Why children’s views matter when assessing child poverty
When it comes to defining and researching child poverty on a national or global basis, it might strike some people as counter intuitive to involve children in the preparatory groundwork at all. Yet by consulting with children and young people in a meaningful and engaging way, they are likely to feel empowered by the process and become engaged with it. Moreover, they may sense that their rights, as well as their views, are being respected. What better way is there to represent the experiences and opinions of children concerning their own circumstances. In estimating differing levels of poverty and differing needs it may in fact be of paramount importance to take into consideration the views of children.
An example of a child-centred approach to analysing child poverty
A study from 2015 attempted to examine the priorities of South African children who were living in poverty by asking them to formulate and then subsequently arrange an itemised list of commodities, services and everyday essentials onto a scale between what they considered an absolute necessity through to an out and out luxury.
Those children undertaking the surveys were first asked to compile a list of essentials for their day to day lives. The top 25 choices were selected for the comparative survey. The results are shown below in table form and contrast with sample responses from adults who were asked to perform the same exercise.
Of the 25 items on the list, only six coincide in the priority ranking from both the adults’ and children’s surveys: three meals a day (1st), toiletries(1st), storybooks(5th), a computer (7th), a Play Station (10th) and an MP3 player (10th). Perhaps it is unsurprising to see the four items which coincide in first and tenth positions.
More interesting are the items with contrasting rankings, for example, adults placed new clothes 4th, whereas children voted them 8th. Does this say something about self-esteem from these differing vantages? Conversely a mobile phone was rated 4th by the children, and 8th by the adults. That result may reference universal issues of utility, practicality, cost, and a sincere desire to be connected to the world beyond home. From a young person’s viewpoint, perhaps having personal access to the internet and social media is likely to seem more important than having their own bed or room because of the broadening and aspirational appeal of a phone. A desk and a chair are ranked 6th by the adults and 10th by the children, which implies that children are happy to work anywhere that is available, convenient and reasonably appropriate.
Educational toys (2nd and 6th), and toys (3rd and 7th) are also ranked in marked contrast by each group. Once again, the educational significance and (in the latter case) the social and cultural value of these commodities should not be underestimated. These five examples speak loudly about differences in perception that children may have when it comes to assessing and evaluating what matters to them most in their everyday lives. It might also say something about their ages. There is, however, the vital matter of the children’s first-hand experience, which chimes with the positioning of school transport (1st and 3rd). For a child trying to get to school that selection affirmingly amounts to a top priority, of equal necessity to having access to a doctor. It also sheds light on the child’s perception of the importance of school, especially given the equal ranking of school equipment.
Therefore, it is little surprise, given the above, that children voted the school trip 2nd, while adults considered that much less of a necessity (5th). Another marked contrast is sports equipment (like toys, also 3rd and 7th), which, importantly, may be linked as much to aspirational motivations, as to notions about the beneficial nature of exercise.
What these results show us
Results, such as this table highlights, confirm that there can be a significant difference in the values which children and adults place on everyday essentials, fundamental services and commodities. It would be intriguing and informative to run this sort of exercise on a cross-cultural, global scale.
Implications for future research and programmes targeting child poverty
When it comes to tackling child poverty, taking children’s views into account is not only morally worthwhile, but it is also potentially ground breaking. This is because it is likely to prove genuinely insightful when evaluating their needs and values, and therefore help to shape the form and goals of future assistance. If decisions about issues like these are simply taken by adults then it is highly probable that the outcome will transpire be partly at odds with what really matters to the children in question. And in turn, those children are likely to wonder how and why such a programme was designed in the first place, and reflect on how beneficial it is to them. Developing an effective campaign to address child poverty is likely to benefit from an inclusive approach which embraces the opinions and values of the people for whom it is essentially intended. In other words, alongside evidence backed views of politicians, researchers and managers at non-government organisations (NGOs), relief agencies and charities, it is equally important to take into consideration children’s opinions about their own needs and values.
Across the world organisations attempting to research and roll out programmes to tackle child poverty have encountered political, economic, ethical and cultural arguments put forward to resist addressing children’s needs. This blog asks why child poverty is sometimes not promoted into the political spotlight. Here are eight reasons.
1: emotional and cultural associations
From time to time in their roles of campaigning against child poverty and implementing relief programmes, non-government organisations (NGOs) and charities like Save the Children and Oxfam have experienced political and cultural obstacles to designing policies and rolling out initiatives which are intended to tackle child poverty. A central difficulty is the emotive nature of the issue. In short, child poverty is a very sensitive matter.
A need for new approaches
At first glance this sort of sensitivity may simply seem to be uncooperative, but it is vital that its significance is appreciated and addressed for genuine progress to be made. Regrettably, it may seem all too easy for NGOs or international organisations, albeit unintentionally, to appear to antagonise political and cultural sensitivities. If there is even a hint that an organisation appears to be aiming to meddle in a political agenda, or impose what could be judged as external values in a uniform fashion across different cultures then there is little surprise that insular resentment, solidarity or even denial may be consequential. Empowering people on a national and local level to formulate campaigns to end child poverty appears to be a good way to proceed. Achieving this, however, is a hugely complex goal.
If there appears to be little political motivation to discuss, research or formulate strategies to tackle children’s circumstances specifically, then addressing in general terms the wellbeing of citizens across various communities which collectively comprise a nation may open up opportunities for some consideration of children. It is from an overarching context which focuses on people’s wellbeing that child poverty may naturally emerge as an important area of concern and so be drawn into mainstream discussions. This should open up the means to introduce new stakeholders in forming a new alliance with policy makers, in turn enabling constructive consultation, funding and planning.
3: structural issues and conflicting research programmes
From time to time organisations encounter a contrasting problem, namely, a policy designed to counter child poverty which has been enthusiastically supported in the formative stages, but lacks fully fledged research or a strong core team to coordinate its effective implementation. Perhaps different research groups have been approached to compile data but have employed different statistical methods. This could mean that any data collated would not necessarily be comparable or compatible, undermining the credibility of the initiative. Constructing multidimensional estimates of child poverty is certainly a more challenging prospect than relying on a simple financial summary based on the arbitrary poverty line of $2.15 per person per day. Appointing a single agency to oversee this vital research could mitigate potential problems. Meanwhile, assembling a purposeful, experienced and connected core team should give momentum and focus to developing, coordinating and rolling out future programmes.
4: Solutions to poverty and child poverty are very similar
If policy makers and government ministers believe that measures to tackle child poverty and poverty in general are very similar, they are likely to consider that solutions to these issues are also very similar. This means that they may see no obvious benefit in subdividing poverty as an economic, social and cultural circumstance. In that scenario, it is quite feasible that there would be little motivation to put in place initiatives to address child poverty in isolation.
However, UNICEF demonstrates that potential solutions to tackling poverty and child poverty can be surprisingly different. For example, child-centred approaches are likely to involve a questionnaire-backed consideration and analysis of the provision, support for and enrolment within education programmes and future vocational training. Ongoing and endline surveys are also vital to update progress through the production of revised data. Naturally, analysing and tackling systemic poverty will not wholly focus on child specific issues.
5: In crisis areas measuring child poverty is counterproductive
A plausible-sounding case can be made that if political and social conditions facing individual communities are fragile, or in crisis, then there is little point in attempting to collect data specific to child poverty. For example, in areas experiencing an ongoing humanitarian crisis, it is simply not a practical priority to research child poverty. Yet maintaining support for a rolling research programme which collates data on child poverty can help to clarify specific and developing circumstances and inform agencies in coordinating strategic responses to both child poverty and any ongoing emergency.
6: Prioritising child poverty only benefits children
UNICEF highlights the fact that addressing child poverty helps to tackle poverty in general. In fact an innovative way to focus on tackling poverty within society is to centralise the significance of child poverty. By addressing the circumstances, needs and rights of children, all members of their communities are likely to feel the benefit of specific policy changes. Building alliances with organisations and stakeholders whose work tackles poverty is vital and forming a coordinated agenda around child poverty helps to benefit everyone. For example, enrolling as many children as possible within education programmes will naturally lead to a better educated workforce, potentially fostering personal aspirations and opening up improved prospects.
7: Concentrating on child poverty is not the best use of resources
An argument can be made that because there are many issues facing children and young people living within culturally disparate communities in a country, child poverty is not necessarily the top priority. Perhaps healthcare or rights should be considered the pre-eminent concerns. Yet by highlighting child poverty and focussing resources on that, it is likely that support will naturally emerge for those other areas which are obviously crucial for young people’s wellbeing. An informed, holistic overview will be a likely outcome of addressing child poverty. Researching and tackling its causes can also shed light on everyone’s living standards, rights and needs.
8: The poorest households have to bear costs of research
Any research programme, policy formulation and the subsequent implementation of a new initiative need to be financed. Interested observers appreciate that such policies are not necessarily paid for by comparatively wealthy tax payers, or international donors, charities, or NGOs. If there is any suggestion that people from low socio-economic backgrounds may be obliged to fund poverty research programmes through personal taxes or even out-of-pocket expenditure, it would be vital to investigate the financing structure of policies and programmes to formulate more appropriate ways to finance direct political intervention.
Compounding the problem of poverty within communities, even with sincerely altruistic goals, is unlikely to lead to welcome, or acceptable, solutions. If the target community feels in any way resentful then such action would also be counterproductive. Before any research begins, it needs to be appropriately funded in an equitably acceptable manner, preferably through associated stakeholders. The fiscal burden cannot be borne by the poorest in the community.
