Impact of war on children

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The number of children in armed conflict zones are around 250 million. [1] They confront physical and mental harms from war experiences.

Contents

"Armed conflict" is defined in two ways according to International Humanitarian Law: "1) international armed conflicts, opposing two or more States, 2) non-international armed conflicts, between governmental forces and nongovernmental armed groups, or between such groups only." [2]

Children in war-zones may act as perpetrators, becoming child soldiers. It is estimated that there are around 300,000 child soldiers around the world and 40 percent of them are girls. [3] [4] Children are also victims of armed conflicts. They are forced to evacuate, [5] suffer from sexually transmitted diseases and are deprived of education opportunities. [6]

Background

The presence of children in the war can go back to Middle Ages and Napoleonic Wars. Children fought in the American Civil war, significantly contributed to the Battle of New Market which was fought in Virginia (May 15, 1864). [7] Children were also fighting in the World War II, especially noted to serve as "Hitler Youth". [4] However, in modern days, the number of child victims is increasing as the proportion of civilian casualties is also increasing. In 18th, 19th, and early 20th centuries, about half the war victims were civilians while it was almost 90 percent by the end of the 1980s. [8] Children compose a large part of the population affected by wars, data from the American Psychological Association show of the 95 percent of civilians killed in recent years' by modern armed conflicts, approximately 50 percent of them were children. [5]

According to United Nations Children's Fund (UNICEF), the estimated casualties of children during the last decade was: "2 million killed, 4–5 million disabled, 12 million left homeless, more than 1 million orphaned or separated from their parents, and some 10 million psychologically traumatized". [8] Currently, there are over two million child refugees fleeing from Syria and over 870,000 refugees from Somalia. [9] Among 100,000 people who have been killed in Syria, at least 10,000 were children. [10]

Potential risk factors of war on children

Direct exposure to violence

Death and injury

By being directly exposed to violence such as bombing and combats, children are killed during conflicts. In 2017 alone, there were 1,210 terrorist attacks around the world, mostly happening in Middle East region and 8,074 fatalities. [11] There were nine terrorist incidents with more than hundred deaths in conflict zones. Also, children are more likely to be injured by landmines. Twenty percent of landmine victims are children in mine-affected countries. [12] They are often intrigued by colorful appearance of landmines and explosives. Children can lose sight or hearing; lose body parts; suffer from the trauma. [12] At least 8,605 people were killed or injured by landmines in 2016 and 6,967 casualties in 2015. [13] Most of them were civilians and 42 percent of civilian casualties were children and the number of child casualties were at least 1,544 in 2016. [13]

Sexual violence

The United Nations define the term "conflict-related sexual violence" as "rape, sexual slavery, forced prostitution, forced pregnancy, forced abortion, enforced sterilization, forced marriage, and any other form of sexual violence of comparable gravity perpetrated against women, men, girls or boys that is directly or indirectly linked to a conflict". [14] More than 20,000 Muslim girls and women have been raped in Bosnia since 1992. Many cases in Rwanda show that every surviving adolescent girl was raped. [15] Sexual violence also causes sexually transmitted diseases – such as HIV/AIDS – to spread. [16] One of the factors is involvement with military forces as they sexually abuse and exploit girls and women during conflicts. [6] Besides, as HIV-positive mothers give birth to HIV-infected children without anti-retroviral drugs, the prevalence of HIV/AIDS tend to spread fast. [6]

Unmet basic needs during warfare

War disrupts the supply of necessities to children and their families like food, water, shelter, health services, and education. [5] Lack of access to these basic needs may deprive children of their physical, social-emotional, and psychological development. In case of South Sudan, constant violent conflicts along with climate shocks greatly damaged the agriculture-based economy. [17] As a result, more than 1.1 million children are suffering from severe food shortages. [17] In countries across Africa and the Middle East, over 2.5 million children are suffering from severe acute malnutrition. [17] Economic sanctions such as trade restrictions from international community and organizations may play a role in serious economic hardship and deterioration of infrastructure in armed conflict zones. [6] This makes it extremely difficult for children to survive as they are usually in the most bottom level of socioeconomic status. As of 2001, around half a million Iraqi children were predicted to be dead due to sanctions regime. [6]

Detrimental parenting behavior can also affect child development. In a war context, families and communities are not able to provide an environment conducive to the children's development. [5] Mike Wessells, Ph.D., a Randolph-Macon College psychology professor with extensive experience in war zones explained; "When parents are emotionally affected by war, that alters their ability to care for their children properly. War stresses increase family violence, creating a pattern that then gets passed on when the children become parents." [18] Scarcity of resources increases cognitive load which affects attention span, cognitive capacity, and executive control that are critical abilities to reason and solve problems. [19] Reduced mental and emotional capabilities caused by stress from a war can degrade their parenting capabilities and negatively change behaviors towards children. [5]

