After the collapse of the self-styled Islamic State militant group (ISIS), many people were left homeless and stateless in refugee camps in Syria and Iraq. Nearly 49,000 children are staying in the Al-Hol camp confined to abysmal conditions. Thus far their home countries have not repatriated them. The pandemic put a temporary hold on any possibility for moving these individuals, but with that hold now lifting, countries could begin to take back the children and mothers who spent time in ISIS-controlled territory. The question is how to do so safely and healthily for all involved. To that end, this article introduces readers to an evidence-based framework for thinking about rehabilitation and reintegration.

With heightened attention from policymakers around the globe, multilateral bodies, and platforms — such as the Organization for Security Cooperation in Europe (OSCE), Global Counterterrorism Forum, and the Strong Cities Network — have developed recommendations, guidances, and other tools to support governments and non-governmental actors as they look to develop rehabilitation and reintegration (R&R) programs for children and mothers. One major concern voiced by representatives of their home countries is: if these children are repatriated, can they lead peaceful lives? Or will their exposure to extremist ideology, trauma, and loss — as well as potential difficulties with mental health, school, and family — place them at high risk for violent extremism, even years from now?

Skeptics say that little to nothing is known about what steps should be taken to mitigate the potential risks. Although the specific developmental trajectories of ISIS returnees have not been studied before, children exposed to other types of trauma and adversity may be similar enough to borrow lessons learned. For example, Theresa Betancourt’s longitudinal studies of child soldiers from Sierra Leone — which show that school success is central to successful rehabilitation, and that managing trauma related mental health problems is key to school success — seems worthy of comparison.

To build upon that type of existing knowledge, we reviewed the evidence of relevant prior work with children exposed to many different forms of trauma and adversity. Our aim was to build an evidence-based framework that could inform the rehabilitation and reintegration of child returnees from the so-called Islamic State. The paper describing this work was recently published in the Annals of Global Health.

Thirty-one prior studies in the areas of refugee children, war-impacted children, child criminal gang members, child victims of maltreatment, and child victims of sex trafficking were reviewed. For each of these five areas, the type and breadth of children’s exposure to trauma and adversity overlapped significantly with that experienced by child returnees.

Based on our analysis, we developed the Rehabilitation and Reintegration Intervention Framework (RRIF), which is the only known evidence-based framework for R&R of child returnees. The RRIF defines an approach that considers how five primary goals — promoting individual mental health and well-being, promoting family support, promoting educational success, promoting community support, and improving structural conditions and protecting public safety — can be pursued across five levels of social interaction — individual, family, educational, community, and societal. Achieving these goals at all five levels requires cooperation between national and local governments, civil society, and scholars collaborating across disciplines.

RRIF also identifies the evidence-based multilevel risk and protective factors and processes that in part shape the outcomes of child returnees. This can inform how specific R&R programs are designed. For example, advocating for special education services that directly target the risks of identified learning problems or gaps in education, promoting the strengths of individual and parental school involvement, can encourage educational success. This is especially key for youth with developmental delays or significant social-emotional problems, as is commonly seen among child returnees.

At a community level, RRIF can inform community preparedness and reintegration of children and families. For example, the framework identifies how each of the five programmatic goals corresponds to evidence-based “levers of community resilience,” which can be used to develop community-level interventions, such as those promoting wellness, access to resources, education, partnership, engagement, equity, and safety.

Of course there is no certainty that any R&R model will work for all child returnees. However, R&R programs based on the existing evidence from relevant prior work should be at least as successful as programs designed to support other child populations affected by severe trauma and adversity, which governments and NGO partners regularly undertake. Other outcomes would suggest that children who suffered under ISIS are somehow different than other child populations exposed to severe trauma and adversity.

Officials from many countries claim that the central problem with repatriation of individuals who spent time in ISIS-controlled territory is the potential persistence of extremist ideology. The corollary to this assumption is that the major focus of R&R should be on deradicalization: getting returnees (mothers or children school aged and above) to disown extremist ideology or to pledge to reject it. This approach has several major shortcomings.

First, this perspective fails to account for studies that have shown disengagement, or not participating in terrorism, is a more achievable goal than deradicalization, or changing a person’s belief in ideology. There is little evidence to support the notion that focusing on changing a person’s ideology is either achievable or effective in reducing risk of violence. Furthermore, focusing on changing a person’s beliefs runs counter to the concept of freedom of thought.

Second, this approach misses a crucial opportunity: addressing the needs of returnees through a multilevel process can shape the contexts that help determine whether an individual acts upon a violent ideology. We have identified a broad range of empirical research that points to modifiable factors that could be addressed in this way and would create conditions more conducive to successful reintegration.

Some might argue that the lack in many low- and middle-income countries of sufficient mental health or social service resources to address even everyday needs of patients and communities with mental health problems is an obstacle to such a comprehensive, multilevel approach. To conduct R&R, countries need psychiatrists, psychologists, and social workers to support and treat returning children and mothers, especially those who have suffered trauma. Yet in many countries these professionals don’t exist, or they haven’t had specialized training in trauma-informed care. To address these needs, many countries need capacity-building activities. This is no reason to abandon evidence-informed R&R, however.

That is where the United States, other high-income countries, and international organizations like the OSCE, Global Counterterrorism Forum, and Strong Cities Network come in. For R&R to succeed, an added level of guidance and support is needed for frontline practitioners, managers, and governmental, civil society, and academic leaders who work with the returnees.

We developed the RRIF to help guide approaches to building capacities that could provide multilevel services to support returning individuals, their families, and their home communities. We expect that local practitioners and other experts will further develop and tailor the framework over time in ways that speak most clearly to their local contexts, so that it can be most helpful in informing project activities’ effectiveness, implementation, and sustainability. This, in turn, will further build our understanding of how to successfully advance R&R as a whole and manage the return of mothers and children from ISIS-controlled territories.

Image: A veiled woman walks with her child at al-Hol camp in al-Hasakeh governorate in northeastern Syria on February 17, 2019. (Photo by BULENT KILIC / AFP via Getty Images)