Arguments and obstacles put forward against tackling child poverty arise from genuine economic, cultural, and ethical concerns. Addressing these is very important to ensure that campaigns against child poverty can be conducted effectively and in a coordinated manner. An appropriately respected core team can build constructive working relationships with researchers and key stakeholders to put in place suitable finance and a rigorous, innovative rolling programme, informed and publicised by ongoing data collection.
All discussions and planning need to be undertaken in culturally sensitive, constructive and supportive ways. Moreover, where possible the benefits of detailed analysis, research, and measurement of child poverty need to be set into a holistic context and be clearly appreciated by policy makers and other interested parties. Emerging aims and policies to address the complexities of child poverty should therefore be based on well informed agreement.
The UN estimates that 72% of all water used is in agriculture. A further 16% is used by local communities for example, through domestic supplies. The final 12% is used in industry.
Water scarcity and child poverty
Of the basic necessities which are taken into account by organisations like the World Bank to help reach a multi-dimensional definition of child poverty, a safe water supply is as fundamental as it gets.
Many people are affected by drought every year
The World Health Organisation (WHO) estimates that approximately 55 million people around the world are affected by drought every year. Some of the most vulnerable work in agriculture and its associated trades. Droughts are obviously hazardous to livestock and crops everywhere. Depending on their severity, water shortages lead to people’s livelihoods being jeopardised or wiped out. The wellbeing of families and communities can be compromised if crops fail, or animals die from thirst. At its worst, drought can lead to whole communities migrating in search of safer, more reliable water supplies.
Many people are affected by water scarcity
Water scarcity impacts on about 40% of the global population, or 3.5 billion people.
A definition of water stress
Water stress is defined by assessing when a region or community draws on more than a quarter of its renewable freshwater supply. This is an initial red line intended to trigger a roll out of appropriate measures, official alerts and messages.
About 800 children under the age of five die every day because they are suffering from diarrhoea which has arisen from being forced to drink dirty water. Approximately 2.3 billion people do not have access to basic facilities such as a toilet.
Many people face the threat of forced migration because of drought
The WHO estimates that during the next seven years, as many as 700 million people, or one twelfth of the world’s population, will remain at risk of forced migration due to the threat of drought. Across the globe, approximately 2.2 billion people, or about a quarter of the global population, do not have access to a reliable and safe water supply.
Water scarcity is becoming more commonplace
The UN considers that the effects of climate change are making water sources less reliable. Natural water storage – that is, water which is retained in the soil, or in ice and snow – is decreasing. This inevitably leads to mounting pressure points on resources, meaning interruptions to supplies. Consequently, in dry seasons widespread disruption across communities, agriculture and industry becomes inevitable.
Those likely to be hardest hit by water scarcity
People who live in poverty, in low income countries, and on the fringes of their societies are most commonly affected by even minor fluctuations in water supplies. When it comes to a crisis brought on by a natural disaster or political unrest, women and children are, as a rule, the hardest hit group. Responsibility for fulfilling family requirements tends to fall on women and children. For water scarcity translates into a practical, pressing need to collect water. This is a laborious task, even if water can be sourced locally, and can use up much energy and time on a daily basis. For children it may mean that they have no choice but to miss school.
Helping to establish safe water supplies
Organisations like Oxfam introduced rolling programmes to supply water storage tanks as long ago as 1976. These are obviously transformative because they can be used as a central depot and distribution centre.
Another key piece of equipment in the fight to establish safe water supplies is the testing kit. This needs to be lightweight, and easy to store, transport and use. Kits should be able to confirm that water is uncontaminated and has appropriate levels of chlorine.
The jerry can is still an important resource in the battle to provide emergency supplies of safe water. Sizes vary but an optimum measure is 20 litres, enough to permit people to carry them while providing enough water for domestic use for a few days.
Other essential equipment includes pipe work, taps, standpipes, tanks and toilets.
Further medium term help
While pumping water to many communities is a medium-term goal, installing irrigation systems for use in agriculture is also vitally important. This will not only preserve crops and livestock, it will also help to secure livelihoods.
Moreover, advice and information need to be made available to as many people as possible. One route to achieving this lies in reaching out to communities through schools.
The importance of data in controlling water scarcity
In many countries there is no established, official monitoring system in place to facilitate a water management programme. This is important to help strategic considerations and provide accurate updates. Monitoring schemes can help to balance community, agricultural and industrial needs.
What is the best way ahead?
The UN argues for a collaborative approach. There is a need to view water as a scarce resource. There is an increasing onus on the global community to introduce Integrated Water Resources Management Schemes (IWRMS). These should empower policy makers with a framework to align the requirements of various water users in light of supply and usage patterns and projected demands. They provide up to date insight to help assess levels of water reserves. Essentially, data help to control water scarcity.
How can IWRMS control water scarcity?
Data monitoring arising from IWRMS is able to shed light on issues such as losses and leaks from water distribution infrastructure. Moreover, data monitoring enables better allocation of water resources and targeted deployment of repair and relief measures. A desalination programme may become a viable strategy which could be endorsed and focussed by findings from IWRMS. Appropriate safe recycling of grey water is a further issue which can be explored through the implementation of IWRMS. Such systems give greater control of water resources through more accurate assessments.
Other measures to address water stress
Awareness, communication and appropriate technology all contribute to the production of more accurate data relating to levels of water reserves and associated resources. This in turn can be augmented through educational programmes and media alerts, explaining the benefits of water-saving and the use of green practices, particularly within industrial and agricultural contexts. Any methods which help people to appreciate the need to promote sustainable use, conserve water and reduce waste will benefit everyone.
Sustainable use of groundwater is vital to ensure that communities in vulnerable areas can adapt to the impact of climate change and better manage the needs and demands of an expanding population.
WaterAid describes the visibly lifechanging sense of relief when a community is supplied with a safe, reliable freshwater supply. Clean water, decent sanitary and toilet facilities together with beneficial hygiene practices are fundamental to ending the relentless cycle of child poverty across the globe. When an NGO like WaterAid oversees the installation of a well, or a standpipe, children benefit immeasurably. And not just by being released from water collection duties which support the family. Aiming to guarantee a fresh water supply, rationalise usage, pool expertise, and implement conservation measures will contribute hugely in the ongoing fight to end child poverty.
Armed conflict can be one of the most destructive events known to humankind. From the stone age until the present day, wars have been fought over resources, territory, power, and riches in an almost constantly recurring cycle. It damages infrastructure, topples economies, destroys social networks, and has particularly harmful consequences on children and young people regarding their well-being and development.
However, whilst wars and conflicts have always raged there has invariably always been a distinction drawn between combatants and civilians[i]; a bargain struck so that the most vulnerable of society would be granted immunity from the horrors of war. Unfortunately, this sentiment does not represent the realities of war, nor how those most vulnerable often act in the face of conflict – in particular, how children act.
Children in modern conflicts have unfortunately become intrinsic to warfare and how it is waged with the most basic laws of the Geneva Convention being violated in every major warzone as children are targeted in efforts to inflict terror on populations. This callous tactic not only poses a severe physical threat to children, as they may be killed or injured but also a psychological threat to wellbeing and life post-war. What has become most worrying in modern times is how the impacts of conflict do not always affect children as passive actors. In many countries where war is present, children are increasingly assuming more active roles in the conflicts that persist in their communities.
Children brandishing arms is indeed by no means a new development. The Spartans took boys from their family homes at the age of seven to train in the military whilst the Ottoman Empire stole children from its subjects in the Balkan states to fill out the ranks of its Janissary army through a system referred to as the devshirme[ii]. In more recent history, when the Iranian regime began to falter in the Iran-Iraq war of the 1980s children from the ages 12 upward were called up to fight Saddam Hussein’s Iraq in the new ‘Holy War’[iii]. But in present times, the training and use of child soldiers has become more commonplace than ever.
In 2017 it was estimated that more than 100,000 children were currently being forced to play active roles in conflicts[iv] in the fifteen UN-identified countries Yemen, Somalia, Myanmar, Sierra Leone, Colombia, Afghanistan, South Sudan, Sudan, the DRC, Iraq, Mali, Nigeria, Syria, the Philippines, and the Central African Republic. However, these are only the recognised countries and there are many more nations where groups are suspected of cultivating children as active participants in violence and crimes across the globe; even in some Western countries where terror cells, separatist groups and nationalists lurk beneath the visage of peace.
Today most active child soldiers are enlisted in rebel militia groups in developing nations in Africa, Asia, and South America. Militia groups often rely on a steady stream of voluntary recruits to sustain their operations. But when this voluntary stream runs dry some do resort to forced recruitment – a strategy that has become particularly prevalent among those groups that operate with children in their ranks. The extent and scale of this recruitment can, and does, differ between groups as conflicts run their course as some may employ children for individual missions whereas others will utilise them throughout.
It is important to note that this is not a problem limited to young males. The role of child soldiers is played by both boys and girls; and whilst it is commonly assumed that children recruited by militia groups are automatically handed weapons and trained as soldiers, it is not always the case. Children often take up other roles within these groups such as cooks, spies, or messengers. Young girls are particularly vulnerable when recruited as they can also face the burden of sex work resulting in physical and mental damage that lasts a lifetime even when emancipated. Regardless of how they are recruited or what role they play, child soldiers are victims of war and poverty. A child enacting a role that does not send them to the front lines of a conflict is still exposed to varying levels of violence, abuse, risk, and hardship – even though it may take different forms.
But what is most worrying about the current station of child soldiers is that not all of them are taken by force from their domiciles, or even coerced. A large quota voluntarily join armed conflicts with little resistance. The reasons for this all link back to poverty and deprivation in times of conflict.
