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Position statement

Caring for children and adolescents impacted by armed conflict: A rights-based approach

Posted: Oct 15, 2025

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Principal author(s)

Shazeen Suleman MD, Charles Hui MD, Ripudaman Minhas MD, Ashley Vandermorris MD; Canadian Paediatric Society, Caring for Kids New to Canada Task Force

Abstract

Understanding how armed conflict impacts children and adolescents in wartime helps their care providers take the necessary time and space to attend to, and address, the unique exposures and health needs of newcomer families to Canada. This statement examines the direct, indirect, and remote effects of armed conflict on those disproportionately affected by violence, disruption, and displacement. Young people whose educational, socially supportive, and health service structures are seriously compromised or destroyed by armed conflict often experience huge gaps in access to care and live with long-unmet physical and mental health needs. Based on Canada’s obligations under the United Nations Convention of the Rights of the Child, this statement offers strategies and resources that care providers can use to better recognize, appreciate, and address the effects of armed conflict—and migration experiences—as part of essential quality care.

Key words: Armed conflict; Health effects; Mental health effects; Paediatrics; War

Background and context

For centuries, conflicts between rival powers, countries, and alliances have led to cycles of violence, displacement, and destruction in much of the human world. Armed conflict, defined by international law as “war, civil war or armed hostilities” involves weapons use between states or against a non-state actor[1] (Box 1). International law determines what the rules of engagement in armed conflicts should be, and when these are breached, relevant actors can be brought to trial before the International Criminal Court[2].

Studies indicate that armed conflicts arise from multiple causes, with political and economic instability, religious, ethnic, and racial discrimination, nationalism, and limitations on resources driven increasingly by climate change commonly implicated in recent hostilities[2]-[4]. Where armed conflicts drive displacement they disproportionately impact children and adolescents, women, and the elderly. At the end of September 2023, an estimated 114 million people worldwide had been displaced by war or armed conflict[5].

Nearly 40 years ago, the United Nations conceived, wrote, and adopted the Convention of the Rights of the Child (UNCRC), which Canada ratified in 1991[6]. The UN was responding in part to the rising numbers of children being impacted by armed conflict and other humanitarian disasters around the world, and recognizing that children’s rights need to be articulated and upheld by international law. The UNCRC asserts that children are entitled both to the full breadth of human rights afforded to adults and to specific legal protections based on their unique developmental needs and vulnerabilities. Integral to protecting their rights as children is enabling them to grow and thrive “in an atmosphere of happiness, love, and understanding” and supporting their development in alignment with the ideals of “peace, dignity, tolerance, freedom, equality and solidarity”[7]. Importantly, the UNCRC emphasizes the responsibility of all countries to work to improve the living conditions of children in every country.

As a Convention signatory, Canada assumed the obligation to respect, protect, and fulfill the rights of children as expressed in the UNCRC, and is legally bound by its terms[8]. As paediatric health care providers practicing in that context, we are likewise bound to uphold the principles of the UNCRC through our work with children, adolescents, and families. Critically, our duty extends to supporting the fundamental rights of all children and adolescents, including migrant young people and those displaced by armed conflict, whether they are citizens of or residing in Canada or elsewhere[9].

This statement describes the impacts of armed conflict on children and adolescents and outlines how Canada’s obligations under the UNCRC can guide the work of paediatric care providers, while recognizing that armed conflicts occur and will continue to occur in various contexts around the world. Whether experienced directly, indirectly, or even remotely, armed conflicts affect young people at different times and in different ways (Box 1).

