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“The only thing necessary for these diseases to the triumph is for good people and governments to do nothing.”



"Even if they have never seen a gun, millions of children suffer from wars, as resources that could have been invested in development are diverted into armaments. Indeed, one of the most distressing realities of our time is that most wars have been fought in precisely those countries that could least afford them."State of the World's Children, United Nations Children's Fund (UNICEF), 1996.

The wounds inflicted by armed conflict on children - physical injury, gender-based violence, psychosocial distress, are affronts to every impulse that inspired the United Nations Convention on the Rights of the Child. Armed conflict affects all aspects of child development - physical, mental and emotional. Such effects accumulate and interact with each other. To be effective, assistance must take account of each. The impact of armed conflict cannot be fully understood without looking at the related effects on women, families and the community support systems that provide protection and a secure environment for development. Children's well-being is best ensured through family and community-based solutions that draw on local culture and an understanding of child development.

The disruption of food supplies, the destruction of crops and agricultural infrastructures, the disintegration of families and communities, the displacement of populations and the destruction of educational and health services and of water and sanitation systems, all take a heavy toll on children. Article 39 of the Convention on the Rights of the Child states that "States Parties shall take all appropriate measures to promote physical and psychological recovery and social reintegration of a child victim of: any form of neglect, exploitation, or abuse; torture or any other form of cruel, inhuman or degrading treatment or punishment; or armed conflicts. Such recovery and reintegration shall take place in an environment which fosters the health, self-respect and dignity of the child." Ensuring that health and nutrition, psychosocial well-being and education are priority components of humanitarian assistance is the best way to ensure children's physical and psychological recovery and social reintegration.


Armed conflict is a major public health hazard that cannot be ignored. Any disease that caused as much large-scale damage to children would long ago have attracted the urgent attention of public health specialists. When armed conflict kills and maims more children than soldiers, the health sector has a special obligation to speak out.

Thousands of children are killed every year as a direct result of fighting - from knife wounds, bullets, bombs and landmines, but many more die from malnutrition and disease caused or increased by armed conflicts. In Mozambique alone, between 1981 and 1988, armed conflict was the cause underlying 454,000 child deaths. Many of today's armed conflicts take place in some of the world's poorest countries, where children are already vulnerable.

Children are the most vulnerable to collective assaults on health and well-being. At the height of the conflict in Somalia, more than half the deaths of children in some places were caused by measles. Diarrhoea is another common and often deadly disease. Cholera is a constant threat as exemplified in refugee camps in Bangladesh, Kenya, Malawi, Nepal, Somalia and Zaire. The World Health Organization (WHO) estimates that half the world's refugees may be infected with tuberculosis, as crowded conditions in refugee camps provide a breeding ground for infections. Malaria and acute respiratory infections, including pneumonia, also claim many lives.


Disrupted health services and food supplies

In most wars, health facilities come under attack, in direct violation of international humanitarian law. Those facilities that remain open during a conflict are often looted or forced to close down, and the remainder are sometimes difficult to reach because of curfews. Restrictions on travel also hamper the distribution of drugs and other medical supplies, causing health systems' referral services and logistic support to break down. Many of the health services of a country are diverted to the needs of military casualties. Hospitals are forced to neglect the regular care of patients or to shift them to health centres. A concentration on military needs also means that children injured in a conflict may not get effective treatment or rehabilitation. Children living with disabilities get little, if any, support. For children, a dangerous implication of the breakdown of a country's health facilities during conflicts is the disruption of vaccination programmes.

Children as "zones of peace"
Claiming children as "zones of peace" has become an important concept of humanitarian relief programmes. Commitment to this principle by all warring parties has taken various forms. In El Salvador, beginning in 1985, Government and rebel forces agreed to three "days of tranquillity" during which 250,000 children were immunized against polio, measles, diptheria and other diseases, a process that was repeated annually for six years until the end of the civil war. In Afghanistan in 1988-1989, health teams were permitted to operate in both Government and rebel-held areas, raising vaccination levels in some areas above 80 per cent. In the case of Operation Lifeline Sudan, arrangements were made for "corridors of peace" so that relief supplies and vaccines could be delivered during relative lulls in the conflict.