Recruitment vs Voluntary Conscription
Whilst many children are recruited by armed groups, it is not enough to simply condemn those groups responsible for recruitment; especially when it is also the case that many children voluntarily and willingly join up. Children who join armed groups voluntarily are often already experiencing the impacts of war or conflict which can push them towards fighting. Traumatisation and brutalisation are two key experiences that push some children to join up. Children can experience high levels of trauma when witnessing violence through shelling strikes, shootings, landmine explosions and other atrocities in their communities that provoke them to conscript with armed groups to fight back – whether against a civil enemy of one further afield. Similarly, brutalisation is experienced as children are targeted by warring factions and are subject to search operations, improper detention in unlawful circumstances and sometimes torture – all of which contribute to a decision to fight the perceived inducer of these experiences.
But the main contributing factor that pushes children and young people to join armed conflict is deprivation and poverty. Families who have been displaced by conflicts and who are lacking income, jobs, food, and other necessities for survival often encourage children to voluntarily join armed groups as a way to make ends meet in extreme circumstances. Employment in armed groups affords children the potential for a roof over their heads, food, and, to a lesser degree, protection from the war outside. The choice to fight therefore becomes a plea to change their position in society and improve their opportunities for growth and development – or rather, at least it is perceived that way. The reality when living and participating in armed groups is often far different.
But what if war hasn’t devastated a child’s home; why do they then still choose to conscript? An answer for this lies in the Middle East at the tip of the Arabian Peninsula, in Yemen. Yemen is a country whose civil war has been ongoing since 2014 and child soldiers have become an intrinsic part of the Houthi rebel group’s (and to a lesser extent government forces too) tactics. Since 2015, there have been nearly 4000 verified child soldiers active in the region[v] – with the actual unverified number expected to be much higher. The UN says that over 10,200 children have been killed or maimed in the war since its start nearly a decade ago which has pushed many others into the fighting. But what is most concerning, however, is the unusual socially prescribed relationship young men and boys have with guns.
Acquiring and owning weapons is engrained in Yemeni culture historically[vi] and the link between gun ownership and manliness is an intrinsic part of Yemeni tradition that has stood for hundreds of years. Even before guns, men used to carry curved daggers known as jambiya as a sign of strength and manhood. Firing guns in celebration of weddings, birthdays and more is common practice and a sign for rejoice among many. But whilst traditional tribal law prohibited the use of these weapons by and against women and children, these rules have been bent and broken over the last decade, especially with young boys.
The eternal pairing of weapons and manliness has resulted in the self-arming of many young boys who visualise their coming-of-age with fantastical ideas of guns and masculinity reinforced by a needless war that only provokes conscription to armed groups. For Yemeni boys, not having a gun would lower their status in social circles and limit their opportunities for development whilst transitioning into adult life. It is therefore as intrinsic a possession as the shoes on your feet and is why the country has such a prolific gun culture. There are an estimated 2 guns for every 1 person in the country with a population of roughly 23 million[vii]. Focussing the blame onto rebel groups, therefore, ignores the systemic problem that causes voluntary conscription in the first place and ignores an opportunity to challenge the issue at its roots.
The Dar Al-Salam Organisation: منظمة دار السلام (DASO) – or ‘House of Peace’ in English – is an indigenous Yemeni non-governmental organisation (NGO) focused on conflict resolution and disarming practices. The organisation has developed over 250 grassroots peace committees across the country working with over 4000 tribal leaders to conduct multiple youth peace-building workshops across the country. The workshops aim to promote the ethos of peaceful coexistence as an alternative to war[viii] to combat the doctrine of guns and manhood among the country’s young boys (and girls, although to a slightly lesser extent). The organisation also runs campaigns to stop youth conscription into violence to prevent further young people from involving themselves in the war.
But whilst campaigning and education on disarming practices are pivotal to the country’s fight against gun culture and child soldiers, the problem persists. As a result of the war, children experience issues of traumatisation and brutality as a common occurrence whilst also experiencing deprivation and poverty. All this pushes people to sign up to play more active roles in conflict – a position only reinforced by Yemen’s deeply enshrined hegemonic gun culture. This unfortunate cycle of adverse experiences only serves to push more young people into the midst of war and conflict. But despite now having a position to earn both economic and social capital, the experiences of children in these situations are far from improved.
Adverse Childhood Experiences (ACEs)
The experiences we have in our early life, particularly those in childhood, play a significant role in individual growth and development. Both our physical and mental health; our behaviour and emotions; and our ability to form meaningful attachments and relationships can be drastically altered and impacted by our situational experiences both as a child and in later life.
The concept of adverse childhood experiences or ACEs is central to a discussion about child soldiers. The concept defines and encompasses the potentially traumatic experiences that some children live with between the ages of 0-17. The term incorporates various experiences, including domestic abuse, neglect, witnessing and partaking in violence; substance misuse, mental health concerns and consistent instability in the home and the community[ix].
Whilst the impacts of ACEs are significant while young, people who experience ACEs in early life often suffer from the adverse effects of it in later life – particularly with their mental and physical health. People often suffer from an increased risk of certain health conditions in later life such as heart disease and cancer whilst also experiencing greater levels of mental health conditions such as depression and anxiety – of those people who are diagnosed with mental health conditions in adulthood, 1 in 3 have previously experienced ACEs[x]. ACEs are also linked to issues of toxic stress (both as a child and as an adult) which can have adverse effects on various aspects of a person’s life[xi], including a further risk to physical health.
Poverty is itself an ACE. Children living in poverty are already at greater risk of experiencing significant physical and mental health problems which negatively impact their well-being. Poverty brings with it a multitude of economic and social insecurities such as lacking the necessary resources to feed or clothe oneself efficiently, heat their home, or properly engage with wider social actors resulting from inefficient opportunities to socialise and social stigmas and labels of the poor. The effects of poverty on a child are devastating on their own but when combined with localised violence and crime, the impacts can be even greater.
Most importantly, children who experience a combination of ACEs and poverty can have their integral understanding of social interaction thwarted and often struggle to understand various emotions (both personally and when exhibited by others). This makes it extremely complicated to process thoughts and feelings both as a child experiencing ACEs and as an adult. Young people experiencing ACEs often, therefore, find it hard to form attachments with others. This can be the result of an unsafe home ensuing from neglect or abuse but can further translate into wider social interaction. When lacking attachment, people are known to struggle as we are inherently sociable creatures[xii] and this is a key contributing factor as to why some children voluntarily join militia groups or gangs. These collectives can provide children with the support and attachment missing from their lives growing up experiencing poverty, neglect, and various other ACEs in the home. If voluntary, joining an armed group like this can instil a sense of connection and attachment that is otherwise vacant in the lives of impoverished children[xiii]. However, the reality of life inside an armed group is far from this and often involves the experience of multiple other ACEs.
How do ACEs Affect a Child Soldier’s Development and Adult Life?
The ACEs that children experience whilst playing their role in warfare are proven to drastically impact their psychological and social development whilst young and leave long-lasting legacies on their mental and physical health as they grow up – some of which are gender specific.
Whilst acting as soldiers, children face various ACEs such as a loss of access to school and healthcare, poor access to food and suitable shelter, forced displacement, and separation from family[xiv]. They further witness and endure physical and sexual abuse. But the most traumatic ACE that affects children both as active and passive actors in armed conflict is witnessing, and partaking in, violence. Children in militia groups are routinely exposed to varying levels of death and injury in war. Some experiences come from the side-lines, acting as medics to injured peers, others come looking down the barrel of a gun on a battlefield. Regardless of how they may be experienced, witnessing such atrocities causes significant harm to children while still serving in armed groups and for a long period after adulthood.
The psychological distress of fighting in wars is well documented with various studies concluding a strong link between the violence experienced in combat and the diagnosis of multiple different mental health concerns such as depression, anxiety, and post-traumatic stress disorder (PTSD)[xv]. But how experiences of conflict operate in the psyche of children post-war is not as widely understood. Both adult soldiers coming home from combat tours and child soldiers in post-war situations experience psychological issues exhibited in sleep disturbances, eating disorders, aggressive behaviours, and a dramatic increase in suicidal behaviour maintained by high levels of toxic stress. Individuals are unable to turn off their body’s fight or flight response to previously experienced stressful situations and therefore exist in a constant state of stressful anxiety. This is particularly potent among children who have experienced multiple ACEs and is especially evident among ex-child soldiers.
For example, between 1991 and 2002, Sierra Leone experienced one of the worst civil conflicts in recent history that displaced over 75% of its population[xvi] resulting in both a poverty and refugee crisis. The conflict was notorious for the roles that children played throughout whether as combatants or in other positions. In 2021, the country had a Human Development Index (HDI) score of 0.477[xvii], placing it 181stout of 191 countries published on the list; and whilst health professionals in the country are justifiably prioritising their focus on the country’s high rates of infant mortality, there has been a lack of attention paid to the fragile psychological state of the country’s ex-child soldiers who were active in the 90s.
Research by Theresa Betancourt, the leading expert on Sierra Leone’s child soldiers, found that ex-child recruits in the country are experiencing high levels of trauma since the conflict ended in 2002. Of those children who had joined armed groups, 63% had witnessed violent death; 62% had been beaten by armed forces; 39% had been forced to take drugs; and 27% had killed or injured others in war[xviii]. Experiencing these kinds of atrocities at a young age can impair the development of the prefrontal cortex which affects logical thinking and memory. This can contribute to a greater risk of suffering from depression and anxiety among war-exposed youths as they disassociate their feelings from their experiences and therefore struggle to logically tackle social encounters when the feelings resurface in later life. These, in turn, impact other areas of life such as finances, attachment and social interaction – especially when there are lasting stigmas attached to their actions whilst in service.
