Open Access, Open Eyes: How New Evidence Is Reframing Child Mental Health in Conflict
Dr. Sunoor Verma and Dr. Slim Slama
Children’s minds are on the frontline of today’s conflicts. From Gaza to Sudan, Ukraine to Yemen, millions of children are growing up amid bombardment, displacement and the daily fear that schools, hospitals and homes may no longer be safe. Attacks on health systems and personnel are increasingly documented and condemned, yet the invisible toll on children’s mental health remains vastly under-recognised and even more poorly funded. This is not due to a lack of evidence, but rather a persistent failure to prioritise mental health within humanitarian and health responses.This is the gap that the new BMJ Collection on child mental health in conflict settings, proposed and funded by the World Innovation Summit for Health (WISH), seeks to address. Developed in partnership with The BMJ, and fully and independently commissioned, peer reviewed and edited by its editorial team, the collection brings together new evidence on how conflict shapes young minds and on what health and humanitarian systems can do differently in response.
Consider a child brought to a clinic for a physical injury, while the distress behind their silence, nightmares, and withdrawal goes unnoticed and untreated.
For WISH, this collection is an integral part of its long term work on attack on health in humanitarian conflicts, not a stand alone project. The WISH and WHO report “In the Line of Fire: Protecting Health in Armed Conflict”, launched at the WISH7 Summit in November 2024, documented the rising number and complexity of attacks on healthcare and called for stronger legal protections, better data and much greater political accountability. It made clear that the damage is not only physical. When health facilities are bombed, ambulances are blocked or health workers are threatened, communities lose trust in the very systems that are meant to protect them. For children, whose brains and identities are still developing, this erosion of safety and trust can have lifelong consequences for mental health, learning and social relationships.
The BMJ Collection takes this logic to where it most urgently belongs, which is with the mental health of children living through conflict. If attacks on health systems undermine the foundations of wellbeing, then protecting health must explicitly include protecting children’s mental health. Mental health support in emergencies cannot be treated as an optional extra that is considered only after physical needs are met. Yet in practice, this is still too often the case. In conflict settings it is part of the core health response. The three peer reviewed papers in the collection each address a critical but often overlooked dimension of this reality and together they move the discussion from general concern to specific, actionable solutions.
The first strand of work highlighted in the series concerns the long-term consequences of early exposure to violence and instability. Children who live through bombardment, forced displacement or the loss of caregivers to conflict do not simply recover once the shooting stops. Without appropriate support, these experiences can shape their mental health, educational pathways and economic prospects well into adulthood. The evidence points to increased risks of depression, anxiety and other mental health conditions, as well as poorer school performance and reduced chances of decent work. Unresolved childhood trauma can also contribute to cycles of violence and fragility, affecting families and communities across generations. This shifts the policy lens from short-term recovery to long-term human capital investment.Recognizing this long horizon changes how we should think about recovery, from a short-term return to basic services to a generational investment in human potential.
The second core insight from the collection is that effective and scalable interventions already exist, including in very fragile settings. Programmes delivered by trained non-specialists, such as community health workers or teachers, have shown promising results in reducing symptoms of psychological distress among children and adolescents affected by conflict. Integrating such interventions into primary care, schools and community-based services is both feasible and relatively affordable, yet remains insufficiently prioritised and financed. The papers argue for practical approaches such as task sharing, stepped care and the inclusion of mental health indicators in routine health and education information systems so that children in distress can be identified and supported earlier and more consistently.
The third major contribution of the series lies in its focus on financing and governance. Despite extremely high levels of need, mental health receives only a tiny fraction of humanitarian funding, and child and adolescent mental health an even smaller share.This reflects a structural imbalance in how health priorities are defined and funded in crises.Where resources are available, they are often short term and project based and are poorly embedded in national health and education plans. At a time when reductions in official development assistance and constrained humanitarian response plans are driving a renewed focus on narrowly defined “lifesaving” interventions, mental health and psychosocial support—including community-based approaches—risk being deprioritised despite their essential role as a first line of response. The collection calls for long term, system wide approaches that embed child mental health into national policies, align humanitarian and development funding around shared outcomes, and encourage donors to treat investment in mental health as core to rebuilding societies rather than as discretionary spending. This involves better data, clearer accountability and a willingness to measure success in ways that go beyond mortality and service coverage to include emotional recovery and social functioning.
WISH’s role throughout this process has been deliberately catalytic. As a platform that bridges evidence, policy and global health diplomacy, WISH has convened high-level dialogue across Doha, New York, Geneva and Osaka to address the realities of health systems under attack. The BMJ Collection on child mental health in conflict settings extends this agenda by ensuring that the mental health of children is no longer a side note in debates about attacks on health but a central concern. WISH proposed the collection, provided funding, and covered the open-access fees, so that all three papers are freely available to readers everywhere. This commitment to open access is more than a technical detail. It ensures that frontline practitioners, policymakers, advocates, and researchers in low- and middle-income countries, who are often closest to these issues, can use and build on the findings without financial barriers.
By supporting open-access publication, WISH has helped maximise the reach and potential impact of the collection. The evidence can now inform national policies, humanitarian guidelines and donor strategies in real time, rather than remaining locked behind paywalls. It also fits with WISH’s broader effort to bridge the gap between global policy discussions and the lived realities of children in conflict zones. Through its programmes on attack on health, WISH is already engaging governments, UN agencies and civil society on how to prevent and respond to attacks on healthcare facilities and workers. The child mental health collection offers concrete answers to related questions that are often neglected, such as how to design services that take account of the psychological impact of attacks, how to support children who witness violence or lose trusted health workers, and how to know whether recovery efforts are truly reaching children in distress.
Placing this series at the heart of WISH’s work on attack on health sends a clear message. In conflict settings, protecting children’s mental health is inseparable from protecting health systems. Rebuilding hospitals without addressing the fear that keeps families away is not enough. Running vaccination campaigns while leaving trauma untreated is not enough.
Moving forward, this requires concrete shifts in policy and practice:
- Integrating child mental health into all humanitarian health packages as a core component
- Allocating sustained and predictable financing, including dedicated funding streams
- Embedding mental health indicators in health and education systems
- Aligning humanitarian and development approaches around long-term outcomes for children
For WISH, this BMJ Collection is both a result of years of work and a starting point for the next phase. It brings rigorous evidence into an area where moral urgency has long outpaced practical guidance. The question is no longer what needs to be done, but whether the international community is willing to act.
Children living through conflict have already lost too much. If their minds as well as their bodies are to be protected, child mental health must be treated as one of the central health priorities of our time rather than as an afterthought.
