, or guidance within the rules of engagement (ROE). While this review provides an initial indication of the potential impacts of encounters with children, it also highlights the dearth of available information on the mental health impacts that may be exerted by these experiences. In particular, research is needed on the impacts of deployment-related encounters with children to guide the development of pre- and post-deployment interventions aimed at preparing personnel to deal with the unique impacts that encountering children may bring, and to support families and healthcare providers in assisting such personnel upon their return.

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). Among treatment-seeking Canadian Veterans, the proportion of those endorsing this same experience (i.e. seeing suffering women and children) rises to 60.5% (King et al., 2020). Critically, such encounters have been associated with increased risk of posttraumatic stress disorder (PTSD) and depression in military personnel (Nazarov et al., 2018). Exposure to PMIEs has also demonstrated consistent associations with suicidality (Jamieson et al., 2023) and more recent examinations show that other psychiatric problems such as social anxiety disorder, panic disorder, and generalized anxiety disorder are also more prevalent among those endorsing PMIEs (Easterbrook et al., 2023).

While these findings provide an indication of the potential harm that deployment-related encounters with children may exert on mental health, research falls short of fully elucidating the nature and impact of such encounters, especially among Canadian personnel. Furthermore, despite Canada’s role in international peacekeeping and their leadership as the chair of the Group of Friends of Children and Armed Conflict at the UN, there has been limited recognition of the connections between protecting children in armed conflict and the impacts such experiences can exert on the personnel carrying out this responsibility. The Vancouver Principles on Peacekeeping and the Prevention of the Recruitment and Use of Child Soldiers (Canada GA, 2019), endorsed by over 100 United Nations member states, was among the first guidance to acknowledge the link between military mental health and encounters with children and explicates the need to ‘actively promote and support research on the trauma experienced by personnel confronting child soldiers and interacting with children affected by armed conflict, and to provide appropriate pre-deployment preparation, as well as mental health support during and post-deployment’ (Canada GA, 2019).

The objectives of this research were therefore to (1) qualitatively examine the nature and mental health impacts of deployment-related encounters with children among Canadian military personnel, (2) consider how these encounters may differ by gender, and (3) identify areas for prevention and enhanced intervention related to the mental health impacts of deployment-related encounters with children.

2. Methods

This study was approved by the Research Ethics Board at The Centre for Addiction and Mental Health (REB# 2021/045) as well as the Research Ethics Boards at Dalhousie University (REB# 2021-5723), Mount Saint Vincent University (REB 2022-015), Western University (#120351), and the Lawson Health Research Institute (ReDA#11430).

2.1. Participants

Canadian Armed Forces (CAF) Veterans (n = 16) who encountered children during a military deployment were recruited to participate in this study through advertisements distributed among Canadian stakeholders (e.g. Veteran Trainers to Eradicate the Use of Child Soldiers) and on social media (i.e. Facebook, Twitter). Current and former clients of specialized operational stress injury clinics in Canada who had previously consented to be contacted for research opportunities were also sent the study invitation by e-mail. Interested individuals contacted the project coordinator who confirmed eligibility, provided an overview of the study and scheduled interviews. Participants were compensated with a $50 Amazon gift card.

2.2. Procedure

In a recorded one-to-one semi-structured interview, participants answered questions regarding past military experiences including their professional role, type of mission in which deployment-related encounters with children were experienced, the nature of specific encounters, the psychological, social, emotional and behavioural impacts of the encounters, and supports sought and utilized in response to these impacts. Questions were also asked about occupational training and deployment preparations related to encountering children. The full interview script is available in the supplementary materials.

Interviews were conducted by authors S.A.H. and C.C. both clinically trained therapists, using secure Cisco WebEx video conferencing software. Interviews lasted on average 79 minutes (range 43–173 minutes) and took place between November 2021 and June 2023. Prior to the interview, participants were provided with information regarding emergency mental health procedures and supports. Socio-demographic information (i.e. age, province of residence, employment and marital status, number and age of children, religious/spiritual affiliation, gender identity) was collected at the end of each interview and entered manually by the interviewer into REDCap (Harris et al., 2009). Interviews were audio-recorded and transcribed verbatim.

2.3. Data analysis

Interviews were analysed following Braun and Clarke’s (Braun & Clarke, 2006) six-stage thematic approach. Themes refer to patterns of responses in the data that relate to the research question from which we draw meaning (Braun & Clarke, 2006). The process involves familiarization and initial coding, organizing codes into potential themes, summarizing data relevant to each theme, reviewing, verifying, defining and then naming each theme. NVivo 12 software (QSR International, 2017) was used to manage the data. Interviews were coded by several authors independently. The research team met regularly to review coded excerpts, and to resolve any discrepancies through group consensus.

3. Results

3.1. Sample characteristics

Participants ranged in age from 37 to 68 years (M = 53.81, SD = 9.86). Most were from Ontario (n = 7, 43.8%) followed by Nova Scotia (n = 3, 18.8%) and British Columbia (n = 2, 12.5%). Most participants were married (n = 11, 68.8%; separated/divorced n = 4, 25.0%; single n = 1, 6.3%), and had children (n = 13, 81.3%). The majority identified as men (n = 14; 2 abstained from responding). Of note, our intention was to recruit a balanced proportion of women participants, but no women Veterans volunteered to participate and therefore it was unfortunately not possible to address our second objective. Most participants stated they were not currently practising any religion or spirituality (n = 13, 81.3%). Participants’ working statuses were described as retired (n = 5, 31.3%) working (n = 4, 25%), self-employed (n = 5, 31.3%), going to school (n = 1, 6.3%), long-term illness/disability (n = 2, 12.5%), unemployed (n = 1, 6.3%) and other (n = 1, 6.3%). Regarding military characteristics, most participants served in the Regular Force (n = 14, 87.5%), and with the Army (n = 12, 75%). Participants' rank at time of release included senior officer (n = 5, 31.3%), junior officer (n = 3, 18.8%), senior non-commissioned officer (n = 6, 37.5%) and junior non-commissioned officer (n = 2, 12.5%). The majority of participants had multiple deployments (n = 13, 81.3%), to areas including Eastern Africa, Western and Central Asia, Europe, Central American and the Caribbean.

