The impact of war on children
War affects children in all the ways it affects adults, but also in different ways. First, children are dependent on the care, empathy, and attention of adults who love them. Their attachments are frequently disrupted in times of war, due to the loss of parents, extreme preoccupation of parents in protecting and finding subsistence for the family, and emotional unavailability of depressed or distracted parents. The child may be in substitute care with someone who cares for him or her only slightly – relatives or an orphanage. A certain proportion of war-affected children lose all adult protection – “unaccompanied children,” as they are known in refugee situations.
Second, impacts in childhood may adversely affect the life trajectory of children far more than adults. Consider children who lose the opportunity for education during war, children who are forced to move into refugee or displaced person camps, where they wait for years in miserable circumstances for normal life to resume, if it ever does. Consider a child disabled in war; they may, in addition to loss of a limb, sight, or cognitive capacity, lose the opportunity of schooling and of a social life. A girl who is raped may be marginalized by her society and lose the opportunity for marriage. Long after the war has ended, these lives will never attain the potential they had before the impact of war.
Listing the impacts of war on children is a sadly straightforward task:
Death. Hundreds of thousands of children die of direct violence in war each year (2). They die as civilians caught in the violence of war, as combatants directly targeted, or in the course of ethnic cleansing.
Injury. Children suffer a range of war injuries. Certain weapons affect them particularly. A landmine explosion is more likely to kill or seriously injure a child than an adult (3). Thousands of children suffer landmine injuries each year (4).
Disability. Millions of children are disabled by war, many of whom have grossly inadequate access to rehabilitation services. A child may have to wait up to 10 years before having a prosthetic limb fitted. Children who survive landmine blasts rarely receive prostheses that are able to keep up with the continued growth of their limbs.
Illness. Conditions for maintenance of child health deteriorate in war – nutrition, water safety, sanitation, housing, access to health services. There may be loss of immunity to disease vectors with population movement. Refugee children are particularly vulnerable to the deadly combination of malnutrition and infectious illness. There is also interruption of population immunization programs by war which may be responsible for increases in child mortality.
Rape and prostitution for subsistence. These phenomena which often occur in situations of war, ethnic cleansing, and refugee life leave lasting physical impacts in sexually-transmitted diseases, including HIV/AIDS, psychological impacts and changes in life trajectory.
Psychological suffering. Children are exposed to situations of terror and horror during war – experiences that may leave enduring impacts in posttraumatic stress disorder. Severe losses and disruptions in their lives lead to high rates of depression and anxiety in war-affected children. These impacts may be prolonged by exposures to further privations and violence in refugee situations.
Moral and spiritual impacts. The experience of indifference from the surrounding world, or, worse still, malevolence may cause children to suffer loss of meaning in their construction of themselves in their world. They may have to change their moral structure and lie, steal, and sell sex to survive. They may have their moral structure forcibly dismantled and replaced in training to kill as part of a military force.
Social and cultural losses. Children may lose their community and its culture during war, sometimes having it reconstituted in refugee or diaspora situations.
Child soldiers. It is estimated that there are tens of thousands of young people under 18 serving in militias in about 60 countries. They are particularly vulnerable to all of the impacts listed above (5).
Action on this cluster of tragic phenomena is usually considered under two categories – how to mitigate some of the damage to children and how to heal children after they are damaged.
Making war less damaging to children (secondary prevention)
1. Implement international humanitarian law regarding the protection of children in war. The Geneva Conventions and the Convention on the Rights of the Child deal with protection of war-affected children with regard to food, clothing, medicine, education, and family reunion. In addition, they are intended to protect children from ethnic cleansing and recruitment into armed forces. However, compliance with these instruments is poor, especially when recruiting children to armed forces is concerned.
2. Ensure that general economic sanctions against a country are never used again, as they were used in Iraq as a substitute for war. Children and poor adults are those who suffer most from economic sanctions. Use of economic sanctions should be considered a war crime, just as is laying siege to a city to starve its population.
3. Ensure special consideration for children who are in flight from war zones and who live in camps for refugees and internally displaced people, especially children who are unaccompanied by adults. Special considerations need to be given for family reunion, systems of distribution of resources (sometimes to women rather than to men), internal layout of camps (to prevent attacks on girls), the provision of facilities for education and play, and special help for child-headed families.
4. Institute measures to reduce sexual exploitation and gender-based violence against women and girls in war. These measures include training of soldiers, including peacekeeping forces; inclusion of relevant interventions in humanitarian responses to population emergencies in war; reporting and support systems for victims of rape in camps for refugees and internally displaced persons; the prosecution of rape as a war crime; and making organized rape a crime against humanity.