Box 1. Terms and definitions

Armed conflict

Can occur within or across borders and involves the use of violence or weapons between states or non-state actors (e.g., militias, gangs, terror organizations)

Direct impacts of armed conflict

Affect the physical and mental health of children living in close proximity, including disruption of family supports and undermining or destroying health care, educational, or social infrastructure through violence

Indirect impacts of armed conflict

Affect children and adolescents who may no longer live near armed conflict but experience downstream effects (e.g., on social determinants of health)

Remote impacts of armed conflict

Affect children and adolescents who are not in close proximity to armed conflict (e.g., as part of a diaspora) but who are still connected with a conflict due to family, culture, or other bonds

Direct impacts of armed conflict on children and adolescents

At time of writing, more than 473 million children were living near an armed conflict and another 47.2 million had been displaced[10]. This statement describes the direct impacts of armed conflict on the physical and mental health of children and adolescents living in close proximity to conflict settings, including when health care, educational, or social infrastructure has been destroyed[11]. In general (and explored more specifically below) armed conflicts increase child mortality and morbidity through malnutrition, physical injuries, infectious diseases, poor mental health, and poor sexual and reproductive health[12]. The destruction of health care systems and infrastructure impedes delivery of preventative care, including vaccine delivery, prenatal and well-child care, and interferes with timely access to life-saving treatments for children and adolescents directly injured by conflict, which is discussed in further detail below. 

UNICEF has identified six grave violations perpetrated against children and adolescents in time of war: killing and maiming; the recruitment or use of children and adolescents in armed forces or groups; attacks on schools or hospitals; rape or other grave sexual violence; abduction; and denying humanitarian access for children[13]. Between 2005 and 2023, UNICEF verified more than 347,000 grave violations in thirty conflict situations across the world, which is likely an underestimate[13].

Direct measures of child and adolescent mortality caused by armed conflict are difficult because surveillance infrastructures are frequently disrupted as mobile populations flee unsafe conditions. Various methodologies can yield wide-ranging estimates, but the destruction of health care, shelter, and food sources is believed to increase child mortality rates more than direct violence[14]. It has been estimated that between 10 and 11 million children under the age of 5 years died due to armed conflict between 1995 and 2015, which represents approximately 6% of all infant and child deaths during that period[15]. In addition to weapons-related injuries, unexploded ordnance such as landmines can cause life-long injuries and disabilities, including well after an armed conflict has receded. In one systematic review, landmine injuries were found to result in amputations or traumatic brain injuries in 38% of cases[16].

The destruction of public health care infrastructure in conflict settings has wide-reaching impacts, with both vaccine-preventable and other infectious diseases spreading rapidly for many reasons[17]. Overcrowding and the disruption of routine vaccine delivery programs increase the risks of spreading vaccine-preventable diseases such as measles and polio, while displacement and shifting populations create high-risk environments for outbreaks of cholera, hepatitis E, and tuberculosis[17]-[22]. The breakdown of basic health-related systems, such as access to clean water, sanitation, and public health services, further limits preventive programs (e.g., immunization), and the diagnosis, management, and prevention of serious infections. 

Armed conflicts often destroy social services related to food, education, and health care[23], with consequences for the health of children and adolescents living near or in conflict areas that cannot be overstated. Armed conflicts drive food insecurity for millions of people worldwide[24]. Chronic malnutrition and growth aberrations such as low birth weight, stunting, and wasting are experienced by children born in conflict zones[25]-[27], all of which can have life-long, negative impacts on development. Attacks on educational and health care facilities during armed conflicts are considered to violate international law, yet they often occur, directly causing morbidity and mortality, disrupting educational opportunities, and negating the protections normally afforded to children and adolescents by educational settings[28][29].

Armed conflict can be traumatic for anyone experiencing it. But for children and adolescents, exposure to violence, especially when coupled with displacement, separation from familiar environments and caregivers, and disrupted community supports, has been associated with increased prevalence of mental health disorders. Anxiety disorders and depression rates are two to four times higher than global norms in conflict-affected populations[30]. The loss of physical and community safeguards leaves children, adolescents, and women vulnerable to sexual violence and exploitation[31][32]. One review of sexual violence in women refugees in complex humanitarian emergencies estimated that 21% experienced sexual violence, which is likely an underestimate. Sexual violence directly affects mental and reproductive health while increasing risk for sexually transmitted infections[33][34]. Disruptions in preventative sexual and reproductive health care delivery for adolescents and young adults are common during armed conflict[34] and can have lifelong consequences. Missed opportunities for family planning and lack of access to sexual health screening can lead to increased rates of unplanned pregnancy and chronic infection. 