Disruption of education also occurs with the destruction of schools during wars. [20] The human and financial resources are compromised during crisis. The United Nations reported that more than 13 million children are deprived of education opportunities and more than 8,850 schools were destroyed because of armed conflicts in the Middle East. [21] [22] According to UNICEF report, In Yemen, 1.8 million children were out of education in 2015. [22] Between 2014 and 2015, almost half a million children in Gaza Strip were not able to go to school because of the damages on schools. [22] In Sudan, more than three million children cannot go to school because of the conflicts. [22] In Mozambique, around 45 percent of primary schools were destroyed during the conflict. [6] Fear and disruption make it hard for children and teacher to focus on education. [23] This generates an educational gap, depriving children of essential education, building social-emotional skills, and thus reintegrating into society. In addition, gender equality can also be compromised as education disruption in armed conflict zones generally excludes girls. [24]

Impact on psychological development of children

Brain development

Early childhood experience accounts for a large part of human brain development. Neural connections for sensory ability, language, and cognitive function are all actively made during the first year for a child. [25] The plasticity and malleability which refer to the flexibility of the brain is highest in the early brain development years. [25] Therefore, the brain can be readily changed by surrounding environments of children. In that sense, children in armed conflict zones may be more susceptible to mental problems such as anxiety and depression, as well as physiological problems in the immune system and central nervous systems.

Stress in early childhood can impede brain development of children that results in both physical and mental health problems. [26] Healthy brain and physical development can be hampered by excessive or prolonged activation of stress response systems. [26] Although both adrenaline and cortisol help prepare the body for coping with stressors, when they are used to prolonged and uncontrollable stress, this stress response system can lead to impairments in both mental and physical health. [26]

Lack of basic resources may also impede child brain development. Childhood socioeconomic status influences neural development and affects cognitive ability and mental health through adult life. [27] [28] Especially, poverty is regarded to deteriorate cognitive capacity. Many studies have shown that poverty in early childhood can be harmful in that poor families lack time and financial resources to invest in promoting child development. [29] [30] This suggests that the serious deprivation of resources in armed conflict zones is extremely detrimental to cognitive development of children during warfare.

Okasha and Elkholy (2012) have theorized that psychological immunization can help children who are frequently exposed to conflict to better acclimate themselves to the stressors of war. [31]

Attachment theory

Children who are detached from a family in early age may go through problems regarding attachment. [32] Children under five are more likely to experience a greater risk of depression and anxiety compared to adolescents. Attachment theory suggests that the ability of a child to create attachment can be deterred by deviant environmental conditions and reflected experiences with caregivers. [33] [34] Different types of attachments can be formed with different caregivers and upbringing environment. In addition, different experiences of attachment in childhood are known to be related to mental health issues in adulthood. [33] [34]

Other psychological impacts

Children in war-zones witness and experience horrendous violent activities which may lead to development of psychological disorders such as posttraumatic stress disorder (PTSD). [6] [35] [36] By 2017, 3 million children from Syria have witnessed effects of war directly. [37] 80% of the 94 Iraqi children exposed to the Feb 13, 1991 bombing showed PTSD symptoms. Also, study shows that 41 percent of Palestinian children from Gaza Strip suffered from PTSD. [38] The incidence of the effects of war has a 10 to 90 percent variation in terms of developing PTSD, depression and behavioral problems. [39] PTSD is known to have intergenerational effects. [40]

Rehabilitation issues

Reintegration into society for child soldiers

There are around 300,000 child soldiers around the world. [41]

Disarmament, demobilization, and reintegration (DDR) programs are conducted to rehabilitate child soldiers and war-affected children. [42] The creation of DDR in Sierra Leone was led by UNICEF in 1999. However, disarmament consistently failed to attract female combatants who were forced to provide sexual services as they were too afraid to step forward for demobilization process. [43]

Child soldiers are often stigmatized and confronted with discrimination from community. [44] Reintegration and rehabilitation depends on the level of violence occurred in the region, acceptance from family and community, and resources like education and training programs to recover war-affected youth. [44] The Paris Principles suggest extensive and detailed guidelines on reintegration of children associated with armed forces or armed groups. [45]

