IMPACT OF ARMED CONFLICT ON CHILDREN, PART 5

1. Sanctions
2. The present report focuses on armed conflict, but a closely-related issue that also has a serious impact on children is the imposition of economic sanctions. In recent years, economic sanctions have been seen as a cheaper, non-violent alternative to warfare. In his follow-up report to “An Agenda for Peace” (A/50/60), the Secretary-General of the United Nations recognized that sanctions raise the ethical question of whether suffering inflicted on vulnerable groups in the target country is a legitimate means of exerting pressure on political leaders. Since 1991, under Article 41, Chapter VII of the Charter of the United Nations, the international community has collectively imposed sanctions on Iraq, the Federal Republic of Yugoslavia (Serbia and Montenegro), the Libyan Arab Jamahiriya and Haiti. In addition, countries can and have employed bilateral sanctions. In the post-cold war era, it seems likely that sanctions will play an increasingly important part in international policy. Governments are reluctant to commit troops and funds to international military intervention and see sanctions as a safer recourse that can be applied at lower cost to the embargoing power. While not necessarily the case, sanctions also appear less deadly than military action for the population of the target country.
3. Humanitarian exemptions
4. In theory, most sanctions regimes exempt critical humanitarian supplies from general embargoes. In practice, sanctions have so far proved blunt instruments. Humanitarian exemptions tend to be ambiguous and are interpreted arbitrarily and inconsistently. They often cause resource shortages; disrupt the distribution of food, pharmaceuticals and sanitation supplies; and reduce the capacity of the public health system to maintain the quality of food, water, air, and medicine. Delays, confusion and the denial of requests to import essential humanitarian goods cause resource shortages. While these effects might seem to be spread evenly across the target populations, they inevitably fall most heavily on the poor. Those with power and influence will usually have ways of acquiring what they need, while the general population struggles to survive with what remains. While adults can endure long periods of hardship and privation, children have much less resistance, and they are less likely to survive persistent shortages. Studies from Cuba, Haiti and Iraq following the imposition of sanctions each showed a rapid rise in the proportion of children who were malnourished. In Haiti after 1991, for example, one study indicated that the price of staple foods increased fivefold and the proportion of malnourished children increased from 5 to 23 per cent. 30/
5. Even when exemptions are permitted, the conditions applied may be unacceptable to the Government in power. Indeed, those Governments and authorities against which sanctions are imposed are rarely personally affected and may be precisely those less responsive to the plight of their people.

Iraq since 1990 has experienced the most comprehensive regime ever imposed.

In order to mitigate some of the effects on health and nutrition, the Security Council adopted resolution 706   (1991) to permit the use of frozen Iraqi funds to purchase food and medicine, stipulating that these supplies had to be purchased and distributed under the supervision of the United Nations. The Iraqi Government considered these conditions unacceptable and only started to discuss them in 1995. Meanwhile, the situation for children has deteriorated.

Over the past five years, infant mortality is thought to have tripled.

The “oil-for-food” procedures contained in Security Council resolution 986     (1995) present an opportunity to mitigate the negative impact of sanctions on Iraqi children. To take full advantage of this opportunity, however, all currency generated through oil sales should be dedicated to humanitarian and civilian purposes.

108. In the interests of children, the international community should cease to impose comprehensive economic sanctions without obligatory and enforceable humanitarian exemptions and agreed mechanisms for monitoring the impact of sanctions on children and other vulnerable groups. Any measures taken should be precisely targeted at the vulnerabilities of the political or military leaders whose behaviour the international community wishes to change. These actions could include an arms embargo, the freezing of all corporate and individual overseas assets, the stopping of certain kinds of economic transactions, the suspension of air links and other forms of communication and the isolation of countries from the rest of the world through cultural, academic and economic boycotts.
109. The need for child impact assessments and monitoring
110. Sanctions should be judged against the standards of universal human rights, particularly the Convention on the Rights of the Child. The primary consideration must always be the potential human impact, which should influence the imposition and choice of sanctions, the duration, the legal provisions and the operation of the sanctions regime. Sanctions should not be imposed without advance assessment of the economic and social structure of the target country and the ability of the international community to sustain continuous monitoring.
111. Monitoring systems make it possible to assess the impact of the embargo on health and well-being. At minimum, such assessments should measure changes in access to essential medicines and medical supplies (especially items that may serve both civilian and military purposes such as chlorine for water purification or lab reagents for health screening and testing), water quality and quantity, the nutritional state of children and the infant mortality rate.
112. When targeted sanctions are imposed, humanitarian exemptions should be formulated with clear guidelines. At the same time, in order to help vulnerable groups, the established agencies should formulate appropriate humanitarian assistance programmes. If essential humanitarian goods are denied to the population, the sanctioning powers have a responsibility to assure new sources of supply. When the Security Council imposes sanctions, it should also simultaneously provide resources to neutral, independent bodies to monitor the situation of vulnerable groups. In the event that the position of children deteriorates, the United Nations should assume responsibility for redressing the situation.
113. Since many of the effects of sanctions, particularly the health impact, may only become evident over a period of years, no sanctions regime should be allowed to continue indefinitely. When the Security Council imposes sanctions, it should also clearly define the circumstances under which they should be lifted. If the sanctions fail to produce the desired result within a predetermined period, they should be replaced by other measures.
114. Specific recommendations on sanctions
115. The expert submits the following recommendations on sanctions:

• The international community should ensure that whenever sanctions are imposed they provide for humanitarian, child-focused exemptions. The international community should establish effective monitoring mechanisms and child impact assessments. These must be developed with clear application guidelines;
• Humanitarian assistance programmes of the United Nations specialized agencies and of NGOs should be exempt from approval by the Security Council Sanctions Committee;
• A primary concern when planning a targeted sanctions regime should be to minimize its impact on vulnerable groups, and particularly children. Sanctions or other measures taken by the Security Council should be precisely targeted at the vulnerabilities of those whose behaviour the international community wishes to change;
• The Security Council Sanctions Committee should closely monitor the humanitarian impact of sanctions and amend sanctions immediately if they are shown to cause undue suffering to children.

1. Health and nutrition
2. The effects of armed conflict on child development accumulate and interact with each other. The stage of physical, psychosocial, cognitive and moral development that a child has reached directly affects his or her ability to cope with these impacts. Consistent with article 39 of the Convention on the Rights of the Child, obliging States Parties to promote the physical and psychological recovery and social reintegration of children affected by armed conflict, the following three subsections of the report are devoted to health and nutrition, psychosocial well-being and education.
3. Thousands of children are killed every year as a direct result of fighting, from knife wounds, bullets, bombs and landmines, but many more die from malnutrition and disease caused or increased by armed conflicts. The interruption of food supplies, the destruction of food crops and agricultural infrastructures, the disintegration of families and communities, the displacement of populations, the destruction of health services and programmes and of water and sanitation systems all take a heavy toll on children. Many die as a direct result of diminished food intake that causes acute and severe malnutrition, while others, compromised by malnutrition, become unable to resist common childhood diseases and infections.
4. Given their vulnerability, it is no surprise that around 2 million children are estimated to have died as a result of armed conflict in the last decade. 32/ In Mozambique alone, between 1981 and 1988, armed conflict caused 454,000 child deaths, while in Somalia, according to WHO, crude mortality rates increased 7 to 25 times. Some of the highest death rates occur among children in refugee camps. These statistics are in stark contrast to the intent behind article 6 of the Convention on the Rights of the Child, which asserts that States Parties shall ensure to the maximum extent possible the survival and development of the child. Article 24 states that the child has a right to the highest standard of health and medical care available.
5. Many of today’s armed conflicts take place in some of the world’s poorest countries, where children are already vulnerable to malnutrition and disease, and the onset of armed conflict increases death rates up to 24 times.

All children are at risk when conflicts break out, but the most vulnerable are those who are under five and already malnourished.

1. Communicable diseases
2. Since 1990, the most commonly reported causes of death among refugees and internally displaced persons during the early influx phase have been diarrhoeal diseases, acute respiratory infections, measles and other infectious diseases. Even in peacetime, these are the major killers of children, accounting for some seven million child deaths each year. 33/ Their effects are heightened during conflicts, partly because malnutrition is likely to be more prevalent, thereby increasing chances of infection.
3. Diarrhoea is one of the most common diseases. In Somalia during 1992,

23 to 50 per cent of deaths in Baidoa, Afgoi and Berbera were reported to be due to diarrhoea. Cholera is also a constant threat and, following armed conflicts, it has occurred in refugee camps in Bangladesh, Kenya, Malawi, Nepal, Somalia and Zaire, amongst others. Acute respiratory infections, including pneumonia, are particularly lethal in children and, according to WHO, killing one-third of the children who died in six refugee centres in Goma, Zaire, in 1994. Measles epidemics have been reported in recent situations of conflict or displacement in several African countries – at the height of the conflict in Somalia, more than half the deaths in some places were caused by measles. As tuberculosis re-emerges as a dangerous threat to health the world over, its effect is heightened by armed conflict and disruption. WHO estimates that half the world’s refugees may be infected with tuberculosis, as the crowded conditions in refugee camps often promote the spread of tubercular infection. Malaria has always been a major cause of morbidity and mortality among refugees in tropical areas, particularly among people who come from areas of marginal transmission and who move through or settle in endemic areas. Children, as always, are the most vulnerable to these collective assaults on health and well-being.

