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War affects children in all the ways it affects adults, but also in different ways. First, children are dependent on the care, empathy, and attention of adults who love them. Their attachments are frequently disrupted in times of war, due to the loss of parents, extreme preoccupation of parents in protecting and finding subsistence for the family, and emotional unavailability of depressed or distracted parents. The child may be in substitute care with someone who cares for him or her only slightly \u2013 relatives or an orphanage. A certain proportion of war-affected children lose all adult protection \u2013 \u201cunaccompanied children,\u201d as they are known in refugee situations.<\/p>\n

Second, impacts in childhood may adversely affect the life trajectory of children far more than adults. Consider children who lose the opportunity for education during war, children who are forced to move into refugee or displaced person camps, where they wait for years in miserable circumstances for normal life to resume, if it ever does. Consider a child disabled in war; they may, in addition to loss of a limb, sight, or cognitive capacity, lose the opportunity of schooling and of a social life. A girl who is raped may be marginalized by her society and lose the opportunity for marriage. Long after the war has ended, these lives will never attain the potential they had before the impact of war.<\/p>\n

Listing the impacts of war on children is a sadly straightforward task:<\/p>\n

Death.<\/em>\u00a0Hundreds of thousands of children die of direct violence in war each year (2<\/a>). They die as civilians caught in the violence of war, as combatants directly targeted, or in the course of ethnic cleansing.<\/p>\n

Injury.<\/em>\u00a0Children suffer a range of war injuries. Certain weapons affect them particularly. A landmine explosion is more likely to kill or seriously injure a child than an adult (3<\/a>). Thousands of children suffer landmine injuries each year (4<\/a>).<\/p>\n

Disability.<\/em>\u00a0Millions of children are disabled by war, many of whom have grossly inadequate access to rehabilitation services. A child may have to wait up to 10 years before having a prosthetic limb fitted. Children who survive landmine blasts rarely receive prostheses that are able to keep up with the continued growth of their limbs.<\/p>\n

Illness.<\/em>\u00a0Conditions for maintenance of child health deteriorate in war \u2013 nutrition, water safety, sanitation, housing, access to health services. There may be loss of immunity to disease vectors with population movement. Refugee children are particularly vulnerable to the deadly combination of malnutrition and infectious illness. There is also interruption of population immunization programs by war which may be responsible for increases in child mortality.<\/p>\n

Rape and prostitution for subsistence.<\/em>\u00a0These phenomena which often occur in situations of war, ethnic cleansing, and refugee life leave lasting physical impacts in sexually-transmitted diseases, including HIV\/AIDS, psychological impacts and changes in life trajectory.<\/p>\n

Psychological suffering.<\/em>\u00a0Children are exposed to situations of terror and horror during war \u2013 experiences that may leave enduring impacts in posttraumatic stress disorder. Severe losses and disruptions in their lives lead to high rates of depression and anxiety in war-affected children. These impacts may be prolonged by exposures to further privations and violence in refugee situations.<\/p>\n

Moral and spiritual impacts.<\/em>\u00a0The experience of indifference from the surrounding world, or, worse still, malevolence may cause children to suffer loss of meaning in their construction of themselves in their world. They may have to change their moral structure and lie, steal, and sell sex to survive. They may have their moral structure forcibly dismantled and replaced in training to kill as part of a military force.<\/p>\n

Social and cultural losses.<\/em>\u00a0Children may lose their community and its culture during war, sometimes having it reconstituted in refugee or diaspora situations.<\/p>\n

Child soldiers.<\/em>\u00a0It is estimated that there are tens of thousands of young people under 18 serving in militias in about 60 countries. They are particularly vulnerable to all of the impacts listed above (5<\/a>).<\/p>\n<\/div>\n

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Remedial strategies<\/h2>\n

Action on this cluster of tragic phenomena is usually considered under two categories \u2013 how to mitigate some of the damage to children and how to heal children after they are damaged.<\/p>\n

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Making war less damaging to children (secondary prevention)<\/h3>\n

1. Implement international humanitarian law regarding the protection of children in war. The Geneva Conventions and the Convention on the Rights of the Child deal with protection of war-affected children with regard to food, clothing, medicine, education, and family reunion. In addition, they are intended to protect children from ethnic cleansing and recruitment into armed forces. However, compliance with these instruments is poor, especially when recruiting children to armed forces is concerned.<\/p>\n

2. Ensure that general economic sanctions against a country are never used again, as they were used in Iraq as a substitute for war. Children and poor adults are those who suffer most from economic sanctions. Use of economic sanctions should be considered a war crime, just as is laying siege to a city to starve its population.<\/p>\n

3. Ensure special consideration for children who are in flight from war zones and who live in camps for refugees and internally displaced people, especially children who are unaccompanied by adults. Special considerations need to be given for family reunion, systems of distribution of resources (sometimes to women rather than to men), internal layout of camps (to prevent attacks on girls), the provision of facilities for education and play, and special help for child-headed families.<\/p>\n

4. Institute measures to reduce sexual exploitation and gender-based violence against women and girls in war. These measures include training of soldiers, including peacekeeping forces; inclusion of relevant interventions in humanitarian responses to population emergencies in war; reporting and support systems for victims of rape in camps for refugees and internally displaced persons; the prosecution of rape as a war crime; and making organized rape a crime against humanity.<\/p>\n

5. Parties to a conflict must facilitate humanitarian assistance to ensure that the health infrastructure of children\u2019s lives is not destroyed. Perpetrators should be prosecuted for such actions as destroying clinics, schools, and hospitals \u2013 all of which are protected by international law. Where access to health services, such as immunization, is hindered by the violent conflict, there should be humanitarian ceasefires to enable access.<\/p>\n

6. Include children\u2019s interests in peace agreements. Since 1999, several peace agreements have specifically referred to children in the post-violence arrangements for disarmament, demobilization, and reintegration (6<\/a>). Children are recognized as victims and perpetrators of violence in several truth-and-reconciliation commissions, but children have played little role in these systems.<\/p>\n<\/div>\n

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Rehabilitating children affected by war (tertiary prevention)<\/h3>\n

During the immediate humanitarian response to victims of war and in the longer-term attempts to reconstruct health services after war, there are attempts by both local and international actors to care for children\u2019s needs for health care. Physical and psychological rehabilitation is instituted to varying degrees depending on the resources available. Sometimes these are minimal or absent. There have been many efforts to help the psychological impacts of war on children. Few have been evaluated.<\/p>\n

Some efforts at rehabilitation of war-affected children include social healing moving toward education in the Culture of Peace. This is an approach to primary prevention of recurrence of war.<\/p>\n<\/div>\n<\/div>\n

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Imperative to end war<\/h2>\n

It may strike the reader that, although the many efforts to make war less damaging for children are important and should continue and be strengthened, this is a pathetically feeble response in the light of the intensity and magnitude of the suffering involved. From a certain perspective, there is even something preposterous about an exclusive focus on making war more tolerable for children. We rail against approaching HIV\/AIDS, tuberculosis, or malaria in this way. Poverty, on the other hand, like war, may be treated with the assumption that it will always be with us, and is a fact of life. These assumptions should be vigorously challenged.<\/p>\n