138 - Mitigating harm to children in conflicts: standardized casualty counts, prevention, and costs.

Poster Number: 138
Publication Number: 138.121

Thomas V. Adamkiewicz, Morehouse School of Medicine, Atlanta, GA, United States

Background: In 2021, the United Nations reported that 19,165 children suffered grave violations in armed conflicts, including 8,070 children (42%) either killed (n=2,515) or maimed (n=5,555).

Objective: This study examined casualties in children in 3 armed conflicts (Yemen, Syria and Ukraine) and explores standardizing reporting.

Design/Methods: For Yemen, yearly absolute number of children that died under the age of five were estimated using  UN data. Then number of deaths if there was no conflict were estimated assuming that pre 2014 under 5 mortality trends continued during the conflict period (2014-2019). Excess deaths were derived by subtracting both. Casualty count per day was derived by dividing the total number of excess deaths by the number of days of observation. Data was compared to previously published estimates. Child casualty counts in Yemen and Syria were aggregated from UN yearly reports (2014-2021). For Ukraine, UN  casualty counts per day were calculated for intervals between reports. Average child ICU cost was estimated at $20,000 (Graves, 2015, Peace, 2023), and cost of malnutrition treatment at $160 per child (Isanaka, 2017).

Results: Yemen excess death per day estimates were similar to previous reports and between 8-30 times higher compared to casualties from direct military attacks (table). Nutritional care cost that may have prevented these deaths, were estimated between $1.5-$5.9 million per year. Over 8 years, child casualties from armed attacks in Yemen and Syria remained mostly above 1 child casualty per day. In Ukraine, casualty counts per day were overall higher compared to Yemen and Syria, but decreased in the second part of the year, despite ongoing attacks on civilian areas. In 2021 overall cost of ICU care for all child casualties should these have survived, was estimated at $161 million, or about 8% of total arms expenditures for that year ($2 trillion).

Conclusion(s):

Child casualty per day measures the magnitude of harm to children of a single conflict, irrespective of population size, and allows comparison between conflicts. Wars amplified with embargoes and sanctions, as in Yemen, cause significant excess deaths. Deployment of protective measures in Ukraine seemed to have prevented child casualties. In the 2022, the US Congress approved the National Defense Authorization Act that for the first time mandates the reporting of casualties in women and children. Real time casualty per day counts should be part of reporting systems, with type of injuries specified. Prohibition of harm to children should be enshrined in a convention.