Children and Armed Conflict

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Children and Armed Con

ict

Sherry Shenoda, MDa, Ayesha Kadir, MD, MScb, Jeffrey Goldhagen, MD, MPHa

We are really tired of these wars…I’m speaking up for peace. Malala Yousafzai, Nobel Peace Prize laureate and child rights activist

Multiple armed conflicts throughout the world are profoundly impacting the physical and mental health of children. The conflict in Gaza, Syria’s civil war, the targeting of children in Iraq, the kidnapping and murder of schoolchildren in Nigeria, the recruitment of child soldiers by ISIS, and the street violence in inner-city America are among the reasons UNICEF identified 2014 as the most dangerous year in recent history for children.1In past conflicts, children were collateral damage; now, they are targeted victims of war.

In the shadow of this carnage, it is incumbent upon pediatricians as child advocates to respond to these gross violations of children’s rights. We know that we owe children our voices and protection, but it is not always clear how we can advocate for and protect them. This dilemma is especially true with regard to advocacy and support for children affected by wars and violent conflicts distant from the United States. To date, no American Academy of Pediatrics policy has been established regarding the impact of armed conflict on children.

In these circumstances, the principles, standards, and norms of child rights, equity, and social justice provide pediatricians with the capacity to advocate for affected children with the strength of a unified global voice and the power of legal precedent. The United Nations Convention on the Rights of the Child (CRC)2provides clear guidelines, through the explicit articulation of 40 substantive child rights, for the protection of children affected by humanitarian crises, as well as the promotion of their well-being and participation in decisions that are being made on their behalf. The CRC establishes the legal basis and precedent for these rights, in addition to mechanisms to advocate for their implementation in the international arena. Because all rights are interdependent and indivisible, the CRC also underscores the necessity of conducting child rights impact analyses to ensure that all rights due to children as rights-holders (ie, humans with inherent rights) are fulfilled. Particular attention is given to the rights of children affected by armed conflict.

With respect to children in Gaza, for example, the CRC defines the duties of States Parties to protect children from armed conflict (Articles 19 and 38) and exploitation (Articles 34–36). Similarly, with regard to the.1 million displaced Syrian children, the CRC defines the rights of displaced and

a

Department of Pediatrics, University of Florida, Jacksonville, Florida; andbLondon School of Hygiene and Tropical Medicine, London, United

Kingdom

Dr Shenoda conceptualized the article and did the background research to articulate the basics of the problem, drafted the original manuscript, and edited and approved thefinal manuscript; Dr Kadir reviewed and revised the original manuscript, elaborating on specific instances of child involvement in armed conflict and on the specifics of previous successful efforts at mitigating the damage of armed conflict on children; and Dr Goldhagen reviewed and revised the original manuscript, providing a more in-depth analysis of specific articles and the application of the United Nations Convention on the Rights of the Child to the issue of children in armed conflict. All authors provided significant contribution to the writing and revision of the manuscript.

www.pediatrics.org/cgi/doi/10.1542/peds.2015-0948

DOI:10.1542/peds.2015-0948 Accepted for publication May 18, 2015

Address correspondence to Sherry Shenoda, MD, Department of Pediatrics, University of Florida–Jacksonville, 841 Prudential Dr, Suite 1330, Jacksonville, FL. E-mail: sherry. shenoda@jax.ufl.edu

PEDIATRICS (ISSN Numbers: Print, 0031-4005; Online, 1098-4275).

Copyright © 2015 by the American Academy of Pediatrics

FINANCIAL DISCLOSURE:The authors have indicated they have nofinancial relationships relevant to this article to disclose.

FUNDING:No external funding.

POTENTIAL CONFLICT OF INTEREST:The authors have indicated they have no potential conflicts of interest to disclose.

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refugee children to protection and humanitarian assistance (Articles 20 and 22), with explicit guidance on the care of unaccompanied minors (Article 22), the management of situations in which children are separated from their parents (Article 9), and children’s rights to freedom of thought, conscience, and religion (Articles 12 and 14). The CRC delineates responsibilities of transit countries (Article 30), outlines the process of guardianship and reunification with family members (Articles 5 and 10), and addresses the provision of educational, health, and welfare services (Articles 24, 26, 27, and 28). Under the CRC, children who have been affected by armed conflict have the right to rehabilitation and reintegration in an environment that fosters their physical and mental health, self-respect, and dignity (Article 39).

By using a rights-based approach to advocacy and trauma-informed protocols, organizations such as War Child3and UNICEF4are able to create child-safe spaces for recovery and reintegration and thereby mitigate some of the harm caused by armed conflicts. They provide children with skills to cope with their experiences and look beyond them toward education and opportunities for a brighter future. These and other similar organizations endow physicians with the capacity to advocate for children affected by armed conflict in the domains of clinical care, health systems, and policy. Other physician-led

organizations, including International Physicians for the Prevention of Nuclear War, Physicians for Social Responsibility, and Physicians for Human Rights, have established a precedent for action by promoting and protecting the rights of patients, families, and communities. These organizations provide opportunities for physicians to support and engage in the investigation of rights abuses, political advocacy, and the generation of global health policy.

