As the United Nations International Children’s Fund (UNICEF) says: “In war, children suffer the most.”

As I write, children are dying and losing loved ones every single day in multiple locations around the world, including Ukraine, Gaza, Israel, Russia, Sudan, Somalia, Libya, Myanmar, Yemen, Congo, and numerous other countries. These children are suffering in ways that are quite simply horrific and completely incompatible with normal development.

In fact, globally, one in four children, or more than 400 million, live in a country affected by armed conflict, terrorism, or disaster.¹ And armed conflict can last throughout a child’s entire life, such as in Liberia where civil war caused widespread trauma from 1989 to 2004.²

The effects of war are innumerable. They extend far beyond the trauma that is experienced by the loss of loved ones or witnessing or being the victim of violence. In wartime, children, teens, and adults may all experience a brutal shattering of parts of their inner worlds. Their mental functioning is assaulted by destructive forces.³

Moreover, they experience all the secondary losses of war including the loss of home and community due to fighting and bombardment. These include losses embedded in the experiences of evacuation and immigration, including the loss of contact with friends and the division of families, as well as the difficulties associated with adapting to one or more new living arrangements. And they include the loss of food security, the loss of the provision of proper public health measures, and the loss of general health care including mental health care.

The World Health Organization (WHO) and UNICEF estimated that approximately 20 million children and adolescents have been displaced from their country of origin as refugees in the year 2023.⁴

We must also remember that the numbers of children living through war and experiencing displacement are even larger than this because there are many kinds of war—including not only armed conflicts between nations, but also drug wars, gang wars, and more localized street fighting caused by conditions of poverty and social inequality—and these, too, cause people to suffer and to flee.

In Ukraine alone, as of March 2022, half of all Ukrainian refugees were children. And this number does not even include all of the children who have been kidnapped and forced to adapt to life in Russia. Again, this is a lot of children who have lost their homes, friends, neighborhoods, schools, and so much more.

The past two decades have marked increasing interest in the psychological impact of war on children. Many researchers have studied this subject and it is well documented that exposure to adverse childhood events (including violence and war trauma) leads to a higher-than-average incidence of acute stress disorder, post-traumatic stress disorder (PTSD), and physiological and mental illness.

The most important thing we know about the effect of war on children is that even above and beyond the exposure to risk and violence, the most traumatizing event for children is the threat of separation from one or both parents or actual separation from them. Given the intense attachment of children to their parents, this is the worst consequence of war for children and leads to the most suffering.⁵

We also know that the most common mental health effects of exposure to war for children are elevated symptoms of traumatic stress, depressive disorders, anxiety disorders, and PTSD.