Afghan Children Pay the Price of Brutal War

This blog by César Chelala highlights the issues that children are facing in Afghanistan, which heavily impact their health, education and overall well-being. The post is a part of Wikichild's series on under-5 mortality rates, along with it's spotlight on the recent Save the Children report "State of the World's Mothers 2013: Surviving the first day".

Decades of insecurity and war in Afghanistan have provoked a heavy toll on children’s lives and well-being. An under-5 mortality rate of 199 per 1,000 live births as reported by UNICEF is among the highest in the world. That means that more than one out of every five children is dead by the time they are five. In addition, health and education systems suffer from lack of funds and qualified professionals, a situation worsened by the security situation.

The statistics are frightening. More than 60% of all child deaths and disabilities are due to respiratory and intestinal infections, and of vaccine-preventable diseases such as measles. Diarrhea kills tens of thousands of children every year. Many also die from severance of breast-feeding before time. An estimated 7.5 million children and adults are at risk from hunger and malnutrition, the latter affecting children's growth in particular.

According to United Nations statistics, malnutrition among children has increased by 50 percent or more countrywide when compared to 2012. This is happening despite billions of dollars in humanitarian aid by Western governments. One of the most affected places is the malnutrition ward at Bost Hospital, in war-torn Helmand Province, but a similar situation can be found even at Indira Gandhi Children’s Hospital in Kabul.

Although it is difficult to pinpoint the causes for the increase in malnutrition levels, experts indicate several factors that contribute to it such as widespread poverty, difficulties in the implementation of feeding and therapeutic programs, and lack of breastfeeding. Despite low incomes, many mothers are lured by the beautiful pictures on milk cartons, and tend to believe that this milk provides better nutrition for their children.

Children in Afghanistan can also be affected by polio, since Afghanistan is one of only four countries in the world where the disease is still endemic. Despite high vaccination rates, however, there were 47 documented cases of polio in the country.

Some cities, such as Jalalabad, the largest city in eastern Afghanistan, located at the junction of the Kabul and Kunar rivers, are high risk areas for polio due in large part to the massive and continuous population movements from and into polio infected areas. In South Asia in 2000, over 40 percent of the confirmed cases of polio occurred in Pakistan and Afghanistan.

To control the spread of disease, UNICEF and the Department of Public Health in Nangarhar, one of Afghanistan’s 34 provinces, have launched the “Women Courtyard” initiative, aimed at providing local women with information about polio and other vaccine-preventable diseases, as well as such related issues as hygiene and waterborne illnesses.

While this is an important initiative, certain popular traditions still constitute a hindrance to its successful implementation. One such tradition is that babies cannot leave their homes before the 40th day after birth, a tradition which prevents many newborns from being vaccinated at the appropriate time.

To make matters worse, deadly attacks have targeted schools and impeded access to critical health care. According to Daniel Toole, UNICEF Regional Director for East Asia and the Pacific, “We have had attacks on villages and on schools by both anti-government elements as well as by coalition forces and international troops that have hit civilians."

Just in the first four months of 2013 over 400 children were killed and maimed as a result of the protracted conflict. Statistics seem to show that 2013 may well have been the second most deadly year since 2001.

The result of this conflict is that not a single child growing up in Afghanistan today has known peace in his/her lifetime. Deteriorated mental health is one of the consequences of a permanent state of war. A UNICEF study has found that the majority of children under 16 years of age in Kabul suffer from psychological trauma resulting in serious mental health problems including psychiatric disorders and post-traumatic stress syndrome.

Children in Afghanistan are exposed not only to violence related to acts of war but also to violence resulting from accidents, beatings by close relatives or neighbors, or seeing close relatives being beaten or executed. A study published in the Lancet has pointed out, “In Afghan children’s lives, everyday violence matters just as much as militarized violence in the recollection of traumatic experiences.”

Daniel Toole remarked at a press briefing in Geneva, “Afghanistan today is without doubt the most dangerous place to be born,” a sad commentary on the beleaguered country.

- César Chelala

César Chelala, MD, PhD, is an international public health consultant and the foreign correspondent for the Middle East Times International (Australia). He also is a co-winner of an Overseas Press Club of America award for an article on human rights.

This blog first appeared 11 January, 2014 on The WIP blog site. 

See related articles:

Levels and Trends in Child Mortality 
Childhood Under Fire: The impact of two years of conflict in Syria

UNICEF Child Well-being measure

UNICEF - Towards a Post-2015 World Fit for Children

UNICEF Report Card 10: Measuring child poverty

Children and Malnutrition

Giving Children A Voice

Image taken from 'Out in the Cold' ©Save the Children

The Syrian conflict has now entered its 21^st month and is showing few signs of abating. Over the course of this period between 40,000 and 55,000 Syrians have been killed and about 1.2 million people are said to be displaced.