The CRC is a particularly useful tool for pediatricians and other health workers involved in the clinical care of children affected by armed conflict in the United States and globally. Simple removal of children from conflict is not enough; affected children have the need and right to have their best interests considered in decisions that affect them (Article 3), without discrimination (Article 2), and to health care relevant to their needs (Article 24), with the goal of achieving a state of optimal health and well-being (Article 6). They also have the right to rehabilitation and guided

reintegration postconflict (Article 39). As refugees and other children escaping violence are resettled in host countries, pediatricians and other health workers involved in their medical care should use the rights-based framework provided by the CRC to assess and respond to children’s medical, behavioral, psychological, and social needs in a holistic manner. These needs translate into the rights due to the child, rights that are indivisible and interdependent.

Although the United States remains the only country that has not ratified the CRC, this exclusion does not preclude its use by pediatricians as a powerful tool to advocate for and advance the health and well-being of children affected by armed conflict and violence. Ratification of the CRC and its Optional Protocol on Children and Armed Conflict would, however, establish a stronger legal basis for the national and global voice of US pediatricians, and both validate and increase the credibility of their long-standing advocacy for children’s health and well-being. It is thus important for the American Academy of Pediatrics and other pediatric professional societies such as the Academic Pediatric Association, the American Pediatric Society, and pediatricians as citizens to redouble their efforts in support of

ratification.

In this regard, pediatricians should be prepared to address the most frequent legal, political, and cultural objections to ratification. Although a detailed discussion of these objections is beyond the scope of this article, they include, among others: (1) opposition to the United States being subject to international law; (2) hesitancy to extend

socioeconomic rights to children that would havefinancial consequences; (3) objections to allowing children and adolescents any capacity for independent decision-making, such as accessing family planning, choosing religious affiliation, or friendships; and (4) arguments that extending rights to children will negatively affect parental rights. For example, the group Parental Rights has raised concerns about the potential for the United Nations to usurp the rights of parents to raise their children if the United States ratified the CRC.5However, 9 articles in the CRC refute this argument by explicitly defining the critical responsibilities, roles, and rights of parents to act in the best interests of their children. A number of publications discuss these

concerns regarding ratification and provide careful and thorough counterarguments.6

Pediatricians have the knowledge, experience, and credibility to prioritize the effects of armed conflict on children in thefields of medicine and public health. As child advocates and duty-bearers (ie, people whose duty it is to protect and promote the rights of children), we have the responsibility to articulate and disseminate our knowledge and experience to policy makers in our own educational and professional organizations as well as in our governments. Toward this end, it is vitally important that we develop and publish policies that condemn the involvement of children in armed conflicts as a pressing child-rights issue, disseminate these policies widely, and argue for the

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implementation of rights-based interventions for the preventing and mitigating of the impact of armed conflict on children.

It is imperative that we address armed conflict and the violence it wreaks upon children by using the language and structure of child rights. Our efforts will be more just, honest, and effective if we do so by

translating the principles, standards, and norms of child rights into practice in clinical care, health systems development, and the generation of health policy. The American Academy of Pediatrics has taken a step in guiding pediatricians on how to do this through its policy statement“Health Equity and Children’s Rights.”7We must implement the policy statement, continue to advocate for ratification of the CRC in the United States, and, above all, stand together with Malala

and others who speak and act so passionately for the peace we seek for all of our children.

ABBREVIATION

CRC: Convention on the Rights of the Child

REFERENCES

1. UNICEF. With 15 million children caught up in major conflicts, UNICEF declares 2014 a devastating year for children. Available at: www.unicef.org/media/ media_78058.html. Accessed March 11, 2015

2. United Nations Human Rights, Office of the High Commissioner for Human Rights. Convention on the Rights of the Child. Available at: www.ohchr.org/EN/ ProfessionalInterest/Pages/CRC.aspx. Accessed March 11, 2015

3. War Child, Youth Working Group. Youth and conflict—briefing paper. Available at: www.warchild.org.uk/about/publications/ youth-and-conflict-briefing-paper. Accessed April 28, 2015

4. UNICEF. Advocacy campaign on mental health and psychosocial support in emergencies. Available at: www.unicef. org/protection/57929_57983.html. Accessed April 28, 2015

5. Gunn TJ. The religious right and the opposition to US ratification of the convention on the rights of the child, 20. Emory Int’l L Rev.2006;111:128

6. Bartholet E. Ratification by the United States of the convention on the rights of the child: pros and cons from a child’s rights perspective.Ann Am Acad Pol Soc Sci. 2011;633(1):80–101

7. Council on Community Pediatrics and Committee on Native American Child Health. Policy statement—health equity and children’s rights.Pediatrics.2010; 125(4):838–849

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DOI: 10.1542/peds.2015-0948 originally published online July 6, 2015;

2015;136;e309

Pediatrics

Sherry Shenoda, Ayesha Kadir and Jeffrey Goldhagen

Children and Armed Conflict

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DOI: 10.1542/peds.2015-0948 originally published online July 6, 2015;

2015;136;e309

Pediatrics

Sherry Shenoda, Ayesha Kadir and Jeffrey Goldhagen

Children and Armed Conflict

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