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.UNICEF. 2010. The State of the World's Children Report, Special Edition. New York, UNICEF. 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.
Impact of emergency and conflict experiences In sum, emergency and conflict may impact on children's development in the following manner: Physical: exacerbation of medical problems, headaches, fatigue, unexplained physical complaints. Cognitive: trouble concentrating, preoccupation with the traumatic event, recurring dreams or nightmares, questioning spiritual beliefs, inability to process the event. Emotional: depression or sadness, irritability, anger, resentfulness, despair, hopelessness, feelings of guilt, phobias, health concerns, anxiety, or fearfulness. Social: increased conflicts with family and friends, sleep problems, crying, changes in appetite, social withdrawal, talking repeatedly about the traumatic event, refusal to go to school, repetitive play.
Impact on pregnancy Research shows that environmental factors and experiences can alter the genetic make-up of a developing child. Exposure to prolonged stress, environmental toxins or nutritional deficits chemically alter genes in the foetus or young child and may shape the individual's development temporarily or permanently. Violence and maternal depression may also impair child development and mental health.Walker, S. P., Wachs, T. D. et al. 2007. Child development: risk factors for adverse outcomes in developing countries. The Lancet, Vol. 369(9556), pp. 145–157. When trauma occurs at critical times of development for the foetus or young child, the impact on specialized cells for organs such as the brain, heart, or kidney can result in underdevelopment with lifetime implications for physical and mental health. For instance, a study on Iraq showed the rate of heart defects at birth in Fallujah to be 13 times the rate found in Europe. And for birth defects involving the nervous system the rate was calculated to be 33 times that found in Europe for the same number of births.Alaani, S., Adsfahani, M. S., Tafash, M., and Manduca, P. 2008. Four polygamous families with congenital birth defects from Fallujah, Iraq . In Save the Children, Protecting Children in a Time of Crisis. Annual Report. Prolonged stress during pregnancy or early childhood can be particularly toxic and, in the absence of protective relationships, may also result in permanent genetic changes in developing brain cells. Evidence has shown that toxins and stress from the mother cross the placenta into the umbilical cord,Balakrishnan, B., Henare, K., Thorstensen, E. B., Ponnampalam, A. P., Mitchell DPhil, M. D. 2010. Transfer of bisphenol A across the human placenta. American Journal of Obstetrics and Gynecology, Vol. 202, pp. 393–395. leading to premature and low birth weight babies.Shonkoff, J. P., Boyce, W. T. and McEwen, B. S. 2009. Neuroscience, molecular biology, and the childhood roots of health disparities: Building a new framework for health promotion and disease prevention . JAMA, Vol. 301(21), pp. 2252–2259. Likewise, conflict trauma can affect pregnant women and the subsequent emotional health of their children. In addition, babies of severely stressed and worried mothers are at higher risk to be born small or prematurely.
Impact on child development
Children's reactions to emergencies fluctuate depending on age, temperament, genetics, pre-existing problems, coping skills and cognitive competencies, and the dose of the emergency. Although most children are said to recover over time, if emergency reactions are left untreated, they can have a significant adverse impact on children's social, emotional, behavioural and physical development.Zubenko, W. N. and Capozzoli, J. 2002. Children in Disasters: A Practical Guide to Healing and Recovery, New York, Oxford University Press.
Age 6 and younger In conflict-affected countries the average mortality rate for children under 5 is more than double the rate in other countries. On the average, twelve children out of a hundred die before their fifth birthday, compared with six out of a hundred. Common reactions among this age group are severe separation distress, crying, clinging, immobility and/or aimless motion, whimpering, screaming, sleeping and eating disorders, nightmares, fearfulness, regressive behaviours such as thumb-sucking, Bed-Wetting, loss of bowel/bladder control, inability to dress or eat without assistance, and fear of darkness, crowds and being left alone.
