Fergal Kin
Warning: The text contains details about the impact of conflict on children in war zones and descriptions of injuries that may be disturbing to some readers.
Abdelrahman's father was killed first. The family home was hit in an Israeli airstrike. The boy's mother, Asma al-Nashash, 29, recalls that they "carried him out in pieces."
Then, on July 16, 2024, an airstrike hit a school in Nuseirat, in central Gaza.
Eleven-year-old Abdelrahman was seriously wounded.
Doctors had to amputate his leg.
His mental state began to deteriorate.
“He started pulling his hair out and hitting himself very hard,” Asma recalls.
"He turned into a depressed boy, seeing his friends playing and running around, and him sitting alone."
When I met Abdelrahman in a hospital in Jordan in May 2025, he was withdrawn and cautious.
Dozens of children have been evacuated to the Kingdom of Jordan from Gaza for medical treatment.
“We will return to Gaza,” he tells me.
"We will die there."
Abdelrahman is one of thousands of traumatized children I have met in nearly four decades of reporting on war conflicts.
Some faces are etched in my memory.
Some of them seem like I met them yesterday.
They reflect the depth of the horror inflicted on children in our time.
The first was on a hilltop in Eritrea in the mid-1980s.
Adonai Mikael was a child victim of an Ethiopian napalm attack, crying in agony as the wind blew dust into his wounds.
His screams, the expressions of pure agony in his eyes, forced me to flee from the tent where he was being treated.
In Belfast a few years later, I remember a boy walking behind a coffin with his father, who had been blown up by Irish Republican Army (IRA).
I've never seen so much distance in someone's eyes before.
In Sierra Leone during the civil war, there was a little girl whose hands were cut off by a drunken paramilitary; from Soweto, there is a picture of a child helping his mother sweep the blood of a murder victim from their doorstep; and in Rwanda, there is a boy who broke down when I asked him why the other children called him "Grenade" - a moment of callousness that I will forever regret.
He was wounded in the explosion that killed his parents.
The numbers support the sheer scale of the crisis.
In 2024, 520 million children - one in five in the world - lived in conflict zones, according to an analysis by the Oslo Peace Research Institute, which cross-referenced conflict records with population data to arrive at that estimate.
Professor Teresa Betancourt, author of the book Shadow into Light (Shadows into Light: A Generation of Former Child Soldiers Comes of Age), a book about former child soldiers, calls this "the greatest humanitarian disaster since World War II."
She warns that trauma has consequences that reach far into the future.
"It can affect the developmental architecture of the brain in young children, with lifelong consequences for learning, behavior, and physical and mental health."
But considering how much time has been spent researching the effects of war on children's minds, what can help?
This is a question that has never been more relevant than after this period of numerous global conflicts that have affected millions of children:
- from Sudanese who, in October, saw their mothers and sisters raped by paramilitaries in El-Fasher, Darfur;
- through the young men kidnapped from Israel by Hamas on October 7, 2023, many of whom witnessed the massacre of their families and neighbors;
- to children from Pumpkins in Ukraine, whose parents were allegedly massacred by Russian troops in February 2022 (Russia has steadfastly denied any crimes from the beginning, claiming they were fabricated);
- and hundreds of thousands of children like Abdelrahman who have suffered through more than two years of war in Gaza.
I must point out here that I have personal experience in this field.
I suffered from post-traumatic stress disorder (PTSD), both as a child from a broken home and later, as an adult, witnessing war and genocide.
Although it's different from experiencing war as a child, I know the symptoms all too well: extreme anxiety, hypervigilance - when you're constantly on guard against threats - flashbacks, nightmares, and depression.
The symptoms were severe enough to require several hospital treatments.
My personal experience has made me extremely curious about how children react to all of this and how they are treated.
“The evidence is pretty strong across various studies that exposure to war and displacement is associated with a higher risk of mental health problems,” says Michael Plus, a professor of psychology at the University of Surrey.
He has conducted long-term research on children of Syrian war refugees and warns that assumptions should not be made lightly.
"It's important to accept the fact that children differ in how they react."
A variety of factors can influence the outcome.
How long was the child exposed to these traumatic events?
Were the children physically injured?
Have they lost someone important in their lives or seen them killed or wounded?
Did they have physical safety and emotional support after all?
