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When is enough, enough? Humanitarian rights and protection for children in conflict settings must be revisited

BMJ 2024; 386 doi: https://doi.org/10.1136/bmj-2024-081515 (Published 04 September 2024) Cite this as: BMJ 2024;386:e081515

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Re: When is enough, enough? Humanitarian rights and protection for children in conflict settings must be revisited

Dear Editor
Humanitarian protection for children in conflict settings must be revisited - The case to add a jus post bellum perspective

Bhutta and colleagues [1] have argued convincingly how the rules of engagement in war need addressing to better protect those non-combatants that are within their childhood years. The recent data coming out of Gaza (with all the caveats acknowledged on the source and accuracy of the data) shows a conflict that has the highest proportion of impact on children of all the conflicts they considered. The rules of engagement, described in the paper as the why and how of war (more often described as the jus ad bellum and jus in bello) are the areas that require the most immediate attention for obvious reasons.

However, there is also a case to add the jus post bellum to these considerations. Jus post bellum usually concerns matters such as justice for war crimes and atrocities, reparations and reconciliation. Some authors believe the jus post bellum considerations are an extension for the jus ad bellum ones [2]. International Humanitarian Law (IHL) includes the post bellum situation particularly with respect to bringing to justice the perpetrators of in bello crimes.

However, there are many aspects to post bello. In this regard, the consideration is that of relational reconciliation [3]. In the North Thames Neurodisability Teaching webinar in September 2024 on the neurodevelopmental effects of conflict on children, the impact in middle childhood of continual exposure to the violence and war deprivations on the developing brain and the consequential long term effects on how the emerging adults then interpret the world. Similarly, the emotional and behavioural effects on children in Gaza have been reported many years before the current iteration of the conflict there with raised levels of conduct disorders, ADHD and PTSD [4]. Similar has been reported on Bedouin children [5].

The importance of play, positive role-modelling and education is well known in shaping how children relate to others and their emerging personalities as an adult. Efforts to ensure survival, freedom from attack and access to basic care remain the priorities of the in bello situation for children and would be the key focus of any child-specific amendment to IHL. A specific addition to IHL for a focus on the relational reconciliation for children in the post bello phase would be key to prevent an emergence of a generation who see themselves as being instruments of a continuation of past conflicts. The post bello duty would then fall on both sides in a conflict, as both sides have an interest in moving forward rather than becoming trapped in the disease of conflict [6].

Although pacificists like me would not forward the argument, even just war protagonists would acknowledge Cicero’s words from over two millennia ago:
“wars, then, ought to be undertaken for this purpose, that we may live in peace, without injustice” [1]

With an estimated 240 million children living currently in armed conflict-affected countries and child soldier recruitment increased by 159% to 30 000 verified cases [7] child specific post bello inclusion in any IHL amendments is an essential addition to those laid out by Bhutta, Dominguez and Wise or else the words of Tamara Stepanovna Umnyagina in Alexievich’s Nobel Prize winning book will continue to ring true for generations:
“My precious one…People still hate each other. They go on killing That’s the most incomprehensible thing to me..” [7]

1 Bhutta ZA, Dominguez GB, Wise PH. When is enough, enough? Humanitarian rights and protection for children in conflict settings must be revisited. BMJ. 2024 Sep 4;e081515–5.‌
2 Lee S. Ethics and war : an introduction. Cambridge ; New York: Cambridge University Press; 2012.
3 Lu, C. Reconciliation and Reparations in Lazar S, Frowe H. The Oxford handbook of ethics of war. New York, Ny: Oxford University Press; 2018.
4 Miller T, El‐Masri M, Allodt F, Qouta S. II: Emotional and behavioural problems and trauma exposure of school‐age Palestinian children in Gaza: Some preliminary findings. Medicine, Conflict and Survival. 1999 Oct;15(4):368–78.
5 Massad S, Khammash U, Shute R. Political violence and mental health of Bedouin children in the West Bank, Palestine: a cross-sectional study. Medicine, Conflict and Survival. 2017 Jul 3;33(3):188–206.
6 Abuelaish I, Arya N. The Palestinian–Israeli conflict: a disease for which root causes must be acknowledged and treated. Medicine, Conflict and Survival. 2017 Jul 3;33(3):184–7.
7 Prieto Rudolphy M. The Morality of the Laws of War. Oxford University Press; 2023.

Competing interests: No competing interests

22 September 2024
John Hutchins
Consultant Community Paediatrician
The Lionel Penrose Trust
London, UK