142. The potential for greater spread of sexually transmitted diseases, including HIV/AIDS, increases dramatically during conflicts. Population movements, rape, sexual violence and the breakdown of established social values all increase the likelihood of unprotected sexual activity and larger numbers of sexual partners. Reduced access to reproductive health services, including education, increases the vulnerability of adolescents in particular.

The breakdown of health services and blood transfusion services lacking the ability to screen for HIV/AIDS also increase transmission. NGOs and agencies such as FAO and UNICEF have noted a dramatic increase in the incidence of child headed households as one of the consequences of HIV/AIDS in parts of Africa. This trend is likely to increase. It is essential that agencies design clear strategies to assist children in these situations without disrupting family unity.

2. Reproductive health
3. In times of conflict, the provision of primary health care in conjunction with interventions to secure clean water, adequate nutrition, shelter and sanitation, will be the priority health agenda. However, reproductive health is also important for the physical and psychosocial well-being of men and women, and particularly of young girls. The reproductive health of pregnant women and mothers is integrally tied to the health of newborns and children. WHO advocates that reproductive health services based on women’s needs and demands, with full respect for religious and cultural backgrounds, should be available in all situations. The effects of armed conflicts – family and community breakdown, rapid social change, the breakdown of support systems, increased sexual violence and rape, malnutrition, epidemics and inadequate health services, including poor prenatal care – make it imperative that the right to reproductive health care is given high priority. The problems caused by complications in pregnancy and delivery and by unwanted and unsafe sex can be immediate, as is the case with chronic pelvic inflammatory diseases. They can also adversely effect women’s future sexual and reproductive health and that of their children by leading to health conditions such as infertility, paediatric AIDS and congenital syphilis.
4. The insufficient attention paid to reproductive health issues in emergency situations led to the development of the UNHCR/UNFPA Inter-Agency Field Manual on Reproductive Health in Refugee Situations. Reproductive health programmes that involve women and adolescents in their design, implementation and assessment help to build personal capacities, lead to more relevant programmes and can make important contributions to the health and development of young people and women in situations of armed conflict. In South Africa, for example, UNICEF reports that young people have been involved effectively in the design, testing and implementation of youth health situation analyses, and in Ghana, peer educators in health projects for children living or working in the streets, 34/ have improved their programmes by involving young people in assessments.
5. Disability
6. Millions of children are killed by armed conflict, but three times as many are seriously injured or permanently disabled by it. According to WHO, armed conflict and political violence are the leading causes of injury, impairment and physical disability and primarily responsible for the conditions of over 4 million children who currently live with disabilities.

In Afghanistan alone, some 100,000 children have war-related disabilities, many of them caused by landmines. The lack of basic services and the destruction of health facilities during armed conflict mean that children living with disabilities get little support. Only 3 per cent in developing countries receive adequate rehabilitative care, and the provision of prosthetics to children is an area that requires increased attention and financial support. In Angola and Mozambique, less than 20 per cent of children needing them received low-cost prosthetic devices; in Nicaragua and El Salvador, services were also available for only 20 per cent of the children in need. This lack of rehabilitative care is contrary to article 23 of the Convention on the Rights of the Child, which lays out clearly the responsibilities of States Parties for ensuring effective access of disabled children to education, health and rehabilitation services.

4. Destruction of health facilities
5. In most wars, and particularly in internal conflicts, health facilities come under attack, in direct violation of the Geneva Conventions of 1949. During the armed conflict from 1982 to 1987 in Nicaragua, for example, 106 of the country’s 450 health units were eventually put out of service as a result of complete or partial destruction, and a further 37 health posts were closed owing to frequent attacks. The intensity of the war also diverted much of the health service to the needs of immediate casualties. Hospitals maintained low occupancy rates in order to be able to receive the injured at short notice and they were forced either to neglect the regular care of patients or to shift them to health centres. Even health facilities that remain open during a conflict offer very restricted service. In Mozambique, between 1982 and 1990, about 70 per cent of health units were looted or forced to close down and the remainder were difficult to reach because of curfews.