Multiple other external stressors influence how individuals behave post-conflict. Perceived stigmas from external actors play a massive role in how ex-child soldiers perceive themselves and measure their self-worth. It also limits their opportunities to socialise as other actors do not accept or accommodate them in a way that allows them to reintegrate into mainstream society. This can ultimately result in individuals retreating to the fringes of civilisation so as not to feel judged. But this reinforces their perceptions of themselves and how they feel society views them and amplifies the potential spiral of an individual’s mental health.
But despite the odds stacked against them, the rehabilitation and reintegration of child soldiers back into mainstream society is possible. Evidence suggests that despite the trauma many ex-child soldiers live with resulting from the numerous ACEs they have experienced, positive developmental outcomes are achievable if the right resources and support available[xix]. There is a multitude of humanitarian aid and support that incorporates holistic trauma-led approaches to helping children after wartime that can and do help children who have actively participated in conflicts.
The United Nations Mission in Sierra Leone set out a peacebuilding mandate that focussed on the demobilisation, disarmament, and reintegration of child soldiers’ post-civil conflict. The agency disarmed 75,000 ex-fighters, many of whom were children and in efforts to promote peace, alongside other UN agencies, set up numerous projects to provide jobs to thousands of unemployed youths rebuilding schools, medical centres and more[xx]. Most importantly, the projects provided a safe space overseen by UN peacekeepers where young children involved in fighting could reintegrate into wider society without the stresses or stigmas that may have otherwise been present if excluded.
More generally across the world, UNICEF, commissioned by the UN Special Representative of the Secretary-General for Children and Armed Conflict, provides psychological support during this transition period. They run courses on sensitisation and reconciliation efforts so that children can cognitively process what they have experienced and begin to live with the trauma they may possess.[xxi]. Furthermore, once children have completed these courses, some programmes attempt to reunite them with their families so that they can receive the love, support and attachment that is so desperately needed to promote stability and good mental well-being.
There are also many other NGOs acting to combat the impact of ACEs on ex-child soldiers. The Children and War Foundation is a non-profit organisation that helps children in communities that were previously affected by war. They have developed numerous study-proven interventions and support groups for ex-child soldiers to discuss their experiences and develop coping strategies in life after war. War Child is another agency that does similar work but also additionally runs multiple rehabilitation programmes for children suffering from drug addiction as a result of doping in armed militia groups that aim to reduce their reliance on using and instead focus on positive growth outcomes.
It must be noted that the rehabilitation of ex-child soldiers is highly gendered and whilst the above services are available for both genders, young women and girls face additional challenges when reintegrating back into wider society – especially when they have been victims of sexual abuse. 1 in 6 children in war zones are victims of sexual abuse; of that statistic, 98% are young women[xxii]. With a lack of state systems to report the crime, social stigmas, and the fear of retaliation by the perpetrator; young women can often feel extremely isolated when conflicts resolve and, like other ACEs, the impacts of the abuse can have long-lasting negative effects. UNICEF runs programmes the world over for child victims of sexual abuse. These include support for safe and accessible reporting, reliable medical support, and gender-based violence recovery sessions where both physical and mental well-being support is available for survivors living with the impacts of abuse and exploitation.
The Bigger Picture
What becomes clear is that condemning those who recruit child soldiers is not a complete solution. Children, in many instances, will fight voluntarily. And whilst in some cases this may be a desired position of status, such as for young men in Yemen; in many instances, the life of a child soldier is thrust upon its participant as a result of wider social processes. War itself alongside vulnerability, insecurity, deprivation, and poverty are all key push factors for the voluntary conscription of children into armed groups. When this is combined with the forceful nature of militia recruitment tactics, it produces a recipe for a cycle of abuse that will continue unless addressed as a whole.
The work that is being done by the UN and various other NGOs around the world to help ex-child soldiers confront the adverse experiences they encounter whilst fighting is pivotal to their rehabilitation and assimilation back into wider social practices. But if we are to prevent children from fighting in conflicts in the future, then we need to eradicate the root societal causes as well as address the post-conflict fallout whilst condemning and fighting the groups that recruit in the first place. But in a world order where ‘the original sin of humanity is its inability to live at peace’[xxiii]; will this ever be a plausible and encompassing solution?
[i] Singer, P.W. (2005). Children at War. Pantheon Books, New York.
[xiv] Betancourt, T, et al. (2020). Stigma and Acceptance of Sierra Leone’s Child Soldiers: A Prospective Longitudinal Study of Adult Mental Health and Social Functioning. Journal of the American Academy of Child and Adolescent Psychiatry. Vol. 59; No. 6: p. 715-726.
[xv] Applewhite, L., Arincorayan, D., Adams, B. (2016). Exploring the prevalence of adverse childhood experiences in soldiers seeking behavioural health care during combat deployment. Military Medicine, Vol. 181; No. 10: p. 1275–1280.
[xvi] Betancourt, T. et al. (2011). Sierra Leone’s Child Soldiers: War Exposures and Mental Health Problems by Gender. J Adolesc Health. Jul; 49(1): p. 21-28.
[xix] Betancourt, T, et al. (2020). Stigma and Acceptance of Sierra Leone’s Child Soldiers: A Prospective Longitudinal Study of Adult Mental Health and Social Functioning. Journal of the American Academy of Child and Adolescent Psychiatry. Vol. 59; No. 6: p. 715-726.
Save The Children has published a report into the promotion and benefits of reading for all children, irrespective of geographical and cultural background.
Reading helps children to develop literary skills, improve cognitive skills and it can fire their imagination. Reading can often be entertaining, educational and engaging. It can become an important hobby, enrich a young child’s vocabulary and instil a sense of critical and emotional awareness through empathy. Moreover, reading is broadening because of its cross-cultural insights and potential.
Reading really can help to empower children in the battle against poverty
Remarkably, researchers suggest that reading for just half an hour each week can improve children’s mental wellbeing, enhancing self-esteem and confidence. In the long term, reading may even help to stave off symptoms of mental illness like dementia. There is little doubt that good literacy is potentially life-enhancing. Reading from a young age can boost future employment prospects. Good literacy from a young age can ultimately open doors to higher education which in turn can lead to better paid jobs.
How young should children begin reading?
Researchers believe that it is never too young to experience a child’s picture book. These are designed to be eye catching. Their storylines are often inspirational and introduce exciting, amusing, and poignant themes. In short, they help to stimulate cognitive development. So, certainly before school age it is beneficial for children to experience simple text which will help to enrich their vocabulary.
Save the Children estimate that around the world about 50% of all 3-6 year old children do not have access to preschool learning. That amounts to approximately 160 million children. Therefore, NGOs and charities are working with local communities to raise awareness of the significance of reading. Ideally, parents should be supported in encouraging their children to begin to read. If a young child enjoys looking at a book, then as she develops she is likely to embrace further opportunities to read more sophisticated material.
A lack of age-appropriate material
Early readers are in short supply in many communities. Regrettably, recent research from USAID undertaken across eleven sub-Saharan countries revealed that the biggest shortage of children’s books, written in local language, is in pre-school literature. For instance, in Nigeria, of the 500 spoken languages only six were represented through young children’s books.
Save the Children worked in four regions to attempt to increase access to high quality children’s books. In Bhutan, Cambodia, the Philippines and Rwanda, the charity has worked alongside publishers to promote and increase supplies of high quality children’s books, written in local languages. Unsurprisingly follow up research has demonstrated that an increased availability of appropriate books has led to improved levels of child literacy.
The most important catalyst
Parental interest and support for young child literacy is very important in raising reading standards. Since across the developing world many children do not spend long in class, and therefore do not spend long practising and developing reading skills at school, it is very important to promote reading to children as a leisure activity beyond a formal educational curriculum.
Steps to nurture an interest in reading beyond school
NGOs and charities have experimented by establishing community-based reading clubs, book buddies and book banks, where children are able to borrow and exchange reading material. Save the Children has set about promoting the benefits of children’s reading through parental workshops. The charity has also rolled out Literary Boost, a literacy programme designed to support and foster reading skills in under resourced areas.
Literary Boost led to improved letter recognition, greater fluency and confidence with basic reading, and deeper understanding of a story.
Programmes like Literary Boost help teachers too
Across the globe many teachers are not specifically trained to develop children’s reading and literary skills. Therefore, they need support and training to help effectively convey principles of literary education to young children. In Rwanda, for example, a manual was produced to advise teachers how they can teach reading skills in the most practical and effective way, given that Literary Boost is designed to target these five reading skills:
Recognition of the alphabet and commonplace words
Awareness of phonetics and pronunciation
General fluency and accuracy
Understanding context, characterisation, and themes
These key skills address the fundamental components of reading and help to ensure more accomplished literacy and comprehension.
Did Literary Boost make a uniform cross-cultural impact?
As Literary Boost was implemented it became clear that it improved child literacy, irrespective of local contexts. The programme was rolled out at twelve community sites in developing countries, ranging from an urban setting in Indonesia to another in rural Ethiopia. In each one, children’s literacy improved.
Researchers conclude that reading and writing practice and development need to be conducted in a language which the children concerned understand and speak at home. While this may sound like common sense, it is important in schools where children speak different languages to make reading as child centred and specific as possible. Rich cultural contexts in classrooms are always challenging for teachers, especially in big classes.
Does speaking a minority language disadvantage children in terms of literacy?
Sadly, minority languages can marginalise a community, politically, economically and educationally. Those people who live in a linguistic minority are also disadvantaged as they attempt to find appropriate education for their children. Because children develop linguistic and literary skills through practice and everyday use, the more opportunities they have for speaking, reading and writing the greater the likely benefit. Self-esteem and confidence are also linked to developing literacy skills. If in school some children speak, read and write a different language to the one they speak at home, then they are unlikely to keep up with peers who operate in just the one language.
