The blast injuries suffered at war zones are traumatizing, leaving individuals locked in the sort of suffering nobody should have to endure.
Devastatingly, the sort of extreme, explosive weapons used to destroy weapons on the battlefield have increasingly been used in civilian territory, and the damage inflicted on the bodies of children is catastrophic.
Children differ from adults in regards to how they are affected by blast injuries and are at greater risk of being maimed or killed by explosive devices.
Their delicate skulls and muscles have not have the chance to fully develop, meaning their brains, lungs and other internal organs have far less protection than those of fully grown adults.
I spoke with James Denselow, the head of the Save The Children’s conflict team. Denselow works to protect children from across the world whose lives have been ripped apart by conflicts they are far too young to understand.
Speaking with UNILAD about shifting trends among civilians affected by conflict in recent times, Denselow reported an increased number of children being affected by extremely violent and lengthy conflicts.
According to Denselow, one out of five children in the world currently live in areas which have been impacted by conflict:
Over 140 million children are in high intensity conflicts and often these are very long, very brutal conflict, like the ones we’re seeing in Yemen, in Syria.
What we’re trying to do is push back against that trend. And not only are we seeing more children being affected by more conflicts that are longer and more brutal, we’re also seeing this trend around explosive weapons.
More and more people are moving to cities and we’re seeing weapons that are used on the battlefields being used in cities. These are weapons designed to destroy tanks, and take down military equipment.
They obviously have a devastating effect on children.
Research from Save the Children shows 83 per cent of 17,401 child battle deaths between March 18, 2011 and December 31, 2016 were due to blast injuries. This is compared with 56 per cent of 84,052 adult civilian deaths, and 12 per cent of 41,844 adult combatant deaths during the same time period.
These are breakable, fragile human beings who should be playing outside with their friends, knowing there is a safe home waiting for them at the end of the day.
They shouldn’t have to live with the physical and psychological trauma of losing body parts. And – should this terrible type of injury happen – you would hope they would at least receive the best possible medical care.
Sadly, clinics in war-torn areas are all too often ill-equipped to treat children who have suffered blast injuries, who require much different treatment than adults.
Most of the literature on blast injuries has historically centred around treating soldiers; grown adults who at least have the fully formed muscles and bone density to stand a fighting chance.
Furthermore, blast injuries often occur in areas where there is limited medical care and difficulties getting experts there.
Denselow told UNILAD about the ‘unique vulnerabilities’ medics in war zones have to bear in mind when treating children:
They are a lot smaller, they have different levels of blood and fluid and bone density. They often are exposed to higher levels of bombs.
They’re obviously growing, I’ve met children who’ve lost limbs in blast injuries and obviously their bones will keep growing and they will need to have multiple operations. Most of them will require pain management.
It’s grim as it gets really. As someone who’s the father of a very young child, you want to protect your child from getting hurt against anything. The notion of having to protect them against a 500 pound bomb, or an IV is kind of terrifying.
Fortunately, even in a world filled with such evils, there are individuals committed to looking out for children who have gone through unimaginable suffering.
A pioneering paediatric blast injuries field manual has – as of May 2019 – been distributed to emergency units throughout northwest Syria, including to the civil war-torn cities of Idlib and Aleppo.
The Paediatric Blast Injury Field Manual is the very first handbook of its kind, offering lifesaving instructions on how to treat a child who has been injured in various harrowing circumstances, including airstrikes, artillery and landmines.
All manner of situations are covered in this manual, from resuscitating children out on the battlefields to saving limbs. There is also information on the longer term treatments of rehabilitation and psychological care.
The manual was developed by the Paediatric Blast Injury Partnership (PBIP), a multi-skilled coalition of doctors, humanitarians and other experts from fields such as surgery, paediatrics, rehabilitation and prosthetic design.
Founded by the Save the Children and Imperial College London, the coalition authored the manual to be used easily by anyone with medical training.
As well as being ‘lightweight and durable’, this groundbreaking handbook can be read in the poorly lit conditions often facing medics working under such perilous conditions.
Denselow told UNILAD how he hopes this manual will ‘make a difference in some of the darkest parts of the world’:
What we’ve done with the paedeatric blast injuries field manual is to bring together this incredible coalition of people who really care about children and want to make a difference.
They’ve designed this manual for Syrian medics, who are not specialists often in the paedeatric sphere and there are unique vulnerabilities that children have that are different to adults.
Of course, these types of injuries are not ones which can be fixed quickly, with young patients often facing long, complicated roads to recovery.
Children will often be left with profound emotional and psychological scars from their ordeal, and it’s crucial their mental health and well-being is prioritized.
Denselow told UNILAD how mental well-being has been placed at the ‘heart’ of the manual:
It’s not just a physical injury, it’s also the invisible wounds, it’s also the mental agony that can happen.
What we’ve done in the manual is ensure that what we call mental health and psycho-social support is kind of in the DNA of the whole manual, from the point of injury through until limb replacement, prosthetics, aftercare.
So the idea of looking after children’s mental well-being is really in the heart of this document.
I spoke with paediatric emergency medicine consultant Dr Paul Reavley about his experiences treating children with blast injuries, and why he thinks this manual will prove invaluable to medics in the field.
The lead author of this field manual, Dr Reavley, is a former UK military doctor as well as a consultant paediatric emergency physician at the Bristol Royal Hospital for Children.
