Mitigating toxic stress in children affected by conflict and displacement

Anushka Ataullahjan and colleagues describe the myriad stressors related to conflict and displacement experienced by children and how best to reduce their negative effect Armed conflict and displacement pose a threat to the health and wellbeing of children. As the global community begins to recognize the cumulative effects of conflict and displacement related stressors, our attention has shifted to toxic stress and its short and long term health effects.1 Toxic stress, regarded as the result of prolonged activation of the stress response, can occur before birth and during childhood is known to contribute to epigenetic changes, with health and neurodevelopmental consequences.2 However, various social factors and early and appropriate intervention can help mitigate the negative effects.3 Over 415 million children were living in conflict affected countries in 2018,4 including 33 million displaced children (16 million refugees and asylum seekers, and 17 million internally displaced children).5 Although all children are vulnerable to toxic stress, certain subgroups are particularly vulnerable because of their marginalization—for example, orphaned or unaccompanied children, girls, children with HIV infection, and children with developmental disorders or a disability. These groups may face additional stressors and have reduced access to services. The emergence of covid-19 has also raised concerns about spread in conflict affected populations adding to the risk of toxic stress (box 1). Box 1 ### Covid-19 in humanitarian settings Conflict affected populations are particularly vulnerable to covid-19. Overcrowding and inadequate water and sanitation systems in refugee camps and informal settlements, coupled with previously existing illnesses, may increase the spread and severity of covid-19.67 Moreover, resource and health system constraints may restrict access to adequate and appropriate care.67 Control measures such as physical distancing may be difficult and may also increase economic precarity, intimate partner violence, and food insecurity in populations already vulnerable because of … RETURN TO TEXT