The Psychosocial Consequences for Children and Young People who are Exposed to Terrorism, War, Conflict and Natural Disasters

Richard Williams

Disclosures

Curr Opin Psychiatry. 2006;19(4):337-349. 

In This Article

Introduction

Paradoxically, the growth of communications technology has enabled us to 'experience' catastrophic natural disasters, confrontations, conflict and war from the safety of our own homes. It has also provided a flexible infrastructure for implementing the theory and practice of the virtual organizations that are emerging now[1] and which are favoured by terrorists. Unsurprisingly, in this context, the literature relating to the psychological impacts of natural and human-created disasters and catastrophes has grown rapidly in the 21st century. A number of recent general reviews are available; the February edition of World Psychiatry, for example, contains nine papers.[2,3] The World Psychiatric Association[3] has recognized disaster psychiatry as a new speciality.

More than 145 conflicts amounting to wars have occurred since World War II and the vast majority have taken place in developing countries. Evidently, there has been a paradigm shift such that, through speed of communications and direct involvement, psychological impacts of human-made disasters are now core rather than side effects. Concerns about terrorism have grown enormously since 2001. A number of authors have written commentaries on the psychological aspects.[4,5,6,7,8] Psychological impacts are the defining hallmark of terrorism and are increasingly recognized as prominent attributes of all disasters.

As Smith[9] has shown, the battleground for modern confrontation and conflict lies within civilian domains rather than on discrete battlefields. Thus, in most human conflicts, there are interactions between the direct effects of warlike and terrorist actions on local environments resulting in hazardous situations for the health, wealth and social welfare of local populations, which are, thereby, precipitated into much greater devastation or catastrophe.[10] Resident and displaced populations, refugees, and famine-affected peoples are caught up in conflict.[11] Some approximated facts related to the decade 1993-2003 are the following:

  1. Two million children were killed and six million children were injured or permanently disabled in war zones.

  2. Of war-exposed survivors, one million children were orphaned and 20 million displaced to refugee camps or other camps.

  3. Civilians comprise 80-90% of all who die or are injured in conflicts - mostly children and their mothers.[12]

These stark facts raise questions about what we have learned as a consequence in numerous domains of life. In this paper, I am principally concerned with psychosocial care of children and adolescent persons. Given the volume of publications, I do not attempt to provide an authoritative review of all that is available. My intention is to identify some of the topics that appear in print and the lessons that have been learned from past experience and research on policy, practice, and corporate and clinical governance of health service delivery in the immediate aftermath of disasters. As the lives of children and young people are bound up with adults on whom they are dependent, I also touch on general recommendations. Recent world events show that we tend to learn the same lessons recurrently (e.g. the importance of involving schools in working with children after disasters[13]).

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