147. A concentration on military needs also means that children injured in a conflict may not get effective treatment or rehabilitation. Effects on general health care can be just as severe. Health services suffer from a shortage of personnel as health workers move to other areas or leave the country. After the Khmer Rouge period, for example, Cambodia was left with only about 30 doctors. Restrictions on travel also hamper the distribution of drugs and other medical supplies, and health referral services, supervision and logistic support break down.
148. For children, one of the most dangerous implications of this breakdown is the disruption of rural vaccination programmes. During Bangladesh’s struggle for independence in 1971-1972, childhood deaths increased 47 per cent. Smallpox, a disease that had virtually disappeared prior to the conflict, claimed 18,000 lives. By 1973, in Uganda, immunization coverage had reached an all-time high of 73 per cent. After the fighting started in that country, coverage declined steadily until, according to WHO sources, by 1990, fewer than 10 per cent of eligible children were being immunized with anti­tuberculosis vaccine (BCG), and fewer than 5 per cent against diphtheria, pertussis and tetanus (DPT), measles and poliomyelitis. The situation has improved dramatically, but the lessons are clear.

5. Protecting health services and health workers
6. In actions at both global and national level, the health sector should continue to promote children’s rights to survival and development while doing all it can to prevent and alleviate their suffering. In the midst of armed conflict, WHO urges that health facilities be respected as safe environments for the care of patients and as safe workplaces for health workers. The delivery of medical assistance should not be prevented or obstructed.

Moreover, the health care system and the community should work together, using health care wherever possible as an opportunity to gain access to children for other positive purposes.

150. During times of war, health services should emphasize the need for continuity of care and long-term follow-up. Emergency health relief must be linked with long-term development support and planning that not only permit survival, but also bring about long-lasting positive changes in children’s lives. Paediatric and gynaecological care must become a regular component of all relief programmes. In the post-conflict phase, health systems must be sustainable, and programmes must be designed with as much involvement as possible from the affected communities. One obstacle to the full enjoyment of health services is that they are often dominated by men, whether expatriate or from the host country. For cultural or religious reasons, many women and girls underutilize the services despite risks to their health. Governments, United Nations bodies and specialized agencies such as WHO, UNHCR and UNICEF should increase the numbers of female health and protection professionals available in emergency situations.
151. Armed conflict is a major public health hazard that cannot be ignored.

Any disease that had caused as much large-scale damage to children would long ago have attracted the urgent attention of public health specialists. When armed conflict kills and maims more children than soldiers, the health sector has a special obligation to speak out. Health professionals must be advocates of the rights of the child.

6. Disruption of food supplies
7. One of the most immediate effects of armed conflict is to disrupt food supplies. Food production is affected in many ways. Farmers, who are often women and older children, become fearful of working on plots of land too far from their homes. They reduce the area under cultivation, and their water sources, systems of irrigation and flood control may also be destroyed. Restrictions on movement limit access to such necessities as seeds and fertilizers and stop farmers from taking their produce to market. Damage to food systems is incidental to conflicts in some cases. In others it is deliberate, as in the early 1980s in Ethiopia, when the Government’s scorched earth policies destroyed hundreds of thousands of acres of food-producing land in Tigray. 35/ Both the quantity and quality of available food is affected by damage done to food systems, and even when the conflict subsides, it is difficult to recover quickly. In many countries, mined fields prevent their use as agricultural land. In the Juba valley in Somalia, where people have been returning to their villages since 1993, the continuing lack of security means that the main harvest in 1995 was as much as 50 per cent lower than before the conflict. 36/
8. Warfare also takes its toll on livestock. In the Kongor area of Sudan, for example, a massacre of both people and cattle reduced livestock from around 1.5 million down to 50,000. This situation creates particular problems for young children who rely on milk as part of their basic diet.

Loss of livestock also undermines family security in general, since cattle are frequently used as a form of savings.

