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Early Childhood Development During Times of Conflict and Violence

MIGRATION PATTERNS AND DEMOGRAPHIC SHIFTS OF REFUGEES IN THE MIDDLE EAST

Demographic shifts that occur during times of conflict affect the environment in which children grow and develop. Mohannad Al-Nsour, executive director of the Eastern Mediterranean Public Health Network in Jordan, explored the effect that fleeing conflict has on children’s well-being. He did so by highlighting the migration patterns and demographic shifts of the current global refugee population, specifically focusing on the Syrian conflict and its impacts within Jordan and the Middle East. Al-Nsour emphasized that the Syrian conflict is the single worst and largest driver of global displacement since World War II, citing 59.5 million cumulative displaced people in 2014 (the most recent figure), compared to 51.2 million per year earlier in 2013, and 37.5 million in 2005. Worldwide, 1 in every 122 humans are now either a refugee, internally displaced, or seeking asylum. He highlighted that more than 50 percent of Syrian refugees displaced in the Middle East are children (see Figure 2-1). These children are placed at risk because of limited provisions of critical basic services. Regionally, according to the United Nations High Commissioner for Refugees (UNHCR) statistics, 4,263,020 Syrian refugees are registered in the Regional Refugee Resilience Plan (3RP) countries, which include Egypt, Jordan, Iraq, Lebanon, and Turkey (UNHCR, 2014) (see Figure 2-2).

In addition to children’s vulnerability increased by the food insecurity occurring in refugee households, Al-Nsour outlined several health effects that have resulted from the Syrian refugee crisis. He noted that the

public health systems are overloaded with patients, resulting in overworked health care workers and shortages of medication and equipment. Additionally, the public health system is strained, including provisions of vaccination coverage and access to adequate and appropriate reproductive health care. Furthermore, the gaps in specific health services is not unique to refugee communities but also extends into host communities, as systems are taxed with population fluctuations and overwhelming growth over a short period of time in the countries receiving refugees—especially Jordan and Lebanon. Al-Nsour pointed out that the mass population movement in the region has left children more exposed to adverse conditions affecting their growth and transition to adulthood (see Box 2-1). Additionally, these demographic shifts influence how the contextual environment is able to support children, youth, families, and communities.

To promote cohesion and reduce tension in the region, Al-Nsour highlighted the need for a resilience-based approach to target both refugee and host communities. More specifically, Al-Nsour made a call for humanitarian support to not create a parallel resource-based system, but he called for development and humanitarian support to function in a complementary dynamic. In addition, it is important to focus on community-centered approaches that promote independence, dignity, self-esteem, satisfaction, and ownership, and which are ultimately sustainable. Investing in such approaches and aligning these with host country strategies may

help ensure that discrimination, competition, and additional conflict are avoided. Al-Nsour called for generating evidence-based data to inform health interventions and responses that are adaptable to align with a country’s context. Doing so, he argued, would facilitate coordinated integration of health services across multiple sectors and levels of government involvement to ensure standardized and cohesive care to refugee and host populations.

A GENERATION OF REFUGEES

Rami Khouri of the American University of Beirut, Lebanon, shifted away from the patterns and processes characterizing refugees in the Middle East to speak about the environment in which children today are born, grow, and mature. Khouri suggested that the early ages at which children living in the Syrian conflict are being forced to function as adults indicates the difficult situation that prevails and continues to evolve in the region. Within this context Khouri referenced individuals ages 10 to 12 years old functioning as adults or in some cases young girls being married off, according to UN reports (UNICEF, 2015a). Some children as young as 5 or 6 years old are working to earn money for their families. Khouri called these figures and the stories behind them an indicator of a very difficult current situation that will continue to evolve.

Khouri noted that this is the first generation of young people (categorized as up to age 14) that were born into a situation of simultaneous hopelessness and rebellion mainstreamed among their parents and older siblings. Indicators of trouble for the region surfaced in the 1980s in several early warning signs, which Khouri said included large-scale emigration of young people out of the Arab world seeking opportunities they did not have at home. Additionally, he noted the mass support for the Muslim Brotherhood. The uprisings of 2011 that still reverberate today reflect mass citizen discontent across the entire region. Khouri said the situation in Syria is the culmination of events in the region where ultimately preservation of political authority has been given priority over the rights of citizenship.

