From pogroms to "ethnic cleansing": meeting the needs of war affected children.

Children are both the direct and indirect targets during wars. They are directly affected by violence aimed at them and their families; they are indirectly affected by the distress caused to their families; they may be internally displaced or find themselves crossing borders as asylum seekers. Their experiences during and immediately after war militate against their developing in a safe, secure, and predictable environment. Their human rights are compromised and their mental health put at risk. Whether in the country at and after war, or in the country that offers refuge, children's mental health needs have to be properly assessed and met. In many cases, children may only require a sense of safety and support via their family and school. In other cases, they require more complicated psychosocial interventions that address the various stress reactions they manifest. This paper addresses these issues against the context of a major community-based programme in Mostar in Bosnia during the recent civil war there. It argues that we have reasonably good screening measures to identify children at high risk of developing mental health problems. It presents an hierarchical model of support and intervention whereby psychosocial help is delivered primarily through schools with only a small proportion of more complex needs being met by specially trained mental health professionals. There is a strong need to evaluate various methods of delivering help and to develop new ways of reaching needy children in a nonstigmatising way.