Indirect impacts of armed conflict on children and adolescents

The downstream effects of health care system breakdown, with resultant impacts on social determinants of health, have been well described[35]. We know the impacts of armed conflict on children and adolescents resonate well beyond direct or in-the-moment effects. Health care providers in Canada must be able to recognize and appreciate the potential for indirect and remote conflict-related effects presenting in newcomer children, adolescents, and families.

Many children and adolescents affected by armed conflict arrive in Canada as refugees, asylum seekers, or displaced persons. They may face detention in an immigration holding centre or other facility upon arrival[36]. To date few children have been detained in Canada, but it remains important to recognize and anticipate the potential for psychological and physical harms occurring in detention facilities[37]-[40].

Caring for children and adolescents who have experienced migration and forced displacement, regardless of their immigration status, demands consideration of their unique health needs[41]. Specific needs and implications for care are detailed at the Canadian Paediatric Society's Caring for Kids New to Canada website. For immigrants fleeing armed conflict, physical health needs are often amplified by trauma. Also, they may have experienced huge gaps in access to care and be living with long-unmet physical and mental health needs[42][43]. Clinically, migrant children and adolescents who have experienced armed conflict may present with wide-ranging physical conditions—from under-immunization and infectious diseases, such as tuberculosis[45], to nutritional and growth concerns, including toxic lead exposures[46] and malnutrition[47]. Co-occurring mental health, developmental, and behavioural concerns[48] may also be present, such as post-traumatic stress disorder (PTSD), anxiety, depression, or suicidality[48].

Children, adolescents, and families affected by armed conflict may require extra support over time from health care providers related to resettlement and acculturation processes[49]. This care may include supports for integrating into educational settings following prolonged absences from formal schooling. Children and adolescents with a pre-existing chronic illness or disability who arrive in Canada as refugees or asylum-seekers have already encountered the burdens and barriers imposed by broken health care systems and services[50][51]. Upon arrival they face additional barriers to care posed by a new health care system[52], health insurance that varies depending on immigration status[53][54], language barriers[42], and a disjointed, often siloed network of services for children and adolescents with disabilities and other chronic conditions.

Focused care must be given to unaccompanied and separated children (UASC) who arrive in Canada without a parent or guardian[55]. Canada does not have a coordinated, centralized federal agency responsible for tracking unaccompanied adolescents in particular, making it difficult to know precisely how many UASC are living in Canada[56]. Often UASC are referred to provincial/territorial child protection agencies that can help support progress toward permanent immigration status[57]. However, racialized or otherwise minoritized UASC may experience new exposures to harm in the child welfare system[58]. Unaccompanied adolescents are at higher risk for poorer physical and mental health outcomes in the longer term, sexual and criminal exploitation, and of becoming the victims of trafficking[43][59]. Health care providers should be especially attentive to the health, safety, and well-being of UASC that present to care.

Armed conflict seriously undermines social determinants of health for children, adolescents, and families, even at a distance. Migrant families in Canada face high levels of poverty and food and housing insecurity[60]-[62]. Rising xenophobia and racism also threaten their well-being and safety[63][64]. Many families, particularly those with precarious immigration status, live in fear of separation due to deportation, a vulnerability that can lead to children and adolescents being separated from the only caregivers (and even countries) they have ever known[65]. While some Canadian jurisdictions have protections in place for newcomers under the age of 19 who are in the care of a child welfare agency, there are no such provisions for children and adolescents living with caregivers[66]. Some children and adolescents born in Canada have parents who fled armed conflict but whose status is precarious, and they may face the anguish of losing a parent through deportation or another mechanism of separation[67].

