A displaced boy whose town was destroyed by bandits studies in a catch-up class in Haiti.
Photo courtesy Georges Harry Rouser, UNICEF
On Feb. 28, the first day of the U.S.-Israel war with Iran, massive bombing devastated a school for girls in the southern part of Iran, killing as many as 170 children. The action was condemned by humanitarian and public health leaders as unconscionable.
“A strike on a school represents a grave assault on children, on education and on the future of an entire community,” leaders of the U.N. Office of the High Commissioner for Human Rights said in a statement. “There is no excuse for killing girls in a classroom.”
While heartbreaking, the loss of lives among children during conflict is not unusual. Over 1 in 5 children in the world live in countries and regions engaged in armed combat, according to a 2024 report by Save the Children, and often become unintended victims. Since 2010, children living in conflict zones has increased by 60%.
Today tens of millions of children suffer in years-long conflicts in the Gaza Strip, Myanmar, Sudan, Syria, Ukraine and other places.
Over 72,000 Palestinians have died as of mid-March in the three-year Israel-Palestinian conflict in Gaza, including 21,000 children, according to the World Health Organization. In March, about 80 humanitarian health groups were in the region, including Project HOPE, a global health and humanitarian aid organization.
As in Gaza, most combat during modern conflicts takes place in urban centers, increasing civilian casualties and worsening damage to hospitals and health care centers, according to Arlan Fuller, JD, MA, Project HOPE's director of emergency preparedness and response.
“In urban fighting, you're going to see a lot more airstrikes and artillery fire that cause a lot of collateral damage,” he told The Nation's Health. “And that's when you start to see children, with their high vulnerability, bearing the brunt of it.”
In some fighting, hospitals and schools are targeted, despite the fact it is against international humanitarian law and condemned by the U.N. Security Council, Fuller said.
Food, clean water, hygiene, shelter and basic health care are prioritized in humanitarian health responses. In recent years, more aid organizations are also prioritizing child mental health therapies and protection from sexual assault, exploitation or abuse.
Armed conflict takes a massive toll not only on physical health, but also on mental health. Children bear an outsized impact.
Tymofii, 11, stands in 2025 in a damaged playground at a kindergarten school he once attended in Partyzanske, Ukraine. The school was destroyed by Russian bombing during the ongoing war. Since 2010, children living in combat zones has increased by 60%, according to a recent report.
Photo by Oleksii Filippov, courtesy UNICEF
“What happens for children in war is that they end up having lots of adverse childhood experiences, and that can be very negative in their development,” said Sweta Shah, PhD, MA, a resident fellow at Brookings Institution who is an expert in early childhood education and development.
“When you have a lot of ACEs, the stress becomes elevated and can turn toxic,” she told The Nation's Health. “And toxic stress can change the chemical makeup in the body, lasting through a child's lifetime.”
Children exposed to war need safety, security and stability, she said. Humanitarian services can create safe spaces for children, where they have toys and one another to play with and a daily routine to help them feel secure.
Also important is affection. Shah quotes the late child psychologist Urie Bronfenbrenner: “Every child needs at least one adult that's irrationally crazy about him or her.”
“Love and social connection are not something always thought of in situations of war,” Shah said. “Children need that from a caregiver or parent in situations of war because they're very dependent on adults, as they're still developing.”
Project HOPE prioritizes children's mental health care and psychosocial support, not only for children, but also for other underrepresented groups such as pregnant women, new mothers, aid workers, people with disabilities and older people, Fuller said.
As of mid-March, the organization had seven health clinics in Gaza, distributing clean drinking water and supporting medical units. It also had a strong presence in Lebanon, where more than 700,000 people have been displaced. The organization has activated two mobile primary care units, delivering psychosocial support and medical care, Fuller said.
Project HOPE has also been using local partners to monitor public health in Iran. Sources said respiratory illnesses and asthma from burning oil refineries had increased, and vaccines and medicines for chronic health conditions were in short supply.
Rahaf holds her 2-year-old child, Ivana, at a Beirut hospital after the child was burned during an October 2024 Israeli airstrike in a village in South Lebanon.
Photo by Fouad Choufany, courtesy UNICEF
Project HOPE is on-site for natural disasters as well. It has been a constant presence in Altadena, California, following the Eaton Fire in 2025, which destroyed 9,000 structures and took 19 lives. Eighty percent of residents remain displaced. Child mental health and trauma care are being addressed, including through distribution of kid kits containing toys and art materials.
The organization was also in Myanmar, a mountainous country in Southeast Asia that has endured decades of civil war and poverty. It offered aid last year after a catastrophic earthquake displaced about 2 million children.
America's retreat from foreign humanitarian aid under the Trump administration has resonated globally. Along with lives lost from the pullback, the U.S. is losing the global goodwill and soft power that comes with humanitarian presence, Fuller said.
“If we continue to have no presence in these humanitarian actions, other countries will seem more supportive, better allies and better partners,” Fuller said. “That will hurt us in the future.”
For more, visit www.projecthope.org.
- Copyright The Nation’s Health, American Public Health Association