Psychological treatment process

Psychological treatment is considered to be more challenging after the age of five. [34] This is because the plasticity of the brain reduces after the age of five since much of the brain's development occurs before the age of six. [46] Long-term psychological treatment is many times required. Some children develop resilience and are able to overcome significant adversity. [47] Helpful community surroundings and stable caregivers are regarded as being able to build capacity to recover from adverse childhood experiences. [47]

Intervention programs for children in war-zones

Narrative exposure therapy

Narrative exposure therapy is a short-term individual intervention for treatment of PTSD based on the cognitive-behavioral exposure therapy. KidNET is a narrative exposure therapy used with war-affected children aged 12–17 years. Under this, the mental health professional encourages the patients to describe the events of their life – from birth till present. Improvements through KidNET are seen in the refugee children in eastern Europe, children affected by the Rwandan genocide, and the children in Sri Lanka.

Testimonial psychotherapy is another short-term individual treatment for the war-affected individuals in which they record their experiences with trauma. These recordings are then later analyzed by doctors along with the patients to understand how the personal experiences are connected to trauma. [48]

Dyad Psychosocial Support

Dyad psychosocial support is a family-level treatment for mother and children affected by war aiming at the emotional and psychological development of children. One example of the program was carried out in Bosnia for a duration of 5-month in which weekly meetings of the mothers were carried out to discuss their children's development, coping mechanisms, and trauma. [49] This program indicated net positive results in terms of the "maternal mental health, children's weight gain, and children's psychosocial functioning and mental health". [48]

Youth Readiness Intervention Program

Youth Readiness intervention program (Sierra Leone) is aimed at youth in the war to treat emotional and psychological issues and inculcate pro-social behavior in them. [48] A study by Betancourt et al. evaluates results from Sierra Leone. [50] It reports positive results.

See also

Related Research Articles

<span class="mw-page-title-main">Causes of mental disorders</span> Etiology of psychopathology

A mental disorder is an impairment of the mind disrupting normal thinking, feeling, mood, behavior, or social interactions, and accompanied by significant distress or dysfunction. The causes of mental disorders are very complex and vary depending on the particular disorder and the individual. Although the causes of most mental disorders are not fully understood, researchers have identified a variety of biological, psychological, and environmental factors that can contribute to the development or progression of mental disorders. Most mental disorders result in a combination of several different factors rather than just a single factor.

<span class="mw-page-title-main">Post-traumatic stress disorder</span> Mental disorder associated with trauma

Post-traumatic stress disorder (PTSD) is a mental and behavioral disorder that develops from experiencing a traumatic event, such as sexual assault, warfare, traffic collisions, child abuse, domestic violence, or other threats on a person's life or well-being. Symptoms may include disturbing thoughts, feelings, or dreams related to the events, mental or physical distress to trauma-related cues, attempts to avoid trauma-related cues, alterations in the way a person thinks and feels, and an increase in the fight-or-flight response. These symptoms last for more than a month after the event and can include triggers such as misophonia. Young children are less likely to show distress, but instead may express their memories through play. A person with PTSD is at a higher risk of suicide and intentional self-harm.

Psychological trauma is an emotional response caused by severe distressing events that are outside the normal range of human experiences. It must be understood by the affected person as directly threatening the affected person or their loved ones generally with death, severe bodily injury, or sexual violence; indirect exposure, such as from watching television news, may be extremely distressing and can produce an involuntary and possibly overwhelming physiological stress response, but does not produce trauma per se. Examples of distressing events include violence, rape, or a terrorist attack.

Eye movement desensitization and reprocessing (EMDR) is a form of psychotherapy that is a recommended treatment for post-traumatic stress disorder (PTSD), but remains controversial within the psychological community. It was devised by Francine Shapiro in 1987 and originally designed to alleviate the distress associated with traumatic memories such as PTSD.

<span class="mw-page-title-main">Complex post-traumatic stress disorder</span> Psychological disorder

Complex post-traumatic stress disorder is a stress-related mental disorder generally occurring in response to complex traumas, i.e., commonly prolonged or repetitive exposures to a series of traumatic events, within which individuals perceive little or no chance to escape.

Sex is correlated with the prevalence of certain mental disorders, including depression, anxiety and somatic complaints. For example, women are more likely to be diagnosed with major depression, while men are more likely to be diagnosed with substance abuse and antisocial personality disorder. There are no marked gender differences in the diagnosis rates of disorders like schizophrenia and bipolar disorder. Men are at risk to suffer from post-traumatic stress disorder (PTSD) due to past violent experiences such as accidents, wars and witnessing death, and women are diagnosed with PTSD at higher rates due to experiences with sexual assault, rape and child sexual abuse. Nonbinary or genderqueer identification describes people who do not identify as either male or female. People who identify as nonbinary or gender queer show increased risk for depression, anxiety and post-traumatic stress disorder. People who identify as transgender demonstrate increased risk for depression, anxiety, and post-traumatic stress disorder.