Moreover, opportunities for practice are most overtly beneficial to young children when they are enjoyable. Hence the undisputed links between children enjoying reading as a hobby and developing good literary skills. Research from the Literary Boost programme reveals that the more time a child can devote to reading in and out of school, the more positive the impact on their literary key skills is likely to be.
It is not just in developing countries that initiatives like this operate. For example, in the UK, Save the Children designed Families Connect, another programme which is intended to help parents when they read stories with their children.
The purpose of school reading assessments
In principle, assessments inform teachers about two important aspects of their reading schedules. First, they shed light on the developing skills and progress of each child within a particular class or year group. Second, they enable regular, evidence-led adaptation of programmes to cater better to the needs of individual children. Moreover, formalised data from schools can help to inform and shape policy makers’ decisions about revisions to the curriculum.
Conclusion: when a reading policy and programme are most effective
Save the Children’s experience is conclusive. They have found that targeting better literacy rates is most effective when they achieved an alliance between teachers, parents, and policy makers to improve opportunities for children to read. The broader range of stakeholders concerned the more impact the programme is likely to make. Essentially an acknowledged culture of reading, funded by educational budgets and steered by adaptable policies will ensure that more children learn to read well from an early age. For those children the future will be more exciting and aspirational as a result, because ultimately reading can help to empower people in the battle to defeat child poverty.
It has long been reasoned that, globally speaking, all children matter, but sadly not every child is taken into consideration when it comes to collating data and surveying statistics on a national basis.
Some children tend to be omitted from national surveys
For one thing, it is not always administratively easy to consult with people who live in unofficial or unregistered circumstances. Nor might it be considered safe for researchers to reach out to consult a representative sample of these people. Statistically it is likely to be difficult to establish precisely what would comprise a representative sample group, wherever accurate census records do not exist. For example, in Madagascar there was no officially sanctioned census conducted between 1973 and 2018. This means that for decades many people’s living conditions and circumstances were officially unrecognized. Moreover, the people in question might not have wanted to participate in a national statistical survey.
Why people might be suspicious of statistical research
There are many people who remain undocumented members of their societies, who naturally fear officially registering with authorities because they believe that the process might compromise their personal safety and wellbeing. Although data research into child poverty is a broadly anonymous process, it might appear to be otherwise to the most vulnerable people who live on the edge of society and who do not want to risk formal contact with state officials or state appointed organisations. If people intended to benefit from the findings of research remain suspicious of it then it’s findings and any subsequent policy decisions are likely to be intrinsically flawed.
People who live beyond the reach of researchers
People who live in an area that could be classified as a war zone, or where breakdowns in social order are thought to present high risks to researchers, are likely to be omitted from a mainstream consultation. Yet these are the very people whose status will likely fall into low socio-economic groups of which a high proportion would probably be classed as impoverished. If these people do not feature in consultations, then the statistical findings will not be representative of the reality across the country.
People whose lifestyles are traditionally nomadic whether through their cultures or through their trades are also likely to be underrepresented in national surveys simply because they are not easy to locate or consult. Limited resources mean that researchers are unlikely to be able to monitor and sample nomadic peoples.
Many children continue to live on the streets. Some are orphans, some have been abandoned, some have run away. It is not an easy prospect to conduct surveys which consult with them and represent their circumstances in accurate analysis. This is partly because of the unknown numbers involved. There is also a moral issue regarding the right of a child to give consent to data collection and representation, if no appropriate adult is available. Therefore, it is vital that the beneficial purposes of research surveys and the anonymous uses of data are carefully and sensitively explained.
Other children beyond the scope of national research
For a variety of reasons, some young people live in fairly informal households, in which children themselves act as the head of their family group. If research is conducted through a representative sample of households and schools these children are unlikely to be represented on a survey. There are inevitably some children who are removed altogether from their societies at the hands of child traffickers. These are essentially beyond the reach of any research programme, however comprehensive and exhaustive.
There is a purposeful emphasis that arises within the SDGs in relation to children and child poverty, namely that no child should be left behind. This notion is important in informing the nature of research into child poverty. Innovative and all-embracing methods of data collection need to be rolled out and estimates need to be produced without excluding any of the groups cited above. Acknowledging these limitations in statistical research is an important milestone in achieving more representative data to inform strategic planning to counter child poverty.
Household and school based surveys are inherently useful in assessing and clarifying levels of child poverty, preparing the ground for appropriately targeted legislation and relief campaigns. Without them much of the success in reducing child poverty on a global scale would have been impossible. However, it is vital to build in fail safe mechanisms to the research which ensures that the poorest and most vulnerable children are formally represented and taken into consideration. Sampling frameworks may have missed many millions of people and children from their data. In 2016, problems like these prompted over 175 organisations to write an open letter to the UN Statistical Commission on SDG indicators, arguing for the potential benefits of more culturally specific data collection and analysis to ensure that countries acknowledged and represented all children in their assessments of child poverty. Organisations like UNICEF have championed that sentiment ever since.
While no data research can be one hundred percent accurate, and while accessibility may continue to be problematic, culturally sensitive research surveys can afford more than an overarching sense of the uncounted child populations who live in conditions like those cited above. Moreover, they can help to shed light on particular challenges they face. By consulting and engaging members of local populations more appropriate surveys can be designed and a deeper appreciation of target areas should be the result. Representatives from local communities will naturally contribute accurate knowledge of their social environments.
ATD Fourth World in Antananarivo, Madagascar
Prior to the 2018 census, ADT Fourth World reached out to local communities in Antananarivo. Through local knowledge they ascertained that a majority of households living on a refuse dump in the north of the capital were unregistered with the state. By collaborating with households, ATD Fourth World was able to undertake mapping research which clarified circumstances of people living in the area. For instance, approximately 70% of those living on the dump were younger than twenty, and a majority did not have official documentation such as a birth certificate. Because local people were warmly engaged in the research, the process actually helped to bring people together, and garnered a sense of identity as well as information about common challenges which they faced.
Technology and its ethical use in research
Satellite imagery as well as mobile and GPS technology could potentially be employed to identify migrant and homeless groups. As mobile phone use continues to spread, there remains an ethical concern regarding data collection and observation which could expose some populations to political dangers. It goes without saying that vulnerable populations need to be overtly protected.
The 2016 open letter from those 175 organisations succinctly summarises the need for better research into child poverty and living conditions:
‘The post‐2015 global monitoring framework must establish mechanisms to integrate household-based data with additional information on children temporarily or permanently living outside of households… The post‐2015 global monitoring framework offers an opportunity to do more and better on behalf of the world’s most vulnerable children – ensuring, first and foremost, that they are no longer invisible.’
Essentially all children matter, but they will only benefit from research and new political initiatives if they are represented in bespoke surveys designed to aid them.
Supporting farmers in Tajikistan can be transformative in fighting child poverty.
Tajikistan is situated in central Asia, north of Afghanistan, west of China, south of Kyrgyzstan. It is a rugged, landlocked republic. Approximately ten million people live there.
The biggest employment sector is agriculture. The World Bank estimates that about 48% of the national workforce is employed in farming and its derivative trades. In total, agriculture amounts to approximately a quarter of the country’s Gross Domestic Product (GDP).
Arable land in Tajikistan
Only about 7% of the land is classified as arable. Farming in Tajikistan is not based around large scale corporations. There are many farmers who own or manage a small holding where they produce crops for their own consumption and sell on excess produce into the local community via markets. Their land ranges from an allotment sized strip to two or three acres. So it is mostly small scale and family run.
Technology is not prevalent in Tajikistan’s agricultural industries
It is challenging for small holder farmers to develop their businesses because they have little opportunity to draw on modern technology. Farming is steeped in traditional methods, and labour intensive. Training is rare, which means that local farmers do not have the necessary business acumen, or motivation, to exploit upscaling and updating. This restricts them to a local focus, inhibits their income prospects and limits access to fundamental resources like fertilisers and seeds.
Farmers in Tajikistan face difficulties in securing loans. They tend to live from season to season, which means that they are especially vulnerable to fluctuations in the weather. Some farmers rely on relatives to help them with planting, general maintenance, and harvesting a crop. Those relatives are likely to be young, sometimes children and either not well paid, or unpaid.
How the World Bank is helping to change lives in Tajikistan
The World Bank tells the story of Shiringul, a woman small holder farmer from the district of Shahrinav. She desperately needed financial support to sheer up her business, enhance its efficiency and protect it against weather fluctuations.
The area of Shiringul’s land amounts to about three acres (that’s approximately the size of three football pitches). Shiringul approached a Tajikistan credit institution for a loan. Through the endorsement of the World Bank not only was Shiringul awarded the loan she applied for, but also an additional grant made through the Agriculture Commercialisation Project (ACP), a financial support facility backed by the World Bank.
The difference that the combined loan and grant made to the small holding
The injection of new finance helped Shiringul transform her small holding. For example, she was able to construct a large green house. This was an innovative addition because a greenhouse essentially extends a growing season. It gives protection from cold weather snaps, frost, etc. It also means that Shiringul can continue to farm some crops in any weather when it might otherwise prove very difficult to cultivate her land. Moreover, a greenhouse can keep pests at bay, or make them easier to control, while allowing a farmer to keep beneficial insects inside the controlled environment. A green house also usually leads to a more bountiful crop. Shiringul can now grow cucumbers for the first time.
How else do farmers like Shrinigul benefit from additional agricultural technology and infrastructure?