One of the most immediate effects of armed conflict is the disruption of food supplies. Farmers, who are often women and older children, become fearful of working on plots of land too far from their homes. They reduce the area under cultivation, and their water sources, systems of irrigation and flood control may also be destroyed. Restrictions on movement limit access to such necessities as seeds and fertilizers and stop farmers from taking their produce to market. Most households in developing countries, including many farm households, rely on market purchases to meet their food needs. Economic disarray heightens unemployment, reducing people's ability to buy food.

Sometimes, damage to food systems is deliberate. For example, in the early 1980s in Ethiopia, the Government's scorched earth policies destroyed hundreds of thousands of acres of food-producing land. In many countries, landmines prevent the use of agricultural land. In contravention of international law, warring parties may block relief supplies or divert them for their own use. Feeding centres for children and vulnerable groups are frequently bombed or attacked.

Warfare also takes its toll on livestock. This creates particular problems for young children who rely on milk as part of their basic diet. In the Kongor area of Sudan, the massacre of cattle reduced livestock from around 1.5 million to 50,000.

Malnutrition and the importance of breastfeeding

Adequate nourishment depends on the way food is distributed, the way children are fed, hygiene and the time parents have available to care for children. Malnutrition can affect all children, but it causes the greatest mortality and morbidity among young children, especially those under three years of age. Breastfeeding provides ideal nutrition for infants, reduces the incidence and severity of infectious diseases and contributes to women's health.

During conflicts, mothers may experience hunger, exhaustion and distress that can make them less able to care for their children. Breastfeeding may be endangered by the mother's loss of confidence in her ability to produce milk. The general disruption in routine can separate mothers from their children for long periods. As conflicts proceed, social structures and networks break down. Knowledge about breastfeeding is passed from one generation to the next, and this can be lost when people flee and families are broken up. Yet artificial feeding, risky at all times, is even more dangerous in unsettled circumstances. Unless mothers are severely malnourished, they can breastfeed adequately despite severe stress. In times of armed conflict, it is important to support women's capacity to breastfeed by providing adequate dietary intake for lactating women and ensuring that they are not separated from their children.

Reproductive health

The effects of armed conflicts - the fragmenting of family and community, rapid social change, the breakdown of support systems, increased sexual exploitation and rape, malnutrition, and inadequate health services, including poor ante-natal care -- make it imperative that reproductive health care be given high priority. Health education, care and counselling are especially important for women and girls who have been raped or who have been forced into prostitution. The potential for the spread of sexually transmitted diseases, including HIV/AIDS, increases dramatically during conflicts. The breakdown of health services, and blood transfusion services lacking the ability to screen for HIV/AIDS, contribute to the increase in transmission.

In war-affected populations, gynaecological and paediatric health services are often unavailable. An obstacle to the full use of health services in emergencies is that they are often dominated by men, whether expatriate or from the host country. As a result, many women and girls, for cultural or religious reasons, underutilize the services despite risks to their health. One way to overcome this obstacle is to increase the numbers of available female health and protection professionals.

Some recommendations for action

o Parties to a conflict should be obliged to maintain basic health systems and services and water supplies.

o Special attention should be paid to primary health care and the care of children with chronic or acute conditions. Adequate rehabilitative care, such as the provision of artificial limbs for injured or permanently disabled children, should be ensured to facilitate the fullest possible social integration.

o Child-focused health needs assessments involving local professionals, young people and communities should be speedily carried out by organizations working in conflict situations, and should take into account food, health and care factors and the coping strategies likely to be used by the affected population.

o During conflicts, Governments and non-State entities should be encouraged to facilitate "days of tranquillity" or "corridors of peace" to ensure continuity of basic child health measures and delivery of humanitarian relief.

o Parties in conflict should refrain from destroying food crops, water sources and agriculture infrastructures in order to minimize disruption of food supply and production capacities.

o Emergency relief should give attention to the rehabilitation of agriculture, livestock and fisheries and to employment or income-generating programmes, to enhance local capacities to improve household security on a self-reliant and sustainable basis.

o Health professionals must be advocates of the rights of the child. WHO, in collaboration with professional, humanitarian and human rights organizations, should encourage paediatricians and all other doctors and health workers to disseminate child rights information and to report rights violations encountered in the course of their work.