5. Parties to a conflict must facilitate humanitarian assistance to ensure that the health infrastructure of children’s lives is not destroyed. Perpetrators should be prosecuted for such actions as destroying clinics, schools, and hospitals – all of which are protected by international law. Where access to health services, such as immunization, is hindered by the violent conflict, there should be humanitarian ceasefires to enable access.
6. Include children’s interests in peace agreements. Since 1999, several peace agreements have specifically referred to children in the post-violence arrangements for disarmament, demobilization, and reintegration (6). Children are recognized as victims and perpetrators of violence in several truth-and-reconciliation commissions, but children have played little role in these systems.
Rehabilitating children affected by war (tertiary prevention)
During the immediate humanitarian response to victims of war and in the longer-term attempts to reconstruct health services after war, there are attempts by both local and international actors to care for children’s needs for health care. Physical and psychological rehabilitation is instituted to varying degrees depending on the resources available. Sometimes these are minimal or absent. There have been many efforts to help the psychological impacts of war on children. Few have been evaluated.
Some efforts at rehabilitation of war-affected children include social healing moving toward education in the Culture of Peace. This is an approach to primary prevention of recurrence of war.
Imperative to end war
It may strike the reader that, although the many efforts to make war less damaging for children are important and should continue and be strengthened, this is a pathetically feeble response in the light of the intensity and magnitude of the suffering involved. From a certain perspective, there is even something preposterous about an exclusive focus on making war more tolerable for children. We rail against approaching HIV/AIDS, tuberculosis, or malaria in this way. Poverty, on the other hand, like war, may be treated with the assumption that it will always be with us, and is a fact of life. These assumptions should be vigorously challenged.
War is a recent phenomenon in human evolutionary history. For most of our species’ existence there is no evidence of war.
There are many current cultures without war.
In the European Union, social institutions for dealing with conflict have evolved to a point where war is unthinkable between member states.
There are clear alternatives to war in dealing with intra- and inter-state conflicts.
Judicial process: The World Court resolves many interstate conflicts.
Democratic functioning is designed to resolve intra-state conflicts. Good design of constitutions is another factor in this function.
Dialogue: UN conflict management capacities already quietly resolve many serious conflicts. Better resourcing could enhance these capacities. Other agencies also act in this mode.
Nonviolent struggle is frequently successful in deposing dictators or dysfunctional regimes. Usually this is done without good organization or training. Such efforts could be even more successful with these resources added.
Cultural change from endorsement and support of violence in conflict response to support and knowledge of peace processes. Consider cultural change in Sweden over the last few centuries from a belligerent country to a peaceful one. UNESCO has worked specifically to promote a culture of peace.
It is time for health professionals to define war as a serious global public health problem. The public health imperative is primary prevention – removing the vector of illness or making conditions unfavorable for survival of the vector. If a peace system can be devised for an entity as large, diverse, and populous as Europe, it can be devised at a global level. It would be naive to suggest that this is easily achievable. But it would be cynical, in the light of the suffering of the war-affected children of the world, to accept war as an inevitable part of the human condition. There are global networks, formal and informal, of health professionals who think in terms of eliminating war and who work to accomplish this. International Physicians for the Prevention of Nuclear War (IPPNW) is such a network, particularly focusing on the role of health professionals working to eliminate war (7). A network with the same goal is TRANSCEND, a peace and development network which includes several physicians (8).
1. Santa Barbara J. Can medicine contribute to preventing war? Croat Med J. 2004;45:783–5.[PubMed]
2. Machel G. The impact of armed conflict on children: report of the expert of the secretary general of the United Nations. New York: United Nations; 1996. Available from: http://www.unicef.org/graca/a51-306_en.pdf, Accessed: October 21, 2006.
3. Pearn J. Children and war. J Paediatr Child Health. 2003;39:166–72.[PubMed]
4. US Fund forUNICEF. Landmines pose the greatest risk for children. Available from: http://www.unicefusa.org/site/apps/nl/content2.asp?c=duLRI8O0H&b=279482&ct=307827. Accessed: November 14, 2006.
5. Coalition to stop the use of child soldiers. Child soldiers global report 2004. Available from: http://www.eldis.org/static/DOC16469.htm, Accessed: November 10, 2006.