Childhood trauma is often described as serious adverse childhood experiences. Children may go through a range of experiences that classify as psychological trauma; these might include neglect, abandonment, sexual abuse, emotional abuse, and physical abuse. They may also witness abuse of a sibling or parent, or have a mentally ill parent. These events can have profound psychological, physiological, and sociological impacts leading to lasting negative effects on health and well-being. These events may include antisocial behaviors, attention deficit hyperactivity disorder (ADHD), and sleep disturbances. Additionally, children whose mothers have experienced traumatic or stressful events during pregnancy have an increased risk of mental health disorders and other neurodevelopmental disorders.

Memory and trauma is the deleterious effects that physical or psychological trauma has on memory.

Derealization is an alteration in the perception of the external world, causing those with the condition to perceive it as unreal, distant, distorted or in other words falsified. Other symptoms include feeling as if one's environment is lacking in spontaneity, emotional coloring, and depth. It is a dissociative symptom that may appear in moments of severe stress.

PTSD or post-traumatic stress disorder, is a psychiatric disorder characterised by intrusive thoughts and memories, dreams or flashbacks of the event; avoidance of people, places and activities that remind the individual of the event; ongoing negative beliefs about oneself or the world, mood changes and persistent feelings of anger, guilt or fear; alterations in arousal such as increased irritability, angry outbursts, being hypervigilant, or having difficulty with concentration and sleep.

Transgenerational trauma is the psychological and physiological effects that the trauma experienced by people has on subsequent generations in that group. The primary mode of transmission is the shared family environment of the infant causing psychological, behavioral and social changes in the individual.

Trauma focused cognitive behavioral therapy (TF-CBT) is an evidence-based psychotherapy or counselling that aims at addressing the needs of children and adolescents with post traumatic stress disorder (PTSD) and other difficulties related to traumatic life events. This treatment was developed and proposed by Drs. Anthony Mannarino, Judith Cohen, and Esther Deblinger in 2006. The goal of TF-CBT is to provide psychoeducation to both the child and non-offending caregivers, then help them identify, cope, and re-regulate maladaptive emotions, thoughts, and behaviors. Research has shown TF-CBT to be effective in treating childhood PTSD and with children who have experienced or witnessed traumatic events, including but not limited to physical or sexual victimization, child maltreatment, domestic violence, community violence, accidents, natural disasters, and war. More recently, TF-CBT has been applied to and found effective in treating complex posttraumatic stress disorder.

A moral injury is an injury to an individual's moral conscience and values resulting from an act of perceived moral transgression on the part of themselves or others. It produces profound feelings of guilt or shame, moral disorientation, and societal alienation. In some cases it may cause a sense of betrayal and anger toward colleagues, commanders, the organization, politics, or society at large.

Operational stress injury or OSI is a non-clinical, non-medical term referring to a persistent psychological difficulty caused by traumatic experiences or prolonged high stress or fatigue during service as a military member or first responder. The term does not replace any individual diagnoses or disorders, but rather describes a category of mental health concerns linked to the particular challenges that these military members or first responders encounter in their service. There is not yet a single fixed definition. The term was first conceptualized within the Canadian Armed Forces to help foster understanding of the broader mental health challenges faced by military members who have been impacted by traumatic experiences and who face difficulty as a result. OSI encompasses a number of the diagnoses found in the Diagnostic and Statistical Manual of Mental Disorders (DSM) classification system, with the common thread being a linkage to the operational experiences of the afflicted. The term has gained traction outside of the military community as an appropriate way to describe similar challenges suffered by those whose work regularly exposes them to trauma, particularly front line emergency first responders such as but not limited to police, firefighters, paramedics, correctional officers, and emergency dispatchers. The term, at present mostly used within Canada, is increasingly significant in the development of legislation, policy, treatments and benefits in the military and first responder communities.

