12 World Health • 49th Year, No.6, November-December 1996
Children and armed conflict
Carol Dieddah
During the early stages of displacement, death rates among children under five years of age ore for higher than among older children and adults.
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ince the end of the Second World War more than 21 million people, most of them women and children, have died in armed conflicts. In the past decade alone two rill Ilion children have died as the direct result of war and many times that number have been displaced from their homes. All children are at risk in times of war and deprivation.They are affected both directly- through death, injury and psycholog- ical trauma caused by the conflict itself- and indirectly through dis- placement, reduced nutrition, un- healthy conditions and disrupted health services.
The weapons of war cause death and injury to soldiers and civilians alike. Worldwide, some 10 000 people per year-most of them civilians and children- are killed by land-rllines and thousands more are crippled or blinded. But death and disability as a result of direct injury are only part of the tragic story.
When war drives families from their homes, children are the first to suc- cumb to harsh living conditions.
During the early stages of displace- ment, death rates among children under five years of age are far higher than among older children and adults. The risk of communicable diseases, already the major cause of death among children in peacetime, is greatly increased in wartime due to displacement, malnutrition, and the breakdown of safe water supplies and sanitation systems. Deaths
Emotional scars may last forever. This 1 (}year·
old 9irl refu9ee at Split airport, Croatia, was held for two months in a prison camp where she witnessed atrocities.
proliferate from diarrhoea and dehy- dration as well as from lethal out- breaks of dysentery and cholera.
Acute respiratory infections, measles, typhoid and malaria also exact a very heavy toll -and the most vulnerable victims are children.
Mental health
Children who have witnessed atroci- ties or have been subject to violence and abuse are likely to suffer long- term mental and emotional disorders.
The breakdown of family, cultural and social units exacerbates psycho- logical trauma and throws children
into a world of uncertainty and despair. Schooling is often disrupted with the onset of violence. The breakdown of family and commu- nity controls, as well as separation from homeland and culture, may often lead to risky behaviour such as increased unprotected sexual activ- ity, drug abuse and violence. Child soldiers, deprived of a normal child- hood, stand little chance of assimila- tion into society later in life.
Girls are liable to be subjected to sexual violence, particularly in ethnic conflict; rape of women and girls may be a deliberate policy.
Sexual violence, inequitable food distribution and health services that ignore the special needs of women and girls all reduce their chances of survival. The consequences of war and displacement include unwanted pregnancies, unsafe abortion, aban- doned babies, infanticide and in- creased rates of sexually transrllitted diseases and HIV infection. In addition, blood transfusion services in situations of conflict often lack the ability to check for HIV.
The health of the child is closely related to that of the mother, so damage inflicted on the mother is indirectly inflicted on the child.
Malnutrition starts first in children, and infants are particularly at risk, so continued breast-feeding is vital.
However, many mothers may them- selves be malnourished. In times of armed conflict, crops are destroyed, stocks pillaged and supplies inter- rupted, diverted or embargoed.
Deprived of resources, mothers are less able to give their children the care and protection they need for a healthy life. In many cases, children are separated from their families altogether.
Armed conflict frequently leads to a breakdown of the health care system. Medicines are in short supply, communications are blocked and health personnel may flee the
World Health • 49th Year, No.6, November-December 1996
Psycho-dramas, in which children act out killings they have seen, ore
used to promote readjustment
Education is the right of all children. Young children learn to read their own language at this class in a camp for Vietnamese refugees in Hong Kong.
areas of conflict just as levels of child malnutrition and infection start to rise.
Nevertheless, in some conflicts the presence of children has been recognized as constituting a "zone of peace", and warring parties have agreed to a truce so that essential health services can be delivered to children (see page 14). The United Nations Convention on the Rights of the Child and other international treaties (see box) call for not only the child's protection but also "to the maximum extent possible the sur- vival and development of the child".
Commitment to protect the young must be rigorously applied in situa- tions of armed conflict and civil unrest, and is part of the responsibil- ity of health workers.
In view of the enormous impact of armed conflict on children world- wide, international solidarity and coordination are essential. Health personnel need training in meeting the short-term needs of traumatized children as well as in giving follow- up care. In the longer term, of course, it is only through peace that societies will be healed and children realize a healthier future. All these issues are covered in the United Nations study on the Impact of Armed Conflict on Children issued after the resolution adopted by the General Assembly in November 1996 . •
Dr Cord Djeddah is Medical Officer, Women, Health and Development Unit, World Health Organization, 1211 Geneva 27, Switzerland.
Relevant a r ticles in international treaties to protect children in armed conflict
Rights in the convention to apply to all children without exception; the State to protect children from any form of discrimination or punishment based on family's status, race, colour, sex, language, religion, political or other opinion, national, ethnic or social origin. (CRC Art. 2)
The right to live with parents unless this is deemed incompatible with the child's best interests; the right to maintain contact with both parents; the State to provide information when separation results from State action. (CRC Art. 9)
The right of disabled children to special care and training designed to help achieve self-reliance, and a full and decent life in a society. (CRC Art. 23)
The right to the highest attainable standard of health and access to medical services; the obligations of the State to attempt to diminish infant and child mortality, combat disease and malnutrition, ensure health care for expectant mothers, provide access to health education, develop preventive health care and abolish harmful traditional practices. (CRC Art. 24)
The State to promote the physical and psychological recovery and social reintegration of child victims of abuse, neglect, exploitation, torture or armed conflicts in an environment which fosters the health, self-respect and dignity of
the child. (CRC Art. 39) .
Allow the free passage of medical supplies, food and clothing for children, expectant mothers, maternity cases and nursing mothers. (4GC Art. 23 & 55)
Parties to the conflict shall encourage intellectual, educational and recreational pursuits, sports and games. Special playgrounds shall be reserved for children. (4GC Art. 94)
All non-combatants are protected against: violence to life, health and physical or mental well-being, in particular murder as well as cruel treatment such as torture, mutilation or any form of corporal punishment; collective punishments; taking of hostages; acts of terrorism; outrages upon personal dignity; slavery and the slave trade in all their forms; pillage; threats to commit any of the foregoing acts. (P2 Art. 4 (2))
CRC =The UN Convention on the Rights of the Child
4GC = The Fourth Geneva Convention
P2 = Protocol II additional to the Geneva Conventions
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