Injury and Disease
Children die in war from the direct effects of gunfire and explosive devices, but they also die from their vulnerability to unexploded ordnance and landmines, often long after conflicts have ended.
Adolescents, especially boys (presumably because of their greater spatial freedoms) are most vulnerable to injury by landmines. Shabila et al. (2010) found that around one third of landmine injuries in Iraq were of under- 18s and two thirds over-18s with a high proportion of 7-12-year olds having to be treated with upper limb amputations, compared to other groups. This suggests that children are handling landmines although no studies have established why children might play with or pick up landmines. Other studies have found a higher incidence in children (Bilukha et al. 2003).Direct attacks, for example, on hospitals and indirect impacts, for example, of sanctions disproportionately affect children. Guerrero-Serdan (2009) found that following the 2003 Gulf War children in areas of the most violence had stunted growth because of their lack of access to nutritional foods. A study of 16,076 Iraqi children between 1985 and 1991 to investigate the impact of the USA-led invasion of Iraq and sanctions against Iraq found that child mortality in Iraqi children under 5 years of age had increased threefold. The authors “estimate that an excess of more than 46,900 children died between January and August 1991” (Ascherio and Chase 1992). A Harvard study team doing a rapid assessment of the impacts of war and sanctions on under fives in Iraq in April and May 1991 found that the war had directly led to increases in waterborne diseases, including cholera, typhoid, and severe gastroenteritis. Young children are particularly vulnerable to the effects of increases in diarrheal diseases, malnutrition, respiratory infections, and other infectious diseases. These are the same diseases that would affect children preconflict but during war there are significant increases in child mortality from these diseases.
Once humanitarian relief is in place, under-five mortality relative to over five mortality decreases during conflict. This may be because humanitarian aid targets young children (Guha Sapir and van Panhuis 2004). Attacks on hospitals also make parents reluctant to take their children to hospital for treatment leading to increases in death from disease and injury.In addition to injury caused by accidental damage from landmines and unexploded ordnance, children are directly disproportionately affected by the state’s failure to protect civilians. Child civilian deaths as a result of the Iraq War in the period 2003-2008 identified 2146 children killed with the major causes of death being small-arms gunfire, suicide bombs, aerial bombing, and mortar fire (Hicks et al. 2009). In Iraq in 2013, three children were killed every two days in attacks, shelling, and cross-fire (War Child 2014). The continuing deterioration of security in Iraq since 2014 has led to the deaths of at least 14,947 civilians and 29,189 wounded. These figures are not disaggregated by age but are indicative of a rapidly deteriorating security situation (UN Security Council 2015). The UN report on Iraq in 2014 identified 1831 injuries of children and 1256 child deaths in the period from January 2014 to April 2015. Death and injury to children in 2011-2013 were mostly the result of attacks (improvised explosive devices and indirect fire) from armed (nonstate) groups. In 2014 and 2015, documented child casualties (injuries and deaths) increased further as the government and international forces “initiated and intensified” counter-ISIL operations leading to the indiscriminate killing of civilians, including children, in clear defiance of “the principles of international humanitarian law that call for the exercise of distinction, precaution and proportionality” (UN Security Council 2015). In the conflict in Syria, civilian deaths have been very large. 113,735 recorded civilian and combatant deaths were recorded by the end of August 2013 and of these 11,420 were children aged 17 years or younger.
Save the Children says that 15% of civilian casualties (injury and death) worldwide are children. Most of the children (71% of the 10,586 for whom a cause of death was recorded) killed in Syria were killed by explosive weapons. A further 26.5% of recorded deaths were caused by small-arms fire (Dardagan and Salama 2013).Children’s bodies have specific vulnerabilities to war-related death and injury including narrower airways making them more prone to bronchospasm and obstruction, more compliant chest walls which mean that thoracic injuries can occur without evidence of external injury, their smaller and more pliable ribs and thin abdominal walls give them less abdominal protection than adults, and they have larger organs, proportional to body size, than adults which makes them more prone to injury. They are more vulnerable to spinal injury because of having relatively large heads and immature neck musculature (http://www.acep.org/blastinjury/ pediatrics).
This section has shown that children’s bodies, their “biological immaturity,” makes a critical difference to their experience of war. Recognition of this fact needs to come to the center of our attention when researching war-affected children.
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