During an investigation of the relationship between exposure to day raids and shelling and behavioural and emotional problems among Palestinian children, aged 3–6, in the Gaza Strip, children demonstrated sleeping problems, poor concentration, attention-seeking behaviour, dependency, temper tantrums and increased fear. Mothers of Palestinian kindergarten children reported severely impaired psychosocial and emotional functioning in their children.Massad, S., Nieto, F. J., Palta, M., Smith, M., Clark, R., Thabet, A., 2009. Mental health of Palestinian children in kindergartens: Resilience and vulnerability. Child and Adolescent Mental Health, Vol. 14(2), pp. 89–96, . Thabet et al.Thabet, A. A., Vostanis, P. and Karim, K. 2005. Group crisis intervention for children during ongoing war conflict. Psychiatry, Vol.14, pp. 262–269. examined the behavioural and emotional problems of 309 Palestinian pre-schoolers, and found that direct and indirect exposure to war trauma increased the risk of poor mental health. Zahr et al.,Zahr, L. K. 1996. Effects of war on the behavior of Lebanese pre-school children: The influence of home environment and family functioning. American Journal of Orthopsychiatry, Vol. 66, pp. 401–408. in a study on the effect of war on Lebanese pre-school children, found more problems in children aged 3–6 years exposed to heavy shelling over a 2-year period than in a control group living without this threat. According to Yaktine,Yaktine, U. 1978. Effect of war on Lebanese children: New trends in children's culture. The Arabic Cultural Club, 119–121. (Arabic language) 40 mothers of different socio-economic backgrounds during the civil war in Beirut reported that their pre-school children became more anxious and fearful about bombardments and explosions. After SCUD missile attacks, displaced Israeli pre-school children demonstrated aggression, hyperactivity and oppositional behaviour and stress. This was compared with non-displaced children and, despite a continuous decrease in symptom severity, risk factors identified shortly after the Gulf War continued to exert their influence on children five years after the traumatic exposure.Laor, N., Wolmer, L., Cohen, D. J. 2001. Mothers' functioning and children's symptoms 5 years after a SCUD missile attack . American Journal of Psychiatry, Vol. 158, No. 7, pp. 1020–1026.
Ages 6 to 11 Common symptoms in this age bracket include disturbing thoughts and images, nightmares, eating and sleeping disorders, noncompliance, irritability, extreme withdrawal, outbursts of anger and fighting, disruptive behaviour, inability to pay attention, irrational fears, regressive behaviour, depression and anxiety, feeling of guilt and emotional numbing, excessive clinging, headaches, nausea and visual or hearing problems. Traumatic events experienced before the age of 11 are three times more likely to result in serious emotional and behavioural difficulties than those experienced later in life.Goodman, G. S., Batterman-Faunce, J. M., Schaaf, J. M., and Kenney, R. 2002. Nearly 4 years after an event: Children's eyewitness memory and adults' perceptions of children's accuracy. Child Abuse and Neglect, Vol. 26(8), pp. 849–884.
According to the Palestinian Counseling Centre, Save the Children, even six months after the demolition of their homes, young Palestinian children experienced withdrawal, somatic complaints, depression/anxiety, unexplained pain, breathing problems, attention difficulties and violent behaviour. They were afraid to go to school, had problems relating to other children and greater attachment to caregivers. As a result, parents reported deterioration in educational achievement and ability to study.
Al-Amine and LiabreAl Amine, A. and Llabre, M. 2008. The psychological conditions of children and youth in Lebanon after July 2006 War. Lebanese Association for Educational Studies, Kuwait Society for the Advancement of Arab Children. revealed that 27.7 per cent of Lebanese children aged between 6 and 12 developed symptoms of PTSD, as well as from problems sleeping, agitation, difficulties in concentrating and excessive awareness of events related to the 2006 Lebanese-Israeli war. Many children in Sudan and northern Uganda who were forced to witness family members being tortured and murdered exhibited stunting, PTSD and other trauma-related disorders.
PTSD
Studies on the effect of emergencies and conflict on the physical and mental health of children between birth and 8 years old show that where the disaster is natural, the rate of PTSD occurs in anywhere from 3 to 87 per cent of affected children.Garrison, C. Z., Bryant, E. S., Addy, C. L., Spurrier, P. G., Freedy, J. R., and Kilpatrick, D. G. 1995. Posttraumatic stress disorder in adolescents after Hurricane Andrew. Journal of the American Academy of Child and Adolescent Psychiatry, Vol. 34, pp. 1193–1201.Shannon, M. P., Lonigan, C. J., Finch, A. J. and Taylor, C. M. 1994. Children exposed to disaster: I. Epidemiology of post-traumatic symptoms and symptom profiles. Journal of American Academy of Child and Adolescent Psychiatry, Vol. 33, pp. 80–93. However, rates of PTSD for children living in chronic conflict conditions varies from 15 to 50 per centDe Jong, J. T. V. M. 2002. Trauma, War, and Violence: Public Mental Health in Socio Cultural Context. New York, Kluwer. as evidenced in the following countries: Iran, Iraq, Israel, Kuwait, Lebanon, Palestine, Rwanda, South Africa, and Sudan.
Disabilities