As the Syrian civil war enters its seventh year, campaigners are warning the scars of the conflict will be etched on the mental wellbeing of children, with a whole generation left “emotionally destroyed” from the trauma.
Children in the war torn country have been bombed, starved and seen their friends and families die before their eyes.
Their homes, schools and hospitals have been destroyed and thousands have been torn apart from their families and friends as they flee the fighting.
Save the Children describes the psychological toll placed on minors as “enormous”, with youngsters living in almost constant fear.
The charity's warning comes a day after seven-year-old Bana Alabed wrote an open letter to Theresa May asking the UK to send “medicine, doctors, water and milk” to help save “dying children”.
In the charity’s latest report released on Tuesday, called Invisible Wounds, the reality facing Syrian children’s mental health and wellbeing have been assessed.
The organisation says the majority of the 450 children it spoke to have shown signs of “severe emotional distress”.
The 5 most harrowing affects the war has had on Syria’s children:
Self-harm and suicide attempts
Save the Children said many of the minors they spoke with described increases in self-harm, suicide attempts, bedwetting, speech problems and aggressive or withdrawn behaviour.
Of those interviewed, 89% said children have become more fearful and nervous as the war has gone on.
Mental health experts have also warned that Syrian children are showing signs of ‘toxic stress’, which can lead to developmental issues and lifelong health problems.
Severe emotional distress
Two thirds of Syrian children have lost loved ones, had their home bombed or been injured, the charity said.
Many have seen friends or family members killed in front of them.
Seven-year-old Razan’s* mother and sister were killed when a missile fell on their home. She was pulled from the rubble alive and couldn’t stop screaming. Now she suffers frequent hallucinations.
Saif*, a teenager from rural Aleppo, told Save the Children: “I get angry when someone in my family or my friends die.
“My chest hurts and I can’t breathe, so I sit alone because I don’t want to scream at anyone or hit anyone.”
Toxic stress
Experts warn that prolonged exposure to traumatic events, such as bombing and violence, is putting Syrian children at high risk of toxic stress – the most dangerous form of stress response.
Toxic stress disrupts the development of the brain and other organs and increases the risk of heart disease, substance abuse, depression and other mental health disorders into adulthood.
Ahmed*, now nine, witnessed beheadings and lashings in Isis-held areas. When they saw his father’s body after he was killed by shelling, Ahmed and his sisters couldn’t speak for days afterwards.
Psychologically crushed
An aid worker in the besieged town of Madaya described how children are “psychologically crushed and tired”.
Children do not respond to activities such as singing, but instead “draw images of children being butchered in the war, or tanks, or the siege and the lack of food”, the aid worker said.
Children’s emotional distress is compounded by dire shortages of food, clean water and medical care.
Hala, a teacher from Madaya said that children “wish they were hit by a sniper, because if they got injured they would go to the hospital and leave the siege and eat whatever they want”.
A tipping point
The mental health of Syria’s children is at a tipping point, Save the Children reports.
Dr Marcia Brophy, the charity’s senior Middle East mental health and psychosocial support adviser, said: “We are failing children inside Syria, some of whom are being left to cope with harrowing experiences – from witnessing their parents killed in front of them to the horrors of life under siege – without proper support.
“We need to ensure that children who have already lost six years of their lives to war don’t have to lose their whole future as well.”
The charity warned that, with early intervention and support, Syria’s children can recover from traumatic experiences.
But without swift action, a whole generation could be lost “to the terror of war”.
Save the Children is calling for the United Nations to assist in bringing about an immediate ceasefire.
*Names have been changed to protect children’s identities.