The violence has been universal, afflicting all parts of the country's population, but one of the most striking features of this civil war has been brutality enacted on children. Thousands of children have died in attacks and many more have been injured, traumatised and driven from their homes.

Save the Children has followed the conflict closely; having published a number of timely reports the charity, like UNICEF, has set up an appeal to protect Syria's children and provide them with food, shelter and emotional support.

Save the Children's most recent report 'Out in the Cold, Syria's Children Left Unprotected' documents the appalling winter conditions facing child refugees who have dispersed across the Middle East, attempting to find refuge in Iraq, Lebanon and Jordan. Sub-zero temperatures have already hit the region and “startling low levels of aid” (Out in the Cold, page 14)  mean that children will have to endure this winter without enough support. According to Justin Forsyth, the chief executive of the STR, world leaders must act quickly:

“[the] international community needs to match its diplomatic and security concerns with funding to help children. Unless there is a surge in funding, thousands of children are going to spend a bitter winter without proper shelter from the cold, and many will become sick as a result.”

One only has to look at Andrea Bruce's devastating photo essay published earlier this year by The New York Times to understand the truly horrendous effects that cold can have. Bruce's haunting, Caravaggio like pictures tell the story of Lailuma, an Afgan mother living with her family in a refugee camp outside Kabul who lost nine of her children over the course of the winter.

'Out in the Cold' follows a similar structure to Save the Children's previous report 'Untold Atrocities,The Stories of Syria's Children' in that the majority of its contents is made up of first person accounts of the deteriorating situation for refugees. Among the testimonies are stories of children huddling three to a blanket, sleeping in makeshift shelters made of billboards and falling sick as temperatures plunge in the region. One such story comes from 11 year old Ali, who has been living in an abandoned school in northern Lebanon for close to two years:

“I need clothes to wear... My parents dont have money, they dont have anything. Who should I ask for clothes from? I'm not happy at all. We would love to go back to Syria.”

A feature of these reports is that they break from what might be seen as a more traditional style of research based dissemination. Instead, they aim to allow the emotive force of the featured children's stories to emphasise the need for changes to be made. This is certainly not a new form of reporting; organisations from past and present have released similar reports and campaigns, however, it seems that these groups are increasingly using children's voices to deliver their message in a bid to inform policy making. Aside from STR, UNICEF has dedicated a section of their overall mission statement to the VOICE's of children, the UN followed up on its MACHEL Strategic Review by publishing a compilation of the views and recommendations of some 1,700 young people from 92 countries to raise awareness about the issues facing children in armed conflict and Defence for Children International has released a number of publications voicing the issues faced by Palestinian's in East Jerusalem.

It is arguable that in highly politicized humanitarian crises like the one in Syria or nearby Palestine, the simplicity of a child's story transcends the debate over who is in the wrong and forces us to remember that innocent humans are suffering. There will of course be those who criticize such reports, arguing that they only provide a limited perspective on complex situations. However, it seems that if a one sided report is going to be effective - using first person child accounts to drive an argument may be a less fallible method than others as children are unlikely to approach their testimonies with a strong political leaning. Save the Children's Syrian reports are undoubtedly subjective, they have an agenda, but the stories coming out of them are far from politicized, they do not point fingers, they only speak of the confusion and terror felt by children who cannot comprehend the violence going on around them. At a time when we are bombarded with information on a daily basis, 'Out in the Cold' and the reports that have preceded it offer a concise, easily accessible and striking message that forces us to view the Syrian conflict through the lens of those who most need rescuing from it. 

Robbie Lawrence

Wikichild Coordinator

@Wiki_child

@robbielawrence1

Uncounted sexual violence

“We could scream but no one will hear us, they cover our mouths and threaten us.”

Unnamed child, Colombia

When we consider that 75 to 95 percent of rapes are never reported to the police in England , it will come as no surprise that we know very little about the full extent of sexual violence committed in conflict and post-conflict settings, let alone how many survivors of sexual violence in conflict are children. While many of these crimes go unreported and unpublished – a horrific example of the “uncounted,” for which this blog is named – we know enough to be able to say that incidents of rape and sexual abuse during conflict and instability are pervasive in countries from all regions of the world and that children often make up a significant number of survivors of sexual violence, and sometimes the majority.

