The boy who blew himself in Dera Ismail Khan last Muharram was hardly 17 years old. Still a child, legally speaking, dying a violent death, martyr to some, and terrorist to others. He may be one of many among thousands already dead either due to suicide bombing or victims of armed conflicts between various groups.

In the recent few years there has been a rise in the number of child casualties in various conflicts taking place in different parts of the world. From Waziristan to West bank and from Jerusalem to Algiers the world is in grip of terrorism and armed conflicts. Some are regional and others are global in nature.

Unlike the last century, this century has not seen a world war so far, however the nature of violence has greatly transformed. It is now the civilian population rather then the professional soldiers who are the major victims of these conflicts. Whether it is the aerial bombing of a village in Iraq or suicide bombing of a school bus in Israel or child soldiers recruited, trained and sent to the trenches by “Jihadi” groups – it essentially means that the most vulnerable population is the worst hit i.e. children of the world.

A recent report says that more than 500,000 children under 18 have been recruited into state and non state armed groups in over 85 countries worldwide and at a given time 300,000 of these are actively fighting as soldiers against civil governments, armed force or armed opposition groups (www.child-soldiers.org). These are scary figures and highlight a menace which may threaten the very existence of human race, disrupt society totally and dislodge children from safety of innocence and put them on a path of extermination.

UNICEF reports that hardly any of these young people are actual “volunteers” most are either abducted or coerced into becoming volunteers. Many of them come from poor, marginalized, illiterate communities and they find recruitment to a militant group as more attractive then the dismal options they have. Once they are caught in this web there is no escape, they either become suicide bombers, child soldiers or victim of a bullet coming from another child on the other side of the divide. A sixteen years old girl who escaped or was rescued from the shackles of a militia called “Lord’s Resistance Army”, a Christian militia in North Uganda, narrated an incident in which another boy who tried to escape was killed by his young comrades with sticks at the order of their commander. He pointed a gun at them while they performed their duty. This boy was perhaps 12 at that time.

Children are often abused in such circumstances in many different ways. Some of these recruits who are too young or physically week to fight are subjected to harsh labor, sexual exploitation and sometime spying for the group.

During armed attacks on populations and other terrorist activities, there is utter chaos and adults often loose sight of their children. Sometimes they are so terrified that are not able to protect them. Kids are then rendered extremely vulnerable to injury, extreme fear and become victims of hostile adults trying to quench their blood thirst. Often these children would be abducted and then exploited in many different ways. Those who survive, realize that they have lost their parents and other relatives and may have to depend on others for caring and sustenance. One Palestinian study showed that the west bank children who are victims of exposure to trauma and violence by Israel army and civilian settlers showed a greatly increased incidence of depression.

Another horrifying trend is the over identification with warring groups and emulating their activities as part of the street play. A recent news report form Baghdad describes kids on the street playing “Shiite Militia versus Sunni terrorists” game, where they pretend to kill each other with toy guns. This is not a normal behaviour. It indicates that they have become desensitized to violence, dehumanized the perceived enemy and has a much distorted style of coping with stress of exposure to violence. The same report tells us that at toy stores in Baghdad 95% of the toys sold are guns! These children hardly take any interest in studies because “…..they think they may end up displaced or killed so why should they bother to study.”

There are different ways in which violence against children manifests itself as have been mentioned above. In all scenarios physical injury may be the immediate consequence but there are multiple long term implications and most of them are in the area of mental health. Those who survive intense, long term exposure to trauma and who later live in chaotic situations such as camps or make shift settlements are most vulnerable for psychopathology (mental illness). Irritability, sleep problems, restlessness, bed wetting, sadness and concentration problems have been reported as immediate consequences. Some children become disruptive at school or home thus becoming subject to harsh discipline by insensitive or good intentioned but naïve adults.

Adolescents have been found to be more vulnerable then children. In the long term such children grow up to be maladjusted, mistrustful adults who have disturbed attachment and loss of empathy to others. Poor self esteem and hopelessness may skew their personality they may never develop a positive sense of self. Anger, violence, disinhibition can lead to a life filled with violence and crime. Drug and alcohol usage is no surprise while poor concentration may result in underachievement. More severe cases may result in PTSD. (Post Traumatic Stress Disorder). Depression, Anxiety, Panic disorder all have been described in such children.

Fortunately most children if given a chance to survive in a safe, non threatening environment will grow up normally. This results mainly from resilience which is a tremendous gift of nature. Many factors affect resilience which include temperament, physical health, psychosocial quality of their homes, and family’s relatedness to the community.

Lastly community’s response to these children and protective services available make a remarkable difference. Parenting style also has a deep impact. Authoritarian, distant emotional response, decreased supervision may predict a worst outcome. All this might be very discouraging and we may not have control over global conflicts, however we can modify a bleaker out come by some preventive and interventive measures. Restoring a safe, structured care environment should be our first priority. Limiting exposure to media that highlights global violence may be necessary. Play and art therapy have known to work and so has counseling and letting them bereave and go through sense of grief with help. Training teachers and other surviving adults to recognize signs of stress as well as providing psychological help to those adults, particularly mothers, so then they can maintain a calm and peaceful environment around these children. Children would also need academic help and restoring self esteem by getting engaged in positive, meaningful co-curricular activities and playing developmentally appropriate roles in the community.

Above recommendations are part of a position statement by an international group of psychiatrist who are working towards helping child victims of war and disaster.

In conclusion, using words from Carol Bellamy, executive director of UNICEF, “Children are not expendable, they belong in schools and in their families. It is our responsibility to ensure that they are protected from the horrors of warfare.”