War is a Public Health Emergency

War has both immediate and long-term public health consequences: people can be killed or injured from violence itself, or can develop health problems stemming from the traumatic experience of war and the scarcity of access to adequate health care. War can affect people at any life stage—from infancy and early childhood to adulthood—for long periods of time, but children are probably most profoundly affected by war, given the utmost importance of the early years in a child's life. First, a child exposed to war is at increased risk of death in infancy or orphanhood.1Wagner Z Heft-Neal S Bhutta ZA Black RE Burke M Bendavid E Armed conflict and child mortality in Africa: a geospatial analysis.Lancet. 2018; 392: 857-865Summary Full Text Full Text PDF PubMed Scopus (70) Google Scholar, 2Wagner Z Heft-Neal S Wise PH et al.Women and children living in areas of armed conflict in Africa: a geospatial analysis of mortality and orphanhood.Lancet Glob Health. 2019; 7: e1622-e1631Summary Full Text Full Text PDF PubMed Scopus (31) Google Scholar Second, children exposed to the toxic stresses of war could develop numerous mental health issues, including post-traumatic stress disorder, depression, anxiety, behavioural problems, and suicidal behaviour,3Samara M Hammuda S Vostanis P El-Khodary B Al-Dewik N Children's prolonged exposure to the toxic stress of war trauma in the Middle East.BMJ. 2020; 371m3155Google Scholar which are often difficult to address due to the scarce availability of mental health resources in war zones. Finally, although current evidence on the long-term effects of war itself on children is still fragmentary, research suggests that children exposed to war could be robbed of the right to early childhood education and healthy early childhood development.4Goto R Frodl T Skokauskas N Armed conflict and early childhood development in 12 low- and middle-income countries.Pediatrics. 2021; 148e2021050332Crossref PubMed Scopus (5) Google Scholar Given the strong evidence that healthy early childhood development and quality early childhood education can affect several outcomes later in life, from mental and physical health in adulthood5Campbell F Conti G Heckman JJ et al.Early childhood investments substantially boost adult health.Science. 2014; 343: 1478-1485Crossref PubMed Scopus (551) Google Scholar to educational attainment and income,6Gertler P Heckman J Pinto R et al.Labor market returns to an early childhood stimulation intervention in Jamaica.Science. 2014; 344: 998-1001Crossref PubMed Scopus (269) Google Scholar war can cripple societies for years to come by hampering healthy development through severed early childhood education programmes and exposure to toxic stress. Russia's invasion of Ukraine once again sheds light on the adverse effects of war and is an important reminder that previous and ongoing wars all over the world have damaged, and will continue to damage, the lives of children. At stake is not only the lives of adults involved in war, but the lives of children and the next generation too. The effects of war on children are devastating and long-lasting, and it is no overstatement that war is a public health emergency that spans numerous years. On behalf of all children exposed to war and the International Society for Adolescent Psychiatry and Psychology, International Association for Child and Adolescent Psychiatry and Allied Professions, World Association for Infant Mental Health, and Child and Adolescent Psychiatry Section of the World Psychiatric Association, we demand that all fighting cease immediately and that all avenues for just and peaceful resolution of conflict be assertively pursued. We declare no competing interests. Armed conflict and child mortality in Africa: a geospatial analysisArmed conflict substantially and persistently increases infant mortality in Africa, with effect sizes on a scale with malnutrition and several times greater than existing estimates of the mortality burden of conflict. The toll of conflict on children, who are presumably not combatants, underscores the indirect toll of conflict on civilian populations, and the importance of developing interventions to address child health in areas of conflict. Full-Text PDF