3.2. Thematic analysis

Six primary themes were identified in the thematic analysis: types of encounters, contextual factors, appraisals of encounters, impacts of encounters, coping, and supports. Several sub-themes for each were also identified and are described below. The thematic structure is shown in Table 1.

Table 1. Thematic structure describing the nature and impact of deployment-related encounters with children.

Theme	Sub-theme(s)	Description	Exemplar excerpts
Types of encounters		Describes factual aspects of deployment-related encounters with children provided by participants
	Children recruited and used in armed violence	Describes encounters with children who were recruited and used in conflict and/or being exploited by others in the aim of the conflict. Includes contact with those clearly involved in violence but age is difficult to determine	‘They kill the mother right in front of their faces and then it’s game over. Now these kids have absolutely nothing. Now they lure these kids by giving that little boy a weapon and tell him that he is a man now and he has to fight for his survival.’
	Children as part of the population	Describes encounters with children in the general conflict environment but that are not recruited and used in conflict activities	‘I mean you saw all the all the things that you needed to see in terms of kids without shoes and kids freezing and sadly, there was some mass grave sites that had children in them.’
	Ambiguous encounters with children	Describes encounters with children whereby participants were uncertain of the intention or role of the child (i.e. whether or not they are recruited and used in the aim of the conflict)	‘We didn’t really have a good understanding of how the enemy was using children in terms of reconnaissance or information passage and those things.’
Contextual factors		Describes aspects of the context of deployment-related encounters with children pertinent to the participant’s experience of the encounter. This includes aspects of their personal and professional roles and experience, as well as contextual factors relevant to the deployment objectives and area itself
	Mission framework	Describes aspects of the participant’s role during the mission and the mission’s objectives, organization, resources and operating procedures relevant to the encounters with children described. Includes both protective and risk factors (e.g. inappropriate/inadequate training for encountering children on deployment) ‘What the mission/deployment is bringing to the encounter’	‘I mean my job was to try to get these kids out of there through, like I said, bartering and pleading with them so they can go back …  go back to school.’ ‘I was not supposed to be involved face to face with the rebel group leaders, child soldiers.’
	Deployment environment	Describes aspects of the deployment environment (e.g. cultural norms, population density, poverty, urbanization, degree of military engagement/exposure to the aftermath of violence) relevant to the encounters with children described ‘What the environment is bringing to the encounter’	‘Yeah, ridiculous poverty, family violence, lack of education, lack of resources.’
	Personal context	Describes aspects of the participant’s personal life experience (e.g. social roles, personal history, personality, past military experiences) relevant to the encounters with children described ‘What the person is bringing to the encounter’	‘No, that bothers me that, you know, some kids got mutilated, some kids did the mutilation … I was abused as a kid … and it just brought back a lot of hurtful memories’; ‘And I think the depth of emotion is different to once you become a parent in terms of when you see children hungry and cold.’
Appraisals of encounters		Describes aspects (e.g. sensory experience) and processes (e.g. sense-making) relevant to the individual’s appraisal of the encounter. Applies to both acute appraisals and those made in retrospect
	Socio-cultural appraisals	Describes aspects and sense-making processes relevant to the participant’s appraisals of the encounter which pertain to their understanding of the social world (e.g. personal, community, political). Includes attempts to reconcile their experiences with their schemas of children, conflict and culture derived from both their home environment and the conflict environment	‘I mean, that’s your whole point of being is to be the provider for your family. So, if they tell you, “Look, if you just carry this or drive this car we’ll send you to Allah with your virgins and your family will be taken care of forever”  …  And the same thing goes with the kids … They just don’t understand being tricked.’
	Strategic/tactical appraisals	Describes appraisals of the encounter which have a strategic or tactical significance (i.e. which influence strategic/tactical decision-making, or the perceived consequences of the encounter are of a strategic/tactical nature). Includes the degree to which the individual felt adequately prepared to make a strategic/tactical appraisal during child encounters, and any perceived strategic/tactical consequences arising from the encounter	‘A child soldier who’s been indoctrinated or worse …  thinks they’re actually invincible and a bullet can’t kill them … They’re not putting their weapon down. How do you deal with that?  …  I don’t have a lot of time to decide what I’m going to do, right? We don’t prepare people for that.’
Impacts of encounters		Describes domains of psycho-social experience and aspects of such that have been impacted by participants’ deployment-related encounters with children
	Social/interpersonal impacts	Describes consequences of encounters with children that impact the participant’s social experience (e.g. roles and responsibilities) and ability to connect with others. These include impacts that occurred at the time of the encounter/while on deployment, as well as after returning from deployment	‘OK. I can go into school concerts now. Initially, for a couple of years, I had really bad PTSD with regards to crowds and people, I’ve been working through that, especially for kids.’
	Psychological impacts	Describes consequences of encounters with children that impact the participant’s psychological (i.e. emotional, behavioural and cognitive) experience. These include impacts that occurred at the time of the encounter/while on deployment, as well as after returning from deployment Emotional: Feelings, affective states, emotions arising in response to the child encounter Cognitive: Thoughts, beliefs, attitudes about the self, others, and the world arising as a result of the child encounter Behavioural: Behaviours (e.g. not engaging in certain activities) arising in response to the child encounter	‘I’m telling you it’s seeing kids being butchered like that, it’s nobody wants to see that. That’s the worst, that’s the worst thing I ever saw in my life ever.’
	Existential impacts	Describes consequences of encounters with children that impact the participant’s overarching sense of identity, morality/ethics, spirituality, meaning and purpose. These include impacts that occurred at the time of the encounter/while on deployment, as well as after returning from deployment	‘Every time I hear someone say … it was God’s plan. Really? God wants all these kids dying and being used as child soldiers? This makes no sense to me.’
	Professional/operational impacts	Describes consequences of encounters with children that impact the participant’s engagement with and interest in the military institution and their perceived ability to perform their military duties (e.g. did not engage a child posing a physical threat). Include impacts that occurred at the time of the encounter/while on deployment, as well as after returning from deployment	‘I feel like saying, “Runaway kids, run far away. Don’t get involved.”’
Coping		Describes aspects of participants’ attempts to manage the impacts of their deployment-related experiences with children
	On deployment	Describes coping strategies used while on deployment to cope with the experience of child encounters. Includes both positive/adaptive and negative/maladaptive coping	‘I think emotionally you get pretty good at kind of protecting yourself in terms of that’s not my world, that’s the world I’m working in.’
	After deployment	Describes coping strategies used after returning from deployment to cope with the experience of child encounters. Includes both positive/adaptive and negative/maladaptive coping	‘I like to talk because I need to get it out of me. Because if I don’t then it bottles up and it turns into something else right?’
Supports		Describes resources and sources of support that the participant was in contact with after the child encounter, and their experiences with these
	Formal supports	Describes formal sources of support (e.g. health providers, organizations for Veterans) and participants’ experiences of them. Includes perceived barriers to obtaining or benefiting from support	‘I got support. They give me pills that makes me carry on working properly. If I didn’t have that, I would probably – I don’t know. If I didn’t have any of that stuff I would’ve probably lost everything.’
	Informal supports	Describes informal sources of support (e.g. family members, peer support, activities) and participants’ experiences of them	‘You know, I still have guys, soldiers, peers … We all understand what – you know, and you can see in his face or in your face, you know, “Hey come here, we have to sort of you out because you’re not OK.”’