Historically, those concerned with the situation of children during armed conflict have focused primarily on their physical vulnerability. But the loss, grief and fear a child has experienced must also be taken into account. For increasing numbers of children living in war-torn nations, childhood has become a nightmare. Armed conflict destroys homes, separates families, splinters communities, breaks down trust among people and disrupts health and education services, undermining the very foundation of children's lives. The psychosocial concerns intrinsic to child develoment must be taken into account. Seeing their parents or other important adults in their lives as vulnerable can severely undermine children's confidence and add to their sense of fear. As bad as these experiences are, many children have witnessed their parents' torture, murder or rape, and have been threatened with death themselves.

In a UNICEF survey of 3,030 children in Rwanda in 1995, nearly 80 per cent had lost immediate family members, and more than one third of these had actually witnessed the murders.

When children have experienced traumatic or other events in times of war, they may suffer from increased anxiety about being separated from their families, or they may have nightmares or trouble sleeping. They may cease playing and laughing, lose their appetites and withdraw from contact. Younger children may have difficulty concentrating in school. Older children and adolescents may become anxious or depressed, feel hopeless about the future or develop aggressive behaviour.

Best practices for recovery

Experience has shown that with supportive caregivers and secure communities, most children will achieve a sense of healing. Helping war-affected children to build on their own strengths and resilience, in collaboration with trusted caregivers, is an important strategy in the process of healing. Integrating modern knowledge of child development and child rights with local concepts and practices will result in more effective and sustainable ways to meet children's needs. Although many symptoms of distress have universal characteristics, the ways in which people express, embody and give meaning to their distress are largely dependent on social, cultural and political contexts and are based on different belief systems.

All phases of emergency and reconstruction assistance programmes should take psychosocial considerations into account, while avoiding the development of separate mental health programmes. Such programmes should also give priority to preventing further traumatic experiences, such as preventing family separation, undertaking practical measures to prevent gender-based violence, and avoiding the isolation and stigmatization that can result from institutionalization. Exploring a child's experience with violence and the meaning it holds in her or his life is important to the process of healing and recovery. While many forms of external assistance can help to promote psychosocial recovery, such explorations with children should take place in a stable, supportive environment, by caregivers who have solid and continuing relationships with the child. Ethical issues and confidentiality must be carefully considered. When journalists or researchers encourage a child to relate "horror stories", the interview can open up old wounds and tear down a child's defenses. Children who are photographed and identified by name can become vulnerable to additional harassment.

It is important that those who wish to help with the healing process have a deep understanding of and respect for the societies in which they are working. Aside from knowing the basic principles of child development and the way it is understood locally, they should also understand local culture and practices, including the rites and ceremonies related to growing up and becoming an adult, as well as those associated with death, burial and mourning.

An African girl at the age of 10 was made to witness her mother's rape and murder, and was herself forced to serve for two years as a concubine for rebel soldiers. After finally managing to escape, she went for treatment at the provincial hospital. A nurse realized there was something particularly wrong with the girl. In addition to having contracted a sexually transmitted infection, she was very withdrawn and sad. Encouraged by the nurse's soft and caring treatment, the girl told her story. She repeated it later to a social worker and was moved to a foster home, where she developed a close relationship with her foster mother. At the girl's wish, a traditional cleansing ceremony was held to rid her of all the bad things that had befallen her.

Children who have been continually exposed to violence almost always experience a significant change in their beliefs and attitudes, including a fundamental loss of trust in others. This is especially true of children who have been attacked or abused by people previously considered neighbours or friends, as happened in Rwanda and the former Yugoslavia. Rebuilding the ability to trust is a universal challenge in the wake of conflicts, but it is particularly important for those who are a part of children's daily lives.

