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Why Children Are the Hardest Hit in Conflicts


In the past weeks, Eastern Aleppo has been struck by the heaviest bombardment since the Syrian conflict began. For the first time, there are no hospitals in Syria operating at full capacity. As artillery shells rained over those taking refuge in the ruins, leaflets scattered by planes warned: “If you don’t leave these areas quickly you will be annihilated.” For the international community, the following words are damning: “You know that everyone has left you alone to face your doom and have offered you no help.” 

However, it is not the case that the suffering of the Syrian people and conflicts around the world exist in a vacuum; as health workers, humanitarian workers and journalists will attest. 

Humanitarian groups have been vocal about the obstacles they face in accessing communities in high-risk populations with life-saving food, medical supplies and vaccines. They are routinely denied access to suffering populations and are targeted in indiscriminate bombings against civilians — exposing a form of warfare that not only denies special protection to noncombatants, but strategically targets them as a means to an end. 

Children make up a disturbing proportion of casualties and injuries in conflicts. Humanitarian organizations in Eastern Aleppo report that approximately half of the casualties they are pulling from the rubble or treating in hospitals are children. Half of the nearly five million refugees who have fled Syria into neighboring countries are children, while nearly eight million more remain. 

Details of the ongoing conflict in Syria are shocking, but they are by no means unique. Children have always been the biggest victims of war.

And the harms of conflicts go beyond bloodshed. Disrupted food supplies hit children the hardest, stunting growth and hindering brain development. When water supplies are contaminated, it is children who are most susceptible to highly infectious and deadly diseases like diarrhea and pneumonia. Together, these two diseases are still the leading causes of death in children under the age of five. 

In April, UNICEF reported that nearly two-thirds of children who have not been immunized with basic vaccines live in conflict-affected countries. Vaccine-preventable diseases like measles and rubella are major causes of child mortality in humanitarian emergencies. For millions living in refugee camps, close quarters, reduced immunization rates, lack of access to sanitation, and severe malnutrition are breeding grounds for infectious disease and feed into an intractable cycle of poverty. 

These concerns have been raised by the public health community seeking to address the immediate dangers facing children in emergencies. 

In response to more than 94 attacks on 63 MSF-supported hospitals and clinics in 2015, Doctors without Borders was prompted to launch the #NotATarget campaign declaring health facilities and civilians off-limits. On October 3, 2015, the US military destroyed an MSF hospital in Afghanistan, killing 42 people – “the highest number of staff and patients killed in a single incident in the history of the organization’s humanitarian work.” 

Doctors without Borders reported that three floors of Aleppo’s only dedicated children’s hospital has been destroyed in the most recent wave of bombing, while others are attempting to function without electric generators and basic supplies.

In conflicts, attacks on health workers, medical supplies, and health facilities are powerful reminders of the collateral damage of war. Prior to the war, Syria was making gains in life expectancy and seeing promising shifts in disease patterns from communicable to noncommunicable disease. Now the country’s public health system is collapsing under extreme pressure from shortages of food, medical supplies, and clean water. 

The impact of conflict on public health is apparent elsewhere. In August, two children were paralyzed by the polio virus in Nigeria’s northern Borno state, where Islamic militant group Boko Haram had cut off access to government health care workers and international relief groups. 

The new cases — a major setback in the global effort to eliminate polio — came a year after the country was declared “polio-free” by the World Health Organization and two years since the last confirmed case in Africa. The WHO responded to the reports, warning of the need to prioritize immunization of children in hard-to-reach areas such as the Lake Chad region, which spans several countries and is often affected by conflict and large population movements. 

Now, Nigeria is conducting massive polio immunization campaigns across accessible parts of the state, while health care facilities, schools, and, in particular, children continue to be targeted in violent attacks carried out by militant groups.

In conflicts around the world, health emergencies chip away at systems already struggling to cope with the devastating impact of war. The reemergence of polio and outbreaks of measles aggravates conflict on the ground and the lasting impact on children. As unwilling participants in wars waged by adults, they have experienced too much on the frontlines of wars waged against their understanding of normalcy and security. 

In 1990, the UN adopted principles for protecting children around the world, in times of peace and conflict. They’re simple in intention, but have so far eluded the world. Now is not the time to abandon their urgent call to action.