Remote impacts of armed conflict on children

Practitioners are also likely to encounter children and adolescents living with the remote effects of armed conflict. A great many individuals in Canada identify as members of widespread but also close-knit ethno-cultural communities (diaspora). For them, more remote impacts of armed conflict abroad should not be underestimated. Children and adolescents are affected when families struggle to cope with distressing news of injuries, killings, or other negative impacts of armed conflict on distant family members or communities. They may face interpersonal and systemic racism, hate, and discrimination. They are also exposed to household or community discussions, media coverage, or social media content relating to wars elsewhere[68]-[70]. Distressing conversations and news content impact children and adolescents in different ways based on their developmental age and stage, personal temperament, and current mental state. Potentially triggering television, media, and social media content can increase the likelihood of experiencing PTSD symptoms[71]. Remote effects can be accentuated when children or adolescents perceive anxiety or duress in their caregivers[72], who may struggle with re-triggering their own traumatic experiences when watching the news or hearing of loved ones impacted by armed conflict. Even the remote impacts of armed conflict can be challenging for children and adolescents because they have the potential to disrupt development, especially in cognitive domains, where mental constructs of social safety evolve[73]. Serious disruption of these constructs can lead to PTSD symptomatology and other mental health impacts in the longer term.

Responding to the impacts of armed conflict

Paediatric health providers in Canada have a responsibility to understand how armed conflict may be impacting newcomer patients, families, and the broader community (Figure 1).

Figure 1. Direct, indirect, and remote impacts of armed conflict on children, adolescents, and families

Clearly, the exposure of children and adolescents to armed conflict directly undermines the rights codified in the UNCRC. Not only do conflict conditions put the survival and development of children at immediate risk (UNCRC Article 6) but they also produce a measure of geopolitical instability that undermines the rights of all  young people to grow and develop in a world dedicated to peace, which includes promotion of their best interests[7].

Recognizing this, Article 38 of the UNCRC calls for “the protection and care of children who are affected by an armed conflict”[7], whether directly, indirectly, or remotely. More broadly, the UNCRC grounds our common values and priorities as paediatric care providers and helps us orient efforts to ensure apolitical, child and youth-centred, trauma-informed care for all young newcomers to Canada.

We know that every clinical encounter is an opportunity to assess for, identify, and address issues impeding the well-being of individual children or adolescents. Taking the time and space to attend to and consider the unique exposures of newcomers, including the impacts of conflicts endured or their migration experiences, is essential quality care. We know that children and adolescents can be disproportionately impacted by armed conflict and often have multiple marginalized identities. The following strategies can help ensure quality care for young newcomers to Canada:

  • Comprehensive health screening guided by the Caring for Kids New to Canada website.
  • Mental health screening and referral to care providers trained to work with children and adolescents affected by armed conflict.
  • Awareness of and screening for gaps in care caused by the indirect effects of armed conflict.
  • Providing trauma-informed care for all patients[74][75].
  • Appropriate use of trained interpreters during clinical encounters.
  • Developing partnerships with settlement agencies and other community-based organizations supporting newcomer children, adolescents, and families.

Beyond clinical encounters, upholding the rights of children and adolescents should include:

  • Researching medical approaches and strategies that mitigate armed conflict-related risks to children’s well-being.
  • Integrating the rights of children and adolescents into medical school and health professional curriculums.
  • Engaging in advocacy work to draw attention to and help counter threats to young people’s safety, liberty, and healthy development (e.g., ending child detention, keeping families together, speaking out against rights violations, and supporting policies that uphold the rights of children and adolescents).

Conclusion

War anywhere in the world is harmful for children and adolescents everywhere. As child health advocates in Canada, a signatory to the UNCRC, paediatricians should centre the rights it codifies and apply its principles in practice by championing justice and safety for children and adolescents worldwide. When caring for young people impacted by armed conflict, we must attend to and address their unique needs while upholding their rights. Children and adolescents everywhere deserve to be healthy, nurtured, and safe, and the onus of care for newcomers must be rights-centred, trauma-informed, and advocacy-driven.

Recommended resources

Acknowledgements

The Board of Directors thanks the following Canadian Paediatric Society groups for their careful review of this position statement: Antiracism Steering Committee; Caring for Kids New to Canada Task Force; Global Child and Youth Health Section Executive; and Mental Health and Developmental Disabilities Committee.

Funding
There is no funding to declare.  

Potential Conflict of Interest
The authors have indicated they have no conflicts of interest.

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Disclaimer: The recommendations in this position statement do not indicate an exclusive course of treatment or procedure to be followed. Variations, taking into account individual circumstances, may be appropriate. Internet addresses are current at time of publication.

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