Daily Times

Children were forced to watch their teacher get burned alive as the Taliban murdered 132 schoolchildren in the worst ever terrorist attack in Pakistan’s history when they struck the Army Public School on December 16, 2014. Right after the terrorist attack, everyone had questions they wanted answered and feelings they needed to express. Lots of people suffered because of these attacks, many more than those who were injured or killed. It was not uncommon to hear from these children the horrible trauma, the blood, the gore, the screams and tears and then, of course, the proceeding nightmares and sleep deprivation. I cannot imagine how difficult it would have been for them watching this atrocious terror assault but, in the end, it did not matter. I was not their parent and so it was up to someone else to make that decision. But even then the question remains: How did these children cope after something so terrible?
Each year, millions of children are exposed to some sort of extreme traumatic stressor. Terrorism may have terrible effects on children’s adjustment. The events of Paris and Mali, and the unceasing suicide attacks in the Middle East underscore the importance of understanding how children and adolescents react to disasters and terrorism. The body of evidence related to children and their responses to disasters and trauma is growing. Mental health professionals are increasing their understanding about what factors are associated with increased risk and affect how children cope with traumatic events.
The advent of major terrorist assaults has ushered in a sense of insecurity and vulnerability before unknown to children in Pakistan. Terrorist acts have deeply shaken the sense of safety, security and well-being of our surviving children and families. These terrorist acts may also have increased the chances for mental illness in our children. The risk is moderately high that children in Pakistan may exhibit a wide range of emotional, physical and psychological reactions following these man-made disasters. Large-scale terrorist disasters witnessed by children all underscore the need for a broad mental health approach. This approach is critical for our children’s well-being.
Children’s responses to terrorism include acute stress disorder, post-traumatic stress disorder, anxiety, depression, regressive behaviour, separation problems, sleep difficulties and behavioural problems. However, several aspects of terrorist attacks result in unique stressors and reactions, and pose specific challenges. Terrorist attacks and their aftermath have a powerful impact on children and their families. The unpredictable, indefinite threat of terrorist events, the profound effect on adults and communities, and the effect of extensive terrorist-related media coverage exacerbates underlying anxieties and contributes to a continuous state of stress and anxiety.
Acts of war and terrorism are increasingly prevalent in contemporary society. Weaponry has become more efficient, accurate and powerful, resulting in more devastation and loss of human life. Children are often overlooked as victims of such violence. Such reactions are best understood within the context of social-emotional and cognitive development, as children respond differently to the stress of violence depending on their developmental level. Furthermore, the violence of war and terrorism often results in a multi-tiered cascade of negative life events including loss of loved ones, displacement, lack of educational infrastructure and drastic changes in personalities and emotional wellbeing. These numerous losses, challenges and stresses affect children’s brains, minds and bodies in an orchestrated whole organism response.
Around the world, children are being exposed to violence in multiple forms, frequently developing traumatic stress reactions. Involving children in the violence of war is a big worry when it comes to Islamic State (IS). The terror group has reportedly been recruiting children under 15 for special camps established specifically to brainwash minors with their extremist ideology. Children are reportedly taught how to use weapons and even shown how to behead people by using dolls. After the age of 16, the boys are sent to a military camp, where they are given intensive training in the art of warfare and prepared for a possible future in either front-line militia or suicide bombings. Children are being indoctrinated and radicalised from birth, leading to a whole generation who will know nothing other than IS ideology. Like other ‘total organisations’, IS aims to create a new identity for these young, vulnerable children. Playing with their psyche, IS attempts to form a sense of group identification in these young children. Their sense of belonging to the power perceived group easily moulds them with IS vision. As psychiatrist Otto Kernberg explains: “Individuals born into a totalitarian system and educated by it from early childhood have very little choice to escape from total identification with that system.”
Using children under the age of 18 as soldiers is a war crime. A study of 300 former Ugandan child soldiers found that approximately one third were diagnosed with Post-Traumatic Stress Disorder (PTSD). Two-thirds were suffering behavioural and emotional problems, mostly anxiety and depression. So-called moral injury pain or damage to the conscience caused by witnessing, failing to prevent or perpetrating acts that violate ethical norms is a risk factor for further violence, PTSD and depression. The widespread commission of atrocities could lead to a form of societal PTSD both for victims and perpetrators. One of the results of continuously witnessing morally injurious actions, or of perpetrating them, is the blunting of feeling and loss of empathy. Concerning how it may be, some child soldiers escaped profound mental illness by developing an appetite for aggression, showing that those who learn to take pleasure from killing appear to be less susceptible to PTSD symptoms.
Children are being left as victims of and through terrorism. This is the real social tragedy. Is terrorism deliberately trying to create a world with a war on both fronts? It is impossible to know conscious intentions but, either way, the end result of its after-effects are causing major mental health problems in children. This will no doubt be a deeply traumatised generation with a host of new complexities from within.

The writer is a professor of Psychiatry and consultant Forensic Psychiatrist in the UK. He can be contacted at fawad_shifa@yahoo.com