A sample of 2.976 children from Bosnia and Herzegovina, all of whom were exposed to war and were between the ages of 9 and 14, reported high levels of post-traumatic and grief symptoms.
But there is the potential for long-term health damage - heart disease, autoimmune problems - associated with "toxic stress", when the body is flooded with hormones such as cortisol and catecholamines, which produce adrenaline.
There is also a nascent field of research called epigenetics, which asks whether the experience of trauma in one generation can manifest itself in later generations through changes in the way our genes behave.
Are we more susceptible to, say, poorer mental health, addictions, or other health problems if our families have a history of trauma - and how much does that have to do with genetics versus family environment and everyday lives?
- Invisible children born from rape during the war in Bosnia
- Memories from the war school in Bosnia
- Genocide in Srebrenica through the eyes of children
The family trickle-down effect
Epigenetics is a much-discussed, experimental area of scientific research in which there is still much to learn.
"I think there is some evidence for some kind of intergenerational transmission of trauma," says Professor Plus.
"Some of it or most of it will happen through social practices rather than biological practices, but there is some evidence to suggest that some epigenetic factors are at work as well."
Professor Metin Basoglu, director of the Istanbul Center for Behavioral Sciences, is skeptical.
However, he says it is possible that certain temperament traits (for example, predispositions that are passed down genetically through generations) make some people more vulnerable to traumatic events.
While researching a book about my own PTSD, I recall a conversation with one of the most eminent experts in the field, Professor Simon Wesley, former President of the Royal College of Psychiatrists.
I wondered if my own family history - great-grandparents born during the Great Famine in Ireland, a grandmother who was traumatized by wartime experiences in the 1920s - could have made me genetically more susceptible to PTSD?
“There’s simply no way to know that, without studying a representative group of samples from the same area, with ancestors born in the same area and exposed to the same conditions,” he told me.
"I can't do this to one person...
"What I think is much easier to understand - and, I think, also the strongest - is the influence of our environment."
"And it's absolutely impossible to grow up in the household you grew up in, with the interests you have, without it having an impact on you."
There is a broad consensus that trauma is a family crisis.
It's not just a matter of what a child sees or experiences - there's also the impact on adults.
“Not only do children in war zones face the death of caregivers and traumatic separations,” says Professor Betancourt, “but caregivers are also experiencing their own trauma and pain, and therefore may not be fully available to help protect and guide children through the horrors of war.”
Professor Plus's research among Syrian refugees supports this.
Among the 80 percent of children who were found to be vulnerable to more than one psychological disorder, family circumstances were key.
The study, published in 2022, involved about 1.600 Syrian refugee families in Lebanon.
Professor Plus says that children's living conditions (such as access to safe housing, food and schooling) have been shown to be "about ten times more predictive of their mental health".
Children who adjusted more healthily may have had "a social environment that was very protective of them, maybe their parents were able to protect them, maybe they had close friendships, relationships, maybe they had access to school, all those external things that somehow mitigate the negative impacts of war exposure."
The roots of this knowledge in the UK go back to World War II and the experiences of children who survived eight months of German air raids from September 1940 to May 1941.
Professor Edgar Jones of King's College London points to a study conducted on 212 children treated at Great Ormond Street Children's Hospital during the war.
When researchers looked for the children in 1949 - four years after the conflict ended - they found that only 21 percent of the children had recovered.
The role of parents - both positive and negative - emerged as an important finding.
"It has been estimated that the severity of children's reactions to the bombing was influenced by their parents' reactions to the trauma, either by increasing or calming their anxiety," says Professor Jones.
Overcoming fear and establishing control
In my experience, therapy and medication helped, as did the constant support of family and friends.
Without the power of caring relationships, I don't believe I would have been able to climb out of the darkness.
I was encouraged to confront my own avoidance of anything that might remind me of my trauma.
For example, I went through a long period of avoiding traveling to the African continent, fearing that my mere presence there would trigger reminders of the Rwandan genocide.
But my therapist gradually began to encourage me to face my fear.
It took me a few years, but I did return, and I continue to visit places there that are dear to my heart.
Professor Basoglu pioneered the use of something called CFBT - Controlled Focused Behavioral Therapy - among survivors of the 1999 Turkish earthquake, which killed 18.000 people.
The idea is to encourage individuals to take control of their own fear of the event happening again.
In the case of children who constantly clung tightly to their parents, this was attempted by encouraging them to get used to sleeping alone.
