Intended for healthcare professionals


Protecting children from armed conflict

BMJ 1998; 317 doi: (Published 31 October 1998) Cite this as: BMJ 1998;317:1249

Children affected by war must not be stigmatised as permanently damaged

  1. Derek Summerfield, Psychiatrist
  1. Medical Foundation for the Care of Victims of Torture, London NW5 3EJ
  2. Royal Manchester Children's Hospital, Manchester M27 1HA
  3. Health Operations Division, International Committee of the Red Cross, 1202 Geneva, Switzerland

    EDITOR— Southall and Abbasi quote Unicef when they state that the psychological consequences of armed conflict on children are so great that they can rarely be repaired.1 Unicef indeed says that “time does not heal trauma,” but there is no sound empirical basis for a generalisation that risks stigmatising whole populations of children affected by war as sick or permanently damaged. Even child survivors of Auschwitz did not turn out like this as a general rule, and there are no published studies of children from non-Western war zones to support such a conlusion.

    Unicef and other agencies need to review such claims and costly interventions based on them; the claims owe more to prevailing sociocultural assumptions in the West than anything else. Over the past 50 years psychological explanations for life events and the medicalisation of distress have grown hugely. Because many people believe, for example, that rape or other criminal violence, childhood abuse, or even persistent bullying at school is an experience that may have lifelong psychological effects it seems unthinkable that war and atrocity should not do this to almost everyone exposed to them. Constructions of “trauma” deployed in the health field are increasingly expansive and undiscriminating.2

    No one wants to play down …

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