6. Collier P, Elliott VL, Hegre H, Hoeffler A, Reynal-Querol M, Sambanis N. Breaking the conflict trap: civil war and development policy (A World Bank policy research report). Washington DC: World Bank and Oxford University Press; 2003.
7. International Physicians for the Prevention of Nuclear War. Available from: http://www.ippnw.org. Accessed: November 22, 2006.
8. Transcend. Available from: http://www.transcend.org. Accessed: November 22, 2006.
In 1877, soon after retiring as president of the United States, Ulysses S. Grant, embarked with his wife on a two-year tour of the world. At almost every location, he was greeted as a hero. In England, the son of the Duke of Wellington, whose father had vanquished Napoleon, greeted Grant as a military genius, the primary architect of Union victory in the American Civil War. Parading English workers hailed him as the man whose military prowess had saved the world’s leading experiment in democratic government and as a Hero of Freedom who had helped secure the emancipation of America’s four million slaves. Otto von Bismarck, the Chancellor of Germany, welcomed Grant as a nation builder, who had accomplished on the battlefield something—national unity—that Bismarck was attempting to create for his own people.
As the reaction to Grant’s tour demonstrates, contemporaries recognized the Civil War as an event of international significance. The various meanings imparted to it offer a useful way of outlining why the Civil War was so pivotal in our own history. The war changed the nature of warfare, gave rise to today’s American nation-state, and destroyed a slave society unprecedented in the modern world. In its aftermath, during the era of Reconstruction, Americans struggled to come to terms with these dramatic changes and, temporarily, established biracial democratic government on the ashes of slavery.
In the physical destruction it brought to the South, the economic changes it produced throughout the nation, and the new ideas it spawned, the Civil War altered the lives of several generations of Americans. The war produced a loss of life unprecedented in the American experience. The 620,000 combatants who perished nearly outnumber those who died in all other American wars combined. For those who lived through it, the Civil War would always remain the defining experience of their lives.
The Civil War is sometimes called the first modern war, although what constitutes "modernity" in warfare is a matter of debate. It was the first war to bring the full impact of the industrial revolution to bear on the battlefield. Railroads transported troops and supplies, and railroad junctions such as Chattanooga, Atlanta, and Petersburg became major military objectives. The telegraph made possible instantaneous communication between generals and between the battlefield and home front. The war took place soon after a revolution in arms manufacture had replaced the traditional musket, accurate at only a short range, with the more modern, and deadly, rifle and bullet. This development changed the nature of combat, emphasizing the importance of heavy fortifications and elaborate trenches and giving those on the defensive—usually Southern armies—an immense advantage over attacking forces. The rifle produced the appalling casualty statistics of Civil War battles. At Gettysburg, there were nearly fifty thousand dead, wounded, and missing. Total wartime casualties numbered well over one million, in an American population of around thirty-two million.
The Civil War began as a conventional contest of army versus army but by the end had become a war of society against society, with slavery, the foundation of the southern social order, becoming a target. In such a contest, civilian morale proved as crucial to sustaining and winning the war as events on the battlefield, and the population’s will to fight became as much a military consideration as armies in the field. Historians have long debated whether the Union’s victory was inevitable. Certainly, the Union overshadowed the Confederacy in manpower and economic resources. But the Union also had a far greater task. It had to conquer an area as large as western Europe, while the Confederacy, like the American patriots during the War of Independence, could lose battle after battle and still win the war, if their opponents tired of the conflict. Thus, political leadership was crucial to victory, and Lincoln proved far more successful than his Confederate counterpart, Jefferson Davis, in mobilizing public sentiment. One historian has suggested that if the North and South had exchanged presidents, the South would have won the war.
Northern victory consolidated the American Union. In this sense, the Civil War forms part of the nineteenth-century process of nation-building. But Lincoln’s Union was rather different from the nations being constructed in Europe. It was conceived as neither the reclamation of ancestral lands nor the institutional embodiment of a common ancestry, language, or culture. Rather, as Lincoln himself insisted, the nation was the incarnation of a universal set of ideas, centered on political democracy and human liberty. These principles, of course, had been enunciated by the Founding Fathers, but only with the destruction of slavery could the United States seriously claim to represent to the world the idea of human liberty.