3.2.1. Types of encounters

This theme describes factual aspects of deployment-related encounters with children provided by participants. Within these primary theme, three sub-themes were identified: children recruited and used in armed violence, children as part of the local population, and ambiguous encounters with children.

3.2.1.1. Children recruited and used in armed violence

Participants described children who were recruited and used in armed violence as performing a variety of roles such as being used as social or physical shields, porters, laying/arming bombs, participating in combat roles, and working at checkpoints. Boys¹ were identified more often as engaging in violence or combat roles. Children in such scenarios were depicted as unpredictable and at times intoxicated, with one participant recalling, ‘I remember I’m at a checkpoint and these three kids are either drunk at the checkpoint, they all have a weapon – or they’re drugged up and they’re scared.’ Indeed, participants identified drugs as one of several pathways to recruitment, used in addition to abduction, coercion through indoctrination, and economic incentives.

Participants also witnessed the sexual exploitation of children, both boys and girls. As one participant shared, ‘our very first tour was all about mostly northern alliance men dealing with children and assaulting them and dealing with them sexually.’

Though uncommon, some Veterans described engaging and employing local children themselves, for example, with the intention to separate the child from a more hazardous situation. Participants also noted the strategic value of engaging with local children, including creating a positive rapport with community members by helping children provide for their families and reducing the number of children employed by oppositional forces. As a participant stated, ‘I used kids. I knew that it was good – I understood that being good to the kids in a community setting in a conflict is important. That’s how you get people to like you.’

3.2.1.2. Children as part of the local population

Participants generally encountered children in settings such as markets, schools, or seeing children playing; however, participants made it clear that these experiences differed starkly from what they would typically see in a non-conflict area (e.g. ‘seeing children playing … on … [armour] shells where the [enemy] executed prisoners … . Just like, these kids don’t know’). Participants also recalled providing medical care to children (e.g. helping deliver babies), helping children who had lost their caregivers in attacks, or witnessing children involved in mass mutilations and casualties. For instance, as one participant reflected,

they left the kids there alive, every adult in that village had their heads cut off and they took the head[s] and they dispersed them in the jungle, and the kids are obviously exposed to this, going ‘where’s my mother and father?’

3.2.1.3. Ambiguous encounters with children

Given the turmoil of armed violence, participants described the ambiguities that often accompanied encounters with children. Uncertainties about the children’s role in the conflict, their intentions, whether they met internationally accepted norms and local cultural perspectives regarding childhood versus adulthood were all aspects of encounters that added to the complexity of decision-making processes. For example, a participant shared: ‘a 16-year-old, is it a man, or a child? Like what’s a child soldier?  …  Like, is it really a child soldier when it’s tribal culture? Where you live and die by the tribe?’ Another participant noted that their military training had not prepared them for ambiguity around whether a person encountered is a child or an adult: ‘ …  because all it was all “fighting aged males.” Well, can somebody define to me what a fighting aged male is, or is that my own call?’

