Advocacy for children in conflict areas

Salem Professor in Global Practice Theresa Betancourt, director of the Research Program on Children and Adversity (RPCA), Assistant Professor William Byansi, and doctoral student Maria Gutiérrez Torres were co-authors of one of three recent articles in the BMJ—formerly known as the British Medical Journal—penned by members of the World Innovation Summit for Health (WISH), whose affiliations include the Centre for Global Child Health, Center for Violence and Injury Prevention, International Pediatric Association, and Institute for Global Health and Development.

According to WISH, it is estimated that more than 473 million children—one in five—are living in active conflict zones (not including the numbers in post-conflict settings such as Sierra Leone or Rwanda). Assistance for these children must move beyond initial, event-based responses to investment in mental health and social services systems that can provide support along the life course for families recovering from cumulative and intergenerational adversity, say the authors. WISH advocates integrating mental health and psychosocial supports (MHPSS) across health, education, and social protection platforms.

An internationally recognized expert in war-related childhood trauma, Betancourt has conducted a two-decade study of children who were pulled into Sierra Leone’s bloody 11-year civil war. That work has been cited as the most extensive examination of post-war intergenerational relationships since studies of Holocaust survivors. Her book Shadows Into Light: A Generation of Former Child Soldiers Comes of Age, published in 2025, offers a fresh perspective on the project, including narratives of several of the young people in the study told in their own words. Many of these children are now adults and starting their own families while navigating life in a country grappling with significant adversity from poverty to challenges due to climate change and health epidemics.

“One of the problems in responding to war-affected children, youth, and families is that a lot of attention has been paid to immediate needs for food, shelter, housing safety, and so on—but mental health needs are often overlooked even in those immediate crisis responses,” said Betancourt in a recent interview. “Once peace accords and some modicum of safety have been put in place, there’s often lack of attention to the long-term mental health needs of war-affected children, youth, and families, even though the experiences of trauma and loss can unfold over the course of a lifetime.”

Among the other countries in which Betancourt and RPCA have undertaken projects is Rwanda, where many years of collaboration led to the development of the Sugira Muryango family home visiting and violence prevention program. Studies have shown that families receiving the intervention demonstrated improvement in parent-child relations, play, father engagement, health and hygiene practices, caregiver mental health, as well as reduced intimate partner violence and less harsh discipline of children.

Rwanda thus offers a template for the evidence-based MPHSS interventions that reflect the paradigm shift WISH calls for in its trio of BMJ articles. But most of these interventions, the authors note, fail to reach enough people in need and are insufficiently integrated into national systems, thus becoming poorly coordinated short-term projects. Building scalable and sustainable MHPSS systems requires integrating interventions into health, education, and social protection platforms, with genuine engagement of conflict-affected communities in design and delivery, according to the co-authors, which underscores collaboration among governments, civil society, researchers, humanitarian actors, and donors as crucial.

Moving beyond short-term emergency responses, governments and humanitarian actors must support integration of MHPSS into long-term policy and financing frameworks, the WISH authors wrote. Workforce capacity building, quality assurance, and local ownership are key to ensuring lasting impact as well as systems that are strengthened for the long haul.

“One of the most important shifts highlighted in this collection of articles is moving from asking what works to asking how we deliver what works to everyone who needs it,” said Byansi. “Task sharing and implementation science are central to that shift by bridging the gap between evidence and real-world impact and expanding the mental health workforce in humanitarian settings where specialists are scarce.”

Added Gutiérrez Torres, “As a physician from Colombia, I have seen how the mental health needs of children and families affected by armed conflict unfold over years and even generations, long after the immediate emergency response ends. These series of BMJ papers argue for what these communities have been telling us for decades: Mental health and psychosocial support cannot be an afterthought to humanitarian aid. It must be built into how we rebuild health systems, schools, and social protection from the very beginning.

“The encouraging part is that we now have real evidence that locally led, family-centered interventions can reach scale when researchers, governments, and communities work in genuine partnership.”