154. Most households in developing countries, including many farm households, rely on market purchases to meet their food needs. Economic disruption heightens unemployment, reducing people’s ability to buy food. People in cities are sometimes tempted to resort to looting to feed their families, thus escalating the violence. The continuation of conflict also hinders the distribution of relief. In contravention of humanitarian law, warring parties frequently block relief supplies or divert them for their own use. In addition, feeding centres for children and vulnerable groups are frequently bombed or attacked.
155. Malnutrition
156. For the youngest children especially, many health problems during armed conflicts are linked to malnutrition. Before the war in former Yugoslavia, per capita food supplies were relatively abundant, representing 140 per cent of daily requirements compared with 98 per cent in Liberia and 81 per cent in Somalia. The situation in Bosnia and Herzegovina subsequently deteriorated, but still did not reach levels as shockingly low as in Somalia during 1993 or Liberia in 1995. At those times, more than 50 per cent of the children in some regions were suffering from moderate or severe malnutrition.
157. Malnutrition can affect all children, but it causes the greatest mortality and morbidity among young children, especially those under the age of three. In emergencies, very young children may be at high risk of “wasting” or acute malnutrition, a condition indicated by low weight for height. During the 1983 famine in southern Sudan, FAO reported that the prevalence of wasting reached the unprecedented level of 65 per cent. Recent refugee crises have shown how rapidly morbidity and mortality can progress.

Malnutrition weakens children’s ability to resist attacks of common childhood diseases, and the course and outcome of these diseases are more severe and more often fatal in malnourished children. Malnutrition also has a negative impact on children’s cognitive development. In addition to these nutritional hazards, the circumstances of armed conflict greatly increase exposure to environmental hazards. Poor waste disposal and inadequate or contaminated water supplies aggravate the vicious circle of malnutrition and infection.

157. Adequate nourishment also depends on the way food is distributed, the way children are fed, their hygiene and the time parents have available to care for children. Armed conflict puts heavy constraints on the care system, forcing mothers and other members of the family to spend more time outside the home searching for water, food or work. Above all, when the whole family has to take flight, it has little chance to give children the close attention they need.
158. Breastfeeding provides ideal nutrition for infants, reduces the incidence and severity of infectious diseases and contributes to women’s health. Infants should be breastfed exclusively for about six months and should continue to be breastfed with adequate complementary food for two years or beyond. During conflicts, mothers may experience hunger, exhaustion and trauma that can make them less able to care for their children. Breastfeeding may be endangered by the mother’s loss of confidence in her ability to produce milk. Unless they are severely malnourished, mothers can breastfeed adequately despite severe stress. In addition, the general disruption can separate mothers from their children for long periods. As the conflicts proceed, social structures and networks break down. Knowledge about breastfeeding is passed from one generation to the next and this can be lost when people flee and families are broken up. Artificial feeding, risky at all times, is even more dangerous in unsettled circumstances.
159. In times of armed conflict, it is important to support women’s capacity to breastfeed by providing adequate dietary intake for lactating women and ensuring that they are not separated from their children. Unfortunately, during emergencies, donors often respond with large quantities of breast milk substitutes for which there has been little medical or social justification.

In July 1996, in response to the increasing prevalence of HIV infection globally and to additional information on the risk of HIV transmission through breastfeeding, the Joint and Co-sponsored United Nations Programme on HIV/AIDS circulated an interim statement on HIV and infant feeding. That statement emphasized the importance of breastfeeding, while highlighting the urgency of developing policies on HIV infection and infant feeding. It provided policy makers with a number of key elements for the formulation of such policies, laying particular stress on empowering women to make informed decisions about infant feeding.

160. Children’s health and growth are also affected by the lack of fresh fruits and vegetables, which are good sources of vitamins and minerals.

Quality of diet is particularly important for small children, who can only eat small quantities of food at one time. Thus, it is essential to ensure that their food has a high concentration of energy and nutrients or is given frequently. When, during a conflict, the nutritional quality of food deteriorates, the family may not have the necessary means or knowledge to make changes that will assure children an adequate diet.