Being able to grow crops for longer ensures that Shiringul can sell produce during colder months and extend her income throughout the year. This is hugely beneficial for the family business and the local community, and not just in terms of providing a more secure food supply. Shiringul now employs seven local people from her village, including three women, to assist her in the green house.
The benefit of this sort of employment opportunity for everyone
If local women from rural communities find it difficult to manage to support their children and families, this type of work is a financial lifeline. It guarantees a way out of poverty and its associated worries. It also brings a sense of achievement and self-esteem, partly arising from workplace camaraderie. There are also perks associated with the job. For example, Shiringul provides a hot meal each working day for her employees.
The ACP particularly aims to support women, young people and members of the disabled community. Securing a loan is one aspect of the role, but equally important is support for formulating business plans. The personal, environmental and economic impact of financial support like this is transformative. Promoting job creation in rural areas helps to keep families out of poverty, ensuring that children and young people enjoy a higher standard of living. Enhancing traditional farming methods leads to more efficient practice and productivity, but it also creates business opportunities to benefit the whole community.
The success of the ACP scheme
Over the last five years loans and matching grants awarded from the ACP scheme have supported rural farming projects across Tajikistan. Nearly 3,000 farmers, about half of whom are women, have been awarded grants and loans totalling $4 million. Moreover, 130 small holder farms have been established as a result of financial intervention. In all $1.8 million has been injected into the Tajikistan economy at a local level to help start up businesses. Of the 130 new businesses supported, 35 were established by women, 90 by young people and the remaining five by disabled people.
How Shiringul is intending to spend her profits
The World Bank quotes Shiringul’s ambition to invest in her children’s future: ‘My dream is to be able to afford to give all my children higher education, especially my daughters.’ Such a heartfelt revelation demonstrates just how significant the ACP’s scheme is for people living in rural Tajikistan. This far sighted financial intervention and support not only empowers local people; it helps to bring rising prosperity to local communities; it naturally fights against poverty, and it is truly aspirational in terms of the potential impact that can be made on families and children in particular.
Cholera is a bacterial illness which infects the intestines. It is ingested through contaminated water or food. The disease spreads where there is no clean water supply. Poor sanitation and dirty water are the perfect spawning grounds for the bacteria. Therefore, children who face life in slums and refugee camps, and people displaced by conflicts or natural disasters are most at risk. Over the past 15 years, the vast majority of cases were to be found in regions which had the worst water and sanitation services, if any.
Cholera is curable
While cholera is a very serious disease and can be fatal, especially to children under the age of five, those who are undernourished are particularly vulnerable to the most serious symptoms. This is certainly ironic but yes, cholera can be treated, cured and, with appropriate foresight, prevented in the first place. There are vaccines available.
Where Cholera strikes
Cholera thrives wherever there is abject poverty. The disease has become poverty’s bellwether, announcing the appalling toll which the illness continues to wreak on the poorest and most under resourced communities.
Those most at risk
People, particularly children, who live in unstable circumstances, who have been displaced from their homes or have inadequate basic services and resources. UNICEF estimates that 1.1 billion people are at risk, however many cases are not recorded at all. Officially, researchers suggest that there are over four million cases every year and approximately 150,000 cholera-related deaths. This makes the fatality rate about 4%.
UNICEF aims to significantly reduce the threat that cholera poses by 2030.
What makes a region cholera-endemic?
UNICEF defines this as any place where cases of the disease have been found for three consecutive years, implying local transmission. However, outbreaks can occur in any communities which have poor sanitation and dirty water supplies.
Climate change also adds to the threat of cholera. Unusually heavy rainfall and consequent flooding can overwhelm and disrupt normal water supplies and sanitation services. If families and communities have to rely on unsafe or tainted water, they are at much greater risk of exposure to water-borne illness.
Symptoms of cholera
Many infected people have few symptoms. Some have mild or even no symptoms at all. The most common are diarrhoea and dehydration. After initial infection, symptoms can appear any time between twelve hours to five days.
The link between poor sanitation and cholera
Cholera bacteria remain in human faeces for up to ten days. Unfortunately, wherever there is poor sanitation, the bacteria are recycled into the immediate environment which only compounds the problem and can result in further cases of infection.
UNICEF and other NGOs supply orally taken rehydration solutions (ORSs). The primary components are salt and sugar. They are powdered, light weight, distributed in sachets and easy to ingest, but they need to be dissolved in clean water, and therein lies another irony. To cure cholera people need clean water. Moreover, if children are severely dehydrated, they may need emergency medical care when fluids can be supplied intravenously alongside courses of antibiotics. Zinc is also an important trace element which helps to reduce the severity of the disease.
There are three orally administered vaccines endorsed by the World Health Organisation (WHO), Dukoral, Shanchol and Euvichol-Plus. These need to be taken in two doses. The International Co-ordinating Group (ICG) stockpiles these vaccines and supplies them to areas where there are outbreaks. The ICG has overseen the administration of more than 100 million doses of these vaccines. Anyone who survives a bout of cholera acquires long lasting immunity to the disease.
Progress made in the fight against cholera
In the decade 2010-2019, total deaths from severe cases of diarrhoea among infant children fell by approximately 60%. Researchers point to the increased distribution of ORS formula treatments as a major reason for this dramatic change. Moreover, supplying clean water to communities also makes a huge difference. However, during the past three years, outbreaks have unfortunately been on the rise.
In 2022 there were cholera outbreaks in thirty countries. That amounted to a 145% rise on the previous five-year average. In the middle east, Syria and Lebanon reported cases for the first time in many years.
In south and east Africa, a cholera epidemic is ongoing. In January 2023, it was reported that Malawi was suffering its worst outbreak to date. Cholera has struck all 29 districts within the country and thousands of children have been infected.
During 2022 Haiti witnessed thousands of cases and hundreds of people died, among them many children. Infants account for 40% of cases. Community conditions in Haiti are still mired by the aftermath of the 2021 earthquake, a malnutrition crisis, political instability and clashes between armed militia gangs.
Action to help these people
UNICEF and other aid organisations are working with governments and others NGOs to help coordinate the distribution of water treatment tablets to ensure that water in vulnerable and affected communities is safe.
UNICEF and its partners are also supplying ORS sachets, zinc and antibiotics to local medical departments.
Moreover, local people are also receiving training to recognise and respond to symptoms of cholera, administer its treatment and to educate to help its prevention. Raising awareness through local media and schools is also important.
The top priority is to ensure that vulnerable communities and displaced refugees have access to clean, safe water and appropriate sanitation. A second priority is to make available the World Health Organisation’s oral vaccines. Likewise efficient and targeted supplies of ORSs, zinc supplements and antibiotics are essential. Local communities need to be empowered to look after their own wellbeing at the most basic level. For example, simple measures like handwashing, personal hygiene awareness including the safest possible disposal of human waste will also help to control the spread of the disease.
The statistical target
Prompt and formal treatment and educational campaigns should bring the fatality rate down from 4% to below 1%. Hand in hand with the efficient roll out of treatment is active and reactive monitoring for the disease. Accurate data relating to cholera need to be collected, collated and circulated at regional, national and local levels.
Is the end of Cholera in sight?
It is always worthwhile to plough resources into eradicating a disease which is preventable (through vaccinations) and curable (through treatments). In 2021 UNICEF issued more than 93 million zinc tablets and over 30 million ORSs. However, in societies where everyday life is unstable because of natural disasters, forced migration, or conflict, outbreaks of cholera remain a deadly threat. For the time being, further humanitarian help is vital to control outbreaks of this disease.
UNICEF and its partners are reaffirming their commitment to tackle cholera so that by 2030 it is no longer a serious threat to vulnerable populations around the world, and especially the world’s poorest children. To that end, UNICEF is focussing on fifty countries where it considers the greatest risk lies.
This blog asks which organisations are central to assessing child poverty. UNICEF has attempted to summarise the roles and influence of major bodies involved in research, analysis and publication of data relevant to child poverty. The research demonstrates that collaborative work can form the most effective basis of campaigns to raise the political profile of child poverty. Here are half a dozen important stakeholders.
1: A national office for statistics. This is usually a civil service style department which is administered and funded under a government umbrella. These departments are officially authorised to conduct research, collate data and results, carry out discrete analysis, publish findings and make evidence-based recommendations. If their research programme and findings concern the overarching field of poverty, then it may be possible to extrapolate discrete data which particularly concerns child poverty. An office for national statistics is very likely to oversee and implement a regular national census as well as surveys relating to household income and expenditure. Data generated by these activities is vital to shed light on issues relating to child poverty and should help to inform strategic planning to tackle it.
2: A government finance ministry. This is a likely source of information and data on poverty in general across a country. Official recognition, endorsement and ongoing support of such a ministry is vital for the timely funding, launch and ultimate effectiveness of a rolling campaign against child poverty.
3: UNICEF. Over the past twenty years the role of UNICEF has been instrumental in raising awareness and promoting the importance of child poverty on the global stage. One reason that child poverty is reducing on a global scale is because of the coordinated work undertaken by UNICEF. It has led negotiations with various stakeholders on a country by country basis, organised international efforts and initiatives, promoted research, data collection and analysis, fostered official discussions, helped to formulate appropriate policies, and worked behind the scenes to bring about programmes to reduce child poverty.
UNICEF has worked alongside governments and organisations in dozens of low income countries to ensure that reports and studies exploring child poverty have been undertaken, together with specific assessments, for example investigations examining conditions in urban slums or the impacts made by an individual grant from the government. UNICEF has access to an increasingly vast data bank which is important for informing planning. Much of this data is regularly updated, which enables trends to be traced and the impact of a policy or campaign to be effectively measured.