3.2.2. Contextual factors

The context surrounding encounters with children in conflict zones influenced participants’ perceptions of their experiences. These contextual factors were divided into three sub-themes: personal context, deployment environment, and mission framework.

3.2.2.1. Personal context

Past adverse childhood experiences notably influenced participants’ experiences of encounters with children during deployments. For example, witnessing the mutilation of children was particularly impactful for one participant who described being, ‘abused as a kid … [and] it just brought back a lot of hurtful memories.’ Experiences of childhood abuse led to feelings of protectiveness for others: ‘I didn’t have a protection mechanism when I was growing up  …  So, being that protector as much as you can anywhere in the world is that leading feeling.’

Being a parent also differentially impacted participants: ‘you can directly relate your children to that child …  and I think the depth of emotion is different too once you become a parent in terms of when you see children hungry and cold.’ The emotional connection to children during deployment environments became pronounced for participants when they encountered children who were of the same age as their own children: ‘kids that were relatively the same age as [my] stepson,’ were put, ‘in harm’s way for [the enemy’s] own reasons.’ Similarly, being a parent led to difficulty reconciling certain deployment-related encounters with children, for example one participant noted:

 … that was one of the hardest things I ever had to live with  …  how I wanted to hurt this guy, hurt this child, I mean, and that is not a normal thing for a Canadian person to do or even think.

3.2.2.2. Deployment environment

Participants described the socio-political context of deployment environments which were often compounded by poor living conditions and lack of public health and social resources, including: ‘ridiculous poverty, family violence, lack of education, [and] lack of resources.’ Within these complex environments, participants expressed witnessing many unexpected and disheartening encounters with children:

When you see a body it’s direct. But like, we all expect to see that. But, like, a crib, a young grave, a grieving mother, a crippled fucking child. Those are hard. Addicted – I saw some kids, 9 year old addicted to fucking heroin.

One participant further elucidated that, ‘there’s children and women and various old men. They don’t have heat. They don’t have water. They don’t – they’re not being helped out by civil society.’

Participants noted a stark contrast between some well-resourced deployment locations and those where people were less fortunate:

some places seem[ed] like they really did care to an extent about the kids because the kids looked happy and they looked clean and they would have a school that they went to … in other places they just looked destitute and poor.

Despite the attempts of civilians to protect local children, the deleterious effects of conflict were noted regarding ‘the masses of children that were malnourished, [who] received violence on almost a daily basis.’ Some participants also reported being troubled by the communities’ sense of normality relating to such adversity, such as a description by a participant of the aftermath of a mortar brigade: ‘after these mortars dropped around, they would go into town, go to school, go to work … like it wasn’t even … a bad commute.’

3.2.2.3. Mission framework

Participants described how the overall mission framework, including the context, culture, and composition of the contributing troops, influenced the likelihood and nature of encounters with children during deployments. For example, participants discussed a perceived incompatibility between ROEs and their instincts to protect children in conflict zones. As noted by one participant, their ‘[ROEs] weren’t there to “correct”’ things such as children facing extreme poverty. Regarding children recruited and used as soldiers, one participant described, ‘when you’re deployed, rules of engagement don’t have an age limit.’ Participants described not wanting to engage with children in combat, yet they understood that it was their duty to protect their troops: ‘ … the [ROEs] were very clear and there was no ambiguity whatsoever … if there was a kid, who I thought had a trigger for a suicide vest I could, G-d forbid, kill that kid to stop them from detonating.’

Of significance, all the participants referenced a lack of training and preparation focused on children, and many noted the presence of children within their deployment environment was unexpected: ‘But when I left Canada no, I was never under the impression that I would run into kids that have been killed that savagely and that I would – that I would meet these terrible, terrible, terrible people.’ Another participant reflected: ‘I never had the idea that kids could have a bomb. We just didn’t talk a lot about kids, I guess … Or the morality of – if you had to shoot a kid that … was never a topic of discussion.’

Participants also highlighted that working in specialized roles and isolated locations impacted their experiences: ‘I felt very alone on that mission […] having a buddy with you would be really [good].’ Other participants described how their unit composition (e.g. whether deployed with their home unit or with international forces) played a role, as training, customs, and cultures can come into conflict.

3.2.3. Appraisals of encounters

Participants’ appraisals of their encounters with children during military deployments was described as a factor influencing the impact of the encounter(s). We identified two main types of appraisals: socio-cultural and strategic or tactical.

3.2.3.1. Socio-cultural appraisals

Participants reflected on how cultural perspectives influenced their understanding of encounters with children on deployment. These included the participant’s cultural lens, the mission culture, and the local context. Participants described various sources of dissonance and rationalizations for what they experienced as typical for their operational context, for example:

… it’s like, kids are born good. And so, when you’re seeing this [engagement in violence] at a young age, it’s not that they’re bad kids; they haven’t had a chance to grow into that, if they’re actually going to grow into that. It’s just that that’s the way it is for them.

These rationalizations suggested that cultural relativism was important to the processing of their encounters with children in many cases:

… they were using a completely different mindset than you were  …  . And so that’s an important deduction because people often think that you’re dealing – rationality is universal. Rationality is different in different parts of the world. It’s completely rational to do something that we would find abhorrent.

Reflections on how and why children were recruited and used in armed conflict were also discussed, some suggesting it could be a means for children to support themselves and their families, or represent the influence of multi-generational warfare:

That’s how enemies will utilize children because you could weaponize kids under the right conditions, right? […] In the end, they just see more soldiers and that’s generational pain in some cases […] There’s nothing you can do to change that because you’re not from there.