A number of activities have been identified as supporting healing by fostering in children a sense of purpose, self-esteem and identity. These include establishing daily routines such as going to school, preparing food, washing clothes and working in the fields; providing children with the intellectual and emotional stimulation through structured group activities such as play, sports, drawing, drama and story-telling; and providing the opportunity for expression, attachment and trust that comes from a stable, caring and nurturing relationship with adults.

Through training and raising awareness of central caregivers, including parents, teachers and community health workers, a diversity of programmes can enhance the community's ability to provide for children and vulnerable groups. Rather than focusing on a child's emotional wounds, programmes should aim to support healing processes and re-establish a sense of normalcy.

Empowering families and communities in the healing process

The family is essential to children's care and protection and is an important social, economic and cultural factor in child development. But often, families are worn down by conflicts, both physically and emotionally, and face increased impoverishment.

The most effective and sustainable approach to recovery is to mobilize the existing social care system. This could involve mobilizing a refugee community to support suitable foster families or extended family systems for the care of unaccompanied children. Another alternative is to provide care through peer-group living arrangements that are strongly integrated into communities. Institutional approaches can contribute to isolation and stigmatization and have proven ineffective.

Some recommendations for action

o All phases of emergency and reconstruction assistance programmes should take psychosocial considerations into account, while avoiding the development of separate mental health programmes. They should also give priority to preventing further traumatic experiences.

o Rather than focusing on a child's emotional wounds, programmes should aim to support healing processes and re-establish a sense of normalcy.

o Programmes to support psychosocial well-being should include local culture, perceptions of child development, and an understanding of political and social realities and children's rights. They should mobilize the community care network around children.

o Governments, donors and relief organizations should prevent the institutionalization of children. When groups of children considered vulnerable, such as child soldiers, are singled out for special attention, it should be done with the full cooperation of the community so as to ensure their long-term reintegration.


Education has a crucial preventive and rehabilitative part to play in fulfilling the needs and rights of children in conflict and post-conflict situations. Education also serves much broader functions. It gives shape and structure to children's lives and can instil community values, promote justice and respect for human rights and enhance peace, stability and interdependence.

Unfortunately, not even schools are safe from attack during times of armed conflict. In rural areas the school building may be the only substantial permanent structure, making it highly susceptible to shelling, closure or looting. Often, local teachers are prime targets because they are important community members or because they may hold strong political views. The destruction of education networks represents one of the greatest developmental setbacks for countries affected by armed conflict. Lost education and vocational skills take years to replace, making the overall task of postwar recovery even more difficult.

If countries continue to employ four times as many soldiers as teachers, education and social systems will remain fragile and inadequate, and Governments will continue to fail children and break the promises made to them through ratification of the Convention on the Rights of the Child. Impact of Armed Conflict on Children, United Nations, 1996.

During armed conflicts, fear and disruption make it difficult to create an atmosphere conducive to learning, and the morale of both teachers and pupils is likely to be low. As conflicts drag on for months or even years, economic and social conditions suffer and educational opportunities become more limited or even cease to exist altogether. Sometimes, even when educational opportunities exist in war-torn areas, parents may be reluctant to send their children to school. They may be afraid that the children will not be safe while they are on their way to and from school, or during classes. Mothers and fathers may need their children to work in the fields, in shops or at home caring for the youngest children.

Educational activity must be established as a priority component of all humanitarian assistance. When children have been forced to leave their homes and are crowded into displaced persons camps, establishing schooling systems as soon as possible reassures everyone by signaling a degree of stability and a return to normal roles and relationships within the family and community. Refugee children can sometimes attend regular schools in host countries, as provided for in international law, though very few get the opportunity to do so. Some host Governments refuse to provide -- or to allow international agencies to provide -- educational activity for refugee children. The efforts of United Nations agencies and other organizations to meet the educational service needs of children affected by conflict require significantly increased support.