4: The World Bank. This international organisation has for many years promoted and supported poverty analysis in lower and middle income nations. It produces and updates the monetary measure of poverty, currently $2.15 per person per day. However, it has expressly documented why a multi-dimensional approach to measuring poverty is vital. The World Bank also provides a wealth of resources informing the measurement of global poverty, and in addition it publishes reports on poverty on a country by country basis.
Partly prompted by the Global Commission on Poverty, the World Bank has also adopted a policy to research and publish poverty profiles specifically for children (under 18 years of age). Its research and analysis of multidimensional poverty has highlighted the benefits of defining poverty from a lifestyle viewpoint, taking into consideration factors like rights, access to a reliable electricity supply, sanitation and hygiene, nutrition, education programmes, medical care as well as safe housing.
5: Charities, non-government organisations (NGOs), civil society organisations and research bureaux. Each of these groups of stakeholders plays a significant role in raising the profile of child poverty, and helping to keep it on the political agenda, both nationally and worldwide. They help to raise awareness and secure finance. This can be done by collecting data, undertaking research and investigations, conducting appropriate interviews with people concerned and other stakeholders, as well as by actively campaigning, fundraising and implementing new measures. They also work with media and journalists. Such contributions can help to influence and shape government policy.
Small charities can also play important roles in measuring child poverty. For example, alongside their other campaigns, they can raise awareness and help to shape discussions by regularly airing issues on an active blog, or through their online presence.
In a country which undertakes no official research into child poverty these bodies can give a lead in formulating estimates, from which it is possible to raise the profile of child poverty in terms of public awareness. Such publicity and promotion can generate political pressure and help to build momentum which can lead to a review of government policy. Charities such as Save the Children, Oxfam and the remarkable Médecins sans Frontières often catch the headlines for their roles at the forefront of interventionist humanitarian relief. Often this follows in the wake of a specific emergency, whether the result of an environmental event, war, breakdown in law and order, or economic crisis. Data and evidence from their experience on the ground, and campaigns organised as a consequence, can help to inform decision making about, and raise awareness of, child poverty.
6: The United Nations Development Programme (UNDP) is an outreach network which aims to connect governments and organisations to facilitate mutually beneficial exchanges of experience, knowledge and resources to help improve lifestyles for the global population. Poverty reduction is at the heart of their mission. They operate in 170 countries, fostering development research, planning and initiatives to formulate solutions to political and cultural challenges. While the UNDP promotes sustainable development, climate and emergency resilience, peacebuilding and democratic governance, it also assists in attracting aid.
The UNDP was responsible for constructing the multi-dimensional poverty index. This method of assessing poverty in general and child poverty specifically has helped to rationalise the arbitrary-seeming income-based poverty line. Together with the Oxford Poverty and Human Development Initiative (OPHI), the UNDP publishes regular country specific analyses of poverty.
The importance of alliances
The above stakeholders often formally collaborate in their collective missions. Developing such partnerships is central to forming influential and respected alliances which can more readily help to advise and shape political responses to child poverty. While naturally the role and relative importance of these stakeholders varies from country to country, they are nonetheless central to achieving the goal of constructing a national pathway to tackle and eradicate child poverty.
In conclusion, thorough and effective measurement of child poverty leads to its reduction. These stakeholders all contribute to that end.
It is a commonly accepted fact that war and conflict perpetuate the displacement and mass movements of populations subjected to its violence. The term refugee’s first noted use was in 17th century France to refer to the Huguenots – French protestants who fled to surrounding nations when their religious liberty was threatened with violence – and has been an unfortunate recurrent staple in both academic and media discourses ever since[i].
Despite its common usage, many people often use the terms refugee and migrant interchangeably – a mishap heavily utilised in the UK Brexit campaign in 2016. However, the terms denote two different situations, and it is important to distinguish between the two. Migrants are defined as those who choose to leave their homes; refugees, on the other hand, are forced by the threat of persecution or violence.
Poverty has become a well-known, often long-term outcome of forced displacement. Whether this is historical or contemporary, refugees are forced to deal with hardships in both living standards and social exclusion when fleeing conflict. Despite some states having asylum and social policies for refugees, a growing Western shift towards right-wing social views and the adoption of isolationist national policies on migration have had detrimental effects on the living standards and well-being of refugee populations living in new countries in search of greater stability and welfare. Those most susceptible to these issues are children.
The Issues at a Glance
Poverty is multifaceted by nature and there is a myriad of issues that stem from its base that refugees face, particularly when living in unstable, makeshift refugee camps. Securing necessities such as medicine, fuel, shelter, food, and water is a constant struggle for displaced families, especially given that many of those fleeing conflicts lack the economic funds required to obtain these resources. The issue is only worsened when families are split up or children are orphaned by war – there are over 170,000 unaccompanied and forcibly displaced children worldwide today[ii]. The lack of these necessities further impacts the cognitive and psychological welfare of children which can, and does, stunt both physical and cognitive growth in the long term.
Whilst these are major issues that must be addressed if we are to combat the levels of poverty refugees face, they are (despite their monetary derivative) somewhat controllable amenities. By this, I do not mean that they are readily available – as they are not – and to say so would disregard the hardships refugees face trying to acquire them and their importance for survival. Rather, they are things that can be sought with the right resources. However, as stated, most refugees do not possess the economic or social capital for this. Whilst some may work jobs (which are often poor-paying, insecure 0-hour contracts), many instead become heavily reliant on foreign humanitarian aid – especially those in camps.
Humanitarian organisations such as The Red Cross and Lighthouse Relief, particularly UNICEF for children, send aid packages to refugees worldwide to help address some of the issues they face, primarily in the form of food packages and hygiene toiletries. Children are often the ones to receive a large proportion of this aid which allows them to secure the basic necessities for survival – although this is not always the case.
But, whilst humanitarian aid may offer some relief in certain instances, it struggles to meet the needs of all those who require it and is not an answer for all the issues that poverty presents. Children living in foreign countries often struggle with sociability because of language barriers and a difference in cultural hegemony. In other words, they lack the social skills required to socialise in that specific region as it is often different from what they are used to at home. This in turn means they lack the necessary social interactions required for social growth which only serves to isolate them from the wider society in which they now reside. This can lead to the creation of isolationist diasporic refugee communities that live on the outskirts of their new host country, limiting a child’s capacity for growth.
Palestinian displacement in Lebanon
The civil unrest in Israel-Palestine has left the eastern coastal plain of the Middle East in conflict since the state’s partition in 1948. It has created displacement of refugees on a massively unprecedented scale. A large proportion of those forced from their homes in the West Bank have fled to neighbouring Lebanon. An estimated 300,000 Palestinian refugees are currently living in Lebanon[iii]. Of these 300,000, approximately 93% are living in poverty[iv]. The situation is the same for those in Jordan and Syria.
The Israeli state ‘opposes their return to Israel as it would alter the country’s Jewish character whilst the Lebanese state opposes their implantation in Lebanon’[v] as their practice of largely Sunni Islam is perceived to threaten the already fragile coalition of constituencies governing the country. The result leaves Palestinian refugees in a limbo state, living in camps, struggling to obtain necessities, and existing as outsiders not only to Palestine but to their new hosts too. Living in such ostracising conditions can and does have negative effects on the levels of well-being and esteem experienced by those on the outskirts of society.
When it comes to basic needs, food insecurity is strife amongst the children of these populations with 23.8% of those under 5 being malnourished leading to long-term growth stunting[vi] and a further 25% prevalence of anaemia. Disease is a common issue produced mainly by inadequate housing. Cholera and cardiovascular disease are highly prevalent among Palestinian children because of indoor pollutants, infestation, mould, and dampness in the home – issues impossible to deal with when you are not formally recognised by the state in which you reside.
Many children do not have any form of formal education – an issue largely exacerbated by lacking electricity. In the Lebanon camps, households are only supplied with 2 hours of government-regulated electricity a day meaning children have little else to do but hang around in the alleys between buildings in camps to play and wander, exposing them to dangers of abuse, abduction, and trafficking – an issue that particularly affects young girls.
The conditions in which these children live do not serve to better their position in society since leaving the conflict zones of the West Bank and Gaza. They place them at a disadvantage by removing their opportunities for socialisation with wider social actors which only condemns them to live at arm’s length from their native Lebanese peers, whether that be in school or work or play.
Whilst there is still a great deal to be done, multiple agencies are working to improve the position and livelihoods of young Palestinian refugees. Last year, ANERA helped 1,357 Palestinian refugee graduates in Lebanon get jobs in the vocational sector after leaving one of their multiple schools in the region[vii]. The skills they use not only benefit them immediately but also help the wider refugee community in which they live by injecting money into the area to fund development. Furthermore, future generations will benefit from the skills taught to them by employed young adults. Having a job also lessens the reliance on foreign aid and helps to develop an individual’s cultural capital by exposing them to wider social inclusion through work, which can, in turn, reduce the stigmatisation of refugee populations in host nations.
The biggest humanitarian force in the region is the United Nations Relief and Works Agency for Palestinian Refugees (UNRWA). Established in 1949 following the first Arab-Israeli conflict post-partition, the organisation currently provides education to over 39,000 Palestinian child refugees living in the 12 camps of southern Lebanon – a number which rises to 545,000 students when incorporating those in Jordan, Syria, Turkey and more[viii]. A similar picture is painted about healthcare with 550,000 registered patients each year visiting one of 27 different healthcare clinics in southern Lebanon[ix] helping to combat the issues of disease that too commonly prevent children from living until adulthood. The organisation is currently in the process of reforming its healthcare policy to bring a new holistic family health team approach to better suit the needs of refugee populations.
