One in four children in Syria are at risk of developing mental health disorders, according to a new report released by the nonprofit group Save the Children on Monday.

Save the Children staff and their local partners interviewed 458 children and adults, and consulted mental health specialists, on the toll Syria’s six-year war is having on children.

The report, titled “Invisible Wounds,” chronicles the day-to-day traumas children there face, including:



About 3 million Syrian children are under the age of 6 and know nothing but war. One in four children is at risk of developing mental health disorders, the report said.

Children are demonstrating symptoms of constant stress, including bedwetting, self-inflicted harm and suicide attempts, along with aggressive and withdrawn behavior. They are having “difficulty speaking and are stuttering, and some of them suffer from partial amnesia,” said an aid worker in the northwestern city of Idlib.

More than half of those interviewed said adolescents are using drugs and alcohol to “escape” their situation.

Access to school is also an issue because:



Schools are no longer running or the buildings are used for other purposes, the report said. Children are working to support the family; boys are recruited as fighters; and girls are married off at an extremely young age to ease the financial burden on their parents.

And about half of children polled, who were able to attend school, said they didn’t feel safe there.

Syrians lack access to mental health professionals:

In some regions of more than 1 million people, those interviewed said there was only one professional psychiatrist, according to the report.

Two-thirds of children said they lost a relative, had their house bombed, or were injured in the war.

One-quarter of the children said they rarely or never had someone to talk to about their fears, the report said.

Why it matters

Aid groups are concerned that because of the prolonged fighting disrupting children’s lives, there will be a “lost generation” of uneducated youth with psychological scars. More than 2 million children in Syria, along with 700,000 children in refugee camps in neighboring countries, don’t have access to an education, according to the United Nations.

A “cessation of hostilities” announced in December did little to protect all children in Syria because there were still pockets of fighting in areas that humanitarian organizations couldn’t reach, said Geert Cappelaere, UNICEF’s regional director for the Middle East and North Africa, in Geneva last month.

“The immeasurable cost in lives and suffering should shame the world into taking immediate action in finding a political solution to the war,” he said. “What if these were your children?”

What can be done?

Groups such as Save the Children offer programs that help children express their worries through art, and establish community activity centers where children can talk to counselors about their anger and fears. One child in the “Invisible Wounds” report drew her mother much smaller than the rest of the family. The art teacher later learned that her mother had died although the child wasn’t able to say it.

Even though adversity early in childhood can have lingering effects, all hope is not lost, according to the report.

“What came through clearly in the research is that despite all they are going through, many children still dream of a better future, of becoming doctors and teachers who can contribute to building a peaceful, prosperous Syria. All they want is the opportunity to do so,” it said.

The interviews took place between December 2016 and February 2017 in Aleppo, Damascus, Daraa, al-Hasakah, Homs, Idlib and Rif Damascus in areas held by the opposition. Interviewers were unable to access government- and Islamic State-held areas.

Editor’s Note: We later interviewed Sonia Khush, Save the Children’s Syria director, using questions from Twitter.