Bonati Maurizio
Department of Medical Epidemiology, Istituto di Ricerche Farmacologiche Mario Negri, Milano, Lombardia, Italy
BMJ Paediatr Open. 2025 Apr 24;9(1):e003379. doi: 10.1136/bmjpo-2025-003379.
There are many dozens of armed conflicts going on around the world. Some of these conflicts are well known, others are not. Some began recently, while others have been going on for more than 50 years. The drivers and dynamics of current wars vary widely in their political, military and humanitarian dimensions. Armed conflicts have complex, multilevel impacts on many aspects of human development through destruction, degradation, disruption, diversion and devaluation.Millions of children are injured, killed and separated from their families and witness brutal violence. Kidnapping, rape and the use of children as soldiers are also among the horrific side effects of most wars. Nearly one in five children globally lives in or is fleeing conflict zones, and half of all civilians killed by landmines and explosive remnants of war are children. Worldwide, children are killed in war and are more likely to die before the age of one or five than children born in the same region during periods without conflict. Child mortality is a proxy for overall well-being and a leading indicator of progress (or the lack of it). The evolution of the under-five mortality rate (U5MR) over time, before, during and after an armed conflict is an index of child health conditions. The three historical cases reported in this article (Bosnia and Herzegovina, Syria, and Rwanda) indicate that, after the acute phase of an armed conflict, it takes approximately 15 years to restore, maintain and resume the trend of improvement in U5MR levels to those prior to the conflict. How long does it take to restore the baseline conditions of child health at the end of an armed conflict? This is an essential question to which adequate answers must be provided in order to guarantee the rights denied by war.
世界各地正在发生许多起武装冲突。其中一些冲突广为人知，另一些则不然。一些冲突是最近才开始的，而另一些已经持续了50多年。当前战争的驱动因素和动态在政治、军事和人道主义层面差异很大。武装冲突通过破坏、退化、扰乱、转移和贬值对人类发展的许多方面产生复杂的多层次影响。数以百万计的儿童受伤、死亡，与家人分离，并目睹残酷的暴力。绑架、强奸以及将儿童用作士兵也是大多数战争可怕的副作用。全球近五分之一的儿童生活在冲突地区或正在逃离冲突地区，死于地雷和战争遗留爆炸物的平民中有一半是儿童。在世界范围内，儿童死于战争，并且比起同一地区在非冲突时期出生的儿童，他们在一岁或五岁前死亡的可能性更大。儿童死亡率是总体福祉的一个指标，也是进步（或缺乏进步）的一个主要指标。五岁以下儿童死亡率（U5MR）在武装冲突之前、期间和之后随时间的演变是儿童健康状况的一个指数。本文报道的三个历史案例（波斯尼亚和黑塞哥维那、叙利亚和卢旺达）表明，在武装冲突的急性期过后，大约需要15年时间才能将U5MR水平恢复、维持并恢复到冲突前的改善趋势。在武装冲突结束时，恢复儿童健康的基线状况需要多长时间？这是一个必须给出充分答案的关键问题，以便保障被战争剥夺的权利。
