Around the world there is strife and violence. In all those global hotspots -- from Syria to Iraq, from Afghanistan to Darfur -- innocent children are among those suffering the most, yet there is often too little attention paid to the physical and emotional trauma they endure.
Syria -- where, prior to 2010 almost all children were enrolled in school and literacy rates exceeded 90 percent -- today has the second-lowest enrollment rate in the world, with almost three million children no longer in class. One in three Syrian children reports having suffered physical violence - some struck or kicked, others shot. More than 7,000 children have died in the conflict and five million more need emergency assistance to address their suffering.
Exposure to continuous violence -- not only via direct assault, but by witnessing acts of brutality against adults and children around them, and being forced to separate from family and friends -- takes an enormous toll on young bodies and minds. Even if children can get to school, acute psychological stress makes it nearly impossible to concentrate and learn. Teachers face huge pressures trying to teach the large numbers of traumatized children with limited resources.
At home, parents can provide little comfort or reassurance; adults have not had a chance to properly mourn their own losses and recover from their own traumatic experiences.
With no secure, safe attachments, dysfunctional family structures create a cycle of intergenerational neglect. Children engulfed by these conflicts suffer from numerous behavioral disturbances and trauma-related stress reactions: sleep disorders, agitated hyperactive behavior, depression, anxiety, malnutrition, and a host of other developmental disorders.
Overall, these conditions fall under a label familiar to us in addressing the problems of soldiers returning from a battlefield -- post traumatic stress disorder, PTSD. But there is a critical difference here because, unlike soldiers safely back at home, children in a war zone have no "post-trauma" setting. The violence goes on and they are in a permanent state of trauma.
We have learned that these un-ending levels of elevated stress have actual measurable physical effects on the brain. The innate "fight or flight" response is activated as a survival mechanism. Elevated levels of cortisol and adrenaline surge through the body, helping it respond.
However with constant threat and stress, researchers have found, insecure attachments develop -- even for a child in the womb. The brain actually releases different chemicals than it would in infants or children living in a safe, calm, and predictable environment. The way the child forms bonds and organizes their attachment to others is permanently altered by this brain chemical infusion.
The fight or flight amygdala responding pathways prevent the brain's prefrontal cortex (where more complex reasoning and organizing responses occur) from engaging and developing. As a result, children learn to respond only in "survival mode." Healthy mental development and social attachment are likely to be permanently altered -- destroying the social fabric of the country for decades to come and keeping conflict at the forefront. The cycle of violence becomes embedded in the next generation.
So what can we do? Ending the violence obviously is the first priority, but we know that peace in some of these places may not come soon. And, again, massive damage has been inflicted on the mental states of a generation of children -- damage that will take time to heal, even with the concerted efforts of mental health professionals both in the conflict-ravaged nations, and from the international community.
Even as the wars rage on, international relief groups and dedicated health professionals must start preparing to address the long-term needs of these children -- including restoration of their emotional health. We must create environments where the children know they are protected from exploitation and harm. Students must return to school. And their emotional healing must be promoted with psychological care and support on a massive scale.
Otherwise, we will be faced with a lost generation in world hotspots -- one unable to manage long-term peace in the homelands or to work cooperatively with the rest of the world to make sure future generations of children do not also suffer this way.