However, the issue is that the United Nations general assembly has had to continuously renew the UNRWA’s mandate since its establishment in the absence of a solution to the refugee crisis that Palestine’s population has faced for decades now. Whilst it is the case that some have gained valuable skills in education and work, there are still many others who have not and continue to live in poor, unsafe conditions ostracised by wider society. And whilst the work that NGOs do is pivotal to Palestinian society’s survival and upkeep, its efforts are negligible until such a time that a long-lasting peace can be brokered and enforced – something that has had little success thus far.
The Syrian Refugee Crisis
Probably the most well-known example of modern displacement of refugees lies just north of Israel/Palestine. In the 10 years following the start of the Syrian civil conflict in 2011, over half the country’s population have been displaced across 130 countries around the world – 70% of whom are living in poverty producing what the UN High Commissioner for Refugees, Filippo Grandi, has called ‘the largest refugee crisis in modern times’[x].
In September last year, UNICEF released a report noting that there are currently 5,900,000 Syrian children living as refugees who need support[xi]. Like the Palestinian populations mentioned above, many Syrian refugees reside in large camps riddled with incidents of poverty. Lacking education, work, poor health, and security are just some of the similarities in issues that Syrian refugees face. What tends to go under the radar most often in the discussion of Syrian displacement is the social and psychological influence that life as a refugee has on the children who flee.
Notions of national pride are cracking under the weight of a refugee crisis that is still very much ongoing. This is particularly true for young men and boys living as refugees from Syria, especially as Syrian nationalism is allied strongly with traditional perceptions of masculinity to fight for the ‘fatherland’[xii] – a somewhat colloquial spin on the commonly used phrase ‘motherland.’ Syrian boys have struggled to adjust their ideas of manhood and masculinity when living as a refugee as their function of masculinity has been challenged by western ideals on changing gender norms[xiii] which has caused a rise in anxiety and depression among young male refugees.
Similarly, living as a refugee, especially for long periods, can, and does, influence and form a child’s perception of both themselves and their country. A recent report found that a group of children who have been displaced and are living in makeshift refuges on the outskirts of Idlib in north-western Syria have been struggling to identify with their cultural heritage after 10 years of conflict has thwarted their sense of home[xiv]. Despite the country’s rich heritage, Syrian children today do not see their war-scarred country as holding any future opportunities for them and most would rather move elsewhere in the hopes of better education, well-being and standard of living. The desired location for most is in Europe.
But the past 10 years have seen Syrians in Europe face xenophobia and hate crime at an alarmingly high rate. Largely a result of Western political and media representations, some young Syrians have been victims of crimes by those native to the host society. In August of 2021, Turkish Nationalists gathered near an enclave of Syrian refugees and began to attack their homes and businesses[xv]. In the UK in 2018, a 15-year-old male Syrian student was attacked by his peers after school whilst a young Syrian girl was pushed in front of a train in North London[xvi]. Many incidents go unreported to the police as they feel they either won’t be believed or fear that cultural and language barriers prevent them from seeking help.
Even applying for asylum can be a long and arduous task. For refugees in the UK to gain access to healthcare, housing, and many other necessities for life, they need to have applied for asylum or pre-settled status – a task that can be complex, especially when those applying are young adults and families with children who do not speak English. And whilst you can still reside in the UK whilst the application pends, you are still not formally recognised by the state as having asylum and as such do not reap the benefits of stuff, often leaving families in poor financial and housing situations. However, various institutions can offer support in this process; Migrant Help UK, Refugee Council and Shelter all have services dedicated to the support of refugees applying for asylum.
Once asylum is granted the benefits for refugee populations can be massive, especially as some refugees (particularly those with children as they are considered most vulnerable) are eligible for the resettlement scheme. In 2022 alone, 1054 Syrian refugees were resettled in the UK[xvii], 52% of the total scheme.
Of course, it is not always as simple as this and many Syrian children travelling alone in particular do not have the means or skills to make it to the UK and thus end up in insecure accommodations or camps across Europe. The bulk of these exist in Turkey, an area recently struck by an immense earthquake, producing further issues for survival as a refugee. The most well-known Syrian refugee camp, however, exists in Calais, northern France.
The ‘Calais Jungle’ represents a severe example of what Syrian children face when living in refugee camps both alone and with their families. Hunger is commonplace with each person being given only one meal a day. Any food kept by those in the camp cannot be stored effectively as there is minimal electricity and infrastructure, leaving food and water to be contaminated by the high levels of pathogenic bacteria present causing vomiting and diarrhoea.
Hygiene is poor with 1 toilet per 75 refugees, more than three times the acceptable standard recommended by the UNHCR. Furthermore, since there are no effective means to wash clothes or bedding there are mass infestations of scabies and lice throughout the camp.
These issues are concerning for children’s physical health, but it is again important to look at how this burden has detrimental impacts on mental health and how the perception of oneself may change in light of how others perceive you – a notion particularly prominent in European media. Refugees are continuously labelled as the scapegoat for issues in Europe by Western media outlets; a representation that impacts on the well-being and self-esteem of refugee children by reaffirming them as a cultural other[xviii]; as different.
Living with this feeling of otherness only serves to worsen the issues of ongoing psychological trauma, anxiety and depression – which are all common mental health concerns that refugee children in the Calais jungle (and other camps) live with. For Syrian children, these stem from both the pre-displacement experiences of war and conflict in Syria; and the post-refugee life experiences resulting from the separation of families, difficulties in the asylum-seeking procedures, social exclusion and more[xix] in their new host nation (France in this instance).
As such, the concerns are not simply for the immediate impacts of these psychological issues but also the long-term damage they can do to a child’s ability to grow, communicate, socialise, and develop. Children suffering from psychological trauma are more likely than the local population to struggle with social anxiety, preventing them from engaging properly at school or sports clubs or in other social settings. These issues can manifest in later life with many refugees practising avoidance in social networks so as not to re-trigger the memories of lived trauma from before.
There is, however, much being done to assist and help Syrian refugees and children in the form of foreign aid. The UNHCR poverty alleviation coalition is the largest actor in the sphere of Syrian humanitarianism. There are currently upward of 6.8 million internally displaced Syrians and external refugees registered with the UNHCR for aid in the form of cash, food and cooking appliances, medicine, and more[xx]. For those living as refugees abroad, the organisation has a programme for protection and inclusion solutions focusing on increasing engagement between young Syrians and their peers in foreign host nations. Last year the commission conducted 19,888 social activities and social awareness sessions aimed at raising awareness for the mental health concerns that couple with the physical aspects of poverty and the lived experiences of trauma, engaging 16,000+ people[xxi]. The organisation runs specialised mental health groups led by psychiatrists and psychotherapists that aim at openly discussing issues to combat the stigma associated with mental health among young boys and men.
Sessions on family and community support aim to direct support towards child refugees, supporting local community centres to help with development in child-friendly settings. In addition to this, child protection committees consisting of social workers, teachers and other professionals work with Syrian children to identify potential protection issues and trends in refugee communities to help address problems before they develop by referring them to WHO (World Health Organisation) medical professionals for support with their mental well-being.
It hopes within the next year to increase its output and step up its involvement in this area, which is particularly important when addressing the mental health concerns stemming from social ostracism that many refugees face. But whilst these movements towards incorporating mental health support are pivotal in the fight against poverty, only 25% of those involved in the programmes offered were male – the largest sufferers of depression and anxiety in the population. There needs to be a focus on engaging more men, especially young men and boys who are most susceptible to trauma and PTSD which can have long-lasting consequences.
Various other organisations operate relief programmes contributing infrastructural support as well as food. SIRF (The Syria International NGO Regional Forum) brings together a multitude of agencies dedicated to assisting in efforts to help Syrian people live in light of the civil war. The agencies provide a range of support from medical care (both psychological and physical) to the provision of supplies necessary for survival (such as food and water) and are pivotal in helping to keep Syrian children in insecure accommodations safe in the ongoing refugee crisis across the Middle East and the rest of the world.
So, while there are a lot of issues that refugees face, there is a great deal of support available for them – whether that’s direct from the United Nations or NGOs. But is it enough? Whilst it is definitive that governments and NGOs need to continue to address the physical and monetary issues that refugees face, there also needs to be an acknowledgement of the long-term social and mental impacts that life as a refugee inflicts. The UNHCR’s programmes on well-being dedicated to supporting children and adults in refugee settings with managing their mental health are a great start but there is only minimal engagement by refugee populations in comparison to the millions spread worldwide. There is much more that can be done to engage large diasporic refugee communities, especially men and young boys concerning mental health support, and until such a time that these well-being needs are addressed fully, we are unlikely to see a change in the levels of social ostracism that refugees face in the world today.
[v] Perdigon, S. (2015). ‘For Us It Is Otherwise’ – Three Sketches on Making Poverty Sensible in the Palestinian Refugee Camps on Lebanon. Current Anthropology, 56(S11), pp. S88-S96.
[vi] AbuKishk N, Gilbert H, Seita A, Mukherjee J, Rohloff PJ. (2021) Under-five malnutrition among Palestine refugee children living in camps in Jordan: a mixed-methods study. BMJ Glob Health. Aug;6(8):e005577. doi: 10.1136/bmjgh-2021-005577. PMID: 34348932; PMCID: PMC8340287.
[viii] UNRWA. (2022). Socio-economic situation of Palestinian refugees in Lebanon Crisis Monitoring Report – High-Frequency Survey Results – September 2022. Amman: United Nations Relief and Works Agency for Palestinian Refugees.
[ix] UNRWA. (2022). Socio-economic situation of Palestinian refugees in Lebanon Crisis Monitoring Report – High-Frequency Survey Results – September 2022. Amman: United Nations Relief and Works Agency for Palestinian Refugees.