3.2.3.2. Strategic and tactical appraisals

Participants reflected on the implications of children being present in conflict areas; in some regions, the presence of children indicated safety, while in others, children bore no influence on the emergence of violence. One participant stated, ‘these people will absolutely have no problem hanging children from streetlights and trees to punish a village for siding with allied forces.’ Participants also spoke of how children were strategically used to conceal acts of violence (e.g. enemy combatants using children to lay bombs).

Participants noted that they interacted differently with children compared to adults based on perceived maturity and developmental differences. As one participant expressed, ‘I was always more worried that children had less training, less maturity, more risk of accidental discharge or not understanding a situation.’ Another participant explained, ‘I think approaching a checkpoint when I saw […] young youth soldiers or children maybe we approached a little slower.’ Another explained, ‘when you look at these little legs running at you … I’m like – my G-d it’s a kid. Like if it was an adult, I probably would put a round into him, like without a second thought.’

ROEs also influenced participants’ interactions with children, with one participant stating: ‘You need to act. I don’t care if the kid’s 14 or 15 if he’s demonstrating a hostile act towards someone, my ROEs say I’m supposed to stop that, right?’ Several participants highlighted the importance of clear ROEs in light of how enemy tactics have shifted over time to exploit soldiers’ inherent value to protect children:

The pattern that was exploited in 2000 or in 2010 in [country] was the fact that soldiers tend to greet kids differently, and they blatantly show an affinity for them, and they want to protect them, so that was exploited.

3.2.4. Impacts of encounters

Several impacts of deployment-related encounters with children were described, representing various psycho-social aspects of participants’ experiences. These were divided into four sub-themes: Psychological, existential, social and interpersonal, and professional and operational impacts.

3.2.4.1. Psychological impacts

All aspects of participants’ psychological experience, including emotions, behaviours, and/or cognitions were impacted following deployment-related encounters with children, leading to distress. Witnessing mutilated or dead children was described as ‘terrible,’ and ‘unsettling.’ One participant experienced, ‘absolute mind-bending rage at the thought of someone putting children directly at risk,’ while for another, at first, ‘it was [numbness] […] But after that, once [they] got their senses all back, more like rage.’ In describing the lasting effects of such encounters, one participant reported that, ‘it’s tough. Dealing with the emotion, there’s a sense of helplessness. Overwhelming helplessness sometimes.’

Readjusting back to civilian life was also difficult for many participants. For example, one participant described a ‘fear of being touched,’ after an experience where mutilated children would poke ‘at [him] when they were trying to get into [his] pockets.’ Another participant described their distress when adjusting back to life in Canada:

I had problems when I came back from [country], I broke downtown … I just saw people were shopping, it was a beautiful day and I froze on the spot. And I’m like, these people have no fucking idea what’s going on in the world.

Notably, some participants did not experience persistent negative impacts to this degree, stating for example: ‘I am thankful that I am not consistently reminded of the actions that have taken the lives of children in the face of war.’

3.2.4.2. Existential impacts

Exposure to children during deployments, particularly those used in armed violence, prompted participants to contemplate their own and/or others’ sense of morality. One participant expressed confusion and dissonance over their experiences: ‘how can they do that to their own people […] how can you not shoot yourself after killing a bunch of little guys? I mean how can you live with yourself?’ Another participant expressed that their sense of identity was impacted after having to shoot and kill children used in armed conflict: ‘I went from being the protector, the anti-bully, to a destroyer of worlds. It was soul-defeating.’ Participants who had engaged children for small jobs, under the assumption they were contributing positively to the child’s life, experienced feelings of moral ambiguity, reflecting, ‘did I use these children because I really thought I was doing something good or just I wanted to enrich² myself?’ While the majority of deployment-related encounters with children prompted negative impacts, one participant expressed fulfilment following a harrowing experience of discovering and helping to transport multiple children left for dead: ‘I will always say that even though [country] was the most difficult mission, that was the most fulfilling for me  …  to get some kids out of there.’

In addition to impacts on morality and identity, religious understanding and feelings of hope were also affected. As one participant stated, ‘children are … born innocent,’ and so to witness children involved in combat ‘ruins your faith in a lot of things.’ Similar sentiments were expressed by participants who identified as ‘not religious,’ for example: ‘Every time I hear someone say … it was G-d’s plan. Really? G-d wants all these kids dying and being used as child soldiers? This makes no sense to me.’ Lastly, one participant expressed diminished hope for the happiness of their own children: ‘how do you have hope for your children when, like, you’ve been to places where there was fucking chains and cages, where there was human trafficking.’

3.2.4.3. Social and interpersonal impacts

Certain traumatic deployment-related encounters with children led participants to express difficulties being present around children post-deployment. One participant shared, ‘well, I have a 14-year-old daughter, obviously I can be around kids … [but] I’m not comfortable being around kids or swarms of people.’ Several participants described being hypervigilant and ‘over-protective’ towards children post-deployment, with one describing, ‘And so when you come home, you’re not really home. I think that you kind of get into that habit of risk, risk, risk, and you just kind of look at it that way and children specifically.’

