Armed conflicts: Pair of reports puts focus on their wide-ranging toll on children
SherryShenoda, M.D., FAAP and AyeshaKadir, M.D., M.Sc., FAAP
AAP Technical Report
A Jew, Muslim and Christian got together in 2014, nearly paralyzed by the horror of
the war in Syria.
“We cannot keep silent about this,” was the consensus. The result is the first-ever
AAP policy statement and technical report on children and armed conflict.
More than one in 10 children are affected by armed conflict. The number of people
forcibly displaced from their homes now stands at 68.5 million, including more than
25 million refugees. Half of refugees are children, and most of them are displaced
by armed conflict.
The urgency of the policy statement and technical report cannot be overstated.
Based on human rights principles, the policy provides a basic set of minimum standard
recommendations for clinical practice, systems change and public policy. The technical
report synthesizes the available knowledge as a starting point for understanding and
dialogue about the issues facing children affected by conflict and how the pediatric
and world community can respond.
Armed conflict does far more than the obvious to children. Not only does it injure,
kill and cause psychological trauma, conflict can lead to long-lasting harm to child
health and development. Forced displacement, inadequate and unsafe living conditions,
food insecurity, environmental hazards, separation from family, caregiver mental health,
destruction of health systems, and barriers in access to health care and education
are some downstream effects on child health. Further, combatants target children and
health workers, and children are recruited or forced to take part in combat in a variety
of ways. The severity and chronicity of the stresses that children endure from armed
conflict make it a toxic stress and a significant social determinant of child health.
The reports offer guidance in the following three areas.
Child health professionals need access to training in trauma-informed care and services. They should be prepared
to diagnose and provide initial management for prevalent mental health conditions,
and collaborate with refugee resettlement and other agencies.
Systems serving children exposed to armed conflict can provide access to physical, mental, behavioral, developmental and oral health
and rehabilitative services. They need to protect children from abuse and exploitation,
including physical abuse, kidnapping, early marriage, sexual violence, inappropriate
placement/adoption, labor, drug abuse, trafficking and detention. Children’s births
should be registered, and children should not be made stateless.
Political advocacy efforts should seek to protect children younger than 18 years from involvement in armed conflict
and to ensure that children involved in armed conflict as combatants receive rehabilitation.
Governments should uphold the Geneva Conventions with respect to the sanctity of safe
spaces for children and ensure medical and educational neutrality. Special protection
should be afforded to displaced and refugee children, and children should not be separated
from their families.
Dr. Shenoda is the lead author of the policy statement, and Dr. Kadir is the lead
author of the technical report.