It is easy to forget how decentralized the United States was in 1861, and how limited were the powers of the federal government. There was no national banking system, no national railroad gauge, no national tax system, not even reliable maps of the areas where the war would take place. The army in 1861 numbered 14,000 men, the federal budget was minuscule, and nearly all functions of government were handled at the state and local level. The Civil War created the modern national state in America. It also profoundly altered the federal government’s relationship to the American economy. To mobilize the North’s economic resources, the Lincoln administration instituted the first national banking system and national currency, the first national taxes on income, and the first highly protective tariffs, and laid the foundation for the first transcontinental railroad. Whether the war retarded or encouraged economic growth in the short run remains a point of debate among historians. But the economic policies of the Union forged a long-lasting alliance between the Republican Party, the national state, and the emerging class of industrial capitalists. The transfer of political power in Washington from southern planters to allies of northern industrialists and merchants created the political conditions under which the United States emerged by century’s end as the greatest economic power on earth.
Central to the war’s meaning was the abolition of slavery. Slavery lay at the root of the political crisis that produced the Civil War, and the war became, although it did not begin as, a struggle for emancipation. Union victory eradicated slavery from American life. Yet the war left it to future generations to confront the numerous legacies of slavery and to embark on the unfinished quest for racial justice.
The destruction of slavery—by presidential proclamation, legislation, and constitutional amendment—was a key act in the nation-building process. A war begun to preserve the old Union without threatening slavery produced one of the greatest social revolutions of the nineteenth century. The old image of Lincoln single-handedly abolishing slavery with the stroke of his pen has long been abandoned, for too many other Americans—politicians, reformers, soldiers, and slaves themselves—contributed to the coming of emancipation. In 1862, with military success elusive, Radical Republicans in Congress and abolitionists clamoring for action against slavery, and slaves by the thousands fleeing the plantations wherever the Union Army appeared, Lincoln concluded that his initial policy of fighting a war solely to preserve the Union had to change. The Emancipation Proclamation, issued on January 1, 1863, profoundly altered the nature of the war and the future course of American history. It was the Proclamation, moreover, more than any other single wartime event, that transformed a war of armies into a conflict of societies. Although it freed few slaves on the day it was issued, as it applied almost exclusively to areas under Confederate control, the Emancipation Proclamation ensured that Union victory would produce a social revolution within the South and a redefinition of the place of blacks in American life. There could now be no going back to the prewar Union. A new system of labor, politics, and race relations would have to replace the shattered institution of slavery.
Before the Civil War, the definition of those entitled to enjoy the "blessings of liberty" protected by the Constitution was increasingly defined by race. In the Dred Scott decision of 1857, Chief Justice Roger B. Taney declared that no black person could be a citizen of the United States. The enlistment of 200,000 black men in the Union armed forces during the second half of the war placed black citizenship on the postwar agenda. From the war emerged the principle of a national citizenship whose members enjoyed the equal protection of the laws. That principle, which we know today as "civil rights," originated in the Civil War and the turbulent era of Reconstruction that followed.
With Union victory, the status of the former slaves in the reunited nation became the focal point of the politics of postwar Reconstruction. In a society that had made political participation a core element of freedom, the right to vote inevitably became central to the former slaves’ desire for empowerment and autonomy. As soon as the Civil War ended, and in some parts of the South even earlier, blacks who had been free before the war came together with emancipated slaves in conventions, parades, and petition drives to demand suffrage and, on occasion, to organize their own "freedom ballots." Radical Republicans in the North supported black male suffrage both as an act of justice and as the only way to prevent former Confederates from dominating southern political life.
However, Andrew Johnson, who succeeded the martyred Lincoln as president in April 1865, inaugurated a program of Reconstruction that placed full power in the hands of white southerners. The new governments established during the summer and fall of 1865 enacted laws—the notorious Black Codes—that severely limited the rights of former slaves in an effort to force them to return to work as dependent plantation laborers. In response, the Republican majority in Congress in 1866 enacted its own plan of Reconstruction. In the Civil Rights Act of 1866 and the Fourteenth Amendment to the Constitution, they permanently altered the federal system and the nature of American citizenship.
For the first time, the national government assumed basic responsibility for defining and protecting Americans’ civil rights. The Fourteenth Amendment enshrined in the Constitution the ideas of birthright citizenship and equal rights for all Americans. The Amendment prohibited states from abridging the "privileges and immunities of citizens" or denying them the "equal protection of the law." This broad language opened the door for future Congresses and the federal courts to breathe meaning into the guarantee of legal equality, a process that occupied the courts for much of the twentieth century. Later, the Fifteenth Amendment barred the states from making race a qualification for voting. Strictly speaking, suffrage remained a privilege rather than a right, subject to numerous regulations by the states. But by the time Reconstruction legislation had run its course, the federal government had taken upon itself the responsibility for ensuring that states respected the equal civil and political rights of all American citizens. Reconstruction radicalism, however, had its limits. The right to vote, expanded to eliminate the barrier of race, was still restricted to men, despite the demands of the era’s woman suffrage movement. And no steps were taken to provide an economic underpinning for African Americans’ new freedom—the "forty acres and a mule" former slaves insisted would guarantee them economic independence from their former owners.