Exposure to children in combat areas also led participants to feel disconnected from their friends and family (e.g. ‘it’s extremely difficult for me to be a father now’). The disparity between participants’ deployment environments and home environments often evoked a sense of detachment from Western lifestyles, for example: ‘ … it was a horrible Christmas and I got angry at everyone for all their first world problems and my new wife is like what the hell is wrong with you, can’t you get along with anyone?’ Another participant noted: ‘I was very, very impatient with my kids even though I love them to death. I was very, very impatient with my wife, and still today … .’ In contrast, one participant described that their experiences with children recruited and used as soldiers led to them becoming, ‘much more appreciative of [their] own family and the chance that [their] kids got to have a better life, and that their kids are having a better one as well.’

3.2.4.4. Professional and operational impacts

Following encounters with children, many participants expressed feeling a lack of trust and respect towards their superiors. Participants described the lack of briefing regarding children in deployment environments, stating, ‘I hadn’t been briefed, so I’m a little choked, a little angry … they act like they know it all, they don’t.’ In some cases, this distrust extended beyond their own leadership to allied organizations and mission partners. One participant explained they were explicitly told women and children would not be involved in the conflict they were deployed to, which was untrue:

It makes you not believe that your intelligence folks or the [local allies] themselves … of course they would want to believe that [enemy combatants] would not use women and children as human shields or as tools to be able to gain advantage in battle. But that’s just not the case.

The moral ambiguity of engaging with children in combat in some cases led to difficulties with professional duties. For example, one participant’s encounter with a child holding a rocket launcher led to the moral dilemma of having to shoot or not shoot the child. The hesitation this participant experienced led to feelings of embarrassment and internal moral conflict, resulting in avoidance of reporting the incident for fear of retribution: ‘I wasn’t going to say a damn thing to [chain of command] because – […] one, they’ll probably lock me up or two, they’ll charge me for doing something or whatever. So it was a lot of distrust.’ In this case, the participant noted that their reluctance to discuss the event and its impact on them caused them psychological distress.

3.2.5. Coping

Participants described several attempts made to manage the impacts of their deployment-related experiences with children. Descriptions of strategies employed both during and after deployment are described below.

3.2.5.1. Coping during deployment

While deployed, participants described utilizing avoidance-based coping strategies, such as keeping busy (e.g. ‘I guess there was just so many distractions, you know, when I actually had the time … that’s probably what saved me other there, I never had a lot of downtime’), evading mention of deployment-related encounters with children (e.g. ‘you know what, I didn’t even write in my diary, it’s weird, I wrote almost everything in the diary  …  And it’s really weird, I didn’t even write that’), and using alcohol (e.g. ‘there was binge drinking. I don’t know if that was normed in society … But we had extremely deep mess nights of drinking’). For some participants, compartmentalizing their experiences was an important coping strategy. This included suppressing thoughts children as such (e.g. ‘I think I have suppressed a lot of emotion and it’s surprising the normality of children. You see, like, it’s just like you cannot view them as children. It’s too fucking hard’), as well as compartmentalizing their perceptions of home versus deployment environment (e.g. ‘I think emotionally you get pretty good at kind of protecting yourself in terms of that’s not my world, that’s the world I’m working in’).

3.2.5.2. Coping after deployment

Heavy alcohol use was identified as a common coping strategy post-deployment: ‘I drink too much once every two weeks, you know, intentionally … you know, have my release. And so, that was my version of counselling.’ Drinking was mostly done in solitary during decompression or at home. However, several participants described shifting from using alcohol towards more adaptive strategies over time, such as talking with others: ‘I like to talk because I need to get it out of me. Because if I don’t then it bottles up and it turns into something else right?’ Additional adaptive strategies mentioned by participants included connecting with others (e.g. peers, family, or through charity), having a ‘safe spot,’ utilizing training, exercising, and having structure.

3.2.6. Supports

Lastly, participants described their experiences with various resources and sources of support subsequent to their experiences with children on deployment. These were divided into two sub-themes: formal and informal supports.

3.2.6.1. Formal supports

Post-deployment, some participants described seeking professional psychological and psychiatric support on their own accord. One participant expressed ‘If I didn’t have any of that stuff I would’ve probably lost everything.’ Another participant sought support following a deployment where they encountered children recruited and used as soldiers and found several children left for dead in the jungle, stating, ‘I got in right away, a psychiatrist saw me right away. And basically we set up a lifeline where if I start having real issues, I can call.’ Of note, this participant’s history of managing traumatic experiences influenced their immediate awareness of needing support.

Participants also discussed their experiences with decompression provided by the CAF. While one participant expressed that the CAF had ‘a good program,’ as ‘when you come back off deployment, they want you to go to work the next day …  just to make sure that you’re not … heading toward a bell tower somewhere with a rifle.’ Other participants described a lack of, or ineffective, decompression support at their time of service, stating: ‘there was no real follow-up’ and another expressing ‘there was zero support.’ Notably, one participant summarized that the support ‘post-deployment was laughable.’

One contributing factor to the perceived ineffectiveness of this support was the distrust participants expressed having with their trainers, and particularly civilian trainers: ‘I said well you know what, can’t trust these guys, they’re freaking incompetent.’ Distrust and participant disengagement with formal supports seemed to coincide and having more qualified and relatable trainers seemed to mediate this issue: ‘why didn’t [we] have a military psychiatrist or someone you know who could at least show I wear a uniform, I deal with military all the time. This person had no credibility with anybody in the room.’