Khouri stated that the vulnerabilities that affect children and young people are a result of the stressful conditions in the region, whose lasting effects on children are not yet known. By way of example, he added that there is not enough evidence gathered on the relationship between contextual and political factors and their effects on both adults and children. Young people see their parents or older siblings today either participating in street demonstrations, fighting in civil wars, giving up on their efforts to create more democratic participatory and accountable societies, and in desperate cases, calculating risks at home against potential death to flee

the region. This is the first generation today that is socialized in this very unusual context. Yet despite the lack of evidence, Khouri suggested that these children are likely to succumb to the drivers of poverty, marginalization, vulnerability, and political despair as they reach adolescence and adulthood, noting that every single one of the drivers today is worse than it was in 2011 when the uprising in Syria and other Arab states erupted. Khouri said that all the elements in the lives of these young people are either stagnant or regressing for the majority.

Khouri stated that in Egypt alone, there have been approximately 9 million children born in the past 5 years. While the Egyptian system in its current operational form cannot turn its back to the needs of this recent addition, there are approximately 81 million people in Egypt today where the system already fails to feed, house, employ, educate, and provide health care. The result in the Egyptian context has been peaceful strikes compounded by violent demonstrations and attacks by extremist groups.

Keeping in mind the perplexing situation that is shaping the lives of young people today in the region, Khouri commented on the state of adolescents, noting that while there are some pockets of excellence in entrepreneurship, dynamism, self-expression, confidence, maturity, and wealth creation, the situation that encompasses the realities of the majority of youth in the region can be characterized as one where some 24 million children are not in school because of the low quality of education, poor standards of instructional learning, and inadequate learning conditions. Citing an April 2015 UNICEF study, 21 million young people (encompassing children and adolescents) were out of school or in danger of dropping out of school, and Khouri noted that figure is now likely closer to 24 million because of the effect of wars in several Arab states (UNICEF, 2015b).

According to a 2015 Brookings Institution study, half of the children who are in school are not learning, meaning they have not mastered basic literacy and numeracy, which Khouri says explains why there are large numbers of children who choose to no longer attend school (Steer et al., 2014). He argued that schools by and large are not transmitting to the youth the values, social skills, and capabilities that children need to become productive, happy, and safe adults. Khouri fears that perhaps half of this entire cohort of children today between the ages of 6 and 18 is likely condemned to a lifetime of poor educational quality, low professional attainment, and a lack of creative and entrepreneurial thinking. Extrapolated beyond their adolescent years, Khouri suggested that these children could perpetuate the situation they are growing accustomed to in their descent into poverty, marginalization, vulnerability, and political despair.

Khouri attributed young people’s perceptions and responses largely to strong, often lasting feelings of helplessness. He cited the highest unemployment rate globally for the past 20 years as being among col-

lege graduates in the Arab world. Those who do remain in school are susceptible to an educational system that plays a role in making Arab youth less tolerant socially and religiously. And those who do find work largely do so in the informal sector where they lack access to employment contracts, guaranteed wages, social protection, social security, and health insurance. Khouri noted that individuals seek materials issues (housing, water, jobs, income) over nonmaterial political and human rights issues, yet these individuals typically understand that the lack of political rights and prevalence of corruption may be the underlying reason why material issues are not achievable.

Understanding the relationship between living conditions and opportunities for change is important, Khouri argued, because without better understanding this relationship and the combination of factors that lead to individual perceptions of marginalization, young people will continue to acquiesce to their own marginalization. Young people need the ability to imagine that it is within their power to break the cycle of poverty, marginalization, and helplessness.

THREE REGIONAL TRENDS AFFECTING EARLY CHILDHOOD DEVELOPMENT

Mohammed Abu-Nimer, professor of peace and conflict resolution at the American University in the United States and senior advisor at KAICIID, pointed out that the physical imprint of conflict is not the only detriment suffered; conflict leaves its mark on one’s individual, social, and religious identity. Abu-Nimer highlighted three regional trends that are affecting early childhood development. The first trend is that children’s environments are saturated with conflict and destruction, leaving children exposed to excessive violence in their daily lives. The second trend that Abu-Nimer pointed to is that a public, visible, and aggressive discourse against diversity and pluralism exists. This affects children insofar as they are exposed to calls for the elimination of differences and intolerances of identity through expressions that do not align with their own. Abu-Nimer suggested that dialogue that perpetuates situations that do not align with an individual provides justification to be intolerant. The third trend is based on public and social media outlets’ capacity to promote regional discourses around exclusion and polarization, with Abu-Nimer suggesting that some go so far as to call for religious superiority or ethnic impurity.

