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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
We thank Dr. Hutchins for elevating the importance of highlighting the mitigation of harm inflicted on children as an essential part of a just peace. We agree with him that many of these harms find expression in adverse emotional and behavioral consequences that can ripple across childhood and persist long into adulthood (1, 2).
Dr. Hutchins rightly emphasizes the importance of addressing these consequences as part of a jus post bellum regime. However, we would like to extend this suggestion by pointing out that these long-term developmental consequences should also be considered a component of the broader indirect effects of war. These indirect effects pertain directly to jus in bello targeting and humanitarian considerations and, as we stressed, are of particular importance to children and yet are inadequately addressed in Gaza, Lebanon, Sudan, Ukraine and other areas of extreme violence around the world.

1. Bhutta ZA, Bhavnani S, Betancourt TS, Tomlinson M, Patel V. Adverse childhood experiences and lifelong health. Nat Med. 2023 Jul;29(7):1639-1648. doi: 10.1038/s41591-023-02426-0. E
2. Koga C, Tsuji T, Hanazato M, Nakagomi A, Tabuchi T. Intergenerational Chain of Violence, Adverse Childhood Experiences, and Elder Abuse Perpetration. JAMA Netw Open. 2024 Sep 3;7(9):e2436150. doi: 10.1001/jamanetworkopen.2024.36150.

Competing interests: No competing interests

29 September 2024
Zulfiqar A Bhutta
Co-Director, Centre for Global Child Health
Paul H Wise, Georgia Dominguez
The Hospital for Sick Children
686 Bay Street, Toronto, ON M5G 0A4, Canada