Participants expressed the need for more comprehensive and structured pre-deployment training to prepare personnel for encounters with children in conflict zones, particularly children recruited and used as soldiers. As one participant recalled, ‘I don’t know how much training really – or talked about kids … I think people need to be mentally prepared in a place like that.’ Another participant suggested the importance of ‘preparing our soldiers psychologically to interact with children and with other vulnerable populations when they go into these conflict zones’ as ‘they maybe … hurt psychologically when they come out …  because there’s a distance between expectation and reality.’ And yet another participant described how, ‘one of the shortfalls in … [their] pre-deployment training [was] … they basically go off of what’s been done the last three, four, five years, unless someone comes out and says hey, change this,’ highlighting the need for iterative revisions to training. Notably, participants’ accounts of pre-deployment supports were in reference to deployments between 2006 and 2015, so they may not entirely reflect the availability and inclusion of current training programmes.

3.2.6.2. Informal supports

Informal supports included support from individuals such as family members or friends, or through activities (e.g. exercise). Some participants expressed ease in providing support to those with similar experiences to themselves, as one described, ‘I’ve told people I know that have been in these situations, “you have the primary responsibility to get help. People don’t know you need help if you don’t tell them you need help, OK?”’ There were a few barriers discussed by participants regarding such strategies, including the worry of burdening others (e.g. ‘you bring this up in polite conversation, probably not. People don’t want to hear about it’). Another was the stigma associated with seeking support, ‘I went back to work and I would never ask … you for any help for all kinds of reasons. Not that I’m that macho, but I was the guy who was the boss man.’ One participant described how they only felt truly supported when discussing their experiences with other military members, ‘because then you can talk about things … You can’t talk to some of your friends and family about. They don’t understand, you know?’ Despite these barriers some participants expressed being able to open up and receive support from their families which had a positive impact, ‘I went to see my cousins and I was very grateful for them, because you know, it’s family, they brought me in … I’m glad I had somewhere to go to. That was very big and very important.’ Certain activities, such as engaging in charity programmes, were also identified as being supportive to participants.

4. Discussion

This study sought to qualitatively examine the nature and mental health impacts of deployment-related encounters with children among Canadian military personnel and to identify areas for prevention and intervention related to the mental health impacts of such encounters. Results from our study indicate that to effectively address the expanding needs of military personnel and Veterans returning from deployment, it is crucial to carefully examine the range of military experiences that may lead to challenges in psycho-social well-being, and the various ways these challenges may be expressed. Implications for prevention and intervention relevant to the themes identified in our study are discussed in detail below.

Our findings reveal complex interactions between various types of appraisals and dissonance related to expectations, morality, cultural norms, and professional duties. For instance, unpreparedness when encountering children, and particularly children recruited and used in violence, was a trans-thematic experience (i.e. 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. For example, while some participants described employing children during military deployments, the practice of employing children in any capacity by armed forces in a deployed context is highly discouraged, as children may be placed at heightened risk due to their proximity to legitimate military targets.

Importantly, a sense of having been unprepared has been shown to elicit longer-term distress in the aftermath of traumatic events, such as handling human remains or being a victim of torture (Başoğlu et al., 1997; McCarroll et al., 1995). While evidence is lacking, some pre-deployment efforts to prepare personnel for potentially traumatic events display some promise (Bisson et al., 2021), highlighting that pre-deployment preparations specific to encounters with children may help buffer the potential consequences of such events. Recent advances in policy also hold promise in their acknowledgement of the need to prepare military personnel for encounters with children, as evidenced with the Vancouver Principles (Canada GA, 2019). Notably, recent research has suggested that certain considerations, such as increased workload and administrative tasks associated with pre-deployment preparation, may lead to disengagement during pre-deployment training (Doody et al., 2022), underscoring that strong leadership will be required for training and policy efforts to have their intended impacts (Forchuk et al., 2024).

The varied impacts of deployment-related encounters with children documented in this study support the notion that encounters can be both psychologically and morally damaging, resulting in distress associated with dissonance in identity, faith, and interpersonal difficulties. Apparent in participants’ narratives were domains of impact previously identified as central to moral injury, including changes in one’s self-perceptions (e.g. core moral beliefs, identity), moral attitudes (e.g. judging others moralistically), social impacts (e.g. mistrust, disruptions in connectedness), and disruptions in spirituality (e.g. sense of meaning and purpose) (Houle et al., 2021; Litz et al., 2022). These findings echo previous qualitative analyses conducted among civilian child protection workers, showing that a sense of dissonance or failure stemming from witnessing children being harmed, and a perceived inability to protect children is a potential source of moral injury (Haight et al., 2017). As Ein and colleagues (Ein et al., 2023) recently suggested, encounters with children in vulnerable situations may elicit the desire to protect Western views of childhood innocence, amplifying the risk of violations of core binding moral foundations (Graham et al., 2011). According to moral foundations theory (Graham et al., 2011), binding moral foundations are inherently adaptive characteristics promoting a group’s evolutionary survival, such as in-group loyalty, respect, and purity or sanctity. The study of moral foundations in relation to PMIEs and moral injury is relatively novel (Forkus & Weiss, 2021), however, associations among moral foundations and deployment-related encounters with children have not yet been directly examined. Research is needed to examine such associations, as they may guide our understanding of the interpersonal and psychiatric impacts of encounters with children described herein.