Abu-Nimer went on to state that these three trends are unfolding against the backdrop of disastrous displacement of individuals and families and massive infrastructure deficiencies in attempts to respond to the basic needs of children. He deemed it necessary amid such realities to link

early childhood development agencies with values of diversity and better tools for dialogue. If the region is going to break the cycle of violence and sectarianism that has torn apart the region’s social, ethnic, and religious fabric, Abu-Nimer called for children at an early age to be systematically exposed to values of accepting differences as part of their natural environment. Citing a study among teachers in Egypt, Iraq, Jordan, Lebanon, and Palestine, 92 percent of Arab teachers interviewed expressed the need for skills to reduce the practice of social violence in their schools. Abu-Nimer went on to state that in none of the educational systems that were part of the study did a formal class exist to teach reconciliation or forgiveness. Given this reality, he questioned if we do not invest in reconciliation and forgiveness in early childhood and in elementary schools, how can there be an expectation to transition from war to peace?

Abu-Nimer emphasized the critical importance for early childhood development to be linked systematically with peace and pluralism, especially education for social cohesion. He went on to say that the link has to be obvious considering the challenges and obstacles facing those in the region. He provided four concrete ways to create the link:

1. Raise awareness for human relationships based on solidarity and compassion.
2. Relate this awareness back to what a child is contextually familiar with.
3. Develop skills to sort out the significant amount of information that children are confronted with.
4. Learn ways to use peace to initiate the problem-solving process, rather than relying on others to do this.

Abu-Nimer provided several examples of where KAICIID has successfully created a link between early childhood development with peace building. Among the examples he highlighted was a manual that was produced to teach forgiveness and reconciliation, which was the first to be produced in Arabic. While the manual is intended for informal education settings, his hope is that it can be adopted and become the standard by which every teacher learns how to teach social reconciliation and peace. Abu-Nimer concluded by reminding workshop participants that their skills and expertise are all interdependent, insofar as individual and collective actions have immediate effects on people all over the world.

DISPLACED CHILDREN IN TURKEY

Selcuk Sirin of New York University stated that to talk about refugees is to talk about children, most of whom are under the age of 18 and

another 40 percent under the age of 12. He presented a project conducted out of Bahcesehir University in Istanbul in collaboration with New York University and other partners across psychology, psychiatry, social work, and media developers. Sirin explained that the field-based study, which took place in settlement camps amid the conflict, engaged media developers for the purpose of telling the world the issues that young people—and particularly young children—face in the contexts in which they are living.

Results of the study revealed that 80 percent experienced a death in their family and 60 percent had experienced a stressful life event. Putting the numbers together, Sirin argued, points to a stressed group of children, with 45 percent suffering from posttraumatic stress disorder (PTSD). The study also measured depression among Syrian refugee children and found that clinical levels of depression existed in 40 percent of children, which Sirin noted is approximately 10 times the level in a typical population. While the study made use of standardized measures for mental health, it also used methods to capture illustrative expressions of emotional experiences by way of a series of three drawings—of a person, of war, and of hope. Drawings of individuals contained blood, dying, and other signs of conflict (see Figure 2-3), and drawings depicting war revealed imagery associated with violence (see Figure 2-4).

In addition to mental health, the study also measured educational needs. Sirin drew attention to the fact that prior to the conflict, Syria was a model country with literacy rates in excess of 90 percent among the country’s children. These rates were the highest in the region and well above literacy rates among school children in Turkey. After the conflict began, those numbers plummeted, with now almost half of Syrian children no longer enrolled in schools. In Turkey, there are 2.7 million refugees from Syria, with more than 1 million kids who are school aged; 10 percent of these children live in a refugee camp. Sirin pointed out that the 10 percent of children living in camps are the ones who have access to formal education because of services being provided by the Turkish government or NGOs. Instead, the challenge lies with the 90 percent of children who are no longer living in camps. Sirin noted that there will be long-term ramifications for this population that will constitute a generation of young people who are traumatized, were exposed to violence, and who are no longer educated. The Turkish government has responded by laying claim to full control of access to and delivery of services for this population of refugees, which in turn makes it difficult for researchers and NGOs to collaborate in their provision.

Sirin concluded by explaining several current events and the ensuing media coverage that has affected the number of refugees that the United States and countries in Europe are willing to accept. Yet he noted that

when an entire generation of uneducated children lack positive vehicles that support hope for a better future, they turn to negative groups conducting illegal activities. Sirin urged that amid the current refugee crisis, humanity will need to learn from the lessons of the past and act differently. He presented the final set of images in the sequence of a person, war, and hope that research subjects were asked to draw. Illustrations of hope conveyed the message that despite difficult conditions, children are resilient, and they can imagine a better future (see Figure 2-5).