Hope Amid Ruin: Responding to the Mental Health Crisis Among War-Affected Children

The United Nations International Children’s Emergency Fund (UNICEF) reports that an unprecedented number of children are actively affected by war and violence across the globe. Approximately 473 million children are thought to either live in or have been forcibly displaced due to conflict. That’s 1 in every 6 children globally, marking the highest number of affected children since World War II [1]. Between conflicts in Sudan, Haiti, Gaza, the Congo, and more, the world has not been this dangerous for children in eight decades. Modern conflicts tend to persist much longer than those in the past, leading to chronic mental distress for many suffering under the rule of violence. The ensuing refugee crises further compound these tragedies, with children accounting for half of all refugees worldwide [2]. As such, we are only just beginning to understand the long-term consequences on children.

The physical health impacts of violence and civil unrest on children are vast. Direct trauma, inadequate healthcare, malnutrition, and the spread of infectious diseases all contribute to a dire outlook for children in war zones. Preterm births, low birth weights, and stillbirth rates are all higher in this population, underscoring the severity of conditions endured by children in conflict settings [5]. As they are in critical stages of cognitive and neurological development, children are uniquely susceptible to the effects of violence [2]. Studies have found that exposure to civil violence significantly increases the risk of mental health issues and persists for decades [3]. The trauma of watching one’s home reduced to rubble or experiencing the loss of parents is profoundly disturbing, particularly for the young. This distress manifests in insomnia, nightmares, bedwetting, and strained relationships with family members in the short term [4].

The deprivation of basic mental and physical health services exacerbates these issues further. Over time, many children begin to withdraw from family and exhibit aggressive behaviors, often manifesting physically [4]. This cycle of violence perpetuates itself, ensuring a steady stream of combatants who sustain ongoing conflicts.

Early intervention is critical in preventing the long-term sequelae of trauma, including PTSD, anxiety, and depression. A “golden hour” period exists for psychological trauma, much like in emergency medicine, where timely intervention can significantly impact outcomes. In war zones such as Ukraine, practitioners have capitalized on this critical window by implementing mental health first aid as a targeted intervention to help victims recover from psychological trauma [6]. Psychological first aid not only addresses acute stress but has also been shown to improve children's resilience [7]. Such targeted interventions are essential in reducing long-term mental health burdens across the world[8].

Investing in targeted mental health interventions is a necessary and worthwhile effort to mitigate the lasting effects of war on children. Recognizing this, the South-South Medical Alliance is committed to supporting mental health workers in conflict zones, ensuring that children receive the care they need to heal and rebuild their futures.

References

1. United Nations International Children's Emergency Fund (UNICEF). Not a New Normal: 2024 One of the Worst Years in UNICEF’s History for Children in Conflict. Published December 28, 2024. Accessed March 4, 2025. https://www.unicef.org/press-releases/not-new-normal-2024-one-worst-years-unicefs-history-children-conflict

2. Hazer, L., Gredebäck, G. The effects of war, displacement, and trauma on child development. Humanit Soc Sci Commun 10, 909 (2023). https://doi.org/10.1057/s41599-023-02438-8

3. Axinn WG, Bruffaerts R, Kessler TL, et al. Findings From the World Mental Health Surveys of Civil Violence Exposure and Its Association With Subsequent Onset and Persistence of Mental Disorders. JAMA Netw Open. 2023;6(6):e2318919. doi:10.1001/jamanetworkopen.2023.18919

4. Save the Children. 6 Ways Conflict Impacts Children’s Mental Health. Published 2024. Accessed March 4, 2025. https://www.savethechildren.org/us/what-we-do/protection/mental-health/ways-conflict-impacts-childrens-mental-health

5. Bürgin D, Anagnostopoulos D; Board and Policy Division of ESCAP; Vitiello B, Sukale T, Schmid M, Fegert JM. Impact of war and forced displacement on children's mental health-multilevel, needs-oriented, and trauma-informed approaches. Eur Child Adolesc Psychiatry. 2022 Jun;31(6):845-853. doi: 10.1007/s00787-022-01974-z. PMID: 35286450; PMCID: PMC9209349.

6. Mann B. Ukraine and Gaza: The Hidden Effects of War Trauma on Children. BBC Future. Published February 20, 2024. Accessed March 4, 2025. https://www.bbc.com/future/article/20240220-ukraine-and-gaza-the-hidden-effects-of-war-trauma-on-children

7. Bürgin, D., Anagnostopoulos, D., the Board and Policy Division of ESCAP. et al. Impact of war and forced displacement on children’s mental health—multilevel, needs-oriented, and trauma-informed approaches. Eur Child Adolesc Psychiatry 31, 845–853 (2022). https://doi.org/10.1007/s00787-022-01974-z

8. Betancourt, Theresa S. ScD, MA; Meyers-Ohki, Sarah E. BA; Charrow, Alexandra P. BA; Tol, Wietse A. PhD. Interventions for Children Affected by War: An Ecological Perspective on Psychosocial Support and Mental Health Care. Harvard Review of Psychiatry 21(2):p 70-91, March/April 2013. | DOI: 10.1097/HRP.0b013e318283bf8f