Importantly, personal experiences and characteristics appeared to undergird appraisals and impacts of deployment-related encounters with children, as evidenced by participants’ explications of parenthood or personal histories of childhood abuse as factors which amplified the effects of their experiences. While research consistently supports the notion that adverse childhood experiences are a risk factor for negative mental health outcomes among previously deployed military service personnel (Reed-Fitzke et al., 2023), the psycho-social mechanisms of this association remain understudied in the context of PMIEs. Previous research among Canadian military personnel and Veterans has shown that past PMIE exposure may prompt a form of attentional bias towards moral interpretations and reactions to events (Houle et al., 2021), similar to cognitive biases observed in PTSD (Pineles et al., 2009). Whether such cognitive mechanisms play a role in how childhood trauma prompts and maintains distress in the aftermath of PMIEs is yet to be examined empirically. Disruptions in trust and attachment occurring as a result of adverse childhood experiences have also been hypothesized to affect the way individuals perceive and integrate potentially transgressive experiences over their life course (Kidwell & Kerig, 2023). Additional research is therefore needed to examine these hypothesized mechanisms, as such evidence is likely to inform intervention approaches for those struggling in the aftermath of deployment-related encounters with children. Regarding parenting, while previous studies have shown that adverse childhood experiences and other traumatic events increase the risk of mental health problems among the children of survivors, no research has examined the influence of war-related PMIEs on parenting or other family dynamics. As our results suggest that encounters with children may produce impairments in interpersonal functioning, examination of interpersonal impacts on families is highly warranted.

Notably, particular impacts of deployment-related encounters observed in this study appear to fall within the purview of psychiatric problems such as PTSD, depression and alcohol misuse. For example, participants described children as trauma reminders, evoking distressing emotions including anger, numbness, and helplessness as well as becoming hypervigilant and protective towards children. While this study did not focus specifically on the impacts of encounters with children in the context of psychiatric problems, it is clear that further attention to the influence of deployment-related encounters with children on psychopathology is warranted, and that screening for exposure to these encounters and their impacts is likely to beneficially inform clinical care. Additional quantitative work is required to further elucidate the risk that particular deployment-related encounters with children pose to the development of specific mental health problems.

Coping with deployment-related encounters with children through alcohol use was a strategy used both during and after deployment. Alcohol misuse following deployment is a common form of avoidant coping documented throughout military research (Pietrzak et al., 2013), especially following experiences of combat where lethal force is employed (Kelley et al., 2019). Alcohol misuse has also been shown to be associated with PMIE exposure (Battles et al., 2019). Additional avoidance-based coping strategies such as staying busy during deployment were also reported, further aligning with prior military research (Williamson et al., 2019). For some participants, these strategies seemed to transition towards more adaptive forms of coping (e.g. connecting with others, exercise) post-deployment and over time. Previous research suggests that social support in particular may moderate the association between avoidant coping and negative mental health outcomes (Romero et al., 2015) and our participants’ narratives support this notion. The transition from deployment to civilian life, where individuals reconnect with friends and family is therefore likely to be a key period in which coping strategies developed during deployment should be characterized and mitigated if needed. Of note, several participants in this study who described alcohol use on deployment were describing experiences from decades past, therefore, additional research which reflects more current experiences of coping with encounters with children on deployment is warranted.

Participants in this study also highlighted a lack of formal supports, especially pre-deployment training relevant to encounters with children and post-deployment supports. The available literature surrounding the overall effectiveness of post-deployment decompression is scarce and presents a mixed picture. While some studies report positive findings (Garber & Zamorski, 2012), others highlight the ineffectiveness of decompression programmes, particularly psychological debriefing (Kennis & te Brake, 2022). Again, while dated to some extent, our sample echoed the latter, with suggestions that incorporating military members and Veterans in post-deployment supports may facilitate the military-to-civilian transition, help identify any mental health needs and promote support-seeking. Moreover, comfort in confiding in military peers remained important to participants who noted the benefits of non-formal supports. This is particularly noteworthy given research demonstrating associations between social support and reductions in military-related adverse psychological outcomes such as PTSD and suicidal ideation (Harper et al., 2020; Houtsma et al., 2017). Still, whether such findings hold in cases where deployment-related encounters with children and their impacts may be particularly salient is unknown, and additional work is needed to understand how the particularities of encounters with children may compare with existing findings.

This study is the first to generate valuable qualitative insights into the nature and mental health impacts of deployment-related encounters with children, however, several limitations should be noted. First, our sample is restricted to primarily men, limiting generalizability. While our recruitment plan was to include a subsample of women and examine gender differences in our research question, no women Veterans volunteered to participate in the study. It is likely that gender impacts both the types of encounters with children, by virtue of traditional military and peace support role differences between men and women, as well as the consequences of these encounters, as various cultural appraisals and personal experiences impacting perceptions may differ between genders. Research which examines these potential nuances is highly warranted. In addition, future research should seek to incorporate perspectives from active-duty military personnel, including those involved in contemporary conflicts. Such evidence will serve to illustrate the dynamic landscape of deployment-related encounters with children and help anticipate any mental health consequences. Additionally, extending beyond military personnel to staff of humanitarian and diplomatic organizations may provide additional insights into contemporary conflict environments and core aspects of how encounters with children can affect mental health.

This study sheds crucial light on the nature and impacts of deployment-related encounters with children among Canadian Veterans, elucidating the complex challenges faced by military members, and uncovering opportunities to improve training and support. Our findings underscore the necessity for further research to guide the development of targeted preparations and interventions, tailored to these unique experiences.

Disclosure statement

No potential conflict of interest was reported by the author(s).

Data availability statement

Due to the sensitive nature of the research supporting data is not available.

Additional information

Funding

This project was funded through the generous support of a philanthropic donor.

Notes

1 For the purpose of this paper, the labels “boy” and “girl” apply to children described by participants both as boys/girls or as male/female. This label was chosen for consistency, since it is not possible to ascertain the sex or gender identities of the children encountered.

2 Here, the participant spoke of “enrichment” in terms of fostering positive relationships with the local community.