Nonetheless, Reconstruction witnessed a remarkable political revolution in the South. In 1867, African American men in the defeated Confederacy were given the right to vote and hold office—a radical departure from pre-Civil War days, when blacks could vote only in a handful of northern states. A politically mobilized black community joined with white allies to bring the Republican Party to power throughout the South, and with it a redefinition of the purposes and responsibilities of government. The region’s first public school systems were established, and efforts were made to rebuild and diversify the shattered economy. For the first time in American history, black men held positions of political power, ranging from the US Congress to state legislatures, and local sheriffs, school board officials, and justices of the peace. The Reconstruction ideal of interracial democracy and color-blind citizenship eventually succumbed to a counterattack from violent organizations like the Ku Klux Klan and the progressive abandonment of the principle of equality in the North and the idea of federal intervention to protect the rights of the newly freed slaves. Not until the "Second Reconstruction"—the civil rights revolution of the 1960s—would the United States once again seek to come to terms with the political and social consequences of the destruction of slavery.
With the overthrow of biracial state governments in the South and the withdrawal of the last federal troops from the region by President Rutherford B. Hayes in 1877, the era of the Civil War and Reconstruction came to an end. But conflict continued in the arena of historical interpretation and public memory. In the North, the Grand Army of the Republic, the organization of war veterans, became a fixture of Republican politics and a presence in every northern community. Even as the Republican Party abandoned its earlier idealism, the loyalties created by the war helped it retain national dominance well into the twentieth century. In the South, the Confederate experience came to be remembered as the Lost Cause, a noble struggle for local rights and individual liberty (with the defense of slavery conveniently forgotten).
By the turn of the century, as soldiers from North and South fought side by side in the Spanish-American War, it seemed that the nation had put the bitterness of the 1860s behind it. But the road to reunion was paved with black Americans’ shattered dreams. With northern acquiescence, the Solid South, now uniformly Democratic, effectively nullified the Fourteenth and Fifteenth Amendments and imposed a new racial order based on disenfranchisement, segregation, and economic inequality.
Historical accounts of Reconstruction played an important part in this retreat from the ideal of equality. For much of the twentieth century, both scholarly and popular writing presented Reconstruction as the lowest point in the saga of American history. Supposedly, Radical Republicans in Congress vindictively fastened black supremacy upon the defeated Confederacy and an orgy of corruption and misgovernment followed, presided over by unscrupulous "carpetbaggers" (northerners who ventured south to reap the spoils of office), "scalawags" (white southerners who cooperated with the Republican Party for personal gain), and ignorant and childlike freed people. After much needless suffering, the South’s white community banded together to restore "home rule" (a euphemism for white supremacy). Originating in the political propaganda of Reconstruction’s opponents, this interpretation rested on the assumption that African Americans were by nature incapable of participating in democratic government and that black suffrage was the gravest error of the Civil War period. This quite inaccurate "memory" of Reconstruction was invoked for decades as a potent defense of the South’s racial status quo in the era of segregation and disenfranchisement. More recently, in the wake of the civil rights revolution of the 1960s, scholars have taken a far more sympathetic approach to Reconstruction, viewing it as an effort, noble if flawed, to create interracial democracy in the South. The tragedy was not that it was attempted, but that it failed.
Overall, the era of the Civil War and Reconstruction raised questions that remain central to our understanding of ourselves as a nation. What should be the balance of power between local authority and the national government; who is entitled to American citizenship; what are the meanings of freedom and equality in the United States? These questions remain subjects of controversy today. In that sense, the Civil War is not yet over.
 David Potter, "Jefferson Davis and the Political Factors in Confederate Defeat," in Why the North Won the Civil War, ed. David H. Donald (New York: Touchstone, 1996), 93–114.
Eric Foner, the DeWitt Clinton Professor of History at Columbia University, is the author of numerous books on the Civil War and Reconstruction. His most recent book, The Fiery Trial: Abraham Lincoln and American Slavery (2010), has received the Pulitzer, Bancroft, and Lincoln Prizes.