A rape victim with a children’scounsellor - South Kivu, easternDRC - Hidden Survivors 

The following snapshots – outlined in our new briefing Hidden Survivors launched today – offer some indication of the prevalence and scope of the problem:

• During the post-election crisis in Côte d’Ivoire between 1 November 2010 and 30 September 2011, children made up 51.7% of cases of sexual violence. In more than half of the cases of sexual violence against children, the survivors were below 15 years of age.
• In 2008 in the Democratic Republic of Congo (DRC), the United Nations Population Fund recorded nearly 16,000 cases of sexual violence against women and girls. Of those instances, 65% involved children, mostly adolescent girls
• In 2006, the Lancet published research estimating that nearly one-fifth of girls were raped in the greater Port-au-Prince areas during the armed rebellion between February 2004 and December 2005

While there is ample evidence of sexual violence against women and girls, there is little systematic documentation of the existence of or impact of sexual violence on men and boys. The evidence that does exist, however, points to a serious – if under-reported – problem. In the DRC it has been estimated that men and boys make up 4-10% of survivors of sexual violence who seek treatment. In Afghanistan, the UN Special Representative on Children and Armed Conflict and others have repeatedly brought attention to the sexual abuse of boys. There have also been reports of sexual violence against boys as well as girls in the current conflict in Syria.

Given the extent of the scourge of sexual violence in conflict and its impact on children we welcome the UK Government and William Hague’s personal commitment to placing this issue at the top of the agenda for the UK’s Presidency of the G8 next year. This week a group of around 60 experts on the issue of sexual violence in conflict from around the world gathered at Wilton Park to help the Foreign Office develop and shape this important initiative.

While the appearance of Angelina Jolie was the only aspect of the conference that captured media attention, there was much that was encouraging about the discussions at Wilton Park from a children’s rights perspective. William Hague recognised in the opening statements of his speech that children make up 50% of the survivors of sexual violence in DRC, for example. And the Minister of Gender and Development from Liberia spoke at length about the appalling impact of sexual violence in homes in post-conflict Liberia on children, pushing the issue beyond the confines of “rape as a weapon of war” and into a broader set of familiar development concerns such as grinding poverty, breakdown of social norms, and lack of respect for women’s rights.

We do have lingering concerns that the UK Government’s initiative on Preventing Sexual Violence in Conflict will – ironically, given the name – not go far enough towards prevention of sexual violence and instead focus on a narrow element of reducing impunity: that of increasing international prosecutions. Using international prosecutions to send a message at the highest levels that sexual violence in conflict will not go unpunished is an important part of the story, but it is only part.

So how do we lessen the extent to which survivors – and especially child survivors – of sexual violence in conflict and post-conflict settings that go uncounted (both as part of ensuring that those affected by these crimes receive the support and services they require but also as part of challenging the culture of impunity)? How do we prevent pervasive sexual violence from taking root in conflict and post-conflict settings in the first place?

Counting is a big part of the story. We have the tools to gather the data and monitor incidents of sexual violence, and other grave violations of children’s rights, but the relevant bodies within the UN and beyond often lack the funding and political support to fully exploit the potential of their mandates, as the SRSG on Children and Armed Conflict explained during her talk at Save the Children on Friday November 16th.

And we know that where there are no age-appropriate services for health or psychological care, where judicial systems are not designed to meet the needs of children, and where societies do not recognise the particular vulnerabilities that children face, reporting of abuse and exploitation of children will remain low. These systems and services will need funding from donors in many cases. And supporting governments to introduce and strengthen age- and sex- disaggregated data collection will need to be part of the response.

Increased funding, and a better understanding of how funding is currently allocated is also vital. Protective sectors like child protection and education – which play an important role in preventing children from being subject to sexual violence in the first place, as well as an important part of a the response mechanism for children who do survive violent abuse – for example, were the two worst-funded humanitarian sectors in 2009 – only 32% of requirements were met and many projects within that were only partially funded. Beyond these figures, we don’t actually know how much was spent on programmes that specifically aim to tackle sexual violence in conflict – so disaggregated data on funding for child-focused sexual violence programmes also needs to be publically available.

Sexual violence is one of the most shocking crimes committed during conflict. It happens all over the world – from Afghanistan to Colombia to Somalia – and its consequences linger long after the fighting has stopped. But it is not inevitable. And our shock and horror at the thought of children suffering these crimes should not mean they go uncounted.

Alison Holder

This article was first published on Uncounted - This blog is about inequality and development and those who are uncounted. It is written and maintained by Alex Cobham, Save the Children's Head of Research. Uncounted aims to stimulate debate but is not a reflection of official Save the Children policy