"Once they overcame the fear, all reactions to traumatic stress associated with the fear also improved," says Professor Basoglu.
Israeli psychologists working with children released from Hamas captivity after the October 7 attack also emphasize the importance of reestablishing a sense of control.
In the magazine studio Child and adolescent psychiatry and mental health, a team of Israeli specialists wrote that this was achieved by “providing survivors with information and a space to express their concerns, while ensuring that their needs and voices are heard.”
But successful interventions depend heavily on creating a stable environment in which the fear of being killed or maimed is not a constant reality.
"What they also need is for their parents to be well, for them to live in a safe place, for them to have access to education, for them to have a routine, for them to have some kind of predictability," says Professor Plus.
This is rarely certain in war-torn areas.
Truces are breaking down. Front lines are freezing. Displaced people are stuck in camps.
'We were dehumanized'
Yet those words about a safe place bring to mind my friend Beata and the difference that stability has made in her life.
She was 15 when the Rwandan genocide - the worst mass killing since the Nazi Holocaust - broke out in 1994.
Up to 800.000 people, mostly members of the Tutsi minority, were massacred over a period of 100 days.
As a journalist, I traveled in a convoy evacuating orphaned children, including Beata Umubjeki Maires, through roadblocks manned by the murderous Interahamwe militia.
It was a terrifying experience, but especially for the children whose families were killed.
From blockade to blockade, we didn't know if we would be attacked by gangs wielding machetes.
Years later, when she was researching her own experiences (later published in the book Convoy), Beata contacted me.
I remember how taken aback I was by her composure and openness.
She was married, had two children, lived in France, and was now a successful writer.
"The first thing that helped me was exile in France, because I left behind the scenes of genocide."
"I found myself in a safe, peaceful place, with shelter, a foster family that took care of all my material needs, and with the opportunity to see a psychologist."
"I went back to school in September and that helped me too."
Beata was joined by her mother, who also survived.
Her father died before the massacre began.
Although she was very composed, some fears remained.
She panicked one night when classical music was played on the radio - similar to the music played on Rwandan radio the night the genocide began.
Fireworks or the sounds of hunters firing forced her to hide under a desk in the classroom "because I thought war had broken out in France."
I wondered if he was making a conscious effort to protect his own children from the traumatic legacy of the genocide.
"There are things that are hard to tell your children, how we were dehumanized, how I was almost raped. The term 'unspeakable' makes sense when you're telling these stories to children. We're afraid of contaminating them with our own trauma."
But for Beata, multi-layering is key here.
"Their only image of Rwanda must not be genocide."
"I told them stories from my childhood and every time I went there, I would bring them fruit so they could also discover a land full of diverse flavors."
Although she lives a fulfilled and happy life, Beata still suffers from anxiety and takes antidepressants to combat insomnia.
I also take medication, and like Beata, I don't see it as a burden or a stigma.
Instead, I consider myself lucky to have access to care and medication.
Creating a safe community is also seen as crucial among many experts.
“They are not just victims of mental health,” says Professor Plus.
"They are little people with interests and so they need to go to school, they need to have opportunities to play together - and that could be just as important as dealing with the mental health issues they are facing."
Psychologists working in Gaza are well aware of these needs.
Davide Musardo, who volunteers with Doctors Without Borders, wrote about trying to provide therapy while drones attack and explosions are heard in the background.
"In Gaza, you can survive, but the exposure to trauma is constant. Everything is missing, even the idea of a future."
"For people, the greatest suffering is not today's - the bombs, the fighting and the mourning - but what comes after."
"There is very little faith in peace and reconstruction, and the children I saw in hospitals showed clear signs of regression."
It is possible that, in devastated Gaza, the current ceasefire will become a permanent peace, allowing for the renovation and restoration of family life and education.
It is possible, but by no means certain.
There are attempts to renew negotiations in Sudan, but very little optimism about their outcome.
The war in Ukraine, and many other wars, continue to rage every day.
Trauma is as old as war itself.
Politicians, journalists, and experts interested in the consequences of conflict often ask: "What will happen when the killing stops?"
But elsewhere the killing will continue.
It is the relentless tragedy of children caught in wars they did not start, and over which they have no control.
Despite all the knowledge gained about treating trauma, humanity is far from dealing with its main cause - war itself.
Additional reporting: Harriet Whitehead
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