161. Even when the conflict is over, it may take a long time to return to normal feeding. FAO reports that, in Mozambique, for example, some young couples returning to the country from refugee camps did not know how to prepare any foods other than the maize, beans and oil that had been distributed to them as rations. They were not familiar with traditional foods or feeding practices and did not know which local foods to use during weaning. And where parents or grandparents had been lost, there was no one available to teach them.
162. Protecting food security
163. One of the most common responses to emergencies of all kinds, including armed conflicts, is food relief. It is important to move away from the view that food relief is a solution in itself, and towards the more constructive approach that includes food relief as part of a wider strategy aimed at improving household food security and the general health status of the population. This is particularly crucial in many long-running conflicts, where people need to build up their own capacities to support themselves. In southern Sudan, the short-term distribution of food is now being linked with support for agriculture, livestock and fisheries programmes.
164. In many cases, recourse to outside food assistance is unavoidable. In these circumstances the goal should be to meet the food needs of all persons, including young children, by ensuring access to a nutritionally adequate general ration. When this is not feasible, it may be necessary to establish supplementary feeding programmes for vulnerable groups, but these should be regarded as short-term measures to compensate for inadequate general rations. Dry rations that can be used by families in their own homes are preferable to feeding centres, as WHO surveys suggest that less than 50 per cent of malnourished children actually attend the centres. They may be too far away, and mothers may be reluctant to spend a disproportionate amount of time with a malnourished child over other members of the family. During a field visit to Rwanda, the expert was made aware of how many children from the poorest families did not attend feeding centres. UNICEF staff reported that these families often expressed feelings of shame or spoke of discouragement from better-off neighbours. Moreover, many such programmes have been poorly managed. Overcrowded feeding centres lacking basic sanitation and hygiene, with inadequate water supplies and poorly mixed food, do little for malnourished children and actually lead to the spread of disease.
165. In too many situations, children are considered separately from the family, and feeding programmes for children are established without considering other options that would improve their nutritional status. These options include improving household food security and reducing women’s workloads by offering better access to water and fuel. This would clear more time in a woman’s day for caring for her children. The Statements of the First and Third Regional Consultations on Africa and the field trips for this study underlined the importance of family unity and of capacity-building for family and community self-reliance.
166. Specific recommendations on health and nutrition
167. The expert submits the following recommendations on health and nutrition:

• All parties to a conflict must ensure the maintenance of basic health systems and services and water supplies. Where new programmes must be introduced, they should be based on community participation and take into account the need for long-term sustainability. Special attention should be paid to primary health care and the care of children with chronic or acute conditions. Adequate rehabilitative care, such as provision of artificial limbs for injured and permanently disabled children, should be ensured to facilitate the fullest possible social integration;
• Child-focused basic health needs assessments involving local professionals, young people and communities should be speedily carried out by organizations working in conflict situations. They should take into account food, health and care factors and the coping strategies likely to be used by the affected population;
• During conflicts, Governments should support the health and well­being of their population by facilitating “days of tranquillity” or “corridors of peace” to ensure continuity of basic child health measures and delivery of humanitarian relief. United Nations bodies, international NGOs and civil society groups (particularly religious groups) should approach and persuade non-state armed entities to cooperate in such efforts;
• WFP, in collaboration with WHO, UNHCR and other United Nations bodies, specialized agencies and other international organizations, should take a lead role in consolidating current attempts to ensure that emergency food and other relief distribution is structured so as to strengthen family unity, integrity and coping mechanisms. It should be an integral part of a broader strategy for improving the nutrition and health status and physical and mental development of children and the food and health securities of their families;
• Parties in conflict should refrain from destruction of food crops, water sources and agriculture infrastructures in order to cause minimum disruption of food supply and production capacities. Emergency relief should give more attention to the rehabilitation of agriculture, livestock, fisheries and employment or income generating programmes in order to enhance local capacities to improve household food security on a self-reliant and sustainable basis;
• The expert urges WHO, in collaboration with professional, humanitarian and human rights organizations such as the International Paediatric Association, Medecins Sans Frontie’res and Physicians for Human Rights, to encourage doctors, paediatricians and all other health workers to disseminate child rights information and report rights violations encountered in the course of their work.

1. Promoting psychological recovery and social reintegration
2. Armed conflict affects all aspects of child development – physical, mental and emotional – and to be effective, assistance must take each into account. Historically, those concerned with the situation of children during armed conflict have focused primarily on their physical vulnerability. The loss, grief and fear a child has experienced must also be considered. This concern is reflected in article 39 of the Convention of the Rights of the Child, which requires States Parties to take all appropriate measures to promote children’s physical and psychological recovery and social reintegration. This is best achieved by ensuring, from the outset of all assistance programmes that the psychosocial concerns intrinsic to child growth and development are addressed.
3. In a survey of 3,030 children conducted by UNICEF in Rwanda in 1995, nearly 80 per cent of the children had lost immediate family members, and more than one third of these had actually witnessed their murders. These atrocities indicate the extremes to which children have been exposed during conflicts. But apart from direct violence, children are also deeply affected by other distressing experiences. Armed conflict destroys homes, splinters communities and breaks down trust among people, undermining the very foundations of children’s lives. The impact of being let down and betrayed by adults is measureless in that it shatters the child’s world view.