After nearly six years of conflict in Syria, the physical scars of war are obvious on countless shattered buildings and bodies. The mental toll of living through 2,190 days of brutal violence, particularly for children who have grown up in its shadow, is harder to fathom. For some there are outward signs -- children who lose the ability to speak, who wet themselves or scream when they hear a loud noise. For others the signs are subtler, including terrors in the night and withdrawal or aggression during the day. But we are seeing a mental health crisis among Syrian children and if we do not act now, it will be very difficult to undo the damage done.
The prevailing framework of children's mental health in conflict focuses almost exclusively on post-traumatic stress disorder (PTSD), despite the reality that for the children of Syria there is no 'post'.
According to a report released this week by Save the Children, at least 3 million Syrian children under the age of six have known nothing but war, and millions more have grown up in fear under the shadow of conflict. Ongoing bombing and shelling, including the threatening sound of warplanes circling overhead day and night, is the main cause of psychological stress and upset in children's daily lives. Half of the children interviewed say they never or rarely feel safe at school and 40 percent say they don't feel safe to play outside, even right outside their own home, while almost all adults say children's behavior has become more fearful and nervous as the war goes on.
The prevailing framework of children's mental health in conflict focuses almost exclusively on post-traumatic stress disorder (PTSD), despite the reality that for the children of Syria there is no 'post'. Instead, we need to better understand what six years of continual 'toxic stress' means for Syrian children. Toxic stress is defined as the "most dangerous form of stress response" that can occur when children experience strong, frequent or prolonged adversity without adequate adult support.
Childhoods last a lifetime and our experiences during our earliest years can have a permanent impact on the architecture of the developing brain. Continuous toxic stress response affects children's mental and physical health, including their cognitive, socioemotional, and physical development. It disrupts the development of the brain and other organs, and increases the risk of stress-related diseases, heart disease, diabetes, immune system problems, substance abuse, depression and other mental health disorders into adulthood.
Experiencing situations of extreme trauma, as so many children in Syria do, and living in a continuous state of toxic stress can also reduce neural connections in areas of the brain dedicated to learning and reasoning, affecting children's abilities to perform academically and beyond.
These impacts are not inevitable and, if children have supportive relationships with caring adults early in their lives and professional support, the damaging and potentially deadly effects of toxic stress can be reversed. However Syria's child mental health crisis comes as traditional and official support structures have collapsed, with parents and marriages cracking under the strain of the war and professionals having fled the country in droves. One in four children interviewed said they rarely or never have a place to turn if they are upset or sad.
Ultimately, children need the main cause of their toxic stress to end -- the relentless violence that continues to rain down on Syria's villages and cities with impunity, and has taken the heaviest toll on children. Despite a recent ceasefire announcement, we are still seeing children in Syria bombed and killed on a daily basis.
While some throw their hands in the air and say that the Syrian conflict is too brutal and too complicated to be tackled, others should see this as a rallying call to take steps to end it.
After six years of relentless war many children have lost critical time for development, and the long-term damage has the potential to become irreversible and permanent. We are now at a tipping point moment where if we don't act fast to end the causes of toxic stress for Syria's children and help them to rebuild their lives, a generation will grow into broken adults.
While some throw their hands in the air and say that the Syrian conflict is too brutal and too complicated to be tackled, others should see this as a rallying call to take steps to end it. After many years working on this crisis, I know that for children inside Syria there is no end to their mental anguish without an end to the war. In Brussels this April, the world's powers will convene for what EU High Representative Federica Mogherini described as potentially "the moment for the international community together to turn the page and start the political transition, the reconciliation process and the reconstruction of Syria".
World powers can and must use this moment to demand an end to the targeting of schools, hospitals and children themselves. They must send a strong message to the parties to the conflict that perpetrators of violations of children's rights will be brought to justice and no longer able to attack and kill civilians with impunity. They should also make a new global commitment to support children's mental health and wellbeing in emergencies, recognising the long-term damage that will be done to a generation of children in Syria without proper support. This includes sufficiently funding mental health and psychosocial programming in humanitarian contexts and ensuring that it becomes a core programmatic intervention in humanitarian emergencies.
There are no 'safe zones' for what remains of childhood inside Syria today, but as we mark the sixth anniversary of the conflict we can take the steps to build a better and safer future for a generation of children.
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