Early childhood trauma refers to various types of adversity and traumatic events experienced during the early years of a person's life. This is deemed the most critical developmental period in human life by psychologists. A critical period refers to a sensitive time during the early years of childhood in which children may be more vulnerable to be affected by environmental stimulation. These traumatic events can include serious illness, natural disasters, family violence, sudden separation from a family member, being the victim of abuse, or suffering the loss of a loved one. Traumatic experiences in early childhood can result in severe consequences throughout adulthood, for instance developing post-traumatic stress disorder, depression, or anxiety. The effects of this trauma can be experienced very differently depending on factors such as how long the trauma was, how severe and even the age of the child when it occurred. Negative childhood experiences can have a tremendous impact on future violence victimization and perpetration, and lifelong health and opportunity. However, not all children who are exposed to negative stimuli in early childhood will be affected severely in later life; some children come out unscathed after being faced with traumatic events, which is known as resilience. Many factors can account for the invulnerability displayed by certain children in response to adverse social conditions: gender, vulnerability, social support systems, and innate character traits. Much of the research in this area has referred to the Adverse Childhood Experiences Study (ACE) study. The ACE study found several protective factors against developing mental health disorders, including mother-child relations, parental health, and community support. However, having adverse childhood experiences creates long-lasting impacts on psychosocial functioning, such as a heightened awareness of environmental threats, feelings of loneliness, and cognitive deficits. Individuals with ACEs are more prone to developing severe symptoms than individuals in the same diagnostic category.

<span class="mw-page-title-main">Children in emergencies and conflicts</span>

Conflicts and emergencies around the world pose detrimental risks to the health, safety, and well-being of children. There are many different kinds of conflicts and emergencies, for example, violence, armed conflicts, war, and natural disasters. Some 13 million children are displaced by armed conflicts and violence around the world. Where violent conflicts are the norm, the lives of young children are significantly disrupted and their families have great difficulty in offering the sensitive and consistent care that young children need for their healthy development. One impact is the high rates of PTSD seen in children living with natural disasters or chronic conflict.

<span class="mw-page-title-main">Emily A. Holmes</span> Clinical psychologist and neuroscientist

Emily A. Holmes is a clinical psychologist and neuroscientist known for her research on mental imagery in relation to psychological treatments for post traumatic stress disorder (PTSD), bipolar disorder, and depression. Holmes is Professor at the department of Women's and Children's Health at Uppsala University. She also holds an appointment as Honorary Professor of Clinical Psychology at the University of Oxford.

Out-of-home placements are an alternative form of care when children must be removed from their homes. Children who are placed out of the home differ in the types and severity of maltreatment experienced compared to children who remain in the home. One-half to two-thirds of youth have experienced a traumatic event leading to increased awareness and growing literature on the impact of trauma on youth. The most common reasons for out-of-home placements are due to physical or sexual abuse, violence, and neglect. Youth who are at risk in their own homes for abuse, neglect, or maltreatment, as well as youth with severe emotional and behavior issues, are placed out of the home with extended family and friends, foster care, or in residential facilities. Out-of-home placements aim to provide children with safety and stability. This temporary, safe environment allows youth to have their physical, mental, moral, and social needs met. However, these youth are in a vulnerable position for experiencing repeated abuse and neglect.

Sexual trauma therapy is medical and psychological interventions provided to survivors of sexual violence aiming to treat their physical injuries and cope with mental trauma caused by the event. Examples of sexual violence include any acts of unwanted sexual actions like sexual harassment, groping, rape, and circulation of sexual content without consent.

Being exposed to traumatic events such as war, violence, disasters, loss, injury or illness can cause trauma. Additionally, the most common diagnostic instruments such as the ICD-11 and the DSM-5 expand on this definition of trauma to include perceived threat to death, injury, or sexual violence to self or a loved one. Even after the situation has passed, the experience can bring up a sense of vulnerability, hopelessness, anger and fear.

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  45. ↑ "The Paris Principles" (PDF). UNICEF. 2007. Archived (PDF) from the original on 2016-10-30. Retrieved 2018-03-04.
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  47. 1 2 "Resilience". Center on the Developing Child at Harvard University. Archived from the original on 2018-02-20. Retrieved 2018-02-19.
  48. 1 2 3 Betancourt TS, Meyers-Ohki SE, Charrow AP, Tol WA (2013). "Interventions for children affected by war: an ecological perspective on psychosocial support and mental health care". Harvard Review of Psychiatry. 21 (2): 70–91. doi:10.1097/HRP.0b013e318283bf8f. PMC   4098699 . PMID   23656831.
  49. ↑ Dybdahl, Ragnhild (2001). "A Psychosocial Support Programme for Children and Mothers in War". Clinical Child Psychology and Psychiatry. 6 (3): 425–436. doi:10.1177/1359104501006003010. S2CID   146561046.
  50. ↑ Developing a group mental health intervention for war affected youth. CUNY Academic Works.
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