Children’s prolonged exposure to the toxic stress of war trauma in the Middle East
BMJ 2020; 371 doi: https://doi.org/10.1136/bmj.m3155 (Published 19 November 2020) Cite this as: BMJ 2020;371:m3155Read our collection on toxic stress and PTSD in children
- Muthanna Samara, professor of psychology1,
- Sara Hammuda, research fellow in psychology1,
- Panos Vostanis, professor of child mental health2,
- Basel El-Khodary, assistant professor of psychology3,
- Nader Al-Dewik, associate professor and consultant clinical scientist of molecular and human genetics1 4
- 1Department of Psychology, Kingston University London, United Kingdom
- 2Department of Neuroscience, Psychology and Behaviour, University of Leicester, United Kingdom
- 3Department of Psychology, Islamic University Gaza, Palestine
- 4Department of Paediatrics and Interim Translational Research Institute (iTRI), Hamad Medical Corporation (HMC) and College of Health and Life Science (CHLS), Hamad Bin Khalifa University (HBKU), Doha, Qatar
- Correspondence to: M Samara m.samara{at}kingston.ac.uk
Violent political conflict has had a devastating effect on the physical and mental health of children in the Middle East (box 1).1 Many have been killed or injured. Many have been displaced, including 2.5 million Syrian child refugees.2 Conversely, Palestinian children under blockade in the Gaza Strip cannot escape even to relative safety.3
A century of political violence
The Middle East has seen several wars since the second world war—between Arab states and Israel, between 1948 and 1982; the Lebanese Civil War, from 1975 to 1990; wars in Iraq beginning in 1980 and with continuing unrest to the present day; the invasion of Kuwait in 1990; and the North Yemen Civil War, from 1962 to 1970. In late 2010, anti-government protests throughout the Middle East gave rise to the so called Arab Spring. Subsequent Libyan, Syrian, and Yemeni civil wars have been violent and prolonged. In addition, Palestinians in the Gaza Strip have experienced three wars in the past 12 years and have been living under a blockade since 2007.
RETURN TO TEXTYemen’s dire situation has triggered the world’s biggest food security emergency and the largest recorded cholera epidemic.4 Children in conflict settings may lack access to water and experience bombing, loss of their home, and the injury or death of loved ones.56 Sexual exploitation and abduction can proliferate when rule of law collapses.1 The effects of poverty and destroyed healthcare and schools can persist long after violence has ceased.
The threat of harm intensifies exposure to psychological trauma.1 Continuous exposure to trauma is associated with mental health problems including post-traumatic stress disorder (PTSD) …