Creative ways to maintain education

Even in situations of armed conflict, it is important to carry on educating children and young people, no matter how difficult the circumstances. Education promotes their psychosocial and physical well-being. Teachers can recognize signs of stress in children as well as impart vital survival information on issues such as personal safety and health or the dangers of landmines. They can also promote tolerance and respect for human rights. Since schools are likely to be targets for military attack, alternative sites for classrooms can be established, as was done in Eritrea in the late 1980s when classes were often held under trees, in caves or in camouflaged huts built from sticks and foliage. Similar arrangements were made during the height of the fighting in many places in the former Yugoslavia, where classes were held in the cellars of people's homes, often by candlelight.

One important innovation in educating children in emergency situations has been the development by the United Nations Educational, Scientific and Cultural Organization (UNESCO) and UNICEF of a Teacher's Emergency Pack (TEP), otherwise known as "school-in-a-box". The pack contains basic materials: brushes and paints, chalk, paper, pens, pencils and exercise books. It was first used in Somalia in 1992 and further refined in the refugee camps in Djibouti. The packs were widely used for Rwandan refugees at Ngara in Tanzania, where children attended primary schools in tents on a shift basis.

Education can also incorporate flexible systems of "distance learning": home or group study using pre-packaged teaching materials complemented by broadcast and recorded media. Such systems are especially valuable for girls when parents are reluctant to have them travel far from home. Education can also be strengthened through a variety of community channels. In Sierra Leone, non-traditional teachers, including mothers and adolescents, were trained and deployed. When public sector agencies are absent or severely weakened, community groups and non-governmental organizations (NGOs) can support local educational administrators in their efforts to keep children in schools. For example, a group of Sri Lankan children who had lost one or both parents in the civil war were refused entry to primary school because they had no birth certificates and no money to pay the high fee demanded to issue a new one. An international NGO working in the country brought the situation to the notice of the National Child Rights Coalition, which took it up with the education authorities. The children received their birth certificates and were able to attend school.

Educating for peace

All sectors of society must come together to build "ethical frameworks", integrating traditional values of cooperation through religious and community leaders with international legal standards, such as the United Nations Convention on the Rights of the Child. Some of the groundwork for this can be laid in schools. Both the content and the process of education should promote peace, social justice, respect for human rights and the acceptance of responsibility. Children need to learn the skills of negotiation, problem solving, critical thinking and communication that will enable them to resolve conflicts without resorting to violence. To achieve these goals, a number of countries have already undertaken peace education programmes. In Lebanon, the Education for Peace Programme, jointly undertaken in 1989 by the Lebanese Government, NGOs, youth volunteers and UNICEF, now benefits thousands of children. The Student Palaver Conflict Management Programme in Liberia employs adolescents as resources in peer conflict resolution and mediation activities in schools.

In Sri Lanka, an Education for Conflict Resolution Programme has been integrated into primary and secondary school education. An innovative element is the programme's use of various public media to reach out-of-school children and other sectors of the community. While such initiatives are not always successful, they are indispensable to the eventual rehabilitation of a shattered society.

Some recommendations for action

o All possible efforts should be made to maintain education systems during conflicts. The international community must insist that Government or non-State entities involved in conflicts not target educational facilities, and indeed promote active protection of such services.

o Preparation should also be made for sustaining education outside of formal school buildings, using community facilities and strengthening alternative education through a variety of community channels.

o Donors should extend the boundaries of emergency funding to include support for education. The establishment of educational activity, including the provision of teaching aids and basic education materials, should be accepted as a priority component of humanitarian assistance.

o As soon as camps are established for refugees or internally displaced persons, children and youth should be brought together for educational activities. Incentives for attendance should also be encouraged through, for example, measures to promote safety and security.

o Support for the re-establishment and continuity of education must be a priority strategy for donors and NGOs in conflict and post-conflict situations. Teachers should be trained to understand the ways in which conflict affects children as well as to impart vital survival information on issues such as landmines, health and promoting respect for human rights.