The faces of young and armed combatants can be seen from Africa to Asia to Latin America. Human rights groups say there are girls and boys under 15 who fight in 37 of the world's 55 continuing or just-ended wars; more than 300,000 under the age of 18 are forced into combat, or to work as spies, servants and sexual slaves. The impact on their mental and physical well-being cannot be underestimated.
Shukuru, 13, is talking on a mobile phone somewhere in the Congo. He explains in Swahili how he got to be what he is now, a bodyguard for a rebel commander. He says he protects his boss with a Kalashnikov assault rifle. The irony is stunning. He has been forced into protecting the very people who abducted him.
"I was taken by force one day," Shukuru says, "while working in the marketplace carrying goods for shoppers." The boy's parents had died a few years before. He did what he had to do to survive, he explains at the child center where he finds refuge after a long day of work.
According to Refugees International, which arranged the telephone interview with Shukuru, children and young adults are usually pressured into fighting, or are lured with the promise of food, shelter and protection from the crossfire during civil war. Once in, they often are used to make paths across mine fields, or spy on the enemy. Often they are pumped up with amphetamines, alcohol or marijuana before they are sent to the front lines where they die in disproportionate numbers.
Ivan Melvin Rogers, 23, is a former child soldier, who was orphaned at age 11 when both his parents were murdered in front of the family home in Liberia. While at a refugee camp in Liberia, he says, he was introduced to a colonel in the Sierra Leonean army, who trained him to be a counter-intelligence spy. He says he went through months of rigorous training to learn how to gather information from the rebel Revolutionary United Front (RUF), whose trademark was to hack off the hands of their enemies.
In a telephone interview from Nigeria, where he fled after he left the military, Ivan explains what he experienced in his formative years.
"I have seen many people die, many friends of mine. On January 6, 1999, I was shot, and I still have a bullet in my stomach," he said. "About 20 to 30 of my friends and soldiers fighting with me - about 60 percent of them were my close friends - were killed right in front of me."
Aid workers and others who work with child combatants say children are often recruited because they are easier to brainwash into fearless killing. But, they say, it is also this ability to adapt to their environment that can help them recover from years of combat, if given the proper support.
"Most children are resilient, and can regain normal functioning and move toward a normal development process, if the appropriate environment is provided," explains Rebecca Winthrop, who works for the International Rescue Committee's education program for children affected by armed conflict in New York.
That includes rebuilding the educational system and reintegrating these children into their own societies.
Joanne Selinske, director of the U.S. branch of International Social Services, a group that helps children and families affected by war, says reintegrating a child into his or her culture is essential to recovery. Adoption by families abroad, she says, is too disruptive.
"While it gives an individual child the opportunity to find a new family, it runs the risk of denying that child the opportunity to thrive in the cultural, religious or social heritage that they were born into," she said.
But reintegration is not easy. Because many children have been immersed in the military culture and violence in their formative years, many communities fear their return. And, not every community deals with the reintegration the same way.
Jane Lowicki of the Women's Commission for Refugee Women and Children in New York explains that different psychological and sociological perspectives of communities play a role.
"In northern Uganda, some organizations have found that, although the West might see post-traumatic stress disorder as what some of the kids may be experiencing, with nightmares and other things, the community does not view it in the same way, necessarily. And they [the community] might feel, for instance, that they [the children] are haunted by spirits - the spirits of those people they may have been forced to kill in the fighting force. So what some other organizations have helped them do is participate in traditional cleansing rituals, where the community goes through a process of acceptance of the young person, and purging them of the "haunting" they are experiencing. And, that has shown great success in their ability to come back," she said.
Despite the psychological trauma, Ms. Lowicki says, children can extract life lessons from their experiences, if given guidance and support.
"Whether it is finding different jobs to do within the fighting force, so that they are not subjected to certain type of abuse - they are also being challenged to take on new responsibility," she said. "And in some cases, this gives them a lot of life skills and certain decision-making and survival skills that, if - with the proper support - they are able to leave the fighting force, can serve them well in trying to recover in their lives."
Ivan Rogers agrees that life as a child soldier has taught him how to survive against all odds. He says the bullet in his stomach could kill him, unless he has it removed. He recently scraped together enough money to travel to South Africa, where he hopes to have the surgery. Is he prepared to handle life after that? He says he is not certain.
This report part of VOA's series on World Health