Re: When is enough, enough? Humanitarian rights and protection for children in conflict settings must be revisited
Dear Editor
Bhutta et al are right to call for a revisiting of the protection afforded to civilians in International Law to Civilians in war Zones and especially to children (1).
However, in our opinion, part of that Revisiting must include the protection of the Mental Health of Civilians and Children from the major bombardments of populated areas which have become commonplace in modern warfare. The physical damage to the bodies of victims is self evident. What is not necessarily evident is the damage caused by the mental trauma of war caused by such bombardments.
Recently we have argued that the inflicting of Mental trauma, which could cause personality changes, should be considered a war crime in its own right, especially when it is civilians who are exposed to mental trauma (2). We made our argument based on a review of the development of personality disorders in persons exposed to mental trauma caused by war (2). Given that Post Traumatic Stress Disorder, which can now be shown by such methods as MRI scanning to cause anatomical changes in the brain (for example a smaller Hippocampus (6)), is so commonplace on exposure to war Trauma (3), and if not treated, personality changes and even personality disorders develop in the long term (2) (3) (4) (5), we argue that the exposure of civilians, including children, should be considered a war crime in its own right (2).
This will require changes in international law, but would, providing it can be enforced, have important impact on how war is presently conducted, by making illegal heavy artillery bombardment and air strikes illegal in populated areas.
Mark Agius
Michaela Agius
References
(1) Bhutta ZA Dominguez GB, Wise P.H. When is enough, enough? Humanitarian rights and protection for children in conflict settings must be revisited BMJ . 2024 Sep 4:386:e081515.
(2) Mark Agius & Michaela Agius. SINCE EXPOSURE TO MENTAL TRAUMA, ESPECIALLY WAR TRAUMA, CAUSES PERSONALITY CHANGES, SHOULD DELIBERATE EXPOSURE TO TRAUMA OF CIVILIANS BE IN ITSELF A WAR CRIME? Psychiatria Danubina, 2023; Vol. 35, Suppl. 2, pp 6-37
(3) Bollinger AR, Riggs DS, Blake DD, Ruzek JI: Prevalence of personality disorders among combat veterans with posttraumatic stress disorder. J Trauma Stress. 2000; 13:255-70
(4) C’De Baca J, Castillo DT, Mackaronis JE, Qualls C: Ethnic Differences in Personality Disorder Patterns among Women Veterans Diagnosed with PTSD. Behav Sci (Basel) 2014; 4:72-86
(5) Richman H, Frueh BC: Personality disorder symptomatology among Vietnam veterans with combat-related PTSD. Anxiety 1996; 2:286-95
(6) Woon FL, Sood S, Hedges DW. Hippocampal volume deficits associated with exposure to psychological trauma and posttraumatic stress disorder in adults: A meta-analysis Progress in Neuro-Psychopharmacology and Biological Psychiatry Volume 34, Issue 7, 1 October 2010, Pages 1181-1188
Competing interests:
No competing interests
23 September 2024
Mark Agius
Retired Associate Specialist Psychiatry
Michaela Agius (Medical Student, University of Malta)
Rapid Response:
Re: When is enough, enough? Humanitarian rights and protection for children in conflict settings must be revisited
Dear Editor
Bhutta et al are right to call for a revisiting of the protection afforded to civilians in International Law to Civilians in war Zones and especially to children (1).
However, in our opinion, part of that Revisiting must include the protection of the Mental Health of Civilians and Children from the major bombardments of populated areas which have become commonplace in modern warfare. The physical damage to the bodies of victims is self evident. What is not necessarily evident is the damage caused by the mental trauma of war caused by such bombardments.
Recently we have argued that the inflicting of Mental trauma, which could cause personality changes, should be considered a war crime in its own right, especially when it is civilians who are exposed to mental trauma (2). We made our argument based on a review of the development of personality disorders in persons exposed to mental trauma caused by war (2). Given that Post Traumatic Stress Disorder, which can now be shown by such methods as MRI scanning to cause anatomical changes in the brain (for example a smaller Hippocampus (6)), is so commonplace on exposure to war Trauma (3), and if not treated, personality changes and even personality disorders develop in the long term (2) (3) (4) (5), we argue that the exposure of civilians, including children, should be considered a war crime in its own right (2).
This will require changes in international law, but would, providing it can be enforced, have important impact on how war is presently conducted, by making illegal heavy artillery bombardment and air strikes illegal in populated areas.
Mark Agius
Michaela Agius
References
(1) Bhutta ZA Dominguez GB, Wise P.H. When is enough, enough? Humanitarian rights and protection for children in conflict settings must be revisited BMJ . 2024 Sep 4:386:e081515.
(2) Mark Agius & Michaela Agius. SINCE EXPOSURE TO MENTAL TRAUMA, ESPECIALLY WAR TRAUMA, CAUSES PERSONALITY CHANGES, SHOULD DELIBERATE EXPOSURE TO TRAUMA OF CIVILIANS BE IN ITSELF A WAR CRIME? Psychiatria Danubina, 2023; Vol. 35, Suppl. 2, pp 6-37
(3) Bollinger AR, Riggs DS, Blake DD, Ruzek JI: Prevalence of personality disorders among combat veterans with posttraumatic stress disorder. J Trauma Stress. 2000; 13:255-70
(4) C’De Baca J, Castillo DT, Mackaronis JE, Qualls C: Ethnic Differences in Personality Disorder Patterns among Women Veterans Diagnosed with PTSD. Behav Sci (Basel) 2014; 4:72-86
(5) Richman H, Frueh BC: Personality disorder symptomatology among Vietnam veterans with combat-related PTSD. Anxiety 1996; 2:286-95
(6) Woon FL, Sood S, Hedges DW. Hippocampal volume deficits associated with exposure to psychological trauma and posttraumatic stress disorder in adults: A meta-analysis Progress in Neuro-Psychopharmacology and Biological Psychiatry Volume 34, Issue 7, 1 October 2010, Pages 1181-1188
Competing interests: No competing interests