From 2000 to 2018, Dr Reavley was deployed numerous times as a medical officer to countries such Iraq and Afghanistan. It was here where he came to understand the horrific challenges of treating children in war zones.
Recalling his military deployment, Dr Reavley said:
When deployed with the military we encountered children seriously injured by blast very frequently. It varied but research from conflicts like Afghanistan showed that between three per cent and 10 per cent of patients presenting to military medical facilities were children.
On average that was at least weekly if not daily at times. The types of cases we frequently dealt with range from relatively minor multiple fragmentation wounds, penetrating abdominal and chest wounds to multiple amputations.
I recall two particular cases in Afghanistan. One an eight-year-old girl who had lost both legs (the marque injury of Afghanistan) and one arm in an IED explosion and a second case where a child was in cardiac arrest secondary to blood loss.
The girl was about the same age as my own daughter. I’m a trained paediatrician, but that connection shook me hard. And it hits you just when your mind needs to be at its clearest.
Dr Reavley is confident that the manual will have a lifesaving effect, telling UNILAD how it ‘will undoubtedly save lives’:
It contains practical advice and guidance on how to deal with the injured child effectively, pointing out the key differences between adults and children as you go through the care pathway.
It deals with not just emergency care but subsequent ward care and even psychological care too, following the child from the point of injury through to discharge home.
Very importantly though it also aims to empower the user to treat the child not just by illustrating differences between adults and children but similarities too, giving them the confidence to use whatever experience they do have to be successful.
It’s too early to gauge the manual’s impact but feedback so far from people around the world and in many different organisations is that is fills a very important capability gap, it is clear, readable and easy to use.
We are very confident that this little book will save and improve the lives of children.
Going forward, Save The Children will have the manual translated into several languages, distributing it later this year to other areas of conflict such as Yemen and Afghanistan.
Of course, dealing with such heartbreaking cases takes its toll on medics, who are often mentally unprepared to deal with children going through such extreme suffering.
Speaking with UNILAD about the importance of psychological support for carers, Dr Reavley explained, ‘no one prepares you for the sight of seeing a child injured by a blast’.
Dr Reavley told UNILAD about how he personally manages to focus on the positive while working with such devastating situations:
I am a parent and there is no doubt that at times my work, in particular my military experience has taken its toll. Dealing with children is very difficult, not only when they don’t survive but when you see a young life changed forever.
I often think about some of the children who were brought in to us. But, treating children successfully is incredibly rewarding and this usually outweighs the price. Focusing on the positives in any role is very important.
I am very proud of the book we have put together and I will get a great deal of satisfaction if it helps only one child.
It’s terrible to realise we live in the sort of world where this manual needs to be written, where surgeons have to be trained to treat tiny limbs and resuscitate patients too young to comprehend what a bomb is and why it’s used.
In an ideal world, policies would be implemented to prevent such serious injuries from occurring in the first place. And medics would never have to try and get used to the sight of eight year olds in agony.
According to Denselow, millions of pounds have been poured into researching and developing ways to protect wealthy Western armies from explosive weaponry, resulting in alterations to everything from armour to vehicle design.
Sadly, child civilian protection has not received nearly the same dizzying amounts of funding, meaning this manual truly is a very scarce and special light.
It’s been one hundred years since the formation of Save The Children, with great progress being made throughout the subsequent decades. The NGO is now calling upon the British government to implement a new strategy to protect children in war torn areas, with their campaign #StopTheWarOnChildren.
This new strategy would include measures to avoid the use of indiscriminate explosive weapons within populated areas, as well as committing to the suspension of arms sales where there are risks of child fatalities or injuries.
Save The Children also want the government to support a Global Paediatric Trauma Register, a resource which would help to track trends in regards to children who have been hurt from military action either by the UK or its allies.
Denselow spoke of how the UK government is currently reviewing its strategy in regards to protecting civilians in conflict, meaning this is a crucial time to push for greater protections of children:
We look to the British government to be a leader in this space. And they do some pretty good things already. They do some other things that we don’t think are so good.
I think an opportunity to step up to the plate, if you will. Obviously we’ve got a kind of difficult world at the moment in terms of crisis and multilateralism and the challenge of Brexit.
But there’s an opportunity now in the light of the new information about the number of children in conflict zones and how they are uniquely affected.
[…] I think this is a really important time for the British government to have an ambitious strategy that looks to put children at its heart and will try and push back against this trend and make a lot of difference.
It is of course all too easy for those of us living in the relative comfort of the UK to think of such calamitous injuries as being a world away. The ‘green zones’ and ‘red zones’, as Denselow puts it.
We are all of us guilty of watching news stories about the destruction of civilian territories and feeling a pang of sympathy which will be long forgotten by the time Eastenders comes on.
Perhaps we will feel a twinge of relief that our own little people are safe and well in their beds, with only the lightest of playground grazes on their tiny kneecaps.
Perhaps our apathy is because we think there is nothing we can do to help. But there is plenty we as ordinary British citizens can do. From signing petitions to getting involved in campaigns, we can all show our support to those whose childhoods have been swallowed whole by a nightmare.
You can find out more about how you can support Save The Children’s Stop The War On Children campaign here.
If you have a story you want to tell send it to UNILAD via [email protected]
Jules studied English Literature with Creative Writing at Lancaster University before earning her masters in International Relations at Leiden University in The Netherlands (Hoi!). She then trained as a journalist through News Associates in Manchester. Jules has previously worked as a mental health blogger, copywriter and freelancer for various publications.