Multiple studies in recent years have highlighted the extensive, and often devastating damage war can have on the long-term mental health of children living in conflict zones.
Data from two such studies conducted in Ethiopia demonstrated the impact of persistent, disruptive armed conflict on children's psyche, with aspects of post-traumatic stress disorder (PTSD) and anxiety being frequently observed among the surveyed subjects.
The state of Tigray in Ethiopia has been through a civil war between the federal government and a militant separation group arguing for the liberation of the region. The capital was left in ruins after a primary conflict which ended with the signing of the Pretoria Agreement in 2022, yet the political situation remains precarious till date. Among the impacted citizens, children are a particularly vulnerable group, developing moderate to severe mental health problems arising from prolonged trauma.
Studies attribute these issues to altered connectivity in the amygdala, a part of the brain that controls fear responses and anxiety. On experiencing sustained exposure to stressors, there is reported hyperactivity in the hypothalamic-pituitary-adrenal (HPA) axis responses, causing anxiety. Anxiety, in turn, leads to a higher risk of developing PTSD later in life.
Earlier analyses of traumatized children demonstrate the direct consequence of war on mental well-being. Iraqi and Syrian refugee adolescents who had been displaced in the U.S. showed an anxiety prevalence of 38%, and their condition worsened during a two-year follow-up period.
In Tigray, anxiety among the youth was 11% before the conflict, coinciding with global averages. However, the frequency tripled after the war, rising to 34% in children, and 39% among high-school students.
A study by Gebremedhin et al was conducted in over 10,000 students at a public school in Tigray to measure anxiety prevalence in November 2024. Four mental health professionals designed and offered surveys to the student body and further assessed behavioral and cognitive aspects by random selection. A similar study by Tesfau et al evaluated over 600 patients to determine the prevalence of PTSD using a checklist for cross-referencing symptoms.
The results concluded that anxiety and PTSD were more prevalent among students who may be female, bullied in class, or were injured in the course of the conflict. Three out of ten students were diagnosed with PTSD. Understandably, the loss of a parent in the conflict or witnessing a violent death were major contributors to higher levels of anxiety recorded in some students.
Some reported an ongoing substance abuse, mainly of alcohol, amounting to 44% of the nearly 600 students chosen for a special evaluation. Approximately 84% had experienced direct exposure to fighting in conflict zones, or participated in active combat, despite being less than 18 years of age. Investigators highlighted this as the most striking part of the findings.
More than 23% admitted to suicidal ideation at some point in their lives, with 19% disclosing that the same began in the preceding 12 months. This may be linked to the conflict, but several students also reported experiences with sexual or domestic violence.
The overall prevalence of anxiety and PTSD was markedly lower in students who had the support of family or a community system. Having living parents or authority figures at home seemed to decrease the likelihood of exposure to anxiety-driving elements.
It was stated that while conditions like PTSD were widely diagnosed, it was not well-known in the region. The 32% prevalence of anxiety was much higher than the 23%-26% observed in children from war-torn regions of Afghanistan, Palestine, and Uganda.
The investigators reiterated the urgent need for a focused mental health intervention among children and adolescents. Gender-sensitive, trauma-informed treatments like cognitive-behavioral therapy (CBT) and eye movement desensitization and reprocessing (EMDR) were recommended for the long-term maintenance of mental health in students, as these have shown verified success in younger populations.
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